The effects of green tea tablets and metformin on ovulation and menstrual cycle regularity in women with polycystic ovary syndrome.

Polycystic ovary syndrome is the most common cause of oligo-ovulation and anovulation among women of reproductive age, contributing to infertility. This study aimed to compare the effects of green tea tablets and metformin on ovulation, menstrual cycle regularity, and antioxidant biomarkers in women with polycystic ovary syndrome (PCOS). In this clinical trial study, 94 women with PCOS were randomly assigned to three groups: green tea (n = 33), metformin (n = 29), and control (n = 32). Menstrual status and oxidative stress parameters, including total antioxidant capacity, thiol, and lipid peroxidation, were compared before and 3 months after the intervention among all three groups. Data analysis was conducted using SPSS software version 22 and employing the analysis of variance and paired t-tests. Following the intervention, the mean menstrual cycle duration in the green tea, metformin, and control groups was 32.22 ± 12.78, 48.72 ± 37.06, and 48.53 ± 31.04 days, respectively (P = 0.040). There was no statistically significant difference between the three groups in terms of biochemical, hormonal, and antioxidant indices before and after the intervention (P > 0.05). The intake of green tea tablets was associated with better outcomes in regulating the menstrual cycle in women with PCOS.

The maternal factors associated with infant low birth weight: an umbrella review.

BACKGROUND: In this umbrella review, we systematically evaluated the evidence from meta-analyses and systematic reviews of maternal factors associated with low birth weight. METHODS: PubMed, Scopus, and Web of Science were searched to identify all relevant published studies up to August 2023. We included all meta-analysis studies (based on cohort, case-control, cross-sectional studies) that examined the association between maternal factors (15 risk factors) and risk of LBW, regardless of publication date. A random-effects meta-analysis was conducted to estimate the summary effect size along with the 95% confidence interval (CI), 95% prediction interval, and heterogeneity (I2) in all meta-analyses. Hedges' g was used as the effect size metric. The effects of small studies and excess significance biases were assessed using funnel plots and the Egger's test, respectively. The methodological quality of the included studies was assessed using the AMSTAR 2 tool. RESULTS: We included 13 systematic Review with 15 meta-analysis studies in our study based on the inclusion criteria. The following 13 maternal factors were identified as risk factors for low birth weight: crack/cocaine (odds ratio [OR] 2.82, 95% confidence interval [CI] 2.26-3.52), infertility (OR 1.34, 95% CI 1.2-1.48), smoking (OR 2.00, 95% CI 1.76-2.28), periodontal disease (OR 2.41, 95% CI 1.67-3.47), depression (OR 1.84, 95% CI 1.34-2.53), anemia (OR 1.32, 95% CI 1.13-1.55), caffeine/coffee (OR 1.34, 95% CI 1.14-1.57), heavy physical workload (OR 1.87, 95% CI 1.00-3.47), lifting ≥ 11 kg (OR 1.59, 95% CI 1.02-2.48), underweight (OR 1.79, 95% CI 1.20-2.67), alcohol (OR 1.23, 95% CI 1.04-1.46), hypertension (OR 3.90, 95% CI 2.73-5.58), and hypothyroidism (OR 1.40, 95% CI 1.01-1.94). A significant negative association was also reported between antenatal care and low birth weight. CONCLUSIONS: This umbrella review identified drug use (such as crack/cocaine), infertility, smoking, periodontal disease, depression, caffeine and anemia as risk factors for low birth weight in pregnant women. These findings suggest that pregnant women can reduce the risk of low birth weight by maintaining good oral health, eating a healthy diet, managing stress and mental health, and avoiding smoking and drug use.

Diabetic foot ulcers risk prediction in patients with type 2 diabetes using classifier based on associations rule mining.

