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Abstract In this investigation, we explored the kinetics of Cr(VI) reduction to Cr(III) on carbon nanotube decorated with palladium (Pd-CNTs) nanocatalyst, using formic acid as the reducing agent. This study has been bone utilizing kinetic Monte Carlo simulation and experimental design methods. The mechanism and kinetic parameters of this reaction are provided. The effect various factors such as reaction time, pH level, dichromate (Cr2O7 2−) concentration, and formic acid concentration on Cr(VI) reduction was studied. Concentrations of HCOOH and Cr2O7 2− were identified as the crucial variables, while the HCOOH concentration has the most significant impact. Positive influences on Cr(VI) reduction were observed with increasing pH level and HCOOH concentration. Reaction time positively affects on Cr(VI) reduction efficiency. However, the concentration of Cr2O7 2− showed an increasing effect up to a threshold, negatively impacting the efficiency. The optimal conditions (Reaction time = 60 min, pH = 4.5, [Cr2O7 2−] = 5.05 × 10−3 M, and [HCOOH] = 0.95 M) for Cr(VI) reduction. At optimal conditions, the Cr(VI) reduction efficiency was obtained to be 100%.

Abstract Background Teledentistry is applied in oral medicine to help dental practitioners and specialists manage complex oral conditions. This scoping review aims to synthesize the available evidence regarding the technical requirements and the provision of security services, as well as the recommendations on standard oral cavity photography methods for using teledentistry in oral medicine. Method The present scoping review was conducted in 2022 according to the Joanna Briggs Institute (JBI) manual. Four databases were systematically searched, including ISI Web of Science, PubMed, Scopus, and ProQuest, from January 1999 to December 2021. After finalizing the search strategy, all the original articles, reviews, editorials, letters, comments, and book chapters were included. All the dissertations uploaded in English with a full-text electronic file were also included to achieve a comprehensive picture of the available literature. Two types of analysis were applied: the quantitative descriptive analysis applying Excel 2016 and the qualitative thematic analysis using MAXQDA version 10. Results The included papers were published during 1999–2021. Most of the included articles were from Brazil (n = 9, 21.43%), India (n = 6, 14.28%), the USA (n = 6, 14.28%), and the UK (n = 5, 11.90%). Social media usage as a teledentistry platform increased considerably between 2019 and 2021. Teledentistry platforms have been classified into four categories, including email, telephone, social network applications (WhatsApp, zoom, Google Meeting, Instagram, line Application, Viber, and Messenger), and teledentistry systems (teledentistry systems, which were designed specially to perform a teledentistry project). Teledentistry has been conducted to store and forward (n = 15, 30.71%), real-time (n = 9, 21.43%), or both (n = 12, 35.71%). According to the thematic results, basic technical requirements have been categorized into four, including teledentistry platform, type of interactions, internet connection, and photography tool. Other thematic results demonstrate seven categories of recommendations, including general factors, light, patient position, phone position, setting of a mobile phone camera, photo sending requirements, and photo visualization. Conclusion According to the results, over the past 7 years, especially during the COVID-19 pandemic, social network applications such as WhatsApp and Zoom have been used more frequently. Also, photography recommendations with a mobile phone camera depend on several factors such as general factors, light, patient position, phone position, setting of the mobile phone camera, and photo-sending requirements. Given the increased use of mobile cameras for oral photography, these recommendations can help improve the quality of images and subsequently improve the reliability of clinical decision-making in managing patients' conditions.

BackgroundIntrapartum continuity of care to reduce maternal morbidity and mortality relies heavily on a functional and effective referral system between tiers of care. Capacity building of providers in managing intrapartum referrals is expected to improve the efficiency of the referral system, but this does not always work in practice. This study explored the experiences and perceptions of maternity healthcare providers on emergency intrapartum referrals in Dar es Salaam, Tanzania.MethodsAn exploratory qualitative study was conducted at Amana Regional Referral Hospital and Muhimbili National Hospital in Dar es Salaam. Maternity healthcare providers were purposively recruited based on cadre, working experience of more than three years in the maternity wards. An in-depth interview guide which involved questions and probes was used to conduct eleven interviews. Data was thematically analyzed.ResultsThree major themes emerged, namely: 1) causes of referrals are beyond medical indications; 2) limited maternity healthcare provider capability at referring facilities; and 3) limited communication between referring and receiving facilities. According to maternity healthcare professionals, referrals were seen as a way to minimize blame and a clinical management tool to prevent difficulties. They advocated for more understanding of the skill set among maternity healthcare providers, but some had negative perceptions towards performing their responsibilities.ConclusionsSkills gaps among maternity healthcare providers at referring hospitals influenced referral decision-making and service provision. There was hostility between referring and receiving hospitals. Capacity-strengthening strategies such as ongoing skills training and changes in attitudes toward referrals require improvements. The referring hospital should only consider referrals as a last resort after other case management has been completed.

Introduction Systemic lupus erythematosus (SLE) is a multisystem disorder that can affect multiple organs; psychiatric manifestations including depression and anxiety are commonly seen in SLE. The aim of this study is to explore the prevalence of depression, anxiety, and stress, and assess the quality of life (QOL) in patients with SLE and also evaluate associated risk factors. Material and methods In this cross-sectional study, adult patients with SLE were identified through our institution’s SLE data registry. Participants were evaluated with three questionnaires: Depression, Anxiety, and Stress Scale (DASS-42), General Health Ouestionnaire-28 (GHQ-28), and World Health Organization quality of life instrument short form (WHO-QOL BREF). Results A total of 222 patients were included in the study, 203 (91%) of whom were female and 19 were male (9%). Participants had a mean age of 35.6 ±9.5 years. According to DASS-42 questionnaire, 22.1%, 28.7% and 20.3% of patients had varying degrees of depression, anxiety, and stress, respectively. Based on GHQ-28 questionnaire, 137 (62%) of patients reported some degree of distress. Quality of life score was 12.8, 13, 14.3, and 13.9 in physical health, psychological health, social relationships, and environmental health, respectively. Conclusions We found that depression, anxiety, and stress are common in patients with SLE, and quality of life is significantly affected. A high percentage of patients with SLE deal with some degree of distress. Routine evaluation of the quality of life and psychological disturbances is recommended in patients with SLE. Non-pharmacological interventions as well as specialist referral should be considered in patients with anxiety, depression, or stress.

BACKGROUND: There is a higher prevalence of oral health problems among people with rheumatoid arthritis (RA) than the general population. Receiving and continuing dental treatment is challenging for this patient group for many reasons. Therefore, the purpose of this study was to identify the most common oral concerns and the barriers and facilitators of access to dental health care through a qualitative evaluation. METHODS: In this study, an interpretative/hermeneutic approach was used. Through purposive sampling, 50 RA patients (38 women and 12 men) who referred to 3 rheumatology centers in Yazd, Iran, between May and July 2021 were recruited. Sampling was continued until data saturation was reached. To determine the main oral concerns of patients, unstructured interviews and an audio recorder were used for face-to-face interviews. RESULTS: The information extracted from the questionnaires and recorded information were classified into 4 main themes: 1) physical limitations of RA patients in chewing, swallowing, or following oral hygiene instructions; 2) pain and discomfort that RA patients reported in their mouth and teeth; 3) social and psychological limitations; and 4) barriers and facilitators of dental treatments. CONCLUSION: Due to differences in the level of awareness and unique systemic conditions of each interviewee, they had different oral health-related concerns. It seems that a comprehensive approach is necessary to adapt oral health services to the needs of this population. We hope that our findings can help determine the priorities of oral and dental care in these patients and simplify their access to dental services.

