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Background: There is no specific quality of life (QoL) measurement tool to quantify QoL in patients with biliary tract cancer. Quality of life measurement is an increasingly crucial trial end point and is now being incorporated into clinical practice.Methods: This International Multicentre Phase IV Validation Study assessed the QLQ-BIL21 module in 172 patients with cholangiocarcinoma and 91 patients with cancer of the gallbladder. Patients completed the questionnaire at baseline pretherapy and subsequently at 2 months. Following this, the psychometric properties of reliability, validity, scale structure and responsiveness to change were analysed.Results: Analysis of the QLQ-BIL21 scales showed appropriate reliability with Cronbach's α-coefficients >0.70 for all scales overall. Intraclass correlations exceeded 0.80 for all scales. Convergent validity >0.40 was demonstrated for all items within scales, and discriminant validity was confirmed with values <0.70 for all scales compared with each other. Scale scores changed in accordance with Karnofsky performance status and in response to clinical change.Conclusions: The QLQ-BIL21 is a valid tool for the assessment of QoL in patients with cholangiocarcinoma and cancer of the gallbladder. [ABSTRACT FROM AUTHOR]

Background: Quality of life measurement in cholangiocarcinoma and gallbladder cancer involves the assessment of patient-reported issues related to the symptoms, disease and treatment of these tumours. This study describes the development of the disease-specific quality of life (QoL) questionnaire for patients with cholangiocarcinoma and gallbladder cancer to supplement the European Organization for Research and Treatment of Cancer (EORTC)-QLQ C30 core cancer questionnaire.Methods: Phases 1-3 of the guidelines for module development published by the EORTC were followed, with adaptations for incorporation of questions from existing modules.Results: A total of 47 QoL issues (questions) were identified; 44 questions from the two related validated questionnaires, the EORTC QLQ-PAN26 (pancreatic module) and the EORTC QLQ-LMC21 (liver metastases module), two from the Functional Assessment of Cancer Therapy hepatobiliary module questionnaire in the literature search and one from healthcare professional interviews. Following phase 1 and 2 interviews with patients (n=101) and health care professionals (n=6), a 23-question provisional questionnaire was formulated. There were five questions from PAN26, 15 from LMC21 and three extra questions. In phase 3, the provisional item list was pre-tested in 52 patients in four languages and this resulted in a 21-item module.Conclusion: This is the only disease-specific QoL questionnaire for patients with cholangiocarcinoma and gallbladder cancer, and initial assessments show it to be accurate and acceptable to patients in reflecting QoL in these diseases. [ABSTRACT FROM AUTHOR]

AimsTo investigate potential factors associated with the presence of myopia in a cohort of young adult men carrying out their military service in Greece.MethodsA nested case–control study of 200 conscripts (99 myopes and 101 non-myopes). The cohort consisted of approximately 1000 conscripts in compulsory national service. All cohort members had been screened for refractive errors by Snellen visual acuity measurement at presentation to military service; individuals not achieving visual activity 6/6 underwent noncycloplaegic refraction. The study sample consisted of the first 99 myopic and 101 nonmyopic conscripts who attended the study. In-person interviews of these 200 conscripts were conducted to obtain information on family history, occupation, level of education, near-work activities, and sleeping behaviour. χ2 and Mann–Whitney tests were used as univariate analysis methods to identify the potential factors associated with the presence of myopia. Multiple logistic regression was used to estimate the adjusted relative risk of myopia.ResultsUnivariate analysis showed that parental family history (P<0.001), older age (P<0.001), tertiary education (P<0.001), hours of reading per day (P<0.001), hours of computer use per day (P<0.001), and higher social classes (P<0.001) were associated with myopia. Sleeping in artificial or ambient light was not associated with myopia (P=0.75). Multiple logistic regression analysis showed that older age (OR=1.25, 95% CI 1.05–1.49), tertiary education (OR=12.67, 95% CI 3.57–44.88) and parental family history (OR=3.39, 95% CI 1.56–7.36) were independently associated with myopia.ConclusionIn young Greek conscripts, parental family history, older age, and education level are independently associated with myopia.Eye (2008) 22, 542–546; doi:10.1038/sj.eye.6702693; published online 12 January 2007 [ABSTRACT FROM AUTHOR]

