Joint modeling of longitudinal and competing risks for assessing blood oxygen saturation and its association with survival outcomes in COVID-19 patients.

BACKGROUND: The objective of the present study is to evaluate the association between longitudinal and survival outcomes in the presence of competing risk events. To illustrate the application of joint modeling in clinical research, we assessed the blood oxygen saturation (SPO2) and its association with survival outcomes in coronavirus disease (COVID-19). MATERIALS AND METHODS: In this prospective cohort study, we followed 300 COVID-19 patients, who were diagnosed with severe COVID-19 in the Rohani Hospital in Babol, the north of Iran from October 22, 2020 to March 5, 2021, where death was the event of interest, surviving was the competing risk event and SPO2 was the longitudinal outcome. Joint modeling analyses were compared to separate analyses for these data. RESULT: The estimation of the association parameter in the joint modeling verified the association between longitudinal outcome SPO2 with survival outcome of death (Hazard Ratio (HR) = 0.33, P = 0.001) and the competing risk outcome of surviving (HR = 4.18, P < 0.001). Based on the joint modeling, longitudinal outcome (SPO2) decreased in hypertension patients (ß = -0.28, P = 0.581) and increased in those with a high level of SPO2 on admission (ß = 0.75, P = 0.03). Also, in the survival submodel in the joint model, the risk of death survival outcome increased in patients with diabetes comorbidity (HR = 4.38, P = 0.026). CONCLUSION: The association between longitudinal measurements of SPO2 and survival outcomes of COVID-19 confirms that SPO2 is an important indicator in this disease. Thus, the application of this joint model can provide useful clinical evidence in the different areas of medical sciences.

The glycosylated hemoglobin level and the severity of cardiovascular involvement in patients with the first episode of acute coronary syndrome.

Background: The current study was carried out aiming at investigating the relationship between glycosylated hemoglobin level and coronary atherosclerosis in patients with the first episode of acute coronary syndrome. Methods: This case-control study evaluated 450 patients with the first episode of acute coronary syndrome in Ayatollah Rouhani Hospital in Babol (Iran) from 2011 to 2018. Based on glycosylated hemoglobin, patients were divided into three groups of non-diabetic, pre-diabetic, and diabetic (n=150 in each group). Since SYNTAX score and Gensini score are employed to evaluate the extent of cardiovascular disease and predict CVD in patients with CAD over long-term follow-up, we calculated SYNTAX score and Gensini score based on angiographic results. Results: Concerning the factors related to the severity of cardiovascular involvement, the results revealed no significant difference between the diabetic and pre-diabetic groups in terms of the frequency of patients in terms of SYNTAX score, Gensini score, and the number of vessels involved (0.142 and 87, respectively, and P=0.102). However, this difference between the diabetic and non-diabetic groups, as well as between the pre-diabetic and non-diabetic groups was statistically significant (respectively for SYNTAX score, p< 0.001 and P=0.001; for Gensini score, P=0.013 and P=0.019; and for the number of vessels involved P=0.001and p<0.001). Conclusion: According to the findings of the current study, since there was no significant difference between diabetic and pre-diabetic patients in terms of the components indicating the severity of cardiovascular involvement, pre-diabetes itself may be associated with the severity of cardiovascular involvement as a predisposing factor.

Mediatory role of the serum mineral level and discharge disability of stroke survivors.

Background: Possible association between minerals contributing and mortality related to stroke were seen, but prospective data on the relation of vitamin D, magnesium and calcium serum levels with stroke were inconsistent. Consideration about the potential health effects of minerals and nutrients, the current study was conducted. Methods: This analytical cross-sectional study was conducted on 216 stroke survivors who were referred to the Ayatollah Rouhani Hospital of Babol, Iran. Demographic characteristics, clinical variables, and serum mineral levels were completed in the checklist. Admit score and discharge scale of these patients were determined according to the National Institute of Health Stroke Scale. A path model was constructed to explore the interrelationship between variables and to verify the relationship between variables and disability discharges. Results: Of 216 stroke patients, 185 (85.6%) cases were ischemic. The discharge status of 29 (12.9%) cases were severe or expired. The patients with moderate and severe admit scores, hemorrhagic stroke type, diabetes mellitus, hypertension and live in the village significantly had a poor discharge disability scale (all of p<0.05). Of all direct paths, Mg (ß=-2.85), and among indirect paths, calcium(ß=-3.59) had the highest effect on the discharge scale. Only mg had affected the discharge scale through direct and indirect (ß=-2.45) paths and had the greatest reverse effect on the discharge scale (ß=-5.30; totally). Conclusion: Hypomagnesemia and hypocalcemia play a mediatory role in poor outcomes. Especially, hypomagnesemia was the direct parameter for poor outcomes. The independent role of each mineral in this issue is difficult to define and suggested for future study.

