Uptake of Breast Cancer Screening Practices in Low and Middle-Income Countries: A Systematic Review and Meta-Analysis.

BACKGROUND: Breast cancer is the most prevalent cancer worldwide and the leading cause of cancer mortality in women. Uptake of breast cancer screening and early-detection practices in low- and middle-income countries (LMICs) has not been synthesized. We aimed to systematically quantify uptake of breast cancer screening in LMICs. METHODS: We performed a systematic review and meta-analysis of observational population-based studies that reported the uptake of screening or early-detection practices. We searched PubMed, Scopus, Embase, and Web of Knowledge databases to January 2024. We pooled data using random-effects meta-analysis, and explored heterogeneity using subgroup analyses. FINDINGS: 174 population-based studies encompassing >78 million women were included. Pooled prevalence of self-reported uptake of screening mammography, self-reported having had clinical breast examination for screening, and self-reported regular breast self-examination (relevant for breast awareness in LMICs) were 22.7% (95% CI: 18.6-27.2), 23.1% (95% CI: 19.5-27.0), and 14.6% (95% CI: 11.6-17.9) respectively. Uptake of breast cancer screening practices was lowest in Africa and low and lower-middle income countries. Uptake of breast cancer screening practices remained stable over time or slightly decreased. Women who lived in rural area, were single, had lower income level, had low educational attainment, were unemployed, were uninsured and had no family history of breast cancer were generally least likely to self-report uptake of breast cancer screening. CONCLUSION: This meta-analysis identified concerningly low uptake of breast cancer screening practices in LMICs. Governments should prioritize developing context-appropriate strategies to address this low uptake to support population-level stage-shifting of breast cancer in LMICs.

Identification of Circular Patterns in Capsule Endoscopy Bubble Frames.

Background: A significant number of frames captured by the wireless capsule endoscopy are involved with varying amounts of bubbles. Whereas different studies have considered bubbles as nonuseful agents due to the fact that they reduce the visualization quality of the small intestine mucosa, this research aims to develop a practical way of assessing the rheological capability of the circular bubbles as a suggestion for future clinical diagnostic purposes. Methods: From the Kvasir-capsule endoscopy dataset, frames with varying levels of bubble engagements were chosen in two categories based on bubble size. Border reflections are present on the edges of round-shaped bubbles in their boundaries, and in the frequency domain, high-frequency bands correspond to these edges in the spatial domain. The first step is about high-pass filtering of border reflections using wavelet transform (WT) and Differential of Gaussian, and the second step is related to applying the Fast Circlet Transform (FCT) and the Hough transform as circle detection tools on extracted borders and evaluating the distribution and abundance of all bubbles with the variety of radii. Results: Border's extraction using WT as a preprocessing approach makes it easier for circle detection tool for better concentration on high-frequency circular patterns. Consequently, applying FCT with predefined parameters can specify the variety and range of radius and the abundance for all bubbles in an image. The overall discrimination factor (ODF) of 15.01, and 7.1 showing distinct bubble distributions in the gastrointestinal (GI) tract. The discrimination in ODF from datasets 1-2 suggests a relationship between the rheological properties of bubbles and their coverage area plus their abundance, highlighting the WT and FCT performance in determining bubbles' distributions for diagnostic objectives. Conclusion: The implementation of an object-oriented attitude in gastrointestinal analysis makes it intelligible for gastroenterologists to approximate the constituent features of intra-intestinal fluids. this can't be evaluated until the bubbles are considered as non-useful agents. The obtained results from the datasets proved that the difference between the calculated ODF can be used as an indicator for the quality estimation of intraintestinal fluids' rheological features like viscosity, which helps gastroenterologists evaluate the quality of patient digestion.

Investigating the relationship between compassion fatigue and moral injury in nurses.

