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Introduction and Background: This study explores effective strategies for allocating financial resources in postearthquake urban reconstruction. Given the financial complexities of such projects, it is essential to have a structured plan to identify challenges and address potential gaps. The research underscores the importance of predisaster planning in managing financial resources efficiently. Methodology: District 2 of Tehran municipality was chosen as the case study due to its significant risk exposure and vulnerability, making it a suitable representation of a medium-sized urban area. The study includes two key components: seismic risk assessment and financial resource allocation. Seismic risk was modeled using computational methods and risk analysis techniques. Strategies for budget allocation were formulated based on insights from interviews, historical case studies, and computational modeling. Results: Scenarios ranging from optimistic to pessimistic were analyzed to assess their impact on reconstruction timelines. Results show that reconstruction for an urban area like District 2 could be completed in 4.3 years in the optimistic scenario, 9.2 years in the probable scenario, and 11.3 years in the pessimistic scenario. Conclusion: The study reveals that efficient resource allocation minimizes delays, while insufficient planning significantly prolongs recovery. These findings demonstrate the importance of pre-disaster planning and effective resource allocation in expediting recovery and improving resilience in medium-sized cities. [ABSTRACT FROM AUTHOR]

Objectives: This study was designed to characterize the prevalence, pattern of herbal use, and related factors among diabetic patients in Tabriz, Iran. Methods: A descriptive cross-sectional study was carried out on 322 diabetic patients with random cluster sampling of specialized and subspecialized clinics in Tabriz, Iran. Binary logistic regression analysis was performed to evaluate the association between predictor variables (sociodemographic and disease-related characteristics and patient preference for treatment type) with herb use Interviews were conducted using a structured questionnaire from October 1, 2022, to April 23, 2023. Data was analyzed using SPSS software. Results: Out of 322 patients, 155 individuals (48.1%) used herbal medicines to lower their blood sugar. The most commonly used herbs included Urtica dioica L. (51.6%), Abelmoschus esculentus L. (14.8%), Eryngium planum L. (11%), Trigonella foenum-graecum L. (9%) and Cinnamomum verum (9%). The chance of herb use in women was 1.64 times (adjusted odds ratio (AOR) = 1.64, 95% confidence interval (CI) = 1.06 to 2.55) higher than men. With each passing year of diabetes diagnosis, the probability of using herbal medicines increased by 5% (AOR = 1.05, 95% CI = 1.01 to 1.08). Diabetic patients who use herbal medicines significantly prefer to use their conventional medications alongside herbal remedies (P-value < 0.001) and only a small percentage of them prefer to rely solely on herbs. Conclusions: Some of the diabetic patients in Tabriz, Iran, use herbal medicines for managing diabetes. Female gender, longer duration of diabetes, and patients who prefer to use both treatment (conventional and traditional) methods were identified as predicting factors for herbal medicinal use among diabetic patients. [ABSTRACT FROM AUTHOR]

Background: The National Institutes of Health Stroke Scale (NIHSS) is a pivotal clinical tool used to assess patients with acute stroke. However, substantial heterogeneity in the application and interpretation of stroke scale items can occur. This systematic review aimed to elucidate heterogeneity in measuring the NIHSS. Material and methods: A literature search was performed on PubMed/OVID/Cochran's CENTRAL from inception to 2023. The references of the included papers were reviewed for further eligible articles. Clinical characteristic, NIHSS values, and sources of heterogeneity were recorded. Non-human and non-English language articles were excluded. The study quality was assessed using MINORS and GRADE. Meta-analysis and meta-regression were performed using a random-effects model to explore the sources of heterogeneity. Results: Twenty-one papers for a total of 818 patients (mean per study: 39 ± 37) and 9696 NIHSS examinations (median per study: 8 [CI95% 2 to 42]) were included. Motor function had a higher ICC agreement (ranging from 0.85 ["Right Leg"] to 0.90 ["Right Arm"]) compared to the remaining items (ranging from 0.58 ["Facial Palsy"] to 0.85 ["Level of consciousness commands"]. The meta-regression showed a low effect size of covariates such as language version, remote evaluation, and retrospective analysis on NIHSS items (e.g., for "Level of consciousness commands," language effect was 0.30 [CI95% 0.20 to 0.48] and for "Visual", the retrospective assessment effect was -0.27 [CI95% -0.51 to -0.03]). Conclusion: The NIHSS scores showed moderate to excellent inter-rater agreement, with the highest heterogeneity in non-motor function evaluation. Using a non-English version, remote evaluation and retrospective analysis had small effects in terms of heterogeneity in the NIHSS scores. [ABSTRACT FROM AUTHOR]

Objective: This study aims to systematically review and meta-analyze the electromyographic activity of masticatory muscles in cleft palate and non-cleft patients, and identify influencing factors. Design: Systematic Review and Meta-analysis Patients and Exposures: Patients with cleft lip/ palate Comparison: Patients without CL/P. Main Outcome Measures: Electrical activity of masseter and temporalis muscles at rest and during peak activation Results: After a comprehensive search in MEDLINE, Web of Science, EMBASE, Scopus, and Cochrane's CENTRAL up to December 2022, without language or date restrictions. Eligible trials were selected based on the PECO question and assessed for bias using Cochrane's ROBINS-E tool. Eight clinical trials with 474 participants were included in the review. Then relevant data was extracted from included studies using customized forms. A random-effects meta-analysis was performed to combine the results of the studies, meta-analyses showed that CL/P patients have elevated electrical activity in the masseter (P =.01) and temporalis (P = <.01) muscles at rest compared to non-cleft control patients. During maximum bite force, cleft patients exhibited a statistically significant decrease in electrical activity in both the masseter (P =.03) and temporalis (P = <.01) muscles. Conclusions: According to our meta-analysis, cleft patients exhibited increased resting muscle activity but decreased activity during maximum bite force, indicating reduced efficiency of masticatory muscles compared to non-cleft patients. These differences can be attributed to anatomical variations, compensatory mechanisms, and previous treatments. [ABSTRACT FROM AUTHOR]