Abstract Background Ischaemic stroke is a common disorder with genetic and environmental components contributing to overall risk. Atherothromboembolic abnormalities, which play a crucial role in the pathogenesis of ischaemic stroke, are often the end result of dysregulation of lipid metabolism. The ATP Binding Cassette Transporter (ABCA1) is a key gene involved in lipid metabolism. It encodes the cholesterol regulatory efflux protein which mediates the transfer of cellular phospholipids and cholesterol to acceptor apolipoproteins such as apolipoprotein A-I (ApoA-I). Common polymorphisms in this gene affect High Density Lipoprotein Cholesterol (HDL-C) and Apolipoprotein A-I levels and so influence the risk of atherosclerosis. This study has assessed the distribution of ABCA1 polymorphisms and haplotype arrangements in patients with ischaemic stroke and compared them to an appropriate control group. It also examined the relationship of these polymorphisms with serum lipid profiles in cases and controls. Methods We studied four common polymorphisms in ABCA1 gene: G/A-L158L, G/A-R219K, G/A-G316G and G/A-R1587K in 400 Caucasian ischaemic stroke patients and 487 controls. Dynamic Allele Specific Hybridisation (DASH) was used as the genotyping assay. Results Genotype and allele frequencies of all polymorphisms were similar in cases and controls, except for a modest difference in the ABCA1 R219K allele frequency (P-value = 0.05). Using the PHASE2 program, haplotype frequencies for the four loci (158, 219, 316, and 1587) were estimated in cases and controls. There was no significant difference in overall haplotypes arrangement in patients group compared to controls (p = 0.27). 2211 and 1211 haplotypes (1 = common allele, 2 = rare allele) were more frequent in cases (p = 0.05). Adjusted ORs indicated 40% and 46% excess risk of stroke for these haplotypes respectively. However, none of the adjusted ORs were statistically significant. Individuals who had R219K "22" genotype had a higher LDL level (p = 0.001). Conclusion Our study does not support a major role for the ABCA1 gene as a risk factor for ischaemic stroke. Some haplotypes may confer a minor amount of increased risk or protection. Polymorphisms in this gene may influence serum lipid profile.

Introduction: Quality of life (QoL) is an important outcome measure in clinical trials and is increasingly being used as an endpoint. The QLQ-GINET21 is a questionnaire developed with the EORTC QoL Group but which had not previously been validated. Aim(s): We describe an international validation study designed to assess the clinical and psychometric reliability, validity and responsiveness-to-change of the QLQ-GINET21 in patients with NETs. Materials and methods: Two-hundred and fifty patients were recruited into this international multicenter study. The sites of NET included any gut or lung primary with metastases, or a pancreatic primary. The study required that all patients complete two HRQoL questionnaires - the EORTC QLQ-C30 (version 3.0) and the QLQ-GINET21 - at all assessment time points. Each was studied in two groups: Group 1 (somatostatin [SMS] analogues and Interferon) and Group 2 (all other treatments). Results: Internal consistency of scales using Cronbach's alpha was > 0.7 for all parts of the QLQ-GINET21 at baseline or six months (Time point 3). Intraclass correlation of scales was >0.85 for all scales. Discriminant validity was confirmed with values <0.70 for all scales compared with each other. Scores changed over time in accordance with changes of performance status and in response to expected clinical changes after therapies. Mean scores were not significantly different between pancreatic tumors and other tumors. Conclusion; The QLQ-GINET21 is a valid and responsive method of assessing HRQoL in NETs. [ABSTRACT FROM AUTHOR]

