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Abstract This research was carried out to optimize the extraction process of proteins from pomegranate seeds and characterize their in vitro digestibility as well as their thermal and functional properties. For this purpose, the study screened five parameters (liquid/solid ratio, pH, temperature, NaCl concentration, and time) that could potentially influence the extraction process. This screening was conducted using a two‐level Placket–Burman design (PBD). The significant parameters (pH and NaCl concentration) were subsequently optimized using a three‐level face‐centered central composite design (FCCD) to determine the optimum extraction conditions. A maximum protein recovery of 83.8% was obtained at pH 11.0 and NaCl concentration of 0.0 M. Pomegranate seed protein isolate (PSPI) with a protein content of 92.4% (w/w) was obtained through the isoelectric precipitation of pomegranate seed protein extracted under the optimized conditions. An emulsifying activity index of 14.1 m2 g−1 was observed at the isoelectric pH, where the emulsion stability index was at 8.2%. PSPI also showed high water‐ and oil‐holding capacities (3.7 and 4.3 g g−1, respectively). The essential amino acid levels in PSPI (except for valine and isoleucine) exceeded the recommended amounts set by WHO/FAO/UNU for adults, highlighting its high nutritional value. Based on thermal analysis data, denaturation of PSPI could occur at 89.5°C. The in vitro digestibility of PSPI was found to be 74.3%. PSPI shows a potential as a novel ingredient for substituting animal‐based proteins in various food applications.

Abstract Background In mammals, amino acid metabolism has evolved to control immune responses. Tryptophan (Trp) is the rarest essential amino acid found in food and its metabolism has evolved to be a primary regulatory node in the control of immune responses. Celiac disease (CeD) is a developed immunological condition caused by gluten intolerance and is linked to chronic small intestine enteropathy in genetically predisposed individuals. Dendritic cells (DCs), serving as the bridge between innate and adaptive immunities, can influence immunological responses in CeD through phenotypic alterations. Objective This review aims to highlight the connection between Trp metabolism and tolerogenic DCs, and the significance of this interaction in the pathogenesis of CeD. Results It is been recognized that various DC subtypes contribute to the pathogenesis of CeD. Tolerogenic DCs, in particular, are instrumental in inducing immune tolerance, leading to T‐reg differentiation that helps maintain intestinal immune tolerance against inflammatory responses in CeD patients and those with other autoimmune disorders. T‐regs, a subset of T‐cells, play a crucial role in maintaining intestinal immunological homeostasis by regulating the activities of other immune cells. Notably, Trp metabolism, essential for T‐reg function, facilitates T‐reg differentiation through microbiota‐mediated degradation and the kynurenine pathway. Conclusion Therefore, alterations in Trp metabolism could potentially influence the immune response in CeD, affecting both the development of the disease and the persistence of symptoms despite adherence to a gluten‐free diet.

Abstract Background and Aim One of the leading reasons that patients, particularly older persons, are brought to the orthopedic emergency room is a fracture at the end of the radius. In this study, a new traction method for distal radius fractures was compared with manual reduction. Methods The census method was used in this clinical trial to study 45 patients (46 hands) who were referred to Hamedan Besat Hospital in 2021. Patients were randomly assigned to two groups. The manual reduction (pressure and traction by an assistant and a doctor) method was implemented in Group A, and the new traction procedure (pressure and traction by hardware or a device) was performed in Group B. The radiographic results of reduction in both groups were investigated and compared immediately and in the first and 6 weeks after surgery. Results The following results were observed in the new and manual groups in the sixth week after surgery: average volar tilt: 4.19 ± 3.79 and 4.08 ± 3.88 (p = 0.926), radial angulation: 2.18 ± 1.27 and 2.21 ± 1.35 (p = 0.934), radial shortening: 10.52 ± 0.65 and 10.56 ± 0.68 (p = 0.828), radial inclination: 22.52 ± 2.46 and 22.71 ± 2.01 (p = 0.787), dorsal angulation: −5.89 ± 0.33 and 5.22 ± −1.91 (p = 1.00), ulnar variance: 1.66 ± 0.90 and 1.67 ± 0.81 (p = 0.958), and average pain score: 2.40 ± 0.68 and 2.47 ± 0.73 (p = 0.737). Conclusion The new reduction procedure with hardware in patients with distal radius fractures showed the same effect as the traditional method based on pressure and traction by the assistant and doctor in terms of radiographic changes and pain score of the fracture site.

Abstract Introduction Death due to covid‐19 is one of the biggest health challenges in the world. There are many models that can predict death due to COVID‐19. This study aimed to fit and compare Decision Tree (DT), Support Vector Machine (SVM), and AdaBoost models to predict death due to COVID‐19. Methods To describe the variables, mean (SD) and frequency (%) were reported. To determine the relationship between the variables and the death caused by COVID‐19, chi‐square test was performed with a significance level of 0.05. To compare DT, SVM and AdaBoost models for predicting death due to COVID‐19 from sensitivity, specificity, accuracy and the area under the rock curve under R software using psych, caTools, random over‐sampling examples, rpart, rpartplot packages was done. Results Out of the total of 23,054 patients studied, 10,935 cases (46.5%) were women, and 12,569 cases (53.5%) were men. Additionally, the mean age of the patients was 54.9 ± 21.0 years. There is a statistically significant relationship between gender, fever, cough, muscle pain, smell and taste, abdominal pain, nausea and vomiting, diarrhea, anorexia, dizziness, chest pain, intubation, cancer, diabetes, chronic blood disease, Violation of immunity, pregnancy, Dialysis, chronic lung disease with the death of covid‐19 patients showed (p

Abstract Background and Aims After conducting a comprehensive literature search of two medical electronic databases, PubMed and Embase, as well as two citation databases, Web of Science Core Collections (WoS) and Scopus, we aimed to conduct an Altmetric and Scientometric analysis of the History of Medicine literature in medical research. Methods The following software tools were used for analyzing the retrieved records from PubMed and Embase databases and conducting a collaboration analysis to identify the countries involved in scientific medical papers, as well as clustering keywords to reveal the trend of History of Medicine research for the future. These software tools (VOSviewer 1.6.18 and Spss 16) allowed the researchers to visualize bibliometric networks, perform statistical analysis, and identify patterns and trends in the data. Results Our analysis revealed 53,771 records from PubMed and 54,405 records from EMBASE databases retrieved in the field of History of Medicine by 105,286 contributed authors in WoS. We identified 157 countries that collaborated on scientific medical papers. By clustering 59,995 keywords, we were able to reveal the trend of History of Medicine research for the future. Our findings showed a positive association between traditional bibliometrics and social media metrics such as the Altmetric Attention Score in the History of Medicine literature (p

Abstract Background and Aims Considering the increasing use of information technology (IT) and the need of the implementation of related projects, the lack of IT specialists in the health system is one of the major challenges that require planning and foreseeing. This study was conducted with the aim of predicting the number of required IT personnel in hospitals of Isfahan University of Medical Sciences based on the modeling of identified and weighed influential factors in 2023. Method First, Delphi method and multi‐criteria decision‐making (MCDM) using the Expository Posthaste Effective Resemblant Tool (ExPERT) were conducted to identify and weigh the components that affect IT staff's workload in hospitals. Then, the model for predicting the required number of IT personnel for the involved hospitals was developed. In all stages, the obtained information and results were checked and confirmed using experts' opinions in Focus Group Discussions. Results Twenty‐one hospitals (57%) out of 37 hospitals are facing a shortage of IT personnel. This varies from 0.5 to 1.6 personnel in different hospitals. Thirteen hospitals (35%) were reported to have adequate IT staffing and three hospitals (8%) had excess IT staffing. Conclusion This study provided a predictive model for required IT staff in hospitals using MCDM through ExPERT which can be used in cases where the use of workload‐based methods such as Workload Indicators of Staffing Need is complex or time‐consuming.

