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IntroductionDrying is one of the oldest methods of food preservation. To increase the efficiency of heat and mass transfer while maintaining product quality, the study of the drying process is crucial scientifically and meticulously. It is possible to conduct experimental tests, trial and error, in the drying process. However, this approach consumes time and cost, with a significant amount of energy resources. By harnessing available software and leveraging technological advancement to develop a general model for drying food under varying initial conditions, the drying process can be significantly optimized.Materials and MethodsThis study was conducted with the aim of simulating heat and mass transfer during Refractance window drying for aloe vera gel. Comsol Multiphysics version 5.6 is a three-dimensional model used to solve heat and mass transfer equations. For this purpose, the differential equations of heat and mass transfer were solved simultaneously and interdependently. The above model considered various initial conditions: water temperature of 60, 70, 80, and 90℃, and aloe vera gel thickness of 5 and 10 mm. The initial humidity and temperature of the aloe vera is uniform. The initial temperature is 4℃ and the initial humidity of the fresh aloe vera sample is 110 gwater/gdry matter. Heat is supplied only by hot water from the bottom surface of the product.Results and DiscussionThe drying time was needed to reduce the moisture content of aloe vera gel from 110 to 0.1 gwater/gdry matter during Refractance window drying. Aloe vera gel with a thickness of 5 mm dried in 120, 100, 70, and 50 minutes at water temperatures of 60, 70, 80, and 90℃, respectively. For a 10 mm thick layer of aloe vera gel, the drying time was 240, 190, 150, and 120 minutes, for water temperatures of 60 to 90℃, respectively. These results demonstrate the importance of both the water temperature and thickness on the drying time. Furthermore, the drying rate of aloe vera gel increased as the water temperature increased from 60 to 90℃, the drying rates were 0.915, 1.099, 1.57, and 2.198 gwater/min for 5 mm thickness and 0.457, 0.578, 0.732, and 0.915 gwater/min for 10 mm thick layer of aloe vera gel, respectively.ConclusionBased on the simulation results, the optimal model is with a water temperature of 90℃ and an aloe vera gel thickness of 5 mm. Overall, the modeling results are consistent with the results of experimental data.

IntroductionCeliac disease is one of the most common digestive disorder. Chicken nugget is one of the most popular instant and ready-to-eat foods, and wheat flour is one of its main coating ingredients, which contains approximately 60% gluten. Quinoa is a gluten-free grain, as a good source of dietary fiber, has various applications in the meat products processing system as a stabilizer, fat substitute, structural components, etc. The addition of hydrocolloids also helps to improve the rheological properties of gluten-free products. The purpose of this research was to evaluate the effect of quinoa-corn mixed flour in the preparation of nugget batter as a gluten-free combination as an alternative to wheat flour, and also to investigate the effect of adding HPMC hydrocolloid on the final product characteristics. In this research, a rotatable central composite design was used to investigate the effect of two independent variables including different proportions of quinoa-corn flour (0-100, 50-50, 100-0%) and different levels of hydrocolloid (0.5-1-1.5%) on the quality characteristics of nugget. With the increase of quinoa replacement level, moisture content (0.60), batter pick up (138) and redness level 5.5 (a*) increased, and oil content (11), hardness (7.5), brightness level 41(L*), yellowness level 20(b*) decreased. The increase of HPMC also caused an increase in moisture content (0.59), brightness level (L*) of 0.39, batter pick up (137) and decrease in oil content (10) and hardness (7). Optimum conditions for the production of gluten-free nugget were determined by considering the optimal amounts for the production of high quality and healthy products, contained 90% quinoa and HPMC at a level of about 1%. Materials and Methods Corn flour was purchased from the pilot of Ferdowsi University of Mashhad. The de-saponified quinoa was prepared from Kashmir and then ground. In order to make the grains more uniform, both flours were sieved using a 30 mesh. Hydrocolloid hydroxypropyl methylcellulose was also prepared from Kian Shimi Mashhad. Oyla frying oil was used for frying the samples.The chicken nugget formulation was a mixture of 86% minced chicken, 10% onion, 1.5% garlic powder, 1% salt and 1.5% pepper. After complete mixing, these materials were poured into a freezer bag until a homogeneous and uniform mixture was obtained, and they were flatted until they reached the desired thickness (1 cm). Plastics containing chicken paste were stored in the freezer for 2 hours to facilitate cutting. Then molding was done with a circular mold with a diameter of 4 cm (Dehghan Nasiri et al., 2012).The batter formulation consisted of flour, water, baking powder, salt and hydrocolloids. In order to investigate the effect of quinoa and corn flours, and hydrocolloids, these substances were added to nugget water paste in different percentages (quinoa-corn ratio: 0-100, 50-50, 0-100 and hydrocolloids at the level of 1-1 / 5 -0.5%) and then mixed with water by mixer for 1 minute. The molded samples were first coated with flour and then immersed in the batter for 60 seconds and dripped for 30 seconds. Finally, deep frying was performed in the fryer at 170 ° C for 3.5 minutes. The fried samples were taken out of the fryer basket and the excess oil on the surface of the nuggets was removed with absorbent paper. The oil was changed after twice frying. After cooling the samples at room temperature, the tests such as moisture content, oil content, texture (hardness), color, batter pick up, peroxide and overall acceptance were performed.In this study, Design Expert 10.0.7 software and a rotatable central composite design to investigate the effect of two independent variables including different ratios of quinoa-corn flour (0-100, 50-50, 0-100%) and hydrocolloid (0.5-1-1.5%), Was used on the quality characteristics of the nugget. Finally, different models were fitted to the data obtained from the experiments and the best model was selected according to the results of analysis of variance. Results and DiscussionWith increasing quinoa replacement level, moisture content, redness (a*) and pH increased and oil content, batter pick up, texture (hardness), brightness (L*), yellowness (b*) and cooking loss decreased. Increasing the HPMC also increased the moisture content, brightness (L*), cooking loss, batter pick up, and decreased oil content and hardness. Optimum condition for production of gluten-free chicken nuggets, considering the appropriate properties was found to be 90% quinoa flour and 1% HPMC. Conclusion In general, it can be concluded that the addition of quinoa and HPMC leads to the production of high quality products with high moisture and low oil content and high nutritional value.