The Frequency of Intraventricular Hemorrhage and its Risk Factors.

BACKGROUND: Intraventricular hemorrhage) IVH(is the most prevalent type of cerebrovascular accident in premature infants, which can result in lasting neurological complications. The aim of this study was to ascertain the frequency of IVH and its associated risk factors within our particular context. MATERIALS AND METHODS: This cross-sectional study was carried out in a tertiary neonatal intensive care unit of a maternal and neonatal hospital from September 2018 to August 2019. Premature infants under 34 weeks of age and with birth weight < 1500 grams who did not have significant congenital anomalies participated in the study. A brain ultrasound was performed by a sonologist during the first week. The infants were subsequently categorized into two groups: those with and without IVH. A comparative analysis was conducted using the chi-square test and logistic regression. A significance level of p<0.05 was considered statistically significant. RESULTS: Of the 205 premature infants who completed the study, IVH was reported in 107 cases (52.1%), of which 97.3% of bleeding cases were grade I and II and 2.7% accounted for severe bleeding (grade III and IV). Gestational age less than 28 weeks, weight less than 1000 g, vaginal delivery, asphyxia and resuscitation, history of intubation and mechanical ventilation, cord blood acidity, dopamine infusion, and history of fever and chorioamnionitis in the mother have been found to be significantly associated with increased risk of IVH (p<0.001). Antenatal corticosteroids decreased the risk (OR=10.63). CONCLUSION: In this study, IVH has been found to be common in infants under 1500 g of weight, but the severe form was low in frequency and was observed significantly in high-risk pregnancies.

Disulfiram ameliorates bleomycin induced pulmonary inflammation and fibrosis in rats.

Bleomycin (BL) is a widely used anticancer drug that can cause pulmonary fibrosis due to increased fibroblast proliferation and increased secretion of extracellular matrix. RASSF1A is a tumor suppressor gene that is down-regulated by DNA methylation during fibrosis. Disulfiram (DSF), a noncytosine DNA methyltransferase inhibitor, can revert epigenetic biomarkers and re-express silenced genes. We investigated anti-inflammatory and anti-fibrotic effects of DSF on regulation of epigenetic molecules and histopathology in a rat model of BL induced pulmonary fibrosis. We used six groups of rats: sesame oil (SO) control (Co) group, BL group, BL + SO group and three BL + DSF groups administered 1 mg/kg DSF (BL + DSF), 10 mg/kg DSF (BL + DSF10) or 100 mg/kg DSF (BL + DSF100), respectively. BL was administered intratracheally to induce pulmonary fibrosis. DSF and SO were injected intraperitoneally (i.p.) 2 days before BL administration; these injections were continued for 3 weeks. At the end of the study, lung tissues were removed for molecular and histopathologic studies. Administration of 10 or 100 mg/kg DSF after BL induced pulmonary inflammation and fibrosis, and up-regulated RASSF1A and down-regulated TNF-α and IL-1 ß compared to the BL and BL + SO groups. A RASSF1A unmethylated band was observed using the methylation-specific PCR technique in rats that had been administered 10 and 100 mg/kg DSF, which indicated partial DNA demethylation. Histopathologic evaluation revealed that fibrosis and all inflammatory scores were decreased significantly in the BL + DSF10 and BL + DSF100 groups compared to the BL group. Our findings indicate that DSF modified DNA methylation by up-regulating RASSF1A, which reduced inflammation and fibrosis in BL induced pulmonary inflammation and fibrosis.