Introduction and Objectives: There is an unmet need to develop high-quality evidence addressing tuberculosis (TB)-related mental health comorbidity, particularly in the context of lower-middle-income countries. This study aims to examine the effectiveness and cost-effectiveness of cognitive behavioural therapy (CBT) versus enhanced treatment as usual (ETAU) in improving depressive symptoms in people with TB and comorbid depression, enhancing adherence with anti-TB treatment (ATT) and its implementation in the real-world setting of Pakistan., Methods: We will conduct a pragmatic parallel arm randomised control trial with an internal pilot. A brief psychological intervention based on CBT has been developed using a combination of qualitative and ethnographic studies. The inbuilt pilot trial will have a sample size of 80, while we plan to recruit 560 (280 per arm) participants in the definitive trial. Participants who started on ATT within 1 month of diagnosis for pulmonary and extrapulmonary TB or multidrug resistant TB (MDR-TB) and meeting the criteria for depression on Patient Health Questionnaire-9 (PHQ-9) will be randomised with 1:1 allocation to receive six sessions of CBT (delivered by TB healthcare workers) or ETAU. Data on the feasibility outcomes of the pilot will be considered to proceed with the definitive trial. Participants will be assessed (by a blinded assessor) for the following main trial primary outcomes: (1) severity of depression using PHQ-9 scale (interviewer-administered questionnaire) at baseline, weeks 8, 24 and 32 postrandomisation and (2) ATT at baseline and week 24 at the end of ATT therapy., Ethics and Dissemination: Ethical approval has been obtained from Keele University Research Ethics Committee (ref: 2023-0599-792), Khyber Medical University Ethical Review Board (ref: DIR/KMU-EB/CT/000990) and National Bioethics Committee Pakistan (ref: No.4-87/NBC-998/23/587). The results of this study will be reported in peer-reviewed journals and academic conferences and disseminated to stakeholders and policymakers., Trial Registration Number: ISRCTN10761003., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Traumatic brain injury (TBI) is damage to the brain by an external physical force. It may result in cognitive and physical dysfunction. It is one of the main causes of disability and death all around the world. In 2016, the worldwide incidence of acute TBI was nearly 27 million cases. Therapeutic interventions currently in use provide poor outcomes. So recent research has focused on stem cells as a potential treatment. The major objective of this study was to conduct a systematic review of the recent clinical trials in the field of stem cell transplantation for patients with TBI. The Cochrane Library, Web of Science, SCOPUS, PubMed and also Google Scholar were searched for relevant terms such as "traumatic brain injury", " brain trauma", "brain injury", "head injury", "TBI", "stem cell", and "cell transplantation" and for publications from January 2013 to June 2023. Clinical trials and case series which utilized stem cells for TBI treatment were included. The data about case selection and sample size, mechanism of injury, time between primary injury and cell transplantation, type of stem cells transplanted, route of stem cell administration, number of cells transplanted, episodes of transplantation, follow-up time, outcome measures and results, and adverse events were extracted. Finally, 11 studies met the defined criteria and were included in the review. The total sample size of all studies was 402, consisting of 249 cases of stem cell transplantation and 153 control subjects. The most commonly used cells were BMMNCs, the preferred route of transplantation was intrathecal transplantation, and all studies reported improvement in clinical, radiologic, or biochemical markers after transplantation. No serious adverse events were reported. Stem cell therapy is safe and logistically feasible and leads to neurological improvement in patients with traumatic brain injury. However, further controlled, randomized, multicenter studies with large sample sizes are needed to determine the optimal cell and dose, timing of transplantation in acute or chronic phases of TBI, and the optimal route and number of transplants., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Background: Breast cancer is the most common cancer in women. Delay in the diagnosis of breast cancer is a major challenge that can lead to disease progression. Identifying the predictors of breast cancer screening behavior is necessary to promote early detection of breast cancer. This study aims to investigate the predictors of breast cancer screening behavior in women aged 20-69 referred to public health centers., Methods: This cross-sectional study was conducted on 17255 women aged 20-69 years old in Isfahan Province referred to Public Health Centers by the multi-stage random sampling method. data were collected based on the paper forms of women's care aged 20-69 at public health centers, Isfahan, Iran, in 2012. Using STATA 14, logistic regression was employed to explore predictors of breast cancer screening behavior at a 5% significance level., Results: The mean age of women was 36.75 ± 10.46. About 6006 (34.8%) of women had a history of breast self-examination, and among women aged over 40 years, 17.7% reported ever having a mammogram. The most important factors influencing breast self-examination were age 40-49 (OR = 1.18; 95% CI: 1.06-1.33), history of hormone consumption (OR = 1.23; 95% CI: 1.15-1.33), family history of breast cancer in first-degree relatives (OR = 14.22; 95% CI: 9.83-20.57. The most important factors influencing mammography were hormone consumption (OR = 1.26; 95% CI: 1.05-1.51), and family history of breast cancer in first-degree relatives (OR = 32.55; 95% CI: 20.08-52.70)., Conclusions: Our findings indicated that the performance of breast self-examination and mammography was low. The frequency of BC screening behavior was higher among women with BC risk factors The results revealed the need for health authorities to pay attention to education in BC detection methods., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 International Journal of Preventive Medicine.)

