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Background: Endometriosis is an idiopathic gynecological condition affecting women with pelvic pain and infertilityin reproductive ages. Due to preventive and therapeutic effects of soy isoflavones (SI) and broccoli extract (BE) ontumor angiogenesis, inflammation and oxidative stress and since endometriosis is accompanied by chronic inflammation,in this study, we aim to evaluate the potential role of these compounds on the pathological scores of endometriosisand also consider the expression level of the gene markers of autophagy, apoptosis, and oxidative stress in anendometriosis rat model.Materials and Methods: In the present experimental study, 45 mature female Sprague- Dawley rats weighing 220 ±20 g at the age of eight weeks with surgically induced endometriosis was divided into five groups and treated for sixweeks with normal saline (control group), BE, SI, BE+SI by oral gavage, and also Diphereline intramuscularly. Thehistopathological scores of the endometrial implants (0, 1, 2, 3: no, poorly, moderately and well-preserved epitheliallayers, respectively) and the mRNA expression level of Bcl-2, Bax, Caspase-3, Beclin-1, Lc3, and Sod within peritonealtissue were compared among the groups.Results: Pathologic scores of the implants in the Diphereline (1.2 ± 0.27) and BE+SI (1.2 ± 0.41) groups were declinedsignificantly in comparison with the control group (2.08 ± 0.44) (P≤0.001). In the endometriotic structures,the mRNA expression levels of our target genes were improved significantly (P≤0.01) in comparison with the controlgroup.Conclusion: The findings of the current study demonstrated that the simultaneous consumption of a certain amount ofbroccoli extract and SI can be considered as a promising therapeutic strategy for treatment of endometriosis.

Pedestrianization is a prevalent strategy, especially in urban centers, aimed at creating safer and more vibrant environments. However, there remains a conspicuous absence of studies exploring the social consequences of pedestrianization in the Middle East (ME). This research aims to bridge this gap by assessing the social impacts of pedestrianization on Chaharbagh Abbasi Pedestrian Street (ChAPS), a historical social hub of Isfahan, a city in the heart of Iran, which was revitalized from a car-oriented to a car-free street between 2017 and 2020. We focused on five independent factors: social interaction (SI), sense of belongingness (SB), sense of responsibility (SR), security (SEC), and safety (SAF). Data from 984 in-person questionnaires and online surveys were analyzed via SPSS and ArcGIS, and pre- and post-project outcomes were compared. The findings indicate an improvement in SAF, SB, and SI, a negligible change in SEC, and an unexpected decrease in SR post-pedestrianization. Specifically, SI improved for 60% of visitors and 72% of urban residents reliant on public transportation. SAF increased by 97% and 80% for city inhabitants and visitors, respectively, while SEC witnessed minimal progress of under 10% for both groups. Despite SB achieving a remarkable improvement of 93%, SR surprisingly decreased by 21.5% for those living far from ChAPS. The study aligns with the United Nations Sustainable Development Goal (SDG) 11 (Sustainable Cities and Communities), indicating the pedestrianization project’s contribution to social sustainability to a large extent. However, further efforts are needed to fully meet SDG sub-indicators. This study provides practical guidelines for urban planners intending to enhance social sustainability through built environmental planning at the city level in the ME.

Key Clinical Message We report a case of a 21‐year‐old male with stage IIIB sigmoid colon adenocarcinoma who experienced atypical chest pain post‐adjuvant chemotherapy with Capecitabine (5‐FU prodrug). Evaluation revealed an unexpectedly detected interventricular septum hemangioma. Due to the vasospasm effect of chemotherapy presenting with semi‐ischemia, conservative management was chosen for atypical presentation.

Pedestrianization is an urban revitalization strategy to enhance sustainability and livability in car-oriented cities. Despite many studies in this research field, the effects of pedestrianization on the economy of cities in developing countries still need further investigation. Additionally, the impact of this strategy on the tenant mix of commercial and historical areas in Middle East countries is nebulous. To address these inadequacies, we considered Chaharbagh Abbasi street, located in the heart of Isfahan, Iran, and investigated the impact of a pedestrianization project with particular emphasis on how it affects the economic sustainability of existent commercial fabric. Pre- and post-project data along with field observations and quantifications used to assess structural replacements in trade, were analyzed with SPSS and ArcGIS software. The results revealed unexpected outcomes, such as the closure of some traditional businesses (27.5%), a stagnation in sales (69%) and a decrease in job offers (84%) leading the local economy to a fragile situation. Conversely, it was found that the footfall volume increased by 64% and 73% from the retailers’ and pedestrians’ viewpoints. This evolution along with a wide opening of food and beverage stores (approximately 60%) makes the post-pedestrianization results more promising than earlier predictions. In conclusion, these findings reinforce the importance of pedestrian streets in revitalizing economic activities in historical and commercial areas from the perspective of economic sustainability. Due to the lack of similar investigations in Middle East countries, these findings can support decision-makers and urban planners to take preventive measures in preserving the diversity of individual small shops for upcoming urban rehabilitation projects in terms of pedestrianization.

Cerebral amyloid angiopathy (CAA) is a type of cerebrovascular disorder characterised by the accumulation of amyloid within the leptomeninges and small/medium-sized cerebral blood vessels. Typically, cerebral haemorrhages are one of the first clinical manifestations of CAA, posing a considerable challenge to the timely diagnosis of CAA as the bleedings only occur during the later disease stages. Fluid biomarkers may change prior to imaging biomarkers, and therefore, they could be the future of CAA diagnosis. Additionally, they can be used as primary outcome markers in prospective clinical trials. Among fluid biomarkers, blood-based biomarkers offer a distinct advantage over cerebrospinal fluid biomarkers as they do not require a procedure as invasive as a lumbar puncture. This article aimed to provide an overview of the present clinical data concerning fluid biomarkers associated with CAA and point out the direction of future studies. Among all the biomarkers discussed, amyloid β, neurofilament light chain, matrix metalloproteinases, complement 3, uric acid, and lactadherin demonstrated the most promising evidence. However, the field of fluid biomarkers for CAA is an under-researched area, and in most cases, there are only one or two studies on each of the biomarkers mentioned in this review. Additionally, a small sample size is a common limitation of the discussed studies. Hence, it is hard to reach a solid conclusion on the clinical significance of each biomarker at different stages of the disease or in various subpopulations of CAA. In order to overcome this issue, larger longitudinal and multicentered studies are needed.

Background and purpose: Cancer diagnosis is a threatening and traumatic experience. Confusion caused by distressing thoughts about cancer can lead to additional suffering and, along with avoidance, can be a key factor in maintenance of traumatic reactions. The current research aimed at comparing the effectiveness of Unified Protocol (UP) of transdiagnostic intervention and mindfulness based schema therapy (MBST) on posttraumatic avoidance (PA) and chronic illness-related cognitive fusion (CICF) in patients with breast cancer (BC). Materials and methods: A semi-experimental study with pretest-posttest design and a follow-up period of 45 days was performed. Statistical population included all female patients with BC in Mashhad, Iran 2018-2021. Cognitive Fusion Questionnaire-Chronic Illness (CFQ-CI) and Posttraumatic Avoidance Scale (PAS) were administered. Forty one patients were selected using purposive sampling and were randomly divided into two experimental groups and a control group. UP of transdiagnostic intervention and MBST were applied in intervention groups for 10 weekly sessions. The control group attended two educational sessions. Data analysis was done using multivariate covariance analysis and Bonferroni post hoc test. Results: The mean scores for CICF and PA were significantly different between the intervention groups and the control group at post-test and follow-up (P0.05). Conclusion: MBST and UP are suggested to be applied in patients with BC to reduce their psychological problems. (Clinical Trials Registry Number: IRCT20211012128050165N1)

Background and Objectives: Breast cancer is the most commonly diagnosed cancer in women which can cause spiritual distress in them. This study aims to assess the effects of mindfulness-based schema therapy (MBST) and transdiagnostic intervention on spiritual distress of women with breast cancer. Methods: This is a quasi-experimental study (Clinical trial) with a pre-test/post-test/ follow-up design using a control group. Participants were 41 women with breast cancer referred to Omid and Imam Reza hospitals in Mashhad, Iran during 2017-2020, who were selected using a convenience sampling method and randomly assigned into two experimental groups and one control group. For both experimental groups, the intervention was performed at ten weekly sessions. The used instrument was the Spiritual Distress Scale of Ku et al. Data were analyzed using repeated measures analysis of variance and Bonferroni post hoc test in SPSS software, version 25 software. Results: There was a significant difference in the mean scores of spiritual distress in the experimental groups compared to the control group in the post-test and follow-up phases (P0.05). Conclusion: Both transdiagnostic intervention and MBST can reduce the spiritual distress of women with breast cancer.

