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Background: Asthma, as a physical disease, is influenced by psychological problems, and resilience is a positive adaptation to reacting to adverse conditions. This study aimed to resolve the mediating role of resilience in the relationship between perceived social support and self-care in patients with asthma. Materials and Methods: Research method of the present study is a descriptive-correlational study based on structural equation modeling technique. The statistical population of the study was all patients with asthma in the specialized asthma clinic of Sayad Shirazi hospital in Gorgan (N=200). According to the sample size, 127 people were selected through the Grace-Morgan table and entered the study. The research instruments were Simet et al.'s (1988) perceived social support scale, Connor and Davidson (2003) resilience questionnaire, and Niknam et al.'s (2013) self-care behavior questionnaire. For data analysis, path analysis method was used in Amos and SPSS-24 software. (Dates and dar Dastres have been neglected) Results: The results of model analysis showed that the initial model has a good fit with the data. The study of mediating role showed that resilience has a significant mediating role in the relationship between perceived social support and self-care behavior, also. Conclusion: These findings indicate that resilience and perceived social support are variables upsetting self-care of patients with asthma. These results have important implications for psychopathology, prevention and treatment of patients with asthma.

Ghafar Ali Mahmoudi,1 Peyman Astaraki,1 Azita Zafar Mohtashami,1 Maryam Ahadi2 1Faculty of Medicine, Department of Internal Medicine, Lorestan University of Medical Sciences, 2Legal Medicine Research Center of Lorestan, Khorramabad, Iran Abstract: N-acetylcysteine (NAC) is used widely and effectively in oral and intravenous forms as a specific antidote for acetaminophen poisoning. Here we report a rare case of iatrogenic NAC overdose following an error in preparation of the solution, and describe its clinical symptoms. Laboratory results and are presented and examined. A 23-year-old alert female patient weighing 65 kg presented to the emergency ward with weakness, lethargy, extreme fatigue, nausea, and dizziness. She had normal arterial blood gas and vital signs. An excessive dosage of NAC over a short period of time can lead to hemolysis, thrombocytopenia, and acute renal failure in patients with normal glucose-6-phosphate dehydrogenase, and finally to death. Considering the similarity between some of the clinical symptoms of acetaminophen overdose and NAC overdose, it is vitally important for the administration phases and checking of the patient's symptoms to be carried out attentively and cautiously. Keywords: N-acetylcysteine, overdose, acetaminophen poisoning, medication error

This work proposes new and accurate systematic methodologies for ex situ measurements of through‐plane thermal and in‐plane electronic conductivities of catalyst layers (CLs) of polymer electrolyte membrane fuel cells (PEMFC). The developed methods are based on measurements of different thicknesses/lengths of a CL on different substrates. Suitability of the proposed methods is confirmed through a set of microstructural properties measurements on a typical CL design to ensure the measured CLs would be representative of CLs in a real fuel cell product. Conductivity measurements of two CL designs with different compositions and microstructures confirm capability of the developed procedures to track structural changes in CLs. The present characterization platform is not limited to CLs and may be used for other composite porous materials with similar structures. [ABSTRACT FROM AUTHOR]

The dynamic effects of pair correlation functions (pcf) on spin relaxation by translational diffusion in infinite two-dimensional fluids are considered explicitly through a Smoluchowski equation, for the usual conditional probability, with appropriate boundary conditions, especially at the contact separation of the interacting pair of molecules. The solution of this equation by finite difference techniques permits the calculation of time correlation functions, spectral densities, and spin-relaxation rates associated with a dipolar relaxation mechanism between the spin-bearing molecules. Comparison of the two-dimensional spin-relaxation results obtained with different pcf is presented. The spectral densities and spin-relaxation rates are indeed found to be significantly altered by the pcf. For example, for a nonuniform pcf, the two-dimensional spectral densities, at (and above) the Larmor frequency ω0, are greater for translational correlation times τt that are an order of magnitude faster than τt=ω-10 which provides the maximum spectral density in bulk theory. This fast motion result is consistent with the two-dimensional dynamical results found by other techniques. Moreover for a nonuniform pcf and a single translational correlation time, two well-defined minima are found in the variation of the spin-lattice relaxation time with the diffusion coefficient. This could be very useful for interpreting the spin-relaxation data of diffusing complexes in clays, intercalation compounds, and bilayers. [ABSTRACT FROM AUTHOR]

Abstract Gas diffusion layers (GDLs) provide pathways for water removal in a polymer electrolyte membrane (PEM) Fuel Cell. Woven GDLs, have shown higher capability to retain water and improve performance under humid conditions compared to non-woven GDLs. In this work, we investigate water transport, distribution and location of breakthrough in woven GDLs using fluorescent microscopy. GDLs with no coating, 30, and 55 wt% fluorinate ethylene propylene (FEP) were investigated. FEP increases hydrophobicity and affects thermal and electrical conductivities. The results show that the FEP-treated GDLs have higher breakthrough pressures and water contact angles than non-treated GDLs. For untreated samples, water breakthrough occurs in non-compressed regions; whereas, for FEP-treated samples emergence occurs in the compressed regions. Furthermore, water was observed to first cover visible pores inside the GDLs prior to breakthrough. Increasing FEP loading promotes the propagation of water inside the GDLs. Thermal conductivity is found to improve with FEP coating and attains a maximum at 30 wt% FEP loading, whereas electrical conductivity decreases with increasing FEP loading. This analysis shows more pores are engaged in water transport with higher FEP loading. Implementation of woven GDLs in fuel cell design requires a balancing of the water and heat transport benefits with the reduced electrical conductivity. Graphical abstract Image 1 Highlights • Effect of different FEP loading on water breakthrough is investigated for woven GDLs. • Water transport of woven GDLs was visualized employing fluorescent microscopy. • The optimum FEP coating for thermal conductivity is 30 wt% among samples (0 and 55). • Water propagate in treated GDLs and the breakthrough happens in compressed regions. [ABSTRACT FROM AUTHOR]