Obstructive sleep apnea (OSA) is widespread, under-recognized, and under-treated, impacting the health and quality of life for millions. The current gold standard for sleep apnea testing is based on the in-lab sleep study, which is costly, cumbersome, not readily available and represents a well-known roadblock to managing this huge societal burden. Assessment of neuromuscular function involved in the upper airway using electromyography (EMG) has shown potential to characterize and diagnose sleep apnea, while the development of transmembranous electromyography (tmEMG), a painless surface probe, has made this opportunity practical and highly feasible. However, experience and ability to interpret electrical signals from the upper airway are scarce, and much of the pertinent information within the signal is likely difficult to detect visually. To overcome this issue, we explored the use of transformers, a deep learning (DL) model architecture with attention mechanisms, to model tmEMG data and distinguish between electromyographic signals from a cohort of control, neurogenic, and sleep apnea patients. Our approach involved three strategies to train a generalizable model on a relatively small dataset including, (1) transfer learning using an audio spectral transformer (AST), (2) the use of 6,000 simulated EMG recordings, converted to spectrograms and using standard backpropagation for fine-tuning, and (3) application of regularization to prevent overfitting and enhance generalizability. This DL approach was tested using 177 transoral EMG recordings from a prior study's database that included six healthy controls, five moderate to severe OSA patients, and five amyotrophic lateral sclerosis (ALS) patients with evidence of bulbar involvement (neurogenic injury). Sensitivity and specificity for classifying neurogenic cases from controls were 98% and 73%, respectively, while classifying OSA from controls were 88% and 64%, respectively. Notably, by averaging the predicted probabilities of each segment for individual patients, the model correctly classified up to 82% of control and OSA patients. These results not only suggest a potential to diagnose OSA patients accurately, but also to identify OSA endotypes that involve neuromuscular pathology, which has major implications for clinical management, patient outcomes, and research. [ABSTRACT FROM AUTHOR]

Background: This article aims to present the single-institution outcomes of patients with Fibrolamellar Carcinoma (FLC) treated with liver-directed therapies (LDT). Methods: In this single-center retrospective study, all patients diagnosed with FLC who underwent LDT were identified. Between July 2012 and July 2023, six patients were identified. One patient was excluded due to bleeding. Demographic and clinical parameters were recorded. Complications within 30 days of the LDT were evaluated. Radiological treatment responses at 1, 6, and 12 months were assessed per mRECIST. Results: A total of five patients, which included three females and two males, were reviewed. Three patients were treated with transarterial hepatic embolization (TAE; n = 3), transarterial radioembolization (TARE; n = 1), and combined TAE + radiofrequency ablation (n = 1). The objective response rate at one month was 80% [CR = 2 (40%), PR = 2 (40%), and SD = 1 (20%)]. At 12 months (n = 4), two patients demonstrated CR (50%) and two demonstrated PR (50%). Overall survival from LDT at five years was 50%. There was no 30-day mortality among this group of patients or any adverse event attributable to the LDT. Conclusion: TAE, TARE, and ablation are safe and effective therapeutic options for FLC. Based on this study and previously published case reports, ablation and TARE yielded the most favorable results. [ABSTRACT FROM AUTHOR]

In this study, the contents of potentially toxic elements (Cd, Cr, Pb, Cu, Zn, Ni and Mn) in urban surface soils collected from city of Khorramabad were determined to assess the soil contamination rates, potential ecological risks and also spatial distribution of the analyzed elements. In so doing, a total of 55 surface soil samples were collected from 11 sampling sites. After acid digestion of samples, the contents of the elements were determined using flame atomic absorption spectrometer. Then, the pollution rates and potential ecological risks of the soil samples were assessed using various models including geo-accumulation index (I-geo), potential ecological risk index (RI), enrichment factor (EF) and pollution load index (PLI). The spatial distribution of the analyzed elements was estimated using the kriging interpolation technique. Based on the results, the observed mean I-geo values could be classified as "unpolluted" for all heavy metals in the study area. Besides, the EF values of Fe (1), Zn (340), Cr (445), Cd (1000), Ni (605), Cu (874), Pb (316) and Mn (900) indicated that all the elements had extremely severe enrichment. Moreover, the RI values indicated that the whole study area could be categorized as 'moderate'. The values of PLI indicated that the study area could be considered as 'non-polluted'. The calculated values of the studied indices and their spatial distribution showed that the elements concentration in E (G3T4S1) and I (G6T2S2) sampling sites were more than those in the other sites and that, for managing and controlling the anthropogenic activities in those sites, special care and appropriate interventions are needed. In conclusion, while an increase in soil contamination in the study area is expected in the future, the use of bioaccumulator species for biomonitoring and bioremediation of the contaminated areas with potentially toxic elements (PTEs) is recommended. [ABSTRACT FROM AUTHOR]

Salinity and lead are two important abiotic stresses that limit crop growth and yield. In this study, we assayed the effect of these stresses on tolerant and sensitive maize genotypes. Four-week-old maize plants were treated with 250 mM sodium chloride (NaCl) and 250 µM lead (Pb). Our results show that NaCl or Pb treatment of the sensitive genotype caused a significant reduction in the root length, plant height, total fresh and dry weights, as well as chlorophyll, and carotenoid content. Salt stress led to a significant decrease in the relative water content, shoot and root length, fresh and dry weight as well as leaf area and K+ content but increase Na+ content. Both NaCl and Pb stresses increased the antioxidant enzyme activity, proline content, malondialdehyde, and hydrogen peroxide levels. Principal component analysis (PCA) accounted for 69.8% and 16.5% of the total variation among all the variables studied. PCA also suggested a positive correlation between hydrogen peroxide, malondialdehyde, peroxidase, catalase, ascorbate peroxidase levels, and Na+ content and a negative correlation between K+ content, chlorophyll content, relative water content, leaf area, root length, plant height, and total fresh, and dry weights. Together, these results suggest that the salt-tolerant maize genotype is more suitable for adapting to Pb stress compared to the salt-sensitive genotype. [ABSTRACT FROM AUTHOR]

In all country construction projects include an enormous number of financial transactions and it's necessary that the contracts between stakeholders should be more advanced in technology. The advance of Blockchain technology has been incontrovertible in recent years and this allowed the contracts to be programmed on Blockchain as smart contracts. The main goal of this paper is to identify and prioritize critical success factors of Smart Contracts in the construction industry. For identifying factors, we used library study and for prioritizing them, field study. To collect data, we designed a DANP questionnaire, from a panel senior managers and engineering experts. The results show that technology maturity is the most important factor in Smart Contract success; security of contracts, support from the engineering community, stakeholders' consideration, and competition in the building industry were other important factors which took their next levels. [ABSTRACT FROM AUTHOR]

Large-scale modes of climate variability, such as the El Niño-Southern Oscillation, North Atlantic Oscillation, and Indian Ocean Dipole, show significant regional correlations with seasonal weather conditions, and are routinely forecast by meteorological agencies attempting to anticipate seasonal precipitation patterns. Here, we use machine learning together with more traditional approaches to quantify how much precipitation variability can be explained by large-scale modes of variability, and to understand the degree to which these modes interact non-linearly. We find that the relationship between climate modes and precipitation is predominantly non-linear. In some regions and seasons climate modes can explain up to 80% of precipitation variability. However, variability explained is below 10% for more than half of the land surface, and only 1% of the land shows values above 50%. This outcome provides a clear rationale to limit expectations of predictability from modes of variability in all but a few select regions and seasons. [ABSTRACT FROM AUTHOR]

