Gender differences in cardiac rehabilitation participation and outcomes: an 18-year retrospective study in Iran.

BACKGROUND: Cardiac rehabilitation (CR) is crucial for addressing cardiovascular diseases globally, with a specific emphasis on gender differences. Despite its demonstrated benefits for women, there's limited acceptance globally, especially in low- and middle-income countries. The program aims to optimize risk factors and improve overall patient well-being. METHODS: A cohort study was performed on those who were candidates for CR programs during 2001-2019. Assessments were performed within one week before and one week after the 8-week CR program. Age, sex, smoking status, clinical data, resting systolic and diastolic blood pressure (SBP and DBP, respectively), echocardiography and laboratory data were obtained. Functional capacity was evaluated using the international physical activity questionnaire, and a treadmill exercise test. Anxiety, depression, general quality of life (QoL), and health-related QoL were selected for psychological status. Then statistical analysis was performed on data. RESULT: In this study, the number of male patients was 1526 (73.69%). The average age of patients in the female group was higher than that of males (58.66 ± 9.08 vs. 56.18 ± 9.94), according to the crude model results, the changes in emotional, social and physical scores were significant (P-value:0.028, 0.018, 0.030), as well as the differences in Mets and smoking were significant (P-value for both < 0.001) in the adjusted model, the emotional variables and Mets changes were significant in two groups, so that the emotional score in the female group was higher than that of the male group, and the female Mets score was significantly lower than that of the male group. CONCLUSION: The CR program can improve cardiovascular outcomes, but the greatest impact was on the quality of life, patient METs and smoking behavers. Also the number of female participants in the CR program was less than the number of males.

The Effectiveness of Self-Compassion Based Training Program on Resilience of Mothers of Children with Type 1 Diabetes in Isfahan, Iran.

Background: Concerns about the complications of diabetes and the responsibility of constantly managing a child's blood glucose are stressful for parents, especially for mothers, and can reduce their resilience. This study aimed to investigate the effectiveness of a self-compassion-based training program on the resilience of mothers of children with type 1 diabetes. Materials and Methods: This is a randomized clinical trial study. The statistical population of the study consisted of all mothers of children with type 1 diabetes who were being treated at the Isfahan Endocrine and Metabolism Research Centre, Iran. The study samples were recruited conveniently, 64 of whom were randomly divided into two groups (compassion training program = 32; control group = 32). The intervention group participated in eight training sessions. Data were analyzed using t-test, and Analysis of Covariance (ANCOVA) tests for between-group comparisons of dependent variables. Results: There was no significant difference between the mean scores of resilience before intervention (p > 0.05). Mean scores of resilience in the intervention group were significantly higher than the control group immediately (F1,60 = 9.726 p = 0.003) and 1 month after intervention (F1, 60 = 13.146, p = 0.001). Conclusions: It may be worthwhile to suggest compassion-based training program for mothers of children with type 1 diabetes to improve their resilience.

Exploring the influence of scheduled meetings on physiological indicators of hospitalized patients satisfaction facing acute myocardial infarction in the intensive care unit.

BACKGROUND: Satisfaction of patients is among the top priorities of health-care providers. Meeting with families is essential for patients who are admitted to various wards, although it has been restricted for many reasons such as its impact on physiologic indicators. This present research study aimed to exploring the influence of scheduled meetings on physiological indicators of hospitalized patients satisfaction facing acute myocardial infarction in the intensive care unit. MATERIALS AND METHODS: This study was a nonrandomized clinical trial with a control group conducted in the cardiac care unit ward of Hamadan's Ekbatan Hospital. Sixty patients with acute myocardial infarction were chosen through convenient sampling and assigned to intervention (planned meeting) and control (routine meeting) groups in a nonrandomized manner. Data were collected by a researcher-made questionnaire of patient satisfaction and the observatory checklist of physiologic indicators and then analyzed in IBM SPSS Statistics v23. RESULTS: The total mean score of satisfaction did not significantly differ between the two groups (P = 0.921). The satisfaction of patients for "the conduct of visitors" was significantly higher in the intervention group (P = 0.005). During the study, no meaningful difference was found between the two groups for physiologic indicators (P > 0.05), while these indicators, except for blood O2 saturation, were meaningfully increased in the control group during routine meetings (P < 0.05). CONCLUSION: Planned meetings did not promote total satisfaction of patients with meetings, but improved some aspects of satisfaction, such as the conduct of visitors. The planned meeting is recommended as an alternative for a routine meeting, as it did not affect the physiologic indicators of patients in the intervention group.

