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Understanding of the vulnerability of populations exposed to wildfires is limited. We used an index from the U.S. Centers for Disease Control and Prevention to assess the social vulnerability of populations exposed to wildfire from 2000-2021 in California, Oregon, and Washington, which accounted for 90% of exposures in the western United States. The number of people exposed to fire from 2000-2010 to 2011-2021 increased substantially, with the largest increase, nearly 250%, for people with high social vulnerability. In Oregon and Washington, a higher percentage of exposed people were highly vulnerable (>40%) than in California (~8%). Increased social vulnerability of populations in burned areas was the primary contributor to increased exposure of the highly vulnerable in California, whereas encroachment of wildfires on vulnerable populations was the primary contributor in Oregon and Washington. Our results emphasize the importance of integrating the vulnerability of at-risk populations in wildfire mitigation and adaptation plans.

Combined heart-liver transplantation (CHLT) is a viable option for concurrent heart and liver failure, yet its indications are unclear. This preliminary study aimed to describe pre-transplant characteristics and outcomes of patients with liver fibrosis undergoing HT and CHLT, while exploring decompensated liver dysfunction following HT. A total of 52 patients (HT = 42; CHLT = 10) were included. In HT patients, F1 fibrosis was more common (52%), with 43% exhibiting F3 or F4 fibrosis. F4 fibrosis was predominant in the CHLT patients (80%). Post-hepatic portal hypertension was present in 62% of HT and 90% of CHLT patients. None progressed to liver decompensation (i.e., new ascites, variceal bleed, jaundice, hepatic hydrothorax, or hepatic encephalopathy) after HT. Over a median follow-up period of 3.7 [IQR 1.2–9.1] years, the two groups did not differ statistically in survival (p = 0.60). Altogether, HT and CHLT may have similar survival outcomes, and HT patients may not progress to decompensation postoperatively despite advanced fibrosis. Decompensated cirrhosis could serve as a factor for identifying CHLT candidates, but it is crucial to differentiate it from post-hepatic portal hypertension, which does not necessitate liver transplant. Further research is needed to determine selection criteria for CHLT, ensuring efficient utility of organs.

Critical to human survival, water resources, including groundwater and particularly rivers, are under threat from anthropogenic pollution. The major Kashafrud River, located in northeastern Iran, is a seasonal watercourse currently encountering numerous challenges. At present, a stretch of this historic river (Parkandabad to the basin's exit) carries wastewater, comprising industrial, urban, agricultural, and even livestock effluents, transforming it into a conduit for sewage. This study reviews existing research on the challenges faced by the Kashafrud River, including pollution, climate change, and its impacts, as well as reduced runoff and drought. It outlines the crisis afflicting the river and then explores solutions to mitigate the current conditions. This research process involved reviewing previous studies on the challenges of Kashafrud, conducting field visits, engaging in discussions with local residents, and validating these findings through consultation with regional water experts responsible for overseeing this water course. Research indicates that there has been a limited focus on the pollution issue in Kashafrud, underscoring the evident necessity for comprehensive scientific inquiry aimed at presenting suitable solutions to tackle river contamination. In conclusion, through analyzing solutions proposed in previous studies and summarizing their strengths and weaknesses, 13 practical solutions were presented to provide the most effective strategies for addressing the challenges of this significant river.

Introduction: This study aimed to determine nitrate levels in water wells supplying drinking water in Taft city, Iran, and assess the associated health risks using the method proposed by the US Environmental Protection Agency. Materials and Methods: In 2021, the average annual nitrate levels were determined in 48 drinking water wells which were located in Zone 39 (Taft city). Health risk assessment and sensitivity analysis were conducted to identify the most influential variables. Results: The mean nitrate content in the water wells under study was 32.88 ± 18 mg/L. Out of the 48 examined water wells, 10 had nitrate levels higher than the standard value (50 mg/L) established by the Iranian Institute of Standardization (Standard No. 1053) and WHO. The calculated Hazard Quotient (HQ) for children and adolescents was greater than 1, while it was less than 1 for adults. Nitrate concentration in drinking water was found to be the most important influencing variable in the calculated HQ for children and adolescents. Conclusion: The results indicated that children and adolescents’ health in the studied area is at risk, and appropriate measures must be implemented to avoid and control the exposure of these vulnerable groups; they can be continuous monitoring of nitrate levels using on-site treatment methods where nitrate concentrations exceed the standard level, and decommissioning wells with high nitrate levels.

Regarding energy efficiency, the unit contract problem (UCP) is significant. It need to be seen as the assurance of occasions and energy commodities in which the generator offers the most value in addition to having a large amount of energy storage. In this study, we offer a novel approach to solve the UCP issue for a 10-generator test system with variable prices depending on hourly variations in power demand, utilizing particle swarm optimization (PSO). The objective is to keep energy levels sufficient to fulfill demand while reducing the total cost of producing power. Initially, a collection of objects that may hold the key to solving UCP are generated via the suggested PSO technique. Their dedications to the project and the power they create have an impact on everyone's health because of the mobility restriction. Using a combination of their own and other objects' histories, objects may discover the best solution for UCP via the iterative adjustments in speed and location made by the PSO algorithm. This strategy might boost generator economy and efficiency while also resolving the UCP issue. A number of scenarios with various storage factors should be taken into account in order to assess the PSO method's efficacy. The results demonstrate that the cost-confidence ratio is regarded as equal and that the algorithm may converge to the ideal or nearly optimal solution. The efficiency of alternative optimization techniques and the suggested PSO approach are compared using comparative analysis. The findings demonstrate that PSO is more cost-effective than earlier research in identifying the effects of rising storage prices on power consumption between 50 and 100 MW.