The primary purpose of the speed limit system is to enforce reasonable and safe speed. To reduce secondary problems such as accidents and queuing, Variable Speed Limits (VSL) has been suggested. In this paper VSL is used to better safety and traffic parameters. Traffic parameters including speed, queue length and stopping time have been pondering. For VLS, an optimization decision tree algorithm with the function of microscopic simulation was used. The results in case of sub saturated, saturated and supersaturated at a bottleneck are examined and compared with the Allaby logic tree. The results show that the proposed decision tree shows an improved performance in terms of safety and comfort along the highway. The VSL pilot project is part of the Road Safety Improvement Program included in Iran's road safety action plan that is in the research process in the BHRC Research Institute, Road and Housing & Urban Development Research that is planned for next 10-year Transportation safety view Plan. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to put forward the effect of different turbulence closure models on an enhanced Moving Particle Semi-implicit (MPS) method for solving continuity and momentum equations of viscous fluid. MPS method is a mesh-free Lagrangian method capable of solving non-linear governing equations and simulating complex free surface flow circumstances. Various turbulence closure models are added to a MPS program and applied it to different fluid mechanic problems to investigate the effect of these types of closure. Dam break simulation outcome indicates that the two-equation k -- ∈ turbulence model improves free surface estimation accuracy most. It also shows that type of utilized Kernel function has no significant efficacy on stability when the effect of turbulence is included. Further, an algorithm called Incomplete Conjugate Cholesky Gradient (ICCG) is applied for computing pressure implicitly. Applying developed model to well-known sample problems cited in the literature represents that using turbulence closure models can enhance the prediction of developed model as well as stability of the simulations. [ABSTRACT FROM AUTHOR]

The possible role of cochlear function in tinnitus generation is still a matter of debate. To assess the role of outer hair cell dysfunction in tinnitus and its possible relationship with ultra-high frequency (UHF) hearing sensitivity, transient evoked otoacoustic emissions (TEOAE) and UHF hearing thresholds were investigated in normal hearing individuals with and without tinnitus. Eighteen individuals with tinnitus and 22 without tinnitus participated in this study. TEOAE was recorded with click stimulus at 80 dBpeSPL. UHF pure tone audiometry was performed at 10, 12.5, 16, and 18 k Hz. The individuals with tinnitus had significantly poorer UHF hearing sensitivity compared to the control group at 12.5 and 18 k Hz (p<0.048). TEOAE was significantly abnormal in 72.2% of the tinnitus, and 18.2% of the control groups (p=0.001). 'There was a stronger correlation between increasing UHFs hearing threshold and decreasing SNRs of TEOAEs in the tinnitus group compared to the controls. The results support the deafferentation hypothesis, which suggests that the cochlear damage triggers tinnitus incidence, even in patients with normal hearing sensitivity on conventional audiometry, and considers a deafferentation as the underlying cause that elicits central reorganization and eventually leads to tinnitus. The deafferentation hypothesis provides a rationale for performing UHF threshold and OAE assessments in subjectively normal hearing patients with tinnitus. Our study revealed poorer UHF hearing thresholds and more TEOAE abnormalities in normal hearing individuals with tinnitus compared to the controls. Perhaps the alterations in the basal cochlea, following a decrease in UHF hearing sensitivity, affect OAEs that are originated from more apical cochlear parts in tinnitus ears more than non-tinnitus ears. [ABSTRACT FROM AUTHOR]

Tinnitus can cause functional or even structural changes at cortical regions. Given the possible role of the inferior colliculus (IC) in tinnitus due to the distribution of lateral inhibition and receiving input from top-down pathways, we investigated whether tinnitus can also affect subcortical regions, mainly the IC. Auditory brainstem responses to click (cABR) and speech stimuli (sABR) were recorded in 18 individuals with tinnitus and 22 controls without tinnitus matched based on their ages and genders. All subjects had normal hearing sensitivity. Latencies of cABR in waves V and Vn, as well as interpeak latencies (IPLs) of III-V and I-V were significantly longer in individuals with tinnitus compared to the controls. Individuals with tinnitus presented significantly longer latencies of all sABR waves than the control group. The tinnitus patients also presented significant decrease in the amplitude and slope of the V-A complex and declined encoding of the first and higher formants. A combination of bottom-up and top-down processes were involved in the impaired timing in the individuals with tinnitus. The deficits in the auditory processing at the subcortical level (presumably the mi dBrain) could be caused by abnormal bottom-up inputs (i.e. those from more peripheral auditory structures) or abnormal top-down inputs (i.e. abnormal modulations from more central structures through efferent pathways. As a main possible generator of late waves of cABR and all waves of sABR is the IC, these findings indicate that the subcortical regions, particularly the IC, may undergo maladaptive plasticity following tinnitus. The consistency between the results of cABR and sABR indicated that tinnitus might affect the processing of simple and complex stimuli in the same manner. [ABSTRACT FROM AUTHOR]

Tailor-made notched music training (TMNMT) is a novel treatment approach that aims to reverse maladaptive plasticity by inducing lateral inhibition (LI) at the level of the auditory cortex. By considering the possible role of the inferior colliculus (IC) in tinnitus due to the distribution of LI and receiving input from top-down pathways, it has been hypothesized that the short-term application of TMNMT can also reverse maladaptive subcortical plasticity resulting from tinnitus. Auditory brainstem responses' to complex stimuli (cABR) were recorded in nine normal-hearing individuals with tinnitus (4 males). The TMNMT was accomplished compressively during 5 contiguous days. The effects of shortterm intensive TMNMT on the cABR component, tinnitus loudness, and tinnitus handicap inventory (THI) scores were investigated. The latency of cABRs in wave V (p=0.041) was shorter after music training than before, however, there was no significant difference in other components of cABR (p>0.086). There was a significant difference in visual analog scale (p=0.027) and loudness matching (p=0.011) measurements before versus after TMNMT. No significant difference was observed in THI scores (p=0.307) before and following the musical intervention. 'Tire possible explanation for cABR changes following TMNMT is the reverse hierarchy theory (RHT). The RHT argues that top-down processes can influence neural encoding at the level of the brainstem and therefore sensory processing. Following frequent exposures, the higher levels which generally receive input from lower levels will also affect the encoding of stimuli by lower levels. This finding indicated prompt neural reorganization of the brainstem in tinnitus patients with exposure to TMNMT. It seems that TMNMT may partially reverse maladaptive plasticity at the subcortical level; however, the recovery was partial. [ABSTRACT FROM AUTHOR]