Determinants of mammography screening in Tehranian women in 2018 based on the health belief model: A cross-sectional study.

BACKGROUND: Breast cancer is the most common type of cancer among women. Mammography is the most sensitive and important method for screening and early diagnosis of breast cancer. Considering the importance of using mammography in breast cancer screening, this study was performed to evaluate mammographic determinants. MATERIALS AND METHODS: In the cross-sectional study, we surveyed 985 women over 40 years in Tehran concerning demographic characteristics: age, socioeconomic status, a problem in the breast, alcohol use, drug use, and health belief model. Logistic regression was used to identify determinant factors associated with mammography performance. RESULTS: The results of this study showed that 42.1% (95% confidence interval [CI]: 38, 45) participant performed mammography at least once during their lifetime. Age (odds ratio [OR] = 4.252; 95% CI = 2.041-8.857); housing situation (OR = 1.706; 95% CI = 1.178-2.469); having breast problems (OR = 5.224; 95% CI = 3.501-7.795); socioeconomic status (OR = 1.855; 95% CI = 1.035-3.325); family income level (OR = 1.998; 95% CI = 1.028-3.884); alcohol consumption (OR = 2.676; 95% CI = 1.344-5.328); smoking (OR = 2.824; 95% CI = 1.418-5.623); self-efficacy (OR = 1.935; 95% CI = 1.242-3.015); perceived barriers (OR = 2.017; 95% CI = 1.348-3.019); self-care (OR = 4.901; 95% CI = 3.152-7.620); perceived susceptibility (OR = 1.971; 95% CI = 1.271-3.057) and perceived severity (OR = 1.830; 95% CI = 1.170-2.860) were mammography behaviors determinants. CONCLUSION: The findings indicated that the rate of mammography screening among Tehranian women is low and highlights the need for developing a comprehensive national breast cancer control program, which should be considered as the priority for health-care providers. Furthermore, the identification of these factors can help to design an appropriate educational intervention that focuses on the benefits of mammography screening.

Artificial neural network and logistic regression modelling to characterize COVID-19 infected patients in local areas of Iran.

BACKGROUND: COVID-19 is an infectious disease that started spreading globally at the end of 2019. Due to differences in patient characteristics and symptoms in different regions, in this research, a comparative study was performed on COVID-19 patients in 6 provinces of Iran. Also, multilayer perceptron (MLP) neural network and Logistic Regression (LR) models were applied for the diagnosis of COVID-19. METHODS: A total of 1043 patients with suspected COVID-19 infection in Iran participated in this study. 29 characteristics, symptoms and underlying disease were obtained from hospitalized patients. Afterwards, we compared the obtained data between confirmed cases. Furthermore, the data was applied for building the ANN and LR models to diagnosis the infected patients by COVID-19. RESULTS: In 750 confirmed patients, Common symptoms were: fever (%) >37.5 °C, cough, shortness of breath, fatigue, chills and headache. The most common underlying diseases were: hypertension, diabetes, chronic obstructive pulmonary disease and coronary heart disease. Finally, the accuracy of the ANN model to the diagnosis of COVID-19 infection was higher than the LR model. CONCLUSION: The prevalent symptoms and underlying diseases of COVID-19 patients were similar in different provinces, but the incidence of symptoms was significantly different from each other. Also, the study demonstrated that ANN and LR models have a high ability in the diagnosis of COVID-19 infection.

A study of cardiopulmonary resuscitation literacy among the personnel of universities of medical sciences based in Kermanshah and Khuzestan provinces based on the latest 2015 cardiopulmonary resuscitation guidelines.

