Solvent-free synthesis of biostable segmented polyurethane shape memory polymers for biomedical applications

Biostable shape memory polymers that remain stable in physiological conditions are beneficial for user-defined shape recovery in response to a specific stimulus. For potential commercialization and biocompatibility considerations, biomaterial synthesis must be simple and scalable. Hence, a library of biostable and cytocompatible shape memory polymers with tunable thermomechanical properties based on hard segment content was synthesized using a solvent-free method. Polymer surface chemistry, thermomechanical and shape memory properties, and biostability were assessed. We also investigated the effects of processing methods on thermomechanical and shape memory properties. All polymers showed high glass transition temperatures (>50 °C), which indicates that their temporary shape could be preserved after implantation. Polymers also demonstrate high shape fixity (73-80%) and shape recovery (93-95%). Minimal mass loss (<5%) was observed in accelerated oxidative (20% H2O2) and hydrolytic (0.1 M NaOH) media. Additionally, minimal shape recovery (∼0%) occurred in programmed samples with higher hard segment content that were stored in degradation media. After 40 days of storage in media, programmed samples recovered their primary shapes upon heating to temperatures above their transition temperature. Annealing to above the polymer melting point and solvent casting of polymers improved shape memory and thermal properties. To enable their potential use as biomaterial scaffolds, fiber formation of synthesized polyurethanes was compared with those of samples synthesized using a previously reported solvent-based method. The new method provided polymers that can form fibrous scaffolds with improved mechanical and shape memory properties, which is attributed to the higher molecular weight and crystalline content of polymers synthesized using the new, solvent-free approach. These biostable segmented polyurethanes could be coupled with a range of components that respond to specific stimuli, such as enzymes, magnetic field, pH, or light, to enable a specific shape change response, which could be coupled with drug and/or bioactive material delivery in future work.

The application of artificial intelligence in health policy: a scoping review

BACKGROUND

Policymakers require precise and in-time information to make informed decisions in complex environments such as health systems. Artificial intelligence (AI) is a novel approach that makes collecting and analyzing data in complex systems more accessible. This study highlights recent research on AI's application and capabilities in health policymaking.

METHODS

We searched PubMed, Scopus, and the Web of Science databases to find relevant studies from 2000 to 2023, using the keywords "artificial intelligence" and "policymaking." We used Walt and Gilson's policy triangle framework for charting the data.

RESULTS

The results revealed that using AI in health policy paved the way for novel analyses and innovative solutions for intelligent decision-making and data collection, potentially enhancing policymaking capacities, particularly in the evaluation phase. It can also be employed to create innovative agendas with fewer political constraints and greater rationality, resulting in evidence-based policies. By creating new platforms and toolkits, AI also offers the chance to make judgments based on solid facts. The majority of the proposed AI solutions for health policy aim to improve decision-making rather than replace experts.

CONCLUSION

Numerous approaches exist for AI to influence the health policymaking process. Health systems can benefit from AI's potential to foster the meaningful use of evidence-based policymaking.

Self-Defensive Antimicrobial Shape Memory Polyurethanes with Honey-Based Compounds

Infection treatment plays a crucial role in aiding the body in wound healing. To that end, we developed a library of antimicrobial polymers based on segmented shape memory polyurethanes with nondrug-based antimicrobials (i.e., honey-based phenolic acids (PAs)) using both chemical and physical incorporation approaches. The antimicrobial shape memory polymers (SMPs) have high transition temperatures (>55 °C) to enable maintenance of temporary, programmed shapes in physiological conditions unless a specific external stimulus is present. Polymers showed tunable mechanical and shape memory properties by changing the ratio, chemistry, and incorporation method of PAs. Cytocompatible (∼100% cell viability) synthesized polymers inhibited growth rates of Staphylococcus aureus (∼100% with physically incorporated PAs and >80% with chemically incorporated PAs) and Escherichia coli (∼100% for samples with cinnamic acid (physical and chemical)). Crystal violet assays showed that all formulations inhibit biofilm formation in surrounding solutions, and chemically incorporated samples showed surface antibiofilm properties with S. aureus. Molecular dynamics simulations confirm that PAs have higher levels of interactions with S. aureus cell membranes than E. coli. Long-term antimicrobial properties were measured after storage of the sample in aqueous conditions; the polymers retained their antimicrobial properties against E. coli after up to 20 days. As a proof of concept, magnetic particles were incorporated into the polymer to trigger user-defined shape recovery by applying an external magnetic field. Shape recovery disrupted preformed S. aureus biofilms on polymer surfaces. This antimicrobial biomaterial platform could enable user- or environmentally controlled shape change and/or antimicrobial release to enhance infection treatment efforts.

Social stigma during COVID-19: A systematic review

Objectives

Stigmatization was reported throughout the COVID pandemic for COVID-19 patients and close contacts. The aim of this systematic review was to comprehensively examine the prevalence and impact of stigmatization during COVID-19 pandemic.

Methods

English articles were searched using online databases that included PubMed, Scopus, Embase, and Web of Science up to 24 August 2022. A two-step screening and selection process was followed utilizing an inclusion and exclusion criteria and then data was extracted from eligible articles. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist was followed, and the risk of bias was assessed using the Newcastle-Ottawa Scale.

Results

Seventy-six studies were eligible for inclusion. Twenty-two studies reported the prevalence of social stigma due to COVID-19 infection with social isolation being the most commonly reported stigma. There were 20 studies that reported the majority of participants experienced stigma due to COVID-19 infection, which was as high as 100% of participants in two studies. Participants in 16 studies reported blaming from others as the second most common type of stigma, with various other types reported such as psychological pressure, verbal violence, avoidance, and labeling. The most common effect of the stigma was anxiety followed by depression, and then reduction of socialization.

Conclusion

Findings from the present review have identified that COVID-19-related stigma studies have generally focused on its prevalence, type, and outcome. Greater awareness of this topic may assist with improving public education during pandemics such as COVID-19 as well as access to support services for individuals impacted by stigmatization.

The application of artificial intelligence in health financing: a scoping review

INTRODUCTION

Artificial Intelligence (AI) represents a significant advancement in technology, and it is crucial for policymakers to incorporate AI thinking into policies and to fully explore, analyze and utilize massive data and conduct AI-related policies. AI has the potential to optimize healthcare financing systems. This study provides an overview of the AI application domains in healthcare financing.

