Search

The present study evaluated the rational prescription of linezolid, the prevalence of thrombocytopenia, and major drug interactions in patients with cardiovascular diseases. We conducted a retrospective cross-sectional study on linezolid-treated patients at Shahid Chamran Heart Hospital in Isfahan from March 21, 2021, to March 20, 2022. Our research involved 132 patients who received linezolid. We reported 43.18% of linezolid prescriptions as irrational. Linezolid-induced thrombocytopenia is more common than previous studies, with a prevalence of 47.9%. We found a significant relationship between thrombocytopenia and the concomitant use of aspirin. The duration of treatment was identified as predicting factor for linezolid-induced thrombocytopenia. Moreover, the prevalence of interactions in the X and D categories was determined. Serotonergic and catecholamine medications were associated with 56.1% and 47.7% medication interactions, respectively. Our study found a high prevalence of linezolid-induced thrombocytopenia among patients with cardiovascular diseases. Based on this study, physicians should focus more closely on prescribing linezolid to patients with cardiovascular diseases. In addition to following rational antibiotic use, this susceptible group is also at an elevated risk of side effects (thrombocytopenia) and medication interactions.

Objective: According to the importance of evaluating the antimicrobial resistance pattern in the management of nosocomial infections (NIs), we decided to investigate the prevalence of antimicrobial resistance in Chamran Heart Hospital. Methods: This retrospective cross-sectional observational study was performed for 6 months from February to July 2022 at Shahid Chamran Hospital of Isfahan, Iran. All hospitalized patients with any NIs were eligible for the study. Clinical specimens were obtained from patients with NIs. All specimens underwent microbial culture, and if bacterial growth developed, differential tests were performed. Antibiotic susceptibility testing also was performed per the standards of Clinical and Laboratory Standards Institute, 2022. Findings: Out of 201 examined samples, urinary infection (34.83%), pneumonia (27.86%), and sepsis (13.43%) were reported to be the most prevalent infections. Among Gram-negatives (76.12%), Citrobacter spp. (26.37%), Escherichia coli (24.87%), and Klebsiella spp. (11.44%) were the most common pathogens. About 54.9% of Citrobacter spp., 33.3% of E. coli, and 45.45% of Klebsiella spp. were resistant to carbapenems. About 1.88% and 15% of Citrobacter spp. were identified as pan-drug-resistant bacteria and extensively drug-resistant (XDR), respectively. In addition, 4.34% of Klebsiella spp. were identified as XDR. Among Gram-positives (23.88%), Enterococcus spp. (8.95%) was identified as the most common pathogen, and the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) was 11.11% and 61.11%, respectively. Conclusion: In our study, carbapenem-resistant Enterobacteriaceae accounts for about 50% of all NIs. Moreover, despite the low prevalence of MRSA, VRE was reported to be high in our center when compared with other studies.

Abstract Delafossite semiconductors have attracted substantial attention in the field of electro-optics owing to their unique properties and availability of p-type materials that are applicable for solar cells, photocatalysts, photodetectors (PDs) and p-type transparent conductive oxides (TCOs). The CuGaO2 (CGO), as one of the most promising p-type delafossite materials, has appealing electrical and optical properties. In this work, we are able to synthesize CGO with different phases by adopting solid-state reaction route using sputtering followed by heat treatment at different temperatures. By examining the structural properties of CGO thin films, we found that the pure delafossite phase appears at the annealing temperature of 900 °C. While at lower temperatures, delafossite phase can be observed, but along with spinel phase. Furthermore, their structural and physical characterizations indicate an improvement of material-quality at temperatures higher than 600 °C. Thereafter, we fabricated a CGO-based ultraviolet-PD (UV-PD) with a metal–semiconductor-metal (MSM) configuration which exhibits a remarkable performance compared to the other CGO-based UV-PDs and have also investigated the effect of metal contacts on the device performance. We demonstrate that UV-PD with the employment of Cu as the electrical contact shows a Schottky behavior with a responsivity of 29 mA/W with a short response time of 1.8 and 5.9 s for rise and decay times, respectively. In contrast, the UV-PD with Ag electrode has shown an improved responsivity of about 85 mA/W with a slower rise/decay time of 12.2/12.8 s. Our work sheds light on the development of p-type delafossite semiconductor for possible optoelectronics application of the future.

