Arrhythmia detection by the graph convolution network and a proposed structure for communication between cardiac leads.

One of the most common causes of death worldwide is heart disease, including arrhythmia. Today, sciences such as artificial intelligence and medical statistics are looking for methods and models for correct and automatic diagnosis of cardiac arrhythmia. In pursuit of increasing the accuracy of automated methods, many studies have been conducted. However, in none of the previous articles, the relationship and structure between the heart leads have not been included in the model. It seems that the structure of ECG data can help develop the accuracy of arrhythmia detection. Therefore, in this study, a new structure of Electrocardiogram (ECG) data was introduced, and the Graph Convolution Network (GCN), which has the possibility of learning the structure, was used to develop the accuracy of cardiac arrhythmia diagnosis. Considering the relationship between the heart leads and clusters based on different ECG poles, a new structure was introduced. In this structure, the Mutual Information(MI) index was used to evaluate the relationship between the leads, and weight was given based on the poles of the leads. Weighted Mutual Information (WMI) matrices (new structure) were formed by R software. Finally, the 15-layer GCN network was adjusted by this structure and the arrhythmia of people was detected and classified by it. To evaluate the performance of the proposed new network, sensitivity, precision, specificity, accuracy, and confusion matrix indices were used. Also, the accuracy of GCN networks was compared by three different structures, including WMI, MI, and Identity. Chapman's 12-lead ECG Dataset was used in this study. The results showed that the values of sensitivity, precision, specificity, and accuracy of the GCN-WMI network with 15 intermediate layers were equal to 98.74%, 99.08%, 99.97% & 99.82%, respectively. This new proposed network was more accurate than the Graph Convolution Network-Mutual Information (GCN-MI) with an accuracy equal to 99.71% and GCN-Id with an accuracy equal to 92.68%. Therefore, utilizing this network, the types of arrhythmia were recognized and classified. Also, the new network proposed by the Graph Convolution Network-Weighted Mutual Information (GCN-WMI) was more accurate than those conducted in other studies on the same data set (Chapman). Based on the obtained results, the structure proposed in this study increased the accuracy of cardiac arrhythmia diagnosis and classification on the Chapman data set. Achieving such accuracy for arrhythmia diagnosis is a great achievement in clinical sciences.

The risk of sexual dysfunction associated with alcohol consumption in women: a systematic review and meta-analysis.

BACKGROUND: Alcohol abuse among women is a significant health problem. Consuming alcohol in high amounts causes decreased sexual stimulation, vaginal lubrication, dyspareunia, and difficulty reaching orgasm. Due to the different effects of alcohol consumption on sexual function, this study aimed to investigate the effect of alcohol consumption on sexual dysfunction in women. METHODS: In this study, the researchers conducted a systematic search of several databases, including PubMed, Google Scholar, Scopus, Web of Science, Embase, and ScienceDirect, as well as the Google Scholar search engine, to identify studies reporting the impact of alcohol consumption on female sexual dysfunction. The search was conducted up until July 2022. A total of 225 articles were searched in the databases, and an additional 10 relevant articles were identified through manual search. After removing 93 articles due to duplication, 90 articles were excluded based on the study's inclusion and exclusion criteria. During the merit evaluation phase, 26 articles were excluded through the full-text study based on the study's inclusion and exclusion criteria, while 26 articles were excluded due to their low quality. Ultimately, only 7 studies were deemed suitable for the final evaluation. The analysis was conducted using a random effects model, while the heterogeneity of the studies was assessed using the I2 index. Data analysis was performed using the Comprehensive Meta-Analysis Version 2 software. RESULTS: Based on the review of 7 studies involving a total sample size of 50,225 women and using the random effects method, the calculated odds ratio was 1.74 (95% CI: 1.006-3.04). This indicates that alcohol consumption increases the likelihood of sexual dysfunction in women by 74%. The Begg and Mazumdar rank correlation test, was used to analyze the distribution bias, but the results were not significant at the 0.1 significance level (p = 0.763). CONCLUSION: The findings of this study demonstrate a significant correlation between alcohol consumption and an increased risk of sexual dysfunction in women. These results highlight the need for policymakers to prioritize this issue and raise awareness regarding the harmful effects of alcohol consumption on female sexual function and its impact on population health and reproduction.