Anaplastic thyroid cancer (ATC), a rare and highly aggressive malignancy, is characterized by an exceptionally poor prognosis, where the majority of patients present with extensive local invasion and/or distant metastases. 20-30% of ATCs harbor the BRAF-V600E mutation. Neoadjuvant BRAF-targeted therapy may have the potential to downstage and facilitate surgical resection for patients with locally advanced and unresectable primary tumors with BRAF mutation and may convey a survival advantage in those with metastatic disease. There is emerging evidence to support the use of other targeted agents, including multikinase inhibitors, as well as the incorporation of immunotherapy into the treatment regimen. Rapid molecular and pathological diagnosis and expert multidisciplinary discussion at specialized treatment centers are critical to expedite investigations and initiate treatment for this complex and rapidly progressive disease., (© 2024 The Author(s). Asia‐Pacific Journal of Clinical Oncology published by John Wiley & Sons Australia, Ltd.)

The presence of mineral pollutants, combined with bacterial contamination, has significantly impacted groundwater quality and led to various health-related issues in mining-impacted areas. Therefore, we measured the concentration of fluoride (F - ), phosphate (PO 4 3- ), sulphate (SO 4 2- ), ammonium (NH 4 + ), nitrate (NO 3 - ), the total coliforms (TCs), and physiochemical characteristics in groundwater samples of South Khorasan, Eastern Iran. For this, we collected water samples from 100 wells in spring and autumn across this mining-impacted area. We then measured the concentrations of mineral pollutants and assessed their associated health risks to children and adults using the Environmental Protection Agency (EPA) models and spatiotemporal zoning maps in ArcGIS. The concentrations of PO 4 3- , NH 4 + , SO 4 2- , NO 3 - , and F - were 0.70 ± 0.34, 0.82 ± 0.9, 175.45 ± 123, 15.26 ± 9.41, and 0.53 ± 0.68 mg/L in spring, and 0.71 ± 3.18, 4.68 ± 31, 306.72 ± 615.80, 19.30 ± 15.61, and 0.72 ± 0.65 mg/L in autumn, respectively. PO 4 3- , NH 4 + , and SO 4 2- exceeded both the World Health Organization (WHO) and EPA, but NO 3 - exceeded only EPA standards. TCs in both seasons exceeded the standards set by the EPA and WHO. The hazard quotient (HQ) values indicated non-carcinogenic risks for F⁻ and NO 3 ⁻, while posing no risks NH 4 ⁺ and PO 4 3 ⁻ in both adults and children during autumn and spring.Hazard index (HI) was greater than 1 for all minerals in both children and adults in autumn and spring. No correlation was observed between mineral compounds and TCs in the study area, yet the water samples were highly contaminated by coliform with a significant risk to adults and children. In essence, both mineral pollutants and TCs potentially pose serious risks to human, and more efforts are required to improve the quality of water in this area., (© 2024. The Author(s).)

Background: The distinction between normal and high blood pressure remains a debated topic, with varying guidelines on when to start medication. Contemporary guidelines advocate for the initiation of antihypertensive therapy in individuals who present with high-normal blood pressure, particularly those exhibiting elevated 10-year atherosclerotic cardiovascular disease (ASCVD) risk scores. Despite these recommendations, there is a notable lack of direct evidence supporting the efficacy of treating high-normal blood pressure to prevent major adverse cardiovascular events (MACE)., Methods: The PRINT-TAHA9 trial, a unicentric, randomized, open-label, controlled, parallel clinical study, seeks to explore the effects of intensive blood pressure control on MACE in participants with high-normal blood pressure. We will enroll 1620 adults aged 18 years and above with a systolic blood pressure range of 130-140 mmHg, diastolic blood pressure under 90 mmHg, and atherosclerotic cardiovascular disease (ASCVD) risk score exceeding 7.5%. The study will be executed in five distinct phases, with each phase enrolling between 300 and 400 participants. Participants will be randomly assigned to either the treatment group receiving antihypertensive medication (amlodipine/valsartan) and a low-salt/low-fat diet or to the control group receiving a similar diet. Follow-up visits are scheduled every 6 months over a 3-year period to monitor blood pressure, evaluate medication adherence, document any adverse events, and adjust the intervention as necessary. Cox proportional hazards regression analysis will be employed to examine the disparities between the two arms., Discussion: Despite guidelines promoting early treatment of elevated blood pressure, the debate continues due to insufficient evidence that such interventions significantly reduce the occurrence of MACE. This trial seeks to address this critical evidence gap., Trial Registration: The PRINT-TAHA9 trial was registered in October 2019 with the Iranian Registry of Clinical Trials (IRCT.ir) under the registration number IRCT20191002044961N1. https://irct.behdasht.gov.ir/trial/43092 ., (© 2024. The Author(s).)

Background: Data on the epidemiology of inflammatory bowel disease (IBD) in the Middle East are scarce. We aimed to describe the clinical phenotype, disease course, and medication usage of IBD cases from Iran in the Middle East., Methods: We conducted a cross-sectional study of registered IBD patients in the Iranian Registry of Crohn's and Colitis (IRCC) from 2017 until 2022. We collected information on demographic characteristics, past medical history, family history, disease extent and location, extra-intestinal manifestations, IBD medications, and activity using the IBD-control-8 questionnaire and the Manitoba IBD index, admissions history, history of colon cancer, and IBD-related surgeries., Results: In total, 9746 patients with ulcerative colitis (UC) (n=7793), and Crohn's disease (CD) (n=1953) were reported. The UC to CD ratio was 3.99. The median age at diagnosis was 29.2 (IQR: 22.6,37.6) and 27.6 (IQR: 20.6,37.6) for patients with UC and CD, respectively. The male-to-female ratio was 1.28 in CD patients. A positive family history was observed in 17.9% of UC patients. The majority of UC patients had pancolitis (47%). Ileocolonic involvement was the most common type of involvement in CD patients (43.7%), and the prevalence of stricturing behavior was 4.6%. A prevalence of 0.3% was observed for colorectal cancer among patients with UC. Moreover,15.2% of UC patients and 38.4% of CD patients had been treated with anti-tumor necrosis factor (anti-TNF)., Conclusion: In this national registry-based study, there are significant differences in some clinical phenotypes such as the prevalence of extra-intestinal manifestations and treatment strategies such as biological use in different geographical locations., (© 2024 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