Comparison of the apical seal obtained by Adseal, Proseal, and AH26 sealers in root canal obturation with lateral compaction technique.

Background: Root canal obturation is an important step in endodontic treatment, which is performed aiming to three-dimensionally seal the canal and prevent microleakage, reentry, and proliferation of microorganisms in the root canal system. On the other hand, microleakage eventually leads to root canal treatment failure. Sealing ability is an important property of endodontic sealers. This in vitro study aimed to compare the quality of apical seals obtained by three endodontic sealers. Materials and Methods: This in vitro experimental study evaluated 48 extracted single-canal maxillary incisors. Hard- and soft-tissue residues were removed and the teeth were immersed in 5.25% of sodium hypochlorite for disinfection. The teeth were decoronated at the cementoenamel junction with a diamond disc such that 10 mm of root length remained. Canal patency was ensured using a #10 K-file. The canals were then instrumented with ProTaper rotary system. The canals were randomly divided into three experimental groups for the application of Adseal, Proseal, and AH26 sealers, and positive and negative control groups. Sealers were applied in the canals using lateral compaction technique. The external root surfaces were then coated with two layers of nail varnish except for the apical 3 mm. The amount of microleakage was quantified using the dye-penetration technique. The Tukey's test was used to compare the microleakage between the experimental and control groups. The Kruskal-Wallis test was applied to compare the microleakage of experimental groups (P < 0.05). Results: The amount of microleakage in canals filled with Adseal, Proseal, and AH26 sealers with lateral compaction technique was 2.33 ± 0.64, 2.2 ± 0.81, and 2.22 ± 0.71 µm, respectively. No significant difference was noted among the three sealers regarding microleakage (P = 0.84). However, the amount of microleakage in the sealer groups was significantly lower than that in the control group (P < 0.001). Conclusion: The application of Adseal, Proseal, and AH26 had equal efficacy for the provision of optimal apical seal in filling of root canals with lateral compaction technique. The application of sealers yielded a significantly superior apical seal compared with the control group.

Effect of Different Forms of Fluoride Application on Surface Roughness of Rhodium-Coated NiTi Orthodontic Wires: A Clinical Trial.

Objectives: This study aimed to assess the effect of different forms of fluoride application on surface roughness of rhodium-coated nickel-titanium (NiTi) orthodontic wires. Materials and Methods: This randomized clinical trial was conducted on 15 patients randomly divided into three groups: toothbrush with Oral-B toothpaste only, Oral-B toothpaste, and daily mouthwash, Oral-B toothpaste, and sodium fluoride gel. The surface roughness indices of orthodontic wires including arithmetic mean height (Sa), root mean square height, root mean square gradient, developed interfacial area ratio (Sdr) and maximum surface height were measured by atomic force microscopy at baseline and after 6 weeks of application in the patients' mouths. Data were analyzed by paired t-test, ANOVA, Games-Howell, and Tukey-HSD tests (P<0.05). Results: All surface roughness parameters in all three groups showed a significant increase after intervention, except for Sa in the toothpaste-only group (P=0.057) and Sdr in the sodium fluoride gel group (P=0.064). Conclusion: The surface roughness of rhodium-coated NiTi orthodontic wires increases following the use of different forms of fluoride.

Surface Micro-Hardness and Wear Resistance of a Self-Adhesive Flowable Composite in Comparison to Conventional Flowable Composites.