Background: Cardiovascular diseases (CVDs) are among the most important causes of premature death, disability, disease burden, and increasing the cost of healthcare worldwide. Having an overview of service utilization can help policymakers to plan more effective use of those services and to cut costs. Thus, this study aims to determine the amount of use as well as the cost of various outpatient diagnostic procedures for CVDs in Isfahan province of Iran from 2011 to 2017., Materials and Methods: This descriptive study used insurance claim data (time period: 2011-2017) from Health Insurance Organization in Isfahan province to determine the amount of use and the cost of various outpatient diagnostic procedures for CVDs. Afterward, based on these data, the use and the cost of various outpatient diagnostic procedures for CVDs were estimated for the total population of Isfahan province. The list of outpatient diagnostic procedures for CVDs was carefully chosen according to experts' opinions., Results: The use and the cost of outpatient diagnostic procedures for CVDs have drastically increased in the study period (2011-2017). Since 2011, the number of procedures and their related costs have increased 6.6 and 30.76 times (11.74 times, adjusted with PPP conversion factor), respectively. Per capita use (per thousand people) was 18.75 in 2011, reaching 116.51 in 2017. Per capita cost (per thousand people) was 1,887,660 IRR (355 PPP$) in 2011, reaching 54,660,365 IRR (3920 PPP$) in 2017. The highest cost and use were related to echocardiography and electrocardiography, respectively. A notable increase has been observed in the share of radionuclide myocardial perfusion scan and analysis of pacemakers and ICDs of the total cost., Conclusions: The use of outpatient diagnostic procedures for CVDs has drastically increased during the studied period. Consequently, the cost borne by the health system and the patients have notably increased. This may be because of the increase in the incidence and prevalence of CVDs during the study period. Greater access to related health services can be mentioned as another reason for this increase. Further research is needed to explain all potential reasons and their importance, which can provoke a suitable health policy reaction., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Journal of Education and Health Promotion.)

Background: Numerous clinical trials have reported conflicting results regarding the benefit of digoxin in treating heart failure (HF) patients. This study was conducted with the aim to demonstrate the impact of added digoxin to beta-blocker and beta-blocker alone on all-cause mortality and rehospitalization among these patients., Methods: We investigated the data of 1998 patients admitted with a primary diagnosis of decompensated HF in the prospective Persian Heart Failure Patients Registry in Iran. The outcomes of interest were time until death and time until first rehospitalization. Multivariate cox regression was used to compare the impact of beta-blocker plus digoxin and beta-blocker alone on 2.5-year survival and 90-day rehospitalization., Results: The mean age of the participants was 69.18 ± 13.26 years, and 38.1% of patients were women. The incidence rate of all-cause mortality in the total sample was 0.18 and 0.22 in patients on beta-blocker plus digoxin and beta-blocker alone, respectively [incidence rate ratio (IRR) = 1.25; 95% CI: 0.92-1.7]. The adjusted risk of all-cause mortality was significantly higher in women discharged with beta-blocker plus digoxin than beta-blocker groups [hazard ratio (HR) = 2.31; 95% CI: 1.27-4.19]. Rates of 90-day first rehospitalization were 0.10 and 0.12 in the beta-blocker plus digoxin and beta-blocker alone groups, respectively (IRR = 0.85; 95% CI: 0.53-1.35). After adjustment for covariates, beta-blocker plus digoxin therapy had no significant effect on increasing the risk of 90-day first rehospitalization in the total cohort (HR = 0.77; 95% CI: 0.48-1.23), in men (HR = 0.73; 95% CI: 0.40-1.35), and women (HR = 0.76; 95% CI: 0.36-1.65)., Conclusion: In patients hospitalized with decompensated HF, digoxin administration at discharge was associated with increased 30-month mortality risk in women., (© 2022 Isfahan Cardiovascular Research Center & Isfahan University of Medical Sciences.)

