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This paper aims to investigate the tragacanth gum potential as a natural polymer combined with natural clay mineral (montmorillonite, kaolinite, and illite) nanoparticles (NPs) to form NPepolymer suspension for enhanced oil recovery (EOR) in carbonate reservoirs. Thermal gravimetric analysis (TGA) tests were conducted initially in order to evaluate the properties of tragacanth gum. Subsequently, scanning electron microscopy (SEM) and energy-dispersive X-ray (EDX) tests were used to detect the structure of clay particles. In various scenarios, the effects of natural NPs and polymer on the wettability alteration, interfacial tension (IFT) reduction, viscosity improvement, and oil recovery were investigated through contact angle system, ring method, AntonPaar viscometer, and core flooding tests, respectively. The entire experiment was conducted at 25, 50, and 75 °C, respectively. According to the experimental results, the clay minerals alone did not have a significant effect on viscosity, but the addition of minerals to the polymer solution leads to the viscosity enhancement remarkably, resulting mobility ratio improvement. Among clay NPs, the combination of natural polymer and kaolinite results in increased viscosity at all temperatures. Considerable wettability alteration was also observed in the case of natural polymer and illite NPs. Illite in combination with natural polymer showed an ability in reducing IFT. Finally, the results of displacement experiments revealed that the combination of natural polymer and kaolinite could be the best option for EOR due to its substantial ability to improve the recovery factor. [ABSTRACT FROM AUTHOR]

Introduction Foreign body ingestion can lead to esophageal complications, including perforation and impaction, in up to 20% of cases, making it a critical situation. Misdiagnosis or delayed diagnosis can cause severe complications. Case presentation We present the case of a 78-year-old female who swallowed an acrylic partial denture leading to progressive dysphagia and a vegetative ulcerative lesion on endoscopy. The lesion was initially misdiagnosed as a neoplasm of the esophagus. CT scan and a repeat endoscopy revealed the presence of a denture in the esophagus. The denture was successfully removed with a rigid esophagoscope, and no evidence of complications was reported in follow-up visits. Discussion Diagnosis of esophageal foreign bodies involves imaging studies and endoscopy, which is the gold standard for diagnosis and management. CT scans also have an important role in diagnosing controversial cases. Treatment depends on the size, shape, and location of the object. [ABSTRACT FROM AUTHOR]

Background: Manymedical students experience heavy occupational stress during their long education period. Occupational stress can be affected by several factors, including spiritual intelligence. Objectives: This study aimed to determine the level of occupational stress in medical interns during the COVID-19 pandemic and the effect of spiritual intelligence. Methods: This cross-sectional study was performed on 209 medical interns at Shahid Beheshti University of Medical Sciences (Tehran, Iran) in the autumn of 2020. Eligible medical students answered two online questionnaires: The Opisow occupational stress questionnaire and the King Spiritual Intelligence Questionnaire. Data were analyzed in SPSS 16 and EQS6.1 using structural equation modeling. Results: The mean occupational stress score and the mean spiritual intelligence score of the participants were 184.57 ± 23.57 and 50.44 ± 13.97, respectively. All the model fitness indices were in the acceptable range (CMIN/df = 2.3, RMSEA= 0.07, GFI = 0.91, and CFI = 0.93); thus, the proposed model was confirmed. Spiritual intelligence was a factor affecting occupational stress (β = -0.45). Besides, all of the subscales of spiritual intelligence negatively affected occupational stress with the following effect sizes: Transcendent awareness (β = -0.53), critical existential thinking (β = -0.43), production of personal meaning (β = -0.41), and consciousness state expansion (β = -0.27). Conclusions: According to the model fitness indices, it can be concluded that the proposed model was acceptable. All subscales of spiritual intelligence had a negative impact on occupational stress. [ABSTRACT FROM AUTHOR]

In this research, a combined experimental and analytical program was conducted to study the effect of the single and hybrid fibers [polyvinyl alcohol (PVA) and steel] on the material characteristics of the sustainable high-strength self-compacting concrete incorporating a 100% replacement ratio of aggregate with granite industry by-product. The experiment includes 13 mixture compositions to understand mechanical and impact properties. The analytical investigation comprises statistical analysis of impact behavior, optimized mix compositions, and regression analysis between mechanical properties. The sustainable cementitious composites were made with 100% recycled fine aggregate, different volume fractions of PVA and steel fibers (0%, 0.5%, 1.0%, 1.5%, and 2.0%), and a constant proportion of Class F fly ash as partial replacement of cement. Mechanical properties of hardened concrete were studied in terms of compressive strength, splitting tensile strength, and three-point flexural tests. Specimens were subjected to repeated drop-weight, ultrasonic pulse velocity, and water absorption tests to determine impact resistance, integrity, and durability. It was discovered that incorporating fibers into fully recycled fine-aggregate concrete improves the material's properties, which was found to be highly dependent on the use of single or hybrid fibers, their types, and their content. The energy-absorbing and energy-dissipating capability of samples was improved remarkably with the addition of fiber volume dosage. The best efficiency was for the mixture with 1.5% hooked-end fibers according to the higher values of mechanical and impact properties and the lower cost. [ABSTRACT FROM AUTHOR]

Blocking the grid voltage imbalance through the $\alpha \beta$ -frame delayed signal cancellation ($\alpha \beta$ DSC) operator requires a relatively high delay value of $1/4$ cycle. Since the dynamic behavior of the $\alpha \beta$ -frame cascaded delayed signal cancellation based phase-locked loop ($\alpha \beta$ CDSC-PLL) depends on the total delay length of the cascaded operators, this value can slow down the dynamic response. In this paper, however, inspired by the delayed signal cancelation (DSC) concept, an enhanced $\alpha \beta$ -frame DSC operator, which removes the grid voltage imbalance with a delay length of only $1/12$ cycle, is proposed. The small-signal model of the suggested frequency adaptive operator is derived, making the tuning procedure and stability analysis easy yet effective. Due to the shorter delay length, using the proposed operator in the $\alpha \beta$ CDSC-PLL structure leads to a higher speed-of-response and, therefore, a less phase-angle error during grid voltage scenarios. Moreover, when the total delay length decreases, the filtering capability will be improved using more operators at the chain of the cascaded DSC operators. The performance of the $\alpha \beta$ CDSC-PLL and its suggested enhanced structure, benefiting from the proposed operator, are compared through theoretical analysis and experimental tests, which verify that the proposed structure offers a better dynamic response and filtering capability. [ABSTRACT FROM AUTHOR]

