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Abstract ApoB insertion/deletion (ins/del) genetic variant (rs11279109) is thought to be related to cardio-metabolic markers and obesity. This association has the potential to be modified by dietary patterns. Since the majority of studies concerned the role of dietary acid load (DAL) or ApoB in type 2 diabetes mellitus (T2DM) and its complications independently, and due to the insufficient data regarding the possible interactions between ApoB genetic variants and DAL on anthropometric and metabolic markers, we aimed to study the interaction between this genetic variant and dietary acid load (DAL) on cardio-metabolic markers, along with leptin among Iranian individuals with T2DM. 700 T2DM patients were randomly recruited. A validated semi-quantitative food frequency questionnaire was used for DAL calculation including potential renal acid load (PRAL) and net-endogenous acid production (NEAP). The polymerase chain reaction was used for genotyping the ApoB ins/del (rs11279109). The general linear model was applied to find the interactions in the crude and adjusted models. Patients with del/del genotype (rs11279109) with high PRAL intake have lower low-density lipoprotein cholesterol (LDL-C) (Pinteraction = 0.004), LDL/HDL ratio (Pinteraction = 0.02), total cholesterol (TC) (Pinteraction = 0.04), triglyceride (TG) (Pinteraction = 0.04), leptin (Pinteraction = 0.04) and interleukin-18 (IL-18) (Pinteraction = 0.04). Moreover, the interaction of gene and DAL in the PRAL method on TG concentration (P = 0.04), waist circumference (WC) (P = 0.04), and LDL/HDL ratio (P = 0.04) were significant. Eventually, a positive relationship was observed between the presence of the del/del genotype (rs11279109) and higher levels of TG, TC, LDL-C, IL-18, and LDL/HDL, in individuals with lower adherence to DAL, after adjusting for various covariates. Further studies are needed to investigate and confirm these findings.

Abstract This study aims to examine TPO gene mutations in congenital hypothyroidism (CH) within consanguineous Iranian Azeri families. Three families were subjected to next-generation sequencing and were subsequently validated using Sanger sequencing. The investigation revealed three homozygous pathogenic variants, one of which was identified as a novel variation, occurring within the TPO gene. These findings emphasize the notable prevalence of TPO gene mutations in Iranian Azeri affected by CH, thus establishing the pathogenic nature of the newly discovered variation in the studied patients.

Abstract A soft switching non‐isolated bidirectional DC–DC converter with an improved voltage conversion ratio without any additional auxiliary switch is presented in this paper. In the proposed converter, improved step‐up/step‐down gain conversion is achieved by employing the coupled inductors method. Also, the auxiliary circuit provides soft switching conditions for all the semiconductor elements, regardless of the power flow direction and without any extra voltage stress. The other switch helps provide soft switching conditions for the main switch. Moreover, the switch used for providing soft switching conditions operates as a synchronous rectifier as well. The additional circuit added to attain soft switching is composed of an inductor, coupled with the converter's main inductor, and two auxiliary diodes. The auxiliary diodes benefit from zero‐current‐switching conditions. Fully soft switching conditions for all semiconductor devices, removing the reverse recovery problem, and a low number of components have led to mitigating switching losses and improving efficiency. Detailed operating principles and a theoretical analysis of the proposed converter are presented. Also, the experimental results of a 220 W prototype circuit are provided to confirm the validity of the proposed topology.

Abstract Background The present study investigated the level of 5-hydroxyindoleacetic acid (5-HIAA) in perforated and nonperforated appendicitis patients. This issue is important for timely diagnosis of acute appendicitis complications and making decision about the surgical plan and type of incision. Methods This prospective study was conducted on patients with acute appendicitis. 5-HIAA levels were measured in urine spot sample of every patient before the surgery. The patients were finally included based on result of pathology for presence of appendicitis or not and sorted by direct surgical detection for exist of perforation or not. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of 5-HIAA were investigated. The data were statistically analyzed by SPSS v.27. Results A total of 150 patients were included in two groups as 40 patients in the perforated appendicitis group and 110 patients in the noncomplicated acute appendicitis group. The average age of patients in the perforated appendicitis group was 28.8 ± 6.07 years, and that of patients in the acute appendicitis group was 29.6 ± 6.96 years. 94 patients (63%) were male, and 56 (37%) were female. No significant difference was observed in terms of age or sex between the two groups. The difference in the 5-HIAA concentration between the acute appendicitis group (0.3 ± 0.04 mg/dl) and the perforated appendicitis group (0.5 ± 0.03 mg/dl) was significant (P

Abstract Background Advances in medical imaging have made it possible to classify ankle fractures using Artificial Intelligence (AI). Recent studies have demonstrated good internal validity for machine learning algorithms using the AO/OTA 2018 classification. This study aimed to externally validate one such model for ankle fracture classification and ways to improve external validity. Methods In this retrospective observation study, we trained a deep-learning neural network (7,500 ankle studies) to classify traumatic malleolar fractures according to the AO/OTA classification. Our internal validation dataset (IVD) contained 409 studies collected from Danderyd Hospital in Stockholm, Sweden, between 2002 and 2016. The external validation dataset (EVD) contained 399 studies collected from Flinders Medical Centre, Adelaide, Australia, between 2016 and 2020. Our primary outcome measures were the area under the receiver operating characteristic (AUC) and the area under the precision-recall curve (AUPR) for fracture classification of AO/OTA malleolar (44) fractures. Secondary outcomes were performance on other fractures visible on ankle radiographs and inter-observer reliability of reviewers. Results Compared to the weighted mean AUC (wAUC) 0.86 (95%CI 0.82–0.89) for fracture detection in the EVD, the network attained wAUC 0.95 (95%CI 0.94–0.97) for the IVD. The area under the precision-recall curve (AUPR) was 0.93 vs. 0.96. The wAUC for individual outcomes (type 44A-C, group 44A1-C3, and subgroup 44A1.1-C3.3) was 0.82 for the EVD and 0.93 for the IVD. The weighted mean AUPR (wAUPR) was 0.59 vs 0.63. Throughout, the performance was superior to that of a random classifier for the EVD. Conclusion Although the two datasets had considerable differences, the model transferred well to the EVD and the alternative clinical scenario it represents. The direct clinical implications of this study are that algorithms developed elsewhere need local validation and that discrepancies can be rectified using targeted training. In a wider sense, we believe this opens up possibilities for building advanced treatment recommendations based on exact fracture types that are more objective than current clinical decisions, often influenced by who is present during rounds.

Abstract SARS-CoV-2, the virus responsible for the COVID-19 pandemic, has undergone various genetic alterations due to evolutionary pressures exerted by host cells, including intracellular antiviral mechanisms such as targeting by human microRNAs (miRNAs). This study investigates the impact of miRNAs hsa-miR-3132 and hsa-miR-4650 on the viral genome. Sequence alignment revealed conserved mutations in the binding sites of these miRNAs in adapted strains compared to the original Wuhan-Hu-1 strain, leading to their deletion. Despite modest expression of these miRNAs in SARS-CoV-2 target tissues, their efficacy against mutant strains is reduced due to the loss of binding sites. Structural analysis indicates that the mutant genome is more stable than the Wuhan-Hu-1 genome. Luciferase and virus titration assays demonstrate that hsa-miR-3132 and hsa-miR-4650 effectively target the Nsp3 gene in the Wuhan-Hu-1 strain but not in mutant strains lacking their binding sites. These findings suggest that the observed mutations help the virus evade selective pressure from human miRNAs, contributing to its adaptation

Abstract Background: Melatonin and L-carnitine are free radical scavengers with antiapoptotic and antioxidant properties that improve oocyte development. Objective: This study aimed to find the possible effect of combining 2 antioxidant agents of melatonin and L-carnitine on oocyte morphology, maturation, apoptosis, and expression of bone morphogenetic protein 15 (BMP-15) and growth differentiation factor 9 (GDF-9) genes in a mice model. Materials and Methods: To overstimulation, 60 female NMRI mice were injected intraperitoneally using mare serum gonadotropin. On day 2 post-injection, 70 cumulus-oocyte complexes were collected from each mouse. The collected oocytes randomly were then divided into 4 groups including, the control, melatonin, L-carnitine, and melatonin + L-carnitine groups. The morphology and maturation rate of the oocytes was evaluated using a light microscope. Apoptosis was identified by terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling assay and the expression of BMP-15 and growth and differentiation factor GDF-9 genes was also evaluated by real-time polymerase chain reaction. Results: Oocyte diameter significantly was increased in combination treatment of L-carnitine and melatonin compared to other groups (p < 0.05). L-carnitine group showed the highest mean percentage of oocyte cytoplasmic pattern. Results of the terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling indicated that the lowest apoptosis rate belonged to the melatonin + L-carnitine group. Moreover, the combination groups showed the highest number of oocytes and maturation rate. The BMP-15 and GDF-9 genes were significantly upregulated in all treatment groups compared to the control group. Conclusion: Our results suggested a combination of melatonin + L-carnitine administration as a more effective choice for in vitro promotion of oocyte maturation.

