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As the most common type of inherited retinal degenerative disease, retinitis pigmentosa (RP) has taken clinical and prenatal attention. Considering the clinical importance of consanguineous marriages, new mutations in this type of pregnancy have a high risk and increase the importance of Prenatal Diagnosis (PND). In vitro analysis was done through Whole Exome Sequencing (WES) for a 36-year-old woman who was referred to a genetic laboratory in Kermanshah in 2021 for PND. The woman had consanguineous marriage and was pregnant with twins (a boy and a girl). Mutation confirmation tests were also performed on her husband and both fetuses to find mutations. Moreover, in silico analyses were performed by SWISS-MODEL, ProSA, Molprobity, Swiss-Pdb Viewer, and ERRAT. The WES analysis showed a novel mutation of the RP2 gene (exon2:c. 359G>C: p.R120P) in the 36-year-old pregnant woman. Mutations identified in her husband and her twins revealed changes in protein conformations. Further modeling and validation evaluations showed the replacement of Arg by Pro at the 120th residue site of the cognate protein. For the first time, our report introduced a novel missense mutation in the RP2 gene associated with severe signs of RP in an Iranian family based on an X-linked recessive pattern of genetic inheritance. These findings may pave the way for a better diagnosis of RP in genetic counseling and PND.

Abstract Vascular pulsation at the optic nerve head (ONH) reflects vessel properties. Reduction in the stimulated retinal vasodilatory capacity has been reported in diabetes, but its relation with vascular pulsation is unknown. Here we report a new retinal imaging system for correlative assessment of ONH vascular pulsation and stimulated retinal vasodilation. Retinal reflectance images were acquired before and during light flicker stimulation to quantify arterial and venous vasodilation (DAR, DVR) in subjects with and without diabetic retinopathy (N = 25). ONH vascular pulsation amplitude and frequency (PA, PF), were quantified by curve fitting of periodic intensity waveforms acquired in retinal vasculature (RV) and ONH tissue (ONHT) regions. The relationships between pulsation metrics, heart rate (HR), intraocular pressure (IOP), and vasodilatory responses were evaluated. Pulsation metrics were not significantly different between regions (p ≥ 0.70). In RV, inter-image variabilities of PA and PF were 10% and 6%, whereas inter-observer variabilities were 7% and 2% respectively. In both regions, PF was correlated with HR (p ≤ 0.001). PA was associated with DAR in both regions (p ≤ 0.03), but only with DVR in RV (p ≤ 0.05). Overall, ONH vascular pulsation was associated with stimulated retinal vasodilation, suggesting diabetes may have concomitant effects on retinal vasculature compliance and neurovascular coupling.

Abstract Aims To identify informational and practical deficits of mothers of hospitalized children with acute gastroenteritis and to determine the effect of intervention on enhancing mothers' participation in providing care. Design This study was a two‐group pre‐ and post‐test quasi‐experimental study. Methods Sample size was eighty mothers of hospitalized children younger than 5 years with acute gastroenteritis in each group using consecutive sampling method. Based on the needs assessment, the training and practical demonstration were performed individually in the intervention group. The control group received usual and standard care. The care practice of mothers were observed before and three times after the intervention at a 1‐day interval. The confidence level was 0.95. Results After intervention, there was a significant increase in the mothers' care practice in the intervention group and a significant difference between the two groups. The participatory care approach could enhance mothers' practice in providing care to the hospitalized children with AGE.

BackgroundPencil beam scanning (PBS) proton therapy can provide highly conformal target dose distributions and healthy tissue sparing. However, proton therapy of hepatocellular carcinoma (HCC) is prone to dosimetrical uncertainties induced by respiratory motion. This study aims to develop intra-treatment tumor motion monitoring during respiratory gated proton therapy and combine it with motion-including dose reconstruction to estimate the delivered tumor doses for individual HCC treatment fractions.MethodsThree HCC-patients were planned to receive 58 GyRBE (n=2) or 67.5 GyRBE (n=1) of exhale respiratory gated PBS proton therapy in 15 fractions. The treatment planning was based on the exhale phase of a 4-dimensional CT scan. Daily setup was based on cone-beam CT (CBCT) imaging of three implanted fiducial markers. An external marker block (RPM) on the patient’s abdomen was used for exhale gating in free breathing. This study was based on 5 fractions (patient 1), 1 fraction (patient 2) and 6 fractions (patient 3) where a post-treatment control CBCT was available. After treatment, segmented 2D marker positions in the post-treatment CBCT projections provided the estimated 3D motion trajectory during the CBCT by a probability-based method. An external-internal correlation model (ECM) that estimated the tumor motion from the RPM motion was built from the synchronized RPM signal and marker motion in the CBCT. The ECM was then used to estimate intra-treatment tumor motion. Finally, the motion-including CTV dose was estimated using a dose reconstruction method that emulates tumor motion in beam’s eye view as lateral spot shifts and in-depth motion as changes in the proton beam energy. The CTV homogeneity index (HI) The CTV homogeneity index (HI) was calculated as D2% − D98%D50% ×100%.ResultsThe tumor position during spot delivery had a root-mean-square error of 1.3 mm in left-right, 2.8 mm in cranio-caudal and 1.7 mm in anterior-posterior directions compared to the planned position. On average, the CTV HI was larger than planned by 3.7%-points (range: 1.0-6.6%-points) for individual fractions and by 0.7%-points (range: 0.3-1.1%-points) for the average dose of 5 or 6 fractions.ConclusionsA method to estimate internal tumor motion and reconstruct the motion-including fraction dose for PBS proton therapy of HCC was developed and demonstrated successfully clinically.