Introduction The phenomenon of climate change and global warming is one of the biggest challenges of the present age, which has affected the hydrological cycle on a global and regional scale. The purpose of this study is to investigate the effects of climate change on torrential rains And Temprature, Rainfall, Run off in Tehran province. In this study, changes in torrential rainfall in Tehran and the frequency and intensity of torrential rainfall in the future and climate change and the rate of increase of floods on periodic floods have been investigated.Materials and Methods This research has been done in two study discussions (meteorological, hydrological). First, parameters (temperature and precipitation) for synoptic stations (Abali, Shemiran, Mehrabad) for the period (1988-2020) were received from the Meteorological Organization and rainfall and runoff data from hydrometric stations were received from the Tehran Regional Water Authority. Down Scaling model and methods in this research SDSM-DC, Mann-Kendall, Rclimdex, XLSTAT, to simulate future floods and SMADA, HEC-HMS model to simulate floods in current and future periods have been used.Results and Discussion The results showed that the temperature extreme indices in all stations had an increasing trend and the precipitation indices had an increasing trend only in Abali station. But rainfall in Shemiran and Mehrabad stations had a decreasing trend. Examination of rainfall changes using Mann-Kendall test in most months of the year shows a stable trend and jumps are observed in the rainy months, which can be justified by the increase in rainfall frequency. In the CanESM Model 2 simulation, emphasizing the RCP8.5 release scenario, an increasing temperature trend was observed for the coming decades. The highest temperature increase belongs to Mehrabad station with an average temperature increase of 5.1 percent for the period 2021-2083. The highest rainfall for all three stations is estimated in March next year. Therefore, with the increase of temperature trend, changes in the type of precipitation have occurred, which can be affected by urban microclimate. Simulation of the rainfall-runoff model of the basin with the HEC-HMS model showed that the volume of discharge in the future will be reduced by 5 percent and for return periods, the maximum discharge is estimated at 1501.7 cubic meters.Conclusion Due to Rainfall behavior is expected to increase in the coming decades, while reducing its fluctuations. It is predicted that the climate of Tehran in the future will have more fluctuations in precipitation and warmer than the current situation, and this increase and frequency of precipitation is likely to increase flood frequency and reinforce its occurrence, while rainfall will occur more accidentally but with greater intensity, leading to environmental and urban hazards.

Introduction: In this study, we aimed to elucidate the crosstalk between the Wnt/β-catenin signaling pathway and colorectal cancer (CRC) associated with inflammatory bowel disease (IBD) using a bioinformatics analysis of putative common biomarkers and a systems biology approach. Materials and methods: The following criteria were used to search the GEO and ArrayExpress databases for terms related to CRC and IBD: 1. The dataset containing the transcriptomic data, and 2. Untreated samples by medications or drugs. A total of 42 datasets were selected for additional analysis. The GEO2R identified the differentially expressed genes. The genes involved in the Wnt signaling pathway were extracted from the KEGG database. Enrichment analysis and miRNA target prediction were conducted through the ToppGene online tool. Results: In CRC datasets, there were 1168 up- and 998 down-regulated probes, whereas, in IBD datasets, there were 256 up- and 200 down-regulated probes. There were 65 upregulated and 57 downregulated genes shared by CRC and IBD. According to KEGG, there were 166 genes in the Wnt pathway. FriZZled5 (FZD5) was a down-regulated gene in both CRC and IBD, as determined by the intersection of CRC- and IBD-related DEGs with the Wnt pathway. It was also demonstrated that miR-191, miR-885-5p, miR-378a-3p, and miR-396-3p affect the FriZZled5 gene expression. Conclusion: It is possible that increased expression of miR-191 and miR-885-5p, or decreased expression of miR-378a -3p and miR396-3, in IBD and CRC results in decreased expression of the FZD5 gene. Based on the function of this gene, FZD5 may be a potential therapeutic target in IBD that progresses to CRC.

Alternative Legendre polynomials (ALPs) are used for approximating the solution of nonlinear Volterra-Fredholm integral equations (VFIEs) of the rst kind. The problem is rst transformed into a second kind VFIE and then, using the ALP operational matrices of integration and the product, the solution of the later problem is reduced to the one of solving a system of nonlinear algebraic equations with unknown ALP coecients of the exact solution. An error analysis of the method is given. Results of numerical examples are presented, which illustrate that the proposed method achieve good accuracy even using a small number of ALPs. ./files/site1/files/%D8%A8%D8%B2%D9%85.pdf

