PErspective and current status of Radiotherapy Service in IRan (PERSIR)-1 study: assessment of current external beam radiotherapy facilities, staff and techniques compared to the international guidelines.

BACKGROUND AND PURPOSE: Radiotherapy (RT) is an essential treatment modality against cancer and becoming even more in demand due to the anticipated increase in cancer incidence. Due to the rapid development of RT technologies amid financial challenges, we aimed to assess the available RT facilities and the issues with achieving health equity based on current equipment compared to the previous reports from Iran. MATERIALS AND METHODS: A survey arranged by the Iran Cancer Institute's Radiation Oncology Research Center (RORC) was sent to all of the country's radiotherapy centers in 2022. Four components were retrieved: the reimbursement type, equipment, human resources, and patient load. To calculate the radiotherapy utilization rate (RUR), the Lancet Commission was used. The findings were compared with the previous national data. RESULTS: Seventy-six active radiotherapy centers with 123 Linear accelerators (LINACs) were identified. The centers have been directed in three ways. 10 (20 LINACs), 36 (50 LINACs), and 30 centers (53 LINACs) were charity-, private-, and public-based, respectively. Four provinces had no centers. There was no active intraoperative radiotherapy machine despite its availability in 4 centers. One orthovoltage X-ray machine was active and 14 brachytherapy devices were treating patients. There were 344, 252, and 419 active radiation oncologists, medical physicists, and radiation therapy technologists, respectively. The ratio of LINAC and radiation oncologists to one million populations was 1.68 and 4.10, respectively. Since 2017, 35±5 radiation oncology residents have been trained each year. CONCLUSION: There has been a notable growth in RT facilities since the previous reports and Iran's situation is currently acceptable among LMICs. However, there is an urgent need to improve the distribution of the RT infrastructure and provide more facilities that can deliver advanced techniques.

Effect of Postoperative Kinesio Taping on Knee Edema, Pain, and Range of Motion After Total Knee Arthroplasty and Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-analysis of Randomized Clinical Trials.

BACKGROUND: Kinesio taping (KT) has been shown to be clinically effective in a wide range of musculoskeletal disorders. Despite evidence supporting KT, there still needs to be more certainty regarding its clinical worthiness in managing postoperative conditions. This study aims to assess the effect of postoperative KT on knee edema, pain, and range of motion (ROM) when added to routine physiotherapy after knee surgery. METHODS: In this systematic review and meta-analysis, MEDLINE, Embase, Scopus, Web of Science, and CENTRAL databases were searched from their inception to July 2023. Randomized controlled trials (RCTs) comparing routine physiotherapy with and without KT were included. Random-effect models were used to calculate the standardized mean difference (SMD), confidence interval, and heterogeneity (I2). RESULTS: Sixteen RCTs on 842 operated knees were included. KT reduced knee edema in first week (SMD, -0.59, p < 0.001), 14th postoperative day (POD) (SMD, -0.78, p < 0.001), and 28 to 42 days postop (SMD, -0.66, p < 0.001). The KT demonstrated significant pain improvement in second week (SMD, -0.87, p < 0.001) and the fourth week (SMD, -0.53, p < 0.001). The KT groups demonstrated ROM improvement within second week (SMD, 0.69, p = 0.010) and in the 28th POD (SMD, 0.89, p = 0.009). Subgroup analysis demonstrated minimal heterogeneity in anterior cruciate ligament reconstruction (ACLR) cases. However, it did not show significant superiority regarding ankle, calf, or thigh edema and Lysholm scale. CONCLUSION: This study suggests that adding KT to routine postoperative physiotherapy reduces pain and knee edema after total knee arthroplasty or ACLR. Low to very low certainty of evidence for all outcomes and the limited number of studies emphasize the need for more high-quality primary studies to explore the optimal method of KT application and its effectiveness in specific knee surgeries. LEVEL OF EVIDENCE: Level I. See Instructions for Authors for a complete description of levels of evidence.