Objectives: The durability of composite restorations is directly affected by the mechanical properties of the composite. The aim of this study was to evaluate the hardness and wear resistance of self-adhesive flowable composite (SAF) in comparison with conventional flowable composites. Materials and Methods: In this in vitro study, 50 composite specimens were prepared in brass molds with 10mm ×10mm ×2mm and divided into five groups (n=10). Specimens included three conventional flowable composites (Grandio flow, Filtek flow and Admira fusion flow), one self-adhering flowable composite (SAF, Vertise flow) and a microhybrid composite (filtek z250). After polishing, the micro-hardness of the specimens was measured in a Vickers hardness device, and the specimens were then subjected to 5000, 10000, 20000, 40000, 80000 and 120000 wear cycles in a wear tester. One-way ANOVA/Games-Howell, Kruskal Wallis, and Friedman tests were used for statistical analysis. The significance level was set at P<0.05. Results: The surface micro-hardness of the SAF was significantly lower than that of the microhybrid composite (P=0.01). There was no significant difference between the surface hardness of the different tested flowable composites (P>0.05). Also, the wear resistance of the studied composites was not significantly different in various cycles (P>0.05). Conclusion: Based on our results, SAF would not be an ideal substitute for conventional flowable composites in high-stress areas.

Scoring System and Diagnosis of Papillary Thyroid Carcinoma Using Human Bone Marrow Endothelium Marker-1, Cytokeratin 19, and Galectin-3.

Background: The increasing incidence of papillary thyroid carcinoma (PTC) and the inadequacy of routine histologic examination in its diagnosis necessitate the application of ancillary studies like immunohistochemistry. This research aimed to investigate the scoring system and diagnosis of PTC with cytokeratin 19 (CK19), human bone marrow endothelium marker-1 (HBME-1), and galectin-3. Methods: This experimental laboratory study was performed at Babol University of Medical Sciences, Mazandaran, Iran from April 2017 to March 2019. Neoplastic and nonneoplastic tissue samples of 100 cases with a diagnosis of PTC were selected by convenience sampling. CK19, HBME-1, and galectin-3 immunohistochemistry markers were used on tissue samples. Analysis was performed using the t test and the chi-square test, as well as the receiver operator characteristic (ROC) curve (significance level P < 0.05). Results: The CK19 staining was observed in all 100 (100%) non-neoplastic tissues, but HBME-1 and galectin-3 were positive in 36 (36%) and 14 (14%) of non-neoplastic tissues, respectively. The intensity scores of all the markers and their total had significantly different means in PTC and non-neoplastic tissues (P < 0.001). A significant difference was observed between the total score of each marker and the total score of their combination (P < 0.001). The combination of all 3 markers with an 11.5 0 cut-off for the total score showed the most sensitive (0.99) and specific (1.00) results. Conclusion: Interpreting CK19, HBME-1, and galectin-3 with the aid of the proposed scoring system was fruitful. HBME-1 and galectin-3 can be used individually or in combination for the diagnosis of PTC.

Reliability and validity of the Persian version of psoriatic arthritis screening questionnaire.

Background: The Early Arthritis for Psoriatic Patients (EARP) questionnaire is a fast and simple way to screen psoriatic arthritis. This study was carried out to investigate the diagnostic accuracy of the Persian version of the Early Arthritis for Psoriatic Patients (P-EARP) questionnaire. Methods: A total of 100 psoriasis patients responded to the questionnaire after the translation procedure (translation, back translation). After determining the validity of the questionnaire, the diagnostic accuracy of the P-EARP questionnaire was assessed using the ROC curve (receiver operating characteristic curve). Internal and external reliability of the questionnaire were also evaluated by statistical tests. Results: In assessing the reliability of the questionnaire using test-retest, correlation coefficient (r=0.994, p <0.001) and Cronbach's alpha (α = 0.85) were obtained. The P-EARP questionnaire had a sensitivity and specificity of 90.48% and 96.55% in ROC analysis, respectively, and cutoff point 3 was regarded as the cutoff point of the P-EARP questionnaire like the original version of the questionnaire (EARP). Conclusion: The results of this study showed that the P-EARP questionnaire had high sensitivity and specificity for the identification of psoriatic arthritis. The P-EARP questionnaire is an appropriate screening tool for the identification of psoriatic arthritis in the dermatology clinics.

Epidemiological trend of suicide in north of Iran from 2011 to 2018 with a focus on joinpoint regression.

