Canalicular Adenoma in the Parotid Gland: A Rare Case Study.

Canalicular adenoma (CA) is a rare benign tumor of the salivary glands, predominantly affecting elderly females, with a strong predilection for the upper lip. While CA commonly arises in the minor salivary glands, its occurrence in the parotid gland is exceptionally rare. In this report, we present a unique case of CA in the parotid gland, adding to the scant literature with only 8 documented instances. The patient, a 57-year-old Asian male, presented with a painless swelling in the left parotid gland that had been persisting for 8 years. Clinical examination and imaging studies identified a lobulated mass, prompting surgical intervention. The patient underwent a superficial parotidectomy, and pathological examination of the excised tissue confirmed the diagnosis of CA, with no signs of malignancy. This case illustrates the diagnostic and management challenges associated with CA, particularly given its rare presentation in the parotid gland. Accurate diagnosis is reliant on surgical biopsy, and careful surgical planning is imperative, especially considering the proximity of the facial nerve. Our case underscores the need for heightened awareness of CA's unique presentations, particularly within the Asian population. Given the potential for recurrence, long-term follow-up is essential. Further research is needed to elucidate the biological behavior of CA and to refine management strategies for optimal patient outcomes.

Bilateral Combined Laryngocele: Comprehensive Review of the Literature.

Laryngocele, an abnormal dilation of the appendix of the laryngeal ventricle filled with air, is a rare condition predominantly presenting unilaterally. However, bilateral occurrences are exceedingly rare. In this article, we present a case of bilateral laryngocele along with a comprehensive literature review. A 57-year-old male presented with dyspnea, stridor, and bilateral neck masses. His medical history included chronic cough and intermittent hoarseness. Over a 3 month period, the neck masses progressively enlarged, resulting in respiratory distress. Interestingly, he denied experiencing weight loss, decreased appetite, or fever. Clinical examination revealed sizable, soft masses on both sides of the neck, obstructing lymph node assessment. Computed tomography (CT) imaging confirmed the presence of a left combined laryngopyocele and a right combined laryngocele. Subsequently, the patient underwent tracheostomy. Benign biopsy results excluded malignancy. Surgical excision of bilateral laryngoceles resulted in an uneventful recovery. The term "laryngocele" was introduced by Virchow in 1867 to describe the abnormal dilation of the saccule associated with Morgagni's ventricle. Diagnosis involves a thorough patient history, physical examination, and radiological imaging, notably CT, to differentiate laryngoceles from other conditions. Typically asymptomatic, they are often incidentally discovered around age 50, although symptoms such as voice changes or breathing difficulties can manifest. A review of the literature identified 77 documented cases, primarily in males, exhibiting various symptoms and treatment modalities. This case underscores the rarity of bilateral combined laryngocele, emphasizing the importance of timely diagnosis and surgical intervention for favorable outcomes. Comprehensive research reveals diverse clinical aspects, highlighting the necessity for continued investigation to enhance management strategies.

Treating refractory thin endometrium through a novel way of activation and administration of Platelet-rich plasma in sexually active women: An interventional prospective cohort clinical study.

A prospective cohort study investigated the effectiveness of platelet-rich plasma (PRP) infusion for refractory thin endometrium in 38 infertile patients. Patients showed significant improvement in endometrial thickness post-PRP injection, leading to successful implantation and pregnancy. The study revealed a negative correlation between antimullerian hormone (AMH) levels and the need for PRP interventions, suggesting higher ovarian reserve may reduce the necessity for repeated treatments. This implies AMH levels could serve as a prognostic indicator for treatment outcomes, aiding clinicians in optimizing protocols and reducing patient burden. Further research is needed to confirm these findings in larger and more diverse populations, along with exploring long-term reproductive success rates post-PRP treatment.

Developing a Risk Reduction Support System for Health System in Iran: A Case Study in Blood Supply Chain Management.

Health systems are recognised as playing a potentially important role in many risk management strategies; however, there is strong evidence that health systems themselves have been the victims of unanticipated risks and have lost their functionality in providing reliable services. Existing risk identification and assessment tools in the health sector, particularly in the blood supply chain, address and evaluate risks without taking into account their interdependence and a holistic perspective. As a result, the aim of this paper is to develop a new systemic framework based on a semi-quantitative risk assessment approach to measure supply chain risks, which will be implemented through a case study on the Iranian BSC. This paper identifies and assesses supply chain risks (SCRs) by employing a novel systemic process known as SSM-SNA-ISM (SSI). First, the supply chain and its risks are identified using Soft Systems Methodology (SSM). Then, given the large number of risks, the second stage uses Social Network Analysis (SNA) to identify the relationships between the risks and select the most important ones. In the third stage, risk levelling is performed with a more in-depth analysis of the selected risks and the application of Interpretive Structural Modelling (ISM), and further analysis is performed using the Cross-Impact Matrix Multiplication Applied to Classification (MICMAC). The study found that by using the new proposed approach, taking into account risk relationships, and taking a holistic view, various supply chain risks could be assessed more effectively, especially when the number of risks is large. The findings also revealed that resolving the root risks of the blood supply chain frequently necessitates management skills. This paper contributes to the literature on supply chain risk management in two ways: First, a novel systemic approach to identifying and evaluating risks is proposed. This process offers a fresh perspective on supply chain risk modelling by utilising systems thinking tools. Second, by identifying Iranian BSC risks and identifying special risks.