Turbulent impinging jet array is one of the most efficient and popular techniques for cooling gas turbine blades. In the present paper, we numerically investigated how the geometrical design parameters affect the cooling performance for jet array impinged to a curved target. The influence parameters, including jet spacing (2.5 = 10), jet angle (-45° = 45°), and off-center distance (0 = 6) on average Nusselt number, air pressure drop, and heat transfer uniformity index (UI) were identified through a parametric study at a constant total mass flow rate. Results show, increasing jet spacing improved heat transfer but lowered uniformity and required more compression power. Tilting the jets generally decreases the average Nusselt number but boosts the uniformity. Also, increasing the inclination angle reduces the pressure drop. Moving the jets off-center consistently lowered pressure drop until 4 and average Nusselt number till 2 without affecting uniformity much up to until, and beyond those values, increased them. best performance based on average Nusselt number is achieved for the case of = 10,0, and = 0. Also, the uniformity index is maximized and pressure drop is minimized at, and= 0. [ABSTRACT FROM AUTHOR]

This study aims to assess the spatio-temporal defoliation dynamics of box tree, one of the few evergreen species of the Hyrcanian Forests. For this, we integrated multi-temporal leaf-off optical Sentinel-2 and radar Sentinel-1 data from 2017 to 2021 with elevation data. A state-of-the-art sample migration approach was used to generate annual reference samples of two categories (defoliated and healthy box tree) for a set of target years 2017–2020. This approach is based on field samples of the reference year 2021 and two similarity measures, the Euclidean distance and the spectral angle distance. The analysis of spectral and radar profiles showed that the migrated samples were well representative of both defoliated and healthy box trees categories. The migrated samples were then used for spatially mapping the two classes using support vector machine classification. The results of support vector machine classification indicated a large extent of box tree mortality. The most significant changes from healthy box trees to defoliated ones, or vice versa, occurred during the years 2017 and 2018. In the consecutive years of 2019, 2020, and 2021, no significant changes in the distribution of healthy or defoliated box trees were observed. The statistical assessment also revealed that mortality of evergreen understory tree species can be mapped with practically sufficient overall accuracies reaching from 84% (in 2017) to 91%–92% (in 2020 and 2021) using spaceborne remote sensing data. This information using freely accessible satellite data can benefit forest managers responsible for monitoring landscapes affected by the box moth and facilitates the identification of optimal control programs. [ABSTRACT FROM AUTHOR]

The microcrack formation mechanisms and mitigation strategies were thoroughly investigated and explained in Hastelloy X samples fabricated via Laser Powder Bed Fusion (LPBF) with varying printing parameters and geometries. The microstructure evolution regarding microcrack formation is comprehensively examined in conjunction with thermal residual stresses affected by process parameters (e.g., laser power, scan velocity determining volumetric energy density, VED), proximity to build/substrate interface, and print section aspect ratio. Results indicated for microcracks to form in Hastelloy X, the VED must exceed the critical value of ~ 114 J/mm3, below which the lack-of-fusion porosity persists, thereby highlighting a trade-off with densification. Similar trends were also observed for a Cantor high-entropy alloy. Higher residual stresses near the print/substrate interface increase susceptibility to hot-cracking, leading to a higher density of microcracks at lower build heights along the Z-axis. A higher aspect ratio of the print section can further intensify the residual stresses, thus contributing to a higher density of microcracks as well as warpage in the bar sample. Finally, SEM observations and quantitative EBSD analysis establish a strong correlation between microcrack susceptibility, grain coarsening, and a Z-aligned grain/crystallographic texture, especially at higher VEDs or closer to the substrate. These findings provide insights for mitigating microcrack evolution and refining LPBF processes. [ABSTRACT FROM AUTHOR]

While MOF-74 drug delivery platforms are known for their high drug loading capacity (DLC) and efficiency (DLE), surface chemistry modifications can further enhance their performance. Two variants of Zn-MOF-74 nanoparticles (particle size < 100 nm, per microscopic analysis) were prepared at room temperature, fully characterized and loaded with doxorubicin (DOX) as a model drug. UV-visible spectrometry revealed a DLE of 96.5% and a DLC of 19.6% for zinc acetate (RA-MOF-74) nanocarrier, against zinc nitrate (RN-MOF-74) with 88.8% and 18.3% in the same order. RA-MOF-74 nanocarriers were coated with polydopamine (PDA) through an in-situ polymerization process to enhance physicochemical properties and compatibility with biological systems. Both the uncoated and PDA-coated RA-MOF-74 showed accelerated drug release at pH 5.5 due to quicker structural collapse, which experienced an increase of 24.3% for the former and a 6.2% increase for the latter sample. The biological properties of loaded Zn-MOF-74 nanocarriers demonstrated acceptable anti-cancer activity, and possessing low hemolytic activity. Moreover, the cytotoxicity results indicated an inhibition of 85.73% against MDA-MB-231 breast cancer cells for the DOX-loaded MOF-74, notably about 5% higher than that of the pure DOX at a concentration of 400 µg/ml. At the same concentration, loaded MOF-74 showed a hemolytic activity of 9.62%, which was significantly lower than 28.97% assigned to the pure DOX. These results demonstrate the potential of Zn-MOF-74 nanoparticles for diverse medical applications, warranting further investigation of their in vivo performance in both therapeutic and diagnostic roles. [ABSTRACT FROM AUTHOR]

Smoking is a significant contributing factor to the development of many complex diseases. One of the most important stimuli for aging in the human body is constant exposure to environmental factors such as cigarette smoke. Free radicals in cigarette smoke cause reactive oxygen species production at the cellular level and induce inflammatory responses. The respiratory system of smokers exhibits age‐related characteristics, such as enhanced oxidative stress, accumulated damaged proteins, and increased inflammation. Autophagy is triggered by tobacco smoke as a protective mechanism to prevent and reduce molecular stress. However, smoking can interfere with the normal functioning of autophagy in various ways. Smoking‐induced impairment of autophagy leads to irreversible cellular damage accumulation, causing cells to undergo cellular aging or senescence. Senescent cells lose their ability to divide and display a distinct secretory phenotype called the senescence‐associated secretory phenotype (SASP) and produce numerous growth factors, immune modulators, and inflammatory cytokines. This review discusses the effects of tobacco smoke exposure on autophagy alteration, cellular aging, and senescence induction in exposed animal models, as well as in exposed epithelial and immune cells in the body. [ABSTRACT FROM AUTHOR]