Background: Deaths due to potential suicide are preventable and this phenomenon is costly for the health care system and contradicts the values and cultural standards of an Islamic country. Methods: This study is a retrospective study. The research population includes all cases of suicide during the years 2011-2018 who were referred to the emergency department of Babol hospitals. The results were analyzed using SPSS v.23 and Joinpoint Trend Analysis software 4.9.0.0 to identify significant changes in the temporal trends of the outbreak. Results: The highest percentage of suicides occurred in summer (27.8%), on Saturdays (13%) and at night (53%). A total of 1.9% of the cases were commit suicides (leading to death). The highest frequency of suicide was shown in 1397 (21.2%) and the lowest in 1392 (5.1%) and was more common in women (68.2% vs. 31.8%). Suicide-related deaths was higher in the second four years (63.5%), but suicide rate was significantly higher in the first four years (2011-2014) and the mortality rate due to suicide was higher in men than women. Conclusion: Suicide attempts were higher in women than men but the death rate was higher in men which means that men attempt suicide more seriously than women. The model also predicted that suicide rates would rise in the coming years. For this reason, this important issue, along with a detailed analysis of the roots of suicidal ideation and preventive measures, should be considered by health officials and social institutions.

Complications of patients with hematologic malignancies in a selected Iranian population.

Background: Hematologic malignancies in childhood and their treatments can cause dental anomalies and jaw bone abnormalities; therefore, the aim of this study was to assess the prevalence of these disorders in children. Methods: This cross-sectional study was conducted on all children diagnosed with hematologic malignancies that referred to in Amirkola Children's Hospital from 2011 to 2018. All of children underwent clinical evaluation in a Dental Radiology Clinic and panoramic imaging was performed. The radiographs were examined for dental anomalies and jaw bone abnormalities. The data were analyzed by descriptive analysis using chi-square, Mann-Whitney and Kruskal-Wallis with a 95% confidence interval. Results: The study population consisted of 32 children and 9.46% of these patients showed intraoral signs in clinical evaluations. Panoramic radiographs indicated dental anomalies in 12 (63.9%) and jaw bone abnormalities in 17 (89.4%) patients. The most common dental anomaly and bone abnormality were taurodontism and changes in lamina dura, respectively. By measuring the mandibular cortical index (MCI), it was revealed that 13 had osteopenia, in which 4 of them had severe osteopenia (osteoporosis). The statistical analysis demonstrated that there was a significant difference between the incidence of osteoporosis and changes in lamina dura with the gender (p<0.05). Conclusion: Due to early onset of osteopenia and osteoporosis and the presence of dental and bone abnormalities in half of study population, early assessment of their clinical and radiographic condition can be helpful in the prevention and the early treatment of their oral complications.

Expression Assessment of the Helicobacter pyloribabA and sabA Genes in Patients with Peptic Ulcer, Duodenal Ulcer and Gastric Cancer.

Helicobacter pylori as a common gastrointestinal (GI) pathogen must possess certain virulence characteristics to colonize the stomach, evade host immune responses, and subsequently induce GI diseases. This research aimed to investigate the expression level of two important genes, the sialic acid-binding adherence (SabA) and the blood group antigen-binding adhesion (BabA) in H. pylori strains isolated from adult patients living in the northern part of Iran, and their association with peptic ulcer disease (PUD) and gastric cancer (GC). This cross-sectional study was carried out on adult patients referring to the GI clinic of the hospitals affiliated to Babol University of Medical Sciences, Iran. New cases diagnosed with gastritis, peptic ulcer or gastric cancer were included. Endoscopic-guided gastric biopsies were examined and H. pylori positive colonies were analyzed to determine the expression of babA and sabA genes, utilizing specific primers and the SYBR Green dye. Among 175 patients with mean age of 51.6±15.6 years, 101 (57.7%) of the individuals tested positive for H. pylori infection. Statistical analysis revealed a significant correlation between sabA (P=0.003) and babA (P=0.002) gene expression and development of PUD and GC. Smoking (P=0.052), gender (P=0.004) and positive babA gene expression (P=0.009) had the greatest association with occurrence of PUD or GC in H. pylori positive patients.  In summary, the presence of the sabA gene in people infected with H. pylori increased the risk of GC compared to gastritis, while, the presence of the babA gene was significantly increased in gastric ulcer patients. Considering the diversity of H. pylori isolates and the varying results observed in different geographical regions, further comprehensive studies are required to evaluate the function of these genes in H. pylori pathogenesis and their relationship with clinical outcomes.

