Identifying factors associated with of blood pressure using Structural Equation Modeling: evidence from a large Kurdish cohort study in Iran.

BACKGROUND: Identifying the risk factors leading to hypertension can help explain why some populations are at a greater risk for developing hypertension than others. The present study seeks to identify the association between the risk factors of hypertension in 35- to 65-year-old participants in western Iran. METHODS: This cross-sectional study was conducted on 9705 adults from baseline data of Ravansar Non-Communicable Disease (RaNCD) cohort study, in the west region of Iran. Each of the latent variables were confirmed by confirmatory factor analysis. Using Structural Equation Modeling (SEM), we assessed the direct and indirect effects of factors associated with blood pressure. RESULTS: Socioeconomic status (SES), physical activity, mean of serum lipids, obesity, diabetes and family history of hypertension had a diverse impact on the blood pressure, directly and (or) indirectly. The standardized total effect of SES, physical activity, mean of serum lipids, and obesity were -0.09 vs. -0.14, -0.04 vs. -0.04, 0.13 vs. 0.13 and 0.24 vs. 0.15 in men and women, respectively. Diabetes had a direct relationship with the blood pressure in women (0.03). CONCLUSION: With regard to control of high blood pressure, public health interventions must target obesity, lifestyle and other risk related to nutritional status such as hyperlipidemia and hyperglycemia in Iranian population and among those with higher SES.

An investigation into patient-specific 3D printed titanium stents and the use of etching to overcome Selective Laser Melting design constraints.

Due to limitations in available paediatric stents for treatment of aortic coarctation, adult stents are often used off-label resulting in less than optimal outcomes. The increasingly widespread use of CT and/or MR imaging for pre-surgical assessment, and the emergence of additive manufacturing processes such as 3D printing, could enable bespoke devices to be produced efficiently and cost-effectively. However, 3D printed metallic stents need to be self-supporting leading to limitations in their design. In this study, we investigate the use of etching to overcome these design constraints and improve stent surface finish. Furthermore, using a combination of experimental bench testing and finite element (FE) methods we investigate how etching influences stent performance. Then using an inverse finite element approach the material properties of the printed and etched stents were calibrated and compared. We show that without etching the titanium stents, the inverse FE approach underestimates the stiffness of the as-built stent (E = 33.89 GPa) when compared to an average of 76.84 GPa for the etched stent designs. Finally, using patient-specific finite element models the different stents' performance were tested to assess patient outcomes and lumen gain and vessel stresses were found to be strongly influenced by the stent design and postprocessing. Within this study, etching is confirmed as a means to create open-cell stent designs whilst still conforming to additive manufacturing 'rules' and concomitantly improving stent surface finish. Additionally, the feasibility of using an in-vivo imaging-to-product development pipeline is demonstrated that enables patient-specific stents to be produced for varying anatomies to achieve optimum device performance.

The effect of child-abuse on the behavioral problems in the children of the parents with substance use disorder: Presenting a model of structural equations.

Child abuse may potentially create the behavioral problems particularly in the children of parents with substance use disorder. Thus, the current study was conducted to investigate the effects of child abuse on the behavioral problems in the children of parents with substance use disorder using the emotional regulation and social skills as mediators. In this paper, the method of Structural Equation Modeling (SEM) was applied. The study population included 358 children of parents with substance use disorder whose parents had referred to the addiction treatment center in Kermanshah province, Iran (2017-2018). Conners Comprehensive Behavior Rating Scales (CBRS), Emotion Regulation Checklist (ERC), Social Skills Rating Scale (SSRS) Questionnaire, and Child Abuse Questionnaire were also used for data collection. IBM SPSS Amos 22 software was utilized for statistical analysis of the obtained data. The SEM was also analyzed to confirm fit of the model. The results showed a direct relationship between the child abuse and behavioral problems so that, the boys outperformed the girls in this regard. The findings also suggested a significant relationship between the family characteristics and behavioral problems. On the other hand, family characteristics and emotional regulation had direct and significant effects on improvement of the social skills (P < 0.001). The results revealed a direct effect of child abuse on the behavioral problems in the children of parents with substance use disorder. Thus, it is suggested to take a preventive approach toward child abuse in the children of parents with substance use disorder by employing a comprehensive program and intervention methods.

