Drug addiction is one of the current world’s hygienic, mental and social problems. There are different treatments for this illness. MMT (Methadone Maintenance Therapy) is considered as a standard and acceptable thera...Drug addiction is one of the current world’s hygienic, mental and social problems. There are different treatments for this illness. MMT (Methadone Maintenance Therapy) is considered as a standard and acceptable therapy for addiction;and there are many affecting factors regarding gaining success in this type of treatment. In this study, we investigated some of these factors. One of the most important issues in MMT is to keep up patient on his/her treatment till complete abstinence;therefore, it is recommended that the patient does not leave his/her therapy without discretion of the therapist. In this study, 230 patients, who began MMT, and admitted to addiction treatment centers of Yazd province were included. In this study, the survival rate in the first, third, and sixth months were evaluated as 93.9%, 63.48%, and 28.36%, respectively. It was found that following parameters are important in rate of survival during treatment: family support, gender, dose of methadone and concomitant use of morphine during treatment. Moreover, factors like level of education, marital status, age and concomitant use of methamphetamine during treatment can be effective in this regard.展开更多
Objective: Little is known about the prescription pattern of psychotropic drugs for patients with schizophrenia in Pakistan. The purpose of this study was to evaluate the characteristic features of psychotropic drug p...Objective: Little is known about the prescription pattern of psychotropic drugs for patients with schizophrenia in Pakistan. The purpose of this study was to evaluate the characteristic features of psychotropic drug prescriptions for patients with schizophrenia in Pakistan. Methods: Three centers in Pakistan participated in a large scale collaborative study known as Research on Asian Prescription Pattern (REAP). The 2016 REAP survey included centers from 15 countries in Asia and used a unified research protocol. The design of the study was quantitative and of descriptive epidemiology. Analysis was made on the data collected from three centers i.e., Lahore, Karachi and Islamabad. The data collected in Pakistan were compared with those from other Asian countries. The details of REAP were presented on the homepage of REAP (http://www.REAP.Asia). Results: From Pakistan, 298 patients were included. Patients with schizophrenia in Pakistan received higher rate of antipsychotic polypharmacy and a higher rate of co-prescription of mood stabilizers and anxiolytics when compared with participants from other South Asian countries (India and Bangladesh). Conclusion: The main findings of the study were that a majority of the patients were prescribed antipsychotic polypharmacy drugs in Pakistan. Insufficient training on the use of psychotropic drugs and a lack of treatment guideline are considered to be the major contributing factors. Further education and training on the proper use of psychotropic drugs are recommended to psychiatrists in Pakistan. The guidelines on pharmacotherapy for patients with schizophrenia should also be developed and promoted in Pakistan.展开更多
Background:Maternal viral infection during pregnancy can lead to maternal immune activation(MIA),increasing the risk of neurodevelopmental disorders in offspring.Amantadine(AMA)exhibits antiviral activity and is widel...Background:Maternal viral infection during pregnancy can lead to maternal immune activation(MIA),increasing the risk of neurodevelopmental disorders in offspring.Amantadine(AMA)exhibits antiviral activity and is widely employed in the management of neurologic conditions.Nevertheless,the efficacy of AMA in treating MIA is currently not established.Methods:MIA was induced by polyinosinic acid-polycytidylic acid(poly(I:C));AMA was administered from embryonic(E)day 11.5 for 3 days.BV-2 cells were stimulated using poly(I:C)and treated with AMA.Behavior was assessed via open field test,elevated plus maze test,three-chamber sociability test,and marble burying test.Neuronal morphology was vizualized using Nissl stain;apoptosis via TUNEL(terminal deoxynucleotidyl transferase dUTP nick-end labeling)stain;protein expression(Iba1,NeuN,CD68,TNF-α[tumor necrosis factor-alpha],IL-1β[interleukin-1β])using immunofluorescence(IF);interleukin-6(IL-6)levels using enzyme-linked immunosorbent assay;reactive oxygen species using staining;Iba1,NeuN,Bcl-2,Bax,and cleaved caspase 3 using Western blot;and gene expression changes using RNA-seq.Results:AMA treatment reduced the levels of IL-6 in maternal blood,improved autism-like behaviors in MIA offspring,and effectively prevented neuronal damage and neuroinflammation.In vitro cellular studies have demonstrated that AMA effectively downregulates the expression levels of pro-inflammatory cytokines,including IL-6,TNF-α,and IL-1β.RNA-seq analysis indicated that AMA mitigates abnormal activation of microglia by modulating inflammatory pathways associated with IL-6.Conclusion:AMA can prevent the development of neuropsychiatric disorders in MIA offspring.This effect may be related to its ability to attenuate neuronal damage,reduce neuronal apoptosis,and inhibit neuroinflammation,indicating that the antiviral drug AMA may be a potential treatment for MIA.展开更多
Objective To establish a body composition analysis system based on chest CT,and to observe its value for evaluating content of chest muscle and adipose.Methods T7—T8 layer CT images of 108 pneumonia patients were col...Objective To establish a body composition analysis system based on chest CT,and to observe its value for evaluating content of chest muscle and adipose.Methods T7—T8 layer CT images of 108 pneumonia patients were collected(segmented dataset),and chest CT data of 984 patients were screened from the COVID 19-CT dataset(10 cases were randomly selected as whole test dataset,the remaining 974 cases were selected as layer selection dataset).T7—T8 layer was classified based on convolutional neural network(CNN)derived networks,including ResNet,ResNeXt,MobileNet,ShuffleNet,DenseNet,EfficientNet and ConvNeXt,then the accuracy,precision,recall and specificity were used to evaluate the performance of layer selection dataset.The skeletal muscle(SM),subcutaneous adipose tissue(SAT),intermuscular adipose tissue(IMAT)and visceral adipose tissue(VAT)were segmented using classical fully CNN(FCN)derived network,including FCN,SegNet,UNet,Attention UNet,UNET++,nnUNet,UNeXt and CMUNeXt,then Dice similarity coefficient(DSC),intersection over union(IoU)and 95 Hausdorff distance(HD)were used to evaluate the performance of segmented dataset.The automatic body composition analysis system was constructed based on optimal layer selection network and segmentation network,the mean absolute error(MAE),root mean squared error(RMSE)and standard deviation(SD)of MAE were used to evaluate the performance of automatic system for testing the whole test dataset.Results The accuracy,precision,recall and specificity of DenseNet network for automatically classifying T7—T8 layer from chest CT images was 95.06%,84.83%,92.27%and 95.78%,respectively,which were all higher than those of the other layer selection networks.In segmentation of SM,SAT,IMAT and overall,DSC and IoU of UNet++network were all higher,while 95HD of UNet++network were all lower than those of the other segmentation networks.Using DenseNet as the layer selection network and UNet++as the segmentation network,MAE of the automatic body composition analysis system for predicting SM,SAT,IMAT,VAT and MAE was 27.09,6.95,6.65 and 3.35 cm 2,respectively.Conclusion The body composition analysis system based on chest CT could be used to assess content of chest muscle and adipose.Among them,the UNet++network had better segmentation performance in adipose tissue than SM.展开更多