In this paper, the robust vertex centdian location problem with uncertain vertex weights on general graphs is studied. The used criterion to solve the problem is the min-max regret criterion. This problem is investigated with objective function contains $lambda$ and a polynomial time algorithm for the problem is presented. It is shown that the vertex centdian problem on general graphs is solved in cubic time.

Abstract Background: Ectopic pregnancy (EP) is one of the major causes of maternal mortality during the first trimester of pregnancy. Objective: Four treatment methods for EP including single-dose methotrexate (SD-MTX), double-dose methotrexate, expectant and surgical management were considered. Materials and Methods: In this cross-sectional study, the clinical characteristics of 365 women aged 15-44 yr who had been diagnosed with EP were reviewed from March 2017 to March 2019 in hospitals affiliated to Shiraz University of Medical Sciences, Shiraz, Iran. Receiver operating characteristics curves were plotted to determine the cut-off points for size of ectopic mass and beta-human chorionic gonadotropin (β-hCG) that suitably discriminated between double-dose methotrexate and surgery management. Results: The most common site of EP was adnexa. According to the receiver operating characteristics analysis, surgery was the best plan for the women with an ectopic mass > 34.50 mm in diameter or with an initial β-hCG level > 6419 mIU/ml. The β-hCG levels in the women successfully treated with SD-MTX were significantly lower than in those with failed treatment (p = 0.02). The SD-MTX group had a higher success rate and significantly shorter duration of hospitalization, and so this was a more effective medical treatment in comparison with the double-dose protocol. Conclusion: Surgery is proposed as the best option for the cases with large ectopic mass or high β-hCG level. SD-MTX had a higher success rate and shorter hospital stay than the double-dose protocol, and so was found to be an efficient and safe alternative. Further randomized clinical trials with larger sample sizes are recommended to validate the current results.

Background: The coronavirus disease-2019 (COVID-19), caused by a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is now spread worldwide. Therefore, informative and reliable data related to the exact effects of COVID-19 on fertility and pregnancy is still of great interest until the pandemic is declared over. General guidelines regarding the protection and management of COVID-19 have been published and new information will continue to be updated daily. Methods: In this review, we summarized clinical health guidelines for reproductive and infertility centers to improve quality management in assisted reproductive technology and minimize the potentially harmful consequences of COVID-19 on pregnancy and fertility. Results: As specified in the literature, protocols consist of five categories, including protocols for couples, protocols for women, protocols for men, labor and delivery, and postpartum and breastfeeding. Conclusion: General protocols for patients and staff may vary depending on specific conditions. However, this review provides some rules to ensure their safety against the disease during the pandemic.

Background: Insulin resistance (IR) occurs in 50–70% of women with polycystic ovary syndrome (PCOS) and can be applied as a prediabetic feature in PCOS. Objective: In this study, indirect methods including fasting blood sugar (FBS), fasting insulin (FI), FBS/FI ratio, and quantitative insulin sensitivity check index (QUICKI) were compared with the homeostasis model assessment of insulin resistance (HOMA-IR) as a standard technique. The association of IR to sex hormone-binding globulin (SHBG) and several hormones was also analyzed. Materials and Methods: This cross-sectional study was performed on 74 PCOS women. Sensitivity and specificity of each IR method was calculated based on HOMA-IR. Hormonal profiles of the patients were compared between the groups with defined normal and abnormal values of IR. Results: Triglyceride levels had a positive association with FBS and HOMA-IR (p = 0.002 and p = 0.01, respectively) with a negative association to QUICKI and SHBG (p = 0.02 and p = 0.02, respectively). SHBG showed a significant negative association with FBS (p = 0.001). Dehydroepiandrosterone sulfate showed a positive association with FI (p = 0.002). Seven PCOS women showed abnormal SHBG levels ( < 36 nmol/L) while expressed normal values of the rest of the studied variables. FI and QUICKI had the highest sensitivity while FBS/FI and QUICKI had the highest specificity when HOMA-IR was applied as a standard test. Conclusion: SHBG and triglyceride had a significant negative and positive association with IR, respectively. HOMA-IR followed by FI and QUICKI is the most sensitive test for the detection of IR. SHBG levels can be a helpful biomarker for the diagnosis of PCOS.

Statement of the Problem: The tumor suppressor role of myoepithelial cells and related mechanisms in breast tumors are well understood. However, the role of these cells in tumors of salivary glands is debatable. Purpose: The present study was designed to determine the expression of p63, mammary serine protease inhibitor (maspin) and matrix metalloproteinase 2 (MMP-2) in mucoepidermoid carcinoma (MEC) and adenoid cystic carcinoma (ADCC) of salivary glands due to various cellular differentiation and structure. The association between the expression of these markers and clinicopathologic features and myoepithelial differentiation were also evaluated. Materials and Method: P63, maspin, and MMP-2 expression were immunohistochemically studied in 67 cases including35 cases of MEC and 32 cases of ADCC. The smooth muscle actin (SMA) staining was also applied to confirm the presence of myoepithelial differentiation. Data was analyzed using Chi-square test, Mann-Whitney U test and t-test. Results: The expression of p63 (p= 0.009) and maspin (p= 0.012) significantly differed between the study groups. P63 positive cells in MEC were negative for SMA staining in contrast to ADCC. Furthermore, the expression of P63 (p= 0.045) and maspin (p= 0.019) significantly and inversely correlated with histologic grade in ADCC. Likewise, positive significant correlation was detected between histologic grade and expression of P63 (p= 0.018) and MMP-2 (p= 0.003) in MEC samples. Conclusion: Our findings showed that MEC is devoid of myoepithelial cells. The difference in expression of P63 and maspin in ADCC and MEC highlighted the role and presence of myoepithelial cells in ADCC. Indeed, the high expression of P63 and maspin in well-differentiated ADCCs suggests the tumor suppressor effect of myoepithelial cells. Considering the association between the evaluated markers and histological grade, p63 in both tumors, maspin in ADCC and MMP-2 in MEC may be efficient predictors of clinical behavior.

Background & Objective: Prediction of response to neoadjuvant treatment is an important part of treatment of patients with breast cancer. This study aimed to assess changes in serum levels of Cytokeratin 18 during neoadjuvant chemotherapy in patients with locally advanced breast cancer and its association with neoadjuvant treatments. Methods: This research was performed on newly diagnosed breast cancer patients referred to Omid Radiotherapy Center and radiotherapy and oncology departments of Emam Reza and Ghaem hospitals, in Mashhad, Iran. Serum levels of M30 and M65 fragments of Cytokeratin 18 were measured before and 24 hours after the first course of neoadjuvant chemotherapy. Changes in serum levels of Cytokeratin 18 and its fragments and their correlation with pathologic response were analyzed. Result: Pre- and post-chemotherapy levels of M30 were respectively 223.9±18.94 and 250.7±23.92 U/L (P=0.24). For M65, these levels were respectively 301.5±313.9 and 330.2±352.2 U/L (P=0.1). Changes in M30 level during chemotherapy in patients with and without pathologic complete response were -20±92.69 and 43.1±106.5, respectively (P=0.1). For M65, these changes were respectively -247±55 and 76±240 (P=0.1). Baseline levels of M30 and M65 had no relation with menopausal status, tumor grade, hormone receptor status, Ki67 expression, molecular subtype, and stage. Conclusion: Our findings showed statistically insignificant changes in the level of Caspase-cleaved- (M30) and uncleaved- (M65) cytokeratin 18 fragments (apoptotic and necrotic indicators, respectively) during neoadjuvant chemotherapy in patients with breast cancer. There was no notable relationship between tumor-related factors and either baseline levels or serum changes of CK18 fragments. Also, there was no correlation between M30/M65 level and pathologic response to neoadjuvant chemotherapy.