Selective Laser Melting of Ti-6Al-4V: The Impact of Post-processing on the Tensile, Fatigue and Biological Properties for Medical Implant Applications.

One of the main challenges in additive manufacturing (AM) of medical implants for the treatment of bone tissue defects is to optimise the mechanical and biological performance. The use of post-processing can be a necessity to improve the physical properties of customised AM processed implants. In this study, Ti-6Al-4V coupons were manufactured using selective laser melting (SLM) in two build orientations (vertical and horizontal) and subsequently post-processed using combinations of hot isostatic pressing (HIP), sandblasting (SB), polishing (PL) and chemical etching (CE). The effect of the different post-manufacturing strategies on the tensile and fatigue performance of the SLMed parts was investigated and rationalised by observing the surface topography. Vertically built samples showed higher yield strength (YS) and ultimate tensile strength (UTS) than the horizontal samples, increasing from 760.9 ± 22.3 MPa and 961.3 ± 50.2 MPa in the horizontal condition to 820.09 ± 16.5 MPa and 1006.7 ± 6.3 MPa in the vertical condition, respectively. After the HIP treatment, the ductility was substantially improved in both orientations; by 2.1 and 2.9 folds in the vertical and horizontal orientations, respectively. The vertically built samples demonstrated a superior ductility of 22% following HIP and polishing. Furthermore, chemical etching was found to be the most effective surface post-processing treatment to improve the fatigue performance after HIP, achieving the highest run-out strength of 450 MPa. Most importantly, chemical etching after HIP enhanced the cellular affinity of the surface, in addition to its good fatigue performance, making it a promising post-processing approach for bone implants where tissue integration is needed.

Developing a highly selective method for preconcentration and determination of cobalt in water and nut samples using 1-(2-pyridylazo)-2-naphthol and UV-visible spectroscopy.

BACKGROUND: Heavy metal contamination in water and agricultural products is a major concern that causes risks for human health. This article describes a highly selective approach to preconcentrate cobalt(II) (Co(II)) ions based on the standard UV-visible measurement of Co(II)-1-(2-pyridylazo)-2-naphthol complex at λ = 628 nm in water and nut samples. In this method, magnetic silica (mSiO2 ) was utilized as a practical sorbent and 1-(2-pyridylazo)-2-naphthol was employed as a complexing agent in the elution step. The adsorbent was characterized via X-ray diffraction spectroscopy, Fourier transform infrared spectroscopy, and scanning electron microscopy. The effects of the main variables (pH, adsorption time, sorbent amount, pH of eluent, ligand volume, and desorption time) were investigated and established. RESULTS: The maximum recovery was achieved at pH 7 ± 0.3, adsorption time of 60 min, sorbent amount of 40 mg, eluent pH 8 ± 0.2, ligand volume of 2 mL (16.95 × 10-4 mol L-1 ) and desorption time of 30 min. The linearity of dynamic range (10-500 µg L-1 ), limit of detection (0.32 µg L-1 ), relative standard deviation (3.04%), and preconcentration factor (25) show the reliability of the method. The sorbent was reusable 12 times. Selectivity and the effect of interference ions were successfully examined. The adsorption process of Co(II) ions on mSiO2 was investigated based on Langmuir and Freundlich isotherms. The Freundlich model was fitted with the system and the maximum capacity adsorption of mSiO2 for Co(II) adsorption is 2.35 mg g-1 . Then, the kinetics study revealed that the adsorption process of Co(II) ions on the mSiO2 follows the pseudo-first-order model. The thermodynamics parameters ΔG, ΔS, and ΔH were calculated. CONCLUSION: The method was fruitfully applied to preconcentrate Co(II) ions in water and nut samples. This method offers high selectivity and precision for determining Co(II) ions. © 2020 Society of Chemical Industry.

Investigating associated factors with glomerular filtration rate: structural equation modeling.

