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Abstract Introduction Several landmark randomized‐controlled trials (RCTs) have demonstrated the efficacy of sodium‐glucose co‐transport 2 (SGLT2) inhibitors in reducing all‐cause mortality, cardiovascular (CV) mortality and heart failure (HF) hospitalizations. Much interest surrounds their mechanism of action and whether they have direct effects on reverse cardiac remodelling. Therefore, we conducted a meta‐analysis of placebo controlled RCTs evaluating the impact of SGLT2 inhibition on imaging derived markers of reverse cardiac remodelling in patients with HF. Methods We performed a systematic review and meta‐analysis in accordance with the Preferred Reporting Items for Systematic Review and Meta‐Analysis (PRISMA) Statement and Cochrane Collaboration. Data interrogation of each major database including PubMed, EMBASE, MEDLINE and Cochrane Library was performed. RCTs evaluating HF patients >18 years comparing SGLT2 inhibitor versus placebo‐control were included. Outcome measures included left ventricular end‐diastolic volume and volume index (LVEDV/LVEDVi), left ventricular end‐systolic volume and volume index (LVSDV/LVSDVi), left ventricular ejection fraction (LVEF), left ventricular mass index (LVMi), left atrial volume index (LAVi) and left ventricular global longitudinal strain (LV GLS). Studies with an HF with preserved ejection fraction population were excluded from analysis of parameters, which would be significantly affected by baseline LVEF, such as volumes and LVEF. The mean difference and standard error were extracted from each study and a random effects model used pool the mean difference and standard error across studies. A pre‐specified sub‐group analysis was performed to stratify results according to imaging modality used (cardiac magnetic resonance imaging and echocardiography). This study is registered on PROSPERO: CRD42023482722. Results Seven randomized, placebo‐controlled trials in patients with HF comprising a total population of 657 patients were included. Overall LVEF of included studies ranged from 29 ± 8.0% to 55.5 ± 4.2%. In studies included in analysis of HFrEF parameters, baseline LVEF ranged from 29 ± 8% to 45.5 ± 12%. Pooled data demonstrated SGLT2 inhibition, compared with placebo control, resulted in significant improvements in mean difference of LVEDV [−11.62 ml (95% confidence interval, CI −17.90 to −5.25; z = 3.67, P = 0.0004)], LVEDVi [−6.08 ml (95% CI −9.96 to −2.20; z = 3.07; P = 0.002)], LVESV [−12.47 ml (95% CI −19.12 to −5.82; z = 3.68; P = 0.0002)], LVESVi [−6.02 ml (95% CI −10.34 to −1.70; z = 2.73; P = 0.006)], LVM [−9.77 g (95% CI −17.65 to −1.89; z = 2.43; P = 0.02)], LVMi (−3.52 g [95% CI −7.04 to 0.01; z = 1.96; P = 0.05)] and LVEF [+2.54 mL (95% CI 1.10 to 3.98; z = 3.62; P = 0.0005)]. No significant difference in GLS (n = 327) [+0.42% (95%CI −0.19 to 1.02; P = 0.18)] or LAVi [−3.25 ml (95% CI −8.20 to 1.69; z = 1.29; P = 0.20)] was noted. Conclusion This meta‐analysis provides additional data and insight into the effects of SGLT2 inhibition on reverse cardiac remodelling in patients with HF. Compared with placebo control, we found that treatment with a SGLT2 inhibitor produced significant improvements in several markers of reverse cardiac remodelling.

