mohamadreza akbari

Extended Abstract
Introduction and

The knowledge-based economy is one the factors of economic growth and development in countries, which has always been the focus of various governments. Advanced economies such as those of North America, Europe, or East Asia have achieved prosperity, independence, economic and political power in the past years by focusing on this type of economy. Therefore, the current study tries to investigate the effect of the innovation index on the green GDP by using Engel-Granger causality and past studies.

In this article, an attempt has been made to first use the Granger-parasitic method, which is used to detect the causality between time series, and then the Autoregressive Distributed Lag (ARDL) method to investigate the relationship between variables and the data needed in this study during the years 1995-2020 were collected from various sources, including the World Bank and the statistical yearbook of Iran. The results showed that fuel energy consumption, labor force, innovation index, and education index with green GDP do not cause Granger causality to each other, but Granger causality from green GDP to capital stock and vice versa (bidirectional relationship between them). It also flows from green growth to the education index and vice versa.

The results in the auto regression method with a broad interval showed that the partial elasticities of production for the inputs of fuel energy consumption, labor force, capital stock, human capital, global innovation index and education index are the same coefficients of the variables in the production function. Considering that the elasticities of inputs during production and in different years are constant in the Cobb-Douglas function; It can be interpreted in this way that the elasticity of green GDP with one break, human capital, global innovation index, global innovation index with one lag, education index and education index with one lag are 0.22, 0.21, 0.18, 0.35, 0.51 and 0.97 respectively.

As a result, it can be said that the development of a knowledge-based economy in Iran is not friendly to nature and creates CO2 and has a negative effect on green GDP.

To evaluate the frequency of facial asymmetry parameters in patients with head tilt versus those with head turn.

This cross-sectional comparative study was performed on 155 cases, including 58 patients with congenital pure head turn due to Duane retraction syndrome (DRS), 33 patients with congenital pure head tilt due to upshoot in adduction or DRS, and 64 orthotropic subjects as the control group. The facial appearance was evaluated by computerized analysis of digital photographs of patients’ faces. Relative facial size (the ratio of the distance between the external canthus and the corner of the lips of both face sides) and facial angle (the angular difference between a line that connects two external canthi and another line that connects the two corners of the lips) measured as quantitative facial parameters. Qualitative parameters were evaluated by the presence of one-sided face, cheek, and nostril compression; and columella deviation.

The facial asymmetry frequency in patients with head tilt, head turn, and orthotropic subjects was observed in 32 (97%), 50 (86.2%), and 22 (34.3%), respectively (P < 0.001). In patients with head tilt and head turn, the mean facial angle was 1.78º ± 1.01º and 1.19º ± 0.84º, respectively (P = 0.004) and the mean relative facial size was 1.027 ± 0.018 and 1.018 ± 0.014, respectively (P = 0.018). The frequencies of one-sided nostril compression, cheek compression, face compression, and columella deviation in patients with pure head tilt were found in 19 (58%), 21 (64%), 19 (58%), and 19 (58%) patients, respectively, and in patients with pure head turn the frequencies were observed in 42 (72%), 37 (63%), 27 (47%), and 43 (74%), respectively. All quantitative and qualitative facial asymmetry parameters and facial asymmetry frequencies were significantly higher in head tilt and head turn patients as compared to the control group (P < 0.001).

All facial asymmetry parameters in patients with head tilt and head turn were significantly higher than orthotropic subjects. The quantitative parameters such as relative facial size and facial angle were significantly higher in patients with pure head tilt than pure head turn. The results revealed that pure head tilt was associated with a higher prevalence of facial asymmetry than pure head turn.

To provide a comprehensive review on different characteristics of abnormal head postures (AHPs) due to different ocular causes, its measurement, and its effect on facial appearance.

In this review article, PubMed, Scopus, and Google Scholar search engines were searched for the scientific articles and books published between 1975 and September 2020 based on the keywords of this article. The selected articles were collected, summarized, classified, evaluated, and finally concluded.