METHOD

We conducted a scoping review in six steps: formulating research questions, identifying relevant studies by conducting a comprehensive literature search using appropriate keywords, screening titles and abstracts for relevance, reviewing full texts of relevant articles, charting extracted data, and compiling and summarizing findings. Specifically, the research question sought to identify the applications of artificial intelligence in health financing supported by the published literature and explore potential future applications. PubMed, Scopus, and Web of Science databases were searched between 2000 and 2023.

RESULTS

We discovered that AI has a significant impact on various aspects of health financing, such as governance, revenue raising, pooling, and strategic purchasing. We provide evidence-based recommendations for establishing and improving the health financing system based on AI.

CONCLUSIONS

To ensure that vulnerable groups face minimum challenges and benefit from improved health financing, we urge national and international institutions worldwide to use and adopt AI tools and applications.

Research agenda for using artificial intelligence in health governance: interpretive scoping review and framework

BACKGROUND

The governance of health systems is complex in nature due to several intertwined and multi-dimensional factors contributing to it. Recent challenges of health systems reflect the need for innovative approaches that can minimize adverse consequences of policies. Hence, there is compelling evidence of a distinct outlook on the health ecosystem using artificial intelligence (AI). Therefore, this study aimed to investigate the roles of AI and its applications in health system governance through an interpretive scoping review of current evidence.

METHOD

This study intended to offer a research agenda and framework for the applications of AI in health systems governance. To include shreds of evidence with a greater focus on the application of AI in health governance from different perspectives, we searched the published literature from 2000 to 2023 through PubMed, Scopus, and Web of Science Databases.

RESULTS

Our findings showed that integrating AI capabilities into health systems governance has the potential to influence three cardinal dimensions of health. These include social determinants of health, elements of governance, and health system tasks and goals. AI paves the way for strengthening the health system's governance through various aspects, i.e., intelligence innovations, flexible boundaries, multidimensional analysis, new insights, and cognition modifications to the health ecosystem area.

CONCLUSION

AI is expected to be seen as a tool with new applications and capabilities, with the potential to change each component of governance in the health ecosystem, which can eventually help achieve health-related goals.

Developing an organizational capacity assessment tool and capacity-building package for the National Center for Prevention and Control of Noncommunicable Diseases in Iran

Non-communicable diseases represent 71% of all deaths worldwide. In 2015, Sustainable Development Goals, including target 3.4 of SDGs, were seated on the world agenda; "By 2030, reduce premature mortality from NCDs by one-third. More than half of the world's countries are not on track to reach SDG 3.4, and the COVID-19 crisis has hampered the delivery of essential NCD services globally, which means the premature death of millions of people and indicates the need for capacity building for health systems. We designed a tool to measure the capacity of the National Center for Non-Communicable Disease and then presented the proposed policy package to enhance the national center's organizational capacity. The data for this explanatory sequential mixed method study was collected using quantitative and qualitative approaches between February 2020 and December 2021. The tool for assessing organizational capacity for NCDs was developed, and its validity and reliability were measured. The developed tool assessed the organizational capacity by evaluating NCNCD's managers and experts. Following the quantitative phase, a qualitative phase focused on the low-capacity points revealed by the tool. The causes of low capacity were investigated, as well as potential interventions to improve capacity. The developed tool comprises six main domains and eighteen subdomains, including (Governance, Organizational Management, Human Resources Management, Financial Management, Program Management, and Relations Management) which verified validity and reliability. In seven separate National Center for Non-Communicable Disease units, the organizational capacity was measured using the designed tool. (Cardiovascular disease and hypertension; diabetes; chronic respiratory disease; obesity and physical activity; tobacco and alcohol; nutrition; and cancers). The organizational management dimensions and the sub-dimensions of the organizational structure of the Ministry of Health and Medical Education and units affiliated with the national center, in all cases, were almost one of the main challenges that affected the country's capacity to fight against NCDs. However, all units had a relatively good situation in terms of governance (mission statement, vision, and written strategic plan). The content analysis of experts' opinions on the low-capacity subdomains highlighted challenges and recommended capacity-building interventions. Transparency in methods and processes is necessary to allocate funding among various health programs and evaluate their effects through cost-effectiveness indicators. This study identified weak points or areas where capacity building is required. The root causes of low capacity and interventions to build capacity are listed in each dimension of the tool. Some of the proposed interventions, such as strengthening organizational structures, have the potential to impact other domains. Improving organizational capacity for NCDs can assist countries to achieve national and global goals with greater efficiency.

Antibacterial and Cytocompatible pH-Responsive Peptide Hydrogel

A short peptide, FHHF-11, was designed to change stiffness as a function of pH due to changing degree of protonation of histidines. As pH changes in the physiologically relevant range, G' was measured at 0 Pa (pH 6) and 50,000 Pa (pH 8). This peptide-based hydrogel is antimicrobial and cytocompatible with skin cells (fibroblasts). It was demonstrated that the incorporation of unnatural AzAla tryptophan analog residue improves the antimicrobial properties of the hydrogel. The material developed can have a practical application and be a paradigm shift in the approach to wound treatment, and it will improve healing outcomes for millions of patients each year.

In vitro and in vivo degradation correlations for polyurethane foams with tunable degradation rates

Polyurethane foams present a tunable biomaterial platform with potential for use in a range of regenerative medicine applications. Achieving a balance between scaffold degradation rates and tissue ingrowth is vital for successful wound healing, and significant in vivo testing is required to understand these processes. Vigorous in vitro testing can minimize the number of animals that are required to gather reliable data; however, it is difficult to accurately select in vitro degradation conditions that can effectively mimic in vivo results. To that end, we performed a comprehensive in vitro assessment of the degradation of porous shape memory polyurethane foams with tunable degradation rates using varying concentrations of hydrogen peroxide to identify the medium that closely mimics measured in vivo degradation rates. Material degradation was studied over 12 weeks in vitro in 1%, 2%, or 3% hydrogen peroxide and in vivo in subcutaneous pockets in Sprague Dawley rats. We found that the in vitro degradation conditions that best predicted in vivo degradation rates varied based on the number of mechanisms by which the polymer degraded and the polymer hydrophilicity. Namely, more hydrophilic materials that degrade by both hydrolysis and oxidation require lower concentrations of hydrogen peroxide (1%) to mimic in vivo rates, while more hydrophobic scaffolds that degrade by oxidation alone require higher concentrations of hydrogen peroxide (3%) to model in vivo degradation. This information can be used to rationally select in vitro degradation conditions that accurately identify in vivo degradation rates prior to characterization in an animal model.

