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Azadeh Bahadoran,1,2 Mehdi Ebrahimi,3 Swee Keong Yeap,1 Nikoo Safi,1 Hassan Moeini,4 Mohd Hair-Bejo,1,5 Mohd Zobir Hussein,6 Abdul Rahman Omar1,5 1Institute of Bioscience, Universiti Putra Malaysia, UPM, Serdang, 2Department of Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, 3Department of Veterinary Preclinical Sciences, Universiti Putra Malaysia, UPM, Serdang, Malaysia; 4German Cancer Research Center, Heidelberg, Germany; 5Department of Veterinary Pathology and Microbiology, Universiti Putra Malaysia, UPM, 6Advanced Technology Institute, Universiti Putra Malaysia, UPM, Serdang, Malaysia Abstract: This study was aimed to evaluate the immunogenicity of recombinant plasmid deoxyribonucleic acid (DNA), pBud-H5-green fluorescent protein (GFP)-interferon-regulatory factor (IRF)3 following delivery using polyamidoamine (PAMAM) dendrimer and transactivator of transcription (TAT)-conjugated PAMAM dendrimer as well as the effect of IRF3 as the genetic adjuvant. BALB/c mice were vaccinated transdermally with pBud-H5-GFP, PAMAM/pBud-H5-GFP, TAT-PAMAM/pBud-H5-GFP, and TAT-PAMAM/pBud-H5-GFP-IRF3. The expression analysis of H5 gene from the blood by using quantitative real-time reverse transcriptase polymerase chain reaction confirmed the ability of PAMAM dendrimer as a carrier for gene delivery, as well as the ability of TAT peptide to enhance the delivery efficiency of PAMAM dendrimer. Mice immunized with modified PAMAM by TAT peptide showed higher hemagglutination inhibition titer, and larger CD3+/CD4+ T cells and CD3+/CD8+ T cells population, as well as the production of cytokines, namely, interferon (IFN)-γ, interleukin (IL)-2, IL-15, IL-12, IL-6, and tumor necrosis factor-α compared with those immunized with native PAMAM. These results suggest that the function of TAT peptide as a cell-penetrating peptide is able to enhance the gene delivery, which results in rapid distribution of H5 in the tissues of the immunized mice. Furthermore, pBud-H5-GFP co-expressing IRF3 as a genetic adjuvant demonstrated the highest hemagglutination inhibition titer besides larger CD3+/CD4+ and CD3+/CD8+ T cells population, and strong Th1-like cytokine responses among all the systems tested. In conclusion, TAT-PAMAM dendrimer-based delivery system with IRF3 as a genetic adjuvant is an attractive transdermal DNA vaccine delivery system utilized to evaluate the efficacy of the developed DNA vaccine in inducing protection during challenge with virulent H5N1 virus. Keywords: influenza virus, DNA vaccine, vaccine delivery, dendrimer, TAT peptide

Abstract Background The association between macronutrient consumption and the risk of type 2 diabetes (T2D) remains equivocal. Here, we investigated whether the quantity and quality of macronutrient intake are associated with T2D incidence in a West Asian population. Methods T2D-free adults (n = 2457, mean age 38.5 ± 13.6 years, 54.2% women) who participated in the third examination cycle (2005–2008) of the Tehran Lipid and Glucose Study were followed for a median of 8.6 years. We estimated the macronutrient quality index (MQI), its individual sub-indices (carbohydrate quality index (CQI), fat quality index (FQI), and healthy plate protein quality index (HPPQI)), as well as the macronutrient quantity. The risk of T2D in relation to macronutrient quantity, quality, and their combined effects was examined using Cox proportional hazard models adjusted for known risk factors for T2D. Results During the study follow-up, 257 incident cases of T2D were documented. Individuals in the highest tertiles of MQI and CQI had a 27% (HR = 0.73, 95% CI = 0.54, 0.98) and 29% (HR = 0.71, 95% CI = 0.51–0.99) lower T2D risk than those in the lowest tertiles. The T2D incidence was 35% lower in the middle HPPQI tertile than in the lowest (HR = 0.65, 95% CI = 0.47, 0.89). The multivariable adjusted model showed that individuals in the middle and highest tertiles of carbohydrate intake had 32% (HR = 0.68, 95% CI = 0.49–0.95) and 26% (HR = 0.74, 95% CI = 0.55–1.00) lower risks of T2D than individuals in the lowest tertile. A high-quantity, high-quality carbohydrate diet (≥ 58.5% of energy from carbohydrate with a CQI ≥ 13) and a low-glycemic index (GI), high-fiber diet (GI

