Nested CNN architecture for three-dimensional dose distribution prediction in tomotherapy for prostate cancer.

BACKGROUND: The hypothesis of changing network layers to increase the accuracy of dose distribution prediction, instead of expanding their dimensions, which requires complex calculations, has been considered in our study. MATERIALS AND METHODS: A total of 137 prostate cancer patients treated with the tomotherapy technique were categorized as 80% training and validating as well as 20% testing for the nested UNet and UNet architectures. Mean absolute error (MAE) was used to measure the dosimetry indices of dose-volume histograms (DVHs), and geometry indices, including the structural similarity index measure (SSIM), dice similarity coefficient (DSC), and Jaccard similarity coefficient (JSC), were used to evaluate the isodose volume (IV) similarity prediction. To verify a statistically significant difference, the two-way statistical Wilcoxon test was used at a level of 0.05 (p < 0.05). RESULTS: Use of a nested UNet architecture reduced the predicted dose MAE in DVH indices. The MAE for planning target volume (PTV), bladder, rectum, and right and left femur were D98% = 1.11 ± 0.90; D98% = 2.27 ± 2.85, Dmean = 0.84 ± 0.62; D98% = 1.47 ± 12.02, Dmean = 0.77 ± 1.59; D2% = 0.65 ± 0.70, Dmean = 0.96 ± 2.82; and D2% = 1.18 ± 6.65, Dmean = 0.44 ± 1.13, respectively. Additionally, the greatest geometric similarity was observed in the mean SSIM for UNet and nested UNet (0.91 vs. 0.94, respectively). CONCLUSION: The nested UNet network can be considered a suitable network due to its ability to improve the accuracy of dose distribution prediction compared to the UNet network in an acceptable time.

Quality of life in children with asthma compared to healthy children: a case-control study.

OBJECTIVE: Asthma is a chronic condition characterized by episodic wheezing, cough, and shortness of breath resulting from airway hyperresponsiveness and inflammation. Over 300 million people are affected worldwide, and its prevalence is increasing by 50% every decade. Assessing the quality of life in children with asthma is fundamental, as consistently poor health-related quality of life is associated with poorly controlled asthma. This study is aimed to evaluate and compare factors associated with HRQOL between healthy controls and children with asthma. METHODS: In the current case-control study, 50 children aged 8-12 years with asthma (cases) enrolled at outpatient hospital clinics by a trained pediatric allergist/immunologist (A.P.) and matched with 50 healthy controls by age and sex. All enrolled subjects were interviewed utilizing the PedsQL questionnaire to assess health-related quality of life; also, patient demographics, including age, sex, and family income status, were obtained from a questionnaire. RESULTS: A total of 100 children comprising 62 males and 38 females with a mean age of 9.63 ± 1.38 years, participated in this study. The average score of children with asthma was 81.63 ± 9.38, and the average score for healthy participants was 89.58 ± 7.91. We found that asthma was associated with a significant drop in health-related quality of life in this sample. CONCLUSIONS: The results indicated that the PedsQL score and its subscales, except social functioning, were significantly higher in children with asthma compared to healthy ones. Also, SABA use, nocturnal symptoms, and asthma severity are negatively related to the health-related quality of life.

Exploring the relationship between asthma, its severity and anxiety symptoms in pediatric patients: a case-control study.

BACKGROUND: Asthma is a global health concern, especially among children, and is associated with various underlying mechanisms. Childhood exposure to early life stress and anxiety can potentially exacerbate asthma symptoms and complicate its management. While some studies have suggested the benefits of psychological therapies as adjuncts to medication in asthma management, evidence remains inconsistent, emphasizing the need for rigorous evaluation. METHOD: This case-control study involved 120 children aged 5-15, with 60 children having asthma and 60 healthy controls. Asthma severity was assessed based on EPR3 guidelines, while anxiety symptoms were measured using the Spence Children's Anxiety Scale (SCAS). Demographic data and asthma-related information were collected via questionnaires. Statistical analyses were conducted to explore the relationship between asthma and anxiety. RESULTS: Children with asthma exhibited significantly higher anxiety symptoms compared to those without asthma (p < 0.001). Subdomain analysis revealed elevated scores in separation anxiety (SA; p = 0.025), social phobia (SP; p < 0.001), agoraphobia (p = 0.004), and fears of physical injury (p < 0.001) in children with asthma. Furthermore, increased need for SABA, frequency of nocturnal symptoms, and asthma severity were associated with higher anxiety levels in pediatric asthma patients. CONCLUSIONS: This study highlights a significant association between asthma and heightened anxiety symptoms in children, particularly in domains, such as SA, SP, agoraphobia, and fears related to physical injury. However, limitations include reliance on self-evaluation questionnaires and the observational nature of the study, emphasizing the need for cautious interpretation.