Objective:To explore the relationship between nursing professional values and ethical climate and nurses'professional quality of life.Methods:The present study is a descriptive,cross-sectional work in which 400 nu...Objective:To explore the relationship between nursing professional values and ethical climate and nurses'professional quality of life.Methods:The present study is a descriptive,cross-sectional work in which 400 nurses from various wards of hospitals in the south-east of Iran were studied.Data were collected using a questionnaire consisting of four sections:demographics,Nurses'Professional Values Scale-Revised(NPVS-R),the Hospital Ethical Climate Survey(HECS),and the Professional Quality of Life Scale(ProQOL).Results:The total mean scores for professional values were 105.29±15.60.The total mean score for the ethical climate was 100.09±17.11.The mean scores for the indexes of compassion satisfaction,burnout,and secondary traumatic stress were 45.29±8.93,34.38±6.84,and 32.15±7.02 respectively.The relationships between professional values and the indexes of compassion satisfaction(r=0.56),burnout(r=0.26),and secondary traumatic stress(r=0.18)were found to be positive and significant(P<0.001).Also,the relationships between ethical climate and the items of compassion satisfaction(r=0.60,P<0.001),burnout(r=0.15,P=0.002)were found to be positive and significant.Conclusion:An understanding of nurses'perception of professional values and improving the ethical climate at work can help nursing administrators identify more effective strategies toward increasing compassion satisfaction and lessening bumout and work-related stress.展开更多
Clozapine is the only antipsychotic in the United States that has been approved by the Food and Drug Administration (FDA) for treatment-resistant schizophrenia. It provides effective treatment even when patients do no...Clozapine is the only antipsychotic in the United States that has been approved by the Food and Drug Administration (FDA) for treatment-resistant schizophrenia. It provides effective treatment even when patients do not respond to other second- generation antipsychotics.[1] It also remains the most effective antipsychotic available. No existing first or second-generation antipsychotic has been展开更多
Biomimetic materials have emerged as attractive and competitive alternatives for tissue engineering(TE)and regenerative medicine.In contrast to conventional biomaterials or synthetic materials,biomimetic scaffolds bas...Biomimetic materials have emerged as attractive and competitive alternatives for tissue engineering(TE)and regenerative medicine.In contrast to conventional biomaterials or synthetic materials,biomimetic scaffolds based on natural biomaterial can offer cells a broad spectrum of biochemical and biophysical cues that mimic the in vivo extracellular matrix(ECM).Additionally,such materials have mechanical adaptability,micro-structure interconnectivity,and inherent bioactivity,making them ideal for the design of living implants for specific applications in TE and regenerative medicine.This paper provides an overview for recent progress of biomimetic natural biomaterials(BNBMs),including advances in their preparation,functionality,potential applications and future challenges.We highlight recent advances in the fabrication of BNBMs and outline general strategies for functionalizing and tailoring the BNBMs with various biological and physicochemical characteristics of native ECM.Moreover,we offer an overview of recent key advances in the functionalization and applications of versatile BNBMs for TE applications.Finally,we conclude by offering our perspective on open challenges and future developments in this rapidly-evolving field.展开更多
Objective:To investigate the trend of animal bites in southern Iran from 2015 to 2019.Methods:This is a cross-sectional study of patients with animal bites who were referred to the Center for Disease Control in the th...Objective:To investigate the trend of animal bites in southern Iran from 2015 to 2019.Methods:This is a cross-sectional study of patients with animal bites who were referred to the Center for Disease Control in the three cities of Larestan,Evaz,and Khonj in Fars province,southern Iran from 2015 to 2019.The trend of animal bites incidence was analyzed using the Cochran-Armitage trend test.Results:In total,from 2015 to 2019,1944 cases of animal bites were reported.A total of 79.8%of the cases were men.The overall average incidence of animal bites was 142.93 per 100000 people.The incidence of animal bites was significantly increased(Ptrend<0.001).The highest incidence was in November(79.04 per 100000 people)followed by January(76.1 per 100000 people)and February(69.48 per 100000 people);also,the lowest incidence was in August(47.42 per 100000 people)and July(50.0 per 100000 people).Conclusions:The incidence of animal bites has significantly increased.Given the importance of rabies,control and management of animal bites should be emphasized and considered.展开更多
Objectives: Nurses' autonomy is a complex and multi-dimensional concept that has often been overlooked.Although many studies have addressed patients' autonomy,there has been no assessment of nurses' experi...Objectives: Nurses' autonomy is a complex and multi-dimensional concept that has often been overlooked.Although many studies have addressed patients' autonomy,there has been no assessment of nurses' experience of professional autonomy.The present study aimed to assess nurses' lived experiences of professional autonomy in Shiraz,Iran.Methods: The present qualitative study was conducted in Shiraz (Iran) from January 2016 to February 2018.The target population was selected among nursing professionals employed by various hospitals affiliated to Shiraz University of Medical Sciences,Shiraz,Iran.The experiences of the participants were assessed through 14 in-depth semi-structured interviews.The response of the participants was analyzed using Van Manen's 6-step approach for interpretive phenomenology.Results: Based on the analysis of the interviews,4 themes,11 categories,and 13 sub-categories were extracted.The themes were: Advocacy for patients and nurses,independence in the workplace,Involvement in professional decision-making,and Professional accountability.Conclusion: Due to the intense interaction between nurses and patients,a better quality of care will be achieved if the professional autonomy of nurses is ensured.Healthcare authorities and hospital managers should provide the framework and permit the nurses to practically exercise full independence in the workplace.展开更多
Objective and Impact Statement.There is a need to develop rodent coils capable of targeted brain stimulation for treating neuropsychiatric disorders and understanding brain mechanisms.We describe a novel rodent coil d...Objective and Impact Statement.There is a need to develop rodent coils capable of targeted brain stimulation for treating neuropsychiatric disorders and understanding brain mechanisms.We describe a novel rodent coil design to improve the focality for targeted stimulations in small rodent brains.Introduction.Transcranial magnetic stimulation(TMS)is becoming increasingly important for treating neuropsychiatric disorders and understanding brain mechanisms.Preclinical studies permit invasive manipulations and are essential for the mechanistic understanding of TMS effects and explorations of therapeutic outcomes in disease models.However,existing TMS tools lack focality for targeted stimulations.Notably,there has been limited fundamental research on developing coils capable of focal stimulation at deep brain regions on small animals like rodents.Methods.In this study,ferromagnetic cores are added to a novel angle-tuned coil design to enhance the coil performance regarding penetration depth and focality.Numerical simulations and experimental electric field measurements were conducted to optimize the coil design.Results.The proposed coil system demonstrated a significantly smaller stimulation spot size and enhanced electric field decay rate in comparison to existing coils.Adding the ferromagnetic core reduces the energy requirements up to 60%for rodent brain stimulation.The simulated results are validated with experimental measurements and demonstration of suprathreshold rodent limb excitation through targeted motor cortex activation.Conclusion.The newly developed coils are suitable tools for focal stimulations of the rodent brain due to their smaller stimulation spot size and improved electric field decay rate.展开更多
