Effects of neurorehabilitation with and without dry needling technique on muscle thickness, reflex torque, spasticity and functional performance in chronic ischemic stroke patients with spastic upper extremity muscles: a blinded randomized sham-controlled clinical trial.

PURPOSE: Evaluation the effects of dry needling on sonographic, biomechanical and functional parameters of spastic upper extremity muscles. METHODS: Twenty-four patients (35-65 years) with spastic hand were randomly allocated into two equal groups: intervention and sham-controlled groups. The treatment protocol was 12-sessions neurorehabilitation for both groups and 4-sessions dry needling or sham-needling for the intervention group and sham-controlled group respectively on wrist and fingers flexor muscles. The outcomes were muscle thickness, spasticity, upper extremity motor function, hand dexterity and reflex torque which were assessed before, after the 12th session, and after one-month follow-up by a blinded assessor. RESULTS: The analysis showed that there was a significant reduction in muscle thickness, spasticity and reflex torque and a significant increment in motor function and dexterity in both groups after treatment (p < 0.01). However, these changes were significantly higher in the intervention group (p < 0.01) except for spasticity. Moreover, a significant improvement was seen in all outcomes measured one-month after the end of the treatment in the intervention group (p < 0.01). CONCLUSIONS: Dry needling plus neurorehabilitation could decrease muscle thickness, spasticity and reflex torque and improve upper-extremity motor performance and dexterity in chronic stroke patients. These changes were lasted one-month after treatment.Trial Registration Number: IRCT20200904048609N1IMPLICATION FOR REHABILITATIONUpper extremity spasticity is one of the stroke consequences which interfere with motor function and dexterity of patient hand in activity of daily livingApplying the dry needling accompanied with neurorehabilitation program in post-stroke patients with muscle spasticity can reduce the muscle thickness, spasticity and reflex torque and improve upper extremity functions.

The effect of perturbation training with and without applying the dry needling on leg muscles in patients with chronic ankle sprain.

INTRODUCTION: Ankle sprain is a common musculoskeletal injury that leads to recurrent instability. Repeated ankle sprain can be a mechanism for creating trigger point. Proper treatment of trigger points, in addition to preventing recurrence of sprains, may reduce pain and improve muscle function. This improvement can be the result of preserving the surrounding tissues from excessive pressure. OBJECTIVE: Investigate the added value of dry needling into perturbation training protocol for chronic ankle sprain. DESIGN: Randomized clinical trial; assessor-blind; before and after comparison. SETTING: Treatment of patients referred to the institutional rehabilitation clinics. MAIN OUTCOME MEASURE(S): Functional assessment with FAAM questionnaire score, Pain with NPRS scale, ankle instability severity with Cumberland tool. METHODS: Twenty-four patients with chronic ankle instability participated in this clinical trial and were randomly divided into two groups. Intervention was 12 sessions in which one group received only perturbation training and the other group received perturbation training along with dry needling. Repeated measures ANOVA was used to investigate the effect of treatment. RESULTS: Data Analysis showed significant difference in NPRS and FAAM and Cumberland score before and after treatment in each group (P < 0.001). Comparison of the results between the groups did not show any significant difference (P > 0.05). CONCLUSION: The findings showed that adding dry needling technique to the perturbation training does not have greater effects on the pain and function of patients with chronic ankle instability.

Predicting evaporation with optimized artificial neural network using multi-objective salp swarm algorithm.