Psychometric Properties of the Persian Version of Cardiovascular Management Self-efficacy Scale.

BACKGROUND: Self-efficacy plays a major role in the management of cardiovascular disease (CVD). The original Cardiovascular Management Self-efficacy Scale (CMSS) was developed in 2016 in Italian patients with CVD; however, no such scale exists for Iranian patients with CVD. OBJECTIVE: We translated the CMSS into Persian and assessed its validity, reliability, and psychometric properties in Iranian patients with CVD. METHODS: This study was conducted for 4 months in 2017 on a group of consenting patients with CVD (N = 363) recruited from a cardiovascular hospital in Kermanshah, Iran. The reliability of the Persian CMSS was evaluated. We assessed validity, including face, content, construct, convergent, divergent, and discriminate validity, using the General Self-efficacy Scale, the Hospital Anxiety and Depression Scale, and the 36-item Short Form Health Survey Scale. Known-group validity was assessed among patients with high blood pressure. RESULTS: The Persian CMSS had acceptable face and content validity. No floor or ceiling effects were found for the total scale. Cronbach α was calculated as .68. Test-retest reliability was confirmed by intraclass correlation coefficient (ICC1,3 = 0.98, P < .001). Using exploratory factor analysis, 3 subscales were identified, similar to the original version. Significant correlations were found between the Persian CMSS and both the General Self-efficacy Scale (r = 0.94, P < .001) and Hospital Anxiety and Depression Scale (r = -0.35, P < .05). Self-efficacy measured using the Persian CMSS was statistically different between 2 levels of patients' health status (P < .05). Patients with hypertension had a lower level of self-efficacy than those in the healthy group (P < .05). CONCLUSIONS: The Persian version of CMSS provides a practical, reliable, and valid scale for evaluating self-efficacy in the clinical management of Persian Iranian patients with CVD.

Effect of pre-pregnancy maternal body mass index on pregnancy outcomes in nulliparous women in the Islamic Republic of Iran.

This study was conducted to evaluate the effect of pre-pregnancy BMI on pregnancy outcomes. BMI was calculated measured in 360 nulliparous women. According to BMI, pregnant women were placed into three groups: group I (lean group BMI ≤ 19.8), group II (normal weight group BMI = 19.9-24.9), and group III (obese group BMI ≥ 25). Data were analyzed using SPSS 16. The mean duration of the first and the second stage of labour were significantly different between three groups (P < 0.001). Cesarean section ratio in group I was lower than group II (OR = 0.15; P = 0.013). Instrumental delivery in group III was more than group II (OR=4.6; P = 0.002). Risk of nonreactive non-stress test (NST) was significantly different between groups II and III (OR = 5.7; P = 0.009). Induction ratio in group I was lower than group II (OR=0.43; P = 0.002). Deviation of BMI from the normal level is associated with adverse outcomes of pregnancy and delivery.

The Relationship Between Hemodialysis and the Echocardiographic Findings in Patients with Chronic Kidney Disease.

BACKGROUND: The incidence of cardiac morbidity and mortality is high in patients treated with hemodialysis (HD). The aim of this study was to evaluate the relationship between HD and the echocardiographic findings in patients with chronic kidney disease (CKD). METHODS: Between 2012 and 2014, 150 patients with CKD. The echocardiographic data were done based on American Society of Cardiology (ASE). Measurement method for Ejection Fraction was E balling and for Diastolic Function was Tissue Doppler. Anemia, thyroid conditions and dialysis through an arteriovenous fistula or permanent catheter of dialysis for the patients are not considered. RESULTS: The mean age at diagnosis for the patients was 57.8 years, 52.7% were males. Out of 150 patients, 112 patients (74.7%) had diabetes and 117 patients (78%) had a history of hypertension. The prevalence of all echocardiographic findings was more after the first dialysis compared with before the first dialysis in diabetic patients (P<0.05), but in non-diabetic patients, was not for the tricuspid valve stenosis, impaired right ventricular volume, systolic dysfunction and pulmonary hypertension (P>0.05). CONCLUSIONS: According to the findings of this study, seems that more accurate selection of patients for dialysis, paying special attention to hemodynamic change during dialysis, patient education about diet and better control of uremia and diabetes is essential.