Objectives: Many cases of cervical artery dissection are considered "spontaneous." Recent data suggest that while cervical artery dissection may proportionally explain more strokes in young patients, hospitalization for dissection increases with age, suggesting a potential role of acquired vascular disease. In this study, we hypothesized that traditional vascular risk factors and comorbidities are associated with cervical artery dissection. Methods: We performed a retrospective cohort study using administrative claims data from a 5% sample of Medicare beneficiaries. Exposures of interest included traditional vascular risk factors and comorbidities: coronary artery disease, hyperlipidemia, hypertension, diabetes mellitus, heart failure, chronic kidney disease, chronic obstructive pulmonary disease, valvular heart disease, atrial fibrillation, tobacco use, and alcohol abuse. The primary outcome was a new diagnosis of cervical artery dissection. Marginal structural Cox models were used to characterize the association between the exposures and outcomes, adjusted for time‐dependent confounding. Results: Among 2,256,710 eligible Medicare beneficiaries, 730 (0.03%) developed cervical artery dissection. The following exposures were found to be significantly associated with the development of cervical artery dissection: hypertension (HR 1.84 [95% CI: 1.40–2.41]), alcohol use (HR 1.83 [1.52–2.21]), atrial fibrillation (HR 1.80 [1.53–2.11]), tobacco use (HR 1.80 [1.52–2.13]), coronary artery disease (HR 1.56 [1.33–1.82]), and valvular heart disease (HR 1.23 [1.05–1.45]). Interpretation: In a large cohort of older people, several traditional vascular risk factors and comorbidities were associated with subsequent cervical artery dissection. Further studies exploring the role of such factors in the development of cervical artery dissection are warranted. [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the effectiveness of a Persian Medicine herbal formula and a Traditional Chinese Medicine intervention (acupuncture) on the improvement of weight and anthropometric indices of overweight patients. Methods: This study was a randomized placebo-controlled double-blind clinical trial. A total of 200 overweight patients were randomly divided into 4 groups receiving either (1) Herbal capsule, (2) placebo capsule, (3) acupuncture, or (4) sham acupuncture. Herbal capsules were filled with hydroethanolic extract of Cuminum cyminum L. seed, Apium graveolens L. seed, Ruta graveolens L. seed, Trachyspermum ammi (L.) Sprague seed, Origanum majorana L. leaf, and sodium tetraborate and placebo capsules with avicel. Patients received two 500mg capsules or 12 acupuncture sessions over 8 weeks. Study outcomes, consisted of weight, body mass index (BMI), anthropometric indices including chest, arm, wrist, waist, hip, and leg circumferences, and waist/hip ratio (WHR), were evaluated 3 times: before treatment, after 4 weeks, and after 8 weeks. Results: The herbal formula significantly reduced weight, BMI, WHR, and chest and waist circumferences compared to the placebo capsule (P < 0.05). Furthermore, acupuncture improved all study outcomes, except WHR, compared to sham acupuncture (P < 0.05). Despite the effects of herbal formula and acupuncture were the same on WHR and chest, waist, and leg circumferences (P < 0.05), acupuncture reduced weight, BMI, and arm, wrist, and hip circumferences more than herbal formula (P < 0.05). Conclusion: Complementary and alternative therapeutic methods, such as herbal treatments and acupuncture, show promising effects in improving weight and anthropometric indices of overweight patients. [ABSTRACT FROM AUTHOR]

One method for estimating floods in areas lacking statistical data is the use of regional frequency analysis based on machine learning. In this study, statistical and clustering-based approaches were evaluated for flood estimation in the Karkheh watershed. The hydrological homogeneity of the obtained zones was then assessed using linear moments and heterogeneity adjustment methods proposed by Hosking and Wallis. Then, the ZDIST statistic was used to calculate the three-parameter distributions for stations within each hydrologically homogeneous cluster. These parameters were computed using linear moments, and floods with different return periods at each station were estimated using regional relationships. The results indicated the creation of two clusters in this area, with five stations in cluster one and 11 stations in cluster two. The statistical homogeneity values for clusters one and two were calculated as 0.33 and 0.17, respectively, indicating the homogeneity of each region. Generalized Pearson type III and generalized extreme value distributions were selected as the best regional distributions for clusters 1 and 2, respectively. The results also showed that floods could be estimated for return periods of 2, 5, 25 years, and more. The highest estimated flood is predicted at the Jelugir-e Majin station, where the flood with a 2-year return period reaches 1034 m3 s−1. This increases to 5360 m3 s−1 for a 100-year return period. The approach presented in this study is recommended for similar regions lacking complete information. [ABSTRACT FROM AUTHOR]

This study investigated the severity of mistletoe infection on junipers and the relationship between tree characteristics, physiographic factors and mistletoe infection. The study was conducted in two protected areas: Parvar and Miankouh Tash in Semnan Province, Iran. A dwarf mistletoe‐infested area of 400 ha was sampled by placing a 250 × 250 m grid over a map of each study area. A 20 × 20 m (400 m2) plot was placed at the intersection of grid lines. This resulted in a total of 110 forested plots: 45 plots in Parvar and 65 plots in Miankouh Tash. In each plot, all live junipers were measured for total height, crown area, collar diameter and crown diameter. Mistletoe severity was estimated using the 6‐class dwarf mistletoe rating system (DMR). Dead trees were also recorded and examined for evidence of past mistletoe infection. The Boruta algorithm was used for feature selection, and the selected features were utilised for predicting DMR using a random forest (RF) model. Over 40% of junipers in the sample plots were infected and 7.5% were dead. Mortality was greater in severely infested plots compared to uninfested and lightly infested plots. The results of univariate analysis demonstrated that the largest trees across plots were more severely infected. Infection severity was highest on steep terrains (slopes more than 60%) where the largest junipers were growing. Based on Boruta feature selection algorithm, collar diameter, tree height and crown area of junipers have been detected as the most important variables for the explanation of infection severity. Crown diameter, geographical aspect, density of juniper trees, altitude and juniper canopy cover were classified as tentative variables in this model. Slope percentage beside two variables related to stand characteristics including all woody species (basal area and tree density) were the rejected variables. The correlation coefficient (r) and root mean square error (RMSE) between the predictions by RF and the measured DMR were 0.83 and 0.53 respectively. These results indicate that the selected environmental variables can be used for spatial prediction of DMR in both study areas. Because increased mortality was observed for severely infected areas, more efficient management methods are needed to control the dwarf mistletoe populations in the Alborz Mountains. [ABSTRACT FROM AUTHOR]

This study evaluated production traits, apparent total tract digestibility (ATTD), and fecal microbiota composition in finishing boars (n = 207) selected for feed efficiency (FE; low = LFE; high = HFE) based on estimated breeding value for feed conversion ratio (FCR) within a Large White dam and sire genetic lines. Also, the association between gut microbiota with production and digestibility traits was investigated. Regardless of the genetic line, HFE pigs presented low FCR (P < 0.05), had thinner back fat (P < 0.05) and had greater loin depth (P < 0.05) than LFE pigs. Also, HFE pigs had a significantly higher ATTD for Ca and a tendency for a higher crude protein (P = 0.06) and phosphorous (P = 0.10) ATTD than LFE pigs. No significant differences in alpha- and beta-diversity measurements for fecal microbiota were seen between FE groups in each genetic line. The genera Lactobacillus and Prevotella were associated (P < 0.01) with some growth performance (e.g., feed intake), carcass traits (e.g., backfat thickness), and nutrient digestibility (e.g., Ca). In conclusion, HFE pigs had favourable production traits and higher digestibility of key nutrients than LFE pigs; however, the bacterial genera were associated with phenotypic traits but not by genetic merit. [ABSTRACT FROM AUTHOR]