Abstract Background Repeat‐breeder cows repeatedly fail to conceive after at least three attempts and return to oestrus at apparently normal intervals. Repeat‐breeder cows cause economic losses in dairy farms in different ways. Objective In the present study, we investigated the effect of sustained‐release progesterone injection in two different doses on the expression of interferon‐related genes in repeat‐breeder dairy cows. Methods A total of 96 repeat‐breeder primiparous and multiparous cows were assigned among three groups: control group, inseminated and do not receive progesterone treatment; P400 and P600 groups, inseminated and received a single‐intramuscular injection of 400 and 600 mg slow‐release progesterone 5 days after insemination, respectively. Blood sampling was carried out on Day 20 after AI for progesterone measurement and evaluation of gene expression for ISG15, MX1 and MX2 genes. Results One injection of sustained‐release progesterone increased the expression of ISG15, MX1 and MX2 genes with differences between two different progesterone concentrations. For all three genes, the level of gene expression was higher in progesterone‐supplemented group than in control group, when P400 and P600 groups considered together. The level of MX2 gene expression was significantly higher in pregnant cows than non‐pregnant cows. There was a significant positive correlation between expression level of all three genes and blood progesterone concentration. The expression level of ISG15 gene showed a significant positive correlation with MX1 and MX2 gene expression. Conclusion The use of this sustained‐release progesterone is simple and can be used in repeat‐breeder cows to improve fertility.

IntroductionPredicting river flow is one of the most crucial aspects in water resources management. Improving forecasting methods can lead to a reduction in damages caused by hydrological phenomena. Studies indicate that artificial neural network models provide better predictions for river flow compared to physical and conceptual models. However, since these models may not offer reliable performance in estimating unstable data, using preprocessing techniques is necessary to enhance the accuracy and performance of artificial neural networks in estimating hydrological time series with nonlinear relationships. One of these methods is wavelet transformation, which utilizes signal processing techniques. Materials and MethodsIn this study, to evaluate the efficiency of discrete and continuous wavelet types in the Wavelet-Artificial Neural Network (WANN) hybrid model for monthly flow prediction, a case study was conducted on the Kardeh Dam watershed in the northeast of Iran, serving as a water source for part of Mashhad city and irrigation downstream agricultural lands. Monthly streamflow estimates for the upstream sub-basin of the Kardeh Dam were obtained from the meteorological and hydrometric stations' monthly statistics over a 30-year period (1991-2020). The WANN model is a hybrid time series model where the output of the wavelet transform serves as a data preprocessing method entering an artificial neural network as the predictive model. The combination of wavelet analysis and artificial neural network implies using wavelet capabilities for feature extraction, followed by the neural network to learn patterns and predict data, potentially enhancing the models' performance by leveraging both methods. The 4-fold cross-validation method was employed for the artificial neural network model validation, where the model underwent validation and accuracy assessment four times, each time using 75% of the data for training and the remaining 25% for model validation. The final results were presented by averaging the validation and accuracy results obtained from each of the four model runs. To evaluate and compare the performance of the models used in this study, three evaluation indices, Nash-Sutcliffe Efficiency (NSE), Root Mean Square Error (RMSE), and Pearson correlation coefficient (R), were employed. Results and DiscussionThe analysis of meteorological and hydrometric data in this study revealed that monthly streamflow in two time steps, T-1 and T-2, were the most effective predictive variables. Each of the two runoff variables of the previous month (Qt-1) and the previous two months (Qt-2) were analyzed by each of the Haar and Fejer-Korovkin2 discrete wavelet transforms and the two continuous Symlet3 and Daubechies2 wavelets at three levels. The results of each level of decomposition was given as input to the ANN model. The presented results at each decomposition level indicated that hybrid models could accurately predict lower flows compared to the single ANN model, and the estimation of maximum values also significantly improved in the hybrid models. Among the wavelets used, Haar wavelets exhibited the weakest performance, and the less commonly employed Kf2 wavelet showed a moderate performance. Since the Haar and Fk2 wavelets, with their discrete structure, did not perform well in decomposing continuous monthly streamflow data, continuous wavelet models outperformed discrete wavelet models. The hybrid models, combining wavelet analysis and artificial neural networks, demonstrated up to an 11% improvement over the performance of the single neural network model. ConclusionStreamflow is a crucial element in the hydrological cycle, and predicting it is vital for purposes such as flood prediction and providing water for consumption. The objective of this research was to evaluate the performance of different types of discrete and continuous wavelet models at various decomposition levels in enhancing the efficiency of artificial neural network (ANN) models for streamflow prediction. Since climate and watershed characteristics can influence the nature of data fluctuations and, consequently, the results of the wavelet model decomposition, choosing an appropriate wavelet model is essential for obtaining the best results. Considering the existing variations in the results of different studies regarding the selection of the best wavelet type, it is suggested to use both continuous and discrete wavelet types in modeling to achieve the best predictions and select the optimal results. Given that a lower number of input variables in neural network models lead to higher accuracy in modeling results, it is recommended to perform decomposition at a two-level depth to reduce input components to the neural network model, thereby reducing the model execution time.

