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Hydrophilic acylated surface protein B ( HASPB) is an immunogenic Leishmania protein against which antibodies are produced in the sera of cutaneous and visceral Leishmaniasis (VL) patients. Kinetoplastid membrane protein 11 ( KMP11) is another protein antigen of Leishmania which is reported as a promising candidate for vaccination of VL. It is a highly conserved surface protein present in all members of kinetoplastid family and is expressed in both promastigotes and amastigotes. In this study, the coding sequence of KMP11 and HASPB was cloned into a pCDH- cGFP lentiviral vector as a fusion protein. The gene expression was confirmed using RT- PCR and Western blot methods. After injection of the recombinant KMP11- HASPB-expressing lentiviruses to BALB/c mice, using ELISA technique, a significant increase in IFN-γ and IL-4 as well as IgG1 and IgG2a was observed compared to the control group. Furthermore, the number of parasites in the liver and spleen of vaccinated mice decreased significantly compared with the control group. [ABSTRACT FROM AUTHOR]

Introduction: Increasing old age and frailty is putting pressure on health services with 5– 10% of patients attending the emergency department (ED) and 30% of patients in acute medical units classified as older and frail. National Health Service improvement mandates that by 2020 hospital trusts with type one EDs provide at least 70 hours of acute frailty service each week. Methodology: A two-week pilot (Monday–Friday 8 am-5 pm) was undertaken, with a “Front Door Frailty Team” comprising a consultant, junior doctor, specialist nurse and pharmacist, with therapy input from the existing ED team. They were based in the ED seeing patients on arrival, referrals from the ED team and patients in the ED observation ward—opposed to the usual pathway of referral from the ED team to medical team. Data was captured using “Cerner” electronic healthcare records. A plan, do, study, act methodology was used throughout with daily debrief and huddle sessions. Results: 95 patients were seen over two weeks. In the over 65 s, average time to be seen was 50 minutes quicker than the ED team over the same period, with reduced admission rate (25.7% vs 46.5%). The wait between decision to admit and departure was shortened by 119 minutes. Overall, this led to patients spending on average 133 minutes less in the ED. 64 patients were discharged, of which 44 had community follow-up (including 37.5% of 64 referred to acute elderly clinic and 25% to rapid response). 47 medications were stopped across 25 patients. Conclusion:The pilot shows that introduction of an early comprehensive geriatric assessment in the ED can lead to patients being seen sooner, withmore timely decisions over their care and reduction in hospital admissions. It allowed for greater provision of acute clinics and community services as well as prompt medication review and real time medication changes. [ABSTRACT FROM AUTHOR]

Introduction: 2.5 million people in the UK are aged over 80 and up to 50% can be considered frail. Complex co-morbidities and polypharmacy are linked with adverse drug effects and negative outcomes. NICE recommends a medication review yearly, and a hospital admission provides an opportunity for this. STOPP-Frail is a screening tool designed to highlight medications that could be reduced/stopped with a view to improving quality of life. We conducted a quality improvement project to quantify levels of inappropriate prescribing at Croydon University Hospital (CUH), with a view to de-prescribing and reducing adverse drug effects. Methods: A retrospective analysis was carried out on the Elderly Care wards at CUH. Data was collected from 60 consecutive patients discharged from 1st November 2018, utilising electronic Cerner records. Recorded medication on admission and discharge, noting any amendments in accordance with the STOPP-Frail criteria. Results: Data collected from 60 patients; one exclusion for not meeting STOPP-Frail criteria (n=59). Median age 86 years (69 to 103 years). Mean number of medications on admission 7.42 (1 to 15). 93.2% patients had polypharmacy (defined as ≥ 4 medications). Mean number of medications on discharge 8.22; an increase of 0.8/patient. 19.4% admission medications met STOPP-Frail criteria for inappropriate prescriptions. Only 18.8% of these were reduced or stopped during admission. Gastrointestinal and cardiovascular medications were most commonly inappropriately prescribed (n=27 and 24 respectively). Most common medications not amended were lipid-lowering therapies (n=21) and proton-pump inhibitors (n= 20). Conclusions: The opportunity to rationalise medication in the frailest patients admitted to CUH is missed in over 80% of cases. STOPP-Frail provides clear guidance to aid clinicians in reducing inappropriate prescribing. An educational programme is in place to highlight medication rationalisation and guide clinicians in the use of the STOPP-Frail tool. This includes doctors’ induction, departmental teaching, posters and computer flash cards. [ABSTRACT FROM AUTHOR]