Statement of the Problem: For many years, practitioners have been encountered with dental rehabilitation of atrophic jaws. Among many of alternatives, free iliac graft can be a reasonable and also problematic choice to be accomplished. Purpose: The aim of this study was to evaluate the implant survival rate and bone loss in implants inserted in reconstructed jaws with free iliac graft.Materials and Method: In this clinical trial study, twelve patients that underwent bone reconstruction with free iliac graft were included in this retrospective study. The patients underwent surgery over a 6-year period from September 2011 to July 2017. Panoramic images were taken immediately after implant insertion and at the follow-up session. The parameters that were assessed included implant survival rate, bone level changes, and surrounding tissue conditions.Results: One hundred and nine implants were placed in eight female and four male patients, of which 65 (59.6%) were inserted in the reconstructed maxilla and 44 (40.3%) in the reconstructed mandible. The interval between the reconstruction surgery and follow-up session was 28.75 months and the mean interval between implant insertion and the follow-up session was 21.75 months, ranging from 6 to 72 months. The total average of crestal bone resorption was 2.44 mm (range: 0 to 5.43 mm).Conclusion: This study found that rehabilitation of atrophic jaws with dental implants placed in free iliac graft was associated with acceptable marginal bone loss, survival rate, satisfaction, and esthetic results among the patients.

Objectives According to the World Health Organization, depression is a common mental health illness that is characterised by a persistent feeling of sadness and loss of interest. The present study examined the association of two mental health variables (ie, depression, anxiety) with quality of life (QoL) and the sociodemographic characteristics of Afghan women living in urban areas under the rule of Taliban government in Afghanistan.Design Cross-sectional study administered between 10 November 2021 to 25 December 2021 among women.Setting Across major provinces of Afghanistan (Herat, Mazar-e-Sharif, Kabul and Samangan).Measurements Data were collected using a pretested structured questionnaire. Data entry was carried out using Microsoft Excel 2016. And then exported to IBM SPSS V.26 for Microsoft Windows. Logistic regression models were used to examine the association of depression, anxiety with QoL and sociodemographic characteristics among women (N=438).Results The prevalence of depression symptoms was 80.4%, and the prevalence of mild to extremely severe anxiety was 81.0%. Depression symptoms among Afghan women were associated with being older, having more children, lower education level, other individuals’ bad behaviour, bad events experienced in the past month, and feeling physically ill. Multiple regression analysis indicated that low monthly household income (adjusted OR, AOR 2.260; 95% CI 1.179 to 4.331, p=0.014) poor physical domain of QoL (AOR 4.436; 95% CI 1.748 to 11.256, p=0.002) and poor psychological domain of QoL (AOR 23.499; 95% CI 7.737 to 71.369, p

Background and Aim: Nosocomial infection is an infection that a patient develops 48 hours after hospitalization or up to 72 hours after discharge. The infection should not exist at the time of admission, and should not be in the latent stage. Nosocomial infections can lead to economic, social, and physiological problems for the patients and hospital staff. Since nurse aids and service staff have important roles in controlling nosocomial infections, this study aimed to develop and validate a questionnaire to assess their knowledge, attitude, and performance in regard to nosocomial infections. Materials and Methods: This descriptive-analytical study was performed in 2019. Questionnaire items were extracted by searching SID, Magiran, PubMed, Scopus, and Science Direct databases using Google Scholar search engine. The questionnaire validity was assessed using the opinion of 10 nosocomial infection control specialists. In order to assess the reliability and face validity, the questionnaire was given to 135 nurse aids and service staff working in Tehran hospitals. Data were analyzed using SPSS18 software and LISREL8.8. Results: The content validity index and content validity ratio for knowledge, attitude, and performance sections of the questionnaire were between 0.8 and 1. The face validity of the questionnaire items ranged from 1.6 to 5. In the knowledge section of the questionnaire, Kuder- Richardson reliability coefficient was 0.7 and Cronbach's alpha for attitude and performance sections were 0.76 and 0.71, respectively. The Pearson correlation coefficient for knowledge, attitude, and performance were 0.86, 0.89, and 0.93, respectively. Three-factor confirmatory analysis showed the questionnaire had a good fit The mean scores of employees’ knowledge, attitude, and performance in regard to nosocomial infections were 0.44±0.19 (intermediate), 0.71±0.18 (positive) and 0.63±0.16 (intermediate), respectively Conclusion: The questionnaire had good validity and reliability for assessment of nurse aids’ and service staffs’ knowledge, attitude and performance in relation to nosocomial infections. The levels of performance and knowledge of the nurse aids and service staff working at Tehran hospitals about nosocomial infections control were moderate and their attitude was neutral.

Blood donor age has become a major concern due to the age-associated variations in the content and concentration of circulating extracellular nano-sized vesicles (EVs), including exosomes. These EVs mirror the state of their parental cells and transfer it to the recipient cells via biological messengers such as microRNAs (miRNAs, miRs). Since the behavior of hematopoietic stem cells (HSCs) is potentially affected by the miRs of plasma-derived EVs, a better understanding of the content of EVs is important for the safety and efficacy perspectives in blood transfusion medicine. Herein, we investigated whether the plasma-derived EVs of young (18–25 years) and elderly human donors (45–60 years) can deliver “youth” or “aging” signals into human umbilical cord blood (hUCB)-derived HSCs in vitro. The results showed that EVs altered the growth functionality and differentiation of HSCs depending on the age of the donor from which they are derived. EVs of young donors could ameliorate the proliferation and self-renewal potential of HSCs whereas those of aged donors induced senescence-associated differentiation in the target cells, particularly toward the myeloid lineage. These findings were confirmed by flow cytometric analysis of surface markers and microarray profiling of genes related to stemness (e.g., SOX-1, Nanog) and differentiation (e.g., PU-1). The results displayed an up-regulation of miR-29 and miR-96 and a down-regulation of miR-146 in EVs derived from elderly donors. The higher expression of miR-29 and miR-96 contributed to the diminished expression of CDK-6 and CDKN1A (p21), promoting senescence fate via cell growth suppression, while the lower expression of miR-146 positively regulates TRAF-6 expression to accelerate biological aging. Our findings reveal that plasma-derived EVs from young donors can reverse the aging-associated changes in HSCs, while vice versa, the EVs from elderly donors rather promote the senescence process.