Abstract Background Nationally representative clinical data on the oral health needs of Canadians has not been available since the 1970s. The purpose of this study was to determine the normative treatment needs of a nationally representative sample of Canadians and describe how these needs were distributed. Methods A secondary analysis of data collected through the Canadian Health Measures Survey (CHMS) was undertaken. Sampling and bootstrap weights were applied to make the data nationally representative. Descriptive frequencies were used to examine the sample characteristics and to examine the treatment type(s) needed by the population. Bivariate logistic regressions were used to see if any characteristics were predictive of having an unmet dental treatment need, and of having specific treatment needs. Lastly, multivariate logistic regression was used to identify the strongest predictors of having an unmet dental treatment need. Results Most of the population had no treatment needs and of the 34.2% who did, most needed restorative (20.4%) and preventive (13.7%) care. The strongest predictors of need were having poor oral health, reporting a self-perceived need for treatment and visiting the dentist infrequently. Conclusions It is estimated that roughly 12 million Canadians have at least one unmet dental treatment need. Policymakers now have information by which to assess if programs match the dental treatment needs of Canadians and of particular subgroups experiencing excess risk.

Abstract Background The general dentist–specialist relationship is important for effective patient care and the professional environment. This study explores the non-clinical factors that may influence the general dentist–specialist relationship in Canada. Methods A cross-sectional web-based survey of a sample of general dentists across Canada was conducted (N ≈ 11,300). The survey collected information on practitioner (e.g., age, gender, years of practice) and practice (e.g., location, ownership) factors. Two outcomes were assessed: not perceiving specialists as completely collegial and perceiving competitive pressure from specialists. Binary and multivariable logistic regression analysis was conducted. Results A total of 1328 general dentists responded, yielding a response rate of 11.7%. The strongest associations for perceiving specialists as not completely collegial include being a practice owner (OR = 2.15, 95% CI 1.23, 3.74), working in two or more practices (OR = 1.69, 95% CI 1.07, 2.65), practicing in a small population center (OR = 0.46, 95% CI 0.22, 0.94), and contributing equally to the household income (OR = 0.47, 95% CI 0.26, 0.84). The strongest associations with perceiving medium/large competitive pressure from specialists include having a general practice residency or advanced education in general dentistry (OR = 2.00, 95% CI 1.17, 3.41) and having specialists in close proximity to the practice (OR = 2.52, 95% CI 1.12, 5.69). Conclusion Practitioner and practice factors, mostly related to business and dental care market dynamics, are associated with the potential for strained relationships between general dentists and specialists in Canada. This study points to the need for dental professional organizations to openly discuss the current state of the dental care market, as it has important implications for the profession.

Introduction: Vicia ervilia, known as bitter vetch is an ancient grain legume crop from Poaceae family. Due to its low cost and production capability in Iran and having high protein content, the resulted flour and its protein products can be evaluated in terms of usability in the food industry. This study was aimed to evaluate the production efficiency, purity and chemical compounds of the V. ervilia protein isolates produced by different methods of alkali and acid extraction–sedimentation at isoelectric point, dialysis –salt extraction and miscella sedimentationMethods: In this study, V. ervilia was provided from the Agricultural Jihad Organization of Lorestan province and the protein isolates of V. ervilia were produced using different methods of protein extraction such as Acidic extraction-sedimentation at isoelectric point, Alkaline extraction-sedimentation at the isoelectric point, dialysis-salt extraction and extraction by miscella sedimentation.Results: The results showed that saline extraction methods (salt-dialysis and miscella) were significantly more effective than the isoelectric sedimentation methods (alkaline and acidic) on increasing the efficiency, purity and protein content of isolates and decreasing the impurities and carbohydrates.Conclusion: The results of this research show that the salt extraction methods (salt-dialysis and miscella) are significantly more effective in increasing the efficiency, purity and protein rate of isolates and in decreasing impurities and carbohydrates than the isoelectric sedimentation methods (alkaline and acidic).

Abstract Background Socioeconomic status (SES) is associated with stroke incidence and mortality. Distribution of stroke risk factors is changing worldwide; evidence on these trends is crucial to the allocation of resources for prevention strategies to tackle major modifiable risk factors with the highest impact on stroke burden. Methods We extracted data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017. We analysed trends in global and SES-specific age-standardised stroke incidence, prevalence, mortality, and disability-adjusted life years (DALYs) lost from 1990 to 2017. We also estimated the age-standardised attributable risk of stroke mortality associated with common risk factors in low-, low-middle-, upper-middle-, and high-income countries. Further, we explored the effect of age and sex on associations of risk factors with stroke mortality from 1990 to 2017. Results Despite a growth in crude number of stroke events from 1990 to 2017, there has been an 11.3% decrease in age-standardised stroke incidence rate worldwide (150.5, 95% uncertainty interval [UI] 140.3–161.8 per 100,000 in 2017). This has been accompanied by an overall 3.1% increase in age-standardised stroke prevalence rate (1300.6, UI 1229.0–1374.7 per 100,000 in 2017) and a 33.4% decrease in age-standardised stroke mortality rate (80.5, UI 78.9–82.6 per 100,000 in 2017) over the same time period. The rising trends in age-standardised stroke prevalence have been observed only in middle-income countries, despite declining trends in age-standardised stroke incidence and mortality in all income categories since 2005. Further, there has been almost a 34% reduction in stroke death rate (67.8, UI 64.1–71.1 per 100,000 in 2017) attributable to modifiable risk factors, more prominently in wealthier countries. Conclusions Almost half of stroke-related deaths are attributable to poor management of modifiable risk factors, and thus potentially preventable. We should appreciate societal barriers in lower-SES groups to design tailored preventive strategies. Despite improvements in general health knowledge, access to healthcare, and preventative strategies, SES is still strongly associated with modifiable risk factors and stroke burden; thus, screening of people from low SES at higher stroke risk is crucial.

