Remifentanil versus dexmedtomidine for posterior spinal fusion surgery

Background: Controlling the hemodynamic situation of patients who have spinal operation is of prime importance, and maintaining the heart rate and blood pressure in normal or low- normal levels in these patients can reduce their bleeding loss. One of the commonly used drugs for this purpose is remifentanil. Another sedative-hypnotic-analgesic drug, with acceptable effects is dexmedetomidine. The aim of this study was to compare the effect of dexmedetomidine with remifentanil in spinal operation. Methods: In a double blind randomized clinical trial, using random sampling method, 60 patients with the age range of 15-65 years who were candidates for posterior spinal fusion operation were included. Induction of anesthesia was performed, and both groups received isoflurane 1 during the surgery. Remifentanil was injected via infusion pump in one group. The patients in the trial group received dexmedetomidine. As trial outcomes, heart rate and blood pressure were measured before, after induction and during the operation. Pain score, sedation score and the need to analgesic therapy were recorded in the recovery room and the ward. Independent sample t-test and chi-square were used for statistical analysis. Results: Dexmedetomidine had a significant lowering impact on intraoperative blood pressure and heart rate compared to remifentanil (p<0.001). The mean of sedation scores after extubation in patients who received dexmedetomidine was significantly higher than the sedation scores in patients who received remifentanil (p<0.001). The mean of post-extubation and recovery pain score in patients taking remifentanil was significantly higher than patients taking dexmedetomidine (p<0.05). Conclusion: Dexmedetomidine in patients with spinal operation is associated with lower postoperative pain score and intraoperative bleeding. Hemodynamic effects are significantly better in patients received dexmedetomidine

The prediction model for additively manufacturing of NiTiHf high-temperature shape memory alloy

NiTi-based alloys are one of the most well-known alloys among shape memory alloys having a wide range of applications from biomedical to aerospace areas. Adding a third element to the binary alloys of NiTi changes the thermomechanical properties of the material remarkably. Two unique features of stability and high transformation temperature have turned NiTiHf as a suitable ternary shape memory alloys in various applications. Selective laser melting (SLM) as a layer-based fabrication method addresses the difficulties and limitations of conventional methods. Process parameters of SLM play a prominent role in the properties of the final parts so that by using the different sets of process parameters, different thermomechanical responses can be achieved. In this study, different sets of process parameters (PPs) including laser power, hatch space, and scanning speed were defined to fabricate the NiTiHf samples. Changing the PPs is a powerful tool for tailoring the thermomechanical response of the fabricated parts such as transformation temperature (TTs), density, and mechanical response. In this work, an artificial neural network (ANN) was developed to achieve a prediction tool for finding the effect of the PPs on the TTs and the size deviation of the printed parts

An advanced computational intelligent framework to predict shear sonic velocity with application to mechanical rock classification

Shear sonic wave velocity (Vs) has a wide variety of implications, from reservoir management and development to geomechanical and geophysical studies. In the current study, two approaches were adopted to predict shear sonic wave velocities (Vs) from several petrophysical well logs, including gamma ray (GR), density (RHOB), neutron (NPHI), and compressional sonic wave velocity (Vp). For this purpose, five intelligent models of random forest (RF), extra tree (ET), Gaussian process regression (GPR), and the integration of adaptive neuro fuzzy inference system (ANFIS) with differential evolution (DE) and imperialist competitive algorithm (ICA) optimizers were implemented. In the first approach, the target was estimated based only on Vp, and the second scenario predicted Vs from the integration of Vp, GR, RHOB, and NPHI inputs. In each scenario, 8061 data points belonging to an oilfield located in the southwest of Iran were investigated. The ET model showed a lower average absolute percent relative error (AAPRE) compared to other models for both approaches. Considering the first approach in which the Vp was the only input, the obtained AAPRE values for RF, ET, GPR, ANFIS + DE, and ANFIS + ICA models are 1.54%, 1.34%, 1.54%, 1.56%, and 1.57%, respectively. In the second scenario, the achieved AAPRE values for RF, ET, GPR, ANFIS + DE, and ANFIS + ICA models are 1.25%, 1.03%, 1.16%, 1.63%, and 1.49%, respectively. The Williams plot proved the validity of both one-input and four-inputs ET model. Regarding the ET model constructed based on only one variable,Williams plot interestingly showed that all 8061 data points are valid data. Also, the outcome of the Leverage approach for the ET model designed with four inputs highlighted that there are only 240 "out of leverage" data sets. In addition, only 169 data are suspected. Also, the sensitivity analysis results typified that the Vp has a higher effect on the target parameter (Vs) than other implemented inputs. Overall, the second scenario demonstrated more satisfactory Vs predictions due to the lower obtained errors of its developed models. Finally, the two ET models with the linear regression model, which is of high interest to the industry, were applied to diagnose candidate layers along the formation for hydraulic fracturing. While the linear regression model fails to accurately trace variations of rock properties, the intelligent models successfully detect brittle intervals consistent with field measurements