Identifying diabetic patients at risk of developing foot ulcers, as one of the most significant complications of diabetes, is a crucial healthcare concern. This study aimed to develop an associative classification model (CBA) using the Apriori algorithm to predict diabetic foot ulcers (DFU). This retrospective cohort study included 666 patients with type 2 diabetes referred to Shahid Beheshti Hospital in Iran between April 2020 and August 2022, of which 279 (42%) had DFU. Data on 29 specific baseline features were collected, which were preprocessed by discretizing numerical variables based on medical cutoffs. The target variable was the occurrence of DFU, and the minimum support, confidence, and lift thresholds were set to 0.01, 0.7, and 1, respectively. After data preparation and cleaning, a CBA model was created using the Apriori algorithm, with 80% of the data used as a training set and 20% as a testing set. The accuracy and AUC (area under the roc curve) measure were used to evaluate the performance of the model. The CBA model discovered a total of 146 rules for two patient groups. Several factors, such as longer duration of diabetes over 10 years, insulin therapy, male sex, older age, smoking, addiction to other drugs, family history of diabetes, higher body mass index, physical inactivity, and diabetes complications such as proliferative and non-proliferative retinopathy and nephropathy, were identified as major risk factors contributing to the development of DFU. The CBA model achieved an overall accuracy of 96%. Also, the AUC value was 0.962 (95%CI 0.924, 1.000). The developed model has a high accuracy in predicting the risk of DFU in patients with type 2 diabetes. The creation of accurate predictive models for DFU has the potential to significantly reduce the burden of managing recurring ulcers and the need for amputation, which are significant health concerns associated with diabetes.

Hematological parameters in newly diagnosed TB patients: A systematic review and meta-analysis.

Despite all efforts, tuberculosis (TB) remains one of the 10 leading causes of death worldwide. The hematopoietic system is seriously affected by TB and there is little information about the hematological profile of patients with TB. In this regard, this systematic review and meta-analysis aimed to assess hematological parameters among newly diagnosed TB patients. Relevant papers were found by searching in the PubMed database until April 2023. Fifteen papers involving 3354 patients were included. One-sample meta-analysis revealed the low pooled mean values for Hgb of 11.679 g/dl (95 % CI: 10.982-12.377) and the increased pooled ESR of 63.569 mm/h (95 % CI: 57.834-69.304) among newly diagnosed TB patients. The pooled prevalence of anemia, leukocytosis, thrombocytosis, and lymphopenia was 61.6 % (95 % CI: 45.4-75.6 %), 45.9 % (95 % CI: 39.1-52.9 %), 31.9 % (95%CI: 15-55.3 %) and 23.1 % (95%CI: 5.4-61.5 %) between TB patients, respectively. From a two-sample meta-analysis, the RBC and HgB values for TB patients were significantly lower than that of healthy controls (p < 0.05). Awareness of common blood abnormalities like elevated ESR, leukocytosis, and anemia in newly diagnosed TB patients helps physicians in early diagnosis and better management of disease.

Association between Metabolic Syndrome Risk Factors and Immunohistochemical Profile in Women with Breast Cancer.

Background: The association between metabolic syndrome (MetS) and breast cancer may significantly impact the mortality and incidence of breast cancer. This study aimed to assess the association between MetS risk factors and immunohistochemical (IHC) profiles in women with breast cancer. Methods: This cross-sectional study used the medical records of 300 breast cancer patients with an average age of 53.11±12.97 years in the Chemotherapy and Radiation Therapy Clinic of Dr. Anbiai, Tehran, Iran (2020-2021). The cases were divided into five subgroups including luminal A, luminal B (HER-2-), luminal B (HER-2+), HER-2 overexpressing, and triple negative. Results: There was no difference in the prognostic indicators between the presence and absence of MetS in women with breast cancer. A higher proportion of luminal A tumors (39.3%), luminal B (HER-2+) (25%), triple-negative (17%), luminal B (HER-2-) (10.7%), HER-2 overexpression (8%) was observed in women with MetS than those without MetS. Multivariate logistic regression analysis showed that patients with MetS had a 41% higher chance of developing luminal A than those without MetS, and patients with a BMI≥30 Kg/m2 had an 80% higher chance of developing luminal B (HER-2+) than those with a BMI<30 Kg/m2. Moreover, women with a waist circumference higher than 88 cm had a 14 % lower chance of developing Luminal B (HER-2+) than those with a waist circumference less than 88 cm. Conclusion: There was no difference in prognostic indicators and IHC profile in patients with and without MetS.

Association between the severity of periodontitis, COVID-19, C-reactive protein and interleukin-6 levels in hospitalized patients: a case‒control study.