The Best Surgical Treatment for Cervical Radiculopathy: A Systematic Review and Network Meta-Analysis.

A case with an inflamed or damaged nerve root in the cervical spine is defined as cervical radiculopathy.The purpose of the current study is to recognize the most effective surgical procedures in cervical radiculopathy subjects. All related studies were taken using PubMed searching international databases, Scopus, ISI Web of Science (WoS), and Science direct with no limit of until November 20th, 2021. Finally, based on the inclusion and exclusion criteria, after reviewing all randomized controlled trial studies which had the related data the researchers were looking for, they conducted meta-analysis with the seven remaining studies including eight different treatments. Heterogeneity was evaluated by Cochran's Q and Higgins I2 using R software for the network. In the results presented in this study, the neck disability index (NDI) changes as a result of taking cervical anterior discectomy without (ACD) and with fusion (ACDF) and ACD arthroplasty were -0.003, -1.659, and -1.656, respectively. According to the final diagram of the network, 11 comparisons were made in pairs. When each treatment group is compared with ACDF, it is shown that there was a significant mean effect among the patients who receive Mobi-C, Kineflx|C, and ADR, with mean differences of - 8.60 [CI 95% (- 12.75, - 4.45)], - 1.10 [CI 95% (- 5.22, 3.02)], and - 1.00 [CI 95% (- 7.18, 5.18)], respectively. The most effective surgical treatments for cervical radiculopathy were Mobi-c, Kineflx|C, and artificial disc replacement compared to ACDF treatment, respectively.

Developing Graph Convolutional Networks and Mutual Information for Arrhythmic Diagnosis Based on Multichannel ECG Signals.

Cardiovascular diseases, like arrhythmia, as the leading causes of death in the world, can be automatically diagnosed using an electrocardiogram (ECG). The ECG-based diagnostic has notably resulted in reducing human errors. The main aim of this study is to increase the accuracy of arrhythmia diagnosis and classify various types of arrhythmias in individuals (suffering from cardiovascular diseases) using a novel graph convolutional network (GCN) benefitting from mutual information (MI) indices extracted from the ECG leads. In this research, for the first time, the relationships of 12 ECG leads measured using MI as an adjacency matrix were illustrated by the developed GCN and included in the ECG-based diagnostic method. Cross-validation methods were applied to select both training and testing groups. The proposed methodology was validated in practice by applying it to the large ECG database, recently published by Chapman University. The GCN-MI structure with 15 layers was selected as the best model for the selected database, which illustrates a very high accuracy in classifying different types of rhythms. The classification indicators of sensitivity, precision, specificity, and accuracy for classifying heart rhythm type, using GCN-MI, were computed as 98.45%, 97.89%, 99.85%, and 99.71%, respectively. The results of the present study and its comparison with other studies showed that considering the MI index to measure the relationship between cardiac leads has led to the improvement of GCN performance for detecting and classifying the type of arrhythmias, in comparison to the existing methods. For example, the above classification indicators for the GCN with the identity adjacency matrix (or GCN-Id) were reported to be 68.24%, 72.83%, 95.24%, and 92.68%, respectively.

Target-controlled infusion of remifentanil to provide analgesia for awake nasotracheal fiberoptic intubations in cervical trauma patients.

