Modifying the false discovery rate procedure based on the information theory under arbitrary correlation structure and its performance in high-dimensional genomic data.

BACKGROUND: Controlling the False Discovery Rate (FDR) in Multiple Comparison Procedures (MCPs) has widespread applications in many scientific fields. Previous studies show that the correlation structure between test statistics increases the variance and bias of FDR. The objective of this study is to modify the effect of correlation in MCPs based on the information theory. We proposed three modified procedures (M1, M2, and M3) under strong, moderate, and mild assumptions based on the conditional Fisher Information of the consecutive sorted test statistics for controlling the false discovery rate under arbitrary correlation structure. The performance of the proposed procedures was compared with the Benjamini-Hochberg (BH) and Benjamini-Yekutieli (BY) procedures in simulation study and real high-dimensional data of colorectal cancer gene expressions. In the simulation study, we generated 1000 differential multivariate Gaussian features with different levels of the correlation structure and screened the significance features by the FDR controlling procedures, with strong control on the Family Wise Error Rates. RESULTS: When there was no correlation between 1000 simulated features, the performance of the BH procedure was similar to the three proposed procedures. In low to medium correlation structures the BY procedure is too conservative. The BH procedure is too liberal, and the mean number of screened features was constant at the different levels of the correlation between features. The mean number of screened features by proposed procedures was between BY and BH procedures and reduced when the correlations increased. Where the features are highly correlated the number of screened features by proposed procedures reached the Bonferroni (BF) procedure, as expected. In real data analysis the BY, BH, M1, M2, and M3 procedures were done to screen gene expressions of colorectal cancer. To fit a predictive model based on the screened features the Efficient Bayesian Logistic Regression (EBLR) model was used. The fitted EBLR models based on the screened features by M1 and M2 procedures have minimum entropies and are more efficient than BY and BH procedures. CONCLUSION: The modified proposed procedures based on information theory, are much more flexible than BH and BY procedures for the amount of correlation between test statistics. The modified procedures avoided screening the non-informative features and so the number of screened features reduced with the increase in the level of correlation.

Evaluation of the gene encoding carnitine transporter (OCTN2/SLC22A5) expression in human breast cancer and its association with clinicopathological characteristics.

BACKGROUND: Fatty acid oxidation (FAO) is a major energy-generating process in the mitochondria and supports proliferation, growth, and survival of cancer cells. L-Carnitine is an essential co-factor for carrying long-chain fatty acids into the mitochondria. The entry of l-carnitine across cell membrane is regulated by OCTN2 (SLC22A5). Thus, it can plays a significant role in the mitochondrial fatty acid oxidation. This study aimed to evaluate the OCTN2 expression and its association with clinicopathological characteristics in breast cancer. METHODS: In this work, OCTN2 was examined in 54 pairs of fresh samples of breast cancer (BC) and adjacent noncancerous tissue using quantitative real-time polymerase chain reaction and immunohistochemistry (IHC). The IHC approach was also used to investigate the expression of additional clinicopathological features. RESULTS: The present research findings revealed that the relative expression of OCTN2 in BC tissues was substantially higher than the adjacent normal tissues. This up-regulation was correlated positively with tumor size and Ki-67 and negatively with the progesterone receptor (PR) status, providing evidence of the opposite effects of OCTN2 and PR on tumor development. CONCLUSION: The study shows that the OCTN2 expression in BC patients may be used as a prognostic biomarker and a tumor oncogene. As a result, it could be considered a possible therapeutic target. Nevertheless, the significance of the findings needs to be confirmed by further studies.

How effective is diluted povidone-iodine in preventing periprosthetic joint infection in total joint arthroplasty (TJA)? An updated systematic review and meta-analysis.

PURPOSE: Periprosthetic joint infection (PJI) is a serious complication with total joint arthroplasty (TJA), that necessitates reoperation. Pre-closure irrigation with dilute povidone-iodine (PI) is among the preventive measures, but its efficiency is still controversial. As a result, the focus of this systematic review and meta-analysis is on the effect of dilute PI wound irrigation in the prevention of PJI following TJA. METHODS: We systematically reviewed and analyzed articles that compared PI with other agents in terms of PJI rate after TJA, searching Medline, Scopus, Web of science, and Cochrane databases. A number of 13 papers including 63,950 patients in total, were finally considered in qualitative and quantitative assessments. We have also further assessed review articles. RESULTS: In comparison with normal saline (NS), PI reduced post-operative infection rate (OR: 0.44; CI 95%: 0.34-0.56). However, there was no difference between PI and chlorhexidine (CHG) (OR: 1.61; CI 95%: 0.83-3.09)) or undetermined comparators (OR: 1.08; CI 95%: 0.67-1.76). CONCLUSION: PI irrigation seems an efficient preventive measure for post-operative PJI and would seem to be the most feasible for TJA protocol.

