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Pulmonary endarterectomy (PEA) surgery is the main curative treatment for chronic thromboembolic pulmonary hypertension (CTEPH). Despite the importance of quality of life (QoL), it is under-reported in clinical studies done on CTEPH. The present study aims to prospectively investigate health-related QoL, determined by the 36-item Short Form Health Survey (SF-36) and the EQ-5D-5L form, in a CTEPH cohort. Consent was obtained from surgical candidates who were referred to the Toronto CTEPH program. QoL forms were collected at baseline, and the 3-month follow-up visit and clinical data were retrospectively reviewed (Table 1). 32 subjects (15 men, 17 women; age range, 22-74y) were studied from 59 surgical cases from April 2021- June 2022. EQ-5D-5L health states were directly converted into country-specific utility index values using a Canada-specific value set. SF-36 questions were categorized into 8 domains and scored on a 0-100 scale. Responses at the two time points were compared using a paired t-test analysis with p values less than 0.05 considered statistically significant. SF-36 analysis showed a significant improvement in 5 of the 8 domains, most substantially in physical functioning and vitality (Fig. 1A). Significant improvements were also observed in the physical component summary score but not in the mental component summary score (Fig. 1B). EQ-5D-5L results demonstrated a significant increase in the mean visual analogue scale (VAS) score, a self-reported numerical indicator of patient health, from 55.66±22.10 at baseline to 68.81±18.24 at post-op (Fig. 1C). The significant improvement in the mean utility index score from 0.69±0.20 to 0.80±0.12 further supported the VAS score findings (Fig. 1D). Given that pulmonary hypertension can lead to physical activity restrictions that would necessitate lifestyle changes, these post-treatment improvements in patients' QoL demonstrate the importance and success of PEA. [ABSTRACT FROM AUTHOR]

INTRODUCTION: Cholestatic liver diseases are characterized by impaired hepatocellular secretion of bile, resulting in intracellular accumulation of bile acids which result in a shift in the oxidant/prooxidant balance in favor of increased free radical activity and injury of different tissues including liver and intestine. The aim of this research was to study protective effect of lipoic acid (LA) as a potent antioxidant in cholestasis induced hepatic and intestinal injury in rats. MATERIALS AND METHODS: Forty five adult male Wistar rats were randomly assigned to four groups each containing fifteen rats as follows: sham operation (SO) (control), bile duct ligating (BDL), and BDL+LA (25 mg/kg). After fourteen days hepatic and intestinal tissue sampled and blood serum sampled for pathologic and biochemical studies. RESULTS: Levels of SOD and GPx antioxidant enzymes were higher in BDL+LA group comparing to BDL group, levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST) and γ-glutamyltranspeptidase (GGT), and pathologic scores in liver and intestine were lower in BDL+LA group comparing to BDL group significantly, but there is no significant difference in concentrations of total bilirubin between groups. CONCLUSIONS: Our results showed the protective potential of LA with liver and intestine damage. Despite improvements in operative technique and the development of potent, broad-spectrum antibiotics, biliary tract surgery in patients with obstructive jaundice is still associated with high morbidity and mortality rates In summary, our results show that BDL induced hepatic and intestinal injury were significantly attenuated by LA administration and the administration of LA could effectively diminish this damage. [ABSTRACT FROM AUTHOR]

Proprioceptive inputs have crucial roles in control of the posture. The aim of the present study was to assess the effect of interfering with these signals on postural stability by ice-induced anaesthesia and local calf muscle fatigue. Seventeen healthy young individuals participated in this study to stand quietly and on an unstable platform under normal, anaesthesia, and fatigue conditions. A force platform calculated excursions of centre of pressure. Stabilogram-diffusion analysis was utilised to evaluate how body controls the posture with and without proprioceptive inputs. Time intervals of using the sensory feedback is significantly increased by anaesthesia in quiet standing (430 ms, p  = 0.034) to note more delayed use of sensory information in a closed-loop. Additionally, fatigue significantly increased the time intervals of using sensory feedback during standing on the unstable platform (290 ms, p  = 0.016). Interestingly, sensory interventions had no effect on the stability of the open-loop control of posture (short-term control), but they significantly influenced the closed-loop control (long-term control) ( p  < 0.004). Specifically, fatigue led to increased instabilities when the body used sensory inputs during both quiet standing ( p  = 0.021) and standing on the unstable platform ( p  = 0.041). These findings highlight the importance of proprioception in balance control for healthy individuals. Interfering with proprioceptive inputs, either through anaesthesia or fatigue, resulted in instabilities during balance maintenance. Our study provides new insights into the mechanisms underlying postural control, emphasising the significance of proprioceptive inputs. Understanding how proprioception affects balance maintenance may have implications for rehabilitation strategies, injury prevention, and the development of interventions to improve postural stability.