Abstract Switching functionality is pivotal in advancing communication systems, serving as a paramount mechanism. Despite numerous innovations in this field, optical switch design, fabrication, and characterization have traditionally followed an iterative approach. Within this paradigm, the designer formulates an informed conjecture regarding the switch's structural configuration and subsequently resolves Maxwell's equations to ascertain its performance. Conversely, the inverse problem, which entails deriving a switch geometry to achieve a targeted electromagnetic response, continues to pose formidable challenges and necessitates substantial time and effort, particularly under the constraints of specific assumptions. In this work, we propose a deep neural network-based method to approximate the spectral transmittance of all-optical switches. The findings substantiate the efficacy of deep learning in the design of all-optical plasmonic switches, which are renowned as the fastest switches at the nanoscale. The nonlinear Kerr effect in square resonators is leveraged to demonstrate the switching performance. Juxtaposed with conventional simulations, the proposed model showcases a remarkable improvement in computational efficiency. Furthermore, deep learning can resolve nanophotonic inverse design problems without reliance on trial-and-error or empirical strategies. Compared to simulations, the mean squared error for both forward and inverse models is meager, with values of around 0.03 and 0.02, respectively. The deep learning-proposed switches exhibit excellent suitability for integration into photonic integrated circuits, substantially influencing the progression of all-optical signal processing.

Abstract We investigated the effect of repeated sessions of anodal transcranial direct current stimulation (a-tDCS) on subjective and objective measures of recovery, cognitive and sport-specific performance in professional soccer players following a soccer match simulation (SMS). Sixteen soccer players participated in this randomized, crossover, and sham-controlled study. They completed baseline assessments of well-being, total quality recovery (TQR), electromyographic activity (EMG) of the thigh muscles, countermovement jump (CMJ), and cognitive and Loughborough soccer passing test (LSPT) skills. Then, the participants engaged in an SMS routine (2 × 45 min, 15-min intervals). There was no significant difference in rating of perceived exertion (RPE) during the SMS in the anodal (17.25 ± 0.85) and sham (16.93 ± 0.92) conditions (p = 0.19). Following the SMS, the participants were randomized to receive three sessions of a-tDCS (2 mA, 20 min, +F3/−F4) targeting the left dorsolateral prefrontal cortex (DLPFC) or sham immediately after, 24 h, and 48 h after the SMS. Finally, the same outcome measures were evaluated 24 and 48 h following the SMS. A two-way repeated-measures ANOVA showed that a-tDCS stimulation improved passing skills (decreased time to perform the LSPT and number of errors; all ps

A spillway comprises several sections, primarily the crest and chute, essential for safe water flow from an upstream reservoir to a downstream river. Incorporating a hydrofoil crest and stepped chute features creates an efficient Hydrofoil-Crested Stepped Spillway (HCSS). The hydraulic features of the 60 HCSS models, which were designed through the National Advisory Committee for Aeronautics (NACA) equation, are assessed through laboratory experiments under a skimming flow regime, where the five hydrofoil formation indexes (t), three numbers of steps (Ns), and four chute angles (θ) are of concern. The findings indicate that an escalation in the ratio of upstream depth (yup) to spillway height (P), correlates with a rise in the discharge coefficient (Cd) in HCSSs. Furthermore, augmenting the t effectively boosts the Cd value. On average, the Cd value of the crest at t = 1 surpasses that at t = 0.2 by 20 %. This increase in t accentuates the curvature of the spillway crest, thereby enhancing the curvature of streamlines and reducing the flow distance therein. The Energy Dissipation Ratio (EDR) of HCSS is influenced by factors such as t (positively correlated), Ns (positively correlated), and θ (negatively correlated). Optimal performance of the HCSS is observed at t = 1, where both the Cd and EDR reach their peak values.

Middle cerebral artery occlusion (MCAO) is a model for inducing ischemic stroke in rodents, leading to devastating brain damage. Oxidative stress (OS) plays a crucial role in the pathogenesis of ischemia. In this study, the effect of melatonin and N-acetylcysteine on ischemia-reperfusion-induced oxidative stress injury in the cerebral cortex of male rats was investigated. 30 male Wistar rats were divided into sham, ischemic, NAC, melatonin and NAC + melatonin groups. All groups, except the sham group, underwent MCAO on the left side, and the treatment groups received intraperitoneal injections of either 50 mg/kg N-acetylcysteine (NAC) or 5 mg/kg melatonin or a combination of both 24 and 48 hours later. At 24 and 72 hours after surgery, the animals were examined for sensory and motor activity. The cerebral cortex was dissected after sacrificing the rats, infarct volume estimated and the concentrations of glutathione peroxidase (GPx), superoxide dismutase (SOD), catalase (CAT), malondialdehyde (MDA) and nuclear factor erythroid-2 related factor 2 (Nrf2) were analyzed by enzyme-linked immunosorbent assay (ELISA). The results indicate that the NAC + melatonin group exhibited elevated sensory-motor activity and a reduced infarct volume rate in comparison to the ischemic group (p≤ 0.05). Compared to the ischemic group, the NAC + melatonin group showed a significant increase in SOD concentration and a significant decrease in MDA (p≤ 0.05). It can therefore be concluded that the simultaneous administration of NAC and melatonin can reduce the cerebral infarction volume, and improve neurological functions by modulating SOD and MDA.

Abstract Wash water, municipal solid waste incineration (MSWI) fly ash, and propylene (PP) fibers were employed simultaneously to produce self-compacting repair mortar (SCRM). Different SCRM mixtures were utilized, incorporating 35, 70, and 140 kg/m3 of MSWI fly ash, along with 0.1% of PP fibers. The research focused on investigating the workability, mechanical properties, and global warming potential (GWP) of SCRM. The incorporation of MSWI fly ash and wash water in SCRM resulted in reduced workability, necessitating an increase in the use of superplasticizer. Adding MSWI fly ash decreases compressive strength. The minimum compressive strength was observed when employing 140 kg/m3 of MSWI fly ash and wash water instead of tap water simultaneously. By increasing the proportion of MSWI fly ash content and correspondingly reducing the cement content in SCRM samples, there was a decrease in flexural strength. The ultrasonic pulse velocity (UPV) of all SCRM samples falls within acceptable range. Adding MSWI fly ash to SCRM reduces fracture toughness, and the concurrent use of wash water and MSWI fly ash significantly decreases fracture toughness. Incorporating PP fibers into SCRM resulted in increased compressive strength. Utilizing wash water and MSWI fly ash in SCRM significantly reduces GWP. The avoidance of wash water consumption mitigates the environmental impact of SCRM.

Abstract Transcranial direct current stimulation (tDCS) can increase cortical excitability of a targeted brain area. This study aimed to investigate the effect of adding anodal-tDCS (a-tDCS) to neuromuscular training (NMT) on the dynamic knee valgus (DKV) and feedforward activity (FFA) of knee muscles. Thirty-four Taekwondo athletes with DKV, were randomly assigned to either NMT + a-tDCS (N = 17) or NMT + sham tDCS (N = 17). DKV and the knee muscles' FFA at the moment of single and double-leg landing and lateral hopping tasks were evaluated before and after the interventions. DKV and FFA of the knee muscles was improved in all tasks (P 0.05). The FFA of the semitendinosus, vastus medialis, gluteus medius, and gastrocnemius muscles in the single-leg landing (P

Abstract Objective The present umbrella review aims to collate and summarize the findings from previous meta-analyses on the Triglyceride and Glucose (TyG) Index, providing insights to clinicians, researchers, and policymakers regarding the usefulness of this biomarker in various clinical settings. Methods A comprehensive search was conducted in PubMed, Scopus, and Web of Science up to April 14, 2024, without language restrictions. The AMSTAR2 checklist assessed the methodological quality of the included meta-analyses. Statistical analyses were performed using Comprehensive Meta-Analysis (CMA) software. Results A total of 32 studies were finally included. The results revealed significant associations between the TyG index and various health outcomes. For kidney outcomes, a high TyG index was significantly associated with an increased risk of contrast-induced nephropathy (CIN) (OR = 2.24, 95% CI: 1.82–2.77) and chronic kidney disease (CKD) (RR = 1.46, 95% CI: 1.32–1.63). High TyG index was significantly associated with an increased risk of type 2 diabetes mellitus (T2DM) (RR = 3.53, 95% CI: 2.74–4.54), gestational diabetes mellitus (GDM) (OR = 2.41, 95% CI: 1.48–3.91), and diabetic retinopathy (DR) (OR = 2.34, 95% CI: 1.31–4.19). Regarding metabolic diseases, the TyG index was significantly higher in patients with obstructive sleep apnea (OSA) (SMD = 0.86, 95% CI: 0.57–1.15), metabolic syndrome (MD = 0.83, 95% CI: 0.74–0.93), and non-alcoholic fatty liver disease (NAFLD) (OR = 2.36, 95% CI: 1.88–2.97) compared to those without these conditions. In cerebrovascular diseases, a higher TyG index was significantly associated with an increased risk of dementia (OR = 1.14, 95% CI: 1.12–1.16), cognitive impairment (OR = 2.31, 95% CI: 1.38–3.86), and ischemic stroke (OR = 1.37, 95% CI: 1.22–1.54). For cardiovascular outcomes, the TyG index showed significant associations with an increased risk of heart failure (HF) (HR = 1.21, 95% CI: 1.12–1.30), atrial fibrillation (AF) (SMD = 1.22, 95% CI: 0.57–1.87), and hypertension (HTN) (RR = 1.52, 95% CI: 1.25–1.85). Conclusion The TyG index is a promising biomarker for screening and predicting various medical conditions, particularly those related to insulin resistance and metabolic disorders. However, the heterogeneity and methodological quality of the included studies suggest the need for further high-quality research to confirm these findings and refine the clinical utility of the TyG index. Graphical abstract