Background. Peripheral blood smear examination is an invaluable laboratory test, which provides the complete hematologic and/or nonhematologic picture of a case. In addition to verifying the results of automated cell counters, it has the potential to identify some pathologic and morphologic changes that remain hidden using the cell counters alone. Case Presentation. A 40-year-old man with a three-year history of alcohol intake and marijuana abuse presented with severe lower extremities of the bone and abdominal pain. Physical examination showed high blood pressure, high pulse rate, and abdominal tenderness. He underwent extensive laboratory and imaging tests, and cholecystectomy and bone marrow studies were associated with no definite diagnosis. Right after all these invasive, expensive, and time-consuming investigations during a month, finding coarse basophilic stippling in the red blood cells in the peripheral blood smear by an expert led to the final diagnosis. Elevated blood lead level and the presence of ring sideroblasts in the bone marrow study confirmed the diagnosis of lead poisoning, and the patient responded well to chelator therapy in a short period. Conclusion. This case clearly showed the value of peripheral blood smear review and its impact on patient care. In order not to lose the cases, laboratories are recommended to design their own policy for peripheral blood smear review. The peripheral blood smear is the fastest, simplest, and most available screening test, which can prevent many misdiagnoses and malpractices. It provides rich morphological information, among which basophilic stippling is highly suggestive of lead poisoning. [ABSTRACT FROM AUTHOR]

Background: The incidence of smuggling and illegal transport of substances by internal concealment, also known as body packing, is increasing. The clinical approach to body packers has changed significantly over the past two decades. In addition, the mortality of body packers is an important issue in patient management. The purpose of the current study is to determine the statistics and mortality related to body packing. Methods: In this cross-sectional study, all body packer patients who referred to Loghman Hakim hospital were evaluated from 2010 to 2017. Demographic characteristics, findings of clinical imaging, treatment, and outcome of the patients were recorded. The data were analyzed using SPSS version 21. Results: A total of 303 patients were enrolled in the study after the diagnosis of body packing by abdominal CT scanning without contrast. Conservative treatment including whole bowel irrigation (WBI) accompanied by close monitoring was done for 78% (n = 236) of patients; moreover, 26 patients (8.5%) underwent surgery after WBI, and 41 patients (13.5%) underwent surgery without bowel irrigation. Mortality was observed in eight patients (2.7%) five of whom (62.5%) died before surgery and had the clinical manifestation of crystal (methamphetamine) and cannabis toxicity. Furthermore, three patients (37.5%) died due to the complications of surgery such as gastrointestinal leakage of an abdominal abscess. Conclusion: Conservative treatment seems to be better for the management of body packers. In addition, it is necessary to monitor patients for possible signs and symptoms of intoxication and gastrointestinal obstruction. [ABSTRACT FROM AUTHOR]

Objective: To estimate the prevalence and significance of cranial nerve (CN) imaging abnormalities in patients with hereditary neuropathy and discuss clinical implications. Methods: We retrospectively analyzed data from patients at four tertiary academic medical centers with hereditary neuropathy diagnoses who had undergone gadolinium‐enhanced magnetic resonance imaging (MRI) of the brain or skull base between 2004 and 2018. MRI scans, as well as computed tomography imaging when available, were reviewed and bivariable analysis was performed to identify predictors of CN abnormalities on imaging. Results: Among 39 patients meeting study criteria, 11 had clinical CN deficits (28%) and 8 had CN abnormalities on imaging (21%). Of the patients with CN abnormalities on imaging, half had CN deficits (4/8) and only a quarter had imaging abnormalities of the CNs with the deficits (2/8). Imaging abnormalities were found in varied CNs, including CNs III, V, VII, and the VII/VIII complex in the internal auditory canal. MRI obtained for the purpose of evaluating CN deficits had a statistically significant increased likelihood of containing CN imaging abnormalities. However, CN deficits themselves were not predictive of imaging abnormalities. Conclusion: Thickening and enhancement of CNs on MRI may be found in approximately 1/5 of patients with hereditary neuropathies and are inconsistently associated with clinical deficits. These imaging findings should not be mistaken for neoplastic and infectious processes as they may be manifestations of the patients' underlying genetic neuropathy. Level of Evidence: 4. [ABSTRACT FROM AUTHOR]

Objectives: To compare five different seeding methods to delineate hand, foot, and lip components of the corticospinal tract (CST) using single tensor tractography. Methods: We studied five healthy subjects and 10 brain tumor patients. For each subject, we used five different seeding methods, from (1) cerebral peduncle (CP), (2) posterior limb of the internal capsule (PLIC), (3) white matter subjacent to functional MRI activations (fMRl), (4) whole brain and then selecting the fibers that pass through both fMRI and CP(WBF-CP), and (5) whole brain and then selecting the fibers that pass through both fMRI and PLIC (WBF-PLIC). Two blinded neuroradiologists rated delineations as anatomically successful or unsuccessful tractography. The proportions of successful trials from different methods were compared by Fisher's exact test. Results: To delineate hand motor tract, seeding through fMRI activation areas was more effective than through CP (p<0.01), but not significantly different from PLIC (p>0.1). WBF-CP delineated hand motor tracts in a larger proportion of trials than CP alone (p<0.05). Similarly, WBF-PLIC depicted hand motor tracts in a larger proportion of trials than PLIC alone (p<0.01). Foot motor tracts were delineated in all trials by either PLIC or whole brain seeding (WBF-CP and WBF-PLIC). Seeding from CP or fMRI activation resulted in foot motor tract visualization in 87% of the trials (95% confidence interval: 60-98%). The lip motor tracts were delineated only by WBF-PLIC and in 36% of trials (95% confidence interval: 11-69%). Conclusions: Whole brain seeding and then selecting the tracts that pass through two anatomically relevant ROIs can delineate more plausible hand and lip motor tracts than seeding from a single ROI. Foot motor tracts can be successfully delineated regardless of the seeding method used. [ABSTRACT FROM AUTHOR]