AHP can be caused by various ocular or nonocular diseases. The prevalence of ocular causes of AHP was reported to be 18%–25%. 1.1% of patients presenting to ophthalmology clinics has AHP. The first step in evaluating a patient with AHP is a correct differential diagnosis between nonocular and ocular sources by performing comprehensive eye examinations and ruling out other causes of orthopedic and neurological AHP. Ocular AHP occurs for a variety of reasons, the most important of which include nystagmus, superior oblique palsy, and Duane’s retraction syndrome. AHP may be an essential clinical sign for an underlying disease, which can only be appropriately treated by the accurate determination of the cause. Long‑standing AHP may lead to facial asymmetry and secondary muscular and skeletal changes.

In conclusion, a proper differential diagnosis between nonocular and ocular causes, knowledge of the different forms of AHP and their measurement methods, accurate diagnosis of the cause, and proper and timely treatment of ocular AHP can prevent facial asymmetry and secondary muscular and skeletal changes in the patients.

To evaluate the correlation between the angle of deviation in different gazes and the amount of head tilt in patients with congenital unilateral superior oblique muscle palsy (SOP).

This case series study was performed on 20 consecutive SOP patients with head tilt. Based on the Bielschowsky three-step test, the angle of deviation was measured in different gazes. Furthermore, the hypertropia difference between the two lateral gazes (gaze difference) and the two head tilt sides (bilateral head tilt difference) was calculated. For measuring head tilt, close‑up pictures from 40 cm with a habitual abnormal head position were captured and analyzed by the Corel Draw X7 software.

The mean age of patients was 13 ± 9 years (range, 2.5–31 years). The mean angle of hypertropia in ipsilateral and contralateral head tilt was 24.5 Δ ± 7.1 Δ and 6.5 Δ ± 4.2 Δ, respectively (P < 0.001), and in ipsilateral and contralateral lateral gaze positions, it was 8.2 Δ ± 5.5 Δ and 22.5 Δ ± 6.1 Δ, respectively (P < 0.001). The mean of bilateral head tilt hypertropia difference was 18 Δ ± 5.3 Δ and gaze hypertropia difference was 14.3 Δ ± 6.16 Δ. There was a positive correlation between bilateral head tilt hypertropia difference and the amount of head tilt (R = 0.609, R2 = 0.371, P = 0.004, the amount of head tilt = 0.39 × [Bilateral head tilt hypertropia difference] +1.77). The amount of head tilt also had a positive correlation with the gaze hypertropia difference (R = 0.492, R2 = 0.242, P = 0.028, the amount of head tilt = 0.27 × [gaze hypertropia difference] +4.81).

In SOP patients, the amount of head tilt had a positive correlation with bilateral head tilt hypertropia difference and also gaze hypertropia difference.

Metallic foams and cellular metals are a type of new-advanced engineering materials which can be successfully used in various industrial applications due to their unique behavior and properties. In this work, steel foams were produced through powder metallurgy route using urea granules as a space holder, and porosity percentage, microstructure, and compressive behavior of them were investigated. In addition, the compressive behavior of manufactured foams was simulated using finite element method by the Gurson–Tvergaard–Needleman model and the effects of operational parameters in this model were investigated due to better prediction of mechanical behavior of steel foams. The results indicated that the average of porosity in the steel foam is 79.3 percent, which consists of cells formed by the dissolution of urea granules and remained pores between the sintered iron particles. Stress vs. strain curves of the manufactured steel foams showed the conventional behavior of metal foams, with elastic deformation region and a relatively longitudinal plateau region and, a fracture point, finally. Mesh sizes, fn, q1 and q2 have the significant effect on stress vs. strain curves, but q1 and fn have the most and the least effects, respectively.