Abstract This paper discusses the simultaneous management of active and reactive power of a flexible renewable energy-based virtual power plant placed in a smart distribution system, based on the economic, operational, and voltage security objectives of the distribution system operator. The formulated problem aims to specify the minimum weighted sum of energy cost, energy loss, and voltage security index, considering the optimal power flow model, voltage security formulation, and the operating model of the virtual power plant. The virtual unit includes renewable sources, like wind systems, photovoltaic, and bio-waste units. Flexibility resources include electric vehicle parking lot and price-based demand response. In the mentioned scheme, parameters of load, renewable sources, electric vehicles, and energy prices are uncertain. This paper utilizes the Unscented Transformation method for modeling uncertainties. Fuzzy decision-making is utilized to extract a compromised solution. The suggested approach innovatively considers the simultaneous management of active and reactive power of a virtual unit with electric vehicles and price-based demand response. This is performed to promote economic, operational, and network security objectives. According to numerical results, the approach with optimal power management of renewable virtual units is capable of boosting the economic, operation, and voltage security status of the network by approximately 43%, 47–62%, and 26.9%, respectively, to power flow studies. Only price-based demand response can improve the voltage security, operation, and economic states of the network by about 19.5%, 35–47%, and 44%, respectively, compared to the power flow model.

Abstract Background This study investigated the effects of repetitive unihemispheric concurrent dual-site anodal transcranial direct current stimulation (a-tDCSUHCDS) associated with the use of virtual reality games (VR) on the motor coordination of sedentary adolescent girls. Methods Thirty-six inactive adolescent girls were randomly assigned into 3 groups (n = 12 per group): (1) VR + a-tDCSUHCDS, (2) VR + sham-tDCSUHCDS, and (3) Control. The VR + a-tDCSUHCDS and VR + s-tDCSUHCDS groups received the intervention three times a week for four weeks. In each experimental session, participants first received either 20 min of a-tDCSUHCDS (2 mA at each anodal electrode) targeting the primary motor cortex (M1) and the left dorsolateral prefrontal cortex (DLPFC) or sham and then performed VR for 1 h. The control group received no intervention. Eye-hand coordination (EHC) and bimanual coordination (BC) were measured at baseline, post-intervention, and two weeks later (retention test) using the automatic scoring mirror tracer and continuous two-arm coordination test, respectively. Results Results showed that the EHC was significantly higher in the VR + a-tDCS and VR + s-tDCS groups at post-intervention (all ps< 0.001) and the retention test (all ps< 0.001) compared to the control group. Moreover, the EHC was significantly higher in the VR + a-tDCS group compared to the VR + s-tDCS group (p = 0.024) at the retention. Similarly, VR + a-tDCS and VR + s-tDCS improved BC compared to the control group at post-intervention (all ps< 0.001) and retention test (all ps< 0.001). In addition, higher BC was observed in the VR + a-tDCS group compared to the VR + s-tDCS group (p< 0.001) at the retention test. Conclusions Our results suggest that adding a-tDCSUHCDS to VR over 12 sessions may have an additional effect on VR training for improving and retaining motor coordination in sedentary adolescent girls.

Abstract Background Cleft in the mitral valve leaflet is a primary cause of congenital mitral regurgitation, stemming from developmental anomalies in the mitral valve and frequently associated with other congenital heart defects. Concurrent presence of cleft in mitral valve leaflet with atrial septal defect and ventricular septal defect is relatively rare. Echocardiography, especially transesophageal echocardiography, is essential in diagnosing cleft mitral valve leaflet and related congenital heart defects, providing critical, detailed imagery for accurate assessment. This study presents a young female patient whose anterior mitral cleft, along with atrial septal defect and ventricular septal defect, was revealed through three-dimensional transesophageal echocardiography. Case presentation A 25-year-old Iranian female, experiencing progressive dyspnea and diminished physical capacity over 3 months, was referred to our hospital. Initial examination and transthoracic echocardiography indicated severe mitral regurgitation. Further evaluation with transesophageal echocardiography corroborated these findings and identified a cleft in the anterior mitral valve leaflet, coupled with mild left ventricular enlargement and significant left atrial enlargement. The complexity of the patient’s condition was heightened by the diagnosis of cleft mitral valve leaflet in conjunction with atrial septal defect and ventricular septal defect, showing the complex nature of congenital defects. Conclusion This case emphasizes the critical role of transthoracic echocardiography in diagnosing cleft of mitral valve leaflet and associated cardiac anomalies, showcasing its superiority over transthoracic echocardiography for detailed visualization of cardiac structures. The identification of multiple congenital defects highlights the necessity for a comprehensive diagnostic approach to manage and treat patients with complex congenital heart diseases effectively. Future research should aim to refine diagnostic methodologies to enhance patient outcomes for cleft of mitral valve leaflets and related congenital conditions.

Abstract Background Considering the challenges of the referral system in the family physician program and the impact of COVID-19 pandemic on the performance of the relevant ministry’s programs, it is necessary to assess the performance of the referral system. This study was conducted with the aim of investigating the performance of the family physician referral system before and during COVID-19 in Golestan province. Methods The present repeated cross-sectional study was conducted on secondary data Recorded of 786,603 cases referred and cared by family physicians (including information on physicians’ and midwives’ visits, percentage of prescriptions and other information) in Golestan province from 2017 to 2022 in a census and retrospective manner. Data were collected using the reference ratio checklist and analyzed with SPSS 23 software at a significance level of less than 0.05. Results Referral to 10 types of medical specialties and 10 indicators of family physicians referral before and during COVID-19 were investigated. The highest and lowest percentages of referrals by family physicians were belonged to the surgical (17.6%) and infectious (2%) specialists before COVID-19, and internal medicine (15.07%) and urology (3%) specialists during COVID-19, respectively. Referral due to physician’s diagnosis increased by 19.3% compared to before Covid-19, target group increased by 0.86%, care decreased by 2.69% and reverse referral decreased by 36.1%. The amount of population covered by rural insurance, the amount of visits to midwives, the percentage of electronic appointments in the post-Covid-19 years have changed significantly compared to before.it (P-Value

Abstract Background Degenerative lumbar spinal stenosis (LSS) is a common condition that involves the narrowing of the spinal canal. Diagnosing instability traditionally requires standing lateral radiographs to detect dynamic translation, but there is debate about relying solely on radiographs due to challenges like patient discomfort and radiation exposure. This study aimed to evaluate if Magnetic Resonance Imaging (MRI) findings could effectively diagnose instability observed on radiographs. Methods We reviewed 478 consecutive patients with degenerative LSS who had surgery at our institution. Instability was defined as a sagittal translation exceeding 3 mm on standing lateral radiographs in both extension and flexion. Patients were divided into stable (those with 3 mm translation). The study assessed potential variables for instability, including MRI findings like facet joint effusion, facet joint angle, disk height index, intradiscal vacuum presence, endplate sclerosis, ligamentum flavum hypertrophy, and multifidus muscle fatty degeneration, comparing these factors between the two groups. Results A total of 478 consecutive patients diagnosed with degenerative Lumbar Spinal Stenosis (LSS) were included. The average age of the patients was 66.32 years, with 43.3% being male. Approximately 27.6% of the cases exhibited signs of instability on the standing lateral radiograph during extension and flexion. The multivariate analysis using binary logistic regression revealed that facet joint effusion (odds ratio [OR] 2.73; 95% confidence interval [CI] 1.27–3.94; P = 0.002), disk height index (OR 2.22; 95% CI 1.68–3.35; P = 0.009), and the presence of the Vacuum sign (OR 1.77; 95% CI 1.32–2.84; P = 0.021) were identified as factors associated with instability. Conclusions Our findings showed thata higher facet joint effusion, the presence of Vacuum sign, and a greater Disk Height Index were associated with the presence of instability on the standing lateral radiograph in extension and flexion in patients with degenerative LSS.