Abstract Background Emergency medical centers are globally one of the most important pillars of pre-hospital care. The most important purpose of this system is to provide satisfactory services in the shortest possible time and in accordance with the modern scientific standards of the world. The present study aimed to compare the effect of virtual and face-to-face training methods on the quality of service provided by Kermanshah pre-hospital emergency personnel, Iran. Methods This was a randomized educational intervention trial performed among the staff of Kermanshah Emergency Medical Center. Individuals were randomly divided into two training groups of virtual and face-to-face. Participants in the face-to-face group received slides, lectures, and practical work with moulage for 6 h a day. Subjects were taught the four skills of intubation, laryngeal mask airway (LMA), cardiopulmonary resuscitation (CPR) and attenuated electrical device (AED). Participants in the virtual group received the same content in the form of a training video on CD with a full explanation of the project's objectives. Pre- and post-test scores of participants were compared within and between the groups by Stata 14.0 software. Results Eighty-seven individuals were participated in the study, 43 of whom were assigned to the face-to-face training group and 44 to the virtual training group. There was no significant difference between the two groups in terms of work experience and educational level (P > 0.05). Post-training scores in both groups were significantly higher than pre-training in the four skills (P ≤ 0.005). After adjusting for educational level and work experience, however, the quality of CPR, intubation, and AED was higher in the face-to-face training group than in the virtual group. However, the increase in the mean score of LMA in the virtual training was not significantly different than that of the face-to-face training group. Conclusion The results of our study showed the same efficacy of both face-to-face and virtual methods in improving the performance of personnel in tracheal intubation, LMA, CPR and AED shock skills. E-learning methods can be used as a complement to face-to-face methods in education.

Background and Aim: The prevalence of gallstones in patients with diabetes mellitus is higher than non-diabetic patients. The pathophysiological mechanism of gallstone formation in type 2 diabetic patients is still unclear. Therefore, the aim of this case-control study was the evaluation of gallbladder motor function as one of the contributing factors to gallbladder dysfunction in type 2 diabetic patients by gallbladder ultrasound. Materials and Methods: In this study, case group included 54 patients with diabetes mellitus and control group consisted of 51 age, sex, and BMI-matched healthy subjects. Ultrasound was performed for all subjects in two groups, one in fasting and the other after eating light meals. Gallbladder volume was measured in the fasting state (V1) and post meal (V2), and the resulting ejection fraction of the gallbladder was calculated. Also, in these subjects, demographic variables such as age, sex, BMI and number of births were analyzed. Results: Sex ratio age, number of births and BMI was the same in both case and control groups (P> 0.05). In independent t-test analysis, there was no significant relationship between mean V1, V2 and EF in the case and control groups (P> 0.05). Also, there was no significant difference between sex and mean V1, V2 and EF in both groups (P> 0.05). The prevalence of gallstones in the diabetic group was significantly higher than the control group (P = 0.026). Conclusion: The results of the present study confirmed the high prevalence of gallstones in diabetic patients but there were no statistical deference between groups for gallbladder motor function. However, probably other factors are involved in the formation of gallstones in diabetic individuals.

Background and aims: A high-fat diet increases triglyceride (TG) accumulations in hepatocytes and results in non-alcoholic fatty liver diseases (NAFLDs). In this regard, this study investigated the effect of high-intensity interval training (HIIT), along with a high-fat diet on the serum levels of aminotransferases in male Wistar rats. Methods: Forty male Wistar rats were randomly assigned to the standard diet, high-fat diet, exercise + standard diet, and exercise + high-fat diet groups (each containing 10 animals). HIIT program consisted of 6-12 repetitions of 2-minute highs-intensity exercise (85-90% of the maximum speed) interspersed with 1-minute low-intensity exercise (45-50% peak speed) with the frequency of 5 sessions a week over 12 weeks. High-fat diet groups received a diet regimen including 58% fat, 25% protein, and 17% carbohydrate, ad libitum. The blood samples were taken from the left ventricle 48 hours following the last intervention to assess TG, alanine aminotransferase (ALT), and aspartate amino-transferase (AST) concentrations. Data were analyzed using one-way ANOVA and Tukey’s post-hoc tests. Results: The findings showed the mean of ALT, AST, and TG in the high-fat diet group was significantly greater compared to the standard diet group (P=0.001). Furthermore, the mean of ALT, AST, and TG in the exercise + high-fat diet group was significantly lower in comparison with the high-fat diet group (P=0.01, P=0.017, and P=0.012, respectively). Conclusion: Although HIIT ameliorated high-fat diet-induced elevations in the serum levels of TG, ALT, and AST, they did not reach the baseline levels. Thus, it may indicate that a diet as the underlying cause of NAFLDs is more important than any other interventions such as exercise.

Abstract Background Medical training programs candidate’s interview is an integral part of the residency matching process. During the coronavirus disease 2019 (COVID-19) pandemic, conducting these interviews was challenging due to infection prevention restrains (social distancing, namely) and travel restrictions. E-interviews were implemented by the Saudi Commission for Healthcare Specialties (SCFHS) since the matching cycle of March 2020 to hold the interviews in a safer virtual environment while maintaining the same matching quality and standards. Aim This study was conducted to assess the medical training residency program applicants’ satisfaction, stress, and other perspectives for the (SCFHS) March 2020 Matching-cycle conducted through an urgently implemented E-interviews process. Method A cross-sectional, nationwide survey (Additional file 1) was sent to 4153 residency-nominated applicants to the (SCFHS) March 2020 cycle. Results Among the 510 candidates who responded, 62.2% applied for medical specialties, 20.2% applied for surgical specialties, and 17.6% applied for critical care and emergency specialties. Most respondents (61.2%) never had previous experience with web-based video conferences. Most respondents (80.2%) used the Zoom application to conduct the current E-interviews, whereas only 15.9% used the FaceTime application. 63.3% of the respondents preferred E-interviews over in-person interviews, and 60.6% rated their experience as very good or excellent. 75.7% of the respondents agreed that all their residency program queries were adequately addressed during the E-interviews. At the same time, 52.2% of them agreed that E-interviews allowed them to represent themselves accurately. 28.2% felt no stress at all with their E-interviews experience, while 41.2% felt little stressed and only 8.2% felt highly stressed. The factors that were independently and inversely associated with applicants’ level of stress with E-interviews experience were their ability to represent themselves during the interviews (p = 0.001), cost-savings (p

Abstract Gestational stress can increase postpartum depression in women. To treat maternal depression, fluoxetine (FLX) is most commonly prescribed. While FLX may be effective for the mother, at high doses it may have adverse effects on the fetus. As environmental enrichment (EE) can reduce maternal stress effects, we hypothesized that a subthreshold dose of FLX increases the impact of EE to reduce anxiety and depression-like behavior in postpartum dams exposed to gestational stress. We evaluated this hypothesis in mice and to assess underlying mechanisms we additionally measured hypothalamic–pituitary–adrenal (HPA) axis function and brain levels of the hormone oxytocin, which are thought to be implicated in postpartum depression. Gestational stress increased anxiety- and depression-like behavior in postpartum dams. This was accompanied by an increase in HPA axis function and a decrease in whole-brain oxytocin levels in dams. A combination of FLX and EE remediated the behavioral, HPA axis and oxytocin changes induced by gestational stress. Central administration of an oxytocin receptor antagonist prevented the remediating effect of FLX + EE, indicating that brain oxytocin contributes to the effect of FLX + EE. These findings suggest that oxytocin is causally involved in FLX + EE mediated remediation of postpartum stress-related behaviors, and HPA axis function in postpartum dams.

