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Abstract Background The English version of the Foot Function Index (FFI) is a reliable and valid tool for measuring pain and functional instability due to chronic lateral ankle instability (CLAI). However, its use among Arabic speakers with CLAI is limited because of the unavailability of the Arabic version of the FFI (FFI‐Arb). This study aimed to translate, cross‐culturally adapt and validate the FFI from the original English version into Arabic. Methods The FFI questionnaire was translated using the Beaton guidelines. Two‐hundred‐and‐thirty native Arabic‐speaking participants with CLAI were recruited from different physiotherapy clinics in Saudi Arabia. The convergent validity of the FFI‐Arb was tested using the Spearman correlation with the Arabic version Cumberland ankle instability tool (CAIT‐Arab). Test‐retest reliability was tested among 92 participants who completed the form again after seven days. Results Two‐hundred‐and‐thirty participants were enrolled (mean age = 32.09, Standard deviation (SD) = 8.64 years old). There was excellent internal consistency for the three subscales of FFI: pain (0.95), disability (0.97), and activity limitation (0.86), as for the total score (0.98). Convergent validity was analyzed by Spearman rank correlation between the new translated versions of FFI‐Arb and CAIT‐Arab. The total FFI‐Arb and CAIT‐Arab scores were moderately correlated (rho = − 0.569; p

Key Clinical Message It is important to maintain a vigilant approach towards incidental, rare findings like coronary artery aneurysms (CAAs) presenting with arrhythmia, particularly in patients with a history of myocardial infarction and cardiovascular risk factors. Diagnosis needs thorough evaluation. Tailoring management strategies to individual patient characteristics is crucial for optimizing outcomes.

Key Clinical Message This report highlights an unexpected baclofen side effect, a medication known for its safety profile. The rarity of excessive perspiration as a side effect distinguishes this case from typical baclofen adverse reactions. Documenting uncommon reactions is vital for physicians to broaden their awareness of baclofen's side effects and improve care.

Abstract This article intends to propose a new concept of electric machines that works based on a category of magnetic fluids called “ferrofluids”. For this purpose, a disc‐shaped rotor filled with ferrofluid material is employed instead of a common rotor of an axial‐flux machine, and the conceptual design of the new machine named here “axial‐flux ferrofluid electric machine (FFEM)” is presented. The operation principle of the FFEM is described and a dynamic‐transient model built on the d–q axes equivalent circuits is presented. Simulations are carried out by applying the given model in MATLAB and the results are investigated in different operating conditions. In order to identify the basic parameters and validate the simulation results, a prototype of the FFEM has been designed and manufactured, and some preliminary functional tests have been performed on the prototype. All simulation and experimental results indicate some distinguished excellent performances of the new machine. In the end, it can be stated briefly with some confidence that ferrofluid electric machines can have a high potential for future research and applications in various industries due to the simplicity of the structure, self‐starting capability, ability to work at a wide range of speeds and a flat torque profile.

Key Clinical Message Melkersson–Rosenthal syndrome can cause recurring bilateral facial paralysis. When steroids fail, surgical decompression of facial nerve is recommended, with endoscopic trans‐canal decompression as a safe, minimally invasive, and effective option. Abstract Melkersson–Rosenthal syndrome (MRS) is a rare neuro‐mucocutaneous disorder, clinically diagnosed by a triad of orofacial swelling, recurrent facial palsy, and fissured tongue. Due to the lack of a comprehensive understanding of MRS, there is no accepted standard of care. In this study we report a 30‐year‐old female patient, who was referred to the otolaryngology clinic of Rasool Akram Hospital, with classical triad of MRS that was managed by endoscopic trans‐canal facial nerve decompression. Bilateral endoscopic trans‐canal facial nerve decompression was done when we did not find any improvement with systemic steroids. Endoscopic trans‐canal facial nerve decompression could be a safe, reliable minimal invasive treatment of facial paralysis in MRS patients. It needs no external incision or temporal bone drilling which makes this method more convenient for patients with shorter recovery time.

Key Clinical Message Methicillin‐resistant staph aureus (MRSA) infections are challenging to treat, and with the emergence of community‐associated MRSA (CA‐MRSA) strains, early consideration of this pathogen in populations without typical risk factors is critical. Here we present a case of CA‐MRSA pneumonia that resulted in Community‐acquired pneumonia (CAP) with septic shock, pyelonephritis, and muscle abscess.