Abstract Background The identification of novel toxins from overlooked and taxonomically exceptional species bears potential for various pharmacological applications. The remipede Xibalbanus tulumensis, an underwater cave-dwelling crustacean, is the only crustacean for which a venom system has been described. Its venom contains several xibalbin peptides that have an inhibitor cysteine knot (ICK) scaffold. Results Our screenings revealed that all tested xibalbin variants particularly inhibit potassium channels. Xib1 and xib13 with their eight-cysteine domain similar to spider knottins also inhibit voltage-gated sodium channels. No activity was noted on calcium channels. Expanding the functional testing, we demonstrate that xib1 and xib13 increase PKA-II and Erk1/2 sensitization signaling in nociceptive neurons, which may initiate pain sensitization. Our phylogenetic analysis suggests that xib13 either originates from the common ancestor of pancrustaceans or earlier while xib1 is more restricted to remipedes. The ten-cysteine scaffolded xib2 emerged from xib1, a result that is supported by our phylogenetic and machine learning-based analyses. Conclusions Our functional characterization of synthesized variants of xib1, xib2, and xib13 elucidates their potential as inhibitors of potassium channels in mammalian systems. The specific interaction of xib2 with Kv1.6 channels, which are relevant to treating variants of epilepsy, shows potential for further studies. At higher concentrations, xib1 and xib13 activate the kinases PKA-II and ERK1/2 in mammalian sensory neurons, suggesting pain sensitization and potential applications related to pain research and therapy. While tested insect channels suggest that all probably act as neurotoxins, the biological function of xib1, xib2, and xib13 requires further elucidation. A novel finding on their evolutionary origin is the apparent emergence of X. tulumensis-specific xib2 from xib1. Our study is an important cornerstone for future studies to untangle the origin and function of these enigmatic proteins as important components of remipede but also other pancrustacean and arthropod venoms.

Background & Aim: Rumination is a prevalent issue among medical science students, potentially affecting their academic performance. This study aims to evaluate the effectiveness of Mandala therapy in reducing rumination among medical science students at the Islamic Azad University, Tonekabon branch. Methods & Materials: This quasi-experimental study employed a pre-test, post-test design with a control group. A total of 40 medical students from the Islamic Azad University, Tonekabon branch, who exhibited signs of rumination participated in the study in 2023. Participants were selected through convenience sampling and randomly assigned to either the experimental group (20 participants) or the control group (20 participants). The intervention consisted of four 60-minute sessions of Mandala therapy. Data were collected using the Nolen-Hoeksema and Morrow's rumination questionnaire. Descriptive statistics and analysis of covariance (ANCOVA) were performed using SPSS version 26 to analyze the data. Results: Demographic analysis indicated no significant differences between the experimental and control groups concerning gender, age, or semester (P

Introduction: Glomangiopericytoma (GPC) is an extremely rare paranasal sinuses and nasal cavity vascular neoplasm introduced and differentiated from the conventional hemangiopericytoma in 1998 by Granter et al. Up to now, to the best of our knowledge less than 250 confirmed cases have been reported in the literature. However, the exact etiology is unknown but some risk factors including trauma, hypertension, long term steroid use and pregnancy have been suggested as predisposing factors. Nasal obstruction is the most common presentation followed by intermittent epistaxis, pain, proptosis and epiphora. Case presentation: Here we describe a case of right sided glomangiopericytoma that was completely resected with safe margins by a Weber-Ferguson approach and underwent adjuvant radiotherapy with no evidence of recurrence one year after surgery. Discussion: Although glomangiopericytoma is very rare but it should be considered in case of confronting a unilateral vascular mass especially in pregnant female with a history of hypertension, trauma or long-term steroid usage. Definite diagnosis is based on immunohistochemistry and preoperative imaging is mandatory as endoscopic approach should be kept for small sized tumors with definitely identified origin. Conclusion: Glomangiopericytoma is a rare tumor classified as a low-grade borderline malignancy tumor. Complete excision and long term follow up due to high rate of recurrence is required.

Abstract Background This study was conceived to assess the postoperative stability of condylar position following fixation with miniplates and lag screws after bilateral sagittal split osteotomy (BSSO). Methods This retrospective study included a cohort of 20 patients undergoing BSSO using the Obwegeser-Dal Pont modification. The bony segments were stabilized using either miniplates with two 2.0-mm monocortical screws per segment or three 2.0-mm bicortical lag screws along the mandible’s superior border. Pre- and postoperative (7-day interval) spiral computed tomography scans were conducted to assess skeletal changes across both groups. Data analysis employed Wilcoxon signed-rank and Wilcoxon rank-sum tests (α = 0.05). Results No statistically significant difference was observed between the pre-and postoperative condylar position parameters (P>0.05). However, the lag screw group showed a marginal significant increase in the left condyle’s angulation (preoperative: 24.83 ± 6.37 vs. postoperative: 32.5 ± 4.93; P = 0.04). Changes in condylar height, length, and width were not statistically significant before and after BSSO in either groups (P>0.05). Nor was any statistically significant difference found between the miniplates and lag screws groups regarding condylar position parameters (P>0.05). Conclusion The results indicated that both lag screw and miniplate fixation methods can be effectively employed in BSSO procedures without impacting condylar position parameters. Thus, either fixation method can be chosen depending on factors such as the surgeon’s preference and clinical outcomes.

Abstract The purpose of this research is to explain and validate the coordination model of the marketing and sales department in the insurance industry in Iran. The present research is applicable in terms of purpose. The statistical population of the research includes experienced managers in insurance marketing and sales, senior experts of insurance companies and university professors; and the statistical sample was considered to be 181 people using Cochran's formula. Sampling in this research is in the form of random clusters. The collection tool in this research includes a researcher-made questionnaire derived from the qualitative method. Data analysis was done by SPSS software. The findings showed that the coordination model of the marketing and sales department in the insurance industry is affected by various factors directly and indirectly, and managers' understanding of the complexity of the relationship between these two units is of great importance in the growth of insurance companies and creating a competitive advantage for them. In order to ensure the achievement of the goals, managers must pay attention to the causal conditions such as the implementation of the risk management dashboard, structural integration and coordination in the business, creating synergy in organizational decisions, recognizing the prerequisites for coordination between the two departments of marketing and sales in the form of background conditions or coordination challenges such as "partial prejudices, non-specialist human capital, conflict of interests, managers' taste, CEO's attitude, ethical considerations, unfavorable customer support when receiving damages and fulfilling the organization's obligations, as well as interfering conditions such as upstream documents, market conditions (market stakeholders), legal conditions, and competitive conditions. Extended Abstract Introduction The marketing and sales departments are of great importance as the two executive arms and factors of success in the insurance industry. The insurance industry, as one of the major economic institutions and because of the supporting role it plays for other industries, is considered as one of the symbols of the development of countries and for other economic institutions and households; an important economic institution and a strong support institution (Asadi & Hedayati Biland, 2019; Asadollahi & Haji Ali Akbari, 2020). Due to the nature of its activity, this industry is one of the important channels of savings and, as a result, one of the important and central financial institutions, which, along with other financial institutions, helps in the preparation and allocation of capital and the financing of economic units (Zubiri et al, 2016). In order to be able to take on this crucial role in the society, the said industry should, like other economic enterprises, seek to survive, gain profit or even develop by attracting and keeping customers and creating powerful sales networks (Huang et al, 2016). One of the influential factors in the success of the insurance industry is the sales network, which is of twofold importance, considering the characteristics of the marketing field. The insurance sales and marketing network consists of all executives, staff, infrastructures, software and hardware; and should be in the form of a targeted planning process as a success factor, marketing lever, and executive arm of the insurance industry; and should be managed based on marketing skills and Sales (Shafei, 2020). By reviewing past studies, it was found that despite the importance of identifying the coordination framework between the sales and marketing departments, no study has been conducted on the coordination framework and model between marketing and the sales network in this insurance industry, so this study was conducted for this purpose, and it answers the question: what are the important direct, indirect and intervening variables in the coordination of marketing and sales in the insurance industry? Theoretical Framework Marketing and sales Integration solutions between sales and marketing departments have been classified into four categories of structural, system/process, cultural, and human solutions in the form of a theoretical framework (Peterson & Dover, 2021). Marketing strategies are the advantage of customer information sources and business performance, and it has been shown that there is a strong relationship between customer information sources, marketing strategies used by the company, and business performance (Varadarajan, 2020). It has also been shown that by increasing the company's market share as a result of good marketing and coordination with the sales department, the cost of advertising is reduced and the value of the company's shares is also improved (Redjeki et al, 2021). Arabshahi & Abbaszadehgaretekan (2023) studied the effect of electronic customer relationship management on marketing performance by analyzing the mediating role of product innovation and emphasizing customer knowledge. In this descriptive survey study, 165 managers and supervisors of the central headquarters, branches and representative offices of Dana Insurance in Mashhad were selected by a simple random method. The findings indicated that the electronic customer relationship management variable had a positive and significant effect on product innovation development, and the product innovation development variable had a positive and significant effect on marketing performance. On the other hand, customer knowledge has a positive and significant effect on marketing performance and product innovation development, and electronic customer relationship management and customer knowledge through product innovation development has a positive and significant effect on marketing performance. Nazarpuri et al, (2022) investigate the impact of marketing dashboard on organizational competitiveness, and believe that for more and more accurate marketing dashboards, the use of organizational mechanisms and infrastructures such as marketing memory and competitive intelligence is effective in its design and implementation. Also, the components of marketing dashboard, marketing memory and competitive intelligence have a positive and significant effect on organizational competitiveness. Research methodology The present research is applicable in terms of purpose. The statistical population of the research includes experienced managers in insurance marketing and sales, senior experts of insurance companies and university professors; and the statistical sample was considered to be 181 people using Cochran's formula. Sampling in this research is in the form of random clusters. The collection tool in this research includes a researcher-made questionnaire derived from the qualitative method. Research findings Data analysis was done by SPSS software. The findings showed that the coordination model of the marketing and sales department in the insurance industry is affected by various factors directly and indirectly, and managers' understanding of the complexity of the relationship between these two units is of great importance in the growth of insurance companies and creating a competitive advantage for them. In order to ensure the achievement of the goals, managers must pay attention to the causal conditions such as the implementation of the risk management dashboard, structural integration and coordination in the business, creating synergy in organizational decisions, recognizing the prerequisites for coordination between the two departments of marketing and sales in the form of background conditions or coordination challenges such as "partial prejudices, non-specialist human capital, conflict of interests, managers' taste, CEO's attitude, ethical considerations, unfavorable customer support when receiving damages and fulfilling the organization's obligations, as well as interfering conditions such as upstream documents, market conditions (market stakeholders), legal conditions, and competitive conditions. Conclusion The current research has been carried out with the aim of explaining and validating the coordination model of the marketing and sales department in the insurance industry in Iran. The results of this research are aligned with the results of Biemans et al, (2022), Malshe et al, (2021), Asadi (2019), Asadollahi & Haji Ali Akbari (2020), Peterson et al, (2021), Vaid et al, (2020), Arabshahi & Abbaszadehgaretekan (2023), Nazarpuri et al, (2022), Zalkani Andarvar (2021), and Yazdani Kachuei et al, (2022). Biemans et al, (2022) showed that there are different relationships between marketing and sales departments in different work areas, and coordinating the activities of these two departments can help the organization to achieve its goals. According to the research results, the following suggestions were made: It is suggested to the managers of insurance companies that when choosing coordination mechanisms and tools between the sales and marketing units, they should pay attention to the intervening conditions such as upstream documents, market conditions (market stakeholders), legal conditions, competitive conditions, the number and maturity level of human capital and received feedback from the customers, and the level of maturity of the customers so that they do not make mistakes in choosing the mechanisms for the establishment of sales and marketing coordination in their insurance centers, and make the most of these tools.

