A study on fractional tumor-immune interaction model related to lung cancer via generalized Laguerre polynomials.

BACKGROUND: Cancer, a complex and deadly health concern today, is characterized by forming potentially malignant tumors or cancer cells. The dynamic interaction between these cells and their environment is crucial to the disease. Mathematical models can enhance our understanding of these interactions, helping us predict disease progression and treatment strategies. METHODS: In this study, we develop a fractional tumor-immune interaction model specifically for lung cancer (FTIIM-LC). We present some definitions and significant results related to the Caputo operator. We employ the generalized Laguerre polynomials (GLPs) method to find the optimal solution for the FTIIM-LC model. We then conduct a numerical simulation and compare the results of our method with other techniques and real-world data. RESULTS: We propose a FTIIM-LC model in this paper. The approximate solution for the proposed model is derived using a series of expansions in a new set of polynomials, the GLPs. To streamline the process, we integrate Lagrange multipliers, GLPs, and operational matrices of fractional and ordinary derivatives. We conduct a numerical simulation to study the effects of varying fractional orders and achieve the expected theoretical results. CONCLUSION: The findings of this study demonstrate that the optimization methods used can effectively predict and analyze complex phenomena. This innovative approach can also be applied to other nonlinear differential equations, such as the fractional Klein-Gordon equation, fractional diffusion-wave equation, breast cancer model, and fractional optimal control problems.

Clinical and polysomnographic characteristics in adults referred to the sleep laboratory: a single-center study.

BACKGROUND: Polysomnography is the gold standard diagnostic method for obstructive sleep apnea syndrome, and on-time treatment can help prevent further complications of obstructive sleep apnea. However, polysomnography is associated with some difficulties for the patients and physicians, which hinder its application. This study aimed to evaluate the clinical features and polysomnography findings of patients with obstructive sleep apnea. METHODS: Data were retrospectively collected from polysomnography studies at the Sleep Laboratory of Namazi Hospital, Shiraz, Iran, from February 2013 to December 2017. Polysomnography was performed for any patients suspected of obstructive sleep apnea. The researcher reviewed the data extracted and selected the essential clinical features for the statistical analysis. The association of variables with the polysomnography findings was analyzed. RESULTS: Significant associations were observed between the following factors and severity of obstructive sleep apnea: older age (p = 0.01), snoring (p = 0.122), history of sleep disorders (p = 0.11), no sedatives before sleep (p = 0.039), nocturia (p = 0.001), apnea (p = 0.035), no smoking (p = 0.039), no substance abuse (p = 0.011), hypertension (p = 0.001), cardiac diseases (p = 0.025), and overweight and obesity (p < 0.001). CONCLUSION: Considering the concomitant occurrence of obstructive sleep apnea with obesity, hypertension, cardiac disease, snoring, and observed apnea, polysomnography is recommended in these patients before further assessments.

Muscle mass and function are related to respiratory function in chronic obstructive pulmonary disease.

Background: Chronic obstructive pulmonary disease (COPD), as an airway limitation condition, is accompanied by alteration of muscle mass and function. We aimed to determine the relationship between disease severity and body composition, muscle function, and nutritional status in COPD patients. Methods: This cross-sectional study was conducted on 129 COPD participants. Muscle strength, body composition, and calf circumference (CC) were measured using a hydraulic hand dynamometer, bioelectrical impedance analysis (BIA), and a tape measure, respectively. Furthermore, fat-free mass index (FFMI), body mass index (BMI) and muscle mass value were calculated by equations. Forced expiratory volume in one second (FEV1) was assessed as well. Nutritional status was also evaluated by subjective global assessment (SGA) questionnaire. SPSS software (version 21 ) was used, chi-square, fisher's exact test, univariate and multivariate linear regression models were used for statistical analysis. P-values less than 0.05 were considered significant. Results: Based on FEV1 classification, 52.7% of the patients had severe conditions. The reports indicated that the prevalence of low CC was 54.2%, low muscle mass 38.7%, low FFMI 34.8%, low right handgrip strength 61.2% and low left handgrip strength 64.3%. Furthermore, there was an increasing trend based on FEV1 in low CC (p=0.032), low muscle mass (p=0.005), low FFMI (p=0.002), low right handgrip strength (p=0.004) and low left handgrip strength (p=0.014). The results of univariate analysis showed muscle mass (p=0.036), total protein (p=0.043), FFM (p=0.047), FFMI (p=0.007), SGA (p=0.029), right handgrip strength (p=0.004) and left hand grip strength (p=0.023) were associated with FEV1. In addition, the results of multivariate analysis demonstrated low values of FFMI (p=0.005) and right handgrip strength (p=0.042) were the main detrimental factors for FEV1. The results of multivariate analysis were confirmed by stepwise model. Conclusion: Low values of muscle mass and function are prevalent among COPD patients. The present study revealed that low FFMI and handgrip strength were closely related to disease severity.