A New Approach on the pain management of intramuscular injection: A Triple-Blind Randomized Clinical Trial.

BACKGROUND: Pain management is an important part of care provided by nurses. AIMS: The present study aimed to investigate the effect of an innovative method named the skin traction, pressure, and rapid muscle release (TPR) on reducing IM injection pain compared with the Z-track injection method DESIGN: This triple-blind clinical trial investigated 63 patients who required Methocarbamol injection. METHODS: Two, 5-cc methocarbamol injections were given to each patient by the two techniques in two of his/her muscles. In the TPR technique, after applying skin traction and imposing deep pressure on the muscle, the needle was inserted at a 90° angle near the skin and the muscle was released rapidly towards the needle. Hence, the needle was embedded in the muscle. However, muscle release was not applied in the Z-track method. The visual analog scale (VAS) was used to measure pain intensity. For data analysis, T-independent and χ2 tests were used. RESULTS: The findings showed that the mean pain score in TPR and Z-track methods was 1.68 ± 1.20 and 3.76 ± 1.42, respectively. The difference was statistically significant. CONCLUSION: The results of this study showed that the innovative method (TPR) can be used as a substitute for the Z-track method to reduce IM injection pain.

Evaluation of the effect of selecting gluteal injection site on the pain injection based on anthropometric indices and body shape pattern: A randomised controlled trial study.

AIMS AND OBJECTIVES: This study was aimed at comparing the effect of injection site selection based on anthropometric indices and body shape pattern on pain injection. BACKGROUND: Pain is one of the common complications of intramuscular injection. Selecting the right place for gluteal injection is one of the challenges of nursing which can increase the safety and success of the injection and thereby reduce the pain severity caused by it. DESIGN: Open-label randomized controlled trial study. METHODS: In this study, 162 eligible subjects referred to the emergency unit of Vasei Hospital of Sabzevar, Iran were randomly assigned to three groups of control, anthropometric indices and body shape pattern. Subjects in the control group received dorsogluteal injection (traditional way). In the anthropometric group, body mass index (BMI), waist circumference (WC) and anterior superior iliac spine to iliac tubercle (ASIS-IT), and in body shape pattern group, observed body shape indices (OBS), BMI and sex were used to select the gluteal injection site. Pain injection was assessed using the Visual Analogue Scale (VAS). The CONSORT checklist was used. RESULTS: The mean age of the participant was 39.43 ± 13.16 and 43.21% (n = 70) were male. Based on multiple linear regression analysis, the mean pain injection was substantially lower in body shape pattern as compared to the control group (r2 : .26; bxy = -0.41; 95% CI: -0.81, -0.01; p = .043). The mean pain injection was significantly greater in the left leg injection than right one (r2 : .26; bxy = 0.44; 95% CI: 0.06, 0.81; p = .021). CONCLUSIONS: Findings of this study suggest that the selection of a gluteal injection site based on body shape pattern in comparison with traditional dorsogluteal injection method has a significant effect on pain injection relief. RELEVANCE TO CLINICAL PRACTICE: Nurses can choose the appropriate gluteal injection site based on the body shape pattern to reduce the pain of the intramuscular (IM) gluteal injections.

Comparison of tamoxifen and hormone replacement cycle (HRT) in frozen embryo transfer. A randomized controlled trial.

