javad jalili

Percutaneous Trans hepatic biliary drainage (PTBD) is a successful palliative treatment for malignant obstructive jaundice. Despite the past that PTBD complications occur more frequently. Currently, with the help of an ultrasound guide, these side effects and possibility of adjacent organ damages have decreased interestingly. One of the rare complications of this procedure is acute pancreatitis.

We discuss an uncommon case of acute pancreatitis following PTBD in an elderly woman who presented to the hospital with jaundice and anorexia. Conservative therapy without decatheterization was the treatment of choice in our patient. Eventually after receiving conservative therapy for her pancreatitis, she was discharged from the hospital in good general condition and she has not experienced any episodes of abdominal pain again.

Acute pancreatitis is one of the causes of sepsis during PTBD catheterization. Early management of this complication after PTBD can decrease morbidity and mortality of the patients.

The event of Sarpol-e Zahab with magnitude of 7.3 severely struck the border area of Iran an Iraq in Kermanshah province, leading to catastrophic damages to a wide region, specially Sarpol-e Zahab city. Douts arous whether the damage distribution allover the city stemed from seismic ground response or superficial loose fill material. The issue was explord in this study by especial attention to an area with high damages in Sarpol-e Zahab, called Fooladi. Since the seismic bedrock motion was not available, it was first deconvoluted from the recorded acceleration on the ground surface. Then ground response analysis was conducted at three different locations in Fooladi area, by applying deconvolved motion. It was determined that the local site condotion was accountable for damage severity specially in Fooladi area.

Female characters, whether in the position of lover or beloved in Attar's Masnavis, actively establish emotional relationships with men and their attitudes toward love effectively contribute to the formation of this relationship. This research aims to investigate these characters' knowing about love dimensions in Attar's Masnavis (Mantiq Al-Tair, Elahinameh, and Mosibatnameh) based on Sternberg's triangular theory of love using the documentary method and provides answer to these questions: Do the patterns of women's romantic relationships match Sternberg's point of view? To which dimensions of love have women paid more attention? and what has been the difference between women's attitude and men's to these issues? The results of this research show that the pattern of romantic relationships of women has been in agreement with Sternberg's point of view, but female characters in Attar's anecdotes</em> have paid more attention to some dimensions and components of love due to cultural differences and mystical attitudes; such that in their views, the men in the position of the lover should prove their intimacy and commitment before addressing the passion dimension, and after that their passion expression can be accepted. The women themselves in the position of the lover always comply with all three dimensions of love, and, in general, guide men in lovemaking to attain the </em>perfect and ideal love.
   

In a case study, behavior of an underground-railway tunnel of the Tehran metro subjected to tremendous explosive load was explored by numerical analysis. Blast wave propagation in the soil is studied by effective stress analysis in PLAXIS 2D finite element code. To assure reliability of the code in performing a robust dynamic calculation, Lamb Problem was modeled by the code and results were compared with analytical solutions, which was satisfactory. Due to the significant effect of the soil type and layering on the dynamic response of the buried structures in an explosive loading, care was taken in the study to resemble the real soil layering, relying on the available geotechnical investigations in the area. Based on the available data and also semi-empirical relations, HS Small soil model was calibrated to resemble soil behavior. In this regard, five parameters of density, elastic modulus, Poisson’s ratio, damping ration and layer thickness were carefully defined for each layer. Semi-empirical relationships were used to calculate soil dynamic shear modulus, which were larger than the static shear modulus. HS Small model has the ability to resemble the cyclic behavior of the soil by applying Masing’s rules in a load-unload-reload cycle. PLAXIS updates the stiffness matrix of the soil mass at each step of the analysis according to the strain and deformations that have been created in the soil, which increases the precision of the calculations. In this study, the Unified Facilities Criteria (UFC 3-340-03) manual was used to calculate the blast pressure. The weight of TNT explosive (charge weight) was considered 510 pounds (230 weight) in this regard. The type of explosion is assumed as an unconfined explosion, i.e., a surface burst. According to the UFC 3-340-03, the graph of changes of explosive pressure with time which is presented as a triangular pulse in the time domain, was defined in applied to the model geometry in the finite element code. Appropriate mesh dimensions relative to the transmitted wave-length in the numerical simulation play an important role in the precision of the results. Consequently, the frequency content of the pressure-time signal was probed in the frequency domain using the Fourier transform technique. To reduce the reflection of the waves from the model boundaries, viscous absorbent boundaries were defined in the model, as well as enlarging the model dimensions to reduce unwanted and unreal reflections from the boundaries of the model as much as possible.
After careful definition of the model geometry and loadings, both static and dynamic calculations were performed. The former simulated the construction of the underground tunnel, and the latter simulated the surface burst after tunnel construction, ignoring the crater caused by the explosion on the surface. The results show that the peak stress at the crown and bottom of the tunnel decreases as the soil density of the first layer increases, irrespective of static or dynamic values of the soil modulus. However, the stress values corresponding to the static parameters are greater than those of dynamic parameters. This comparison shows that if the static shear modulus values are preferred, the tunnel should be designed regarding larger stresses, which is not economical. Despite the decreasing effect of the first layer density on the stress magnitudes, the increase of the density of the second layer -that surrounds the tunnel- increases the stresses at the crown and bottom of the tunnel. The results also revealed that the effect of Poisson’s ratio of the soil on the tunnel's stresses are very small, but with the increase in the damping ratio, the amount of stress in the tunnel crown decreases dramatically. As the soil layers thicknesses increase, stress at the crown of tunnel decreases. These findings are useful to plan a safer design for crowded subway stations, regarding proper soil layering and properties

