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Heart transplantation is the treatment of choice for those with end-stage heart failure. However, despite improvements in immunosuppressive treatment, patients are at significant risk of allograft rejection, especially early after transplantation. Any changes in patient's heart condition including reduced left ventricular ejection fraction, arrhythmia and any types of blocks need attention. Herein we report on a 29-year-old man who underwent heart transplantation 5 years before due to dilated cardiomyopathy. He was on immunosuppressive therapy and was good until one week before his admission, when he felt palpitation. Electrocardiography during palpitation showed a second-degree AV-block with heart rate of 60 beats/min. Echocardiography showed good left ventricular systolic function with no regional wall motion abnormality. The patient referred for coronary angiography and endomyocardial biopsy. The angiography was normal. The biopsy showed rejection compatible with ISHLT grade 2R. After treating the patient with 1.5 g methylprednisolone, the symptoms relieved and the block resolved. Bradycardia and second-degree AV-block late after heart transplantation could be a sign of cardiac allograft rejection and need more evaluation, especially endomyocardial biopsy. [ABSTRACT FROM AUTHOR]

Background: Although lung transplantation is a well-accepted treatment for end-stage lung diseases patients, only 15%-20% of the brain-dead donors' lungs are usable for transplantation. This results in high mortality of candidates on waiting lists. Ex-vivo lung perfusion (EVLP) is a novel method for better evaluation of a potential lung for transplantation. Objective: To report the first experience of EVLP in Iran. Methods: The study included a pig in Vienna Medical University, Vienna, Austria, and 4 humans in Masih Daneshvari Hospital, Tehran, Iran. All brain-dead donors from 2013 to 2015 in Tehran were evaluated for EVLP. Donors without signs of severe chest trauma or pneumonia, with poor oxygenation were included. Results: An increasing trend in difference between the pulmonary arterial pO2 and left atrial pO2, an increasing pattern in dynamic lung compliance, and a decreasing trend in the pulmonary vascular resistance, were observed. Conclusion: The initial experience of EVLP in Iran was successful in terms of important/critical parameters. The results emphasize on some important considerations such as precisely following standard lung harvesting and monitoring temperature and pressure. EVLP technique may not be a cost-effective option for low-income countries at first glance. However, because this is the only therapeutic treatment for endstage lung disease, it is advisable to continue working on this method to find alternatives with lesser costs. [ABSTRACT FROM AUTHOR]

Deterioration is a fact which has influenced most of the historic cities of Iran. What is certain in such cities, this problem has hampered the growth of the urban texture and is pushing it around. Therefore, in addition to destroying the internal texture of the historic parts of the city, it is creating huge costs upon the city by emerging new contexts. The current paper approach is descriptive-analyticand the method is combination of both field studies and documental methods. The research was conducted by using both SWOT and AHP techniques and also Expert choice software. In this research, we have assessed the strengths, weaknesses, opportunities and threats of urban deteriorated contexts of Dogonbadan city. The findings obtained from above model indicate that in terms of strengths, providing renewal and development plans of deteriorated context (ultimate weight= 0.315) , Existing urban services including: water, electricity, gas,.. (ultimate weight= 0.274) and confortable accessibility to urban center market and other parts of the town (ultimate weight= 0.193) are the most important factors. In the context of weaknesses, high unemployment rate (ultimate rate= 0.284), low income (ultimate weight= 0.195) and inappropriate streets (ultimate weight= 0.158), are the most important factors respectively. In terms of opportunities, locating in Oil City Dogonbadan (ultimate weight= 0.41), proximity to shopping centers of the city (ultimate weight= 0.184) and existence of residential areas around the texture (ultimate weight= 0.123), are the most important factors. And ultimately, among the threats, the factors such as: The increasing influx of immigrants into the context (ultimate weight= 0.349), negative attitudes towards living in these textures (ultimate weight= 0.216) and disregard to public participation (ultimate weight= 0.198), are the most important factors. Final analyzes in this research has led to efficient strategies to optimize and improve the urban deteriorated contexts in the Dogonbadan which have been given as details in the paper. [ABSTRACT FROM AUTHOR]

The article discusses the highlights of a conference titled 1st Symposium on Organ Donation in Collaboration with Spain which was held in Tehran, Iran from July 25-27, 2011. Training course and workshops, which were translated to Persian and English, were offered to nurses and physicians. Transplant teams from Iran discussed their achievements to delegates from other countries.

Background/Objective: Telemedicine is useful in monitoring patients, and in particular those who are suffering from chronic illnesses (e.g., lung transplant recipients). Methods: This cohort study was conducted on 15 lung transplant recipients. The patients provided physicians with data from spirometry as well as their clinical respiratory symptoms via SMS messages. If the spirometry results or clinical symptoms required follow-up, the monitoring physician contacted the patient according to guidelines and gave appropriate instructions. Results: Qualitative assessment of satisfaction showed that the sense of increased support from medical staff was rated highest (93%). Conclusion: Telespirometry is an efficient method of monitoring lung transplant recipients and leads to patient's satisfaction, compliance, adherence to study protocol and sense of security. Nevertheless, for optimal implementation of this method, thorough training of both medical staff and patients is required. [ABSTRACT FROM AUTHOR]

The discovery of unique microRNA (miR) patterns and their corresponding genes in sarcoma patients indicates their involvement in cancer development and suggests their potential use in medical management. MiRs were identified from The Cancer Genome Atlas (TCGA) dataset, with a Deep Neural Network (DNN) employed for novel miR identification. MiRDB facilitated target predictions. Functional enrichment analysis, identify critical pathways, protein-protein interaction network, and diseases/clinical data correlations were explored. COX regression, Kaplan-Meier analyses, and CombioROC was also utilized. The population consisted of 119 females and 142 males, and 1046 miRs were uncovered. Ten miRs was selected for further analysis using DNN. Upon analyzing for gene ontology, it was found that these genes showed enrichment in various activities. We identified a significant association between the overall survival rate of sarcoma patients and miRs levels. The combination of miR.3688 and miR.3936 achieved the greatest diagnostic standing. MiRs have the capability to screen sarcoma patients to identify undetected tumors, predict prognosis, and pinpoint prospective targets for treatment. Further large clinical trials are required to validate our findings., Competing Interests: Supplementary Information. Competing interests: The authors declare no competing interests. Ethics declarations: The data used in this study were taken from the TCGA dataset ( http://tcga-data.nci.nih.gov/tcga/ ), and all considerations related to the code of ethics and patient satisfaction have been considered and announced on this site. Therefore, considering that experimental data was not used in this study, there was no need to obtain consent and code of ethics., (© 2025. The Author(s).)

