A Cure Rate Model with Discrete Frailty on Hodgkin Lymphoma Patients after Diagnosis

Introduction: Hodgkin lymphoma (HL) is an uncommon cancer of lymphocytes, characterized by cancerous Reed-Sternberg cells in an inflammatory background. HL is an exceptionally curable disease with combination chemotherapy, radiotherapy, or combined modality treatment. This analysis aimed to identify significant prognostic factors on the cure rate. Materials and Methods: The medical records of 110 patients hospitalized from 2007 up to 2014 with 18 months follow-up was retrospectively reviewed in Taleghani hospital of Tehran, Iran. The survival time was set as the time interval between diagnosis and a patient's death from HL. Also, if the cure rate was present in survival, data encompasses zero frailty. Thus, using hyper-Poisson (hP) distribution as discrete frailty, the unobserved heterogeneity and random effects were accounted for. Results: The estimated cure fraction was 81.2%, which was obtained after 2717 days (7.4 years). In noncured cases, the mean survival time was 1535 days (4.2 years). Also, the five and ten-year survival rates were 0.91 and 0.80, respectively. After diagnosis, results revealed that patients with age  45, hemoglobin  12, WBC  15000, and BMI  30 were associated with poor outcome by using simple analysis. More importantly, there is no significant difference between males and females in the cure of HL patients. Conclusion: As expected, the study indicated that a high proportion of HL patients got cured. A cure rate model with discrete frailty utilization provided a suitable way to account for heterogeneity among HL patients. &nbsp

Long-term Survival of Multiple Myeloma Based on CBC Test at Diagnosis Using Defective Marshall-Olkin Cure Model

Introduction: As a malignant proliferative disorder, multiple myeloma (MM) is classified as a cancer of the immune system. Generally, a complete blood count (CBC) is the first test for a patient with symptoms of MM. Through CBC, physicians can monitor abnormalities in the blood. To normalize malignancies in their blood, patients must first go through conventional chemotherapy. Afterward, if eligible, subjects would receive high-dose therapy and hematopoietic stem cell transplantation (HSCT). Primarily, patients would be subjected to autologous hematopoietic stem cell transplantation (auto-HSCT). Materials and Methods: This retrospective cohort study consisted of 56 MM patients who were diagnosed between January 2010 and August 2016 and were followed up until February 2022. The survival rate of MM patients was assessed based on CBC test at the time of diagnosis. The clinical conditions, i.e., Thrombocytopenia, Leukopenia, and Anemia, were extracted from the CBC test and were used as the desired prognostic factors in companion with age at diagnosis. Overall survival based on the mentioned factors was analyzed using the defective Marshall-Olkin gompertz cure model, which was programmed in R software version 4.0.3. Results: The mean age at diagnosis was 52.76 (SD = 7.1). The probability of long-term survival for patients in this study was 46%, with five-year overall survival equaling 73.2%. Patients with thrombocytopenia had about 86% lower odds of long-term survival compared with patients with normal Platelet levels (Plt). Conclusion: The present study indicates that deficiency in Plt count is a significant factor leading to poor survival of MM patients

Joint frailty model for recurrent events and a terminal event in the presence of cure fraction

The observations of repeated or recurrent events occur in many longitudinal studies. Furthermore, sometimes there may exist a terminal event such as death, which is strongly correlated with recurrent events. In many situations, a fraction of subjects who will never experience the event of interest during a long follow-up period is considered to be cured. In this article, we proposed a joint frailty model in the presence of cure fraction. The dependency is modeled by shared frailty that is contained in both the recurrent andterminal events hazard functions. It allows to estimate two separate sets of parameters on the recurrent, death, and cure model. We applied the maximum likelihood method under a piecewise constant hazard function for model fitting. The proposed model is evaluated by simulation studies and an application to a breast cancer data is provided

Survival Analysis of Iranian Patients with Breast Cancer Using Joint Frailty Model with a Cure Rate