Background: Compassion fatigue and professional quality of life are important in health and professional ethics. Aim: This study aimed to determine the relationship between compassion satisfaction, compassion fatigue, secondary traumatic stress, and moral injury in nurses. Research design: This research is a cross-sectional descriptive-analytical study. The research community of this research was all the nurses of the teaching hospitals of Ardabil city. Three questionnaires on demographic characteristics, the Professional Quality of Life Scale (ProQOL), and the Moral Injury Events Scale were used to collect data. SPSS (version 22) software was used for data analysis. Participants and research context: The study recruited 297 nurses randomly selected from five teaching hospitals in Ardabil city. Ethical considerations: Ethical approval was obtained from the Ardabil University of Medical Sciences ethics committee (with the code of ethics IR.ARUMS.REC.1401.198). Informed consent was obtained from the participants. Results: The results showed that the mean compassion satisfaction score of this study's participants was 37.61 ± 8.86, the mean compassion fatigue score of this study's participants was 28.73 ± 7.04, and the mean secondary traumatic stress score of this study's participants was 29.95 ± 7.84. The mean score of moral injury among nurses was 31.19 ± 8.54. The results showed a negative significant relationship between compassion satisfaction and moral injury (p < 0.001). Also, there is a positive significant relationship between compassion fatigue and secondary traumatic stress with moral injury (p < 0.001). Conclusion: The results of this study show a negative relationship between compassion satisfaction and moral injury. According to the results of the present study, nurse managers should implement educational interventions, create ethical processes, and clear ethical guidelines to reduce moral injury and increase compassion satisfaction.

Numerical Simulation of the Transient Flow around the Combined Morphing Leading-Edge and Trailing-Edge Airfoil.

An integrated approach to active flow control is proposed by finding both the drooping leading edge and the morphing trailing edge for flow management. This strategy aims to manage flow separation control by utilizing the synergistic effects of both control mechanisms, which we call the combined morphing leading edge and trailing edge (CoMpLETE) technique. This design is inspired by a bionic porpoise nose and the flap movements of the cetacean species. The motion of this mechanism achieves a continuous, wave-like, variable airfoil camber. The dynamic motion of the airfoil's upper and lower surface coordinates in response to unsteady conditions is achieved by combining the thickness-to-chord (t/c) distribution with the time-dependent camber line equation. A parameterization model was constructed to mimic the motion around the morphing airfoil at various deflection amplitudes at the stall angle of attack and morphing actuation start times. The mean properties and qualitative trends of the flow phenomena are captured by the transition SST (shear stress transport) model. The effectiveness of the dynamically morphing airfoil as a flow control approach is evaluated by obtaining flow field data, such as velocity streamlines, vorticity contours, and aerodynamic forces. Different cases are investigated for the CoMpLETE morphing airfoil, which evaluates the airfoil's parameters, such as its morphing location, deflection amplitude, and morphing starting time. The morphing airfoil's performance is analyzed to provide further insights into the dynamic lift and drag force variations at pre-defined deflection frequencies of 0.5 Hz, 1 Hz, and 2 Hz. The findings demonstrate that adjusting the airfoil camber reduces streamwise adverse pressure gradients, thus preventing significant flow separation. Although the trailing-edge deflection and its location along the chord influence the generation and separation of the leading-edge vortex (LEV), these results show that the combined effect of the morphing leading edge and trailing edge has the potential to mitigate flow separation. The morphing airfoil successfully contributes to the flow reattachment and significantly increases the maximum lift coefficient (cl,max)). This work also broadens its focus to investigate the aerodynamic effects of a dynamically morphing leading and trailing edge, which seamlessly transitions along the side edges. The aerodynamic performance analysis is investigated across varying morphing frequencies, amplitudes, and actuation times.

Production and characterization of nondairy gluten-free fermented beverage based on buckwheat and lentil.

The present study aimed to optimize the formulation of buckwheat/lentil gluten-free beverages fermented with Lactobacillus plantarum and Bifidobacterium bifidum. Physicochemical parameters of 14 different beverages, such as pH, acidity, total solids, ash, total phenol content, antioxidant activity, and sensory test, were assessed after 24 h of fermentation. The results showed that the numbers of viable cells of lactobacilli and bifidobacteria on the first day of the experiment were 9.9 and 9.6 log (CFU ml-1), respectively, which were over 9 log (CFU ml-1). During 24 h from the fermentation, the number of viable cells for all beverages decreased, which reached an average probiotic count of 8.81 log (CFU ml-1) that was statistically significantly different from the probiotic count before fermentation (p < .05). Cell viability was evaluated and shelf life was estimated during 15-day refrigerated storage. At the end of the storage (15th day), the beverages contained an average of 8.4 log (CFU ml-1) of live lactobacilli cells and 7.8 log (CFU ml-1) of viable bifidobacterial cells. The optimized levels of independent factors for sprouted buckwheat and lentil flours were 51.96% and 48.04%, respectively. The optimized probiotic beverage was contained 0.25 (% lactic acid) acidity, 5.7 pH, 7.9% total solids, 0.4% ash, 41.02% DPPH, 26.96 (mg GAE/ml) phenol compounds, and 8.65 log (CFU ml-1) probiotic count. The optimized beverage had distinct organoleptic properties on day 15 of refrigerated storage. This study showed that Bifidobacterium bifidum can be used for the development of potentially probiotic beverage with sprouted buckwheat and lentil.