Introduction: The global coronavirus disease 2019 (COVID-19) pandemic necessitated urgent vaccine development, raising concerns about potential vaccine adverse events (AEs)., Methods: In this prospective cohort study, conducted from February 2021 to December 2022, all individuals across Iran who received any COVID-19 vaccine dose and reported adverse events were investigated. Our aim was to evaluate these AEs based on the vaccine types, patients' age and types of AES, and provide a comprehensive analysis., Results: In Iran, 155 million COVID-19 vaccine doses were administered, with Covilo (Sinopharm) being the most commonly vaccine administered (80.35%). Adverse events predominantly affected individuals aged 40-70 (45%). A total of 86,275 adverse events were recorded, with 92.7% classified as non-serious and 6 299 (7.3%) serious and among the serious cases, 279 were confirmed to be vaccine-related, with 46 resulting in fatalities and 233 requiring hospitalizations. The incidence of serious AEs was 0.41 per 10,000 doses. Serious AEs were more frequently associated with Sputnik V and Vaxzevria (AstraZeneca), with 0.73 and 0.64 cases per 10,000 injections, respectively. Coagulation and thrombosis disorders were the most common serious AEs (29%), followed by neurological (24.7%) and cardiovascular AEs (15.8%)., Discussion: In conclusion, the AEs of COVID-19 vaccination were primarily mild and transient, while serious AEs remained exceptionally rare., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2025 Jamaati, Karimi, Arshi, Zahraei, Panahi, Nouri, Hajimoradi, Hasanzade, Mokhtari, Tayeri, Abedini, Mohamadnia, Tabarsi, Sharif-Kashani, Marjani, Rashid Farokhi, Hashemian, Hosseini-Baharanchi, Norizadeh, Astani, Noorali, Ahmadi, Shafaghi and Ghorbani.)

Scaling in insect wings is a complex phenomenon that seems pivotal in maintaining wing functionality. In this study, the relationship between wing size and the size, location, and shape of wing cells in dragonflies and damselflies (Odonata) is investigated, aiming to address the question of how these factors are interconnected. To this end, WingGram, the recently developed computer-vision-based software, is used to extract the geometric features of wing cells of 389 dragonflies and damselfly wings from 197 species and 16 families. It has been found that the cell length of the wings does not depend on the wing size. Despite the wide variation in wing length (8.42 to 56.5 mm) and cell length (0.1 to 8.5 mm), over 80% of the cells had a length ranging from 0.5 to 1.5 mm, which was previously identified as the critical crack length of the membrane of locust wings. An isometric scaling of cells is also observed with maximum size in each wing, which increased as the size increased. Smaller cells tended to be more circular than larger cells. The results have implications for bio-mimetics, inspiring new materials and designs for artificial wings with potential applications in aerospace engineering and robotics., (© 2024 The Authors. Advanced Science published by Wiley‐VCH GmbH.)

Background and Aim: Cough is a common symptom among patients with sarcoidosis, and the Leicester Cough Questionnaire, a cough-specific quality-of-life measure, evaluates the impact of cough across physical, psychological, and social domains in patients with chronic cough. The aim of this study was cross-cultural adaptation and validation of Persian version of Leicester Cough Questionnaire (LCQ) in pulmonary sarcoidosis in Iran., Methods: Psychometric analyses included translation and back translation of the questionnaire, face validity, content validity, construct validity, criterion-related validity, internal consistency, and test -retest reliability were performed., Results: Twenty-five participants demonstrated no major language barriers or difficulties in completing the questionnaire and adequate face validity of ≥1.5. Twelve experts confirmed the content validity was good (CVR˃0.56, I-CVI≤0.79, S-CVI/Ave˃0.80). Totally, 190 patients were included in the study. The Pearson's coefficients and their significance's (P<0.05) showed an acceptable agreement between the LCQ and the SF-36 questionnaire. The goodness-of-fit of the conceptual model including psychological, physical, and social domains, obtained from EFA, was confirmed throughout the RMSEA of 0.09 (<0.1), NFI of 0.9, NNFI of 0.91, and CFI of 0.92 which all were ≥0.9. The Persian LCQ showed an excellent internal consistency regarding Cronbach's alpha of 0.974 and ICC (95%CI) value of 0.983 (0.977, 0.987)., Conclusions: The psychometric properties showed that the Persian version of LCQ is a valid and reliable measure to evaluate cough-specific quality of life and is a fit-for-purpose measure for use in patients with pulmonary sarcoidosis and the results can guide clinicians in treatment decisions.

Background: Obtaining consent from potential donor families is a challenging step in the donation process and is influenced by various factors., Methods: In this cross-sectional study, we utilized a questionnaire containing 14 questions about facilitators and barriers in the family interview process. The questionnaire was distributed in March 2023 to intensive care unit (ICU) nurses who had experience with donor family interviews. We collected the opinions of these respondents on hospital performance and drew comparisons between the studied hospitals., Results: A total of 60 participating ICU nurses provided mean scores for hospital performance in family interviews of 2.60±0.84 for type I hospitals (those providing neurosurgery and trauma care) and 2.035±0.890 for type II hospitals (those without neurosurgery and trauma services; P=0.04). The mean scores for public and private hospitals were 1.86±0.86 and 2.59±0.85, respectively (P=0.008). Based on the findings, the most important facilitators were the availability of organ donation staff and access to a professional team for family discussions. Conversely, poor physician communication skills and limited communication capabilities among medical staff were identified as significant barriers. Implementation of a professional team for family interviews was found to be more critical for type II hospitals. Poor physician communication skills were a significant concern in public hospitals, while families' lack of awareness of patient prognosis emerged as a key barrier in private hospitals., Conclusions: This study highlights numerous facilitators and barriers that vary across hospitals. Addressing these issues individually and developing tailored plans to enhance hospital performance in interviewing donor families is essential.

Background: Chronic Kidney Disease (CKD) is a prevalent and life-threatening situation recognized as an emerging health issue. The present study aimed to evaluate the effect of demographic and laboratory parameters on the survival of patients with End-Stage Renal Disease (ESRD) in a hemodialysis (HD) center in Iran., Materials and Methods: This study was conducted on patients receiving chronic HD in Iran Helal Pharmaceutical and Clinical Complex between 2014 and 2018. The survival time was considered as the time interval between HD initiation and death. Receiving kidney transplantation was regarded as a competing risk, and an improper form of two-parameter Weibull distribution was utilized to simultaneously model the time to both death and renal transplantation. The Bayesian approach was conducted for parameters estimation., Results: Overall, 29 (26.6%) patients expired, and 19 (17.4%) received kidney transplants. The male gender was related to poor survival, having nearly 4.6 folds higher hazard of mortality (90% HPD region: 1.36-15.49). Moreover, Serum calcium levels [Formula: see text]9.5 mg/dL (adjusted Sub-hazard ratio (S-HR)=2.33, 90% HPD region: 1.05-5.32) and intact parathyroid hormone (iPTH) [Formula: see text]150 pg/mL (adjusted S-HR = 2.56, 90% HPD region: 1.09-6.15) were associated with an elevated hazard of mortality. The cumulative incidence function (CIF) for transplantation was greater than death in the first two years of the study. Subsequently, the CIF for death exceeded transplantation in the following two years. The 4-year cumulative incidence of death and kidney transplantation was 63.7% and 36.3%, respectively., Conclusion: Male gender, hypercalcemia, and hypoparathyroidism were associated with worse outcomes. Correcting mentioned laboratory parameters may improve patients' survival in the HD population., (© 2023. The Author(s).)

