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Background: Behavioral and Psychological Symptoms of Dementia (BPSD) are common during Alzheimer's disease and cause severe problems for patients and their caregivers. Objectives: To assess the therapeutic efficacy of Pregabalin in comparison with a placebo in treating BPSD in patients with Alzheimer's disease (AD) visiting the memory and cognition clinic of Roozbeh Psychiatric Hospital in Tehran, Iran. Methods: A 12-week double-blind, randomized comparison of Pregabalin and placebo treatments was conducted in 53 patients with DSM-V diagnosis of dementia of Alzheimer's type. They were randomly assigned to receive Pregabalin (doses: 50 titrated up to 300 mg/day) or a placebo. Clinical response was evaluated using the Neuropsychiatric Inventory (NPI), and the Behavioral Pathology in AD Rating Scale (BEHAVE-AD) scores compared with baseline. Side effects were also recorded carefully. Results: Patients receiving Pregabalin had better outcomes in comparison with patients receiving a placebo regarding both NPI and BEHAVE-AD scores after 12 weeks (p -value = 0.009 for NPI and p -value = 0.003 for BEHAVE-AD). There was also a statistically significant decrease in the treatment group depression sub-score regarding NPI and BEHAVE-AD (respectively, p -value =0.000, 0.003). The caregiver burden sub-score of the NPI test was also lower in patients receiving pregabalin (p -value = 0.000). There was no statistically significant difference between the occurrence of adverse effects between the two groups (p -value = 1.00). Conclusion: Pregabalin at a dose of 300 mg/day was well tolerated and associated with reductions in the severity and frequency of behavioral symptoms in patients with AD. Pregabalin could be considered a favorable choice for treating BPSD in adults with mild to moderate stages of Alzheimer 's-type dementia, considering its befitting safety profile. Clinical trial registration: https://www.irct.ir/trial/52750 , identifier IRCT20201201049553N1 [ABSTRACT FROM AUTHOR]

Dementia diagnosis often relies on expensive and invasive neuroimaging techniques that limit access to early screening. This study proposes an innovative approach for facilitating early dementia screening by estimating diffusion tensor imaging (DTI) measures using accessible lifestyle and brain imaging factors. Conventional DTI analysis, though effective, is often hindered by high costs and limited accessibility. To address this challenge, fuzzy subtractive clustering identified 14 influential variables from the Lifestyle for Brain Health and Brain Atrophy and Lesion Index frameworks, encompassing demographics, medical conditions, lifestyle factors, and structural brain markers. A multilayer perceptron (MLP) neural network was developed using these selected variables to predict fractional anisotropy (FA), a DTI metric reflecting white matter integrity and cognitive function. The MLP model achieved promising results, with a mean squared error of 0.000 878 on the test set for FA prediction, demonstrating its potential for accurate DTI estimation without costly neuroimaging techniques. The FA values in the dataset ranged from 0 to 1, with higher values indicating greater white matter integrity. Thus, a mean squared error of 0.000 878 suggests that the model's predictions were highly accurate compared to the observed FA values. This multifactorial approach aligns with the current understanding of dementia's complex etiology influenced by various biological, environmental, and lifestyle factors. By integrating readily available data into a predictive model, this method enables widespread, cost-effective screening for early dementia risk assessment. The proposed accessible screening tool could facilitate timely interventions, preventive strategies, and efficient resource allocation in public health programs, ultimately improving patient outcomes and caregiver burden. [ABSTRACT FROM AUTHOR]

With the increasing proportion of the elderly population, neurodegenerative diseases such as dementia are becoming more prevalent worldwide. Vascular risk factors are considered significant targets for cognitive decline prevention. We reviewed the effect of cardiovascular risk factors on cognitive decline prevention in the elderly to evaluate the quantity and quality of evidence in managing the elderly population with cognitive decline. Data analysis was available from 25 studies that explored the effects of controlling cardiovascular risk factors on the risk of cognitive impairment. These risk factors include diabetes mellitus, high blood pressure, high cholesterol levels, and exercise and physical activity. The most positive evidence was found for exercise and physical activity. On the other hand, diabetes mellitus and cholesterol modifications showed no positive impact on cognitive function. Studies on hypertension control were incongruous. There is a need for large-sample, robust randomized clinical trials to provide sufficient evidence for the modification of various cardiovascular risk factors in preventing cognitive decline. [ABSTRACT FROM AUTHOR]