Post-chemo-radiotherapy response and pseudo-progression evaluation on glioma cell types by multi-parametric magnetic resonance imaging: a prospective study.

BACKGROUND: We focused on Differentiated pseudoprogression (PPN) of progression (PN) and the response to radiotherapy (RT) or chemoradiotherapy (CRT) using diffusion and metabolic imaging. METHODS: Seventy-five patients with glioma were included in this prospective study (approved by the Iranian Registry of Clinical Trials (IRCT) (IRCT20230904059352N1) in September 2023). Contrast-enhanced lesion volume (CELV), non-enhanced lesion volume (NELV), necrotic tumor volume (NTV), and quantitative values ​​of apparent diffusion coefficient (ADC) and magnetic resonance spectroscopy (Cho/Cr, Cho/NAA and NAA/Cr) were calculated by a neuroradiologist using a semi-automatic method. All patients were followed at one and six months after CRT. RESULTS: The results of the study showed statistically significant changes before and six months after RT-CRT for M-CELV in all glioma types (𝑝 < 0.05). In glioma cell types, the changes in M-ADC, M-Cho/Cr, and Cho/NAA indices for PN were incremental and greater for PPN patients. M-NAA/Cr ratio decreased after six months which was significant only on PN for GBM, and Epn (𝑝 < 0.05). A significant difference was observed between diffusion indices, metabolic ratios, and CELV changes after six months in all types (𝑝 < 0.05). None of the patients were suspected PPN one month after treatment. The DWI/ADC indices had higher sensitivity and specificity (98.25% and 96.57%, respectively). CONCLUSION: The results of the present study showed that ADC values and Cho/Cr and Cho/NAA ratios can be used to differentiate between patients with PPN and PN, although ADC is more sensitive and specific.

Brain diffusion MRI biomarkers after oncology treatments.

In addition to providing a measurement of the tumor's size and dimensions, magnetic resonance imaging (MRI) provides excellent noninvasive radiographic detection of tumor location. The MRI technique is an important modality that has been shown to be useful in the prognosis, diagnosis, treatment planning, and evaluation of response and recurrence in solid cancers. Diffusion-weighted imaging (DWI) is an imaging technique that quantifies water mobility. This imaging approach is good for identifying sub-voxel microstructure of tissues, correlates with tumor cellularity, and has been proven to be valuable in the early assessment of cytotoxic treatment for a variety of malignancies. Diffusion tensor imaging (DTI) is an MRI method that assesses the preferred amount of water transport inside tissues. This enables precise measurements of water diffusion, which changes according to the direction of white matter fibers, their density, and myelination. This measurement corresponds to some related variables: fractional anisotropy (FA), mean diffusivity (MD), radial diffusivity (RD), axial diffusivity (AD), and others. DTI biomarkers can detect subtle changes in white matter microstructure and integrity following radiation therapy (RT) or chemoradiotherapy, which may have implications for cognitive function and quality of life. In our study, these indices were evaluated after brain chemoradiotherapy.

Family clustering of SARS-CoV-2 in Qazvin, Northwest of Iran.

Background: Human infection affected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been recognized as a global health concern. We report the epidemiological and clinical characteristics of patients with a familial cluster of SARS-CoV-2 from Qazvin province (located in the northwest of Iran). Methods: In this cross-sectional study, we enrolled 332 hospitalized patients that were confirmed SARS-CoV-2 diseases with laboratory-based (PT-PCR) test in Qazvin province, Iran. Having family infection transmission and subsequently, family clustering of SARS-COV-2 disease was assessed with the Generalized Estimating Equation model in patients. Results: Crude odds ratio estimates of creating family clustering of SARS-CoV-2 infection was 0.47 times [95% CI: 0.23, 0.98, p=0.045] less for female compared to the males; 2.26 [95% CI: 1.11, 4.58, p=0.024] and 2.69 [95% CI: 1.47, 4.93, p=0.001] for SARS-CoV-2 patients that had digestive and muscle pain in comparison with those did not this mentioned symptoms, respectively. 1.52 [95% CI: 1.05, 2.23, p=0.024] for patients with a longer hospitalization compared with patients that had shorter duration of hospitalization and adjusted odds ratio estimates were 2.13 [95% CI: 1.12, 4.03, p=0.020] for patients who receive public health services in comparison those did not receive public health services. Conclusion: Our findings confirm the person-to-person transmission of this novel coronavirus in family settings and hospitals, and the reports of infected travelers in other geographical regions. Major gaps in our knowledge about the potential factors in creating family clustering of SARS-CoV-2 infection, epidemiology, duration of human transmission and etc. need fulfillment by future studies.

Estimating the Size of Hidden Groups.