Background:  In the INSPIRATION-S trial, atorvastatin versus placebo was associated with a nonsignificant 16% reduction in 30-day composite of venous/arterial thrombosis or death in intensive care unit (ICU) patients with COVID-19. Thrombo-inflammatory response in coronavirus disease 2019 (COVID-19) may last beyond the first 30 days., Methods:  This article reports the effects of atorvastatin 20 mg daily versus placebo on 90-day clinical and functional outcomes from INSPIRATION-S, a double-blind multicenter randomized trial of adult ICU patients with COVID-19. The main outcome for this prespecified study was a composite of adjudicated venous/arterial thrombosis, treatment with extracorporeal membrane oxygenation (ECMO), or all-cause mortality. Functional status was assessed with the Post-COVID-19 Functional Scale., Results:  In the primary analysis, 587 patients were included (age: 57 [Q1-Q3: 45-68] years; 44% women). By 90-day follow-up, the main outcome occurred in 96 (33.1%) patients assigned to atorvastatin and 113 (38.0%) assigned to placebo (hazard ratio [HR]: 0.80, 95% confidence interval [CI]: 0.60-1.05, p  = 0.11). Atorvastatin in patients who presented within 7 days of symptom onset was associated with reduced 90-day hazard for the main outcome (HR: 0.60, 95% CI: 0.42-0.86, p interaction  = 0.02). Atorvastatin use was associated with improved 90-day functional status, although the upper bound CI crossed 1.0 (OR ordinal : 0.64, 95% CI: 0.41-1.01, p  = 0.05)., Conclusion:  Atorvastatin 20 mg compared with placebo did not significantly reduce the 90-day composite of death, treatment with ECMO, or venous/arterial thrombosis. However, the point estimates do not exclude a potential clinically meaningful treatment effect, especially among patients who presented within 7 days of symptom onset (NCT04486508)., Competing Interests: D. V. reports consultant and speaker for BMS/Pfizer, Daiichi-Sankyo, Rovi, and Sanofi. Dr. Gupta received payment from the Arnold & Porter Law Firm for work related to the Sanofi clopidogrel litigation and from the Ben C. Martin Law Firm for work related to the Cook inferior vena cava filter litigation. A. G. holds equity in a health care telecardiology startup, Heartbeat Health, Inc., and received consulting fees from Edwards LifeSciences. M. V. M. has received support from an institutional grant by the National Institutes of Health/National Heart, Lung, and Blood Institute to Columbia University Irving Medical Center (T32 HL007854). S. S. S. reports honoraria from Janssen and Chiesi and research grant support from the American Heart Association. G. P. has received research support from Bristol-Myers Squibb/Pfizer Alliance, Bayer, Janssen, Alexion, Amgen, and Boston Scientific Corporation, and consulting fees from Bristol-Myers Squibb/Pfizer Alliance, Boston Scientific Corporation, Janssen, Namsa, Prairie Education and Research Cooperative, Boston Clinical Research Institute, and Amgen. S. A. P. reports being on the Advisory Board for Abbott, Boston Scientific, Medtronic, CSI, Philips, Janssen; research grants: Abbott, Boston Scientific, Surmodics, TriReme Medical, Shockwave Medical; and receiving consulting fees from Terumo and Abiomed. M. M. received an unrestricted educational grant for research from Sanofi, Leo, and Rovi, and fees for participating in advisory meetings from Sanofi. A. J. K. reports institutional funding to Columbia University and/or Cardiovascular Research Foundation from Medtronic, Boston Scientific, Abbott Vascular, Amgen, CSI, Philips, ReCor Medical, Neurotronic, Biotronik, Chiesi, Bolt Medical, Magenta Medical, Canon, SoniVie, Shockwave Medical, and Merck. In addition to research grants, institutional funding includes fees paid to Columbia University and/or Cardiovascular Research Foundation for consulting and/or speaking engagements in which Dr. Kirtane controlled the content. Personal: consulting from IMDS; Travel Expenses/Meals from Medtronic, Boston Scientific, Abbott Vascular, CSI, Siemens, Philips, ReCor Medical, Chiesi, OpSens, Zoll, and Regeneron. S. B. reports unrestricted research grants from Bayer, Concept Medical, INARI, Boston Scientific, Bard, and Sanofi; honoraria from Bayer, Concept Medical, INARI, and Boston Scientific. B. W. V. T. has received research support from Novartis, Swedish Orphan Biovitrum, Olatec Therapeutics, Serpin Pharm, and R-Pharm. He has been a consultant of R-Pharm and Serpin Pharma. G. W. S. has received speaker or other honoraria from Cook, Terumo, and Orchestra Biomed; served as a consultant to Valfix, TherOx, Vascular Dynamics, Robocath, HeartFlow, Gore, Ablative Solutions, Miracor, Neovasc, V-Wave, Abiomed, Ancora, MAIA Pharmaceuticals, Vectorious, Reva, Matrizyme, and Cardiomech; and has received equity or options from Ancora, Cagent, Applied Therapeutics, Biostar family of funds, SpectraWave, Orchestra Biomed, Aria, Cardiac Success, MedFocus family of funds, and Valfix. G. Y. H. L. reports consultant and speaker for BMS/Pfizer, Boehringer Ingelheim, and Daiichi-Sankyo. No fees are received personally. H. M. K. reports personal fees from UnitedHealth, personal fees from IBM Watson Health, personal fees from Element Science, personal fees from Aetna, personal fees from Facebook, personal fees from Siegfried & Jensen Law Firm, personal fees from Arnold & Porter Law Firm, personal fees from Ben C. Martin Law Firm, personal fees from National Center for Cardiovascular Diseases, Beijing, ownership of HugoHealth, ownership of Refactor Health, contracts from the Centers for Medicare & Medicaid Services, grants from Medtronic and the Food and Drug Administration, grants from Medtronic and Johnson and Johnson, grants from Shenzhen Center for Health Information, and is a Venture Partner at FPrime. Outside the submitted work. B. B. is supported by a research grant from The Mary Horrigan Connors Center for Women's Health and Gender Biology at Brigham and Women's Hospital. B. B. reports that he is a consulting expert, on behalf of the plaintiff, for litigation related to two specific brand models of IVC filters. All other authors report no relevant disclosures., (Thieme. All rights reserved.)