BACKGROUND: Glomerular filtration rate (GFR) is a valid indicator of kidney function. Different factors can affect GFR. The purpose of this study is to assess the direct and indirect effects of GFR-related factors using structural equation modeling. PATIENTS AND METHODS: We analyzed data from the baseline phase of the Ravansar Non-Communicable Disease cohort study. Data on socio-behavioral, nutritional, cardiovascular, and metabolic risk factors were analyzed using a conceptual model in order to test direct and indirect effects of factors related to GFR, separately in male and female, using the structural equation modeling. RESULTS: Of 8927 individuals who participated in this study, 4212 subjects were male (47.20%). The mean and standard deviation of GFR was 76.05 (±14.31) per 1.73 m2. GFR for 0.2, 11.3, 73.0 and 15.5% of people were < 30, 30 - 59, 60 - 90 and >90, respectively. Hypertension and aging in both sexes and atherogenic factor in males directly, and in females, directly and indirectly, had decreasing effects on GFR. Blood urea nitrogen and smoking in male and female, directly or indirectly through other variables, were associated with a lower GFR. In females, diabetes had a direct and indirect decreasing effect on GFR. Obesity in females was directly associated with upper and indirectly associated with lower GFR. CONCLUSION: According to our results, aging, hypertension, diabetes, obesity, high lipid profile, and BUN had a decreasing direct and indirect effect on GFR. Although low GFR might have different reasons, our findings, are in line with other reports and provide more detailed information about important risk factors of low GFR. Public awareness of such factors can improve practice of positive health behaviors.

Magnetic Mn2O3 nanocomposite covered with N,N'-bis(salicylidene)ethylenediamine for selective preconcentration of cadmium(II) prior to its quantification by FAAS.

This article describes a method for highly selective preconcentration of Cd(II) via magnetic Mn2O3 coated by N,N'-bis(salicylidene)ethylenediamine (BSED). The metal oxide components were prepared via combining sol-gel and precipitation methods. Then, BSED was added as the third component of the composite. X-ray diffraction, scanning electron microscopy, transmission electron microscopy, alternating gradient force magnetometry, and Fourier transform infrared spectroscopy were applied to characterize the materials. BSED selectively forms a complex with Cd(II), and the sorbent can then be magnetically separated. The preconcentration conditions were optimized as pH value (4.0 ± 0.5), sorbent amount (30 mg), adsorption time (20 min), eluent 2 M HNO3), eluent volume (1.5 mL) and desorption time (4 min). The quantification of Cd(II) was done by flame atomic absorption spectroscopy. The method has the following figures of merit: (a) a detection limit of 320 µg L-1, (b) a relative standard deviation of 1.1%, (c) an enhancement factor of 36, (d) a preconcentration factor of 33, and (e) a linear dynamic range that extends from 10 to 120 µg L-1. Other features include the use of safe reagents, fast and simple preparation, high selectivity and reliable analytical performance. The effects of potentially interfering ions were examined. The Dubinin-Radushkevich model and the pseudo second-order model are found to fit the adsorption behavior. The absorption is spontaneous and exothermic. The method was successfully applied to the determination of Cd(II) in (spiked) fruit samples. Graphical abstract Schematic presentation of a nanocomposite (Fe3O4 - Mn2O3 - Schiff base) that was prepared from MnCl2, H2O2, FeCl2, FeCl3, NH3, salicylaldehyde, ethylenediamine and tetraethylammonium hydroxide for the magnetic solid phase extraction of cadmium at trace levels.

The design of additively manufactured lattices to increase the functionality of medical implants.

The rise of antibiotic resistant bacterial species is driving the requirement for medical devices that minimise infection risks. Antimicrobial functionality may be achieved by modifying the implant design to incorporate a reservoir that locally releases a therapeutic. For this approach to be successful it is critical that mechanical functionality of the implant is maintained. This study explores the opportunity to exploit the design flexibilities possible using additive manufacturing to develop porous lattices that maximise the volume available for drug loading while maintaining load-bearing capacity of a hip implant. Eight unit cell types were initially investigated and a volume fraction of 30% was identified as the lowest level at which all lattices met the design criteria in ISO 13314. Finite element analysis (FEA) identified three lattice types that exhibited significantly lower displacement (10-fold) compared with other designs; Schwartz primitive, Schwartz primitive pinched and cylinder grid. These lattices were additively manufactured in Ti-6Al-4V using selective laser melting. Each design exceeded the minimum strength requirements for orthopaedic hip implants according to ISO 7206-4. The Schwartz primitive (Pinched) lattice geometry, with 10% volume fill and a cubic unit cell period of 10, allowed the greatest void volume of all lattice designs whilst meeting the fatigue requirements for use in an orthopaedic implant (ISO 7206-4). This paper demonstrates an example of how additive manufacture may be exploited to add additional functionality to medical implants.