Abstract Background There is a solid relationship between alexithymia and suicide risk. Nonetheless, the specific impact of alexithymia's distinct subscales on suicide risk has received the attention it deserves. This article presents a comprehensive exploration of suicide risk among university students, focusing on the interconnections among alexithymia, insomnia, and suicidal behavior. Three components of alexithymia including difficulties in describing emotions or feelings (DDF), difficulties in identifying emotions or feelings (DIF), and the externally oriented thinking were considered. Methods The study involved 208 participants from a Persian university sample, examining the significance of incorporating both alexithymia and insomnia in suicide risk assessment and intervention planning. Insomnia was positioned as a pivotal mediator. A secure electronic link in the Telegram application was employed to collect the data. Both linear and nonlinear prediction models were used to explore potential associations among alexithymia, insomnia, and suicide risk. Results The study revealed substantial positive correlations between alexithymia and suicide risk, as well as between insomnia and suicide risk. Additionally, specific components of alexithymia exhibited noteworthy links to suicide risk. The inclusion of insomnia scores in suicide risk predictions is critical, as it greatly enhances the precision of risk assessments and facilitates the design of targeted and effective therapeutic interventions. The association between alexithymia and suicide risk showed a significant relationship (r = .29, p

Abstract A two‐degrees‐of‐freedom (2DOF) dual‐rotor axial‐flux induction motor (2DOF‐DRAFIM) is proposed with independent movement capability of rotors and its performance is evaluated in detail. First, using the analytical equations, the steady‐state model of the motor is presented and the electrical equivalent circuit is extracted along with an electromagnetic design algorithm for the proposed motor. In the next step, using two‐dimensional and three‐dimensional finite element modelling (FEM), the performance of the proposed motor is investigated. The results of the experimental measurements on the manufactured prototype confirm the validity of the results of theoretical modelling and finite element simulations. The proposed structure provides some unique features. One of the fascinating behaviours of the proposed 2DOF‐DRAFIM is that the higher‐speed rotor produces higher output torque and the lower‐speed rotor has lower torque. In this regard, the 2DOF structure can be considered a potential concept for electric vehicles (EVs) without needing a conventional mechanical differential.

Abstract Background and Aims Data on mild cognitive impairment (MCI) in low‐ to middle‐income countries are still being determined, despite the fact that most future older adults are expected to reside in these regions. This study aimed to investigate the prevalence and associated factors of MCI in Iran. Methods A cross‐sectional study was conducted on 4938 community‐dwelling subjects aged 50 years or above in the first wave of the Ardakan Cohort Study on Aging. MCI was evaluated using the Mini‐Mental State Examination (MMSE) and the Abbreviated Mental Test Score (AMTS) in literate and illiterate individuals. The relationship between factors associated with the odds of MCI was assessed through logistic regression. Results The prevalence of MCI among all participants, the literates and illiterates, was 15.8%, 6.3%, and 36.4%, respectively. It was found that failure to accomplish any of the MMSE or AMTS items was significantly related to MCI (p

Introduction Incomplete reperfusion following Mechanical Thrombectomy (MT) ranges from 12–34% and patients with Intracranial atherosclerotic (ICAS) occlusions are disproportionally affected.(1, 2)These patients are also more likely to experience poor functional outcomes. (3) Rescue stenting (RS) in these patients has shown promising rates of recanalization and better outcomes in preliminary studies. In our systemic review and meta‐analysis, we included Sixteen dual arm and seven single arm studies in order to study recanalization rate and compare outcomes following rescue stenting in patients with incomplete reperfusion compared to those managed conservatively (no‐RS).(4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19)(20, 21, 22, 23, 24, 25, 26) Methods Our study was performed according to the preferred reporting items for systematic review and meta‐analysis (PRISMA) guidelines.(27) We incorporated studies that included participants, aged 18 years or older, and met the following criteria: (1) participants with ischemic stroke with Intracranial Atherosclerotic Stenosis (ICAS) who underwent at least one attempt of MT and had incomplete perfusion after the procedure (2) participants who received rescue stenting after MT with incomplete reperfusion, with no restrictions on the type of stents or stenting procedure used; (3) both observational studies (case series, cohort studies) and experimental designs (randomized controlled trials) were considered; (4) the control group consisted of patients incomplete reperfusion following MT but did not received no rescue stenting and were conservatively managed. We reported the recanalization rate in patients undergoing MT and compared the outcomes between the RS and no‐RS groups; MRS ≤ 2 at 90 days, Mortality at 90 days, Symptomatic Intra cranial Hemorrhage (sICH), Any Intracranial Hemorrhage (ICH), vessel dissection and vessel perforation Results Patients who underwent stenting experienced recanalization rate of 84% (95% CI: 79.0 – 88.1). They also had significantly higher odds of a better functional outcome (MRS ≤ 2 at 90 days) at 3 months compared to the no‐RS group (OR 2.70 [95% CI: 1.89 ‐ 3.86]). Odds of sICH (OR 0.92 [95% CI: 0.62 ‐ 1.36]) and any ICH (OR: 0.64 [95% CI 0.40 ‐ 1.03]) were lower but insignificant in the RS group. Odds of mortality at 90 days were significantly lower in the RS group(OR 0.59 [95% CI: 0.42 ‐ 0.83]). No significant difference in Odds of Vessel dissection (OR 1.22 [95% CI: 0.19 ‐ 8.07]) or vessel perforation (OR 0.40 [ 95% CI: 0.10 ‐ 1.61]) between the two groups was noted. Conclusion Out meta‐analysis which included the most recent studies indicates that rescue setting after mechanical thrombectomy for large artery intracranial atherosclerosis with incomplete perfusion or with residual stenosis (>50 percent) is associated with better clinical outcomes and indicates lower mortality rate and associated complications. Therefore, rescue stenting can be considered as a safe and viable option in these patients.