BACKGROUND: Awake fiberoptic tracheal intubation is the best choice for situations in which neck movement is limited or hazardous, and remifentanil is one of the most popular drugs that are used in these circumstances. We administered remifentanil with target-controlled and manually controlled infusion techniques in two groups of patients who had cervical trauma and semielective maxillofacial surgery. METHODS: Twenty-two patients were enrolled and randomly assigned to two groups. Bronchoscopy data were gathered in four data points. In the target-controlled infusion (TCI) group, patients received 0.8 ng · mL remifentanil as effect-site target, and in the manually controlled group, patients received remifentanil with a loading dose of 0.75 µg · kg and 0.075 µg · kg · min as maintenance. Patients were evaluated separately for recall and pain during procedure 24 hours after operation by visual analog scale. Comparison of vital signs was performed using Mann-Whitney U test. Fischer's exact test was used to analyze quantitative data when appropriate. RESULTS: Preparation time was shorter in the TCI group, and remifentanil effect-site targets were higher in the TCI group. Vital signs were more stable in the TCI group. Levels of sedation were comparable in both groups. Recall and pain during endoscopy were more common in the manually controlled infusion group. CONCLUSION: Remifentanil infusion could be recommended to provide good conscious sedation in procedures such as awake nasotracheal intubation, but target-controlled remifentanil infusion seems to provide better conditions compared with manually controlled remifentanil infusion and is easier to use.

Target-controlled infusion anesthesia with propofol and remifentanil compared with manually controlled infusion anesthesia in mastoidectomy surgeries.

Target-controlled infusion (TCI) system is increasingly used in anesthesia to control the concentration of selected drugs in the plasma or at the site of drug effect (effect-site). The performance of propofol TCI delivery when combined with remifentanil in patients undergoing elective surgeries has been investigated. Our aim in this study was to assess the anesthesia profile of the propofol and remifentanil target controlled infusion (TCI) anesthesia as compared to the manually controlled infusion (MCI), in mastoidectomy surgery, where a bloodless field is of utmost importance to the surgeon. Sixty patients, aged 18-60 years ASA I-II enrolled in the study, were divided into two equal groups. Group MCI received propofol and remifentanil by conventional-dose-weight infusion method, and Group TCI received propofol 4 microg/ml and remifentanil 4 ng/ml as effect-site target concentration. The hemodynamic variability, recovery profile, postoperative nausea and vomiting (PONV), surgeons satisfaction were assessed. Results were analyzed by SPSS version 11.5. The two groups were comparable with respect to age, ASA class, sex, weight, basal vital signs, operation time. The blood pressure and pulse were above desired levels in some data points in the MCI Group (P < or = 0.05). The PACU stay time to reach Aldret score of 10 was longer in the MCI Group (42.54 +/- 8 vs 59.01 +/- 6 min) (P < or = 0.05). The PONV was more common in the MCI Group (P < or = 0.05). Surgeon's satisfaction of the surgical field showed no significant differences except when described as "good", more common in the TCI Group. TCI is capable to induce and maintain anesthesia as well as MCI. In some stages of anesthesia, the TCI control of vital signs are better than the MCI. In some stages of anesthesia, the TCI control of vital signs are beter than the MCI. Recovery profile and complication rate and surgeon's satisfactions are more acceptable in the TCI than in the MCI Group.

A Systematic Review and Meta-Analysis: Evaluation of the ß-Human Papillomavirus in Immunosuppressed Individuals with Cutaneous Squamous Cell Carcinoma.

BACKGROUND: Some types of beta-human papillomavirus (ß-HPV) may be one of the probable causes of squamous cell carcinoma (SCC) in transplant recipients. ß-HPVs are linked to SCC in the literature with small number of subjects. AIM: Herein, the first meta-analysis was carried out on the association between ß-HPVs and cutaneous SCC in immunosuppressed patients. METHODS: A systematic search was carried out in the PubMed and Scopus databases up to December 2018. The odds ratio (OR) were calculated by RevMan 5.3 software and the event rate (ER) by Comprehensive Meta-Analysis 2.0 software with a 95% confidence interval (CI). RESULTS: A total of 1250 records were identified through the two databases, but at last eleven studies were included in the meta-analysis that they were published from 1989 to 2018. The results showed a significantly high prevalence of ß-HPVs in cutaneous SCC patients (ER = 69.1%; 95%CI: 58.7%, 77.8%). In addition, the prevalence of overall ß-HPVs and ß-HPVs of 5, 8, 9, 17, 49, 75, and 76 in immunosuppressed cutaneous SCC patients was significantly higher compared with controls. CONCLUSIONS: The findings of the present meta-analysis support the hypothesis that ß-HPV may play a role in cutaneous SCC development in immunosuppressed individuals.