Prevalence, Complications, and Risk Factors of Falls and Fear of Falling Among Older Adults; Based on Ardakan Cohort Study on Aging (ACSA).

Introduction: The objective of this study was to assess the prevalence of falls, fear of falling (FOF), complications arising from falls, and identify possible sociodemographic and health-related factors associated with these outcomes among older adults. Methods: This cross-sectional study was based on the first wave of the Ardakan Cohort Study on Aging (ACSA), which includes participants over 50 years of age residing in Ardakan, Iran. Fall history, number of fall events, FOF, hospitalizations, and fractures in the past 12 months were assessed through a face-to-face interview. Health-related factors were recorded on a self-expressed basis. Associations were assessed using multiple logistic regression. Results: Among the 4,990 participants, fall history in the past 12 months was prevalent in 19.9%, with 10.1% reporting more than two fall events. Women (p < 0.001) and older participants (p< 0.001) had a higher prevalence. In females, 28.8% reported moderate to severe FOF, while 21% experienced disruptions in their daily activities as a result of this fear. The prevalence of fractures following falls was 5.1% in males and 8.6% in females. After adjusting for confounding factors, FOF (OR: 1.59, 95% CI: 1.33-1.91, p<0.001), imbalance (OR: 2.45, 95% CI: 1.68-3.58, p<0.001), urinary incontinence (OR: 1.44, 95% CI: 1.04-1.9, p=0.025), cognitive impairment (OR: 1.21, 95% CI: 1.01-1.46, p=0.049), vertigo or dizziness (OR: 1.39, 95% CI: 1.15-1.68, p<0.001), osteoporosis (OR: 1.24, 95% CI: 1.03-1.50, p=0.023), osteoarthritis (OR: 1.33, 95% CI: 1.13-1.56, p=0.001), depression (OR: 1.30, 95% CI: 1.06-1.60, p=0.010), and Central Nervous System (CNS)-affecting diseases (OR: 1.99, 95% CI: 1.33-2.97, p=0.001) were found to have positive associations with falls. Conclusion: This study showed that about one-fifth of those over 50 in Iran have experienced at least one fall within a year. Self-expressed imbalance, FOF, and urinary incontinence were the most prominent risk factors. Due to resulting in hospitalization and fractures, falls also lead to fear of falling and the associated limitation of activities.

Neutrophil to lymphocyte ratio as an assessment tool to differentiate between uterine sarcoma and myoma: a systematic review and meta-analysis.

BACKGROUND: This systematic review and meta-analysis aimed to determine the potential value of neutrophil to lymphocyte ratio (NLR) as an assessment tool in the clinical distinction between uterine sarcoma and uterine leiomyoma. METHODS: We comprehensively searched Web of Science, Scopus, and PubMed for relevant papers published before March 19, 2023. The standardized mean difference (SMD) was provided, along with a 95% confidence interval (CI). The random-effects model was employed to derive pooled effects due to the high levels of heterogeneity. The Newcastle-Ottawa scale was used for the quality assessment. Our study was registered in PROSPERO (CRD42023478331). RESULTS: Overall, seven articles were included in the analysis. A random-effect model revealed that patients with uterine sarcoma had higher NLR levels compared to those with uterine myoma (SMD = 0.60, 95% CI = 0.22-0.98; p = 0.002). In the subgroup analysis according to sample size, we found that patients with uterine sarcoma had elevated levels of NLR compared to those with uterine myoma in either large studies (SMD = 0.58, 95% CI = 0.04-1.13; P < 0.001) or small studies (SMD = 0.64, 95% CI = 0.33-0.96; P = 0.32). In the sensitivity analysis, we found that the final result was not significantly changed when single studies were removed, suggesting that the finding of this meta-analysis was stable. The pooled sensitivity of NLR was 0.68 (95% CI = 0.61-0.73), and the pooled specificity was 0.64 (95% CI = 0.59-0.69). CONCLUSION: NLR might be utilized as an assessment tool in clinics to help clinicians differentiate between patients with uterine sarcoma and those with myoma.