Introduction: Defamiliarization or foreignization is a formalist concept that influences common and familiar scenes and presents them in new ways and different from everyday realities. According to Shklovsky, the concept implies that foreignizing whatever is familiar and habitual. Walking, for example, is a regular act but dance is changing and tangible act. We often inhale air automatically; the same is true of language, it is the middle ground in which we move. But, when the air is suddenly polluted or accompanied by dust, our attention is drawn to our breathing, and it may affect our physical life as a profound experience. Formalists believe that art changes our habits and whatever is about us and makes the strange. Art and literature are supposed to discover things for the second time. Formalists believe that art and literature should arouse astonishment and unfamiliarity in audience and make them feel a strange feeling. According to them, artists try to move things far away from their regular context and create unexpected features. Therefore, defamiliarization or foreignization seeks to break the habits, but it is based on reality. Shafiei Kadkani believes that there is no limitation for defamiliarization, and every kind of innovation in art is a sort of defamiliarization. It is worth mentioning that all tactics for making arts are universal and common among cultures and the result of human being’s creativity. Writing, especially creating novels, is among the arts that work based on defamiliarizatin. Novelists put aside familiar methods of narrating stories to present their idea in a special and personal way because that would result in innovation in writing and make the readership feel close to the writer, the exact thing that formalism emphasizes. The novelist has the ability to present an exact image of life artistically. This happens when he uses a set of strategies such as defamiliarization or foreignization for writing a new, unfamiliar and irregular novel. He continuously tries to makes novelties even when his works are different in terms of literary type (anecdote, short story, and novel). It can be said that he stands against real perceptions, and this resistance results in new writings. Therefore, he presents a story with unusual and unfamiliar issues that seem to be the basics. The basics are in such a way that would prevent the author from going far away from the events and characters. Shkolvsky explains the theory that a bond is made between us and all the things around us, something that becomes internalized in wisdom. In this way, the things unconsciously become new, and the new idea becomes a habit. The role of literariness here is making us conscious again. This is done through what shekovsky calls it defamiliarization/foreignization, which is breaking the bonds between things and us. Shkolvsky explains the theory that a bond is made between us and all the things around us, which becomes internalized in wisdom. In this way, the things unconsciously become new and the new idea becomes a habit. The role of literariness here is making us conscious again. This is done through what Shkolvsky calls it defamiliarization/foreignization, which is breaking the bonds between things and us. Regarding the subject and using the theory as a framework, his study sought to explore the effect of defamilirazation, as a formalist technique, on the title, characters, time, events, theme, style, language of the novel ‘The Thief and the Dogs’.( اللّصّ والکلاب) Objective: The study aimed to explore the criticism concept of defamiliaraization and its effect on novel and literary works. Regarding the objective, the novel ‘The Thief and the Dogs’ was selected as it was identified to be an appropriate one. Method and Results: This is a descriptive-analytical study showing that the novel ‘The Thief and the Dogs’ is a mystery in which defamiliarization is visible and the technique makes the novel strange. The mysterious features of the novel make it strange and different from what one may encounter in daily life. Conclusion: The followings were concluded through exploring the examples of defamiliarization in ‘The Thief and the Dogs’: 1. Defamiliarization occurs in this novel when paradox, irony and symbols become dominant. The symbols are full of ironies, and the term Kalab (thief) has two visible and hidden meanings, but the writer meant the second one which means “treacherous”. The audience understands the symbol and the breach of semantic norms that makes the text defamiliarized. 2. When looked from formalism point of view, symbols and messages that are in different aspects of Egypt community, religion and woman, make the novel defamiliarized. 3. The paradox of characters makes the readership familiar with unusual concepts. 4. Expected and unexpected events create a paradox and result in a defamiliarized language of the novel.

Abstract Background Cyclophosphamide (CP) is an anti-neoplastic alkylating agent that is extensively used in different chemotherapy regimens. Adverse effects on the reproductive system, especially spermatogenesis, are one of the most important side effects of this drug. It is medically essential to use complementary and alternative drugs. Herbal drugs have long been used as a complementary treatment. Our purpose was to study the effect of hydroalcoholic Allium atroviolaceum L. extract on spermatogenesis in CP-treated mice. Results CP affected a significant decrease in sperm count, motility, viability, and morphology. Sperm count was significantly higher in the all extract groups than in the group of control (p

Abstract Rescue robots are expected to carry out reconnaissance and dexterity operations in unknown environments comprising unstructured obstacles. Although a wide variety of designs and implementations have been presented within the field of rescue robotics, embedding all mobility, dexterity, and reconnaissance capabilities in a single robot remains a challenging problem. This paper explains the design and implementation of Karo, a mobile robot that exhibits a high degree of mobility at the side of maintaining required dexterity and exploration capabilities for urban search and rescue (USAR) missions. We first elicit the system requirements of a standard rescue robot from the frameworks of Rescue Robot League (RRL) of RoboCup and then, propose the conceptual design of Karo by drafting a locomotion and manipulation system. Considering that, this work presents comprehensive design processes along with detail mechanical design of the robot’s platform and its 7-DOF manipulator. Further, we present the design and implementation of the command and control system by discussing the robot’s power system, sensors, and hardware systems. In conjunction with this, we elucidate the way that Karo’s software system and human–robot interface are implemented and employed. Furthermore, we undertake extensive evaluations of Karo’s field performance to investigate whether the principal objective of this work has been satisfied. We demonstrate that Karo has effectively accomplished assigned standardized rescue operations by evaluating all aspects of its capabilities in both RRL’s test suites and training suites of a fire department. Finally, the comprehensiveness of Karo’s capabilities has been verified by drawing quantitative comparisons between Karo’s performance and other leading robots participating in RRL.

BACKGROUND: Cardioplegia is one of the main post-operative cardiac protective factors widely used in recent decades in the form of crystalloid (St. Thomas) and bloody solutions [del Nido (DN)]. The purpose of this study was to compare the effect of a crystalloid cardioplegic agent (St. Thomas) with that of a bloody cardioplegic agent (DN) in pediatric cardiac surgery among children with Tetralogy of Fallot (TOF).METHODS: This study was performed on 60 children with TOF, who were candidates for heart repair surgery. The participants were randomly divided into two groups of crystalloid cardioplegic agent and bloody cardioplegic agent. Operative outcomes such as required time for onset of heart arrest, duration of returning to normal heart rhythm, and cardiopulmonary bypass (CPB) time, and operative complications were compared between the two groups.RESULTS: The duration of returning to normal heart rhythm (50.43 ± 10.93 seconds vs. 43.03 ± 16.35 seconds; P = 0.044) and duration of inotropy (80.40 ± 27.14 hours vs. 63.20 ± 26.91 hours; P = 0.017) were significantly higher in the DN group compared to the St. Thomas group. However, there were no significant differences between the two groups in terms of heart arrest time, cross-clamp time, CPB time, supplementary lasix‎ time, duration of intubation, and intensive care unit (ICU) and hospital length of stay (LOS) (P > 0.050).CONCLUSION: The use of St. Thomas cardioplegic solution was more effective in reducing the duration of returning to normal heart rhythm and inotropy compared with DN cardioplegic agent, and a single dose of these two cardioplegic agents can keep the mean cardiac arrest duration within the range of 50-70 minutes. It seems that the use of St. Thomas cardioplegic solution can be suggested in pediatric heart surgery.