Avascular necrosis(AVN), which is known as osteonecrosis, ischemic bone necrosis, or aseptic necrosis, is a condition that results in the destruction of bone cells. This ischemic disease, which more commonly has an effect on the femoral head and hip joint, is more prevalent in middle age and the elderly, but it is estimated that in the future, it will involve all ages. Furthermore, the conquering population in this disease is females. Femoral head AVN is caused by a disruption in the femoral head blood flow and is popularly known as the blackening of the femoral head or hip joint(3). The alterations in the blood supply may fall out following a trauma or due to a non-traumatic event. Hip dislocation, fracture of the Femoral neck and related surgical procedures, alcohol abuse, and corticosteroid therapy frequently lead to AVN development. Several studies show that the most common cause of AVN is corticosteroid use. Corticosteroids as rescue drugs in treating the bulk of autoimmune diseases like MS and Behchet, pulmonary diseases like asthma, and recent covid 19 patients are the most suspected cause of this disease. Femoral head AVN Signs and symptoms are Increasing pain and stiff joints, Limited range of motion, Limping, and Difficulty climbing stairs, standing, or walking. Diagnosis of AVN can be established based on history, physical examinations, and radiographic evaluations. In the primitive phases, bone scintigraphy and MRI are the favored indicative implements. X-ray findings of AVN in the early periods normally look regular. Spontaneous regression of avascular necrosis is rare, and there is no agreement on the AVN therapy up to now. Non-surgical techniques are devoted to patients in the early phase of the disease and are composed of pharmacologic and physical therapy. Operation is highly recommended for patients with advanced disease. Total Hip Arthroplasty as a prosperous surgery is the choice of treatment for patients with intolerant symptoms and high-stage involvement of the hip joint.

Background and Objective: Considering the importance of respecting the rights and satisfaction of patients, as well as the destructive role of anxiety in patients' recovery processes, the present study aimed to evaluate the effect of regular nursing rounds based on ethical care on the level of satisfaction and anxiety of hospitalized patients. Materials and Methods: This quasi-experimental study was conducted based on a pre-test-post-test design in Fatemieh Hospital in Hamadan, Iran. A total of 100 hospitalized patients were assigned to two groups of control and intervention (n=50 in each group), and patients in the intervention group received a clinical round based on ethical care, in addition to routine care. The control group also received routine care. Finally, the difference between the mean scores of satisfaction of nursing services and the anxiety of the two groups before and after the intervention was analyzed in SPSS V.20 software using descriptive and inferential tests. Results: The two groups of intervention and control were not statistically significant in terms of underlying variables and disease and were homogeneous. In the intervention group after receiving the relevant training, anxiety decreased and the level of patients' satisfaction with the quality of nursing care increased significantly, as compared to patients in the control group; therefore, the intervention was effective (P