Degree of saturation of soil is an important factor in preparing specimens of soil in the laboratory. The moisture content of the specimen affects its behavior, especially in undrained loading, either by change of the structure of soil or by change of effective stress path. Even though special equipment is required to measure the change of unsaturated specimen’s geometry, they are not provided in many engineering laboratories due to economic and technical reasons. One alternative for a precise measurement is to saturate the specimens. We show herein that apart from such expensive measurements and saturating the specimens even though it is not saturated in the field, estimating the change of specimen size by simplifying the relevant assumptions and resembling the degree of saturation of the field in the laboratory is to be preferred. Two case studies of monotonic and cyclic triaxial tests are reported herein to show this priority based on field tests and image processing results. It is concluded that given the variation of the degree of saturation of the soil in the field, as well as its volumetric behavior while being sheared, that is, either being compressional or dilative, are essential to make the optimal decision on the selection of the proper degree of saturation at the laboratory.

 Breast cancer is one of the most common cancers in women. Involvement of regional lymph nodes by breast cancer has shown to be a significant marker in the overall diagnosis of patients. In this study, we aimed to investigate the role of gray-scale ultrasound and elastography in discriminating benign from malignant axillary lymph nodes in patients with breast cancer.

 In this analytical study, patients with breast cancer who were referred to sonography ward of a tertiary medical educational center and found to have suspicious lymph nodes were investigated. Formal properties were evaluated by grayscale ultrasound and tissue properties were assessed by elastography. Biopsies were performed on all cases and suspicious tissues were removed.

 This study was conducted on 50 patients with the mean age of 48.54±10.58 years. 52% of patients had a mass in their right breast and the most prevalent type of breast cancer was intra-ductal carcinoma. 60% of the lymph nodes were reported to be malignant. In 56% of the lymph nodes, grayscale ultrasound tests demonstrated unusual findings and the most common finding was the removal of fat from lymph node hilum. Moreover, elastography results indicated that 36% of the cases have grade 4 (blue) lesions.

 This study indicated that grayscale ultrasound and elastography have high sensitivity and specificity in detecting metastatic lymph nodes. This finding was in line with the findings reported in many of the previous studies.

 This study assessed anxiety and depression scores based on the Hospital Anxiety and Depression Scale (HADS) questionnaire, inpatients recalled after mammography.

 In this cohort study, women referred for mammography completed the HADS questionnaire. In 2019, 84 patients who required recall based on the results of their previous mammogram were selected and then completed the HADS questionnaire for the second stage. The HADS questionnaire was used to examine psychological problems. SPSS was used to analyze the collected data.

