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Maryam Balali,1,2 Behnam Kamalidehghan,3 Mohammad Farhadi,2 Fatemeh Ahmadipour,4 Mahmoud Dehghani Ashkezari,1 Mohsen Rezaei Hemami,2 Hossein Arabzadeh,2 Masoumeh Falah,2 Goh Yong Meng,5 Massoud Houshmand3 1Department of Biology, Islamic Azad University, Ashkezar Branch, Ashkezar, 2Department and Research Centre of ENT and Head & Neck Surgery, Iran University of Medical Sciences, Tehran, Iran; 3Medical Genetics Department, National Institute of Genetic Engineering and Biotechnology, Tehran, Iran; 4Department of Pharmacy, Faculty of Medicine, University of Malaya, Kuala Lumpur, 5Department of Veterinary Preclinical Sciences, Faculty of Veterinary Medicine, Universiti Putra Malaysia, Serdang, Malaysia Abstract: Mitochondrial DNA mutations play an important role in causing sensorineural hearing loss. The purpose of this study was to determine the association of the mitochondrial genes RNR1, MT-TL1, and ND1 as well as the nuclear genes GJB2 and GJB6 with audiological examinations in nonfamilial Iranians with cochlear implants, using polymerase chain reaction, DNA sequencing, and RNA secondary structure analysis. We found that there were no novel mutations in the mitochondrial gene 12S rRNA (MT-RNR1) in patients with and without GJB2 mutation (GJB2+ and GJB2-, respectively), but a total of six polymorphisms were found. No mutations were observed in tRNALeu(UUR) (MT-TL1). Furthermore, eight polymorphisms were found in the mitochondrial ND1 gene. Additionally, no mutations were observed in the nuclear GJB6 gene in patients in the GJB2- and GJB2+ groups. The speech intelligibility rating and category of auditory perception tests were statistically assessed in patients in the GJB2- and GJB2+ groups. The results indicated that there was a significant difference (P

Background and Aims: Vitiligo is known to affect the quality of social and personal life in some countries. This study aims to assess the quality of life (QOL) in vitiligo sufferers among the Iranian population and to evaluate its relation with different variables.Methods: One hundred vitiligo patients answered a questionnaire based on the Dermatology Life Quality Index (DLQI).Results: The mean DLQI score was 8.16. There were statistically significant relationships between DLQI scores and marital status, skin phototype, and disease extension independently.Conclusions: This study shows that vitiligo has a major impact on the QOL of patients in Iran. Hence dermatologists should pay attention to the psychological effects of this cosmetic disease and try to decrease its extension and disfiguring effects by various treatments. [ABSTRACT FROM AUTHOR]

The development and expansion of road networks pose considerable threats to natural habitats and wildlife, fostering a landscape of fear. In addition to direct mortality caused by road collisions, road construction and maintenance often result in habitat fragmentation and loss, impeding animal movement and gene flow between populations. Mountain ungulates are already confined to fragmented habitat patches and roads can cause substantial disturbances to their critical ecological processes, such as dispersal and migration. In this study, we employed two key mountain ungulates, the wild goat (Capra aegagrus) and mouflon (Ovis gmelini), as functional models to examine how road networks impact the quantity and connectivity of natural habitats in southwestern Iran, where extensive road construction has led to significant landscape changes. We used the MaxEnt method to predict species distribution, the circuit theory to evaluate habitat connectivity, and the Spatial Road Disturbance Index (SPROADI) to assess road impacts. During the modeling process, we selected eleven important variables and employed a model parametrization strategy to identify the optimal configuration for the MaxEnt model. For SPROADI index we used three sub-indices, including traffic intensity, vicinity impact, and fragmentation grade. We then integrated the results of these analyses to identify areas with the most significant environmental impacts of roads on the coherency of the natural habitats. The findings indicate that suitable habitats for wild goats are widely distributed across the study area, while suitable habitats for mouflon are primarily concentrated in the northeastern region. Conservation gap analysis revealed that only 8% of wild goat habitats and 7% of mouflon habitats are covered by protected areas (PAs). The SPROADI map highlighted that 23% of the study area is negatively influenced by road networks. Moreover, 30.4% of highest-probability corridors for mouflon, and 25.7% for wild goat, were highly vulnerable to the impacts of roads. Our combined approach enabled us to quantitatively assess species-specific vulnerability to the impacts of heavy road networks. This study emphasizes the urgent need to address the negative effects of road networks on wildlife habitats and connectivity corridors. Our approach effectively identifies sensitive areas, which can help inform mitigation strategies and support more effective conservation planning in significantly transformed landscapes., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier Ltd. All rights reserved.)

Anticipating and mitigating the impacts of climate change on biodiversity requires a comprehensive understanding on key habitats utilized by species. Yet, such information for high mobile marine megafauna species remains limited. Here, we compile a global database comprising published satellite tracking data (n = 1035 individuals) to spatially delineate foraging grounds for seven sea turtle species and assess their thermal stability. We identified 133 foraging areas distributed around the globe, of which only 2% of the total surface is enclosed within an existing protected area. One-third of the total coverage of foraging hotspots is situated in high seas, where conservation focus is often neglected. Our analyses revealed that more than two-thirds of these vital marine habitats will experience new sea surface temperature (SST) conditions by 2100, exposing sea turtles to potential thermal risks. Our findings underline the importance of global ocean conservation efforts, which can meet climate challenges even in remote environments., (© 2024. The Author(s).)

The intensity of human-carnivore conflict in socio-ecological systems may primarily be determined by people's attitudes and perceptions of carnivore-related threats. Direct or indirect threats posed by large carnivores to human interests may eventually lead to negative attitudes that can trigger retaliatory bahaviour against them. We studied local people's attitudes towards striped hyena (Hyaena hyaena), the nature and extent of the human-hyena conflict, and the socio-cultural drivers of the conflicts in 19 rural communities in southwestern Iran. We employed structural equation modelling to assess socio-cultural factors affecting attitudes towards striped hyenas. The findings of 300 interviews showed significant differences in local people's superstitious attitudes regarding gender, age, and education. More than 40% of the participants had encountered hyenas, and on average, each respondent lost 0.44 livestock in the past five years due to hyena attacks. However, livestock depredation by the hyena was low (13.3%) compared to the damage inflicted by all carnivores (73%). While the respondents indicated some degrees of fear, hatred to hyena was relatively low and they generally showed positive attitudes towards the species. Women and older people expressed the highest and respondents with higher education the least superstitious beliefs. Attitude score of respondents toward hyenas was correlated negatively with hatred for hyenas and positively with knowledge about them, but socio-demographics effects on attitudes towards hyenas were not statistically significant. Self-reported livestock loss was a relatively good predictor of hatred and fear. Herders who had not protected their livestock reported carnivore attacks at least once. We conclude that superstitions can potentially negatively affect hyena persistence, but can be reduced by improving the educational level of local people., Competing Interests: The authors have declared that no competing interests exist., (Copyright: This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.)