Background: The coronavirus 2019 (COVID-19) has affected the lives of many people worldwide. Patients with chronic underlying morbidities are vulnerable to get the severe form of the infection. The goal of this study was to evaluate the outcome of patients with pulmonary arterial hypertension during the COVID-19 pandemic in Iran., Methods: This cross-sectional study was conducted at a large tertiary center for pulmonary artery hypertension (PAH) patients. The primary end point was the prevalence of SARS-CoV-2 infection in PAH patients. The secondary end points were investigating the severity and mortality of COVID-19 infection in PAH patients during the COVID-19 pandemic., Results: Totally 75 patients were enrolled in the study from December 2019 to October 2021 and 64% were female. The mean ± SD age was 49 ± 16 years. The prevalence of COVID-19 in PAH/chronic thromboembolic pulmonary hypertension patients was 44%. About 66.7% of patients had comorbidities, which was a prognostic factor for COVID-19 infection in PAH patients (P < 0.001). Fifty-six percent of infected patients were asymptomatic. The most reported symptoms in symptomatic patients were fever (28%) and malaise (29%). Twelve percent of patients were admitted with severe symptoms. The mortality rate in infected individuals was 3.7%., Conclusions: COVID-19 infection in PAH/chronic thromboembolic pulmonary hypertension patients seems to be associated with high mortality and morbidity. More scientific proof is needed to clarify different aspect of COVID-19 infection in this population., (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)

Various severe acute respiratory syndrome coronavirus 2 vaccines with different platforms have been administered worldwide; however, their effectiveness in critical cases of COVID-19 has remained a concern. In this national cohort study, 24 016 intensive care unit (ICU) coronavirus disease-2019 (COVID-19) admissions were included from January to April 2022. The mortality and length of ICU stay were compared between the vaccinated and unvaccinated patients. A total of 9428 (39.25%) patients were unvaccinated, and 14 588 (60.75%) patients had received at least one dose of the vaccine. Compared with the unvaccinated, the first, second, and third doses of vaccine resulted in 8%, 20%, and 33% lower risk of ICU mortality in the adjusted model, with risk ratio (RR): 0.92, 95% confidence interval (CI): 0.84-1.001, RR: 0.80, 95% CI: 0.77-0.83, and RR: 0.67, 95% CI: 0.64-0.71, respectively. The mean survival time was significantly shorter in the unvaccinated versus the fully vaccinated patients (hazard ratio [HR]: 0.84, 95% CI: 0.80-0.88); p < 0.001). All vaccine platforms successfully decreased the hazard of ICU death compared with the unvaccinated group. The duration of ICU stay was significantly shorter in the fully vaccinated than in unvaccinated group (MD, -0.62, 95% CI: -0.82 to -0.42; p < 0.001). Since COVID-19 vaccination in all doses and platforms has been able to reduce the risk of mortality and length of ICU-stay, universal vaccination is recommended based on vaccine availability., (© 2023 Wiley Periodicals LLC.)

Background: Remdesivir is effective against SARS-Cov-2 with little evidence of its adverse effect on the cardiac system. The aim of the present study is investigating the incidence of bradycardia in COVID-19 patients treated with Remdesivir. Methods: This prospective longitudinal study was conducted in a tertiary center on COVID-19 patients for Remdesivir therapy. The objectives were to investigate the incidence of sinus bradycardia, and also the association between their demographics, underlying diseases, and the disease severity with developing bradycardia in COVID-19 patients treated with Remdesivir. Results: Of 177 patients, 44% were male. The mean (±standard deviation) age of patients was 49.79 ± 15.16 years old. Also, 33% were hospitalized due to more severe symptoms. Oxygen support was required for all hospitalized subjects. A total of 40% of the patients had comorbidities, with the most common comorbidity being hypertension. The overall incidence of bradycardia (heart rate<60 bpm) in patients receiving Remdesivir was 27%, of whom 70% had extreme bradycardia (heart rate <50 bpm). There was also a statistically significant reduction in heart rate after five doses of Remdesivir compared to the baseline heart rates. In the multivariable model, none of the covariates including age above 60 years, female sex, CRP>50 mg/L, O2 saturation<90%, underlying cardiovascular disease, hypertension and diabetes mellitus, and beta-blockers were associated with Remdesivir-induced bradycardia. No association was found between the COVID-19 severity indicators and bradycardia. Conclusion: As sinus bradycardia is a prevalent adverse cardiac effect of Remdesivir, it is recommended that all COVID-19 patients receiving Remdesivir, be evaluated for heart rate based on examination; and in the case of bradyarrhythmia, cardiac monitoring should be performed during administration to prevent adverse drug reactions., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Hajimoradi, Sharif Kashani, Dastan, Aghdasi, Abedini, Naghashzadeh, Mohamadifar, Keshmiri, Noorali, Lookzadeh, Alizadeh, Siri, Tavasolpanahi, Abdolmohammadi, Shafaghi, Rouhani and Shafaghi.)

Background: Bioimpedance vector analysis (BIVA) has been suggested as a valuable tool in assessing volume status in critically ill patients. However, its effectiveness in guiding fluid removal by continuous renal replacement therapy (CRRT) has not been evaluated., Methods: In this randomized controlled trial, 65 critically ill patients receiving CRRT were allocated on a 1:1 ratio to have UF prescribed and adjusted using BIVA fluid assessment in the intervention group (32 patients) or conventional clinical parameters (33 patients). The primary outcome was the lean body mass (LBM) water content at CRRT discontinuation, and the secondary outcomes included the mortality rate, urinary output, the duration of ventilation support, and ICU stay., Results: The study group was associated with a lower water content of LBM (80.7 ± 9.4 vs. 85.9 ± 10.4%; p < 0.05), and a higher mean UF-rate and urinary output (1.5 ± 0.8 vs. 1.2 ± 0.5 ml/kg/h and 0.9 ± 0.9 vs 0.5 ± 0.6 ml/kg/h, both: p < 0.05). The mortality rate, the length of ICU stay, and ventilation support duration were similar., Conclusion: BIVA guided UF prescription may be associated with a lower rate of fluid overload. Larger studies are required to evaluate its impact on patients' outcomes., Competing Interests: Declaration of Competing Interest None., (Copyright © 2022 Elsevier Inc. All rights reserved.)

