Response to the Article “Comparison of the Cost-Utility Analysis of Electroacupuncture and Nonsteroidal Antiinflammatory Drugs in the Treatment of Chronic Low Back Pain”

Hossein Ayati 사단법인약침학회 2019 Journal of Acupuncture & Meridian Studies Vol.12 No.1

Dear Editor in Chief,We compared the cost-utility of electroacupuncture and NSAIDs in the treatment of chronic low back pain, and the results were published in JAMS on April 2018. Recently, we received a response to that article, making some questions and raising some great points. With many thanks to the commenting author(s) for the time and consideration, our response is as follows. 1. It is important to explain why NSAIDs were chosen as the comparator and what types and dosing schedules of NSAIDs were studied. According to the international guidelines, NSAIDs are used to treat chronic low back pain, and patients often use these drugs to relieve the pain [1], so these drugs are an appropriate choice to be the standard comparator. Types and dosing of NSAIDs, which was studied, are listed in Table 1 [2]. In this study, the average consumption of these drugs (alone or combined with other NSAIDs) was multiplied with the drug price to obtain the cost of these medications. 2. The costs presented in the study are not transparent. It is challenging to analyze the specific costs, especially the direct nonmedical costs, because they are not specified. In the materials and methods section of the article, a variety of costs and the way they were measured are clearly explained. The direct nonmedical costs include travel, meals, and hoteling costs when patients are receiving medical services. However, in this study, we considered only the travel costs because all participants were residents of Tehran. 3. The study failed to present the results in the appropriate format; cost-utility analyses require results in terms of quality-adjusted life years and incremental cost-utility ratios (ICER). However, only utilities and average costeffectiveness ratios (ACER) were reported in the study. The ACER is the ratio of the cost to benefit of an intervention without any comparisons to alternatives, and ICER is always used when comparing different treatment options Owing to the 1-year study period, cost-utility analysis does not require quality-adjusted life year calculation [3]. According to our results, the cost of the electroacupuncture method was less than NSAID therapy method and the electroacupuncture method was more effective, so the electroacupuncture method is the dominant option, and the NSAID therapy method is a dominated option, and in this situation, it is not necessary to calculate the ICER [4]. The ACER is also reported as an additional calculation in this study. 4. The study did not conduct any sensitivity analysis, thus not allowing for any uncertainty in the estimates of costs and consequences, which were already vague and difficult to decipher. Regarding the sensitivity analysis, when applying the one-way sensitivity analysis, (the variation range was 20% for costs and effectiveness), the results did not change, so the sensitivity analysis results were not presented in the article. However, the results of the one-sided sensitivity analysis are reported here (Fig. 1). We appreciate the commenting authors and hope that the aforementioned explanations are satisfying. Best regards. On behalf of co-authors. M. Hossein Ayati, MD, PhD.

HAZARDOUS WASTE MANAGEMENT IN ISLAMIC REPUBLIC OF IRAN

( Hossein Ganjidoust ),( Bita Ayati ) 한국폐기물자원순환학회 2002 APLAS Vol.2002 No.1

Lots of industrial wastewater is produced every day in all countries. Large amount of money is spent for treatment of this wastewater. The industries do not like seriously to spend the money because they will not get any profit from that. In another words, industries do not get back any money that they expect on treating their own wastewater. But it is a real requirement from the environmental protection agencies that the wastewater discharges have to obey certain constituent's level. Large amount of hazardous waste materials is produced in the country. It is important to control them for securing the human beings life. Many rules are set by the Department of Environment, which must be implemented by industries and other sectors. Amongst these rules, are special one for the hazardous waste materials handling, storage, collection, disposal, and so on. It is the purpose of this study to investigate the current situation and major problems in I.R. Iran in the generation, collection, transportation, storage, handling, processing and disposal of hazardous substances and wastes. The hazardous waste minimization case studies in one or two companies were also another purpose of this study.