Ameloblastomas demonstrate various clinical and microscopic patterns. They typically have been described as possessing three biologic variants including solid, cystic (unicystic) and peripheral, of which about 13% to 21% of all cases are unicystic. Granular cell subtype is a rare variant especially when both the inner and peripheral layers of tumoral islands composed exclusively of eosinophilic granular cells. The purpose of this case report is to present a unique case of cystic ameloblastoma with an unusual radiographic and microscopic pattern affecting a 25-year-old female. Awareness of these rare histopathologic features for oral pathologist is essential to help correct diagnosis.

Introduction Breast cancer is one of the most common and worrisome diseases among women all over the world which becomes more difficult with localized relapses and metastases in this disease and the chance of survival is reduced. therefore the effect of various factors on the incidence of metastases can have an important role in the treatment and prevention of disease progression. Materials and Methods In this study, 1959 women with breast cancer who referred to Omid Hospital in Mashhad from 2001 to 2011 were selected and evaluated. To analyze the data, after the imputation of missing data, the method of penalized profile likelihood was used and data analysis was done in the software R. Results The results of the analysis showed that family background, clinical stage, Her2 protein, and T (tumor size) variables had a significant effect on the incidence of metastasis in breast cancer patients. Conclusion According to the results, the stage code and her2 variables, tumor size and family history in all conditions of analysis had a significant effect on the incidence of metastasis in patients with breast.

Background: Mental health problems such as anxiety and disappointment are common in patients with heart disease, resulting in poor outcomes. The purpose of this study was to compare the effectiveness of two methods of relaxation and prayer therapy on anxiety and hope in patients with coronary artery disease (CAD). Materials and Methods: A quasi-experimental study was conducted in three groups of 25 subjects (i.e., two groups of relaxation and prayer therapy and one control group) and two stages (i.e., pretest and posttest) in hospitals affiliated to Isfahan University of Medical Sciences, Iran. Data collection instrument consisted of three parts: (a) demographic and individual characteristics of the subjects, (b) Beck Anxiety Inventory, and (c) Snyder's Hope Scale. The interventions consisted of Benson's relaxation and prayer therapy. Data were analyzed using descriptive and inferential statistics. Results: The results showed that there was a significant difference between the mean score of anxiety after intervention in the three groups which was related to each of the relaxation and prayer therapy group with the control group. Also, the result of analysis of covariance with controlling the effect of pretest revealed significant between-subject effects of interventions on posttest scores of hope (F(2, 71) = 8.55, p = 0.012, ηp2 = 0.12) and anxiety (F(2, 71) = 4.71, p < 0.001, ηp2 = 0.19). Conclusions: Both relaxation and prayer therapy interventions are effective in promoting hope and reducing anxiety in patients with CAD and provide optimal, short-term, and easy-to-follow options for the health team.

Adenomatoid odontogenic tumor is a non-aggressive slow growing epithelial odontogenic tumor with varied clinical and microscopic features. This neoplasm rarely appears as a completely cystic lesion histopathologically; therefore, oral pathologists should be aware of the various histopathologic types of this lesion. The main objective of this case report is to present a rare challenging case of maxillary extrafollicular cystic adenomatoid odontogenic tumor affecting a 28-year-old male.

In January 2001, a flood in Kerman province revealed Jiroft ancient city belonging to 5000 B.C. and there, a treasure of objects with distinctive carvings were discovered. Considering the anonymity of this ancient civilization and its importance, works and motifs left by this civilization are the only available sources of information which can provide valuable information about beliefs, customs, the way of life, and other aspects of said civilization. Present paper aims to identify beliefs of Jiroft civilization in 5000 BC. It seems there are signs of Mithraism in the motifs of Jiroft civilization. Studying the existence of Mithraism ritual in Motifs of Ancient civilization is the main subject of present paper. Geographical and historical situation of Jiroft civilization; then, categorization of works based on type, their shape and application are studied in present paper. Afterwards, Mithraism and its signs are introduced; in addition, the relationship of Jiroft civilization motifs with Mithraism is taken into account. Therefor we have compared signs of Mithraism with motifs of ancient Mithra temples and with soapstone vessels of Jiroft civilization. Many similarities have been observed among Mithraism signs and motifs of Mithra temples with Ancient motifs of Jiroft Civilization. According to the results of present research, it is likely that Jiroft civilization religion in 5000 BC was Mithraism. Library research methods has been used in this study.

Osteoblastoma is a rare solitary osteoblastic bone neoplasm. It is characterized by proliferation of osteoblasts forming trabeculae within a vascular fibrous stroma. There is a variety of jaw bone lesions with very close clinical, radiological and microscopic interrelations, which make diagnosis more challenging. Familiarity with these rare bony lesions is vital for oral pathologists. This report presents a new case of asymptomatic mandibular osteoblastoma occurring in a 43-year-old male

Background & objective: Globally, breast cancer is the most common malignancy among females. Prohibition (PHB)-I, a homologous protein, was initially introduced as a suppressor gene for amplification process. Further, the protein has a key role in the cell cycle and is capable of inhibiting DNA transcription in many cell types. Therefore, its possible role in different types of human malignancies is of interest. The current study aimed at examining the relationship between the tissue distribution of PHB-I and prognostic factors of breast cancer. Method: Paraffin-embedded tissue specimens of 33 patients diagnosed with breast cancer at Omid teaching Hospital, Mashhad, Iran were studied and a commercial monoclonal antibody was used to perform immunohistochemistry (IHC). The relationship between PHB-I tissue expression with age, disease stage, tumor grade and size, as well as hormone receptor status including estrogen (ER) and progesterone (PR) receptors, and Her-2 receptor were evaluated. Results: The Immunohistochemical analysis showed a relative increase in PHB-I tissue expression along with higher tumor grade (P=0.057). In addition, higher expression of ER and PR were observed (P=0.027 and 0.009, respectively). The age of patients and other prognostic factors including Her-2 receptor status and disease stage did not statistically correlate with PHB-I expression. Conclusion: An increased expression of PHB-I was observed in the breast cancer tumors of the current study patients compared with the anatomically healthy margin. Its coloration with some prognostic factors such as disease grade and expression of ER and PR might indicate the PHB-I potential application for diagnostic and patient management purposes.

Objectives: Genital wart is a sexually transmitted disease caused by human papillomavirus (HPV) and is responsible for discomfort, and decreased quality of life and productivity in victims with a high recurrence rate after treatments. This study aimed to compare the efficacy and safety of formaldehyde 5% with cryotherapy for the treatment of female genital warts. Methods: Eighty women with at least two similar genital warts who visited the outpatient dermatology clinic of Shahid Faghihi hospital, Shiraz, Iran, were enrolled in this study. One lesion of each patient was self-treated with formaldehyde 5% in flexible collodion gel once daily for 28 days and the other matched lesion was treated by weekly repeated cryotherapy courses. The number of eradicated lesions and the mean days needed to treat, pain scores, complications and patient satisfaction were compared between the treatment methods. Results: Complete clearance of lesions was observed in 58.7% of formaldehyde-treated lesions compared to 88.7% for cryotherapy (P value = 0.000). With formaldehyde-treated lesions, 51% complained of pain, 36.3% had pruritus, 86.3% had skin dryness, 88.8% complained of burning sensation and 93.7% showed erythema. In the cryotherapy group, 92.5% complained of pain, 15% had burning sensation, 75% showed erythema, 5% had atrophy, 80% developed post-inflammatory hyper or hypopigmentation (PIH) and 92.5% suffered from ulceration. Seventy-five (93%) found it easy to apply and (47) 58% were satisfied with their treatment results. Conclusions: Self-administration of formaldehyde 5% resulted in a lower clearance rate but had better cosmetic outcomes with lower pain scores compared to cryotherapy.

