Prediction of Mental Health in MS Patients: The Role of Psychological Resilience and Cognitive Integration

Abstract Introduction: Multiple Sclerosis is a chronic disease of the central nervous system in which myelin damage occurs locally. This study was conducted to predict the mental health of patients with MS regarding cognitive integration and psychological resilience. Methods: In a correlational-descriptive study, all people with MS disease in the west of Iran in 2015 were studied. Hundred people were selected from medical and clinical centers by using easy sampling method. They filled out acceptance and action of Bond et al (2011), cognitive incongruity Gillanders et al (2014), mental health (GHQ-12) and Demographic Information Sheet questionnaires. Pearson correlation factor and regression efficiency factor were used to analyze data with SPSS V. 22 software. Results: The results showed that mental health has a negative correlation with psychological integration (r=-0.438, P<0.001) and positive significant correlation with psychological resilience (r=0.487, P<0.001). Regression analysis showed that 24.3% of mental health variance factor is predicted by psychological resilience (P<0.001). Conclusions: According to the results, information and knowledge could be provided by holding training courses to increase psychological resilience, so that mental health of MS patients would be provided

A Multidisciplinary Lifestyle Intervention for Women with Polycystic Ovary Syndrome: The Role of a Pulse-Based Diet and Aerobic Exercise on Reproductive, Cardio-Metabolic, and Quality of Life Outcomes

Polycystic ovary syndrome (PCOS) is a complex endocrinopathy associated with adverse cardio-metabolic, reproductive, and quality of life outcomes. Controversy surrounds the optimal diet composition to mediate favourable health-related outcomes for women with PCOS. The main hypothesis of the present work was that a nutritionally balanced, low-glycemic index, pulse-based diet containing lentils, beans, split peas, and chickpeas would increase insulin sensitivity; thereby, improving multiple health-related outcomes of PCOS. The objectives of the present work were 1) to examine the prevalence and characteristics of metabolic syndrome (MetS), glucoregulation, type 2 diabetes, and risk factors for cardiovascular disease in women with PCOS, and 2) to compare the effect of a pulse-based diet to the National Cholesterol Education Program’s Therapeutic Lifestyle Changes (TLC) diet on reproductive health measures, cardio-metabolic risk profile, health-related quality of life (HRQoL) indices, dietary intakes, and pulse consumption behaviours in women with PCOS. To examine the study Objective 1, data were pooled from 2 prospective and cross-sectional studies on 237 women with PCOS and 42 (non-PCOS) controls (18-36y; Chapter 3). The prevalence of metabolic syndrome was 29.5% in the PCOS group, approximately 6-fold higher than age-matched controls (P<0.001), with worse glucose control, acanthosis nigricans, body mass index (BMI), systolic blood pressure (SBP), triglyceride (TG), high- (HDL-C) and low- (LDL-C) density lipoprotein cholesterol, total cholesterol to HDL-C (TC/HDL-C), and highly sensitive C-reactive protein levels (P<0.001 to P=0.03). Women with PCOS and MetS exhibited exacerbated levels of insulin and glucose responses to an oral glucose tolerance test (OGTT), TC, TC/HDL-C ratio, hirsutism, and acanthosis nigricans than BMI-matched counterparts without MetS (P<0.001 to P=0.05). Our observations support the opinion that MetS exacerbates hyperandrogenism, dyslipidemia, and glucose control in PCOS, possibly by aggravating inherent insulin resistance. To address the main goal of the study, Objective 2, 95 women with PCOS (18-35y) were randomized to receive either the pulse-based diet or the TLC diet, without purposefully inducing calorie restriction, for 16 weeks. All women participated in an aerobic exercise program and received education and counselling about PCOS and lifestyle modification. Thirty women in the pulse-based diet and 31 in TLC diet group completed the study. Chapter 4 represents the reproductive outcome results of Objective 2. Bilateral antral follicle count, ovarian volume, total testosterone (TT) levels, average and longest intervals between menses decreased over time in both groups (P≤0.05). Sex-hormone binding globulin levels increased (P<0.01) in both groups with a tendency for a greater increase in the pulse-based diet group (P=0.07). In Chapter 5, cardio-metabolic outcomes of Objective 2 are addressed. The pulse-based diet group had a greater reduction in total area under the curve (AUC) for insulin response to an OGTT than the TLC diet group (P=0.05). Following the intervention, the pulse-based diet group exhibited lower diastolic BP, TG, LDL-C, and TC/HDL-C, as well as a greater increase in HDL-C when compared to the TLC diet group (P≤0.05). Body weight, waist circumference, percent body fat, SBP, homeostatic model assessment of insulin resistance, glucose AUC, and TC decreased in both groups (P≤0.03). Both groups maintained some of the improvements in cardio-metabolic and endocrine measures after 16 and 12 months post-intervention, including TT, HDL-C, and TC/HDL-C levels (P≥0.05); however, contrary to our hypothesis, groups had a tendency to revert to the baseline measures for certain cardio-metabolic and endocrine measures including fasting insulin and TC levels 6 and 12 months after the completion of the intervention (P≤0.05). Following the 16-week intervention, the HRQoL scores of both groups increased in the domains of knowledge, concerns about PCOS, healthcare satisfaction, and lifestyle practices comprised of physical activity and healthy diets (P<0.05; Chapter 6). The dietary component of Objective 2 is addressed in Chapter 7. Both intervention groups voluntarily reduced their average daily energy intake from baseline (P<0.001). Dietary intakes increased for fiber, folate, magnesium, iron, and decreased for cholesterol in the pulse-based diet group compared to the TLC diet group (P<0.05). Women in the pulse-based diet group exhibited higher scores in the domain of knowledge about the nutritional composition of pulses, recommended servings of legumes based on Canada’s Food Guide, environmental, and economic benefits of pulse consumption when compared with the TLC diet group (P<0.05). Both groups exhibited increased scores in the domain of attitudes about the palatability, accessibility, preparation, and affordability of pulse foods over the 16 weeks (P<0.01). Supported by the favourable health outcomes from the present intervention, an evidence-based pulse-based recipe resource guide has been developed for use by allied healthcare professionals and their clients (Appendix C). In conclusion, both dietary interventions, without calorie restriction, in combination with aerobic exercise, education, and healthcare counselling yielded substantial improvements in multiple PCOS-specific health outcomes. The pulse-based diet was more effective than the TLC diet in decreasing insulin response to OGTT, improving many key risk factors for cardiometabolic disease, and the overall dietary intakes in women with PCOS. In general, women did not maintain the reproductive and metabolic improvements. Further research is required to promote the consumption of nutrient-rich pulse foods and sustainable adherence to healthy lifestyle behaviours in women with PCOS in the long term