Procalcitonin Has Good Accuracy for Prognosis of Critical Condition and Mortality in COVID-19: A Diagnostic Test Accuracy Systematic Review and Meta-analysis.

Several reports have determined that changes in white blood cell counts and inflammatory biomarkers are related to disease outcome of coronavirus disease 2019 (COVID-19) and they can be utilized as prognostic biomarkers. For introducing a factor as a diagnostic/prognostic biomarker, diagnostic test accuracy (DTA) systematic review and meta-analysis are recommended. For the first time, we aimed to determine the accuracies of white blood cell counts and inflammatory biomarkers for prognosis of COVID-19 patient's outcome by a DTA meta-analysis. Until August24, 2020, we searched Web of Sciences, Scopus, and MEDLINE/PubMed databases to achieve related papers. Summary points and lines of included studies were calculated from 2×2 tables by bivariate/hierarchical models. Critical condition and mortality were considered as outcomes. A total of 13387 patients from 28 studies were included in this study. Six biomarkers containing leukocytosis, neutrophilia, lymphopenia, increased level of C-reactive protein, procalcitonin (PCT), and ferritin met the inclusion criteria. Analysis of the area under the curve (AUCHSROC) indicated that the PCT was the only applicable prognostic biomarker for critical condition and mortality (AUCHSROC=0.80 for both conditions). Pooled-diagnostic odds ratios were 6.78 (95% CI, 3.65-12.61) for prognosis of critical condition and 13.21 (95% CI, 3.95-44.19) for mortality. Other biomarkers had insufficient accuracies for both conditions (AUCHSROC< 0.80). Among evaluated biomarkers, only PCT has good accuracy for the prognosis of both critical condition and mortality in COVID-19 and it can be considered as a single prognostic biomarker for poor outcomes. Also, PCT has more accuracy for the prognosis of mortality in comparison to critical condition.

Usefulness of Blood Parameters for Preliminary Diagnosis of Brucellosis.

BACKGROUND: Human brucellosis is a multisystem disease with a wide range of clinical signs which often leads to misdiagnosis and treatment delay. Early diagnosis of this disease can prevent the serious complications and mismanagements. This study aimed to evaluate the hematological parameters with predictive value for the diagnosis of brucellosis. METHODS: In this prospective case-control study which was done during 2015-2017 in Imam Reza Hospital, Kermanshah Province, west Iran, 100 patients with a confirmed diagnosis of brucellosis (brucellosis group) and 100 healthy individuals (control group) were studied. The hematological parameters, including hemoglobin (Hb), red blood cell (RBC), white blood cell (WBC) count, lymphocyte count, neutrophil count, platelet count (PLTs), mean platelet volume (MPV), platelet distribution width (PDW), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) of both groups were recorded. The data were statistically compared between the brucellosis and the control groups. RESULTS: The mean age of patients and healthy groups was 44.04 ± 23.11 and 37.92 ± 24.80, respectively (P = 0.062). The WBC, CRP and neutrophil counts were significantly higher in the brucellosis group (P < 0.05). Based on the receiver operating characteristic (ROC) analysis, the sensitivity and specificity were 54% and 66% for the WBC, 45% and 71% for the neutrophil and 65% and 72% for the CRP, respectively. There was no statistically significant difference between the two groups in terms of Hb, RBC, WBC, lymphocyte and platelet count, MPV, PDW and ESR (P > 0.05). CONCLUSION: The results of this study indicate that WBC, CRP and neutrophil count can be used as valuable markers in the preliminary diagnosis of brucellosis. However, further researches are required to standardize these parameters for various forms of brucellosis.

Randomized Controlled Trial of Comparative Hypocaloric vs Full-Energy Enteral Feeding During the First Week of Hospitalization in Neurosurgical Patients at the Intensive Care Unit.