Despite the prevalence of hydatid cyst in humans, its occurrence in the heart is rare. The clinical signs of the mentioned cyst in the heart are diverse, which makes its diagnosis challenging. In addition, the cardiac hydatidosis is diagnosed late as this disease progresses gradually. In this report, the cases discussed of a case with intraventricular cardiac hydatid cyst with coronary artery disease and multiple hepatic hydatid cysts. After diagnosis, the patient underwent coronary artery bypass graft surgery, and the cyst was successfully removed. Considering the probability of heart involvement in endemic regions, devoting due attention to the disease as well as performing faster diagnosis of the disease can play a significant role in reducing its complications.

Background: Femoral neck fracture is a common posttraumatic injury in the elderly. Currently, orthopedic surgeons conducting total hip arthroplasty (THA) for hip fractures have various prosthetic alternatives. Dual-mobility cup THA is recommended for hip fracture patients to reduce prosthesis dislocation. Therefore, the goal of this research is to evaluate the effectiveness of conventional prostheses against dual-mobility prostheses in treating femoral neck fractures in two groups of patients. Materials and Methods: The current clinical investigation involved patients with femoral neck fractures. Among approved 84 patients, 44 and 40 were undergoing conventional THA (group A) and dual-mobility THA (group B), respectively. Patients were observed regularly after surgeries, and the same measurements were performed. The data were assembled and entered into SPSS software (version 25, IBM Corporation, Armonk, NY, USA) and analyzed. In all analyses, a P value of less than 0.05 was considered significant. Results: Eighty-four cases with an average age of 63.97 years were evaluated. In postoperative follow-up, there were no statistically significant differences between the groups in terms of Harris hip score, SF-36, and infection (P > 0.05). However, patients who received conventional implants had more dislocation postoperatively (P = 0.045). Regarding the rehabilitation costs, there were no statistically significant differences between the groups, so the group using the conventional implants incurred a higher cost (P = 0.041). Conclusion: According to the results, both dual mobility and conventional implants had optimal functional outcomes in patients with femoral neck fractures.

‎In this paper we consider variational iteration method to investigate solution of Kuramoto-Sivashinsky equations‎. ‎Comparison of the results of this method obtained just in 2-iterations with RBF based mesh‎ -‎free method and local continuous Galerkin methods‎, ‎shows the efficiency of this method‎. ‎Numerical experiments are‎ ‎included to show the efficiency of this method‎.

Introduction Size and strength of skeletal muscles are reduced during aging. It seems research on potential interventions that can reduce the loss of function is very important. Therefore, the purpose of this study was to investigate the effect of eight weeks of combined exercise with and without blood flow restriction on serum levels of myostatin, folinolatin and IGF-1 in the elderly women. Materials and Methods 40 older women with ranging from 55-70 years were randomly divided into four groups, 1) combined exercises with a blood flow restriction, 2) low intensity exercise without blood flow restriction, 3) combined exercise with high intensity without blood flow restriction and 4) control group. The Training program included resistance and aerobic training in eight weeks (three sessions per week). Serum levels of myostatin, follistatin and IGF-1 were measured before and after the training period. One-way repeated-measures ANOVA was used to assess the effect of training protocols. The significance level was set at P 0.05). Conclusion The use of combined exercise with vascular occlusion in elderly women leads to positive effects of anabolic agents in preventing muscle atrophy. It is recommended that combined exercise includes in the training program for elderly women.

New communication technologies with the potential to create change in social communication, has become the most important element of social change in the modern age. Social media has been able to create virtual social networks consisting of different users, users with their activities networks, can legally reproduce social action. The purpose of this study is to investigate those actions that contain socially violent themes, and therefore the purpose of about 3,000 socially violent tweets published over a period of one year, the second half of 1998 and the first half of 1999 on the network Twitter social was achieved through contact, content analysis, and the goals and motivations for republishing users' virtual social violence. The purpose of republishing their social protests is to examine 9 general themes. Users publish their social protests on topics that include violence against the constitution, the guardianship of the constitution, officials and managers of the Islamic Republic, the manner of administering justice, public media activities, religiosity, virtual actions in Virtual social networks and finally reading the position of women in society and the demands of women.

Pile buckling is infrequent, but sometimes it can occur in slender piles (i.e., micropiles) driven into soils with soft layers and/or voids. Buckling analysis of piles becomes more complex if the pile is surrounded by multi-layered soil. In this case, the well-known Timoshenko’s solution for pile buckling is of no use because it refers to single-layered soils. A variational approach for buckling analysis of piles in multi-layered soils is herein proposed. The proposed method allows for the estimation of the critical buckling load of piles in any multi-layered soil and for any boundary condition, provided that the distribution of the soil coefficient of the subgrade reaction is available. An eigenvalue-eigenvector problem is defined, where each eigenvector is the set of coefficients of a Fourier series describing the second-order displaced shape of the pile, and the related buckling load is the eigenvalue, thus obtaining the effective buckling load as the minimum eigenvalue. Besides the pile deformed shape, the stiffness distribution in the multi-layered soil is also described through a Fourier series. The Rayleigh–Ritz direct method is used to identify the Fourier development coefficients describing the pile deformation. For validation, buckling analysis results were compared with those obtained from an experimental test and a finite element analysis available in the literature, which confirmed this method’s reliability.