Coronary artery bypass grafting is a surgical operation that bypasses atherosclerotic coronary vessels and restores blood flow to the ischemic zone of hearts. And two different conventional methods are ON-pump CABG, and Off-pump CABG.  Altogether, the efficacy and safety of these two types of surgical procedures are still under debate. In this study, we aim to compare the efficacy, safety, and cost-effectiveness of these two different methods in admitted patients to Imam Reza Hospital in Mashhad in Iran during 2006 to 2016. In this prospective cohort study, 533 patients who underwent CABG in Imam Reza hospital in Mashhad during 2006 to 2016 were identified. The data was collected using hospital records including demographic data, chief complaint, history of previous disease, ejection fraction, number of graft, blood transfusion, time of anesthesia, time of surgery, days of hospitalization, days of ICU stay, needs for reoperation, post-operative complication, expenses of hospitalization. Of 533 patients were 347 patients of whom male. The mean age was 59.53±10.21 and the mean BMI was 26.38±5.4. The most common chief complaint of the patients was chest pain. 38 patients of 533 cases underwent on-pump surgery and 495 underwent off-pump technique. There were no significant differences for age, and gender. The prevalence of HTN, diabetes, MI, and hyperlipidemia had no differences among two groups. Renal failure was more common in on-pump group; whereas, pulmonary disease was more common in off-pump group. On-pump surgery required significantly longer hospitalization and ICU care. Also needs for reoperation was more common among on-pump surgery. Total expenses were significantly higher in on-pump group.10.5% of those who underwent on-pump surgery died after surgery. This rate was only 3.1% among off-pump group. In this study we showed that, the patients who underwent on-pump surgery, required longer hospitalization, and ICU care. Total expenses were significantly higher in on-pump group. In addition, the mortality rate of on-pump group was significantly higher than the off-pump group. Also needs for reoperation was more common among on-pump surgery. Altogether, it seems that off-pump surgery is safer with low expenses than on-pump CABG.

In this work, the effects of addition of 2 wt. % Cu and 2 wt. % P on the porosity percent, microstructure, and mechanical properties of 0.5 wt. % C steel foams manufactured by powder metallurgy through urea granulates as space holder were separately investigated. After manufacturing steel foams, determination of porosity percent by dimensional measurement, microstructural evaluation through optical and scanning electron microscopes, and investigation of mechanical behavior by compression test were conducted. The average of porosity percent in steel foams with Cu and P are 75 and 80 percent, respectively. In microscopic evaluations, two types of cells were observed that consisted of the solved urea cells and pores in the cells walls. In addition, the thickness of the cells walls was approximately measured from 90 to 102 micron. In the compressive stress vs. strain curves of Cu and P added steel foams, a long plateau region was observed. It is noteworthy that plateau region in the P added steel foams was as teeth-saw shape that related to the fracture of cells walls.

Postoperative bleeding in cardiac surgery is not an uncommon complication and can be evaluated with surgical and nonsurgical causes. Although any type of coagulopathy should be treated before, during, and after the surgical procedure, cardiac surgeons should have perfect surgical techniques for step by step hemostasis to minimize blood loss. This retrospective study was conducted on 85 patients out of 1075 (0.07%) ones required Reexploration of the Mediastinal to control the excessive bleeding after different cardiac procedures in Imam Reza Hospital in Mashhad of Iran from January 2018 to January 2019. Out of 85 patients who required Mediastinal Reexploration, 61 (71%) and 24(29%) patients underwent the off-pump procedure and cardiopulmonary bypass, respectively. The most common sites for surgical bleeding in the order were missed branches of left internal mammary artery / saphenous vein graft (65%), proximal or distal coronary anastomosis (18%), and aortic /atrial suture line (16%). The death in patients under study was 7 (8%), half of which were not related to Mediastinal Reexploration. The possibility of postoperative bleeding can be minimized through correction of clotting factor deficiencies, improvement of surgical techniques in hemostasis.

Sexual dysfunction is one of the most common problems in men after coronary artery bypass graft surgery (CABG). The aim of this study was to compare male sexual function before and 6 months after CABG. This cross-sectional study recruited 70 CABG candidates who completely fulfilled the inclusion criteria without any exclusion criteria. The patients were asked to complete the International Index of Erectile Function (IIEF) questionnaire before and also 6 months after the operation. Demographic data and also the type of surgery were recorded. At the end of the study period, different dimensions of sexual function were compared before and after CABG. The mean age of the patients was 57.7 ± 7.86 years, and 15 (21.4%) cases were diabetic. Six months after CABG, a significant decrease was observed in all the aspects of sexual function (P < 0.001). The mean erectile function score decreased from 19.91 ± 6.4 to 17.46 ± 6.82, the mean orgasmic function score from 7.19 ± 2.62 to 6.17 ± 2.99, the mean sexual desire score from 6.44 ± 2.47 to 4.91 ± 2.76, the mean intercourse satisfaction score from 8.59 ± 3.57 to 7.4 ± 3.77, the mean overall satisfaction score from 6.71 ± 2.29 to 5.34 ± 2.77 and the total score of the IIEF from 48.84 ± 13.26 to 41.29 ± 14.75. Comparisons of sexual function quality before and after CABG divided by diabetic and nondiabetic patients also demonstrated the same results in all the domains. Except for the intercourse satisfaction in the nondiabetic patients, sexual function decreased significantly. The results of this study indicated the negative effect of CABG on all the different aspects of sexual function. Given the direct impact of sexual function on patients’ quality of life, it is essential to take this aspect of patients’ function into account more than before by applying empowerment therapies after CABG, if necessary.

