Extending Survival in a Patient with Extensive Stage of Small Cell Lung Cancer Presenting with Superior Vena Cava Syndrome as an Initial Symptom: A Case Study

Introduction: Superior vena cava (SVC) syndrome which is defined as the obstruction of blood flow through the SVC vein, often affecting patients with malignancy especially small cell lung cancer (SCLC) and is potentially an emergent condition needing prompt management. It is an ominous sign with poor prognosis and a mean of 8-10 months survival rate. Case presentation: Here we present a middle-aged man who presented with fascial swelling and dyspnea with final diagnosis of advanced SCLC. Combination of multiple chemotherapy regimen, prophylactic brain radiation with administration of anticoagulant drugs were performed for him leading toward extension of his survival to 28 months. Conclusion: These therapeutic approaches may lead to extending the survival in patients with SVC syndrome and SCLC

Extending Survival in a Patient with Extensive Stage of Small Cell Lung Cancer Presenting with Superior Vena Cava Syndrome as an Initial Symptom: A Case Study

Introduction: Superior vena cava (SVC) syndrome which is defined as the obstruction of blood flow through the SVC vein, often affecting patients with malignancy especially small cell lung cancer (SCLC) and is potentially an emergent condition needing prompt management. It is an ominous sign with poor prognosis and a mean of 8-10 months survival rate. Case presentation: Here we present a middle-aged man who presented with fascial swelling and dyspnea with final diagnosis of advanced SCLC. Combination of multiple chemotherapy regimen, prophylactic brain radiation with administration of anticoagulant drugs were performed for him leading toward extension of his survival to 28 months. Conclusion: These therapeutic approaches may lead to extending the survival in patients with SVC syndrome and SCLC

Hemodynamic Changes After Intubation of Endotracheal Tube, LMA Classic™, and I-gel in Patients Candidates for Elective Eye Surgery

Background: One of the concerns of the anesthetists in performing surgical procedures is hemodynamic changes after laryngoscopy and tracheal tube intubation. In these cases, stress response with the release of catecholamines leads to increased blood pressure and heart rate in patientswhoare prone to cardiovascular disease and cerebral events, leading to the life-threatening risks. Objectives: Endotracheal Intubation (ETT) is one of the most stress response techniques for airway management. Here, wecompare the effects of tree devices including ETT, laryngeal mask airway (LMA) classic, and I-gel with each other. Methods: The present study investigated the hemodynamic changes in patients undergoing elective cataract surgery after the intubation of an endotracheal tube. This clinical trial study was conducted on 75 patients with ASA class I or II in both genders and in the age group of 50 - 65 years old. The effects of LMA Classic™ and I-gel were also investigated. In this study, patients’ vital signs such as pulse rate, systolic blood pressure, and diastolic blood pressure were measured and recorded at times before insertion of the airway devices, one, two, and five minutes after the insertion. Results and Conclusions: Before the start of the operation, there was no significant difference between the groups in terms of hemodynamic parameters. Immediately before inserting ETT, LMA, or I-gel, the heart rate and systolic and diastolic blood pressure increased significantly in all groups. Our results generally showed that the hemodynamic changes due to the I-gel insertion compared to the tracheal tube and LMA Classic™ insertion followed minor adjustments. In a comparison between the insertion of the endotracheal tube and LMA Classic™, the use of the LMA Classic™ was associated with more stabilit