BACKGROUND: The COVID-19 pandemic is perhaps one of the most important events of the 21st century. Periodontitis is one of the most prevalent diseases of the oral cavity. Due to possible pathways of interaction between these two diseases, we investigated their association. METHODS: The study population consisted of hospitalized patients with established COVID-19 diagnoses. Patients with mild to moderate COVID-19 were considered controls, while cases had severe to critical COVID-19. Periodontal examination and serum and saliva sampling were performed for each patient. Relevant medical data were extracted from patients' hospital files. RESULTS: Of the enrolled patients, 122 were included in the statistical analyses. The severity of periodontitis was directly and significantly correlated with the severity of COVID-19 (P < 0.001). Patients with generalized stage III or IV periodontitis displayed an adjusted odds ratio of 4.24 for severe to critical COVID-19. Salivary and serum interleukin-6 levels were significantly associated with COVID-19 severity (P values: 0.002 and 0.004, respectively). Hospitalization length was significantly associated with the severity of periodontitis (P = 0.004). Clinical attachment level and gingival index were associated with increased odds for adverse events (P values: 0.004 and 0.035, respectively), while number of remaining teeth was associated with decreased odds for adverse events (P = 0.023). CONCLUSIONS: This study showed that the severity of periodontitis is associated with the severity of COVID-19. This association might manifest as increased odds of adverse events. COVID-19 severity was associated with higher levels of salivary and serum interleukin-6 levels.

Effect of dental distance from implant and MAR algorithm on the detection of vertical root fracture in CBCT images

Three-dimensional cone-beam computed tomography (CBCT) has an important role in the detection of vertical root fractures (VRFs). The effect of artifact generation by high-density objects like dental implants on image quality was well documented. This study aimed to assess the effect of tooth-implant distance and the application of metal artifact reduction (MAR) algorithm on the detection of VRFs on CBCT scans. This study was conducted on 20 endodontically treated single-rooted teeth. VRFs were induced in 10 teeth, while the other 10 remained intact. The implant was inserted in the right second premolar socket area, and two teeth were inserted in right canine and right first premolar sockets area randomly and underwent CBCT with and without the application of MAR algorithm. SPSS 21 was used to analyze the results (alpha=0.05). According to the findings of this study, all four variables of sensitivity, specificity, accuracy, and positive predictive values in diagnosis were higher in cases without MAR software at both close(roots in first premolar sockets) and far distances (roots in canine sockets) from the implant. However, the highest rate of diagnosis accuracy of the first and second radiologists was in the far distance group from the implant without MAR, and the lowest rate of diagnosis accuracy in the first and second radiologists was in the close distance to the implant. Applying MAR algorithm had no positive effect on detection of VRFs on CBCT scans in both close and distant scenarios.

La tomografía computarizada de haz cónico tridimensional (CBCT) tiene un papel importante en la detección de fracturas radiculares verticales (VRF). El efecto de la generación de artefactos por objetos de alta densidad como los implantes dentales en la calidad de la imagen está bien documentado. Este estudio tuvo como objetivo evaluar el efecto de la distancia entre el diente y el implante y la aplicación del algoritmo de reducción de artefactos metálicos (MAR) en la detección de VRF en escaneos CBCT. Este estudio se realizó en 20 dientes uniradiculares tratados endodónticamente. Se indujeron VRF en 10 dientes, mientras que los otros 10 permanecieron intactos. El implante se insertó en el área del alveolo del segundo premolar derecho, y dos dientes se insertaron en el canino derecho y en el área del alvéolo del primer premolar derecho al azar y se sometieron a CBCT con y sin la aplicación del algoritmo MAR. Se utilizó SPSS 21 para analizar los resultados (alfa=0,05). De acuerdo con los hallazgos de este estudio, las cuatro variables de sensibilidad, especificidad, precisión y valores predictivos positivos en el diagnóstico fueron más altas en los casos sin el software MAR tanto en distancias cercanas (raíces en las cavidades de los primeros premolares) como lejanas (raíces en las cavidades de los caninos) del implante. Sin embargo, la tasa más alta de precisión diagnóstica del primer y segundo radiólogo fue en el grupo de mayor distancia al implante sin MAR, y la tasa más baja de precisión diagnóstica en el primer y segundo radiólogo fue en la distancia cercana al implante. La aplicación del algoritmo MAR no tuvo un efecto positivo en la detección de VRF en escaneos CBCT en escenarios cercanos y distantes.

The Performance Evaluation of The Random Forest Algorithm for A Gene Selection in Identifying Genes Associated with Resectable Pancreatic Cancer in Microarray Dataset: A Retrospective Study.