NSU studies have been applied in different countries. For example, this technique has been used in the United States to estimate the number of women who had been raped in the last year.

The Effect of Solution-Oriented Counseling on Coping Strategies in Mental Health Issues in Women with Gestational Diabetes.

This study aimed to investigate the effectiveness of solution-oriented intervention in patients with gestational diabetes, stress and anxiety on using coping strategies. This study was a randomized clinical trial with a control group. The population consisted of 56 diabetic women under treatment with insulin, who obtained higher score in one of the psychological disorders using DASS-21 (Depression, anxiety, stress scale). The participants were randomly assigned in two interventional (n = 28) and control (n = 28) groups after signing the written informed consent forms. The solution-oriented interventional program was conducted in six 60-min sessions for 6 weeks. Immediately after the final session and 6-8 weeks after the first session of the intervention, both groups completed coping inventory for stressful situations. The analytical statistic of t-test, chi-square, and variance analysis with repeated measurements using SPSS were used to analyze the data. solution-oriented counseling increased the problem-solving coping strategy in the intervention group (P = 0.001); the scores obtained by the subjects in the interventional group after adjusting the score before the intervention increased 2.68 units immediately after the intervention, which was not statistically significant (p-value = 0.44). However, it increased 11.5 scores six weeks after the intervention, which was statistically significant (P = 0.00). But, emotional and avoidance coping strategies were not significantly different between the two groups. This technique can be easily trained to all clients, and since it is focused on finding various solutions for psychological problems by clients, it can be used to reduce stress and anxiety in other chronic diseases as well.IRCT code: The code of this clinical trial study is IRCT20200202046339N1.

The real-time reproduction number, impact of interventions and prediction of the epidemic size of COVID-19 in the center of Iran.

BACKGROUND: The monitoring of reproduction number over time provides feedback on the effectiveness of interventions and on the need to intensify control efforts. Hence, we aimed to compute basic (R0) and real-time (Rt) reproduction number and predict the trend and the size of the coronavirus disease 2019 (COVID-19) outbreak in the center of Iran. MATERIALS AND METHODS: We used the 887 confirmed cases of COVID-19 from February 20, 2020, to April 17, 2020 in the center of Iran. We considered three scenarios for serial intervals (SIs) with gamma distribution. Rt was calculated by the sequential Bayesian and time-dependent methods. Based on a branching process using the Poisson distributed number of new cases per day, the daily incidence and cumulative incidence for the next 30 days were predicted. The analysis was applied in R packages 3.6.3 and STATA 12.0. RESULTS: The model shows that the Rt of COVID-19 has been decreasing since the onset of the epidemic. According to three scenarios based on different distributions of SIs in the past 58 days from the epidemic, Rt has been 1.03 (0.94, 1.14), 1.05 (0.96, 1.15), and 1.08 (0.98, 1.18) and the cumulative incidence cases will be 360 (180, 603), 388 (238, 573), and 444 (249, 707) for the next 30 days, respectively. CONCLUSION: Based on the real-time data extracted from the center of Iran, Rt has been decreasing substantially since the beginning of the epidemic, and it is expected to remain almost constant or continue to decline slightly in the next 30 days, which is consequence of the schools and universities shutting down, reduction of working hours, mass screening, and social distancing.

Increased incidence of the type 1 diabetes and diabetic ketoacidosis severity in children during COVID-19 pandemic.

AIM: The effect of COVID-19 on the occurrence of type 1 diabetes and ketoacidosis in children and adolescent. METHODS: In this descriptive-analytical cross-sectional study, the records of all children and adolescents hospitalized due to type1 diabetes for two years ago and during the COVID-19 pandemic and its peaks were investigated (January 2018-2022). Also, the desired variables including the frequency of hospitalized patients (known and new cases), the frequency of DKA, the severity of DKA, the duration of discharge from DKA, age, body mass index, duration of hospitalization, clinical symptoms including cerebral edema, laboratory data and the total daily dose insulin required at the time of discharge were compared and statistically analyzed. RESULTS: Out of the 334 hospitalized T1DM patients, the rate of new T1DM patients was significantly higher (P = 0.006) during the pandemic. Clearly, there were more cases of DKA during the pandemic (P = 0.007). The higher severity of DKA (0.026) and the need for higher doses of insulin (P = 0.005) were also observed. The hospitalization rate was higher during the corona peaks, particularly peaks 1 and 4, compared to the non-peak days of COVID-19. CONCLUSION: The increase in the incidence of diabetes (new cases) in the pandemic can suggest the role of the COVID-19 virus as an igniter. Also, as a trigger for the higher incidence of DKA with higher severities, which is probably caused by more damage to the pancreatic beta cells and requires higher doses of insulin.