Prevalence and associated factors of mild cognitive impairment among middle-aged and older adults: Results of the first phase of Ardakan Cohort Study on Aging.

Background and Aims: Data on mild cognitive impairment (MCI) in low- to middle-income countries are still being determined, despite the fact that most future older adults are expected to reside in these regions. This study aimed to investigate the prevalence and associated factors of MCI in Iran. Methods: A cross-sectional study was conducted on 4938 community-dwelling subjects aged 50 years or above in the first wave of the Ardakan Cohort Study on Aging. MCI was evaluated using the Mini-Mental State Examination (MMSE) and the Abbreviated Mental Test Score (AMTS) in literate and illiterate individuals. The relationship between factors associated with the odds of MCI was assessed through logistic regression. Results: The prevalence of MCI among all participants, the literates and illiterates, was 15.8%, 6.3%, and 36.4%, respectively. It was found that failure to accomplish any of the MMSE or AMTS items was significantly related to MCI (p < 0.001). Age ([odds ratio (OR): 1.05; p < 0.001 in the literates], [OR: 1.06; p < 0.001 in the illiterates]), sex (OR: 0.13; p < 0.001 in the illiterates), history of stroke ([OR: 2.86; p = 0.006 in the literates], [OR: 2.04; p = 0.045 in the illiterates]), and depression ([OR: 1.87; p < 0.001 in the literates], [OR: 1.41; p = 0.008 in the illiterates]) were significantly associated with MCI. Conclusion: This study highlights the significant associations between age, education, depression, stroke, and MCI in Iranian participants. These findings emphasize the need for targeted interventions in low-literacy populations, mental health screening, and stroke prevention strategies to mitigate the burden of MCI and enhance cognitive health.

Laparoscopic management of ovarian cysts during pregnancy under urgent situations.

BACKGROUND: Majority of adnexal masses are incidental findings during pregnancy and resolve spontaneously. They may complicate pregnancy due to haemorrhage, cyst rupture and ovarian torsion. Laparoscopy is the preferred surgical intervention owing to shorter operative time, quicker recovery and lower post-operative pain. However, safety and feasibility of laparoscopic surgery in the management of ovarian cysts in pregnant women is challenging especially at advanced gestational ages and in urgent situations. METHODS: In this retrospective study, a total of 48 cases of urgent laparoscopic surgeries were evaluated in the first and second trimesters of pregnancy between March 2018 and March 2021 in Al-Zahra Hospital, Tabriz, Iran. RESULTS: The operations were ended in all patients successfully. The mean operation time was 45 min. There were no foetal maternal complications. All pregnancies had been terminated after 37 weeks of gestation. Oophorectomy had been performed in six patients and six other patients needed blood transfusion. Ovarian torsion was the most common reason for emergency surgery and mature teratoma was the most commonly reported pathology. Tocolytic therapy was required in six patients, and all of the patients were prescribed 50 mg of injectable progesterone twice daily for 10 days after surgery. The mean intra-abdominal pressure was equal to 15 mmHg and the mean end-expiratory carbon dioxide (CO 2 ) pressure was 36 mmHg. Intravenous paracetamol was used to relieve post-operative pain. The mean hospitalisation time was 1.63 days. CONCLUSION: Most of the ovarian cysts can be managed laparoscopically with ensured safety and lower morbidity even in emergency situations at advanced gestational ages.

Investigating biodegradation of polyethylene and polypropylene microplastics in Tehran DWTPs.