Objective:Clinical education plays a key role in preparing students for patient care.Laparoscopy is one of the most important minimally invasive surgeries(MISs)wherein surgical technologists are responsible for camera...Objective:Clinical education plays a key role in preparing students for patient care.Laparoscopy is one of the most important minimally invasive surgeries(MISs)wherein surgical technologists are responsible for camera navigation and assistant surgeons are responsible for peg transfer.Therefore,it is necessary to improve the attitude of the operating room students toward these skills during their study period.The present study was conducted to determine the effect of simulating training in the fundamentals of laparoscopic surgery(FLS)on the attitude of the operating room students.Methods:This interventional study was conducted on 28 operating room students of Iran University of Medical Sciences in 2019.The census sampling method was used.The data-collection tool included the“Intrinsic motivation inventory(IMI)questionnaire.”The educational intervention was carried out in theoretical(booklet design)and practical(simulation)sections.Data analysis was carried out using descriptive and inferential analyses including the paired t-test,Mann–Whitney U test,and independent t-test.The collected data were analyzed using R and SPSS software.P-value<0.05 was considered as the significant level.Results:The mean±SD of the participants'age was 22.93±2.14 years,and the majority of them were women(67.9%).There was a significant difference in the mean scores of students'attitudes toward the FLS before and after the educational intervention(P<0.001)in all dimensions(interest,perceived competence,perceived choice,and tension).There was also a significant correlation between gender and interest dimension(P=0.005).Conclusions:The results of the present study showed that simulating the training FLS curriculum positively affects students'attitudes.Therefore,the researchers suggest that for creating a positive attitude,increasing students'interest in laparoscopic surgery,and ensuring a more effective presence in the operating room,this training should be considered in the operating room curriculum.展开更多
Objective:According to the World Federation of Medical Education,critical thinking should be part of the training of medical and paramedical students.Professionals can improve the quality of care of patients after sur...Objective:According to the World Federation of Medical Education,critical thinking should be part of the training of medical and paramedical students.Professionals can improve the quality of care of patients after surgery by having or acquiring this skill in health care.Also,Emotional intelligence is introduced as an impor tant and effective factor on the professional performance and mental health of healthcare professionals.Thus,the present study was designed and implemented to determine the relationship between emotional intelligence and critical thinking among operating room nursing students of medical sciences universities in Iran.Methods:This cross-sectional study was done on 420 operating room students in 10 top medical sciences universities of Iran in 2022.The sampling method in this research was multistage sampling.The data collection instruments included demographic characteristics,Rickett's critical thinking,and Bradberry-Greaves'emotional intelligence questionnaires.After receiving the ethics code,data collection was done for 2 months.For data analysis,descriptive and inferential analyses including independent t-tests,analysis of variance,and Pearson correlation were used.The collected data were analyzed by SPSS 18(IBM Corporation,Armonk,New York,United States).P-value<0.05 was considered significant.Results:The mean age of the students participating in this study was 23.02±3.70 years,with women constituting 67.4%of them.The results of data analysis indicated that the mean total score of critical thinking and emotional intelligence was 124.10±37.52 and 114.12±43.63,respectively.A direct significant correlation between critical thinking and emotional intelligence(r=0.459,P-value<0.001)and a significant relationship between gender and emotional intelligence(P-value=0.028)were found.Conclusions:Based on the present study results,educational managers in the Ministry of Health are suggested to consider suitable educational programs for improving critical thinking and emotional intelligence to enhance the quality of care provided by students in operating rooms.展开更多
Background： As medication does not normalize outcomes of children with attention deficit hyperactivity disorder （ADHD）, especially in real-life functioning, nonpharmacological methods are important to target this f...Background： As medication does not normalize outcomes of children with attention deficit hyperactivity disorder （ADHD）, especially in real-life functioning, nonpharmacological methods are important to target this field. This randomized controlled clinical trial was designed to evaluate the effects of a comprehensive executive skill training program for school-aged children with ADHD in a relatively large sample. Methods： The children （aged 6-12 years） with ADHD were randomized to the intervention or waitlist groups. A healthy control group was composed of gender- and age-matched healthy children. The intervention group received a 12-session training program lbr multiple executive skills. Executive function （EF）, ADHD symptoms, and social functioning in the intervention and waitlist groups were evaluated at baseline and the end of the final training session. The healthy controls （HCs） were only assessed once at baseline. Repeated measures analyses of variance were used to compare EF, ADHD symptoms, and social function between intervention and waitlist groups. Results： Thirty-eight children with ADH D in intervention group, 30 in waitlist group, and 23 healthy children in healthy control group were included in final analysis. At posttreatment, intervention group showed significantly lower Behavior Rating Inventory of Executive Function （BRIEF） total score （135.89 ±16.80 vs. 146.09 ± 23.92, P = 0.04） and monitoring score （18.05 ± 2.67 vs. 19.77 ± 3.10, P = 0.02）, ADHD-IV overall score （41.11 ± 7.48 vs. 47.20 ± 8.47, P 〈 0.01 ）, hyperactivity-impulsivity （HI） subscale score （ 18.92 ± 5.09 vs. 21.93 ± 4.93, P = 0.02）, and inattentive subscale score （22.18 ±3.56 vs. 25.27± 5.06, P 〈 0.01 ）, compared with the waitlist group. Repeated measures analyses of variance revealed significant interactions between time and group on the BRIEF inhibition subscale （F = 5.06, P 0.03）, working memory （F- 4.48, P = 0.04）, A DH D-IV overall score （F = 21.72, P 〈 0.01）, HI subscale score （F = 19.08, P 〈 0.01）, and inattentive subscale score （F- 12,40, P 〈 0.01 ）. Multiple-way analysis of variance showed significant differences on all variables of BRIEF, ADHD-rating scale-IV, and WEISS Functional Impairment Scale-Parent form （WFIRS-P） among the intervention and waitlist groups at posttreatment and HCs at baseline. Conclusions： This randomized controlled study on executive skill training in a relatively large sample provided some evidences that the training could improve EF deficits, reduce problematic symptoms, and potentially enhance the social thnctioning in school-aged children with ADHD.展开更多