Objective: Central giant cell granuloma and peripheral giant cell granuloma of the jaw and oral cavity are identical in histopathologic features, although they are different in pathogenesis and clinical behavior. The aim of present study was to compare CD 68 and factor VIII related antigen (VIII-RA ) immunoreactivity in central giant cell granuloma and peripheral giant cell granuloma to determine the biologic nature and clinical behavior of these lesions which may lead to a better or new treatment modality. Material and Method: CD68 and factor VIII-RA expression were examined immunohistochemically in 22 cases of central giant cell granuloma (10 aggressive and 12 non- aggressive ) and 19 cases of peripheral giant cell granuloma. The Kruskal-Wallis test followed by the Dunn test was used for data analysis. Results: CD68 expression was observed in approximately 100% of multinucleated giant cells and 50% of mononuclear cells. Overexpression of factor VIII-RA in the endothelial cells of capillary like vessels in the periphery of the lesions was prominent. A statistical significant difference for CD68 intensity score in mononuclear cells among three groups (P=0.016) was observed. Indeed, factor VIII-RA intensity score in the endothelial cells of central giant cell granuloma and peripheral giant cell granuloma showed significant difference (P=0.004). Conclusion: These findings support the histiocyte/macrophage nature of multinucleated giant cells and mononuclear cells. Overexpression and high intensity score of CD68 in mononuclear cells and the high intensity score of factor VIII-RA in endothelial cells represent less aggressive behavior in central giant cell granuloma.

Background and purpose: Despite growing use of energy-saving lamps or compact fluorescent lamps (CFLs), there are concerns about ultraviolet radiation in their output. In this study, the output of CFLs available in Iranian market in the range of infrared, visible, and ultraviolet were measured and the possibility of hydroxyl radical production by their radiation was evaluated. Materials and methods: The spectrum and light intensity of 33 CFLs were recorded by a spectrometer and radiometers equipped with special infrared, visible, and ultraviolet sensors. The possibility of hydroxyl radical production by three lamps with highest ultraviolet emission intensity was examined and fluorimetric signal of the terephthalic acid dosimeters was evaluated. Parameters such as luminescence efficiency, spectrum integral and the output percentage of lamps were determined in different areas of the spectrum and compared with photopeak curve of human vision. Results: In lamps with identical powers, there was no significant difference between the intensity of visible and infrared lights. In ultraviolet radiation, the intensity of daylight CFLs was twice as much as soft white CFLs, which had greater intensity compared to incandescent lights. The infrared intensity in incandescent lamps is ten times more than CFLs. The chemical dosimetry showed that lamps produced by three manufacturers were able to generate hydroxyl radicals in short distances and during long radiations. Conclusion: CFLs’ radiation is considered to be safe at more than one meter distance. However, at shorter distances and long exposures, some lamps may cause damage to eyes and skin due to ultraviolet radiation. Therefore, it is recommended to monitor specifications of CFLs released into the market.

Background: Breast cancer is the most common cancer in women and can have several profound effects on women’s life. Estrogen and androgens reduction cause sexual problems. Reduction of hormones produce problems such as vaginal dryness, vaginal and vulvar tissue thinning, loss of elasticity of the vagina, hot flashes and other problems. Depression in these patients is also a factor in reducing sexuality. Disruption at any sexual stage can cause sexual problems. In this article; we compare sexual dysfunction in patients with breast cancer and healthy people. Methods: According to the women’s case-control study with simple un-randomized sampling method a total of 245 patients with breast cancer in Ghaem and Emam Reza and Omid hospital from july 2011 to july 2013 entered the study. All patients were on follow-up after therapy, and had a therapy portfolio. In order to achieve better results, questionnaires were distributed among 126 healthy subjects that matched our patient group in terms of age and other factors and were used as the control group. Female sexual function index (FSFI) questionnaire was filled out by an independent interviewer and all medical, personal and social ethics were applied. The data was then gathered and the score were analyzed with statistical tests. Results: The study was performed on patients 20 to 50 years, mainly in patients aged 35 to 45 years (51.8%). The average age was 41.44±5.87 years. In our study, the most dysfunction was in sexual desire (57.6%), vaginal moisture (53.1%), sexual excitement (48.2%), orgasm (44.1%), and dyspareunia (52.2%) in breast cancer patients. There was significant difference between two group (P

Background and Aim: Fibrous dysplasia (FD) and ossifying fibroma (OF) are the most important fibro-osseous lesions (FOLs) of the jaws with similarities in radiographic and morphological features while showing completely different biological behavior. Limited studies have been evaluated immunohistochemistry markers, such as osteopontin (OPN) and osteocalcin to help differentiate these two lesions. This study aimed to assess the immunoexpression of OPN and Ki67 as potential markers for differentiation of different FOLs. Materials and Methods: This cross-sectional study was conducted on 12 FD, 19 OF, and eight FOL samples retrieved from the archives of the department of oral pathology. The specimens were examined immunohistochemically using streptavidin-biotin method for OPN and Ki67. The intensity score (IS), proportional score (PS) and total score (TS) were assessed in hard and soft tissue matrix and in mesenchymal cells for Ki67. The data were analyzed by independent samples Kruskal-Wallis. Results: Osteopontin showed positive immunoreaction in both stromal and trabecular components of all FDs and OFs. Among the scores, PS and TS of bone trabeculae were significantly different in FD and OF (P=0.005). Nevertheless, no significant difference was observed in Ki67 expression in mesenchymal cells (P=0.880) and OPN scores in soft tissue matrix between the lesions; their P-value were 0.336, 0.340 and 0.415 for IS, TS, and PS, respectively. Conclusion: Osteopontin can serve as a useful marker for differential diagnosis of FD and OF. However, we suggest evaluation of other NCMPs, especially functionally similar molecules such as bone sialoproteins (BSPs) in FOLs for differential diagnosis.

Coronavirus disease 2019 (COVID-19), a global pandemic, is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Angiotensin-converting enzyme 2 (ACE2) is the receptor for SARS-CoV-2 and transmembrane serine protease 2 (TMPRSS2) facilitates ACE2-mediated virus entry. Moreover, the expression of ACE2 in the testes of infertile men is higher than normal, which indicates that infertile men may be susceptible to be infected and SARS-CoV-2 may cause reproductive disorder through the pathway induced by ACE2 and TMPRSS2. Little is known about the pathway regulation of ACE2 and TMPRSS2 expression in male reproductive disorder. Since the regulation of gene expression is mediated by microRNAs (miRNAs) and long non-coding RNAs (lncRNAs) at the post-transcriptional level, the aim of this study was to analyze the dysregulated miRNA–lncRNA interactions of ACE2 and TMPRSS2 in male reproductive disorder. Using bioinformatics analysis, we speculate that the predicted miRNAs including miR-125a-5p, miR-125b-5p, miR-574-5p, and miR-936 as regulators of ACE2 and miR-204-5p as a modulator of TMPRSS2 are associated with male infertility. The lncRNAs with a tissue-specific expression for testis including GRM7-AS3, ARHGAP26-AS1, BSN-AS1, KRBOX1-AS1, CACNA1C-IT3, AC012361.1, FGF14-IT1, AC012494.1, and GS1-24F4.2 were predicted. The identified miRNAs and lncRNAs are proposed as potential biomarkers to study the possible association between COVID-19 and male infertility. This study encourages further studies of miRNA–lncRNA interactions to explain the molecular mechanisms of male infertility in COVID-19 patients.