Microplastic (MP) pollution is a growing concern and various methods are being sought to alleviate the level of pollution worldwide. This study investigates the biodegradation capacity of MPs by indigenous microorganisms of raw water from Tehran drinking water treatment plants. By exposing polypropylene (PP) and polyethylene (PE) MPs to selected microbial colonies, structural, morphological, and chemical changes were detected by scanning electron microscope (SEM), cell weight measurement, Fourier transform infrared (FTIR), Raman spectroscopy test, and thermal gravimetric analysis (TGA). Selected bacterial strains include Pseudomonas protegens strain (A), Bacillus cereus strain (B), and Pseudomonas protegens strain (C). SEM analysis showed roughness and cracks on PP MPs exposed to strains A and C. However, PE MPs exposed to strain B faced limited degradation. In samples related to strain A, the Raman spectrum was completely changed, and a new chemical structure was created. Both TGA and FTIR analysis confirmed changes detected by Raman analysis of PP and PE MPs in chemical changes in this study. The results of cell dry weight loss for microbial strains A, B, and C were 13.5, 38.6, and 25.6%, respectively. Moreover, MPs weight loss was recorded at 32.6% for PP MPs with strain A, 13.3% for PE MPs with strain B, and 25.6% for PP MPs with strain C.

Ciprofloxacin antibiotic removal from aqueous solutions by ZnO nanoparticles coated on ACA: modeling and optimization.

Antibiotics are one of the most widely used drug groups. The presence of antibiotics in urban water sources and sewage creates many environmental and medical risks for humans and other living organisms. In this study, the potential of zinc oxide (ZnO) coated on almond shell activated carbon (ACA-ZnO) in removing ciprofloxacin (CIP) from aqueous solutions was investigated. Almond shell was used to make activated carbon. Zinc oxide nanoparticles were prepared by the sol-gel method, and finally, ZnO nanoparticles were bonded to activated carbon. The effect of independent parameters pH, contact time, adsorbent dose, and initial CIP concentration on CIP removal efficiency using ACA-ZnO was investigated by response surface methodology. Optimal removal was obtained at pH = 5.4, CIP initial concentration = 7.4 mg/L, adsorbent dose = 0.82 g/L, and reaction time = 67.3 min. This study followed a quadratic model (R2 = 0.958). The best model of adsorption isotherm fits with the Freundlich model (R2 = 0.9972) and the maximum capacity was 251.42 mg/g adsorption kinetics, and pseudo-second-order kinetic model (R2 = 0.959). The results of this study showed that ACA-ZnO as an adsorbent is very efficient, without environmental side effect and cost-benefit.

The Role of Childhood Circumstances on Social Conditions and Health of Middle-Aged and Older Adults: Ardakan Cohort Study on Aging (ACSA).

Some studies suggest that childhood can affect some later outcomes. This cross-sectional study of the first phase of the Ardakan Cohort Study on Aging (ACSA) on 5,197 individuals examined the effects of childhood socioeconomic and health on aging well. Childhood socioeconomic status (SES) was measured using parents' education and self-expressed family's financial status. Quality of Life (SF-12), Satisfaction with Life Scale (SWLS), WHO well-being scale, and self-reported health questionnaire were used. All data, including childhood experiences, was collected at a single time point. Poor childhood health was associated with lower well-being, life satisfaction, and mental quality of life (OR: .53, p = .032, OR: 0.49, p = .019, and ß: -3.51, p = .008, respectively). The family's financial status during childhood was associated with the mental and physical quality of life, satisfaction, well-being, and health (all p < .05). Fathers and mothers who had some level of education increased the odds of being healthy by 1.20 and 1.49 times, respectively. Childhood circumstances affect older adults' health and social conditions. Policies to improve childhood health and SES should be prioritized.

Diagnostic significance of neutrophil to lymphocyte ratio in endometriosis: a systematic review and meta-analysis.