Civil structures are always considered one of the most valuable properties of each country. Many factors can lead to local damages in different parts of structures during their operational life. These damages are reflected in the vibration responses of structures. This research aims to detect the existence and determine the location of damage in a truss bridge under a moving load using an artificial neural network and experimental wavelet transform. For this purpose, a two-dimensional truss bridge was built in the laboratory to investigate this research's objectives. Earlier experimental studies in damage detection were subjected to excitations such as impact loads and electrodynamic shakers. Since the appearance of damage effects in the vibration responses of the structure mainly depends on the applied location of the impact load, a moving load that crosses the entire length of the bridge can be used as input excitation to detect the presence and location of damages for which there is no available data. After measuring the vibration responses of the bridge, 17 time-domain features were extracted from the raw signals, which were used to detect the presence of damage. Although feature extraction is applied to raw signals, the signal processing stage was not eliminated for damage localization. By processing the response signals of the healthy and damaged state of the bridge using experimental wavelet transform, these signals were decomposed into different modes and 5 non-parametric damage-sensitive features such as Shannon and Tsallis entropies, Root Mean Square (RMS), Shape Factor and kurtosis which are all based on statistical parameters in addition to energy, were extracted. Finally, these damage-sensitive features were presented as input to the neural network whereas the state of the bridge (healthy or damaged) was considered as its target. The obtained results showed that the proposed method can effectively detect the presence and the location of the damage in the truss bridge.

Abstract Background The COVID-19 pandemic has led to the broad acceptance of distance education (DE), with university professors and students conducting the teaching–learning process remotely from their homes. The propose of this study to investigate the prevalence of musculoskeletal disorders (MSDs) before and during the COVID-19 pandemic and identify risk factors associated with DE that may contribute to an increased incidence of these disorders among university professors. Methods This cross-sectional analytical study took a comparative approach and involved 310 university professors in Iran. Data were gathered using an online questionnaire. Initially, demographic and occupational information of the professors, hours of physical activity, and hours spent using electronic devices were recorded. Participants were then asked to report MSDs in various body areas throughout the previous year and the previous seven days. Finally, MSDs risk factors such as workstation ergonomics during computer, laptop, smartphone, and tablet use, as well as working postures during online teaching or offline content development during the COVID-19 pandemic, were examined. Results The majority of the participants were male (66.13%), with a PhD (46.77%) and a faculty member position (74.2%). On average, the use of computers and laptops increased by 2.67 h and 2.72 h, respectively, during the pandemic compared to before the pandemic. This increase was statistically significant (P

Abstract This study employs a sophisticated bi‐level optimization methodology to model the most efficient operation of microgrids (MGs) within the operational framework of distribution companies (DCs). In this bi‐level optimization problem, the upper level strives to maximize the profits of both MGs owners and DCs, while the lower level is dedicated to ensuring load balance, managing distributed generation, and implementing load curtailment strategies. The coordination of power transmission is facilitated by the DCs. At the upper level of decision‐making, the optimal pricing strategies for power transactions are determined, accounting for various factors such as market prices, demand response programs, and uncertainties in wind speed. Through the utilization of a bi‐level optimization framework, this study comprehensively captures the complex interactions between MGs and DCs, taking into consideration the objectives and constraints of both entities. This approach offers a more precise representation of the decision‐making process in retail electricity markets, thereby providing valuable insights into the optimal operation of MGs within the DCs setting.

Abstract Background Multiple Sclerosis (MS) a central nervous system autoimmune disorder, mainly affecting young adults and more prevalent among women, can lead to sexual dysfunction (SD) among both males and females with MS. Female sexual dysfunction can be defined as dyspareunia, a lack of sexual desire, disorders in the arousal and orgasm phases, and sexual pain disorders. The purpose of this study is to investigate the changes in sexual function among females with MS whose treatment was switched from first-line injectable medications to other agents after a six-month duration. And assess the changes in all three domains of SD. Methods In this longitudinal study females diagnosed with MS, aged between 18 and 50 years old, and were candidates for switching their treatment from interferon beta-1a (intra-muscular and subcutaneous), and Glatiramer Acetate (GA), to Fingolimod, Dimethyl Fumarate (DMF), or Natalizumab (NTZ) due to patients’ convenience and tolerability and adverse events were included. “Multiple Sclerosis Intimacy and Sexuality Questionnaire-19” was used to evaluate the SD changes before and six months after the new treatment initiation. Statistical analysis was conducted using SPSS V.24 software. Histograms and the Shapiro-Wilk test were used to assess the normality of the variables; due to the non-normal distribution of quantitative variables (except for age), the Wilcoxon signed-rank test was used to compare the scores, before and six months after the medication change. The level of significance was considered less than 0.05. Results Out of 107 female participants (average age: 35.09 ± 5.61), The mean of overall MSISQ-19 scores, before and six months after the medication change were not significant (p-value = 0.091). However, considering the subdomains, the medication changes only affected the tertiary subdomain of MSISQ-19 (p-value = 0.017). Still, the scores of other subdomains did not change significantly (p-value = 0.761 for primary SD and 0.479 for secondary SD). Also, there wasn’t any significant difference between EDSS before and after the medication change (p-value = 0.461). Conclusions To our knowledge, this was the first study, assessing the effect of MS medication change on the improvement of SD among patients. According to the results of the presented cross-sectional study, we found that during a six-month period, the tertiary subdomain of MSISQ-19 symptoms improved significantly, while the changes in other SD domains were not significant.