INTRODUCTION: Cardiopulmonary resuscitation (CPR) is regarded as the most important skill of the medical staff who is required to be aware of the latest changes to the CPR guidelines so that they can take the most effective actions in the critical conditions of CPR. Therefore, the present study aimed to determine the levels of CPR literacy among the personnel of universities of medical sciences based in Kermanshah and Khuzestan provinces based on the latest 2015 CPR guidelines in 2019. MATERIALS AND METHODS: In this descriptive, analytical, cross-sectional study, 525 subjects were selected as the sample population using the two-stage cluster sampling. For data collection, a researcher-made questionnaire was used, whose content validity and reliability were confirmed (r = 0.71). The study screened the data received and analyzed valid data set through the ttest and Spearman's correlation coefficient by incorporating SPSS Statistics software version 23.0. In addition, P < 0.05 was considered statistically significant. RESULTS: The 2015 CPR literacy levels of the samples were as follows: excellent (85 subjects or 16.2%), good (404 subjects or 77%), and average (36 subjects or 6.9%). The results of Pearson's correlation coefficient revealed a weak and inverse relationship between the levels of CPR literacy and the age of samples (r = -0.092) and work experience (-0.029), which were statistically significant. In addition, the results of Mann-Whitney U-test demonstrated that the level of CPR literacy among the personnel of Ahwaz University of Medical Sciences exceeded that among the personnel of Kermanshah University of Medical Sciences (P < 0.001). CONCLUSION: It is suggested that in retraining the nursing and paramedical personnel, CPR be carried out with more emphasis on the changes introduced in this guideline compared to that in 2010, including esophageal tracheal airway, reasons for the cessation of CPR, intraosseous infusion, and induced hypothermia.

LCST polymers with UCST behavior.

In this study, temperature dependent behavior of dense dispersions of core crosslinked flower-like micelles is investigated. Micelles were prepared by mixing aqueous solutions of two ABA block copolymers with PEG B-blocks and thermosensitive A-blocks containing PNIPAM and crosslinkable moieties. At a temperature above the lower critical solution temperature (LCST), self-assembly of the polymers resulted in the formation of flower-like micelles with a hydrophilic PEG shell and a hydrophobic core. The micellar core was stabilized by native chemical ligation (NCL). Above the LCST, micelles displayed a radius of ∼35 nm, while a radius of ∼48 nm was found below the LCST due to hydration of the PNIPAM core. Concentrated dispersions of these micelles (≥7.5 wt%) showed glassy state behavior below a critical temperature (Tc: 28 °C) which is close to the LCST of the polymers. Below this Tc, the increase in the micelle volume resulted in compression of micelles together above a certain concentration and formation of a glass. We quantified and compared micelle packing at different concentrations and temperatures. The storage moduli (G') of the dispersions showed a universal dependence on the effective volume fraction, which increased substantially above a certain effective volume fraction of φ = 1.2. Furthermore, a disordered lattice model describing this behavior fitted the experimental data and revealed a critical volume fraction of φc = 1.31 close to the experimental value of φ = 1.2. The findings reported provide insights for the molecular design of novel thermosensitive PNIPAM nanoparticles with tunable structural and mechanical properties.

Obtaining active recombinant proteins from bacterial inclusion bodies using salt solutions under neutral pH conditions.

Eukaryotic recombinant proteins expressed in bacterial cells usually aggregate within the cells as inclusion bodies. Despite the widely-accepted theory considering inclusion bodies as inactive materials, inclusion bodies may contain large amounts of correctly-folded active recombinant proteins. Proteins trapped in inclusion bodies can be released using a high pH solution (pH ≥ 11); however, they may undergo structural changes in such pH conditions that may lead to their inactivation. Shifting in pH alongside the use of metal ions can help recover protein activity. The model protein we used in this study, 9R-Nimo.scFv, is highly active when extracted from bacterial inclusion bodies at high pH condition (pH 12) but loses its activity when pH is reduced to pH 7. We evaluated the capacity of nine salt solutions in terms of recovering protein activity in neutral pH conditions and found that ZnSO4 solution was the best one for this purpose. KNO3 and MnSO4 were also found to have a good capacity for recovering protein activity, as well.

Conversion of an Injectable MMP-Degradable Hydrogel into Core-Cross-Linked Micelles.