In this study the rheological and textural properties of Iranian white cheese produced by ultrafiltration technique containing gum tragacanth and xanthan each in the range of 0-0.1%, and basil seed and linseed mucilage each in the range of 0-0.2% were evaluated. According to the results obtained, values of Elastic (G/) and viscous (G//) moduli increased with increasing frequency sweep in all the cheese samples. G/ was always greater than G//. The values of G/ and G// in the sample containing 0.05% of gum tragacanth, 0.05% of xanthan gum and 0.1% of basil seed mucilage and the sample containing 0.05% of xanthan gum, 0.1% basil seed and 0.1% linseed mucilage were maximum. Also, in samples containing 0.1% of xanthan gum and 0.2% of linseed mucilage and containing 0.1% of gum tragacanth were minimum. With increasing basil seeds mucilage in the samples, hardness, cohesiveness, gumminess and chewiness increased in comparison with the control sample (p < 0.01). According to the results obtained, for preparation of white cheese produced by ultrafiltration technique, application of 0.05% of gum tragacanth, 0.05 % of xanthan gum and 0.1 % of linseed mucilage, is recommended.

Background: Heat shock protein 27 (HSP27) is an intracellular chaperone constitutively expressed in many cell types including cardio myocytes and endothelial cells. Circulating levels of HSP27 and anti-HSP27 antibody are higher in patients with CVD. Anti-HSP27 antibody concentrations were also reported to be increased in atherogenesis. We aimed to evaluate serum anti-HSP27 antibody titers in individuals with, or without, MetS in the MASHAD study cohort with large sample size in 6,568 subjects.

For the food sector, onion rejects are an appealing source of value-added byproducts. Bioactive compounds were recovered from yellow onion rejects using a pulse electric field process at 6000 v and 60 pulses. The onion extract was encapsulated with whey protein isolate (WPI), pectin (P), and sodium caseinate (SC) with a mass ratio of 1:5 (extract/wall material, w/w). A Simplex lattice with augmented axial points in the mixture design was applied for the optimization of wall material for the encapsulation of onion reject extract by freeze-drying (FD). The optimal wall materials were 47.6 g/100 g (SC), 10.0 g/100 g (P), and 42.4 g/100 g (WPI), with encapsulation yield (EY) of 85.1%, total phenolic content (TPC) of 48.7 mg gallic acid equivalent/g DW, total flavonoid content (TFC) of 92.0 mg quercetin equivalent/g DW, and DPPH capacity of 76.1%, respectively. The morphological properties of the optimal encapsulate demonstrated spherical particles with a rough surface. At optimal conditions, the minimum inhibitory concentration (MIC) of the extract (mean diameter of inhibition zone: 18.8 mm) was shown as antifungal activity against Aspergillus niger.

This prospective cohort study aimed to investigate the impact of maternal oral inflammation on human milk composition including neutrophil counts, activation state (based on cluster of differentiation (CD) markers expression), and fatty acid levels. Fifty mothers were recruited from St. Michael’s hospital, Toronto, and followed up from 2–4 weeks until 4 months postpartum. Oral rinse and human milk samples were collected at both timepoints. Oral polymorphonuclear neutrophils (oPMNs) within the rinses were quantified using flow cytometry and the participants’ oral health state was categorized into three groups (i.e., healthy, moderate, and severe) based on the oPMNs counts. Fatty acids were identified and quantified using a gas chromatography-flame ionization detector (GC-FID). Compared to mothers with a healthy oral health state, mothers with moderate to severe oral inflammation had a statistically significant decrease in the expression of CD64 biomarker, an increase in the expression of CD14 biomarker on human milk neutrophils and a decrease in the levels of eicosapentaenoic acid (C20:5n-3) in their human milk at follow-up compared to baseline. This study demonstrates for the first time that maternal oral inflammation can affect human milk composition. The mechanism by which these alterations can affect infant health outcomes in the long term critically needs to be considered.

This study investigated the effect of lactic-acid-bacteria fermentation on the microstructure and gastrointestinal digestibility of soy proteins using a digestomics approach. Fermented soy protein isolates (FSPIs) under varied fermentation-terminal pH demonstrated a colloidal solution (FSPI-7.0/6.0) or yogurt-like curd (FSPI-5.0/4.0) state. Cryo-electron microscopy figures demonstrated the loosely stacked layer of FSPI-7.0/6.0 samples, whereas a denser gel network was observed for FSPI-5.0/4.0 samples. Molecular interactions shifted from dominant ionic bonds to hydrophobic forces and disulfide bonds. The gastric/intestinal digestion demonstrated that the curd samples afforded a significantly low particle size and high-soluble protein and peptide contents in the medium and late digestive phases. A peptidomics study showed that the FSPI-6.0 digestate at early intestinal digestion had a high peptidome abundance, whereas FSPI curd digestates (FSPI-5.0/4.0) elicited a postponed but more extensive promotion during medium and late digestion. Glycinin G2/G4 and β-conglycinin α/α’ subunits were the major subunits promoted by FSPI-curds. The spatial structures of glycinin G2 and β-conglycinin α subunits demonstrated variations located in seven regions. Glycinin G2 region 6 (A349–K356) and β-conglycinin α subunit region 7 (E556–E575), which were located at the interior of the 3D structure, were the key regions contributing to discrepancies at the late stage.

This study was aimed at optimizing the astaxanthin extraction efficiency from shrimp shell (green tiger, Penaeus semisulcatus). Astaxanthin was extracted using selected nonpolar/polar solvents (petroleum ether, n-hexane, ethanol, acetone) individually and in ternary mixtures of petroleum ether, acetone, and water in ratios of 15:50:35, 50:45:5, and 15:75:10 for different times (2,4 and 6 h). The results showed that solvents with higher polarity were more suitable for the extraction of astaxanthin, and increasing the extraction time from 2 to 6 h improved the extraction yield. The conditions of extraction of astaxanthin with the desirable solvent were then optimized with the ultrasonic method using the Box-Behnken design [variables included: extraction temperature (25 to 45 °C), extraction time (5 to 15 min), and ultrasound amplitude (20 to 100%)]. Optimal extraction conditions were determined as the ultrasonic amplitude of 23.6%, extraction time of 13.9 min, and extraction temperature of 26.3 °C. Under this optimum condition, the amount of astaxanthin, ferric reducing antioxidant power, and free radical scavenging capacity of the extract were obtained as 51.5%, 1705 μmol of Fe2+/g, and 73.9%, respectively. Extraction and analysis of the extract at the optimum point were used to validate the results.