Evaluating equality in prescribing Novel Oral Anticoagulants (NOACs) in England: the protocol of a Bayesian small area analysis

Background Atrial fibrillation (AF) is the most common cardiac arrhythmia, affecting about 1.6% of the population in England. Novel oral anticoagulants (NOACs) are approved AF treatments that reduce stroke risk. In this study, we estimate the equality in individual NOAC prescriptions with high spatial resolution in Clinical Commissioning Groups (CCGs) across England from 2014 to 2019. Methods A Bayesian spatio-temporal model will be used to estimate and predict the individual NOAC prescription trend on ‘prescription data’ as an indicator of health services utilisation, using a small area analysis methodology. The main dataset in this study is the “Practice Level Prescribing in England,” which contains four individual NOACs prescribed by all registered GP practices in England. We will use the defined daily dose (DDD) equivalent methodology, as recommended by the World Health Organization (WHO), to compare across space and time. Four licensed NOACs datasets will be summed per 1,000 patients at the CCG-level over time. We will also adjust for CCG-level covariates, such as demographic data, Multiple Deprivation Index, and rural-urban classification. We aim to employ the extended BYM2 model (space-time model) using the RStan package. Discussion This study suggests a new statistical modelling approach to link prescription and socioeconomic data to model pharmacoepidemiologic data. Quantifying space and time differences will allow for the evaluation of inequalities in the prescription of NOACs. The methodology will help develop geographically targeted public health interventions, campaigns, audits, or guidelines to improve areas of low prescription. This approach can be used for other medications, especially those used for chronic diseases that must be monitored over time

The relationship between maternal awareness, socioeconomic situation of families and metabolic control in children with type 1 diabetes miletus in an Iranian population

Background: Type 1 diabetes mellitus (T1DM) is one of the most common chronic pediatric conditions, with potentially life-threatening sequels. However, good metabolic control can protect the patients against sequels. Objectives: The aim of this study was to examine the relationship between awareness of the mothers about this disease on improving diabetic children metabolic control and also, to examine the relationship between socioeconomic situations of families and control of diabetes in this group of patients. Patients and Methods: This is a cross-sectional descriptive analytic study on 80 diabetic children and their mothers, who were registered in the diabetes association of Iran, for outpatient control of disease. Diabetes knowledge was measured by Michigan diabetes knowledge test and glycemic control was assessed by glycosylated hemoglobin (HbA1c). To assess the socio-economic status of a diabetic child's family, educational level, occupational and marital status of parents were asked and the socioeconomic status (SES) was evaluated with Hollingshed four-factor index of SES. Results: Mothers' mean knowledge score was 17.72, children's mean HbA1c was 7.77 and mean of SES was 27.89. There was no significant correlation between children's HbA1c and mother's SES. Also, there was an inverse linear relationship between mothers' knowledge score and children's HbA1c and there was a direct linear relationship between the mothers' knowledge score and SES. Conclusions: Finally, based on the results obtained in this study, it can be concluded that the awareness of mothers of T1DM children has a good impact on blood sugar control, whereas the SES of families has no direct effect on blood sugar control. Additionally, SES can indirectly impact on the consciousness of mothers and lead to the reduction of HbA1c. © 2015, Iranian Society of Pediatrics