The development of new computational approaches that are able to design the correct personalized drugs is the crucial therapeutic issue in cancer research. However, tumor heterogeneity is the main obstacle to developing patient-specific single drugs or combinations of drugs that already exist in clinics. In this study, we developed a computational approach that integrates copy number alteration, gene expression, and a protein interaction network of 73 basal breast cancer samples. 2509 prognostic genes harboring a copy number alteration were identified using survival analysis, and a protein–protein interaction network considering the direct interactions was created. Each patient was described by a specific combination of seven altered hub proteins that fully characterize the 73 basal breast cancer patients. We suggested the optimal combination therapy for each patient considering drug–protein interactions. Our approach is able to confirm well-known cancer related genes and suggest novel potential drug target genes. In conclusion, we presented a new computational approach in breast cancer to deal with the intra-tumor heterogeneity towards personalized cancer therapy.

abstract Medicinal plants have many traditional claims including the treatment of ailments of infectious origin. In the evaluation of traditional claims, scientific research is extremely important. In this study, five homoisoflavonoids named 3-(4'-hydroxybenzylidene)-5,7-dihydroxy-6-methoxychroman-4-one(Autumnalin),3-(4'-hydroxybenzyl)-5,7-dihydroxy-6-methoxychroman-4-one (3,9-dihydro-autumnalin), 3-(3',4'-dihydroxybenzyl)-5,8-dihydroxy-7-methoxychroman-4-one,3-(3',4'-dihydroxybenzylidene)-5,8-dihydroxy-7-methoxychroman-4-one and 3-(3',4'-dihydroxybenzylidene)-5,7-dihydroxy-6-methoxychroman-4-one, were isolated from the bulbs of the plant Scilla persica HAUSSKN. Their structures were established on the basis of extensive spectroscopic analyses such as NMR, MS, IR and UV.

Introduction: Early diagnosis and appropriate treatment is required in esophageal cancer due to its invasive nature. The aim of this study was to evaluate early post-esophagectomy complications in patients with esophageal cancer who received neoadjuvant chemoradiotherapy (NACR). Materials and Methods: This randomized clinical trial was carried out between 2009 and 2011. Patients with lower-third esophageal cancer were randomly assigned to one of two groups. The first group consisted of 50 patients receiving standard chemoradiotherapy (Group A) and then undergoing surgery, and the second group consisted of 50 patients undergoing surgery only (Group B). Patients were evaluated with respect to age, gender, clinical symptoms, type of pathology, time of surgery, perioperative blood loss, and number of lymph nodes resected as well as early post-operative complicate including leakage at the anastomosis site, chylothorax and pulmonary complications, hospitalization period, and mortality rate within the first 30 days after surgery. Results: The mean age of patients was 55 years. Seventy-two patients had squamous cell carcinoma (SCC) and 28 patients had adenocarcinoma (ACC). There was no significant difference between the two groups with respect to age, gender, time of surgery, complications including anastomotic leakage, chylothorax, pulmonary complications, cardiac complications, deep venous thrombosis (DVT), or mortality. However, there was a significant difference between the two groups regarding hospital stay, time of surgery, perioperative blood loss, and number of lymph nodes resected. Conclusion: The use of NACR did not increase early post-operative complications or mortality among patients with esophageal cancer.

Breast cancer is one of the most prevalent cancers that oncologists are faced with in their clinics. The varieties of clinical features of the disease result to very different scenarios in the processes of treatment decision making. While classic factors of stage, grade, age and hormone receptor status are still the criterion for choosing treatment, a very delicate list of other prognostic and predictive factors have been entered to this field over recent two decades. The evidence-based medicine rules to treat patients based on the best evidences that have been found by powered randomized clinical trials. Different panels and guidelines gathering these evidences try to help oncologists to find the best treatment methods through the variable and sometimes contradicting results. As it is always the main objective, increasing the survival rates in addition to the ideal aim of curing the disease is usually the target. Finding the best and the most practical chemotherapy regimen against breast cancer needs to notice the biology of this disease and its varieties along with each individual patient condition. It is clear that not all patients need the most complicated and expensive treatment.

Objective: p16INK4a is a tumor suppressor gene playing a critical role. Researches have indicated the gene to be altered in oral squamous cell carcinoma. Present studies have tried to assess the correlation between p16INK4a expression and INK4a locus mutation in relation to grades and stages of this tumor. Materials and Methods: Expression of p16INK4a was studied immunohistochemically in 58 oral squamous sell carcinoma samples and INK4a locus mutation was determined by polymerase chain reaction (PCR) and conformation sensitive gel electrophoresis (CSGE). Results: Expression of p16INK4a was higher in stage1 compared to stage 2, 3, and 4 (P = 0.234). The difference was not significant in grade 1, 2, and 3 (P = 0.671). The average values of total score (TS) were significantly higher in stage1 compared to stage 2, 3, and 4 (P = 0.035). The average values of complete score (CS) were higher in stage 1 compared to stage 2, 3, and 4 (P = 0.061). The research did not show a significant correlation between lymph node involvement and p16INK4a expression (P = 0.491). It seems that 5.1% (3/58) of samples have mutation in INK4a locus. Conclusion: Loss of p16INK4a expression occurred in initial stages of oral squamous cell carcinoma. Evaluation of TS and CS for p16INK4a might be a useful clinical indicator concerning the tumor. However, gene mutation is believed to have minor rate of genetic alteration in carcinogenesis.

Introduction: Auditory temporal resolution and auditory temporal ordering are two major components of the auditory temporal processing abilities that contribute to speech perception and language development. Auditory temporal resolution and auditory temporal ordering can be evaluated by gap-in-noise (GIN) and pitch-pattern-sequence (PPS) tests, respectively. In this survey, the effect of bilingualism as a potential confounding factor on auditory temporal processing abilities was investigated in early Azari-Persian bilinguals. Materials and Methods: In this cross-sectional non-interventional study, GIN and PPS tests were performed on 24 (12 men and 12 women) early Azari-Persian bilingual persons and 24 (12 men and 12 women) Persian monolingual subjects in the age range of 18–30 years, with a mean age of 24.57 years in bilingual and 24.68 years in monolingual subjects. Data were analyzed with t-test using SPSS software version 16. Results: There was no statistically significant difference between mean gap threshold and mean percentages of the correct response of the GIN test and average percentage of correct responses in the PPS test between early Azari-Persian bilinguals and Persian monolinguals (P≥0.05). Conclusion: According to the findings of this study, bilingualism did not have notable effect on auditory temporal processing abilities.

Introduction: Deployment of set screws with cephalomedullary nails (CMNs) may control rotation and/or dynamization of peritrochanteric femur fractures. We hypothesize equivalent radiographic and ambulatory outcomes for patients treated with CMNs for peritrochanteric femur fractures regardless of set screw use. Methods: CPT code 27245 was utilized to retrospectively identify patients treated with a CMN for peritrochanteric femur fractures at our institutions between January 2011 and December 2017. Of 581 patients identified, 217 met the inclusion criteria. CMN fixation of peritrochanteric femur fractures with and without set screw utilization were compared with respect to fracture collapse and ambulatory status. Results: The difference between mean intra-operative and post-union lateral screw protuberance (▲LSP) were 3.62mm and 2.26mm in the no set screw (NSS) and set screw (SS) groups, respectively. Thus, the NSS group on average had 1.36mm greater fracture collapse than the SS group (p = 0.007) with a LLD of 0.88mm. The relative risks of ambulatory status decline were 0.93 (95 % CI = 0.66–1.31) and 1.74 (95 % CI = 0.41–7.21) when comparing SS to NSS groups in pre-injury independent and cane/walker dependent patients respectively. Discussion/conclusion: Patients who were treated with CMNs without utilization of a set screw had greater fracture collapse compared to patients who underwent set screw deployment. The average difference in fracture collapse of 1.36mm had a resultant difference in leg length difference (LLD) of only 0.88mm. Clinical outcomes, however, as measured by gross ambulatory did not appear to be affected by this change in LLD but studies with larger patient populations are needed to accurately conclude this observation.