Psycho-emotional recovery, the meaning of care in the process of providing palliative care to Iranian people with cancer: A grounded theory study.

AIM: Despite the significance of palliative care in treating people with cancer, the provision of this type of care in Iran is vague and unorganized. This research intends to explore the meaning of care in the process of providing palliative care to Iranian people with cancer and to develop a theory that would explain the phenomenon. DESIGN: This is a qualitative study in nature and Corbin and Strauss' Grounded Theory approach was used for data analysis. METHODS: Data was collected through semi structured interviews that were held with 21 participants who have had experiences in receiving and providing palliative care. The study was conducted in April to December 2019 in palliative care centres of Tehran. Sampling first started purposefully and moved to theoretical once concepts began to emerge from the data. Comparative and continuous data analysis was undertaken using Corbin and Strauss' (Basics of qualitative research: Techniques and procedures for developing grounded theory, Sage, 2015) approach. RESULTS: Main concerns of care providers in providing palliative care was to reduce the affliction and anxiety of patients by understanding the difficult state of patient and psycho-emotional recovery was identified as the core category, which was performed via three critical strategies: building emotional connection, reinforcing positive mindset and having a core value in care.

Comparing efficacy and safety of P013, a proposed pertuzumab biosimilar, with the reference product in HER2-positive breast cancer patients: a randomized, phase III, equivalency clinical trial.

BACKGROUND: Breast cancer is the most frequently diagnosed cancer and the leading reason for cancer-related death among women. Neoadjuvant treatment with dual-HER2 (human epidermal growth factor receptor 2) blockade has shown promising effects in this regard. The present study aimed to compare the efficacy and safety of a proposed pertuzumab biosimilar with the reference pertuzumab. METHODS: This randomized, phase III, multicenter, equivalency clinical trial was conducted on chemotherapy-naive women with HER2-positive breast cancer. Patients were randomly assigned (1:1) to receive six cycles of either P013 (CinnaGen, Iran) or the originator product (Perjeta, Roche, Switzerland) along with trastuzumab, carboplatin, and docetaxel every 3 weeks. Patients were stratified by cancer type (operable, locally advanced, inflammatory) and hormone receptor status. The primary endpoint was breast pathologic complete response (bpCR). Secondary endpoints included comparisons of total pCR, overall response rate (ORR), breast-conserving surgery (BCS), safety, and immunogenicity. RESULTS: Two hundred fourteen patients were randomized to treatment groups. bpCR rate in the per-protocol population was 67.62% in the P013 and 71.57% in the reference drug groups. Based on bpCR, P013 was equivalent to the reference pertuzumab with a mean difference of - 0.04 (95% CI: - 0.16, 0.09). Secondary endpoints were also comparable between the two groups. CONCLUSIONS: The proposed biosimilar P013 was equivalent to the reference product in terms of efficacy. The safety of both medications was also comparable.

Impact of Melatonin and Branched-Chain Amino Acids Cosupplementation on Quality of Life, Fatigue, and Nutritional Status in Cachectic Heart Failure Patients: A Randomized Controlled Trial.

Background: Cardiac cachexia (CC) adversely affects the lifestyle of heart failure (HF) patients. The current study examined the impact of melatonin cosupplementation and branched-chain amino acids (BCAAs) on quality of life (QoL), fatigue, and nutritional status in cachectic HF patients. Methods: In this trial, 84 CC patients were randomized to melatonin, BCAAs, or coadministration (both) as intervention groups and a control group over 8 weeks. At baseline and postintervention, QoL, fatigue, and nutritional status were assessed. Results: After intervention, improvement in the overall and physical dimensions of QoL and appetite score were found to be statistically significant in the BCAAs (P < .001) and the melatonin+BCAAs (P < .001) groups compared with the placebo group. The emotional dimension score was significantly lower in the BCAAs group compared with the placebo group (P = .001). There was a statistically significant improvement in fatigue severity in all 3 intervention groups compared with the placebo group. The nutrition risk index (NRI) score increased significantly only in the melatonin group (P = .015), and there was no significant difference between the other groups (P = .804). Conclusions: Cosupplementation with BCAAs and melatonin improved QoL, fatigue status, and appetite in cachectic HF patients but did not affect NRI.