In this study, the effects of flaxseed-mucilage (2, 4, and 6%), Stevia (0, 50, and 100%), and ultrasound (5, 10, and 15 min at a constant frequency of 20 kHz) on physico-chemical properties, antioxidant activity, color, and sensory evaluation of formulated flaxseed-mucilage cocoa milk (FCM) product were evaluated using a response surface methodology. Results demonstrated that increasing the flaxseed-mucilage content reduced (p

Background: The upgoing thumb sign has been frequently observed in patients with minor strokes and transient ischemic attacks as an indicator of brain involvement. We assessed the effect of primary motor cortex (M1) inhibition in the development of the upgoing thumb sign. Methods: Used repetitive Transcranial Magnetic Stimulation (rTMS, 1Hz frequency for 15min, 1s ISI, 900 pulses) at 60% of resting motor threshold to inhibit the right or left primary motor cortex of 10 healthy individuals. Participants were examined before and after rTMS by a neurologist who was blind to the site of motor cortex inhibition. Results: 10 neurological intact participants (5 women/5 men) were recruited for this study. 2 cases were excluded due to pre-existing possible thumb signs. After the inhibition of the primary motor cortex, in 6 subjects out of 8, we observed a thumb sign contralateral to the site of primary motor cortex inhibition. In one subject an ipsilateral thumbs sign was noted. In another case, we did not find an upgoing thumb sign. Conclusion: The upgoing thumb sign is a subtle neurological finding that may be related to the primary motor cortex or corticospinal pathways involvements. Keywords: Corticospinal tract, Upper motor neuron lesions, Primary motor cortex, Transcranial magnetic stimulation

Stroke is the leading cause of death and disability in the world after the cancer and cardiovascular diseases. Genetic factors have main significance to got stroke. Renin-angiotensin system contains candidate genes and polymorphisms for causing stroke. There are reported associations between stroke and angiotensin II type-1 receptor g. 1166A > C polymorphism (rs5186). Therefore in this study this association was investigated for the east Iranian population. This study is based on 201 stroke patients and 220 controls. To predict the genetic risk of stroke allele and genotype frequencies of angiotensin II type-1 receptor rs5186 were analyzed in this population according to stroke subtypes, gender, age, hypertension, diabetes mellitus, high and low density lipoprotein and triglycerides. According to statistical analysis no significant difference was found between case and control groups. But there were a significant relevance between total cholesterol and stroke (p = 0.037). In this population angiotensin II type-1 receptor g. 1166A > C polymorphism did not increase the risk of stroke. The main reason for this study is complex nature of gene-environment interactions in the pathophysiology of this disease.

Background and PurposeSickle cell disease (SCD) is strongly linked to stroke across all haplotypes in the pediatric population. Transcranial Doppler (TCD) ultrasound is known to identify the highest risk group in African-Americans who need to receive and stay on blood transfusions, but it is unclear if the same flow velocity cut-offs can be applied to the Iranian population. We aimed to evaluate baseline TCD findings in Iranian children with SCD and no prior strokes.MethodsChildren with genetically confirmed SCD (Arabian haplotype, homozygote) and without SCD (controls) were prospectively recruited from pediatric outpatient clinic over a period of 9 months. We performed TCD in both groups to determine flow velocities in the middle cerebral (MCA) and terminal internal carotid arteries (TICA).ResultsOf 74 screened children, 60 met the inclusion/exclusion criteria (62% female; mean age 10±4 years). Baseline characteristics did not differ between the cases and controls, except hemoglobin (Hb) which was significantly lower in the SCD group (P

Background: Carotid ultrasound appears to be useful in the assessment of cardiovascular risk. In this study, we have assessed the carotid intima-media thickness (CIMT) in a group of individuals without a history of cardiovascular events. Methods: A sample of 431subjects (189 [43.9%] males and 242 [56.1%] females) was obtained from an urban population using a stratified-cluster method in Mashhad stroke and heart atherosclerosis disorder study. None of the subjects had a history of the cardiovascular event. Carotid artery duplex ultrasound was used to determine the CIMT in all subjects, and to identify those with an abnormal value (CIMT [+]; i.e., CIMT ≥ 0.8 mm). Dietary intake of participants was assessed using a questionnaire for 24-h dietary recall. The relationship between anthropometric, biochemical and dietary data and CIMT were assessed. Results: The mean age of subjects was 48.7 ± 8.0 years. Of the 431 patients, 118 (27.4%) were found to be CIMT (+). Of the cardiovascular parameters assessed, only age (odds ratio [OR] [95% confidence interval (CI)], 1.11 [0.56-4.34]; P < 0.01) and male gender (OR [95% CI], 1.14 [0.63-2.23]; P < 0.05) were significant independent predictors of ultrasound defined CIMT. Crude and total energy adjusted intake were not associated with the presence of CIMT (+). Conclusions: It appears that within a relatively young Iranian population of individuals without a history of cardiovascular event, the presence of CIMT (+) defined by duplex ultrasound cut-off value of ≥0.8 mm, did not associate with several modifiable cardiovascular risk factors or measures of dietary intake.