BACKGROUND: The purpose of this systematic review and meta-analysis was to compile existing evidence on the significance of the NLR in predicting endometriosis in order to aid clinical decision-making and outcomes. METHODS: We searched ProQuest, Web of Science, and PubMed for related studies published before January 2, 2023. Standardized mean difference (SMD) with a 95% confidence interval (CI) was reported for each outcome. Because a significant level of heterogeneity was found, we used the random-effects model to calculate pooled effects. We used Newcastle-Ottawa Scale (NOS) for quality assessment. RESULTS: Overall, 18 article with were included in the analysis. A random-effect model revealed that patients with endometriosis had elevated levels of NLR compared to healthy controls (SMD = 0.79, 95% CI = 0.33 to 1.25, P < 0.001). Patients with endometriosis had elevated levels of NLR compared to those with other benign tumors (SMD = 0.85, 95% CI = 0.17 to 1.53, P = 0.014). In addition, NLR level of patients with stage III and IV endometriosis was not different from that of patients with stage I and II endometrioma (SMD = 0.30, 95% CI = -0.14 to 0.74, P = 0.18). However, NLR level was not different between endometriosis patients with and without peritoneal lesions (SMD = -0.12, 95% CI = -0.34to 0.10, P = 0.28), between patients with and without endometrioma (SMD = 0.20, 95% CI = -0.15 to 0.55, P = 0.26) and between endometriosis patients with and without deep lesions (SMD = 0.04, 95% CI = -0.20 to 0.28, P = 0.72). The pooled sensitivity of NLR was 0.67 (95% CI = 0.60-0.73), and the pooled specificity was 0.68 (95% CI, 0.62-0.73). CONCLUSIONS: NLR might be utilized in clinics as a possible predictor to help clinicians diagnose endometriosis in affected women.

The Association of Social Support, Depression, and Loneliness with Health-Related Quality of Life in Over 50 Years Adults: Ardakan Cohort Study on Ageing (ACSA).

BACKGROUND AND AIM: Social factors play a crucial role in the quality of life of + 50 adults. This study aimed to investigate the association between social support, depression, and loneliness and the health-related quality of life in + 50 adults of Ardakan. METHODS: This was a cross-sectional study from the first phase of Ardakan Cohort Study on Aging (ACSA) in 2019. Health-Related Quality of Life (HRQoL, SF-16), Duke Social Support Index (DSSI), and Center for Epidemiologic Studies Depression Scale (CES-D10) were used to assess the variables of interest. Multivariable linear regression was used to model the associated factors with the score of the SF-16 tool in two dimensions; physical (PCS) and mental (MCS). FINDINGS: A total of 5197 over 50 years individuals included in this study; The mean age was 62.2 ± 7.3 years old, and 52% were male. The mean score for PCS and MCS subscales was 45.6 (95% CI 45.4 to 45.9) and 49.3 (95% CI 49.0 to 49.5), respectively. Adjusted for other variables, having less feeling level of loneliness, and not having depressive symptoms were related to better PCS and MCS scores. CONCLUSION: The HRQoL for the mental aspect of HRQoL was better than the physical in elder populations. Also, much more focus should be paid to older adults who experience inadequate social support, higher levels of loneliness, and depressive symptoms.

Intra-Operative Adjunctive Magnesium Sulfate in Pain Management of Total Knee Arthroplasty; a Systematic Review and Meta-analysis.

Introduction: There has been growing interest in the potential role of adjunctive magnesium sulfate in improving pain management. This systematic review and meta-analysis aimed to assess the effect of intra-operative adjunctive magnesium sulfate on pain management and opioid consumption in total knee arthroplasty (TKA). Methods: A comprehensive search was conducted in Medline, Embase, Scopus, Web of Science, and Cochrane Library databases, covering studies up to April 2023. The extracted data included pain management outcomes, opioid consumption, and adverse effects from the selected studies. Standardized mean differences (SMDs) were calculated for continuous outcomes, while risk ratios (RRs) were calculated for dichotomous outcomes. Meta-analysis was conducted employing random-effects models in STATA 17. Results: In this meta-analysis of 8 randomized controlled trials involving 536 patients, adjunctive magnesium sulfate in TKA was found to significantly reduce opioid consumption during the first 24 hours after operation (SMD: -1.88, 95% confidence interval (CI): [-3.66 to -0.10]; p = 0.038). It also resulted in lower pain scores at rest 24 hours after surgery (SMD: -1.53, 95% CI: [-2.70 to -0.37]; p = 0.010). There were no significant differences in time to first rescue analgesic and adverse effects between the groups. The included studies were assessed to have low to high levels of risk of bias. Conclusion: This study presents evidence at low to moderate levels supporting the use of intra-operative adjunctive magnesium sulfate in TKA for improved pain management and reduced opioid consumption. However, further research is needed to address the heterogeneity and to explore optimal dosing regimens and routes of administration to maximize the benefits of magnesium sulfate in TKA.