Development of a Machine Learning-Based Screening Method for Thyroid Nodules Classification by Solving the Imbalance Challenge in Thyroid Nodules Data.

BACKGROUND: This study aims to show the impact of imbalanced data and the typical evaluation methods in developing and misleading assessments of machine learning-based models for preoperative thyroid nodules screening. STUDY DESIGN: A retrospective study. METHODS: The ultrasonography features for 431 thyroid nodules cases were extracted from medical records of 313 patients in Babol, Iran. Since thyroid nodules are commonly benign, the relevant data are usually unbalanced in classes. It can lead to the bias of learning models toward the majority class. To solve it, a hybrid resampling method called the Smote-was used to creating balance data. Following that, the support vector classification (SVC) algorithm was trained by balance and unbalanced datasets as Models 2 and 3, respectively, in Python language programming. Their performance was then compared with the logistic regression model as Model 1 that fitted traditionally. RESULTS: The prevalence of malignant nodules was obtained at 14% (n = 61). In addition, 87% of the patients in this study were women. However, there was no difference in the prevalence of malignancy for gender. Furthermore, the accuracy, area under the curve, and geometric mean values were estimated at 92.1%, 93.2%, and 76.8% for Model 1, 91.3%, 93%, and 77.6% for Model 2, and finally, 91%, 92.6% and 84.2% for Model 3, respectively. Similarly, the results identified Micro calcification, Taller than wide shape, as well as lack of ISO and hyperechogenicity features as the most effective malignant variables. CONCLUSION: Paying attention to data challenges, such as data imbalances, and using proper criteria measures can improve the performance of machine learning models for preoperative thyroid nodules screening.

Evaluation of Time-Varying Biomarkers in Mortality Outcome in COVID-19: an Application of Extended Cox Regression Model.

Background: COVID-19 pandemic has created many challenges for clinicians. The monitoring trend for laboratory biomarkers is helpful to provide additional information to determine the role of those in the severity status and death outcome. Objective: This article aimed to evaluate the time-varying biomarkers by LOWESS Plot, check the proportional hazard assumption, and use to extended Cox model if it is violated. Methods: In the retrospective study, we evaluated a total of 1641 samples of confirmed patients with COVID-19 from October until March 2021 and referred them to the central hospital of Ayatollah Rohani Hospital affiliated with Babol University of medical sciences, Iran. We measured four biomarkers AST, LDH, NLR, and lymphocyte in over the hospitalization to find out the influence of those on the rate of death of COVID-19 patients. Results: The standard Cox model suggested that all biomarkers were prognostic factors of death (AST: HR=2.89, P<0.001, Lymphocyte: HR=2.60, P=0.004, LDH: HR=2.60, P=0.006, NLR: HR=1.80, P<0.001). The additional evaluation showed that the PH assumption was not met for the NLR biomarker. NLR biomarkers had a significant time-varying effect, and its effect increase over time (HR(t)=exp (0.234+0.261×log(t)), p=0.001). While the main effect of NLR did not show any significant effect on death outcome (HR=1.26, P=0.097). Conclusion: The reversal of results between the Cox PH model and the extended Cox model provides insight into the value of considering time-varying covariates in the analysis, which can lead to misleading results otherwise.

Complications of patients with thalassemia major and intermedia in a selected Iranian population.