The effect of combined conventional and modified ultrafiltration on mechanical ventilation and hemodynamic changes in congenital heart surgery

Background: Cardiopulmonary bypass is associated with increased fluid accumulation around the heart which influences pulmonary and cardiac diastolic function. The aim of this study was to compare the effects of modified ultrafiltration (MUF) versus conventional ultrafiltration (CUF) on duration of mechanical ventilation and hemodynamic status in children undergoing congenital heart surgery. Materials and Methods: A randomized clinical trial was conducted on 46 pediatric patients undergoing cardiopulmonary bypass throughout their congenital heart surgery. Arteriovenous MUF plus CUF was performed in 23 patients (intervention group) and sole CUF was performed for other 23 patients (control group). In MUF group, arterial cannula was linked to the filter inlet through the arterial line, and for 10 min, 10 ml/kg/min of blood was filtered and returned via cardioplegia line to the right atrium. Different parameters including hemodynamic variables, length of mechanical ventilation, Intensive Care Unit (ICU) stay, and inotrope requirement were compared between the two groups. Results: At immediate post�MUF phase, there was a statistically significant increase in the mean arterial pressure, systolic blood pressure, and diastolic blood pressure (P < 0.05) only in the study group. Furthermore, there was a significant difference in time of mechanical ventilation (P = 0.004) and ICU stay (P = 0.007) between the two groups. Inotropes including milrinone (P = 0.04), epinephrine (P = 0.001), and dobutamine (P = 0.002) were used significantly less frequently for patients in the intervention than the control group. Conclusion: Administration of MUF following surgery improves hemodynamic status of patients and also significantly decreases the duration of mechanical ventilation and inotrope requirement within 48 h after surgery. � 2016 Journal of Research in Medical Sciences

Geographical and socioeconomic inequalities in female breast cancer incidence and mortality in Iran: A Bayesian spatial analysis of registry data

Background In Iran, trends in breast cancer incidence and mortality have generally been monitored at national level. The purpose of this study is to examine province-level disparities in age-standardised breast cancer incidence versus mortality from 2000 to 2010 and their association with socioeconomic status. Methods In this study, data from Iran’s national cancer and death registry systems, and covariates from census and household expenditure surveys were used. We estimated the age-standardised incidence and mortality rates in women aged more than 30 years for all 31 provinces in the consecutive time intervals 2000–2003, 2004–2007 and 2008–2010 using a Bayesian spatial model. Results Mean age-standardised breast cancer incidence across provinces increased over time from 15.0 per 100,000 people (95% credible interval 12.0,18.3) in 2000–2003 to 39.6 (34.5,45.1) in 2008–2010. The mean breast cancer mortality rate declined from 10.9 (8.3,13.8) to 9.9 (7.5,12.5) deaths per 100,000 people in the same period. When grouped by wealth index quintiles, provinces in the highest quintile had higher levels of incidence and mortality. In the wealthiest quintile, reductions in mortality over time were larger than those observed among provinces in the poorest quintile. Relative breast cancer mortality decreased by 16.7% in the highest quintile compared to 10.8% in the lowest quintile. Conclusions Breast cancer incidence has increased over time, with lower incidence in the poorest provinces likely driven by underdiagnoses or late-stage diagnosis. Although the reported mortality rate is still higher in wealthier provinces, the larger decline over time in these provinces indicates a possible future reversal, with the most deprived provinces having higher mortality rates. Ongoing analysis of incidence and mortality at sub-national level is crucial in addressing inequalities in healthcare systems and public health both in Iran and elsewhere

Genetic Variants in Immune Related Genes as Predictors of Responsiveness to BCG Immunotherapy in Metastatic Melanoma Patients.