Context Every government implements various policies to mitigate road traffic injuries (RTIs). Many of these interventions are performed by traffic police. To evaluate effectiveness and efficiency of police enforcement, numerous studies have been conducted. Potential capabilities of epidemiology could get opportunity to improve these studies. The aim of this study was to extract and discuss some related methodological points of traffic police effectiveness and efficiency from related studies, in view of epidemiology discipline. Evidence Acquisition Related articles were searched with “traffic police”, “effectiveness”, “efficiency” and “road safety” keywords in ScienceDirect, PubMed and Safetylit databases. Related papers were selected and read carefully to summarize and discuss the epidemiological points with aims of giving clues to improve quality of studies. Results From a total of 797 articles, 20 were eligible which among them 17 articles were about effectiveness and 3 of them were about efficiency evaluations. Discussed points were the method of study, taking a holistic view to all positive and negative side effects, desired inputs and outputs, relation pattern between police enforcement and outcome and potential confounders. Conclusions Better understanding of the effectiveness and efficiency mechanism and having valid evaluation required considering specific theories and points in this field. Applying a dynamic approach with considering epidemiological concepts and sophisticated statistical models could improve quality of studies in this field.

Background Road traffic injuries (RTIs) are the main causes of death and disability in Iran. However, very few studies about the temporal variations of RTIs have been published to date. Objectives This study was conducted to investigate the temporal pattern of RTIs in Iran in 2012. Materials and Methods All road traffic accidents (RTAs) reported to traffic police during a one-year period (March 21, 2012 through March 21, 2013) were investigated after obtaining permission from the law enforcement force of the Islamic Republic of Iran. Distributions of RTAs were obtained for season, month, week, and hour scales, and for long holidays (more than one day) and the day prior to long holidays (DPLH). The final analysis was carried out using the Poisson regression model to calculate incidence rate ratios for RTIs. All analyses were conducted using STATA 13.1 and Excel software; statistical significance was set at P < 0.05. Results A total of 452,192 RTAs were examined. The estimated rate of all accidents was 219 per 10,000 registered vehicles, or 595 per 100,000 people. About 28% of all RTAs, and more than one third of fatal RTAs, occurred during the summer months. The incidence rate for all traffic accidents on DPLH was 1.20, compared to workdays as a reference category, and it was 1.40 for fatal crashes. The rate of fatal road traffic accidents in outer cities was 3.2 times higher than in inner ones. Conclusions Our findings reveal that there are temporal variations in traffic accidents, and long holidays significantly influence accident rates. Traffic injuries have different patterns on outer/inner city roads, based on weekday and holiday status. Thus, these findings could be used to create effective initiatives aimed at traffic management.

