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Abstract This paper introduces a novel high-voltage gain topology for a solid-state transformer, integrating a DC-DC converter and dual active bridge converters. The proposed design features three DC links operating at different voltage levels. The first DC link connects to a single-switch high step-up DC-DC converter, while the second DC link interfaces with an AC source via a rectifier, allowing the use of both DC and AC inputs. A high-frequency transformer ensures galvanic isolation between the sources and the third DC link. The DC-DC converter employs coupled inductors and voltage multiplier cells, offering distinct advantages such as a high voltage gain, reduced voltage stress on semiconductors, and minimized current ripple. These features make the topology highly suitable for transferring power from renewable energy sources, such as photovoltaic panels, to a high-voltage DC link in microgrid or nanogrid applications. The novelty lies in the combination of multiple voltage levels, high-frequency isolation, and the ability to handle both DC and AC inputs efficiently. An experimental prototype, delivering 620 W with a 25 V DC input and 110 V AC input, is built, and the results validate the converter’s effectiveness.

Abstract In the field of Brain Machine Interface (BMI), the process of translating motor intention into a machine command is denoted as decoding. However, despite recent advancements, decoding remains a formidable challenge within BMI. The utilization of current decoding algorithms in the field of BMI often involves computational complexity and requires the use of computers. This is primarily due to the reliance on mathematical models to address the decoding issue and perform subsequent output calculations. Unfortunately, computers are not feasible for implantable BMI systems due to their size and power consumption. To address this predicament, this study proposes a pioneering approach inspired by hyperdimensional computing. This approach first involves identifying the pattern of each stimulus by considering the normal firing rate distribution of each neuron. Subsequently, the newly observed firing pattern for each input is compared with the patterns detected at each moment for each neuron. The algorithm, which shares similarities with hyperdimensional computing, identifies the most similar pattern as the final output. This approach reduces the dependence on mathematical models. The efficacy of this method is assessed through the utilization of an authentic dataset acquired from the Frontal Eye Field (FEF) of two male rhesus monkeys. The output space encompasses eight possible angles. The results demonstrate an accuracy rate of 51.5% while exhibiting significantly low computational complexity, involving a mere 2050 adder operators. Furthermore, the proposed algorithm is implemented on a field-programmable gate array (FPGA) and as an ASIC designe in a standard CMOS 180 nm technology, underscoring its suitability for real-time implantable BMI applications. The implementation required only 2.3 Kbytes of RAM, occupied an area of 2.2 mm2, and consumed 9.32 µW at a 1.8 V power supply. Consequently, the proposed solution represents an accurate, low computational complexity, hardware-friendly, and real-time approach.

Abstract Objective The non-invasive and inexpensive predictive indicators seem to be essential for the evaluation of coronavirus disease-19 (COVID-19) prognosis. Uric acid to high-density lipoprotein-cholesterol ratio (UHR) have been known as inflammatory and metabolic biomarker in some disorders. This study aimed to evaluate the usefulness of serum uric acid (UA) and UHR values on admission as prognostic indicators for the severity and mortality of COVID-19. Regression models were accomplished to assess the association between UA and UHR with the severity and mortality of COVID-19. Results This study was performed with 424 confirmed COVID-19 patients. The mean UA and UHR values of the severe group and deceased group were statistically higher than those mild group and survivor group, respectively (P

Abstract This paper presents the design and analysis of a high voltage gain converter utilizing a coupled inductor with reduced voltage stress, specifically for photovoltaic energy-based systems. The proposed converter employs a two-winding coupled inductor and voltage multiplier cells to achieve an increase in output voltage while mitigating voltage stress across semiconductor components. Additionally, the voltage multiplier cells function as voltage clamps for the power switch, further enhancing the converter's performance. The converter features a single switch design, which simplifies control, reduces cost, and improves reliability. Key advantages of the converter include a low component count, a common ground between input and output ports, and high efficiency. The converter's performance is thoroughly investigated through mode analysis and steady-state analysis. Comparative evaluations with similar converters are conducted to highlight the benefits and performance of the proposed design. To validate the theoretical analysis, a 125 W prototype with 26 V input and 200 V output voltages operating at a 50 kHz switching frequency is developed, and experimental results are presented, demonstrating the effectiveness and practicality of the proposed high voltage gain converter.

