همبستگی عزت نفس با پیشرفت تحصیلی در دانشجویان دانشکده‌ی پرستاری و مامایی زنجان 1388

زمینه و هدف: یکی از بزرگترین معضلات آموزشی، افت تحصیلی دانشجویان است. بنابراین توجه به بهداشت روانی و پیشرفت تحصیلی این گروه اهمیت به‌سزایی دارد. پاره‌ای از مطالعات بیانگر ارتباط مستقیم بین عزت نفس و پیشرفت تحصیلی است، لیکن بعضی از صاحب نظران رابطه‌ی مستقیم این دو را مورد تردید قرار داده‌اند. این پژوهش با هدف تعیین همبستگی عزت نفس با پیشرفت تحصیلی دانشجویان دانشکده‌ی پرستاری و مامایی زنجان انجام شده است. روش بررسی: این پژوهش یک مطالعه‌ی همبستگی بود، کلیه‌ی دانشجویان دانشکده‌ی پرستاری و مامایی زنجان که حداقل دو نیم‌سال سابقه‌ی تحصیلی داشتند، (182 نفر) در مطالعه شرکت کردند. ابزار جمع‌آوری اطلاعات پرسش‌نامه بود. پرسش‌نامه از دو بخش شامل: ویژگی‌های فردی و تحصیلی واحدهای پژوهش و آزمون 58 سوالی عزت نفس کوپراسمیت تشکیل شده بود. یافته‌ها: ضریب همبستگی پیرسون رابطه‌ی معنی‌داری بین عزت نفس و پیشرفت تحصیلی دانشجویان نشان داد (31/0= r ). ولی عزت نفس با سن و جنسیت ارتباط آماری معنی‌داری نداشت (05/0 P ). نتیجه‌گیری: با توجه به وجود همبستگی مثبت بین عزت نفس و پیشرفت تحصیلی دانشجویان، به نظر می‌رسد استفاده از روش‌های تقویت عزت نفس می‌تواند در جلوگیری از افت تحصیلی دانشجویان نقش داشته باشد

Magnetic resonance imaging and histology correlation in Cushing's disease

Introduction We continuously look for new techniques to improve the radicality of resection and to eliminate the negative effects of surgery. One of the methods that has been implemented in the perioperative management of Cushing's disease was the combination of three magnetic resonance imaging (MRI) sequences: SE, SPGR and fSPGR. Material and methods We enrolled 41 patients (11 males, 30 females) diagnosed with Cushing's disease. A 3D tumour model with a navigation console was developed using each SPGR, fSPGR and SE sequence. The largest model was then used. In all cases, a standard four-handed, bi-nostril endoscopic endonasal technique was used. Endocrinological follow-up evaluation using morning cortisol sampling was performed for 6–34 months in our study. Results In total, 36 patients (88%) were disease-free following surgery. Our results indicate we achieved 100% sensitivity of MR. Overall, the conformity of at least one donor site, as compared with the places designated on MR, was in 78% of patients. We searched the place of compliance in individual locations. There is a consensus in individual locations in 63 of the 123 cases (or 56%). The correlation gamma function at a 5% significance level was then 0.27. Discussion The combination of MR sequences (SE, SPGR, fSPGR), neuronavigation system and iMRI led to increased sensitivity of up to 100%. Specificity reached 56% in our study. Conclusion We found a high success rate in surgical procedure in terms of the correlation between MR findings and histology, which leads to remission of Cushing's disease

Decompression alone versus decompression with instrumented fusion in the treatment of lumbar degenerative spondylolisthesis: a systematic review and meta-analysis of randomised trials