Adjuvant immunotherapy in melanoma patients improves clinical outcomes. However, success is unpredictable due to inherited heterogeneity of immune responses. Inherent immune genes associated with single nucleotide polymorphisms (SNPs) may influence anti-tumor immune responses. We assessed the predictive ability of 26 immune-gene SNPs genomic panels for a clinical response to adjuvant BCG (Bacillus Calmette-Guérin) immunotherapy, using melanoma patient cohorts derived from three phase III multicenter clinical trials: AJCC (American Joint Committee on Cancer) stage IV patients given adjuvant BCG (pilot cohort; n = 92), AJCC stage III patients given adjuvant BCG (verification cohort; n = 269), and AJCC stage III patients that are sentinel lymph node (SLN) positive receiving no immunotherapy (control cohort; n = 80). The SNP panel analysis demonstrated that the responder patient group had an improved disease-free survival (DFS) (hazard ratio [HR] 1.84, 95% CI 1.09-3.13, p = 0.021) in the pilot cohort. In the verification cohort, an improved overall survival (OS) (HR 1.67, 95% CI 1.07-2.67, p = 0.025) was observed. No significant differences of SNPs were observed in DFS or OS in the control patient cohort. This study demonstrates that SNP immune genes can be utilized as a predictive tool for identifying melanoma patients that are inherently responsive to BCG and potentially other immunotherapies in the future

Relationship between Social Determinants of Health and General Health Status of the Elderly in Alborz Province: Path Analysis

The purpose of this study was to examine the relationship between social determinants of health (SDH), quality of life, lifestyle, and general health of the aging people in Alborz province. A descriptive cross-sectional study conducted in 2000 aging people. A two-stage cluster sampling was applied to select participants. We used a four-section questionnaire. The statistical analysis was performed with AMOS 22. We used path analysis to examine whether SDH, QOL and lifestyle would directly or indirectly affect general health and whether the pathway model was acceptable. The general health status of the most of participants was low. The results of path analysis show that general health is affected by the SDH, lifestyle and quality of life. Our pathway model was an acceptable model. Variables such as marital status, educational level, job, income, number of family members, QOL, and lifestyle can be considered as predictors of general health status in the aging people. It can be concluded that it is necessary to provide appropriate strategies to promote general health of the elder person. © 2020, Springer Science+Business Media, LLC, part of Springer Nature

Appropriate anesthesia regimen to control sevoflurane-induced emergence agitation in children; propofol-lidocaine and thiopental sodium-lidocaine: A randomized controlled trial

Background: Emergence Agitation (EA) is a common problem in pediatric anesthesia. The current study evaluated the effect of intravenous lidocaine combined with propofol or thiopental sodium to control EA by sevoflurane in children. Objectives: The current study aimed to compare the effectiveness of two anesthesia regimen propofol-lidocaine and thiopental sodium lidocaine to control sevoflurane-induced emergence agitation in children. Patients and Methods: The study enrolled 120 children aged 12 to 36 months with retinoblastoma who underwent induction of anesthesia with sevoflurane for Eye Examination Under Anesthesia (EUA). Sampling was done at Rasoul-Akram Hospital in Tehran, Iran. The subjects were randomly assigned into four groups including: group one (thiopental sodium-lidocaine TL), group two (thiopental sodium-saline TS), group three (propofol-lidocaine PL), and group four (propofol-saline PS). Emergence agitation was assessed by using a five-point scoring scale, every 10 minutes during the first 30 minutes after admission to the recovery room. Results: EA occurred in 24 cases (20%) of children. Incidence of EA in the TS, TL, PS, and PL groups were 21 (70%), 2 (6.7%), 1 (3.3%), and 0 (0%), respectively (P < 0.001). Nausea and vomiting after anesthesia did not occur in any of the patients. After removal of the endotracheal tube, laryngospasm complication occurrence in the TS group (10 cases) was higher than the other groups and no statistically significant difference was observed (P = 0.1). Conclusions: Propofol-lidocaine anesthesia regimen was more effective to control the pediatric emergence agitation than the other combinations. © 2014, Iranian Red Crescent Medical Journal