Background: Stroke, one of the most important causes of morbidity and mortality in the world, is of great importance in young adults (15-45 years), amongst whom the causes of stroke and transient ischemic attack (TIA) are different from those in older ages and a significant portion of them have no known etiology. Patent foramen ovale (PFO) is considered a probable cause in this group.Methods: Patients between 15 and 45 years of age with TIA or stroke were examined and evaluated for causes of cerebrovascular accidents. Patients with no definite cause for stroke or TIA, except for PFO, despite our extensive evaluations were categorized as cryptogenic. The controls were comprised of those between 15 and 45 years old who underwent transesophageal echocardiography (TEE) for reasons other than stroke. The frequency of PFO and its characteristics were compared between the two groups.Results: The case group comprised 48 patients with cryptogenic stroke (n=31) and TIA (n=17), and the control group consisted of 57 patients. The age distribution of the groups was normal, and there was no significant difference between the age and gender of the two groups. The frequency of PFO in the case and control groups was 52% and 25%, respectively (p value=0.003, odds ratio=3.33, confidence interval=1.46-7.63). The exaggerated motion of the interatrial septum (IAS) in the case and control groups was 18.8% and 0%, respectively. Right-to-left shunt at rest in the case and control groups was 78% and 28%, respectively (significant differences). The differences in terms of PFO size, number of bubbles, and atrial septal aneurysm were not significant between the two groups.Conclusion: PFO had a relation with stroke and TIA in the young adults, and right-to-left shunt at rest and exaggerated motion of the IAS could increase the possibility of paradoxical emboli. It seems that the presence of atrial septal aneurysm, number of bubbles, and PFO size did not increase the risk of cerebrovascular accidents.

Naghmeh Mokhber1, Carol J Lane2, Mohamad R Azarpazhooh3, Elham Salari4, Reza Fayazi5, Mohamad T Shakeri6, Allan H Young71Assistant Professor of Psychiatry, 3Assistant Professor of Neurology, 4Mashhad Department of Forensic Psychiatry, 5Assistant Professor of Psychiatry, 6Assistant Professor of Statistics, Mashhad University of Medical Science, Mashhad, Iran; 2Department of Psychiatry, University of British Columbia, Vancouver, Canada7Abstract: The treatment of dysphoric mania is challenging given the need to treat symptoms of both depression and mania simultaneously without provoking any clinical exacerbation. The newer antiepileptic drugs such as gabapentin, lamotrogine, and carbamazepine are often used as adjuncts to either lithium or valproic acid in the treatment of bipolar disorder. We decided to undertake a monotherapy trial because previous evidence suggested mixed states may be more responsive to anticonvulsants than more traditional antimanic agents. 51 patients with a DSM IV diagnosis of dysphoric mania were randomized to three groups comprising gapbapentin, lamotrogine or carbamazepine and followed for 8 weeks. Psychiatric diagnosis was verified by the structural clinical interview for the DSM-IV (SCID). The MMPI-2 in full was used to assess symptoms at baseline and 8 weeks. All three groups showed significant changes in MMPI-2 scores for depression and mania subscales. Gabapentin showed the greatest change in depression symptom improvement relative to lamotrogine and carbamazepine, respectively. Although manic symptoms improved overall, there were no differences between groups in the degree of manic symptom improvement.Keywords: dysphoric mania, manic-depression, depression, anticonvulsant, mood stabilizer

Background: Stroke, one of the most important causes of morbidity and mortality in the world, is of great importance in young adults (15-45 years), amongst whom the causes of stroke and transient ischemic attack (TIA) are different from those in older ages and a significant portion of them have no known etiology. Patent foramen ovale (PFO) is considered a probable cause in this group. Methods: Patients between 15 and 45 years of age with TIA or stroke were examined and evaluated for causes of cerebrovascular accidents. Patients with no definite cause for stroke or TIA, except for PFO, despite our extensive evaluations were categorized as cryptogenic. The controls were comprised of those between 15 and 45 years old who underwent transesophageal echocardiography (TEE) for reasons other than stroke. The frequency of PFO and its characteristics were compared between the two groups. Results: The case group comprised 48 patients with cryptogenic stroke (n=31) and TIA (n=17), and the control group consisted of 57 patients. The age distribution of the groups was normal, and there was no significant difference between the age and gender of the two groups. The frequency of PFO in the case and control groups was 52% and 25%, respectively (p value=0.003, odds ratio=3.33, confidence interval=1.46-7.63). The exaggerated motion of the interatrial septum (IAS) in the case and control groups was 18.8% and 0%, respectively. Right-to-left shunt at rest in the case and control groups was 78% and 28%, respectively (significant differences). The differences in terms of PFO size, number of bubbles, and atrial septal aneurysm were not significant between the two groups. Conclusion: PFO had a relation with stroke and TIA in the young adults, and right-to-left shunt at rest and exaggerated motion of the IAS could increase the possibility of paradoxical emboli. It seems that the presence of atrial septal aneurysm, number of bubbles, and PFO size did not increase the risk of cerebrovascular accidents.

The aim of the present study was to evaluate the efficiency of sulfur dioxide release sheets on the basis of acetate cellulose film to control the growth of molds, especially botrytis cinerea, during the storage period of kiwifruit. For this purpose, the storage of kiwifruit inoculated with botrytis cinerea in the presence of one and dual sulfur dioxide releasing sheets (containing 30 and 50% metabisulfit salts, respectively) on the acetate cellulose bed was investigated. After 15 days of storage (9 days in cold store and 7 days in ambient temperature), the least bursting and crushing (4.5%) was obtained in the presence of single-stage sheets that were placed on the surface and bottom of the packages. Also, in the ninth day, mold was not observed in the 60% of packages in the presence of sulfur dioxide releasing sheets. On the 15th day, the amount of total sugar, acidity, firmness, residual sulfur, and soluble solids in packaged kiwis in the presence of two dual releasing sheets placed on the surface and bottom of packages were, respectively, 9.9 g/100 g, 1.09%, 4.75 N, 0.24 mg/g and 12.21%. In general, it can be said that sulfur dioxide releasing sheets have an effective function on cold storage in increasing the shelf life of fruits, especially fruits that are attacked by gray mold.