OBJECTIVE: In microarray datasets, hundreds and thousands of genes are measured in a small number of samples, and sometimes due to problems that occur during the experiment, the expression value of some genes is recorded as missing. It is a difficult task to determine the genes that cause disease or cancer from a large number of genes. This study aimed to find effective genes in pancreatic cancer (PC). First, the K-nearest neighbor (KNN) imputation method was used to solve the problem of missing values (MVs) of gene expression. Then, the random forest algorithm was used to identify the genes associated with PC. MATERIALS AND METHODS: In this retrospective study, 24 samples from the GSE14245 dataset were examined. Twelve samples were from patients with PC, and 12 samples were from healthy control. After preprocessing and applying the fold-change technique, 29482 genes were used. We used the KNN imputation method to impute when a particular gene had MVs. Then, the genes most strongly associated with PC were selected using the random forest algorithm. We classified the dataset using support vector machine (SVM) and naïve bayes (NB) classifiers, and F-score and Jaccard indices were reported. RESULTS: Out of the 29482 genes, 1185 genes with fold-changes greater than 3 were selected. After selecting the most associated genes, 21 genes with the most important value were identified. S100P and GPX3 had the highest and lowest importance values, respectively. The F-score and Jaccard value of the SVM and NB classifiers were 95.5, 93, 92, and 92 percent, respectively. CONCLUSION: This study is based on the application of the fold change technique, imputation method, and random forest algorithm and could find the most associated genes that were not identified in many studies. We therefore suggest researchers use the random forest algorithm to detect the related genes within the disease of interest.

Correlation of Wilms' Tumor 1 (WT1) with Oxidative Stress Markers and Expression of miR-361-5p; New Aspect of WT1 in Breast Cancer.

Breast carcinoma is a heterogeneous disease that affects millions of women worldwide. Wilms' tumor 1 (WT1) is an oncogene that promotes proliferation, metastasis and reduces apoptosis. MicroRNAs (miR) are short noncoding RNAs with a major role in cancer metastasis. In present study, we investigated the association of serum level of WT1 with oxidative stress and expression of miR-361-5p in breast cancer. Serum samples of 45 patients and of 45 healthy women analyzed for protein level of WT1, malondialdehyde (MDA), total oxidant status (TOS), and total antioxidant capacity (TAC). Serum and tissue expression of miR-361-5p in 45 tumor tissues and 45 paired non-tumor adjacent tissues and 45 serum samples of patients and healthy women analyzed by qRT-PCR. Protein levels of WT1 not significantly difference in serum of patients compared to healthy controls. Serum levels of MDA and TOS in patients were higher, but TAC level was lower than healthy controls (p < 0.001). There was a positive correlation between WT1 with MDA and TOS, and a negative correlation between WT1 with TAC in patients. miR-361-5p expression in tumor tissues and serum of patients was lower than non-tumor adjacent tissues and serum of healthy controls, respectively (p < 0.001). Moreover, there was a negative correlation between miR-361-5p and WT1 in patients. The positive correlation between WT1 with MDA and TOS and negative correlation between TAC and miR-361-5p suggests that this gene can play an important role in worse prognoses in breast cancer. Additionally, miR-361-5p may serve as an invasive biomarker for early detection of breast cancer.

Effect of photobiomodulation therapy with different wavelengths on bone mineral density in osteoporotic rats.

Osteoporosis is associated with severe pain, bone deformity, fracture, and bone loss. It is important to find strategies to prevent bone resorption and treat osteoporosis. This study sought to assess the effect of photobiomodulation therapy (PBMT) with different wavelengths on bone mineral density (BMD) in osteoporotic rats. This animal study evaluated 63 adult female rats. The rats underwent ovariectomy to induce osteoporosis. Ovariectomized rats were randomly divided into 9 groups of control (OC), treatment with zoledronic acid alone (0.02 mg/kg), and treatment with 660 nm, 810 nm, and 940 nm PBMT alone (3 times a week for 6 weeks, energy density of 4 J/cm2), and combined with zoledronic acid. The healthy control group (HC) only underwent sham surgery. The rats underwent cone-beam computed tomography (CBCT) 52 days after the first treatment session to measure their BMD according to the gray value (GV) of images. To assess the biomechanical properties of bone, the resected bones were subjected to 3-point bending test (3-PBT). The experimental groups had significant differences with the OC group regarding radiographic and biomechanical properties of bone (P < 0.05), indicating a healing course. No significant difference was noted between the experimental groups treated with different laser wavelengths and those treated with zoledronic acid (P > 0.05). In the condition of this study, it was found that PBMT at a constant energy density of 4 J/cm2 with 660-, 810-, and 940-nm wavelengths is effective for enhancement of bone mineral density and biomechanical properties. No significant difference was noted between different wavelengths of diode laser regarding radiographic and biomechanical properties of bone.

Intelligent prediction of major adverse cardiovascular events (MACCE) following percutaneous coronary intervention using ANFIS-PSO model.