Abstract: In this study, the feasibility of the synthesis of Fe–TiC–Al2O3 hybrid nanocomposite via mechanical activation followed by carbothermal reduction was investigated. The raw materials including ilmenite, carbon black and aluminum powder were milled in a high energy planetary ball mill. At different time intervals, samples were taken for characterization. After phase evaluation with XRD, some samples were heat treated in an atmosphere controlled tube furnace. Studies proved that increasing the milling time of the raw materials resulted in the formation of more amorphous phase and more active materials. Furthermore, investigations showed that after carbothermal reduction, the synthesized TiC crystallites were in the scale of nanometers and the lattice parameter had some deviation from the standard value. At higher heat treatment temperatures, the crystallite sizes increased, while the deviation from the standard lattice parameter decreased. [ABSTRACT FROM AUTHOR]

Abstract: Transport of dispersed particles in liquids through porous beds is widely recognized to occur in many industrial processes. The process of particle deposition from a colloidal suspension flowing through a porous medium is usually called deep bed filtration. The goal of the process can be either filtration of the particles by the granular media or, on the contrary, avoiding the particle filtration. Physical and chemical forces between suspended particles and grains of the media (collectors), particle size, fluid velocity and grain size play vital roles in the removal of particles from a suspension. Particle deposition can change the pore morphology and consequently the porosity of the porous medium and the local pressure gradient. This can cause permeability decline and therefore, loss of productivity or injectivity of wells. This article presents a comprehensive review of the literature related to deep bed filtration theories. Different mathematical models for evaluating both initial and transient stage of particle removal have been proposed during last decades. Trajectory analysis or convective diffusion equations have been used in microscopic modeling or so-called fundamental modeling to compute initial removal efficiency. Although these could predict the filter performance under favorable conditions but they underestimate the removal efficiency under unfavorable conditions. Hence, semi-empirical equations were developed for predicting removal efficiency under unfavorable conditions. Macroscopic or phenomenological modeling has been used to predict transient stage removal efficiency of deep bed filtration process. Predicting filter performance by this method requires the knowledge of functionality of filter coefficient. Filter coefficient can be obtained by using search optimization technique along with effluent concentration history. A review on different mathematical models for evaluating both initial and transient stage of particle removal process is presented. [Copyright &y& Elsevier]

Image-guided neurosurgery is an important development in the management of brain tumours. Intra-operative imaging is an extension of this modality. It is important because it compensates for brain shift, allows accurate navigation, and gives verification of what has been done surgically before the patient leaves the operating room. It extends the capacity of image-guided surgery significantly. This paper describes the use intra-operative imaging using MR for brain tumour surgery, the devices presently available for doing this, and potential future applications of intra-operative imaging. It describes in some detail the specific indications for intra-operative imaging including biopsy, resection of intra-axial tumours, and identification and resection of some extra-axial tumours. The description includes the advantages and disadvantages of using intra-operative MRI in this setting. [ABSTRACT FROM AUTHOR]

Background Serous cystic neoplasms of the pancreas are regarded as a benign entity with rare malignant potential. Surgical resection is generally considered curative. Objective To perform the largest single institution review of patients who underwent surgical resection for serous cystic neoplasms of the pancreas in the hopes of guiding future management. Methods Between June 1988 and January 2005, 158 patients with serous cystic neoplasms of the pancreas underwent surgical resection. A retrospective analysis was performed. Univariate and multivariate models were used to determine factors influencing perioperative morbidity and mortality. Major complications were defined as pancreatic fistula or anastomotic leak, postoperative bleed, retained operative material, or death. Minor complications were defined as wound infection, postoperative obstruction/ ileus requiring total parenteral nutrition (TPN), delayed gastric emptying, arrhythmia, or other infection. Results The mean age of the patients was 62.1 years, with 75% being female. The majority of patients were symptomatic at presentation (63%), with abdominal pain as the most common symptom. Of the 158 patients, 75 underwent distal pancreatectomy, 65 underwent pancreaticoduodenectomy, nine underwent central pancreatectomy, five underwent local resection or enucleation, and four underwent total pancreatectomy. Mean tumor diameter was 5.1 cm. Mean operative time was 277 min. Mean postoperative length of hospital stay was 11 days. One patient was diagnosed at presentation with serous cystadenocarcinoma. The remaining 157 patients were initially diagnosed with benign serous cystadenoma. One of three patients with locally aggressive benign disease later presented with metastatic disease. Resection margins for all 158 patients were negative for tumor, and only one (0.6%) showed lymph node involvement. There was one intraoperative death. The incidence of major perioperative complications was 18%, whereas the incidence of minor complications was 33%. Men were significantly more likely to experience minor perioperative complications (OR=3.74, P=0.008), whereas patients greater than 65 years showed a trend toward fewer major complications (OR=0.36, P=0.09). Conclusions Surgically resected serous cystic neoplasms of the pancreas are typically seen in asymptomatic women as 5 cm neoplasms and are predominantly benign. Most are resected via either a left- or right-sided pancreatectomy with low mortality risk, but with notable major or minor morbidity. Cystadenocarcinoma is a rare finding on initial resection of serous cystic neoplasms. However, initial pathology specimens exhibiting benign but locally aggressive neoplasia may indicate an increased likelihood of recurrence or metachronous metastasis, although this claim is limited by a small patient subpopulation in this study and warrants further review. [ABSTRACT FROM AUTHOR]