In this study, a new type of injectable hydrogel called "HyMic" that can convert into core cross-linked (CCL) micelles upon exposure to matrix metalloproteinases (MMP's), was designed and developed for drug delivery applications. HyMic is composed of CCL micelles connected via an enzyme cleavable linker. To this end, two complementary ABA block copolymers with polyethylene glycol (PEG) as B block were synthesized using atom transfer radical polymerization (ATRP). The A blocks were composed of a random copolymer of N-isopropylacrylamide (NIPAM) and either N-(2-hydroxypropyl)methacrylamide-cysteine (HPMA-Cys) or N-(2-hydroxypropyl) methacrylamide-ethylthioglycolate succinic acid (HPMA-ETSA). Mixing the aqueous solutions of the obtained polymers and rising the temperature above the cloud point of the PNIPAM block resulted in the self-assembly of these polymers into flower-like micelles composed of a hydrophilic PEG shell and hydrophobic core. The micellar core was cross-linked by native chemical ligation between the cysteine (in HPMA-Cys) and thioester (in HPMA-ETSA) functionalities. A slight excess of thioester to cysteine groups (molar ratio 3:2) was used to allow further chemical reactions exploiting the unreacted thioester groups. The obtained micelles displayed a Z-average diameter of 80 ± 1 nm (PDI 0.1), and ζ-potential of -4.2 ± 0.4 mV and were linked using two types of pentablock copolymers of P(NIPAM-co-HPMA-Cys)-PEG-peptide-PEG-P(NIPAM-co-HPMA-Cys) (Pep-NC) to yield hydrogels. The pentablock copolymers were synthesized using a PEG-peptide-PEG ATRP macroinitiator and the peptide midblock (lysine-glycine-proline-glutamine-isoleucine-phenylalanine-glycine-glutamine-lysine (Lys-Gly-Pro-Gln-Gly-Ile-Phe-Gly-Gln-Lys)) consisted of either l- or d-amino acids (l-Pep-NC or d-Pep-NC), of which the l-amino acid sequence is a substrate for matrix metalloproteases 2 and 9 (MMPs 2 and 9). Upon mixing of the CCL micelles and the linker (l/d-Pep-NC), the cysteine functionalities of the l/d-Pep-NC reacted with remaining thioester moieties in the micellar core via native chemical ligation yielding a hydrogel within 160 min as demonstrated by rheological measurements. As anticipated, the gel cross-linked with l-Pep-NC was degraded in 7-45 days upon exposure to metalloproteases in a concentration-dependent manner, while the gel cross-linked with the d-Pep-NC remained intact even after 2 months. Dynamic light scattering analysis of the release medium revealed the presence of nanoparticles with a Z-average diameter of ∼120 nm (PDI < 0.3) and ζ-potential of ∼-3 mV, indicating release of core cross-linked micelles upon HyMic exposure to metalloproteases. An in vitro study demonstrated that the released CCL micelles were taken up by HeLa cells. Therefore, HyMic as an injectable and enzyme degradable hydrogel displaying controlled and on-demand release of CCL micelles has potential for intracellular drug delivery in tissues with upregulation of MMPs, for example, in cancer tissues.

Native Chemical Ligation for Cross-Linking of Flower-Like Micelles.

In this study, native chemical ligation (NCL) was used as a selective cross-linking method to form core-cross-linked thermosensitive polymeric micelles for drug delivery applications. To this end, two complementary ABA triblock copolymers having polyethylene glycol (PEG) as midblock were synthesized by atom transfer radical polymerization (ATRP). The thermosensitive poly isopropylacrylamide (PNIPAM) outer blocks of the polymers were copolymerized with either N-(2-hydroxypropyl)methacrylamide-cysteine (HPMA-Cys), P(NIPAM- co-HPMA-Cys)-PEG-P(NIPAM- co-HPMA-Cys) (PNC) or N-(2-hydroxypropyl)methacrylamide-ethylthioglycolate succinic acid (HPMA-ETSA), P(NIPAM- co-HPMA-ETSA)-PEG-P(NIPAM- co-HPMA-ETSA) (PNE). Mixing of these polymers in aqueous solution followed by heating to 50 °C resulted in the formation of thermosensitive flower-like micelles. Subsequently, native chemical ligation in the core of micelles resulted in stabilization of the micelles with a Z-average of 65 nm at body temperature. Decreasing the temperature to 10 °C only affected the size of the micelles (increased to 90 nm) but hardly affected the polydispersity index (PDI) and aggregation number ( Nagg) confirming covalent stabilization of the micelles by NCL. CryoTEM images showed micelles with an uniform spherical shape and dark patches close to the corona of micelles were observed in the tomographic view. The dark patches represent more dense areas in the micelles which coincide with the higher content of HPMA-Cys/ETSA close to the PEG chain revealed by the polymerization kinetics study. Notably, this cross-linking method provides the possibility for conjugation of functional molecules either by using the thiol moieties still present after NCL or by simply adjusting the molar ratio between the polymers (resulting in excess cysteine or thioester moieties) during micelle formation. Furthermore, in vitro cell experiments demonstrated that fluorescently labeled micelles were successfully taken up by HeLa cells while cell viability remained high even at high micelle concentrations. These results demonstrate the potential of these micelles for drug delivery applications.