Abstract DC microgrids are integral to smart grids, enhancing grid reliability, power quality, and energy efficiency while enabling individual grid independence. They combine distributed and renewable energy sources, reducing overall energy consumption. High-gain DC–DC converters are crucial for elevating voltages from low-voltage DC sources like solar panels and wind turbines in DC microgrids. This paper introduces a non-isolated DC–DC converter designed to achieve ultra-high step-up (UHSU) voltage conversion utilizing a two-winding coupled inductor (CI). The propounded UHSU configuration achieves a substantial voltage increase by employing low duty cycles and a decreased turn ratio for the CI, resulting in a smaller core size. Moreover, this UHSU circuit incorporates soft-switching capabilities for both power switches and diodes, enhancing its efficiency. By keeping the voltage stress on the switches low, the design minimizes losses and improves overall efficiency. The operational modes are thoroughly analyzed, and comparisons with other topologies are presented to demonstrate the effectiveness of the proffered UHSU circuit. Finally, the performance of the UHSU circuit is validated through the construction and testing of a 150-W laboratory prototype operating at a switching frequency of 50 kHz, with Vin = 20 V and Vout = 300 V.

Abstract To identify factors associated with post-recurrence survival (PRS), we examined our institutional recurrence patterns following definitive resection for rectal cancer. We reviewed all patients with rectal cancer diagnosed at three hospitals in the east of Iran from 2011 to 2020. The optimal cut-off value was determined by receiver operating characteristic (ROC) analysis to determine early recurrence. The effect of recurrence time was evaluated on PRS. 326 eligible patients with a mean ± SD age of 56 ± 12.8 years were included in this study. In a median (IQR: Inter-quartile range) follow-up time of 76 (62.2) months, 106 (32.5%) patients experienced at least any recurrence (locoregional or distant metastasis) following primary resection. The median (IQR) time from initial surgery to recurrence was 29.5 (31.2) months. Based on ROC analysis, early recurrence was specified at ≤ 29 months. However, for the patients who experienced only locoregional recurrence, 33 months was the cut-off to define early recurrence. Recurrence time and recurrence management were both significant variables on PRS. Moreover, TNM staging was significantly associated with early recurrence (P = 0.003). In this research, recurrence time, recurrence management and TNM staging were found to be correlated with PRS.

Abstract This paper presents a novel topology for Z-source inverters (ZSI). The new Z-Source network is based on the coupled-inductors and active switched boost. Features of the topology include high voltage boost ability, single magnetic-core, low voltage stress on the active switch, and capacitors. The principles of operation, analysis, voltage and current equations of each component, and the converter voltage gain in the steady-state are presented. A comparison with other topologies has also been performed to determine the advantages and disadvantages of the proposed ZSI. Finally, experimental results of the laboratory prototype are presented to confirm the performance of the proposed topology.

Objectives: Nitric oxide is the most important mediator of penile erection after the onset of sexual excitement. It activates cyclic guanosine monophosphate (cGMP), increasing penile blood flow. Most pharmaceutical medications prevent enzyme phosphodiesterase type 5 (PDE-5) from breaking down cGMP, thus keeping its level high. However, due to the adverse effects of pharmacological therapies, herbal drugs that improve sexual function have gained attention recently. This study aimed to investigate the combined effects of ginseng, Tribulus terrestris, and L-arginine amino acid on the sexual performance of individuals with erectile dysfunction (ED) using the 5-item version of the International Index of Erectile Function (IIEF-5) questionnaire. Methods: Over three months, 98 men with erectile dysfunction were randomly assigned to receive either 500 mg of herbal supplements or placebo pills. Each herbal tablet contained 100 mg of protodioscin, 35 mg of ginsenosides, and 250 mg of L-arginine. Results: The results showed that the changes in the average scores of ILEF-5 within each group before and after the intervention indicated that all parameters related to the improvement of sexual function in patients with erectile dysfunction improved in the herbal treatment group (p < 0.001). The herbal group significantly improved IIEF-5 scores in non-diabetics (p < 0.05). However, there was no significant difference in the changes of IIEF-5 scores between the two intervention and control groups in diabetic patients. Conclusion: In conclusion, ginseng, Tribulus terrestris, and L-arginine have properties that increase energy and strengthen sexual function, making them suitable for patients with sexual disorders.

Objective: Anthracycline administration in children is associated with cardiac dysfunction. Speckle-tracking echocardiography (STE) can detect subclinical cardiac damage that may go undetected by conventional two-dimensional (2D) echocardiography. This study aims to investigate medium-term anthracycline cardiotoxicity using STE and determine a safer administrable level of anthracyclines (ACs). Methods: This observational case–control study enrolled 37 healthy controls and 78 pediatric cancer survivors who received chemotherapy. The patients were divided into two groups: cardiotoxic received (CR) and cardiotoxic free (CF). Data on segmental longitudinal strain (LS), global LS (GLS), and 2D echocardiographic parameters were collected after a drug-free period of at least one year. Results: A total of 115 children with a mean age of 108 ± 55 months, of whom 66% were males, were included in the study. Both the groups of cancer survivors exhibited significantly reduced GLS compared to healthy controls (CR vs. controls, P = 0.001; CF vs. controls, P = 0.013), but no significant difference in left ventricular ejection fraction (LVEF) was observed (P = 0.75). Overall, cancer survivors treated with ACs demonstrated a significant reduction in strain in 10 left ventricular segments, particularly in the basal segments (P < 0.05). Among CR patients, those with impaired GLS (n = 43, GLS worse than −21.9) had significantly higher mean age and cumulative anthracycline dose compared to CR patients with normal GLS (age, P = 0.024; anthracycline dosage, P = 0.036). Using an anthracycline cutoff of 223 mg/m2 resulted in a higher detection rate (49% vs. 25%) and fewer missed cases (51% vs. 74%) compared to the 360 mg/m2 anthracycline cutoff. Conclusion: Childhood cancer survivors demonstrate significantly reduced GLS while preserving a normal LVEF, which does not differ significantly from reference values of healthy children. The reduction in strain appears to be associated with higher anthracycline doses and older age. Lowering the anthracycline threshold to 223 mg/m2 may improve the predictability of a decline in cardiac function using strain imaging at medium-term follow-up.