Polyhydroxyalkanoates(PHAs)are diversiform biopolyesters with a similar structure and different side chain groups,synthesized by a variety of microorganism.Due to their excellent biodegradability and biocompatibility,...Polyhydroxyalkanoates(PHAs)are diversiform biopolyesters with a similar structure and different side chain groups,synthesized by a variety of microorganism.Due to their excellent biodegradability and biocompatibility,PHAs have been used for many applications,including medical implants,antibacterial agents and bioengineering.Nano-architecture is an emerging area for the use of PHAs.This review summarizes the current status and challenges of PHAs-based particles on the micro-and nano-scale,including their production,degradation,biological safety,and surface functionalization.We also focus on the applications of PHA particles in drug delivery systems,environment protection,tissue engi-neering,vaccine engineering,food science,biotechnology and cosmetics.Finally,the future development trends of PHAs-based particles are prospected.展开更多
Objective The aim of this study was to describe health services utilisation and responsiveness in East Azerbaijan province,Iran.Design A cross-sectional household study as part of a larger research on primary healthca...Objective The aim of this study was to describe health services utilisation and responsiveness in East Azerbaijan province,Iran.Design A cross-sectional household study as part of a larger research on primary healthcare system.setting We carried out the study in East Azerbaijan Province,northwest Iran from July to September 2015.Participants A total of 1318 households were included.results Most of the participating households had social security health insurance.Heart failure or hypertension care,general outpatient care and arthritis care were the most used services.High services cost and inadequate medicine and medical equipment were introduced to be the main barriers to health services utilisation in Tabriz and province representative sample(PRS),respectively.Health system responsiveness mean score(the maximum is 100)was 33.71±16.15(95%CI 32.45 to 34.97)in Tabriz and 32.02±14.3(95%CI 30.9 to 33.13)in PRS,which showed significant difference(p≤0.02).Conclusions Differences in the utilisation and responsiveness of health services and distribution of health resources were observed between Tabriz and PRS.Evidently,health system responsiveness in both Tabriz and PRS was at low level.The results demonstrate the need for changing resource distribution policies and employing reactive health policies to response the public health.展开更多
Infection and rejection in musculoskeletal trauma often pose challenges for natural healing,prompting the exploration of biomimetic organ and tissue transplantation as a common alternative solution.Polyhydroxyalkanoat...Infection and rejection in musculoskeletal trauma often pose challenges for natural healing,prompting the exploration of biomimetic organ and tissue transplantation as a common alternative solution.Polyhydroxyalkanoates(PHAs)are a large family of biopolyesters synthesised in microorganism,demonstrating excellent biocompatibility and controllable biodegradability for tissue remodelling and drug delivery.With different monomer-combination and polymer-types,multi-mechanical properties of PHAs making them have great application prospects in medical devices with stretching,compression,twist in long time,especially in musculoskeletal tissue engineering.This review systematically summarises the applications of PHAs in multiple tissues repair and drug release,encompassing areas such as bone,cartilage,joint,skin,tendons,ligament,cardiovascular tissue,and nervous tissue.It also discusses challenges encountered in their application,including high production costs,potential cytotoxicity,and uncontrollable particle size distribution.In conclusion,PHAs offer a compelling avenue for musculoskeletal system applications,striking a balance between biocompatibility and mechanical performance.However,addressing challenges in their production and application requires further research to unleash their full potential in tackling the complexities of musculoskeletal regeneration.展开更多
Compared to data on adolescents and adults,limited research has been conducted on biological correlates among young children with possible psychological difficulties,especially in Asian countries.By focusing on variou...Compared to data on adolescents and adults,limited research has been conducted on biological correlates among young children with possible psychological difficulties,especially in Asian countries.By focusing on various peripheral biochemical indicators,we investigated potential biological correlates of psychological states in a community sample of Taiwan Residents school children aged6–10 years.In total,307 students(159 obese children and148 normal-weight children) were selected from first- and fourth-grade school children in eight elementary schools in the Taipei metropolitan area in 2009.These children underwent a comprehensive health examination,including a physical examination,blood sample analysis,andquestionnaire administration in a hospital.Differences in anthropometric and serum biochemical readings were compared between children with average and worse levels on each of the five psychological domains.We found that interleukin(IL)-1β [b = 1.29,95 % confidence interval(CI) 0.50–2.09],IL-10(b = 1.61,95 % CI \0.01–3.24),fasting blood glucose(b = 0.08,95 % CI 0.01–0.15),homocysteine(b = 0.63,95 % CI 0.09–1.18),and aspartate transaminase(AST)(b = 0.15,95 % CI \0.01–0.31)were significantly positively associated with anxiety.In addition,IL-1β,insulin,AST,and alanine aminotransaminase(ALT) were significantly positively associated with depression.Anger and disruptive behaviors were also related to specific biological correlates.Specific biological correlates,including AST/ALT,cardiovascular diseaserelated variables,and specific cytokines,were linked to particular psychological states among young children in this Asian population.These might provide a route for better understanding the biological aspects of children's mental health and might contribute to research on diagnostic or predictive biomarkers for psychiatric diseases in young children.展开更多
文摘Drug addiction is one of the current world’s hygienic, mental and social problems. There are different treatments for this illness. MMT (Methadone Maintenance Therapy) is considered as a standard and acceptable therapy for addiction;and there are many affecting factors regarding gaining success in this type of treatment. In this study, we investigated some of these factors. One of the most important issues in MMT is to keep up patient on his/her treatment till complete abstinence;therefore, it is recommended that the patient does not leave his/her therapy without discretion of the therapist. In this study, 230 patients, who began MMT, and admitted to addiction treatment centers of Yazd province were included. In this study, the survival rate in the first, third, and sixth months were evaluated as 93.9%, 63.48%, and 28.36%, respectively. It was found that following parameters are important in rate of survival during treatment: family support, gender, dose of methadone and concomitant use of morphine during treatment. Moreover, factors like level of education, marital status, age and concomitant use of methamphetamine during treatment can be effective in this regard.