Charge transport in topological insulators is notably influenced by moisture and air in the surrounding environment. At present, however, little is known about the detailed composition of the oxidized surface and its impact on the electrical characteristics of these materials. Here, we investigate the surface oxide formation on the topological insulator Bi2Te2Se (BTS) and how this affects its electrical behavior. While ambient exposure of BTS nanoplatelets predominantly creates surface hydroxyl groups, oxygen plasma treatment yields a compact, few-nanometer thick surface oxide layer. The plasma causes p-type doping, accompanied by a decrease of the effective platelet thickness, the interplay of which is manifested in a resistance maximum as a function of plasma treatment time. It is furthermore demonstrated that the structural integrity of the plasma-derived surface oxide is sufficient to enable its use as a gate insulator layer in combination with a top gate. [ABSTRACT FROM AUTHOR]

Cutaneous leishmaniasis is considered as one of the most concerns of the World Health Organization (WHO). The main objective of this study was to use polycaprolactone (PCL) nanofiber scaffolds in order to provide a topical drug delivery system capable of delivering glucantime (glu) and quercetin (qur) to cutaneous leishmaniasis wounds. First, PCL/glu/qur, PCL/glu, and PCL/qur nanofibers were prepared by an electrospinning method followed by characterization through scanning electron microscopy (SEM) and fourier transform infrared spectroscopy (FTIR). Subsequently, we investigated the release of the drugs from nano-scaffolds and anti-promastigote effects. Lastly, the effect of nanobandage was evaluated on 20 female inbred BALB/c mice infected with the parasite. The nanofibers were bead-free and uniform with an average diameter of 224 ± 25 nm and showed a sustained release. Results from in vivo experiments showed that the number of amastigotes and macrophages infected with the parasite and the infiltration of inflammatory cells in mice treated with PCL/qur and PCL/glu/qur nanofibers significantly decreased as compared with those treated with the PCL/glu and PCL nanofibers. Collectively, PCL/glu/qur and PCL/qur nanofibers have promising therapeutic effects in cutaneous leishmaniasis wound healing., Competing Interests: Declaration of Competing Interest The authors declare the following financial interests/personal relationships that may be considered potential competing interests: EffatAlemzadeh reports were provided by Birjand University of Medical Sciences. EffatAlemzadeh reports a relationship with Birjand University of Medical Sciences that includes: employment and non-financial support. - If there are other authors, they 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. Published by Elsevier B.V.)

Neurodegenerative disorders, such as Alzheimer's and Parkinson's diseases, share key characteristics, notably cognitive impairment and significant cell death in specific brain regions. Cognition, a complex mental process allowing individuals to perceive time and place, is disrupted in these conditions. This consistent disruption suggests the possibility of a shared underlying mechanism across all neurodegenerative diseases. One potential common factor is the activation of pathways leading to cell death. Despite significant progress in understanding cell death pathways, no definitive treatments have emerged. This has shifted focus towards less-explored mechanisms like ferroptosis, which holds potential due to its involvement in oxidative stress and iron metabolism. Unlike apoptosis or necrosis, ferroptosis offers a novel therapeutic avenue due to its distinct biochemical and genetic underpinnings, making it a promising target in neurodegenerative disease treatment. Ferroptosis is distinguished from other cellular death mechanisms, by distinctive characteristics such as an imbalance of iron hemostasis, peroxidation of lipids in the plasma membrane, and dysregulated glutathione metabolism. In this review, we discuss the potential role of ferroptosis in cognitive impairment. We then summarize the evidence linking ferroptosis biomarkers to cognitive impairment brought on by neurodegeneration while highlighting recent advancements in our understanding of the molecular and genetic mechanisms behind the condition. Finally, we discuss the prospective therapeutic implications of targeting ferroptosis for the treatment of cognitive abnormalities associated with neurodegeneration, including natural and synthetic substances that suppress ferroptosis via a variety of mechanisms. Promising therapeutic candidates, including antioxidants and iron chelators, are being explored to inhibit ferroptosis and mitigate cognitive decline., 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.)

Knee osteoarthritis (KOA) is a prevalent chronic condition characterized by inflammation and oxidative stress, particularly in individuals over 40. Dietary factors, specifically dietary acid load (DAL), may influence these pathological processes. However, the relationship between DAL and inflammatory markers, oxidative stress, and clinical features in patients with KOA remains unexplored. This cross-sectional study involved 147 participants aged 40 and above diagnosed with moderate to severe bilateral primary KOA. Dietary intake was assessed using a validated food frequency questionnaire, and DAL was quantified using Potential Renal Acid Load (PRAL) and Net Endogenous Acid Production (NEAP) indices. Clinical symptoms were evaluated using the WOMAC Index. Biochemical markers of oxidative stress and inflammation were measured from serum samples. Higher PRAL and NEAP scores were associated with increased levels of thiobarbituric acid reactive substances (TBARS) and total oxidant status (TOS), indicating elevated oxidative stress. Additionally, serum levels of inflammatory markers, including TNF-α and hs-CRP, positively correlated with higher DAL scores. Clinical assessments revealed that increased PRAL scores were related to greater severity of symptoms as measured by the WOMAC Index. This study demonstrates a significant association between dietary acid load and markers of inflammation and oxidative stress in KOA patients. These findings suggest that dietary modifications aimed at reducing acid load may serve as a beneficial adjunctive strategy in managing KOA and improving patient outcomes., Competing Interests: Declarations. Competing interests: The authors declare no competing interests. Ethics approval and consent to participate: All experiments were performed in accordance with the declaration of Helsinki and Zabol University of Medical Sciences ethical guidelines and regulations. The research protocol was approved by the Zabol University of Medical Sciences (ethics code number: IR.ZBMU.REC.1402.110). All participants signed a written inform consent before participating in the study., (© 2025. The Author(s).)

Aims: This study investigates the differences in patient demographics and outcomes between teaching and non-teaching hospitals in Iran. By analyzing these differences, it aims to provide useful information for policymakers to optimize resource allocation, improve patient care, and balance educational and service delivery goals in teaching hospitals., Materials and Methods: In this cross-sectional investigation, both teaching and non-teaching general hospitals were examined. A comprehensive analysis was carried out on 13 non-teaching and 25 teaching hospitals with homogeneity, utilizing Health Information System (HIS) data comprising 10,611,647 records through census sampling in 2019. Before employing the logistic regression models to clarify the relationship between a binary dependent variable (distinguishing teaching or non-teaching hospitals) and independent variables, we utilize the Recursive Feature Elimination (RFE) technique to select the most crucial predictor variables., Findings: the optimal logistic regression model revealed that the teaching status of hospitals played a crucial role as an indirect predictor for variables including referral patients, length of stay (<24 hours), patients with partial improvement, and those who received less than 3 services. It also emerged as a direct predictor for variables such as length of stay (>30 days), patients receiving more than the mean services, death rate, and patients with complete improvement. Moreover, the teaching status had an indirect impact on variables like outpatient cases, length of stay (>30 days), and paraclinical services, while directly predicting variables such as patients with supplementary insurance and vulnerable groups insurance type, rehabilitation services, clinic wards, and length of stay (between 4-30 days)., Conclusion: In Iranian teaching hospitals, we observed an increase in patient numbers, extended length of stay, a rise in both the quantity and complexity of services, and more intricate patient admissions. It appears that small teaching hospitals in Iran have transitioned from being referral centers to functioning as outpatient centers with active clinics.

Background: Metabolic dysfunction-associated steatotic liver disease (MASLD) is the most prevalent chronic liver disease and can affect individuals without producing any symptoms. We aimed to explore the value of serum sirtuin-1 (Sirt-1) in the diagnosis of MASLD., Methods: This case-control study analyzed data collected from 190 individuals aged 20 to 60 years. Anthropometric parameters, demographic information, and serum biochemical variables-including glycemic parameters, lipid profiles, liver enzymes, and Sirt-1 levels-were assessed. The correlation between serum Sirt-1 and biochemical variables was examined using Pearson's correlation coefficient. Receiver operating characteristic (ROC) curve analysis was employed to evaluate the diagnostic value of serum Sirt-1 in the context of MASLD., Results: Serum Sirt-1 levels was significantly lower in the MASLD group (p < 0.001) and was inversely correlated with serum insulin (r = -0.163, p = 0.025), HOMA-IR (r = -0.169, p = 0.020) and triglyceride (r = -0.190, p = 0.009) and positively correlated with serum levels of high-density lipoprotein cholesterol (HDL-C) (r = 0.214, p = 0.003). The area under the curve (AUC) of Sirt-1 to predict the presence of MASLD was 0.76 (p < 0.001, 95% CI: 0.69, 0.82) with a sensitivity of 78.9, specificity of 61.1, positive predictive value (PPV) of 67.0%, and negative predictive value (NPV) of 74.0%. The optimal cutoff, determined using Youden's index, was 23.75 ng/mL. This indicates that serum Sirt-1 levels below 23.75 ng/mL may be indicative of MASLD., Conclusions: The present study demonstrated that serum Sirt-1 levels were significantly lower in patients with MASLD. Furthermore, these levels were correlated with various metabolic parameters, including insulin resistance and the serum lipid profile. A serum Sirt-1 level below the cutoff of 23.75 ng/mL exhibited a significant association with the presence of MASLD, suggesting its potential utility in identifying patients with this condition., Competing Interests: Declarations. Ethics approval and consent to participate: All experiments were performed in accordance with the declaration of Helsinki and Tehran University of Medical Sciences ethical guidelines and regulations. The research protocol was approved by the Tehran University of Medical Sciences (ethics code number: IR.TUMS.MEDICINE.REC.1402.630). All participants signed a written inform consent before participating in the study. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2025. The Author(s).)