Abstract In this paper, a new topology is introduced for capacitor-based multi-level inverters. The proposed topology is based on combination of two Cross-Square-Switched T-Type inverters. This structure can be generalized in two modular and cascaded modes. In the cascaded mode, higher voltage levels are produced with low power switches. The main features of the proposed topology include the level generation without the utilization of the H-bridge module, the low number of switching components, a lower number of DC voltage sources, and low total blocking voltage. Besides, in the proposed topology, the number of conducting switches in the current path for each different voltage level is low, which leads to a conduction loss decrement. The loss simulations are performed, and the results are presented. A study provides a detailed comparison of the proposed topology in terms of various parameters. In this paper, the nearest level modulation switching, which is low-frequency switching, is utilized to generate voltage levels. To confirm the performance of the proposed topology, a simulation was performed with MATLAB/Simulink software, and a laboratory sample was implemented. Comparative results, simulation results, and implementation results indicate the appropriate performance of the proposed structure in different steady-state and dynamic conditions.

Abstract Many COVID-19 survivors experience lingering post-COVID-19 symptoms, notably chronic fatigue persisting for months after the acute phase. Despite its prevalence, limited research has explored effective treatments for post-COVID-19 fatigue. This randomized controlled clinical trial assessed the impact of Amantadine on patients with post-COVID-19 fatigue. The intervention group received Amantadine for two weeks, while the control group received no treatment. Fatigue levels were assessed using the Visual Analog Fatigue Scale (VAFS) and Fatigue Severity Scale (FSS) questionnaires before and after the trial. At the study's onset, VAFS mean scores were 7.90 ± 0.60 in the intervention group and 7.34 ± 0.58 in the control group (P-value = 0.087). After two weeks, intervention group scores dropped to 3.37 ± 0.44, significantly lower than the control group's 5.97 ± 0.29 (P-value

Introduction: Considering the morphology of alveolar bone is of great importance in orthodontic treatment planning. This study aimed to investigate the thickness of the anterior alveolar bone of the jaws in subjects with class I and class III malocclusions. Materials & Methods: This cross-sectional study evaluated 50 CBCT images of the upper jaw and 20 CBCT images of the lower jaw obtained from the archive of a Radiology Center. The selected patients had equal numbers of class I or class III malocclusions. The thickness of the alveolar bone was measured in the anterior parts of the maxilla and mandible at three areas including the apex, middle root and alveolar crest at both buccal and lingual sides. To assess data reliability, 20% of images were randomly selected and the measurements were repeated 10 days later. Independent sample t-test and chi-square test were used for statistical analysis.Results: There was no significant difference in the mean age (P=0.448) and gender (P=1.00) of the patients between the two groups. In the upper jaw, the mean alveolar bone thickness in class III patients was significantly lower at the buccal crest (P=0.015) and palatal apex (P0.05) Conclusion: It is necessary to pay more attention to alveolar bone thickness at the buccal crest of the maxilla and lingual region of the mandible in class III patients undergoing orthodontic treatment.

Background: Patients with coronavirus disease 2019 (COVID-19) experience symptoms of cognitive impairment. These patients perceive a lot of stress and are required to comply with quarantine conditions. Remote stress management training, in accordance with the principles of quarantine of these patients, can be effective in their recovery process. Therefore, this study was conducted with the aim of investigating the effect of remote stress management training on the cognitive status of patients with COVID-19. Methods: In this randomized clinical trial, the research population was all the patients with COVID-19 referred to Gharazi Hospital in Isfahan City, Iran, in the winter of 2021. Seventy patients were selected by available sampling method and divided into two intervention and control groups (35 people) by limited randomization method. For the intervention group, the remote stress management online training program was implemented in five 60-minute sessions over two weeks. The control group did not receive training. The cognitive status index was measured using Folstein et al.'s brief cognitive status examination questionnaire [Mini-Mental State Examination (MMSE)] before and after the training sessions. The data were analyzed with SPSS software at two levels of descriptive and inferential statistics and by performing chi-square test, independent t-test, paired t-test as well as the analysis of covariance (ANCOVA). Findings: The comparison of the average scores of the cognitive status in the pre-test and post-test phases of the two groups showed that the remote stress management training had a significant effect on the cognitive status of the patients with COVID-19 and improved this index in the intervention group (P ≤ 0.05). Conclusion: Based on the results, remote stress management training can improve the cognitive status of patients with COVID-19. Therefore, this method of training is recommended due to the convenience and possibility of using it in the quarantine conditions of these patients.