Key Clinical Message Brugada syndrome (BrS), a genetically inherited ion channelopathy, has been linked to a considerable number of unexplained sudden cardiac deaths in patients without structural heart defects, and Brugada phenocopy (BrP) is a condition where there is an identical electrocardiogram (ECG) pattern to a congenital BrS, but this is due to other reversible etiologies. A 37‐year‐old male patient with a documented history of hypertension presented with vomiting after taking 43, 10 mg, melatonin pills and binge drinking locally made alcohol 2 days before. ECG showed right ventricular conduction delay with a “saddleback” appearance, with the J point elevated more than 2 mm and the terminal portion of the ST‐segment elevated more than 1 mm in leads V1 and/or V2. Which returned to normal after a few hours. The association between the use of melatonin and the finding of the Brugada pattern (BP) in a patient with normal heart structure or abnormal ECGs has been documented in much literature, and although no official melatonin dosage is recommended for adults, melatonin has been reported to cause and protect from arrhythmias through different mechanisms. In our patient, after alcohol intoxication was ruled out as a cause, melatonin was the only significant risk factor related to his ECG findings. The BP can be found in patients with otherwise normal heart structure and ECG records, and an overdose of melatonin, which is used as an over‐the‐counter sleep medication, was found to be a possible cause of finding this pattern in these patients after excluding other known causes.

Key Clinical Message Ectopic pituitary adenoma is a rare neoplasm located in the clivus and could mimic other clival tumors. Diagnosis and treatment could be challenging. It should be considered in the differential diagnosis of clival tumors. Abstract Ectopic pituitary adenomas (EPAs) are isolated adenomas that can be located in variable locations outside the sella turcica and have a normal‐appearing pituitary gland. These tumors are rare and are thought to often arise from embryological remnants along the route of Rathke's pouch migration. EPAs are associated with a wide range of clinical manifestations depending on hormonal activity and involvement of adjacent structures, which can represent a challenge in making the diagnosis and deciding on the most appropriate management. In this case study, we report a 47‐year‐old male who presented with visual disturbances, a headache, and generalized weakness. Magnetic resonance imaging showed a 2 cm mass located in the clivus invading the sphenoid sinus with an intact pituitary gland. The patient underwent endoscopic transsphenoidal surgery to eradicate the mass while maintaining the integrity of the pituitary gland, which was successful and uneventful. Pathological studies were consistent with prolactinoma, with no cytological malignant features. Post‐surgery, symptoms notably improved, and serum prolactin levels significantly dropped, The patient's condition was satisfactory on follow‐up with no long‐term complications reported. This paper contributes to the existing literature by sharing the clinical management of a challenging and uncommon case.

Abstract This article describes a detailed analytical method for obtaining the capacitance matrix elements in variable capacitance synchronous machines (VCSMs). The analytical modelling approach is performed by introducing a decentralized sinusoidal distribution of the stator/rotor electrodes and involves obtaining the capacitance matrix elements based on the electro motive force distribution in the air gap and calculating the induced electric charge in the stator/rotor electrode surfaces. The proposed analytical formulas are valid for both radial‐field and axial‐field VCSM structures. The analytical model is evaluated and well verified through analysing a multi‐stack axial‐field VCSM using 3D finite element simulation. Furthermore, a prototype of the VCSM is manufactured and tested to validate the results obtained from the proposed analytical model and finite element method simulations. Based on the results, the proposed model and analytical formulas are able to accurately estimate the capacitance matrix elements of the VCSMs.