Objective To determine the efficacy of adding instrumented spinal fusion to decompression to treat degenerative spondylolisthesis (DS). Design Systematic review with meta-analysis. Data sources MEDLINE, Embase, Emcare, Cochrane Library, CINAHL, Scopus, ProQuest Dissertations & Theses Global, ClinicalTrials.gov and WHO International Clinical Trials Registry Platform from inception to May 2022. Eligibility criteria for study selection Randomised controlled trials (RCTs) comparing decompression with instrumented fusion to decompression alone in patients with DS. Two reviewers independently screened the studies, assessed the risk of bias and extracted data. We provide the Grading of Recommendations, Assessment, Development and Evaluation assessment of the certainty of evidence (COE). Results We identified 4514 records and included four trials with 523 participants. At a 2-year follow-up, adding fusion to decompression likely results in trivial difference in the Oswestry Disability Index (range 0–100, with higher values indicating greater impairment) with mean difference (MD) 0.86 (95% CI −4.53 to 6.26; moderate COE). Similar results were observed for back and leg pain measured on a scale of 0 to 100, with higher values indicating more severe pain. There was a slightly increased improvement in back pain (2-year follow-up) in the group without fusion shown by MD −5·92 points (95% CI −11.00 to −0.84; moderate COE). There was a trivial difference in leg pain between the groups, slightly favouring the one without fusion, with MD −1.25 points (95% CI −6.71 to 4.21; moderate COE). Our findings at 2-year follow-up suggest that omitting fusion may increase the reoperation rate slightly (OR 1.23; 0.70 to 2.17; low COE). Conclusions Evidence suggests no benefits of adding instrumented fusion to decompression for treating DS. Isolated decompression seems sufficient for most patients. Further RCTs assessing spondylolisthesis stability are needed to determine which patients would benefit from fusion. PROSPERO registration number CRD42022308267

Outcomes of patients after successful left ventricular assist device explantation: a EUROMACS study

Aims: Sufficient myocardial recovery with the subsequent explantation of a left ventricular assist device (LVAD) occurs in approximately 1–2% of the cases. However, follow-up data about this condition are scarcely available in the literature. This study aimed to report the long-term outcomes and clinical management following LVAD explantation. Methods and results: An analysis of the European Registry for Patients with Mechanical Circulatory Support was performed to identify all adult patients with myocardial recovery and successful explantation. Pre-implant characteristics were retrieved and compared with the non-recovery patients. The follow-up data after explantation were collected via a questionnaire. A Kaplan–Meier analysis for freedom of the composite endpoint of death, heart transplantation, LVAD reimplantion, or heart failure (HF) relapse was conducted. A total of 45 (1.4%) cases with myocardial recovery resulting in successful LVAD explantation were identified. Compared with those who did not experience myocardial recovery, the explanted patients were younger (44 vs. 56 years, P < 0.001), had a shorter duration of cardiac disease (P < 0.001), and were less likely to have ischaemic cardiomyopathy (9% vs. 41.8%, P < 0.001). Follow-up after explantation could be acquired in 28 (62%) cases. The median age at LVAD implantation was 43 years (inter-quartile range: 29–52),

Diagnostic challenges in complicated case of glioblastoma

Glioblastoma is the commonest primary malignant brain tumor, with a very poor prognosis and short overall survival. It is characterized by its high intra- and intertumoral heterogeneity, in terms of both the level of single-nucleotide variants, copy number alterations, and aneuploidy. Therefore, routine diagnosis can be challenging in some cases. We present a complicated case of glioblastoma, which was characterized with five cytogenomic methods: interphase fluorescence in situ hybridization, multiplex ligation-dependent probe amplification, comparative genomic hybridization array and single-nucleotide polymorphism, targeted gene panel, and whole-genome sequencing. These cytogenomic methods revealed classical findings associated with glioblastoma, such as a lack of IDH and TERT mutations, gain of chromosome 7, and loss of chromosome 10. At least three pathological clones were identified, including one with whole-genome duplication, and one with loss of 1p and suspected loss of 19q. Deletion and mutation of the TP53 gene were detected with numerous breakends on 17p and 20q. Based on these findings, we recommend a combined approach to the diagnosis of glioblastoma involving the detection of copy number alterations, mutations, and aneuploidy. The choice of the best combination of methods is based on cost, time required, staff expertise, and laboratory equipment. This integrated strategy could contribute directly to tangible improvements in the diagnosis, prognosis, and prediction of the therapeutic responses of patients with brain tumors