BACKGROUND: Nutrition support plays a pivotal role in improving the clinical outcomes of the patients admitted to the intensive care unit (ICU). However, there are controversies regarding the optimal amount of energy for the reduction of morbidity and mortality in neurosurgical patients at the ICU. METHODS: This randomized clinical trial was conducted on 560 patients who were admitted to trauma, stroke, and neurosurgery ICUs, and 68 patients were enrolled based on the inclusion criteria. In total, data of 58 patients were analyzed. In the full-energy group, enteral feeding started at 75% of their daily energy expenditure and gradually increased to 90%-100%. In the hypocaloric group, enteral feeding started with 30% of the daily energy expenditure and reached 75% within 7 days of the intervention. RESULTS: No significant differences were observed in the baseline characteristics of the patients in the hypocaloric and full-energy groups. The incidence of severe gastrointestinal intolerance was relatively high in the full-energy group (P < .001). Duration of mechanical ventilation and length of hospital stay were lower in the hypocaloric group compared with the full-energy group (P = .014 and P = .046, respectively). However, no significant differences were denoted in the length of ICU admission (P = .163), 28-day mortality (P = .640), and pneumonia (P = .162) between the study groups. CONCLUSIONS: In the neurocritical care unit, hypocaloric enteral feeding was associated with lower gastrointestinal intolerance, as well as reduced duration of ventilator dependence and length of hospital stay.

Assessing the effect of arrival time of physician and cardiopulmonary resuscitation (CPR) team on the outcome of CPR.

Introduction: Negligence of proper time and poor performance of resuscitation team can lead to more mortality and negative consequences of cardiac arrest, as well as less survival. This study was conducted with objective of determining the arrival time of physician and resuscitation team to survive the victims of cardiopulmonary arrest. Materials and methods: In this prospective and descriptive-analytic study, the resuscitation performance and the arrival time of resuscitation team in 143 inpatients who had been diagnosed with witnessed cardiopulmonary arrest were examined using a researcher-made checklist. Data analysis was performed using parametric and non-parametric statistical tests and SPSS. Results: Initial survival rate was 26.6%. In general, the mean time of physician's presence after the code announcement in minutes and seconds was 02:31 ± 01:22. It was also 02:24 ± 01:15 in successful cases and 02:34 ± 01:25 in unsuccessful cases. Independent t-test did not show a significant difference between the physician's presence time and the rate of initial successful resuscitation (p = 0.504). The time of first shock after observing ventricular fibrillation/tachycardia (in minutes and seconds) was 01:30 ± 00:47. According to independent t-test, the aforementioned time was less than the mean time (02:31 ± 01:22) of physician's presence (p < 0.001). Conclusions: In this study, the initial survival rate in comparison to other regions in the country was almost more favorable and it was similar to global norms. In this study, the starting time of resuscitation was within the acceptable range. There was no relationship between the presence of physician and the initial survival rate of patients, as well as the use of defibrillator (by physician compared to other team members) and intubation with the initial survival rate. This could indicate the adequate performance of resuscitation team in the absence of physician on the condition of having sufficient knowledge and skill.

Investigating the effect of group counseling on family stress and anxiety of primiparous mothers during delivery.

BACKGROUND: Family is considered as the first source of care and support for the mother. Family stress and anxiety can be transmitted to the pregnant mother and have negative effects on pregnancy, childbirth, postpartum, and even their fetus. Given that one of the policies of the World Health Organization is to emphasize "safe family is safe with mother" this study was aimed to determine the effect of group counseling on family stress and anxiety of primiparous mothers during delivery. METHODS: This quasi-experimental study was conducted in 2016 on 72 family members of pregnant women who were referred to midwifery clinics in two health centers in Saveh-Iran. In this research, two members of each family (husband and other family of the pregnant woman) were selected using convenience sampling and were randomly divided into two groups of 36 families. At the beginning of the third trimester of pregnancy, standard questionnaires of Cohen's Perceived Stress and Cattell Anxiety scale were completed by both groups. For the intervention group, six sessions of cognitive group counseling were held weekly and the control group did not receive the intervention. Then, at the time of hospitalizing pregnant women for childbirth, the questionnaires were completed again by the family of both groups and the two groups were compared in terms of stress and anxiety before and after the intervention. Data were analyzed by SPSS software version 16 using appropriate statistical tests. FINDINGS: The findings showed that there was no significant difference between mean scores of stress, anxiety, hidden anxiety and obvious anxiety before intervention in both intervention and control groups. In the intervention group, Perceived stress score (p < 0.001), anxiety score (p < 0.001), hidden anxiety score (p = 0.003) and obvious anxiety score (p < 0.001) after intervention, with a statistically significant difference were lower than the control group. CONCLUSION: Group counseling can reduce the stress and anxiety of the family of primiparous mothers.