Background and Purpose: The aim of this study was the cross-cultural adaptation and psychometric evaluation of the Persian version of Clinical Decision Making in Nursing Scale (CDMNS)., Methods: The original CDMNS was translated into Persian using the Beaton's guideline. Its qualitative face validity, qualitative and quantitative content validity, its construct validity, and reliability was assessed., Results: Eleven items out of forty items were deleted due to factor loading values less than 0.3. Subsequently, model fit indices changed as follows: Chi-square value divided by degree of freedom (χ 2 /DF): 2.8, root mean score error of approximation (RMSEA): 0.07, standardized root mean square residual (SRMR): 0.06, comparative fit index (CFI): 0.93, goodness of fit index (GFI): 0.80, and adjusted goodness of fit index (AGFI): 0.77. The Cronbach's alpha values and test-retest intraclass correlation coefficient of the 29-item scale and its subscales also increased after deleted., Conclusion: The 29-item Persian CDMNS is a valid and reliable instrument for assessing Iranian nurses' perceptions of clinical decision-making., (© Copyright 2021 Springer Publishing Company, LLC.)

Background: Pediatric-onset multiple sclerosis (POMS) is an autoimmune demyelinating disorder of the central nervous system (CNS), affecting individuals younger than 18 years of age. We sought to characterize the epidemiological and clinical features of patients with POMS in Isfahan, Iran, from April 1997 to March 2020. Methods: The medical records of patients with POMS in the databases of Isfahan Department of Public Health and Isfahan Multiple Sclerosis Society (IMSS) were retrospectively reviewed. The 2006 and 2016 Isfahan Province population censuses were used as reference values for assessing the temporal trend of POMS. Results: From April 1997 to March 2020, 509 individuals under18 years of age were diagnosed with POMS in Isfahan. 404 of these patients (79.4%) were girls, and 105 patients (20.6%) were boys (a female to male ratio of 3.85:1). Most of the patients (83%) were monosymptomatic at onset, with optic neuritis and brainstem-cerebellar disorders being the most frequent initial presentations. Mean ± standard deviation (SD) of age at disease diagnosis was 15.8 ± 2.5 years (ranging from 3 to 18, mode = 18). From April 2019 to March 2020, the crude prevalence and the crude incidence rate of the POMS were 5.42 per 100000 and 1.86 per 100000, respectively. Poisson regression analysis revealed a 3.4% increase in the incidence rate of POMS from April 1997 to March 2020 [relative rate:1.034, 95% confidence interval (CI): 1.021-1.048]. Conclusion: The female to male ratio in our cohort was significantly higher than any other studies conducted previously. The high female to male ratio and increasing incidence of the disease suggest increasing regionalization of care., (Copyright © 2021 Iranian Neurological Association, and Tehran University of Medical Sciences Published by Tehran University of Medical Sciences.)

Background: The NLST reported a significant 20% reduction in lung cancer mortality with three annual low-dose CT (LDCT) screens and the Dutch-Belgian NELSON trial indicates a similar reduction. We present the results of the UKLS trial., Methods: From October 2011 to February 2013, we randomly allocated 4 055 participants to either a single invitation to screening with LDCT or to no screening (usual care). Eligible participants (aged 50-75) had a risk score (LLPv2) ≥ 4.5% of developing lung cancer over five years. Data were collected on lung cancer cases to 31 December 2019 and deaths to 29 February 2020 through linkage to national registries. The primary outcome was mortality due to lung cancer. We included our results in a random-effects meta-analysis to provide a synthesis of the latest randomised trial evidence., Findings: 1 987 participants in the intervention and 1 981 in the usual care arms were followed for a median of 7.3 years (IQR 7.1-7.6), 86 cancers were diagnosed in the LDCT arm and 75 in the control arm. 30 lung cancer deaths were reported in the screening arm, 46 in the control arm, (relative rate 0.65 [95% CI 0.41-1.02]; p=0.062). The meta-analysis indicated a significant reduction in lung cancer mortality with a pooled overall relative rate of 0.84 (95% CI 0.76-0.92) from nine eligible trials., Interpretation: The UKLS trial of single LDCT indicates a reduction of lung cancer death of similar magnitude to the NELSON and NLST trials and was included in a meta-analysis of nine randomised trials which provides unequivocal support for lung cancer screening in identified risk groups., Funding: NIHR Health Technology Assessment programme; NIHR Policy Research programme; Roy Castle Lung Cancer Foundation., Competing Interests: JKF has received fees from AstraZeneca (Speaker's Bureau) and advisory boards of Epigenomics; NUCLEIX Ltd. AstraZeneca, iDNA; Grant Support: Janssen Research & Development, LLC. RCR is on the advisory boards of AstraZeneca and Roche. DRB has received speaker remuneration from AstraZeneca, Roche, MSD, BMS, Johnson and Johnson. KB has received personal fees from Astra Zeneca outside the submitted work. TE receives research support from AstraZeneca, Bayer, Pfizer; is employed by Roche (from March 2020) and was employed by AstraZeneca (to March 2020) and has stock in AstraZeneca and Roche; is a trustee of Macmillan Cancer Support.  AN has current grants and contracts with BRC, DART; Honoraria Aidence BV, AstraZeneca; Support from BLF, and as the clinical lead for NTLHC. No competing interests from all other co-authors., (© 2021 The Authors.)