Echocardiographic Parameters Associated with Bendopnea in Patients with Systolic Heart Failure.

Background: Bendopnea, defined as dyspnea while bending, can be observed in patients with heart failure (HF). In this study, we investigated the frequency of this symptom in patients with systolic HF and its association with echocardiographic parameters. Methods: In this study, patients with left ventricular ejection fraction (LVEF) ≤45% and decompensated HF referred to our clinics were prospectively recruited. All the patients were examined by cardiologists for collecting data on the presence of bendopnea and baseline characteristics. They also underwent electrocardiographic and echocardiographic examinations. All findings were compared between the patients with or without bendopnea. Results: A total of 120 patients at a mean age of 65.19±12.62 years were evaluated, and 74.8% were men. Bendopnea was observed in 44.2% of the patients. The etiology of HF was ischemic in most patients (81.9%), and the functional class of most patients (85.9%) was III or IV. The mortality rate at the 6-month follow-up was comparable between the patients with or without bendopnea (6.1% vs 9.5%; P=0.507). The waist circumference (odds ratio [OR], 1.037, 95% confidence interval [CI], 1.005 to 1.070; P=0.023), paroxysmal nocturnal dyspnea (OR, 0.338, 95% CI, 0.132 to 0.866; P=0.024), and right atrial size (OR, 1.084, 95% CI, 1.002 to 1.172; P=0.044) were associated with bendopnea. Conclusion: Bendopnea can be frequently found among patients with systolic HF. This phenomenon is associated with obesity and baseline symptoms of patients and right atrial size upon echocardiographic examinations. It can help clinicians with the risk stratification of HF patients.

Polypharmacy Pattern in Iran: A Comprehensive Analysis of a Large Prescription Database.

Background: Polypharmacy is a significant patient safety concern. Objectives: This study aims to estimate the prevalence of polypharmacy, its continuity and associated factors, and common medication classes among a large outpatient population in East Azerbaijan province, Iran. Methods: A retrospective prescription data analysis was performed. The cohort included all ≥ 20 years old subjects with at least one prescription filled during the main three-month study period (2020 March 1 - 2020 May 31). Polypharmacy was defined as being exposed to more than four different medications during the main study period, and continuous polypharmacy was defined as being exposed to more than four medications during both the main study period and follow-up period (2020 October 1 - 2020 December 31). The frequency and prevalence of polypharmacy, along with predictive factors, were estimated. We performed multivariate logistic regression and estimated odds ratios (ORs) to investigate the risk factors for polypharmacy. Results: 307,820 patients included (mean age 49.8 years, 62.9% female, mean drug use 3.7 (SD = 2.6). Polypharmacy was observed in 28.3% (CI: 28.1 - 28.4), of which 36.6% experienced continuous polypharmacy. The odds of being exposed to polypharmacy increased with being female, increasing age, and exposure to chronic conditions. The groups of medications most utilized by polypharmacy patients were those indicated for gastro-esophageal reflux diseases, beta-blocking agents, antidepressants, blood glucose-lowering drugs, and antithrombotic agents. Conclusions: Strategies should be formulated to inform healthcare policymakers and providers about the magnitude of the polypharmacy phenomenon, associated factors, and the common medication classes involved.

Interactive Effect of Probiotics Supplementation and Weight Loss Diet on Metabolic Syndrome Features in Patients With Coronary Artery Diseases: A Double-Blind, Placebo-Controlled, Randomized Clinical Trial.