Application of Sparse Linear Discriminant Analysis and Elastic Net for Diagnosis of IgA Nephropathy: Statistical and Biological Viewpoints

Background: IgA nephropathy (IgAN) is the most common primary glomerulonephritis diagnosed based on renal biopsy. Mesangial IgA deposits along with the proliferation of mesangial cells are the histologic hallmark of IgAN. Non-invasive diagnostic tools may help to prompt diagnosis and therapy. The discovery of potential and reliable urinary biomarkers for diagnosis of IgAN depends on applying robust and suitable models. Applying two multivariate modeling methods on a urine proteomic dataset were obtained from IgAN patients, and comparison of the results of these methods were the purpose of this study. Methods: Two models were constructed for urinary protein profiles of 13 patients and 8 healthy individuals, based on sparse linear discriminant analysis (SLDA) and elastic net (EN) regression methods. A panel of selected biomarkers with the best coefficients were proposed and further analyzed for biological relevance using functional annotation and pathway analysis. Results: Transferrin, α1-antitrypsin, and albumin fragments were the most important up-regulated biomarkers, while fibulin-5, YIP1 family member 3, prasoposin, and osteopontin were the most important down-regulated biomarkers. Pathway analysis revealed that complement and coagulation cascades and extracellular matrix-receptor interaction pathways impaired in the pathogenesis of IgAN. Conclusion: SLDA and EN had an equal importance for diagnosis of IgAN and were useful methods for exploring and processing proteomic data. In addition, the suggested biomarkers are reliable candidates for further validation to non-invasive diagnose of IgAN based on urine examination.

Efficacy and tolerability of adjunctive gabapentin and memantine in obsessive compulsive disorder: Double-blind, randomized, placebo-controlled trial.

BACKGROUND: In the search for additional pharmacologic treatments of patients with obsessive-compulsive disorders (OCD), the glutamatergic system is attracting growing interest. While adjuvant memantine to a standard medication with a selective serotonin-reuptake inhibitor (SSRI) appears to reduce OCD symptoms, the adjuvant effect of gabapentin is less certain. The aim of the present randomized, double-blind and three-arm clinical trial was therefore to assess whether, compared to placebo, gabapentin (GAB) or memantine (MEM) adjuvant to a standard medication with an SSRI (fluoxetine; FLU) might lead to further improvements. METHODS: A total of 99 outpatients (mean age: 29.59 years; 49.5% females) diagnosed with OCD were randomly assigned to one of the following three conditions: FLU + gabapentin (FLU + GAB); FLU + memantine (FLU + MEM); FLU + placebo (FLU + PLA). Experts rated patients' symptoms of OCD with the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) at baseline, and 4 and 8 weeks later. RESULTS: YBOCS scores did not decrease over time. No group differences were observed. However, the significant Time by Group interaction showed that Y-BOCS scores decreased significantly over time in the FLU + PLA group. Response rates did not differ between the three study conditions. Typical side-effects were rash (FLU + MEM), drowsiness (FLU + GAB), anxiety (FLU + GAB; FLU + PLA), and drowsiness plus anxiety (FLU + GAB). CONCLUSIONS: The present pattern of results suggests that glutamatergic medications such as gabapentin and memantine adjuvant to a standard treatment with an SSRI have no additional positive impact on patients with OCD, as measured with the Y-BOCS. Additionally, side-effects were reported. Future studies should use more fine-grained tools to assess, for example, patients' sleep and cognitive functioning, and patients' view of symptoms.

Inhibition of Apoptosis and Proliferation in T Cells by Immunosuppressive Silymarine.