Patients with primary acute aortic dissection are at higher risk of complications, including increasing aortic aneurysm diameter, aortic rupture, aortic pseudo aneurysm, and recurrent aortic dissection. Case presentation We presented the case of a recurrent pseudo aneurysm and rupture of the aorta in the distal ascending aorta and proximal arch 3 years after the initial procedure for acute aortic dissection. The patient had bleeding from previous skin incision. In computed tomography angiography, the site of rupture of the aorta and abnormal communication with sternum were confirmed. Conclusion Recurrent aortic dissection is a catastrophic event and has high mortality; however, it is rare and is treated in a short time by redo surgery.

The case in this study was a 33-year-old woman suffering from acute pericardial tamponade with severe left ventricular systolic dysfunction (LVEF=10%) after myocarditis as a result of possible viral respiratory infection.
The diagnosis was confirmed with two transthoracic echocardiography (TTE) evaluation showing moderate pericardial effusion with diastolic right atrium and ventricle collapse. The hemodynamic and respiratory condition of the patient was unstable and emergent. The drainage of pericardial space was life-saving with good results.

  The use of anticoagulant and ant platelet medications, especially warfarin and clopidogrel, is on a growing trend. Warfarin usage is commonly accompanied with hemorrhagic complications resulting in a noticeable mortality rate. Patient's ant coagulated with warfarin suffers from intracranial hemorrhage after a head injury. For the purpose of the study, the relevant articles published from 1966 to January 2017 were searched in several databases, including of Medline, Scopus, Google Scholar, and MEDLINE (through PubMed). The search process was performed using the following medical subject headings: “Warfarin” combined with “Warfarin-associated hemorrhage”, “Head injury and warfarin-related intracranial hemorrhage”, “Intracerebral hemorrhage”, and “Treatment of coagulopathy”. The search process resulted in the inclusion of 242 articles. According to the results of the reviewed studies, the best treatments for the reversal of coagulopathy in warfarinised patients in elective or urgent conditions following a head injury are prothrombin complex concentrate (PCC) and fresh frozen plasma, along with vitamin K, based on the discretion of the treating physician. According to the studies, the administration of PCC or any other treatments with a similar or close formulation to PCC is significantly more effective and faster in the reversal of coagulopathy and reduction of international normalized ratio in comparison with the use of fresh frozen plasma or other therapies in warfarinised patients admitted with serious intracranial hemorrhage following a head injury. Delivery of an effective treatment to these patients can be accomplished by planning for medical interventions, decreasing time delays for operations, and selecting a suitable or alternative treatment.

Controlled intraoperative cardioplegia is indispensable to pediatric cardiac surgery procedures. Several preservation techniques have been proposed for such purposes, with varying application by different surgeons. The custodiol cardioplegia is a recent approach that is considered to be a safe and effective cardiac protector. This narrative review was conducted via searching in four databases, including PubMed, Scopus, Embase, and ScienceDirect. The studies focused on the efficacy and safety of custodiol cardioplegia reviewed, especially in pediatric cardiac surgeries and relevant procedures. In total, 21 articles were eligible, and the findings highlighted the controversies regarding the use of various cardioplegic solutions and the variability of their application by surgeons. However, data were inadequate regarding the optimal cardioplegic solutions in this regard. Some of the studies performed on adults suggested that custodiol cardioplegia may be equivalent to conventional blood cardioplegia. Most of the reviewed articles showed a consensus on the safety and efficacy of custodiol cardioplegia in adult and pediatric cardiac surgeries. It is believed that custodiol procedures are not only easily delivered, but they are also convenient and less time-consuming and provide long-lasting motion and bloodless fields for the surgeon to perform the operation. Therefore, use of custodiol cardioplegia has been reported to be safe, effective, and cost-efficient compared to conventional cardioplegic solutions. However, different findings have also been denoted in some of the studies in this regard, implying the equal effectiveness of these techniques.