Objective: This study aimed to assess the effect of sumac supplement in biochemical and anthropometric measurements in overweight or obese patients with non-alcoholic fatty liver disease.Materials and Methods: In this double-blind randomized controlled trial, 45 NAFLD patients were randomly divided into two groups. The intervention group received sumac capsules (3 g/day) with a balanced diet for 8 weeks, while the placebo group received placebo with a balanced diet. Anthropometric indices, lipid profile, fasting blood glucose, insulin, Homeostatic Model Assessment for Insulin Resistance, aspartate transaminase, alanine aminotransferase, high sensitivity C-reactive protein and malondialdehyde were measured at baseline and at the end of the study.Results: The results revealed a significant decrease in anthropometric indices (weight (p=0.001), body mass index (p=0.001), waist circumference (p=0.001), body fat mass (p=0.001), body fat percentage (p=0.001), visceral fat score (p=0.001), biochemical levels of total cholesterol (p=0.007), fasting blood sugar (p=0.006), insulin (p=0.004) and HOMA-IR (p=0.002)) after the intervention compared to the baseline. However, no significant difference was observed between the two groups concerning anthropometric and biochemical indices.Conclusion: In this study, no significant differences were observed between the two groups regarding anthropometric and biochemical indices. Thus, further studies with larger sample sizes are recommended to be conducted on the issue.

Abstract Introduction Human papillomavirus (HPV) presents a potential threat to the onset of carcinogenesis in the cervix, anogenital regions, and oropharynx. HPV encompasses over 200 types, with at least 12 having the potential to cause cancer, impacting the majority of sexually active individuals. In this current research, we explore the occurrence and spread of HPV genotypes. Material and methods During this cross-sectional study conducted in Sanandaj, Iran from Feb 2022 to Aug 2023, diverse samples including oral, vaginal, and genital were collected from individuals referred to private laboratories in Sanandaj, Iran. After sample collection and DNA extraction (FAVORGEN, Taiwan), they were subjected to PCR and genotyping (MehrViru, Iran). The subsequent statistical analysis unveiled infection rates across different demographics and age groups. STATA (version 17) were used for statistical analysis. We examined infection rates across demographics using t-tests and Odds Ratio. Results Overall, 26% (249) out of 950 cases tested positive for HPV, with 69% of these classified as high-risk. Among the examined population, 98% (933) were female, and 2% (17) were male. Females aged 31–40 exhibited the highest percentage of HPV prevalence (115/460) in the study with the majority of positive cases belonging to HR genotypes. The overall most frequent genotypes identified were 6, 16, 52, 53, 51, 58, and 56. HPV-16 exhibited the highest frequency among HR genotypes, accounting for 42 (17%) occurrences, followed by HPV-52 with a frequency of 32 (13%). Conclusion Our findings emphasize the significant prevalence of HPV among females, particularly in the 21–30 age group. The identification of high-risk genotypes, underscores the importance of targeted interventions for specific age cohorts. The age-stratified analysis highlights a consistent predominance of high-risk HPV across age groups, indicating the need for age-specific preventive measures. These results contribute valuable information for designing effective screening and vaccination strategies, to alleviate the impact of diseases associated with HPV.

Studies have identified elevation-dependent warming trends, but investigations of such trends in fire danger are absent in the literature. Here, we demonstrate that while there have been widespread increases in fire danger across the mountainous western US from 1979 to 2020, trends were most acute at high-elevation regions above 3000 m. The greatest increase in the number of days conducive to large fires occurred at 2500-3000 m, adding 63 critical fire danger days between 1979 and 2020. This includes 22 critical fire danger days occurring outside the warm season (May-September). Furthermore, our findings indicate increased elevational synchronization of fire danger in western US mountains, which can facilitate increased geographic opportunities for ignitions and fire spread that further complicate fire management operations. We hypothesize that several physical mechanisms underpinned the observed trends, including elevationally disparate impacts of earlier snowmelt, intensified land-atmosphere feedbacks, irrigation, and aerosols, in addition to widespread warming/drying.

The utilization of fault current limiters (FCLs) provides an effective approach to alleviate the negative consequences associated with short circuit currents. This equipment can affect other system specifications. In this paper, the effects of FCL on power system transient stability are investigated by a theoretical-comparative study. In this study, different FCL impedances (inductive and resistive) are analyzed and compared considering two locations for FCL installation and different locations of fault occurrence in a single-machine infinite bus system. To evaluate the power system's transient stability, the authors adopt an approach based on the equal area criterion, which calculates the difference between accelerating and decelerating areas. Another issue addressed in this article is the fault-clearing time effect on the power system's transient stability as FCL is installed in the power grid. The results have been confirmed through the use of MATLAB software.