Despite extensive research on the biomechanics of insect wings over the past years, direct mechanical measurements on sensitive wing specimens remain very challenging. This is especially true for examining delicate museum specimens. This has made the finite element method popular in studies of wing biomechanics. Considering the complexities of insect wings, developing a wing model is usually error-prone and time-consuming. Hence, numerical studies in this area have often accompanied oversimplified models. Here we address this challenge by developing a new tool for fast, precise modelling of insect wings. This application, called WingGram, uses computer vision to detect the boundaries of wings and wing cells from a 2D image. The app can be used to develop wing models that include complex venations, corrugations and camber. WingGram can extract geometric features of the wings, including dimensions of the wing domain and subdomains and the location of vein junctions. Allowing researchers to simply model wings with a variety of forms, shapes and sizes, our application can facilitate studies of insect wing morphology and biomechanics. Being an open-access resource, WingGram has a unique application to expand how scientists, educators, and industry professionals analyse insect wings and similar shell structures in other fields, such as aerospace., (© 2022. The Author(s).)

After the outbreak of the novel coronavirus at the end of December 2019 in China, it has become a global pandemic. Clinical manifestation of coronavirus disease 2019 (COVID-19) has a wide range of presentations from asymptomatic to severe multi-organ involvement. Hemoptysis appears to be one of the major manifestations of severe acute respiratory syndrome that is related to COVID-19 infection. The occurrence of hemoptysis is multifactorial. However, massive hemoptysis is usually related to pulmonary aspergillosis or severe bronchiectasis due to corticosteroid pulse therapy that can be life-threatening. This manuscript presents five cases of successful life-saving bronchial artery embolization in patients with COVID-19 infection who were suffering from massive hemoptysis that was mostly related to aspergillosis and bronchiectasis. These cases are followed by a review of the literature., Competing Interests: Conflict of Interest None declared., (International College of Angiology. This article is published by Thieme.)

SARS-CoV-2 vaccines provide a safe solution with a major impact on reducing the spread of the virus and mild side effects. Research has shown rare cases of myocarditis after mRNA vaccines. This study presents a 29-year-old male with chest pain after 48 h of receiving rAd26 and rAd5 vector-based COVID-19 vaccine (Sputnik V vaccine). The electrocardiogram revealed ST-segment elevation. Also, the laboratory screening was remarkable for elevated cardiac Troponin-I level, and leukocytosis; and echocardiography depicted severe left ventricular systolic dysfunction. Overall, endomyocardial biopsy proved lymphocytic myocarditis such that the patient was successfully treated with immunosuppressive and guideline-directed medical treatment., (© 2022 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.)

Coronavirus disease 2019 (COVID-19), a highly contagious infectious disease, has had a catastrophic effect on the world's demographics resulting in more than 2.9 million deaths worldwide till January 2021. It can lead to systemic multi-organ complications; in particular, venous and arterial thromboembolism risk is significantly increased. Venous thromboembolism (VTE) occurs in 22.7% of patients with COVID-19 in the ICU and 8% in non-ICU hospitalized patients. Studies evaluating thromboprophylaxis strategies in patients with COVID-19 are needed to improve the prevention of VTE. VTE is the most commonly reported thrombotic complication, with higher incidence rates among critically ill patients. Several vaccines have been licensed and are currently used to combat the COVID-19 pandemic. Also, several cases of vaccine-induced thrombosis have been reported. Vaccination remains the most critical measure to curb the COVID-19 pandemic. There is a broad consensus that the benefits of vaccination greatly outweigh the potential risks of rare vaccine side effects, such as vaccine-induced immune thrombotic thrombocytopenia (VITT). Therefore, the importance of vaccination should be emphasized. This statement aims to focus on VITT., (Copyright© 2022 National Research Institute of Tuberculosis and Lung Disease.)

Aims: At present, there is no definitive treatment for COVID-19 and to break the pandemic chain, prevention is the best choice. Meanwhile different controlling strategies are considered, in this study, we aimed to understand public insights toward the medical advisement., Material: A self-constructed questionnaire including information regarding various preventive elements such as wearing a mask, using gloves, attention to safe social distance, using disinfectant materials was prepared. After content validity, the questionnaire was circulated in cyberspace and the public was invited to complete it. After five days, the percentage of risky behavior related behaviors to the mask (RBM), hygiene (RBH), and social distance (RBD) were analyzed and compared in different situations with tableau and SPSS 26., Results: A total of 7,000 people with the mean age of 31.5 ± 12.2 years completed the questionnaire, of which 39% were men. RBM was 76.54% whereas hand hygiene and distance risky behaviors were 11.49% and 15.33%, respectively ( P = 0.01). RBD was significantly higher among people with COVID-19 patients in their families. The pattern of RBH based on the level of worry about getting COVID-19 was similar in the group without worry and with the highest level of worry., Conclusions: In this ever-changing situation of the COVID-19 pandemic, community awareness, and logical perception regarding correct use and has a crucial role in optimal COVID-19 controlling, which should not be neglected. It is important to have the latest information, which comes from trustworthy sources as a preventive key in both healthcare and community settings., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 International Journal of Preventive Medicine.)

Background: Kidney transplantation is the best treatment for people with End-Stage Renal Disease (ESRD). Kidney allocation is the most important challenge in kidney transplantation process. In this study, a Fuzzy Inference System (FIS) was developed to rank the patients based on kidney allocation factors. The main objective was to develop an expert system, which would mimic the expert intuitive thinking and decision-making process in the face of the complexity of kidney allocation., Methods: In the first stage, kidney allocation factors were identified. Next, Intuitionistic Fuzzy Analytic Hierarchy Process (IF-AHP) has been used to weigh them. The purpose of this stage is to develop a point scoring system for kidney allocation. Fuzzy if-then rules were extracted from the United Network for Organ Sharing (UNOS) dataset by constructing the decision tree, in the second stage. Then, a Multi-Input Single-Output (MISO) Mamdani fuzzy inference system was developed for ranking the patients on the waiting list., Results: To evaluate the performance of the developed Fuzzy Inference System for Kidney Allocation (FISKA), it was compared with a point scoring system and a filtering system as two common approaches for kidney allocation. The results indicated that FISKA is more acceptable to the experts than the mentioned common methods., Conclusion: Given the scarcity of donated kidneys and the importance of optimal use of existing kidneys, FISKA can be very useful for improving kidney allocation systems. Countries that decide to change or improve the kidney allocation system can simply use the proposed model. Furthermore, this model is applicable to other organs, including lung, liver, and heart., (© 2022. The Author(s).)