Background. Nutrition and probiotics supplementation are considered as nondrug strategies for the control of coronary artery disease (CAD). The aim of the present study was to investigate the interactive effects of probiotic supplementation and weight loss program on anthropometric and metabolic syndrome (MetS) indices in patients with CAD. Methods. A randomized, double-blind, placebo-controlled trial was performed in 44 overweight CAD patients. All the patients received weight loss program (5% to 10% of initial body weight) throughout the study course. The subjects were randomly assigned into intervention or placebo groups (n = 22, each) and received a probiotic or maltodextrin capsule/day, respectively, for 12 consecutive weeks. Anthropometric and MetS indices were assessed. Results. There was a significant decrease in total cholesterol (-30.7 ± 49.83 vs -5.9 ± 65 mmol/L, P = .043) and low-density lipoprotein cholesterol (-25.64 ± 51.7 vs -5.44 ± 70.1 mg/dL, P = .049) in the probiotic group compared to the placebo group. Other MetS feature indices and blood pressure did not differ significantly within or between groups. Conclusion. Probiotics supplementation improved total cholesterol and low-density lipoprotein cholesterol but had no effect on other lipid profile parameters and anthropometric indices. The weight loss diet plus probiotics supplementations resulted in more favorable decrease of cardiovascular risk factors compared to a weight loss program alone.

Increased circulating platelet and endothelial-derived microparticles in patients with cardiac syndrome X.

BACKGROUND: Cardiac syndrome X (CSX) has been associated with endothelial dysfunction and inflammation. We conducted a case-control study to evaluate the association between plateletý and endothelial-derived microparticles (PMPs and EMPs), as specific quantitative plasma markers of endothelial dysfunction, and the presence of CSX. METHODS: The present study was conducted on 40 CSX patients and 19 healthy individuals. C-reactive protein (CRP), and hematological and biochemical parameters were evaluated. The MP concentration in platelet-poor plasma (PPP) was quantitatively determined through flow cytometry using specific anti-human CD31, CD41a, CD62E, and CD144 antibodies. RESULTS: The mean platelet volume (MPV) and positive CRP rate (≥ 3.8 mg/l) were higher in patients compared to controls (P = 0.020 and P = 0.010, respectively). The CD62E+, CD144+, and CD31+41- EMPs, as well as CD41+ and CD31+CD41+ PMPs showed significant increase in CSX patients compared to controls (P < 0.050). There were direct correlations between the mean percentage of detected EMPs and PMPs as well as between their expression intensity; however, a reverse correlation was seen between the percentage of MPs and CD144 and CD41. Moreover, the MP level was reversely associated with prothrombin time (PT) and partial thromboplastin time (PTT) values. Only CD31+CD41+ PMP was correlated with CRP. CONCLUSION: It seems that EMPs and PMPs increase in CSX, which may contribute to various processes involved in the development of this syndrome.

Automatic Generation of Structured Radiology Reports for Volumetric Computed Tomography Images Using Question-Specific Deep Feature Extraction and Learning.

BACKGROUND: In today's modern medicine, the use of radiological imaging devices has spread at medical centers. Therefore, the need for accurate, reliable, and portable medical image analysis and understanding systems has been increasing constantly. Accompanying images with the required clinical information, in the form of structured reports, is very important, because images play a pivotal role in detect, planning, and diagnosis of different diseases. Report-writing can be exposure to error, tedious and labor-intensive for physicians and radiologists; to address these issues, there is a need for systems that generate medical image reports automatically and efficiently. Thus, automatic report generation systems are among the most desired applications. METHODS: This research proposes an automatic structured-radiology report generation system that is based on deep learning methods. Extracting useful and descriptive image features to model the conceptual contents of the images is one of the main challenges in this regard. Considering the ability of deep neural networks (DNNs) in soliciting informative and effective features as well as lower resource requirements, tailored convolutional neural networks and MobileNets are employed as the main building blocks of the proposed system. To cope with challenges such as multi-slice medical images and diversity of questions asked in a radiology report, our system develops volume-level and question-specific deep features using DNNs. RESULTS: We demonstrate the effectiveness of the proposed system on ImageCLEF2015 Liver computed tomography (CT) annotation task, for filling in a structured radiology report about liver CT. The results confirm the efficiency of the proposed approach, as compared to classic annotation methods. CONCLUSION: We have proposed a question-specific DNNbased system for filling in structured radiology reports about medical images.

Optogenetic stimulation of entorhinal cortex reveals the implication of insulin signaling in adult rat's hippocampal neurogenesis.