Abstract Although an abundant number of studies have investigated the predictability of the commonly used functional screening tests and despite their popularity and applicability, the relationships between these tests have rarely been studied and have not been well established. This study aimed to examine the potential association between the Functional Movement Screen (FMS), Y Balance Test (YBT), and Landing Error Scoring System (LESS). Six hundred twenty-seven Iranian collegiate athletes (347 males, age = 22.63 ± 4.07, weight = 75.98 ± 13.79, height = 181.99 ± 10.15, BMI = 22.84 ± 3.16; and 280 females, age = 22.22 ± 3.37, weight = 60.63 ± 9.58, height = 166.55 ± 6.49, BMI = 21.81 ± 2.84) participated in this study. Following a 5-min warm-up, each participant underwent a standardized screening battery including the FMS, YBT, and LESS, and the scores were recorded and live coded for the statistical analysis, except for the LESS. The LESS tests were video recorded and scored by one expert examiner using an open-source 2D video analysis software (Kinovea- version 0.9.5), afterwards. The Spearman correlation was utilized as a measure for the correlation, and the Mann‒Whitney U test with a significance level of 0.05 was used to check the differences between male and female athletes. The statistical analysis was performed with RStudio 2023.03.0 using R 4.3.1. A small correlation (0.364) was observed between the FMS composite score and the YBT in male athletes. All other pairwise correlations were negligible among male and female athletes, ranging from − 0.096 to 0.294. Reducing the FMS to the component scores targeting the lower extremities did not alter the correlation to the other screening scores. The median FMS composite score in female athletes was significantly higher than that in males (p

Abstract Background Cervical spondylotic myelopathy (CSM) is a prevalent degenerative condition resulting from spinal cord compression and injury. Laminectomy with posterior spinal fusion (LPSF) is a commonly employed treatment approach for CSM patients. This study aimed to assess the effectiveness of machine learning models (MLMs) in predicting clinical outcomes in CSM patients undergoing LPSF. Methods A retrospective analysis was conducted on 329 CSM patients who underwent LPSF at our institution from Jul 2017 to Jul 2023. Neurological outcomes were evaluated using the modified Japanese Orthopaedic Association (mJOA) scale preoperatively and at the final follow-up. Patients were categorized into two groups based on clinical outcomes: the favorable group (recovery rates ≥ 52.8%) and the unfavorable group (recovery rates

Abstract Background Spinal surgery is a common procedure associated with significant postoperative pain, and identifying effective interventions to manage this pain is crucial for optimizing patient outcomes. This review assesses the existing literature to determine the overall impact of vitamin C supplementation on spinal postoperative pain. Vitamin C, also known as ascorbic acid, is an essential nutrient that plays a vital role in numerous physiological processes. It functions as a potent antioxidant, neutralizing free radicals and reducing oxidative stress within the body. Furthermore, vitamin C is a cofactor in collagen synthesis, a crucial component of connective tissues, including those found in the spinal structures. Given its antioxidant and collagen-promoting properties, vitamin C has piqued interest as a potential therapeutic option for postoperative spinal pain. Based on the available evidence, vitamin C may have a beneficial effect on postoperative spinal pain, including reducing pain scores, analgesic consumption, and the incidence of complications such as complex regional pain syndrome. However, more research is needed to fully understand the optimal dosage and duration of vitamin C supplementation for postoperative pain management. Conclusion Vitamin C could be considered a potentially beneficial adjunctive therapy for managing spinal postoperative pain, but its routine use requires further investigation.

Non-steroidal anti-inflammatory drugs (NSAIDs) are one of the most commonly prescribed drugs that can reduce pain. This study aimed to measure the concentration of piroxicam and celecoxib in Iranian hospitals, as well as the effect of electron beam irradiation on the degradation of these pollutants in synthetic and real samples. The high-performance liquid chromatography (HPLC) was used to detect the residual analytes in the samples. The Response Surface Methodology (RSM) was used to design the experiment conditions that investigate the effect of electron beam irradiation on degradation of piroxicam and celecoxib from synthetic samples, and then according to the optimum condition, the experiments were carried out for real wastewater samples. The results of wastewater analysis shown that the mean concentration of PIRO and CELE were 6.32 ± 2.5 and 11.5 ± 3.2 μg/L, respectively. Also, the findings show that 98.98 % and 97.62 % of piroxicam and celecoxib was degraded, respectively, when the optimum conditions (pH = 4, electron beam irradiation = 8 kGy, and concentrations of 60 μg/L for piroxicam and 50 μg/L for celecoxib) were applied. Results show that the degradation rates of piroxicam and celecoxib in the real wastewater sample at optimum condition were 89.6 % and 84.25 %, respectively. So, electron beam irradiation is a long-lasting and promising method for removal emerging contaminants from wastewater, like non-steroidal anti-inflammatory drugs, that can't be removed by conventional wastewater treatment methods; so, it can be used in combination with conventional wastewater treatment methods.

Toxoplasma gondii (T. gondii), an obligate intracellular parasite, is considered as an opportunistic infection and causes toxoplasmosis in humans and animals. Congenital toxoplasmosis can influence pregnancy and cause mild to severe consequences for the fetal and neonatal. During early T. gondii infection, neutrophils as the most abundant white blood cells provide a front line of defense mechanism against infection. The activated dendritic cells are then responsible for initiating an inflammatory response via T-helper 1 (Th1) cells. As part of its robust immune response, the infected host cells produce interferon (IFN-γ). IFN-γ inhibits T. gondii replication and promotes its transformation from an active form to tissue cysts. Although anti- T. gondii antibodies play an important role in infection control, T-helper 2 (Th2) immune response, can facilitate the growth and proliferation of T. gondii in the host cell. In pregnant women infected with T. gondii, the expression of cytokines may vary and in response diverse outcomes are expected. Cytokine profiles serve as valuable indicators for estimating the patho-immunological effects of T. gondii infection. This demonstrates the intricate relationship between pro-inflammatory and anti-inflammatory cytokines, as well as their influence on the various pregnancy outcomes in T. gondii infection.