Background: Breast cancer is a common disease among women around the world. In Iran, it is the most prevalent cancer diagnosed in women. The objective of this study was to assess the cure rate of patients and the associated risk factors. Method: A retrospective cohort study was conducted on 446 patients with breast cancer admitted to the Shahid Ramezanzadeh Radiotherapy Center. Using R 3.2.2 software, the Kaplan-Meier curve, log-rank test, and cure joint frailty model were utilized in the analysis. Results: Of the 446 patients, 17.3% died, 20% experienced relapse, and 62.7% were censored. The 1-5-7-year disease-free survival rates were 95.3%, 73.4%, and 69.3%, respectively. In the cure model, stage, involved lymph node, and surgery were statistically significant. In the recurrence model, stage, involved lymph node, lymphovascular invasion, and hormone therapy were statistically significant. In the death model, stage, lymphovascular invasion, and involved lymph node had a statistically significant effect on the survival time. Conclusion: The cure joint frailty model is a good model when there is a high fraction of patients who do not experience any recurrence or death. In addition, this model allows for the separate estimation of explanatory variable effect on recurrence, death, and cure. The findings of our study can be conducive to preventing the unfavorable effects of breast cancer and increasing the survival of patients

Investigating the Effect of Chemical Management on Weeds Population, Agronomical Traits and Yield of Garlic (Allium sativum L.) in Mazandaran Province

Introduction: Garlic (Allium sativum L.) is an important winter crop in northern of Iran with a total of 9580 ha which produces approximately 90, 197 tons per year. It is the second most widely cultivated species of the genus, Allium after onion (Allium cepa). Also, Garlic along with onions and leeks are three major cultivated species in Alliaceae family. This plant because of high economic and medicinal values is cultivated in 2610 hectares of agricultural lands of Mazandaran Province, Iran. Slow growth rate, low height, and a thin canopy that does not cover the soil enough to sup-press weeds make garlic a poor competitor against the latter until the beginning of spring. According results, reported 71% yield losses in garlic crop if weeds are allowed to grow during the crop season. Weed interference is affected by the time of weed emergence relative to the crop’s phenological development. The weeds, which emerge early or simultaneously with the crop, are highly competitive and should be managed by farmers. Most weed management strategies in cereals target seedlings, as they are the most sensitive stage of the weed. However, emergence of weed seedlings varies every year in timing, extent and intensity. Therefore in this study, the effect of chemical management on reducing the density and biomass of weeds, yield and agronomic characteristics of garlic were studied in Mazandaran Province, Iran. Materials and Methods: After the selection of location test, in order to determine the physical and chemical properties before the preparation of soil for planting, sampling from the soil was carried out from the depth of 0 to 30 cm at some point. The farm was plowed using a moldboard plow, then the used fertilizers in this study were added to the soil twice before planting and then the fertilizers were incorporated with the soil using a Disc. The amount of used fertilizers in this study according to soil test were including: 200 kg Urea per hectare that 100 kg as the base and 50 kg in two foliage stage and 50 kg in 4 foliage stage of garlic, 200 kg superphosphate triple per hectare, and 100 kg potassium sulfate. The research was performed in a land with area of 300 m2 containing 30 plots with dimensions of 3×3 m2. The planting process was done after disinfection of garlic seed varieties of Mazand for 24 hours in a solution of 2% carboxin thiram with the distance of 30×15 cm and the density of 23 plants per m2on 23/10/2012. After about two weeks from planting of garlic, germination was fully performed. The studied factors in 10 dosages of herbicide are including: 1.5, 2 and 2.5 liters per hectare of Trifluralin (Terflan) via formulations (EC 48%), 1.5, 2 and 2.5 liters per hectare of Oxyfluorfen, 1.5 liters per hectare of Oxyfluorfen in two stages (the half in first stage and the rest 18 days later) via formulations (EC 24%), hand weeding control and lack of weeding control (the number of replications of these two treatments were two folds of others (2 replications in each block and 6 replications in total)). Two weeks before planting Trifluralin herbicides were incorporated with the soil and Oxyfluorfen herbicides as post-emergently were applied in the 3 to 4 foliage stages of weeds using a backpack sprayer pump from the side of the nozzle sag (T-Jet). After 145 days from planting, 10 plants per plot were selected and plant heights measured. After maturity of garlics, 10 plants of garlic were eradicated and the number of cloves per bulb was counted and weight of 100 cloves of garlic was weighed. After full maturity of garlic, a square meter of each plot was harvested on 7.5.2013 and the harvested plants was placed for 48 hours in the farm and then bulb yield and biological yield were weighed and harvest index was also calculated. Statistical analysis software SAS (version 9.1) was used for analysis and the obtained averages were compared by means of the Duncan least significant difference test. Results and Discussion: Results showed that the use of different doses of various herbicides had a significant difference on the plant height, weight of 100 cloves, economical and biological yield and harvest index of garlic. In contrast, under treatments of the usage of 1.5 liter of Oxyfluorfen in two stages and hand weeding treatment, plant height of garlic was increased due to lack of competition with weed species and no significant difference was observed between the above treatments with the usage of 1.5, 2 and 2.5 liters of Oxyfluorfen. The adverse effect and phytotoxicity of garlic under the use of different doses of 2 and 2.5 liters of Oxyfluorfen caused disturbances in the production of cloves per bulb of garlic and the plant spent their photosynthetic products in the reclamation of its shoots. In contrast, the highest number of cloves per bulb were counted under the treatments of using 1.5 liter of Oxyfluorfen, hand weeding and 1.5 liter of Oxyfluorfen in two stages. The results showed that the highest economical yield of garlic was obtained in the treatment of using 1.5 liter of Oxyfluorfen, hand weeding treatment and splitting of 1.5 liter of Oxyfluorfen in two stages, and there were no significant differences between the above treatments. The plant used the best from the resulted ecological niche in normal conditions, and it could transfer more photosynthetic materials to the reproductive organs and it could increase the bulb yield with more producing of cloves per bulb with higher weight. Conclusion: The results obtained from experimental trials on plant height, cloves number in the bulb, cloves weight and ultimately economic yield of garlic (bulb) showed that the treatment of using 1.5 liters of Oxyfluorfen in 3 to 4 foliage stages of weed species was the best treatment