Dysregulated miRNAs in recurrent miscarriage: A systematic review.

Recurrent miscarriage (RM) is a complex reproductive medicine disease that affects many families. The cause of RM is unclear at this time; however, lifestyle and genetic variables may influence the process. The slight alteration in miRNA expression has enormous consequences for a variety of difficulties, one of which may be RM. The target of this systematic study was to provide a framework of the dysregulated miRNAs in RM. The Prisma guidelines were applied to perform current systematic review pertaining to articles in the seven databases. Thirty-nine papers out of 245 received fulfilled all inclusion requirements. From all the mentioned miRNAs, 40 were up-regulated (65.57 %), whereas 21 were down-regulated (34.43 %). These dysregulated miRNAs contributed to the pathophysiology of RM by influencing key pathways and processes such as apoptosis, angiogenesis, epithelial-mesenchymal transition, and the immune system. Understanding the dysregulation of miRNAs, as well as the pathways and processes that engage these miRNAs and impact disease pathogenesis, may aid in clarifying the unknown underlying mechanisms of RM and the development of novel molecular therapeutic targets and medical domains.

Full thermoelectric characterization of a single molecule.

Molecules are predicted to be chemically tunable towards high thermoelectric efficiencies and they could outperform existing materials in the field of energy conversion. However, their capabilities at the more technologically relevant temperature of 300 K are yet to be demonstrated. A possible reason could be the lack of a comprehensive technique able to measure the thermal and (thermo)electrical properties, including the role of phonon conduction. Here, by combining the break junction technique with a suspended heat-flux sensor, we measured the total thermal and electrical conductance of a single molecule, at room temperature, together with its Seebeck coefficient. We used this method to extract the figure of merit zT of a tailor-made oligo(phenyleneethynylene)-9,10-anthracenyl molecule with dihydrobenzo[b]thiophene anchoring groups (DHBT-OPE3-An), bridged between gold electrodes. The result is in excellent agreement with predictions from density functional theory and molecular dynamics. This work represents the first measurement, within the same setup, of experimental zT of a single molecule at room temperature and opens new opportunities for the screening of several possible molecules in the light of future thermoelectric applications. The protocol is verified using SAc-OPE3, for which individual measurements for its transport properties exist in the literature.

Effect of duloxetine on opioid consumption and pain after total knee and hip arthroplasty: a systematic review and meta-analysis of randomized clinical trials.

OBJECTIVES: The purpose of this study was to investigate the analgesic effects of duloxetine, specifically on postoperative pain, opioid consumption, and related side effects following total hip or knee arthroplasty. METHODS: In this systematic review and meta-analysis, Medline, Cochrane, EMBASE, Scopus, and Web of Science were searched until November 2022 for studies which compared duloxetine with placebo when added to routine pain management protocols. Individual study risk of bias assessment was conducted based on Cochrane risk of bias tool 2. Random effect model meta-analysis was done on mean differences, to evaluate the outcomes. RESULTS: Nine randomized clinical trials (RCT) were included in the final analysis, totaling 806 patients. Duloxetine reduced opioid consumption (oral morphine milligram equivalents) on postoperative days (POD) 2 (mean difference (MD): -14.35, P = .02), POD 3 (MD: -13.6, P < .001), POD 7 (MD: -7.81, P < .001), and POD 14 (MD: -12.72, P < .001). Duloxetine decreased pain with activity on POD 1, 3, 7, 14, 90 (All P < .05), and pain at rest on POD 2, 3, 7, 14, and 90 (all P < .05). There was no significant difference in the prevalence of the side effects, except for increased risk of somnolence/drowsiness (risk ratio: 1.87, P = .007). CONCLUSION: Current evidence shows low to moderate opioid sparing effects of perioperative duloxetine and a statistically but not clinically significant reduction in pain scores. Patients treated with duloxetine had an increased risk for somnolence and drowsiness.