Multiple sclerosis (MS) is a chronic inflammatory immune-mediated disease of the central nervous system. Despite extensive investigations, many aspects of etiology and pathophysiology remain unclear. In multiple sclerosis patients, immune system reacts against autologous proteins in the myelin membrane. Most evidences support the hypothesis that both genetic and environmental factors contribute to disease development. But after the failure of genetic findings to explain the reason for the unequal incidence of MS in identical twins, investigators focused further on environmental factors such as vitamin D deficiency, smoking, living in different latitudes and perhaps the most importantly the role of viruses in people whom are genetically susceptible to MS. There is increasing evidence that viruses may play important role in MS pathogenesis following environmental triggers. Recently, studies focused on the role of herpes virus family, especially Epstein- Barr virus, human herpes virus 6 (HHV-6) and Varicella Zoster virus, as the virus is prevalent in society. This review mainly focused on the identification of important viruses with key role in MS the mechanism behind pathogenesis and describes the animal models of MS. The results of researches are shown strong evidence of the virus or antibodies to viral components in active plaques in MS affected patients, but still cannot be stated with certainty that one or more specific viruses are simultaneously trigger the disease. Further studies are required to prove the pathogenesis of viruses in MS. [ABSTRACT FROM AUTHOR]

Background: Unplanned admissions for older people can result in lengthy hospital stays. It has been recognised that many of these admissions are avoidable, often associated with adverse patient outcomes and potential resource misappropriation.There is a drive to seek novel processes to better assess and manage frail elderly people presenting to Emergency Departments (ED).Innovation: Within a busy London District General Hospital, an Acute Care of the Elderly (ACE) service was designed. Based in the ED Observation Ward this service provides an in-reach service to the ED, and liaison to the Acute Medical Unit.This is a consultant-led service, with support from a trust grade junior doctor and Band 6 nurse. At present this is a weekday in-hours resource. Comprehensive geriatric assessment is delivered to patients over the age of 80, with complex problems or frailty, but who do not require inpatient care. Therapies and social care support is provided through existing teams operating in the ED.Evaluation: Between January and October 2013, 662 patients have been assessed by the ACE team, in whom 459 inappropriate admissions were avoided. To receive a comprehensive geriatric assessment and appropriate treatment to facilitate discharge of these patients only needed to stay an extra 4.76 hours on average in hospital.Since the introduction of the ACE service the rate of admission in older people from ED Observation Ward has reduced 61.2% in 2012 to 35.1% this year, despite similar levels of activity. Comparing similarly aged patients and episode diagnosis coding, in excess of 4,200 bed days could be saved per year.Conclusions: The ACE service has provided clear benefits to patients and the trust by avoiding un-necessary hospital admission, while providing focused consultant-delivered care in a timely manner. Expansion to a seven-day service is imminent, with expected further benefits. [ABSTRACT FROM AUTHOR]

As food transits the gastrointestinal tract, food structures are disrupted and nutrients are absorbed across the gut barrier. In the past decade, great efforts have focused on the creation of a consensus gastrointestinal digestion protocol (i.e., INFOGEST method) to mimic digestion in the upper gut. However, to better determine the fate of food components, it is also critical to mimic food absorption in vitro . This is usually performed by treating polarized epithelial cells (i.e., differentiated Caco-2 monolayers) with food digesta. This food digesta contains digestive enzymes and bile salts, and if following the INFOGEST protocol, at concentrations that although physiologically relevant are harmful to cells. The lack of a harmonized protocol on how to prepare the food digesta samples for downstream Caco-2 studies creates challenges in comparing inter laboratory results. This article aims to critically review the current detoxification practices, highlight potential routes and their limitations, and recommend common approaches to ensure food digesta is biocompatible with Caco-2 monolayers. Our ultimate aim is to agree a harmonized consensus protocol or framework for in vitro studies focused on the absorption of food components across the intestinal barrier.