IntroductionLimited fresh water resources and access to these resources as well as providing food security for the growing world population have led researchers to make extensive efforts in the field of optimal management of water consumption and determining the cultivation pattern in different regions. Therefore, identifying cultivated crops in a region and determining their area can be very effective in land management and water allocation in these regions. With the growth and advancement of technology in the field of satellite and remote sensing in recent decades, the use of satellite images in order to identify types of land use and types of cultivated products has expanded greatly. Sentinel-1 (radar) and Sentinel-2 (multi-spectral) satellites have been very popular in agriculture due to their improved spatial resolution (10 meters) and appropriate time resolution (5 days for Sentinel 2 and 12 days for Sentinel 1).Materials and MethodsThe studied area is located downstream of the Fariman dam in an area of 22.51 square kilometers (5122 hectares) and the central coordinates are 35 degrees 41 minutes and 59 seconds north latitude and 59 degrees 50 minutes and 49 seconds east longitude. In order to classify satellite images and produce crop maps, ground observation data is needed to train the classification model and also evaluate the accuracy of the results. For this purpose, sample points were taken from different land uses in the region, using GPS. Since it was not possible to take enough samples for all land uses and crops in the determined border, a larger sampling area was selected. Then, all collected data were sorted and for each class, 70% of the data was randomly used to train the classification model and 30% was used to validate the obtained classification results. In the present study, Sentinel 2 satellite images for the first 6 months (crop season) of 2021 and 2022 and digital elevation image (DEM) of the study area were considered. According to the surveys conducted and the reports of the agricultural jihad of Fariman city, the main crops cultivated in the region include maize, tomato, sugar beet, wheat and barley. Therefore, according to the phenological stages of these products in the region, the appropriate time series of images was selected. The accuracy of the classified map was evaluated using the Kappa coefficient and overall accuracy.Results and DiscussionIn order to identify and separate the land use in the study area according to the major cultivated crops, first the agricultural calendar of the crops was determined. Then, satellite images were selected based on crop cultivation period. Based on the evaluation indexes of commission error, omission error, overall accuracy as well as the Kappa coefficient, it was observed that the identification of classes and land use was done well and with high accuracy, so that the overall accuracy for the classification map of 2022 is equal to 0.97 and the kappa coefficient value was 0.94. In order to compare land use changes during the two years 2022 and 2021, classification was also done for the images of the crop year 2021. Since the training samples of agricultural crops were not available separately and in sufficient numbers in the crop year of 2021, the classification map of this year was produced only based on the type of land use, and all crops in one class entered the classification model training process. The values of overall accuracy and kappa coefficient in 2021 were obtained as 0.97 and 0.95 respectively. According to the obtained results, the area of the orchard class has increased since 2021 compared to 2022. After repeated field visits to the study area and investigation of some land uses that had been changed and turned into orchard use, it was found that in some areas in 2022 there was the growth of villa gardens and in some areas the farmers have converted cropland to orchard (construction of an orchard). Even in some cases, the old orchard in the region was destroyed by the farmers and the land was fallow for 2 to 3 years (2021, fallow). In 2022, the farmer built a new orchard. It is also necessary to mention that fallow lands are included in the soil class depending on whether they are newly plowed or have no vegetation, and if weeds have grown on these lands, they are included in the rangeland class. ConclusionThe effective management of water resources from dams for agricultural purposes necessitates the identification of land use downstream of the dams, along with determining the types of crops and their respective areas. In this study, Sentinel 2 satellite images were employed to classify and delineate land use associated with agricultural cultivation downstream of the Fariman dam in Razavi Khorasan Province, spanning the crop years of 2021 and 2022. The results indicate that the Sentinel 2 satellite demonstrates a high capacity to differentiate between various types of land use and crops. The generated map depicting changes in land use and crop cultivation areas can be instrumental in water use planning and the allocation of water resources.

Cystic fibrosis (CF) is a genetic ailment caused by mutations in the cystic fibrosis transmembrane conductance regulator (CFTR) gene. This autosomal recessive disorder is characterized by diverse pathobiological abnormalities, such as the disorder of CFTR channels in mucosal surfaces, caused by inadequate clearance of mucus and sputum, in addition to the malfunctioning of mucous organs. However, the primary motive of mortality in CF patients is pulmonary failure, which is attributed to the colonization of opportunistic microorganisms, formation of resistant biofilms, and a subsequent decline in lung characteristics. In December 2019, the World Health Organization (WHO) declared the outbreak of the radical coronavirus disease 2019 (COVID-19) as a worldwide public health crisis, which unexpectedly spread not only within China but also globally. Given that the respiration system is the primary target of the COVID-19 virus, it is crucial to investigate the impact of COVID-19 on the pathogenesis and mortality of CF patients, mainly in the context of acute respiratory distress syndrome (ARDS). Therefore, the goal of this review is to comprehensively review the present literature on the relationship between cystic fibrosis, COVID-19 contamination, and development of ARDS. Several investigations performed during the early stages of the virus outbreak have discovered unexpected findings regarding the occurrence and effectiveness of COVID-19 in individuals with CF. Contrary to initial expectancies, the rate of infection and the effectiveness of the virus in CF patients are lower than those in the overall population. This finding may be attributed to different factors, including the presence of thick mucus, social avoidance, using remedies that include azithromycin, the fairly younger age of CF patients, decreased presence of ACE-2 receptors, and the effect of CFTR channel disorder on the replication cycle and infectivity of the virus. However, it is important to notice that certain situations, which include undergoing a transplant, can also doubtlessly boost the susceptibility of CF patients to COVID-19. Furthermore, with an increase in age in CF patients, it is vital to take into account the prevalence of the SARS-CoV-2 virus in this population. Therefore, ordinary surveillance of CF patients is vital to evaluate and save the population from the capability of transmission of the virus given the various factors that contribute to the spread of the SARS-CoV-2 outbreak in this precise organization.