Background: Thrombotic complications are considered among the main extrapulmonary manifestations of coronavirus disease 2019 (COVID-19). The optimal type and duration of prophylactic antithrombotic therapy in these patients remain unknown., Methods: This article reports the final (90-day) results of the Intermediate versus Standard-dose Prophylactic anticoagulation In cRitically-ill pATIents with COVID-19: An opeN label randomized controlled trial (INSPIRATION) study. Patients with COVID-19 admitted to intensive care were randomized to intermediate-dose versus standard-dose prophylactic anticoagulation for 30 days, irrespective of hospital discharge status. The primary efficacy outcome was a composite of adjudicated venous or arterial thrombosis, treatment with extracorporeal membrane oxygenation (ECMO), or all-cause death. The main safety outcome was major bleeding., Results: Of 600 randomized patients, 562 entered the modified intention-to-treat analysis (median age [Q1, Q3]: 62 [50, 71] years; 237 [42.2%] women), of whom 336 (59.8%) survived to hospital discharge. The primary outcome occurred in 132 (47.8%) of patients assigned to intermediate dose and 130 (45.4%) patients assigned to standard-dose prophylactic anticoagulation (hazard ratio [HR]: 1.21, 95% confidence interval [CI]: 0.95-1.55, p  = 0.11). Findings were similar for other efficacy outcomes, and in the landmark analysis from days 31 to 90 (HR: 1.59, 95% CI: 0.45-5.06). There were 7 (2.5%) major bleeding events in the intermediate-dose group (including 3 fatal events) and 4 (1.4%) major bleeding events in the standard-dose group (none fatal) (HR: 1.82, 95% CI: 0.53-6.24)., Conclusion: Intermediate-dose compared with standard-dose prophylactic anticoagulation did not reduce a composite of death, treatment with ECMO, or venous or arterial thrombosis at 90-day follow-up., Competing Interests: Dr. Parikh reports being on the Advisory Board for Abbott, Boston Scientific, Medtronic, CSI, Philips, Janssen; research grants: Abbott, Boston Scientific, Surmodics, TriReme Medical, Shockwave Medical; and receiving consulting fees from Terumo and Abiomed. Dr. Gupta received payment from the Arnold & Porter Law Firm for work related to the Sanofi clopidogrel litigation and from the Ben C. Martin Law Firm for work related to the Cook inferior vena cava filter litigation. Dr. Gupta holds equity in a health care telecardiology startup, Heartbeat Health, Inc. and received consulting fees from Edwards LifeSciences. Dr. Madhavan has received support from an institutional grant by the National Institutes of Health/National Heart, Lung, and Blood Institute to Columbia University Irving Medical Center (T32 HL007854). Dr. Sethi reports honoraria from Janssen and Chiesi and research grant support from the American Heart Association. Dr. Piazza has received research grant support to Brigham and Women's Hospital from EKOS, a BTG International Group company, Bayer, the Bristol Myers Squibb/Pfizer Alliance, Portola, and Janssen. He has received consulting fees from Amgen, Pfizer, Boston Scientific Corporation, and Thrombolex. Dr. Kirtane reports institutional funding to Columbia University and/or Cardiovascular Research Foundation from Medtronic, Boston Scientific, Abbott Vascular, Abiomed, CSI, CathWorks, Siemens, Philips, and ReCor Medical. In addition to research grants, institutional funding includes fees paid to Columbia University and/or Cardiovascular Research Foundation for speaking engagements and/or consulting. Personal: travel expenses/meals from Medtronic, Boston Scientific, Abbott Vascular, Abiomed, CSI, CathWorks, Siemens, Philips, ReCor Medical, Chiesi, OpSens, Zoll, and Regeneron. Dr. Van Tassell received research support from Novartis, Swedish Orphan Biovitrum, Olatec Therapeutics, and Serpin Pharma. He is a consultant of R-Pharm, Serpin Pharma. Dr. Stone has received speaker or other honoraria from Cook, Terumo, and Orchestra Biomed; served as a consultant to Valfix, TherOx, Vascular Dynamics, Robocath, HeartFlow, Gore, Ablative Solutions, Miracor, Neovasc, V-Wave, Abiomed, Ancora, MAIA Pharmaceuticals, Vectorious, Reva, Matrizyme, Cardiomech; and has received equity or options from Ancora, Cagent, Applied Therapeutics, Biostar family of funds, SpectraWave, Orchestra Biomed, Aria, Cardiac Success, MedFocus family of funds, and Valfix. Dr. Lip reports consultant and speaker for BMS/Pfizer, Boehringer Ingelheim, and Daiichi-Sankyo. No fees are received personally. Dr. Krumholz reports personal fees from UnitedHealth, personal fees from IBM Watson Health, personal fees from Element Science, personal fees from Aetna, personal fees from Facebook, personal fees from Siegfried & Jensen Law Firm, personal fees from Arnold & Porter Law Firm, personal fees from Ben C. Martin Law Firm, personal fees from National Center for Cardiovascular Diseases, Beijing, ownership of HugoHealth, ownership of Refactor Health, contracts from the Centers for Medicare & Medicaid Services, grants from Medtronic and the Food and Drug Administration, grants from Medtronic and Johnson and Johnson, grants from Shenzhen Center for Health Information, and is a Venture Partner at FPrime, outside the submitted work. Dr. Bikdeli reports that he is a consulting expert, on behalf of the plaintiff, for litigation related to two specific brand models of IVC filters. All other authors report no relevant Enoxaparin was provided through Alborz Darou, Pooyesh Darou, and Caspian Pharmaceuticals companies, and atorvastatin and matching placebo were provided by Sobhan Darou. None of these companies were study sponsors and they had no other role and will not have a role in the design, conduct, analysis, or interpretation of the ongoing results or the decision to submit the resultant manuscript(s)., (Thieme. All rights reserved.)

Background: Kidney transplantation is the best alternative treatment for end-stage renal disease. To optimal use of donated kidneys, graft predicted survival can be used as a factor to allocate kidneys. The performance of prediction techniques is highly dependent on the correct selection of predictors. Hence, the main objective of this research is to propose a novel method for ranking the effective variables for predicting the kidney transplant survival., Methods: Five classification models were used to classify kidney recipients in long- and short-term survival classes. Synthetic minority oversampling and random undersampling were used to overcome the imbalanced class problem. In dealing with missing values, 2 approaches were used (eliminating and imputing them). All variables were categorized into 4 levels. The ranking was evaluated using the sensitivity analysis approach., Results: Thirty-four of the 41 variables were identified as important variables, of which, 5 variables were categorized in very important level ("Recipient creatinine at discharge," "Recipient dialysis time," "Donor history of diabetes," "Donor kidney biopsy," and "Donor cause of death"), 17 variables in important level, and 12 variables in the low important level., Conclusions: In this study, we identify new variables that have not been addressed in any of the previous studies (eg, AGE&#95;DIF and MATCH&#95;GEN). On the other hand, in kidney allocation systems, 2 main criteria are considered: equity and utility. One of the utility subcriteria is the graft survival. Our study findings can be used in the design of systems to predict the graft survival., Competing Interests: The authors declare no funding or conflicts of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background: With the rapidly expanding pandemic of severe acute respiratory syndrome coronavirus-2, a chronic immunosuppressed state in solid organ transplant recipients is a concern. We reported coronavirus disease 2019 in heart transplant recipients and described the patients' course from diagnosis to either hospital admission or improvement in symptoms., Case Presentation: This study retrospectively identified 13 white (Iranian) heart transplant patients with coronavirus disease 2019 between December 2019 and October 2020. The mean age of patients was 43.7 years (19-65 years); seven (70%) were men. Laboratory and treatment data were collected for those admitted or managed as outpatients. Outcomes were also recorded for all patients. This report demonstrates a range of symptoms, clinical severity, and disease course in heart transplant recipients with coronavirus disease 2019, including ten hospitalized patients and three patients, managed entirely in the outpatient setting. One patient passed away, and none of them experienced an episode of clinically overt rejection., Conclusions: We would like to emphasize the importance of being alert in these patients to consider testing in a broad range of clinical presentations and gathering more data for better management., (© 2021. The Author(s).)