Fortified whey beverage for improving muscle mass in chronic obstructive pulmonary disease: a single-blind, randomized clinical trial.

BACKGROUND: The development of effective nutritional supports for patients with chronic obstructive pulmonary diseases (COPD) is still challenging. This study was conducted to investigate the efficacy of daily consumption of fortified whey on inflammation, muscle mass, functionality, and quality of life in patients with moderate-to-severe COPD. METHODS: A single-blind, randomized trial study was performed on patients with COPD (n = 46). Participants in the intervention group (n = 23) daily received 250 ml of whey beverage fortified with magnesium and vitamin C for 8 weeks. Any changes in inflammatory cytokines (including interleukin- 6 (IL-6) and tumor necrosis factor (TNFα)) were the primary outcomes and the secondary outcomes were fat-free mass, handgrip strength, malnutrition, glutathione and malondialdehyde serum concentrations, and health-related quality of life (HRQoL). Body composition and muscle strength were measured by Bioelectrical Impedance Analysis (BIA) and hydraulic hand dynamometer, respectively. Fat-free mass index (FFMI) was also calculated. RESULTS: At the end of the study, 44 patients were analyzed. There were significant decreases in IL-6 concentrations in the intervention group compared to the control group. Also, FFMI, body protein, and handgrip strength increased significantly in the intervention group with significant changes between two groups. Moreover, improvement in health-related quality of life was observed in the intervention group compared to the control group. There were no significant changes in other study variables. CONCLUSIONS: This novel nutritional intervention decreased inflammatory cytokines levels, improved indices of skeletal muscle mass and muscle strength, and ultimately, increased HRQoL in patients with moderate-to-severe COPD. Thus, it is suggested to do further studies to assess the effects of nutrition intervention on COPD progression. TRIAL REGISTRATION: IR.SUMS.REC.1396.85 ( https://www.irct.ir/ ).

Withstanding the obstructive sleep apnea syndrome at the expense of arousal instability, altered cerebral autoregulation and neurocognitive decline.

The present review attempts to put together the available evidence and potential research paradigms at the interface of obstructive sleep apnea syndrome (OSAS), sleep micro- and macrostructure, cerebral vasoreactivity and cognitive neuroscience. Besides the significant health-related consequences of OSAS including hypertension, increased risk of cardio- and cerebrovascular events, notable neurocognitive lapses and excessive daytime somnolence are considered as potential burdens. The intermittent nocturnal hypoxia and hypercapnia which occur in OSAS are known to affect cerebral circulation and result in brain hypoperfusion. Arousal instability is then resulted from altered cyclic alternating patterns (CAPs) reflected in sleep EEG. In chronic state, some pathological loss of gray matter may be resulted from obstructive sleep apnea. This is proposed to be related to an upregulated proinflammatory state which may potentially result in apoptotic cell loss in the brain. On this basis, a pragmatic framework of the possible neural mechanisms which underpin obstructive sleep apnea-related neurocognitive decline has been discussed in this review. In addition, the impact of OSAS on cerebral autoregulation and sleep microstructure has been articulated.

A novel scoring system for early assessment of the risk of the COVID-19-associated mortality in hospitalized patients: COVID-19 BURDEN.

BACKGROUND: Corona Virus Disease 2019 (COVID-19) presentations range from those similar to the common flu to severe pneumonia resulting in hospitalization with significant morbidity and/or mortality. In this study, we made an attempt to develop a predictive scoring model to improve the early detection of high risk COVID-19 patients by analyzing the clinical features and laboratory data available on admission. METHODS: We retrospectively included 480 consecutive adult patients, aged 21-95, who were admitted to Faghihi Teaching Hospital. Clinical and laboratory features were collected from the medical records and analyzed using multiple logistic regression analysis. The final data analysis was utilized to develop a simple scoring model for the early prediction of mortality in COVID-19 patients. The score given to each associated factor was based on the coefficients of the regression analyses. RESULTS: A novel mortality risk score (COVID-19 BURDEN) was derived, incorporating risk factors identified in this cohort. CRP (> 73.1 mg/L), O2 saturation variation (greater than 90%, 84-90%, and less than 84%), increased PT (> 16.2 s), diastolic blood pressure (≤ 75 mmHg), BUN (> 23 mg/dL), and raised LDH (> 731 U/L) were the features constituting the scoring system. The patients are triaged to the groups of low- (score < 4) and high-risk (score ≥ 4) groups. The area under the curve, sensitivity, and specificity for predicting mortality in patients with a score of ≥ 4 were 0.831, 78.12%, and 70.95%, respectively. CONCLUSIONS: Using this scoring system in COVID-19 patients, the patients with a higher risk of mortality can be identified which will help to reduce hospital care costs and improve its quality and outcome.