Background: Figures from Iranian cancer registries indicate that Isfahan ranks first in female breast cancer incidence. Although few previous studies have examined whether the breast cancer incidence trend in Isfahan province has increased over a given period of time, this study employed a joint point regression analysis to answer the same question. Moreover, it compared the data of Isfahan province, from a developing country, with those of England, as a representative of developed countries, and tried to explain the causes of the differences observed between the trends., Methods: This repeated cross-sectional study was conducted on the data of 6057 women in Isfahan province and of 141,011 women in England with breast cancer over the years 2001-2013. The incidence rates were calculated using direct standardization method and based on the 2013 standard European population. For an analysis of the trends in breast cancer incidence rates, Joint Point Regression program, version 4.3.1.0, released in April 2016, was employed., Results: The mean age-standardized incidence rate (ASR) was calculated to be 34.7 per100,000 population over the years 2001 to 2013, which indicated an increase from 22 to 68 in Isfahan province. The corresponding mean ASR for England has also risen from 147.5 to 170.1 per 100,000 women during the same time period. The average annual percentage changes (AAPCs) for Isfahan and England were also calculated to be 9.6 and 1.1, respectively. This indicated an increasing trend in breast cancer incidence rates for Isfahan province over the period in question., Conclusions: The drastic discrepancy in breast cancer incidence rates between these two regions may be attributed to differences in an improved cancer registry system in Iran and women's developing awareness of the cancer over time., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 International Journal of Preventive Medicine.)

Background: The short synacthen test (SST) is the most commonly performed investigation to assess adrenal function. Appropriate criteria for when an SST is performed are subject to debate. We investigated how random serum cortisol levels relate to SST response., Methods: We examined random cortisol measurements taken between 04.40-23.55 p.m. results of SST baseline and 30-/60-min cortisol performed over 12 months (225 SSTs) at Salford Royal Hospital. Serum cortisol was measured on the Siemens Centaur Analyser.A 30-60-min cortisol concentration of ≥450 nmol/L defined a pass; 350-449 nmol/L defined borderline., Results: Patients only proceeded to SST if random cortisol was <400 nmol/L. For those not on corticosteroids for at least 2 weeks, 42/43 (97.7%) cases with random cortisol concentration of ≥200 nmol/L had an SST 'pass'. The relation was less clear with corticosteroid treatment (19/35 cases; 54%).For those not taking glucocorticoid treatment (including inhaled/topical corticosteroids) in the previous 2 weeks, 91.8% of SSTs were pass/2.7% borderline/5.5% fail. For those on steroids, 51.9% of SSTs were a pass/11.4% were borderline.In relation to the postsynacthen cortisol pass cut-off of ≥450 nmol/L, in 15/207 (7.2%) of cases, the 60-min cortisol was ≥450 nmol/L (adequate adrenocortical function), but 30-min cortisol was below this. In all cases where the 30-min cortisol did indicate a pass (i.e. was ≥450 nmol/L) the 60-min cortisol was also ≥450 nmol/L., Conclusion: Our findings suggest that if the random cortisol level is ≥200 nmol/L, regardless of the time of day and the person was not taking corticosteroid treatment in the previous 2 weeks, SST may not be needed. Our data also suggests that 60-min cortisol retains utility., Competing Interests: There are no conflicts of interest., (Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc.)