Key Clinical Message If you encounter an unexplained case of bone marrow edema in a young patient, consider the possibility of osteoid osteoma (OO). Even in the presence of a nidus near vital structures, RFA can safely be used to treat OO.

Key Clinical Message A 67‐year‐old male presented to the emergency department with a 7‐day history of fever, malaise, myalgia, headache, and a seizure episode. Physical examination showed stable vital signs but a fever. Laboratory tests indicated leukocytosis, anemia, thrombocytosis, and elevated inflammatory markers. Imaging revealed multiple intracranial lesions, and cerebrospinal fluid analysis confirmed the presence of acid‐fast bacilli. The patient responded well to anti‐tuberculosis therapy, showing significant clinical improvement within 8 weeks.

Abstract Objective Most people with epilepsy (PWE) could live seizure‐free if treated with one or more antiseizure medications (ASMs). The World Health Organization (WHO) estimates that 75% of PWE in low‐resource settings lack adequate antiseizure treatment. Limited education surrounding epilepsy and the out‐of‐pocket costs of ASMs in particular pose barriers to managing epilepsy in resource‐poor, low‐income settings. The aim of this study is to implement and test a novel strategy to improve outcomes across the epilepsy care cascade marked by (1) retention in epilepsy care, (2) adherence to ASMs, and (3) seizure reduction, with the measured goal of seizure freedom. Methods A randomized, double‐blinded clinical trial will be performed, centered at the Ignace Deen Hospital in Conakry, Republic of Guinea, in Western Sub‐Saharan Africa. Two hundred people with clinically diagnosed epilepsy, ages 18 years and above, will receive education on epilepsy and then be randomized to (i) free ASMs versus (ii) conditional cash, conditioned upon return to the epilepsy clinic. Participants will be followed for 360 days with study visits every 90 days following enrollment. Significance We design a randomized trial for PWE in Guinea, a low‐resource setting with a high proportion of untreated PWE and a nearly completely privatized healthcare system. The trial includes a conditional cash transfer intervention, which has yet to be tested as a targeted means to improve outcomes for people with a chronic neurological disorder. The trial aims to provide an evidence base for the treatment of epilepsy in such settings. Plain Language Summary We present a clinical trial protocol for a randomized, blinded study of 200 people with epilepsy in the low‐resource African Republic of Guinea, providing an educational intervention (E), and then randomizing in a 1:1 allocation to either free antiseizure medication (m) or conditional cash (c2) for 360 days. Measured outcomes include (1) returning to outpatient epilepsy care, (2) adherence to antiseizure medications (ASMs), and (3) reducing the number of seizures. This study is an initial look at giving small amounts of cash for desired results (or “nudges”) for improving epilepsy outcomes in the sub‐Saharan African and brain disorder contexts.

Key Clinical Message Hydatid cyst is a sly disease that can manifest with a spectrum of symptoms in almost every part of the human body, so it is crucial to be familiar with different scenarios that a patient may present. Abstract The echinococcus granulosus parasite causes hydatid disease and is common in areas with animal husbandry and agriculture. Here, we report a middle age woman who presented with abdominal pain that further investigation revealed a cyst in subdiaphragmatic area.

Key Clinical Message It is essential to consider non‐tuberculosis mycobacterium in HIV‐positive patients with fever, abdominal pain, weight loss, and splenomegaly. Abstract Mycobacterium genavense is an opportunistic slow‐growing nontuberculous mycobacterium in patients with immunocompromised backgrounds, especially HIV‐positive patients. In this study, we present two cases of Mycobacterium genovese infection in HIV‐positive patients with a good clinical response to accurate treatment.

Key Clinical Message Swift and precise identification of heterotopic cesarean scar pregnancy, coupled with standardized treatment approaches for handling possible serious complications, form an essential component in reaching favorable outcomes for patients experiencing this rare type of pregnancy. Abstract Heterotopic pregnancy (HP) denotes a form of multiple gestation where intrauterine and ectopic pregnancies coexist. Cesarean scar ectopic pregnancy, on the other hand, involves the implantation of a fetus over the previous cesarean scar. This condition poses a significant risk of uterine rupture, which may lead to serious health complications, and even death. We report a case of a fit 37‐year‐old woman with two previous cesarean deliveries who was diagnosed with a heterotopic cesarean scar pregnancy at 8 weeks gestation following symptoms of lower abdominal pain and delayed menstruation. Both pregnancies demonstrated cardiac activity and the portion of the myometrium located between the bladder wall and the gestational sac was noted to exhibit considerable thinness. The patient underwent an exploratory laparotomy coupled with dilation and curettage and recovered uneventfully. The proper management of a HCSP requires timely diagnosis through ultrasonography. Early diagnosis allows for immediate intervention to prevent complications such as uterine rupture or potentially lethal bleeding.

Background The North Africa and Middle East (NAME) region has one of the highest burdens of ischemic heart disease (IHD) worldwide. This study reports the contemporary epidemiology of IHD in NAME. Methods and Results We estimated the incidence, prevalence, deaths, years of life lost, years lived with disability, disability‐adjusted life years (DALYs), and premature mortality of IHD, and its attributable risk factors in NAME from 1990 to 2019 using the results of the GBD (Global Burden of Disease study 2019). In 2019, 0.8 million lives and 18.0 million DALYs were lost due to IHD in NAME. From 1990 to 2019, the age‐standardized DALY rate of IHD significantly decreased by 33.3%, mostly due to the reduction of years of life lost rather than years lived with disability. In 2019, the proportion of premature death attributable to IHD was higher in NAME compared with global measures: 26.8% versus 16.9% for women and 18.4% versus 14.8% for men, respectively. The age‐standardized DALY rate of IHD attributed to metabolic risks, behavioral risks, and environmental/occupational risks significantly decreased by 28.7%, 37.8%, and 36.4%, respectively. Dietary risk factors, high systolic blood pressure, and high low‐density lipoprotein cholesterol were the top 3 risks contributing to the IHD burden in most countries of NAME in 2019. Conclusions In 2019, IHD was the leading cause of death and lost DALYs in NAME, where premature death due to IHD was greater than the global average. Despite the great reduction in the age‐standardized DALYs of IHD in NAME from 1990 to 2019, this region still had the second‐highest burden of IHD in 2019 globally.