Key Clinical Message: Successful management of a rare case involving both dens evaginatus and dens invaginatus in the same tooth, monitored over a 24-month follow-up., Abstract: Dens invaginatus (DI) is a congenital dental anomaly characterized by the presence of a tooth that resembles a "tooth within a tooth." Conversely, dens evaginatus (DE) is a developmental anomaly distinguished by an additional tubercle or cusp on the tooth's crown. Both DI and DE can result in pulpal and periapical diseases in the affected tooth. This article presents a case of a healthy 14-year-old male with recurrent swelling under the chin and a wound with pus drainage on the right side of the submental area, associated with his left mandibular lateral incisor affected by both DI and DE. Clinical and radiographic examinations revealed that the tooth was necrotic and had a chronic apical abscess. Cone beam computed tomography (CBCT) confirmed Oehlers' type III DI and a talon cusp on the lingual surface of the same tooth. The patient underwent orthograde endodontic treatment. Passive ultrasonic activation of a 5.25% NaOCl solution and a mixture of Ca(OH) 2 and a 2% chlorhexidine solution were utilized to effectively clean and eliminate the persistent pus discharge. After the resolution of the patient's symptoms, the apical third of the root canal and the invaginated space were filled with a plug of mineral trioxide aggregate (MTA), while the remaining root canal was filled using a sealer-based obturation technique. A 24-month follow-up visit revealed complete bone regeneration in the previously affected periradicular tissues., Competing Interests: None., (© 2024 The Author(s). Clinical Case Reports published by John Wiley & Sons Ltd.)

Background: The association between endometriosis and the outcome of pregnancy is one of the interesting topics. Endometriosis-related pain is alleviated with pregnancy; however, it is known to cause adverse outcomes in pregnancy. The main cause is systemic chronic inflammation caused by higher levels of cytokines, growth factors, and angiogenesis factors., Objective: This study aimed to clarify the relationship between endometriosis, deep endometriosis, adenomyosis, surgical treatment, and poor maternal consequences., Materials and Methods: In this case-control study, data from 250 women who gave birth in Hazrat Rasoul Akram hospital, Tehran, Iran from February 2015 to December 2019 was extracted from the hospital information system in January 2020. Participants were divided into 2 groups: 125 women with endometriosis and 125 women without endometriosis. We looked at how endometriosis affected mothers and newborn babies. Data on pregnancy, delivery, and newborns of both groups was extracted., Results: The mean age of participants was 32.74 ± 4.10 and 31.7 ± 5.53 yr in endometriosis and control group, respectively. In terms of pregnancy complications, placenta previa, placenta accreta, placenta abruption, pre-eclampsia, gestational diabetes mellitus, and postpartum hemorrhage remarkably increased in the endometriosis group compared to the control group. Small for gestational age was significantly higher in rectal endometriosis than women without rectal endometriosis (p = 0.03). The neonatal intensive care unit admission rate was notably higher in infants of the endometriosis group compared to controls (40.7% vs. 24.8%, p = 0.009)., Conclusion: Our findings showed women with endometriosis are at a higher risk for important adverse maternal outcomes., Competing Interests: The authors declare that there is no conflict of interest., (Copyright © 2024 Shahmoradi et al.)

Background: Many genitourinary tract disorders could be attributed partly to the microbiota. This study sought to conduct a systematic review of the role of the microbiota in urinary chronic pelvic pain syndrome (UCPPS)., Methods: We searched Embase, Scopus, Web of Science, and PubMed with no time, language, or study type restrictions until December 1, 2023. The JBI Appraisal Tool was used to assess the quality of the studies. Study selection followed the PRISMA statement. Studies addressing microbiome variations among patients suffering from interstitial cystitis/bladder pain syndrome (IC/BPS) or chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) and a control group were considered eligible., Results: A total of 21 studies (1 UCPPS, 12 IC/BPS, and 8 CP/CPPS) comprising 1125 patients were enrolled in our final data synthesis. It has been shown that the reduced diversity and discrepant composition of the gut microbiota may partly be attributed to the UCPPS pathogenesis. In terms of urine microbiota, some operational taxonomic units were shown to be elevated, while others became less abundant. Furthermore, various bacteria and fungi are linked to specific clinical features. Few investigations denied UCPPS as a dysbiotic condition., Conclusions: Urinary and intestinal microbiota appear to be linked with UCPPS, comprising IC/BPS and CP/CPPS. However, given the substantial disparity of published studies, a battery of prospective trials is required to corroborate these findings., (© 2024 Wiley Periodicals LLC.)