文摘Objective: Little is known about the prescription pattern of psychotropic drugs for patients with schizophrenia in Pakistan. The purpose of this study was to evaluate the characteristic features of psychotropic drug prescriptions for patients with schizophrenia in Pakistan. Methods: Three centers in Pakistan participated in a large scale collaborative study known as Research on Asian Prescription Pattern (REAP). The 2016 REAP survey included centers from 15 countries in Asia and used a unified research protocol. The design of the study was quantitative and of descriptive epidemiology. Analysis was made on the data collected from three centers i.e., Lahore, Karachi and Islamabad. The data collected in Pakistan were compared with those from other Asian countries. The details of REAP were presented on the homepage of REAP (http://www.REAP.Asia). Results: From Pakistan, 298 patients were included. Patients with schizophrenia in Pakistan received higher rate of antipsychotic polypharmacy and a higher rate of co-prescription of mood stabilizers and anxiolytics when compared with participants from other South Asian countries (India and Bangladesh). Conclusion: The main findings of the study were that a majority of the patients were prescribed antipsychotic polypharmacy drugs in Pakistan. Insufficient training on the use of psychotropic drugs and a lack of treatment guideline are considered to be the major contributing factors. Further education and training on the proper use of psychotropic drugs are recommended to psychiatrists in Pakistan. The guidelines on pharmacotherapy for patients with schizophrenia should also be developed and promoted in Pakistan.
基金Collaborative Innovation Project of Zigong Medical Big Data and Artificial Intelligence Research Institute,Grant/Award Number:2023-YGY-1-02 and 2024-YGY-02-04National Natural Science Foundation of China,Grant/Award Number:31900950+4 种基金Project Supported by the Natural Science Basic Research Plan in Shaanxi Province of China,Grant/Award Number:2024JCYBMS-706National Key Research and Development Program of China,Grant/Award Number:2022YFC2009900Zigong Science and Technology Program,Grant/Award Number:2023YKY11Scientific Research Project of Zigong Health Commission,Grant/Award Number:22yb001 and 24zd008Key Science and Technology Plan Projects in Zigong,Grant/Award Number:2022ZCNKY07,2023-NKY-01-02,2023-NKY-02-13 and 2023-NKY-02-14。
文摘Background:Maternal viral infection during pregnancy can lead to maternal immune activation(MIA),increasing the risk of neurodevelopmental disorders in offspring.Amantadine(AMA)exhibits antiviral activity and is widely employed in the management of neurologic conditions.Nevertheless,the efficacy of AMA in treating MIA is currently not established.Methods:MIA was induced by polyinosinic acid-polycytidylic acid(poly(I:C));AMA was administered from embryonic(E)day 11.5 for 3 days.BV-2 cells were stimulated using poly(I:C)and treated with AMA.Behavior was assessed via open field test,elevated plus maze test,three-chamber sociability test,and marble burying test.Neuronal morphology was vizualized using Nissl stain;apoptosis via TUNEL(terminal deoxynucleotidyl transferase dUTP nick-end labeling)stain;protein expression(Iba1,NeuN,CD68,TNF-α[tumor necrosis factor-alpha],IL-1β[interleukin-1β])using immunofluorescence(IF);interleukin-6(IL-6)levels using enzyme-linked immunosorbent assay;reactive oxygen species using staining;Iba1,NeuN,Bcl-2,Bax,and cleaved caspase 3 using Western blot;and gene expression changes using RNA-seq.Results:AMA treatment reduced the levels of IL-6 in maternal blood,improved autism-like behaviors in MIA offspring,and effectively prevented neuronal damage and neuroinflammation.In vitro cellular studies have demonstrated that AMA effectively downregulates the expression levels of pro-inflammatory cytokines,including IL-6,TNF-α,and IL-1β.RNA-seq analysis indicated that AMA mitigates abnormal activation of microglia by modulating inflammatory pathways associated with IL-6.Conclusion:AMA can prevent the development of neuropsychiatric disorders in MIA offspring.This effect may be related to its ability to attenuate neuronal damage,reduce neuronal apoptosis,and inhibit neuroinflammation,indicating that the antiviral drug AMA may be a potential treatment for MIA.
文摘Objective To establish a body composition analysis system based on chest CT,and to observe its value for evaluating content of chest muscle and adipose.Methods T7—T8 layer CT images of 108 pneumonia patients were collected(segmented dataset),and chest CT data of 984 patients were screened from the COVID 19-CT dataset(10 cases were randomly selected as whole test dataset,the remaining 974 cases were selected as layer selection dataset).T7—T8 layer was classified based on convolutional neural network(CNN)derived networks,including ResNet,ResNeXt,MobileNet,ShuffleNet,DenseNet,EfficientNet and ConvNeXt,then the accuracy,precision,recall and specificity were used to evaluate the performance of layer selection dataset.The skeletal muscle(SM),subcutaneous adipose tissue(SAT),intermuscular adipose tissue(IMAT)and visceral adipose tissue(VAT)were segmented using classical fully CNN(FCN)derived network,including FCN,SegNet,UNet,Attention UNet,UNET++,nnUNet,UNeXt and CMUNeXt,then Dice similarity coefficient(DSC),intersection over union(IoU)and 95 Hausdorff distance(HD)were used to evaluate the performance of segmented dataset.The automatic body composition analysis system was constructed based on optimal layer selection network and segmentation network,the mean absolute error(MAE),root mean squared error(RMSE)and standard deviation(SD)of MAE were used to evaluate the performance of automatic system for testing the whole test dataset.Results The accuracy,precision,recall and specificity of DenseNet network for automatically classifying T7—T8 layer from chest CT images was 95.06%,84.83%,92.27%and 95.78%,respectively,which were all higher than those of the other layer selection networks.In segmentation of SM,SAT,IMAT and overall,DSC and IoU of UNet++network were all higher,while 95HD of UNet++network were all lower than those of the other segmentation networks.Using DenseNet as the layer selection network and UNet++as the segmentation network,MAE of the automatic body composition analysis system for predicting SM,SAT,IMAT,VAT and MAE was 27.09,6.95,6.65 and 3.35 cm 2,respectively.Conclusion The body composition analysis system based on chest CT could be used to assess content of chest muscle and adipose.Among them,the UNet++network had better segmentation performance in adipose tissue than SM.