OBJECTIVE: The use of frozen embryos in the treatment of infertility with assisted reproductive techniques has been increased. Different methods are used to prepare the endometrium for frozen embryo transfer (FET). The aim of this study was to compare pregnancy outcomes after treatment with tamoxifen and hormonal replacement therapy (HRT) in FET. METHODS: This randomized clinical trial was carried out with 214 infertile women in the infertility research center of Milad Hospital in Mashhad during 2018-2020. We had 84 patients receiving tamoxifen and 92 took HRT. Endometrial thickness (ET) and pregnancy outcome were measured in both groups. RESULTS: Mean infertility duration (p=0.328), number of embryos (p=0.649), FSH (p=0.390), LH (p=0.051) and LH/FSH ratio (p=0.287) as well as type of infertility (primary or secondary) (p=0.295), causes of infertility (p=0.750) and pattern of menstruation (p=0.676) were not significantly different in the two groups. Mean ET in the TMX and HRT groups were 8.72±1.45mm and 9.00±1.69mm, respectively (p=0.423). There was no statistically significant difference between chemical pregnancy (p=0.663), clinical pregnancy (p=0.994) and ongoing pregnancy (p≥0.999) in the TMX and HRT groups. CONCLUSIONS: Treatment with tamoxifen can be as effective as GnRH agonist for endometrial preparation in FET.

Comparing the Effect of Respiratory Physiotherapy and Positive End-Expiratory Pressure Changes on Capnography Results in Intensive Care Unit Patients with Ventilator-Associated Pneumonia.

Background: While critically ill patients experience a life-threatening illness, they commonly develop ventilator-associated pneumonia (VAP) which can increase morbidity, mortality, and healthcare costs. The present study aimed to compare the effect of respiratory physiotherapy and increased positive endexpiratory pressure (PEEP) on capnography results. Materials and Methods: This randomized control clinical trial was performed on 80 adult patients with VAP in the intensive care unit (ICU). The patients were randomized to receive either PEEP at 5 cm H2O, followed by a moderate increase in PEEP to 10 cm H2O, or PEEP at 5 cm H2O with respiratory physiotherapy for 15 min. The numerical values were recorded on the capnograph at minutes 1, 5, 10, 15, and 30 in both methods. Data collection instruments included a checklist and MASIMO capnograph. Results: As evidenced by the obtained results, the two methods significantly differed in the excreted pCO2 (partial pressure of carbon dioxide) (P<0.0001). However, the average amount of excreted pCO2 was higher in the respiratory physiotherapy and PEEP intervention (38.151mmHg) in comparison with increasing PEEP alone method (36.184mmHg). Also, PEEP elevation method prolonged the time of the first phase (inhalation time) and the second phase while shortening the third phase (exhalation time) in capnography waves. Conclusion: CO2 excretion in patients with VAP increased after respiratory physiotherapy. Further, physiotherapy demonstrated more acceptable results in CO2 excretion compared with PEEP changes in mechanically ventilated patients.

Prediction of Normal Tissue Complication Probability (NTCP) After Radiation Therapy Using Imaging and Molecular Biomarkers and Multivariate Modelling.

The aim of this study was to design a predictive radiobiological model of normal brain tissue in low-grade glioma following radiotherapy based on imaging and molecular biomarkers. Fifteen patients with primary brain tumors prospectively participated in this study and underwent radiation therapy. Magnetic resonance imaging (MRI) was obtained from the patients, including T1- and T2-weighted imaging and diffusion tensor imaging (DTI), and a generalized equivalent dose (gEUD) was calculated. The radiobiological model of the normal tissue complication probability (NTCP) was performed using the variables gEUD; axial diffusivity (AD) and radial diffusivity (RD) of the corpus callosum; and serum protein S100B by univariate and multivariate logistic regression XLIIIrd Sir Peter Freyer Memorial Lecture and Surgical Symposium (2018). Changes in AD, RD, and S100B from baseline up to the 6 months after treatment had an increasing trend and were significant in some time points (P-value < 0.05). The model resulting from RD changes in the 6 months after treatment was significantly more predictable of necrosis than other univariate models. The bivariate model combining RD changes in Gy40 dose-volume and gEUD, as well as the trivariate model obtained using gEUD, RD, and S100B, had a higher predictive value among multivariate models at the sixth month of the treatment. Changes in RD diffusion indices and in serum protein S100B value were used in the early-delayed stage as reliable biomarkers for predicting late-delayed damage (necrosis) caused by radiation in the corpus callosum. Current findings could pave the way for intervention therapies to delay the severity of damage to white matter structures, minimize cognitive impairment, and improve the quality of life of patients with low-grade glioma.

The Impact of Incentive Spirometry on Shoulder Tip Pain in Laparoscopic Cholecystectomy: A Randomized Clinical Trial.