Association between serum 25-hydroxy vitamin D levels and severity of asthma.

BACKGROUND & AIMS: Asthma prevalence has increased significantly since the 1960s. Increased airway hyperresponsiveness, decreased pulmonary function, poor asthma management, and steroid resistance have all been linked to vitamin D insufficiency. In addition, treatment with oral corticosteroids increases the risk of vitamin D deficiency. We studied patients with asthma regarding their vitamin D status and its association with disease severity. METHODS: Patients with asthma were included in the study. Spirometry results and serum levels of 25-hydroxyvitamin D, calcium, and phosphorus were measured. RESULTS: Of the 54 subjects, the majority (77.8%) were women, and the mean age was 49.71 ± 12.16 years. Among the patients, 19 (35.2%) had sufficient vitamin D levels, 18 (33.3%) had insufficient vitamin D, and 17 (31.5%) had vitamin D deficiency. The mean FEV/FVC in the group with vitamin D deficiency is significantly lower than those with insufficient vitamin D levels (P = 0.018). The mean calcium and phosphorus levels between the three groups were not different. CONCLUSION: Vitamin D deficiency is common in patients with asthma but is not associated with lung function test results.

3D numerical simulation of hot airflow in the human nasal cavity and trachea.

BACKGROUND AND OBJECTIVE: The primary function of the human respiratory system is gas and moisture exchange, and conditioning inhaled air to prevent damage to the lungs and alveoli. In a fire incident, exposed soft tissues contract and the respiratory system may be severely damaged, possibly leading to respiratory failure and even respiratory arrest. The purpose of this study is to numerically simulate hot airflow in the human upper airway and trachea to investigate heat and moisture transfer and induced thermal injuries. METHODS: For analysis, the airflow is assumed to be laminar and steady, and simulations have been carried out at volume flow rates of 5 and 10 L/min, inlet temperatures of 70-240 °C, and relative humidity up to 40%. The mucous layer and surrounding tissues are incorporated into the conducting zone of the model. The blood perfusion is considered at different rates up to 5(Kg/m3.s) to regulate the temperature, and the vapor concentration is coupled with the energy equation. RESULTS: The temperature and humidity distribution on the airway wall were calculated for all the studied conditions in order to find the mild and severe burn for different inhaled air temperatures. At the inlet temperatures of 70 and 100 °C, there are mild burns in several nasal cavity regions. At the higher temperatures of 160 and 200 °C, these areas suffer from severe burns and mild burns occur at the superior parts and nasopharynx. Rapid evaporation and tissue destruction will be observed if anyone breathes the 240 °C air. CONCLUSIONS: The results show that the hot inlet temperatures drop below 44 °C when passing through the upper airway, and the lower airway was not affected. Increasing the inlet temperature from 70 to 240 °C extends the burns from mild to severe and the affected areas from the beginning of the nasal cavity to the pharynx.

Delayed COVID-19-induced cytokine storm after root canal therapy with favorable response to plasmapheresis, tocilizumab, and methylprednisolone pulses therapy: A case report.

COVID-19 showed different characteristics, and many cases showed clinical manifestations that could not be attributed to other conditions. We present a 22-year-old woman who had an uneventful recovery from COVID-19, and after that, she developed a cytokine storm and a worsening clinical condition 2 days after dental root canal therapy.

Effect of atorvastatin on serum periostin and blood eosinophils in asthma - a placebo-controlled randomized clinical trial.