Objectives: Congestive hepatopathy as a result of advanced heart failure correlates with poor outcomes. Thus, risk-scoring systems have been established to assess the risks for cardiac surgery and hearttransplant, although these systems were originally designed to measure mortality risk in patients with end-stage liver disease. We compared the scores for the Child-Pugh criteria andstandardandmodifiedModels for End-Stage LiverDisease to evaluate the effect of preoperative liver dysfunction on postoperative outcomes inpatients with heart failure who underwent heart transplant., Materials and Methods: Data of 60 consecutive patients who underwent orthotopic heart transplant were analyzed from a historical cohort study from January 1, 2015, to December 31, 2018. We calculated the scores for Child-Pugh criteria and the standard and modified Models for End-Stage Liver Disease., Results: Of the 60 total patients, 48 were male patients, with a median age of 43 years (range, 13-69 years). Twenty patients died before the end of the study. The causes of death were cardiac, liver, and renal diseases. The mortality risk increased 25% (interquartile range, 0.05-0.51) for the patients with 1 point higher score compared with the patients with 1 point lower score based on a modified Model for End-Stage Liver Disease (P = .01)., Conclusions: Preoperative liver dysfunction has a significant effect on patient survival. The modified Modelfor End-Stage LiverDisease scoring system could be an effective predictor of perioperative risk stratification for patients with congestive hepatopathy who are undergoing cardiac transplant.

Importance: Thrombotic events are commonly reported in critically ill patients with COVID-19. Limited data exist to guide the intensity of antithrombotic prophylaxis., Objective: To evaluate the effects of intermediate-dose vs standard-dose prophylactic anticoagulation among patients with COVID-19 admitted to the intensive care unit (ICU)., Design, Setting, and Participants: Multicenter randomized trial with a 2 × 2 factorial design performed in 10 academic centers in Iran comparing intermediate-dose vs standard-dose prophylactic anticoagulation (first hypothesis) and statin therapy vs matching placebo (second hypothesis; not reported in this article) among adult patients admitted to the ICU with COVID-19. Patients were recruited between July 29, 2020, and November 19, 2020. The final follow-up date for the 30-day primary outcome was December 19, 2020., Interventions: Intermediate-dose (enoxaparin, 1 mg/kg daily) (n = 276) vs standard prophylactic anticoagulation (enoxaparin, 40 mg daily) (n = 286), with modification according to body weight and creatinine clearance. The assigned treatments were planned to be continued until completion of 30-day follow-up., Main Outcomes and Measures: The primary efficacy outcome was a composite of venous or arterial thrombosis, treatment with extracorporeal membrane oxygenation, or mortality within 30 days, assessed in randomized patients who met the eligibility criteria and received at least 1 dose of the assigned treatment. Prespecified safety outcomes included major bleeding according to the Bleeding Academic Research Consortium (type 3 or 5 definition), powered for noninferiority (a noninferiority margin of 1.8 based on odds ratio), and severe thrombocytopenia (platelet count <20 ×103/µL). All outcomes were blindly adjudicated., Results: Among 600 randomized patients, 562 (93.7%) were included in the primary analysis (median [interquartile range] age, 62 [50-71] years; 237 [42.2%] women). The primary efficacy outcome occurred in 126 patients (45.7%) in the intermediate-dose group and 126 patients (44.1%) in the standard-dose prophylaxis group (absolute risk difference, 1.5% [95% CI, -6.6% to 9.8%]; odds ratio, 1.06 [95% CI, 0.76-1.48]; P = .70). Major bleeding occurred in 7 patients (2.5%) in the intermediate-dose group and 4 patients (1.4%) in the standard-dose prophylaxis group (risk difference, 1.1% [1-sided 97.5% CI, -∞ to 3.4%]; odds ratio, 1.83 [1-sided 97.5% CI, 0.00-5.93]), not meeting the noninferiority criteria (P for noninferiority >.99). Severe thrombocytopenia occurred only in patients assigned to the intermediate-dose group (6 vs 0 patients; risk difference, 2.2% [95% CI, 0.4%-3.8%]; P = .01)., Conclusions and Relevance: Among patients admitted to the ICU with COVID-19, intermediate-dose prophylactic anticoagulation, compared with standard-dose prophylactic anticoagulation, did not result in a significant difference in the primary outcome of a composite of adjudicated venous or arterial thrombosis, treatment with extracorporeal membrane oxygenation, or mortality within 30 days. These results do not support the routine empirical use of intermediate-dose prophylactic anticoagulation in unselected patients admitted to the ICU with COVID-19., Trial Registration: ClinicalTrials.gov Identifier: NCT04486508.

Pulmonary artery hypertension (PAH) occurs when mean pulmonary artery pressure (PAP) is higher than 25 mmHg in rest or 30 mmHg during activity. Idiopathic pulmonary artery hypertension (IPAH) is defined as PAH without a definite reason. The IPAH is a rare disease with a high mortality rate if left untreated. To date, there has been no definite cure for this entity, and most treatments are for symptom relief or improvement in the quality of life. For many years, decompressing the right heart through a hole in the interatrial septum has been advised to alleviate some of their symptoms, specifically syncope. Atrial flow regulator (AFR) is a device to make an iatrogenic interatrial hole and finally a unidirectional shunt. It has been used for some PAH patients for symptom relief. Herein, we report a 36-year-old female case with diagnosed IPAH for 6 years. In the last 3 years, the case had frequent syncope with shortening intervals. The AFR was implanted for her without any complications. Then, within 6 months of follow-up, she had only one syncope episode. A significant change was observed in her 6-minute walk and PAP., (Copyright© 2021 National Research Institute of Tuberculosis and Lung Disease.)