BACKGROUND: Shoulder pain is among the early postlaparoscopic symptoms related to carbon dioxide used for pneumoperitoneum, which remains in the abdominal cavity. Therefore, incentive spirometry (IS) is a novel technique to alleviate this pain following laparoscopic cholecystectomy (LC). The present study was designed to investigate if the use of IS after LC would relieve shoulder tip pain, and determine the amount of postoperative opioid analgesics utilized. MATERIALS AND METHODS: This randomized clinical trial was conducted on patients who were clinically diagnosed with cholecystitis, and underwent LC. Accordingly, group I patients (n=42) received IS (including 10 deep breaths with a spirometer in sitting or semisitting positions) in full consciousness every 2 hours starting at 2 hours after surgery, but group II patients (n=42) did not have respiratory physiotherapy. The postoperative shoulder pain after the surgery was further evaluated by a numerical rating scale (NRS). RESULTS: At 4, 8, 12, 24, and 48 hours following LC, the NRS pain scores significantly reduced in group I compared with group II. In addition, the results of the repeated measures analysis of variance indicated significantly lower NRS pain scores within the first 48 hours after LC in group I compared with group II. Consequently, the study findings showed a significantly higher percentage of cases in group II, requiring postoperative analgesics, in comparison with group I. CONCLUSIONS: IS decreased the severity of shoulder tip pain after LC with no complications. Thus, IS may be considered as a viable alternative to other laparoscopic interventions. However, still further studies are necessary to evaluate its efficacy compared with other techniques.

Smokeless Tobacco Use in Iran: A Systematic Review.

BACKGROUND: Smokeless tobacco (ST) use is one of the most important public health problems in Southeast Asia. The use of these substances increases the incidence of some cancers and other diseases. The purpose of this review study was to investigate on ST use in Iran. METHODS: A literature search was conducted on PubMed, Google Scholar, and three national databases [Scientific Information Database (SID), IranMedex, and IranDoc] based on the standard search strategy. FINDINGS: Most consumer people lived in Sistan and Baluchestan Province (Zahedan and Chabahar Cities) and Golestan Province, Iran. ST use rates ranged from 11.0% to 45.7% among college students in Sistan and Baluchestan (Zahedan and Chabahar) and Golestan. There are various types of ST consumed in Iran that have been mentioned in various articles, including Pan, Gutka, Nass, Naswar, Biti, and Supari. CONCLUSION: Most studies on ST have been conducted in Sistan and Baluchestan and Golestan Provinces and we need more research for other provinces. Consumption by women is a warning and a threat to women's health in the future. Further studies will be needed to find out more precisely the prevalence of consumption in Iran.

Prioritization of needs among students of University of Medical Sciences: A needs assessment.

INTRODUCTION: The need assessment is a fundamental part of any planning, and almost by neglecting it, the effectiveness of the programs is impossible. The purpose of this study was the prioritization of needs among students of the Iran University of Medical Sciences. MATERIALS AND METHODS: The design study was conducted in two parts; in the first part, the design of the questionnaire was done by qualitative methods. The questionnaires were extracted by interviewing and obtained acceptable validity and reliability. Moreover, the second part created a questionnaire consisting of four categories: education, welfare, economic, and psychological and social. A simple random sampling method was used to select 363 people using the Cochran formula. Finally, 336 people (including 28 people excluded) completed the questionnaire. A questionnaire designed to collect sample data was used and analyzed using version 23 of SPSS. RESULTS: A total of 336 students (26.77 ± 5.45 years) participated in the study. 123 (36.6%) were male and 213 (63.4%) were female. Psychological and social needs of students were prioritized, and educational priorities were ranked second. The findings showed that there was no significant statistical difference between the scores of welfares and psychosocial and educational needs and the gender of the research units (P > 0.05). However, in the mean of economic needs scores, there is a significant statistical difference between the marital status of the research units (P < 0.05). CONCLUSION: The results of our study in the research units showed that the priority of psychosocial needs was more than other needs and the educational priority was the next. According to the results of this study, we suggest that, in future educational and educational planning, policymakers and planners should pay attention to psychological and social issues.

Association between +4259 T>G and -574 G>T Polymorphisms of TIM-3 with Asthma in an Iranian Population.