Abstract Objective This study aims to describe temporal trends of thyroid cancer (ThC) from 2010 to 2019, in Asian countries by geographical region and sociodemographic index, compared with global data. Method Annual case data and age‐standardized rates (ASRs) of epidemiological indicators of ThC cancer data were collected from the 2019 Global Burden of Disease (GBD) study from 2010 to 2019 in 49 countries and territories in Asia. The relative difference (%) between years was used to show comparative variations of ASRs for the indicators studied. The female/male ratio was calculated by dividing female ASRs by male ASRs. Also, these rates were compared between the age group ≥70 years old and younger age groups. Results In 2019, more than 50% of ThC cases and deaths occurred in Asian countries. A total of 53% of ThC patients lived in Asia and more than 60% of the global burden of ThC was imposed on Asian countries. From 2010 to 2019, incidences, deaths, prevalence cases, and DALYs number of ThC cancer increased over 1.28‐, 1.26‐, 1.3‐, and 1.2‐fold, in Asia, respectively. During this period, the age‐standardized incidence rate (ASIR) and the age‐standardized prevalence rate (ASPR) of ThC cancer increased by 5% and 8%, respectively, while the age‐standardized death rate (ASDR) and the age‐standardized DALYs rate (DALYs ASR) of ThC cancer decreased by 6% and 4%, respectively. These trends are different from what happens in other continents. In 2019, age‐specific incidence, death, prevalence, and DALY cases of ThC cancer were peaking at 50–54, 75–79, 50–54, and 55–59 years, respectively. In 2019, the highest ASIR and ASPR of ThC cancer was observed in high‐income Asia Pacific countries and the highest ASDR and DALYs ASR in Southeast Asia countries. Only high‐income Asia Pacific countries experienced a decreasing trend in ASIR and ASPR from 2010 to 2019. ASDR and DALYs ASR have the highest decreasing trend in high‐income Asia Pacific. In 2019, among high SDI Asian countries, the Republic of Korea had the highest ASIR and ASPR, and Brunei Darussalam had the highest ASDR and DALYs ASR. The highest ASIR, ASDR, ASPR, and DALY ASR of ThC cancer was found in Lebanon and Malaysia (high‐middle SDIs), Vietnam (middle SDIs), and Cambodia and Palestine (low‐middle SDIs). Among low SDI Asian countries, Pakistan had the highest ASIR, ASDR, ASPR, and DALY ASR of ThC cancer. All indicators for most countries were higher in women than men. Conclusion More than half of the burden of thyroid cancer is imposed on the residents of the Asian continent. Although the incidence and prevalence of this cancer in Asian countries is lower than that of the world, America, and Europe, the highest rate of death from thyroid cancer occurs in Asia and they witness the highest burden of the disease. Therefore, it seems that implementing early detection strategies and increasing access to treatment facilities in Asia is one of the necessities of thyroid cancer control in its residents.

Abstract Objectives Physiological changes during pregnancy make mothers susceptible to periodontal diseases, in particular gingivitis, which could be prevented by good oral hygiene. Therefore, their knowledge and attitude could affect their oral hygiene and general health. This study therefore aimed to investigate the knowledge, attitude, and practice regarding oral hygiene, of pregnant women living in a city in Iran. Material and Methods It was a cross‐sectional study that was performed in Urmia City in 2019. After completing an informed consent form, pregnant women completed a specially designed questionnaire, which included questions on demographic characteristics and assessed participants' knowledge and attitude about oral health care during pregnancy. A clinical examination of each participant's oral cavity was performed and dental plaque index (PI), gingival index (GI), and number of decayed, missed, filled teeth (DMFT) index were recorded. Any correlations between participants' knowledge and attitude and oral health indices were evaluated. A paired t test and Pearson's correlation coefficient were employed for statistical analysis. Results A total of 96 pregnant women (mean age of 29.11 ± 6.80 years) participated in this study. Among them, 67 had a moderate level of knowledge. There was no significant correlation between participants' knowledge, and attitude levels and educational level (p = .88 and p = .43, respectively). Also, there was no correlation between knowledge and attitude levels and GI, PI, and DMFT (p > .05). Conclusions This study showed that the knowledge and attitude of the pregnant women who participated were not favorable and their oral hygiene needed to be improved.

Abstract Background Canine herpesvirus 1 (CHV‐1) is an important cause of death in newborn puppies and of fertility problems in adult dogs. Identification of risk factors may help to reduce infection rates and alleviate concerns for dog owners and breeders. This study was designed to screen for CHV‐1 infection in bitches of breeding kennels and farms in Iran and relate this to possible risk factors. Methods A total of 63 vaginal samples were collected from dogs in 5 breeding kennels (n = 47) and from 7 farms (n = 16). Real‐time polymerase chain reaction was used to detect the CHV‐1 specific glycoprotein B (gB) gene. Prevalence rates were evaluated in relation to various risk factors, including region, housing, vaccination, deworming, pregnancy, reproductive problems, number of dogs living together and hygiene conditions. Results In total, 21 (33.3%) of 63 vaginal samples were positive for CHV‐1 DNA. The prevalence rate in farms (7/16; 43.7%) was higher than in kennels (14/47; 29.7%). No association was found between CHV‐1 prevalence and potential risk factors. Conclusions CHV‐1 is highly prevalent in dogs in Iranian farms and kennels. Since the CHV1 vaccine is unlicensed in Iran, effective management strategies are essential to reduce the consequences of this pathogen.

Abstract Introduction Central nervous system cancers (CNS cancers) impose a significant burden upon healthcare systems worldwide. Currently, the lack of a comprehensive study to assess various epidemiological indexes of CNS cancers on national and subnational scales in Iran can hamper healthcare planning and resource allocation in this regard. This study aims to fill this gap by providing estimates of CNS cancer epidemiological measures on national and subnational levels in Iran from 1990 to 2019. Materials and Methods This study is a part of Global Burden of Disease (GBD) 2019 that contains epidemiological measures including prevalence, incidence, mortality, Disability‐Adjusted Life Years (DALYs), Years Lived with Disability (YLDs), and Years of Life Lost (YLLs) of CNS cancers. Age standardization was utilized for comparing different provinces. Results In 2019, 5811 (95% Uncertainty Interval: 2942–7046) national new cases and 3494 (1751–4173) deaths due to CNS cancers were reported. National age‐standardized incidence (ASIR), deaths (ASDR), and DALYs rates were 7.3 (3.7–8.8), 4.6 (2.3–5.5), and 156.4 (82.0–187.0) per 100,000 in 2019, respectively. Subnational results revealed that ASDR and ASIR have increased in the past 30 years in all provinces. Although incidence rates have increased in all age groups and genders since 1990, death rates have remained the same for most age groups and genders except for young patients aged under 15, where a decrease in mortality and YLLs can be observed. Conclusion The incidence, deaths, and DALYs of CNS cancers increased at national and subnational levels. These findings should be considered for planning and resource allocation.

Abstract Background Cholangiocarcinoma (CCA), as a rare malignancy of the biliary tree, has a poor prognosis most of the time. CCA is highly epigenetically regulated and several long non‐coding RNAs (lncRNA) have been investigated to have a diagnostic and prognostic role in CCA. The current study aimed to assess the studies finding relevant lncRNAs in CCA systematically. Methods International databases, including PubMed, Cochrane Library, and Embase, were comprehensively searched in order to identify studies investigating any lncRNA in CCA. After screening by title/abstract and full‐text, necessary data were extracted. Random‐effect meta‐analysis was performed for pooling the areas under the curve (AUCs), specificity, and sensitivity of lncRNAs for the diagnosis of CCA. Results A total of 33 studies were chosen to be included in the final analysis, comprised of 2677 patients. Meta‐analysis of AUCs for evaluation of CCA resulted in pooled AUC of 0.79 (95% CI: 0.75–0.82; I2 = 69.11, p

Abstract Objective This systematic review and meta‐analysis aimed to evaluate the diagnostic value of the neutrophil‐to‐lymphocyte ratio (NLR) and platelet‐to‐lymphocyte ratio (PLR) in women with a history of abortion (missed and threatened) and recurrent pregnancy loss (RPL) in comparison with healthy pregnancies. Methods Electronic databases including MEDLINE, Scopus, Web of Science, Embase, and Cochrane Library were searched for NLR and PLR in women who experienced early pregnancy loss up to January 1, 2023 with a combination of proper keywords. Meta‐analysis was done for comparison with three or more studies and summary estimates were measured. Results A total of 390 citations were retrieved initially, and after screening, 16 articles were deemed eligible for the final review. Among these, 14 studies underwent meta‐analysis. The meta‐analysis revealed that the standard mean of the NLR was significantly higher in abortion cases compared to the control group. However, there was no significant difference in the PLR between the pregnancy loss group and the control group. Conclusion NLR was significantly higher among RPL patients compared to the control group, according to these data, NLR may be capable of being used in the diagnosis of RPL as an easy, cheap, and accessible modality. Further studies, which take these variables into account, will need to be undertaken to determine the diagnostic value of NLR and PLR in early pregnancy loss.