Type 2 diabetes (T2D) significantly increases the risk of vascular complications (12-32 %), which are a major cause of death (over 50 %) in T2D patients. In T2D, both endothelial (ET) and vascular smooth muscle (VSM) cells are impaired, which act as independent risk factors for cardiovascular disease. Thus, the question of this systematic review and meta-analysis is: Do ET-dependent and -independent VSM relaxation impair in T2D? We systematically searched PubMed and Scopus databases until March 2024; 44 eligible clinical trial studies (68, 16, 30, and 50 study arms for acetylcholine (ACh), methacholine (MTH), sodium nitroprusside (SNP), and glyceryl trinitrate (GTN)) published were included. ET-dependent VSM relaxation in response to ACh (overall ES = -28.9 %, 95 % CI: -35.2, -22.7; p

Objective The management and risk stratification of non-massive pulmonary embolism (PE) remain unclear. However, early assessment of PE severity can aid physicians in establishing better treatment milestones. There has been no direct comparison of mortality rates in patients with non-massive PE, and existing data are sometimes contradictory. Therefore, we examined the relationship between the Qanadli index and conventional risk stratifiers in PE. Methods We retrospectively analyzed 200 consecutively selected patients diagnosed with PE. The assessment included computed tomography pulmonary angiography, electrocardiography, echocardiography findings, outcomes, and a comparison with the Simplified Pulmonary Embolism Severity Index (SPESI) score. Descriptive, regression, and receiver operating characteristic analyses were performed. Results The mean Qanadli score was 13.5 ± 1.15. Pearson correlation analysis revealed significant associations between the total Qanadli score and several variables: right ventricular enlargement, follow-up ejection fraction, and SPESI score. Although the Qanadli score did not significantly predict mortality, the risk of death increased by 58.8% for each 1-unit increase in the SPESI score. Conclusions Although the Qanadli index is valuable in assessing PE and guiding treatment strategies, its standalone predictive value for mortality may be insufficient. Therefore, incorporating scoring systems such as the SPESI and echocardiographic findings is recommended for more accurate mortality prediction.

This study aimed to investigate the catalytic performance of H-ZSM-5 zeolite compared with physically mixed and sequentially used synthesized γ-alumina and zeolite in the methanol-to-propylene (MTP) reaction. A facile, green and cost-effective method was first applied to prepare a mesoporous γ-Al2O3 support using a combination of sol–gel and hydrothermal methods via a few consecutive steps. This process was carried out using aluminium nitrate and polyethylene glycol with different molecular weights as non-ionic surfactants. X-ray diffraction, transmission electon microscopy, thermogravimetric analysis, ammonia temperature programmed desorption and Brunauer–Emmett–Teller analysis were then used to characterize the prepared γ-Al2O3 catalyst. Afterwards, the catalytic activity of the commercial H-ZSM-5 zeolite (Si/Al = 200) and the effect of the presence of the γ-alumina physically mixed and unmixed with the zeolite were also researched in the MTP reaction. Accordingly, methanol conversion and product selectivity were monitored via gas chromatography. The physically mixed mesoporous γ-Al2O3 and H-ZSM-5 zeolite exhibited the highest catalytic activity in terms of both conversion and selectivity at 400°C. To our knowledge, this research represents the first documented use of γ-alumina and zeolite simultaneously as catalysts in the MTP reaction within the English literature. It is hoped that this work will offer valuable insights for advancing the development of catalytic systems in methanol conversion processes.