The Breast Imaging Reporting and Data System (BI-RADS) category 3 assessment is used for breast imaging findings considered "probably benign," with less than a 2% likelihood of malignancy. It is used to increase specificity by decreasing the number of breast biopsies. It has been validated for mammography, breast US, and emerging indications for use in contrast-enhanced breast MRI. Despite the long-term use of category 3 and numerous published studies that evaluate characteristic imaging findings appropriate for this category, there is still misuse and confusion regarding its accurate use. Imaging findings classified as category 3 require short-term follow-up to assess stability and identify changes that may warrant a biopsy for early diagnosis of breast cancer. Category 3 should not be used in a screening study without a comprehensive diagnostic evaluation that may reveal suspicious features or downgrade a finding to benign. In mammography, category 3 findings are validated for grouped round calcifications, oval circumscribed masses, and nonpalpable asymmetries. In US, category 3 can be applied to oval circumscribed parallel solid masses and complicated cysts. Category 3 can be assigned to clustered microcysts when they are very small or deep in the breast. Recent studies have yielded characteristic findings appropriate for MRI category 3 that are expected to be included in the sixth edition of the BI-RADS atlas. These include oval circumscribed masses with associated T2-hyperintense signal, focal non-mass enhancement, and foci of enhancement with associated T 2-hyperintense signal. Surveillance with short-interval imaging enables radiologists to monitor findings and act early when a change is detected. © RSNA, 2024 Supplemental material is available for this article. See the invited commentary by Cohen and Leung.

Background: Moral distress affects the well-being of health care professionals and can lead to burnout and attrition. Assessing moral distress and taking action based on this assessment are important. A new moral conflict assessment (MCA) designed to prompt action was developed and tested., Objective: To evaluate the utility of the MCA., Methods: All intensive care unit professionals in 3 hospitals were invited to attend a presentation about the MCA and to participate in semistructured interviews that followed the steps of the MCA. Transcriptions of interviews were interpreted by using qualitative content analysis., Results: Analysis of individual interviews of 7 participants and 1 focus group of 3 participants revealed that the MCA was a catalyst for expressing feelings and characterizing moral distress, but optimal use required a facilitator. Participants noted that prevention and amelioration of moral distress were determined by organizational culture issues such as consistent understanding of what can be accomplished in the intensive care unit, resolution of power imbalances among staff, and psychological safety to mention moral issues. Structural determinants included disparate work and education schedules between nurses and physicians. Leader determinants included listening to staff and ensuring accountability to address causes and consequences of moral distress. Education and communication were proposed most often as solutions for moral distress., Conclusions: The evaluation revealed positive and negative features of the MCA. Prevention and amelioration of moral distress require attention to cultural, structural, and leadership issues through education and communication., (©2025 American Association of Critical-Care Nurses.)

Background: The rapid emergence of co-selection between antimicrobials, including antibiotics and disinfectants, presents a significant challenge to healthcare systems. This phenomenon exacerbates contamination risks and limits the effectiveness of strategies to combat antibiotic resistance in clinical settings. This study aimed to investigate the prevalence and characteristics of bacteria in hospital environments that exhibit co-selection mechanisms and their potential implications for patient health, framed within the One Health perspective., Methods: Air and surface samples were collected from seven large hospitals and analyzed to detect antibiotic-resistant bacteria (ARB). The resistance profiles of isolated ARB to various disinfectants were determined. Bacterial species were identified using 16S rRNA gene sequencing, and the presence of antibiotic resistance genes (ARGs) and class 1 integrons (intI1) was investigated., Results: A high percentage (85%) of samples contained ARB, with β-lactam resistance being the most frequently observed. Alarmingly, 94% of isolated ARB exhibited resistance to at least one disinfectant, and 91% demonstrated resistance to three or more disinfectants. Staphylococcus and Bacillus emerged as the dominant genera displaying co-selection. The presence of ARGs, including mecA (associated with methicillin resistance) and qacB (associated with disinfectant resistance), along with intI1, provided further evidence supporting co-selection mechanisms., Conclusion: These findings underscore the critical need for robust antimicrobial resistance surveillance and the prudent use of disinfectants in healthcare settings. Further research into co-selection mechanisms is essential to inform the development of effective infection control strategies and minimize the spread of resistant bacteria., 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 Inc. All rights reserved.)

The advent of non-invasive prenatal testing (NIPT) in the screening of fetal abnormalities has optimized prenatal care and decreased the rate of invasive diagnostic tests. In this retrospective descriptive study, we began with 1874 singleton pregnancies. After exclusion of some cases, the study cohort ended up with 1674 cases. We analyzed the performance of NIPT based on the results of first trimester screening (FTS) using serum screening combined with NT. The cases were also compared to diagnostic testing/pregnancy outcomes. Notably, in the subgroup with FTS risk < 1000, NIPT was reported to be normal in all cases with no false negative results. In the risk group of 1/300-1/1000, NIPT could detect all trisomy 21 cases with one false positive result. Moreover, in the risk group of 1/11 - 1/300, NIPT could detect all cases of trisomy 21, 13 and 18 with low false positive rate. However, the false positive rate for sex chromosomal abnormalities was high. Taken together, the current study confirms the applicability of NIPT as a tool for detection of fetal trisomies with high sensitivity and specificity. Yet, the high rate of false positive results for sex chromosome abnormalities should be considered in the interpretation of the results., Competing Interests: Declarations. Ethics approval and consent to participate: Informed consent has been obtained from all patients. Ethical approval for this study has been obtained from the Ethical Committee of Nilou Lab. All methods were carried out in accordance with relevant guidelines and regulations. Consent to publish: Informed consent has been obtained from all patients. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Introduction: Quantification of dynamic contrast-enhanced (DCE)-MRI has the potential to provide valuable clinical information, but robust pharmacokinetic modeling remains a challenge for clinical adoption., Methods: A 7-layer neural network called DCE-Qnet was trained on simulated DCE-MRI signals derived from the Extended Tofts model with the Parker arterial input function. Network training incorporated B 1 inhomogeneities to estimate perfusion (K trans , v p , v e ), tissue T 1 relaxation, proton density and bolus arrival time (BAT). The accuracy was tested in a digital phantom in comparison to a conventional nonlinear least-squares fitting (NLSQ). In vivo testing was conducted in ten healthy subjects. Regions of interest in the cervix and uterine myometrium were used to calculate the inter-subject variability. The clinical utility was demonstrated on a cervical cancer patient. Test-retest experiments were used to assess reproducibility of the parameter maps in the tumor., Results: The DCE-Qnet reconstruction outperformed NLSQ in the phantom. The coefficient of variation (CV) in the healthy cervix varied between 5 and 51% depending on the parameter. Parameter values in the tumor agreed with previous studies despite differences in methodology. The CV in the tumor varied between 1 and 47%., Conclusion: The proposed approach provides comprehensive DCE-MRI quantification from a single acquisition. DCE-Qnet eliminates the need for separate T 1 scan or BAT processing, leading to a reduction of 10 min per scan and more accurate quantification., Competing Interests: Declarations. Conflict of interest: Ricardo Otazo has a patent on the GRASP technique. Ethical approval: All studies involving human participants were performed in accordance with the ethical standards of the corresponding institutional and/or national research committee., (© 2024. The Author(s), under exclusive licence to European Society for Magnetic Resonance in Medicine and Biology (ESMRMB).)