Introduction: Drug and psychotropic use have undesirable and devastating effects on the human body and soul that lead to an increase in family and social insecurity. Due to the difficulty of treatment, addiction prevention is always emphasized in the studies. Therefore, the present study aimed to determine the effect of educational intervention based on the theory of planning behavior on the prevention of psychotropic abuse among female high school students in Ilam, Iran, during 2018. Materials & Methods: This randomized controlled trial was conducted on 120 students who were randomly assigned to intervention and control groups in the academic year of 2018-19. The data were collected through a researcher-made questionnaire based on the theory of planned behavior, which was used after the confirmation of validity and reliability at pretest and posttest. The educational content was designed based on the theory of planned behavior, and the outcome of the preliminary data was analyzed and administered in five sessions of intervention. The posttest was performed one month after the training, and the data were analyzed using SPSS software (version 22) through the Shapiro-Wilk test, independent t-test, and paired t-test. Ethics code: IR.IAU.SRB.REC.1397.022 Findings: The results of covariance analysis and paired t-test showed the significance of the educational intervention in raising the awareness about the behavior of students in Ilam regarding the prevention of psychotropic abuse at an error level of less than 1%. Moreover, the educational intervention was effective in promoting abstract norms and the behavioral intention of students in Ilam, Iran, regarding the prevention of psychotropic abuse at an error level of less than 1%. Discussions & Conclusions: Educational intervention based on the theory of planned behavior has effects on the prevention of psychoactive substance abuse in the intervention group. Therefore, it is recommended that education officials and other relevant institutions make use of educational techniques based on the behavior change patterns, life skills training, and student empowerment in order to prevent addiction.

Background and Objective: Behavioral disorders among children and adolescents are common and incapacitating which cause many problems for the families and the patient themselves and associated with high prevalence of negative social consequences. This study was done to evaluate the prevalence of psychiatric disorders among children and adolescents in Gorgon, north of Iran (2019). Methods: This descriptive-analytical study was performed on 1025 children and adolescents aged 6-18 years in Gorgan, north of Iran (2019). Subjects were selected by Multistage Cluster Sampling. Digital version of K-SADS test was studied for 24 types of child and adolescent psychiatric disorders. Sampling was done by trained psychologists, among general population and by referring to the house of people. Psychiatric disorders included mood disorders, behavioral disorders, neurodevelopmental disorders, substance abuse disorders, and elimination disorders. Results: The prevalence of psychiatric disorders among children and adolescents was 13.2%. This prevalence was 14.3 % and 12.1% in males and females, respectively. According to age groups, The prevalence of psychiatric disorders was common in 6 to 9 years olds with 17.8% which in comparison with other age groups was significant (P

Background: The coronavirus disease 2019 (COVID-19) pandemic has a significant negative impact on clinical trials. Therefore, maintaining an optimal trial conduct should be considered to minimize risks to trial integrity while ensuring the safety of trial staff and participants. In this study, we aimed to describe the impact of the COVID-19 pandemic on conducting an ongoing clinical trial, along with challenges and solutions encountered and required to continue the trial. Methods: This Phase IV pragmatic randomized superiority controlled open-label trial included children with epilepsy receiving Vitamin D supplementation at King Saud University Medical City, Riyadh, Saudi Arabia (clinicaltrials.gov registration number: NCT03536845). Children with epilepsy receiving chronic antiepileptic medications and with normal baseline 25-hydroxyvitamin D level were randomized to receive cholecalciferol 400 IU/day versus 1000 IU/day for 6 months. The primary outcome was the percentage of children with Vitamin D insufficiency at 6 months. The secondary outcomes included seizure control, bone mineral density, and safety. Results: Under COVID-19 public health emergency measures, exceptional methods were used, such as telemedicine, home visit for blood extractions, shipping of the study medication to the patient's home, using reminder text messages to follow patients' compliance, and using privacy-compliant platforms to connect the research team members. Conclusion: During the widespread pandemic, ethical dilemmas are of major concern, especially when conducting trials on vulnerable age groups. Therefore, actions should be proportionate and based on benefit-risk considerations, affecting the risk of bias from protocol deviation and overall results.

Background: Recurrent pregnancy loss (RPL) is defined as the loss of two or more pregnancies. Several treatment options are available, including progesterone, which is one of the few treatments that improve live birth rates in RPL patients. Objective: To compare the live birth rates, medical and obstetric characteristics, and RPL evaluation results of women with and without progesterone treatment. These women attended the RPL clinic at Soroka University Medical Center. Methods: A retrospective cohort study based on 866 patients was conducted. The patients were divided into two groups and examined: the dydrogesterone treatment group consisting of 509 women and a group of 357 patients who did not receive the treatment. All the patients had a subsequent (index) pregnancy. Results: The two groups were not statistically different in terms of their demographic and clinical characteristics or evaluation results. In a univariate analysis, no statistically significant differences were found between the groups in terms of live birth rates (80.6% vs. 84%; p-value = 0.209). In a multivariate logistic analysis adjusted for maternal age, the ratio of pregnancy losses to the number of pregnancies, other administered treatments, antiphospholipid syndrome, and body mass index, dydrogesterone treatment was found to be independently associated with a higher rate of live births than the control group (adjusted OR = 1.592; CI 95% 1.051–2.413; p-value = 0.028). Conclusions: Progesterone treatment is associated with an increased live birth rate in RPL patients. Studies with larger sample sizes are recommended to strengthen these results.

The sentiment analysis of social media for predicting behavior during a pandemic is seminal in nature. As an applied contribution, we present sentiment-based regression models for predicting the United States COVID-19 first dose, second dose, and booster daily inoculations from 1 June 2021 to 31 March 2022. The models merge independent variables representing fear of the virus and vaccine hesitancy. Large correlations exceeding 77% and 84% for the first-dose and booster-dose models inspire confidence in the merger of the independent variables. Death count as a traditional measure of fear is a lagging indicator of inoculations, while Twitter-positive and -negative tweets are strong predictors of inoculations. Thus, the use of sentiment analysis for predicting inoculations is strongly supported with administrative events being catalysts for tweets. Non-inclusion in the second-dose regression model of data occurring before the 1 June 2021 timeframe appear to limit the second-dose model results—only achieving a moderate correlation exceeding 53%. Limiting tweet collection to geolocated tweets does not encompass the entire US Twitter population. Nonetheless, results from Kaiser Family Foundation (KFF) surveys appear to generally support the regression factors common to the first-dose and booster-dose regression models and their results.