Purpose: We aimed to assess the cost-effectiveness of the vitamin D supplementation program in Iranian adolescents reducing adolescent depressive Symptoms., Methods: In the current cost-effectiveness analysis, the viewpoint of Iran's Ministry of Health was selected. The target population was 1,519,762 Iranian high school students (733,657 girls and 786,105 boys). The total costs of the vitamin D supplementations program were based on the reports of the Nutrition Improvement Office of Iran's Ministry of Health and were adjusted to 2018. The variable of Quality-Adjusted Life Years (QALYs) was considered a suitable variable for estimating the effectiveness of vitamin D supplementation. We chose one year as the time horizon. A decision tree model was constructed in TreeAge Pro. The results of the cost-effectiveness analysis were reported in term of the Incremental Cost-Effectiveness Ratio (ICER)., Results: The results of our study showed that the estimated cost per QALY gained of the vitamin D supplementation program is equal to 1528.6676 $, which indicates that vitamin D supplementation in adolescents(11-18Y) is a cost-effective and a dominant strategy in preventing depression through the cost-saving and QALYs increment compared to the no intervention. Sensitivity analysis showed that the possible variations in vitamin D supplement costs could not alter the results, and vitamin D supplementation may be a predominant and cost-effective strategy to prevent adulthood depression with a 100% probability., Conclusion: The national program of vitamin D supplementation among Iranian adolescents was a cost-efficient strategy reducing adolescent depressive Symptoms through the cost-saving and QALYs increment compared to the no intervention., (© 2023. The Author(s).)

Objectives: Identification the optimal management intervention of sarcopenia is a concern of health systems. We aimed to analyze the cost-effectiveness of sarcopenia management strategies in Iran., Methods: We constructed a lifetime Markov model based on natural history. The strategies comparedincluded exercise training, nutritional supplements, whole body vibration (WBV), and various exercise interventions and nutritional supplement combinations. A total of 7 strategies was evaluated in addition to the non-intervention strategy. Parameter values were extracted from primary data and the literature, and the costs and Quality-adjusted life years (QALYs) were calculated for each strategy. Deterministic and probabilistic sensitivity analysis, including the expected value of perfect information (EVPI), was also performed to determine the robustness of the model. Analyses were performed using the 2020 version of TreeAge Pro software., Results: All seven strategies increased lifetime effectiveness (QALYs). The protein and Vitamin D 3 (P + D) strategy had the highest effectiveness values among all strategies. After removing the dominated strategies, the estimated ICER for the P + D compared to Vitamin D 3 alone (D) strategy was calculated as $131,229. Considering the cost-effectiveness threshold ($25,249), base-case results indicated that the D strategy was the most cost-effective strategy in this evaluation. Sensitivity analysis of model parameters also demonstrated the robustness of results. Also, EVPI was estimated at $273., Conclusions: Study results, as the first economic evaluation of sarcopenia management interventions, showed that despite the higher effectiveness of D + P, the D strategy was the most cost-effective. Completing clinical evidence of various intervention options can lead to more accurate results in the future., (© 2023. The Author(s).)

Background: Surgical site infections (SSIs) account for up to 18% of all healthcare-associated infections (HAIs). The Caresyntax data-driven surgery platform incorporates the most common risk factors for SSI, to identify high-risk surgical patients before they leave the operating theatre and treat them prophylactically with negative pressure wound therapy (NPWT). An economic analysis was performed to assess the costs and health outcomes associated with introduction of the technology in the English healthcare setting., Methods: A hybrid decision tree/Markov model was developed to reflect the treatment pathways that patients undergoing colorectal surgery would typically follow, both over the short term (30-day hospital setting) and long term (lifetime). The analysis considered implementation of Caresyntax's platform-based SSI predictive algorithm in the hospital setting, compared with standard of care, from an English National Health Service (NHS) perspective. The base-case analysis presents results in terms of cost per quality-adjusted life-year (QALY) gained, as well as operational impact., Results: The base-case analysis indicates that the intervention leads to a cost saving of £55.52m across the total NHS colorectal surgery patient population in 1 year. In addition, the intervention has a 98.36% probability of being cost effective over a lifetime horizon. The intervention results in the avoidance of 19,744 SSI events, as well 191,911 excess hospital bed days saved., Conclusion: Caresyntax's platform-based SSI predictive algorithm has the potential to result in cost savings and improved patient quality of life. Additionally, operational gains for the healthcare provider, including reduced infection rates and hospital bed days saved, have been shown through the economic modeling., (© 2023. The Author(s).)

Species distribution models (SDMs) are practical tools to assess the habitat suitability of species with numerous applications in environmental management and conservation planning. The manipulation of the input data to deal with their spatial bias is one of the advantageous methods to enhance the performance of SDMs. However, the development of a model parameterization approach covering different SDMs to achieve well-performing models has rarely been implemented. We integrated input data manipulation and model tuning for four commonly-used SDMs: generalized linear model (GLM), gradient boosted model (GBM), random forest (RF), and maximum entropy (MaxEnt), and compared their predictive performance to model geographically imbalanced-biased data of a rare species complex of mountain vipers. Models were tuned up based on a range of model-specific parameters considering two background selection methods: random and background weighting schemes. The performance of the fine-tuned models was assessed based on recently identified localities of the species. The results indicated that although the fine-tuned version of all models shows great performance in predicting training data (AUC > 0.9 and TSS > 0.5), they produce different results in classifying out-of-bag data. The GBM and RF with higher sensitivity of training data showed more different performances. The GLM, despite having high predictive performance for test data, showed lower specificity. It was only the MaxEnt model that showed high predictive performance and comparable results for identifying test data in both random and background weighting procedures. Our results highlight that while GBM and RF are prone to overfitting training data and GLM over-predict nonsampled areas MaxEnt is capable of producing results that are both predictable (extrapolative) and complex (interpolative). We discuss the assumptions of each model and conclude that MaxEnt could be considered as a practical method to cope with imbalanced-biased data in species distribution modeling approaches., Competing Interests: The authors declare no conflict of interest., (© 2023 The Authors. Ecology and Evolution published by John Wiley & Sons Ltd.)

Identifying the association between the patterns of niche occupation and phylogenetic relationships among sister clades and assisting conservation planning implications are of the most important applications of species distribution models (SDMs). However, most studies have been carried out regardless of within taxon genetic differentiation and the potential of local adaptation occurring within the species level. The Pallas's cat ( Otocolobus manul ) is a less-studied species with unknown biogeography and phylogenetic structure across a widespread yet isolated range from the Caucasus to eastern China. In the current study, by considering a previously proposed genetic structure and based on a cluster analysis on climatic variables, we supposed three clades for this species, including O. m. manul , O. m. ferrugineus , and O. m. nigripectus . We developed SDM for each clade separately and compared it with a general distribution model of the species to determine whether the hypothesized taxonomic resolution affects the predicted ecological niche of the within-species structures. We assessed the effect of climate change on the future distribution of the species to detect the most sensitive clades to global warming scenarios. Our results showed that for all clades' models, the AUC and TSS were greater than the general model. Access to the preferred prey of the Pallas's cat, that is, pika, had a significant effect on the distribution of O. m. manul and O. m. ferrugineus , whereas the most influential variable affecting O. m. nigripectus habitat suitability was terrain slope. Based on our future projections, we found that future climate change likely threatens the clades O. m. ferrugineus and O. m. nigripectus more than O. m. manul , findings that were hidden in the general model. Our results highlight the proficiency of SDMs in recognizing within-taxon habitat use of widespread species and the necessity of this procedure for implementing effective conservation planning of these species., Competing Interests: The authors declare no conflict of interest., (© 2022 The Authors. Ecology and Evolution published by John Wiley & Sons Ltd.)