OBJECTIVE: To investigate the effect of atorvastatin on serum periostin level and blood eosinophil count in patients with asthma. METHODS: Patients diagnosed with asthma were enrolled and randomised into an intervention or placebo group, to receive 40 mg atorvastatin or similar placebo, daily, for 8 weeks. Spirometry was performed at baseline, and at the end of weeks 4 and 8; patients also provided blood samples and completed an asthma control test (ACT) at baseline and at the end of week 8. Primary study outcomes were blood eosinophil count and serum periostin levels. RESULTS: Eighty patients completed the study (40 per group). Mean ACT scores were similar between the intervention and placebo groups at baseline (17.95 ± 3.75 versus 17.98 ± 3.77, respectively), and improved in the intervention group (19.88 ± 3.28), but remained unchanged in the placebo group (18.6 ± 3.26) during the treatment period. No statistically significant differences in spirometric changes, blood eosinophil count or serum periostin levels were observed between the groups during the treatment period. CONCLUSION: Spirometric parameters and inflammatory markers did not change significantly in response to atorvastatin treatment, and did not differ between the placebo and intervention groups.

Effects of N-acetylcysteine on Pulmonary Functions in Patients with Systemic Sclerosis: A Randomized Double Blind, Placebo Controlled Study.

BACKGROUND: Systemic sclerosis (SSc) is a systematic and rare autoimmune disease that affects many organs. N-acetylcysteine (NAC), thiol-containing compound, can act both as the precursor of reduced glutathione and direct scavenger of reactive oxygen species. OBJECTIVE: We assessed the clinical effect of NAC on the pulmonary function test of patients with diffuse scleroderma. METHODS: This study is a randomized double-blind clinical trial that was done on 25 patients with diffuse SSc without lung involvement on primary chest high-resolution computed tomography. Placebo was administered for 13 patients and 1200 milligram NAC for 12 patients. Body plethysmography parameters were assessed at the beginning of the study and after 24 weeks. RESULTS: Patients in the two groups were matched in the basic demographic data like age, duration of disease, and modified Rodnan skin score. The analysis showed no significant differences in parameters of plethysmography between the two groups. After importing the data of 2 patients in the placebo-treated group, who developed interstitial lung disease, DLCO in the placebo-treated group was 90.69 ± 21.29 milliliter at the end of the study, which significantly decreased compared with the beginning of the study (102.30 ± 13.83 ml). Also, changes of DLCO between the two groups were significantly different. CONCLUSION: In this trial, the sensitivity of DLCO as the first marker in the evaluation of pulmonary function in patients with SSc was confirmed. On the other hand, NAC had no effect versus placebo in a period of 24 weeks.

A New Hypothesis on Anxiety, Sleep Insufficiency, and Viral Infections; Reciprocal Links to Consider in Today's "World vs. COVID-19" Endeavors.

In today's ever-growing concerns about the coronavirus disease (COVID-19) pandemic, many experience sleep insufficiencies, such as difficulty falling or staying asleep, sleep-related behavioral symptoms, and out-of-phase circadian rhythmicity despite the lack of history of earlier such symptoms. Meanwhile, the disruption in sleep bioparameters is experienced more in people with a history of sleep disorders. The behavioral sleep disorders in the current situations are prevalent given the today's amount of anxiety everyone is feeling about COVID-19. On the other hand, evidences indicated that the cross-link between impaired sleep efficiency and disrupted innate immunity makes people susceptible to viral infections. The present brief review highlights the links between psychosocial stress, sleep insufficiency, and susceptibility to viral infections in relevance to COVID-19 situation. The stress management measures, including addressing sleep-related disorders and sleep hygiene, will have a notable impact by harnessing immune response and thus reducing the susceptibility to viral infections.

Validity and Reliability of the Persian Versions of National Institute of Health Stroke Scale and Modified National Institute of Health Stroke Scale in Hospitalized Patients.

BACKGROUND: National Institute of Health Stroke Scale (NIHSS) and Modified National Institute of Health Stroke Scale (mNIHSS) are two valid and reliable questionnaires that assess stroke severity. This study aimed to examine and compare the validity and reliability of Persian versions of NIHSS and mNIHSS in hospitalized patients. MATERIALS AND METHODS: The English versions of NIHSS and mNIHSS were translated to Persian (forward and backward), and three neurologists examined the face and content validity of both questionnaires. The Persian versions of NIHSS and mNIHSS were used in 75 hospitalized stroke patients (hemorrhagic and obstructive) admitted to Namazi teaching hospital, Shiraz, Iran. The reliability and validity of the Persian versions were examined by Cronbach's alpha coefficient and convergent validity. RESULTS: The values of Cronbach's alpha for Persian versions of NIHSS and mNIHSS were 0.81 and 0.86, respectively. The scaling success of convergent validity in NIHSS and mNIHSS were 80% and 100%, respectively. CONCLUSION: The Persian versions of NIHSS and mNIHSS were reliable and valid. However, mNIHSS was more valid and reliable than NIHSS. Persian version of mNIHSS can be suggested to be used for assessing stroke severity in hospitalized stroke patients by neurologists and researchers.