Arsenic with the scientific name AS is an element that exists everywhere. It is the fourth among the abundant elements in water, the twelfth in the human body, and the twentieth in the earth's crust. This element exists in sulfide, carbonate, and elemental forms. Different names of arsenic are known as white arsenic (As 2 O 3 ), yellow arsenic (As 2 S 3 ), and red arsenic (As 4 S 4 ). Nowadays, due to its unique properties, arsenic has received much attention from researchers for use in the synthesis of arsenic nanoparticles. According to various studies, arsenic nanoparticles are synthesized by various methods, including biological, physical, and chemical, and it has been shown that the synthetic method used is very important because it has a significant effect on their shape, size, and biological function. Arsenic nanoparticles are among the nanoparticles that have attracted the attention of researchers due to their particle potential as well as their anticancer, antitumor, cytotoxic, and antimicrobial applications. Therefore, the aim of this study is to investigate arsenic nanoparticles biosynthesized by different physical, biological, and chemical methods and their biomedical applications., (© 2024 Wiley Periodicals LLC.)

Background: Idiopathic intracranial hypertension (IIH) is a rare medical condition in children. Based on the different radiological findings reported in various studies in pediatric IIH, this study was conducted to determine the diagnostic value of MRI findings in diagnosing IIH in children., Methods: In this retrospective study, the medical records of all children aged 1 to 18 years who visited Ghaem Hospital in Mashhad, Iran, between 2012 and 2022 and were diagnosed with IIH were gathered. Forty-nine cases of children with IIH and 48 control cases of children with the first unprovoked seizure with no indications of increased intracranial pressure for comparison were selected. Patient demographic information and MRI findings were extracted. The comparison between different MRI findings in the case and control groups was conducted using statistical tests., Results: In the case group, the mean diameter of the subarachnoid space expansion around the optic nerve was 5.96 ± 1.21, compared to 4.79 ± 0.33 in the control group, with statistically significant difference (P < 0.001). All the patients with flattening of the posterior globe or transverse sinus stenosis were in the case group, and the frequency of these findings in the case group was significantly higher than in the control group (P < 0.001). The majority of patients (95.5%) classified under category 3 and 4 of empty sella were part of the case group, and the statistical test results indicated a significant difference between the two groups (P < 0.001). The optic nerve sheath diameter cut-off of 5.35 mm, when used for expansion of the subarachnoid space around the optic nerve, with a sensitivity of 82% and a specificity of 100% in diagnosing IIH., Conclusion: The most reliable diagnostic indicators for diagnosing IIH in children are perioptic subarachnoid space expansion with high sensitivity, and posterior globe flattening and transverse sinus stenosis with high specificity., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Aim: To investigate the association between vitamin D3 level and oxidative stress biomarkers such as Heat Shock Protein 70 (HSP70), ferric reducing ability of plasma (FRAP), advanced oxidation protein products (AOPP) and advanced glycation end products (AGEs) in patients with Type 2 diabetes., Method: In this cross-sectional study, 54 patients including 32 females and 22 males with a mean age of 54.92 ± 11.37 years with T2D attending the diabetes clinic from 2021 to 2022 were included. According to the average level of vitamin D in this population (14.91), they were divided into two groups with vitamin D ≤15 ng/mL and vitamin D >15 ng/mL. Multivariate regression analysis was conducted to evaluate the relationship between vitamin D and AOPP, HSP and FRAP parameters. The correlation between vitamin D and other variables was evaluated via the Pearson correlation test., Result: Vitamin D level had a positive relation with FRAP (β = 0.32, p = 0.017) and HSP (β = 0.39, p = 0.003), but had a negative relation with AOPP (β = -0.30, p = 0.02). The level of 2hPP also had a negative relation with the level of vitamin D (β = -0.33, p = 0.03). There was not any relationship between the level of vitamin D and AGEs or other variables. After adjusting for multiple confounders for the multivariate regression model, HSP remained significant., Conclusion: This research indicates the relationship between vitamin D levels and oxidative stress biomarkers in patients with Type 2 diabetes., (© 2024 The Author(s). Endocrinology, Diabetes & Metabolism published by John Wiley & Sons Ltd.)