The European Registry for Patients with Mechanical Circulatory Support of the European Association for Cardio-Thoracic Surgery:third report

OBJECTIVES: In the third report of the European Registry for Patients with Mechanical Circulatory Support of the European Association for Cardio-Thoracic Surgery, outcomes of patients receiving mechanical circulatory support are reviewed in relation to implant era. METHODS: Procedures in adult patients (January 2011-June 2020) were included. Patients from centres with 3 months). Risk factors for death were explored using univariable Cox regression with a stepwise time-varying hazard ratio (3 months). RESULTS: In total, 4834 procedures in 4486 individual patients (72 hospitals) were included, with a median follow-up of 1.1 (interquartile range: 0.3-2.6) years. The annual number of implants (range: 346-600) did not significantly change (P = 0.41). Both Interagency Registry for Mechanically Assisted Circulatory Support class (classes 4-7: 23, 25 and 33%; P 3 months: 0.45). Bilirubin and creatinine levels were significant risk factors in the early phase but not in the late phase after the implant. CONCLUSIONS: In its 10 years of existence, EUROMACS has become a point of reference enabling benchmarking and outcome monitoring. Patient characteristics and outcomes changed between implant eras. In addition, both occurrence of outcomes and risk factor weights are time dependent

The fourth report of the European Registry for Patients with Mechanical Circulatory Support (EUROMACS) of the European Association for Cardiothoracic Surgery: focus on standardized outcome ratios

OBJECTIVES: This 4th report aimed to provide insights into patient characteristics, outcomes and standardized outcome ratios of patients implanted with durable Mechanical Circulatory Support across participating centres in the European Registry for Patients with Mechanical Circulatory Support (EUROMACS) registry. METHODS: All registered patients receiving durable mechanical circulatory support up to August 2024 were included. The expected number of events was predicted using penalized logistic regression. Standardized outcome ratios (Observed/Expected events) were presented in plots to assess 30-day and 1-year mortality, ischaemic stroke and major bleeding outcomes. Expected events were estimated using penalized logistic regression using demographics and comorbidities as predictors. Centres with <90% follow-up completeness were excluded from standardized outcome ratio assessment. RESULTS: Analysis included 6962 implants in 6408 patients (457 patients underwent repeated implants) registered in EUROMACS from 17 countries (32 centres) (median age: 58 years, 83% males, 17% Interagency Registry for Mechanically Assisted Circulatory Support class 1). Thirty-day mortality, major bleeding and ischaemic stroke probabilities were 9.6, 12.6% and 2.1%, respectively. Standardized mortality ratios showed variability between centres, ranging from 0 (95% CI 0–0) to 1.4 (95% CI 1.2–1.7). Higher standardized bleeding outcome ratios correlated with higher standardized ischaemic stroke ratio’s (Spearman r: 0.56, P ¼ 0.008). CONCLUSIONS: Most included centres perform as expected given the demographics and comorbidities of patients. A positive correlation was found between standardized bleeding and ischaemic stroke ratios, reflecting the need of continuously monitoring of adverse events by quality improvement programs

Mixed finite element solutions to contact problems of nonlinear Gao beam on elastic foundation

This paper analyzes nonlinear contact problems of a large deformed beam on an elastic foundation. The beam model is governed by a nonlinear fourth-order differential equation developed by Gao (1996); while the elastic foundation model is assumed as Winkler’s type. Based on a decomposition method, the nonlinear variational inequality problem is able to be reformed as a min–max problem of a saddle Lagrangian. Therefore, by using mixed finite element method with independent discretization–interpolations for foundation and beam elements, the nonlinear contact problem in continuous space is eventually converted as a nonlinear mixed complementarity problem, which can be solved by combination of interior-point and Newton methods. Applications are illustrated by different boundary conditions. Results show that the nonlinear Gao beam is more stiffer than the Euler–Bernoulli beam