Prolonged droughts and rising water demand have worsened water disputes in the transboundary Helmand basin, shared by Afghanistan and Iran. While both countries have built water storage reservoirs to mitigate water shortages, evaporative losses from these reservoirs reduce their effectiveness. This issue intensifies challenges over water shortages in the region without reliable monitoring data. In this study, reanalysis and remote sensing data was used to calculate the rate of water evaporation from the major water reservoirs located in Helmand basin. Additionally, globally available moisture trajectory datasets were used to analyze where the evaporated water from these major storage reservoirs eventually falls as precipitation. Our main focus was on quantifying how much of this water precipitates outside the Helmand Basin. Our results indicate that evaporative losses of blue water from reservoirs in this transboundary river basin have reached to 284 million cubic meters in 2023. Additionally, our results indicate the presence of a teleconnection, whereby a significant portion of the water evaporated from these reservoirs is transported and then precipitates outside the Helmand Basin, reaching up to an annual average of 92%. The largest portion of this evaporated water was received as precipitation by India, Pakistan, Afghanistan and China, accounting for 25%, 19%, 16% and 6%, respectively. This study provides a real-world example of how improved water intelligence and transparency, achieved through remote sensing data and modelling, can support water diplomacy and conflict resolution in transboundary basins., 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 © 2025 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Introduction: The financial stability of hospitals directly impacts their ability to fulfill their primary mission of enhancing healthcare. This study identifies and prioritizes cost reduction and revenue enhancement strategies for Iranian hospitals., Method: This investigation employed a mixed-methods design, incorporating both qualitative and quantitative approaches. A systematic review of scholarly articles was initially conducted to identify key strategies for cost reduction and revenue enhancement in hospitals. Insights from hospital administrators regarding successful practices and recommended financial improvement measures were subsequently collected through surveys. The combined strategies from these phases were then assessed and ranked using the TOPSIS technique., Findings: This study identified 12 primary strategies and 71 sub-strategies across four dimensions. Notably, strategies aimed at enhancing the quality of care (0.9030), refining process quality (0.7926), and bolstering care provision infrastructure (0.7910) were deemed the most critical. Among the sub-strategies, priority was given to implementing a comprehensive health information system (HIS) (0.7926), identifying and reducing the causes of cancelled surgeries and visit appointments (0.7919), and developing strategies to decrease hospital infection rates (0.7854)., Conclusion: Enhancing the quality of care and upgrading service delivery processes are crucial for improving hospitals' economic performance. Elevating service quality not only improves the economic performance of hospitals but also enhances their financial metrics., Competing Interests: Declarations. Ethics approval and consent to participate: The ethics committee of the Baqiyatallah University of Medical Sciences (BUMS) approved this study (Approval ID: IR.BMSU.REC.1399.205). Informed consent was obtained from all participants prior to their involvement in the study. All participants were provided with detailed information regarding the study's purpose, procedures, and potential risks, and they were assured of their right to withdraw at any time without any negative consequences. Their consent was documented through signed consent forms. All experiments were performed in accordance with relevant guidelines and regulations. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

Dam reservoirs are at the core of local water storage and supply, especially in water-stressed regions of the world with acute water shortage problems. However, evaporative losses from these reservoirs and their storage efficiency are often overlooked in water budgeting. We offer a mechanistic approach that combines physically-based modeling with remote sensing information of reservoir characteristics to reliably predict evaporative losses from dam reservoirs. The developed framework is used to predict evaporative water losses from potential dam reservoirs in different basins worldwide. We apply this framework to 10 of the largest dam reservoirs in the world's water-stressed regions to quantify evaporative water losses. Our analysis, spanning from 2000 to 2020, reveals considerable variations in annual evaporation rates in the reservoirs located in water-deprived regions exceeding 3200 mm/year during the study period with the total evaporative loss reaching 26.5 km 3 /year. The evaporative water loss accounts up to 15.8% of the storage capacity in one of the dam reservoirs, posing significant challenges for water allocation and conservation strategies, with notable economic and environmental consequences in regions already suffering from water scarcity., 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 The Authors. Published by Elsevier Inc. All rights reserved.)