Introduction: This study aimed to investigate the effects of combined remote music and exercise training on the cognitive, psychological, and physical function of patients with Alzheimer's disease (AD). Methods: Forty-one AD patients were randomly allocated to three groups, including control (C), training (T), and training with music (TM) groups. Participants were evaluated by cognitive and performance test batteries before and after the interventions. Both experimental groups performed 36 remote workouts in 3 months online via WhatsApp video call individually with the trainer. Training included simple and varied movements of all physical indicators. The number of sets began with two sets and progressively increased to one set every month, 5--10 repetitions per set. The overload was applied by reducing the break between sets every week. The TM group performed the same exercises while listening to Mozart and traditional Iranian songs. Results: We observed a significant main, group, time, and interaction effect on Romberg (ηp2:0.72), 30 s chair sit and stand (ηp2:0.75), and walking on steppe test (ηp2:0.63). Furthermore, there was a significant main time and interaction effect on push-ups (ηp2:0.43), sit and reach (ηp2:0.64), and MMSE (ηp2:0.76). In all variables, two experimental groups demonstrated substantial improvements than the C group (p < 0.01). In addition, the TM group (27.8%) showed a significant improvement compared to the C group (-6.4%) and the T group (12.2%) in MMSE. Conclusion: Combined remote training with listening to music as adjuvant treatment is an appropriate item to improve the cognitive and physical performance of Alzheimer's patients, especially during the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Background: Tongue Squamous Cell Carcinoma (TSCC) is one of the most consequential oral Squamous Cell Carcinomas (SCC) worldwide. Methods: This retrospective cross-sectional study was conducted on 29 TSCC patients treated with High Dose Rate Brachytherapy (HDR-BT) with or without External Beam Radiotherapy (EBRT) between 2017-2020. Patients without distant metastasis at the time of treatment and at least one year after completion of brachytherapy were included. Results: One-year Overall Survival (OS), Disease-Free Survival (DFS), and Local Control Rate (LCR) were 82.8, 79.3, and 100%, respectively. 6 patients (20.7%) had distant metastasis, of which 5 (17.2%) died. Local recurrence was not observed in any patients, and only one (3.4%) regional recurrence occurred. The most common late toxicity of HDR-BT was dry mouth (79.2%) and dysarthria (66.7%). There were no severe and life-threatening complications (grades 3 and 4) during one year. Also, 79.2% of the patients had good functional performance. One-year OS, the significant difference between the two groups of HDR-BT with and without EBRT (p=0.055). Conclusion: Our findings indicated that the HDR-BT increases the OS of TSCC patients more than EBRT without developing grade 3-4 AEs and metastasis. We showed that the mean 3.2 ±0.7 Gy of HDR-BT has more OS compared to EBRT. [ABSTRACT FROM AUTHOR]

Background: Alzheimer disease (AD) is a neurological disorder with brain network dysfunction. Investigation of the brain network functional connectivity (FC) alterations using resting‐state functional MRI (rs‐fMRI) can provide valuable information about the brain network pattern in early AD diagnosis. Purpose: To quantitatively assess FC patterns of resting‐state brain networks and graph theory metrics (GTMs) to identify potential features for differentiation of amnestic mild cognitive impairment (aMCI) and late‐onset AD from normal. Study Type: Prospective. Subjects: A total of 14 normal, 16 aMCI, and 13 late‐onset AD. Field Strength/Sequence: A 3.0 T; rs‐fMRI: single‐shot 2D‐EPI and T1‐weighted structure: MPRAGE. Assessment: By applying bivariate correlation coefficient and Fisher transformation on the time series of predefined ROIs' pairs, correlation coefficient matrixes and ROI‐to‐ROI connectivity (RRC) were extracted. By thresholding the RRC matrix (with a threshold of 0.15), a graph adjacency matrix was created to compute GTMs. Statistical Tests: Region of interest (ROI)‐based analysis: parametric multivariable statistical analysis (PMSA) with a false discovery rate using (FDR)‐corrected P < 0.05 cluster‐level threshold together with posthoc uncorrected P < 0.05 connection‐level threshold. Graph‐theory analysis (GTA): P‐FDR‐corrected < 0.05. One‐way ANOVA and Chi‐square tests were used to compare clinical characteristics. Results: PMSA differentiated AD from normal, with a significant decrease in FC of default mode, salience, dorsal attention, frontoparietal, language, visual, and cerebellar networks. Furthermore, significant increase in overall FC of visual and language networks was observed in aMCI compared to normal. GTA revealed a significant decrease in global‐efficiency (28.05 < 45), local‐efficiency (22.98 < 24.05), and betweenness‐centrality (14.60 < 17.39) for AD against normal. Moreover, a significant increase in local‐efficiency (33.46 > 24.05) and clustering‐coefficient (25 > 20.18) were found in aMCI compared to normal. Data Conclusion: This study demonstrated resting‐state FC potential as an indicator to differentiate AD, aMCI, and normal. GTA revealed brain integration and breakdown by providing concise and comprehensible statistics. Evidence Level: 1 Technical Efficacy: Stage 2 [ABSTRACT FROM AUTHOR]