Introduction: Colorectal cancer (CRC) is the second leading cause of death worldwide and the use of CRC screening tests can reduce the incidence and mortality of the disease by early detection. This study aims to review cost-effectiveness strategies in different ages and countries, systematically., Methods: We searched ProQuest, Web of Science, Scopus, Cochrane, PubMed and Embase for related studies between 2010 and 2020. Articles that reported costs per Quality-Adjusted Life Year or Life Year Gain and Incremental Cost-Effectiveness Ratios to compare the cost-effectiveness of CRC screening strategies in the average-risk population were included in our study., Results: The search strategies identified 426 records and finally 48 articles were included in the systematic review based on included and excluded criteria. We identified seven strategies for CRC screening. Most of the strategies were performed in aged 50-75. These studies were reported by cost per Quality-Adjusted life year (QALY)/Life Year Gain (LYG) based on methods and perspectives and the ICER of comparison of two-by-two strategies., Conclusion: Most of the CRC screening strategies were cost-effective, but there was big heterogeneity between the cost-effectiveness analysis of CRC screening strategies because of different screening methods, perspectives and screening populations. So, it is important to consider this heterogeneity to compare the economic evaluation studies in this field., (© 2022 John Wiley & Sons Ltd.)

Contact zones are considered as windows into the evolutionary process, allowing identification of factors influencing the evolutionary forces. Here, we combined phylogenetic and morphometric analyses to explore the evolutionary process affecting the taxonomic pattern of two subspecies of Testudo graeca (T. g. buxtoni and T. g. zarudnyi) across their contact zone in Central Iran. Our results showed high levels of phylogeographic and phenotypic variation in the contact zone. Two monophyletic clades including, clade 1 (T. g. zarudnyi) and clade 2 (T. g. buxtoni) were identified. Furthermore, four distinct subclades were found in T. g. buxtoni, across a wide geographic range. Divergence time analysis suggests that the two subspecies diverged from one another after the uplifting of the Zagros Mountains during the early Pliocene. Using neutrality tests and mismatch distribution analysis, we found no evidence of recent population expansion. Morphological associations among geographical populations in the contact zone found more distinctions, with some significant adaptive and non-adaptive morphological variations in these populations. These distinctive morphological populations can be considered as management units (MUs) to conserve the evolutionary potential of this species. Finer scale evolutionary studies are required to address the southern part of the Zagros mountain range, where the overlapping of mitochondrial clades and subclades has occurred. Such information is essential for effective conservation of T. graeca populations, preventing translocation or mixing of individuals without comprehensive genetic and morphological assessment., (© 2022. The Author(s).)

Background: Targeted temperature management (TTM) has been shown to improve neurological outcomes and survival in patients resuscitated from cardiac arrest; however, the cost effectiveness of multiple TTM methods is not well studied., Objective: This study aimed to evaluate the cost effectiveness of intravascular temperature management (IVTM) using Thermogard XP compared with surface cooling methods after cardiac arrest in the England from the perspectives of the UK national health service and Personal Social Services., Methods: We developed a multi-state Markov model that evaluated IVTM (Thermogard XP) compared with surface cooling using two different devices (Blanketrol III and Arctic Sun 5000) over a short-term and lifetime time horizon. Model input parameters were obtained from the literature and local databases. We assumed a hypothetical cohort of 1000 patients who required TTM after cardiac arrest per year in the England. The outcomes were costs (in £, year 2019 values) and quality-adjusted life-years (QALYs), discounted at 3.5% annually. Deterministic and probabilistic sensitivity analyses were undertaken to examine the effect of alternative assumptions and uncertainty in model parameters on the results., Results: The cost-effectiveness analysis determined that Thermogard XP resulted in direct cost savings of £2339 and £2925 (per patient) compared with Blanketrol III and Arctic Sun 5000, respectively, and a gain of 0.98 QALYs over the patient lifetime. The probabilistic sensitivity analysis demonstrated that the probability of Thermogard XP being cost saving would be 69.2% and 65.3% versus the Arctic Sun 5000 and Blanketrol III, respectively., Conclusion: Implementation of IVTM using Thermogard XP can lead to cost savings and improved patient quality of life versus surface cooling methods., (© 2022. The Author(s).)

Objective: As a recognized therapy to improve airway clearance, high-frequency chest wall oscillation (HFCWO) is used to manage reduced vital capacity in patients with complex neuromuscular disorders (cNMD). This study aimed to investigate the budget impact of HFCWO versus chest wall physical therapy (CWPT) from a US-commercial payer perspective., Methods: In combination with a previously developed cost-effectiveness model, a budget impact model was developed to evaluate the incremental budgetary impact associated with introducing a HFCWO device over a 5-year time horizon. The model compared the cost implications associated with the commonly used CWPT procedure, as the current scenario, with a new scenario consisting of 80% of market share for HFCWO. The resource use and costs included in the analyses were costs associated with the HFCWO device (Vest™ System) and its consumables, patient training, and medical services such as hospitalization, medications, emergency room, and outpatient visits. The primary outcome measures included total and incremental budgetary impact per member per year (PMPY)., Results: In a hypothetical plan of 1,000,000 members (men: 49.2%), 2099 patients with cNMD were estimated to be eligible to receive airway clearance services over 5 years. The new scenario (HFCWO and CWPT [US$24 PMPY]) was cost-saving compared with the current scenario (CWPT only [$34 PMPY]) with a cost reduction of US$9.46 PMPY. The model estimated a net cost-saving of US$1,594,131 and US$9,591,343 over 1 and 5 years, respectively., Conclusion: This study suggests the HFCWO technique to manage the reduction in vital capacity in patients with cNMD would lead to favorable budget impact results., (© 2021. The Author(s).)