Purpose: Ectopic pregnancy (EP) is one of the life-threatening disorders in early pregnancy and current strategies are inadequate in its clinical management. There is a need to identify more accurate biomarkers for early diagnosis of ectopic pregnancy., Methods: This case-control study was conducted in a group of 35 women diagnosed with ectopic pregnancy and 31 women with a normal singleton pregnancy. Patients' characteristics including the level of β-hCG, age, body mass index (BMI), and gestational age have been recorded. The plasma levels of cell-free hsa-miR-411, hsa-miR-433, and hsa-miR-524 were examined by qRT-PCR using specific primers., Results: There was no statistically significant difference in maternal age, gestational age, and BMI between the two groups. β-hCG concentrations in EP were significantly lower than normal pregnancy group. Cell-free hsa-miR-411 and hsa-miR-433 had statistically significant differences in concentrations in women with EP and normal pregnancy. hsa-miR-411 and hsa-miR-433 had better diagnostic values for discriminating EP from normal pregnancy. Moreover, hsa-miR-411 and hsa-miR-433 showed a specificity of 61% and 53%, and a sensitivity of 72% and 79%, respectively., Conclusions: hsa-miR-411 and hsa-miR-433 microRNAs concentrations in plasma have potential as a predicting biomarker for early diagnosis of EP. However, further research is needed before using miRNAs in clinical practice for both diagnostic and therapeutic goals., Competing Interests: Declarations. Conflict of interest: The authors declare no potential competing interests. Ethical approval: This study was performed in line with the principles of the Declaration of Helsinki.This study was approved by the ethics committee of Guilan University of Medical Sciences (Approval ID: IR.GUMS.REC.1400.494). Consent to participate: All participants voluntarily filled out the written informed consent form before they joined the study, and they were free to decide whether to attend or decline at any stage with no effect on their medical care., (© 2024. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Background: Rheumatoid arthritis (RA) is an autoimmune disorder that results in joint dysfunction, inflammation, and increased mortality., Hypothesis/purpose: The aim of this study was to evaluate the efficacy of purslane supplements on clinical outcomes, as well as inflammation and antioxidant markers in patients with RA., Study Design: A double-blinded randomized controlled clinical trial., Methods: In this 12-week trial, 86 participants aged between 20 and 79 were divided into two groups. The intervention group (n = 43) received a 500 mg purslane capsule twice a day, while the control group (n = 43) received a placebo capsule of the same shape and dosage., Results: Seventy-seven patients (37 from the control group and 40 from the purslane group) completed the study. Purslane capsule intake significantly declined visual analog scale (53.38 ± 23.81 vs. 26.25 ± 17.27, p ≤ 0.001), swollen joint count (4.42 ± 3.36 vs. 1.60 ± 1.64, p ≤ 0.001), tender joint count (8.20 ± 5.93 vs. 2.78± 2.15, p ≤ 0.001), High-sensitivity C-reactive protein (p ≤ 0.001), disease activity score (DAS28) (5.17 ± 1.30 vs. 3.48 ± 1.20, p ≤ 0.001) and increased Superoxide dismutase (p = .037), and total antioxidant capacity (p ≤ 0.001) changes. Furthermore, Morning stiffness (p=.002) and Physician Global Assessment (p = .026) significantly decreased in the purslane group compared to the placebo group at the end of the trial. There was a significant decrease in tumor necrosis factor-α (2.885 ± 2.068 vs. 2.330 ± 1.121, p = .046), and erythrocyte sedimentation rate (36.52 ± 20.04 vs. 26.70 ± 22.59, p = .007) levels in the purslane group., Conclusion: Therefore, supplementation with purslane could lead to improved clinical outcomes, and inflammatory and antioxidant indicators in RA patients., Competing Interests: Declaration of competing interest The authors declared that there is no conflict of interest., (Copyright © 2024. Published by Elsevier GmbH.)

While breast cancer screening reduces mortality, disparities in access continue to limit equitable care. Medically underserved groups-including American Indian or Alaska Native, Black, Hispanic, disabled, and LGBTQ+ individuals-face significant barriers in accessing screening mammography services. This AJR Expert Panel Narrative Review leverages the National Institute on Minority Health and Health Disparities Research Framework to analyze persistent inequities in screening, focusing on race, ethnicity, socioeconomic status, disabilities, health insurance, and geography. Screening guidelines vary across organizations, complicating access for underserved groups. Legislative efforts, including breast density notification laws and the Find It Early Act, aim to address disparities but remain insufficient. Traditional risk models can yield inconsistent assessments of high-risk status and disparities in appropriate referral for genetic testing and supplemental screening. Emerging technologies like artificial intelligence (AI) promise to reduce these gaps by improving risk assessment and detection accuracy, although clinical integration requires careful evaluation to avoid exacerbating existing inequities. This article underscores the importance of policies and practices that address the needs of disabled individuals and other marginalized populations, focusing on creating inclusive and effective screening systems. Recommendations are provided to guide future research, policy development, and clinical practices aimed at mitigating disparities in breast cancer screening.

Background: In-service training is critical for achieving organizational goals and developing the health workforce. Therefore, this study aimed to identify contextual factors that significantly impact the implementation of in-service training policies for the health workers., Methods: This study employed an inductive qualitative approach, utilizing semi-structured interviews as the data collection method. The target group consisted of human resources managers and experts. Purposeful sampling was conducted using the snowball method. A total of 23 interviews were conducted, and data saturation was achieved. Framework analysis was performed using MAXQDA10 software to analyze the data. To enhance the credibility of the findings, interview transcripts, and the initially extracted codes were shared with participants for verification. Additionally, various methods were employed to ensure the accuracy and reliability of the data, including seeking input and additional comments from two colleagues and one expert familiar with qualitative research, as well as sending the interview transcripts and extracted codes to each participant for correction during the data collection phase., Results: The analysis of the data identified seven themes and 16 subthemes related to the implementation of in-service training for healthcare workers. These themes include social factors, personal characteristics, economic and political factors, crises and epidemics, organizational factors, and legal factors. Social factors, such as social crises and demographic characteristics, can affect the type of training provided. Personal characteristics, including motivation, age, job position, and gender, can influence the implementation of training. Political and economic factors, such as government policies and budget constraints, also play a role. Crises and epidemics present opportunities for relevant training. Organizational factors, such as top management commitment and organizational culture, determine the success of training. Legal factors, including restrictive laws and incentives, impact the implementation of training., Conclusions: The implementation of policies cannot be considered in isolation from contextual factors. Therefore, decision-makers and policymakers should thoroughly identify and analyze the relevant contextual factors when formulating and implementing policies. This approach will enable them to make informed decisions based on the specific context., Competing Interests: Declarations. Ethics approval and consent to participate: This research was part of a Ph.D. thesis supported by Iran University of Medical Sciences, with the ethical approval number IR.IUMS.REC.1397.1326. Informed consent was obtained from all participants, and they were assured that their information would be used solely for research purposes and kept confidential by the researcher. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests., (© 2024. The Author(s).)

Fanconi anemia (FA) is a rare inherited disorder characterized by congenital abnormalities, progressive bone marrow failure, and a predisposition to malignancies. Detecting FA can be challenging, as it involves identifying increased chromosomal sensitivity to DNA cross-linking agents and detecting causative genetic variants via genome sequencing. We report two cases of siblings with FA, both confirmed to have the FANCD2 variant through whole-exome sequencing (WES). The first patient presented with epistaxis, petechiae, ecchymosis, and lower limb edema. The second patient exhibited epistaxis, diabetes, developmental delay, and physical abnormalities. Interestingly, both patients had negative results on the initial chromosomal breakage test with mitomycin C, a commonly used diagnostic tool for FA. However, further investigation with WES revealed the presence of the FANCD2 variant, confirming the FA diagnosis. This case report highlights the challenges in diagnosing FA, particularly when initial screening tests yield negative results. Molecular genetic testing, such as WES, can provide a definitive diagnosis and guide appropriate management strategies. Early and accurate diagnosis is crucial for improving outcomes in individuals with this potentially fatal illness, as promising advancements in treatments such as hematopoietic stem cell transplantation and gene therapy offer hope for addressing FA., Competing Interests: The authors declare no conflicts of interest., (© 2024 The Author(s). Clinical Case Reports published by John Wiley & Sons Ltd.)