Abstract Background Placenta previa describes a placenta that extends partially or completely over the internal cervical oss. Placenta previa is one of the leading causes of widespread postpartum hemorrhage and maternal mortality worldwide. Another cause of bleeding in pregnant women is Placenta accreta spectrum. Therefore, the aim of the present systematic review and meta-analysis is to determine the effect of prophylactic balloon occlusion of the internal iliac arteries in patients with placenta previa or placental accreta spectrum (PAS). Methods In this systematic review and meta-analysis, to identify and select relevant studies, the SID, MagIran, ScienceDirect, Embase, Scopus, PubMed, Web of Science, and Google Scholar databases were searched, using the keywords of internal iliac artery balloon, placenta, previa, balloon, accreta, increta and percreta, without a lower time limit and until 2020. The heterogeneity of the studies was examined using the I2 index, and subsequently a random effects model was applied. Data analysis was performed within the Comprehensive Meta-Analysis software (version 2). Results In the review of 29 articles with a total sample size of 1140 in the control group, and 1225 in the balloon occlusion group, the mean difference between the two groups was calculated in terms of Intraoperative blood loss index (mL) and it was derived as 3.21 ± 0.38; moreover, in 15 studies with a sample size of 887 in the control group, and 760 in the balloon occlusion group, the mean difference between the two groups in terms of gestation index (weeks) was found as 2.84 ± 0.49; and also with regards to hysterectomy balloon occlusion after prophylactic closure of the iliac artery, hysterectomy (%) balloon occlusion was calculated as 8.9 %, and this, in the hysterectomy control group (%) was obtained as 31.2 %; these differences were statistically significant and showed a positive effect of the intervention (P

The demand for stretchable strain sensors with customizable sensitivities has increased across a spectrum of applications, spanning from human motion detection to plant growth monitoring. Nevertheless, a major challenge remains in the digital fabrication of scalable and cost‐efficient strain sensors with tailored sensitivity to diverse demands. Currently, there is a lack of simple digital fabrication approaches capable of adjusting strain sensitivity in a controlled way with no changes to the material and without affecting the linearity. In this study, parallel microgates‐based strain sensors whose strain sensitivity can be adjusted systematically throughout an all‐laser‐based fabrication process without any material replacement are presented. The technique employs a two‐step direct laser writing method that combines the well‐established capabilities of laser ablation and laser marking, boasting a varying gauge factor of up to 433% (GF  =  168), while paving the way for the mass production of nanocomposite strain sensors. Parallel microgates‐based strain sensors exhibit a remarkable signal‐to‐noise ratio at ultralow strains (ɛ  =  0.001), rendering them ideal for monitoring the gradual growth of plants. As an application demonstration, the proposed sensors are deployed on tomato plants to capture their growth under varying planting conditions including hydroponic and soil mediums, as well as diverse irrigation regimens. [ABSTRACT FROM AUTHOR]

Abstract Background Previous caesarean scar pregnancy is one type of ectopic pregnancy in myometrium and fibrous tissue of previous caesarean scar. One of the therapeutic methods of this type of ectopic pregnancy is treatment with methotrexate. Given various findings on the treatment of caesarean scar pregnancy with methotrexate and lack of global report in this regard, we aimed to achieve a global report on the treatment of CSP with methotrexate through related literature review and analysis of the results of the studies, to enable more precise planning to reduce complications of CSP. Method This review study extracted information through searching national and international databases of SID،, Embase, ScienceDirect, ، Scopus, ، PubMed, Web of Science (ISI) between 2003 and January 2020. To perform the meta-analysis, random-effects model and heterogeneity of the studies with I2 index were investigated. Data were sanalysed using Comprehensive Meta-Analysis version 2. Results In total, 26 articles with a sample size of 600 individuals were enrolled in the meta-analysis. According to the results of the study, the mean level of β-hCG was 28,744.98 ± 4425.1 mIU/ml before the intervention and was 23,836.78 ± 4533.1 mIU/ml after the intervention. The mean intraoperative blood loss (ml) was 4.8 ± 3.76 ml, mean hospital stay (days) was 11.7 ± 1.2 days, mean time for serum-hCG normalization (days) was 41.6 ± 3.2 days, success was 90.7% (95% CI: 86.7–93.5%), and complication was 9% (95% CI: 6.3–12.8%). Conclusion The results of the current study show methotrexate significantly reduces β-hCG levels and can be effective in treating caesarean scar pregnancy and its complications.

Abstract Background Endometriosis is one of the most common causes of infertility. The causes of the disease and its definitive treatments are still unclear. Moreover, Anti-Mullerian Hormone (AMH) is a glycoprotein dimer that is a member of the transient growth factors family. This research work aimed to identify the effect of unilateral and bilateral laparoscopic surgery for endometriosis on AMH levels after 3 months, and 6 months, using meta-analysis. Methods In this study, the articles published in national and international databases of SID, MagIran, IranMedex, IranDoc, Cochrane, Embase, Science Direct, Scopus, PubMed, and Web of Science (ISI) were searched to find electronically published studies between 2010 and 2019. The heterogeneous index between studies was determined using the I2 index. Results In this meta-analysis and systematic review, 19 articles were eligible for inclusion in the study. The standardized mean difference was obtained in examining of unilateral laparoscopic surgery for endometriosis (before intervention 2.8 ± 0.11, and after 3 months 2.05 ± 0.13; and before intervention 3.1 ± 0.46 and after 6 months 2.08 ± 0.31), and in examining bilateral laparoscopic surgery for endometriosis examination (before intervention 2.0 ± 08.08, and after 3 months 1.1 ± 0.1; and before intervention 2.9 ± 0.23 and after 6 months 1.4 ± 0.19). Conclusion The results of this study demonstrate that unilateral and bilateral laparoscopic surgery for endometriosis is effective on AMH levels, and the level decreases in both comparisons.