This study investigates bimetallic and multimetallic catalysts tailored for the reverse water gas shift (RWGS) reaction. Promoting with potassium and iron, while maintaining a constant copper content of 15 wt% on γ-alumina, revealed that bimetallic catalysts containing 7.5 wt% iron and 5 wt% potassium exhibit superior catalytic activity and stability. Among the multimetallic catalysts, the optimal composition was found to be in the 15 wt% Cu-5 wt% Fe-2.5 wt% K/γ-Al2O3 catalyst for the RWGS reaction. The prepared catalysts underwent assessments using various techniques such as N2 adsorption-desorption, XRD, H2-TPR, CO2-TPD, and FESEM. Stability assessments conducted over 72 hours showcased sustained long-term performance for the optimized catalysts, highlighting the influential role of the hierarchical structure. Mesopores extended the catalyst lifetime by reducing permeation limits, while macropores facilitated diffusion process, enhancing selectivity and stability. This hierarchical design also improved mass transfer, amplifying reaction rates. The synthesized catalysts exhibited exceptional specificity, demonstrating 100 % selectivity for the RWGS reaction. Particularly, under H2/CO2=1, these catalysts displayed remarkable carbon dioxide conversion rates, indicating potential for enhancing Cu-based catalysts in RWGS reactions by maximizing active sites.

Objective: Cancer or neoplasm is a cosmopolitan catastrophe that results in more than 20 million new cases and 10 million deaths every year. Some factors lead to carcinogenesis like infectious diseases. Parasites like Toxoplasma gondii, by its components, could modulate the cancer system by inducing apoptosis. The objective of this investigation is to assess the potential of peptides derived from T. gondii in combating cancer by examining their effects on Caco-2, Hep-G2, and HT29 cell lines. Materials and methods: Candidate peptide by its similarity to anticancer compounds was predicted through the computer-based analysis/platform. The impact of the peptide on cell viability, cell proliferation, and gene expression was evaluated through the utilization of MTT assay, flow cytometry, and real-time polymerase chain reaction (PCR) methodologies. Results: The cell viability rate exhibited a significant decrease (p < 0.001) across all cell lines when exposed to a concentration of ≤160 μg. Within the 48-hour timeframe, the half maximal inhibitory concentration (IC50) for HT29 and Hep-G2 cell lines was determined to be 107.2 and 140.6 μg/mL, respectively. Notably, a marked decrease in the expression levels of Bcl2 and APAF1 genes was observed in both the Hep-G2 and HT29 cell lines. Conclusion: These findings indicate that the T. gondii peptide affected cancer cell mortality and led to changes in the expression of genes associated with apoptosis.

In this study, the distribution of eight phthalate esters (PAEs), namely (dimethyl phthalate (DMP), diethyl phthalate (DEP), di-n-butyl phthalate (DBP), butyl benzyl phthalate (BBP), bis (2-ethylhexyl) phthalate (DEHP), and di-n-octyl phthalate (DnOP)) were examined across fifteen sampling stations in Yazd industrial Park. All the PAEs in dust deposited in the outdoor environment were analyzed using a Gas-mass chromatography (GC-MS/MS) device. Both probabilistic and deterministic approaches were utilized to assess the non-carcinogenic and carcinogenic health risks for adult occupational population groups. These risks were associated with three exposure pathways: inhalation, ingestion, and dermal exposure to six phthalates in the dust samples. The findings revealed, among the fifteen sampling stations, highest and lowest concentrations of the PAEs in dust deposited in the outdoor environment were observed in S8 and S6, with BEHP (326.21 ± 4.35) μg/g and DMP (0.00 ± 0.02) μg/g, respectively. The total hazard index (HI) values were below one in all samples, indicating that the combined non-carcinogenic health risk from exposure to phthalates via inhalation, ingestion, and dermal pathways is within acceptable levels in each studied area. The total cancer risk (CR) values for BBP across all exposure routes were consistently low, with magnitudes ranging from 10- x 10−15to 10 x 10−11. The order of cancer risk from phthalate exposure in outdoor environments was ingestion > dermal > inhalation. The sensitivity analysis (SA) results indicated that the influential parameters in the carcinogenic risk in adult occupational population groups were concentration for inhalation and dermal pathways, as well as ingestion rate for the ingestion pathway. The result of this study provides new insight in to PAEs pollution and risk assessments related to the dust deposited in the outdoor environment of industrial Park. Furthermore, this finding is beneficial to the controlling the exposure and promoting steps to reduce PAEs contamination and manage health in the industrial area.

Glioblastoma (GBM), a grade IV brain tumor, presents a severe challenge in treatment and eradication due to its high genetic variability and the existence of stem-like cells with self-renewal potential. Conventional therapies fall short of preventing recurrence and fail to extend the median survival of patients significantly. However, the emergence of gene therapy, which has recently obtained significant clinical outcomes, brings hope. It has the potential to be a suitable strategy for the treatment of GBM. Notably, microRNAs (miRNAs) have been noticed as critical players in the development and progress of GBM. The combined usage of hsa-miR-34a and Cytosine Deaminase (CD) suicide gene and 5-fluorocytosine (5FC) prodrug caused cytotoxicity against U87MG Glioma cells in vitro. The apoptosis and cell cycle arrest rates were measured by flow cytometry. The lentiviral vector generated overexpression of CD/miR-34a in the presence of 5FC significantly promoted apoptosis and caused cell cycle arrest in U87MG cells. The expression level of the BCL2, SOX2, and P53 genes, target genes of hsa-miR-34a, was examined by quantitative real-time PCR. The treatment led to a substantial downregulation of Bcl2 and SOX2 genes while elevating the expression levels of Caspase7 and P53 genes compared to the scrambled control. The hsa-miR-34a hindered the proliferation of GBM cancer cells and elevated apoptosis through the P53–miR-34a–Bcl2 axis. The CD suicide gene with 5FC treatment demonstrated similar results to miR-34a in the apoptosis, cell cycle, and real-time assays. The combination of CD and miR-34a produced a synergistic effect. In vivo, anti-GBM efficacy evaluation in rats bearing intracranial C6 Glioma cells revealed a remarkable induction of apoptosis and a significant inhibition of tumor growth compared with the scrambled control. The simultaneous use of CD/miR-34a with 5FC almost entirely suppressed tumor growth in rat models. The combined application of hsa-miR-34a and CD suicide gene against GBM tumors led to significant induction of apoptosis in U87MG cells and a considerable reduction in tumor growth in vivo.

The main aim of this paper is to introduce a new high step-up/down buck-boost converter with a minimum number of switches which provides the benefit of having the continuity of the input/output current. This single-switch semi-quadratic converter is suitable for high step-up applications while being able to provide step-down voltage gains. Also, by applying some minor changes to the circuit elements, another single-switch buck-boost converter is suggested which has two operative outputs with different voltage gains. One of the outputs of this topology has quadratic buck-boost converter voltage gain which is appropriate for high step-up/step-down applications. The other output could vary from input voltage to minus infinity, ideally. After studying the steady-state operation of the proposed converters in Continuous Conduction Mode (C.C.M), the simulation results are presented. In addition, a comparison among related converters proposed in the literature is made. Finally, experimental results are evaluated by implementing a laboratory prototype of the proposed converter in both step-down and step-up modes. Theoretical, simulation, and experimental results are compatible with each other.

The present study assesses the impact of age hardening parameters, including aging temperature, aging time, and solution time, on the ultimate hardness of heat-treated 2024 aluminum alloys. Using a numerical approach, fuzzy logic systems were utilized as a robust tool to forecast the mechanical characteristics of high copper aluminum solid solutions throughout the age hardening process. In addition, an attempt was made to use a novel simulated annealing technique to determine the optimum hardness and its corresponding process parameters to achieve the highest mechanical properties. Comparing a fuzzy logic model with experimental results obtained from the Brinell hardness test showed the accuracy and confidence of the fuzzy model in representing such properties. The optimization results indicated that the maximum hardness can be obtained with a solution aging temperature of 173.5 °C, an aging time of 19 hours, and a solution time of 58 minutes. Overall, the variation in the experimental peak hardness obtained using the optimized process parameters was the deciding factor in believing the model.

Salinity poses a significant threat to the floral plants. Melatonin has emerged as a potential phytohormone to cope with the adverse effects of salinity on plants due to its multifaceted roles in regulating abiotic stresses. The current study aimed to investigate the impact of melatonin on pansy by modifications in physiological indices under salinity stress. Pansy plants were subjected to salinity stress (0, 50, and 100 mM NaCl) and melatonin (control, 50, and 100 µM). Salinity-induced oxidative stress was apparent through enhanced generation of toxic substances. However, melatonin supplementation improved chlorophyll ‘a’, chlorophyll ‘b’, total chlorophyll, glycine betaine (GB), superoxidase dismutase (SOD), peroxidase (POD), catalases (CAT), and glutathione-reductase (GR), thus promoting improved growth under salinity. The activation of plant defense system and regulation of signaling molecules is indication of lessening of toxic substances within the plant cells. Current findings revealed that supplementation of melatonin enhanced pansy tolerance against salinity stress.