Antimicrobial PVA Hydrogels with Tunable Mechanical Properties and Antimicrobial Release Profiles

Hydrogels are broadly employed in wound healing applications due to their high water content and tissue-mimicking mechanical properties. Healing is hindered by infection in many types of wound, including Crohn's fistulas, tunneling wounds that form between different portions of the digestive system in Crohn's disease patients. Owing to the rise of drug-resistant infections, alternate approaches are required to treat wound infections beyond traditional antibiotics. To address this clinical need, we designed a water-responsive shape memory polymer (SMP) hydrogel, with natural antimicrobials in the form of phenolic acids (PAs), for potential use in wound filling and healing. The shape memory properties could allow for implantation in a low-profile shape, followed by expansion and would filling, while the PAs provide localized delivery of antimicrobials. Here, we developed a urethane-crosslinked poly(vinyl alcohol) hydrogel with cinnamic (CA), p-coumaric (PCA), and caffeic (Ca-A) acid chemically or physically incorporated at varied concentrations. We examined the effects of incorporated PAs on antimicrobial, mechanical, and shape memory properties, and on cell viability. Materials with physically incorporated PAs showed improved antibacterial properties with lower biofilm formation on hydrogel surfaces. Both modulus and elongation at break could be increased simultaneously in hydrogels after both forms of PA incorporation. Cellular response in terms of initial viability and growth over time varied based on PA structure and concentration. Shape memory properties were not negatively affected by PA incorporation. These PA-containing hydrogels with antimicrobial properties could provide a new option for wound filling, infection control, and healing. Furthermore, PA content and structure provide novel tools for tuning material properties independently of network chemistry, which could be harnessed in a range of materials systems and biomedical applications.

Bacterial protease-responsive shape memory polymers for infection surveillance and biofilm inhibition in chronic wounds

Chronic wound healing is often negatively impacted by infection. Efficient infection assessment is crucial for effective treatment, and biofilm inhibition could improve treatment efficacy. To that end, we developed a bacterial protease-responsive shape memory polymer based on a segmented polyurethane with incorporated poly(glutamic acid) peptide (PU-Pep). Poly(glutamic acid) degrades in response to bacterial proteases to trigger shape recovery of PU-Pep films that are programmed into a secondary shape. These materials have transition temperatures well above body temperature (~60°C), which enables stable storage in temporary shapes after implantation. Synthesized polymers have high shape fixity (~74%-88%), shape recovery (~93%-95%), and cytocompatibility (~100%). Strained PU-Pep samples underwent shape recovery within ≤24 h in response to the V8 enzyme from Staphylococcus aureus (S. aureus, ~50% recovery) and multiple bacteria strains (S. aureus [~40%], Staphylococcus epidermidis [~30%], and Escherichia coli [~25%]), and they had minimal shape change in response to media controls and mammalian cells. Shape recovery of strained PU-Pep samples prevented biofilm formation on the sample surfaces, and resulting attached planktonic bacteria were vulnerable to applied treatments. PU-Pep with physically incorporated antimicrobials simultaneously prevented biofilm formation and killed isolated bacteria. PU-Pep dressings displayed visible shape change and resistance to biofilm formation in in vitro and ex vivo models. In the in vitro model, PU-Pep shape change also disrupted pre-formed biofilm structures. This novel bacterial protease-responsive biomaterial could serve as a wound dressing that changes shape specifically during bacterial colonization to alert clinicians to infection and make biofilm-associated infections easier to treat.

Antimicrobial Shape Memory Polymer Hydrogels for Chronic Wound Dressings

Chronic wounds can remain open for several months and have high risks of amputation due to infection. Dressing materials to treat chronic wounds should be conformable for irregular wound geometries, maintain a moist wound bed, and reduce infection risks. To that end, we developed cytocompatible shape memory polyurethane-based poly(ethylene glycol) (PEG) hydrogels that allow facile delivery to the wound site. Plant-based phenolic acids were physically incorporated onto the hydrogel scaffolds to provide antimicrobial properties. These materials were tested to confirm their shape memory properties, cytocompatibility, and antibacterial properties. The incorporation of phenolic acids provides a new mechanism for tuning intermolecular bonding in the hydrogels and corollary mechanical and shape memory properties. Phenolic acid-containing hydrogels demonstrated an increased shape recovery ratio (1.35× higher than the control formulation), and materials with cytocompatibility >90% were identified. Antimicrobial properties were retained over 20 days in hydrogels with higher phenolic acid content. Phenolic acid retention and antimicrobial efficacy were dependent upon phenolic acid structures and interactions with the polymer backbone. This novel hydrogel system provides a platform for future development as a chronic wound dressing material that is easy to implant and reduces infection risks.

Magnetically Actuated Shape Memory Polymers for On-Demand Drug Delivery

Repeated use of intravenous infusions to deliver drugs can cause nerve damage, pain, and infection. There is an unmet need for a drug delivery method that administers drugs on demand for prolonged use. Here, we developed magnetically responsive shape memory polymers (SMPs) to enhance control over drug release. Iron oxide magnetic nanoparticles (mnps) were synthesized and incorporated into previously developed SMPs to enable magnetically induced shape memory effects that can be activated remotely via the application of an alternating magnetic field. These materials were tested for their shape memory properties (dynamic mechanical analysis), cytocompatibility (3T3 fibroblast viability), and tunable drug delivery rates (UV−VIS to evaluate the release of incorporated doxorubicin, 6-mercaptopurine, and/or rhodamine). All polymer composites had >75% cytocompatibility over 72 h. Altering the polymer chemistry and mnp content provided methods to tune drug release. Namely, linear polymers with higher mnp content had faster drug release. Highly cross-linked polymer networks with lower mnp content slowed drug release. Shape memory properties and polymer/drug interactions provided additional variables to tune drug delivery rates. Polymers that were fixed in a strained secondary shape had a slower release rate compared with unstrained polymers, and hydrophobic drugs were released more slowly than hydrophilic drugs. Using these design principles, a single material with gradient chemistry and dual drug loading was synthesized, which provided a unique mechanism to deliver two drugs from a single scaffold with distinct delivery profiles. This system could be employed in future work to provide controlled release of selected drug combinations with enhanced control over release as compared with previous approaches.