基金The study was funded by the Research Department at Fasa University of Medical Sciences,Fasa,Iran
文摘Objective:To explore the relationship between nursing professional values and ethical climate and nurses'professional quality of life.Methods:The present study is a descriptive,cross-sectional work in which 400 nurses from various wards of hospitals in the south-east of Iran were studied.Data were collected using a questionnaire consisting of four sections:demographics,Nurses'Professional Values Scale-Revised(NPVS-R),the Hospital Ethical Climate Survey(HECS),and the Professional Quality of Life Scale(ProQOL).Results:The total mean scores for professional values were 105.29±15.60.The total mean score for the ethical climate was 100.09±17.11.The mean scores for the indexes of compassion satisfaction,burnout,and secondary traumatic stress were 45.29±8.93,34.38±6.84,and 32.15±7.02 respectively.The relationships between professional values and the indexes of compassion satisfaction(r=0.56),burnout(r=0.26),and secondary traumatic stress(r=0.18)were found to be positive and significant(P<0.001).Also,the relationships between ethical climate and the items of compassion satisfaction(r=0.60,P<0.001),burnout(r=0.15,P=0.002)were found to be positive and significant.Conclusion:An understanding of nurses'perception of professional values and improving the ethical climate at work can help nursing administrators identify more effective strategies toward increasing compassion satisfaction and lessening bumout and work-related stress.
文摘Clozapine is the only antipsychotic in the United States that has been approved by the Food and Drug Administration (FDA) for treatment-resistant schizophrenia. It provides effective treatment even when patients do not respond to other second- generation antipsychotics.[1] It also remains the most effective antipsychotic available. No existing first or second-generation antipsychotic has been
基金supported by the National Natural Science Foundation of China(52003113,31900950,82102334,82002313,82072444)the National Key Research&Development Program of China(2018YFC2001502,2018YFB1105705)+6 种基金the Guangdong Basic and Applied Basic Research Foundation(2021A1515010745,2020A1515110356,2023A1515011986)the Shenzhen Fundamental Research Program(JCYJ20190808120405672)the Key Program of the National Natural Science Foundation of Zhejiang Province(LZ22C100001)the Natural Science Foundation of Shanghai(20ZR1469800)the Integration Innovation Fund of Shanghai Jiao Tong University(2021JCPT03),the Science and Technology Projects of Guangzhou City(202102020359)the Zigong Key Science and Technology Plan(2022ZCNKY07).SXC thanks the financial support under the Startup Grant of the University of Chinese Academy of Sciences(WIUCASQD2021026).HW thanks the Futian Healthcare Research Project(FTWS2022013)the financial support of China Postdoctoral Science Foundation(2021TQ0118).SL thanks the financial support of China Postdoctoral Science Foundation(2022M721490).
文摘Biomimetic materials have emerged as attractive and competitive alternatives for tissue engineering(TE)and regenerative medicine.In contrast to conventional biomaterials or synthetic materials,biomimetic scaffolds based on natural biomaterial can offer cells a broad spectrum of biochemical and biophysical cues that mimic the in vivo extracellular matrix(ECM).Additionally,such materials have mechanical adaptability,micro-structure interconnectivity,and inherent bioactivity,making them ideal for the design of living implants for specific applications in TE and regenerative medicine.This paper provides an overview for recent progress of biomimetic natural biomaterials(BNBMs),including advances in their preparation,functionality,potential applications and future challenges.We highlight recent advances in the fabrication of BNBMs and outline general strategies for functionalizing and tailoring the BNBMs with various biological and physicochemical characteristics of native ECM.Moreover,we offer an overview of recent key advances in the functionalization and applications of versatile BNBMs for TE applications.Finally,we conclude by offering our perspective on open challenges and future developments in this rapidly-evolving field.
文摘Objective:To investigate the trend of animal bites in southern Iran from 2015 to 2019.Methods:This is a cross-sectional study of patients with animal bites who were referred to the Center for Disease Control in the three cities of Larestan,Evaz,and Khonj in Fars province,southern Iran from 2015 to 2019.The trend of animal bites incidence was analyzed using the Cochran-Armitage trend test.Results:In total,from 2015 to 2019,1944 cases of animal bites were reported.A total of 79.8%of the cases were men.The overall average incidence of animal bites was 142.93 per 100000 people.The incidence of animal bites was significantly increased(Ptrend<0.001).The highest incidence was in November(79.04 per 100000 people)followed by January(76.1 per 100000 people)and February(69.48 per 100000 people);also,the lowest incidence was in August(47.42 per 100000 people)and July(50.0 per 100000 people).Conclusions:The incidence of animal bites has significantly increased.Given the importance of rabies,control and management of animal bites should be emphasized and considered.
基金supported in part by funding from the Mental Hygiene Administration of the Maryland Department of Health and Mental Hygiene to the Center for Excellence on Early Intervention for Serious Mental Illness(OPASS#14-13717G/M00B4400241)
基金This study was financially supported by the Research Committee of Shiraz University of Medical Sciences (Grant number: 93-7297)
文摘Objectives: Nurses' autonomy is a complex and multi-dimensional concept that has often been overlooked.Although many studies have addressed patients' autonomy,there has been no assessment of nurses' experience of professional autonomy.The present study aimed to assess nurses' lived experiences of professional autonomy in Shiraz,Iran.Methods: The present qualitative study was conducted in Shiraz (Iran) from January 2016 to February 2018.The target population was selected among nursing professionals employed by various hospitals affiliated to Shiraz University of Medical Sciences,Shiraz,Iran.The experiences of the participants were assessed through 14 in-depth semi-structured interviews.The response of the participants was analyzed using Van Manen's 6-step approach for interpretive phenomenology.Results: Based on the analysis of the interviews,4 themes,11 categories,and 13 sub-categories were extracted.The themes were: Advocacy for patients and nurses,independence in the workplace,Involvement in professional decision-making,and Professional accountability.Conclusion: Due to the intense interaction between nurses and patients,a better quality of care will be achieved if the professional autonomy of nurses is ensured.Healthcare authorities and hospital managers should provide the framework and permit the nurses to practically exercise full independence in the workplace.