Exosomes, Microvesicles as Diagnosis, Therapeutic and Drug Delivery Tools

Exosomes are extracellular vesicles with nano size range. The use of exosomes as drug delivery vehicle has useful advantages compared to other vesicular systems. Exosomes are nonimmunogenic, nontoxic, and stable with good composition and potency for crossing blood brain barrier. They can be used as theranostic agents and vaccine therapy. The exosomes are a new choice for nonimmunogenic targeted drug delivery vehicle. Introduction: Exosomes are nano size vesicles secreted by different cell types. The main role of exosomes in the body is a cell to cell communication. They are not immunogenic due to similar structure as body cells. They can cross blood brain barrier, stable in the blood circulation, biocompatible, with low toxicity, suitable size, and structure. These endogenous vesicles can be used for drug delivery, immunevaccines and as diagnostic agents. Methods: The following databases were reviewed for bibliography of using exosomes as delivery agents: Web of science, Scopus, Medline, and Embase. Results: Exosomes can deliver different kinds of cargos (RNA, proteins and small molecules) to the target cells. Exosome as a biomarker of diseases (cancer, cardiovascular disease, MS, etc) personalized therapy with the exosomes that generated from induced pluripotent stem cell (iPSC) derived that used for patient specific and disease specific cell therapy. They have specific role in tissue repair and regeneration, vaccines for immunotherapy (phase II of clinical trial). The strategies to introduce drugs into exosomes are active and passive loading. Artificial exosome mimetics can be isolated from exosome secreting cell lines but these exosomes in comparison with autologous are immunogenic. Isolation techniques of exosomes are ultracentrifugation, electron microscopy, and SDS page. Exosomes were mainly taken up by macrophages in the liver after IV administration. Exosomes characterization methods are biophysical, molecular and microfluidics. Conclusion: Exosomes are good carriers for delivery of drugs and genes to the target without immunogenic reaction. They can be used as immunovacines for the cancer treatment by activating immune system against tumor cells. Exosomes can substitution the liposomes because of their size, structure, non-immunogenicity and their natural composition