Introduction: Many people with type 1 diabetes (T1DM) continue to run high HbA1c levels with an associated elevated risk of cardiovascular events and increased mortality. We describe here how adjunctive prescription of an SGLT2 inhibitor has improved the glycaemic control of several people with T1DM, where the new technology has been intensively deployed., Methods: We report outcomes of six adults with T1DM who have been given dapagliflozin in East Cheshire, UK. Initiation was with education/support from the diabetes specialist nurses. All had an HbA1c of 70 mmol/mol (8.6%) or more before this was initiated. All had been monitoring glycemia with a FreeStyle Libre monitor for at least 6 months prior to this., Results: The age range was 30-68 years. The mean duration of T1DM was 23.3 ± 5.5 years. All were on a basal-bolus regime. Over a 6 month period, HbA1c fell from 78.5 mmol/mol (9.3%) to 55 mmol/mol (7.2%). The greatest reduction in HbA1c was 57 mmol/mol (7.4%). Analysis of the FreeStyle Libre blood glucose records showed that the proportion of blood glucose readings on target (4-10 mmol/L) increased from 33.1 to 65.2% with the addition of dapagliflozin(P = 0.007). The proportion of blood glucose readings above target (>10 mmol/L) decreased from 68.0 to 26.4%, 6 months after initiation of dapagliflozin (P = 0.005). There was no increase in symptomatic hypoglycemia., Conclusion: Dapagliflozin as adjunctive therapy to basal-bolus regime insulin in individuals with T1DM was well tolerated and improved glycemic control with no increase in hypoglycemia. We provide further evidence of the value of this intervention., Competing Interests: There are no conflicts of interest., (Copyright © 2021 The Author(s). Published by Wolters Kluwer Health, Inc.)

Purpose . Recently, a new method was proposed for physical work rate classification based on an adaptive neuro-fuzzy inference system (ANFIS). This study aims to present a genetic algorithm (GA)-optimized ANFIS model for a highly accurate classification of physical work rate. Methods . Thirty healthy men participated in this study. Directly measured heart rate and oxygen consumption of the participants in the laboratory were used for training the ANFIS classifier model in MATLAB version 8.0.0 using a hybrid algorithm. A similar process was done using the GA as an optimization technique. Results . The accuracy, sensitivity and specificity of the ANFIS classifier model were increased successfully. The mean accuracy of the model was increased from 92.95 to 97.92%. Also, the calculated root mean square error of the model was reduced from 5.4186 to 3.1882. The maximum estimation error of the optimized ANFIS during the network testing process was ± 5%. Conclusion . The GA can be effectively used for ANFIS optimization and leads to an accurate classification of physical work rate. In addition to high accuracy, simple implementation and inter-individual variability consideration are two other advantages of the presented model.

Water scarcity is emerging as a major problem in water stressed regions such as Middle East countries which highlights the importance of agricultural reuse of wastewater as a valid alternative source. However, consumption of wastewater-irrigated crops has been implicated as a vehicle for transmission of bacterial infections such as campylobacteriosis. Understanding and minimizing public health threats associated with agricultural reuse of treated wastewater (TWW) are crucial elements in sustainable water resource management. To address this need, the present study was carried out to determine Campylobacter risk for the consumers of TWW-irrigated vegetables by field experiments as well as quantitative microbial risk assessment (QMRA) model. Campylobacter was monitored in secondary treated wastewater, TWW-irrigated soil and harvested vegetables by nested real-time PCR assay. Campylobacter was detected in 64% (16/25) of TWW samples, whereas analysis of TWW-irrigated soil and vegetable samples yielded no positive result for Campylobacter. The estimated mean annual Campylobacter disease burden ranged from 2.37 × 10 -5 to 6.6 × 10 -5 disability-adjusted life years (DALYs) per person per year (pppy) for vegetable consumers which was lower than the less stringent reference level of 10 -4 DALYs pppy has been recommended by world health organization (WHO). Our results in regard to the QMRA estimates and field experiments suggest that the reuse of TWW for irrigation of vegetables doesn't pose a considerable risk to human health from the viewpoint of Campylobacter infections in a semi-arid area., Competing Interests: Declaration of competing interests The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier Ltd. All rights reserved.)