Background: Diabetes is becoming a worldwide concern. Optimal diabetes control reduces diabetes complications. Objectives: We aimed to measure the principal diabetes care parameters to recognize the main deficits in care for patients with diabetes in the region. Methods: This cross-sectional study is based on the Khuzestan Comprehensive Health Study (KCHS) data. Of all participants, 4673 (15.3%) were identified to have diabetes. We invited the known cases of diabetes to complete a checklist about their diabetes through face-to-face interviews, and we obtained a blood sample to measure their HbA1c. Results: Of all participants of the KCHS study, 312 patients with diabetes who met the inclusion criteria were identified. Mean (± SD) HbA1c was 8.5% (± 1.8), and 225 (72.1%) of the participants had poor glycemic control. About 45.2% had blood pressure less than 130/80 mmHg, and 24% had FBS lower than 130 mg/dl. Nearly 37.8% of the participants had LDL < 100 mg/dl and 40% TG < 150 mg/dl. Of all participants, 38.5% had undergone retinal examination, 13.8% had their foot examined, and 39.4% had done urine micro-albumin /Cr test. HbA1c level had a statistically significant relationship with gender (P = 0.012), occupation (P = 0.007), nephropathy (P = 0.004) and retinopathy (P < 0.001). Conclusions: This study showed that less than half of the participants achieved the optimal ADA goals for diabetes care, therefore it is necessary to revise the basic protocols of diabetes care in the region to improve diabetes management. [ABSTRACT FROM AUTHOR]

Background: Knee osteoarthritis causes pain and disability in many people worldwide, for which no definitive treatment has yet been proposed. In this study, we investigated the safety and efficacy of placental mesenchymal stromal cells-derived extracellular vesicles in patients with knee osteoarthritis. Methods: This triple-blind, randomized clinical trial included patients suffering from bilateral knee osteoarthritis with grade 2 or 3. The knees of each patient were randomized to intervention and control. For the intervention knee, 5 cc of placental mesenchymal stromal cells-derived extracellular vesicles were injected, and for the control knee, 5 cc of normal saline was injected. The patients' symptoms were evaluated before the intervention and 2 and 6 months after the intervention using VAS, WOMAC questionnaire, and Lequesne index. MRI was performed before the intervention and 6 months after the intervention to evaluate retropatellar and tibiofemoral cartilage volume, medial and lateral meniscal disintegrity, ACL injury, and effusion-synovitis. Results: 62 knees (31 patients) were enrolled in this study. There were 31 knees as intervention and 31 knees as control. Finally, the data of 58 knees (29 patients) were analyzed, including 28 women and 1 man. The mean age of the patients was 55.38 ± 6.07 years. No statistically significant difference was detected between the two groups in clinical outcomes (including VAS, WOMAC, and Lequesne scores) before treatment and 2 and 6 months after treatment. Also, no statistically significant difference was detected between the two groups in MRI findings before treatment and 6 months after treatment. No systemic complications or severe local reactions occurred in the patients. Conclusion: A single intra-articular injection of placental mesenchymal stromal cells-derived extracellular vesicles (5 cc, 7 × 109 particles/cc) is safe, but does not improve clinical symptoms or MRI findings in knee osteoarthritis beyond placebo. The protocol of this study was approved on 11 May 2022 with registration number IRCT20210423051054N1. [ABSTRACT FROM AUTHOR]

Background:Poor sleep quality and mental health problems are relatively common among medical students, and have many consequences in their lives and education. Moreover, some studies have reported that the above two issues affect each other. In Iran, limited studies have been conducted in this field. Therefore, this study was conducted with the aim to determine the frequency of poor sleep quality and mental health problems among medical students and the association between these two variables. Methods: In this cross-sectional study, which was conducted from January to April 2021, 320 medical students of Shahid Beheshti University of Medical Sciences (Tehran, Iran) participated. Sampling was performed through the stratified method based on gender and educational phase. Data was collected using an online questionnaire including the following components: a researcher-made sociodemographic characteristics questionnaire, the Pittsburgh Sleep Quality Index (PSQI), and the Depression, Anxiety, and Stress Scale-21 items (DASS-21 ). Results: The mean age of 320 participants was 22.95 ± 2.59 years and 145 (45.3%) were men. The percentage of medical intern participants (34.7%) was higher than that of basic science (34.4%) and medical extern (30.9%). The mean PSQI score was 8.11 ± 2.99, which shows overall poor sleep quality. The comparison between poor sleepers and good sleepers in terms of sociodemographic variables showed that only grade point average was significantly lower in poor sleepers (P = 0.049). The prevalence of some levels of depression, anxiety, and stress among participants was 1000/o, 100%, and 95.3%, respectively. There were also significant associations between poor sleep quality and all three components of mental health of depression (P < 0.001), anxiety (P < 0.001), and stress (P < 0.001 ). Conclusion: Poor sleep quality and mental health problems are interrelated among medical students, and reduce their academic performance. The high prevalence of these problems indicates the importance of the issue, which requires immediate action by the authorities to decrease its consequences. [ABSTRACT FROM AUTHOR]

The advent of automated vehicles (AVs) and the sharing of these vehicles in traffic flow has raised researchers’ interest in low-cost solutions to traffic congestion, especially at intersections as points of traffic flow interlace. Also, as AVs have not been used commercially yet, it is impossible to analyze the effects of their sharing on traffic flow. However, different scenarios of AVs alongside human-driven vehicles (HDVs) can be modeled and simulated. By defining three levels of automated vehicles along with HDVs, this paper investigates the impact of AVs on intersection capacity by applying a series of hypotheses to the fundamental traffic flow formula. Different scenarios with an AV penetration coefficient of 10% to 70% showed an increase in intersection capacity from 10% to more than 50%. Finally, an innovative interactive framework between intelligent intersections and vehicles is presented to control intersection capacity and performance at of service level B with various percentages of AVs. [ABSTRACT FROM AUTHOR]

Aim/Introduction: This study was designed as the second phase of a prospective cohort study to evaluate the incidence and risk factors of diabetic foot ulcers (DFU). Materials and methods: The study was conducted in a university hospital in Iran. Each participant was checked and followed up for two years in terms of developing newfound DFU as ultimate outcome. We investigated the variables using univariate analysis and then by backward elimination multiple logistic regression. Results: We followed up 901 eligible patients with diabetes for two years. The mean age of the participants was 53.24 ± 11.46 years, and 58.53% of them were female. The two-year cumulative incidence of diabetic foot ulcer was 8% (95% CI 0.071, 0.089) [Incidence rate: 49.9 /1000 person-years]. However, the second-year incidence which was coincident with the COVID-19 pandemic was higher than the first-year incidence (4.18% and 1.8%, respectively). Based on our analysis, the following variables were the main risk factors for DFU incidence: former history of DFU or amputation [OR = 76.5, 95% CI(33.45,174.97), P value < 0.001], ill-fitting foot-wear [OR = 10.38, 95% CI(4.47,24.12), P value < 0.001], smoking [OR = 3.87,95%CI(1.28, 11.71),P value = 0.016], lack of preventive foot care [OR = 2.91%CI(1.02,8.29),P value = 0.045], and insufficient physical activity[OR = 2.25,95% CI(0.95,5.35),P value = 0.066]. Conclusion: Overall, the two-year cumulative incidence of diabetic foot ulcer was 8% [Incidence rate: 49.9 /1000 person-years]; however, the second-year incidence was higher than the first-year incidence which was coincident with the COVID-19 pandemic (4.18% and 1.8%, respectively). Independent risk factors of DFU occurrence were prior history of DFU or amputation, ill-fitting footwear, smoking, lack of preventive foot care, and insufficient physical activity. [ABSTRACT FROM AUTHOR]