Abstract Background We assessed the possible effect of usual dairy consumption on pre-diabetes (Pre-DM) remission or progression to type 2 diabetes (T2D). Methods Pre-DM adults (n = 334, mean age of 49.4 years, and 51.5% men) were assessed for dairy intakes (2006–2008) and followed up to 9 years for incidence of T2D or normal glycemia (NG). All biochemical measurements were done at baseline and all subsequent examinations with 3-y follow-up intervals. Multinomial regression models with adjustment of confounding variables were used to estimate odds ratios (OR) and 95% confidence intervals (CIs) of incident T2D and NG for each serving/d dairy consumption. Results The odds of NG was significantly elevated by 69% (OR = 1.69, 95% CI = 1.00–2.86, P = 0.05) per 200 g/d increased high-fat dairy intake, while the amount of total dairy or low-fat dairy was not related to the outcomes. Higher intakes of yogurt were more likely to be associated with an increased odds of NG (OR = 1.82, 95% CI = 1.20–2.74, P = 0.01). Usual intakes of milk, cheese, or cream-butter were not associated to Pre-DM remission or progression to T2D. Conclusion Regular dairy consumption may increase the chance of Pre-DM regression to NG.

Abstract Background Cardiovascular disease (CVD) is a major cause of death worldwide, although limited data are currently available regarding the impact of consuming ultra-processed food (UPF) on its incidence. Given the increased consumption of UPF in Iran, we aimed to investigate the association between UPF intake and CVD risk. Methods Individuals without CVD (n = 2050) aged ≥ 30 years old were recruited from the Tehran Lipid and Glucose Study (TLGS). Dietary data were collected using a validated food frequency questionnaire (FFQ) and UPF intakes were assessed based on the Nova food classification. Multivariable Cox proportional hazard models adjusted for potential confounders were used to estimate the hazard ratio (HR) and 95% confidence intervals (95% CI) for the risk of CVD across tertiles of UPF intake. Results A 10.1% incidence of CVD occurred over a median follow-up of 10.6 years, with a 22% increase in CVD risk per each 50 g/day UPF intake. Participants with the highest intake of UPF had a 68% greater incidence of CVD compared to those with the lowest intake (HR = 1.68, 95% CI=1.14–2.48) after controlling for potential confounders. Regarding sub-groups of UPF, participants in the 3rd tertile compared to the reference had a significantly increased risk of CVD (HR = 1.56, 95% CI=1.04–2.34). Nevertheless, intake of bread, fast food, sweetened beverages, sweets and desserts, high-fat dairy products, and other UPFs were not associated with greater CVD risk. Conclusion Our findings support the hypothesis that the incidence of CVD is enhanced with the higher consumption of UPF in a representative sample of the Iranian population.

Background: Hydatid cysts (HC) are zoonotic diseases that are mainly caused by . Ovarian HC is a rare condition with different and unspecified presentations. Here we report a rare case of primary ovarian HC. Case Presentation: A 47-year-old woman with chronic abdominal pain and left hemipelvic fullness was referred to the Obstetrics Clinic of the Kowsar Hospital of Qazvin. Abdominopelvic sonography revealed a cystic mass, which primarily suggested a cyst adenoma. The tumor marker levels were within normal limits. After surgical resection, histopathological examination showed a cystic mass with dimensions of 10×6×3 cm, smooth external and internal aspects, wall thickness of 0.3 cm, and multiple pieces of irregular gray membranous tissue. The patient was treated with albendazole 3 months after surgery, and a 6-month follow-up sonogram revealed no signs of recurrence.Discussion: HC has non-specific presentations. Radiologists, pathologists, and surgeons should consider HC as a differential diagnosis for any cystic mass in the pelvic cavity, especially in endemic areas. Surgical resection and albendazole administration are the chosen treatments.

Abstract Background The association of prediabetes (Pre-DM) regression and progression with visceral adiposity index (VAI) and adipose tissue dysfunction (ATD) remains to be investigated. Methods The present cohort study was conducted within the framework of the Tehran Lipid and Glucose Study (TLGS) on 1458 Pre-DM cases (aged ≥ 21 years) who were followed for nine years. VAI was estimated based on waist circumference, body mass index, triglycerides, and high-density lipoprotein cholesterol. ATD status (i.e., absent, mild-moderate, and severe) was defined based on the age-stratified cutoff values of VAI. Multinomial logistic regression models with adjustment of potential confounders were used to estimate the chance of Pre-DM regression to normoglycemia or progression to T2D across ATD status. Results During the study follow-up, 39.0% of the participants developed T2D, and 37.7% returned to normoglycemia. Compared to mild-moderate ATD, Pre-DM subjects with severe ATD had a higher risk of developing T2D by 45% (OR = 1.45, 95% CI = 11.08–1.93). Severe ATD was also associated with a decreased chance of returning to normoglycemia by 26% (OR = 0.74, 95% CI = 0.55–0.99). Participants with severe ATD had significantly higher fasting (overall mean = 111, 95% CI = 109–112 vs. 106, 95% CI = 105–108 mg/dL) and 2h-serum glucose (overall mean = 165, 95% CI = 161–168 vs. 153, 95% CI = 149–156 mg/dL) concentrations over time. Conclusion Severe ATD was associated with an elevated risk of developing T2D and longitudinal poor-glycemic controls in Pre-DM subjects. ATD may be a simple and useful index for detecting subjects at a higher risk of Pre-DM progression to T2D, allowing for timely intervention strategies.