Objective(s): The main objective of the current assay was to evaluate the antibacterial and regenerative effects of hydrogel nanocomposite containing pure natural zeolite (clinoptilolite) integrated with alginate (Alg) as wound healing/dressing biomaterials.Materials and Methods: The zeolites were size excluded, characterized by SEM, DLS, XRD, FTIR, and XRF, and then integrated into Alg hydrogel followed by calcium chloride crosslinking. The Alg and alginate zeolite (Alg/Zeo) hydrogel was characterized by swelling and weight loss tests, also the antibacterial, hemocompatibility, and cell viability tests were performed. In animal studies, the burn wound was induced on the back of rats and treated with the following groups: control, Alg hydrogel, and Alg/Zeo hydrogel.Results: The results showed that the hydrodynamic diameter of zeolites was 367 ± 0.2 nm. Zeolites did not show any significant antibacterial effect, however, the hydrogel nanocomposite containing zeolite had proper swelling as well as hemocompatibility and no cytotoxicity was observed. Following the creation of a third-degree burn wound on the back of rats, the results indicated that the Alg hydrogel and Alg/Zeo nanocomposite accelerated the wound healing process compared with the control group. Re-epithelialization, granulation tissue thickness, collagenization, inflammatory cell recruitment, and angiogenesis level were not significantly different between Alg and Alg/Zeo nanocomposite.Conclusion: These findings revealed that although the incorporation of zeolites did not induce a significant beneficial effect in comparison with Alg hydrogel, using zeolite capacity in hydrogel for loading the antibiotics or other effective compounds can be considered a promising wound dressing.

Background and Aims Patellofemoral pain syndrome often results from misalignment of the patellofemoral joint that can affect lower limb function. Therefore, the present study investigated the relationship between patellar position and lower limb function and balance in athletes with patellofemoral pain syndrome. Methods In this exploratory analytical study, 39 male and female athletes with this syndrome with an average age of 25.6±4.7 years were selected by available sampling. Lower limb function and dynamic balance were measured by the Western Ontario and McMaster Universities Osteoarthritis index (WOMAC) scale and Y balance test, respectively, and patellar position was assessed by digital radiology. The Pearson correlation test was used to analyze the data at a significance level of 0.05. Results The results showed that the position of the patella was significantly associated with lower limb function and dynamic balance (P

Background and Aims: The morphology of knee joint extensor muscles including vastus medialis (VM) and vastus lateralis (VL), is one of the important and effective factors in lateral patellar compression syndrome (LPCS). This study aims to examine the morphological differences of these knee extensor muscles between women with and without LPCS.Methods: In this causal-comparative study, 15 women with LPCS aged 18-30 years and 15 women without LPCS as controls participated who were selected by a convenience sampling methhod. For muscle imaging, the anteromedial (VM) and anterolateral (VL) thigh distal ends were scanned by using a two-dimensional digital ultrasound device (SonoSite Co., USA). The muscles’ cross-sectional area at the patellar base was measured in square centimeters and the muscle-fiber pennation angles of these muscles was measured in degree. Independent t-test was used to compare the variables between the two groups. The significance level was set at 0.05.Results: The cross-sectional area of VM in the control group was significantly higher than in the LPCS group (P=0.001), while the cross sectional area of VL was not significantly different between the two groups (P>0.05). The muscle-fiber pennation angle of VM in the LPCS group was significantly lower than in the control group (P=0.016), while the muscle-fiber pennation angles of VL in the LPCS group was significantly higher than in the control group (P=0.021).Conclusion: The morphology of VM and VL in women with LPCS symptoms shows a significant muscle imbalance that can change the patella position from normal to a more lateral position and increase the contact between the lateral facet of the patella and the lateral femoral condyle, resulting in increased pressure on this area and eventually knee pain.Muscle morphology, Cross-sectional area, Muscle-fiber pennation angle, Lateral patellar compression syndrome, Knee extensors