Aim: To test if opium tincture (OT) was non‐inferior to methadone in retaining participants in opioid agonist treatment (OAT). Design: A Phase III, multi‐centre, parallel‐group, non‐inferiority, double‐blind randomized controlled trial with an allocation ratio of 1:1. Participants were provided treatment and followed for a period of 85 days. Setting: Four OAT clinics in Iran. Participants: Two hundred and four participants with opioid use disorder [mean age (standard deviation) = 37.4 (9.3); female 11.3%] recruited between July 2017 and January 2018. Interventions: Participants were assigned to either OT (102) or methadone (102) using a patient‐centred flexible dosing strategy. Measurements Treatment retention over 85 days was the primary outcome. Self‐reported opioid use outside treatment and occurrence of adverse events (AEs) were the secondary outcomes. Findings Remaining in treatment at the end of the follow‐up were 68.6% in the methadone arm and 59.8% in the OT arm. The relative retention rate of methadone to OT was 1.15 (0.97, 1.36) in both intent‐to‐treat and per‐protocol analyses; non‐inferiority was not supported statistically, as the upper bound of the confidence interval exceeded our pre‐specified non‐inferiority margin (1.25). Opioid use outside treatment was reported by 30.3% of OT (n = 152) and 49.4% of methadone (n = 168) patients, a difference in proportions of −19%: 90% confidence interval (−28%, −10%). The total count of AEs in the OT arm (22 among nine individuals) was significantly higher (P = 0.04) than that in the methadone arm (three among two individuals). Nausea was the most common side effect. Conclusion: While this study could not conclude the non‐inferiority of opium tincture (OT) to methadone for retaining patients in opioid agonist treatment, OT retained 60% of participants to end of follow‐up (85 days) and was superior to methadone in reducing self‐reported opioid use outside treatment. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this study was to evaluate the relative deviation of dose - volume(DVH) parameters for the high - risk clinical target volume(HRCTV) and organ at risk (OARs) using computed tomography (CT) versus magnetic resonance imaging (MRI) in cervical cancer brachytherapy. Methods: In this study, we analyzed 24 patients with pathologically confirmed cervical carcinoma using CT and MR images. The HRCTV and OARs, including the rectum, bladder and sigmoid, were outlined on both images. We calculated the dice coefficient of similarity (DSC) score, and the volume, height, width, and dose parameters including D90, D98, D100 for HRCTV, and dose - volume parameters of OARs including D0.1cc, D1cc, and D2cc. Additionally, we examined the relationship between body mass index (BMI) and the dose parameters.. Results: There was strong correlation between CT and MR images for the bladder (r> = 0,72) and rectum (r> = 0.83) except for the D0.1cc of the bladder. However, there was a poor correlation between the doses of HRCTV for CT and MRI plans for DVH parameters such as D90,D98, and D100. The mean DSC range was between 75.13% for the bladder, 64.13% for the rectum, 56.71% for the sigmoid, and 66.54% for HRCTV. Conclusions: MRI is currently considered the gold standard for tumor delineation. However, CT with clinical information can also provide comparable results, which merit further investigation. When planning treatment, it may be necessary to consider both MRI and CT in order to make an informed decision. [ABSTRACT FROM AUTHOR]

Introduction: Granulation tissue - induced tracheal stenosis (mainly secondary to intubation or lung transplantation) is one of the most common etiologies of benign airway obstructions. Recurrence rates after standard treatment options (surgical resection and/or endobronchial interventions) can inadvertently worsen the stricture through the stimulation of more granulation tissue generation (via increased fibroblast activity and roliferation). Low - dose radiotherapy could be a promising tool to prevent granulation tissue formation after surgery and/or endobronchial interventions regarding its established role in the treatment of keloids or hypertrophic scars, two benign diseases with similar a pathophysiology to tracheal stenosis. This study reviews case reports and small series that used endobronchial brachytherapy (EBBT) or external beam radiotherapy (EBRT) for the management of refractory granulation tissue - in duced tracheal stenosis after surgery and/or endobronchial interventions. Materials: Case reports and series (published up to October 2022) that reported outcomes of patients with recurrent granulation tissue - induced tracheal stenosis (after surgery and/or endobronchial interventions) treated by EBBT or EBRT (in definitive or prophylactic settings) were eligible. Results: Sixteen studies (EBBT: nine studies including 69 patients, EBRT: seven studies including 32 patients) were reviewed. The pooled success rate across all studies was 74% and 97% for EBBT and EBRT, respectively. Conclusions: Radiation therapy appears to be effective in the management of selected patients with recurrent/refractory tracheal stenosis. Response to this treatment is usually good, but further studies with a larger number of patients and long - term followup are necessary to determine the optimal technique, dose, and timing of radiation therapy, late complications, the durability of response, and criteria for patient selection. [ABSTRACT FROM AUTHOR]