Abstract Background and Aims This systematic review aimed to evaluating the effectiveness of machine learning (ML) algorithms for the prediction and diagnosis of meningitis. Methods On November 12, 2022, a systematic review was carried out using a keyword search in the reliable scientific databases PubMed, EMBASE, Scopus, and Web of Science. The recommendations of Preferred Reporting for Systematic Reviews and Meta‐Analyses (PRISMA) were adhered to. Studies conducted in English that employed ML to predict and identify meningitis were deemed to match the inclusion criteria. The eligibility requirements were used to independently review the titles and abstracts. The whole text was then obtained and independently reviewed in accordance with the eligibility requirements. Results After all the research matched the inclusion criteria, a total of 16 studies were added to the systematic review. Studies on the application of ML algorithms in the three categories of disease diagnosis ability (8.16) and disease prediction ability (8.16) (including cases related to identifying patients (50%), risk of death in patients (25%), the consequences of the disease in childhood (12.5%), and its etiology [12.5%]) were placed. Among the ML algorithms used in this study, logistic regression (LR) (4.16, 25%) and multiple logistic regression (MLR) (4.16, 25%) were the most used. All the included studies indicated improvements in the processes of diagnosis, prediction, and disease outbreak with the help of ML algorithms. Conclusion The results of the study showed that in all included studies, ML algorithms were an effective approach to facilitate diagnosis, predict consequences for risk classification, and improve resource utilization by predicting the volume of patients or services as well as discovering risk factors. The role of ML algorithms in improving disease diagnosis was more significant than disease prediction and prevalence. Meanwhile, the use of combined methods can optimize differential diagnoses and facilitate the decision‐making process for healthcare providers.

Abstract Background and Aim In late 2021, the world faced the rapid spread of the SARS‐CoV‐2 Omicron variant, which quickly became the variant of concern. In April 2022, two new lineages of Omicron (BA.4/BA.5) emerged from Africa, where they caused the fifth wave of infection. Method We searched PubMed, Google Scholar, and Scopus online databases up to December 2023 for founding relevant studies. Results BA.4 and BA.5 subgroups, with changes in the spike protein, have a greater ability to escape from the immune system, which was possible with the help of L452R and F486V mutations. Epidemiologically, these evolving subtypes show similarities to seasonal influenza but with higher mortality rates. The symptoms of these subgroups are different from the previous types in the form of upper respiratory symptoms. Antiviral treatments, the use of antibodies such as bebtelovimab, and the development of vaccines are promising. Conclusion Consequently, we must continue to be vigilant in our joint surveillance efforts against COVID‐19 in diagnosis and treatment.

Abstract Background Celiac disease (CD) is a chronic autoimmune disorder characterized by an abnormal immune response to gluten, a protein found in wheat, barley, and rye. It is well established that the integrity of epithelial tight junctions (TJs) and adherens junctions (AJs) plays a crucial role in the pathogenesis of CD. These junctional complexes contribute to the apical–basal polarity of the intestinal epithelial cells, which is crucial for their proper functioning. Methods Sixty CD subjects, and 50 controls were enrolled in the current study. Mucosal samples were obtained from the distal duodenum, total RNA was extracted and complementary DNA was synthesized. The relative expression levels of the desired genes were evaluated by quantitative real‐time polymerase chain reaction based on ΔΔCt method. The gene–gene interaction network was also constructed using GeneMANIA. Results CRB3 (p = .0005), LKB1 (p .05). CRB3 represented a significant diagnostic value for differentiating CD patients from the control group (p = .02). Conclusion The aim of the current study was to evaluate the changes in the mRNA expression levels of SCRIB, PRKCZ, LKB1, and CRB3 genes in the small intestinal biopsy samples of CD patients in comparison to the healthy control subjects. Our data uncover the importance of polarity‐related genes (especially CRB3) in CD pahtomechanism, that may facilitate the planning of the future studies looking for finding innovative diagnostic and therapeutic strategies for CD.

Background. Patients with β-thalassemia major depend on lifelong transfusion, resulting in tissue iron overload. This longitudinal retrospective observational study aims to assess myocardial and liver iron overload using magnetic resonance imaging (MRI) and investigate the lag between myocardial and liver iron unloading in β-thalassemia patients undergoing chelation therapy. Methods. Beta-thalassemia major patients with at least two MRI studies between 2016 and 2020 were enrolled. Myocardial and liver iron overload were defined as T2∗ less than 20 and 2.1, respectively. Outcomes included mortality, myocardial and liver T2∗ changes, and systolic dysfunction assessed by cardiac MRI. Results. Fifty-five patients with a mean age of 24.62 ± 7.94 years, a mean follow-up duration of 24.3 ± 12.9 months, and a mean ferritin level of 1475.75 ± 771.12 ng/mL were enrolled. All of the abovementioned patients only took deferoxamine as the iron-chelating medication. Mortality occurred in three patients (5.5%) during follow-up. Liver T2∗ significantly increased (p value

Introduction. Emergence agitation (EA) is one of the common problems during recovery from general anesthesia, especially in children. In this study, we investigated the effect of dexmedetomidine on the control of agitation after anesthesia with sevoflurane in children. Method. This randomized control-placebo, double-blind prospective clinical trial was conducted on seventy-six children between 2 and 7 years with ASA (American Society of Anesthesiologists) class I who were candidates for elective adenoidectomy surgery and tonsillectomy. Participants were selected by an available sampling method. Patients were randomly placed in one of the two groups D (dexmedetomidine 0.5 μg/kg infusion within ten minutes) or P (placebo: normal saline infusion within ten minutes). A four-point scale evaluated agitation. Pain evaluation was done by FLACC (faces, legs, activity, cry, and consolability). The statistical software was SPSS version 23. P

Objectives. This study aimed to assess the effect of addition of bioactive glass (BG) on the setting time and antibacterial activity of mineral trioxide aggregate (MTA) against Enterococcus faecalis (E. faecalis). Materials and Methods. In this in vitro study, BG was synthesized by the sol-gel technique and added to MTA powder in certain ratios. Three groups of specimens were fabricated from pure MTA, MTA mixed with 10wt% BG, and MTA mixed with 20wt% BG. The setting time of specimens was measured according to ISO9917-2007. Direct contact test was used to assess the antimicrobial activity of the three groups against E. faecalis. Data were analyzed by repeated measures ANOVA (alpha = 0.05). Results. Addition of BG (in both concentrations) to MTA decreased its setting time and improved its antibacterial activity against E. faecalis (p