Prediction of Marital Dissatisfaction Based on the Resilience, Marital Commitment and Rumination

Introduction: Resilience and marital commitment can be considered as a protective factor for maintaining the relationship. On other hand, rumination is a psychological vulnerability factor that has negative effects on resilience and marital commitment. The present study was conducted aimed to predict marital dissatisfaction based on resilience, marital commitment, and rumination in couples seeking for separation.Method: The present study was a cross-sectional study in the form of correlational design. 170 women were selected using purposive sampling from all married women referred to the Dispute Resolution Council in Tehran. Data were collected using demographic checklist, structured clinical interviews, Couple Burnout Measurement, Resilience Scale, rumination questionnaire, and marital commitment scale. Data were analyzed by Pearson correlation coefficient and multiple regression. Results: the results showed that triple components of commitment had a significant and indirect relationship with couple burnout (p&lt; 0.05). Also, there was a significant indirect relationship between rumination with couple burnout and resilience with couple burnout (p&lt; 0.05). Considering the Beta weight based on the first model showed that a standard deviation of change in rumination constituted 0.43 standard deviation of couple burnout. Also, beta coefficients in the second model indicated that a standard deviation of the simultaneous change in rumination dimensions and moral commitment would explain 0.43 and 0.312 standard deviations in couple burnout, respectively (all p's&lt;0.01).Conclusion: These results indicate the role of psychological components in predicting the marital satisfaction and can have clinical applications in designing clinical interventions

Pharyngocutaneous Fistula after Laryngectomy: Incidence, Predisposing Factors, and Outcome

Pharyngocutaneous fistula is a common and troublesome postoperative complication after total laryngectomy. The objective of this report was to determine the incidence, predisposing factors, and outcome of postlaryngectomy pharyngocutaneous fistula in patients operated on in our department and to describe the management of the complication. The medical records of 146 consecutive patients who underwent laryngeal surgery for squamous cell carcinoma of the larynx between 1990 and 2005 were assessed. All patients had similar preoperative/postoperative care. We studied a number of factors that could influence fistula formation such as age, gender, smoking, systemic disease, preoperative radiotherapy, previous tracheotomy, site of tumor, surgical procedure, positive surgical margins, type of closure (T vs. vertical), concurrent neck dissection, suture material, clinical stage, histologic grade, and experience of surgeon (consultant vs. resident). A pharyngocutaneous fistula was observed in 13% (19/146) of the patients within a mean time of 9.6 days from surgery. Spontaneous closure with local wound care was noted in 17 (89%) patients whereas a surgical closure was necessary in two. One patient required surgical closure by direct suture of the pharyngeal mucosa. Pectoralis major myocutaneous flap was used in another one. Our findings showed that fistula formation was significantly more common in patients who received previous radiotherapy or who had positive surgical resection margins or had a systemic disease. The mean healing time was 26 days. We concluded that pharyngocutaneous fistula remains a troublesome complication of the early postoperative period after total laryngectomy. There are many conflicting reports in the literature concerning the predisposing factors, but our data showed that the presence of systemic diseases, previous radiotherapy, and positive surgical margins can all be important predisposing factors, or at least underlying causes. Our experience confirmed that most fistulas can be successfully managed with conservative treatment

Efficient removal of Eriochrome black-T from aqueous solution using NiFe2O4 magnetic nanoparticles

The magnetic NiFe(2)O(4) nanoparticles have been synthesized and used as adsorbents for removal of an azo dye, Eriochrome black-T (EBT) from aqueous solution. The NiFe(2)O(4) nanoparticles were characterized by scanning electron microscope (SEM), Transmission electron microscope (TEM), X-ray diffraction (XRD) and Fourier transform infrared spectra (FTIR). The adsorption studies were carried out under various parameters, such as pH, adsorbent dosage, contact time and initial dye concentration. The experimental results show that the percentage of adsorption increases with an increase in the adsorbent dosage. The maximum adsorption occurred at the pH value of 6.0. The equilibrium uptake was increased with an increase in the initial dye concentration in solution. Adsorption kinetic data were properly fitted with the pseudo-second-order kinetic model. The experimental isotherms data were analyzed using Langmuir and Freundlich isotherm equations. The best fit was obtained by the Langmuir model with high correlation coefficients (R(2) = 0.9733) with a maximum monolayer adsorption capacity of 47.0 m g/g