Treatment of keratoconus is one of the most interesting research fields for researchers in the world. Regenerative medicine based on human stem cells in the treatment of keratoconus has recently received attention. Despite extensive laboratory and animal studies in regenerative medicine of cornea, there are limited clinical studies in keratoconus. These studies showed promising results of stem cell therapy. In initial studies, the transplantation of these cells into stroma was associated with increased vision and improved corneal parameters without side effects. In this article, we tried to review different aspects of keratoconus stem cell therapy, including cell extraction and culture, surgical procedure, effectiveness and safety of this method in human clinical studies., (© 2024. The Author(s).)

Competing Interests: The authors declared that they had no conflict of interest.

Inflammatory bowel disease (IBD), including Crohn's disease (CD) and ulcerative colitis (UC), is a chronic immune-mediated disease. The incidence of IBD is influenced by various genetic and environmental factors, with dietary habits gaining significant scientific interest. While the role of diet in the pathogenesis and development of IBD is still debated, recent studies have demonstrated its potential impact. However, conflicting findings exist regarding the efficacy of dietary interventions in the treatment and control of IBD. This review aimed to summarize the current understanding of the relationship between diet and IBD, highlighting the different perspectives and reasonings observed in recent studies. Overall, it has been shown that dietary habits play a role in the incidence of IBD, and adopting a controlled dietary approach may help manage the disease. Consequently, diet can be considered a predictive and prognostic factor in IBD., Competing Interests: Competing Interests The authors declare no conflict of interest related to this work., (© 2024 Middle East Journal of Digestive Diseases.)

Background: There are many dimensions regarding autism that are closely connected to social structures, policies, and power dynamics, silently impacting the well-being of individuals within the autism spectrum. This research aims to explore these overlooked aspects using a theoretical framework called "structural violence.", Methods: The study was conducted in Kurdistan, Iran, and a qualitative longitudinal approach was chosen. A purposive sampling method was employed to select the participants, with 11 parents taking part. The study data comprised 29 interviews using a topic guide conducted over a span of 2 years. Thematic analysis and a matrix-based approach were utilized for data analysis. To enhance the scientific rigor of this research, four criteria, including Guba and Lincoln's principles, were implemented to ensure methodological accuracy., Results: The research findings highlight four primary forms through which structural violence impacts children on the autism spectrum and their families: access to healthcare, geographic disparities, awareness and stigma, and poverty and financial burden. Additionally, the study identified 11 subthemes related to structural violence in the context of autism and families., Conclusions: We illustrated how structural forces create barriers to accessing adequate healthcare services, exacerbate discrimination based on ethnicity and geography, perpetuate stigma, and contribute to poverty and the inability to meet basic needs. These factors not only worsen health issues but also deepen existing disparities in healthcare access and outcomes for children on the autism spectrum and families. We emphasize the urgent need for systemic changes to address these issues. It is essential to promote public awareness, provide better access to health and support services, and address economic and political factors that contribute to these inequalities., (© 2023. The Author(s).)

Aims: The International Medullary Thyroid Carcinoma Grading System, introduced in 2022, mandates evaluation of the Ki67 proliferation index to assign a histological grade for medullary thyroid carcinoma. However, manual counting remains a tedious and time-consuming task., Methods and Results: We aimed to evaluate the performance of three other counting techniques for the Ki67 index, eyeballing by a trained experienced investigator, a machine learning-based deep learning algorithm (DeepLIIF) and an image analysis software with internal thresholding compared to the gold standard manual counting in a large cohort of 260 primarily resected medullary thyroid carcinoma. The Ki67 proliferation index generated by all three methods correlate near-perfectly with the manual Ki67 index, with kappa values ranging from 0.884 to 0.979 and interclass correlation coefficients ranging from 0.969 to 0.983. Discrepant Ki67 results were only observed in cases with borderline manual Ki67 readings, ranging from 3 to 7%. Medullary thyroid carcinomas with a high Ki67 index (≥ 5%) determined using any of the four methods were associated with significantly decreased disease-specific survival and distant metastasis-free survival., Conclusions: We herein validate a machine learning-based deep-learning platform and an image analysis software with internal thresholding to generate accurate automatic Ki67 proliferation indices in medullary thyroid carcinoma. Manual Ki67 count remains useful when facing a tumour with a borderline Ki67 proliferation index of 3-7%. In daily practice, validation of alternative evaluation methods for the Ki67 index in MTC is required prior to implementation., (© 2023 John Wiley & Sons Ltd.)

Objective: Nonalcoholic fatty liver disease (NAFLD) is characterized by excessive lipid accumulation in hepatocytes with no consumption of alcohol. Recently, curcumin is a natural polyphenol found in turmeric has been examined for the treatment of NAFLD. This study aimed to assess the efficacy of 160 mg/day nano-micelle curcumin on the amelioration of NAFLD by measuring liver enzymes., Materials and Methods: Patients with NAFLD were randomly divided into curcumin (intervention group n=33) and placebo (n=33) groups and at the end of the study, the data of 56 participants who completed the 2-month intervention were analyzed. Laboratory tests and questionnaires were used to gather information. Both groups received recommendations for lifestyle modification, and were advised to other necessary advices. Patients in the curcumin group received 160 mg/day of nano-micelle curcumin in two divided doses for 60 days. The 2 groups were followed up for two months and clinical and laboratory indices were compared., Results: Our data showed a significant decrease in alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in the curcumin group (p<0.01) as well as a significant difference between the groups before and after the intervention in curcumin group (p<0.05). Interestingly, a meaningful decrease in AST serum level was observed in the intervention group (p<0.01)., Conclusion: Our study demonstrated that short-term supplementation with nano-micelle curcumin results in the reduction of AST and ALT and is beneficial for the treatment of NAFLD., Competing Interests: The authors have declared that there is no conflict of interest.