Synthesis of a magnetic WO3 nanocomposite for use in highly selective preconcentration of Pb(II) prior to its quantification by FAAS.

A novel sorbent consisting of WO3 and Fe3O4 is described for preconcentration of Pb(II). It was prepared without consumption of organic solvents. The nano composite was characterized by X-ray diffraction, scanning electron microscopy, transmission electron microscopy, alternating gradient force magnetometer and Brunauer-Emmett-Teller. Having high surface area and being formed oxygen sheets propose the nanocomposite as a sorbent. Adsorption and desorption conditions were optimized and Pb(II) is quantified by flame atomic absorption spectroscopy. The sorbent can highly selectively preconcentrate Pb(II) at pH values between 3 and 7. The preconcentration time is short and sorbent is re-usable. Under the optimized conditions, the method has the following figures of merit: (a) limit of detection of 0.60 ng mL-1, (b) relative standard deviation (n = 5) of 0.87%, (c) preconcentration factor of 33.33 and (d) linearity of dynamic range (10-200 ng.mL-1). Isotherm adsorption, kinetic adsorption and thermodynamic adsorption were stablished. The material was applied to the preconcentration of Pb(II) from herbal medicines. Graphical abstract Schematic presentation of a nanocomposite (Fe3O4 - WO3) that was prepared from sodium tungstate (Na2WO4), oxalic acid, HCl and magnetic Fe3O4 nanoparticles for the magnetic solid phase extraction of lead at trace levels.

Surface Finish has a Critical Influence on Biofilm Formation and Mammalian Cell Attachment to Additively Manufactured Prosthetics.

Additive manufacturing (AM) technologies enable greater geometrical design freedom compared with subtractive processes. This flexibility has been used to manufacture patient-matched implants. Although the advantages of AM are clear, the optimization at each process stage is often understated. Here we demonstrate that surface finishing of selective laser melted (SLM) implants significantly alters topography, which has implications for cellular and biofilm adhesion. Hot isostatic pressing of as-fabricated Ti-6Al-4V implants was shown to reduce porosity (1.04 to 0.02%) and surface roughness (34 ± 8 to 22 ± 3 µm). Despite these surface changes, preosteoblasts exhibited a similar viability and proliferation after 7 days of culture. Contrastingly, sandblasting and polishing significantly reduced cellular activity and increased cytotoxicity. Bacterial specimens (Staphylococcus aureus, Staphylococcus epidermidis and Pseudomonas aeruginosa) adhered more homogeneously to sandblasted implants compared with other treatments. This suggests that sandblasting may place the implant at risk of infection and reduce the strength of interaction with the surrounding soft tissues. The ability to tune the adhesion of cells to additively manufactured Ti-6Al-4V implants using postprocessing methods was demonstrated. Because the degree of tissue integration required of implants is application specific, these methods may be useful to tailor osseointegration. However, surface competition between mammalian and bacterial cells remains a challenge.

Adding functionality with additive manufacturing: Fabrication of titanium-based antibiotic eluting implants.

Additive manufacturing technologies have been utilised in healthcare to create patient-specific implants. This study demonstrates the potential to add new implant functionality by further exploiting the design flexibility of these technologies. Selective laser melting was used to manufacture titanium-based (Ti-6Al-4V) implants containing a reservoir. Pore channels, connecting the implant surface to the reservoir, were incorporated to facilitate antibiotic delivery. An injectable brushite, calcium phosphate cement, was formulated as a carrier vehicle for gentamicin. Incorporation of the antibiotic significantly (p=0.01) improved the compressive strength (5.8±0.7MPa) of the cement compared to non-antibiotic samples. The controlled release of gentamicin sulphate from the calcium phosphate cement injected into the implant reservoir was demonstrated in short term elution studies using ultraviolet-visible spectroscopy. Orientation of the implant pore channels were shown, using micro-computed tomography, to impact design reproducibility and the back-pressure generated during cement injection which ultimately altered porosity. The amount of antibiotic released from all implant designs over a 6hour period (<28% of the total amount) were found to exceed the minimum inhibitory concentrations of Staphylococcus aureus (16µg/mL) and Staphylococcus epidermidis (1µg/mL); two bacterial species commonly associated with periprosthetic infections. Antibacterial efficacy was confirmed against both bacterial cultures using an agar diffusion assay. Interestingly, pore channel orientation was shown to influence the directionality of inhibition zones. Promisingly, this work demonstrates the potential to additively manufacture a titanium-based antibiotic eluting implant, which is an attractive alternative to current treatment strategies of periprosthetic infections.