Pregnancy loss can be defined as a loss before either 20 or 24 weeks of gestation (based on the first day of the last menstrual period) or the loss of an embryo or fetus less than 400 g in weight if the gestation age is unknown. Approximately 23 million pregnancy losses occur worldwide every year, equating to 15–20% of all clinically recognized pregnancies. A pregnancy loss is usually associated with physical consequences, such as early pregnancy bleeding ranging in severity from spotting to hemorrhage. However, it can also be associated with profound psychological distress, which can be felt by both partners and may include feelings of denial, shock, anxiety, depression, post-traumatic stress disorder, and suicide. Progesterone plays a key part in the maintenance of a pregnancy, and progesterone supplementation has been assessed as a preventative measure in patients at increased risk of experiencing a pregnancy loss. The primary objective of this piece is to assess the evidence for various progestogen formulations in the treatment of threatened and recurrent pregnancy loss, postulating that an optimal treatment plan would preferably include a validated psychological support tool as an adjunct to appropriate pharmacological treatment.

Intranasal vaccine administration can overcome the disadvantages of injectable vaccines and present greater efficiency for mass immunization. However, the development of intranasal vaccines is challenged by poor mucosal immunogenicity of antigens and the limited availability of mucosal adjuvants. Here, we examined a number of self-adjuvanting liposomal systems for intranasal delivery of lipopeptide vaccine against group A Streptococcus (GAS). Among them, two liposome formulations bearing lipidated cell-penetrating peptide KALA and a new lipidated chitosan derivative (oleoyl-quaternized chitosan, OTMC) stimulated high systemic antibody titers in outbred mice. The antibodies were fully functional and were able to kill GAS bacteria. Importantly, OTMC was far more effective at stimulating antibody production than the classical immune-stimulating trimethyl chitosan formulation. In a simple physical mixture, OTMC also enhanced the immune responses of the tested vaccine, without the need for a liposome delivery system. The adjuvanting capacity of OTMC was further confirmed by its ability to stimulate cytokine production by dendritic cells. Thus, we discovered a new immune stimulant with promising properties for mucosal vaccine development.

Background: Obesity is a risk factor for several diseases including metabolic and cardiovascular diseases and is underlying cause of liver diseases. Researches indicate that life style modification via changes in physical activity levels and healthy diet can be beneficial for liver function. The aim of this study was to investigate the effects of aerobic training and garlic supplementation on serum levels of ALT and AST. Methods: In a clinical trial, forty obese men (BMI>30 kg/m2) were randomly assigned into four groups (10 per each) including 1- Exercise+Sepplement (ES) 2- Supplement (S) 3- Exercise+Placebo (EP) and 4- Placebo (P). The subjects received garlic capsule two times per day (each capsule contained 500 mg garlic powder) or placebo (starch) over a period of eight weeks. The subjects in exercise groups performed a supervised progressive aerobic training (3 times a week, %50-%70 HRmax, 20-40 mins) at the same time. Before and after the experimental period body composition analysis was performed and blood samples were taken in a fasting state. Data were analyzed using paired t-test, One-Way ANOVA and Tukey’s post hoc tests at the significance level of P

IIntroduction Improving physical performance and delaying fatigue by using nutritional supplements always has been interesting in athletes. The aim of this study was to evaluate the effect of six weeks’ watermelon juice on nitric oxide and exercise performance in elite female taekwondo. Materials and Methods Twenty-five elite female taekwondo players (age 21.84±2.26 yrs; BMI 20.87±1.37 Kg/m2; VO2max 38.86±1.97 ml/min/kg) who had a training experience of more than five years were randomly and voluntary divided into two groups of watermelon juice supplement (n=15) and placebo (n=10). Subjects received 500 ml of watermelon juice or placebo 45 minutes before the taekwondo training sessions for six weeks. Blood samples were taken in the brachial vein in two steps; before and after 6 weeks of supplementation. Data were analyzed using dependent and independent t-test (p≤0.05). Results The results of this study showed levels of nitric oxide (P=0.016) and VO2max (P=0/001) significantly greater compared to the placebo group. Also, there was a significant decrease in muscle soreness 24 and 48 hours after exercise in the supplement group compared to the placebo group (p≤0.05). Conclusion According to the results, watermelon juice will help faster recovery and reduce muscle soreness after 24 and 48 hours follow exercise.

BACKGROUND AND OBJECTIVE: Nicotine is one of the most common addictive substances that has many effects on the central nervous system, including dose-dependent anxiety that is mediated by various proteins. Since the mechanisms and proteins involved in nicotine anxiety are unclear, the purpose of the present study was to investigate the role of p-CREB (cAMP Response Element-Binding Protein) and c-Fos proteins in the basolateral amygdala (BLA) on nicotine-induced anxiety behaviours. METHODS: In this experimental study, 24 male Wistar rats were divided into three groups of 7 (saline, nicotine 0.3 and 0.7 mg/kg, intraperitoneally) in behavioral experiment and four groups of 3 (control: no injection and test, Saline, nicotine 0.3 and 0.7 mg/kg) in immunohistochemical experiments. Anxiety-like behaviours were evaluated with % OAT (Open Arm Time), %OAE (Open Arm Entry), and locomotor activity in the elevated plus maze. The expression of p-CREB and c-Fos proteins in BLA region was also assessed by immunohistochemistry. FINDINGS: Intraperitoneal administration of nicotine at a dose of 0.7mg/kg decreased %OAT (5.4±0.42) and %OAE (29.4±0.61) compared to saline group (15.2±0.82) and (42.1±0.45), indicating an anxiety-like effect (respectively, p

ABSTRACT Background and Objective: It is desirable for athletes, especially female soccer players, to consume beetroot beverage during training as a way of improving both health and performance ,. Therefore, the objective of this study was to assess the effect of beetroot juice intake on lipid profile in female soccer players. Methods: Young and well-trained female soccer players (N=20) were included in a randomized placebo-controlled crossover study. They were categorized into two groups: experimental (beetroot beverage, n=10, age: 23.20±0.91 years, BMI: 22.57±1.54(kg/m2)) and control (placebo, n=10, age: 23±0.81 years, BMI: 23.13±0.58(kg/m2)). Subjects drank either 200 ml concentrated beetroot beverage or an equal amount of placebo 2 hours prior to their trainings for six weeks (18 session). Blood samples were taken 24 hours before and after trials. All data were compared in pretest and posttest via paired sample t-test and independent sample t-test. All statistical analyses were performed at (P≤0.05) by SPSS (version22). Results: Beetroot juice intake increased plasma high density lipoprotein (t= -60.88, P

Objectives: The objective of the study wasto describe the effect of nusinersen therapy and its 1st-year associated outcomes, weaning of ventilator support, and length of stay in pediatric intensive care among ventilator-dependent spinal muscular atrophy (SMA) patients. Methods: This is a multicenter, retrospective case series study that was conducted in four tertiary care centers in Saudi Arabia. We report all the genetically diagnosed SMA ventilator-dependent patients who were admitted to the pediatric intensive care unit (PICU) and received a course of nusinersen therapy from (January 2017 to March 2018). The study endpoints were success to wean or extubate the patient and discharge from the PICU. Results: Five patients from four tertiary PICUs were included in this report. All five patients received a minimum of four doses of nusinersen intrathecally as per the manufacturer. At 12 months postinitiation of therapy, only one patient showed clinical improvement, while the other four patients did not experience improvement in their respiratory status following the administration of nusinersen. These four patients are still admitted in the PICU due to the inability to wean them from respiratory support. The remaining patient was discharged to home successfully and neither require any home ventilatory support nor oxygen therapy. Conclusion: In conclusion, our clinical experience and data suggest that the response to nusinersen therapy is very likely but mostly dependent on the time of initiation of nusinersen therapy and the cumulative number of doses among other variables related to disease severity. However, further studies targeting a larger group of patients with better standardized respiratory care are needed to investigate the effect of nusinersen on particularly the long-term outcomes.