Long-term Survival of Multiple Myeloma Patients using Cure Models

Introduction: Multiple myeloma (MM) is a kind of blood cancer that is caused by the malfunction of plasma cells and their uncontrolled growth, which leads to a decrease in the level of immunity and the formation of bone lesions, especially in the spine, skull, pelvis, and ribs. Common symptoms in MM patients include severe bone pain, kidney problems, anemia, and frequent infections. This study aims to employ appropriate cure models to estimate the cure fraction and prognostic factors affecting overall survival (OS) in MM patients who have undergone transplantation. Materials and Methods: This study has analyzed the medical records of 52 patients with multiple myeloma who were admitted to Taleghani Hospital affiliated with Shahid Beheshti University of Medical Sciences in Tehran from January 2010 to August 2016 and were followed up until February 2022. Four cure models were applied to the data and it determined the cure fraction in the Inverse Gaussian model is higher than in other models, so prognostic factors affecting the survival of patients were examined using this model. Results: The mean age at diagnosis was 53.07 (SD =6.4). The 5-year survival rate for MM patients was 74%, and the long-term survival rate for patients in this study was 54.7%. Using the Inverse Gaussian model, the cure fraction was estimated at 54.4% Conclusion: This study applies cure models to find prognostic factors based on pre-transplant CBC test on the survival time of MM patients who have been treated with auto-HSCT, so the number of platelets pre-transplantation and the patient's age are effective predictors for overall survival

Achievement of and Failure to Achieve Orgasm in Sexual Relationship: Exploring Iranian Women’s Experiences

Abstract Introduction: Female orgasm is a subjective phenomenon that has been wrongly introduced to people and therapists in the halo of exaggeration and perfectionism made by sexual films. This study was conducted to explore the Iranian women's experience of achievement of or failure to achieve orgasm and its consequences in sexual relationship. Method: This qualitative study was conducted using content analysis method. Individual in-depth interviews with 20 married women were continued until data saturation. Sampling was performed using purposive sampling in the environment of two public clinics in Tehran. Data were analyzed using conventional content analysis method. Trustworthiness of data was achieved through Lincoln and Guba criteria. Results: The results of data analysis were categorized into 3 categories, 8 subcategories, and 46 codes. The main categories include feeling of success to achieve orgasm, feeling of failure to achieve orgasm, and husband companionship. Successful orgasm in Iranian women led to the feeling of successfulness with pleasant emotions such as relief, excitement, or love and positive outcomes such as relaxation, intimacy, freshness, and vitality. Women's descriptions of orgasm were mainly psychological and emotional. Failure to achieve orgasm led to the feeling of failure with physical and psychological symptoms such as pain, nervousness, aggressiveness, and negative consequences such as being jealous of husband’s orgasm and regret for getting married. Conclusion: To prevent and treat orgasm disorders in women, it should be noted that successful female orgasm can mainly be accompanied with pleasant emotional states and physical changes may beunclear or intangible, while failure to achieve orgasm in women can lead to vague physical or psychological symptoms. Couples training for sexual talk with spouse, as well as more interaction and companionship between wife and husband have effective roles in achieving female orgasm