Background: This study aimed to evaluate the cost-effectiveness of vitamin D supplementation in preventing type 2 diabetes mellitus (T2DM) among Iranian adolescents., Methods: This analytical observational study was conducted, using the decision tree model constructed in TreeAge Pro to assess the cost per quality-adjusted life-year (QALY) of monthly intake vitamin D supplements to prevent T2DM compared to no intervention from the viewpoint of Iran's Ministry of Health and through an one-year horizon. In the national program of vitamin D supplementation, 1,185,211 Iranian high-school students received 50,000 IU vitamin D supplements monthly for nine months. The costs-related data were modified to 2018. The average cost and effectiveness were compared based on the Incremental Cost-Effectiveness Ratio (ICER)., Results: Our analytical analysis estimated the 4071.25 (USD / QALY) cost per AQALY gained of the monthly intake of 50,000 IU vitamin D for nine months among adolescents over a one-year horizon. Based on the ICER threshold of 1032-2666, vitamin D supplementation was cost-effective for adolescents to prevent adulthood T2DM. It means that vitamin D supplementation costs were substantially less than the costs of T2DM treatments than the no intervention., Conclusions: Based on the findings, the national vitamin D supplementation program for Iranian adolescents could be a cost-effective strategy to reduce the risk of diabetes in adulthood. From an economic perspective, vitamin D supplementation, especially in adolescents with vitamin D deficiency, would be administrated., (© 2021. The Author(s).)

Background: Coronary artery disease (CAD) is the most common type of heart and circulatory disease and is the leading cause of death worldwide. The current diagnostic pathway can lead to patient complications and is also extremely costly. A new medical device, the CADScor System (Acarix AB), was developed for the acoustic detection of CAD before patients undergo invasive diagnostic procedures., Objectives: Our objective was to assess the cost utility of the CADScor System for the diagnosis of CAD at an early stage in the diagnostic testing pathway in England., Methods: A two-part economic model, consisting of a decision tree and Markov model, was developed to consider the cost utility (cost per quality-adjusted life-year [QALY] gained) of introducing the CADScor System for the diagnosis of CAD. The decision tree component explored the short-term costs and diagnostic outcomes associated with introduction of the test compared with the existing testing pathway. A Markov model was developed to explore the longer-term health and economic implications of the condition and original diagnosis, with costs and health effects estimated over different time horizons. Parameter uncertainty was explored in deterministic and probabilistic sensitivity analyses., Results: Base-case results indicated that the CADScor System would result in cost savings (- £131 per patient) and a marginal increase in QALYs (0.00001) over a 1-year time horizon. Probabilistic results indicated that the intervention had a > 99% probability of being cost effective at a willingness-to-pay threshold of £20,000 per QALY gained and 100% probability of being cost saving. Results from the deterministic sensitivity analyses indicated that variations in parameters related to the accuracy and cost of the CADScor System, and the prevalence of CAD, had the greatest impact on the overall results. The overall cost saving was estimated to be over £12.3 million per 100,000 eligible patient population., Conclusions: The CADScor System is a potentially cost-saving test for the diagnosis of CAD. When initiated before the use of non-invasive cardiac imaging tests such as computed tomography coronary angiography, the test reduced costs to the healthcare service over various time horizons., (© 2021. The Author(s).)

Background: The orogeny of the eastern Mediterranean region has substantially affected ecological speciation patterns, particularly of mountain-dwelling species. Mountain vipers of the genus Montivipera are among the paramount examples of Mediterranean neo-endemism, with restricted ranges in the mountains of Anatolia, the Levant, Caucasus, Alborz, and Zagros. Here we explore the phylogenetic and ecological diversification of Montivipera to reconstruct its ecological niche evolution and biogeographic history. Using 177 sequences of three mitochondrial genes, a dated molecular phylogeny of mountain vipers was reconstructed. Based on 320 occurrence points within the entire range of the genus and six climatic variables, ecological niches were modelled and used to infer ancestral niche occupancy. In addition, the biogeographic history and ancestral states of the species were reconstructed across climate gradients., Results: Dated phylogenetic reconstruction revealed that the ancestor of mountain vipers split into two major clades at around 12.18 Mya followed by multiple vicariance events due to rapid orogeny. Montivipera colonised coastal regions from a mountain-dwelling ancestor. We detected a highly complex ecological niche evolution of mountain vipers to temperature seasonality, a variable that also showed a strong phylogenetic signal and high contribution in niche occupation., Conclusion: Raising mountain belts in the Eastern Mediterranean region and subsequent remarkable changes in temperature seasonality have led to the formation of important centres of diversification and endemism in this biodiversity hotspot. High rates of niche conservatism, low genetic diversity, and segregation of ranges into the endemic distribution negatively influenced the adaptive capacity of mountain vipers. We suggest that these species should be considered as evolutionary significant units and priority species for conservation in Mediterranean mountain ecosystems.

Background and Objectives: Sarcopenia is an important age-related disease which can lead to an increased risk of mortality, falls, fractures, and poor quality of life. So, timely detection can be effective in reducing the burden of disease. The aim of this study was to identify the most cost-effective strategy for sarcopenia screening in Iran., Materials and Methods: We constructed a Markov transition model over a life-time horizon based on natural history. Compared strategies included Sarcopenia scoring assessment models (SarSA-Mod), European working group on sarcopenia in older people (EWGSOP), Mini sarcopenia risk assessment (MSRA) and SARC-F. Parameters values were extracted from primary data and the literature, and the costs and Quality-adjusted life years (QALYs) were calculated for each strategy. Sensitivity analysis of uncertain parameters was also performed to determine the robustness of the model. Analysis was performed using 2020 version of TreeAge Pro software., Results: All four screening strategies increased life time QALYs. After removing dominated strategy, the incremental cost per QALY gained for sarcopenia screening varied from $1875.67 for EWGSOP to $1898.33 for MSRA. Our base-case analysis showed that the most cost-effective strategy was EWGSOP and 2nd best was SarSA-Mod with $43,414.3 and $42,663.3 net monetary benefits given one GDP per capita ($5520.311) as willingness to pay, respectively. Sensitivity analysis of model parameters also showed robustness of results., Conclusions: The results of the study, as the first economic evaluation of sarcopenia screening, showed that the EWGSOP strategy is more cost-effective than other strategies.

Species Distribution Models (SDMs) can be used to estimate potential geographic ranges and derive indices to assess species conservation status. However, habitat-specialist species require fine-scale range estimates that reflect resource dependency. Furthermore, local adaptation of intraspecific lineages to distinct environmental conditions across ranges have frequently been neglected in SDMs. Here, we propose a multi-stage SDM approach to estimate the distributional range and potential area of occupancy (pAOO) of Neurergus kaiseri, a spring-dwelling amphibian with two climatically-divergent evolutionary lineages. We integrate both broad-scale climatic variables and fine-resolution environmental data to predict the species distribution while examining the performance of lineage-level versus species-level modelling on the estimated pAOO. Predictions of habitat suitability at the landscape scale differed considerably between evolutionary level models. At the landscape scale, spatial predictions derived from lineage-level models showed low overlap and recognised a larger amount of suitable habitats than species-level model. The variable dependency of lineages was different at the landscape scale, but similar at the local scale. Our results highlight the importance of considering fine-scale resolution approaches, as well as intraspecific genetic structure of taxa to estimate pAOO. The flexible procedure presented here can be used as a guideline for estimating pAOO of other similar species.