Introduction: Many people with type 1 diabetes continue to run high HbA1c levels with associated elevated risk of cardiovascular events and increased mortality. We describe here how use of the FreeStyle Libre flash monitor has improved the glycaemic control of many people with type 1 diabetes where the new technology has been intensively deployed., Methods: We report the outcomes of 92 consecutive adults (18 years of age or more) with type 1 diabetes who have begun using the FreeStyle Libre flash glucose monitor in East Cheshire, UK. Initiation was with education and support from one of the diabetes specialist nurses. An HbA1c of 60 mmol/mol (7.6%) was taken as the threshold for suboptimal glycaemic control., Results: The mean cohort age was 43 years for men and 39 years for women (overall range 17-83 years). In 92 consecutive users, HbA1c decreased by an average of 10.7 mmol/mol (0.98%) after 3 months, and by 16.1 mmol/mol (1.47%) after 6 months. There was also a narrowing of the distribution of HbA1c, with many fewer people running high HbA1c ≥80 mmol/mol (9.5%). After the 6-month follow-up, two 2/92 users did not wish to continue with the monitoring., Conclusion: Flash glucose monitoring has great potential for the management of type 1 diabetes in the adult population and improving metabolic control/quality of life for people across the world. The technology provides significantly more data than the intermittent results obtained by traditional subcutaneous blood glucose monitoring, which may not capture intervals of extreme variability or nocturnal events., Competing Interests: There are no conflicts of interest., (Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.)

Background: There is still a controversy in the preferred method of reperfusion in acute ST-segment elevation myocardial infarction (STEMI), when the achievement of well-defined "golden time" is difficult. We sought to evaluate the procedural and in-hospital outcomes of the strategy of "thrombolytic administration and rescue or routine percutaneous coronary intervention (PCI)" versus "primary PCI (PPCI)" strategy in acute STEMI., Methods: In this observational prospective study, the data of 237 patients with acute STEMI presented or referred to Chamran Cardiovascular Research Center in Isfahan, Iran, were collected (PROVE/ACS study). Baseline characteristics, thrombolysis in myocardial infarction (TIMI) flow grade of infarct-related artery (IRA), left ventricular ejection fraction (LVEF), and in-hospital outcomes were evaluated., Results: The mean age of patients was 61.4 ± 13.0 years, 86.9% were men, 13.1% were diabetic, and 67.9% had anterior STEMI. Patients in the "thrombolytic then PCI" group were younger, more smoker, more often male with higher body weight and lower systolic blood pressure (SBP). The pre-PCI TIMI flow grade 3 was more often seen in the "thrombolytic then PCI" group (39.4% vs. 21.0%, P < 0.001) and less thrombectomy was performed in this group of patients (12.9% vs. 26.7%, P = 0.011). Time to reperfusion was significantly longer in PPCI group (182.4 ± 233.7 minutes vs. 44.6 ± 93.4 minutes, respectively, P < 0.001). No difference in mortality, mean of LVEF, and incidence of atrial fibrillation (AF) was observed in two groups., Conclusion: If the PPCI strategy could not be performed in the golden time, the strategy of thrombolytic administration and rescue or routine PCI leads to more initial IRA patency and less thrombectomy with similar clinical outcomes., (© 2020 Isfahan Cardiovascular Research Center & Isfahan University of Medical Sciences.)

Purpose: To evaluate the efficacy of intravitreal bevacizumab (IVB) combined with intravitreal methotrexate (IVM) in the treatment of diabetic macular edema (DME)., Methods: In this prospective, interventional contralateral eye study, patients with bilateral DME were randomly allocated to receive three monthly injections of IVB (1.25 mg/0.05 mL) plus IVM (400 μg; 0.16 cc) or IVB alone. The outcome measure was changes in the best corrected visual acuity (BCVA), central macular thickness (CMT), and central macular volume (CMV)., Results: Thirty-six treatment-naive eyes of 18 patients with a mean age of 62.38 ± 6.2 years were included in the study. BCVA logMAR changed from 0.95 ± 0.53 at baseline to 0.75 ± 0.53 in the combination group and from 0.72 ± 0.57 to 0.49 ± 0.50 in the IVB alone group at 1 month after the 3 rd injection. BCVA improvement in both groups was not statistically significant compared with the baseline value ( P > 0.99). Compared with the baseline values, mean CMT and CMV were reduced in both groups; however, these changes did not reach a significant level. The differences of CMT changes between the groups were not statistically significant at month 1 ( P = 0.82), month 2 ( P = 0.21), and month 3 ( P = 0.10). Furthermore, the differences of CMV changes between the groups were not statistically significant at month 1 ( P = 0.76), month 2 ( P = 0.82), and month 3 ( P = 0.11)., Conclusions: This pilot study demonstrated no significant therapeutic effects for IVB combined with IVM compared to IVB alone in treatment-naive DME patients over a 3-month course., Competing Interests: There are no conflicts of interest., (Copyright: © 2020 Journal of Current Ophthalmology.)