Patients with diabetes are at risk for liver disorders including glycogen hepatopathy, non-alcoholic fatty liver disease, cirrhosis, and hepatic fibrosis. The pathophysiological mechanisms behind diabetic hepatopathy are complex, some of them include fatty acid accumulation, increased reactive oxygen species, increased advanced glycation end-products, hyperactivity of polyol pathways, increased apoptosis and necrosis, and promotion of fibrosis. A growing number of studies have shown that herbal extracts and their active phytochemicals have antihyperglycemic properties and beneficial effects on diabetic complications. The current review, for the first time, focused on herbal agents that showed beneficial effects on diabetic hepatopathy. For example, animal studies have shown that Moringa oleifera and Morus alba improve liver function in both type-1 and type-2 diabetes. Also, evidence from clinical trials suggests that Boswellia serrata, Juglans regia, Melissa officinalis, Portulaca oleracea, Silybum marianum, Talapotaka Churna, and Urtica dioica reduce serum liver enzymes in diabetic patients. The main active ingredient of these plants to protect the liver seems to be phenolic compounds such as niazirin, chlorogenic acid, resveratrol, etc. Mechanisms responsible for the hepatoprotective activity of herbal agents include improving glucose metabolism, restoring adipokines levels, antioxidant defense, and anti-inflammatory activity. Several signaling pathways are involved in hepatoprotective effects of herbal agents in diabetes, such as phosphoinositide 3-kinase, adenosine monophosphate-activated protein kinase, mitogen-activated protein kinase, and c-Jun NH2-terminal kinase., 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 © 2023 The Authors. Published by Elsevier Masson SAS.. All rights reserved.)

Background: It is unknown if the clinical manifestations and phenotype of disease are comparable between early- and elderly-onset inflammatory bowel disease (IBD). We aimed to seek differences in disease phenotype, course, complications, and treatment between early- and elderly-onset IBD patients., Methods: This retrospective cohort study on registered IBD patients in the Iranian Registry of Crohn's and Colitis (IRCC) compared demographics, disease phenotype, disease activity, IBD-related surgery and medications between early- and elderly-onset IBD. A generalized linear regression model was used to investigate the relative risk of age at diagnosis adjusted for gender and disease duration for the outcomes., Results: From 10048 IBD patients, 749 with early-onset (7.5%), and 472 (4.7%) elderly-onset IBD were enrolled: 855 (63.1%) ulcerative colitis (UC) and 366 (26.9%) Crohn's disease (CD). Left-sided colitis was more frequent among elderly-onset UC patients ( P <0.001). Ileum and ileocolonic locations were the most common types in elderly-onset and early-onset CD patients, respectively. In comparison with elderly-onset UC, early-onset cases more often used prednisolone (22.1% vs. 11.4%, P =0.001), immunomodulators (44.9% vs 25.2%, P <0.001) and anti-tumor necrosis factors (TNF) (20.1% vs 11.9%, P =0.002). Elderly-onset UC patients had 0.7 times lower risk of aggressive phenotype (95%CI:0.6‒0.9, P =0.005). Early-onset CD was associated with higher use of prednisolone (27.7% vs 8.1%, P <0.001), immunomodulators (58.7% vs 41.8%, P =0.005) and anti-TNF (49.6% vs 35.4%, P =0.006)., Conclusion: Early-onset IBD was associated with a more aggressive phenotype and higher prednisolone, immunomodulators, and anti-TNF use., (© 2023 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.)

Purpose: Nosocomial infection is a major threat to the health care system and patient welfare. After the pandemic, new protocols were established in hospitals and communities to protect against the transmission of COVID-19, which may have changed the incidence of nosocomial transmission. This study was conducted to compare the incidence of nosocomial infection before and after the COVID-19 pandemic., Methods: This was a retrospective cohort study performed on trauma patients who were admitted, from May 22, 2018 to November 22, 2021, to the largest level-1 trauma center in Shiraz, Iran (Shahid Rajaei Trauma Hospital). All the trauma patients over 15 years old admitted during the study time were included in this study. Individuals who were declared dead upon arrival were excluded. Patients were evaluated in 2 periods: before the pandemic (May 22, 2018 - February 19, 2020) and after the pandemic (February 19, 2020 - November 22, 2021). Patients were assessed based on demographic information (age, gender, length of hospital stay, and patient outcome), the occurrence of hospital infection, and the type of infection. The analysis was done using SPSS version 25., Results: Overall, 60,561 patients were admitted, with a mean age of 40 years. Nosocomial infection was diagnosed in 4.00% (n = 2423) of all admitted patients. The incidence rate of post-COVID-19 hospital-acquired infections decreased by 16.28% (p < 0.001) when compared to before the pandemic; in contrast, surgical site infection (p < 0.001) and urinary tract infection (p = 0.043) were responsible for this change, while hospital-acquired pneumonia (p = 0.568) and bloodstream infection (p = 0.156) were not significantly different. Overall mortality was 1.79%, while 28.52% of all patients with nosocomial infections died. During the pandemic, there was a 25.78% increase (p < 0.001) in the overall incidence rate of mortality, which was also observed among patients with nosocomial infections (17.84%)., Conclusion: The incidence of nosocomial infection has decreased during the pandemic, possibly due to the use of more personal protective equipment and modified protocols after the outbreak. This also explains the difference in the change in incidence rates of nosocomial infection subtypes., (Copyright © 2023. Production and hosting by Elsevier B.V.)