Background: Chronic rhinosinusitis (CRS) is one of the commonest chronic health problems among adults in the UK. Around 15% of CRS patients undergo functional endoscopic sinus surgery (FESS) annually after failing medical treatment. However, as incomplete resolution of symptoms or complications post-operatively is common, the post-operative management is considered to be as important as the surgery itself. A bioabsorbable corticosteroid-eluting sinus implant (CESI) (Propel ® , mometasone furoate 370 µg) has been used as an alternative post-FESS treatment., Objective: The objective of this study was to assess the cost effectiveness of the corticosteroid-eluting implant versus non-corticosteroid-eluting spacer following FESS for treatment of patients with CRS., Methods: A decision tree model was developed to estimate the cost and effectiveness in each strategy. Costs and effects were estimated from a UK National Health Service (NHS) and personal social services perspective over a 6-month time horizon. Model pathways and parameters were informed by existing clinical guidelines and literature and sensitivity analyses were conducted to explore uncertainties in base-case assumptions., Results: Over a 6-month time horizon, inserting CESI at the end of FESS is less costly (£4646 vs. £4655 per patient) and is the more effective intervention [total quality-adjusted life-years (QALYs) over 6 months 0.443 vs. 0.444] than non-corticosteroid-eluting spacers; hence, it is a dominant strategy. The probabilistic analysis results indicate that CESI following FESS has a 62% probability of being cost effective at the £20,000/per QALY willingness-to-pay threshold and 56% probability of being a cost-saving intervention., Conclusions: The use of CESI after FESS results in fewer post-operative complications than non-corticosteroid-eluting implants and may be a cost-saving technology over a 6-month time horizon. Although the cost of initial treatment with the CESI is greater, cost savings are made due to a reduction in the number of complications experienced.

The phylogeny and species boundaries of Gazella subgutturosa and G. marica have been long debated. The achievements of past conservation efforts have been compromised by a lack of knowledge about the phylogeny and taxonomic status of different populations. We integrated the recent genetic findings by previous studies with morphometric analyses and ecological niche modeling (ENM) to assess discreteness among populations of these gazelle species in Asia. Taxonomic diversity of gazelles was investigated by using principal components analysis (PCA) based on 14 cranial measures of male skulls. Ecological niche divergence was examined based on a PCA on climatic factors and a species distribution modeling (SDM) with environmental variables. Morphometric results indicated substantial differentiation in size between skulls of the western Zagros Mountains including west and south-western Iran and Arabian Peninsula from all other samples east of the Zagros Mountains from Iran to China. ENM also revealed that gazelles in the east and west of Zagros Mountains occupy distinct niches and that there are apparent areas of disconnection across the goitered gazelle suitable range. A complete divergent niche occupation was also observed between goitered gazelles of northern Mongolia and other populations of the species, except those in China. Taking the inferences from ENM and morphology together with previous genetics results, we conclude that gazelles in the west and south-west of Iran may represent G. marica . Also, our combined analyses revealed divergence among gazelles of Iran, Central Asia, and Mongolia/China. These results may pave the way for future studies and have conservation implications particularly for reintroduction/supplementation programs., Competing Interests: The authors declare that they have no competing interests., (© 2020 The Authors. Ecology and Evolution published by John Wiley & Sons Ltd.)

Interspecific hybridization increasingly occurs in the course of anthropogenic actions, such as species translocations and introductions, and habitat modifications or occurs in sympatric species due to the shortage of conspecific mates. Compared with anthropogenically caused hybridization, natural hybridization is more difficult to prove, but both play an important role in conservation. In this study, we detected hybridization of two gazelle sister species, Gazella bennettii (adapted to dry areas) and Gazella subgutturosa (adapted to open plains), in five habitat areas, where G. bennettii naturally occur in central Iran. The hybrids have a nuclear genomic identity (based on two introns), habitat preference, and phenotype of G. bennettii , but the mitochondrial identity (based on cyt b ) of G. subgutturosa . We suggest that natural hybridization of female G. subgutturosa and male G. bennettii happened twice in central Iran in prehistoric times, based on the haplotype pattern that we found. However, we found indications of recent hybridization between both species under special circumstances, for example, in breeding centers, due to translocations, or in areas of sympatry due to the shortage of conspecific mates. Therefore, these two species must be kept separately in the breeding centers, and introduction of one of them into the habitat of the other must be strictly avoided., Competing Interests: The authors declare that they have no competing interests., (© 2020 The Authors. Ecology and Evolution published by John Wiley & Sons Ltd.)

Background: Contrast-induced acute kidney injury (CI-AKI) is a complication commonly associated with invasive angiographic procedures and is considered the leading cause of hospital-acquired acute kidney injury. CI-AKI can lead to a prolonged hospital stay, with a substantial economic impact, and increased mortality. The DyeVert™ PLUS EZ system (FDA approved and CE marked) is a device that has been developed to divert a portion of the theoretical injected contrast media volume (CMV), reducing the overall volume of contrast media injected and aortic reflux, and potentially improving long-term health outcomes., Objectives: To assess the long-term costs and health outcomes associated with the introduction of the DyeVert™ PLUS EZ system into the UK health care service for the prevention of CI-AKI in a cohort of patients with chronic kidney disease (CKD) stage 3-4 undergoing diagnostic coronary angiography (DAG) and/or percutaneous coronary intervention (PCI), and to compare these costs and outcomes with those of the current practice., Methods: A de novo economic model was developed based on the current pathway of managing patients undergoing DAG and/or PCI and on evidence related to the clinical effectiveness of DyeVert™ in terms of its impact on relevant clinical outcomes and health service resource use. Clinical data used to populate the model were derived from the literature or were based on assumptions informed by expert clinical input. Costs included in the model were from the NHS and personal social services perspective and obtained from the literature and UK-based routine sources. Probabilistic distributions were assigned to the majority of model parameters so that a probabilistic analysis could be undertaken, while deterministic sensitivity analyses were also carried out to explore the impact of key parameter variation on the model results., Results: Base-case results indicate that the intervention leads to cost savings (- £435) and improved effectiveness (+ 0.028 QALYs) over the patient's lifetime compared with current practice. Output from the probabilistic analysis points to a high likelihood of the intervention being cost-effective across presented willingness-to-pay (WTP) thresholds. The overall long-term cost saving for the NHS associated with the introduction of the DyeVert™ PLUS EZ system is over £19.7 million for each annual cohort of patients. The cost savings are mainly driven by a lower risk of subsequent diseases and their associated costs., Conclusions: The introduction of the DyeVert™ PLUS EZ system has the potential to reduce costs for the health care service and yield improved clinical outcomes for patients with CKD stage 3-4 undergoing angiographic procedures.