IntroductionA close look at the state of education in Iran and the world shows that despite all efforts to raise the quality of education and upbringing of decent, cultured, and socialized people, human societies are still facing many problems in this field. The way out of these problems is to develop an educational system suitable for human needs and talents. Anthropology is the general title and system of knowledge that includes any understanding of human beings from a philosophical, mystical, moral, and experimental point of view (Khosrupanah, 2014, p. 46). Without knowing human beings, it is not possible to know their talents and needs. with the correct knowledge of man and his various dimensions of existence, one can make the correct use of his talents. In other words, by knowing human beings, human talents can flourish. On the other hand, without knowing humans, the basic problem of education will not reach its final solution; That is, until the human being is unknown, it is not possible to present a correct educational system for the growth of the human being (Nasri, 2014, p. 29).Literature ReviewOver the past years, various researches have been conducted in order to analyze the ideas of martyr Motahari. For example, Hosseini (2009) in his work entitled "Religious-Educational Anthropology" has tried to show that the Islamic educational system pays attention to the elements and factors of the divine education of man and all the necessary propositions in the movement towards excellence. Karami (2007) in a research entitled "Human; Known Creature" investigated topics such as succession and guidance, legislative guidance and human perfection, moral guidance and inspiration, human inner desires and instincts, human knowledge and cognition, human psychological personality, and social life. Also, there have been researches in the field of moral education, such as Mousavi Faraz (2017), who in his research mainly focused on moral education based on the relationship between ethics and religion, the place of human dignity in moral education, and the place of truth and affection in moral education. Based on this, it can be seen that a complete semantic network of educational requirements according to the philosophy of Professor Motahari has not been presented. Based on this, in this research, we are trying to analyze the anthropology of Professor Shahid Morteza Motahari and explore the semantic network of educational requirements related to this anthropology.MethodologyThis research has a qualitative approach and has used descriptive-analytical and inferential research methods. The qualitative approach uses qualitative data to understand and explain phenomena and often seeks to understand the meanings, concepts, explanations, and characteristics of the subject under study (Delavar, 2019, p. 308). The first-hand documents used are the works of Professor Motahari and some articles and books of other researchers. To identify, extract, and categorize concepts, MaxQDA software and its coding tool were used. Qualitative content analysis is a method of subjectively interpreting the content of textual data through the processes of systematic classification, coding, and thematization. (Iman, 2011, p. 88). The qualitative content analysis method is a method to find the connection between different concepts and to recognize conceptual relationships.ResultsThis research shows that Shahid Motahari in his works, first by stating the existing distinctions between humans and other animals concludes that the superiority of humans over animals lies in special human tendencies that are embedded in human nature. Then, in the next stage, by distinguishing between the good and bad people of history and showing the reason for the privilege of the first group over the second group, he introduces human values as the criteria of humanity and finally argues that human values are the special human tendencies that are rooted in his human nature. These values, which are potentially present in human nature, are the special human talents that Shahid Motahari calls them human nature. In light of such knowledge, he believes that in education, it is necessary to know the human being, human talents, the details of the human mind, emotions and feelings, and even the supernatural root of human existence.DiscussionAccording to Shahid Motahari, a human is a creature with many privileges that distinguish him from other creatures, especially animals. What forms the foundation of human existence in nature (Fetrat), and Professor Motahari explains this issue completely by presenting the theory of nature. According to him, the main difference between humans and other living beings is the special human tendencies and the existence of freedom and choice. This point divides the duty of the teacher in the field of education into two very important parts. In the first part, the duty of the teacher is to provide the facilities, meet the needs of the student, and remove the existing obstacles and limitations for the flourishing of human talents. In the second part, the teacher has the duty of providing a system among human talents for the harmonious development of all of themConclusionIt is necessary to maintain a balance among all men's natural talents in human education. Paying attention to some talents and cultivating them, fighting with others, and not creating a balance between them, make a person a dangerous being. Accordingly, in order to answer the question of "how should a human being be educated", from the point of view of Professor Motahari, it can be said that every human being should be educated in such a way that he reaches his own goal; it means that his talents should be recognized and nurtured. That is, based on the knowledge of nature, we should cultivate all our talents in harmony with nature.