Carotid total plaque area (TPA) is an important contributing measurement to the evaluation of stroke risk. Deep learning provides an efficient method for ultrasound carotid plaque segmentation and TPA quantification. However, high performance of deep learning requires datasets with many labeled images for training, which is very labor-intensive. Thus, we propose an image reconstruction-based self-supervised learning algorithm (IR-SSL) for carotid plaque segmentation when few labeled images are available. IR-SSL consists of pre-trained and downstream segmentation tasks. The pre-trained task learns region-wise representations with local consistency by reconstructing plaque images from randomly partitioned and disordered images. The pre-trained model is then transferred to the segmentation network as the initial parameters in the downstream task. IR-SSL was implemented with two networks, UNet++ and U-Net, and evaluated on two independent datasets of 510 carotid ultrasound images from 144 subjects at SPARC (London, Canada) and 638 images from 479 subjects at Zhongnan hospital (Wuhan, China). Compared to the baseline networks, IR-SSL improved the segmentation performance when trained on few labeled images (n = 10, 30, 50 and 100 subjects). For 44 SPARC subjects, IR-SSL yielded Dice-similarity-coefficients (DSC) of 80.14–88.84%, and algorithm TPAs were strongly correlated (r=0.962−0.993, p < 0.001) with manual results. The models trained on the SPARC images but applied to the Zhongnan dataset without retraining achieved DSCs of 80.61–88.18% and strong correlation with manual segmentation (r=0.852−0.978, p < 0.001). These results suggest that IR-SSL could improve deep learning when trained on small labeled datasets, making it useful for monitoring carotid plaque progression/regression in clinical use and trials.

Abstract Background Identifying the risk factors leading to hypertension can help explain why some populations are at a greater risk for developing hypertension than others. The present study seeks to identify the association between the risk factors of hypertension in 35- to 65-year-old participants in western Iran. Methods This cross-sectional study was conducted on 9705 adults from baseline data of Ravansar Non-Communicable Disease (RaNCD) cohort study, in the west region of Iran. Each of the latent variables were confirmed by confirmatory factor analysis. Using Structural Equation Modeling (SEM), we assessed the direct and indirect effects of factors associated with blood pressure. Results Socioeconomic status (SES), physical activity, mean of serum lipids, obesity, diabetes and family history of hypertension had a diverse impact on the blood pressure, directly and (or) indirectly. The standardized total effect of SES, physical activity, mean of serum lipids, and obesity were -0.09 vs. -0.14, -0.04 vs. -0.04, 0.13 vs. 0.13 and 0.24 vs. 0.15 in men and women, respectively. Diabetes had a direct relationship with the blood pressure in women (0.03). Conclusion With regard to control of high blood pressure, public health interventions must target obesity, lifestyle and other risk related to nutritional status such as hyperlipidemia and hyperglycemia in Iranian population and among those with higher SES.

ABSTRACT: Introduction: This paper assesses the nature of the general dentist–specialist relationship, as perceived by general dentists in Canada. Methods: A cross-sectional web-based survey was administered to general dentists across Canada who are part of the Canadian Dental Association register and who have consented to receiving email surveys (N ≈ 11,300). Information including sociodemographic and practitioner- and practice-related factors was collected using a 47-item questionnaire. The general dentist–specialist relationship was conceptualised on the basis of 4 factors: communication, confidence, competition, and referrals. Descriptive analysis was conducted. Results: The response rate for the survey was 11.7% (n = 1328). Most general dentists specified that specialists sent timely information/reports (93%), were partners in delivering care (64%), presented little competitive pressure (87%), and were strongly collegial (85%). Conclusions: In general, the study demonstrated that Canadian general dentists held a positive perception of their relationship with the specialists.

The goal of this research was to find the best way to use shrimp shell as a source of astaxanthin and as an agricultural waste in shrimp processing site. For this purpose, first shrimp shell extract was extracted with the assisting ultrasonic . Then it was encapsulated using different walls (modified starch and maltodextrin with hydrolysis degree of 7 and 20) and spray drying method. Wall composition design was performed using response surface method and simplex lattice design with augmented axial points in mixture design (14 wall compositions). Evaluation of physicochemical properties of microcapsules (moisture content, microencapsulating efficiency, astaxanthin content and antioxidant power) showed that the use of a mixture of maltodextrin and modified starch walls up to the center point of the triangular design (33.33%) improved the physicochemical properties compared to using of walls alone. Optimization of different wall concentrations for microencapsulation of shrimp shell extract containing astaxanthin using numerical and graphical optimization showed that the optimal wall composition containing 18.40% of maltodextrin with a hydrolysis degree7, 41.78% of modified starch and 39.81% of maltodextrin with a hydrolysis degree 20. Also, the stability of astaxanthin in microcapsules during 42 days of storage in different conditions of temperature (4 and 25ͦ C) and humidity (52 and 75%) showed that the amount of astaxanthin decreased linear in all samples (linear coefficient more than 98%), but the amount of final astaxanthin in different samples was significantly different from each other (p

Background Coronary heart disease (CHD) is the leading cause of morbidity and mortality globally, and specifically in Iran. Accurate assessments of Coronary heart disease (CHD) incidence is very necessary for public health. In current study we aimed to investigate the incidence of CHD and importance of several classical, modifiable and un-modifiable risk factors for CHD among an urban population in eastern Iran after 6 years of follow-up. Methods The population of MASHAD cohort study were followed up for 6 years, every 3 years in two step by phone and who reported symptoms of CVD were asked to attend for a cardiac examination, to estimate the incidence of CHD with 95% confidence interval (95% CI) as well multiple logistic regression analysis was performed to assess the association of several baseline characteristics with incidence of CHD event. Evaluation of goodness-of-fit was done using ROC analysis. CHD cases divided into four different classes which include: stable angina, unstable angina pectoris, myocardial infarction and sudden cardiac death. Results In the six years' follow-up of Mashhad study, the incidence rate of all CHD event in men and women in 100,000 people-years with 95% confidence intervals were 1920 (810-3030) and 1160 (730-1590), respectively. The areas under ROC curve (AUC), based on multivariate predictors of CHD outcome, was 0.7825. Conclusion Our findings indicated that the incidence rate of coronary heart diseases in MASHAD cohort study increases with age as well as our final model designed, was able to predict approximately 78% of CHD events in Iranian population.