"nBackground: Nowadays, the treatment of choice for anatomical correction of transposition of great arteries is arterial switch but some children are not good candidates for this operation. In these cases atrial switch or Senning procedure is an accepted method, thus outcome of this procedure needs to be better delineated."n "nMethods: This prospective study included 65 patients that underwent Senning operation in Shahid Rajaee Hospital in Tehran, Iran from 2002 to 2009 and were followed-up for one year."n "nResults: The early and late mortality rates were 16.9% and 1.5%, respectively. 51.8% of early deaths were due to simple Senning procedure, 38.9% due to a Senning with the closure of ventricular septal defect, with or without the repair of pulmonary artery stenosis, 9.3% related to palliative Senning and one late death due to simple Senning. The most common arrhythmia was accelerated junctional rhythm (18.5%). 15% of cases had Senning pathway obstruction and 1.7% had baffle leaks. Regardless of the mortalities, three patients (5.7%) had significant tricuspid regurgitation. Right ventricular systolic dysfunction was found in 13.3% of the cases, primarily in Senning with ventricular septal defect closure (37.5%). One case (1.9%) had visible cyanosis and three (5.7%) had exertional dyspnea but 94.3% of cases remained in functional class I."n "nConclusion: Since the majority of deaths following Senning procedure occur during the first month, especially on the second day post-operatively, assiduity during early post-operative period is crucial. Tricuspid regurgitation or right ventricular systolic dysfunction was not detected in most patients, suggesting optimistic prognosis for these patients.

"nBackground: Coarctation of aorta is narrowing of proximal descending aorta. Interventional procedures such as balloon angioplasty & stent implantation has been progressively in use as alternatives for surgery in increasing number of children with diagnosis of coarctation of aorta. The aim of this study was to evaluate the use of endovascular stent in children with coarctation of aorta."n "nMethods: We evaluated effectiveness and safety of stenting in all patients younger than 18 years old with coarctation and re-coarctation of aorta which treated by stenting between years 2004-9 at rajaei - heart centre in Tehran, Iran. "n "nResults: we studied 53 patients younger than 18 years old with a follow up of six months. Totally 54 stents were implanted. Mean (±SD) age of the patients was 11.6±4.2yrs. Seventeen cases (32%) were younger than 10 years old, and 36 cases (68%) were 10 years and older. Mean (±SD) weight was 39.24±18kg. 16 cases weighting less than 25kg. Peak systolic pressure gradient (SPG) decreased from 46.26±17.07 to 1.03±0.19mmHg after procedure (p

The employee performance evaluation model is a very complex, sensitive process and has a special place in the AJA headquarters, and considering that the future wars are mainly based on joint operations, the designers of military operations should use all the capacities of the real battlefields, including air, space, land and sea for to achieve victory and inflict heavy damage on the other party. The main purpose of this research is to design a model for evaluating the performance of the employees of the Islamic Republic of Iran Army in joint operations, and the research method is descriptive and of an applied development type. The statistical population for the qualitative part includes 10 experts, commanders and managers of strategic levels of AJA and 45 people for the quantitative part.To determine the sample population in the qualitative part, the whole number method and in the quantitative part, the distance estimation method of the mean was used. The data collection tool is library and field study. The experiences of professors and expert community were used for the validity of documents, interviews and questionnaires, and spss software and Cronbach's alpha calculation were used to measure validity.The results of this research show that performance evaluation is one of the most effective monitoring tools for efficiency, empowerment and development and improvement of individual and organizational performance and is associated with meritocracy and meritocracy, meritocracy, meritocracy, and accordingly, meritocracy and the creation of healthy classes. And fair relations motivate managers and employees to work hard