T-cell immunoglobulin and mucin domain (TIM)-3 have been shown to negatively regulate Th1 cell-mediated immunity. Activation of TIM-3 by galectin-9 induces Th1 cell apoptosis, which may contribute to skewing of immune response towards Th2-dominant immunity. The aim of this study was to determine whether certain genetic variations of TIM-3 influence predisposition to asthma in a sample of Iranian population. This case-control study was conducted on 209 patients with asthma and 200 healthy controls. The +4259 T>G and -574 G>T polymorphisms were detected using polymerase chain reaction-restriction fragment length polymorphism(PCR-RFLP) and amplification refractory mutation system-PCR(ARMS-PCR). Total serum IgE was further measured with ELISA. Notably, +4259T > G and-574G>T polymorphisms of TIM-3 were significantly associated with the susceptibility to asthma. In addition, the present study showed a significant difference between the distribution frequency of the GT + TT genotype and T allele on the +4259 T>G and -574 G>T locus between the groups.However, no correlation between the +4259 T > G and -574G > T polymorphisms and total serum IgE levels were observed. Together these results suggest that the TIM-3 +4259 T>G and -574 G>T polymorphisms are greatly associated with the susceptibility of Iranian population to asthma, which could open up new horizons for  better understanding of the pathophysiology, diagnostic, prognostic and therapeutic approaches of asthma.

High prevalence of multidrug-resistance uropathogenic Escherichia coli strains, Isfahan, Iran.

BACKGROUND AND OBJECTIVES: Urinary tract infection (UTI) is one of the most frequent infectious diseases and can occur in all age groups. Escherichia coli is the main cause of this infection. Multiple resistances to antimicrobial agents are increasing quickly in E. coli isolates and may complicate therapeutic strategies for UTI. The aim of this study was to determine the antibiotic resistance pattern and the multidrug-resistance (MDR) phenotypes in uropathogenic E. coli (UPEC). MATERIALS AND METHODS: A total of 135 UPEC isolates were collected from both outpatients (91 isolates) and inpatients (44 isolates) between September, 2012 and February, 2013. In order to determine the MDR among UPEC isolates, we have tested 15 antimicrobial agents and antibiotic susceptibility was done by Kirby-Bauer disk diffusion method. RESULTS: The percentage of MDR isolates (resistant to at least three drug classes such as aminoglycosides, fluoroquinolones, penicillins, cephalosporins, or carbapenems) was 68% in the inpatients and 61% in the outpatients. Antibiotic resistance to ampicillin, ceftazidim, nalidixic acid, and trimethoprim/sulfamethoxazole were higher than 50%. Amikacin, nitrofurantoin, and gentamicin showed markedly greater activity (89.1%, 85.9%, and 82.4% sensitivity, respectively) than other antimicrobial agents. Resistance to meropenem did show either in outpatients or in inpatients. INTERPRETATION AND CONCLUSIONS: The high prevalence of drug resistance among UTI patients calls for continuous monitoring of the incidence of drug resistance for appropriate empiric selection of antibiotic therapy. Empirical treatment of UTIs should be relied on susceptibility patterns from local studies.

Estimation of Organ Activity using Four Different Methods of Background Correction in Conjugate View Method.

To make an accurate estimation of the uptake of radioactivity in an organ using the conjugate view method, corrections of physical factors, such as background activity, scatter, and attenuation are needed. The aim of this study was to evaluate the accuracy of four different methods for background correction in activity quantification of the heart in myocardial perfusion scans. The organ activity was calculated using the conjugate view method. A number of 22 healthy volunteers were injected with 17-19 mCi of (99m)Tc-methoxy-isobutyl-isonitrile (MIBI) at rest or during exercise. Images were obtained by a dual-headed gamma camera. Four methods for background correction were applied: (1) Conventional correction (referred to as the Gates' method), (2) Buijs method, (3) BgdA subtraction, (4) BgdB subtraction. To evaluate the accuracy of these methods, the results of the calculations using the above-mentioned methods were compared with the reference results. The calculated uptake in the heart using conventional method, Buijs method, BgdA subtraction, and BgdB subtraction methods was 1.4 ± 0.7% (P < 0.05), 2.6 ± 0.6% (P < 0.05), 1.3 ± 0.5% (P < 0.05), and 0.8 ± 0.3% (P < 0.05) of injected dose (I.D) at rest and 1.8 ± 0.6% (P > 0.05), 3.1 ± 0.8% (P > 0.05), 1.9 ± 0.8% (P < 0.05), and 1.2 ± 0.5% (P < 0.05) of I.D, during exercise. The mean estimated myocardial uptake of (99m)Tc-MIBI was dependent on the correction method used. Comparison among the four different methods of background activity correction applied in this study showed that the Buijs method was the most suitable method for background correction in myocardial perfusion scan.