Despite studies indicating that asthma patients do not exhibit a higher mortality rate or severity compared to the general population when infected with COVID-19, there have been few reports on predictive factors for mortality in this context. This study aimed to assess the predictive value of systemic inflammation indices including neutrophil-to-lymphocyte (NLR), monocyte-to-lymphocyte (MLR), platelet-to-lymphocyte (PLR), systemic inflammation response index (SIR-I), and systemic inflammation index (SII) in determining mortality rate among patients with COVID-19 and asthma. In this prospective study, the laboratory parameters of 1792 COVID-19 patients were examined, with a subgroup consisting of 112 patients with asthma and 1680 patients without asthma. Receiver operating characteristic (ROC) analysis was employed to assess the potential of inflammatory indices in indicating COVID-19 severity, while Kaplan-Meier curves were utilized to analyze the survival probability with death as the outcome. In deceased non-asthma patients, the levels of leukocyte and differential cell counts, and the values of PLR, NLR, MLR, SII, and SIR-I were higher than in survivors. In contrast, all the above values except PLR and MLR were significant in the asthma groups. The Kaplan–Meier survival curves were consistent with the ROC analysis. However, a multivariate Cox regression analysis revealed that neutrophil counts in non-asthma subjects and leukocyte and neutrophil counts in asthma patients remained significant for survival. In conclusion, while numerous inflammatory indices were associated with mortality in COVID-19 patients without asthma, neutrophil counts could independently predict mortality risk in asthma COVID-19 patients.

Traumatic spinal cord injury (TSCI) is a significant public health challenge that has an adverse impact on functional independence, quality of life, and life expectancy. Management of people’s chronic conditions is a key aspect of contemporary medical practice. Our study was an open label, single arm, prospective pilot study to evaluate the feasibility of treating people with TSCI. The study intervention was treatment with oral selenium and vitamin E. Participants were 18 years or older and experienced a TSCI at least one year prior to enrollment. Daily doses of 50 mcg of selenium and 400 IU of vitamin E were administered. Participants had radiologic (MRI tractography) and clinical (ASIA) assessments prior to initiating treatment, and these assessments were repeated after one year of treatment. Four subjects completed the full twelve-month study. Adherence, based on pill counts, was approximately 75% in all subjects. There were no adverse events related to study medications. During the treatment period, subjects reported improvement in certain symptoms. There was no significant difference in ASIA scores before and after the intervention. Combination treatment with vitamin E and selenium has been demonstrated as safe for TSCI patients. It is possible to use DTI values to locate the epicenter of a lesion as well as gauge the extent of injury. MRI tractography may serve as a meaningful surrogate endpoint. The results of this study suggest that it is feasible to conduct a larger long-term clinical trial to evaluate the efficacy of combination treatment of TSCI.

Background Despite the low incidence rate, ureteral injuries can lead to significant morbidity. Urinary organs can be injured during open or laparoscopic surgery. This study aimed to assess whether a ureteral injury exists between laparoscopic and open surgery over 20 years in Shiraz. Methods This is a retrospective study and 779 patients of rectal cancer were evaluated in Shiraz from 2000 to 2021 by collecting data from the patients’ electronic charts. We evaluated the type of surgery, gender, age, body mass index (BMI), stage, appearance and size of the tumor, preoperative (chemo)-radio-therapy, recurrence, and metastasis. Ureteral injury was analyzed and urinary incontinence was recorded.Results A total number of 131 (22.2%) in laparoscopy surgeries and 42 (30.6%) in laparotomy surgeries had abdominoperineal (A-P) resection. The total number of 254 (43%) in laparoscopy surgeries and 61 (44.5%) of patients had low anterior resection in laparotomy surgeries. The incidence of ureteral injuries was 2.2% for open procedures and 1.5% for laparoscopic and 2.2% for conversion procedures. The rate of urinary incontinence was 65 (11.0%) in laparoscopy and 9 (6.6%) in laparotomy group. Conclusion It is concluded that the ureteral injury after laparotomy is more than laparoscopic surgeries. Although the number of side effects of these surgeries is low, it can be concluded that the possibility of damage to the ureter is less in laparoscopic surgery and that of damage to the nerves of the pelvic floor is more.

Abstract There is a lack of well-verified models in the literature for the prediction of the frictional pressure drop (FPD) in the helically coiled tubes at different conditions/orientations. In this study, the robust and universal models for estimating two-phase FPD in smooth coiled tubes with different orientations were developed using several intelligent approaches. For this reason, a databank comprising 1267 experimental data samples was collected from 12 independent studies, which covers a broad range of fluids, tube diameters, coil diameters, coil axis inclinations, mass fluxes, saturation temperatures, and vapor qualities. The earlier models for straight and coiled tubes were examined using the collected database, which showed absolute average relative error (AARE) higher than 21%. The most relevant dimensionless groups were used as models’ inputs, and the neural network approach of multilayer perceptron and radial basis functions (RBF) were developed based on the homogenous equilibrium method. Although both intelligent models exhibited excellent accuracy, the RBF model predicted the best results with AARE 4.73% for the testing process. In addition, an explicit FPD model was developed by the genetic programming (GP), which showed the AARE of 14.97% for all data points. Capabilities of the proposed models under different conditions were described and, the sensitivity analyses were performed.