이란에서의 유해폐기물 관리

( Hossein Ganjidoust ),( Bita Ayati ) 한국폐기물자원순환학회 2002 APLAS Vol.2002 No.2

많은 양의 산업폐수는 모든 국가에서 매일 발생하며, 이런 산업 폐수 처리를 위해 많은 돈이 소요된다. 산업체들은 산업폐수 처리로부터 이익을 얻을 수 없기 때문에, 돈 소비하는 것을 싫어한다. 즉, 산업체에서 발생한 폐수를 적절하게 처리할 경우 산업체에서는 어떤 돈도 되돌려 받지 못한다. 그러나 폐수의 배출은 어떤 배출기준에 준수하도록 환경부로부터 요구 받는다. 많은 양의 유해폐기물은 발생되며, 인간의 삶의 보호를 위해서는 유해폐기물을 통제하는 것이 중요하다. 많은 규정들은 환경부에서 제정되었으며, 이런 규정들은 산업체들과 다른 분야에 의해서 이행되어진다. 이런 규정 중에, 유해폐기물의 취급, 저장, 수집 및 처분등에 대해서는 매우 특별한 것이다. 본 연구의 목적은 이란에서의 유해폐기물 발생, 수집, 운송, 저장, 취급, 처리, 처분등에서의 현황과 주된 문제점을 조사하는 것이다. 한 두개 기업의 실례 연구 통해서 유해폐기물 최소화는 본 연구의 또 다른 목적이다. Lots of industrial wastewater is produced every day in all countries. Large amount of money is spent for treatment of this wastewater. The industries do not like seriously to spend the money because they will not get any profit from that. In another words, industries do not get back any money that they expect on treating their own wastewater. But it is a real requirement from the environmental protection agencies that the wastewater discharges have to obey certain constituent's level. Large amount of hazardous waste materials is produced in the country. It is important to control them for securing the human beings life. Many rules are set by the Department of Environment, which must be implemented by industries and other sectors. Amongst these rules, are special one for the hazardous waste materials handling, storage, collection, disposal, and so on. It is the purpose of this study to investigate the current situation and major problems in I.R. Iran in the generation, collection, transportation, storage, handling, processing and disposal of hazardous substances and wastes. The hazardous waste minimization case studies in one or two companies were also another purpose of this study.

이란 테헤란 시에서의 도시고형 폐기물 관리

( Bita Ayati ),( Hossein Ganjidoust ),( Nader Mokhtarani ) 한국폐기물자원순환학회 2002 APLAS Vol.2002 No.2

테헤란시에서는 많은 양의 다양한 고형 폐기물이 발생한다. 이란 환경부 (DOM) 는 많은 환경 법규를 제정하여 도시에 위치한 병원, 무역 센타, 산업시설 및 다른 산업분야에서 준수하도록 하고 있다. 이러한 법규에는 도시고형폐기물의 발생, 수거, 운반, 분별, 처리, 최종처분에 관한 것도 마련되어 있다. 거의 모든 도시에서, 감염성 폐기물과 위해성 폐기물을 포함한 산업폐기물이 도시고형폐기물과 함께 매립 처분되고 있다. 비록 매립지에 인도된 폐기물의 양을 알지라도, 폐기물 조성은 알지 못하며, 결국, 각각 다른 폐기물과 함께 매립이 이루어지기 때문에, 폐기물의 구성을 확인 하는 것은 매우 어렵다. 심지어 대부분 매립지 침출수의 수집 처리도 이루어 지지 않았다. 테헤란의 도시 혹은 주변에는 퇴비화 시설이 여러 개 있으며, 종이·유리·플라스틱에 대한 사기업의 재이용시설이 있다. 불행하게도, 인부들은 이런 재활용 가능한 물질들을 비위생적인 상태에서 수집한다. 본 연구의 목적은 이란 테헤란 시에서의 고형폐기물의 발생, 수거, 운반, 처리 과정과 처분 시 발생하는 주된 문제와 현황을 살펴보는 것이며, 시당국에서 가장 중요한 업무 중의 하나인 도시고형폐기물 최소화 프로그램을 논의하고자 하였다. Large amount of different solid wastes are produced in the capital city, Tehran every day. Many rules are set by the Department of Environment (DOE), which must be implemented by hospitals, trade centers, industries and other sectors, which are located in the cities. Amongst these rules, are the ones for municipal solid waste generation, collection, transporting, separation, treatment and final disposal? In almost all cities, municipal solid wastes along with hospital and industrial ones (including hazardous wastes) are disposed in landfill. Although some of the delivered wastes to landfill sides are known in quantities, but not known in qualities. It is therefore, very difficult to identify the composition of the waste, because in some parts different waste are disposed with each other. Even the landfill leachate are not collected and treated in most of the cases. There are several composting centers in and near the city of Tehran. There are also many private reuse centers for papers, glasses and plastics. Unfortunately, some poor people collect these materials in unhealthy conditions. In recent years, municipality has noticed to this problem especially for those papers, which are used in confectionaries. The purpose of this study is to investigate the current situation and major problems in different steps of generation, collection, transportation, treatment processes and disposal of municipal solid wastes in the city of Tehran. The discussion of solid waste minimization programs as one of the important task of the municipality is another purpose of this paper.