基金supported by the NSF grant ECCS-1631820,NIH grants MH112180,MH108148,MH103222a Brain and Behavior Research Foundation grant.
文摘Objective and Impact Statement.There is a need to develop rodent coils capable of targeted brain stimulation for treating neuropsychiatric disorders and understanding brain mechanisms.We describe a novel rodent coil design to improve the focality for targeted stimulations in small rodent brains.Introduction.Transcranial magnetic stimulation(TMS)is becoming increasingly important for treating neuropsychiatric disorders and understanding brain mechanisms.Preclinical studies permit invasive manipulations and are essential for the mechanistic understanding of TMS effects and explorations of therapeutic outcomes in disease models.However,existing TMS tools lack focality for targeted stimulations.Notably,there has been limited fundamental research on developing coils capable of focal stimulation at deep brain regions on small animals like rodents.Methods.In this study,ferromagnetic cores are added to a novel angle-tuned coil design to enhance the coil performance regarding penetration depth and focality.Numerical simulations and experimental electric field measurements were conducted to optimize the coil design.Results.The proposed coil system demonstrated a significantly smaller stimulation spot size and enhanced electric field decay rate in comparison to existing coils.Adding the ferromagnetic core reduces the energy requirements up to 60%for rodent brain stimulation.The simulated results are validated with experimental measurements and demonstration of suprathreshold rodent limb excitation through targeted motor cortex activation.Conclusion.The newly developed coils are suitable tools for focal stimulations of the rodent brain due to their smaller stimulation spot size and improved electric field decay rate.
基金supported by the Iran University of Medical Science。
文摘Objective:Clinical education plays a key role in preparing students for patient care.Laparoscopy is one of the most important minimally invasive surgeries(MISs)wherein surgical technologists are responsible for camera navigation and assistant surgeons are responsible for peg transfer.Therefore,it is necessary to improve the attitude of the operating room students toward these skills during their study period.The present study was conducted to determine the effect of simulating training in the fundamentals of laparoscopic surgery(FLS)on the attitude of the operating room students.Methods:This interventional study was conducted on 28 operating room students of Iran University of Medical Sciences in 2019.The census sampling method was used.The data-collection tool included the“Intrinsic motivation inventory(IMI)questionnaire.”The educational intervention was carried out in theoretical(booklet design)and practical(simulation)sections.Data analysis was carried out using descriptive and inferential analyses including the paired t-test,Mann–Whitney U test,and independent t-test.The collected data were analyzed using R and SPSS software.P-value<0.05 was considered as the significant level.Results:The mean±SD of the participants'age was 22.93±2.14 years,and the majority of them were women(67.9%).There was a significant difference in the mean scores of students'attitudes toward the FLS before and after the educational intervention(P<0.001)in all dimensions(interest,perceived competence,perceived choice,and tension).There was also a significant correlation between gender and interest dimension(P=0.005).Conclusions:The results of the present study showed that simulating the training FLS curriculum positively affects students'attitudes.Therefore,the researchers suggest that for creating a positive attitude,increasing students'interest in laparoscopic surgery,and ensuring a more effective presence in the operating room,this training should be considered in the operating room curriculum.
文摘Objective:According to the World Federation of Medical Education,critical thinking should be part of the training of medical and paramedical students.Professionals can improve the quality of care of patients after surgery by having or acquiring this skill in health care.Also,Emotional intelligence is introduced as an impor tant and effective factor on the professional performance and mental health of healthcare professionals.Thus,the present study was designed and implemented to determine the relationship between emotional intelligence and critical thinking among operating room nursing students of medical sciences universities in Iran.Methods:This cross-sectional study was done on 420 operating room students in 10 top medical sciences universities of Iran in 2022.The sampling method in this research was multistage sampling.The data collection instruments included demographic characteristics,Rickett's critical thinking,and Bradberry-Greaves'emotional intelligence questionnaires.After receiving the ethics code,data collection was done for 2 months.For data analysis,descriptive and inferential analyses including independent t-tests,analysis of variance,and Pearson correlation were used.The collected data were analyzed by SPSS 18(IBM Corporation,Armonk,New York,United States).P-value<0.05 was considered significant.Results:The mean age of the students participating in this study was 23.02±3.70 years,with women constituting 67.4%of them.The results of data analysis indicated that the mean total score of critical thinking and emotional intelligence was 124.10±37.52 and 114.12±43.63,respectively.A direct significant correlation between critical thinking and emotional intelligence(r=0.459,P-value<0.001)and a significant relationship between gender and emotional intelligence(P-value=0.028)were found.Conclusions:Based on the present study results,educational managers in the Ministry of Health are suggested to consider suitable educational programs for improving critical thinking and emotional intelligence to enhance the quality of care provided by students in operating rooms.
文摘Background： As medication does not normalize outcomes of children with attention deficit hyperactivity disorder （ADHD）, especially in real-life functioning, nonpharmacological methods are important to target this field. This randomized controlled clinical trial was designed to evaluate the effects of a comprehensive executive skill training program for school-aged children with ADHD in a relatively large sample. Methods： The children （aged 6-12 years） with ADHD were randomized to the intervention or waitlist groups. A healthy control group was composed of gender- and age-matched healthy children. The intervention group received a 12-session training program lbr multiple executive skills. Executive function （EF）, ADHD symptoms, and social functioning in the intervention and waitlist groups were evaluated at baseline and the end of the final training session. The healthy controls （HCs） were only assessed once at baseline. Repeated measures analyses of variance were used to compare EF, ADHD symptoms, and social function between intervention and waitlist groups. Results： Thirty-eight children with ADH D in intervention group, 30 in waitlist group, and 23 healthy children in healthy control group were included in final analysis. At posttreatment, intervention group showed significantly lower Behavior Rating Inventory of Executive Function （BRIEF） total score （135.89 ±16.80 vs. 146.09 ± 23.92, P = 0.04） and monitoring score （18.05 ± 2.67 vs. 19.77 ± 3.10, P = 0.02）, ADHD-IV overall score （41.11 ± 7.48 vs. 47.20 ± 8.47, P 〈 0.01 ）, hyperactivity-impulsivity （HI） subscale score （ 18.92 ± 5.09 vs. 21.93 ± 4.93, P = 0.02）, and inattentive subscale score （22.18 ±3.56 vs. 25.27± 5.06, P 〈 0.01 ）, compared with the waitlist group. Repeated measures analyses of variance revealed significant interactions between time and group on the BRIEF inhibition subscale （F = 5.06, P 0.03）, working memory （F- 4.48, P = 0.04）, A DH D-IV overall score （F = 21.72, P 〈 0.01）, HI subscale score （F = 19.08, P 〈 0.01）, and inattentive subscale score （F- 12,40, P 〈 0.01 ）. Multiple-way analysis of variance showed significant differences on all variables of BRIEF, ADHD-rating scale-IV, and WEISS Functional Impairment Scale-Parent form （WFIRS-P） among the intervention and waitlist groups at posttreatment and HCs at baseline. Conclusions： This randomized controlled study on executive skill training in a relatively large sample provided some evidences that the training could improve EF deficits, reduce problematic symptoms, and potentially enhance the social thnctioning in school-aged children with ADHD.