Essays in banking regulation

The banking theory and in particular the theories of banking regulation have focused on the riskiness of banks' portfolio. The risk-taking behavior of banks and different situations of moral hazard problem have been the main concentration. This thesis is a collection of three essays which apply a different perspective to questions in the literature of banking regulation. Chapters two and three analyze the risk-taking behavior of a bank which can choose between two regimes of operation. Chapter four adds the regulator into the setup and surveys the banking theories for regulating not only an individual bank but also systemic risk-taking among banks. In the first two chapters, two portfolios different in their expected return and the risk level are available to the bank. When the bank changes the portfolio it is called regime switching. Both chapters study the bank's risk-return preferences in the absence of outsider intervention. While in chapter two the relationship between the cash-flow and the regime choice is investigated in a continuous time setup, in chapter three the analysis is carried out a discrete time setup. The regime choice is examined with respect to the capital level in static and also dynamic setups. Moreover, chapter three questions the standard theory of “gambling for resurrection". Chapter four covers regulatory policies to control a bank's risk of failure and collects macro-prudential regulatory proposals for different risk-taking issues in a banking system

The effect of hydro-alchoholic exteract of (Matricaria recutita L.) on pentylenetetrazole-induced seizure and its relationship with nitric oxide in mice

Background: Matricaria recutit (MAT) has a series of flavonoid compounds with benzodiazepine-like properties. So, it may be effective in the treatment of epilepsy and seizures. This study aimed at examining the effect of intraperitoneal injection of the hydro-alcoholic extract of Matricaria recutita on seizures induced by pentylenetetrazole (PTZ) in mice. Materials and Methods: In this study, 56 male mice (25-30 g) were divided into seven groups (n=8): 1-control (saline), 2-control (PTZ), 3-MAT (50mg/kg), 4-MAT (100 mg/kg), 5- MAT (200 mg/kg), 6- diazepam (1mg/kg) and 7- MAT (50 mg/kg)+diazepam (0.25 mg/kg). After 10 days of treatment in different groups, the PTZ-induced seizure threshold was assessed and nitric oxide (NOX) metabolites in the brain tissue were measured by the Greiss method. Results: The chamomile hydro-alcoholic extract (200 mg/kg), and diazepam (1 mg/kg) significantly increased the seizure threshold (P&lt;0.001). The chamomile hydro-alcoholic extract (50, and 100 mg/kg) did not show anticonvulsant activity. The concentrations of NOX in the diazepam (1 mg/kg), MAT 100 mg/kg, and MAT 200 mg/kg groups were significantly lower than those in the control (PTZ) group and co-administration of MAT (50 mg/kg) with diazepam (0.25) decreased the NOX concentration. The hydro-alcoholic extract of MAT (50 mg/kg) had no significant effect on the NOX concentration. Conclusion: According to the results of this study, the chamomile hydro-alcoholic extract has an inhibitory effect on the PTZ-induced seizure and NOX in male mice

Diabetic peripheral neuropathy class prediction by multicategory support vector machine model: a cross- sectional study

OBJECTIVES Diabetes is increasing in worldwide prevalence, toward epidemic levels. Diabetic neuropathy, one of the most common complications of diabetes mellitus, is a serious condition that can lead to amputation. This study used a multicategory support vector machine (MSVM) to predict diabetic peripheral neuropathy severity classified into four categories using patients’ demographic characteristics and clinical features. METHODS In this study, the data were collected at the Diabetes Center of Hamadan in Iran. Patients were enrolled by the convenience sampling method. Six hundred patients were recruited. After obtaining informed consent, a questionnaire collecting general information and a neuropathy disability score (NDS) questionnaire were administered. The NDS was used to classify the severity of the disease. We used MSVM with both one-against-all and one-against-one methods and three kernel functions, radial basis function (RBF), linear, and polynomial, to predict the class of disease with an unbalanced dataset. The synthetic minority class oversampling technique algorithm was used to improve model performance. To compare the performance of the models, the mean of accuracy was used. RESULTS For predicting diabetic neuropathy, a classifier built from a balanced dataset and the RBF kernel function with a one-against-one strategy predicted the class to which a patient belonged with about 76% accuracy. CONCLUSIONS The results of this study indicate that, in terms of overall classification accuracy, the MSVM model based on a balanced dataset can be useful for predicting the severity of diabetic neuropathy, and it should be further investigated for the prediction of other diseases