Evaporation is a crucial component to be established in agriculture management and water engineering. Evaporation prediction is thus an essential issue for modeling researchers. In this study, the multilayer perceptron (MLP) was used for predicting daily evaporation. MLP model is as one of the famous ANN models with multilayers for predicting different target variables. A new strategy was used to enhance the accuracy of the MLP model. Three multi-objective algorithms, namely, the multi-objective salp swarm algorithm (MOSSA), the multi-objective crow algorithm (MOCA), and the multi-objective particle swarm optimization (MOPSO), were respectively and separately coupled to the MLP model for determining the model parameters, the best input combination, and the best activation function. In this study, three stations in Malaysia, namely, the Muadzam Shah (MS), the Kuala Terengganu (KT), and the Kuantan (KU), were selected for the prediction of the respective daily evaporation. The spacing (SP) and maximum spread (MS) indices were used to evaluate the quality of generated Pareto front (PF) by the algorithms. The lower SP and higher MS showed better PF for the models. It was observed that the MOSSA had higher MS and lower SP than the other algorithms, at all stations. The root means square error (RMSE), mean absolute error (MAE), percent bias (PBIAS), and Nash Sutcliffe efficiency (NSE) quantifiers were used to compare the ability of the models with each other. The MLP-MOSSA had reduced RMSE compared to the MLP-MOCA, MLP-MOPSO, and MLP models by 18%, 25%, and 35%, respectively, at the MS station. The MAE of the MLP-MOSSA was 2.7%, 4.1%, and 26%, respectively lower than those of the MLP-MOCA, MLP-MOPSO, and MLP models at the KU station. The MLP-MOSSA showed lower MAE than the MLP-MOCA, MLP-MOPSO, and MLP models by 16%, 18%, and 19%, respectively, at the KT station. An uncertainty analysis was performed based on the input and parameter uncertainty. The results indicated that the MLP-MOSSA had the lowest uncertainty among the models. Also, the input uncertainty was lower than the parameter uncertainty. The general results indicated that the MLP-MOSSA had the high efficiency for predicting evaporation.

A hybrid novel SVM model for predicting CO2 emissions using Multiobjective Seagull Optimization.

The agricultural sector is one of the most important sources of CO2 emissions. Thus, the current study predicted CO2 emissions based on data from the agricultural sectors of 25 provinces in Iran. The gross domestic product (GDP), the square of the GDP (GDP2), energy use, and income inequality (Gini index) were used as the inputs. The study used support vector machine (SVM) models to predict CO2 emissions. Multiobjective algorithms (MOAs), such as the seagull optimization algorithm (MOSOA), salp swarm algorithm (MOSSA), bat algorithm (MOBA), and particle swarm optimization (MOPSO) algorithm, were used to perform three important tasks for improving the SVM models. Additionally, an inclusive multiple model (IMM) used the outputs of the MOSOA, MOSSA, MOBA, and MOPSO algorithms as the inputs for predicting CO2 emissions. It was observed that the best kernel function based on the SVM-MOSOA was the radial function. Additionally, the best input combination used all the gross domestic product (GDP), squared GDP (GDP2), energy use, and income inequality (Gini index) inputs. The results indicated that the quality of the obtained Pareto front based on the MOSOA was better than those of the other algorithms. Regarding the obtained results, the IMM model decreased the mean absolute errors of the SVM-MOSOA, SVM-MOSSA, SVM-MOBA, and SVM-PSO models by 24, 31, 69, and 76%, respectively, during the training stage. The current study showed that the IMM model was the best model for predicting CO2 emissions.

Suspended sediment load prediction based on soft computing models and Black Widow Optimization Algorithm using an enhanced gamma test.

The suspended sediment load (SSL) prediction is one of the most important issues in water engineering. In this article, the adaptive neuro-fuzzy interface system (ANFIS) and support vector machine (SVM) were used to estimate the SLL of two main tributaries of the Telar River placed in the north of Iran. The main Telar River had two main tributaries, namely, the Telar and the Kasilian. A new evolutionary algorithm, namely, the black widow optimization algorithm (BWOA), was used to enhance the precision of the ANFIS and SVM models for predicting daily SSL. The lagged rainfall, temperature, discharge, and SSL were used as the inputs to the models. The present study used a new hybrid Gamma test to determine the best input scenario. In the next step, the best input combination was determined based on the gamma value. In this research, the abilities of the ANFIS-BWOA and SVM-BWOA were benchmarked with the ANFIS-bat algorithm (BA), SVM-BA, SVM-particle swarm optimization (PSO), and ANFIS-PSO. The mean absolute error (MAE) of ANFIS-BWOA was 0.40%, 2.2%, and 2.5% lower than those of ANFIS-BA, ANFIS-PSO, and ANFIS models in the training level for Telar River. It was concluded that the ANFIS-BWOA had the highest value of R2 among other models in the Telar River. The MAE of the ANFIS-BWOA, SVM-BWOA, SVM-PSO, SVM-BA, and SVM models were 899.12 (Ton/day), 934.23 (Ton/day), 987.12 (Ton/day), 976.12, and 989.12 (Ton/day), respectively, in the testing level for the Kasilian River. An uncertainty analysis was used to investigate the effect of uncertainty of the inputs (first scenario) and the model parameters (the second scenario) on the accuracy of models. It was observed that the input uncertainty higher than the parameter uncertainty.