Key Clinical Message: Systemic Lupus Erythematosus (SLE) can have an insidious onset and a fatal prognosis in children. Patients presenting without typical signs of SLE should undergo further evaluation if they are not responding to the initial diagnosis and treatment. This is especially true for patients with rapidly progressing symptoms and deterioration in spite of treatment., Abstract: Pediatric Systemic Lupus Erythematosus is a chronic autoimmune disorder with various organ involvement pulmonary involvement in the course of this disorder is a rare yet potentially life-threatening complication. In this case report we highlight the findings of a 16-year-old girl acutely and initially presenting with cough and fever, eventually complicating to diffuse alveolar hemorrhage and gradual loss of consciousness. Although the patient was started on immunosuppressive treatment after the diagnosis of lupus, based on renal and hematological impairment, was made and initially responded, she eventually deteriorated., Competing Interests: The authors declare that there is no conflict of interest regarding the publication of this paper., (© 2024 The Author(s). Clinical Case Reports published by John Wiley & Sons Ltd.)

Instrument fracture in the root canal system is an unpleasant incident that may occur during root canal treatment. Comprehensive cleaning of the root canal system is often impossible in the presence of a broken instrument. Therefore, it is often imperative to remove the broken fragment from the root canal system. To date, various methods have been proposed for the removal of broken instruments from the root canal system. However, no consensus has been reached on a safe technique with a high success rate for broken instrument removal. This case series reports six cases of successful removal of broken instruments using different methods including the ultrasonic, tube-and-glue, tube-and-wire, tube-and-internal shaft, and the forceps techniques and also provides a brief review of the relevant literature., Competing Interests: The authors have no conflict of interest to declare., (Copyright © 2024 Mohsen Aminsobhani et al.)

In the present study, an efficacious, safe, inexpensive and eco-friendly microextraction was provided by deep eutectic solvents based on dispersive liquid-liquid microextraction (DLLME - DES) followed by GFAAS. A series of DESs were synthesised using l -menthol as hydrogen bond acceptor (HBA) and carboxylic acids with 4, 6, 8 and 10 carbon atoms as hydrogen bond donors (HBD). The synthesised DESs were used as extractants of arsenic ions. Under optimised conditions, good linearity with coefficient of determination ( r 2 ) 0.992 and an acceptable linear range of 0.3-100 µg kg -1 was obtained. The limit of detection was 0.1 µg kg -1 (S/ N  = 3) for arsenite (As(III)) ions, and a high enrichment factor (EF = 200) was obtained. The enhancement factor and extraction recovery (ER%) of the method were 340 and 60%, respectively. RSDs including inter- and intra-day ranged from 3.2% to 5.8% in three examined concentrations. After a specific digestion, the capability of the synthesised DES in the extraction of As(III) from rice was tested. Total inorganic arsenic was separated similarly after reduction of arsenate (As(V)) to As(III), and As(V) concentration was calculated by difference. Using a second digestion method, total arsenic concentration (sum of organic and inorganic arsenic) in the samples was determined.

Competing Interests: The authors report no conflicts of interest.

