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

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

A comparative study of 20% azelaic acid cream versus 5% tranexamic acid solution for the treatment of postinflammatory hyperpigmentation in patients with acne vulgaris: A single-blinded randomized clinical trial

Background: There is a lack of evidence on the therapeutic efficacy of topical tranexamic acid (TA) for the treatment of acne-related postinflammatory hyperpigmentation (PIH). The current study aimed to assess the efficacy of twice-daily administration of 20% azelaic acid (AZA) cream versus 5% TA solution for the treatment of PIH in patients with acne vulgaris. Materials and Methods: Patients in the present single-blinded randomized clinical trial were randomized into AZA or TA groups for 12 weeks. The rate of healing was assessed by scoring recorded photographs based on postacne hyperpigmentation index (PAHI) at baseline, 4th, 8th, and 12th weeks. The frequency of side effects was examined and recorded at each study time point. Results: Thirty volunteers in each treatment group completed the intervention. PAHI score in both AZA and TA groups improved during the study course (Ptime 0.05). Conclusion: Topical administration of 20% AZA cream and 5% TA solution was comparably efficient in the treatment of acne-related PIH with a significantly better safety profile of TA in the 1st month of the treatment

Comparison of Topical Erythromycin with and without Zinc Acetate in the Treatment of Mild to Moderate Acne Vulgaris

Background and Objective: Considering the role of bacteria in causing some forms of acne, in recent years, the use of antibiotics along with other medications has had positive results in acne treatment; therefore, the present study aimed to compare the effect of the combination of topical erythromycin and zinc acetate with topical erythromycin alone in treating mild to moderate acne vulgaris. Materials and Methods: In this clinical trial, 76 patients with acne vulgaris who were referred to a specialized skin clinic were selected and randomly assigned into two treatment groups, namely, A (n=39) and B (n=37). Group A was treated with a local solution of erythromycin 4% without zinc acetate, and group B was treated with a combined local solution of erythromycin 4% and zinc acetate 1.2%. The treatment continued twice a day for three months. Results: In groups, A and B, respectively, the average lesion intensity score before treatment was 21.1 ± 6.5 and 21.9 ± 5.4 (P=0.555), the first month of treatment was 17.0 ± 6.4 and 15.7 ± 5.9 (P=0.578), the second month of treatment 9.1 ± 4.5 and 6.4 ± 3.3 (P=0.014), the third month of treatment 4.0 ± 3.0 and 2.0 ± 3.0 (P=0.001), and the frequency of complete recovery was 38.5 and 64.9%, respectively (P=0.021). In group B, the severity of papules in the second (P=0.002) and third (P=0.001) months of the treatment was significantly lower than in group A. Conclusion: Based on the obtained results, using a combination of erythromycin 4% with zinc acetate 1.2% as a topical solution is more effective than the topical solution of erythromycin 4% alone in treating acne lesion

The effects of unihemispheric concurrent dual-site transcranial direct current stimulation on motor sequence learning in healthy individuals:A randomized, clinical trial

Background: Unihemispheric concurrent dual-site anodal transcranial direct current stimulation (a-tDCSUHCDS) of primary motor cortex (M1) and dorsolateral prefrontal cortex (DLPFC) are introduced as effective techniques on M1 corticospinal excitability enhancement and its after-effects. Objectives: The current study aimed at investigating the potential effects of multiple sessions of a-tDCSUHCDS of M1-DLPFC on motor skills learning in healthy individuals. Methods: The randomized, clinical trial was conducted on a total of 37 volunteers completed all sessions of the study and were randomly divided into two groups of a-tDCSUHCDS and sham stimulation by the block randomization method. The current study was performed from January to May 2017 in Iran. Participants attended daily 20-minute motor training sessions for three consecutive days, while they concurrently received a-tDCS. Motor skills were assessed before the intervention (day 1), immediately after the intervention (day 3), and one week after the completion of the intervention. Results: A total of 37 participants were included in the data analysis. Immediately after the completion of the intervention on day 3, mean skills in the experimental and control groups were 0.33 and 0.30, respectively. One week after the completion of the intervention, mean skills in the experimental and control groups were 0.36 and 0.29, respectively. The trend of motor learning considerably increased in the experimental (0.17 P < 0.001) and control (0.11 P < 0.001) groups. No significant difference was observed in motor learning immediately after the intervention between the groups (P = 0.23), while there was a significant difference in long-term offline learning between the groups (P = 0.04). Conclusions: Greater motor skills in the a-tDCSUHCDS group compared with the sham tDCS group at one week retention indicated the robustness of the a-tDCSUHCDS effect

JP Journal of Biostatistics

In some biomedical cohort studies, recurrent or repeated events can be terminated by a dependent terminal event like death. In this case, the process of recurrent events may lengthen or shorten the survival time which indicates the dependence between time of recurrences and death. Furthermore, some observed or non-observed prognostic factors made some patients more prone to experiencing relapse earlier or more than others. Therefore, the dependence between the occurrences of these events and the potential heterogeneity across subjects should be considered. General joint frailty model can assess the effect of covariates on the risk of recurrent and death events, simultaneously. The two gamma distributed frailties in this model can consider both the inter-recurrences dependence and the dependence between the recurrences and the survival times. When the sample size is small, using maximum likelihood estimation may lead to erroneous results. That being so, we propose a Bayesian joint frailty model that not only estimates the effects of covariate on recurrent and death events in data with small sample size but also deduces the origin of dependences. The performance of Bayesian joint frailty model is compared with Classical approaches. Our proposed estimation is evaluated by employing a simulation study and illustrated using a real dataset on patients with breast cancer who have undergone Mastectomy

The value of ovarian hyperstimulation syndrome in predicting pregnancy outcome in women with polycystic ovarian syndrome and candidate for in vitro fertilization: A case-control study

Abstract Background: Ovarian hyperstimulation syndrome (OHSS) as a known complication in women with polycystic ovarian syndrome (PCOS) may occur following inducible fertility treatments such as in vitro fertilization (IVF) and can affect the sequels of these treatments. Objective: This study aimed to assess the effects of OHSS on pregnancy outcomes through IVF in women with PCOS. Also, we assessed the value of baseline sexual hormones to predict the pregnancy's success. Materials and Methods: This case-control study was conducted on 180 consecutive women suffering from PCOS who were candidates for IVF at Fatemieh hospital in Hamadan, Iran, from May-July 2022. The women were assigned to the case group (with OHSS, n = 129) and the control group (without OHSS, n = 51). Measuring the sexual hormones was performed using the enzyme-linked immunosorbent technique. Results: In the multivariable logistic regression model, OHSS could not predict the likelihood of clinical or chemical pregnancy following IVF. None of the baseline sexual hormones could predict the successful chemical or clinical pregnancy in PCOS women following IVF. Conclusion: OHSS may not influence IVF-related outcomes in PCOS women. The values of sexual hormones may not also determine the pointed outcome

Additional file 1 of A probabilistic health risk assessment of potentially toxic elements in edible vegetable oils consumed in Hamadan, Iran

Additional file 1: Appendix 1. THQ in the adults consumers due to ingestion traditional vegetable oils content of PTEs. Appendix 2. THQ in the children consumers due to ingestion traditional vegetable oils content of PTEs. Appendix 3. THQ in the adults consumers due to ingestion industrial vegetable oils content of PTEs. Appendix4. THQ in the children consumers due to ingestion industrial vegetable oils content of PTEs