Perfluorooctanesulfonic acid (PFOS) is a neurotoxic widespread organic contaminant which affects several brain functions including memory, motor coordination and social activity. PFOS has the ability to traverse the placenta and the blood brain barrier (BBB) and cause weight gain in female mice. It’s also known that obesity and consumption of a high fat diet have negative effects on the brain, impairs cognition and increases the risk for the development of dementia. The combination effect of developmental exposure to PFOS and the intake of a high-fat diet (HFD) has not been explored. This study investigates the effect of PFOS and /or HFD on weight gain, behavior and transcriptomic and proteomic analysis of adult brain mice. We found that female mice exposed to PFOS alone showed an increase in weight, while HFD expectedly increased body weight. The combination of HFD and PFOS exacerbated generalized behavior such as time spent in the center and rearing, while PFOS alone impacted the distance travelled. These results suggest that PFOS exposure may promote hyperactivity. The combination of PFOS and HFD alter social behavior such as rearing and withdrawal. Although HFD interfered with memory retrieval, biomarkers of dementia did not change except for total Tau and phosphorylated Tau. Tau was impacted by either or both PFOS exposure and HFD. Consistent with behavioral observations, global cerebral transcriptomic analysis showed that PFOS exposure affects calcium signaling, MAPK pathways, ion transmembrane transport, and developmental processes. The combination of HFD with PFOS enhances the effect of PFOS in the brain and affects pathways related to ER stress, axon guidance and extension, and neural migration. Proteomic analysis showed that HFD enhances the impact of PFOS on inflammatory pathways, regulation of cell migration and proliferation, and MAPK signaling pathways. Overall, these data show that PFOS combined with HFD may reprogram the genome and modulate neuromotor development and may promote symptoms linked to attention deficit-hyperactivity disorders (ADHD) and autism spectrum disorders (ASD). Future work will be needed to confirm these connections.

Abstract Background Cystic fibrosis (CF) is an autosomal recessive disorder caused by abnormal function of the chloride ion channels and characterized by pancreatic insufficiency and chronic endobronchial airway infection. Pulmonary dysfunction is very common and could lead to a reduction in the quality of life. Airway clearance techniques (ACT) and physical exercises are introduced as one of the main components of treatment. Therefore, it will be of interest to examine the effect of aerobic exercises compared to conventional chest physiotherapy (CPT) on pulmonary function, functional capacity, sputum culture, and quality of life in patients with CF. Methods Thirty patients with CF will participate in a double-blind parallel controlled trial containing 18 sessions of treatment. Group A consists of CPT and placebo aerobic exercise, and group B includes aerobic exercise and placebo CPT. Pulmonary function, functional capacity, sputum culture, and quality of life will be evaluated with a spirometry test, 6-min walk test (6MWT), sputum culture test, and the Cystic Fibrosis Questionnaire-Revised (CFQ-R), respectively, before and after the intervention. Discussion We will evaluate and compare the effectiveness of aerobic exercises and conventional chest physiotherapy on pulmonary function, functional capacity, sputum culture, and quality of life. Comparing these two treatment patterns can contribute to a better understanding of the effectiveness. Therefore, if there is a significant difference between the two treatments, the superior treatment will be prioritized clinically. Trial registration https://www.irct.ir , IRCT20210505051181N5. Registered on 19 February 2023.