Key Clinical Message: In contrast to intestinal balantidiasis, which is widespread throughout the world, urinary balantidiasis is uncommon. It often affects people with underlying diseases, and acute infections may be fatal. Even though urine is not typical for this parasite, specific morphologic characteristics can aid in accurate diagnosis. Balantidium coli is a ciliated protozoan which can infect intestinal system. Urinary balantidiasis is an extremely rare infection that may cause serious issues in patients with underlying diseases. Herein, we present a case of urinary balantidiasis in a patient with bladder cancer. [ABSTRACT FROM AUTHOR]

Introduction: Post-operative nausea and vomiting (PONV) is a common problem after sleeve gastrectomy. In recent years, following the increase in the number of such operations, special attention has been paid to preventing PONV. Additionally, several prophylaxis methods have been developed, including enhanced recovery after surgery (ERAS) and preventive antiemetics. Nevertheless, PONV has not been completely eliminated, and the clinicians are trying to reduce the incidence of PONV yet. Methods: After successful ERAS implementation, patients were divided into five groups, including control and experimental groups. Metoclopramide (MA), ondansetron (OA), granisetron (GA), and a combination of metoclopramide and ondansetron (MO) were used as antiemetics for each group. The frequency of PONV during the first and second days of admission was recorded using a subjective PONV scale. Results: A total of 130 patients were enrolled in this study. The MO group showed a lower incidence of PONV (46.1%) compared to the control group (53.8%) and other groups. Furthermore, the MO group did not require rescue antiemetics, however, one-third of control cases used rescue antiemetics (0 vs. 34%). Conclusion: Using the combination of metoclopramide and ondansetron is recommended as the antiemetic regimen for the reduction of PONV after sleeve gastrectomy. This combination is more helpful when implemented alongside ERAS protocols. [ABSTRACT FROM AUTHOR]

Background: Hydatid cyst, caused by the larvae of Echinococcus granulosus, is one of the most severe cestode infections occurring in Iran. The liver is the most commonly involved organ. The present study was carried out to review the demographic of 20 years surgically treated hydatic cysts. Methods: Ninety-eight patients were enrolled in the study. Demographic features, time of surgery, cyst size, and albendazole usage have been reviewed from the medical records of patients in Loghman Hakim Hospital, Tehran, Iran, from 2001 to 2021. Statistical analysis was performed to find any correlation between the uses of concurrent albendazole with surgical procedure. Results: Of 98 patients with hydatid cyst, 57 (58.2%) were female. The mean age of patients was 39.4 ±18.7 yrs, and the mean surgery time was 217.5 ± 81.4 minutes. Regarding the infection site, the liver (60.2%) and lungs (22.4%) were the most affected organs, respectively. 56.1% of patients had one cyst, and 42.9 % had two or more cysts. 20.4% of them had taken albendazole before surgery, but 86.7 % took it after the operation. No recurrent cysts were seen among 91.8% of them, but 8.2% mentioned suffering from a recurrent cyst. 85.7% of those recurrent cases did not receive albendazole before surgery, and 75% of recurrent cases after surgery did not take albendazole (P<0.05). Conclusion: Administration of albendazole before and after the operation was significantly related to reduced recurrence, bleeding, morbidity, and even the time of surgery. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the effect of intravitreal triamcinolone acetonide injection on the resolution of subretinal fluid (SRF), and its correlation with visual outcome after scleral buckle (SB) surgery. Methods: A prospective consecutive case series was conducted in patients who underwent SB surgery for macula-off rhegmatogenous retinal detachment (RRD) at Farabi Eye Hospital from February 1, 2012 to August 30, 2013. Exclusion criteria included previous ocular surgery (e.g. primary surgical failure) except cataract surgery, recurrent retinal detachment, macular hole, epiretinal membrane, proliferative vitreoretinopathy grade C, history of trauma, other retinal diseases, and diabetes mellitus. Patients were assigned to two groups. In group 1, patients received 2 mg of intravitreal triamcinolone acetonide injection at the end of surgery while patients in group 2 received intravitreal balanced saline solution for balancing the intraocular pressure (IOP). Patients were followed up at 1 day, 1 week, 1 month, 2 months and 3 months after the surgery by best-corrected visual acuity (BCVA), slitlamp examination, indirect ophthalmoscopy and optical coherence tomography (OCT). OCT (Heidelberg Engineering, Heidelberg, Germany) was used at all visits except day 1 after the surgery. Student's t test and χ2 tests were used for comparisons; p value ≤0.05 was considered significant. Results: Sixty-two eyes of 62 patients were enrolled in the study. There were 33 male patients (53%) and 29 female patients (47%). The average age was 43.8 years (18-72 years). The mean duration of symptoms was 34.7 ± 46.8 days. There were 29 eyes in group 1 and 33 eyes in group 2. Twelve weeks after the operation, 25 patients (40%) had SRF beneath the macula, but there was no significant difference (p = 0.24, χ2 test) between the two groups. Improvement in BCVA in both groups was statistically significant (p ≤ 0.001) but did not differ between the two groups (p = 0.09) apart from week 12, in which the improvement in group 1 was significantly higher (p = 0.03). The incidence of cystoid macular edema did not differ in a statistically significant way between the groups (p = 0.19). IOP in 4 (15%) patients in group 1 rose above 21 mm Hg but responded quickly to 2 weeks of topical antiglaucoma medication. There was no cataract progression in either group. There was no correlation between the incidence of persistent SRF and the extent of detachment in both groups (p = 0.83). There was no surgical failure or redetachment in either group during the study period. Conclusion: Single-dose intravitreal triamcinolone may increase the final BCVA in macula-off RRD patients despite persistent SRF, suggesting the anti-inflammatory role of this drug. © 2014 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Recently, mesenchymal stromal cells (MSCs) and their derivative exosome have become a promising approach in the context of liver diseases therapy, in particular, acute liver failure (ALF). In addition to their differentiation into hepatocytes in vivo, which is partially involved in liver regeneration, MSCs support liver regeneration as a result of their appreciated competencies, such as antiapoptotic, immunomodulatory, antifibrotic, and also antioxidant attributes. Further, MSCs-secreted molecules inspire hepatocyte proliferation in vivo, facilitating damaged tissue recovery in ALF. Given these properties, various MSCs-based approaches have evolved and resulted in encouraging outcomes in ALF animal models and also displayed safety and also modest efficacy in human studies, providing a new avenue for ALF therapy. Irrespective of MSCs-derived exosome, MSCs-based strategies in ALF include administration of native MSCs, genetically modified MSCs, pretreated MSCs, MSCs delivery using biomaterials, and also MSCs in combination with and other therapeutic molecules or modalities. Herein, we will deliver an overview regarding the therapeutic effects of the MSCs and their exosomes in ALF. As well, we will discuss recent progress in preclinical and clinical studies and current challenges in MSCs-based therapies in ALF, with a special focus on in vivo reports. [ABSTRACT FROM AUTHOR]