Researchers consider the planning of power systems to be of utmost importance, and due to its significant budget, further studies on the resilience of energy systems are necessary. Therefore, a five-level dynamic model is developed to improve resilience to natural disaster events. The initial level focuses on expansion planning and system uncertainties, specifically examining the utilization of wind turbines in the proposed energy hub to incorporate the thermal energy market together with demand response program. Its purposes are to improve resilience, minimize input transmission costs, and minimize operating costs. The second level is related to the corrective actions that the system operator should take after the accident for network reconfiguration. The earthquake-induced and attack events, considering unknown events, are modeled and assessed in the third level. Generation expansion planning is performed at the fourth level. As with the whole model, this level tries to improve resilience. The fifth level deals with transmission expansion planning to boost resilience, and the capability of transmission switching is regarded as a low-cost correction factor. The first level optimizes energy hub according to the differential evolutionary algorithm, but the next four levels employ a robust symphony orchestra search algorithm. Finally, the dynamic planning model proposed here is employed on a Garvers 6-bus system and then on a 400 kV 52-bus Iranian power grid. According to the findings, the proposed planning model demonstrates a reduction in capital costs of transmission switches by up to 26%. Also, the expected profit of the generation units increases by as much as 3.75%. Accordingly, the results show that the model is both feasible and effective.

This study delves into the therapeutic potential of β-hydroxybutyrate (BHB) in clear cell renal cell carcinoma (ccRCC), a cancer known for its complex pathogenesis and resistance to conventional treatments. The research specifically explores the impact of BHB on cell viability, autophagy induction, and lipid metabolism in Caki-1 cells. The findings reveal that BHB significantly reduces ccRCC cell viability, particularly under low-glucose conditions. The combination of glucose and BHB treatment activates autophagy pathways, as evidenced by increased expression of autophagy-related genes (Beclin-1, LC3IIβ, and ATG5) and decreased expression of P62 after 48 and 72 hours. Moreover, the combined therapy enhances lipid metabolism, as indicated by elevated expression of PGC-1α and UCP-1, along with upregulation of ACSL3 and CPT1A, which are associated with lipid droplet formation and facilitate lipid breakdown within cells. The study concludes that BHB holds promise as a therapeutic agent for ccRCC, targeting abnormal lipid metabolism, inducing autophagy-mediated cell death, and promoting fat browning. The results suggest potential avenues for precision-guided nutritional therapies in ccRCC treatment, highlighting the innovative role of BHB in addressing the challenges posed by this cancer.

Background. Clinical reasoning and evidence-based medicine (EBM) are important concepts in modern medicine. Objective. We performed this study to investigate the knowledge, attitude, and practice (KAP) status toward clinical reasoning and EBM among the medical interns and gynecology resident physicians of Iran University of Medical Sciences and related factors. Methods. A cross-sectional study (Tehran, Iran, first half of 2022) was conducted based on two researcher-made questionnaires consisting of three components for each including clinical reasoning attitude (CR-A), clinical reasoning knowledge (CR-K), clinical reasoning practice (CR-P), EBM attitude (EBM-A), EBM knowledge (EBM-K), and EBM practice (EBM-P). The related factors were age, gender, educational level, score of general practice education, having research experience, and general practice experience. Results. A total of 60 individuals participated. The mean score was good for CR-A, moderate for CR-K, moderate for CR-P, good for EBM-A, moderate for EBM-K, and moderate for EBM-P. The total score was moderate in both clinical reasoning and EBM. Among the related factors, CR-P was associated with higher educational levels and having experience in general practice (P

Abstract Biofertilizers has potential to improve crop productivity in a sustainable manner yet their impact on forage crops yields and forage quality indices have not been extensively explored. In this study, the impact of different cropping patterns and fertilizer sources on the forage yield and quality of ajowan (Carum copticum L.), fenugreek (Trigonella foenum‐graecum L.), and pea (Pisum sativum L.) was investigated. The findings shed light on the importance of biofertilizer application as a sustainable solution for enhancing forage production and quality in agricultural systems. The experimental treatments involved six cropping patterns [ajowan monoculture, fenugreek monoculture, pea monoculture, intercropping of one row ajowan + one row fenugreek + one row pea (1:1:1), two rows ajowan + two rows fenugreek + two rows pea (2:2:2), and three rows ajowan + three rows fenugreek + three rows pea (3:3:3)] and five fertilizer sources [no fertilizer (control), 100% chemical fertilizer (CF), chemical fertilizer + humic acid (CF + HU), chemical fertilizer + biofertilizer (CF + BF), and humic acid + biofertilizer (HU + BF)]. The results revealed that the 2:2:2 intercrop fertilized with CF + BF had the highest N, P, and K concentrations for the three species. The monoculture systems with CF + BF produced the highest forage yields for ajowan (5492 kg/ha), fenugreek (3811 kg/ha), and pea (12,695 kg/ha). In addition, 2:2:2 intercrop fertilized with CF + BF produced the highest forage quality for all three species, decreasing the crude fiber, acid detergent fiber, and neutral detergent fiber contents and increasing forage ASH, dry matter intake, water‐soluble carbohydrates, and relative feed value. The 2:2:2 intercrop ratio combined with CF + BF application could be recommended to farmers as an eco‐friendly strategy (decreasing chemical fertilizer use) for improving forage productivity and quality in sustainable agricultural systems.

Malignant melanoma of the conjunctiva is a rare tumor of the ocular surface with potential fatal consequences and a high likelihood of recurrence. Although routes for extending the tumor, including local, hematogenous, and lymphatogenous, are pretty straightforward, the indirect extension through free-floating tumoral cells to the nasolacrimal duct is not described thoroughly. We report a case of malignant melanoma of the conjunctiva which presented with local recurrence in the intranasal cavity and lacrimal sac two years after the primary surgery (without involvement of the ocular surface and punctum on the second occasion). However, there was no evidence of distant metastasis on either occasion. This case demonstrates the possible noncontiguous spreading route of melanoma tumoral cells and highlights the need for attention to the surgical technique, and careful follow-up to detect further disease activity.

Renal cell carcinoma (RCC) accounts for the majority of cancer-related deaths worldwide. Overexpression of CD70 has been linked to advanced stages of RCC. Therefore, this study aims to develop a multiepitope vaccine targeting the overexpressed CD70 using immunoinformatics techniques. In this investigation, in silico multiepitope vaccines were constructed by linking specific CD70 protein epitopes for helper T lymphocytes and CD8+ T lymphocytes. To enhance immunogenicity, sequences of cell-penetrating peptide (CPP), penetratin (pAntp), along with the entire sequence of tumor necrosis factor-α (TNF-α), were attached to the N-terminal and C-terminal of the CD70 epitopes. Computational assessments were performed on these chimeric vaccines for antigenicity, allergenicity, peptide toxicity, population coverage, and physicochemical properties. Furthermore, refined 3D constructs were subjected to a range of analyses, encompassing structural B-cell epitope prediction and molecular docking. The chosen vaccine construct underwent diverse assessments such as molecular dynamics simulation, immune response simulation, and in silico cloning. All vaccines comprised antigenic, nontoxic, and nonallergenic epitopes, ensuring extensive global population coverage. The vaccine constructs demonstrated favorable physicochemical characteristics. The binding affinity of chimeric vaccines to the TNF receptor remained relatively stable, influenced by the alignment of vaccine components. Molecular docking and dynamics analyses predicted stable interactions between CD70-CPP-TNF and the TNF receptor, indicating potential efficacy. In silico codon optimization and cloning of the vaccine nucleic acid sequence were accomplished using the pET28a plasmid. Furthermore, this vaccine displayed the capacity to modulate humoral and cellular immune responses. Overall, the results suggest therapeutic potential for the chimeric CD70-CPP-TNF vaccine against RCC. However, validation through in vitro and in vivo experiments is necessary. This trial is registered with NCT04696731 and NCT04046445.