Background: In laparoscopy of colorectal tumors, titanium clips are used to close the surgery site. For post-operation treatment with radiation, the clips might change the dose distribution. In this study, the effect of titanium clips in isodose distribution of 6- and 18-MV photons was evaluated. Methods: Laparoscopy clips were placed on a phantom with material close to soft tissue. Computed tomography (CT) scan images of this phantom were imported in planning software and the percentage depth dose (PDD) and profiles of the dose were obtained for 6- and 18-MV photons. Findings: Calculated PDD showed weakening and backscattering of the dose of radiation in the path after the clips. Dose changes for the regions after the clips had a maximum of 1.7% and 1.1% for 6- and 8-MV photons, respectively. The amount of backscattering was up to 0.4% and 0.7% for 6- and 18-MV photons, respectively. Conclusion: Presence of the titanium clips in the path of radiation changes the depth dose and profiles. The changes for of a single clip are minor. However, for few clips beside each other, the effect of radiation attenuation is not negligible.

Whenever and for any reason the velocity of the fluid ceases in the transfer line or water distribution networks, pressure waves will form in the pipe lines, which can produce a pressure several times more than a pressure pump’s output and lead to a great deal of tension on network’s components, which in turn will cause the water hammer phenomenon. Today, in every water transfer project, a detailed study on the water hammer phenomenon is essential, so that with a full recognition of this process’s adverse effects, the adequate measures would be taken to deal with it.This study uses Water Hammer V8i software to analyze the water hammer of Mehran city’s border terminal water conveyance pipe. The study was executed in 3 phases of simulation with protective equipment, without the protective equipment and with consultant’s recommended equipment. The results indicate that in the phase without the protective equipment, a great deal of negative pressure builds up along the water conveyance pipe line that needs to be controlled. In the next step, various combinations of Hydropneumatic tank and air valves were suggested. The results of several simulations showed that a 2 square meter Hydropneumatic tank and 3 fifty millimeter air valves will be capable of controlling the negative pressure along the pipe line.

This work investigates the effect of different inventory policies of a supply chain model using the system dynamics approach which belongs to the class of Vendor Managed Inventory (VMI), automatic pipeline, inventory and order based production control systems (VMI-APIOBPCS). This work helps management to investigate the effect of different policies such as adding the VMI system or third party logistic (TPL) on the whole cost of the supply chain. To this end, this work applies system dynamics in supply chain with two supplier and one retail channel which consists of VMI system. Moreover, this work studies the performance of the proposed model via three metrics: Bullwhip effect; satisfaction of the end-customer; the amount of the whole inventory of chain.

An amendment to this paper has been published and can be accessed via the original article.

Promoting positive attitude towards an innovation and having it accepted by people is the goal of any innovator. In the recent years Iranian national TV has tried to attract more audience in competition with other media by digitizing its channels and improving the quality of its programs. This research aims to explore the attitude of the people of Nurabad in the province of Lorestan towards digitization of Iranian TV channels and the increase in their number. Regarding the innovational improvement of Iranian TV we tried to answer the following questions: do the benefits coming with an innovation explain people’s attitude toward that innovation? Is this attitude affected by their personal traits? We used survey research as the methodology and using Cochran’s method we found 384 people as a representative sample of all adults living in the city who are over 15 years old. Our sampling method was integrative and synthetic and the sample was chosen by quota multistage sampling. For data gathering we used a questionnaire made by the researcher. A number of professors and scholars confirmed the validity of the questionnaire and its reliability was confirmed by Cronbach's (alpha) which resulted 0.74. Descriptive results of the research show that 67.8 percent of the audiences had a positive attitude towards digitization of the network and their increased number. Analytical results of the research indicate that there were significant relations between the attitude of the audiences toward an innovation and their level of religiousness, their liking of the Islamic Republic, credibility of the Iranian national TV in their minds, the success of the local TV programs, their level of knowledge, advantageousness of the innovation, the experience of previous use of the innovation, the visibility of the results of using the innovation. There were no significant relations between factors such as age, gender, level of education, and socio-economic class of the respondent and also their access to the satellite channels. Regression analysis showed that 46 percent of the changes of the dependent variable can be explained by the independent variables.

Complications of hiatal hernia are potentially lethal, and surgical intervention is necessary. This matter is more important in cases that have ambiguous symptoms and are diagnosed with a delay. Such patients may experience life-threatening course and events. Accordingly, in this report, a 23-year-old male patient with unusual findings is presented. A 23-year-old male patient with acute dyspnea and fever was admitted in infectious disease ward with diagnosis of empyema according to chest radiography and CT-scan findings (Figures 1 and 2). On physical examinations the right lung sounds were normal, and the left lung sounds could not be heard. Then a gastrography was performed because of suspicion to hiatal hernia based on physical examination findings showing the presence of stomach in the thorax (Figure 3). In the surgery, the stomach and the transverse colon were released and reputed in the abdomen (Figure 4). The diaphragm was primarily repaired due to small defect, and the patient was discharged after 4-5 days with good general conditions. This case had a learning note that in the case of acute dyspnea with a positive history of stab wound to the chest, hiatal hernia should be considered as an important diagnosis and in these cases performing a gastrography would help physicians to make true and certain diagnosis and therapeutic decision.