Adult neurogenesis in the hippocampal dentate gyrus plays a critical role in learning and memory. Projections originating from entorhinal cortex, known as the perforant pathway, provide the main input to the dentate gyrus and promote neurogenesis. However, neuromodulators and molecular changes mediating neurogenic effects of this pathway are not yet fully understood. Here, by means of an optogenetic approach, we investigated neurogenesis and synaptic plasticity in the hippocampus of adult rats induced by stimulation of the perforant pathway. The lentiviruses carrying hChR2 (H134R)-mCherry gene under the control of the CaMKII promoter were injected into the medial entorhinal cortex region of adult rats. After 21 days, the entorhinal cortex region was exposed to the blue laser (473 nm) for five consecutive days (30 min/day). The expression of synaptic plasticity and neurogenesis markers in the hippocampus were evaluated using molecular and histological approaches. In parallel, the changes in the gene expression of insulin and its signaling pathway, trophic factors, and components of mitochondrial biogenesis were assessed. Our results showed that optogenetic stimulation of the entorhinal cortex promotes hippocampal neurogenesis and synaptic plasticity concomitant with the increased levels of insulin mRNA and its signaling markers, neurotrophic factors, and activation of mitochondrial biogenesis. These findings suggest that effects of perforant pathway stimulation on the hippocampus, at least in part, are mediated by insulin increase in the dentate gyrus and subsequently activation of its downstream signaling pathway.

Inducing a sense of worthiness in patients: the basis of patient-centered palliative care for cancer patients in Iran.

BACKGROUND: Patient-centered care is one of the main components in providing palliative care for cancer patients. This issue has been the subject of numerous studies and practices in nursing for many years. Few studies, however, have explored the perception of nurses about patient-centered treatments. This study aimed at exploring the perception of care-providers about offering patient-centered care to cancer patients. METHOD: For attaining that aim, 18 care-providers were purposefully selected for an interview which allowed the researchers to explore the enriched experiences of these participants about offering patient-centered palliative care to cancer patients. After transcribing the recorded data, analysis was carried out based on Graneheim and Lundman's method of content analysis. The research was qualitative in nature and conducted in 2019 in Iran. RESULTS: From content analysis, 3 main categories; considering patient's spirituality, maintaining patient's dignity during care, and reducing patient's suffering, were found. The essence of these categories reflect on the care-providers' consideration and effort in "inducing a sense of worthiness" in patients by providing patient-centered care. These categories also reflect on the perspective of care-providers about nurse- patient relationship for providing high qualified palliative care. CONCLUSION: For providing patient-centered care inducing a sense of worthiness in patients, is the most fundamental component in providing palliative care to cancer patients. Therefore, by considering the structures and settings where the care is to be provided in the healthcare system, it is possible to direct the necessary educational, research, and administrative programs related to inducing a sense of worthiness in patients towards providing a more effective palliative care.

Ventricular Dysfunction in Patients with Coronary Slow-Flow Phenomenon: A Single-center Case-control Study.

BACKGROUND: Coronary slow-flow phenomenon (CSFP), characterized by delayed distal vessel opacification of contrast, in the absence of significant epicardial coronary stenosis, has effects on exercise capacity and clinical outcomes. The aim of this study was to explore the systolic and diastolic function of patients with CSFP and to compare it with a group of controls with normal coronary anatomy and flow. MATERIALS AND METHODS: In this case-control study, 45 consecutive CSFP patients and 45 age-, body mass index-, and presentation season-matched controls with normal coronary arteries and normal coronary flows were enrolled from Seyyedoshohada Heart Center from March 2015 to March 2016. A transthoracic echocardiography was done by a blinded echocardiographer using both conventional and tissue Doppler imaging techniques. RESULTS: Patients with CSFP were more likely to be male (P = 0.006) and smoker (P = 0.02) compared to controls. Other risk factors were not different between the two groups. There were no differences between groups in terms of the peak early (E) and late (A) diastolic velocities, deceleration time, early (E') and late (A') peak diastolic velocities at the mitral annulus, and the systolic mitral annular velocity (S'). Global longitudinal strain and peak systolic strain rates was lower in patients with CSFP compared to controls (-16.7% ±2.4% vs. -18.9% ±1.6%, P < 0.001 and 1.10 ± 0.1 vs. 1.24 ± 0.3, P = 0.008, respectively). CONCLUSION: Patients with CSFP showed signs of the left ventricular systolic dysfunction in tissue Doppler echocardiography, which underlines the importance of close follow-up in these patients. Patients with CSFP should be screened for ventricular function preferably by tissue Doppler echocardiography.