Vision-RT system is one of the most effective methods for real-time estimation of target location in external beam radiotherapy. Vision-RT tracks the patient’s surface before and during radiation therapy to improve treatment accuracy. Using proprietary 3D stereo camera units, Vision-RT system tracks the skin surface, compares it to the ideal position, and can automatically signal to the treatment delivery system. The purpose of this study is to investigate the accuracy of Vision RT guided deep inspiration breath-hold left-sided breast cancer radiotherapy. Five patients with left-sided breast cancer were treated by Vision RT guided deep inspiration breath-hold at Aarhus university hospital. Based on the results, in one out of five patients, the undesired heart extended to 0.6-0.9 cm into the treatment fields in 5 out of 15 treatment fractions. Moreover, the required PTV margin to account for patient setup error and intra-fractional error of the first and second treatment field was 2.38 mm, 3 mm and 4.12 mm, respectively.

Introduction: Group B streptococci (GBS) is as an important cause of perinatal morbidity and mortality. GBS is colonized in 10-30% of pregnant women in the vagina or rectum. Transfer of mother-to-child GBS during delivery may result in invasive infection in the newborn during the first week of life. This study was performed with aim to compare the prevalence of GBS in pregnant women with gestational age of 24-34 weeks with symptoms of preterm labor with and without rupture of the membrane. Methods: This case-control study was performed on 50 pregnant women with gestational age of 24-34 weeks referred to Imam Reza (AS) Educational and Medical Center of Kermanshah with signs of preterm delivery in 2016. The subjects were divided into two groups of with rupture of membrane (case) and without rupture of the membrane (control). From the study population, the GBS cultures were collected at admission time from the vagina and were transferred to the medium. The results of culture and demographic information of mothers were compared in two groups. Data were analyzed by SPSS software (version 20) and chi-square and t-test. PResults: There was no significant difference in maternal age (P=0.246), gravidity (P=0.523), gestational age (P=0.716), and history of preterm delivery in previous pregnancies (P=0.942) between two groups of with and without rupture of the membrane. 2 cases (8%) of mothers with rupture of membrane and 1 case (4%) of mothers without rupture of membrane had positive GBS cultures, and the overall prevalence of GBS was estimated 6%. Conclusion: The frequency of positive GBS culture is higher than in pregnant women with rupture of membrane than in pregnant mothers without rupture of membrane

Introduction: Systemic lupus erythematosus (SLE) is a common autoimmune disease and predominantly affects fertile women. This disease is associated with multisystem involvement and has high risk for both the mother and the fetus. One of the major risks for SLE mothers is the occurrence of disease flare during pregnancy. Some studies have shown that SLE flares more during pregnancy, but the conclusion of others is quite the opposite. Therefore, this study was performed with aim to determine the feto-maternal outcome in pregnant women with SLE. Methods: This retrospective study was performed on 38 pregnant women with lupus who were hospitalized in Obstetrics and Gynecology ward of Kermanshah Imam Reza hospital in 2008-2012. The renal parameters including creatinine and urinary protein excretion, hemoglobin and platelet levels, and also pregnancy outcomes- preeclampsia, eclampsia, abortion, preterm delivery, mode of delivery, infant's weight and stillbirth were recorded. Data collection tool was a questionnaire which was designed based on the main goals of the study. Data were analyzed by SPSS software (version 16) and descriptive statistics index. P

Abstract Background Globally, sexual violence is prevalent, particularly for adolescent women. This cluster-randomized controlled implementation trial examines empowerment self-defense (ESD) for sexual assault risk reduction among school-age women in Malawi. Methods The unit of randomization and analysis was the school (n = 141). Intervention participants received a 12-h intervention over 6 weeks, with refreshers. Primary outcomes were past-year prevalence and incident rate of sexual violence. Secondary outcomes included confidence, self-defense knowledge, and, for those victimized, violence disclosure. Interaction effects on outcomes were evaluated with Poisson models with school-correlated robust variance estimates for risk ratios and incident rate ratios (baseline n = 6644, follow-up n = 4278). Results Past-year sexual assault prevalence was reduced among intervention students (risk ratio [RR] 0.68, 95% CI 0.56, 0.82), but not control students (interaction effect p