Background: Due to anemia in thalassemia major (TM) and thalassemia intermedia (TI) patients, bone changes occur, especially in the broad bones like jaw and skull, which are the main sites of hematopoiesis. Therefore, the dentist should be aware of the disease to prevent complications. The aim of this study was to evaluate the radiographic findings of the jaw and teeth in TM and TI patients and to compare the two groups. Methods: 50 TM patients and 50 TI patients in Amirkola Thalassemia Center, whose thalassemia were definitively diagnosed by a hematologist, were selected as the study group and the control group consisted of 50 healthy individuals. In patients` panoramic radiographs, dental anomalies (microdontia, root shortening etc.) and bone disorders (bone marrow hyperplasia, maxillary sinus invisibility etc.) were assessed. A p<0.05 was considered. Results: Dental anomalies were (42.84%) in TI patients and (23.46%) in the control group, the difference was significant. Dental anomalies in TM patients were (38.76%) and in the control group (23.46%) and a significant difference was observed (p<0.001). Bone disorders were (47.94%) in TI patients and in the control group (32.64%). Bone disorders in TM patients were (44.88%) and in the control group was (32.64%) that showed a significant difference. Conclusion: This study showed that in thalassemia patients, bone and dental disorders frequency were higher than healthy individuals. Bone disorders were also more common than dental anomalies. Dental and bone disorders were more common in TI.

The effect of neuromuscular electrical stimulation on serum glucose levels in children and adolescents with type-1 diabetes mellitus: a single group clinical trial.

BACKGROUND: This study aimed to evaluate the effect of Neuromuscular Electrical Stimulation (NMES) on serum glucose level in children and adolescents with type-1 diabetes. METHODS: This before-after, single-group, clinical trial was conducted on 29 patients with type-1 diabetes mellitus with the age range of 7-18 years. The patients underwent NMES in two 20-minute phases on the quadriceps and hamstrings muscles, three sessions per week for a period of 8 weeks. Fasting Blood Sugar (FBS), measured in two ways, by glucometer and laboratory testing, was considered as the primary outcome and the glycated hemoglobin (HbA1c) and the total daily dose (TDD) of insulin were measured as the secondary outcomes. The laboratory FBS and HbA1c were measured 1 day before the intervention (as a baseline value) and then 2 and 6 weeks after the last session of intervention. FBS by glucometer and total daily dose of insulin were recorded daily from 2 weeks before the intervention to the last day of the intervention and consequently, the weekly average of these variables was calculated and used for statistical analysis. RESULTS: The serum level of FBS (measured by glucometer) and the total daily dose of insulin reduced significantly 2 weeks after beginning of intervention. The laboratory serum level of FBS decreased significantly in the second week after the end of intervention compared to the baseline values. Although the HbA1c level decreased at follow-up period (2 and 6 weeks after the intervention), it was not significant. CONCLUSION: It seems that 8 weeks of NMES has beneficial effects on the reduction of FBS and TDD of insulin therefore, it could be suggested as the contributory treatment in management of children and adolescents with type-1 diabetes. TRIAL REGISTRATION: The study was registered at https://fa.irct.ir/user/trial/51739/view (IRCT20100523003998N1) in date of 25/10/2020.

Developing machine learning-based models to predict intrauterine insemination (IUI) success by address modeling challenges in imbalanced data and providing modification solutions for them.

BACKGROUND: This study sought to provide machine learning-based classification models to predict the success of intrauterine insemination (IUI) therapy. Additionally, we sought to illustrate the effect of models fitting with balanced data vs original data with imbalanced data labels using two different types of resampling methods. Finally, we fit models with all features against optimized feature sets using various feature selection techniques. METHODS: The data for the cross-sectional study were collected from 546 infertile couples with IUI at the Fatemehzahra Infertility Research Center, Babol, North of Iran. Logistic regression (LR), support vector classification, random forest, Extreme Gradient Boosting (XGBoost) and, Stacking generalization (Stack) as the machine learning classifiers were used to predict IUI success by Python v3.7. We employed the Smote-Tomek (Stomek) and Smote-ENN (SENN) resampling methods to address the imbalance problem in the original dataset. Furthermore, to increase the performance of the models, mutual information classification (MIC-FS), genetic algorithm (GA-FS), and random forest (RF-FS) were used to select the ideal feature sets for model development. RESULTS: In this study, 28% of patients undergoing IUI treatment obtained a successful pregnancy. Also, the average age of women and men was 24.98 and 29.85 years, respectively. The calibration plot in this study for IUI success prediction by machine learning models showed that between feature selection methods, the RF-FS, and among the datasets used to fit the models, the balanced dataset with the Stomek method had well-calibrating predictions than other methods. Finally, the brier scores for the LR, SVC, RF, XGBoost, and Stack models that were fitted utilizing the Stomek dataset and the chosen feature set using the Random Forest technique obtained equal to 0.202, 0.183, 0.158, 0.129, and 0.134, respectively. It showed duration of infertility, male and female age, sperm concentration, and sperm motility grading score as the most predictable factors in IUI success. CONCLUSION: The results of this study with the XGBoost prediction model can be used to foretell the individual success of IUI for each couple before initiating therapy.