Silybum marianum, is known to have anti-inflammatory, hepatoprotective and anticarciogenic effects. The aim of this study was to compare effects of Silymarin, Rapamycin and FK506 on proliferation and apoptosis of human T cells stimulated with Con A. Peripheral blood mononuclear cells (PBMC) were stimulated with concavalin A (Con A) (5µg/mL) and then treated with different inhibitors (silymarin, rapamycin and FK506) in various concentrations (5 days). Cells were examined using carboxyfluorescein succinimidyl ester (CFSE) assay for proliferation. Then cell apoptosis was analyzed by FITC annexin V/PI staining and flow cytometry. The effects of drugs on the activation of poly ADP ribose polymerase (PARP) pathway in PBMCs stimulated with Con A and treated with IC50 dose of drugs for 5 days were evaluated using the PathScan cleaved PARP sandwich ELISA kit. The results indicated that silymarin inhibited T cell proliferation. In addition, our results pointed out that 100 µM and 200 µM of silymarin significantly have more inhibitory effect on T cells proliferation than FK506 and rapamycin. None of these drugs at IC50 concentration had affected the level of cleaved PARP. Overall, with superior efficacy and lesser toxicity in comparison with other immunosuppressive drugs, silymarin could be a suitable choice of therapy for certain diseases.

Allopurinol Against Progression of Chronic Kidney Disease.

INTRODUCTION: Hyperuricemia is common in approximately 50% of patients with kidney failure due to decreased uric acid excretion, and it has been recently known as an independent factor in the progression of renal insufficiency. Allopurinol inhibits the production of uric acid. The aim of this study was to evaluate the effect of allopurinol on chronic kidney disease progression. MATERIALS AND METHODS: In a clinical trial, patients with stages 3 and 4 of chronic kidney disease were divided into two groups to receive allopurinol, 100 mg, daily and placebo for 12 months. Patients' kidney function and serum uric acid levels were assessed at baseline and 3, 6, and 12 months after initial administration. Subgroups of patients with severe and mild glomerular filtration rate (GFR) impairment (GFR, 15 mL/min/1.73 m2 to 30 mL/min/1.73 m2 and 30 mL/min/1.73 m2 to 60 mL/min/1.73 m2, respectively), were compared between the groups. RESULTS: Serum uric acid levels decreased significantly during after 12 months of allopurinol administration (P = .004). In patients with severe GFR impairment, serum creatinine levels did not decrease significantly and there was no significant increase in GFR, but in those with mild GFR impairment, serum creatinine levels decreased and GFR increase significantly (P < .001) after administration of allopurinol. These effects were not observed in the control subgroups. CONCLUSIONS: Allopurinol may slow down stage 3 chronic kidney disease progression and could be administered with other effective medications for controlling the kidney disease.

Assessment of Iranian Nurses and Emergency Medical Personnel in Terms of Cardiopulmonary Resuscitation Knowledge Based on the 2010 Guideline.

BACKGROUND: The aim of this study was to compare the cardiopulmonary resuscitation (CPR) knowledge of hospital nurses and emergency medical personnel in Kermanshah, Iran. MATERIALS AND METHODS: This descriptive cross-sectional study was conducted on 330 hospital nurses and 159 emergency medical personnel working in educational hospitals and emergency medical centers in Kermanshah. Data were collected using a validated and reliable (r = 0.74) researcher-made questionnaire consisting of a demographic characteristics questionnaire and the 2010 CPR knowledge questionnaire. RESULTS: Based on the most recent CPR guidelines, the knowledge of 19.5%, 78.6%, and 1.9% of the emergency medical staff was excellent, good, and moderate, respectively. None of the participants had poor knowledge. In addition, the knowledge of 20.2%, 65.4%, 14%, and 0.4% of the nurses in this study was excellent, good, moderate, and poor, respectively. There was no significant difference in CPR knowledge between hospital nurses and emergency medical staff. Moreover, no significant association was found between CPR knowledge and gender, age, work experience, field of study, previous occupation, and advanced resuscitation courses. However, CPR knowledge of individuals with training in basic CPR courses was higher than participants without training in these courses (P < 0.05). CONCLUSIONS: Based on the findings of this study, CPR knowledge among Iranian nurses and emergency medical personnel was in an acceptable range. Nevertheless, it is strongly recommended that nurses and emergency staff receive training according to the most recent CPR guidelines.