BACKGROUND: This study aimed to use the hybrid method based on an adaptive neuro-fuzzy inference system (ANFIS) and particle swarm optimization (PSO) to predict the long term occurrence of major adverse cardiac and cerebrovascular events (MACCE) of patients underwent percutaneous coronary intervention (PCI) with stent implantation. METHOD: This retrospective cohort study included a total of 220 patients (69 women and 151 men) who underwent PCI in Ekbatan medical center in Hamadan city, Iran, from March 2009 to March 2012. The occurrence and non-occurrence of MACCE, (including death, CABG, stroke, repeat revascularization) were considered as a binary outcome. The predictive performance of ANFIS model for predicting MACCE was compared with ANFIS-PSO and logistic regression. RESULTS: During ten years of follow-up, ninety-six patients (43.6%) experienced the MACCE event. By applying multivariate logistic regression, the traditional predictors such as age (OR = 1.05, 95%CI: 1.02-1.09), smoking (OR = 3.53, 95%CI: 1.61-7.75), diabetes (OR = 2.17, 95%CI: 2.05-16.20) and stent length (OR = 3.12, 95%CI: 1.48-6.57) was significantly predicable to MACCE. The ANFIS-PSO model had higher accuracy (89%) compared to the ANFIS (81%) and logistic regression (72%) in the prediction of MACCE. CONCLUSION: The predictive performance of ANFIS-PSO is more efficient than the other models in the prediction of MACCE. It is recommended to use this model for intelligent monitoring, classification of high-risk patients and allocation of necessary medical and health resources based on the needs of these patients. However, the clinical value of these findings should be tested in a larger dataset.

Attachment of human periodontal ligament fibroblasts to root dentin conditioned with different endodontic irrigants: An experimental study.

Background. Periradicular surgery is the last treatment option for teeth with persistent periradicular endodontic lesions. This study aimed to assess the adhesion of fibroblasts to root dentin conditioned with ethylenediaminetetraacetic acid (EDTA), MTAD, and QMix. Methods. Twelve dentin discs were fabricated of 6 human single-rooted teeth. Fibroblasts were isolated from the periodontal ligament (PDL) of a premolar tooth. The teeth were healthy and freshly extracted from the socket. The samples were divided into four groups for surface conditioning with (I) EDTA, (II) MTAD, (III) QMix, and the control group. Fibroblasts were cultured on conditioned dentin discs at 37°C, 95% air, and 5% CO2 for 4 hours and then rinsed with PBS three times to eliminate unattached cells from the surface. The mean counts of attached cells were calculated using a Neubauer chamber. Also, the attachment of fibroblasts was evaluated using scanning electron microscopy (SEM). Results. The mean counts of fibroblasts attached to root dentin in EDTA, QMix, MTAD, and control groups were 303±46, 243±41, 213±33, and 347±38, respectively. No significant difference was noted in the number of fibroblasts attached between MTAD, EDTA, and QMix and the control group (P>0.05). Under SEM, the fibroblasts were flat and spindle-shaped, with cytoplasmic processes covering the untreated dentin surface. In the experimental groups, the cells were rounder with fewer processes. All the three groups showed weaker adhesion to dentin compared to the control (untreated dentin) group. Conclusion. Under the limitations of this study, it was concluded that treating the dentin surface with EDTA, MTAD, or QMIX might not be an effective way to improve the adhesion of human PDL fibroblasts.

Comparison of salivary interleukin-6, interleukin-8, C - reactive protein levels and total antioxidants capacity of obese individuals with normal-weight ones.

Objective: Obesity is a worldwide concern that may lead to type 2 diabetes, cardiovascular diseases, etc. Several serum biomarkers have been identified in the saliva of obese individuals, including inflammatory cytokines, adipokines, insulin, and cortisol. The present study aimed to compare salivary interleukin-6 (IL-6), interleukin-8 (IL-8), C-reactive protein (CRP) levels and total antioxidants capacity (TAC) of obese individuals with normal-weighted ones. Methods: In this case-control study, 92 participants matched in terms of age and gender were placed into two groups according to the body mass index (BMI); case group: BMI>30 and control group: 18.5

Effect of sodium fluoride varnish, Gluma, and Er,Cr:YSGG laser in dentin hypersensitivity treatment: a 6-month clinical trial.