Gluten sensitivity contributes to various degrees of neurological manifestations and neurodegenerative immunological changes. We investigated the experimental features of anti-gliadin immune responses in the central nervous system (CNS) of mice. Female C57BL6 mice were divided into three groups. Mice immunized with complete Freund's adjuvant (CFA) or gliadin emulsified in CFA, and the control group received phosphate-buffered saline (PBS). Immunohistochemistry, hematoxylin-eosin, and Luxol fast blue staining were performed on the sections. The serum levels of interleukin (IL)-17 and interferon-gamma (IFN-γ) were measured using enzyme-linked immunosorbent assay (ELISA). Reverse transcriptase-polymerase chain reaction (RT-PCR) was used to assess the mRNA levels of chemokine (C-X-C motif) ligand-2 (CXCL-2), C-C motif chemokine ligand-2 (CCL-2), and CXCL-10. In gliadin+CFA immunized mice, the microscopic lesions included perivascular edema, focal-microgliosis, and acute neuronal necrosis in the cortex, subcortical, Purkinje cell layer, and ventral horn of the spinal cord. While extravasation of anti-IgG antibodies and selective targeting of Purkinje cells were observed in gliadin+CFA immunized mice. A significant increase in serum IL-17 and IFN-g levels (p

Objective(s): Hydatidosis is a zoonotic infection and endemic in Iran. Due to the serological cross-reactivity (of sera) with other parasitic infection, diagnosis of hydatid cyst is considered to be problematic. In this regard, application of recombinant antigens improves serological diagnosis for human hydatidosis. Here, we present an ELISA test based on B8/2 recombinant antigen of Echinococcus granulosus with particular regard to its capability to diagnose human hydatidosis. Materials and Methods: The synthesized E. granulosus B8/2 (EgB8/2) gene was sub-cloned into pET28b (+) plasmid. Nde1 and Hind3 restriction enzymes were used to confirm the recombinant plasmid extraction. Cloning was verified by colony PCR, digestion enzymes, and sequence determination methods. To express rtEgB8/2, strains of Escherichia coli BL21 (DE3) pLysS and Rosetta (DE3) were induced with isopropyl β-D-1-thiogalactopyranoside (IPTG). A Ni-NTA column was used for purification, and the expressed protein was analyzed by SDS-PAGE as well as western blotting. ELISA test was used to identify the antigenicity of produced protein.Results: The presence of EgB8/2 gene fragment in the recombinant plasmid was confirmed. SDS-PAGE showed that the BL21 (DE3) pLysS strain had the highest level of expression and a protein band of 11 kDa was observed in induced bacteria. Western blotting approved the purity of rtEgB8/2 protein, and ELISA test measured sensitivity and specificity as 95% and 97.5%, respectively.Conclusion: E. granulosus metacestode contains a high amount of antigen B protein. These results confirm the reproducibility of high-quality rtEgB8/2 recombinant antigen as a reliable candidate in serological test.

Background & Aim: Tracheal suctioning is one of the ways to clean and open the airway in infants admitted to the neonatal intensive care unit that can be with many negative consequences such as pain, decrease in arterial oxygen saturation, pneumonia, heart rhythm disorder, change In the rhythm and number of respiration and sepsis. Materials & Methods: This is a descriptive correlational study with IR.UMSHA.REC.1395.424 ethical code, was performed on 120 preterm infants in neonatal intensive care unit of Besat and Fatemieh Hospitals of Hamedan. Firstly, before suctioning the patient, the heart rate index of the newborn that needed to be suctioned was registered by the researcher in three shifts based on the findings of the direct monitoring of the infant. The heart rate index was re-recorded during suction. Data were analyzed using descriptive and regression tests. Results: Infants with a catheter of 6 to 9 french were suctioned at 80 to 85 suction pressure. In 26% of cases, the suctioning standards for the duration of suction, standard pressure and proper size of the catheter were not observed. There was a significant difference between the change in heart rate index and pain score (P=0.001). Conclusion: Failure to observe suction standards in premature infants can lead to changes in heart rate index and increase their basic needs, which can impair the recovery process of preterm infants.

During the COVID-19 pandemic, conducting face-to-face medical residency interviews was challenging due to infection prevention precautions, social distancing, and travel restrictions. Virtual interviews were implemented by the Saudi Commission for Health Specialties (SCFHS) as an alternative process for residency matching while striving to maintain the same quality standards. This national survey was conducted to assess the satisfaction and perceptions of faculty members’ virtual interview performance in the assessment for the medical training residency programs. Among the participating 173 faculty members, 34.1% did not have previous experience with video-conferencing. The Zoom application was the most commonly used platform (65.9%). Most (89.6%) of the faculty perceived virtual interviews as “adequate” platforms on which the candidates could express themselves, while almost half of the faculty (53.8%) agreed that virtual interviews allowed them to accurately reach an impression about the candidates. Overall, 73.4% of faculty felt comfortable ranking the virtually interviewed candidates. We conclude that the acceptance of participating faculty members in the first Saudi medical residency training matching cycle virtual interviewing event was well-perceived. This study provides evidence for future application and research of virtual interviews in residency candidates’ assessment, especially after the pandemic crisis resolves.

Biscogniauxia rosacearum, recognized for the first time as a pathogen involved in grapevine trunk diseases in Paveh (west of Iran) vineyards, produced meso-2,3-butanediol (1) as the only phytotoxin. Nectriapyrone (2), (3R)-5-methylmellein (3), (3R)-5-methyl-6-methoxymellein (4), and tyrosol (5) were instead produced as phytotoxins from a strain of the same fungus isolated from oak trees in Zagros forests of Gilan-e Gharb, Kermanshah Province. They were identified comparing their 1H and 13C NMR, ESIMS, and specific optical rotation data with those already reported in the literature. The phytotoxicity of metabolites (1–5) was estimated by leaf puncture assay on Quercus ilex L. and Hedera helix L., and by leaf absorption assay on grapevine (Vitis vinifera L.) at a concentration of 5 × 10−3 and 10−3 M. Tested on grapevine, meso-2,3-butanediol (1) and (3R)-5-methyl-6-methoxymellein (4) resulted to be the most phytotoxic compounds. On Q. ilex, nectriapyrone (2) and tyrosol (5) showed severe necrosis at the highest concentration while none of the compounds (1–5) was active on H. helix. Furthermore, the phytotoxicity of compounds 3 and 4 was also compared with that of some related natural melleins to perform a structure-activity relationship (SAR) study. The results of this study were also discussed.