Men of all ages frequently experience erectile dysfunction (ED) or impotence, and it is a difficult health issue that adversely affects the quality of life of those who experience it. There are multiple types of treatment strategies for ED available, depending on the origin and severity of ED, as well as any underlying medical issues. However, these therapeutics are known to have a number of negative health effects. In contrast, plant-based treatments are more effective for managing diseases due to their ability to modulate biological processes like inflammation, oxidative stress, and cell signaling molecules. Many medicinal plants have been reported to be quite helpful in the improvement of ED. In this review, ED and its causes, diagnostic methods, treatment strategies, and some of the most potent plant-based interventions against ED are discussed in greater detail, along with a description of their mechanisms of action and a brief discussion of approaches to increase their efficacy, with a focus on the management of ED using herbal interventions as complementary and alternative medicines. While there is hope that medicinal plants could provide lead substances for erectile dysfunction medications, additional investigation is necessary to ascertain the efficacy and security of these prospective treatments.

Background: Years of life lost (YLL) is commonly used to determine the social and economic burden of loss due to premature mortality. The present study estimated YLL based on general mortality groups in Golestan Province, Iran, in 2018. Methods: In this cross-sectional study, by referring to the province death registration system information and using standard expected years of life lost (SEYLL) of the World Health Organization (WHO), YLL was calculated due to premature mortality based on general mortality groups in ICD-10 (international classification of diseases 10th revision). Results: The total number of deaths in Golestan Province was 8543 in 2018. The overall YLL due to premature mortality was 129838 years, of which 57.4% occurred among men. The major causes of YLL due to premature mortality (YLL%) were diseases of the circulatory system (I00-I99) (32.3%), external causes (V01-Y89) (17.3%), certain conditions originating in the perinatal period (P00-P96) (14.5%), and cancers (C00-D48) (13.9%). After diseases of the circulatory system, the most common cause of YLL due to premature mortality is external causes (22.9%) among men and cancers (16.2%) among women. In general, the highest YLL rate occurred due to circulatory system diseases (22.5 per 1000 people). Conclusion: According to the results of our study, most years of life lost in both sexes are related to diseases of the circulatory system, followed by external causes of morbidity and mortality. Therefore, it is important to pay attention to the diseases of the circulatory system and its causes, as well as external causes of morbidity and mortality.

Abstract Background Hematoma expansion is a critical factor associated with increased mortality and adverse outcomes in patients with intracerebral hemorrhage (ICH). Identifying and preventing hematoma expansion early on is crucial for effective therapeutic intervention. This study aimed to investigate the potential association between the Red cell distribution width to lymphocyte ratio (RDWLR) and hematoma expansion in ICH patients. Methods We conducted a retrospective analysis of clinical data from 303 ICH patients treated at our department between May 2018 and May 2023. Demographic, clinical, radiological, and laboratory data, including RDWLR upon admission, were assessed. Binary logistic regression analysis was employed to determine independent associations between various variables and hematoma expansion. Results The study included 303 ICH patients, comprising 167 (55.1%) males and 136 (44.9%) females, with a mean age of 65.25 ± 7.32 years at admission. Hematoma expansion occurred in 73 (24.1%) cases. Multivariate analysis revealed correlations between hematoma volume at baseline (OR, 2.73; 95% CI: 1.45 -4,78; P

Abstract Background Kawasaki disease is an acute febrile vasculitis of childhood mainly affecting children under 4 years of age. In the acute stage of the disease, heart function decreases and gradually returns to normal after treatment. However, subendocardial involvement may persist, which cannot be assessed by M-mode echocardiography. Strain echocardiography is a recently developed technique to assess subendocardial involvement of myocardial deformation. We aimed to study the stratified strain of left ventricular function in a Kawasaki patient at least 6 months after the acute stage of the disease with special conditions for entering the study using two-dimensional speckle-tracking imaging. Between September 2020 and October 2022, 27 healthy children and 27 children with a history of Kawasaki disease more than 6 months ago were evaluated using two-dimensional global longitudinal peak systolic strain with automated function imaging technology. Results The mean age of patients was 5.6 years. With M-mode echocardiography, ejection fraction of each group was in the normal range. Mean (± standard deviation) global longitudinal peak strain in four-chamber view of girls with Kawasaki disease was − 23.74 ± 2.77, and that in boys with Kawasaki disease was − 20.93 ± 2.06 (P value = 0.008). GLPS (global longitudinal peak strain) was compared as an overall average and as in a separate segment, which showed significant difference in two comparisons. In our study, a decrease in the function of some cardiac segments is reported. Global longitudinal peak strain in four-chamber view was significantly lower in boys. Comparing different segments, a difference in global left ventricular long-axis strain was found between the two groups. On the other hand, there was a major difference between the two groups in the basal inferolateral, basal anterolateral, and mid-inferolateral, which receives blood from Left Circumflex artery. Conclusion Using stain echocardiography to detect continued subendocardial involvement in asymptomatic children with a history of Kawasaki disease for a better understanding of the condition, effective management and follow-up is recommended.

Zubia Jamil,1 Samreen Khalid,1 Hafiz Muhammad Manan Haider Khan,2 Ikram Waheed,1,3 Amna Ehsan,1,3 Mohammed Alissa,4 Khalid Muhammad,5 Nayla Munawar,6 Yasir Waheed7,8 1Department of Medicine, Foundation University School of Health Sciences, Foundation University, Islamabad, 44000, Pakistan; 2Department of Rehabilitation Sciences, Shifa Tameer-E-Millat University, Islamabad, 44000, Pakistan; 3Department of Medicine, Fauji Foundation Hospital, Rawalpindi, 43600, Pakistan; 4Department of Medical Laboratory, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al-Kharj 11942, Saudi Arabia; 5Department of Biology, College of Science, UAE University, Al Ain, 15551, United Arab Emirates; 6Department of Chemistry, College of Science, UAE University, Al Ain, 15551, United Arab Emirates; 7Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, 1401, Lebanon; 8MEU Research Unit, Middle East University, Amman, 11831, JordanCorrespondence: Yasir Waheed, Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Byblos, 1401, Lebanon, Email yasir_waheed_199@hotmail.com Nayla Munawar, Department of Chemistry, College of Science, UAE University, Al Ain, 15551, United Arab Emirates, Email nmunawar@uaeu.ac.aeIntroduction: The occurrence of dengue fever presents a considerable burden for public health care in developing countries. This study aims to validate APRI as predictor score for severity of dengue fever so that catastrophic events could be prevented, and early triage can save lives.Methods: The retrospective cross-sectional study was done on dengue positive patients from August to November 2023. APRI score was calculated for every patient at the time of admission. The primary end-point was non-complicated disease (Simple dengue fever) vs complicated disease (dengue hemorrhagic fever and dengue shock syndrome). ROC curve was used to identify the role of APRI in prediction of dengue complication. Youden index was used to find the cut-off value of APRI along with sensitivity, specificity, positive and negative likelihood ratios. To further evaluate the role of APRI score, patients were divided into two groups, patients with APRI score greater and lesser than cut-off value. The qualitative variables among two groups were compared by chi-square testing. The predictors of complicated dengue were first determined by univariate regression analysis and then confirmed by multivariate regression analysis.Results: The mean APRI score of 135 patients was 20.06 ± 6.31. AUC for APRI score was 0.93 (p < 0.0001) indicating that APRI score calculated at the time of admission is an excellent marker in determining the complicated dengue. The cut-off value for APRI score was 9.04 (sensitivity 84.91%, specificity 89.02%, p < 0.0001). The patients with APRI < 9.04 mostly developed simple dengue fever (54.1%) vs DHF (4.4%) and DSS (1.5%), while patients with APRI > 9.04 had more DHF (20.7%) and DSS (12.6%) vs simple dengue fever (6.7%). None of the patient died with APRI < 9.04 while the mortality rate was 3.7% in patients with APRI > 9.04.Conclusion: The APRI score, calculated at the time of admission, is an excellent marker in determining the severe dengue.Keywords: dengue, severe dengue, dengue hemorrhagic fever, aspartate aminotransferase, ROC curve, area under curve

Abstract Background Type 2 diabetes mellitus (T2DM) is a significant risk factor for non-alcoholic fatty liver disease (NAFLD). Increased fasting blood sugar (FBS), fasting insulin (FI), and insulin resistance (HOMA-IR) are observed in patients with NAFLD. Gut microbial modulation using prebiotics, probiotics, and synbiotics has shown promise in NAFLD treatment. This meta-umbrella study aimed to investigate the effects of gut microbial modulation on glycemic indices in patients with NAFLD and discuss potential mechanisms of action. Methods A systematic search was conducted in PubMed, Web of Science, Scopus, and Cochrane Library until March 2023 for meta-analyses evaluating the effects of probiotics, prebiotics, and synbiotics on patients with NAFLD. Random-effect models, sensitivity analysis, and subgroup analysis were employed. Results Gut microbial therapy significantly decreased HOMA-IR (ES: −0.41; 95%CI: −0.52, −0.31; P