COVID-19 mortality in patients with immunodeficiency and its predictors: a systematic review

INTRODUCTION

Patients with immunodeficiency are usually more prone to worse outcomes of infectious diseases. However, there are some disagreements in the context of COVID-19, for example, in patients with human immunodeficiency virus (HIV). Herein, we aimed to systematically review the risk and predictors of COVID-19 mortality in people with primary or secondary immunodeficiency.

METHODS

PubMed, Scopus, Web of Science, and Science Direct were searched. We followed a two-step screening process to identify eligible results. We first reviewed the title and abstract of the records and the unqualified studies were removed. Then, their full texts were evaluated based on their coherence with the purpose and inclusion/exclusion criteria, and those eligible for qualitative synthesis were included.

RESULTS

Twenty-two articles were included, which investigated a total of 109,326 with primary or secondary immunodeficiencies. Three studies investigated the pediatric and infant population, while other studies were conducted on the adult population. Overall, studies on both primary and secondary immunodeficiency conflicted as some reported higher and some mentioned lower mortality rates in patients with immunodeficiency.

CONCLUSIONS

Overall, there were two points of view in both types of immunodeficiencies. The first is the classical viewpoint that all immunodeficient patients are at a higher risk of infection leading to a higher mortality rate. The second types of studies found that immunodeficiency might play a less important or even an inverse role in mortality rates by lowering the severity of the inflammatory response. However, it is important to take note to comorbidities, such as DM, HTN, CAD, ESRD, history of lower respiratory infection, etc., and demographic factors, such as obesity and age > 70 years, as they appear to influence the mortality rate, especially in patients with secondary immunodeficiency.

Wideband RCS reduction due to plasma generated by radioactive nuclei for cylindrical object

Radar cross section reduction has been one of the most important research topics in recent years. Plasma-based stealth is a method of reducing the radar cross section, which dampens the electromagnetic waves and reduces the amount of return waves. In this paper, a coating of the radioactive nucleus \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$^{241}{\mathrm{Am}}$$\end{document}241Am on the surface of the cylinder with a radius of 10 cm is considered and the range of the emitted alpha particles and the electron density generated in the air are obtained using the Geant4 code under standard temperature and pressure conditions. By finite element method solution, the radar cross section of the conductive cylindrical object has been simulated and extracted in the presence and absence of plasma created by alpha-particles. The obtained results show a reduction of 5–8 dB \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\mathrm{m}^2$$\end{document}m2 in the radar cross section in the frequency range of 2–12 GHz for specific activity source of 1 Ci/\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\mathrm{cm}^2$$\end{document}cm2.

COVID‐19 mortality and its predictors in the elderly: A systematic review

Background and Aims

Older people have higher rates of comorbidities and may experience more severe inflammatory responses; therefore, are at higher risk of death. Herein, we aimed to systematically review the mortality in coronavirus disease 2019 (COVID‐19) patients and its predictors in this age group.

Methods

We searched PubMed, Web of Science, and Science Direct using relevant keywords. Retrieved records underwent a two‐step screening process consisting of title/abstract and full‐text screenings to identify the eligible studies.

Results

Summarizing findings of 35 studies demonstrated that older patients have higher mortality rates compared to the younger population. A review of articles revealed that increasing age, body mass index, a male gender, dementia, impairment or dependency in daily activities, presence of consolidations on chest X‐ray, hypoxemic respiratory failure, and lower oxygen saturation at admission were risk factors for death. High d‐dimer levels, 25‐hydroxy vitamin D serum deficiencies, high C‐reactive protein (≥5 mg/L) levels plus any other abnormalities of lymphocyte, higher blood urea nitrogen or lactate dehydrogenase, and higher platelet count were predictors of poor prognosis and mortality in the elderly. Studies have also shown that previous treatment with renin–angiotensin–aldosterone system inhibitors, pharmacological treatments of respiratory disorders, antibiotics, corticosteroids, vitamin K antagonist, antihistamines, azithromycin, Itolizumab (an anti‐CD6 monoclonal antibody) in combination with other antivirals reduces COVID‐19 worsening and mortality. Vaccination against seasonal influenza might also reduce COVID‐19 mortality.

Conclusion

Overall, a critical consideration is necessary for the care and management of COVID‐19 in the aged population considering the drastic contrasts in manifestation and prognosis compared to other age groups. Mortality from COVID‐19 is independently associated with the patient's age. Elderly patients with COVID‐19 are more vulnerable to poor outcomes. Thus, strict preventive measures, timely diagnosis, and aggressive therapeutic/nontherapeutic care are of great importance to reduce acute respiratory distress syndrome and severe complications in older people.

COVID-19 mortality and its predictors in the elderly: A systematic review

BACKGROUND AND AIMS

Older people have higher rates of comorbidities and may experience more severe inflammatory responses; therefore, are at higher risk of death. Herein, we aimed to systematically review the mortality in coronavirus disease 2019 (COVID-19) patients and its predictors in this age group.

METHODS

We searched PubMed, Web of Science, and Science Direct using relevant keywords. Retrieved records underwent a two-step screening process consisting of title/abstract and full-text screenings to identify the eligible studies.

RESULTS

Summarizing findings of 35 studies demonstrated that older patients have higher mortality rates compared to the younger population. A review of articles revealed that increasing age, body mass index, a male gender, dementia, impairment or dependency in daily activities, presence of consolidations on chest X-ray, hypoxemic respiratory failure, and lower oxygen saturation at admission were risk factors for death. High d-dimer levels, 25-hydroxy vitamin D serum deficiencies, high C-reactive protein (≥5 mg/L) levels plus any other abnormalities of lymphocyte, higher blood urea nitrogen or lactate dehydrogenase, and higher platelet count were predictors of poor prognosis and mortality in the elderly. Studies have also shown that previous treatment with renin-angiotensin-aldosterone system inhibitors, pharmacological treatments of respiratory disorders, antibiotics, corticosteroids, vitamin K antagonist, antihistamines, azithromycin, Itolizumab (an anti-CD6 monoclonal antibody) in combination with other antivirals reduces COVID-19 worsening and mortality. Vaccination against seasonal influenza might also reduce COVID-19 mortality.