Celiac disease (CD) is a chronic autoimmune enteropathy and multifactorial disease caused by inappropriate immune responses to gluten in the small intestine. Weight loss, anemia, osteoporosis, arthritis, and hepatitis are among the extraintestinal manifestations of active CD. Currently, a strict lifelong gluten-free diet (GFD) is the only safe, effective, and available treatment. Despite the social burden, high expenses, and challenges of following a GFD, 2 to 5 percent of patients do not demonstrate clinical or pathophysiological improvement. Therefore, we need novel and alternative therapeutic approaches for patients. Innovative approaches encompass a broad spectrum of strategies, including enzymatic degradation of gluten, inhibition of intestinal permeability, modulation of the immune response, inhibition of the transglutaminase 2 (TG2) enzyme, blocking antigen presentation by HLA-DQ2/8, and induction of tolerance. Hence, this review is focused on comprehensive therapeutic strategies ranging from dietary approaches to novel methods such as antigen-based immunotherapy, cell and gene therapy, and the usage of nanoparticles for CD treatment., Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)

Introduction: Since the beginning of the 21st century, competency-based education has been proposed as an approach to education in many disciplines including the medical sciences and it has become a dominant approach in many countries. We aimed to explore the lived experiences of general medical students about developing competencies in the academic curriculum., Methods: We conducted a phenomenology method to study lived experiences of general medical students through selecting participants via a purposeful sampling strategy. Snowballing and maximum variation samplings were also applied to recruit additional participants. The study was conducted at a Medical School in Iran. Three successive phases of qualitative data analysis, namely, data reduction by coding, data structuring by categorization, and data interpretation by discussion were applied to analyze the interviews., Results: The results of the research showed that students' lived experiences fall under 4 main themes with 9 subthemes. The main themes show that (1) the compartmentalized curriculum in basic courses is experienced as the missing parts in a puzzle, (2) the physiopathology curriculum is experienced as swimming on land, (3) the externship is experienced as touring a mysterious land, (4) the internship is experienced as unleashed arrows., Discussion: Our findings reveal that despite the changes already made in the curriculum, its compartmentalization is still a main obstacle to achieving competency-based medical education. A strict requirement for leaving the discipline-based curriculum behind is to use an integrated approach, in which basic science courses are connected with clinical cases, and physiopathology courses are connected with externships and internships., (Copyright © 2024 Karami, Hashemi and Van Merrienboer.)

The search for new sources of fortified components from low-cost and sustainable sources has become a trend in the last decade. Food byproducts containing valuable bioactive compounds such as dietary fiber, protein, and phytochemicals are being used as substrates for obtaining beneficial components that can promote health. Extrusion is an efficient technology for converting food by-products into nutrient-rich food ingredients. The objective of this work was to optimize the extrusion process to obtain the best combination of moisture content (14, 18 and 22%) and screw speed (SS) (120,150 and180 rpm), apple pomace (AP): semi-defatted sesame cake (SDSC) blends (25:75, 50:50 and 75:25 w/w) to fabricate textured functional ingredients (TFI) with high values of expansion ratio (ER), water absorption index (WAI), brightness level, total phenolic compounds (TPC) and antioxidant activity (AA) and lower hardness based on a central composite design. The optimal treatment was determined at 176 rpm SS, 18% moisture content and a ratio of (75:25) AP: SDSC. The desirability value has indicated an appropriate match between the predicted and the observed response. TFI exhibited higher soluble dietary fiber fraction (WAI) values and lower plate count values during 30 days of storage compared to the unprocessed by-product, suggesting that TFI could be successfully used for the manufacture of innovative, high quality products such as porridge, beverages, cookies, soups and others that could provide health benefits based on the values obtained., Competing Interests: The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Elnaz milani reports financial support was provided by Academic Center for Education Culture and Research. Elnaz Mialni reports a relationship with Elnaz Milani that includes: funding grants. If there are other authors, they declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 Published by Elsevier Ltd.)