Background: To determine the interchangeability of Scansys (MediWorks, Shanghai, China) and entacam HR (Oculus, Wetzlar, Germany) in anterior segment measurements. Research designs and methods: 42Forty-two healthy individuals' right eye (mean age 31.5 ± 7.3 years) were assessed for keratometry (K), central corneal thickness (CCT), thinnest corneal thickness (TCT), pupil center pachymetry, corneal volume, anterior chamber volume (ACV), anterior chamber depth (ACD), terior chamber angle (ACA), intraocular pressure (IOP) sum, Q-value (asphericity), and horizontal white-to-white (WTW). Intraclass correlation coefficient (ICC), linear regression analysis, difference of mean, and Bland-Altman plots [bias line and 95% limits of agreement (LoA)] were analyzed. Results: Scansys repeated excellently the Pentacam HR for keratometry (except for anterior steep K), ACD, pupil center pachymetry, CCT, TCT, IOP sum, and corneal volume (all ICC > 0.9, r2 > 0.8, and narrow LoAs). There was strong correlations in measuring WTW and ACV (r2 = 0.631 and r2 = 0.623, respectively) and weak correlations in measuring ACA and Q values (all r2 < 0.5). Conclusion: The interchangeability of devices were confirmed in measuring ACD, pupil center achymetry, CCT and TCT, IOP sum, corneal volume, and keratometry except for the anterior steep K. However, in measuring WTW, ACV, asphericity, and ACA, Scansys should not be used instead of Pentacam HR. [ABSTRACT FROM AUTHOR]

Noise is one of the harmful health factors in industrial sites. Hearing impairments are one of the most common occupational diseases in a wide range of industries. The aim of this study is to determine the general prevalence of noise-induced hearing disorders among industrial workers and to homogenize the results of different studies in this field. In this systematic review and meta-analysis study, the keywords of Occupational Noise, Hearing Impairment, Workers, Industry in Science Direct, PubMed, Scopus, Web of Science and Google Scholar databases without any lower time limit and until March 2022. Details of the identified studies were then transferred into the EndNote reference management software. Subsequently, duplicate studies were eliminated, and the remaining studies were evaluated in accordance with the inclusion and exclusion criteria and through the three remaining phases of PRISMA i.e., screening, eligibility, and inclusion. To analyze the eligible studies, the random effects model was used, and the heterogeneity of the studies was assessed using the I2 index. In a review of 69 studies with a sample size of 3,552,888 people, the overall prevalence of hearing impairment among industrial workers was 28.8% (95% CI 26.2%–31.6%). The highest prevalence of hearing impairments was reported among agricultural and fishery workers with 45.7% (95% CI 35.1%–56.7%), and the highest prevalence of hearing impairment among industrial workers was found in the continent of Africa with 46.2% (95% CI 37.4%–55.2%). Due to the higher prevalence of hearing impairments among men, the elderly and in developing countries, it is necessary to establish pertinent laws and regulations in order for workers to use appropriate personal protective equipment (PPE) and mandate employers to provide hearing protection programs. [ABSTRACT FROM AUTHOR]

Background: With the increasing number of surgeries utilizing spinal instrumentation, three-dimensional surgical navigation aims to improve the accuracy of implant placement. However, its widespread clinical adaption has been hindered by factors such as high radiation exposure and interference with standard surgical workflows. Methods: X23D is a novel AI-based fluoroscopy reconstruction technique that generates a 3D anatomical model of the spine from only four fluoroscopy images. Based on this technology, we developed a prototype for the surgical navigation of pedicle screws placement of the lumbar spine, visualizing the 3D-reconstructed spine anatomy and the surgical drill position in real-time. An ex-vivo study was conducted to compare the accuracy of the X23D-based navigation approach with fluoroscopy-aided freehand instrumentation. Five board-certified surgeons placed pedicle screws on six human torsi within a realistic surgical environment. Breach rate, site and extent (Gertzbein-Robbins) were evaluated in postoperative CT scans, as well as execution time, radiation dose, and user experience. Specimens, operating side, and surgeon were randomised. Results: Forty-nine pedicle screws (n = 24 × 23D, n = 25 2D-fluoroscopy) were evaluated, with six breaches occurring in the control group, one of which was considered clinically significant (medial breach grade C). Five breaches with one clinically significant breach were observed in the X23D group. Breach rate, execution time for each lumbar level (X23D 167 s vs. control 156 s), radiation dose (X23D 33.26 mGy vs. control 49.5 mGy), and user experience did not reveal significant differences (p > 0.05) between the groups. Conclusions: Spinal navigation using the X23D-based approach shows promise and performs well in a realistic surgical ex-vivo setting. With further refinements, its accuracy is expected to match clinical-grade navigation systems while reducing radiation dose. [ABSTRACT FROM AUTHOR]

Purpose: The mine sequencing problem is NP-hard. Therefore, simplifying it is necessary. One way to do this is to employ clusters as input instead of individual blocks. The mining cut clustering problem has been little addressed in the literature, and the solutions used are almost always heuristic. We solve the mining cut clustering problem, which is NP-hard, through single- and multi-objective optimization, finding results that are local optima in acceptable computational time. Design/methodology/approach: We first elaborate an ILP-based model to address the mining cut clustering problem. We employ a mono-objective approach and two multi-objective approaches, solving all these models by constraint programming. To choose the best solutions generated by multi-objective approaches, we employ two multi-criteria decision analysis approaches, considering different weight configurations. We developed a case study using real data. Findings: We verified that the approaches based on multi-objective optimization performed better than the mono-objective approach for the economic return criterion. The weighted-sum multi-objective approach presented the best results considering all objective functions used. Once viable solutions were obtained through multi-objective optimization, multi-criteria decision analysis approaches almost always selected the same solution. We obtained solutions that are local optima in acceptable computational time. Research limitations/implications: This study solves an instance with 80 blocks. Consequently, it is aimed at short-term mine planning. The methodology has not yet been evaluated in large instances related to medium- and long-term mine planning. Originality/value: This is the first time that multi-objective optimization has been employed to solve the mining cut custering problem. Even other problems related to mine planning were, at most, solved by goal programming, so that multi-objective optimization is a knowledge that is not widespread among mining researchers. The results are consistent, and the study achieves the objective of finding quality solutions to an NP-hard problem in an acceptable computational time. [ABSTRACT FROM AUTHOR]