BACKGROUND AND AIM: Oral squamous cell carcinoma (OSCC) is a rapidly progressive disease and despite the progress in the treatment of cancer, remains a life-threatening illness with a poor prognosis. Diagnostic techniques of the oral cavity are not painful, non-invasive, simple and inexpensive methods. Clinical decision support systems (CDSSs) are the most important diagnostic technologies used to help health professionals to analyze patients’ data and make decisions. This paper, by studying CDSS applications in the process of providing care for the cancer patients, has looked into the CDSS potentials in OSCC diagnosis. METHODS: We retrieved relevant articles indexed in MEDLINE/PubMed database using high-quality keywords. First the title and then the abstract of the related articles were reviewed in the step of screening. Only research articles which had designed clinical decision support system in different stages of providing care for the cancer patient were retained in this study according to the input criteria. RESULTS: Various studies have been conducted about the important roles of CDSS in health processes related to different types of cancer. According to the aim of studies, we categorized them into several groups including treatment, diagnosis, risk assessment, screening, and survival estimation. CONCLUSION: Successful experiences in the field of CDSS applications in different types of cancer have indicated that machine learning methods have a high potential to manage the data and diagnostic improvement in OSCC intelligently and accurately.

Background: The educational process in different medical schools has been negatively affected by the COVID-19 pandemic worldwide. As a part of the Saudi government’s attempts to contain the spread of the virus, schools’ and universities’ educational activities and face-to-face lectures have been modified to virtual classrooms. The purpose of this study was to explore the perceptions of the faculty and the students of an electronic objective structured clinical examination (E-OSCE) activity that took place during the COVID-19 pandemic in the oldest medical school in Saudi Arabia. Methods: An e-OSCE style examination was designed for the final-year medical students by the pediatrics department, College of Medicine at King Saud University in Riyadh, Saudi Arabia. The examination was administered by Zoom™ video conferencing where both students and faculty participated through their laptop or desktop computers. In order to explore the students’ and the faculty’s perceptions about this experience, a newly designed 13-item online questionnaire was administered at the end of the e-OSCE. Results: Out of 136 participants (23 faculty and 112 students), 73 respondents (e.g., 54% response rate) filled out the questionnaire. Most of the respondents (69.8%) were very comfortable with this new virtual experience. Most participants (53.4%) preferred the e-OSCE compared to the classic face-to-face clinical OSCE during the pandemic. Regarding the e-OSCE assessment student tool, 46.6% reported that it is similar to the classic face-to-face OSCE; however, 38.4% felt it was worse. Conclusions: The e-OSCE can be a very effective alternative to the classic face-to-face OSCE due to the current circumstances that still pose a significant risk of infection transmission. Future studies should examine different virtual strategies to ensure effective OSCE delivery from the perspective of both faculty and students.

BACKGROUND This study was done to define some epidemiological aspects of inflammatory bowel disease (IBD), and to describe its characteristics in west of Iran. METHODS In this descriptive study all patient with the diagnosis of IBD who were visited in universityaffiliated medical centers, between 2014 and 2015 were recruited. Their demographic characteristics, disease-related manifestations, complications, disease course and their chief complaints were analyzed. RESULTS Of 156 referred individuals, 153 patients had ulcerative colitis (UC) and 3 patients had Crohn’s diseases (CD). The mean age of the patients at diagnosis was 35.69±12.35 (range: 17-80) years with the most common age group of 25-35 years and slight female predominance (51.9%). More urban patients were registered (90.4%) and 57% had high school or upper education. Positive family history of the disease was in 25.6% and 66.6% had four or more family members. Furthermore, 51.9% had left sided colitis and 40.4% had pancolitis with bloody diarrhea (79.5%) and abdominal pain (68.6%) as the most common manifestations. 36.5% had other autoimmune diseases. Multiple flare was seen in 47.4%, most commonly due to drug discontinuation (26.28%). Hospital admission was reported in 34.6%. History of contraceptive pill use was in 38.8% of the female patients. CONCLUSION The demographic and clinical manifestations of IBD are usually the same as other developing countries; however, the rarity of CD is eminent. Although the accurate epidemiological characteristic of IBD in Iran is still obscure, it is not a rare disease as previously thought and it seems that gradual reception of a western lifestyle may be linked to the ongoing rise in IBD.

Background: Sleep disorders are a common concern among pediatric epilepsy patients. This study aimed to assess the sleep quality in children with epilepsy. Subjects and Methods: The present study examined parent-reported sleep problems in 34 children (20 boys and 14 girls; age 4–14 years) with epilepsy. Children's Sleep Habits Questionnaire (CSHQ) assesses sleep patterns with 33 sleep disturbance items, and each item is rated on a 3-point scale (99 total score) that describes the frequency of the behaviors. A score of 41 was used as a cutoff for identification of poor and good sleeper. Results: Epilepsy poor sleepers (based on CSHQ score) have more sleep impairment than epilepsy good sleepers (CSHQ score) (P < 0.04), and the CSHQ subscores are as follows: night awakenings (P < 0.03), sleep duration (P < 0.04), daytime sleepiness (P < 0.04), sleep-onset delay (P = 0.02), and bedtime resistance (P = 0.02). Conclusions: Although sleep problems are known to be common among young children with epilepsy, the results of this work may provide the basis for focused studies to gain deeper understanding of sleep disturbances in this population.

Background and objectiveHigh quality evidence-based clinical practice guidelines (CPGs) have a major impact on the appropriate diagnosis and management and positive outcomes. The evidence-based healthcare for patients with attention deficit hyperactive disorder (ADHD) is challenging. The objective of this study was to appraise the quality of published CPGs for ADHD.MethodsA systematic review was conducted for ADHD CPGs using CPG databases, DynaMed, PubMed, and Google Scholar. The quality of each included CPG was appraised by three independent appraisers using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) instrument.ResultsSix CPGs were critically reviewed. The AGREE II standardized domain scores revealed variation between the quality of these CPGs with the National Institute of Health and Care Excellence (NICE), University of Michigan Health System, and American Academy of Pediatrics CPGs as the top three. Overall, the recommendations for management of ADHD were similar in these CPGs.ConclusionsReporting of CPG development is often poorly documented. Guideline development groups should aim to follow the AGREE II criteria to improve the standards and quality of CPGs. The NICE CPG showed the best quality. Embedding the AGREE II appraisal of CPGs in the training and education of healthcare providers is recommended. The protocol for this study was published in PROSPERO (International prospective register of systematic reviews). Link: http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42017078712 and is additionally available from protocols.io. Link: https://dx.doi.org/10.17504/protocols.io.q27dyhn.

Urinary lithiasis in transplanted kidney is a relatively uncommon complication. However, it may lead to a significant morbidity and loss of renal function. The report presents the case of a 32-year-old male renal-transplant recipient, with a stone in renal pelvis who was treated successfully by tubeless percutaneous nephrolithotomy (PCNL). The patient is currently stone free with no complication. This article also reviews in brief the treatment of this rare complication. Reviewing the literature showed, it could be noticed that PCNL is a safe and feasible procedure for treating nephrolithiasis in a transplanted kidney.