Background Recent advances in endovascular therapy (EVT) have led to significant improvements in functional outcomes of patients with stroke. However, early neurological deterioration after EVT has remained a concerning issue. This cohort study was designed to assess the feasibility of early transcranial Doppler (TCD) after EVT and to identify associations between TCD findings and early neurological deterioration. Methods Between October 16, 2020, and March 28, 2021, we recruited 20 patients with acute ischemic stroke with large‐vessel occlusion who underwent EVT. Five patients were excluded because of a poor temporal window; 2 had an unsuccessful intervention. Using TCD, we measured peak systolic velocity, end‐diastolic velocity, mean flow velocity, and pulsatility index for all selected arteries before and within 60 minutes after EVT. We also examined the association between active leptomeningeal collateral flow after EVT and early neurological deterioration. Patients were followed for 3 months, and disability was measured using the modified Rankin scale. Results Two patients had early neurological deterioration with elevated blood pressure and active leptomeningeal flow despite successful EVT. Most patients with poststroke disability (modified Rankin scale>2) had either flow diversion or active leptomeningeal collateral flow in the presence of elevated blood pressure (≥170/93 mm Hg). In cases without early neurological deterioration and in those with a modified Rankin scale

Introduction Delirium is one of the most prevalent complications in intensive care unit (ICU) patients, which is related to worse clinical outcomes including a longer ICU stay, longer duration of mechanical ventilation, higher mortality rates and increased risk of cognitive impairment. Observational studies have suggested that statins might have a positive effect on delirium status of hospitalized patients. To date, there has been no trial assessing the effect of atorvastatin on delirium status in critically ill patients. Thus, the aim of the current study was to determine the efficacy of atorvastatin on delirium status of patients in the ICU. Material and methods In this randomized, double-blind and controlled trial, a total of 90 patients in the general ICU who had delirium for at least 2 days were randomly divided into atorvastatin (40 mg/day) (n = 40) and control (n = 50) groups. Delirium status of the patients was determined twice a day at 10:00 a.m. and 18:00 p.m. using the Richmond Agitation-Sedation Scale (RASS). Results Administration 40 mg/day of atorvastatin significantly reduced the mean RASS score and increased delirium-free days at both morning and afternoon time points compared to the control group (p < 0.05). Conclusions Administration of atorvastatin had a significant positive effect on delirium status in patients admitted to the ICU.

Introduction: Carotid plaque burden is a strong predictor of stroke risk, and preventing stroke reduces the risk of dementia. Treating carotid plaque burden markedly reduces the risk of stroke. Methods: Among patients age 65–80 years attending a stroke prevention clinic, we identified those with a carotid plaque burden in the top 20% of Total Plaque Area (High TPA) and the bottom 20% (Low TPA) and performed cognitive tests: The Montreal Cognitive Assessment test (MoCA), the WAIS-III Digit Symbol-Coding Test (DSST) and Trail-Making Test (TMT) part A and B. Results: There were 31 patients recruited; 11 Low TPA (5 men) and 20 High TPA (17 men), p = 0.04. TPA was 35 ± 25 mm2 in the Low TPA vs.392 ± 169 mm2 in the High TPA group (0.0001). Patients with a high plaque burden had significantly worse performance on all the cognitive tests, all p< 0.05 Discussion: A high carotid plaque burden identifies patients at risk of cognitive impairment. Because carotid plaque burden is treatable, and treating it markedly reduces the risk of stroke, we suggest that measurement of plaque burden is a useful tool for both prediction of cognitive impairment, and prevention of dementia.

BACKGROUND: Interleukin-18 (IL-18) is a pro-inflammatory and pro-atherogenic factor, and its blood level has shown a direct correlation with atherosclerosis. We aimed to evaluate the serum IL-18 level in patients with systemic lupus erythematosus (SLE) and its relationship with the intima-media thickness (IMT) of the carotid artery in these patients, as an indicator of atherosclerosis.METHODS: In this cross-sectional study, 60 patients as the patient group and 30 healthy volunteers as the control group [matched sex, age, and body mass index (BMI)] were selected, and their disease status and general data were gathered using the Systemic Lupus Erythematosus Disease Activity Index 2000 (SLEDAI-2K) form. A blood sample was also obtained from all participants to determine the serum level of IL-18 and other metrics, including high-sensitivity C-reactive protein (hs-CRP), cholesterol, triglyceride (TG), low-density lipoprotein (LDL), high-density lipoprotein (HDL), anti-double stranded deoxyribonucleic acid (anti-dsDNA), complement 3 (C3), and C4. The IMT of the carotid artery was calculated in both groups. We also evaluated the clinical cardiovascular manifestations.RESULTS: The serum IL-18 levels in patients were significantly higher than in the control group (P ˂ 0.005). It had no significant correlation with disease activity (P = 0.10). The patients with SLE with high IL-18 serum levels (> 280 pg/ml) had higher SLEDAI-2K (P = 0.02) than the patients with a low level (< 280), where 280 was the median of the IL-18 levels. The serum IL-18 level had no significant correlation with the carotid artery IMT.CONCLUSION: A high level of IL-18 reflects the disease activity, but it was not significantly correlated with subclinical atherosclerosis, denoted by the carotid artery IMT.

Saffron, as the most expensive agricultural and pharmaceutical product of the world, has a special value among plants. Since the Saffron harvesting period is short, its storage for later processing requires understanding the most effective factors affecting the quality of saffron and its deterioration. Therefore the effects of reposition thickness, storage temperature and storage time of saffron flowers on its chemical parameters including crocin, safranal and picrocrocin values of saffron stigma and its microbial quality indicators including total count, coliform and mold contamination were modelled. This was done using multi-layer perceptron artificial neural network (ANN) and its structure and the learning parameters were optimized using genetic algorithm technique. The optimized MLP neural networkwas capable to predict the saffron quality characteristics during storage with coefficient of determinations higher than %94 and low error values (RMSE lower than 3.5 for all responses). The ANN model showed that reposition thickness has the lowest impact on chemical and microbial parameters deterioration while increasing storage temperature and time drastically increased loss of quality although the effect of storage time is lower than that of storage temperature. Overall, keeping fresh saffron flowers at a low temperature near zero degrees centigrade is necessary for maximum retention of valuable chemical compounds and minimum microbial contamination development during saffron flower storage for further processing.