Abstract Today, probiotics are considered to be living microorganisms whose consumption has a certain number of beneficial effects on the consumer. The present study aimed to investigate the effect of a new probiotic extract (Lactobacillus delbrueckii subsp. lactis KUMS Y33) on the differentiation process of human adipose-derived stem cells (hADSCs) into adipocytes and osteocytes and, as a result, clarify its role in the prevention and treatment of bone age disease. Several bacteria were isolated from traditional yogurt. They were evaluated to characterize the probiotic’s activity. Then, the isolated hADSCs were treated with the probiotic extract, and then osteogenesis and adipogenesis were induced. To evaluate the differentiation process, oil red O and alizarin red staining, a triglyceride content assay, an alkaline phosphatase (ALP) activity assay, as well as real-time PCR and western blot analysis of osteocyte- and adipocyte-specific genes, were performed. Ultimately, the new strain was sequenced and registered on NBCI. In the probiotic-treated group, the triglyceride content and the gene expression and protein levels of C/EBP-α and PPAR-γ2 (adipocyte-specific markers) were significantly decreased compared to the control group (P

Despite reaching enormous achievements in therapeutic approaches worldwide, GBM still remains the most incurable malignancy among various cancers. It emphasizes the necessity of adjuvant therapies from the perspectives of both patients and healthcare providers. Therefore, most emerging studies have focused on various complementary and adjuvant therapies. Among them, metabolic therapy has received special attention, and metformin has been considered as a treatment in various types of cancer, including GBM. It is clearly evident that reaching efficient approaches without a comprehensive evaluation of the key mechanisms is not possible. Among the studied mechanisms, one of the more challenging ones is the effect of metformin on apoptosis and senescence. Moreover, metformin is well known as an insulin sensitizer. However, if insulin signaling is facilitated in the tumor microenvironment, it may result in tumor growth. Therefore, to partially resolve some paradoxical issues, we conducted a narrative review of related studies to address the following questions as comprehensively as possible: 1) Does the improvement of cellular insulin function resulting from metformin have detrimental or beneficial effects on GBM cells? 2) If these effects are detrimental to GBM cells, which is more important: apoptosis or senescence? 3) What determines the cellular decision between apoptosis and senescence?

Introduction: Climate and ecosystem changes in coordination with other factors have challengedmany basic paradigms of natural resource management. The purpose of this research was to knowthe correlation between water, energy, and food in Varamin Plain by the method of the mentalmodel and the dynamics of water, energy, and food correlation under political scenarios.Material and Methods: Data and relationships related to the mental model were collectedthrough interviews with the farmers and managers of the region using the Mental Modelersoftware. Data related to the correlation dynamics model was also collected through organizations,regional stakeholders and authoritative articles. The WEF nexus model developed for the studyarea consists of interconnected relationships for modeling water, agriculture and energysubsystems and their interactions. The simulation model was built using Vensim software, and thesimulation period was considered a 20-year period. The equations in each subsystem were createdbased on the basic equations of the system dynamics approach and the causal loop diagrams ofeach subsystem using relationships and positive and negative feedbacks.Results and Discussion: The results of system dynamic modeling showed that the state of surface waterresources and water security of the plain will be 158 million cubic meters and -162 million cubic meters,respectively, during the period of 20 years, which shows the reduction of resources compared to theoriginal situation. The results of the model without applying the scenario showed that the volume of theVaramin Plain aquifer will decrease from 4000 million cubic meters to 2700 million cubic meters duringthe 20-year period. This shows that the policies of providing water resources, including the excessive useof wells, the development of urbanization and the creation of industries, as well as the lack of increase inthe productivity of agricultural water through modern irrigation methods, are the reasons for such aproblem. The application of scenarios for the allocation of the environmental needs of the Bandalikhanwetland showed that the plain will not have the ecological capacity to allocate water to the wetland, sothat in the next 20 years, the water security of the plain will decrease to 180 million cubic meters. Also,applying the scenario of increasing irrigation efficiency without increasing the cultivated area from 58%to 70% was effective in improving the reduction of agricultural water demand and increasing thecultivated area. The increase in cultivated area up to 41,600 hectares had a positive effect on agriculturalwater demand, but more than this amount caused the pressure on water resources to increase. Based onthe limitations of water resources and the reduction of water security in the Varamin Plain, the productionof the plain's products will also face a decrease. Due to its proximity to the city of Tehran, the VaraminPlain plays an important role in meeting the needs of the people of Tehran and the surrounding cities.Conclusion: Examining the results and comparing the data showed that during the 20-year period,Varamin Plain will have an unfavorable situation regarding water resources and food production.The management of the resources of Varamin Plain requires a change in organizational,agricultural and developmental approaches. The development of solar systems in order to meetthe energy needs, the establishment of the wastewater treatment plant in Varamin and thedevelopment of the treatment plant south of Tehran, as well as moving towards sustainablecompression is effective in creating the stability of the plains resources in order to properly exploitthe resources. On the other hand, increasing the irrigation efficiency without increasing thecultivation area can help in balancing the current situation so that with the implementation of thepolicies of the sixth development plan, the demand for agricultural water will be reduced to someextent and the pressure on the underground water resources will be reduced.