Abstract Background and Aims Chronic obstructive respiratory diseases (COPD) not only cause damage to the respiratory system as well as the heart and blood vessels of the patient but also have a direct effect on the condition of the musculoskeletal system. The risk of falling is increasing due to dysfunction of the joints as well as aging, which occurs frequently in this population. Gait deficits are known as an important risk factor for falls. This research aimed to investigate the gait of COPD patients compared to healthy people to gain a better understanding of the reasons for falls. Methods Twenty patients with COPD and 20 age and BMI‐matched healthy individuals were included in this study. Sixteen markers were applied to the lower body of the subjects. Spatio‐temporal, kinematic, and maximum moment parameters were measured in different phases in three lower body joints, including the hip, knee, and ankle. Results The results showed that all spatio‐temporal parameters in patients were significantly lower than in healthy people. The ankle angle in the sagittal plane at initial contact was significantly difference (p = 0.03). As well as, in the frontal plane the hip angle in the mid‐stance showed a significant difference (p = 0.02). There was also a significant difference in maximum hip moment in the sagittal plane between the two groups (p = 0.01). Conclusion The larger hip angle of the patients can be related to the balance problems in the mediolateral direction. The moment showed a significant difference in the hip joint. Since the hip muscles are directly in a synergistic relationship with the trunk muscles, it seems the performance of these muscles is likely to be seriously damaged due to respiratory diseases.

Key Clinical Message After a Bentall surgery, there is a small chance of developing a serious complication called vascular graft infection. 18F‐FDG PET/CT, a new and accurate diagnostic tool, can help detect it early, especially if the symptoms are unusual. Abstract A 14‐year‐old boy who had undergone Bentall surgery 1 year prior presented with symptoms of fever, chills, loss of appetite, and weight loss over the course of a month. The initial Bentall surgery was performed due to an aneurysm of the thoracic aorta, along with severe aortic valve insufficiency and moderate aortic valve stenosis. The patient was referred to the PET/CT department for evaluation of possible endarteritis or infection of Dacron graft, which had been reported in trans‐esophageal echocardiography as suspicious findings. Despite normal blood tests, blood cultures, and other imaging modalities, the 18F‐FDG PET/CT confirmed the diagnosis of vascular graft infection. This diagnostic tool allowed for timely and appropriate treatment and prevention of possible complications.

Abstract Introduction Toxoplasma gondii infection is considered as one of the most important opportunistic infections and cause of death in HIV patients. Methods In this cross‐sectional study, 334 HIV positive patients were included. The molecular test was performed by the restriction fragment length polymorphism–polymerase chain reaction method. Allelic frequency, haplotype analyses, and linkage disequilibrium were calculated. The odds ratio was calculated. The linear regression model was used to analysis of interleukin (IL)‐17A, IL‐17F, and IL‐6 single‐nucleotide polymorphism genotypes in HIV patients with and without toxoplasmosis. Results In total, 95 tested'patients (28.4%) were positive for toxoplasmosis. The risk of toxoplasma infection in the current study did not correlate with IL‐17 and IL‐6 polymorphism and the risk of contracting toxoplasma was also not significantly correlated in this study. There was no association between the frequency of alleles and the risk of toxoplasma infection in IL‐17 haplotype analysis. Conclusion The findings of this study revealed that there were significant differences in the serum levels of IL‐6 and IL‐17A, but not IL‐17F, between the case and control groups in various genetic models. However, these polymorphisms did not show a significant relationship with toxoplasma infection in HIV‐positive patients. This study represents the first investigation in Iran to explore the role of IL‐6 and IL‐17 polymorphisms in toxoplasma infection among HIV‐positive patients.

Abstract Following the successful development of advanced driver assistance systems (ADAS), the current research directions focus on highely automated vehicles aiming at reducing human driving tasks, and extending the operational design domain, while maintaining a higher level of safety. Currently, there are high research demands in academia and industry to predict driver intention and understating driver readiness, e.g. in response to a “take‐over request” when a transition from automated driving mode to human mode is needed. A driver intention prediction system can assess the driver's readiness for a safe takeover transition. In this study, a novel deep neural network framework is developed by adopting and adapting the DenseNet, long short‐term memory, attention, FlowNet2, and RAFT models to anticipate the diver maneuver intention. Using the public “Brain4Cars” dataset, the driver maneuver intention will be predicted up to 4 s in advance, before the commencement of the driver's action. The driver intention prediction is assessed based on 1) in‐cabin 2) out‐cabin (road) and 3) both in‐out cabin video data. Utilizing K‐fold cross‐validation, the performance of the model is evaluated using accuracy, precision, recall, and F1‐score metrics. The experiments show the proposed DIPNet model outperforms the state‐of‐the‐art in the majority of the driving scenarios.

Objective To investigate whether digital activity fluorescence optical imaging (FOI) patterns of inflammation can identify distinct rheumatoid arthritis (RA) phenotypes. Methods The hands of newly diagnosed patients with RA were evaluated by clinical examination, musculoskeletal ultrasound, and FOI. Inflammation on FOI was defined when capillary leakage and/or fluorophore perfusion was present. The FOI composite image was quantified into a digital disease activity (DACT) score, using novel computerized algorithms. Unsupervised clustering on FOI inflammatory patterns was used to identify subgroups of patients relative to anticyclic citrullinated peptides (ACPA) and/or rheumatoid factor (RF). Results Of 1326 examined hand joints in 39 patients with RA (72% female; 56% ever‐smokers; 54% RF positive and 69% ACPA positive), 400 (30%) showed inflammation by FOI, and 95% (37 of 39) of patients had DACT‐FOI scores greater than 1. Unsupervised analysis on FOI patterns revealed two patient clusters, cluster 1 (n = 29) and cluster 2 (n = 10). The proportion of seropositive patients was significantly higher in cluster 1 versus cluster 2 (90%, 26 of 29 vs. 30%, 3 of 10; P

Abstract The rotor‐circuit (RC) of the doubly fed induction generator‐based wind turbine (DFIG‐WT) consists of various equipment in which faulty conditions must be immediately identified, because this faulty status leads to the loss‐of‐excitation (LOE) phenomenon and may cause some serious damages. In this regard, this paper develops a novel solution to protect the DFIG‐WT during such a condition. For this purpose, a comprehensive investigation on behavior of the DFIG‐WT during the conditions of the RC failures has been carried out. The results show that, the output active power of the machine (Pdfig) can be considered as a suitable initial indicator for detecting the RC failures. However, to reliable detection of the partial‐LOE (PLOE), complete‐LOE (CLOE) and discrimination from the other power system disturbance (PSD), a directional over‐current (DOC) and an under voltage (UV) relays are suggested to be installed in the RC, at both ends of the back‐to‐back converters. Consequently, by detecting the Pdfig decrement, the provided DOC and UV relays in the RC will be triggered to classify the occurred events. The outlined protection scheme is exhaustively investigated on a typical power system which the obtained simulation results show the high reliability in discriminating the RC failures and PSD events with an acceptable detection time.