Background: Vertebrate-mediated seed dispersal is probably the main long distance dispersal mode. Through endozoochory, large mammals act as mobile links between habitats within and among forest patches. Along with other factors, their feeding regimes do affect their contribution as dispersal vectors. We conducted a cross-species comparative experiment involving two herbivores, red deer and roe deer; and two opportunistic omnivores, wild boar and brown bear, all occurring in the forest and steppe-forest ecotone habitats of the south-eastern Caspian region. We compared their role as endozoochorous seed dispersal agents by monitoring seedling emergence in their dungs under greenhouse and natural conditions., Results: In total, 3078 seedlings, corresponding to 136 plant taxa sprouted from 445 paired dung sub-samples, under greenhouse and natural conditions. Only 336 seedlings, corresponding to 36 plant taxa, emerged under natural conditions, among which five taxa did not appear under greenhouse conditions. Graminoids and forbs composed 91% of the seedlings in the greenhouse whereas shrubs were more abundant under natural conditions, representing 55% of the emerged seedlings. Under greenhouse conditions, first red deer and then wild boar dispersed more species than the other two mammals, while under natural conditions brown bear was the most effective vector. We observed remarkably higher species richness and seedling abundance per dung sub-sample under buffered greenhouse conditions than we did under natural conditions., Conclusions: The four sympatric mammals studied provided different seed dispersal services, both in terms of seedling abundance and species richness and may therefore be regarded as complementary. Our results highlight a positive bias when only considering germination under buffered greenhouse conditions. This must be taken into account when planning management options to benefit plant biodiversity based on the dispersal services concluded from greenhouse experiments.

The presence of heavy metals (HMs) in the environment can increase their risk of transfer to the food chain. The present study was conducted to investigate the bioaccumulation of HMs including Hg, Cd and Ni in soft and hard tissues of sentinel crab (Macrophthalmus depressus Rüppell, 1830) in sediments of Mousa Bay in northwest of the Persian Gulf. The average (mean ± SD) amounts of Hg, Cd and Ni in the sediments were 6.27 ± 3.66, 3.8 ± 1.48 and 71.6 ± 5.09 μg/g, whereas the relevant amounts for soft tissues were 6.16 ± 4.64, 3.3 ± 1.7 and 19.7 ± 3.96 μg/g, and for hard tissues were, 2.9 ± 1.67, 3.5 ± 1.35 and 10.44 ± 3.1 μg/g, respectively. Accordingly, soft tissues of the crab could be suitable bioindicators of Hg and Cd, whereas the hard tissues could be used as Cd bioindicator. Since the bioaccumulation of Ni was the most, it might have a higher risk among the metals to enter the food chain in the region., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Human-wildlife conflicts restrict conservation efforts, especially for wide-ranging animals whose home ranges overlap with human activities. We conducted a study to understand conflicts with, and factors influencing the perceived value of an expanding population of onagers (Equus hemionus onager) in local communities in southern Iran. We asked about locals' perceptions of six potential management strategies intended to lessen human-onager conflict. We found that human-onager conflict was restricted to 45% of respondents within the Bahram-e-Goor Protected Area, all of whom were involved in farming or herding activities. Locals within the protected area were more knowledgeable about onagers and valued onagers more than those living outside the protected area. The perceived value of onagers increased with level of education, total annual income, and perceptions of onager population trends; the perceived value of onagers decreased with the magnitude of conflict between onagers and locals. To tolerate or avoid conflicts with onagers, locals were supportive of monetary compensation and changing from a traditional lifestyle to industrialized farming (for farmers) or livestock production (for herders) with the help of government; locals did not support selling land to the government. Our study is among the first in human-wildlife conflict and local attitudes towards an endangered species and its recovery in Iran. We conclude that current levels of human-onager conflict are relatively low and perceived value of onagers is still relatively high. Therefore, wildlife authorities should consider the development of mitigation strategies with local communities before conflicts intensify., Competing Interests: This study was partly funded by Cleveland Metroparks Zoo. There are no patents, products in development or marketed products to declare. This does not alter our adherence to all the PLOS ONE policies on sharing data and materials, as detailed online in the guide for authors.

Climate change is among the most important drivers of biodiversity decline through shift or shrinkage in suitable habitat of species. Mountain vipers of the genus Montivipera are under extreme risk from climate changes given their evolutionary history and geographic distribution. In this study, we divided all Montivipera species into three phylogenetic-geographic Montivipera clades (PGMC; Bornmuelleri, Raddei and Xanthina) and applied an ensemble ecological niche modelling (ENM) approach under different climatic scenarios to assess changes in projected suitable habitats of these species. Based on the predicted range losses, we assessed the projected extinction risk of the species relative to IUCN Red List Criteria. Our result revealed a strong decline in suitable habitats for all PGMCs (63.8%, 79.3% and 96.8% for Xanthina, Raddei and Bornmuelleri, respectively, by 2070 and under 8.5 RCP scenario) with patterns of altitudinal range shifts in response to projected climate change. We found that the mountains close to the Mediterranean Sea are exposed to the highest threats in the future (84.6 ± 9.1 percent range loss). We also revealed that disjunct populations of Montivipera will be additionally highly isolated and fragmented in the future. We argue that leveraging climate niche projections into the risk assessment provides the opportunity to implement IUCN criteria and better assess forthcoming extinction risks of species.

The combination of niche modelling and landscape genetics (genomics) helps to disentangle processes that have shaped population structure in the evolutionary past and presence of species. Herein, we integrate a comprehensive genomic dataset with ecological parameters and niche modelling for the threatened Kaiser's newt, a newt species adapted to mountain spring-ponds in Iran. Genomic analysis suggests the existence of two highly differentiated clades North and South of the Dez River. Genetic variation between the two clades (76.62%) was much greater than within clades (16.25%), suggesting that the Dez River prevented gene flow. River disconnectivity, followed by geographic distance, contributed mostly to genetic differentiation between populations. Environmental niche and landscape resistance had no significant influence. Though a significant difference between climatic niches occupied by each clade at the landscape-scale, habitat niches at the local-scale were equivalent. 'Niche similarity analysis' supported niche conservatism between the two clades despite the southward shift in the climatic niche of the Southern clade. Accordingly, populations of different clades may occupy different climatic niches within their ancestral niche. Our results indicate that the change of climatic conditions of geographically and genetically separated populations does not necessarily result in the shift of an ecological niche.