Modification of gellan gum with nanocrystalline hydroxyapatite facilitates cell expansion and spontaneous osteogenesis.

Nanocomposites composed of hydrogels and calcium phosphates are of great interest in the development of bone graft replacements since they may have a structural and compositional resemblance to bone. Culture beads formed from such materials could be used in stirred tank culture and thereby enable cell expansion in a sufficiently efficient manner to allow for the generation of enough large number of cells for large-scale bone reconstruction. Although combinations of materials such as alginate, collagens, and various calcium phosphates have been investigated as culture beads, these materials are unsuitable for application since they have been shown to rapidly degrade in physiological conditions and enable relatively little tailoring of mechanical properties. In this study, gellan gum-nano sized hydroxyapatite (nHA) composites, which have been shown to be resistant to degradation and easily modified with respect to modulus, were formulated and characterized as regards their ability to enable cell attachment and proliferation. It was shown that the addition of 5 wt% of nHA to the culture beads enabled cell attachment and that an increase in nHA concentration to up to 25 wt% enhanced the rate of cell proliferation. Most importantly, it was demonstrated that the addition of nHA to the cell culture beads enabled the formation of nodules in culture of MC3T3-E1 cells and strikingly stimulated the osteogenic differentiation of bone marrow stromal cells in the absence of osteogenic media when compared with tissue culture plastic (TCP) with the same condition. Biotechnol. Bioeng. 2016;113: 1568-1576. © 2016 Wiley Periodicals, Inc.

Preparation and characterisation of nanophase Sr, Mg, and Zn substituted hydroxyapatite by aqueous precipitation.

Hydroxyapatite (HA) substituted with 2 mol% Sr, 10 mol% Mg, and 2 mol% Zn were precipitated under identical alkaline conditions (pH 11) at 20°C from an aqueous solution. As-synthesised materials were confirmed to be phase pure by XRD and samples prepared in air contained surface adsorbed CO2 as observed by FTIR. SEM studies revealed a globular morphology and agglomeration behaviour, typical of precipitated nHA. EDS spectra confirmed nominal compositions and substitution of Sr, Mg and Zn. At the levels investigated cationic doping was not found to radically influence particle morphology. An indication of the potential in-vivo bioactivity of samples was achieved by analysing samples immersed in SBF for up to 28 days by interferometry and complementary SEM micrographs. Furthermore, a live/dead assay was used and confirmed the viability of seeded MC3T3 osteoblast precursor cells on HA and substituted HA substrates up to 7 days of culture.

Low temperature aqueous precipitation of needle-like nanophase hydroxyapatite.

The use of tissue engineered biodegradable porous scaffolds has become an important focus of the biomedical research field. The precursor materials used to form these structures play a vital role in their overall performance thus making the study and synthesis of these selected materials imperative. The authors present a comparison and characterisation of hydroxyapatite (HA), a popular calcium phosphate (CaP) biomaterial, synthesised by an aqueous precipitation (AP) method. The influence of various reaction conditions on the phase, crystallinity, particle size as well as morphology, molecular structure, potential in-vivo bioactivity and cell viability were assessed by XRD, SEM and TEM, FTIR, a simulated body fluid (SBF) test and a live/dead assay using MC3T3 osteoblast precursor cells, respectively. Naturally carbonated nanoparticles of HA with typically needle-like morphology were synthesised by the reported AP method. Initial pH was found to influence the crystallisation process and determine the CaP phase formed as well as the resultant particle and crystallite sizes. A marked change in particle morphology was also observed above pH 9. The use of toluene as a replacement solvent for water up to 60% was found to reduce the crystallinity of as-synthesised HA. This has marked influence on the effect of ethanolamine (5 wt%), which was found to improve HA crystallinity. SEM and EDS were used to confirm the growth of carbonated apatite on the surface of HA pellets immersed in SBF for up to 28 days. Cell culture results revealed viable cells on all samples where pH was controlled and maintained at 10-11 during precipitation, including those that used ethanolamine and toluene in preparation. When the initial alkali pH was not maintained non-viable cells were observed on HA substrates.