Dentinal hypersensitivity (DH) is a common clinical condition usually associated with exposed dentinal surfaces. The aim of this study was to study the effect of sodium fluoride varnish, Gluma, and Er,Cr:YSGG laser, in the dentin hypersensitivity treatment. One hundred sixty-five teeth with dentin hypersensitivity in 55 patients were involved in this study. Teeth are divided into five groups based on the received treatment (n = 33): G group: Gluma; F group: sodium fluoride varnish (5%); L group: Er,Cr:YSGG laser (wavelength 2780 nm, frequency 20 Hz, power 0.25 W, energy density 44.3 J/cm2, and pulse width of 150 µs at distance of 1 mm for 30 s) which was followed by Er,Cr:YSGG laser; GL group: Gluma + laser; VL group: both sodium fluoride varnish and Gluma, which are common treatments for hypersensitivity, were selected as control groups. The treatment was performed in one session, and the sensitivity to air spray conditioning was recorded after the treatment, at 15 min, 1 week, 1 month, and 6 months as the VAS. Statistical analysis was performed using SPSS Ver. 21 software. One-way ANOVA was used to compare the VAS between all treatment groups at each time-point. One-way repeated measurements ANOVA (RM-ANOVA) and two-way-repeated measurements ANOVA (RM-ANOVA) were used to compare the hypersensitivity of each group and sensitivity of all treatment groups, respectively. Tukey post hoc test was used to compare the groups pairwise. The hypersensitivity between different groups at before and 15 min after the treatment was not significantly different (P = 0.063). The hypersensitivity of all studied groups was decreased after the treatment. The Er,Cr:YSGG laser, alone or in combination with Gluma, in 1 week, 1 month, and 6 month follow-ups, had significantly reduced the hypersensitivity instead of sodium fluoride varnish. All treatments significantly reduced the dentin hypersensitivity up to 6 months. Er,Cr:YSGG laser alone or in combination with Gluma was more effective than sodium fluoride varnish; however, it was not significantly different from other treatments. In a 6-month follow-up of dentine hypersensitivity treatment, Gluma had a significantly higher effect than sodium fluoride. Trial registration: IRCT20190422043343N1. Registered 19 July 2019.

Magnetic resonance imaging study of incidental findings in the paranasal sinuses and ostiomeatal complex.

Purpose: This study aimed to assess incidental abnormal findings in the paranasal sinuses and anatomical variations of the ostiomeatal complex (OMC) on magnetic resonance imaging (MRI) scans. Materials and Methods: MRI scans of 616 patients (mean age, 44.0±19.4 years) were evaluated. Prior to obtaining the MRI scans, a checklist of patients' clinical symptoms was filled out after obtaining their consent. The Lund-Mackay classification was used to assess the paranasal sinuses and OMC. The prevalence of abnormal findings and their associations with patients' age, sex, and subjective symptoms were analyzed by the chi-square test, independent-sample t-test, and analysis of variance. The level of significance was set at 0.05. Results: Abnormal findings in the paranasal sinuses were detected in 32.0% of patients, with a significantly higher prevalence in males (P<0.05), but no significant association with age (P>0.05). Epithelial thickening and retention cyst were the most common abnormal findings in the paranasal sinuses. According to the Lund-Mackay classification, 93% of the study population had normal sinuses (score<4). Concha bullosa and paradoxical concha were detected in 15.3% and 3.4%, respectively, with no significant association with the presence of septal deviation or Lund-Mackay classification (P>0.05). Conclusion: Considering the relatively high prevalence of abnormal findings in the paranasal sinuses, it appears that clinical symptoms alone are not sufficient to diagnose sinusitis. A more accurate strategy would be to assess radiographic images of the paranasal sinuses and use a classification system. Sinusitis should be suspected in patients receiving a high score in this classification.

Optimization of fuzzy c-means (FCM) clustering in cytology image segmentation using the gray wolf algorithm.

BACKGROUND: Image segmentation is considered an important step in image processing. Fuzzy c-means clustering is one of the common methods of image segmentation. However, this method suffers from drawbacks, such as sensitivity to initial values, entrapment in local optima, and the inability to distinguish objects with similar color intensity. This paper proposes the hybrid Fuzzy c-means clustering and Gray wolf optimization for image segmentation to overcome the shortcomings of Fuzzy c-means clustering. The Gray wolf optimization has a high exploration capability in finding the best solution to the problem, which prevents the entrapment of the algorithm in local optima. In this study, breast cytology images were used to validate the methods, and the results of the proposed method were compared to those of c-means clustering. RESULTS: FCMGWO has performed better than FCM in separating the nucleus from the other dark objects in the cell. The clustering was validated using Vpc, Vpe, Davies-Bouldin, and Calinski Harabasz criteria. The FCM and FCMGWO methods have a significant difference with respect to the Vpc and Vpe indexes. However, there is no significant difference between the performances of the two clustering methods with respect to the Calinski-Harabasz and Davies-Bouldin indices. The results indicate the better efficacy of the proposed method. CONCLUSIONS: The hybrid FCMGWO algorithm distinguishes the cells better in images with less detail than in images with high detail. However, FCM exhibits unacceptable performance in both low- and high-detail images.