Spatiotemporal dynamics of ecosystem services provision in a degraded ecosystem: A systematic assessment in the Lake Urmia basin, Iran.

Lake Urmia has experienced severe environmental degradation, mainly characterized by the enormous reduction of its surface area and water level. This issue has been mainly attributed to land-use and land-cover changes, in particular related to agricultural expansion and intensification. In this study, we used the DPSIR framework (D: driving forces, P: pressures, S: states, I: impacts, and R: responses) to systematically describe the ecosystem service dynamics related to anthropogenic activities and climatic parameters in the region. We reviewed the literature and used remote sensing, agricultural, climatic and hydrological data together with expert knowledge to assess the main driving forces and pressures, resulting land-use transitions and their spatiotemporal impacts on ecosystem services and biodiversity using a matrix-based assessment approach. We identified population growth, economic incentives and climate change as the most important driving forces, leading to altered agricultural activities, numerous dam constructions and droughts. Since 1987 cropland areas doubled at the expense of bare soils and natural vegetation, the lake hast lost more than half of its surface area, urban and freshwater areas increased threefold and by 50%, respectively. This favored crop and freshwater provision, while all other ecosystem services remained nearly constant or decreased, though spatial patterns were heterogeneous. For example, regulating and cultural services, and biodiversity mainly decreased at the shorelines of the lake, while provisioning services increased along the major rivers and close to cities. To address the land-use transitions with the most profound impact on ecosystem service provision, we recommend the following measures: increase the water supply to the lake, reduce cropland expansion, manage existing croplands more sustainably and protect natural vegetation. Our study provides a comprehensive overview of the regional ecosystem service dynamics and a valuable baseline for future research and environmental management in the basin.

Fingolimod and changes in hematocrit, hemoglobin and red blood cells of patients with multiple sclerosis.

INTRODUCTION: Fingolimod is the first oral drug approved by Food and Drug Administration (FDA) of United States for treating patients with relapsing-remitting multiple sclerosis (RRMS). Fingolimod acts by immunomodulation but there are still much remained about its different effects. OBJECTIVES: The aim of this study was to evaluate the changes in hematocrit (Hct), hemoglobin (Hb), and red blood cells (RBC) of patients with MS under treatments with fingolimod. METHODS: A total number of 66 MS patients were included to our study based on certain exclusion criteria and eligibility for fingolimod oral treatment. Hct, Hb, and RBC were measured for each patient before drug administrations. Patients were treated with Fingolimod. 5 mg daily and after three months of treatments, measurements of Hct, Hb, and RBC were performed. Data were analyzed using SPSS software version 24. RESULTS: Amounts of Hct, Hb, and RBC were significantly decreased in this patient cohort. Hematocrit was decreased in all patients. Hemoglobin levels were significantly decreased in the female cohorts. Such decreases for male patients were insignificant. Red blood cell counts were also significantly decreased in patients. CONCLUSION: Accumulating line of evidence had surveys on different side effects of fngolimod but here we indicated that fingolimod will also decrease amounts of Hct, Hb, and RBC which could result further problems in patients susceptible to other diseases.

A Study on Radiation Dose Received by Patients during Extracorporeal Shock Wave Lithotripsy.

BACKGROUND: Extracorporeal shock wave lithotripsy (ESWL) is considered as the method of choice for treatment of most stone diseases. The present study aims to evaluate radiation dose received by patients undergoing ESWL. METHODS: In total, 46 patients from both genders were referred to the Shohadaye Ashayer hospital of Khorramabad, Iran and were included in the present study. Patients were positioned in anteroposterior (AP) projection and along 30° anterior oblique (AO) projection upon the X-ray fluoroscopy table and exposures were conducted. Thermoluminescent dosimeters (TLDs) were used for radiation dose measurements. To evaluate the entrance surface dose (ESD), each TLD chip was taped on back of patient at the entrance surfaces of the X-ray beam. RESULTS: The mean number of stones in each patient was 1.4. The stone sizes ranged from 7 to 29 mm, and a mean of 3200 pulses were need for each patient. The mean ESD in the postero-anterior (PA) and oblique X-ray beam entrance were obtained at 12.04 and 68.84 mGy, respectively. There was linear correlation between patient dose with fluoroscopy time, tube current (mA), tube potential (kVp) and patient position (P < 0.001); however, we found no strong correlation between patient dose with patient body mass (P = 0.837), number of shock wave pulses (P = 0.089), stone size (P = 0.773) and locations (P = 0.463). CONCLUSION: The data obtained in the current study are comparable with information available in the literature. They emphasized that ESWL exposes patients to much more radiation compared to those from conventional radiography and is in the range of computed tomography (CT) procedures. Therefore, following safety guidelines is recommended.