We reconstruct the molecular phylogeny of Near Eastern mountain brook newts of the genus Neurergus (family Salamandridae) based on newly determined RADseq data, and compare the outcomes of concatenation-based phylogenetic reconstruction with species-tree inference. Furthermore, we test the current taxonomy of Neurergus (with four species: Neurergus strauchii, N. crocatus, N. kaiseri, and N. derjugini) against coalescent-based species-delimitation approaches of our genome-wide genetic data set. While the position of N. strauchii as sister species to all other Neurergus species was consistent in all of our analyses, the phylogenetic relationships between the three remaining species changed depending on the applied method. The concatenation approach, as well as quartet-based species-tree inference, supported a topology with N. kaiseri as the closest relative to N. derjugini, while full-coalescent species-tree inference approaches supported N. crocatus as sister species of N. derjugini. Investigating the individual signal of gene trees highlighted an extensive variation among gene histories, most likely resulting from incomplete lineage sorting. Coalescent-based species-delimitation models suggest that the current taxonomy might underestimate the species richness within Neurergus and supports seven species. Based on the current sampling, our analysis suggests that N. strauchii, N. derjugini and N. kaiseri might each be subdivided into further species. However, as amphibian species are known to be composed of deep conspecific lineages that do not always warrant species status, these results need to be cautiously interpreted in an integrative taxonomic framework. We hypothesize that the rather shallow divergences detected within N. kaiseri and N. derjugini likely reflect an ongoing speciation process and thus require further investigation. On the contrary, the much deeper genetic divergence found between the two morphologically and geographically differentiated subspecies of N. strauchii leads us to propose that N. s. barani should be considered a distinct species, Neurergus barani Öz, 1994., (Copyright © 2019 Elsevier Inc. All rights reserved.)

Taxonomic over-splitting of extinct or endangered taxa, due to an incomplete knowledge of both skeletal morphological variability and the geographical ranges of past populations, continues to confuse the link between isolated extant populations and their ancestors. This is particularly problematic with the genus Equus. To more reliably determine the evolution and phylogeographic history of the endangered Asiatic wild ass, we studied the genetic diversity and inter-relationships of both extinct and extant populations over the last 100,000 years, including samples throughout its previous range from Western Europe to Southwest and East Asia. Using 229 bp of the mitochondrial hypervariable region, an approach which allowed the inclusion of information from extremely poorly preserved ancient samples, we classify all non-African wild asses into eleven clades that show a clear phylogeographic structure revealing their phylogenetic history. This study places the extinct European wild ass, E. hydruntinus, the phylogeny of which has been debated since the end of the 19th century, into its phylogenetic context within the Asiatic wild asses and reveals recent mitochondrial introgression between populations currently regarded as separate species. The phylogeographic organization of clades resulting from these efforts can be used not only to improve future taxonomic determination of a poorly characterized group of equids, but also to identify historic ranges, interbreeding events between various populations, and the impact of ancient climatic changes. In addition, appropriately placing extant relict populations into a broader phylogeographic and genetic context can better inform ongoing conservation strategies for this highly-endangered species.

Purpose: To provide efficacy and safety of surgery with Trabectome combined with phacoemulsification in primary open-angle glaucoma., Methods: In this interventional case series, 30 consecutive eyes that have had combined phacoemulsification with Trabectome were included. The main outcome measures were change in intraocular pressure (IOP), glaucoma medication use, and the rate of complications., Results: Mean IOP was 18.25 ± 3.28 mmHg preoperatively which decreased to 13.50 ± 2.53 mmHg at 1 year. (P < 0.05). There was a corresponding drop in glaucoma medications from 2.52 ± 0.60 at baseline to 1.40 ± 0.53 at 12 months (P < 0.01). The preoperative BCVA (Log Mar) was improved from 0.68 ± 0.26 pre-operatively to 0.26 ± 0.19, 0.18 ± 0.13, 0.17 ± 0.13, 0.11 ± 0.12, at 5 days and 2, 6, and 12 months, respectively (P < 0.01). The only frequent complication was transient blood reflux resolving spontaneously within a few days. No vision-threatening complication occurred., Conclusion: Combined phacoemulsification and Trabectome significantly lowered IOP and medication use, with early visual rehabilitation in the majority of patients.

Studying the concentration distribution of metals is necessary for soil pollution monitoring and maintaining environmental quality. To date, very little large-scale research has been performed to investigate metal contamination in developing countries. In this study, the content and spatial distributions of five metals (cadmium [Cd], copper [Cu], nickel [Ni], lead [Pb], and zinc [Zn]) were quantified based on 346 topsoil samples from 12 districts in the province of Golestan (northeast [NE] Iran). The concentration levels (mg/kg) of Cd, Cu, Pb, Ni and Zn varied from 0.02 to 0.36, 9.3 to 93.7, 6.8 to 44, 9.5 to 85.35, and 25 to 417.4, respectively. The average concentrations (mg/kg) obtained were as follows: Cd 0.12 ± 0.07, Cu 23.9 ± 9.07, Ni 34.88 ± 11.59, Pb 15.42 ± 5.81 and Zn 82.08 ± 30.87. Significant differences in the distribution of trace elements among districts were detected. The AzadShahr and BandarGaz districts displayed the highest metal concentrations. Greater metal values were obtained in the central, south, west, and NE areas, although Zn concentration was also high to the north of the province. Values of contamination factor and contamination degree indicated that the metal pollution level was on the order of Zn > Cd > Pb > Cu > Ni and that all of the metals belonged to a low or moderate pollution category. Ni and Cu levels derived from natural sources, whereas Cd, Pb, and Zn derived from anthropogenic activities with greater mean concentrations than reference concentrations.

Background: Birth weight appears to play a role in determining high blood pressure (BP) and obesity during childhood. The purpose of this study is to investigate the association between birth weight and later obesity and hypertension among 10- to 13-year-old schoolchildren., Methods: A total of 1,184 primary school students were selected from 20 randomized schools between 2011 and 2012 in Iran. Height, weight, waist circumference and BP were measured using standard instruments. Data were analyzed using stepwise regression and logistic regression models., Results: 13.5% of children had a history of low birth weight. First-degree family history of obesity, excessive gestational weight gain and birth weight were significantly correlated with overweight/obesity and abdominal obesity (p = 0.001), whereas only birth weight was associated with high BP (p = 0.001). An inverse correlation was found between waist circumference and systolic/diastolic BP. The duration of breastfeeding in children with low birth weight was inversely correlated with obesity/overweight, abdominal obesity and hypertension., Conclusion: The results suggests that birth weight is inversely associated with BP and more so with obesity and abdominal obesity. The duration of having been breastfed could have an influence on later hypertension, obesity and abdominal obesity. Further results are needed to test these correlations as well as diagnosing early life factors to prevent young adult overweight/obesity or hypertension., (Copyright © 2013 S. Karger AG, Basel.)

Background: The aim of study is to assess the importance and challenges of Malaria elimination (ME) in Iran's health system., Material: Opinion of experts from Ministry of Health and Medical Education and the chancellors of medical universities affected by malaria were gathered using Focus Group Discussions and in-depth interviews. We asked them about the importance and main challenges of ME in Iran., Results: MAIN FACTORS ON IMPORTANCE OF ME WERE: it's a struggle to reach to equity in the poorest regions of county, prevention of emerging disease in susceptible regions, lowering the cost of control and its effects on the region's socioeconomic condition. Main challenges were Iran's long border with malaria-endemic countries Pakistan and Afghanistan and illegal immigrants, underdevelopment in rural areas, system's insensitivity and diagnosis problem due to reduction of cases., Conclusion: Quantitative and holistic researches are needed for assessing the consequences of ME.