Recovery of Acute Ophthalmoplegia after Hyaluronic Acid Filler Injections to the Temples: A Case Report and Review of the Literature.

Soft tissue filler injection is the second most common nonsurgical cosmetic procedure. Despite the safety of fillers, as use has grown, so has the number of patients affected by adverse events. Ophthalmoplegia following cosmetic filler injection is a rare complication, mostly occurring after injection to the glabella, nasolabial fold, periorbital, and lateral nasal site. In all cases where ophthalmoplegia has been reported following fillers, patients have simultaneously experienced vision loss and other ocular symptoms. We report a case of isolated acute ophthalmoplegia following hyaluronic acid injection solely in the temple region. A 40-year-old woman, 3 hours after the procedure, presented to our hospital with left eye ophthalmoplegia, ptosis, and hypotropia. Treatment started with hyaluronidase, steroids, and anticoagulants. After 4 weeks, left eye ophthalmoplegia remained unchanged, and through a 10-week follow-up, all left ocular movements improved, and only mild hypotropia and ptosis persisted. This case report shows that ophthalmoplegia may also happen with temple region filler injections. We also review available prevention techniques and treatments to avoid such complications when performing soft tissue fillers for gaunt appearance correction.

Modeling and optimization of the coagulation/flocculation process in turbidity removal from water using poly aluminum chloride and rice starch as a natural coagulant aid.

The application of the coagulation/flocculation process is very important due to its simplicity in removing turbidity. Due to the disadvantages of using chemical coagulants in water and the lack of sufficient effect of natural materials alone in removing turbidity for proper performance, the simultaneous use of chemical and natural coagulants is the best way to reduce the harmful effects of chemical coagulants in water. In this study, the application of poly aluminum chloride (PAC) as a chemical coagulant and rice starch as a natural coagulant aid to remove turbidity from aqueous solutions was investigated. Effects of the above coagulants on the four main factors, coagulant dose (0-10 mg/L), coagulant adjuvant dose (0-0.1 mg/L), pH (5-9), turbidity (NTU 0-50), and each five levels were assessed using a central composite design (CCD). Under the optimized conditions, the maximum turbidity elimination efficiency was found to be 96.6%. The validity and adequacy of the proposed model (quadratic model) were confirmed by the corresponding statistics (i.e., F-value of 23.3, p-values of 0.0001, and lack of fit of 0.877 for the model, respectively, R2 = 0.88, R2adj. = 0.84, R2 pred = 0.79, AP = 22.04).

A Long-term Study of NeuroAid (MLC601, MLC901) in Patients with Alzheimer's Disease; An Extension 8-year Follow-up Study.

BACKGROUND: MLC601 and MLC901 showed neuroprotective and neuroregenerative properties and positive results in the treatment of dementia and cognitive impairment. This study aimed to investigate the long-term benefits of monotherapy with MLC601 and MLC901 in patients with Alzheimer's disease (AD). METHODS: In this study, patients with AD, diagnosed by DSM-IV criteria, were enrolled. Patients have received MLC601 for four years, and their regimen has changed to MLC901 for another four years. Recruited patients were followed to assess the efficacy and safety first of MLC601 and MLC901. Mini-Mental State Examination (MMSE) and Alzheimer's Disease Assessment Scale- Cognitive Subscale (ADAS-Cog) were used to assess cognitive function. Safety was evaluated by monitoring adverse events (AEs) and abnormal findings in physical examinations or lab tests. RESULTS: At the end of the trial, the changes in the mean (±SD) MMSE and ADAS-Cog scores were 5.1 (3.09) and 12.5 (10.89), respectively. Both scores showed a significant change in repeated measure analysis, with the ADAS-Cog score indicating a higher change than the MMSE score (P < 0.001). CONCLUSION: For more than eight years, we studied monotherapy with NeuroAid (MLC601, MLC901) in patients with AD. The study contributes further to the long-term safety and efficacy data of MLC in patients with AD.