Aim: To evaluate the efficacy and safety of intrastromal transplantation of adipose-derived stem cells (ASCs) in keratoconus patients., Methods: This study was conducted on 8 eyes of 8 patients with moderate to severe keratoconus. In the patients, ophthalmic assessments including visual acuity, refraction, slit lamp examination, fundoscopy, corneal topography, and confocal microscopy were performed. Autologous stem cells were used. The isolated stem cells were injected into the corneal stroma by using femtosecond laser. Surgical procedure was similar to intracorneal ring implantation. All patients were re-assessed 1, 3, and 6mo after surgery., Results: The baseline mean visual acuity was 0.48±0.18 and improved to 0.66±0.17 after surgery and final acuity increased by 1.85±0.80 lines ( P =0.001). The mean spherical refraction of patients improved 0.34±0.35 D ( P =0.039), and the mean cylindrical refraction of patients improved 0.84±0.23 D ( P =0.016). The mean flat keratometry decreased 0.78±0.71 D ( P =0.017), and the mean steep keratometry decreased 0.59±0.68 D ( P =0.023). The mean central corneal thickness of patients improved of 6.29±4.47 µm ( P =0.03). The mean keratocyte density at the anterior and middle stroma of cornea increased ( P <0.05) but remained stable at the posterior stroma after 6mo. All patients had no complications and their corneas remained transparent., Conclusion: Intrastromal transplantation of ASCs has positive effects on vision and refractive parameters in most patients with keratoconus. After six months, visual acuity improved moderately, corneal parameters reduced slightly, and stromal keratocytes density increased. This modality is safe, and patients do not have any complications., (International Journal of Ophthalmology Press.)

Background: As a common digestive disorder, choledocholithiasis can have serious consequences, including death. Given that opioids have been shown to contribute to the spasm of Oddi's sphincter, which results in biliary stasis in the common bile duct (CBD), it is likely that opioids can also raise the prevalence of choledocholithiasis. In this regard, this study aimed to investigate how common opium addiction was among choledocholithiasis patients in Mashhad, Iran., Methods: The current retrospective observational study was conducted on 599 patients with choledocholithiasis who underwent endoscopic retrograde cholangiopancreatography (ERCP), utilizing information gathered at the Ghaem hospital in Mashhad, Iran, between 2011 and 2015. Patient data were collected from files and records using certain criteria such as gender, opium addiction, hepatic enzymes (AST, ALT, ALP), plasma levels of total bilirubin, and direct bilirubin. The size of the CBD stones as well as the correlation between the gallbladder and CBD stones were calculated., Findings: From among 599 patients included, 345 (57.6%) were female and 254 (42.4%) were male. Moreover, 195 patients (32.2%) had opiate addictions. The size of the CBD stone was correlated with the patient's age (r=0.17, P =0.001). The average stone measured 12.22±3.32 mm. There were notable differences in the mean size of the CBD stone ( P <0.001) between addicted and non-addicted cases; specifically, the mean CBD stone size in addicted cases was 12.715.13 mm while it was 12.34.33 mm in non-addicted cases., Conclusion: This study showed patients with CBD stones have a higher rate of opium addiction compared to the general population, indicating a possible link between the two conditions., Competing Interests: Competing Interests The authors declare no conflict of interest., (© 2023 Kerman University of Medical Sciences.)

Background & Objective: Breast cancer is one of the most common cancers in the world. There are some different types of breast cancer and triple-negative breast cancer is the type in which no receptors for estrogen, progesterone, and human epidermal growth factor receptor-2 are expressed. Identifying factors that can facilitate the diagnosis of triple-negative breast cancer is important. In this study, we decided to investigate the expression of GATA3 and GCDFP15 genes in triple-negative breast cancers., Methods: This is a retrospective descriptive-analytical study that was performed on 50 specimens of samples of triple-negative breast cancer. Data including age and sex, tumor grade, tumor size, types of invasion, GATA-3, and GCDFP-15 were assessed., Results: The mean age of the patients was 48.3±14.17 years. Of the total specimens, 46% were positive for GCDFP15 and 90% were positive for GATA-3. The intensity of GATA3 was evaluated and it was observed that 33(73.3%) of the cells were strongly stained and 12(26.7%) were weakly stained. There were no relationships between GATA-3 and GCDFP-15 with tumor characteristics., Conclusion: GATA-3 and GCDFP-15 may serve as diagnostic markers for triple-negative breast cancers and GATA-3 seems to be more reliable., Competing Interests: The authors declared no conflict of interest.

Background: In recent years, researchers have used many computerized interventions to reduce medical errors, the third cause of death in developed countries. One of such interventions is using differential diagnosis generators in primary care, where physicians may encounter initial symptoms without any diagnostic presuppositions. These systems generate multiple diagnoses, ranked by their likelihood. As such, these reports' accuracy can be determined by the location of the correct diagnosis in the list., Objective: This study aimed to design and evaluate a novel practical web-based differential diagnosis generator solution in primary care., Methods: In this research, a new online clinical decision support system, called DxGenerator, was designed to improve diagnostic accuracy; to this end, an attempt was made to converge a semantic database with the unified medical language system (UMLS) knowledge base, using MetaMap tool and natural language processing. In this regard, 120 diseases of gastrointestinal organs causing abdominal pain were modeled into the database. After designing an inference engine and a pseudo-free-text interactive interface, 172 patient vignettes were inputted into DxGenerator and ISABEL, the most accurate similar system. The Wilcoxon signed ranked test was used to compare the position of correct diagnoses in DxGenerator and ISABEL. The α level was defined as 0.05., Results: On a total of 172 vignettes, the mean and standard deviation of correct diagnosis positions improved from 4.2 ± 5.3 in ISABEL to 3.2 ± 3.9 in DxGenerator. This improvement was significant in the subgroup of uncommon diseases ( p -value < 0.05)., Conclusion: Using UMLS knowledge base and MetaMap Tools can improve the accuracy of diagnostic systems in which terms are entered in a free text manner. Applying these new methods will help the medical community accept medical diagnostic systems better., Competing Interests: None declared., (Thieme. All rights reserved.)