Abstract Objectives The aim of the present study was to describe and evaluate the results of a new technique in endolymphatic sac decompression surgery. Methods Forty‐three patients with intractable unilateral Meniere's disease were selected. Endolymphatic sac was identified after simple mastoidectomy, and its lateral layer was incised, using a sickle knife. Outer layer of the sac was turned around and placed under the anterior bony border. Results Mean duration of the follow‐up was 24 months. Mean tinnitus handicap index, pure tone average (PTA) on thresholds at 500, 1000, 2000, and 4000 Hz, mean speech reception threshold, mean speech discrimination score, hearing stage, and mean vertigo score before and after surgery were evaluated. Conclusion The new marsupialization technique with anterior bony border is a safe and effective way to improve tinnitus, vertigo, and ear fullness among these patients. According to PTA and hearing stage, this surgery can control progressive hearing loss. Level of Evidence 3

Abstract Introduction Patients with sensorineural hearing loss suffer concomitant vestibular dysfunction that is more prevalent in patients with inner ear anomaly and could be aggravated with cochlear implantation. To assess the vestibular dysfunction in patients with cochlear implantation, we compared their results with those of patients with and without inner ear anomaly. Materials and methods This is a historical cohort study lasting for 20 years on 50 patients with cochlear implantation. All patients underwent dynamic posturography and Bruininks‐Oseretsky Test. Results Twenty‐two (44%) of the participants showed some types of inner ear anomaly. The frequency of abnormal Bruininks‐Oseretsky Test was 45.5% and 10.7% (P = .005, odds ratio [OR] = 6.9). Abnormal composite was seen in 77.3% and 21.4%, respectively (P

Extracellular vesicles (EVs) are mRNA-containing cell fragments shed into circulation during pathophysiological events. DNA methyltransferases (DNMT1, DNMT3A, and DNMT3B) regulate gene expression by modifying DNA methylation and altering transcription. Sepsis is a systemic insult resulting in vascular dysfunction, which can lead to shock and death. We analysed plasma from ICU patients for circulating EV numbers, defined as particles isolated from 1 mL plasma at 21,000xg, and DNMTs mRNA content as prognostic markers of septic shock. Compared to plasma from critically ill patients with or without sepsis, plasma from septic shock patients contained more EVs per mL, expressed as total DNMTs mRNAs over 5 days, and more individual DNMT mRNAs at each day. A comparison of EV-DNMT1 (maintenance methylation) with EV-DNMT3A+DNMT3B (de novo methylation) expression correlated highly with severity, and EVs from septic shock patients carried more total DNMT mRNAs and more DNMT3A+DNMT3B mRNAs than control or sepsis EVs. Total plasma EVs also correlated with sepsis severity. EV-DNMT mRNAs load, when coupled with total plasma EV number, may be a novel method to diagnose septic shock upon ICU admittance and offer opportunities to more precisely intervene with standard therapy or other targeted interventions to regulate EV release and/or specific DNMT activity.

This exploratory laboratory study was undertaken to develop and test an in situ bioremediation system intended to point the way toward a possible field application. The proposed method uses a water table management (WTM) system to deliver nutrients or other amendments to subsoil microorganisms for biostimulation and subsequent biodegradation of pollutants in the saturated and unsaturated zones of the soil. The study was carried out on packed soil columns and bioremediation of residual fertilizer nitrate was attempted. Different levels of organic carbon supplement (glucose C) were introduced into these columns via subirrigation in order to supplement the readily available organic carbon levels in the soil. The study was carried out in two experimental setups. The first setup investigated (i) the effect of addition of a high (970 mg L(-1)) and a low (120 mg L(-1)) glucose C level and (ii) the efficacy of using the subirrigation system as a method for nutrient delivery in bioremediation of leached nitrate. This setup was monitored with time, depth, and with reference to the nitrate residue in the soil solution. Leached nitrate was denitrified to less than 10 mg L(-1) nitrate N at both glucose levels. The second setup investigated the effect of a range of low levels of glucose C on nitrate decontamination, soil pH, and total microbial count in order to find out an optimal glucose C level that reduced the most nitrate and maintained the pH homeostasis of soil.