Chimeric antigen receptor (CAR) T-cell therapy is a promising and rapidly expanding therapeutic option for a wide range of human malignancies. Despite the ongoing progress of CAR T-cell therapy in hematologic malignancies, the application of this therapeutic strategy in solid tumors has encountered several challenges due to antigen heterogeneity, suboptimal CAR T-cell trafficking, and the immunosuppressive features of the tumor microenvironment (TME). Oncolytic virotherapy is a novel cancer therapy that employs competent or genetically modified oncolytic viruses (OVs) to preferentially proliferate in tumor cells. OVs in combination with CAR T-cells are promising candidates for overcoming the current drawbacks of CAR T-cell application in tumors through triggering immunogenic cell death (ICD) in cancer cells. ICD is a type of cellular death in which danger-associated molecular patterns (DAMPs) and tumor-specific antigens are released, leading to the stimulation of potent anti-cancer immunity. In the present review, we discuss the biological causes of ICD, different types of ICD, and the synergistic combination of OVs and CAR T-cells to reach potent tumor-specific immunity. [ABSTRACT FROM AUTHOR]

Abnormal vasculature is one of the most conspicuous traits of tumor tissue, largely contributing to tumor immune evasion. The deregulation mainly arises from the potentiated pro-angiogenic factors secretion and can also target immune cells' biological events, such as migration and activation. Owing to this fact, angiogenesis blockade therapy was established to fight cancer by eliminating the nutrient and oxygen supply to the malignant cells by impairing the vascular network. Given the dominant role of vascular-endothelium growth factor (VEGF) in the angiogenesis process, the well-known anti-angiogenic agents mainly depend on the targeting of its actions. However, cancer cells mainly show resistance to anti-angiogenic agents by several mechanisms, and also potentiated local invasiveness and also distant metastasis have been observed following their administration. Herein, we will focus on clinical developments of angiogenesis blockade therapy, more particular, in combination with other conventional treatments, such as immunotherapy, chemoradiotherapy, targeted therapy, and also cancer vaccines. 64SciJHJrfLYaKT285oK4U Video abstract [ABSTRACT FROM AUTHOR]

Abstract: In this research, the possibility of preparing TiC from inexpensive raw material was investigated. Impure Ti chips and carbon black were placed in a high-energy ball mill and sampled in different milling times. The XRD analyses showed that in the times more than 15h of milling all the raw materials were changed to the desired materials. From the broadening of the diffraction lines in the XRD patterns, it was concluded that the TiC crystallites were nanosized and the lattice parameter had deviated slightly from the standard size. [Copyright &y& Elsevier]

Abstract: In this research, the feasibility of the addition of nanocrystalline TiC particles – synthesized via mechanical alloying – to iron matrix melt was investigated. For the preparation of TiC, impure titanium chips and carbon black were placed in a high-energy ball mill and sampled after different milling time. XRD studies showed that at milling times more than 15h, TiC was synthesized. It was observed from the peak broadening of the diffraction patterns that the TiC crystallites were in the scale of nanometer. 0.96wt.% TiC synthesized after 15h was added to a 4wt.% C cast iron melt. It was observed that this small amount of TiC was enough to improve the structure, hardness and wear resistance of the cast iron significantly. [Copyright &y& Elsevier]

Objective. To evaluate the midterm longitudinal changes in chorioretinal structures in patients with coronavirus disease 2019 (COVID-19). Methods. Thirty-four eyes of 17 COVID-19 patients were enrolled. The patients underwent retinal and choroidal imaging upon the recovery (baseline) after 1 and 3 months. Retinal measurements in fovea, parafovea, and perifovea were recorded. To calculate choroidal vascularity index (CVI), luminal and total choroidal areas were measured using Sonada's method. Choroidal thickness was measured at the subfovea 500 microns temporal and nasal to the fovea. Results. Mean CVI was 0.64 ± 0.04 at baseline that significantly increased to 0.67 ± 0.05 (P = 0.012) after 1 month and again significantly decreased to 0.63 ± 0.05 after 3 months (P < 0.001). While the stromal component showed a significant decrease between the baseline and first-month values (1.16 ± 0.29 to 1.01 ± 0.27, P = 0.03), the luminal area mostly changed between months 1 and 3 (2.03 ± 0.28 to 1.91 ± 0.23, P = 0.045). The average of subfoveal choroidal thickness and retinal thickness remained unchanged. Conclusion. CVI is increased in patients with COVID-19 1 month after recovery from COVID-19 and returns to baseline values after 3 months. Regarding the reversible nature of changes, there might be a prominent role in inflammation. [ABSTRACT FROM AUTHOR]