Background: Behçet’s disease (BD) is a multisystemic inflammatory vasculitis of unknown etiology, and vasculitis being its major pathological feature. Objectives: We studied the prevalence of microembolic signals (MES) in patients with diagnosis Behçet's disease. We also tried to determine the frequency of MES in BD patients with or without neurological involvement. Materials and Methods: This study enrolled 40 patients who fulfilled the diagnostic criteria of International Study Group for BD during 2012 to 2013. Bilateral transcranialDoppler ultrasound of the middle cerebral arteries was performed by multigate method. MES were identified based on the criteria of International Consensus group on Microembolus Detection. Results: We found MES in none of our patients with BD. We measured intima-media thickness in all patients. Conclusion: It seems that in our population core histopathologic phenomenon to be other than MES andvasculiticphenomenonmay be implicated as a pathophysiologic factor for central nervous system involvement.The clarification of this subject needs further investigations on Iranian BD patients.

مقدمه: شمال شرقی ایران، به‌ویژه شهر مشهد، از نواحی اندمیک ویروس لنفوتروپیك سلول‌های T انسانی نوع 1 (HTLV-I یا Human T-cell lymphotropic virus type 1) می‌باشد؛ اما در مورد شیوع نوع 2 ویروس (HTLV-II) در این منطقه، اطلاعات كافی موجود نیست. این مطالعه‌ی مقطعی با هدف تعیین شیوع عفونت HTLV-II در جمعیت عمومی مشهد صورت گرفت. روش‌ها: 1678 نفر از جمعیت عمومی شهر مشهد با روش نمونه‌گیری خوشه‌ای چندمرحله‌ای انتخاب شدند. نمونه‌ی خون افراد برای شناسایی آنتی‌بادی‌های ضد HTLV با روش Enzyme-linked immunosorbent assay (ELISA) بررسی شد و سپس به منظور تأیید آلودگی با HTLV-II، ژن TAX و ناحیه‌ی Long terminal repeat (LTR) ویروس با استفاده از پرایمرهای اختصاصی با روش Nested polymerase chain reaction (Nested PCR) بررسی شد. یافته‌ها: از 1678 نفر، امكان گرفتن نمونه‌ی سرم در 1654 مورد فراهم گردید كه تعداد 56 مورد (4/3 درصد) از نظر آنتی‌بادی‌های ضد HTLV با روش ELISA مثبت بودند. در تمامی موارد مثبت، آزمایش Nested PCR برای پروویروس HTLV-II انجام شد که هیچ یك از نمونه‌ها از نظر عفونت با نوع 2 ویروس، مثبت نبود. نتیجه‌گیری: یافته‌های این مطالعه نشان دهنده‌ی عدم وجود عفونت HTLV-II در جمعیت عمومی مشهد می‌باشد. با این وجود، پیشنهاد می‌گردد، شیوع این ویروس در گروه‌های پرخطر، به ویژه معتادین تزریقی، این منطقه بررسی گردد.

The underlying mechanisms leading to the development of human T-cell lymphotropic virus type I (HTLV-I) associated myelopathy/tropical spastic paraparesis (HAM/TSP) in HTLV-I infected individuals are not fully understood. Host genetic factors appear to be involved as risk factors for developing HAM/TSP. We investigated the possible contribution of interleukin-10 (IL-10) as a risk factor to HAM/TSP by comparing frequencies of promoter region single nucleotide polymorphisms in HTLV-I infected Iranian patients who either remained asymptomatic or developed HAM/TSP and asymptomatic HTLV-I carriers. Healthy, uninfected individuals from the same region served as healthy controls. Significant differences were observed in the distribution of IL-10 promoter alleles and genotypes at position -819 and -592 between HAM/TSP patients and healthy controls (P=0.01), and between HTLV-I carriers and healthy controls (P=0.02). The frequency of the low IL-10 producer haplotype (-1082*A, -819*T, -592*A) was significantly associated with HTLV-I carriage or HAM/TSP compared with healthy controls (P= 0.02 and 0.01, respectively). Our results suggest that IL-10 -819*T and -592*A alleles are significant risk factors for developing HTLLV-I infection but do not appear to convey additional risk for developing HAM/TSP

Background: Amyotrophic lateral sclerosis (ALS) is a progressive neurological disorder with high mortality and morbidity. Some risk factors have been implicated for ALS such as exposure to high magnetic fields, and trace elements like selenium, cadmium and lead. Afew studies have been carried out throughout the world to evaluate the prevalence of ALS among veterans. This study was aimed to evaluate ALS frequency among Iran – Iraq war veterans. Methods: Medical records of 52580 veterans were studied and those with suspected neuromuscular disorders were referred to a blind neurologist. ALS was verified according to World Federation of Neurology criteria. Student t-test and chi-square test were used for analysis and a P value less than 0.01 was considered significant. Results: Eleven definite ALS and two possible ALS cases were identified among the subjects. The mean age of onset of the disease was 43.7±9.7 years. All subjects had a record of at least three months involvement in action and symptoms began to show up after 16.5±3.6 years. The mean interval between exhibition of symptoms and the definitive diagnosis of the disease was 16.5 months.Conclusion: The prevalence of ALS in our population was significantly greater than that of international surveys (P

Background:Mustard gas, lethal in high doses, affects multiple organs such as skin, eye and respiratory system. We studied the development of late onset mustardinduced polyneuropathy among chemically wounded Iranian veterans.Methods:In this descriptive study,100 chemically wounded Iranian veterans with severe eye involvement were examined for any signs and symptoms of polyneuropathy by an internist.20 patients were suspected to have neurological symptoms or signs.These patients were examined by a neurologist again. 13 showed abnormal neurological symptoms. Electrodiagnostic exams were performed for this group by another physician.Results:13 veterans had abnormal neurological exam results with prominent sensory signs and symptoms in almost all of them. Brisk deep tendon reflexes were found in 3 cases. Electrodiagnostic studies were compatible with axonal type distal sensory polyneuropathy in 6 subjects. Conclusion: To the best of our knowledge, this is the first report of late onset polyneuropathy among chemically-wounded victims who were exposed to mustard gas. The pathophysiology of this form of neuropathy is still unknown. Unlike most toxic neuropathies,obvious clinical signs and symptoms appeared several years after exposure. No specific treatment for.polyneuropathy due to chemical weapons exposure has been described to date.