A Mixture Cure Model for Interval Censorship with a Change Point based on Age Threshold on Hodgkin Lymphoma Patients after Stem Cell Transplantation: A Cure Model with Change Point for Hodgkin Lymphoma Patients

Abstract Introduction: Hodgkin lymphoma (HL) is one of the best curable cancers. Many researches have validated the benefit of hematopoietic stem cell transplant (HSCT) for patients with relapsed or primary resistant HL. This analysis aimed to identify an effective change point in patients' age, the cure fraction before and after the change point, and significant prognostic factors on the cure fraction before and after the change point for these patients after HSCT in Iran. Materials and Methods: In this retrospective cohort study, there were 156 patients with HL who underwent HSCT from 2007 to 2014 with 18 months of follow up in Tehran, Iran. The survival time was set as the time interval between transplantation and the recurrence of HL. Also, the change point and the cure fraction before and after the change point were estimated using the Bayesian estimation method and log-normal distribution. Results: The estimated cure fraction was 79.2% for all patients. In susceptible cases, the mean survival time was 999 days (2.7 years). Also, the three and five-year survival rates were 82.1% and 80.0%, respectively. The effective change point in the age at transplantation of patients was 35 years, and the cure fraction before the change point was 84.5 % and after the change point was 60.6%. Conclusion: The study concluded that the age of 35 years is a significant change point in the age at transplantation. If individuals underwent HSCT with HL before the age of 35, they have a higher survival rate (recurrent of HL) than those underwent HSCT after 35. Keywords: Hodgkin Lymphoma, Mixture Cure Model, Change Point, Interval Censorship,Bayesian Metho

Women’s orgasm obstacles: A qualitative study

Background: Woman’s orgasm plays a vital role in sexual compatibility and marital satisfaction. Orgasm in women is a learnable phenomenon that is influenced by several factors. Objective: The aim of this study is exploring obstacles to orgasm in Iranian married women. Materials and Methods: This qualitative study with directed content analysis approach was conducted in 2015-2016, on 20 Iranian married women who were individually interviewed at two medical clinics in Tehran, Iran. Results: Orgasm obstacles were explored in one category, 4 subcategories, and 25 codes. The main category was “Multidimensionality of women’s orgasm obstacles”. Subcategories and some codes included: Physical obstacles (wife’s or husband’s boredom, vaginal infection, insufficient vaginal lubrication), psychological obstacles (lack of sexual knowledge, shame, lack of concentration on sex due to household and children problems), relational obstacles (husband’s hurry, having a dispute and annoyance with spouse) and contextual obstacles (Irregular sleep hours, lack of privacy and inability to separate children’s bedroom from their parents, lack of peace at home). Conclusion: For prevention or treatment of female orgasm disorders, attention to physical factors is not enough. Obtaining a comprehensive history about physical, psychological, relational and contextual dimensions of woman’s life is necessary

The Effect of Organic and Bio Fertilizers on Maize (Zea mays), and HydroMax Adjuvants Application on Optimizing of Nicosulfuron Herbicide Efficacy

In order to study the effect of adjuvant on nicosulfuron herbicide efficacy improvement in maize weed control under organic fertilizers application, field study was conducted during 2013- 2014 at research field of Ferdowsi University of Mashhad, Iran. Experiment was arranged in completely randomized design with factorial arrangement of treatments with 16 treatments and three replications. Factors in this experiment were application of organic fertilizers (cow manure and vermicompost) and bio fertilizer mycorrhiza, and a plot without fertilizer as control, nicosulfuron dose at 40, and 80 g a.i ha-1 (Cruz®,4% SC) with and without the adjuvant of HydroMax™. Common purslane (Portulaca oleracea), black nightshade (Solanum nigrum L.), and redroot pigweed (Amaranthus retroflexus L) were the dominant weeds in the experimental fields. Black nightshade and common purslane had the highest relative density 20 and 45 days after spraying (DAS). Results showed that application of hydromax adjuvant increased herbicide efficiency, significantly. However dry weight of common purslane, black nightshade and redroot pigweed decreased 84, 71, 86 and 71, 79, 100 %, when nicosulfuron applied at reduced dose (40 g a.i. ha-1) with adjuvant 20 and 45 DAS, respectively. On the other hand, seed yield and dry weight of maize increased 49 and 60 % respectively, when nicosulfuron applied at 40 g a.i. ha-1 with Hydromax pulse cow manure.&nbsp