Abstract Malignant nerve sheath tumors (MPNSTs) are rare sarcomas tumors which rarely present as intrapelvic mass and are hard to diagnose clinically. We present a 29‐year‐old male patient presented with acute urinary retention and was diagnosed with large intrapelvic mass. After complete surgical resection, the histopathology confirmed the diagnosis of low MPNST.

Background and purpose: Hospitals are one of the vital pillars of the health system. Hospital preparedness in epidemics is a dynamic, complex and multidimensional process that shows the developed capacities and capabilities of the hospital in predicting, reducing the effects, resistance, response, and recovery in the face of biological events. The aim of this study was to investigate the readiness of hospitals in response to the pandemic of COVID-19 disease in Mazandaran province, Iran. Materials and methods: This cross-sectional study was performed in April 2020 using the standard checklist of the Pan American World Health Organization (PAHO 2019). The checklist consists of ten components: incident management system (7 items), coordination (2 items), information management (2 items), logistics (7 items), finance and administration (1item), detection (3 items), diagnosis (3 items), isolation (3 items), cases management (4 items), and prevention and infection control (10 items). Data were analyzed applying Kruskal-Wallis test in SPSS V18. Results: We studied 39 hospitals in the province, including university hospitals (n=26), social security hospitals (n=4), and private hospitals (n=9). Social security hospitals showed the highest level of readiness (mean score= 82 out of 84), university hospitals had moderate level of readiness (mean score= 72.72 out of 84), and private hospitals had the lowest mean score for readiness (72.5 out of 84). According to the total scores, operational readiness was at a good level. Conclusion: The readiness of the hospitals in the face of the COVID-19 pandemic was at a good level in Mazandaran province. However, due to the prolonged pandemic and uncertainty about when it comes to an end, monitoring the key components is essential to maintain high level of preparation.

Abstract Penetration of peritoneal cavity during antegrade double‐J (DJ) stenting is rare. A 52‐year‐old woman presented with signs of peritonitis for 3 days after left PCNL. Abdominal CT scan revealed a perforation of the peritoneum by the distal coil of DJ stent, which was reinserted into the bladder by ureteroscopy.

Abstract Background Emergency and disaster are on the rise in the world. One of the most important components of disaster risk management is the early warning system. Studies have shown divergent models of warning systems with different structures. However, since no systematic review of early warning systems in disasters has been conducted so far, a systematic review of the models, components, and structures of these systems is essential. This protocol is a systematic review study, which aims to evaluate the existing warning systems and their structure. Methodology This study attempts to comprehensively search the previous studies with terms and expressions including disaster, emergency model, early warning system, and their synonyms at MESH. To this end, English articles, which have been published from 1980 to 2019, will be assessed. Google Scholar, PubMed, Web of Science, and Scopus databases as well as relevant specialized websites will be searched. Studies will be evaluated by two individuals independently. Discussion To the best of our knowledge, no systematic review of models, structures, and components of the early warning system has been conducted so far. This study is the first attempt to comprehensively evaluate the models and components of early warning systems. Accordingly, this study will provide evidence of models, structures and elements of the early warning systems. Systematic review registration PROSPERO CRD42018116111

Background and purpose: Iran is one of the top ten countries in the world with disaster. Hospitals have a major role in dealing with disaster-related injuries. The purpose of this study was to assess the level of preparedness in Mazandaran province hospitals in dealing with disasters in order to identify the deficiencies and comparing current conditions with national standards. Materials and methods: In this cross-sectional study, all hospitals affiliated with Mazandaran University of Medical Sciences and Mazandaran Social Security Organization (n=28) were evaluated in 2017. Data were collected using the National Standard Toolkit for Hospital Preparedness. The overall score and the scores for every component were recorded and the level of preparedness were presented according to four levels. Results: The relative preparedness level of hospitals in dealing with disasters was moderate (65.5%). The overall levels of disaster preparedness in the hospitals affiliated with Mazandaran University of Medical Sciences and the social-security hospitals were moderate (63%) and favorable (75%), respectively. The hospitals affiliated with Mazandaran University of Medical Sciences, were found to have good (n=4), moderate (n=14), and poor (n= 5) levels of preparedness. The hospitals of the Social Security Organization were ranked as good (n=2) and moderate (n=3) in disaster preparedness. Conclusion: Most of the hospitals in Mazandaran province, like other regions in Iran, have poor level of disaster preparedness. Therefore, more planning is needed to enhance the hospital’s level of readiness in all dimensions.