Background: Ciclesonide is a lung-activated inhaled corticosteroid that provides effective control of persistent asthma. This study aimed to evaluate the safety and effectiveness of this drug compared to commonly used drugs including fluticasone, budesonide or beclomethasone. Methods: The major medical electronic databases including Scopus, Web of Science, CINHAL, Cochrane Library and PubMed were searched in November 2012. Findings: 567 articles were found. After exclusion of duplicates and irrelevant articles, 11 randomized controlled trials (RCTs) and 5 systematic reviews were included. No significant difference was found between ciclesonide (CIC) with fluticasone propionate (FP), budesonide (BUD) and beclomethasone dipropionate (BDP) in lung function [forced expiratory volume in 1 second (FEV1) and am and pm peak expiratory flow (PEF)], asthma symptoms score, using rescue medicine and asthma exacerbation requiring use of systemic steroids. In addition, no significant difference was found in adverse events such as pharyngitis, rhinitis, upper respiratory infection, and withdrawal from the study due to adverse events or lack of efficacy. The quality of life score favored ciclesonide versus fluticasone. Candidiasis was less frequent with ciclesonide versus fluticasone. Change in the morning PEF between ciclesonide and beclomethasone dipropionate/budesonide was not clinically significant. Conclusion: Ciclesonide and budesonide and beclomethasone gave similar results in safety and effectiveness. Ciclesonide improved the quality of life and reduced the oral candidacies compared to fluticasone. There was limited evidence when comparing ciclesonide with beclometasone.

Root system is effective on increase soil shear strength. This study investigates the root system of Tamarix trees on slope of riverbanks. Five trees (from TAMARIX species) which grow on the river beech were selected in a distance about one km on SAIMEREHRiver in IlamProvince. Circle profile trenching method was employed to obtain characteristics. Results show that the number of roots on upslope is about 22 percent more than downslope. For all diameters, the number of roots in upslope is more than downslope. The average of root diameters on downslope is bigger than upslope. Total root area on upslope is about 27.6 percent more than downslope. It is concluded that root system on riverbank is unsymmetrical and slope has effect on the root system. The number of roots and root area on upslope was more than downslope.

Background: Hypermobile joints are joints with beyond normal range of motion and may be associated with joint derangements. This study aimed to evaluate the prevalence of benign joint hypermobility syndrome (BJHS) among soldiers and effect of training courses on related joint instabilities. Materials and Methods: In a prospective cohort study on 721 soldiers of Iran Army in Isfahan in 2013 the prevalence of joint hypermobility was obtained by using Beighton criteria. Soldiers divided in two groups of healthy and suffered based on their scores. The prevalence of ankle sprain, shoulder and temporomandibular joint (TMJ) dislocations identified before beginning service by history-taking and reviewing paraclinical documents. After 3 months of military training, a recent occurrence of mentioned diseases was revaluated in two groups. The collected data were analyzed using SPSS-20 software using Independent-T and Chi-square tests. Results: The frequency of BJHS before military training was 29.4%. After passing military training period, the incidence of ankle sprain was significantly higher in suffered group achieving the minimum Beighton score (BS) of 4 (4.3%, P = 0.03), 5 (5.5%, P = 0.005) and also 6 out of 9 (6.5%, P = 0.01). The incidence of TMJ dislocation was not significantly different based on a minimum score of 4, while it was higher in suffered group when considering the score of 5 (2.1%) and 6 (2.6%) for discrimination of two groups (P = 0.03). There was no significant difference between two groups in case of shoulder dislocation anyway. Conclusion: Military training can increase the incidence of ankle sprains and TMJ dislocations in hypermobility persons with higher BS in comparison with healthy people. Therefore, screening of joint hypermobility may be useful in identifying individuals at increased risk for joint instabilities.

Background: Floating knee, referred to as ipsilateral fractures of the femur and tibia, is usually associated with several complications and mortality. This study was designed to present our experience with treatment of this injury throughout; age, sex, mechanism of injury, associated injuries, method and results of treatment, and complications of floating knee are discussed. Materials and Methods: This retrospective study was performed between January 2006 and December 2011. All patients with floating knee injuries who were admitted to the referral educational hospitals were included. The information about the 238 cases of floating knee injuries were gathered through the 254,620 trauma files and after excluding 18 patients who died within 6 months, the remaining files were studied and the target information was recorded. Results: The most frequent age group was 20-29 years (44.5%). The floating knee injuries were more common in males (85.5%). Type (D) according to "the classification of Letts and Vincent" was observed in 38.9% cases. The most frequent mechanism of injury was car to motorcycles accidents (48.2%). The most common associated injury was pelvic fractures (86.8%). Open reduction and internal fixation was the common type of treatment (70%). The most common early and late complications were knee hemarthrosis in 31 cases (14%) and knee osteoarthritis in 30 cases (13.6%), respectively. Death during the 5 years follow up was due to circulatory disruption, followed by deep vein thrombosis (61%). There was a significant relation between the age and outcomes as it worsens with age (P-value < 0.05). Conclusion: This study revealed that the complication rate associated with floating knee injuries remained high, regardless of the used treatment regimen and surgeons should focus on reducing complications while treating it.