Brushite cement additives inhibit attachment to cell culture beads.

Brushite-forming calcium phosphate cements are of great interest as bone replacement materials because they are resorbable in physiological conditions. Cell-attached culture beads formed from this material could be of great use for cell therapy. Despite a significant amount of work on optimizing the physicochemical properties of these materials, there are very few studies that have evaluated the capacity of the materials to facilitate cell adhesion. In this study, we have formed resorbable calcium phosphate (brushite) culture beads and for the first time we showed that cell attachment to the surface of the brushite cement (BC) could be inhibited by the presence of an intermediate dicalcium phosphate-citrate complex, formed in the cement as a result of using citric acid, a retardant and viscosity modifier used in many cement formulations. The BC beads formed from the mixture of ß-TCP/orthophosphoric acid using citric acid did not allow cell attachment without further treatment. Ageing of BC beads in serum-free Dulbecco's Modified Eagle's Medium (DMEM) solution at 37°C for 1 week greatly enhanced the cell adhesion capacity of the material. Scanning electron microscopy, X-ray diffraction (XRD), and confocal Raman microspectrometry indicated the increased capacity for cell adhesion was due to the changes in phase composition of BC. XRD patterns collected before and after ageing in aqueous solution and a high initial mass loss, suggest the formation of a dicalcium phosphate-citrate complex within the matrix. Since compacts formed from brushite powder supported cell attachment, it was hypothesized that the dicalcium phosphate-citrate complex prevented attachment to the cement surface.

Infrequent increases in stimulus intensity may interrupt central executive functioning during Rapid Eye Movement sleep.

This study examines the extent to which infrequent changes in the intensity of an auditory stimulus can interrupt the functioning of the central executive during natural sleep. In the waking, conscious state, highly relevant but unattended stimulus input may elicit a positive-going event-related potential, P3a, peaking at about 250 ms. P3a is presumed to reflect the interruption of the central executive controlling ongoing cognitive activities, resulting in potential awareness of stimulus input. In this study, both an increment and decrement in the intensity of a frequently occurring standard stimulus elicited a P3a during wakefulness. During Rapid Eye Movement sleep, only the increment continued to do so. Detection of an increase in the intensity of a standard stimulus is thought to be carried out by two separate systems, the transient detector system (responsible for the detection of transient energy) and the change detection system. By contrast, detection of a decrease in intensity is carried out only by the change detection system. This suggests that interruption of central executive functioning during Rapid Eye Movement is largely a consequence of sufficient output of the auditory transient detector rather than the change detector system. During stage 2, neither the decrement nor the increment was able to elicit a P3a. This is consistent with a deactivation of the central executive and a profound state of unconsciousness.

The effects of very slow rates of stimulus presentation on event-related potential estimates of hearing threshold.

The present study evaluated the use of slow rates of stimulus presentation on the accuracy of the N1-P2 cortical response in estimating hearing threshold. Long interstimulus intervals (ISI) allow the non-specific component of the N1 response to emerge, believed to reflect widespread cortical arousal that facilitates sensory and motor responses. We examined whether the non-specific N1 would be elicited at intensity levels near threshold. Event-related potentials were recorded to 0.5-, 1.0, and 4.0-kHz tone bursts with a long ISI (8-12 s) while the eleven subjects read a book. The stimulus level varied from -5 to 45 dB nHL. The 1.0-kHz tone burst was also presented with a shorter ISI (1.5-2.5 s), akin to that typically used in the audiological setting. The amplitude of N1-P2 was significantly enhanced in the long compared to short ISI condition, but, importantly, only for the stimuli with a level > or =25 dB nHL. Therefore, the N1-P2 recorded with long ISIs was not more precise in estimating threshold than that recorded with short ISIs, remaining visible to within 10 dB of behavioural threshold.