CONCLUSION

Overall, a critical consideration is necessary for the care and management of COVID-19 in the aged population considering the drastic contrasts in manifestation and prognosis compared to other age groups. Mortality from COVID-19 is independently associated with the patient's age. Elderly patients with COVID-19 are more vulnerable to poor outcomes. Thus, strict preventive measures, timely diagnosis, and aggressive therapeutic/nontherapeutic care are of great importance to reduce acute respiratory distress syndrome and severe complications in older people.

Developing an SDSS for optimal sustainable roof covering planning based on UHI variation at neighborhood scale

Nowadays, academics have paid special attention to global warming, because it has several issues such as urban heat island (UHI) related to the quality of life. For this purpose, a spatial decision support system (SDSS) has been developed to investigate the effect of parcels' roof covering type on surface heat island (SHI) values and its variation at the neighborhood scale in Tehran, Iran. This SDSS, as the innovation of the present research, consists of two main steps including estimating the UHI value in the study area and adopting the optimum set of parcels to change their roofs' cover with three types of vegetation, high-albedo material, and flagstone. The first step is accomplished by aggregating various indices related to land cover obtained from Landsat 8 images. The aggregation is done by linear regression method (LRM) with an RMSE and R² equal to 0.942 and 0.897, respectively. Then, the genetic algorithm was used to select the optimal subset, including 10% of the parcels in the area, to change their roof covering type based on minimizing the UHI's variation. The standard deviation obtained after the changes improved from 13.222 to 10.781 °C. The results indicate that to control UHI in the center of the region, it is necessary to inhibit UHI effects at the boundary of the study area with vegetation roof covering since flagstone and high-albedo materials have local effects on controlling the UHI effects.

Medullary thyroid cancer is associated with high serum vitamin D level and polymorphism of vitamin D receptors

Background

Thyroid cancer is the most common endocrine malignancy. Studies have observed an anti-cancer effect for vitamin D and found that polymorphisms of vitamin D receptors can influence the prevalence of various cancers. The present study investigated the serum level of vitamin D and FokI, BsmI and Tru9I polymorphisms of vitamin D receptors.

Methods

Forty patients with medullary thyroid cancer and 40 healthy controls were investigated. The genomic DNA of the subjects was extracted using saturated salt/proteinase K and investigated by PCR sequencing. Serum levels of vitamin D were evaluated by ELISA. The results were analyzed in SPSS and GraphPad Prism 5 software.

Results

The genotypic and allelic frequencies of FokI and BsmI polymorphisms showed no significant differences between test and control groups. For Tru9I polymorphism, Tt genotype and t allelic frequency in the test group were significantly different from those of the control group. Also, we found Tt genotype and t allelic frequency to be significantly associated with medullary thyroid cancer (MTC) type and the agressiveness of the disease. The average serum vitamin D level was 23.32 ng/mL and 18.95 ng/mL for patients and controls, respectively, and the difference between the two groups was statistically significant. Moreover, we found high serum vitamin D level to be associated with t allelic frequency.

Conclusions

Unexpectedly, the mean serum vitamin D level of the test group was significantly higher than that of the control group. Tru9I polymorphism was found to be significantly correlated with the prevalence of medullary thyroid carcinoma.

Effects of Stachys sylvatica hydroalcoholic extract on the ovary and hypophysis-gonadal axis in a rat with polycystic ovary syndrome

Background

Polycystic ovary syndrome (PCOS) is the most common endocrinopathy affecting women. The purpose of this study is to evaluate the effects of Stachys sylvatica hydroalcoholic extract on biochemical and histological parameters in a rat model of polycystic ovary syndrome. Thirty adult female Wistar rats with an average weight of 180 g were divided into five groups of six rats. Animals were divided into groups of control, PCOS (intramuscular injection of 2 mg estradiol valerate, Aburaihan Co., Iran/rat, once), and treated with hydroalcoholic extract of Stachys sylvatica. After 60 days of PCOS induction, 100, 250, and 500 mg/kg BW Stachys sylvatica hydroalcoholic extract were injected intraperitoneally. The control group was just injected with olive oil as a solvent. After 10 days of treatment, animals were weighed and then sacrificed and blood samples were taken from their heart for hormonal studies. Ovaries of all groups were cut for histological studies and fixed in formaldehyde, and 7-μm sections were prepared by microtome and stained using hematoxylin–eosin. The data were analyzed by one-way ANOVA and Tukey-Kramer post hoc test with the SPSS software. The significant level was p < 0.05.

Results

The Stachys sylvatica extract can improve obesity in the PCOS group. The histological and hormonal results showed that PCOS induction can decrease the number of preantral, antral, and Graafian follicles as well as corpus luteum in comparison with the control (p < 0.001), whereas the number of cystic follicles increased significantly (p < 0.001). After treatment with Stachys sylvatica hydroalcoholic extract (500 mg/kg), a significant increase was observed in all these parameters. In addition, the number of cystic follicles decreased significantly (p < 0.001). The level of LH and FSH hormones decreased significantly (p < 0.01) in the PCOS group compared with the control. In contrast, the estrogen level increased significantly (p < 0.01). In the 250 and 500 mg/kg group, treatment with the extract could increase FSH and decrease estrogen concentration significantly relative to the PCOS group (p < 0.01). Results of antral follicle morphometry indicated an increase in follicle diameter and theca thickness, but the thickness of the granulosa layer decreased significantly. An improvement in these measurements was observed in the treated PCOS groups with all doses.

Conclusions

It can be concluded that Stachys sylvatica hydroalcoholic extract can improve some symptoms of polycystic ovary syndrome because of components such as iridoids, flavonoids, and sesquiterpenes with antioxidant and anti-inflammatory effects. In this experiment, 500 mg/kg dose of extract was considered as the most effective dose.