Introduction: In recent years use of self-etch primers has been suggested for fissure sealant therapy due to ease of procedural steps. The aim of this in vitro study was to investigate fissure sealant microleakage in permanent teeth with the acid-etch technique, using one-step and two-step self-etch systems.Materials and Methods: A total of 45 sound premolars were selected. Then the occlusal grooves were freshened by the tip of a #1/4 round bur and divided into 3 groups with 15 samples in each group. In the first group after etching by 37% phosphoric acid, Clinpro sealant was applied on the grooves. In the second and third groups, Clearfil SE Bond two-step self-etch and AdheSe One all-in-one one-step self-etch bonding systems were used, respectively. The teeth were subjected to thermocycling for 1000 cycles at 5‒55ºC thermal range. Then the samples were immersed in 0.2% alkaline Fuchsin for 24 hours. After bucco-lingual cross-sectioning, dye penetration under the sealants was evaluated under a stereomicroscope. Data were analyzed by Kruskal‒Wallis and Mann–Whitney tests.Results: The results showed significant differences between the three groups (p value < 0.001). However, there was no significant difference between Clearfil SE Bond and acid-etch groups in microleakage (p value = 0.902). Significantly greater microleakage was observed in the AdheSe One group compared to other groups (p value < 0.0001).Conclusion: According to the results of this study, microleakage of fissure sealants with Clearfil SE Bond two-step self-etch adhesive was comparable to that of conventional etch-and-rinse technique. However, there was more microleakage with AdheSe One one-step self-etch adhesive compared to other two groups. Key words: Bonding, Dental microleakage, Phosphoric acid, Pit and fissure sealants

Importance-Performance Analysis (IPA) model is a simple and flexible tool to evaluate the organization’s strengths and weaknesses to implement the necessary resources in an appropriate manner. The primary objective of this research is to present an improved model for IPA (i.e. Importance-Performance-Simplicity Analysis) to assess the simplicity of improvement about each of the attributes lying in the matrix and to prioritize them in each quadrant for improvement. Since the attributes lying in quadrant 2 of IPA are very important for customers and, at the same time, has a low level of perceived performance, this paper suggests that management started improvement of these attributes according to the prioritization. In this model, the attributes are prioritized based on simplicity of changes for management while preserving its simplicity of use. For this purpose, Force Field Analysis (FFA) as a simple and effective tool is used for the IPA model. Finally, an example was presented in order to make the model clear.

Background: Along with increased age, learning and memory being two of the survival necessities decrease and may even deteriorate. This has motivated researches in the field of geriatric medicine to find new medicines effective on learning and memory amplification. Studies have shown that through advanced age, increased oxidative stressors lead to damaged brain processes including cognitive functions. Since types of red grape juice contain antioxidants, this study aimed to examine the effect of this material on passive avoidance memory in 1-year old rats. Methods: Twenty rats, each weighing about 270-330 g, were divided into two test and control groups. Both groups with no limitation had access to water vessel. In the control group, the water container contained pure water and in the test group it contained 80% pure water along with 20% grape juice. To prevent modification of ingredients, vessels contents were regularly refreshed. The passive avoidance memory and learning test was done in the learning device following intending treatments for all groups and in similar conditions. In this test, increased time delay for the first time of entry to the dark chamber and sum of the remaining time in the lighted chamber as well as decreased remaining time in the dark chamber indicate improved passive avoidance memory. To data analysis, the Mann-Whitney test was employed. Findings: Compared with the control group, learning and passive avoidance memory indices had significantly increased in the test group. Conclusion: Our results show that drinking grape juice causes increased learning and passive avoidance indices in rats; probably the reason was existence of antioxidant substances in the grape juice. Key words: Red grape juice, Rat, Learning, Passive avoidance memory.

Background: Acute appendicitis is one of the most commonly diagnosed surgical diseases that its accurate diagnosis is still a problem, and there is no certainty. Ultrasound is recommended for diagnosis of appendicitis as an easy and noninvasive method. Therefore, due to the spread of disease and the urgent need to accurately diagnose in all educational centers, we decided to determine the diagnostic value of this inclusive method in identifying acute appendicitis. Materials and Methods: This is a descriptive cross-sectional research that was conducted on 540 patients referring to Educational Center of Ayatollah Kashani Hospital. All individuals suspected to appendicitis, and undergone ultrasound was included in the study, and then the result of ultrasound was compared to the obvious pathological results. Data were entered into statistical software of SPSS 20 and were analyzed. Results: According to the ultrasound findings, appendicitis was diagnosed as negative in 351 ones and positive in 189 ones. Ultrasound sensitivity in the diagnosis of appendicitis was 37.1%, while its specificity was 87.2%. The positive predictive value was 96.8% and the negative predictive value was only 11.7%. Conclusion: Considering very low-negative predictive value in educational centers, it is suggested that ultrasound is done for diagnosis of appendicitis only in complicated cases of appendicitis and differential diagnose (kidney stones, and ovarian cysts). In addition, it is recommended that routine ultrasound be avoided for all patients.