Abstract Some studies indicated that sugar‐sweetened beverages (SSBs) were related to MetS risk, and others found no relationship between MetS and SSBs. Therefore, the present study aimed to investigate the relationship between healthy beverage index (HBI) and MetS in Iranian adults. This cross‐sectional study was performed on baseline data FASA cohort. Out of 10,127 participants in the FASA cohort study, 8838 participants were included in this study. The National Cholesterol Education Program's Adult Treatment Panel (ATP) III was used for MetS definition. The HBI was calculated by a 125‐item food frequency questionnaire with standard criteria. The association between HBI and MetS and its components was evaluated by univariate regression. Multivariate regression with the backward method was used for adjusting confounders. p

Abstract Significant progress has been made in manufacturing emerging technologies in recent years. This progress implemented in‐memory‐computing and neural networks, one of today's hottest research topics. Over time, the need to process complex tasks has increased. This need causes the emergence of intelligent processors. A nonvolatile associative memory based on spintronic synapses utilising magnetic tunnel junction (MTJ) and carbon nanotube field‐effect transistors (CNTFET)‐based neurons is proposed. The proposed design uses the MTJ device because of its fascinating features, such as reliable reconfiguration and nonvolatility. At the same time, CNTFET has overcome conventional complementary metal‐oxide‐semiconductor shortcomings like the short channel effect, drain‐induced barrier lowering, and poor hole mobility. The proposed design is simulated in the presence of process variations. The proposed design aims to increase the number of weights generated in the synapse for higher memory capacity and accuracy. The effect of different tunnel magnetoresistance (TMR) values (100%, 200%, and 300%) on the performance and accuracy of the proposed design has also been investigated. This investigation shows that the proposed design performs well even with a low TMR value, which is very important and remarkable from the fabrication point of view.

Abstract Background Breast cancer (BC), as the top neoplasm in prevalence and mortality in females, imposes a heavy burden on health systems. Evaluation of quality of care and management of patients with BC and its responsible risk factors was the aim of this study. Methods We retrieved epidemiologic data of BC from the Global Burden of Disease (GBD) 1990–2019 database. Epidemiology and burden of BC and its risk factors were explored besides the Quality of Care Index (QCI) introduced before, to assess the provided care for patients with BC in various scales. Provided care for BC risk factors was investigated by their impact on years of life lost and years lived with disability by a novel risk factor quality index (rQCI). We used the socio‐demographic index (SDI) to compare results in different socio‐economic levels. Results In 2019, 1,977,212 (95% UI: 1,807,615–2,145,215) new cases of BC in females and 25,143 (22,231–27,786) in males was diagnosed and this major cancer caused 688,562 (635,323–739,571) deaths in females and 12,098 (10,693–13,322) deaths in males, globally. The all‐age number of deaths and disability‐adjusted life years attributed to BC risk factors in females had an increasing pattern, with a more prominent pattern in metabolic risks. The global estimated age‐standardized QCI for BC in females in 2019 was 78.7. The estimated QCI was highest in high SDI regions (95.7). The top countries with the highest calculated QCI in 2019 were Iceland (100), Japan (99.8), and Finland (98.8), and the bottom countries were Mozambique (16.0), Somalia (8.2), and Central African Republic (5.3). The global estimated age‐standardized rQCI for females was 82.2 in 2019. Conclusion In spite of the partially restrained burden of BC in recent years, the attributable burden to risk factors has increased remarkably. Countries with higher SDI provided better care regarding both the condition and its responsible risk factors.

Background Particulate matter (PM) pollution is a significant risk factor for cardiovascular diseases, causing substantial disease burden and deaths worldwide. This study aimed to investigate the global burden of cardiovascular diseases attributed to PM from 1990 to 2019. Methods and Results We used the GBD (Global Burden of Disease) study 2019 to investigate disability‐adjusted life‐years (DALYs), years of life lost (YLLs), years lived with disability (YLDs), and deaths attributed to PM as well as its subgroups. It was shown that all burden measures' age‐standardized rates for PM were in the same decreasing trend, with the highest decline recorded for deaths (−36.7%). However, the all‐age DALYs increased by 31%, reaching 8.9 million in 2019, to which YLLs contributed the most (8.2 million [95% uncertainty interval, 7.3 million–9.2 million]). Men had higher deaths, DALYs, and YLLs despite lower years lived with disability in 2019 compared with women. There was an 8.1% increase in the age‐standardized rate of DALYs for ambient PM; however, household air pollution from solid fuels decreased by 65.4% in the assessed period. Although higher in men, the low and high sociodemographic index regions had the highest and lowest attributed YLLs/YLDs ratio for PM pollution in 2019, respectively. Conclusions Although the total age‐standardized rate of DALYs for PM‐attributed cardiovascular diseases diminished from 1990 to 2019, the global burden of PM on cardiovascular diseases has increased. The differences between men and women and between regions have clinical and policy implications in global health planning toward more exact funding and resource allocation, in addition to addressing inequity in health care access.

Abstract Background This study aimed to describe the trends in incidence, mortality, and burden of tracheal, bronchial and lung (TBL) cancer in Asia from 2010 through 2019 and compare with global and other continental data. Methods We collected TBL cancer data from the 2019 Global Burden of Disease (GBD) study from 2010 to 2019 in 49 countries and territories in Asia. For all locations, annual case data and age‐standardized rates (ASRs) were used to investigate the incidence, prevalence, mortality, and disability‐adjusted life‐years (DALYs) of TBL from 2010 to 2019. The relative difference (%) between years was used to show comparative variations of ASRs for the indicators studied. Results In 2019, more than 55% of TBL cancer cases and deaths occurred in Asian countries. A total of 57% of lung cancer patients lived in Asia and almost 60% of the global burden of lung cancer was imposed on Asian countries. From 2010 to 2019, incidences, deaths, prevalence cases, and DALYs number of TBL cancer increased over 1.34‐, 1.31‐, 1.31‐, and 1.26‐fold, in Asia. During this period, the age‐standardized incidence rate (ASIR), the age‐standardized death rate (ASDR), the age‐standardized prevalence rate (ASPR), and the age‐standardized DALYs rate (DALYs ASR) of TBL cancer decreased by 1, 3, 4, and 4%, respectively. While at the same time, the decreasing trend of these rates globally and in America and in Europe happened faster. In 2019, age‐specific incidence, death, prevalence, and DALY cases of TBL cancer were peaking at 65–74, 70–74, 65–69, and 65–69 years, respectively. In 2019, the highest ASIR, ASDR, and DALYs ASR of TBL cancer was observed in East Asia countries and the highest ASPR in high‐income Asia Pacific countries. Central Asia and high‐income Asia Pacific countries experienced a decreasing trend in ASIR and ASDR, and the South Asia countries experienced the highest increasing trend from 2010 to 2019. ASPR only decreased in Central Asia, and DALYs ASR only increased in South Asia. In 2019, among high sociodemographic index (SDI) Asian countries, Brunei Darussalam had the highest ASIR, ASDR, and DALYs ASR and the Republic of Korea had the highest ASPR. Among high‐middle SDIs, Turkey and Georgia; among middle SDIs, China and Armenia; among low‐middle SDIs, Mongolia and the Democratic People's Republic of Korea had the highest ASIR, ASDR, ASPR, and DALY ASR of TBL cancer. Among low SDI Asian countries, Pakistan had the highest ASIR, ASDR, ASPR, and DALY ASR of TBL cancer. Conclusion Most of the global burden of lung cancer occurs in Asian countries, and the decreasing trend of incidence, death, prevalence, and burden of this cancer in these countries is slower than in other regions. Therefore, the implementation of necessary measures in order to reduce the process of this cancer is considered urgent.