The relative efficiency of Iranian's rural traffic police: a three-stage DEA model.

BACKGROUND: Road traffic Injuries (RTIs) as a health problem imposes governments to implement different interventions. Target achievement in this issue required effective and efficient measures. Efficiency evaluation of traffic police as one of the responsible administrators is necessary for resource management. Therefore, this study conducted to measure Iran's rural traffic police efficiency. METHODS: This was an ecological study. To obtain pure efficiency score, three-stage DEA model was conducted with seven inputs and three output variables. At the first stage, crude efficiency score was measured with BCC-O model. Next, to extract the effects of socioeconomic, demographic, traffic count and road infrastructure as the environmental variables and statistical noise, the Stochastic Frontier Analysis (SFA) model was applied and the output values were modified according to similar environment and statistical noise conditions. Then, the pure efficiency score was measured using modified outputs and BCC-O model. RESULTS: In total, the efficiency score of 198 police stations from 24 provinces of 31 provinces were measured. The annual means (standard deviation) of damage, injury and fatal accidents were 247.7 (258.4), 184.9 (176.9), and 28.7 (19.5), respectively. Input averages were 5.9 (3.0) patrol teams, 0.5% (0.2) manpower proportions, 7.5 (2.9) patrol cars, 0.5 (1.3) motorcycles, 77,279.1 (46,794.7) penalties, 90.9 (2.8) cultural and educational activity score, 0.7 (2.4) speed cameras. The SFA model showed non-significant differences between police station performances and the most differences attributed to the environmental and random error. One-way main road, by road, traffic count and the number of household owning motorcycle had significant positive relations with inefficiency score. The length of freeway/highway and literacy rate variables had negative relations, significantly. Pure efficiency score was with mean of 0.95 and SD of 0.09. CONCLUSIONS: Iran's traffic police has potential opportunity to reduce RTIs. Adjusting police performance with environmental conditions is necessary. Capability of DEA method in setting quantitative targets for every station induces motivation for managers to reduce RTIs. Repetition of this study is recommended, annually.

Alpha-Tocopherol Reduces Brain Edema and Protects Blood-Brain Barrier Integrity following Focal Cerebral Ischemia in Rats.

OBJECTIVE: This study was conducted to examine the neuroprotective effects of α-tocopherol against edema formation and disruption of the blood-brain barrier (BBB) following transient focal cerebral ischemia in rats. MATERIALS AND METHODS: Ninety-six male Sprague-Dawley rats were divided into 3 major groups (n = 32 in each), namely the sham, and control and α-tocopherol-treated (30 mg/kg) ischemic groups. Transient focal cerebral ischemia (90 min) was induced by occlusion of the left middle cerebral artery. At the end of the 24-hour reperfusion period, the animals were randomly selected and used for 4 investigations (n = 8) in each of the 3 main groups: (a) assessment of neurological score and measurement of infarct size, (b) detection of brain edema formation by the wet/dry method, (c) evaluation of BBB permeability using the Evans blue (EB) extravasation technique, and (d) assessment of the malondialdehyde (MDA) and reduced glutathione (GSH) concentrations using high-performance liquid chromatography methods. RESULTS: Induction of cerebral ischemia in the control group produced extensive brain edema (brain water content 83.8 ± 0.11%) and EB leakage into brain parenchyma (14.58 ± 1.29 µg/g) in conjunction with reduced GSH and elevated MDA levels (5.86 ± 0.31 mmol/mg and 63.57 ± 5.42 nmol/mg, respectively). Treatment with α-tocopherol significantly lowered brain edema formation and reduced EB leakage compared with the control group (p < 0.001, 80.1 ± 0.32% and 6.66 ± 0.87 µg/g, respectively). Meanwhile, treatment with α-tocopherol retained tissue GSH levels and led to a lower MDA level (p < 0.01, 10.17 ± 0.83 mmol/mg, and p < 0.001, 26.84 ± 4.79 nmol/mg, respectively). CONCLUSION: Treatment with α-tocopherol reduced ischemic edema formation and produced protective effects on BBB function following ischemic stroke occurrence. This effect could be through increasing antioxidant activity.

The impact of participatory ergonomics on working conditions, quality, and productivity.

A participatory ergonomics model was designed for improving working conditions, quality, and productivity in a medium-sized manufacturing enterprise by making use of a Supportive Expert Team (SET). In order to implement the model, a team-based structure consisting of a Steering Committee (SC) and 2 Action Groups (AGs) was designed and a 5-phase methodology followed. To validate the model, a similar factory was selected as control. Performance of the model was successful throughout the project. AGs under the supervision of the SC and the support of the SET designed and implemented several ergonomics solutions using local resources. Our findings showed that, in comparison with the control factory, application of such a model could be considered as a provider of a more humanized work environment as well as a more efficient and cost-effective approach.