Background: Chills are muscle contractions and involuntary movements that the patient is not able to control them. Chill (shivering) is a frequent complication after the general anesthesia, which is due to the use of anesthesia drugs and hypothermia; it can increase oxygen intake, systemic blood pressure, and heart rate and can cause cardiac arrhythmias in patients. One of the mechanisms for decreasing postoperative shivering, is the use of the drugs that create less shivering. A variety of anesthetic drugs are used during anesthesia that each one has its own special side effects (complications). The aim of this study was to compare the effects of isuflorane and propofol on postoperative shivering in patients underwent general anesthesia for elective general or orthopedic surgeries. Methods: In a double-blinded clinical trial study, 100 patients at the age of 18-65 years, who underwent elective orthopedic and general surgery in Imam Khomeini Hospital in city of Ilam, Iran, were randomly divided in two groups of 50 during the years 2012-2013. The occurrence and severity of postoperative shivering was compared in the two groups and via 0-3 classification scoring. The findings were analyzed via SPSS software using paired-t and chi-square tests. Findings: 47% of the patients were women and 53% were men. Between the gender and postoperative shivering (P = 0.067) as well as between the age and postoperative shivering (P = 0.774), no significant relationship was found. There was no significant difference between the two groups of isoflurane and propofol in postoperative shivering (P = 0.211). Conclusion: In adult patients undergoing elective general or orthopedic surgery, to reduce the postoperative shivering, there was no difference in using isoflurane or propofol.

Introduction Sleep scoring is an important step in the treatment of sleep disorders. Manual annotation of sleep stages is time-consuming and experience-relevant and, therefore, needs to be done using machine learning techniques. Methods Sleep-EDF polysomnography was used in this study as a dataset. Support vector machines and artificial neural network performance were compared in sleep scoring using wavelet tree features and neighborhood component analysis. Results Neighboring component analysis as a combination of linear and non-linear feature selection method had a substantial role in feature dimension reduction. Artificial neural network and support vector machine achieved 90.30% and 89.93% accuracy, respectively. Discussion and Conclusion Similar to the state of the art performance, the introduced method in the present study achieved an acceptable performance in sleep scoring. Furthermore, its performance can be enhanced using a technique combined with other techniques in feature generation and dimension reduction. It is hoped that, in the future, intelligent techniques can be used in the process of diagnosing and treating sleep disorders.

This paper describes an approach for improving the accuracy of memory-based collaborative filtering, based on the technique for order of preference by similarity to ideal solution (TOPSIS) method. Recommender systems are used to filter the huge amount of data available online based on user-defined preferences. Collaborative filtering (CF) is a commonly used recommendation approach that generates recommendations based on correlations among user preferences. Although several enhancements have increased the accuracy of memory-based CF through the development of improved similarity measures for finding successful neighbors, there has been less investigation into prediction score methods, in which rating/preference scores are assigned to items that have not yet been selected by a user. A TOPSIS solution for evaluating multiple alternatives based on more than one criterion is proposed as an alternative to prediction score methods for evaluating and ranking items based on the results from similar users. The recommendation accuracy of the proposed TOPSIS technique is evaluated by applying it to various common CF baseline methods, which are then used to analyze the MovieLens 100K and 1M benchmark datasets. The results show that CF based on the TOPSIS method is more accurate than baseline CF methods across a number of common evaluation metrics.

مقدمه: سرطان معده در مردان اولین و در زنان سومین سرطان شایع می‌باشد. در این مطالعه به ارایه‌ی مدل توزیع جغرافیایی سرطان معده و شناسایی خوشه‌های پرخطر این سرطان بر حسب جنس به طور جداگانه و با استفاده از آماره‌ی کاوشی فضا- زمان پرداخته شد. روش‌ها: این مطالعه از نوع كاربردی بود و داده‌های گزارش‌ شده‌ی سیستم ثبت سرطان در ایران به تفکیک استان‌ها برای سال‌های 1384 تا 1388 مورد استفاده قرار گرفت. برای تجزیه و تحلیل اطلاعات از آماره‌ی کاوشی فضا- زمان، شناسایی خوشه‌ها از نرم‌افزار SaTScan و برای پهنه‌بندی توزیع سرطان معده و نمایش خوشه‌ها در کشور از نرم‌افزار ArcGIS10 استفاده شد. یافته‌ها: محتمل‌ترین خوشه برای مردان استان‌های اردبیل، گیلان، زنجان، آذربایجان ‌شرقی، قزوین، آذربایجان ‌غربی، كردستان، همدان، تهران و مازندران در دوره‌ی زمانی 1387 تا 1388 شامل گردید که از لحاظ آماری معنی‌دار بود. محتمل‌ترین خوشه برای زنان استان‌های اردبیل، گیلان، زنجان، قزوین، آذربایجان‌ غربی، كردستان، همدان، تهران، مازندران، قم، سمنان و مرکزی شامل شد. نتیجه‌گیری: این مطالعه نشان داد که توزیع سرطان معده در جمعیت مردان و کل جمعیت مشابه است. برای جمعیت زنان الگوی توزیع سرطان معده کمی متفاوت می‌باشد. غربالگری برای تشخیص زود هنگام سرطان معده در مناطق پرخطر توصیه می‌شود.

Introduction: Any disorder in balance is one of the influencing factors on falling risk which its increasing can decrease falling risk and consequent problems. Thus the aim of study was to compare and examine the effects of aquatic, Whole Body Vibration and concurrent training on neuromuscular performance, balance and risk of falling in elderly females. Materials and Methods: 48 females were randomized consecutively into four Groups: the group1 submitted for the aquatic training(13), the group 2 submitted for the Whole Body Vibration Training (WBV)(11), the group 3 submitted for the aquatic training plus Whole Body Vibration Training (concurrent Group)(12), and the Control group(12). Neuromuscular performance, balance and risk of falling was evaluated in all subjects, before, 2 and 4 and 6 weeks after beginning the training and 2 and 4 weeks after completion the exercise period. A one-way ANOVA and two way repeated measure ANOVA used to analyze the data. Results: Results of this study showed that there are significant difference between aquatic, WBV and concurrent training with control group. However, there is significant improvement in neuromuscular performance, balance and risk of falling in WBV and concurrent training groups in 2 weeks after beginning of training, but there is significant improvement in neuromuscular performance, balance and risk of falling in Aquatic training group in 4 weeks after beginning of training. Also, after doing retention test, there is significant decreasing in neuromuscular performance, balance and risk of falling in WBV and concurrent training groups in 2 weeks after detraining period, but there is significant decreasing in neuromuscular performance, balance and risk of falling in Aquatic training group in 4 weeks after detraining period. Conclusion: Due to results, using Aquatic, Whole Body Vibration and concurrent exercises are recommended to decrease likelihood of falling and improve neuromuscular performance and balance in elderly females. Keywords: Aquatic Training, Whole Body Vibration Training, Concurrent Training, neuromuscular performance, balance, risk of falling