Abstract Objectives The effects of dietary sage on the growth performance, antioxidant status, intestinal mucosa morphology, and pulmonary hypertensive response were investigated in broiler chickens with pulmonary hypertension. Methods Chicks (Ross 308) were reared under cold stress for 35 days and treated with 0.05% vitamin C (positive control) and 0 (control), 0.1 or 0.2% sage extracts, then performance, oxidant and antioxidant status, and intestinal morphology were evaluated. Results The index of pulmonary hypertension (RV:TV) was decreased, and weight gain (days 22–35) was increased in all treatments (except for sage 0.1%) compared with control (P

Abstract Vascular nitric oxide (NO•) resistance, manifested by an impaired vasodilator function of NO• in both the macro- and microvessels, is a common state in type 2 diabetes (T2D) associated with developing cardiovascular events and death. Here, we summarize experimental and human evidence of vascular NO• resistance in T2D and discuss its underlying mechanisms. Human studies indicate a ~ 13-94% decrease in the endothelium (ET)-dependent vascular smooth muscle (VSM) relaxation and a 6-42% reduced response to NO• donors, i.e., sodium nitroprusside (SNP) and glyceryl trinitrate (GTN), in patients with T2D. A decreased vascular NO• production, NO• inactivation, and impaired responsiveness of VSM to NO• [occurred due to quenching NO• activity, desensitization of its receptor soluble guanylate cyclase (sGC), and/or impairment of its downstream pathway, cyclic guanosine monophosphate (cGMP)-protein kinase G (PKG)] are the known mechanisms underlying the vascular NO• resistance in T2D. Hyperglycemia-induced overproduction of reactive oxygen species (ROS) and vascular insulin resistance are key players in this state. Therefore, upregulating vascular NO• availability, re-sensitizing or bypassing the non-responsive pathways to NO•, and targeting key vascular sources of ROS production may be clinically relevant pharmacological approaches to circumvent T2D-induced vascular NO• resistance.

Key Clinical Message Cavernous hemangiomas are rare and have various non‐specific clinical presentations, such as menorrhagia. It can mimic different diseases such as endometrial polyps. Pathologists and gynecologists should be aware of performing histopathological examinations of this neoplasm for accurate diagnosis and to avoid unwarranted therapeutic interventions. Abstract Internal genital tract hemangiomas are rare and can be divided into capillary and cavernous. We present a rare case of cavernous hemangioma (CH) of the corpus in a young, non‐pregnant woman. The patient was a 28‐year‐old woman who had complained of menorrhagia for 2.5 years. Sonography showed a hypoechoic intramural area measuring 35 × 23 mm. Histomorphology revealed neoplastic proliferation of dilated thin‐walled arteries of various sizes within the myometrium. Due to the variable clinical presentations of CH, histopathological examination should be performed for an accurate diagnosis. It is a rare entity and we recommend training pathologists and gynecologists on this neoplasm for accurate diagnosis and to avoid unwarranted therapeutic interventions.