Repetitive Arm Movements During Sleep: A Polysomnographic Assessment.

Sleep-related movement disorders should be differentiated from parasomnias, sleep-associated behavioral disorders, and epilepsy. Polysomnography (PSG) is the gold standard in evaluating such disorders. Periodic leg movement disorder during sleep (PLMS), hypnic jerks, bruxism, rhythmic movement disorder, restless legs syndrome, and nocturnal leg cramps have broadly been discussed in the literature. However, periodic arm movement disorder in sleep (PAMS) is a less-appreciated entity perhaps because arm surface electromyography is not an integral part of the standard polysomnography. Results from our PSG study in a case suspected for PAMS prompted us to herewith discuss this problem.

Diagnostic value of tumor markers for differentiating malignant and benign pleural effusions of Iranian patients.

In order to evaluate the diagnostic yield of tumor markers in differentiating malignant and benign pleural effusions, we carried out a prospective study in a group of Iranian people. Pleural and serum levels of carcinoembryonic antigen (CEA), carbohydrate antigen 15-3 (CA 15-3), neuron-specific enolase (NSE) and cancer antigen 125 (CA 125) were assayed prospectively in patients with pleural effusion (40 malignant and 37 benign). The highest sensitivity was obtained with a combination of CA 15-3 in serum, and CA 15-3 and CEA in pleural fluid (80%), also with combination of CA 15-3 in serum, and CA 15-3, NSE and CEA in pleural fluid (80%). The highest specificity was obtained with combination of CA 15-3 in serum, and CA 15-3 and NSE in pleural fluid (100%), and also with combination of CA 15-3 in serum, and CA15-3, NSE and CEA in pleural fluid (100%).

Alpha-1 antitrypsin deficiency in Iranian patients with chronic obstructive pulmonary disease.

BACKGROUND: Alpha-1 antitrypsin deficiency is a genetic disease which affects both lung and liver. This disease is a recognized factor for chronic obstructive pulmonary disease (COPD). However its importance as the cause of COPD in a country such as Iran is unclear. OBJECTIVES: This study was conducted to find out the role of α-1 antitrypsin deficiency as a cause of COPD in Iranian patients. MATERIALS AND METHODS: The serum concentration of α-1 antitrypsin was determined and the genotype of α-1 antitrypsin was also evaluated by PCR-RFLP in 130 patients with COPD and 50 normal healthy blood donors. RESULTS: No α-1 antitrypsin deficient case was found in normal healthy people and COPD patients. CONCLUSIONS: Our results clarify that deficiency of α-antitrypsin is not a major cause of COPD in Iranian patients.

Pulmonary complications in cirrhotic candidates for liver transplantation.

BACKGROUND AND AIMS: The determination of the prevalence of cardiopulmonary complications at a liver transplant center in Iran. METHODS: Ninety-nine patients (61 male and 38 female) with a mean age of 36.5 (15-66) years with proven cirrhosis were enrolled in this study. Patients with primary cardiac disease, current smokers, those with sepsis, hepatocellular carcinoma, recently ruptured esophageal varices and chronic pulmonary or renal diseases were excluded from the study. Sixty-nine patients had ascites. Forty-four patients had grade C Child-Pugh classification. All patients were evaluated for respiratory function by chest X-ray (CXR), room air arterial blood gas, simultaneous pulse oximetry, cardiac echocardiography and spirometry. RESULTS: Sixty-one patients (66.1%) had a widened alveolar-arterial O2 difference ( > 20 mmHg); 14 (14.1%) had hypoxemia; 6 (6.1%) had mean pulmonary arterial pressure (MPAP) = 25-40 mmHg; 12 (12.1%) had tricuspid regurgitation; pleural effusion and lung restriction were detected in 4 (4%) and 50 (50.5%), respectively. P(A-a)O2 was negatively associated with pulmonary hypertension (P < 0.03) and tricuspid regurgitation (P < 0.005). Portal hypertension and portal vein thrombosis were detected in 91 and 8 patients, respectively. CONCLUSIONS: A widened alveolar-arterial oxygen difference was common in our patients, but hypoxemia occurred in 14% of patients. Portopulmonary hypertension was preponderant in those patients of male gender.