Background: Medical tourism in Yazd city has been greatly developed as one of the treatment poles of the country and can be said that this industry has become one of the development axes of Yazd city. The purpose of this research is to identify the most important factors influencing the attraction of non-native medical tourists to the historical city of Yazd. Methods: The current research was of a qualitative type conducted in the fall of 1401. Desk research and Delphi method were used to collect data. The statistical sample of this study included 41 experts in the fields of treatment, tourism, and urban planning, and these experts were selected based on their related specialties using a snowball method. After studying the theoretical foundations of the research, 41 effective factors in attracting medical tourists were specified from related research texts, and during studying, categorization and editing, 23 indicators were provided to the experts in the form of a questionnaire on a 5-point Likert scale, and at the end of the questionnaire, an open question was provided. After analyzing the answers, the results were recorded and a new questionnaire was created for the next stage, which was repeated 3 times. According to the results of the Kolmogorov-Smirnov test at a significance level of 0.05, the correlation between the factors was analyzed using the W. Kendall non-parametric correlation test and the SPSS 18 software, and the Delphi technique was used to achieve the research objectives. Results: In the course of data analysis, indicators with an average difference of less than 0.1 were confirmed, indicators with an average of less than 4 were removed, and other indicators were moved to the next stage. After completing 3 stages of the test, 12 factors were identified as the most important factors affecting medical tourism in Yazd city, and these factors were placed in 5 categories: characteristics of the treatment staff, characteristics of the hospital, economic factors, giving information and communication, and other related factors. According to W. Kendall's correlation coefficients obtained during the 3 Delphi steps, the convergence and agreement of experts' opinions were confirmed. Conclusion: Considering that infrastructure indicators, personnel skills and economic factors are among the most important indicators of attracting medical tourists to the historical city of Yazd, it is suggested that to develop medical tourism in Yazd city, these items should be taken into consideration in managing the current situation of medical centers; Furthermore, investment should focus on the development of medical infrastructure.

Abstract Background This study aimed to assess the effect of blood contamination on marginal adaptation of cold ceramic (CC) and mineral trioxide aggregate (MTA) Angelus using scanning electron microscopy (SEM). Methods This in vitro experimental study was conducted on 24 extracted single-rooted human teeth. After cleaning and shaping, the root canals were filled with lateral compaction technique. The apical 3 mm of the roots was cut, and cavities with 3 mm depth were created at the apex. The teeth were randomly assigned to two group (n = 12) for the application of CC and MTA Angelus as retrograde filling materials. CC and MTA Angelus were prepared by mixing the powder with blood, and applied in the cavities. After 24 h, their marginal adaptation to the canal walls was assessed by SEM. Data were statistically analyzed by t-test (alpha = 0.05). Results The mean marginal gap was 8.98 μm in the CC, and 16.26 μm in the MTA Angelus group; this difference was statistically significant (P

Introduction: The majority of nasopharyngeal cysts are asymptomatic and rare. Nevertheless, these lesions are rarely discovered during regular endoscopies and imaging tests. An upper nasopharyngeal Thornwaldt cyst is a benign, mucosal congenital cyst. Even less frequently, they can cause unexplained sinonasal symptoms such as rhinorrhea, vision problems, and nasal blockage.Case Report: Here, we report a case with new-onset hearing loss after the coronavirus infection, in which his imaging investigation showed a nasopharyngeal mass.Conclusion: After covid-19 infection we should consider branchial Cyst and Thornwaldt Cyst in a high-risk patients. On the other hand, the progressive hearing loss after covid-19 can occur due to activation of this kind of cysts.

Abstract Background Allo-HSCT is a definite approach for the management of a wide variety of lethal and debilitating malignant and non-malignant disorders. However, its two main complications, acute and chronic graft-versus-host disease (GVHD), exert significant morbidities and mortalities. BoS, as a manifestation of chronic lung GVHD, is a gruesome complication of allo-HSCT, and for those with steroid-refractory disease, no approved second-line therapies exist. Mesenchymal stem cells (MSCs) exert anti-inflammatory and growth-promoting effects, and their administration against a wide range of inflammatory and neurologic disorders, as well as GVHD, has been associated with promising outcomes. However, literature on the safety and effectiveness of MSC therapy for BoS and pediatric cGVHD is scarce. Methods We designed a single-arm trial to administer adipose tissue (AT)-derived MSCs to pediatric patients with refractory BoS after allo-HSCT. AT-MSCs from obese, otherwise healthy donors were cultured in an ISO class 1 clean room and injected into the antecubital vein of eligible patients with a dose of 1 × 106/kg. The primary endpoints included a complete or partial response to therapy [in terms of increased forced expiratory volume in one second (FEV1) values and steroid dose reduction] and its safety profile. Results Four eligible patients with a median age of 6.5 years were enrolled in the study. Steroid-induced osteoporosis and myopathy were present in three cases. A partial response was evident in three cases after a single injection of AT-MSCs. The treatment was safe and tolerable, and no treatment-related adverse events were noted. Two patients developed manageable COVID-19 infections one and 4 months after AT-MSC injection. After a median follow-up duration of 19 months, all cases are still alive and have had no indications for lung transplantation. Conclusions AT-MSCs could be safely administered to our pediatric cases with BoS post-allo-HSCT. Considering their advanced stage of disease, their sub-optimal functional capacity due to steroid-induced complications, and COVID-19 infection post-treatment, we believe that AT-MSC therapy can have possible efficacy in the management of pediatric BoS. The conduction of further studies with larger sample sizes and more frequent injections is prudent for further optimization of AT-MSC therapy against BoS. Trial registration Iranian Registry of Clinical Trials (IRCT), IRCT20201202049568N2. Registered 22 February 2021, https://en.irct.ir/trial/53143 .