Pancreatic neuroendocrine tumours (NETs) are currently graded using the World Health Organization (WHO) 2019 system, which is based solely on mitotic count and Ki-67 proliferative index. Although necrosis is a well recognised adverse prognostic feature that is included in the grading systems of NETs of certain types such as pulmonary carcinoid and medullary thyroid carcinoma, there is currently insufficient evidence to support its inclusion in the grading of pancreatic NETs. Therefore, we sought to investigate the prognostic significance of tumour necrosis in our cohort of resected pancreatic NETs, with a view to providing evidence to support its incorporation into the WHO grading scheme. Under our proposal, pancreatic NETs without necrosis would continue to be graded based solely on mitotic count and Ki-67 index using the established WHO cut-offs, while NETs with tumour necrosis would be classified as grade 3, irrespective of proliferative activity. Using this system in our cohort of 110 resected pancreatic NETs, overall survival (OS) was 250, 198, and 151 months (p=0.039) and disease-free survival (DFS) was 180 months, 117 months, and 38 months (p<0.0001) for grades 1, 2, and 3, respectively. In contrast, there was no significant difference in OS (p=0.231) or DFS (p=0.058) between low grade (grade 1) and intermediate-high grade (grade 2/3) tumours using the current WHO system which does not consider necrosis. Interobserver concordance for assessment of necrosis was excellent. In conclusion, necrosis is an independent predictor of OS and DFS for pancreatic NETs, and our findings strongly support its addition to the grading scheme for this tumour., (Copyright © 2022 Royal College of Pathologists of Australasia. Published by Elsevier B.V. All rights reserved.)

Background: Macular edema is the major cause of decreased vision in patients with diabetes. Antioxidative and anti-inflammatory effects of photobiomodulation (PBM) have been reported with near-infrared irradiation. Objective: In this study, the efficacy and safety of PBM with near-infrared radiation in a patient with diabetic macular edema were assessed. Methods: We present the case of a 60-year-old man with diabetic macular edema responding to 670 nm light PBM alone. Results: After PBM, his vision improved and macular edema resolved on optical coherence tomography (OCT) findings without adverse events. In 16 months follow-up, visual acuity remained stable and OCT showed no evidence of recurrence of edema. Conclusions: Six hundred seventy nanometers light PBM can be potentially considered as a therapeutic method in diabetic patients with macular edema. Also, it provides a noninvasive and nonexpensive treatment in home.

Objective: To evaluate the presence/severity of depression, anxiety, and stress among health care workers (HCWs) who work on the specially allocated COVID-19 ward (Group A) and HCWs on the other wards (Group B)., Methods: This questionnaire-based study was conducted from January 25 to February 28, 2021. The mental status was assessed using the Persian version of the 42-item Depression, Anxiety, and Stress score (DASS-42). Gathered data was analyzed using SPSS version 25. The independent T-test and Chi-square tests were used to compare quantitative and qualitative variables., Results: Two-hundred and twenty two questionnaires were eligible for analysis. Group A consisted of 33 HCWs, and 189 (85.1%) individuals were working on the other wards. No statistically significant differences were seen regarding the Socio-demographic features except for the marital status ( p =0.005). The depressions' mean score was comparable between group A and B ( p =0.102). The mean scores of anxiety and stress were significantly lower in group A than group B ( p =0.006), although the frequency of DASS-42 parameters did not differ between these two groups ( p >0.05)., Conclusion: Contrary to our assumptions, this study showed that the DASS-42 parameters were not higher in HCWs working on the COVID-19 wards. This might be justified by developing coping mechanisms, being on the honeymoon phase of the disaster, compassion satisfaction, promising vaccine news, and working on the less impacted hospital., Competing Interests: The authors declare that there are no conflicts of interests.

Mebendazole (MBZ) is an efficacious anthelmintic with known anti-inflammatory and fibrinolytic properties. In this study, we aimed to explore the protective effects of this FDA-approved drug against DSS-induced colitis in a murine model either alone or in combination with Sulfasalazine (SSZ), a standard therapy for ulcerative colitis. We found that MBZ significantly improved colitis disease activity index as assessed by changes in body weight, degree of stool consistency, rectal bleeding, and prolapse. We also found that MBZ ameliorated the colon histopathological score by attenuating crypt loss, mucosal damage, and inflammation score in colitis tissues. Similarly, DSS-induced colon shortening, colon weight loss, and increase in spleen weight were all abrogated in the presence of MBZ. Moreover, MBZ decreased inflammation, possibly by reducing oxidative stress markers, suppressing inflammatory cell infiltration, and down-regulation of inflammatory genes in colon tissues. Furthermore, MBZ potently reduced fibrosis by decreasing collagen deposition and down-regulating pro-fibrotic genes including Col 1a1 and Col 1a2 in colitis tissue homogenates. In conclusion, our study showed that this broad-spectrum anthelminthic could be repurposed as a novel therapy for ulcerative colitis without any observed side effects, however, regarding the concerns about the potential toxicity of MBZ in UC patients, future experiments on MBZ therapy in other models of UC is needed to completely address the toxicity concerns., (© 2022. The Author(s).)