Aim and Background: Psycho-physical disorder is one of the most common medical complaints and a type of debilitating disease that affects different aspects of the patients' personality; therefore, the present study was conducted with the aim of determining the effectiveness of short-term and intensive emotional-oriented therapy on personality organization in women with somatic psychosis. Methods and Materials: This study was semi-experimental with a pre-test, post-test, and two-month follow-up plan with a control group. The target population was all patients with somatic psychosis who referred to the specialized neuropsychiatric clinic in Tehran in 1401. The sample size was determined by referring to Cohen's table. In this way, at the confidence level of 95%, the effect size was 0.30 and the statistical power was 0.83 for each group of 12 people. However, since there was a possibility of some samples dropping out and in order to generalize the results more, the sample size was determined to be 15 people in each group. In the first step, 30 people were selected by available sampling method, and in the second step, these 30 people were replaced in two experimental groups (15 people) and a control group (15 people) in a simple random way (by lottery). The data were obtained using Kernberg Stipo questionnaire (2003) and Nef self-compassion questionnaire (2003) and 15 treatment sessions were performed according to Dovanlo's treatment protocol. Findings: The results of the study indicated the impact of intensive and short-term dynamic psychotherapy on the dimensions of self-compassion and personality organization in patients with somatic psychosis (P

Abstract The design and optimization of an electromagnetic wave absorber for far-field wireless power transmission (WPT) is the subject of this research study. The goal of the research is to effectively absorb energy from ambient RF electromagnetic waves without the usage of a ground plane by employing metasurfaces with chiral components.By integrating trioidal moments into the design theory, the objective is to create a metasurface that functions in two frequency bands and produces high-quality resonance. The study also explores the dual non-homogeneity property of structures, polarization tensor coefficients, and the electromagnetic response of non-homogeneous metasurfaces. Based on the relative orientation of induced fields and moments, it delves deeper into the two basic possibilities for dual non-homogeneous elements. The development of chiral metasurfaces and the notion of electromagnetic chirality and its implications for polarization properties are introduced.

Abstract Root canal therapy (RCT) is a widely performed procedure in dentistry, with over 25 million individuals undergoing it annually. This procedure is carried out to address inflammation or infection within the root canal system of affected teeth. However, accurately aligning CT scan information with the patient's tooth has posed challenges, leading to errors in tool positioning and potential negative outcomes. To overcome these challenges, a mixed reality application is developed using an optical see‐through head‐mounted display (OST‐HMD). The application incorporates visual cues, an augmented mirror, and dynamically updated multi‐view CT slices to address depth perception issues and achieve accurate tooth localization, comprehensive canal exploration, and prevention of perforation during RCT. Through the preliminary experimental assessment, significant improvements in the accuracy of the procedure are observed. Specifically, with the system the accuracy in position was improved from 1.4 to 0.4 mm (more than a 70% gain) using an Optical Tracker (NDI) and from 2.8 to 2.4 mm using an HMD, thereby achieving submillimeter accuracy with NDI. 6 participants were enrolled in the user study. The result of the study suggests that the average displacement on the crown plane of 1.27 ± 0.83 cm, an average depth error of 0.90 ± 0.72 cm and an average angular deviation of 1.83 ± 0.83°. Our error analysis further highlights the impact of HMD spatial localization and head motion on the registration and calibration process. Through seamless integration of CT image information with the patient's tooth, our mixed reality application assists dentists in achieving precise tool placement. This advancement in technology has the potential to elevate the quality of root canal procedures, ensuring better accuracy and enhancing overall treatment outcomes.

Abstract Surgical robotics has revolutionized the field of surgery, facilitating complex procedures in operating rooms. However, the current teleoperation systems often rely on bulky consoles, which limit the mobility of surgeons. This restriction reduces surgeons' awareness of the patient during procedures and narrows the range of implementation scenarios. To address these challenges, an alternative solution is proposed: a mixed reality‐based teleoperation system. This system leverages hand gestures, head motion tracking, and speech commands to enable the teleoperation of surgical robots. The implementation focuses on the da Vinci research kit (dVRK) and utilizes the capabilities of Microsoft HoloLens 2. The system's effectiveness is evaluated through camera navigation tasks and peg transfer tasks. The results indicate that, in comparison to manipulator‐based teleoperation, the system demonstrates comparable viability in endoscope teleoperation. However, it falls short in instrument teleoperation, highlighting the need for further improvements in hand gesture recognition and video display quality.

Abstract Background Contrast-induced nephropathy (CIN) is a form of acute kidney injury (AKI) occurring in patients undergoing cardiac catheterization, such as coronary angiography (CAG) or percutaneous coronary intervention (PCI). Although the conventional criterion for CIN detection involves a rise in creatinine levels within 72 h after contrast media injection, several limitations exist in this definition. Up to now, various meta-analyses have been undertaken to assess the accuracy of different biomarkers of CIN prediction. However, the existing body of research lacks a cohesive overview. To address this gap, a comprehensive umbrella review was necessary to consolidate and summarize the outcomes of prior meta-analyses. This umbrella study aimed to offer a current, evidence-based understanding of the prognostic value of biomarkers in predicting CIN. Methods A systematic search of international databases, including PubMed, Scopus, and Web of Science, from inception to December 12, 2023, was conducted to identify meta-analyses assessing biomarkers for CIN prediction. Our own meta-analysis was performed by extracting data from the included studies. Sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio were assessed using Meta-Disc and CMA softwares. Results Twelve studies were ultimately included in the umbrella review. The results revealed that neutrophil gelatinase-associated lipocalin (NGAL) exhibited the highest area under the curve (AUC), followed by cystatin-C, urinary kidney injury molecule-1 (uKIM-1), and brain natriuretic peptide (BNP) with AUCs of 0.91, 0.89, 0.85, and 0.80, respectively. NGAL also demonstrated the highest positive likelihood ratio [effect size (ES): 6.02, 95% CI 3.86–9.40], followed by cystatin-C, uKIM-1, and BNP [ES: 4.35 (95% CI 2.85–6.65), 3.58 (95% CI 2.75–4.66), and 2.85 (95% CI 2.13–3.82), respectively]. uKIM-1 and cystatin-C had the lowest negative likelihood ratio, followed by NGAL and BNP [ES: 0.25 (95% CI 0.17–0.37), ES: 0.25 (95% CI 0.13–0.50), ES: 0.26 (95% CI 0.17–0.41), and ES: 0.39 (0.28–0.53) respectively]. NGAL emerged as the biomarker with the highest diagnostic odds ratio for CIN, followed by cystatin-C, uKIM-1, BNP, gamma-glutamyl transferase, hypoalbuminemia, contrast media volume to creatinine clearance ratio, preprocedural hyperglycemia, red cell distribution width (RDW), hyperuricemia, neutrophil-to-lymphocyte ratio, C-reactive protein (CRP), high-sensitivity CRP, and low hematocrit (P

Abstract Background Although short-segment posterior spinal fixation (SSPSF) has shown promising clinical outcomes in thoracolumbar burst fractures, the treatment may be prone to a relatively high failure rate. This study aimed to assess the effectiveness of machine learning models (MLMs) in predicting factors associated with treatment failure in thoracolumbar burst fractures treated with SSPSF. Methods A retrospective review of 332 consecutive patients with traumatic thoracolumbar burst fractures who underwent SSPSF at our institution between May 2016 and May 2023 was conducted. Patients were categorized into two groups based on treatment outcome (failure or non-failure). Potential risk factors for treatment failure were compared between the groups. Four MLMs, including random forest (RF), logistic regression (LR), support vector machine (SVM), and k-nearest neighborhood (k-NN), were employed to predict treatment failure. Additionally, LR and RF models were used to assess factors associated with treatment failure. Results Of the 332 included patients, 61.4% were male (n = 204), and treatment failure was observed in 44 patients (13.3%). Logistic regression analysis identified Load Sharing Classification (LSC) score, lack of index level instrumentation, and interpedicular distance (IPD) as factors associated with treatment failure (P

Abstract This paper proposed a new two‐phase high step‐down DC–DC converter is proposed. This converter is derived from the two‐phase series‐capacitor converter. The proposed converter replaces the series capacitor with a new structure that integrates Valley‐Fill circuit and coupled‐inductors concepts. This replacement can improve the voltage gain of the converter as well as a considerable reduction of diodes voltage stress. The proposed structure implements a dual‐phase buck using a single magnetic element. Also, the proposed structure inherently limits the voltage spikes due to the leakage inductance of coupled inductors without any additional clamp circuit. The proposed converter is analyzed, and design guidelines are provided. A 300–24 V prototype converter is implemented to justify the validity of circuit operation and the theoretical analysis.

The creation of a free trade zone plays an important role in the circulation of exports, economic growth and employment, but financial, managerial and economic reasons have caused that there has been no serious movement to achieve the goals and some of the desired goals have not been realized. This research has been done with the aim of designing a policy package of marketing knowledge in free trade zones based on the tacit knowledge of experts using metacombination method. This research is qualitative and inductive in nature with a survey strategy that uses the interview technique. In the meta-composition method, the books, documents and research articles of the investigated community, which entered the meta-composition process after several stages of screening, 21 components were identified as the most important codes that played an essential role in the creation of marketing policies of free trade zones. A policy package that includes the main (mother) policies and supporting policies in three categories of barriers, enablers and facilitators has been presented. The marketing programs of the free trade zones are made through increasing the integrations according to the parent policies and supporting policies