Background: There are many controversies about relationship between hernias and connective tissue disorders in children. The aim of this study was to determine the relationship of benign joint hypermobility syndrome (BHJS) with inguinal hernias in children. Methods: This descriptive analytical study involved children of 2-12 years old who were diagnosed with inguinal hernia during 2009-11. Subjects were admitted to pediatric or pediatric surgery wards of hospital affiliated with Isfahan University of Medical Sciences (Iran). Overall, 200 children in two groups of patients with inguinal hernias and controls were included. Beighton score was used for diagnosis of BHJS in the admitted children and the control group. For evaluation of collected data and the relationship of diseases, we used SPSS18 and chi-square test. Findings: The mean Beighton score was 6.2 ± 2.0 in the case and 2.7 ± 2.2 in the control group, i.e. children with inguinal hernias had significantly higher Beighton scores (P < 0.001). Conclusion: Based on this study, BHJS is prevalent in children with inguinal hernias. Therefore, in every patient with inguinal hernias, the presence of concomitant BHJS should also be considered. Keywords: Pediatric inguinal hernia, Childhood hernia, Joint hypermobility syndrome

Background: Varicose veins are extremely common disease which is due to elevated superficial venous pressures. We aimed to know that if joint hypermobility causes the venous insufficiency following the prolonged standing. Materials and Methods: This prospective cohort study conducted on the soldiers of training periods in a military base of Iran Army in Isfahan in 2013. The active-duty soldiers were first examined by a physician and their Beighton scores (BSs) were obtained. At the onset of the training period, the presence of chronic venous insufficiency was clinically evaluated according to the C class of clinical, etiological, anatomical, and pathological classification. After 3 months, soldiers with and without joint hypermobility were reexamined for manifestations of venous insufficiency based on clinical examination. Results: Of 718 soldiers, 211 subjects were diagnosed for joint hypermobility syndrome (29.3%). The mean BS was significantly higher in hypermobility soldiers (5.5 ± 1.5) than the healthy ones (1.2 ± 1.1). Before the training period, the prevalence of spider and varicose veins in soldiers with joint hypermobility was significantly higher than healthy subjects (P > 0.001). After the training period, the prevalence of venous insufficiency significantly increased in soldiers with joint hypermobility (P > 0.001) while there was no significant difference in healthy group before and after the period of training (P = 0.25). Conclusion: Hypermobility could be considered as a risk factor for the development of venous insufficiency, so it seems necessary to evaluate the population who need to be standing for a long time for evidence of joint hypermobility.

Background: The aim of this study is to evaluate the possible effects of removing the peroneus longus on the ankle and gait parameters, in order to add insufficient hamstring tendons for anterior cruciate ligament (ACL) reconstruction. Materials and Methods: In this controlled clinical trial, 375 patients with ACL rupture who underwent ACL reconstruction arthroscopically using hamstring tendons in the orthopedic clinics of Isfahan University of Medical Sciences in 2010 and 2011 were selected. Fifteen patients were included because their hamstring tendon diameter was lower than 8 mm and peroneus longus was added. After 6 months, the patients were followed using "Kistler force plate" to detect 3D kinematics and kinetics of the ankles and spatiotemporal walking parameters. Results: There was a significant difference between both operated and non-operated ankles in flexion/extension range of motion (P < 0.05). There was no significant difference between the moments of both ankles in sagittal and coronal planes (P > 0.05), but there was a significant difference between the moments of both ankles in the transverse plane (P = 0.006). There was a significant difference in the force of operated and non-operated ankles in all three planes (P < 0.05). There was no significant difference in the mean values of spatiotemporal gait parameters between operated and non-operated sides (P > 0.05). Conclusion: Removing the peroneus longus tendon has no effect on gait parameters and does not lead to instability of the ankle. So, it can be used as an autogenous graft in orthopedic surgeries.

Background: There is conflict of interest in the treatment of intracapsular femoral neck fractures and the outcomes. The aim of this study was evaluation the treatment outcomes of closed and open reduction and internal fixation with screw in 18-50-year-old patients. Materials and Methods: This clinical randomized study was conducted in Ayatollah Kashani Center in Isfahan from Nov 2010 to Nov 2011. In 42 patients selected in a randomized manner, fractures were reduced by closed reduction or open if necessary and C-ARM was controlled in AP and lateral plans. Movement range and femur pain severity were evaluated according to Visual analogue Scale (VAS) score at 3 and 6 months after surgery. Data were analyzed by SPSS 18. Chi-square, t-test, one-way analysis of variance (ANOVA), and descriptive statistics such as frequency distribution, mean, and mean deviation were used. Results: Forty-two patients with femoral neck fracture were treated by open [31 patients (73.8%)] or closed reduction [11 patients (26.2%)] and also osteosynthesis. Their mean age was 47.3 ± 9.8 years; 29 of them were males and 13 were females. Twelve patients had bad range of motion (ROM) (28.6%), 16 had intermediate ROM (38%), and 14 had good ROM (33.4%). After 6 months, 12 patients (28.6%) had bad ROM, 10 (23.8%) had intermediate ROM, and 20 (47.6%) had good ROM. There were 11 cases of non-union (35.5%) in the open reduction group and 4 in the closed group. Conclusion: This study showed that femoral neck fracture is associated with several complications, especially if open reduction was necessary. So, the surgical method and necessary equipments such as radiolucent bed, C-ARM machine, and implant cannulated screw set should be considered.