Recently, mesenchymal stromal cells (MSCs) and also their exosome has become a game-changing tool in the context of tissue engineering and regenerative medicine. MSCs due to their competencies to establish skin cells, such as fibroblast and keratinocyte, and also their unique attribute to suppress inflammation in wound site has attracted increasing attention among scholars. In addition, MSC's other capabilities to induce angiogenesis as a result of secretion of pro-angiogenic factors accompanied with marked anti-fibrotic activities, which mainly mediated by the releases matrix metalloproteinase (MMPs), make them a rational and effective strategy to accelerate wound healing with a small scar. Since the chief healing properties of the MSCs depend on their paracrine effects, it appears that MSCs-derived exosomes also can be an alternative option to support wound healing and skin regeneration as an innovative cell-free approach. Such exosomes convey functional cargos (e.g., growth factor, cytokine, miRNA, etc.) from MSCs to target cells, thereby affecting the recipient skin cells' biological events, such as migration, proliferation, and also secretion of ECM components (e.g., collagen). The main superiorities of exosome therapy over parental MSCs are the diminished risk of tumor formation and also lower immunogenicity. Herein, we deliver an overview of recent in vivo reports rendering the therapeutic benefits of the MSCs-based therapies to ease skin wound healing, and so improving quality of life among patients suffering from such conditions. [ABSTRACT FROM AUTHOR]

Objectives: The present study seeks to provide insight into managing patients with chronic kidney disease (CKD) infected with COVID-19. Methods: Patients with COVID-19 with CKD were included in the study. The eligible patients were divided into four groups: 1) patients who were not on dialysis, 2) patients on maintenance dialysis, 3) patients who underwent dialysis following COVID-19, 4) patients with a history of a kidney transplant. After reviewing clinical charts, nursing records, laboratory findings, radiological reports, and other medical records of CKD patients with COVID-19 confirmed infection, clinical presentation, laboratory data, radiology findings, and results were extracted from documented medical records. The epidemiological, clinical, laboratory and outcome characteristics of the subgroups were evaluated and compared. Results: Seventy-eight patients were included into the study. Hypertension (50 cases, 72.5%), diabetes (44 cases, 63.8%), and Cardiovascular disease (26 cases, 38.2%) were the most common risk factors in the studied patients. Among all participants, 40 (52.6%) patients died. The most common symptom was dyspnea (56.6%), followed by dry cough (38.7%). Comparison of blood, inflammatory, biochemical, and clinical indices among the patients' groups show that LDH (P=0.022), AST (P=0.038), and ALT (P= 0.004) indices were significantly different between groups of patients. According to the results in Table 3, Unilateral ground-glass opacity (GGO) in the radiological findings of the Nondialysis CKD group was significantly (P=0.50) higher than the other groups. Conclusion: It can be concluded that CKD is one of the critical factors that can cause poor prognosis in COVID-19 patients. [ABSTRACT FROM AUTHOR]

Background: Early experience of clinical arena as first situations can be effective in selection or refusing medicine as profession is so important that programmers and administrators should consider these settings as one of the most elements in educational programs. Materials and Methods: This study was a cross-sectional study and including presently studying students in medicine field of medical sciences universities. Sample size was estimated for 275 students. Participants were selected from schools of medicine: Iran University (IUMS), Shahid Beheshti University, and Islamic Azad University using stratified random sampling method. Data was collected in March of 2016 by a researcher made questionnaire determined its validity and reliability. Data was analyzed using chi-squared test, t-test, Mann-Whitney and Kruskal-Wallis test. Results: Mean score of medical students' attitude from 15 five-degree scale questions was 51.22 ± 6.32. The mean scores of attitude in men and women were 51.37±6.16 and 51.06±6.53, respectively (p=0.687). Overall, 13.8% of students had positive attitude towards first contact with patient, 10.5% of students had negative attitude and 75.6% had no opinion. The mean scores of attitude towards first contact with patient in Iran university, Shahid Beheshti university and Islamic Azad university were 50.40±5.00, 52.71±5.91 and 46.12±5.97, respectively (p<0.001). The mean scores of attitude towards first contact with patient in reformed educational system and old educational system were 52.35±5.83 and 46.12±5.97 respectively, with a significant difference between two types of educational system (p<0.001). Conclusion: As respects more positive attitude of students in reformed educational system in comparison with old educational system, special attention to courses of early contact with patient may contribute to decreasing educational insufficiency and distance between theory and practice and lead to the satisfaction all of beneficiaries. [ABSTRACT FROM AUTHOR]

Background Transsphenoidal surgery (TSS) is the most common approach for the treatment of pituitary tumors. However, misdirection, vascular damage, intraoperative cerebrospinal fluid leakage, and optic nerve injuries are all well-known complications, and the risk of adverse events is more likely in less-experienced hands. This prospective study was conducted to validate the accuracy of image-based segmentation coupled with neuronavigation in localizing neurovascular structures during TSS. Methods Twenty-five patients with a pituitary tumor underwent preoperative 3-T magnetic resonance imaging (MRI), and MRI images loaded into the navigation platform were used for segmentation and preoperative planning. After patient registration and subsequent surgical exposure, each segmented neural or vascular element was validated by manual placement of the navigation probe or Doppler probe on or as close as possible to the target. Results Preoperative segmentation of the internal carotid artery and cavernous sinus matched with the intraoperative endoscopic and micro-Doppler findings in all cases. Excellent correspondence between image-based segmentation and the endoscopic view was also evident at the surface of the tumor and at the tumor–normal gland interfaces. Image guidance assisted the surgeons in localizing the optic nerve and chiasm in 64% of cases. The mean accuracy of the measurements was 1.20 ± 0.21 mm. Conclusions Image-based preoperative vascular and neural element segmentation, especially with 3-dimensional reconstruction, is highly informative preoperatively and potentially could assist less-experienced neurosurgeons in preventing vascular and neural injury during TSS. In addition, the accuracy found in this study is comparable to previously reported neuronavigation measurements. This preliminary study is encouraging for future prospective intraoperative validation with larger numbers of patients. [ABSTRACT FROM AUTHOR]