MUNICIPAL SOLID WASTE MANAGEMENT IN THE GREAT CITY OF TEHRAN, I.R.IRAN

( Bita Ayati ),( Hossein Ganjidoust ),( Nader Mokhtarani ) 한국폐기물자원순환학회 2002 APLAS Vol.2002 No.1

Large amount of different solid wastes are produced in the capital city, Tehran every day. Many rules are set by the Department of Environment (DOE), which must be implemented by hospitals, trade centers, industries and other sectors, which are located in the cities. Amongst these rules, are the ones for municipal solid waste generation, collection, transporting, separation, treatment and final disposal? In almost all cities, municipal solid wastes along with hospital and industrial ones (including hazardous wastes) are disposed in landfill. Although some of the delivered wastes to landfill sides are known in quantities, but not known in qualities. It is therefore, very difficult to identify the composition of the waste, because in some parts different waste are disposed with each other. Even the landfill leachate are not collected and treated in most of the cases. There are several composting centers in and near the city of Tehran. There are also many private reuse centers for papers, glasses and plastics. Unfortunately, some poor people collect these materials in unhealthy conditions. In recent years, municipality has noticed to this problem especially for those papers, which are used in confectionaries. The purpose of this study is to investigate the current situation and major problems in different steps of generation, collection, transportation, treatment processes and disposal of municipal solid wastes in the city of Tehran. The discussion of solid waste minimization programs as one of the important task of the municipality is another purpose of this paper.

Degradation of oxytetracycline by nano zero valent iron under UV-A irradiation: Chemical mechanism and kinetic

Hassanzadeh, Parisa,Ganjidoust, Hossein,Ayati, Bita Techno-Press 2014 Advances in environmental research Vol.3 No.1

Pharmaceutical wastewater effluents are well known for their difficult elimination by traditional biotreatment methods and their important contribution to environmental pollution due to its fluctuating and recalcitrant nature. OTC is one of the nonbiodegradable antibiotics that makes antibiotic-resistant, so it can make be high risk for environment. NZVI can be a good choice for removal of OTC in aqueous solution. Response surface methodology (RSM) was used to optimize the amounts of NZVI and OTC to be used at pH 3 and under 200 W, UV-A irradiation. The responses were removal percent of absorption at 290 and 348 nm, TOC and COD of OTC. In the optimum condition, Linear model was performed 155 ppm of OTC were removed by 1000 ppm NZVI after 6.5 hours and the removal efficiency of absorption at 290 and 348 nm, TOC and COD were 87, 95, 85 and 89 percent, respectively. In the similar process, there is no organic compound after 14 hours. The parameters ORP, DO and pH were investigated for 6:30 hours to study the type of NZVI reaction in process. In the beginning of reaction, oxidation was the dominant reaction after 3 hours, photocatalytic reaction was remarkable. The mechanism of OTC degradation is proposed by HPLC/ESI-MS and four by products were found. Also the rate constants (first order kinetic chain reaction model) were 0.0099, 0.0021, 0.0010, 0.0049 and $0.0074min^{-1}$, respectively.