Background: Trauma can lead to significant complications and mortality for victims of accidents.Objectives: The present study was conducted to determine the mortality caused by trauma and its related factors.Methods: The present study was conducted using the data available in the Isfahan Trauma Registration System (ITR) and Hospital Information Systems (HIS). The number of 1266 deceased trauma patients who were registered in this system over 18 months (between September 2020 and March 2022) were included in the study and analyzed.Results: Out of 1266 patients who died from trauma, 604 (47.7%) patients experienced early death, 427 (33.7%) delayed mortality, and 235 (18.6%) late mortality. The mechanism and type of trauma, and the pre-impact conditions were significantly different between the three death categories (P

Abstract Background Supportive end-of-life care plays a significant role for patients with cancer. Significantly, art and aesthetics in nursing are regarded as key components of nursing practice. They may contribute to supportive end-of-life care that nurses provide for patients with cancer. Therefore, this study aimed to examine the effectiveness of aesthetic care training on nurses’ perceptions of end-of-life care in patients with cancer. Methods A quasi-experimental study was conducted with two groups of nurses working in the oncology wards of two hospitals in Kerman, Iran. A sample consisting of 100 nurses was selected by census and randomly assigned to an experimental group (n = 49) and a control group (n = 51). The experimental group received educational workshops on aesthetic care over four weekly-held 90-minute sessions. Both groups completed the Oncology Nurses’ Perceptions of End-Of-Life Care (ONPEoLC) Scale before, immediately after, and one month after the intervention. The data were analyzed with SPSS software version 21 using t-test, Chi-square, and repeated measures ANOVA. The significance level was set to p 0.05). Post-intervention mean scores in the experimental and control groups were 187.1 ± 18.22 and 159.11 ± 22.11, respectively, indicating a statistically significant difference between the two groups (P

Abstract This paper proposes a novel bidirectional DC–DC converter with high voltage conversion ratio and capability of cancelling input current ripple. The proposed converter uses two coupled inductors and switched‐capacitor circuit to increase the voltage conversion ratio. The input current ripple at low voltage side can be eliminated for a pre‐selected duty cycle by adjusting special values of magnetizing inductances of coupled inductors. The input current is divided into two paths of the primary winding of coupled inductors that causes the decrease in the current stresses of switches. The proposed converter has five switches that consist the internal diodes of switches to bring about bidirectional power flow and have boost and buck operations. Here, the proposed topology is analysed in all operating modes and the current and voltage stresses of switches, input current ripple cancelling condition and voltage conversion ratio are calculated. Finally, the accuracy performance of the proposed converter is reconfirmed through EMTDC/PSCAD simulation and experimental results for boost operations.