BackgroundIntraoperative lumbar cerebrospinal fluid (CSF) drainage is a well-recognised technique in cranial and vascular surgery. The goal of the study was to assess the frequency and severity of intracranial hypotension post-intraoperative lumbar drainage performed using two different techniques, a 14G Tuohy needle versus an 18G traditional needle.MethodsThe medical records and imaging studies of 94 patients who had undergone open cranial operation were retrospectively studied: 47 patients had intraoperative lumbar drainage and 47 patients did not. A 14G Tuohy needle was employed in 27 (57.4%) patients and an 18G traditional needle was employed in 20 (42.6%) patients.ResultsThere were signs of intracranial hypotension on MR images in nine (19.1%) patients who had intraoperative lumbar CSF drainage; none of the patients in the control group exhibited the MR signs of intracranial hypotension. A 14G needle was used in 6/9 patients and resulted in severe complications: one patient developed a delayed intracranial epidural hematoma that required emergency evacuation and a blood patch. Another patient developed somnolence that required two epidural blood patches and a third patient had protracted headaches. The 18G needle was used in the remaining 3/9 patients who were asymptomatic or presented with mild headaches.ConclusionThe use of the smaller 18G traditional needle was associated with better outcomes with regards to intracranial hypotension, and the frequency of severe complications was higher with the use of the 14G Tuohy needle. [ABSTRACT FROM AUTHOR]

Abstract  We investigated the feasibility and utilization of conductive plastic electrodes (CPEs) in patients undergoing continuous video-electroencephalographic (EEG) monitoring in the intensive care unit (ICU), and assessed the quality of brain magnetic resonance imaging (MRI) and computed tomography (CT) images obtained during this period. A total of 54 patients were monitored. Seizures were recorded in 16 patients. Twenty-five patients had neuroimaging performed with electrodes in place; 15 MRI and 23 CT scans were performed. All patients had excellent quality anatomical images without clinically significant artifacts, and without any signs or symptoms that raised safety concerns. Recording quality of the EEG was indistinguishable to that achieved with standard gold electrodes. The use of CPEs allowed for uninterrupted EEG recording of patients who required urgent neuroimaging, and decreased the amount of time spent by the technologists required to remove and reattach leads. [ABSTRACT FROM AUTHOR]

Simple Summary: Achieving gross total resection during the first surgical intervention is particularly important for chondrosarcomas and chordomas, as recurrences are frequently impossible to resect due to post-surgical and post-radiation scarring and vascular fragility. Despite overall survival and progression-free survival being strongly dictated by gross total resection, it is reportedly achieved in less than 70% of patients. While the individual utility of several imaging modalities such as intraoperative CT, MRI, ultrasound, endoscopy, fluoroscopy and neuronavigation has already been demonstrated in previous literature; our case series highlights the importance and methodology of their simultaneous, real-time integration in the Advanced Multimodality Image-Guided Operating (AMIGO) suite at our institution to maximize of resection and mitigate complications. Given the difficulty and importance of achieving maximal resection in chordomas and chondrosarcomas, all available tools offered by modern neurosurgery are to be deployed for planning and resection of these complex lesions. As demonstrated by the review of our series of skull base chordoma and chondrosarcoma resections in the Advanced Multimodality Image-Guided Operating (AMIGO) suite, as well as by the recently published literature, we describe the use of advanced multimodality intraoperative imaging and neuronavigation as pivotal to successful radical resection of these skull base lesions while preventing and managing eventual complications. [ABSTRACT FROM AUTHOR]

Methylmalonic acidemia (MMA) is an autosomal-recessive inborn error of metabolism. To recognize the CT and MR brain sectional imaging findings in children with MMA. Brain imaging studies (47 MR and 5 CT studies) from 52 children were reviewed and reported by a neuroradiologist. The clinical data were collected for each patient. The most common findings were ventricular dilation (17 studies), cortical atrophy (15), periventricular white matter abnormality (12), thinning of the corpus callosum (8), subcortical white matter abnormality (6), cerebellar atrophy (4), basal ganglionic calcification (3), and myelination delay (3). The brain images in 14 patients were normal. Radiological findings of MMA are nonspecific. A constellation of common clinical and radiological findings should raise the suspicion of MMA. [ABSTRACT FROM AUTHOR]

The article describes the case report of a 68-year-old right-handed male patient with a history of progressive balance difficulties and who was diagnosed with brain ischemia associated with a developmental venous anomaly (DVA). The condition was confirmed by biopsy using a Leksell stereotactic frame with neuropathologic examination. The possible development derangements in vascular remodeling related to altered hemodynamics in the region of a DVA is mentioned.

Background: Eastern equine encephalitis occurs principally along the east and Gulf coasts of the United States. Recognition of the neuroradiographic manifestations of eastern equine encephalitis could hasten the diagnosis of the illness and speed the response to index cases. Methods: We reviewed all cases of eastern equine encephalitis reported in the United States between 1988 and 1994. The records of 36 patients were studied, along with 57 computed tomographic (CT) scans and 23 magnetic resonance imaging (MRI) scans from 33 patients. Results: The mortality rate was 36 percent, and 35 percent of the survivors were moderately or severely disabled. Neuroradiographic abnormalities were common and best visualized by MRI. Among the patients for whom MRI scans were available, the results were abnormal for all eight comatose patients as well as for all three noncomatose patients who subsequently became comatose. The CT results were abnormal in 21 of 32 patients with readable scans. The abnormal findings included focal lesions in the basal ganglia (found in 71 percent of patients on MRI and in 56 percent on CT), thalami (found in 71 percent on MRI and in 25 percent on CT), and brain stem (found in 43 percent on MRI and in 9 percent on CT). Cortical lesions, meningeal enhancement, and periventricular white-matter changes were less common. The presence of large radiographic lesions did not predict a poor outcome, but either high cerebrospinal fluid white-cell counts or severe hyponatremia did. Conclusions: Eastern equine encephalitis produces focal radiographic signs. The characteristic early involvement of the basal ganglia and thalami distinguishes this illness from herpes simplex encephalitis. MRI is a sensitive technique to identify the characteristic early radiographic manifestations of this viral encephalitis. (N Engl J Med 1997;336:1867-74.) [ABSTRACT FROM AUTHOR]