Meridian Studies in China: A Systematic Review

Guang-Jun Wang,M. Hossein Ayati,Guang-Jun Wang 사단법인약침학회 2010 Journal of Acupuncture & Meridian Studies Vol.3 No.1

Meridian theory is a major part of Chinese medicine and has guided acupuncture and clinical practice for thousands of years. Meridian theory describes many important concepts about the rules of human body function and regulation, but has comparatively huge differences with the basic concepts of modern medicine. These differences have caused deep concern and attracted attention from scholars, both inside and outside of China. The interest in meridian theory lies in determining the structural nature of meridians. Not only is this information still unclear, it is very difficult to achieve clear results in a short period of time. Despite this, the phenomena of meridians can be used as the entry point for meridian studies. After many years of effort, although the physical structure of meridians has not been found, the existence of the meridian phenomena has been fully confirmed. Although there is a lack of morphological evidence for the existence of the meridian,concluding non-existence may be incorrect as morphology techniques develop and structures previously not determined are being found. Since the phenomenon of meridians exists, some biological basis behind its occurrence must be present. This implies that research on meridians needs to continue as research techniques advance and may eventually reveal the biological basis of the meridian phenomenon. In the present review, we analyze the history of meridian studies in China.

Anatomical Features of the Interscapular Area Where Wet Cupping Therapy Is Done and Its Possible Relation to Acupuncture Meridians

Roshanak Ghods,Nasrin Sayfouri,Mohammad Hossein Ayati 사단법인약침학회 2016 Journal of Acupuncture & Meridian Studies Vol.9 No.6

Although wet cupping has been a treatment for centuries, its mechanism of action is not well understood. Because the anatomical features of the wet-cupping area might play a role in its mechanism, we focus on the features of the interscapular area in which a common type of wet-cupping therapy (WCT), called Hijamat-e-Aam in Iranian medicine, is usually applied and discuss the possible relation of those features to the acupuncture meridians. We gathered and analyzed data from reliable textbooks on modern medicine with a focus on the anatomical features of the interscapular area, topics related to WTC in Iranian medicine, and acupuncture sources obtained by searching PubMed, Google-Scholar, and Science Direct. The interscapular area used for WCT was found to have special features: brown adipose tissue, immediate proximity to sympathetic ganglia, passage of the thoracic duct, two important acupuncture meridians, and proximity to the main vessel divisions carrying blood from the heart and the brain. These features indicate that the interscapular application of WCT not only discharges waste materials through a shifting of blood to the site after application of a traction force but also invigorates the body’s metabolism, increases immunity, and regulates blood biochemistry, which are desired therapeutic effects of WCT.

Comparison of an Iranian Traditional Massage (Fateh Method) with Physiotherapy and Acupuncture for Patients with Chronic Low Back Pain: a Randomized Controlled Trial

Namiranian Parva,Karimi Mehrdad,Razavi Seyede Zahra Emami,Garoos Ahmad Fateh,Ayati Mohammad Hossein 사단법인약침학회 2022 Journal of Acupuncture & Meridian Studies Vol.15 No.3

Background: Low back pain (LBP) is currently a major reason for disability worldwide. Therapeutic massage is one of the most popular non-pharmacological methods for managing chronic LBP (CLBP), and the Fateh method is a massage technique based on Iranian Traditional Medicine. Objectives: The current study aimed to compare the effects of Fateh massage with those of acupuncture and physiotherapy on relieving pain and disability in CLBP. Methods: Eighty-four patients with CLBP were categorized into groups that received Fateh massage, acupuncture, or physiotherapy. Each group included 28 randomly assigned patients who completed 10 sessions of therapy. Visual analogue scale (VAS) scores and Roland–Morris disability scores were evaluated at baseline, after intervention, and four weeks later. The findings were analyzed with SPSS software. Results: The baseline VAS and Roland–Morris scores of the three study groups did not indicate significant differences (p > 0.05). All three groups showed significant pre-post improvements in both scores (p < 0.05). At the end of the treatment sessions, the three groups showed no significant difference in the reductions in pain intensity and disability score (p ˃ 0.05). Improvements in disability and pain between the first and third time points were significant in all three groups (p < 0.05 for each group). In addition, the results of massage, physiotherapy, and acupuncture groups were not significantly different (p > 0.05). No adverse events occurred in the patients. Conclusion: The effects of Fateh massage were comparable to those of acupuncture and physiotherapy in reducing pain and disability in patients with CLBP.