Heterofunctional Poly(ethylene glycol) (PEG) Macroinitiator Enabling Controlled Synthesis of ABC Triblock Copolymers.

ABC triblock copolymers with a poly(ethylene glycol) (PEG) midblock have attractive properties for biomedical applications because of PEG's favorable properties regarding biocompatibility and hydrophilicity. However, easy strategies to synthesize polymers containing a PEG midblock are limited. In this study, the successful synthesis of a heterofunctional PEG macroinitiator containing both an azoinitiator and an atom transfer radical polymerization (ATRP) initiator is demonstrated. This novel PEG macroinitiator allows the development of elegant synthesis routes for PEG midblock-containing ABC copolymers that does not require protection of initiating sites or polymer end-group postmodification. Polymers with outer blocks composed of different monomers were synthesized to illustrate the versatility of this macroinitiator. N-Isopropylacrylamide (NIPAM) was included to obtain thermosensitive polymers, 2-(dimethylamino)ethyl methacrylate (DMAEMA) provided pH-sensitive properties, and 2-hydroxyethyl acrylate (HEA) functioned as a noncharged hydrophilic block that also allows for postmodifications reactions. This synthesis approach can further contribute to the design of high-precision polymers with tailorable block compositions and polymer topologies, which is highly attractive for applications in nanotechnology.

The use of rapidly synergistic cloud point extraction for the separation and preconcentration of trace amounts of Ni (II) ions from food and water samples coupling with flame atomic absorption spectrometry determination.

A novel improved preconcentration method known as rapidly synergistic cloud point extraction (RS-CPE) was established for nickel preconcentration and determination prior to its determination by flame atomic absorption spectrometry. In this work, the traditional CPE pattern was changed and greatly simplified in order to be applicable in metal extraction and detection. This method was accomplished in room temperature in 1 min. Non-ionic surfactant Triton X-114 was used as extractant. Octanol worked as cloud point revulsant and synergic reagent. The various parameters affecting the extraction and preconcentration of nickel such as sample pH, 2,2'-Furildioxime concentration, amounts of octanol, amounts of Triton X-114, type of diluting solvent, extraction time, and ionic strength were investigated and optimized. Under optimal conditions, the calibration curve showed an excellent linearity in the concentration range of 2-200 µg L(-1), and the limit of detection was 0.6 µg L(-1) for nickel. The developed method was successfully applied for the determination of nickel in food and water samples. The results showed that, the proposed method can be used as a cheap, rapid, and efficient method for the extraction and preconcentration of nickel from real samples.

Inhibition of Octreotide Acylation Inside PLGA Microspheres by Derivatization of the Amines of the Peptide with a Self-Immolative Protecting Group.

Acylation of biopharmaceuticals such as peptides has been identified as a major obstacle for the successful development of PLGA controlled release formulations. The purpose of this study was to develop a method to inhibit peptide acylation in poly(d,l-lactide-co-glycolide) (PLGA) formulations by reversibly and temporarily blocking the amine groups of a model peptide (octreotide) with a self-immolative protecting group (SIP), O-4-nitrophenyl-O'-4-acetoxybenzyl carbonate. The octreotide with two self-immolative protecting groups (OctdiSIP) on the N-terminus and lysine side chain was synthesized by reaction of the peptide with O-4-nitrophenyl-O'-4-acetoxybenzyl carbonate, purified by preparative RP-HPLC and characterized by mass spectrometry. Degradation studies of OctdiSIP in aqueous solutions of different pH values showed that protected octreotide was stable at low pH (pH 5) whereas the protecting group was eliminated at physiological pH, especially in the presence of an esterase, to generate native octreotide. OctdiSIP encapsulated in PLGA microspheres, prepared using a double emulsion solvent evaporation method, showed substantial inhibition of acylation as compared to the unprotected octreotide: 52.5% of unprotected octreotide was acylated after 50 days incubation of microspheres in PBS pH 7.4 at 37 °C, whereas OctdiSIP showed only 5.0% acylation in the same time frame. In conclusion, the incorporation of self-immolative protection groups provides a viable approach for inhibition of acylation of peptides in PLGA delivery systems.