Ischemic mitral regurgitation is a major source of morbidity and mortality of myocardial infarction. Surgical intervention for significant ischemic mitral regurgitation at the time of coronary artery bypass grafting (CABG) is controversial and has always presented a great challenge. The purpose of this study was to describe the current surgical options for ischemic mitral incompetency and to discuss when mitral valve repair via the Kay method may be favored over mitral valve replacement. Twelve patients candidated for the Kay mitral valve repair plus CABG were recruited. The efficacy of mitral valve repair was echocardiographically recorded at follow-up. To validate the diagnosis of ischemic mitral regurgitation, we conducted a detailed chart review— which included all preoperative cardiac imaging tests at the first, sixth, and 12th postoperative months, as well as the operative records and pathology reports. Twelve patients (5 male and 7 female) underwent CABG plus the Kay mitral valve repair. All the patients had significant mitral valve incompetency, which was resolved in all of them (P<0.05). There was no preoperative or postoperative mortality. No further postoperative mortality was reported at 1 year’s follow-up. The Kay technique for mitral valve repair had a desirable result insofar as 8 (72.7%) patients had only mild mitral regurgitation and 4 (33.3%) had mild-to-moderate mitral regurgitation. In the current era and in Iran, mitral valve repair—especially via the Kay method—has been proven to confer improved short and long-term survival, decreased valve-related morbidity, and enhanced left ventricular function. Future randomized prospective clinical trials are needed to compare this cost-effective surgical technique with its counterparts.

Metabolic syndrome (MS) is considered as an important risk factor for advanced coronary artery disease. This condition can increase the mortality and morbidity in the patients undergoing coronary artery bypass graft (CABG) surgery. The aim of the study was compared mortality and morbidity after off Pump- CABG surgery between patients with and without the Metabolic syndrome.
This prospective cross-sectional study was conducted on 120 patients, who underwent off-pump CABG surgery between October 2014-October 2016. The participants were equally divided into two groups including the patients with and without MS (MS and non-MS, respectively).
According to the results, 68 (56.6%) patients were male. Furthermore, out of the 60 participants with MS, 36 (60%) cases were male. The mean ages of the MS and non-MS groups were 64.96±9.6 and 65.62±10.6 P=0.6 years, respectively. No statistically significant difference was observed between the two groups in terms of the mortality and morbidity (e.g., surgical wound infection, length of Intensive Care Unit and hospital stay, atrial fibrillation rhythm, and bleeding in the first 24 h). The intubation time in patients with Metabolic Syndrome was significantly higher than patients without Metabolic Syndrome (6.66 ± 1.97 vs 5.83 ± 1.93 respectively; P=0.007)
Metabolic syndrome was not associated with higher mortality and morbidity after CABG surgery compare to patients without Metabolic syndrome, although patients with Metabolic syndrome had higher risk for long intubation time.

Pulmonary embolism is associated with high mortality rates despite improvements in its management. The aim of the present study was to analyze the outcome of 20 patients who underwent surgical pulmonary embolectomy in our institution.
The medical records of all patients undergoing pulmonary embolectomy during a 3-year period at our institution were studied for demographic and preoperative data as well as hospital mortality.
Twenty patients underwent pulmonary embolectomy. The patients were aged between 35 and 76 years old. Fourteen (70%) patients were male. The most common risk factor in these patients was a history of major surgery (55%). The hospital mortality rate was 25%.
Pulmonary embolectomy can be considered an effective approach in patients with pulmonary embolism and carries low mortality and morbidity. (Iranian Heart Journal 2017; 18(1):16-19)