Introduction: The aim of our study is evaluation of response rate of VAD (Vincristin, Adriamycin and Dexamethason) regimen as initial treatment in 40 new cases of multiple myeloma. This is the first systemic and classic report of VAD regimen in Iranian population.Methods: All patients with at least stage 2 multiple myeloma or progressive disease after physical examination, para-clinical profile such as (Imaging, CBC, BUN, Creatinine, Ca, P, Alk Phos, protein eletrophoresis, immuno electrophoresis and B 2 Microglobuline) entered to this study and investigation. All patients received VAD regimen (Vincristin 0.4mg/day 1®4 days, Adriamycin 9mg/m2 1®4 days and Dexamethasone 40 mg/day/1®4 (days), 9®12 (days), 17®20 (days) /cycle in outpatient therapy (24mg/morning and 16 mg evening) and repeated every 28 days for 4 cycles. The evaluation of response rate was with: decreased clinical manifestation, changes in para clinical profile and M- component and B 2 microglubuline.Results: Fourty (40) patients enrolled, 24 cases (60%) were female, 16 (40%) male, the mean age was 48 (25­ 64), IgG myeloma was 80% (32), IgA myeloma 15% (6), and IgM myeloma 5% (2).9 cases had thrombocytopenia in initiation of treatment and 7 cases during treatment protocol, and in the end of treatment, thrombocytopenia remained in 3 cases (total 16 cases) with mild thrombocytopenia (PLT=100, 000-120, 000), azotemia detected in 7 cases and in 2 cases resolved during treatment protocol. The over all response rate was 85%, median survival to now was 44.3 months. Toxicity was mild and acceptable.Conclusion: Our result revealed the high response rate of VAD regimen as initial therapy and good survival rate with minor and acceptable toxicity.

This paper proposes two algorithms for Voice Activity Detection (VAD) based on sparse representation in spectro-temporal domain. Spectral-temporal components which, in addition to the frequency and time dimensions, have two other dimensions of the scale and rate. Scale means spectral modulation and the rate means temporal modulation. On the other hand, using sparse representation in learning dictionaries of speech and noise, separate the speech and noise segment to be better separated. The first algorithm was made using two-dimensional STRF (Spectro-Temporal Response Field) space based on sparse representation. Dictionaries with different atomic sizes and two dictionary learning methods: NMF (non-negative matrix factorization) and the K-SVD (k-means clustering method), were investigated in this approach. This algorithm revealed good results at high SNRs (signal-to-noise ratio). The second algorithm, whose approach is more complicated, suggests a speech detector using the sparse representation in four-dimensional STRF space. Due to the large volume of STRF's four-dimensional space, this space was divided into cubes, with dictionaries made for each cube separately by NMF (non-negative matrix factorization) learning algorithm. Simulation results were presented to illustrate the effectiveness of our new VAD algorithms. The results revealed that the achieved performance was 90. 11% and 91. 75% under-5 dB SNR in white and car noise respectively, outperforming most of the state-of-the-art VAD algorithms.

Background: Complete response (CR) and very good partial response (VGPR) are targeted with pre-ASCT induction regimens in patients by diagnosed multiple myeloma (MM), who are candidates for ASCT. In this study, it was aimed to compare the response and survival evaluations of cases who underwent induction treatment by vincristine-doxorubicin-dexamethasone (VAD) protocol versus bortezomib containing regimens. Materials and Methods: The data of 96 ASCT eligible patients, retrospectively analyzed. P value> 0. 05 was considered statistically significant. Results: While 66 cases had received bortezomib containing regimens as induction regimen, 30 cases had received VAD protocol. The total survival was 91. 3 (st. s 6) months and 43 (st. s 7. 9) months, respectively, when we compared the cases without ASCT and with ASCT (p = 0. 001). The OS of patients who underwent ASCT after reaching at least VGPR was longer than the underwent ASCT without reaching VGPR (p=0. 019). Post-ASCT PFS (p=0. 717) and OS (p = 0. 126) analyzes were performed in 74 cases undergoing ASCT treatment, there was no significant statistical difference when patients with treated by VAD protochol and treated by bortezomib containing regimens as pre-ASCT induction regimens was compared to each other. Conclusion: Whatever the type of induction regimen is, the level of response achieved before ASCT is important. The survival of the myeloma patients are much more influenced with HDT-ASCT as well as post-transplantation strategies to keep the patients in remission. Even though it is outdated, we think that the VAD protocol may be an option in patients who are not responding with the new generation of agents in the following days.