Abstract This study aimed to evaluate the effect of saffron, crocin, and safranal on serum levels of oxidants and antioxidants in diabetic rats. The authors searched the databases with standard keywords until June 8, 2021. The random‐effects model was used to pool standardized mean differences (SMD) with 95% confidence intervals to assess the effects of saffron and its active component. To investigate heterogeneity, subgroup analysis and meta‐regression were utilized. Begg and Egger's tests were used to measure publication bias. Our results showed that saffron, crocin, and safranal were able to significantly reduce the serum levels of oxidants with strong efficacy so that saffron had the highest effectiveness on serum malondialdehyde (SMD, −2.84 (μmol/L) [95% confidence interval (CI), −4.32 to −1.36]; p

Abstract Biofilm is considered as a community of microorganisms in which cells adhere to each other on surfaces in a self‐produced matrix of extracellular polymer compounds. In recent years, efforts to use the beneficial aspects of biofilm in probiotic research have intensified. In this study, probiotic biofilms of Lactiplantibacillus plantarum and Lacticaseibacillus rhamnosus were manufactured using milk and transferred to yogurt in whole and pulverized forms to test in real food conditions. Survival was assessed during 21 days of storage time as well as gastrointestinal conditions. The results indicated that Lp. plantarum and Lc. rhamnosus can form a very desirable and strong biofilm that can have a good protective effect on the survival of these bacteria in probiotic yogurt during processing, storage, and gastrointestinal conditions, in a way that, after 120 min of treatment in high acidic gastrointestinal conditions (pH 2.0), the survival rate decreased by only 0.5 and 1.1 log CFU/ml. Probiotic biofilm can be used as a natural way of utilizing bacteria in biotechnology and fermentation, which is an excellent way to increase the utility of probiotics.

ABSTRACT Importance Despite the high burden of respiratory infections among children, the production of exhaled particles during common activities and the efficacy of face masks in children have not been sufficiently studied. Objective To determine the effect of type of activity and mask usage on exhaled particle production in children. Methods Healthy children were asked to perform activities that ranged in intensity (breathing quietly, speaking, singing, coughing, and sneezing) while wearing no mask, a cloth mask, or a surgical mask. The concentration and size of exhaled particles were assessed during each activity. Results Twenty‐three children were enrolled in the study. Average exhaled particle concentration increased by intensity of activity, with the lowest particle concentration during tidal breathing (1.285 particles/cm3 [95% CI 0.943, 1.627]) and highest particle concentration during sneezing (5.183 particles/cm3 [95% CI 1.911, 8.455]). High‐intensity activities were associated with an increase primarily in the respirable size (≤ 5 µm) particle fraction. Surgical and cloth masks were associated with lower average particle concentration compared to no mask (P = 0.026 for sneezing). Surgical masks outperformed cloth masks across all activities, especially within the respirable size fraction. In a multivariable linear regression model, we observed significant effect modification of activity by age and by mask type. Interpretation Similar to adults, children produce exhaled particles that vary in size and concentration across a range of activities. Production of respirable size fraction particles (≤ 5 µm), the dominant mode of transmission of many respiratory viruses, increases significantly with coughing and sneezing and is most effectively reduced by wearing surgical face masks.

Abstract This paper deals with the real‐time optimal operation of active distribution networks (ADNs) hosting hybrid hydrogen‐electricity refuelling stations by benefiting from renewable energy sources (RESs), conversion facilities, and energy storage systems. The hybrid refuelling stations, which are controlled by ADN operator, supply electricity and hydrogen for electric vehicles (EVs) and hydrogen vehicles (HVs), respectively. In addition, the deployment of water equipment technologies in the ADNs, is considered by utilizing water well pumps in the hybrid stations to serve water demand. The principal aim is to minimize the expected operation cost, including the cost of purchasing power from the upstream grid and maintenance and operation costs of each hybrid refuelling station. Various technical and physical constraints are considered to ensure the reliable operation and realistic scheduling of ADNs in the presence of hybrid refuelling stations. This study employs a hybrid information gap decision theory (IGDT)‐stochastic approach to address the uncertain behaviour of wholesale market price, electricity demand of EVs in refuelling stations, RESs output power and nodal demand of ADN to reach a risk‐averse strategy. The developed approach is coded under GAMS software and the effectiveness of the approach is validated by testing on the modified IEEE 33‐bus test system.

Key clinical massage A 23‐year‐old rancher was admitted with the diagnosis of brucellosis. In evaluations, a massive vegetation in the aortic valve was seen. A combination of antibiotic therapy and cardiac surgery were performed, it seems this approach reduces mortality and complications. Abstract Brucellosis (also known as “undulant fever,” “Mediterranean fever,” or “Malta fever”) is a zoonotic infection transmitted to humans from infected animals (cattle, sheep, goats, camels, pigs, or other animals) by ingestion of food products (such as unpasteurized dairy products) or by contact with tissue or fluids. It is the most frequent zoonosis globally and a major public health issue in many resource‐poor nations. Endocarditis is one of the rarest and most dangerous consequences of brucellosis. Additionally, the combination of endocarditis with cardiomyopathy increases its rarity. This condition is usually treated with a high level of suspicion Serological, clinical, and epidemiological data can all be used to make a diagnosis. The use of echocardiography aids in the early diagnosis. Due to the high risk of recurrence and the extent of tissue destruction brought on by Brucella, the majority of experts advise an early surgical intervention; nevertheless, other writers assert that low‐risk patients also require cautious therapy. In this article, we discuss the situation of a patient who underwent surgery and had Brucella endocarditis and heart failure. In conclusion, a combination of antibiotic therapy and cardiac surgery, reduces mortality and complications associated with Brucella endocarditis and improves patient quality of life.

Abstract Background and Aims Reluctance to childbearing and then the reduction of the total fertility rate are common experiences of developed countries and many developing countries, including Iran, therefore, the purpose of this study was explaining barriers to childbearing using the risk communication and community engagement (RCCE) strategy. Methods The study was conducted by action research and according to RCCE during 9 months in Ardabil city. The statistical population consisted of 41 married women aged 15–54 who were eligible for childbearing, these women were purposefully selected from among the people covered by Ardabil health centers and interviewed. Data were collected using open and in‐depth interviews by the researcher and analyzed by content analysis. Results The results of data analysis led to the extraction of three main categories, personal, familial, and social barriers. The “personal barriers” category was classified into three subcategories, namely mental, belief, and awareness barriers, the “familial barriers” category was classified into two subcategories, namely social and financial barriers, and the “social barriers” category was classified into two subcategories, political and managerial barriers. Conclusions According to the results, a set of personal, familial, and social factors could affect childbearing among married women. Identification of these factors can play an effective role in designing educational and managerial programs.

Key clinical message The reformation of teeth with severe wear is a real challenge for clinicians. Through a clinical case study, this case illustrates a minimally invasive approach using the Dahl technique and bonded restorations for the treatment of a worn dentition with a loss of vertical dimension of occlusion and restoring ideal aesthetics.