Critical thinking and clinical decision making in nurse‏

BACKGROUND: Today, nurses are exposed to everchanging complicated conditions in health care services, they provide. To be able to cope with these conditions effectively, they should be competent decision makers. Besides, as decision making conditions get more complicated, using critical thinking is a need. The current study was carried out to evaluate the relationship between critical thinking and clinical decision making, in nurses of critical and general care units of hospitals in Isfahan. In addition, it is also aimed to compare the nurses of critical and general units in critical thinking and clinical decision making. METHODS: This is a correlation, descriptive study of cross-sectional type. The participants are 140 nurses; 70 working in critical care unit and 70, working in general units. Sampling method was random stratified sampling and the data was collected using a questionnaire with three sections; containing items on demographic data, clinical decision making and California critical thinking skills test. The validity and reliability of the questionnaire was approved using content validity, test-retest method and internal correlation test. The data was analyzed using variance analysis, Pearson correlation and t-test. RESULTS: The mean score of critical thinking and clinical decision making was 10.61, 63.27 and 10.67, 61.66 for nurses of critical care and general units, respectively. No statistical significant difference between two groups was observed in the area of clinical decision making and critical thinking. In addition, no statistical correlation was observed between the clinical decision making and critical thinking. CONCLUSIONS: The findings of the study demonstrated that the mean score of critical thinking was low in nurses. Probably, it originates from the educational system shortages and also, the professional environment problems. Some experts believe that the reason for lack of correlation between critical thinking and clinical decision making goes back to the absence of appropriate tool to measure the correlatio

Analysis of the Factors Affecting the Implementation of Virtual R&D in Iranian Tile and Ceramic Companies Using Structural Equation Modeling Approach

The final goal of this study is to provide a model with structural modeling approach of virtual R & D implementation in Iranian ceramic tile companies and small and medium-sized industries and services are one of the broadest fields of activity of manufacturing and economic enterprises that are of great importance. Accordingly, the establishment and expansion of research and development systems in order to infuse new sciences and technologies into this industry is of great importance

A Novel Clustering-Based Algorithm for Continuous and Non-invasive Cuff-Less Blood Pressure Estimation

Extensive research has been performed on continuous, non-invasive, cuffless blood pressure (BP) measurement using artificial intelligence algorithms. This approach involves extracting certain features from physiological signals like ECG, PPG, ICG, BCG, etc. as independent variables and extracting features from Arterial Blood Pressure (ABP) signals as dependent variables, and then using machine learning algorithms to develop a blood pressure estimation model based on these data. The greatest challenge of this field is the insufficient accuracy of estimation models. This paper proposes a novel blood pressure estimation method with a clustering step for accuracy improvement. The proposed method involves extracting Pulse Transit Time (PTT), PPG Intensity Ratio (PIR), and Heart Rate (HR) features from Electrocardiogram (ECG) and Photoplethysmogram (PPG) signals as the inputs of clustering and regression, extracting Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP) features from ABP signals as dependent variables, and finally developing regression models by applying Gradient Boosting Regression (GBR), Random Forest Regression (RFR), and Multilayer Perceptron Regression (MLP) on each cluster. The method was implemented using the MIMICII dataset with the silhouette criterion used to determine the optimal number of clusters. The results showed that because of the inconsistency, high dispersion, and multi-trend behavior of the extracted features vectors, the accuracy can be significantly improved by running a clustering algorithm and then developing a regression model on each cluster, and finally weighted averaging of the results based on the error of each cluster. When implemented with 5 clusters and GBR, this approach yielded an MAE of 2.56 for SBP estimates and 2.23 for DBP estimates, which were significantly better than the best results without clustering (DBP: 6.27, SBP: 6.36)

Bioactive VEGF-C from E. coli

Vascular endothelial growth factor-C (VEGF-C) stimulates lymphatic vessel growth in transgenic models, via viral gene delivery, and as a recombinant protein. Expressing eukaryotic proteins like VEGF-C in bacterial cells has limitations, as these cells lack specific posttranslational modifications and provisions for disulfide bond formation. However, given the cost and time savings associated with bacterial expression systems, there is considerable value in expressing VEGF-C using bacterial cells. We identified two approaches that result in biologically active Escherichia coli-derived VEGF-C. Expectedly, VEGF-C expressed from a truncated cDNA became bioactive after in vitro folding from inclusion bodies. Given that VEGF-C is one of the cysteine-richest growth factors in humans, it was unclear whether known methods to facilitate correct cysteine bond formation allow for the direct expression of bioactive VEGF-C in the cytoplasm. By fusing VEGF-C to maltose-binding protein and expressing these fusions in the redox-modified cytoplasm of the Origami (DE3) strain, we could recover biological activity for deletion mutants lacking the propeptides of VEGF-C. This is the first report of a bioactive VEGF growth factor obtained from E. coli cells circumventing in-vitro folding.Peer reviewe