 In this study, 86 women who were screened with mammography were evaluated. The mean age was 47.2±8.3 years. Based on the HADS questionnaire, the mean anxiety score before mammography was 10.2±4.8, and after the recall was 13.2±4.2, which was statistically significant (P<0.001). Also, the depression score in these patients before mammography was 10.7±3.8, and after the recall was 12.6±3.6 (P<0.001).

 Recalling patients after mammography can increase their anxiety and depression, which can decrease patients’ desire for follow-ups.

Decompressive Craniectomy (DC) is recommended for patients with extensive cerebral infarction. At this study, we aimed to assess the mortality and 3-month outcome of these patients who are not going under DC.

In this prospective descriptive study, all patients referred to Imam Reza Hospital in Urmia, Iran, from 2017-2019 with extensive ischemic stroke with refractory medical edema of the brain who did not undergo surgery were included. Patient’s demographic and other brain stroke-related data were recorded. Patients were evaluated for the improvement of brain stroke symptoms based on the comparison of National Institutes of Health Stroke Scale (NIHSS) criteria at the time of hospitalization with discharge time and also for the degree of disability and mortality at three months follow-up according to mRS criteria. P values less than 0.05 were considered statistically significant.

A total of 28 patients were enrolled in the study. Median age was 76 years. NIHSS score was 21 at admission and 18 at discharge (p<0.05). Of all 28 patient, 22 (78.6%) died during hospital admission and 24 (85.7%) died up to 3 month follow up. None of the 4 survived patients had a good and independent outcome along the 3-month follow-up (MRS<3).

Results of this study showed that in patients with extensive cerebral infarction with edema resistant to medical treatment, fail to perform decompressive craniectomy is associated with a very high mortality rate and poor prognosis.

Warfarin is still the primary drug used to prevent vascular events in patients with atrial fibrillation (AF), especially in low-income countries. Therapeutic failure and non-adherence are common causes of recurrent embolic events. The aim of this study was to investigate possible reasons why INR was outside the therapeutic range in patients presenting with acute ischemic stroke and AF.

This prospective study was performed over a ten-month period and all patients admitted with acute ischemic stroke were enrolled. Patients with AF who did not have INR within the therapeutic range (INR=2-3) at the time of admission were identified. During a face-to-face interview, the reasons for INR being outside the therapeutic range were assessed based on a prepared checklist.

During the study period, 810 patients had an acute ischemic stroke, of which 177 had AF heart rhythm (22%). The median age was 76 (IQR: 71-83), and 87 (52%) were male. Of these 177 patients, 44 (25%) had a previous history of AF (“previous AF” group) and 133 (75%) were diagnosed with AF during the current hospital admission (“new AF” group). Among patients on warfarin but with INR outside the therapeutic range (29 in all), 20 (69%) did not see a physician regularly and/or did not take medication according to the physician’s instructions.

The most common reason for INR being outside the therapeutic range was patients lack of awareness of their heart disease (unrecognized AF). Other reasons included irregular visits to the physician and drug non-adherence.

Undrained behavior of aggregate-clay mixtures in its natural or compacted state, which is used as the core of embankment dams or liner of waste disposal systems, has great importance for geotechnical engineers. Previous studies have shown that excess pore water pressure plays an important role when dealing with cyclic/dynamic behavior of aggregate-clay mixtures. An extensive testing program was conducted on compacted sand-clay mixtures to investigate effects of aggregates on the cyclic behavior of the mixtures under strain- and stress-controlled cyclic loads utilizing triaxial and torsional shear equipment. Clay content was varied from 100 to 40% by volume in tested specimens. Isotropically and anisotropically consolidated specimens were tested under vertical effective stresses of 100 and500 kPa. The aim of the various loading conditions and numerous experiments was to investigate cyclic pore pressure build-up in the mixtures, and developing a pore pressure model based on dissipated energy. The main advantage of the model is that it can capture opposite trend of pore pressure build-up with aggregate content in strain-, and stress-controlled loading. The model is then verified with cyclic triaxial tests on ceramic beads-clay mixtures.

 Sonographic evaluation of the kidneys is a key diagnostic step in determining kidney disorders. Previous studies have suggested that sonographic evaluation helps clinicians in determining the causes of either acute or chronic renal diseases.