Objective: Retinol-binding protein 4 (RBP4) has been shown to be associated with insulin resistance (IR), metabolic indices and metabolic syndrome (MetS) in various patient populations and in obesity. We investigated the association between metabolic parameters, IR and RBP4 during olanzapine therapy., Design: A prospective study., Patients: Thirty-seven participants with psychiatric disorder who were atypical antipsychotic naive and newly initiated on olanzapine were assessed., Measurements: Fasting RBP4, anthropometric and metabolic variables were measured before and after 3 months of olanzapine therapy., Results: Participants who developed MetS showed higher RBP4 levels compared with those without MetS, although not significant (P = 0·053). The variation in RBP4 level was correlated with changes in systolic blood pressure (r = 0·423, P = 0·009), diastolic blood pressure (r = 0·390, P = 0·017), total cholesterol (r = 0·446, P = 0·006) and low-density lipoprotein (LDL) (r = 0·407, P = 0·012). Multiple linear regression analysis illustrated that end-point log insulin level was the most significant independent predictor of final log RBP4 levels (standardized ß = 0·353, P = 0·024)., Conclusions: Our results suggest that RBP4 levels might be associated with at least some olanzapine-induced metabolic abnormalities and cardiovascular disease risk factors., (© 2011 Blackwell Publishing Ltd.)

Objective: To determine the validity of dichotic multiple frequencies auditory steady-state responses (ASSR) as a hearing screening technique versus using distortion product otoacoustic emissions (DPOAEs) among high-risk neonates., Methods: A cross sectional study was performed on 118 high-risk neonates by means of dichotic multiple frequencies ASSR and DPOAE for hearing screening. DPOAE results were used as the standard for hearing screening in parallel with ASSR. Dichotic multiple frequencies ASSR results were analyzed by means of F-value of less or greater than 0.05 criteria as a pass-fail for the responses. Dichotic multiple ASSR hearing screening technique was considered in two intensity levels at 40 and 70 dB HL. The ASSRs thresholds were measured in high risk neonates with and without hearing deficits as determined by DPOAES. The results of ASSR and DPOAE were compared to be gathered by contingency table in order to obtain sensitivity, specificity and other different statistical values. Average performing times for the tests were analyzed., Results: The specificity of dichotic multiple ASSR was 92.6%, 93.8% and the sensitivity was 71.6%, 62.2% at the 70 and 40 dB hearing levels, respectively. Mean ASSR thresholds for normal-hearing infants at an average corrected age of 6 days were 32.2 ± 12.2, 29.8 ± 10.2, 26.2 ± 11.4 and 30.4 ± 10.8 dB HL for 0.5, 1, 2 and 4 kHz, respectively. The average times for performing the tests were 18.7 and 32.9 min respectively., Conclusions: ASSR with this special paradigm is a fairly desirable method for hearing screening of high-risk neonates. There is good concordance between ASSRs and DOPAEs results among high risk neonates referred for hearing screening. The sensitivity and specificity of this test is sufficient for hearing screening in high risk neonates. This test could be valuable for rapid confirmation of normal thresholds. As long as further research have not been conducted on ASSR, great caution should be made to interpret the results of ASSR as a hearing screening technique in young infants and also additional techniques such as the tone-evoked ABRs should be used to cross-check results. It's still too soon to recommend ASSRs as a standalone electrophysiologic measure of hearing thresholds in infants., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

Background: Pemphigus vulgaris (PV) usually presents as non-healing, painful oral erosions, but transient or aphtha-like lesions are not exceptional at the very beginning of the disease leading to the common misdiagnosis of recurrent aphthous stomatitis (RAS). We designed this cross-sectional, questionnaire-based study to evaluate this underreported yet important presentation of PV., Material and Methods: One hundred and eighty-five consecutive PV patients were interviewed and a questionnaire, comprising items related to the natural history of oral lesions, was filled in for each. Fourteen patients who had taken steroids (topical or systemic) before their final diagnosis were excluded., Results: Twenty-three per cent of patients gave a history of transient aphthous-like lesions; 95% of them were misdiagnosed as aphthae. These lesions were especially reported by patients aged 40 years or older (P < 0.047)., Conclusion: PV should be kept in mind as a rare differential diagnosis of transient oral ulcerations. We recommend careful observation of these patients and performing indirect immunofluorescence or desmoglein ELISA and even biopsy in atypical cases, to rule out PV especially in older patients and predisposed ethic groups. To find out the differential aspects of RAS and aphthous-like PV, a cohort study on RAS patients is suggested.

Endozochorous seed dispersal by herbivores can affect plant spatial dynamics and macroecological patterns. We have investigated the number and species composition of viable seeds deposited in faeces of a full guild of macroherbivores (four deer and two lagomorph species) in a forest in eastern Britain. One hundred and one plant species germinated from faecal pellet material, 85 of which were among the 247 vascular plant species recorded in the forest. However, three species - Chenopodium album, Urtica dioica and Agrostis stolonifera - comprised 56% of the seedlings recorded. Of the species recorded in faecal samples, 36% had no recognised dispersal mechanism, while very few (7%) were adapted to endozoochorous dispersal (fleshy fruit or nut). The number of species dispersed by the herbivores was ranked Cervus elaphus and Dama dama (96) > Capreolus capreolus (40) > Muntiacus reevesi (31) > Oryctolagus cuniculus (21) > Lepus europaeus (19), with the other taxa dispersing subsets of those dispersed by C. elpahus and D. dama. The invasive M. reevesi deposited the fewest seeds per gram of faecal pellet material (0.4 g(-1)) and hence fewer seeds per unit area than other deer species despite their numerical dominance, while C. elaphus/D. dama deposited the most (0.43 seeds m(-2) year(-1)). Due to differences in faecal seed density among habitats combined with the ranging behaviour of animals, more seeds were deposited in younger stands, enhancing the potential contribution of macroherbivores to population persistence by dispersal and colonisation in a successional mosaic.

The study was carried out to determine the prevalence and pattern of antimicrobial resistance of Shigella species among patients with acute diarrhoea in Karaj, Tehran, Iran. The study included all acute diarrhoea patients who visited the hospitals and treatment centres of Karaj during November 2001-October 2002. Of 734 stool samples collected from patients with acute diarrhoea and analyzed for Shigella spp., 123 (16.8%) yielded Shigella spp. (7.5% Shigella flexneri, 5.2% S. sonnei, 2.6% S. dysenteriae, and 1.5% S. boydii). Of the Shigella isolates, 90.8% were resistant to one or more antimicrobial agent(s), and 87.8% were multidrug resistant. The most common resistance was to tetracycline (73.5%), trimethoprim-sulphamethoxazole (70.4%), and amoxicillin-clavulanic acid (50.0%). Resistance to cefixime, ciprofloxacin, ceftriaxone, and nalidixic acid was observed in 6.1%, 3.1%, 2.0%, and 1.0% of the isolates respectively. These findings suggest that Shigella spp. may be an important aetiological agent of diarrhoea with a high rate of drug resistance in this region, which requires further study.