Using drone cells to optimize Radio Access Networks is an exemplary way to enhance the capabilities of terrestrial Radio Access Networks. Drones fitted with communication and relay modules can act as drone cells to provide an unobtrusive network connection. The multi-drone-cell placement problem is solved using adapted Dispersive Flies Optimization alongside other meta-heuristic algorithms such as Particle Swarm Optimization and differential evolution. A home-brewed simulator has been used to test the effectiveness of the different implemented algorithms. Specific environment respective parameter tuning has been explored to better highlight the possible advantages of one algorithm over the other in any particular environment. Algorithmic diversity has been explored, leading to several modifications and improvements in the implemented models. The results show that by using tuned parameters, there is a performance uplift in coverage probability when compared to the default meta-heuristic parameters while still remaining within the constraints implied by the problem's requirements and resource limitation. This paper concludes by offering a study and comparison between multiple meta-heuristic approaches, investigating the impact of parameter tuning as well as analyzing the impact of intermittent restarts for the algorithms' persistent diversity. [ABSTRACT FROM AUTHOR]

Spinal cord injury (SCI) is damage to the spinal cord that permanently or temporarily disrupts its function, causing considerable autonomic, sensory, and motor disorders, and involves between 10 and 83 cases per million yearly. Traumatic SCI happens following primary acute mechanical damage, leading to injury to the spinal cord tissue and worsening clinical outcomes. The present therapeutic strategies for this complex disease fundamentally rely on surgical approaches and conservative remedies. However, these modalities are not effective enough for neurological recovery. Therefore, it is necessary to discover more efficient methods to treat patients with SCI. Today, considerable attention has been drawn to bioactive compounds-based remedies and stem cell therapy for curing various ailments and disorders, such as neurological diseases. Some researchers have recommended that harnessing curcumin, a polyphenol obtained from turmeric, in combination with stem cells, like mesenchymal stem cells, neural stem cells, and ependymal stem cells, can remarkably improve neurological recovery-related parameters more effective than the treatment with these two methods separately in experimental models. Hereby, this literature review delves into the functionality of curcumin combined with stem cells in treating SCI with a focus on cellular and molecular mechanisms. [ABSTRACT FROM AUTHOR]

Bolt loosening in bolted lap-joint connections can result in catastrophic failures in industrial settings. Therefore, it is crucial to investigate these connections thoroughly and implement preventative measures. However, examining such connections requires considering multiple influencing parameters. In this study, numerical simulations were conducted using three-dimensional finite element analysis in Abaqus software to evaluate these parameters in detail. The study employed a guided wave-based structural health monitoring approach and a precise ultrasonic-guided Lamb wave propagation method. Time signals were analyzed using phase shift and transmission coefficient (TC) factors as suitable indicators. Additionally, the S0 mode of the captured waves provided a highly informative wave packet for analysis due to its specific order. Initially, various simulations were carried out to determine the optimal length of the overlapping region that would result in the most effective transmission of waves. Increasing the bolt torque and the contact friction coefficient between the two plates in the overlapping region reduces the time for waves to reach the sensor and increases the TC of the passing waves. However, the saturation state does not cause any change in the received signals. Increasing the bolt torque is more effective in facilitating wave transmission through the connections than increasing the contact friction coefficient. Furthermore, variations in excitation voltage do not affect the arrival time or TC of the waves. The continuous wavelet transformation enabled a more detailed time-frequency analysis. The results demonstrate that changes in bolt torque do not impact the wave frequencies reaching the sensors, making the frequency insensitive to bolt loosening. Ultimately, the numerical simulation results were validated through experiments on a table-top laboratory sample. This research enhances researchers' understanding of monitoring the health status of bolted lap-joint connections by investigating the impact of various parameters on guided Lamb wave transmission through these connections. [ABSTRACT FROM AUTHOR]

The use of plant growth-promoting rhizobacteria presents a promising addition to conventional mineral fertilizer use and an alternative strategy for sustainable agricultural crop production. However, genotypic variations in the plant host may result in variability of the beneficial effects from these plant–microbe interactions. This study examined growth promotion effects of commercial vegetable crop cultivars of tomato, cucumber and broccoli following application with five rhizosphere bacteria. Biochemical assays revealed that the bacterial strains used possess several nutrient acquisition traits that benefit plants, including nitrogen fixation, phosphate solubilization, biofilm formation, and indole-3-acetic acid (IAA) production. However, different host cultivars displayed genotype-specific responses from the inoculations, resulting in significant (p < 0.05) plant growth promotion in some cultivars but insignificant (p > 0.05) or no growth promotion in others. Gene expression profiling in tomato cultivars revealed that these cultivar-specific phenotypes are reflected in differential expressions of defense and nutrient acquisition genes, suggesting that plants can be categorized into "microbe-friendly" cultivars (with little or no defense responses against beneficial microbes) and "microbe-hostile" cultivars (with strong defense responses). These results validate the notion that "microbe-friendly" (positive interaction with rhizosphere microbes) should be considered an important trait in breeding programs when developing new cultivars which could result in improved crop yields. [ABSTRACT FROM AUTHOR]

Objectives Recently, deep learning medical image analysis in orthopedics has become highly active. However, progress has been restricted by the absence of large-scale and standardized ground-truth images. To the best of our knowledge, this study is the first to propose an innovative solution, namely a deep few-shot image augmentation pipeline, that addresses this challenge by synthetically generating knee radiographs for training downstream tasks, with a specific focus on knee osteoarthritis Kellgren-Lawrence (KL) grading. Materials and Methods This study leverages a deep few-shot image augmentation pipeline to generate synthetic knee radiographs. Despite the limited availability of training samples, we demonstrate the capability of our proposed computational strategy to produce high-fidelity plain knee radiographs and use them to successfully train a KL grade classifier. Results Our experimental results showcase the effectiveness of the proposed computational pipeline. The generated synthetic radiographs exhibit remarkable fidelity, evidenced by the achieved average Frechet Inception Distance (FID) score of 26.33 for KL grading and 22.538 for bilateral knee radiographs. For KL grading classification, the classifier achieved a test Cohen's Kappa and accuracy of 0.451 and 0.727, respectively. Our computational strategy also resulted in a publicly and freely available imaging dataset of 86 000 synthetic knee radiographs. Conclusions Our approach demonstrates the capability to produce top-notch synthetic knee radiographs and use them for KL grading classification, even when working with a constrained training dataset. The results obtained emphasize the effectiveness of the pipeline in augmenting datasets for knee osteoarthritis research, opening doors for broader applications in orthopedics, medical image analysis, and AI-powered diagnosis. [ABSTRACT FROM AUTHOR]