Although there is early support for schemes based on nuclear grade, necrosis and mitotic rate, there is currently no widely implemented grading system for diffuse pleural mesothelioma (DPM). We investigated current systems and propose a novel Mesothelioma Weighted Grading Scheme (MWGS). The MWGS assigns weighted scores from 0 to 10 based on age (≤74, >74 yrs: 0,1); histologic type (epithelioid, biphasic, sarcomatoid: 0,1,2); necrosis (absent, present: 0,2); mitotic count per 2 mm2 (≤1, 2 to 4, ≥5: 0,1,2); nuclear atypia (mild, moderate, severe: 0,1,2); and BRCA1-associated protein 1 (BAP1) expression (lost, retained: 0,1). A score of 0 to 3 is low grade, 4 to 6 intermediate grade, and 7 to 10 high grade. In 369 consecutive DPMs, median survival was 17.1, 10.1, and 4.1 months for low, intermediate, and high grades (P<0.0001). A progressive increase in score correlated with worsening overall survival (P<0.0001). Interobserver concordance was substantial (κ=0.588), with assessment of nuclear grade being the most subjective parameter (κ=0.195). We compared the MWGS to the 2-tiered system discussed in the World Health Organization (WHO) fifth edition. The WHO system predicted median survival in epithelioid (median 18.0 vs. 11.3 mo, P=0.003) and biphasic (16.2 vs. 4.2 mo, P=0.002), but not sarcomatoid DPM (5.4 vs. 4.7 mo, P=0.407). Interestingly, the WHO grading system was prognostic in cases with BAP1 loss (median survival 18.7 vs. 10.4 mo, P<0.0001), but not retained BAP1 expression (8.9 vs. 6.2 mo, P=0.061). In conclusion, the WHO scheme has merit in epithelioid/biphasic and BAP1-deficient DPM, however, the MWGS can be used for risk stratification of all DPMs, regardless of histologic subtype and BAP1 status., Competing Interests: Conflicts of Interest and Source of Funding: The authors have disclosed that they have no significant relationships with, or financial interest in, any commercial companies pertaining to this article., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background & Objective: The Paris System for Reporting Urinary Cytology (TPS) is a new method for evaluating urinary cytology designed to reduce unreproducible reports. The aim of this study was to reclassify and compare urinary cytology reports with TPS criteria to determine the frequency of unreproducible reports compared to the previous system., Methods: In this study, the laboratory electronic registration system analyzed patients' urine samples taken by voided or washing and brushing methods. The cytological evaluation was performed considering the previous system and TPS by a pathologist. The results of the two systems were compared, and the sensitivity and specificity of TPS were calculated., Results: Urine samples were taken from 876 patients. The mean age of patients was 63.36 ± 12.62. Comparing the routine classification system and TPS, it was observed that the number of atypical reports in the TPS system decreased by 12%, and all of these cases were downgraded to the negative group in the new classification. The sensitivity and specificity of TPS were 29.4% and 95.1%, respectively, if suspected malignancy and positive reports for malignancy were considered. Finally, if positive reports for malignancy were selected, sensitivity and specificity changed to 11.8% and 100%, respectively., Conclusion: Although the TPS system has low sensitivity for the diagnosis of urothelial malignancies, due to its high specificity, it is possible to consider and use this classification for screening patients., Competing Interests: The authors declared no conflict of interest.

A flexible sinusoidal-shaped antenna sensor is introduced in this work, which is a modified half-wave dipole that can be used for strain sensing applications. The presented antenna is an improved extension of the previously introduced antenna sensor for respiration monitoring. The electrical and radiative characteristics of the sinusoidal antenna and the effects of the geometrical factors are studied. An approach is provided for designing the antenna, and equations are introduced to estimate the geometrical parameters based on desired electrical specifications. It is shown that the antenna sensor can be designed to have up to 5.5 times more sensitivity compared to the last generation of the antenna sensor previously introduced for respiration monitoring. The conductive polymer material used to fabricate the new antenna makes it more flexible and durable compared to the previous generation of antenna sensors made of glass-based material. Finally, a reference antenna made of copper and an antenna sensor made of the conductive polymer are fabricated, and their electrical characteristics are analyzed in free space and over the body.

Objective: Nasal fractures need timely and accurate diagnosis for required treatment to prevent future deformities and unnecessary surgery. Radiography does not provide accurate finding in this case. The aim of this study is to evaluated diagnostic efficiency of ultrasound and CT scan for acute nasal fractures., Methods: In this cross-sectional study included patients with nasal trauma referred to (XXX) from January 2020 to December 2020. Diagnostic ultrasound and CT scan was performed on all the patients and data obtained was stored in patient data collection forms along with their demographics. The data was statistically analyzed using SPSS v20., Results: Of 32 patients included in our study, 4 (12.5%) were females and 28 (87.5%) were males. The mean age of the patients was 40.28 ± 16.9 years. The specificity and sensitivity of ultrasound was 100% and 83.33%. The accuracy of the test was 93.75%. The specificity, sensitivity and accuracy were 100%, 95% and 96.88%, respectively. Chi square test also showed that there were a significant association between nose fracture and both CT scan and ultrasound, p < 0.001., Conclusion: Our study showed that both, ultrasound and CT scan are efficient for the diagnosis of nasal fractures in the patients. Further studies with greater sample size are required in this domain., Competing Interests: The authors deny any conflict of interest in any terms or by any means during the study. All the fees provided by research center fund and deployed accordingly., (© 2022 The Authors.)

Background: Estrogen is involved in the pathogenesis of breast and gynecological cancers. Regular use of aspirin reduces estrogen levels. The present study aimed to evaluate the effect of aspirin on estrogen levels in postmenopausal women., Methods: This double-blind, placebo-controlled parallel-group trial was conducted on postmenopausal women referred to an outpatient clinic at a women's hospital in Tehran. Volunteers were randomly assigned to receive aspirin 100 mg/day or placebo for 6 weeks. Estradiol, sex hormone-binding globulin (SHBG), and testosterone levels at baseline and at the end of the intervention were measured by ELISA. Data were analyzed using SPSS 20, Kolmogorov-Smirnov test, independent samples t-test, and Mann-Whitney U test., Results: Twenty-seven and 28 participants were finally analyzed in the aspirin and placebo groups, respectively. There was no significant difference between the two groups in body mass index (BMI), age, or menopausal years. There was a statistically significant difference (p = 0.002) in the amount of  change in estradiol levels of the intervention group (median=- 3.5 pg/ml) compared to the control group (median=1.5 pg/ml). In contrast, there were no significant differences between the two groups regarding testosterone and SHBG levels (p = 0.58, p = 0.32)., Conclusions: Since low doses of aspirin may decrease estradiol levels, it could be considered a promising adjunctive therapeutic candidate in postmenopausal women to decrease BC incidence. However, further studies with larger sample sizes, measurements of estrogen levels and its related compounds in different time points accompanied by long-term follow-ups are needed to better elucidate the potential mechanisms by which nonsteroidal anti-inflammatory drugs (NSAIDs) negatively affect breast cancer., Trial Registration: IRCT201012195397N1. Date of first registration: 03/01/2011., (© 2022. The Author(s).)