Two central questions in COVID-19 treatment which should be considered are: “How does the imbalance of the complement system affect the therapeutic approaches?” and “Do we consider complement inhibitors in therapeutic protocols?”. The complement system is a double-edged sword since it may either promote immune responses against COVID-19 or contribute to destructive inflammation in the host. Therefore, it is crucial to regulate this system with complement inhibitors. In this manuscript, we discuss the molecular mechanisms of complement and complement inhibitors in COVID-19 patients. We searched the terms “COVID-19”, “Complement”, “Complement inhibitor”, “SARS-CoV-2”, and all complement fragments and inhibitors from 2000 to 2022 in PubMed and google scholar and checked the pathways in “KEGG pathway database”. Complement is not well-appreciated in the treatment protocols despite its multiple roles in the disease, and most of the preventive anti-inflammatory therapeutic approaches did not include a complement inhibitor in COVID-19 therapeutic protocols. In this review article, we discussed the most recent studies regarding complement components mediated interventions and the mechanism of these interventions in COVID-19 patients. Since the control of the complement system overactivation is associated with a better prognosis in the initial stages of COVID-19, heparin, anti-thrombin, C1-inhibitor, montelukast, and hydralazine can be effective in the initial stages of this viral infection. Recombinant complement activation (RCA) proteins are more effective in regulating complement compared to terminal pathway therapeutic approaches such as the C3a and C5a inhibitors.

Background: To provide a continuous seal of the root canal, root-filling material should bond to the root canal dentin, ensuring the integrity of both the root-filling material and dentin remains in a static and functional state. The present study assessed the push-out bond strength of mineral trioxide aggregate (MTA) and cold ceramic (CC). Materials and Methods: In this laboratory trial study, 20 single-rooted, extracted human teeth without caries and cracks were selected. Each tooth was mounted in cold-curing resin. Then, 3 mm slices of mid-root dentin were obtained from each tooth. The specimens were randomly divided into two groups (n = 10) and filled with MTA ProRoot and CC. All specimens were stored for 30 days in an incubator at 37°C and 100% humidity. The push-out bond strength of the test materials was measured using a cylindrical punch with a 1-mm diameter. The punch was pushed against the test specimen at a speed of 1.0 mm/min using a universal material testing machine, extruding the filling test material. The push-out force during the test was recorded, and then, the internal surface of the teeth was examined to evaluate the mode of failure. Independent t-test and Chi-square were used to analyze the data. P < 0.05 was considered a significance threshold. Results: The mean push-out bond strength in the CC group was 24.58 (MPa), and in MTA ProRoot, it was 23.77. No significant difference was observed between the two groups. The most frequent mode of failure in both groups was adhesive failure. Conclusion: The two materials have adequate push-out bond strength to root dentin, and there is no difference between the bond strength and mode of failure of the two materials.

Background and Purpose: Adopting a proper location for a hospital will result in allocating optimal resources, improving access to health care, improving the quality of hospital services, reducing the waste of time, reducing energy consumption, decreasing costs, and reducing traffic. Accordingly, this study was conducted to adopt the optimal location for hospitals in Yazd City, Iran. Materials and Methods: This research is descriptive in terms of type and applied in terms of objectives. The used criteria for this study covered data related to military, residential, sports, industrial, green space, education, population density, communication roads, and available hospitals. All effective criteria were distinguished, and a map of each criterion was provided to locate the hospitals optimally. The weight of each criterion was determined by the analytic hierarchy process method and applied to the maps in the GIS software environment. The final land valuation map was prepared by combining the maps to construct the hospital. Results: The highest weight was calculated for the population density layer (0.24) and the lowest for the sports layer (0.025). The classified map to construct a hospital in Yazd City, Iran was classified into 5 categories, from very appropriate to very inappropriate. The map revealed that about 34% of the studied area is appropriate for building a hospital. Conclusion: Due to the importance of proper geographical access to hospital treatment facilities, it is recommended that new hospitals in Yazd be constructed on very appropriate land plots, and the priority in building a hospital to be very appropriate land plots located in the fourth district.

Background & Objectives: Due to the increasing trend of extensive antibiotic resistance among bacterial strains and side effects, seeking novel methods such as nanoparticles (NPs) is promising for infection eradication. Materials & Methods: Eighteen Streptococcus mutans (S. mutans) clinical isolates were collected from dental plaques. Moreover, S. mutans ATCC25175 standard strain was obtained from Pasteur institute of Iran. Following preparation of nanoparticles, their antibacterial effects were assessed compared to chlorhexidine. The nickel NPs (Ni-NPs) was prepared and its antibacterial effect was compared to the 12% chlorhexidine. The minimum inhibitory and bactericidal concentrations (MIC and MBC, respectively) of Ni-NP (dilution range: 0.125-64µg/mL) were measured using broth microdilution method. Results: The nickel NPs (Ni-NPs) was prepared and its antibacterial effect was compared to the 12% chlorhexidine. The minimum inhibitory and bactericidal concentrations (MIC and MBC, respectively) of Ni-NP (dilution range: 0.125-64µg/mL) were measured using broth microdilution method. The MIC and MBC levels of Ni-NP against the clinical isolates ranged 2-16µg/mL and 4-16µg/mL, respectively. These values against the S. mutans ATCC27175 standard strain included 4 and 8µg/mL, respectively. Furthermore, the MIC and MBC of chlorhexidine against clinical isolates ranged 8-64 and 32-64µg/mL, respectively, while both included 64µg/mL against standard strain (p