Identifying risk factors for late HIV diagnosis and survival analysis of people living with HIV/AIDS in Iran (1987-2016).

BACKGROUND: Late-diagnosis of HIV is a major challenge for the control and prevention of AIDS in the world. The present study aimed to specify factors associated with the late diagnosis of HIV in Iran from 1987 to 2016. METHODS: In this retrospective cohort study, data for 4402 diagnosed HIV/AIDS patients were extracted from 158 behavioral disease counseling centers of 31 Iranian provinces. We defined late diagnosis as having a CD4 count less than 350 within 3 months after diagnosis. Multiple logistic regression analysis was used to determine the factors influencing late diagnosis. Moreover, we used multivariate Cox regression to assess the association of these factors with the patients' survival. RESULTS: In this study, the prevalence of late diagnosis among the patients was 58.2%. People aged 50 years and over (adjusted OR = 3.55), transmission through blood transfusion (adjusted OR = 2.89), co-infection with tuberculosis (adjusted OR = 2.06), and male gender (adjusted OR = 1.38) were the strongest predictors for late diagnosis of HIV. On the other hand, baseline CD4 (adjusted HR = 2.21), people aged 50 and over (adjusted HR = 1.81), male gender (adjusted HR = 1.76), being a widow (adjusted HR = 1.68), people with unknown transmission way (adjusted HR = 18.24), people who inject drugs (adjusted HR = 1.87), diagnosis at previous years (adjusted HR = 2.45) and co-infection with tuberculosis (adjusted OR = 1.77) significantly associated with the survival of patients. CONCLUSION: The prevalence of late diagnosis is high among Iranian HIV/AIDS. The risk factors of late diagnoses include being males and aged 50 years and over, transmission through blood transfusion, and co-infection with tuberculosis. Therefore, implementation of screening programs for early diagnosis of HIV these high risk groups is recommended to Iranian health providers and policymakers.

Correlation of miR-600 with WT1 expression and its potential clinical significance in breast cancer.

Aim: The study aimed to explore miR-600 and WT1 expression and its potential clinical significance in breast cancer. Materials & methods: The expression of miR-600 and WT1 in tumor and non-tumor adjacent tissues in 45 breast cancer patients as well as serum level of miR-600 in these patients and 45 healthy group were analyzed. Results: The expression level of miR-600 in tumor tissue and serum of patients was significantly lower than non-tumor adjacent tissues and serum of controls, respectively, while WT1 mRNA and protein levels were higher in tumor tissues compared with non-tumor adjacent tissues. The miR-600 expression was correlated with lymph node metastasis and clinical stage. Conclusion: The miR-600 acts as tumor suppressor and a diagnostic and prognostic biomarker in breast cancer patients.

Risk factors associated with major adverse cardiac and cerebrovascular events following percutaneous coronary intervention: a 10-year follow-up comparing random survival forest and Cox proportional-hazards model.

BACKGROUND: Due to the limited number of studies with long term follow-up of patients undergoing Percutaneous Coronary Intervention (PCI), we investigated the occurrence of Major Adverse Cardiac and Cerebrovascular Events (MACCE) during 10 years of follow-up after coronary angioplasty using Random Survival Forest (RSF) and Cox proportional hazards models. METHODS: The current retrospective cohort study was performed on 220 patients (69 women and 151 men) undergoing coronary angioplasty from March 2009 to March 2012 in Farchshian Medical Center in Hamadan city, Iran. Survival time (month) as the response variable was considered from the date of angioplasty to the main endpoint or the end of the follow-up period (September 2019). To identify the factors influencing the occurrence of MACCE, the performance of Cox and RSF models were investigated in terms of C index, Integrated Brier Score (IBS) and prediction error criteria. RESULTS: Ninety-six patients (43.7%) experienced MACCE by the end of the follow-up period, and the median survival time was estimated to be 98 months. Survival decreased from 99% during the first year to 39% at 10 years' follow-up. By applying the Cox model, the predictors were identified as follows: age (HR = 1.03, 95% CI 1.01-1.05), diabetes (HR = 2.17, 95% CI 1.29-3.66), smoking (HR = 2.41, 95% CI 1.46-3.98), and stent length (HR = 1.74, 95% CI 1.11-2.75). The predictive performance was slightly better by the RSF model (IBS of 0.124 vs. 0.135, C index of 0.648 vs. 0.626 and out-of-bag error rate of 0.352 vs. 0.374 for RSF). In addition to age, diabetes, smoking, and stent length, RSF also included coronary artery disease (acute or chronic) and hyperlipidemia as the most important variables. CONCLUSION: Machine-learning prediction models such as RSF showed better performance than the Cox proportional hazards model for the prediction of MACCE during long-term follow-up after PCI.