PURPOSE:To accelerate coronary MRI acquisitions with arbitrary undersampling patterns by using a novel reconstruction algorithm that applies coil self-consistency using subject-specific neural networks. METHODS:Self-consistent robust artificial-neural-networks for k-space interpolation (sRAKI) performs iterative parallel imaging reconstruction by enforcing self-consistency among coils. The approach bears similarity to SPIRiT, but extends the linear convolutions in SPIRiT to nonlinear interpolation using convolutional neural networks (CNNs). These CNNs are trained individually for each scan using the scan-specific autocalibrating signal (ACS) data. Reconstruction is performed by imposing the learned self-consistency and data-consistency, which enables sRAKI to support random undersampling patterns. Fully-sampled targeted right coronary artery MRI was acquired in six healthy subjects. The data were retrospectively undersampled, and reconstructed using SPIRiT, l1-SPIRiT and sRAKI for acceleration rates of 2 to 5. Additionally, prospectively undersampled whole-heart coronary MRI was acquired to further evaluate reconstruction performance. RESULTS:sRAKI reduces noise amplification and blurring artifacts compared with SPIRiT and l1-SPIRiT, especially at high acceleration rates in targeted coronary MRI. Quantitative analysis shows that sRAKI outperforms these techniques in terms of normalized mean-squared-error (~44% and ~21% over SPIRiT and [Formula: see text]-SPIRiT at rate 5) and vessel sharpness (~10% and ~20% over SPIRiT and l1-SPIRiT at rate 5). Whole-heart data shows the sharpest coronary arteries when resolved using sRAKI, with 11% and 15% improvement in vessel sharpness over SPIRiT and l1-SPIRiT, respectively. CONCLUSION:sRAKI is a database-free neural network-based reconstruction technique that may further accelerate coronary MRI with arbitrary undersampling patterns, while improving noise resilience over linear parallel imaging and image sharpness over l1 regularization techniques.

Background and Aim: Ziehl Nelson staining, fluorescent and also culture are the standard methods for the diagnosis of tuberculosis. In this study, the performance of conventional cultivation methods was compared with Flash PCR. Materials and Methods: A total of 56 sputum samples from patients with suspected tuberculosis in Tuberculosis Center of Arak city were collected and Ziehl–Neelsen and culture in Löwenstein–Jensen medium were accomplished. Moreover, DNA from all of the 56 sputum samples was extracted by Chelex100 method. Molecular evaluation was accomplished by Flash PCR kit containing probes and primers for gene amplification IS6110. Positive and negative controls together with samples were used in a MTC410 apparatus for amplification. FD-12 apparatus was used to evaluate the results. In addition, electrophoresis on agarose was used for confirmation of the results. Findings: From 56 sputum samples of suspected TB patients, 20 samples were positive and 36 samples were negative on microscopic evaluation and culture methods. FLASH-PCR molecular analysis showed that all of 20 positive samples were positive in molecular methods, too. On the other hand, three of sputum samples that were negative by culture and staining were positive in FLASH-PCR method. One of these 3 patients, received Isoniazid, pyrazinamide and ethambutol antibiotic by responsible medicine. All results were confirmed using conventional electrophoresis. Conclusion: In some negative samples, possibly because of the small number of bacteria in sample or a defect in the sampling, the Flash PCR may due good advantages. Therefore, due to the low cost, this method is recommended for routine use.

Background and Aim: Since the external root resorption is not detectable clinically, therefore radiographic examination is very important for diagnose, Therefore, the purpose of this study is to compare the diagnostic efficiency of conventional, digital and CBCT radiography in detecting of external root resorption. Materials and Methods: In this descriptive-analytic study, after radiographic and clinical examination, 20 single-rooted human premolar teeth without calcification and resorption were selected. Cavities were drilled 0.8 mm in diameter with round burs 08 in one-third of the cervical, mid, and apical of the buccal wall, digital and CBCT images were taken. The images were evaluated by 3 faculty members of Mashhad Dental School. The statistical analysis was performed with the SPSS V.18 software and Chi-Square test. The significance level was considered to be 0.05. Results: The ability to detect external resorption by CBCT was significantly higher than the other two methods (P=0.000). However, there was no significant difference between conventional and digital radiography. External resorption in the coronal, middle and apical were 78.7%, 62.3%, and 35.5%, respectively. Conclusion: According to the results, CBCT seems to be more reliable in determining external root resorption, in areas of maxillofacial superimposition, and in one-third of the apical root.