Prevalence and anatomical variations of maxillary sinus septa: A cone-beam computed tomography analysis.

Background: Detailed understanding the anatomy and variations of maxillary sinus septa is necessary. We aimed to investigate prevalence and various anatomical variations of maxillary sinus septa using cone-beam computed tomography (CBCT) images. Material and Methods: In this retrospective cross-sectional study, CBCT scans of 809 patients referred to a specialist dental and maxillofacial radiology clinic in Babol, northern Iran, during 2014-2020 were evaluated. Location, morphology, height, and direction of septa in different planes were recorded. Results: Sinus septa were observed in 37.9% (n=307) of the participants. There were 117 cases with septa only in left sinus, 83 cases with septa only in right sinus, and 107 cases with septa in both sinuses. Totally, 414 septa were seen in the subjects. Prevalence of partial septa was considerably higher than complete septa (77.5% versus 22.5%). Regarding septa location, middle area with a prevalence rate of 58.7% was found more prevalent than other sinus areas. The mean septum height on the left and right sinuses was 6.0±3.1 mm 5.7±3.9, respectively (p<0.001). Regarding left sinus, directions of vertical (63.8%), oblique (30.8%), and straight (63.8%) were the most prevalent compared with other directions in sagittal, frontal, and axial planes, respectively. In relation to right maxillary sinus, direction of vertical in sagittal and frontal planes (72.6% and 24.2%, respectively), and direction of straight in axial plane (58.4%) were the most prevalent directions compared with others in the same planes. Conclusions: Septa prevalence in maxillary sinus was relatively high, with various directions, locations, heights, and shapes. It is recommended to use CBCT for a careful evaluation of toothless area prior to surgeries on the sinus (especially sinus lift) in three plans, in order to take careful measures and prevent postoperative complications in case septa exist. Key words:Maxillary sinus septa, anatomical variation, cone-beam computed tomography, dental implant.

The effects of Rosa foetida extract along with self-care education on primary dysmenorrhea: study protocol for a randomized clinical trial.

BACKGROUND: Dysmenorrhea is one of the most common disorders among young women. Medicinal herbs are one of the alternative methods for the treatment of dysmenorrhea. This study will investigate the effect of Rosa foetida extract, along with self-care behavior education on primary dysmenorrhea among female students of Babol University of medical sciences. METHODS/DESIGN: A randomized clinical trial will be performed on single students, aged 18 to 24 years. The research samples will be divided into three groups. The students will receive self-care behavior education on dysmenorrhea. Following the education, two of the groups will receive Rosa foetida extract capsules and placebo capsules in two consecutive cycles every 8 h for two successive days, respectively. The capsules will have similar physical appearance. The third group will not receive any medication. Data will be collected through demographic characteristic questionnaire, visual analog scale, dysmenorrhea self-care behaviors scale questionnaire, pictorial chart, and menstrual distress scale questionnaire. In order to determine and compare the effect of pharmacological and educational interventions on the severity of dysmenorrhea in groups, an ANOVA analysis of variance test with repeated measures will be used by SPSS software version 22. DISCUSSION: The results will show the effects of Rosa foetida extract along with self-care behavior education on primary dysmenorrhea, and beneficial effects that may be found in the trial of this plant may be of use for women with the same problem. ETHICS AND DISSEMINATION: The study is approved by the Ethics Committee of Babol University of Medical Sciences (IR.MUBABOL.REC.1397.059). TRIAL REGISTRATION: IRCT 20190318043086N1. Registered on 14 June 2019.