Evaluation of non-motor symptoms and their impact on quality of life in patients with Parkinson's disease, Isfahan, Iran.

Background: Parkinson's disease (PD) is diagnosed on the basis of motor symptoms, but non-motor symptoms (NMS) have high prevalence in PD and often antecede motor symptoms for years and cause severe disability. This study was conducted to determine the prevalence of NMS in patients with PD. Methods: This cross-sectional study was performed in Isfahan, Iran, on patients with PD. The prevalence of NMS was evaluated by the NMS questionnaire, the NMS scale, and Parkinson's disease questionnaire-39 (PDQ-39). The Mini-Mental Status Examination (MMSE) was used for assessing cognition. Results: A total of 81 patients, including 60 men and 21 women, were recruited for this study. The prevalence of NMS was 100%, and the most commonly reported symptom was fatigue (87.7%); there was a strong correlation between NMS and the quality of life (QOL) of patients with PD (P < 0.001). Conclusion: This study showed that NMS are highly prevalent in the PD population and adversely affect QOL in these patients. Early diagnosis and treatment can improve QOL and can help in disability management of patients with PD.

Synergic effect of chitosan and dicalcium phosphate on tricalcium silicate-based nanocomposite for root-end dental application.

In recent years, cement composites based on calcium silicate have been more generally considered for medical applications. Calcium silicate Cement are among the categories that are used in dental root canal treatment. The aim of this study is to make new calcium silicate cement with dicalcium phosphate and chitosan additives to preserve and strengthen desirable properties of this type of cements. In this study, composite dental cement based on calcium silicate was prepared. Then effect of adding biodegradable and biocompatible polymer such as chitosan on setting properties and its structure were studied. In this study, a combination of calcium silicate, dicalcium phosphate (DCP) and bismuth oxide (Bi2O3) as powder phase and 2% solution of the chitosan dissolved in 1% acetic acid solution as liquid phase, was used. As well as control sample was obtained by mixing the powder with distilled water as the liquid phase. Based on the obtained results, setting time of composite cement was changed from 51 to 67 minutes by adding chitosan polymer. Presence of chitosan also reduced the compressive strength a little. The bioactivity of the cement were studied in a solution of simulated body fluid (SBF) for 14 days. The samples were analyzed by SEM to identify the microstructure and by XRD to determine crystal structure. The composition of cement before incubation in SBF was included early phases (phase calcium silicate and calcium phosphate) that after 14 days of immersion in SBF, they were converted to layer-shaped hydroxy apatite and the presence of chitosan had not any influence on the final phase of hydroxy apatite.

Comparison between massage and routine physical therapy in women with sub acute and chronic nonspecific low back pain.

OBJECTIVE: The aim of this study was to investigate the comparison of massage therapy and routine physical therapy on patients with sub acute and chronic nonspecific low back pain. METHODS AND MATERIALS: Thirty volunteer female subjects with a sub acute or chronic nonspecific low back pain were randomly enrolled in two groups, massage therapy and routine physical therapy. After massage application, the hamstring and paravertebral muscles stretching and also stabilizing exercises were prescribed. In the routine physical therapy group, TENS, US and vibrator were used besides exercises. Pain intensity according to Numerical Rating Scale, functional disability level in accordance to Oswestry Disability Index, and modified Schober test, for measurement of flexion range of motion, before and after ten sessions of treatment were used to evaluate the effectiveness of the treatment. RESULTS: Pain intensity, Oswestry Disability Index and flexion range of motion had shown significant differences before and after intervention in both groups (p<0.001). The statistical analysis revealed that the massage therapy had significantly improved the pain intensity and Oswestry Disability Index compared to routine physical therapy (p=0.015, p=0.013 respectively), but the range of motion changes were not significant between two groups (p=1.00). CONCLUSION: It can be concluded that both massage therapy and routine physical therapy are useful for sub acute and chronic nonspecific low back pain treatment especially if accompanied with exercise. However, massage is more effective than other electrotherapy modalities, and it can be used alone or with electrotherapy for the treatment of patients with low back pain.