Background: Although previous literature shows tumor location as a prognostic factor in upper tract urothelial carcinoma (UTUC), there remains uninvestigated regarding the impact of tumor location on grade concordance and discrepancies between ureteroscopic (URS) biopsy and final radical nephroureterectomy (RNU) pathology. Methods: In this international study, we retrospectively reviewed the records of 1,498 patients with UTUC who underwent diagnostic URS with concomitant biopsy followed by RNU between 2005 and 2020. Tumor location was divided into four sections: the calyceal-pelvic system, proximal ureter, middle ureter, and distal ureter. Patients with multifocal tumors were excluded from the study. We performed multiple comparison tests and logistic regression analyses. Results: Overall, 1,154 patients were included; 54.4% of those with low-grade URS biopsies were upgraded on RNU. In the multiple comparison tests, middle ureter tumors exhibited the highest probability of upgrading, meanwhile pelvicalyceal tumors exhibited the lowest probability of upgrading (73.7% vs 48.5%, p = 0.007). Downgrading was comparable across all tumor locations. On multivariate analyses, middle ureteral location was significantly associated with a low probability of grade concordance (odds ratio [OR] 0.59; 95% confidence interval [CI], 0.35–1.00; p = 0.049) and an increased risk of upgrading (OR 2.80; 95% CI, 1.20–6.52; p = 0.017). The discordance did not vary regardless of caliceal location, including the lower calyx. Conclusions: Middle ureteral tumors diagnosed to be low grade had a high probability to be undergraded. Our data can inform providers and their patients regarding the likelihood of undergrading according to tumor location, facilitating patient counseling and shared decision making regarding the choice of kidney sparing vs RNU. [ABSTRACT FROM AUTHOR]

Electronic cigarette (EC) is widely advertised as a safe alternative to traditional cigarette (TC). We aimed to investigate the cardiovascular effect of EC with/without nicotine compared with TC. We systematically searched PubMed/MEDLINE, EMBASE, and Cochrane CENTRAL for randomized controlled trials that compared the effect of different smoking modalities on cardiovascular function up to 1 October 2024. Analysis used the weighted mean difference (WMD) with a 95% confidence interval (CI) via Comprehensive Meta-Analysis software, version 3.0. The study evaluated key cardiovascular parameters, including pulse wave velocity (PWV), augmentation index at 75 beats/min (AIx75), flow-mediated dilation (FMD), heart rate (HR), systolic blood pressure, and diastolic blood pressure. We analysed 9 trials involving 370 participants. Acute exposure to EC with nicotine (ECN) compared with nicotine-free EC (EC0) increased PWV (WMD = 0.26; 95% CI: 0.14–0.38, P < 0.001), AIx75 (WMD = 4.29; 95% CI: 2.07–6.51, P < 0.001), and HR (WMD = 5.06; 95% CI: 2.13–7.98, P = 0.001), significantly. In contrast, comparison between ECN and TC revealed no significant differences in FMD (WMD = 0.80; 95% CI: −0.09–1.70, P = 0.08). Our meta-analysis suggests that ECN acutely increases arterial stiffness more than EC0 does. Additionally, we found that the acute effect of ECN on endothelial dysfunction is not different from TC. Therefore, our study suggests that vaping cannot be considered as a safe substitute for TC. Further investigation is needed to explore the long-term cardiovascular effects of vaping and its modalities. [ABSTRACT FROM AUTHOR]

In the domains of health and medicine, current technology facilitates the quicker identification of effective solutions. Smart electronic health networks based on IoT–fog are one of these technologies. It combines the Internet of Things with computing in a fog environment to enable fast and accurate health data processing, transfer, and collecting from patient devices and sensors for caregivers. To reduce fog computing burden and enhance resource allocation, the concept of combining fog computing with the Internet of Things (IoT) has been put out. This research provides a novel method of applying inertial weighted multi-objective particle swarm optimization to optimize simulated e-health smart networks. The term "IoT–fog SEH" refers to this specific technique. The IoT–fog SEH's (Smart E-Health) notable importance of inertia weight makes it easier to modify the search space's dimensions and get the best answer. The IoT–fog SEH approach is used to compare the Cloud-HMS algorithm, Throttled method, and HGWDE algorithm. In terms of reaction time, IoT–fog SEH beats Cloud-HMS, Throttled, and HGWDE algorithms, with improvements of 52.86, 81.02, and 80.44 ms, respectively. IoT–fog SEH beats Cloud-HMS, Throttled, and HGWDE by 51.87, 80.12, and 79.64 ms, respectively, in processing time. The HGWDE algorithm performs better in terms of cost efficiency than the IoT–fog SEH method. It is important to keep in mind that there is no statistically significant difference between these two approaches. The investigated approach was evaluated with the iFogSim program, and the results were contrasted with those obtained with the current methodology. Experimental results show a significant reduction in latency, energy consumption, and network bandwidth use when comparing this study's methodology to previous research endeavors. Specifically, the recommended method leads to a 25% reduction in network bandwidth usage, a 37% reduction in energy consumption, and a 45% reduction in delay. [ABSTRACT FROM AUTHOR]

Human-centricity is the core value behind the evolution of manufacturing towards Industry 5.0. Nevertheless, there is a lack of architecture that considers safety, trustworthiness, and human-centricity at its core. Therefore, we propose an architecture that integrates Artificial Intelligence (Active Learning, Forecasting, Explainable Artificial Intelligence), simulated reality, decision-making, and users' feedback, focussing on synergies between humans and machines. Furthermore, we align the proposed architecture with the Big Data Value Association Reference Architecture Model. Finally, we validate it on three use cases from real-world case studies. [ABSTRACT FROM AUTHOR]

Purpose: To compare pulmonary function metrics obtained with hyperpolarized xenon‐129 (HXe) MRS, using chemical shift saturation recovery (CSSR) and CSI‐CSSR, in healthy rats and a rat model of radiation‐induced lung injury. Methods: HXe‐MR data were acquired in two healthy rats and one rat with radiation‐induced lung injury using whole‐lung spectroscopy and CSI‐CSSR techniques. The CSI‐CSSR acquisitions were performed with both fixed TE and variable TE. Apparent alveolar septal wall thickness, gas transfer dynamics, and regional lung function were quantified and compared across acquisition methods. Spectral analysis included alignment of dissolved‐phase frequency spectra using the membrane resonance as reference, segmentation of gas‐phase (GP) frequency distribution, and characterization of gas uptake in the vasculature. Results: Complex GP line shapes were observed in rat lungs, necessitating pixel‐wise CSI analysis and membrane resonance alignment for improved quantification. Notable differences in alveolar septal wall thickness, dissolved‐phase GP ratios, and GP and red blood cell frequencies were found between acquisition techniques and lung conditions. CSI‐CSSR provided unique insights into regional lung function, including the identification of distinct GP frequency zones potentially corresponding to different airway structures, and the ability to map relative xenon gas transport. Metrics from fixed‐TE and variable‐TE acquisitions usually differed by less than 10%, but the latter yielded a 20% SNR gain. Conclusion: HXe‐MRS and CSI‐CSSR techniques provide similar but not universally interchangeable insights into lung function, particularly in the presence of pathology. [ABSTRACT FROM AUTHOR]