The acyl-CoA-binding domain-containing protein 6 (ACBD6) is ubiquitously expressed, plays a role in the acylation of lipids and proteins and regulates the N-myristoylation of proteins via N-myristoyltransferase enzymes (NMTs). However, its precise function in cells is still unclear, as is the consequence of ACBD6 defects on human pathophysiology. Using exome sequencing and extensive international data sharing efforts, we identified 45 affected individuals from 28 unrelated families (consanguinity 93%) with bi-allelic pathogenic, predominantly loss-of-function (18/20) variants in ACBD6. We generated zebrafish and Xenopus tropicalis acbd6 knockouts by CRISPR/Cas9 and characterized the role of ACBD6 on protein N-myristoylation with myristic acid alkyne (YnMyr) chemical proteomics in the model organisms and human cells, with the latter also being subjected further to ACBD6 peroxisomal localization studies. The affected individuals (23 males and 22 females), aged 1-50 years, typically present with a complex and progressive disease involving moderate-to-severe global developmental delay/intellectual disability (100%) with significant expressive language impairment (98%), movement disorders (97%), facial dysmorphism (95%) and mild cerebellar ataxia (85%) associated with gait impairment (94%), limb spasticity/hypertonia (76%), oculomotor (71%) and behavioural abnormalities (65%), overweight (59%), microcephaly (39%) and epilepsy (33%). The most conspicuous and common movement disorder was dystonia (94%), frequently leading to early-onset progressive postural deformities (97%), limb dystonia (55%) and cervical dystonia (31%). A jerky tremor in the upper limbs (63%), a mild head tremor (59%), parkinsonism/hypokinesia developing with advancing age (32%) and simple motor and vocal tics were among other frequent movement disorders. Midline brain malformations including corpus callosum abnormalities (70%), hypoplasia/agenesis of the anterior commissure (66%), short midbrain and small inferior cerebellar vermis (38% each) as well as hypertrophy of the clava (24%) were common neuroimaging findings. Acbd6-deficient zebrafish and Xenopus models effectively recapitulated many clinical phenotypes reported in patients including movement disorders, progressive neuromotor impairment, seizures, microcephaly, craniofacial dysmorphism and midbrain defects accompanied by developmental delay with increased mortality over time. Unlike ACBD5, ACBD6 did not show a peroxisomal localization and ACBD6-deficiency was not associated with altered peroxisomal parameters in patient fibroblasts. Significant differences in YnMyr-labelling were observed for 68 co- and 18 post-translationally N-myristoylated proteins in patient-derived fibroblasts. N-myristoylation was similarly affected in acbd6-deficient zebrafish and X. tropicalis models, including Fus, Marcks and Chchd-related proteins implicated in neurological diseases. The present study provides evidence that bi-allelic pathogenic variants in ACBD6 lead to a distinct neurodevelopmental syndrome accompanied by complex and progressive cognitive and movement disorders., (© The Author(s) 2023. Published by Oxford University Press on behalf of the Guarantors of Brain.)

Background: Comprehensive palliative care for patients with heart failure can be developed by educating cardiac nurses. The current study aimed to design a heart failure palliative care educational program for nurses., Materials and Methods: This study was carried out using the multi-method approach based on two out of four steps of Uys educational program development at Dr. Chamran Hospital, Isfahan, in 2020-2021. In step 1, educational needs were collected through literature review, interviews with 15 patients and 10 nurses, examination of patients' documents and medical records, and observation. Then, in step 2, the importance and necessity of teaching the proposed topics and the teaching and evaluation method of the items were assessed through two rounds of delphi technique (15 expert panel members). Eventually, the educational program was finalized., Results: In step 1, the educational needs of nurses were identified in 6 general fields and 26 general learning topics. In step 2, educational needs [specialized knowledge (55% necessity and 55% importance) and social support (33% necessity and 33% importance)], teaching methods (role-playing, experiential learning, and journal club), and evaluation method (the information analysis method) were removed due to a lack of consensus (11%). Finally, the main parts of the program, including the program mission and vision, general learning topics, general goals, objectives, teaching strategies, and evaluation strategies, were compiled., Conclusions: This program provides nurses with up-to-date information on various aspects of the physical, psychological, social, spiritual, and educational needs of heart failure patients and ensures the provision of better services to them., Competing Interests: Nothing to declare., (Copyright: © 2024 Iranian Journal of Nursing and Midwifery Research.)