Association of epicardial fat thickness assessed by echocardiography with the severity of coronary artery disease.

Introduction: Epicardial fat thickness (EFT) can reflect risk of cardiovascular disease particularly coronary artery disease (CAD). The aim of this study was to investigate the association of EFT assessed by echocardiography and presence as well as severity of CAD. Methods: Two hundred and twenty consecutive patients who candidate for coronary angiography because of possible CAD were studied. EFT was evaluated in standard parasternal long axis (PlAX) and parasternal short axis (PSAX) view from 3 cardiac cycles at the end of systole and diastole. The severity of CAD was defined in two ways: (1) SYNTAX score, (2) number of vessels with significant lesion. Results: PLAX (EFTS) (EFT in systole) and PLAX (EFTd) (EFT in diastole) were significantly higher in patients with CAD in comparison with patients without CAD (P = 0.046, P = 0.041 respectively). There was a significant correlation between PLAX (EFTS) (P = 0.05), PLAX (EFTd) (P = 0.04) and SYNTAX score. There was no statistically significant relationship between EFT and number of diseased vessel (P > 0.05). Multivariate analysis was done for adjusting the effects of confounding factors and it showed that EFT (OR: 10.53, P = 0.004) was significantly correlated severe CAD as assessed by the SYNTAX score. Conclusion: EFT assessed by transthoracic echocardiography was higher significantly in patients with CAD than in normal patients. EFT as an easily available and cost-effective echocardiographic feature might be useful to predict complexity of CAD.

Emotional Bond: The Nature of Relationship in Palliative Care for Cancer Patients.

AIM: Relationship between care providers and cancer patients is one of the main elements in providing healthcare to these patients. Understanding the characteristics and the nature of the relationship is a basis for further organization of palliative care and will enhance the performance of care providers. The purpose of this study was to investigate the nature of the relationship in palliative care for cancer patients. METHODS: In this qualitative study, 16 participants with rich experiences in the field of cancer patient's palliative care were selected by purposive sampling. A semi-structured face-to-face interview was conducted with each of the participants. After data collection, all interviews were transcribed and reviewed, and then primary codes, sub-categories, and categories were extracted. RESULTS: Data analysis emerged three categories; being alongside the patient, establishing and maintaining cordiality relationship, and mutual understanding with the patient. Moreover, an emotional bonding was the main theme that defined the nature of relationship between the care provider team and cancer patients in a palliative care approach. CONCLUSION: Effective relationship based on emotional bonding is the foundation of palliative care in cancer patients. Considering the structures and palliative care settings in health systems, it is possible to provide training programs regarding the strategies related to establishing emotional bond for effective delivery of palliative care.

Generate Structured Radiology Report from CT Images Using Image Annotation Techniques: Preliminary Results with Liver CT.

A medical annotation system for radiology images extracts clinically useful information from the images, allowing the machines to infer useful abstract semantics and become capable of automatic reasoning and making diagnostic decision. It also supplies human-interpretable explanation for the images. We have implemented a computerized framework that, given a liver CT image, predicts radiological annotations with high accuracy, in order to generate a structured report, which includes predicting very specific high-level semantic content. Each report of a liver CT image is related to different inhomogeneous parts like the liver, lesion, and vessel. We put forward a claim that gathering all kinds of features is not suitable for filling all parts of the report. As a matter of fact, for each group of annotations, one should find and extract the best feature that results in the best answers for that specific annotation. To this end, the main challenge is discovering the relationships between these specific semantic concepts and their association with the low-level image features. Our framework was implemented by combining a set of the state-of-the-art low-level imaging features. In addition, we propose a novel feature (DLBP (deep local binary pattern)) based on LBP that incorporates multi-slice analysis in CT images and further improves the performance. In order to model our annotation system, two methods were used, namely multi-class support vector machine (SVM) and random subspace (RS) which is an ensemble learning method. Applying this representation leads to a high prediction accuracy of 93.1% despite its relatively low dimension in comparison with the existing works.