Individual observational studies examining the association between polyphenols and the risk of lung cancer have reported mixed findings. Therefore, we performed a systematic review and meta-analysis to determine the pooled effects between polyphenol intake and lung cancer risk. A systematic search was performed on PubMed, Scopus, and Web of Science databases in April 2023. Random-effect models were used to estimate odd ratios (OR) and 95% confidence intervals (95% CI). In total, 20 studies were included in the systematic review. The pooled analyses indicated that a higher intake of flavonoids (OR = 0.81; 95% CI: 0.67,0.98; p = 0.03) and isoflavone (OR = 0.82; 95% CI: 0.74,0.92; p < 0.001) were associated with lower odds of lung cancer. In addition, the ingestion of anthocyanidin (OR = 0.80; 95% CI: 0.65,0.98; p = 0.04), kaempferol (OR = 0.78; 95% CI: 0.64,0.96; p = 0.02), quercetin (OR = 0.66; 95% CI: 0.48,0.91; p = 0.01) and flavanones (OR = 0.71; 95% CI: 0.59,0.85; p < 0.001) reduced the likelihood of developing lung cancer. Overall, our findings suggest that flavonoids, isoflavones, anthocyanidin, kaempferol, quercetin, and flavanones may protect against lung cancer. [ABSTRACT FROM AUTHOR]

Objective: To compare the effectiveness of different oral hygiene education strategies on periodontal health in fixed orthodontic patients in a one-month period: assistant-led instruction, social media-based education, and custom-made software. Methods: Sixty orthodontic patients from Mashhad University of Medical Sciences' Dentistry School were randomly assigned into three groups. Each group received oral health education differently: via assistant instruction, educational videos on social media, or a researcher-designed software for Android smartphones. After a month, participants' oral health was evaluated using the plaque index (PI) and the gingival index (GI). Results: Assistant-led education group demonstrated the highest PI (1.26 ± 0.70) and GI (0.92 ± 0.67), while the software group reported the lowest indices (PI = 0.68, GI = 0.46 ± 0.46). The social media group's measurements fell between these extremes (PI = 0.89 ± 0.75, GI = 0.60 ± 0.52). Significant group differences were found for both PI and GI (P = 0.028 and P = 0.047, respectively). Pairwise comparison revealed significantly lower PI and GI in the software group compared to the assistant group. No significant differences were found between the social media and other groups. Conclusion: Our results suggest that the use of specially designed software could be the most effective strategy for improving oral hygiene in orthodontic patients. Meanwhile, traditional assistant-led education showed the least effectiveness. The study supports the potential benefit of utilizing digital tools, such as bespoke software and social media, in oral health education for orthodontic patients. Trial registration: The study was registered in the Iranian Registry of Clinical Trials (IRCT) database with the identification code IRCT20200609047705N2 in 13.07.2021. [ABSTRACT FROM AUTHOR]

Background: The two classic manifestations of primary aldosteronism are hypertension and hypokalemia. However, acute respiratory failure due to hypokalemia in primary hyperaldosteronism is rare. Case presentation: The patient was a 27-year-old female who presented with drowsiness and weakness in all extremities. She had been diagnosed with hypertension three years prior, with irregular follow-up, and had a history of preeclampsia one year later. She exhibited high blood pressure and severe hypokalemia (2 mEq/L), leading to respiratory depression and impending respiratory arrest. Consequently, the patient was intubated and transferred to the intensive care unit (ICU). She also developed rhabdomyolysis. Blood pressure tests, including hormonal tests (aldosterone: 13.2 ng/dL, plasma renin activity: 0.32 ng/mL/h), were conducted. Due to the high aldosterone-renin ratio, an abdominopelvic computed tomography (CT) scan was performed. The CT scan revealed a 14 × 12 mm round mass with a washout value above 60%, consistent with an adrenal adenoma, leading to a diagnosis of primary aldosteronism. The patient was discharged after stabilization, and one and a half months after ICU admission, a laparoscopic left adrenalectomy was successfully performed without post-operative complications. Histopathology showed encapsulated hypertrophy of the adrenal cortex with a predominance of large clear cells, confirming the diagnosis of adrenal adenoma. At the most recent follow-up, the patient had normal potassium levels, was normotensive without any medications, and exhibited no alarming signs or symptoms. Conclusion: Respiratory depression to the extent of impending respiratory failure and rhabdomyolysis as a result of hypokalemia in primary aldosteronism are extremely rare. In this patient, who developed respiratory depression due to resistant hypokalemia, timely investigation of secondary causes and diagnosis of adrenal adenoma were crucial. The surgery provided definitive treatment for the patient's blood pressure and prevented the recurrence of life-threatening complications. [ABSTRACT FROM AUTHOR]

Background: Triple-negative breast cancer (TNBC) exhibits a lower survival rate in comparison to other BC subtypes. Utilizing dendritic cell (DC) vaccines as a form of immunotherapy is becoming a promising new approach to cancer treatment. However, inadequate immunogenicity of tumor antigens leads to unsatisfactory effectiveness of the DC vaccines. Exosomes are the basis for the latest improvements in tumor immunotherapy. This study examined whether TNBC-derived exosomes elicit immunogenicity on the maturation and function of monocyte-derived DCs and the impact of the exosome-treated monocyte-derived DCs (moDCs) on T cell differentiation. Methods: exosomes were isolated from MDA-MB-231 TNBC cancer cells and characterized. Monocytes were separated from peripheral blood mononuclear cells and differentiated into DCs. Then, monocyte-derived DCs were treated with TNBC-derived exosomes. Furthermore, the mRNA levels of the genes and cytokines involved in DC maturation and function were examined using qRT-PCR and ELISA assays. We also cocultured TNBC-derived exosome-treated moDCs with T cells and investigated the role of the treatment in T cell differentiation by evaluating the expression of some related genes by qRT-PCR. The concentration of the cytokines secreted from T cells cocultured with exosome-treated moDCs was quantified by the ELISA assays. Results: Our findings showed that TNBC-derived exosomes induce immunogenicity by enhancing moDCs' maturation and function. In addition, exosome-treated moDCs promote cocultured T-cell expansion by inducing TH1 differentiation through increasing cytokine production. Conclusion: TNBC-derived exosomes could improve vaccine-elicited immunotherapy by inducing an immunogenic response and enhancing the effectiveness of the DC vaccines. However, this needs to be investigated further in future studies. [ABSTRACT FROM AUTHOR]