Antibody-Mediated Resistance to Rhizomania Disease in Sugar Beet Hairy Roots

Agrobacterium rhizogenes-mediated transformation of sugar beet hairy roots expressing single-chain variable fragment (scFv) was exploited to evaluate the efficacy of four antibody-based constructs for interfering with the Beet necrotic yellow vein virus infection. The scFv specific to a major coat protein of virus, p21, was targeted to various cellular compartments including the cytosol (pIC and pICC constructs), apoplast (pIA), and mitochondrion (pIM). After mechanical virus inoculation, most of the hairy root clones expressing scFv in the cytosol displayed low virus titers while the majority of transgenic hairy root clones accumulated antibody in outer membrane of mitochondria or apoplast were infected. This hairy root system provided an efficient and rapid approach to initially investigating root disease resistance like rhizomania prior to transform whole recalcitrant plants such as sugar beet.

Fluctuation relation for heat exchange in Markovian open quantum systems

A fluctuation relation for the heat exchange of an open quantum system under a thermalizing Markovian dynamics is derived. We show that the probability that the system absorbs an amount of heat from its bath, at a given time interval, divided by the probability of the reverse process (releasing the same amount of heat to the bath) is given by an exponential factor which depends on the amount of heat and the difference between the temperatures of the system and the bath. Interestingly, this relation is akin to the standard form of the fluctuation relation (for forward-backward dynamics). We also argue that the probability of the violation of the second law of thermodynamics in the form of the Clausius statement (i.e., net heat transfer from a cold system to its hot bath) drops exponentially with both the amount of heat and the temperature differences of the baths.

Vaccination with human amniotic epithelial cells confer effective protection in a murine model of Colon adenocarcinoma

As a prophylactic cancer vaccine, human amniotic membrane epithelial cells (hAECs) conferred effective protection in a murine model of colon cancer. The immunized mice mounted strong cross-protective CTL and antibody responses. Tumor burden was significantly reduced in tumor-bearing mice after immunization with hAECs. Placental cancer immunotherapy could be a promising approach for primary prevention of cancer. In spite of being the star of therapeutic strategies for cancer treatment, the results of immunotherapeutic approaches are still far from expectations. In this regard, primary prevention of cancer using prophylactic cancer vaccines has gained considerable attention. The immunologic similarities between cancer development and placentation have helped researchers to unravel molecular mechanisms responsible for carcinogenesis and to take advantage of stem cells from reproductive organs to elicit robust anti-cancer immune responses. Here, we showed that vaccination of mice with human amniotic membrane epithelial cells (hAECs) conferred effective protection against colon cancer and led to expansion of systemic and splenic cytotoxic T cell population and induction of cross-protective cytotoxic responses against tumor cells. Vaccinated mice mounted tumor-specific Th1 responses and produced cross-reactive antibodies against cell surface markers of cancer cells. Tumor burden was also significantly reduced in tumor-bearing mice immunized with hAECs. Our findings pave the way for potential future application of hAECs as an effective prophylactic cancer vaccine.

Promising gene delivery system based on polyethylenimine-modified silica nanoparticles

This article reports on the synthesis and full characterization of innovative silica-based nanoparticle composed of fumed silica as a core decorated with polyethylenimine (PEI) with different molecular weights (25, 10 and 1.8 kDa). Wide range of analytical, spectroscopic, and microscopic methods (TEM, DLS, ζ potential, elemental analysis (EA), TNBS and FTIR) were used to characterize the nanoparticles. Furthermore, transfection efficiency of these nanoparticles as non-viral vector was examined. The silica-PEI conjugates retained both the ability of PEI to fully condense plasmid DNA at low N/P ratios and suitable buffering capacity at the endosomal pH range. PEI-functionalized silica remarkably enhanced EGFP-N1 gene expression in murine neuroblastoma (Neuro-2A) cells up to 38 folds compared to PEI 25 kDa. Meanwhile the results of the cytotoxicity assays indicated that these silica-PEI conjugates have acceptable level of viability.

Proteomics screening of adenosine triphosphate-interacting proteins in the liver of diazinon-treated rats

AIM

Diazinon (DZN) is one of the most important organophosphorus compounds used to control pests in agriculture in many countries. Several studies have shown that exposure to DZN may alter protein expression in the liver. In order to further investigate the mechanism of DZN toxicity, differentially expressed ATP-interacting proteins, following subacute exposure to toxin, were separated and identified in rat liver.

MAIN METHODS

Male rats were equally divided into four groups: control (corn oil) and DZN (15 mg/kg) by gavage once a day for 4 weeks. After homogenization of liver tissue, lysates were incubated ATP-sepharose beads. After several washes, ATP-interacting proteins were eluted and separated on 2-D polyacrylamide gels. Deferentially expressed proteins were cut and identified using matrix-assisted laser desorption/ionization/time-of-flight and Mascot database. Identified proteins were classified according to their biological process using protein analysis through evolutionary relationships (PANTHER) Web site.

KEY FINDING

In this work, we showed that several key proteins involved in biological processes such as antioxidant system, oxidative stress, apoptosis, and metabolism were differentially expressed after subacute exposure to DZN.

Identification of possible cytotoxicity mechanism of polyethylenimine by proteomics analysis

Polyethylenimine (PEI) is a polycation widely used for successful gene delivery both in vitro and in vivo experiments. However, different studies showed that PEI could be cytotoxic to transfected cells, and the mechanism of toxicity is poorly understood. Identification of PEI-interacting proteins may help in understanding the toxicity pathways. In this study, we investigated proteins that could interact with PEI in human colorectal adenocarcinoma cells (HT29). In order to identify the proteins interacting with PEI, PEI was immobilized to sepharose beads as solid matrix. The HT29 cell lysate were passed through the matrix. PEI-bound proteins were isolated, and further separation was performed by two-dimensional gel electrophoresis. After gel digestion, proteins were identified by matrix-assisted laser desorption/ionization-time-of-flight (TOF)/TOF mass spectrometry. Our data indicated that most of the identified PEI-interacting proteins such as shock proteins, glutathione-S-transferases, and protein disulfide isomerase are involved in apoptosis process in cells. Thus, although this is a preliminary experiment implicating the involvement of some proteins in PEI cytotoxicity, it could partly explain the mechanism of PEI cytotoxicity in cells.