 The present study aimed to assess the role of ultra-sonography in acute and chronic renal pathologies.

 In this study, 29 patients with parenchymal kidney disease referred to Nephrology Department of Imam Reza Hospital, Tabriz, Iran, participated. The patients’ demographic information, internal diseases, kidney diseases, and other medical conditions were recorded. Then the Doppler and gray scale sonography were performed for both kidneys. Biopsies were taken from patients and were then compared with sonographic findings. The data were analyzed with SPSS software version 22.

 According to pathologic findings, 69% of renal diseases was acute, and 31% of the diseases were chronic. According to the results of Gray Scale ultrasonography, there was a significant correlation between parenchyma thickness, cortex echogenicity (qualitative), medula echogenicity (qualitative and quantitative), and corticomedullary differentiation (quantitative) with pathologic findings (P < 0.05). Furthermore, no significant correlation was observed between the length of the kidney, cortex echogenecity (quantitative), and cortico-medullary differentiation (qualitative) with pathological findings (P < 0.05). In addition, there was a significant correlation between RI and pathologic findings based on Doppler ultrasonography (P < 0.05).

 According to the results of this study, ultrasonography and color Doppler would be useful as an assistance and non-invasive method for the diagnosis and differentiation of the conflict site and the type of pathology involved in all parenchymal kidney disorders

 Varicocele is an important cause of infertility in men. Some studies have suggested that because of the similar pathologic processes involved in chronic venous diseases and varicocele, saphenofemoral insufficiency is an example of chronic venous disease, which causes varicose veins in the lower extremity. It is thought that there may be a relation between saphenofemoral abnormality and the emergence of varicocele, but this relation is not backed by sufficient evidence.

 In this prospective diagnostic study, a total of 50 patients suffering from varicocele and 50 control patients were included. Ultrasonography was performed to determine the emergence of saphenofemoral insufficiency (SFI).

 Mean age of patients in the varicocele group and the control group was 32.4 ± 8.44, and 34.9 ± 6.39, respectively. Out of 50 patients being included in the study with varicocele, 8 had left sided SFI and 9 had right sided SFI, while in the control group, 4 patients were diagnosed with SFI, 2 on each side. The difference between the two groups was statistically significant. There was no relation between the time from diagnosis of varicocele, side of varicocele and the existence of saphenofemoral insufficiency.

 Saphenofemoral insufficiency was shown to be significantly related to varicocele, and can be a sign of probability of emergence or re-emergence of varicocele, and further can be used in clinical examination to guide clinicians in diagnosing varicocele.

This paper describes findings of a series of numerical studies to investigate the effect of Variable Confining Pressure (VCP) on Excess Pore Water Pressure (EPWP) distribution in a mixture of gravelly inclusions floating in matrix of clay, called “mixed clay” material. Mixed clay material has frequently been used as core of embankment dams in seismically active areas of Iran. The mixture naturally exists in rainfall active areas and also is made manually. The matrix provides sealing while the inclusions increase strength and deformation modulus. Previous studies reveal noticeable increase of EPWP among inclusions under cyclic or dynamic loadings, keeping the initial confining pressure constant. The confining pressure is usually held constant based on the triaxial testing routine. However, recent studies have discovered evident variation of confining pressure in different locations of the shaking embankment-core during an earthquake. After reviewing the literature of analytical and experimental studies regarding the magnitudes of VCP caused by different input motions on an embankment, and also those regarding mixture behavior especially in terms of EPWP variation caused by cyclic loads, results of the conducted semi-coupled dynamic analyses on models of triaxial specimens having limited inclusions inside are presented herein. Making use of PLAXIS 2D 2016, specimens with different inclusion sizes and inclusion distances, experiencing VCP are analyzed. The geometry of a triaxial specimen is modelled in PLAXIS environment in an axisymmetric mode. The inclusions are modeled by half-circle geometry at the center of the specimen. The material behavior is undrained, capable of liquefaction resembling, which means that the degradation of the soil is also modeled. Calibration of the model is based on experiments of previous studies on similar materials, taking into account slight modifications to postpone liquefaction generation. This would clarify EPWP generation caused by VCP variation in pre-liquefaction stage; the UBC model is not precise enough in post-liquefaction stage. The bulk modulus of the soil and water are combined and the consequent slight volumetric strain multiplied by the huge bulk modulus of the water provides the excess pore water pressure, while the relatively slight soil skeleton modulus (compared with that of water) leads to nearly zero effective stress. To assure providing of enough precision, two types of calculations were compared: dynamic semi-coupled and static fully-coupled analyses were conducted and results were compared. It was evident that giving permission to EPWP to redistribute in a coupled analysis was not conservative. The parameter that defines VCP effect is the ratio of the confining pressure cycle amplitude to that of deviatoric stress, called “h”. The results of this study shows that cyclic variation of confining and deviatoric stress at the same time would cause the increase of EPWP within inclusions of the matrix. By decrease of inclusion distance to diameter, EPWP increase among inclusions is dominant, which weakens as the distance increases. The EPWP increase is maximum at the minimum h (0.3), which represents the constant confining pressure situation. This shows that neglecting the increase of h as the consequence of VCP is conservative regarding the stability of structures made up of such mixtures during strong ground motions. Findings of this study is in agreement with those of previous ones: increase of EPWP among inclusions affected by loading direction relative to inclusions locations and geometry was evident. Further studies are required to reveal the effect of loading frequency on the results.