Vitamin A deficiency (VAD) can cause a range of ocular manifestations, including night blindness, conjunctival and corneal xerosis and keratomalacia. It is an important cause of preventable blindness. Although usually a result of malnutrition, VAD can accompany malabsorption syndrome. We report a case of VAD as manifested by Bitot’s spots and eventually diagnosed to have celiac disease. It is, therefore, important to consider gastrointestinal diseases causing malabsorption in the evaluation of VAD.

Background: Voluntary assisted dying (VAD) was legalised in Victoria, Australia in June 2019. Physicians can now assist patients to end their lives by providing drugs for self-administration at their voluntary and competent request (or for physician administration in limited circumstances). This study investigates the opinions of clinicians on the implementation of the legislation in one Victorian hospital. Methods: This exploratory survey study was conducted at a 600-bed acute hospital in Melbourne, Australia in Jan 2019. 382 clinicians completed one or more qualitative questions. Participants commented on VAD, potential workplace challenges and staff support required. Free-text responses were analysed using inductive content analysis. Results: Six themes: (1) Polarised views; (2) Fear of conflict; (3) Emotional burden; (4) Vulnerable patients; (5) Organisational challenges; (6) Decision-making. There were diverse views including objections to VAD for religious or ethical reasons, and whole-hearted support based on a compassionate response to suffering and the right of patients to self-determination. Participants feared conflict between colleagues, families and patients, and aggression towards staff. Clinicians called for educational and psychological support. There was concern that vulnerable patients may be coerced to opt for VAD to lessen the burden on families or the health system. Clinicians feared workloads would increase with the introduction of VAD. Patient decision-making capacity in this context must be firmly established before proceeding, and thorough assessments for depression, and optimal symptom management must be implemented before VAD is approved. A dedicated VAD team was suggested to support staff and manage VAD patients. Conclusion: Participants expressed polarised opinions about VAD and showed considerable anxiety about its introduction. Additional education and support are required to ensure that clinicians understand details of the legislation and their professional and personal options. Tolerance and respect for alternative viewpoints must be advocated within the organisation and more broadly.

Context: Vascular dementia (VAD) is the second most common type of dementia after Alzheimer’, s disease worldwide. Vascular dementia is a neurodegenerative disorder characterizedby gradual cognitive impairment. Ischemicandhemorrhagic strokes result in VAD, markedly distributing cerebral blood flow and decreasing patients’,cognitive and memory performance. Due to their high energy demands, neurons are more sensitive to cellular architecture changes and exposed to mitochondrial stress than other cell types. Mitochondrial dysfunction and selective autophagy of mitochondria, known as mitophagy, are associated with VAD. This review aims to elucidate the association between mitophagy and VAD. Evidence Acquisition: This review was conducted independently by at least two researchers dominant in various VAD studies. We searched databases including Elsevier, Google Scholar, and PubMed using the terms ‘, vascular dementia’, , ‘, vascular cognitive impairment’, , and ‘, mitophagy’, . We evaluated 70 articlesonthe relationship between VADand mitophagy and interpreted the results. Adobe Photoshop 2022 was used for drawing figures by researchers. Results: The autophagy process plays a protective role in experimental VAD models via preserving vascular integrity and the structure of the blood-brain barrier, upregulating occludin and claudin protein expressions, reducing oxidative stress, and decreasing cognitive dysfunction. Some studies claim that autophagy could have adverse effects in a time-dependent manner against neuronal injury. Prolonged autophagy and overexpressed autophagic proteins induce ischemic injury and cause neuronal cells to undergo apoptotic cell death. Conclusions: Although there are limited studies on the activation of mitophagy-related pathways in VAD, and the definitive role of mitophagy in neuronal healing is unclear, further research is needed to elucidate mitophagy pathways in neurons.

Heart failure is a leading cause of death around the world. Heart transplantation is the only reliable therapy for improving functional capacity, quality of life, life expectancy, and limiting the options for heart failure patients. In fact, a large number of patients with severe heart failure in need of heart transplantation are unable toreceive therapy with up to 30% mortality before a heart is donated. In recent decades, cardiac replacement and assisting therapies have presented promising outcomesto treat these end-stage patients as alternative solutions. These devices are capable of providing temporary to permanent, partial or full assistance. Such devices can bedivided into two categories based on location and mechanism of augmentation: 1) devices exposed directly to blood including ventricular assistive devices (VADs) andtotal artificial hearts (TAHs) and 2) devices that augment cardiac output through compression of ventricles or another part of circulatory system with no direct contact toblood such as extra-cardiac compression devices (ECCDs). In recent years, novel ECCDs which compress tissue and muscles to indirectly assist blood pumping have beendeveloped to circumscribe problems associated with blood-contacting devices and the risks involved with piercing arterial and ventricular walls. Not only do ECCDs aimto reduce risks from the patient and surgeon perspective, the complexity of engineering an intra-corporeal extra-cardiac device is also reduced.