Introduction: Stretching the shortened structures by stretch exercises is one of the most effective methods for function improvement in patients with patellofemoral pain. Thus, the aim of this study was to compare the effects of proprioceptive neuromuscular facilitation (PNF) and Classic physiotherapy stretching (CPS) exercises on the balance and function in patellofemoral pain patients. Materials & Methods: This was a semi-experimental research in which 33 women with patellofemoral pain syndrome were randomly divided into three PNF (n=11), CPS (n=11) and control (n=11) groups. The PNF group participated in the quadriceps and hamstring PNF for two months, the CPS members participated in the Classic physiotherapy stretching exercisesfor the same period, while the control group did not participate in any exercise program. The function, static as well as dynamic balances were measured by WOMAC scale, Sharpend Romberg test, and SEBT, respectively. Data were analyzed by ANOVA repeated measures at significance level of 0.05. Findings: As there were no differences between functions and balances of different groups, (P>0.05) before training interventions, PNF group’s knees functions improved significantly compared to CPS (P0.05). Discussion & Conclusions: According to the conclusions of our research, PNF training is more effective in improving function and balance patients with patellofemoral pain; although, classic physiotherapy stretching exercises are often used for the treatment of such patients. Hence, applying PNF exercises for the treatment of such diseases are recommended to physiotherapists and rehabilitation professionals.

Background and purpose: Aminoglycosides are broad-spectrum antibiotics that are often used in combination with other antibiotics for the treatment of severe S. aureus infections. This research aimed at investigating the phenotypic and genotypic evaluation of aminoglycoside resistance in clinical isolates of MRSA in Kerman, Iran. Materials and methods: During a one year period, a total of 57 MRSA isolates was collected from 130 isolates of S. aureus. MRSA isolates were tested for susceptibility to 13 antimicrobial agents using disc diffusion method. Then, the presence of aminoglycoside modifying enzymes (AMEs) was evaluated by multiplex polymerase chain reaction. Results: In the MRSA isolates, high resistance rates were observed for tetracycline, erythromycin, kanamycin and gentamicin. In fact, 73.7% and 68.4% of the isolates were found to be resistant to kanamycin and gentamicin, respectively. aac(6′)-Ie-aph(2″), aph(3′)-III, ant(4′)-Ia, and aph(2ʹʹ)-Id genes were detected in 40.3%, 15.7%, 12.2%, and 3.5% of the aminoglycosides–resistant isolates, respectively. Conclusion: The prevalence of aminoglycosides resistance among MRSA isolates is rising, therefore, identification of resistance genes in order to achieve the exact pattern of resistance is helpful in preventing the spread of resistant strains.

Objectives: Musculoskeletal disorders (MSD) are the most prevalent occupational diseases that are serious, fundamental and costly in nature. Methods: This analytical descriptive study included 45 individuals of occupational and physiotherapy community in Hamedan, Nahavand and Malayer cities of Iran. The standardized Nordic questionnaire was used to collect data. Data analysis was done by SPSS software, chi-square test, T-test and Kay Score tests. Results: Study results revealed the prevalence of MSD accounting for 65.9% (n=27) of the study population who at least had one part of their body infected. In a 12 months study period, the disorder symptoms were seen in wrist (34.1%), lumbar (31.7%), knee (29.3%), neck (26.8%), shoulder (19.5%), and back (17%). A significant relation was seen between the symptoms of the wrist and hand. This was more common among occupational therapists. The results also showed that the disorders in occupational therapists affected all the limbs, except the neck. In addition, the females were more susceptible to the disorders compared to the males. Discussion: This study confirmed the rate of prevalence of work-related musculoskeletal disorders and injuries in occupational and physical therapists, with wrist and lumbar being the most affected. The promotion of therapist’s knowledge about MSD and following ergonomic principles and new approaches in the treatment may lower or prevent MSD.

BackgroundRobust Artificial-neural-networks for k-space Interpolation (RAKI) is a recently proposed deep-learning-based reconstruction algorithm for parallel imaging. Its main premise is to perform k-space interpolation using convolutional neural networks (CNNs) trained on subject-specific autocalibration signal (ACS) data. Since training is performed individually for each subject, the reconstruction time is longer than approaches that pre-train on databases. In this study, we sought to reduce the computational time of RAKI.MethodsRAKI was implemented using CPU multi-processing and process pooling to maximize the utility of GPU resources. We also proposed an alternative CNN architecture that interpolates all output channels jointly for specific skipped k-space lines. This new architecture was compared to the original CNN architecture in RAKI, as well as to GRAPPA in phantom, brain and knee MRI datasets, both qualitatively and quantitatively.ResultsThe optimized GPU implementations were approximately 2-to-5-fold faster than a simple GPU implementation. The new CNN architecture further improved the computational time by 4-to-5-fold compared to the optimized GPU implementation using the original RAKI CNN architecture. It also provided significant improvement over GRAPPA both visually and quantitatively, although it performed slightly worse than the original RAKI CNN architecture.ConclusionsThe proposed implementations of RAKI bring the computational time towards clinically acceptable ranges. The new CNN architecture yields faster training, albeit at a slight performance loss, which may be acceptable for faster visualization in some settings.