Background & Purpose: Today, the digital revolution has fundamentally changed the nature of work, organizational boundaries, and the responsibilities of employees of organizations. Digital transformation is the right answer to a world full of change, ambiguity, and uncertainty; Accordingly, the organizations are required to be equipped with digital transformation to keep staying in the field of competition. Since digital transformation is not only related to new digital technologies and is more dependent on human beings, which is called the soft part of digital transformation, managers should be familiar with the soft components of digital transformation, which are necessary for the implementation of a great digital transformation and apply them in their organizations. Thus, the aim of the current research is to identify the soft components of digital transformation, and then design a conceptual framework to explain them.Methodology: This research was qualitative conducted using thematic analysis. The research source of information was made up of databases and qualified international journals in this field, and 43 participants related to the subject under study were selected using the purposeful sampling method.Findings: During the process of analyzing, interpreting, and synthesizing the findings, the conceptual framework resulting from the soft components of digital transformation includes the comprehensive theme of culture with 12 organizing themes and 50 basic themes; The comprehensive theme of skills has 4 organizing themes and 31 basic themes; Also, the overarching theme of the organization manager has 3 organizing themes and 24 basic themes, and finally the inclusive theme of digital leadership has 2 organizing themes and 12 basic themes.Conclusion: The identified soft components of digital transformation indicate that for success in digital transformation, organizations rely on the management of the organization as the one who steers the ship of the organization, and it is also the digital leader who inspires the passion for digital transformation. It creates in people and becomes the pioneer and driver of this transformation in the organization, and by creating a suitable culture, it paves the way for digital transformation. All of these factors are fruitful along with people and their skills; Therefore, an organization that is equipped with all these soft components can claim success in the field of digital transformation.

Background and aim: Home-Visit is a recently growing approach for patients with chronic mental health problems. This study aimed to investigate the effectiveness of this approach in some therapeutic factors in the patients with BID. Material and Methods: In this randomized control trial study, among bipolar I patients discharged from Ghods Psychiatric Hospital in Sanandaj, those who met our inclusion criteria, after informed consent, randomly assigned into intervention and control groups. The evaluators were unaware of the patients' groups. The intervention group received 1-year intervention of home-care services, whereas the control group doesn't receive any intervention, except for their pharmacological treatment. Hamilton-Depression-Rating Scale and Young-Mania-Rating-Scale were used to record possible changes during the steps of our study (before, 6-months and 12-months after intervention). Data were analyzed using SPSS. Results: Our study included 26 patients (19 men, 7 women). 13 assigned to intervention group (Mean age= 36.15, SD=15.04), and 13 assigned to control group (Mean age=34.92, SD=5.15), which did not show any significant difference at the baseline (T=.279, p= .783). The results implied that the intervention group had significant decrease in all of the three variables, including frequency of hospitalization (p=0/001), mania (p=0/002), and depression (p=0/006), compared to the control group. These changes remained the same during the one year follow-up period. Conclusion: Results showed that home-visit was effective in, decreasing the severity of the symptoms, frequency and length of hospital stay in BID patients. It seems possible that increased length of interventions can lead to better outcomes.

Elevation-dependent warming trends have been previously identified, but its effect on fire danger is still unclear. Here the authors show that there has been widespread increases in fire danger across the mountainous western US from 1979 to 2020 with most acute trends at high-elevation regions above 3000 m.

Perfluroalkyl substances (PFASs) are persistent man-made chemicals considered to be emerging pollutants, with Perfluorooctanoic acid (PFOA), Perfluorooctanesulfonic acid (PFOS), and Perfluorohexanesulphonic acid (PFHxS) being linked to hepatotoxicity and steatosis. PFOA, PFOS, and PFHxS can undergo placental and lactational transfer, which results in PFOA, PFOS, and PFHxS distribution to the neonatal liver. Moreover, in pregnant dams, exposure to a PFAS mixture, in combination with a high fat diet, increased hepatic steatosis in offspring at postnatal day 21, but the mechanisms have not been elucidated. It was hypothesized that gestational/lactational PFAS exposure would alter the pup liver proteome and biochemical/signaling pathways. Timed-pregnant CD-1 dams were fed a standard chow or 60% kcal high-fat diet. From GD1 until PND20, dams were dosed via oral gavage with vehicle (0.5% Tween 20), individual doses of PFOA, PFOS, PFHxS at 1 mg/kg, or a mixture (1 mg/kg each, totaling 3 mg/kg). Livers were collected from PND21 offspring and SWATH-MS proteomics was performed. IPA analysis revealed PFAS exposure modified disease and biological function pathways involved in liver damage, xenobiotics, and lipid regulation in the PND21 liver. These pathways included lipid and fatty acid transport, storage, oxidation, and synthesis, as well as xenobiotic metabolism and transport, and liver damage and inflammation. This indicates the pup liver proteome is altered via maternal exposure and predisposes the pup to metabolic dysfunctions.