Background: Heart transplantation is an established treatment for end-stage heart failure patients, but its cost-effectiveness is under question., Objective: This study aimed to assess the cost of heart transplantation in Iran as a developing country in Asia to contribute to future planning in the region., Methods: This study was conducted in two phases. First, in a retrospective multicenter study, hospital data of heart transplant and hospitalization of three active heart transplant centers in Tehran, Iran, were reviewed from April 2013 to May 2015. Then pre-transplantation, transplantation, and one-year posttransplant costs were calculated according to the ABC (activity-based costing) method in 2016., Results: Data were obtained for 120 patients, among which 95 (79.17%) were males with a mean (SD) age of 35.31±13.41 years. Mean (SD) hospital and ICU length of stay were 17.85±14.91 and 9.74±8.94 days, respectively. A significant correlation existed between the mean of hospital and ICU length of stay (P<0.001, r: 0.754). The mean heart transplant and hospitalization cost was 3445.47±1243.29 USD from 2013 to 2015. Using the activity-based costing method, the cost of pre-transplantation, transplantation, and one-year -post-transplantation were extracted 6.5%, 73.5%, and 20%, respectively, with a total cost of 26232 USD., Conclusion: Compared to other countries, the cost of heart transplantation in Iran is very low. Numerous reasons lead to this difference. Firstly, a heart transplantation surgery is performed in university-based hospitals and is supported by the government. On the other hand, a significant difference exists between personnel costs in Iran compared to other countries., Competing Interests: None to be declare.

Background: Massive hemoptysis which is presented in advanced lung diseases is a life-threatening condition. Bronchial artery embolization as a minimally invasive procedure is the treatment of choice either in first or recurrent hemoptysis. This study aimed to assess the early and late efficacy of bronchial angioembolization (BAE) without microcatheter., Methods: In this prospective cohort study, all patients with hemoptysis who had undergone BAE from August 2018 to March 2019 were included. Angiographic patterns including bleeding sources, number of involved vessels, the underlying etiology, and recurrence rate were evaluated in a one-year follow up., Results: 153 patients were included with mean age of 55 ±16 years. 68% of them were male and 58% had life-threatening massive hemoptysis. Three distinct angiographic patterns were recognized. The culprit bleeding vessel was bronchial in 126 (92%), intercostal in 4 (3%), and both vessels in 7 (5%) of cases (p<0.05). One vessel involvement was seen in 56 patients; however it was observed in 69% of non-cystic fibrosis lobar bronchiectasis patients. In 1, 3 and 12 months follow up, recurrent hemoptysis was reported in 15 (11%), 4 (2.5%), and 24 (15.5%), respectively. In 52% of cases, no abnormal vessels were observed during aorta injection, but culprit bronchial or intercostal arteries were found in selective investigational angiography., Conclusion: BAE was successful in the control of hemoptysis and resulted in a low rate of recurrence in different types of lung diseases. This could be due to the embolization of all pathological arteries found during angiography which might have prevented recurrent bleeding., (©Copyright: the Author(s).)

Background: The prevalence of heart failure, as a serious health problem, is increasing around the world due to underlying factors, such as hypertension and diabetes. Although the patient's cooperation in the treatment process plays a crucial role in treatment, only a few combinations of different approaches have been investigated so far. This study aimed to determine the effects of an empowerment program on the patients' self-care behaviors and hospital readmission., Materials and Methods: In this randomized clinical trial, 120 patients with heart failure were divided into experimental and control groups. In the experimental group, the empowerment program, including face-to-face training, educational booklets, and follow-up via Telegram messaging application, was implemented, while the control group only received standard care. Data were collected before the intervention and six months after the intervention, using a researcher-made questionnaire. The Self-Care of Heart Failure Index (SCHFI) was completed for both groups., Results: The results indicated that all three self-care scales, namely, self-care maintenance, self-care management, and self-care confidence, significantly improved in the experimental group compared to the baseline (P=0.000), while the scores of these scales decreased in the control group (P=0.000). The frequency of hospital admission and the length of hospital stay also reduced in the experimental group (P=0.000 and P<0.001, respectively). There was no significant difference in terms of the demographic characteristics between the two groups., Conclusion: The empowerment program significantly improved the patients' self-care behaviors and reduced the frequency and duration of hospitalization. Therefore, implementation of such programs is strongly suggested, especially in heart failure clinics., (Copyright© 2020 National Research Institute of Tuberculosis and Lung Disease.)

Background: Kidney allocation is a multi-criteria and complex decision-making problem, which should also consider ethical issues in addition to the medical aspects. Leading countries in this field use a point scoring system to allocate kidneys. Hence, the purpose of this study is to identify and weight the kidney allocation criteria considering the balance between utility and equity., Methods: To do this, a new fuzzy hybrid approach is proposed, which consists of two steps: In the first step, Fuzzy Delphi Method (FDM) is used to identify the effective criteria in the kidney allocation algorithm. In the second step, Intuitionistic Fuzzy Analytic Hierarchy Process (IF-AHP) is employed to determine the weight of the criteria., Results: The results showed that the highest weight belongs to "Medical emergency" criterion and the lowest weight to "5 HLA mismatches", which is similar to Euro-transplant kidney allocation system (ETKAS). The developed method is evaluated in two steps. First, the proposed model is implemented using a real case study from the Iranian Kidney Allocation System. It was shown that the proposed model has the potential to improve allocation outcome. Second, the proposed model's superiority to the current model is approved by the experts using the results display in the profile matrix. Finally, sensitivity analysis is performed to check the robustness of the proposed model., Conclusions: This paper contributes to the kidney allocation literature by doing the following: (a) developing a comprehensive framework for identification and weightings of criteria for kidney allocation, (b) using, for the first time, the IF-AHP technique to consider hesitancy of decision makers and uncertainty in organ allocation, and (c) proposing an appropriate framework for the countries that intend to improve or modify their organ allocation system.

Background: Thoracic Aortic Injury (TAI) due to penetrating or blunt chest trauma is a critical life-threatening aortic injury. Its diagnosis and treatment always is challenging. An 18-year-old male was admitted due to blunt chest trauma after a high-impact road traffic collision. According to presenting dyspnea, an emergency chest-x-ray revealed left hemothorax for which chest tube was inserted. Hemodynamic monitoring demonstrated uncontrolled hypertension with systolic blood pressure of 200-220 mmHg despite multiple anti-hypertensive drugs. Trans-Thoracic Echocardiography (TTE) revealed abnormal Doppler flow pattern in proximal descending thoracic aorta suggestive for probable coarctation of aorta. Chest CT scan revealed pseudoaneurysm of the descending thoracic aorta just below the isthmus. Due to uncontrolled hypertension, persistent hemothorax and probable aortic pseudoaneurysm presenting as aortic luminal narrowing, surgical resection of the aneurysm was planned. The postoperative course was uneventful and blood pressure normalized without any drugs. Patient is normotensive after 8 years follow up., Competing Interests: Conflict of interest Authors declared that there was no conflict of interest.