Effect of Fe and Al based coagulants and disinfectants on polyethylene microplastics removal in coagulation process through response surface methodology.

Microplastic (MP) pollution has been rising as a threatening risk and recently has appealed to the attention of more researchers. In this study, influential parameters affecting the removal rate of polyethylene microplastics (PEMPs) were optimized through response surface methodology (RSM). In Box Behnken Design (BBD), independent parameters were pH, PEMP size, coagulant dosage and polyacrylamide dosage. Two experimental sets were conducted, one with ferric chloride and the second with poly aluminum chloride as two commonly applied coagulants in drinking water treatment plants (DWTPs). Comparing the results of optimized parameters, PAC was a better coagulant with the predicted removal rate of 58.19%, while the removal rate with ferric chloride as a coagulant was predicted to be 56.37%. Moreover, some experiments were conducted to analyze the effect of ozone gas and sodium hypochlorite as disinfectants on removal rate. The highest removal rate was observed when 2 ppm of O3 was added to the solution coagulated with optimal dosage of PAC, reaching the removal rate of 76.8%.

Implications for pelvic lymph node irradiation in definitive chemoradiotherapy of node negative muscle invasive bladder cancer based on predictive factors of clinicopathologic discrepancy.

PURPOSE: To identify pre-surgical imaging predictive value and factors associated with the clinicopathologic discrepancy for implication of definitive pelvic radiotherapy in clinically node-negative bladder cancer. METHOD: The documented data of bladder cancer patients who underwent radical cystectomy plus pelvic lymphadenectomy were collected retrospectively. Patients' characteristics, last imaging, pathology reports, disease-specific survival and overall survival were retrieved. RESULTS: From 142 patients, pre-surgical imaging had a sensitivity of 76.4%, specificity of 73.7%, positive predictive value (PPV) of 94.9%, and negative predictive value (NPV) of 32.6% (p value < 0.0001) for detection of muscle invasion. Also, for detection of positive lymph nodes, imaging had a sensitivity of 31.8%, specificity of 85.7%, PPV of 50%, and NPV of 73.7% (p value: 0.022). 44.4% of study population were upstaged after surgery (24.6% associated with N-upstaging) and 18.3% were downstaged (12% associated with N-downstaging). Receipt of neoadjuvant chemotherapy and T-stage were not correlated with N-upstaging. On multivariate analysis, lymphovascular invasion (LVI) maintained its significance for independent prediction of upstaging (OR 3.3, 95% CI 1.5-7.5, p value: 0.004) and inversely with downstaging (OR 0.34, 95% CI 0.12-0.96, p value: 0.04). Older age (OR 1.03, 95% CI 1.0-1.05, p value 0.047), positive margins (OR 2.1, 95% CI 1.2-3.8, p value 0.011), presence of LVI (OR 2.5, 95% CI 1.4-4.7, p value 0.003), perineural invasion (OR 2.0, 95% CI 1.2-3.4, p value 0.013), and lymph node ratio (OR 1.011, 95% CI 1.001-1.021, p value 0.03) were associated with worse survival. Also, N-upstaging independently predicted a worse survival after controlling for surgical pathology stage (OR 2.3, 95% CI 1.2-4.5, p value 0.011). CONCLUSIONS: The optimal target volume in definitive chemoradiotherapy of node-negative bladder cancer patients remains to be established. Since then, customizing the treatment is considered especially for positive LVI in TURBT specimen.