Knowledge level of Iranian dental practitioners towards digital radiography and cone-beam computed tomography / Nível de conhecimento de dentistas Iranianos sobre Radiografia Digital e Tomografia Computadorizada de Feixe Cônico

Objective: TThis study aimed to assess the knowledge level of Iranian dental practitioners about digital radiography (DR) and cone-beam computed tomography (CBCT). Material and Methods: In this cross-sectional study, a researcher-designed questionnaire was administered among 180 general dentists and specialists. The questionnaire had three main domains of demographic information, fifteen questions about knowledge of DR (advantages, disadvantages, physical properties) and twenty six questions about knowledge of CBCT (indications, applications, advantages, route of knowledge acquisition). Data were analyzed using descriptive statistics, t-test and Pearson's correlation coefficient. Results: Of 180 participants, 76 (42.2%) were females. The minimum, maximum and mean± standard deviation scores obtained in DR were 4, 14, and 9.031 ± 1.85 and in CBCT were 0,26 and 18.56 ± 4.81, respectively. In the CBCT domain, the participants had maximum knowledge about "low radiation dose" (72.8%) and minimum knowledge about the "role of CBCT in determination of bone density" (45%). In DR domain, the participants had maximum knowledge about "no need for radiographic films" (75.6%) and minimum knowledge about "not requiring manual processing" (15.6%). Overall, participants had higher level of knowledge about CBCT than DR. An inverse correlation was noted between age and work experience with the number of correct answers. However, no significant difference was noted in the knowledge level of males and females regarding CBCT or DR (p = 0.233 and p = 0.227, respectively). Conclusions: further education seem imperative for dentists in this respect for more efficient diagnosis and treatment planning, minimize patient radiation dose and save time and cost. (AU)

Objetivos: Avaliar o nível de conhecimento de dentistas iranianos sobre radiografia digital (RD) e tomografia computadorizada de feixe cônico (TCFC). Materiais e métodos: Neste estudo transversal, um questionário, elaborado por pesquisadores, foi aplicado a 180 dentistas clínicos geral e especialistas. O questionário tinha três domínios principais de informação demográfica, quinze questões sobre conhecimento de RD (vantagens, desvantagens, propriedades físicas) e vinte e seis questões sobre conhecimento de CBCT (indicações, aplicações, vantagens, protocolo de aquisição). Os dados foram analisados por meio de estatística descritiva, teste t e coeficiente de correlação de Pearson. Resultados: Dos 180 participantes, 76 (42,2%) eram do sexo feminino. Os escores mínimo, máximo e média ± desvio padrão obtidos na RD foram 4, 14 e 9,031 ± 1,85 e na CBCT foram 0, 26 e 18,56 ± 4,81, respectivamente. No domínio CBCT, os participantes tinham conhecimento máximo sobre "baixa dose de radiação" (72,8%) e conhecimento mínimo sobre o "papel da CBCT na determinação da densidade óssea" (45%). No domínio RD, os participantes possuíam conhecimento máximo sobre "não há necessidade de filmes radiográficos" (75,6%) e conhecimento mínimo sobre "não requer processamento manual" (15,6%). No geral, os participantes tinham maior nível de conhecimento sobre CBCT do que RD. Foi observado correlação inversa entre idade e experiência de trabalho com o número de acertos. No entanto, nenhuma diferença significativa foi observada no nível de conhecimento de homens e mulheres sobre TCFC ou RD (p = 0,233 e p = 0,227 respectivamente). Conclusão: Parece imperativo para os dentistas iranianos, mais educação nesse aspecto para diagnóstico e planejamento de tratamento mais eficientes, minimizar a dose de radiação para paciente, economizar tempo e custos. (AU)