Joint sparse representation of brain activity patterns in multi-task fMRI data

A single-task functional magnetic resonance imaging (fMRI) experiment may only partially highlight alterations to functional brain networks affected by a particular disorder. Multivariate analysis across multiple fMRI tasks may increase the sensitivity of fMRI-based diagnosis. Prior research using multi-task analysis in fMRI, such as those that use joint independent component analysis (jICA), has mainly assumed that brain activity patterns evoked by different tasks are independent. This may not be valid in practice. Here, we use sparsity, which is a natural characteristic of fMRI data in the spatial domain, and propose a joint sparse representation analysis (jSRA) method to identify common information across different functional subtraction (contrast) images in data from a multi-task fMRI experiment. Sparse representation methods do not require independence, or that the brain activity patterns be nonoverlapping. We use functional subtraction images within the joint sparse representation analysis to generate joint activation sources and their corresponding sparse modulation profiles. We evaluate the use of sparse representation analysis to capture individual differences with simulated fMRI data and with experimental fMRI data. The experimental fMRI data was acquired from 16 young (age: 19-26) and 16 older (age: 57-73) adults obtained from multiple speech comprehension tasks within subjects, where an independent measure (namely, age in years) can be used to differentiate between groups. Simulation results show that this method yields greater sensitivity, precision, and higher Jaccard indexes (which measures similarity and diversity of the true and estimated brain activation sources) than does the jICA method. Moreover, superiority of the jSRA method in capturing individual differences was successfully demonstrated using experimental fMRI data.

Evaluation of Protein Ubiquitylation in Heart Tissue of Rats Exposed to Diazinon (an Organophosphate Insecticide) and Crocin (an Active Saffron Ingredient): Role of HIF-1α

INTRODUCTION

Organophosphate compounds, such as diazinon (DZN), are widely used in agriculture and can lead to formation of reactive oxygen species (ROS) in cardiovascular system. ROS are highly toxic since they can cause serious changes in proteins including ubiquitylation. Crocin (a carotenoid isolated from saffron), has protective effects against DZN cardiotoxicity. In this study level of total protein ubiquitylation as markers of oxidative stress and level of ubiquitin-HIF-1α and P53, known substrates of ubiquitylation, in rat hearts exposed to DZN and crocin were evaluated.

METHODS

Rats were divided into 7 groups: corn oil (control), DZN (15 mg/kg/day, gavage), crocin (12.5, 25, 50 mg/kg/day, i. p.) plus DZN, vitamin E (200 IU/kg, i. p., 3 days a week) plus DZN and crocin (50 mg/kg/day, i. p.). Treatments were continued for 4 weeks. Total protein ubiquitylation, total HIF-1α and P53 were analyzed by western blotting. Total HIF-1α and P53 were purified by immunoprecipitation (IP) and ubiquitin- HIF-1α and P53 were analyzed by western blotting.

RESULTS

Higher protein ubiquitylation levels were observed in DZN treated rats. Decrease in ubiquitin-HIF-1α was also shown, and leads to higher HIF-1α protein levels in DZN group. Crocin (50 mg/kg) and vit. E protected cells against DZN protein ubiquitylation. Significant differences were not observed between the ubiquitin - P53 and total P53 protein levels.

CONCLUSION

Our results showed that ubiquitylation could be considered as a marker of oxidative stress in rats exposed to DZN. Increase in level of HIF-α may compensate adverse effect of DNZ in rat heart.

Tailor-made directional emission in nanoimprinted plasmonic-based light-emitting devices

We demonstrate an enhanced and tailor-made directional emission of light-emitting devices using nanoimprinted hexagonal arrays of aluminum nanoparticles. Fourier microscopy reveals that the luminescence of the device is not only determined by the material properties of the organic dye molecules but is also strongly influenced by the coherent scattering resulting from periodically arranged metal nanoparticles. Emitters can couple to lattice-induced hybrid plasmonic-photonic modes sustained by plasmonic arrays. Such modes enhance the spatial coherence of an emitting layer, allowing the efficient beaming of the emission along narrow angular and spectral ranges. We show that tailoring the separation of the nanoparticles in the array yields an accurate angular distribution of the emission. This combination of large-area metal nanostructures fabricated by nanoimprint lithography and light-emitting devices is beneficial for the design and optimization of solid-state lighting systems.

Spiritual care in nursing: a concept analysis

BACKGROUND

Around the world, spiritual care in nursing is a critical part of providing holistic care, but within our profession, there is a lack of certainty over the meaning of spirituality and delivery of spiritual care, including nurses thinking of spirituality as religion.

METHODS

We adopted the eight-step Walker and Avant's concept analysis approach to provide a definition of the concept, searching and analysing international and national online databases. Inclusion criterion included that articles were published between 1950 and 2012 in English or Persian language. Finally, 151 articles and 7 books were included in the analysis.

FINDINGS

The attributes of spiritual care are healing presence, therapeutic use of self, intuitive sense, exploration of the spiritual perspective, patient-centredness, meaning-centred therapeutic intervention and creation of a spiritually nurturing environment. Spiritual care is a subjective and dynamic concept, a unique aspect of care that integrates all the other aspects. It emerges in the context of nurses' awareness of the transcendent dimension of life and reflects a patient's reality. The provision of spiritual care leads to positive consequences such as healing for patients and promotion of spiritual awareness for nurses.

IMPLICATIONS FOR NURSING AND HEALTH POLICY

The conceptual definition of spiritual care provided in this study can help clinical nurses, educators and nurse managers to develop and implement evidence-based health policies, comprehensive staff training programmes and practical quality assessment guidelines to try to ensure that all nurses are competent to include relevant spiritual care in practice.

CONCLUSION

A comprehensive definition of the concept of spiritual care ensued. The findings can facilitate further development of nursing knowledge and practice in spiritual care and facilitate correction of common misconceptions about the provision of spiritual care.

Identification and determination of the fatty acid composition of Quercus brantii growing in southwestern Iran by GC-MS

This article reports the fatty acid composition of the oil extracts from Quercus brantii fruits growing in Kohgiloye va Boyer Ahmad province in southwestern Iran. The oil from Q. brantii fruits was extracted with hexane in Soxhlet apparatus and subsequently identified and determined by using gas chromatography-mass spectroscopy. The results revealed that the major fatty acids were oleic acid (52.99-66.14%), linoleic acid (10.80-11.11%), palmitic acid (8.08-10.06%), stearic acid (0.74-1.57%), α-linolenic acid (0.19-0.35%), erucic acid (0.12-0.15%) and arachidic acid (0.12-0.13%). The total proportion of unsaturated and saturated oil was 64.60-77.27% and 9.17-11.75%, respectively. Results indicate that the fruits of Q. brantii contained 0.19-0.35% omega-3, 10.92-14.77% omega-6 and 53.14-66.26% omega-9. Therefore, Q. brantii can be introduced as rich sources of fatty acid in food dietary and medical health.