The prospect of using wastewater containing high loads of soluble organic matter (OM) for removing residual agricultural chemicals (fertilizer, pesticide, or herbicide) in farm soil, although promising, could have adverse effects on soil agricultural quality as a result of development of redoximorphic features in the soil profile. In this study, the effect of organic carbon supplement for bioremediation of residual fertilizer nitrate on soil properties, redox potential (Eh), pH, and metal ion mobilization was studied using sandy soils packed in columns. The study was included in a general project, described elsewhere (Ugwuegbu et al., 2000), undertaken to evaluate use of controlled water table management (WTM) systems to supply organic carbon for creating a reduced environment conducive to denitrification of residual fertilizer nitrate leaching from the farm to subsurface water. The columns were subjected to subirrigation with water containing soluble organic carbon in the form of glucose. The work was carried out in two experimental setups and the long-term effect of a range of glucose concentrations on the Eh, pH, and soluble levels of Fe and Mn was investigated. From the results obtained, it could be concluded that excessive organic carbon supplement to soil can have adverse effects on soil quality and that Eh and soluble Fe are the two most practical parameters for monitoring soil health during treatment of farm chemicals.

The significance of disturbances of lipid metabolism caused by xenobiotic acyl-CoAs as possible causes of peroxisomal proliferation has been studied with the enantiomers of 2-phenylpropionic acid (2-PPA), the (R)-enantiomer of which is converted to the acyl-CoA in rats while its (S)-antipode is not. rac-2-PPA (250 mg/kg/day ip x 3) was shown to be an hepatic peroxisomal proliferator in male Sprague-Dawley rats on the basis of increases in microsomal cytochrome P-450 content and lauric acid hydroxylation and hepatic CN(-)-insensitive palmitoyl-CoA oxidation, a peroxisomal marker activity, while electron microscopy revealed a rise in the peroxisome/mitochondria ratio in hepatocytes. Further studies established the dose-response relationships for these biochemical changes. The (R)- and (S)-enantiomers were administered at a dose of 50 mg/kg/day ip x 3 and both were peroxisome proliferators of very similar potency. The effects of 100 mg/kg/day ip x 3 of the racemate, a dose giving ca. 75% of maximal response, were essentially additive of those of 50 mg/kg/day ip x 3 of its two component isomers. The stereoselectivity of acyl-CoA formation from the enantiomers of 2-PPA was confirmed by their differential inhibition of microsomal palmitoyl-CoA synthesis. Taken together, these data indicate that it is very unlikely that the acyl-CoA of 2-PPA plays any role in the peroxisomal proliferation which this compound causes in the rat.

The effects of the beta-adrenoceptor blockers atenolol, metoprolol, pindolol, and propranolol on the ventilatory response to carbon dioxide rebreathing have been determined in a double-blind randomized manner. Eight healthy, male, nonsmoking subjects received cumulative doses of each drug over a 10-hr period. The effects of each drug on heart rate and carbon dioxide sensitivity were determined at intervals of 2 hr and were related to plasma concentrations of each drug. Maximum reduction of exercise heart rate was achieved with all four beta blockers and plasma concentrations were in the usual therapeutic range for these drugs. There was considerable intersubject and within-subject variability in ventilatory responsiveness to inhaled carbon dioxide, but we were not able to discern any alteration in central sensitivity to increasing carbon dioxide concentrations.

The effects on standing heart rate and respiratory function of two relatively selective beta 1-adrenoceptor antagonists, metoprolol and bevantolol, were compared in a double-blind, randomized, crossover study of 16 patients with asthma. After control observations on 2 separate days, the patients received approximately equivalent cardiac beta-adrenoceptor antagonist doses of metoprolol, 12.5, 25, 50, and 100 mg, and bevantolol, 18.75, 37.5, 75 and 150 mg, at intervals of 2 hours. Dosing was stopped if symptoms warranted or if there was a fall of greater than or equal to 20% in the forced expiratory volume in 1 second. In general, the cumulative dosing regimen proved a safe and effective means of assessing bronchial responsiveness to these beta-blockers in asthma, but one patient had to be dropped from the study because of severe bronchoconstriction after the first dose. Of the 15 patients studied who were taking both drugs, seven patients were withdrawn prematurely. In these seven patients, the average maximum tolerated cumulative doses were 45.5 mg bevantolol and 26.8 mg metoprolol, doses that are much lower than those usually required for therapeutic activity. The respiratory response to either drug could not be predicted.