We tested whether hepatic haemodynamics assessed by Doppler ultrasonography can be a predictor of response to therapy in patients with non‑alcoholic fatty liver disease (NAFLD) to prevent further unnecessary diagnostic tests and interventions. Forty eight consecutive patients affected by NAFLD, who refered to some clinics in Tabriz, Iran between 2009 and 2011 were included in the study. Response to therapy was assessed by decrease in liver enzyme levels. Three liver Doppler parameters (hepatic artery resistance index [RI], hepatic artery pulsatility index [PI] and portal vein waveform [PVW]) were analysed in all subjects who showed a decrease in liver function tests results. Wilcoxon and paired student’s t‑test were used for analysis. Forty eight subjects with NAFLD were included in the study during 21 months, out of which 22 (39.1% male – mean age: 37.6 ± 8.3) responded to the treatment and formed the basis of this study. Mean hepatic artery RI increased significantly from 0.60 ± 0.07 to 0.83 ± 0.27before and after treatment, however, there was no significant differences between hepatic artery PI or PVW. Increase in hepatic artery RI assessed by Doppler ultrasound may provide information on improvement of NAFLD in patients during the course of therapy.

As a step forward in an ongoing investigation on behavior of composite clay, which is used as the core material of some large embankment dams all over the world, a series of experiments were conducted to explore the distribution of excess pore water pressure along saturated triaxial clay specimens during cyclic loading. As the predominant feature of the composite clay behavior is the increase in excess pore water pressure in both monotonic and cyclic loadings as a consequence of increase in inclusion content, this paper focuses on formation of such pressure distribution inside the specimens in cyclic loading, by utilizing a miniature inner pressure transducer inside triaxial specimens. Specimens of pure clay and mixed material containing 40% (volumetric) ceramic beads and 60% clay were tested. Under strain-controlled cycles of 1.5% single amplitude, the expected increase of excess pore water pressure was captured at both ends and also inside the sample, which is in agreement with previous findings in this regard.

A series of tests and also numerical analyses were conducted to explore the mechanical behavior of a mixture of coarse gravel-size particles floating in a matrix of silt, sand or clay. The research is a step forward in an ongoing investigation on behavior of composite clay, which is used as the core material of some large embankment dams all over the world. After providing the reader with an overall image about behavior of such materials through the literature, the paper focuses on a predominant feature of the composite soil behavior: increase of non-deformable solid inclusions in a mixture leads to formation of heterogeneity of stress field, excess pore water pressure and strain distribution along the specimens. This paper mainly probes formation of such heterogeneity during experiments by utilizing some miniature pressure transducers inside relatively large hollow cylinder and also cyclic triaxial specimens. The same triaxial specimen geometry is also modeled by finite element code to explore such trend of behavior, results of which are included as the last part of the article.