基金supported by Grants from Key Science and Technology Plan Projects in Zigong (grant No.2022ZCNKY07)National Natural Science Foundation of China (grant No.31900950)Jiangxi Provincial Natural Science Foundation (grant No.20212BAB214048).
文摘Polyhydroxyalkanoates(PHAs)are diversiform biopolyesters with a similar structure and different side chain groups,synthesized by a variety of microorganism.Due to their excellent biodegradability and biocompatibility,PHAs have been used for many applications,including medical implants,antibacterial agents and bioengineering.Nano-architecture is an emerging area for the use of PHAs.This review summarizes the current status and challenges of PHAs-based particles on the micro-and nano-scale,including their production,degradation,biological safety,and surface functionalization.We also focus on the applications of PHA particles in drug delivery systems,environment protection,tissue engi-neering,vaccine engineering,food science,biotechnology and cosmetics.Finally,the future development trends of PHAs-based particles are prospected.
基金This research was done under the support of health vice-chancellor of TUOMS and was funded by Tabriz Health Services Management Research Center,Tabriz University of Medical Science,Tabriz,IranThe study was approved by the Ethical Committee of Tabriz University of Medical Sciences(TUOMS)(TBZMED.REC.1394.35).
文摘Objective The aim of this study was to describe health services utilisation and responsiveness in East Azerbaijan province,Iran.Design A cross-sectional household study as part of a larger research on primary healthcare system.setting We carried out the study in East Azerbaijan Province,northwest Iran from July to September 2015.Participants A total of 1318 households were included.results Most of the participating households had social security health insurance.Heart failure or hypertension care,general outpatient care and arthritis care were the most used services.High services cost and inadequate medicine and medical equipment were introduced to be the main barriers to health services utilisation in Tabriz and province representative sample(PRS),respectively.Health system responsiveness mean score(the maximum is 100)was 33.71±16.15(95%CI 32.45 to 34.97)in Tabriz and 32.02±14.3(95%CI 30.9 to 33.13)in PRS,which showed significant difference(p≤0.02).Conclusions Differences in the utilisation and responsiveness of health services and distribution of health resources were observed between Tabriz and PRS.Evidently,health system responsiveness in both Tabriz and PRS was at low level.The results demonstrate the need for changing resource distribution policies and employing reactive health policies to response the public health.
基金the National Natural Science Foundation of China,Nos.31900950 and 32000944 and Key Science and Technology Plan Projects in Zigong,No.2022ZCNKY07.
文摘Infection and rejection in musculoskeletal trauma often pose challenges for natural healing,prompting the exploration of biomimetic organ and tissue transplantation as a common alternative solution.Polyhydroxyalkanoates(PHAs)are a large family of biopolyesters synthesised in microorganism,demonstrating excellent biocompatibility and controllable biodegradability for tissue remodelling and drug delivery.With different monomer-combination and polymer-types,multi-mechanical properties of PHAs making them have great application prospects in medical devices with stretching,compression,twist in long time,especially in musculoskeletal tissue engineering.This review systematically summarises the applications of PHAs in multiple tissues repair and drug release,encompassing areas such as bone,cartilage,joint,skin,tendons,ligament,cardiovascular tissue,and nervous tissue.It also discusses challenges encountered in their application,including high production costs,potential cytotoxicity,and uncontrollable particle size distribution.In conclusion,PHAs offer a compelling avenue for musculoskeletal system applications,striking a balance between biocompatibility and mechanical performance.However,addressing challenges in their production and application requires further research to unleash their full potential in tackling the complexities of musculoskeletal regeneration.
基金supported by Taipei Medical University Hospital(98TMU-TMUH-01-5,99TMU-TMUH-02-4)
文摘Compared to data on adolescents and adults,limited research has been conducted on biological correlates among young children with possible psychological difficulties,especially in Asian countries.By focusing on various peripheral biochemical indicators,we investigated potential biological correlates of psychological states in a community sample of Taiwan Residents school children aged6–10 years.In total,307 students(159 obese children and148 normal-weight children) were selected from first- and fourth-grade school children in eight elementary schools in the Taipei metropolitan area in 2009.These children underwent a comprehensive health examination,including a physical examination,blood sample analysis,andquestionnaire administration in a hospital.Differences in anthropometric and serum biochemical readings were compared between children with average and worse levels on each of the five psychological domains.We found that interleukin(IL)-1β [b = 1.29,95 % confidence interval(CI) 0.50–2.09],IL-10(b = 1.61,95 % CI \0.01–3.24),fasting blood glucose(b = 0.08,95 % CI 0.01–0.15),homocysteine(b = 0.63,95 % CI 0.09–1.18),and aspartate transaminase(AST)(b = 0.15,95 % CI \0.01–0.31)were significantly positively associated with anxiety.In addition,IL-1β,insulin,AST,and alanine aminotransaminase(ALT) were significantly positively associated with depression.Anger and disruptive behaviors were also related to specific biological correlates.Specific biological correlates,including AST/ALT,cardiovascular diseaserelated variables,and specific cytokines,were linked to particular psychological states among young children in this Asian population.These might provide a route for better understanding the biological aspects of children's mental health and might contribute to research on diagnostic or predictive biomarkers for psychiatric diseases in young children.