Objective Salivary gland cancers (SGC) are rare cancers with currently no standard treatment for recurrent/metastatic disease. Based on checkpoint inhibitors benefit in a broad range of tumours, NIvolumab in Salivary gland CArcinoma of the Head and Neck (NISCAHN) evaluated nivolumab efficacy in SGC.Methods and analysis In this phase II single-stage Fleming design, patients with SGC with a progressive disease progression within 6 months prior to entering the study, were divided into ACC (adenoid cytic carcinoma) and non-ACC. All received nivolumab for a maximum of 12 months. The primary endpoint was the non-progression rate at 6 months (NPR6m) according to Response Evaluation Criteria in Solid Tumors V.1.1. Secondary endpoints included progression-free survival (PFS), overall survival (OS), overall response rate (ORR), tumour growth rate, safety and quality of life (health-related quality of life).Results 46 patients with ACC and 52 patients without ACC were enrolled over 1 year. Median follow-up was respectively 29.2 months and 16.9 months for patients with ACC and non-ACC. In the ACC cohort, with 15/45 patients non-progressive at 6 months, the primary endpoint was met (33.3%; 95% CI 21.8 to NE). Nivolumab failed to demonstrate efficacy in the non-ACC cohort (NPR6m: 14.0%; 7/50 patients). ORR, PFS and OS were 8.7% (95% CI 2.4 to 20.8), 5.3 (95% CI 3.2 to 5.6) and 17.2 months (95% CI 12.5-NE) in the ACC cohort, and 3.8% (95% CI 0.5 to 13.2), 1.8 (95% CI 1.7 to 3.5) and 11.5 months (95% CI 7.5 to 14.8) in the non-ACC cohort. Nivolumab safety profile was consistent with previous reports.Conclusion Nivolumab has limited efficacy in SGC. Differential results were observed in the two cohorts. The primary endpoint was met in the ACC cohort and no new safety signals were identified.Trial registration number EudraCT number: 2016-001794-32/NCT03132038.

Abstract Background The current prospective cohort study aimed to explore the potential associations between dietary sodium (Na), potassium (K), and sodium-to-potassium (Na-to-K) ratio with an incidence risk of cardiovascular disease (CVD) among Iranian adults. Methods The participants of the Tehran Lipid and Glucose Study (men and women aged 30–84 years, n = 2050), free of CVD at baseline (2006–2008) were included. Dietary intakes were assessed using a validated food frequency questionnaire (FFQ), and incident CVD (i.e., coronary heart disease, stroke, and CVD mortality) were documented up to March 2018. Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence interval (CI) regarding the association between dietary Na, K, and Na-to-K ratio with CVD events. Results During a median follow-up of 10.6 years, 10.14% of participants experienced CVD outcomes. A 41% increased risk of CVD in relation to each increase in 1000 mg/d of Na intake. In the fully-adjusted model, higher Na intake (> 4143 versus

Background and Objective: Sepsis is the third most common cause of death, and the umbilical cord is a significant source of sepsis in the first month of life. This study aimed to compare the effect of Eau de Dalibour and distilled water on umbilical cord separation time and infection in neonates at Kowsar Hospital of Qazvin University of Medical Sciences. Methods: This clinical trial was conducted on 76 infants in two groups of 38 people, using Eau de Dalibour and distilled water as a placebo. In the Eau de Dalibour group, 2-3 ml of the drug was used on the umbilical stump from 3 hours after birth and once every 12 hours until 2 days after the separation of the umbilical cord. In the distilled water group, the same procedure was done with distilled water. Finally, the time of separation of the umbilical cord and signs of infection in both groups were investigated and compared. Findings: There were no significant differences between the two groups in terms of gestational age, sex, or birth weight. Umbilical cord separation time was significantly shorter in the Eau de Dalibour group than in the placebo group (5.1±2.4 and 7.44±2.3 days respectively; p

Background and Objective: Jaundice is common in infants and occurs because of hyperbilirubinemia, which can lead to brain injury in neonates. Phototherapy, in addition to its serious side effects, does not seem to be enough in resolving jaundice. This clinical trial aims to compare the efficacy of orlistat and phototherapy combination therapy with that of phototherapy alone in the treatment of neonatal jaundice. Methods: This clinical trial was performed on 120 term neonates with jaundice. Block randomization was used to allocate the infants to the intervention and control groups. The intervention group received orlistat (4 mg/kg body weight) for three consecutive oral doses at the first, second and third day of hospitalization, along with phototherapy. The control group received a placebo and phototherapy. Total and direct plasma bilirubin levels were measured at baseline (before intervention) as well as 24 and 72 h after treatment. Findings: There were no statistically significant differences between the two groups in terms of infant sex, weight, or age. The mean total and direct bilirubin levels in the experimental group did not change compared to those in the control group at the end of the trial (10.44±1.35 vs. 10.6±2.8 and 0.4±0.1 vs. 0.5±0.1, respectively). Conclusion: Orlistat appears to be ineffective in accelerating bilirubin reduction in neonates with jaundice, at least for the first three days of life.