Automatic Detection of Malignant Melanoma using Macroscopic Images

In order to distinguish between benign and malignant types of pigmented skin lesions, computerized procedures have been developed for images taken by different equipment that the most available one of them is conventional digital cameras. In this research, a new procedure to detect malignant melanoma from benign pigmented lesions using macroscopic images is presented. The images are taken by conventional digital cameras with spatial resolution higher than one megapixel and by considering no constraints and special conditions during imaging. In the proposed procedure, new methods to weaken the effect of nonuniform illumination, correction of the effect of thick hairs and large glows on the lesion and also, a new threshold-based segmentation algorithm are presented. 187 features representing asymmetry, border irregularity, color variation, diameter and texture are extracted from the lesion area and after reducing the number of features using principal component analysis (PCA), lesions are determined as malignant or benign using support vector machine classifier. According to the dermatologist diagnosis, the proposed processing methods have the ability to detect lesions area with high accuracy. The evaluation measures of classification have indicated that 13 features extracted by PCA method lead to better results than all of the extracted features. These results led to an accuracy of 82.2%, sensitivity of 77% and specificity of 86.93%. The proposed method may help dermatologists to detect the malignant lesions in the primary stages due to the minimum constraints during imaging, the ease of usage by the public and nonexperts, and high accuracy in detection of the lesion type.

Classification of individuals based on sparse representation of brain cognitive patterns: a functional MRI study

Many neurological disorders can change patterns of brain activity observed in functional imaging studies. These functional differences may be useful for classification of individuals into diagnostic categories. However, due to the high dimensionality of the input feature space and small set of subjects that are usually available, classification based on fMRI data is not trivial. Here, we evaluate the use of a Sparse Representation Analysis method within a Fisher Linear Discriminant (FLD) classification method, taking functional patterns characteristic of different cognitive tasks as the data input. As a test dataset, with a clear 'gold-standard' classification, we attempt to classify individuals as young, or older, based only on functional activation patterns in a speech listening task. Thirty two young (age: 19-26) and older (age: 57-73) adults (16 each) were scanned while listening to noise and to sentences degraded with noise, half of which contained meaningful context that could be used to enhance intelligibility. Different functional contrast images were used within K-SVD to generate basis activation sources and their corresponding sparse modulation profiles. Sparse modulation profiles were used in a FLD framework to classify individuals into the young and older categories. The results demonstrate the feasibility of the general approach, and confirm the potential applicability of the proposed method for real-world diagnostic problems.

Color Doppler indexes in early phase after kidney transplantation and their association with kidney function on six month follow up

BACKGROUND

Doppler ultrasonography (DU) and measurement of its indexes, resistive index (RI) and pulsatility index (PI), is used to investigate transplanted kidney hemodynamic status and function. The aim of this study was to determine the correlation between Doppler indexes in the early phase after transplantation with long-term transplanted kidney function.

MATERIALS AND METHODS

In this cross-sectional study on 38 newly kidney transplant patients, we performed DU with assessment of its indexes within 48 hours, 1 week, and 6 months after kidney transplantation. Serum creatinine after stability and 6 months after kidney transplantation were assessed. Cyclosporine level was measured 1 week after kidney transplantation and compared with DU indexes.

RESULTS

About 71% of kidney transplanted patients reached their normal initial creatinine level(cr<1.5 mg/ dl) and 28% of all patients were involved in kidney dysfunction after 6 months (increase in basic creatinine level more than 25%).There was no significant difference between mean RI and PI in patients with normal and disturbed kidney function based on creatinine level in early posttransplantation period but there was linear correlation between mean RI and PI within 48 hours and 1 week with kidney function after 6 months. Also no association between cyclosporine level and RI and PI was shown. There was a direct association between age and the levels of RI and PI 6 months after transplantation.

CONCLUSION

This study suggests assessment of RI and PI in early period after transplantation and can be used as predictive parameters for long-term function of transplanted kidney and RI more than 0.80 in early phase after transplantation has an acceptable sensitivity and specificity to predict long-term kidney dysfunction.

Demographic Profiles of Adult Trauma During a 5 Year Period (2007-2011) in Kashan, IR Iran

Background

Trauma, in addition to mortality and disability experienced by an individual, imposes direct and indirect economic and social costs on a community. Traditionally, trauma is a disease of young and middle age adults, an age group which is known to be the most dynamic and economically productive of the community. Increasing our knowledge concerning the etiology and patterns of trauma seems to be the most profitable and accessible way to prevent injuries of this nature.

Objectives

This study was designed to evaluate the epidemiology of adult trauma in Kashan, Iran.

Patients and Methods

The current study used a retrospective cross-sectional approach, enrolling all trauma adults (20 - 60 y) admitted to the Shahid Beheshti Hospital, Kashan, between 2007 and 2011. Age, gender, place of residence, work status, educational level, urban/rural location of the accident, method of transportation to hospital, injured body areas of the victims and therapeutic interventions, were extracted from the data registry and analyzed through descriptive statistics using SPSS software.

Results

A total of 22 564 patients were included in this study. Mean age of the victims was 33.18 ± 10.90 years and the male/female ratio was 4:1. Most of the victims were manual workers (61%), and they had completed primary and junior high school level education (49.4%), they were also more likely to be residents of urban areas (88.6%). Regarding the place of injury, most accidents occurred on city streets (43.8%). Approximately 40% of the total victims were transferred to the hospital by emergency medical services (EMS). During the study period, 260 deaths were recorded and among these, 76% were related to traffic accidents.

Conclusions

Regarding the high prevalence of trauma found in manual workers with low educational levels and motorbike users, the establishment of an integrated program aimed at improving public knowledge on the use of safety and protective measures in work environments should be implemented. The use of safety protective equipment by cyclists, motorbikers and car passengers should also be enforced.