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This study was aimed to adopt an ecofriendly method to synthesize nanoparticles with an effective antibacterial and anti-biofilm activity. A food origin hypermucoviscous Klebsiella pneumoniae was isolated from food samples and identified using biochemical tests and the Vitek system. A string test was depended on to identify hypermucoviscous isolates. Enterotoxicity of foodborne hypermucoviscous K. pneumoniae isolates was detected phenotypically using suckling mouse bioassay. Biofilm forming ability was tested for all the isolated bacteria using the Microtiter plate method and Congo Red Agar. A natural food additive Syzygium aromaticum (clove) aqueous extract was used for the biosynthesis of silver nanoparticles in optimized conditions. The biosynthesized clove-silver nanoparticles (Clove-AgNps) were characterized by several techniques, and their antimicrobial and antibiofilm activity was determined. The results of this study revealed that the isolation of 28 K. pneumoniae isolates were isolated from 200 food samples. String test results showed that 16/28 (57.14%) K. pneumoniae isolates were hypermucoviscous. Eleven of these isolates (68.75%) were enterotoxigenic. Using clove aqueous extract as a biological agent was successful in the biosynthesis of AgNPs with an average diameter of 14.12 nm as measured by AFM. The optimum biosynthesis conditions were: 1mM of AgNO3 concentration, pH 7, at 37 °C, and 24 hours. The minimum inhibitory concentration of the clove-AgNPs was detected as 62.5 µg.mL-1. Sub-inhibitory concentration of 31.25 µg.mL-1 of Clove-AgNPs resulted in: 91% decrease in the formed biofilm. It can be concluded that using Syzygium aromaticum is an effective ecofriendly method for AgNPs biosynthesis with excellent antibacterial and anti-biofilm activity against enterotoxigenic hypermucoviscous K. pneumoniae.

In the drilling and production operations, the effectiveness of cementing jobs is crucial for efficient progress. The compressive strength of oil well cement is a key characteristic that reflects its ability to withstand forceful conditions over time. This study evaluates and improves the compressive strength and thickening time of Iraqi oil well cement class G from Babylon cement factory using two types of additives (Nano Alumina and Synthetic Fiber) to comply with the American Petroleum Institute (API) specifications. The additives were used in different proportions, and a set of samples was prepared under different conditions. Compressive strength and thickening time measurements were taken under different conditions. The amounts of Nano Alumina (0.5%, 1%, and 1.5% by weight of cement (BWOC)) were selected with synthetic fiber (0.5 g, 1 g, and 1.5 g, respectively). The results show a significant improvement in compressive strength, with all values meeting the API requirements, and a decrease in the thickening time of Iraqi oil well cement, depending on the proportions of additives. The most significant improvement in compressive strength was achieved in the sample containing 1.5% Nano Alumina by weight of cement (BWOC) and 1.5 g Synthetic Fiber (Barolift), where the compressive strength increased by 40.7% and 33.8% at a temperature of 38 °C and 60 °C, respectively, while the thickening time decreased by 26.53% at this ratio of additives. The results demonstrate the feasibility of using these additives to enhance the performance of Iraqi oil well cement, expanding its potential application in Iraqi oil fields.

Accurate and interpretable segmentation of medical images is crucial for computer-aided diagnosis and image-guided interventions. This study explores the integration of semantic segmentation and explainable AI techniques on the MnMs-2 Cardiac MRI dataset. We propose a segmentation model that achieves competitive dice scores (nearly 90 %) and Hausdorff distance (less than 70), demonstrating its effectiveness for cardiac MRI analysis. Furthermore, we leverage Grad-CAM, and Feature Ablation, explainable AI techniques, to visualise the regions of interest guiding the model predictions for a target class. This integration enhances interpretability, allowing us to gain insights into the model decision-making process and build trust in its predictions.

Copyright of Iraqi Journal of Chemical & Petroleum Engineering is the property of Republic of Iraq Ministry of Higher Education & Scientific Research (MOHESR) and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Shohalter's approach, known for its critique of the current state and tradition of women's writing, provides a platform for examining women's literature through the lens of gender differences. Shohalter analyzes literary content and structure by considering biological, linguistic, psychological, and cultural factors. The protagonist of this story is a lonely woman who is unjustly driven away from her home due to false accusations by her husband and becomes a wanderer in Tehran. In the novel, male characters, collectively or individually, play a role in the protagonist's tragic fate, while female characters, despite their futile efforts, strive to support her. The author creates an imaginary place called "Goran" to depict the historical oppression of women by a male-dominated culture. This study aims to analyze the characteristics of Iranian women's writing in the novel "Peyadeh" using Shohalter's fourfold approach through a descriptive-analytical method. The results demonstrate that topics such as pregnancy and childbirth, relationships with men, maternal attributes, and connections among women can be examined from a biological, psychological, and linguistic perspective based on Shohalter's framework. Furthermore, a notable stylistic feature of the text is its unique blend of native Iranian narrative style, combining third-person and first-person perspectives with the utilization of emotional sentences, reminiscent of storytelling among Iranian women.

Introduction Olfactory dysfunction (OD) has emerged as a notable symptom among coronavirus disease 2019 (COVID-19) patients, with its prevalence varying among different populations. Recognizing the need to provide therapeutic solutions for these individuals, the present study seeks to comprehensively review the current evidence on potential underlying mechanisms and treatment modalities to manage OD in COVID-19 patients.

Introduction. As the COVID-19 pandemic continues to pose a significant challenge to global health, effective therapeutic options for preventing and treating the disease have become increasingly important. We aimed to provide an update on current treatments and therapeutic options for COVID-19 patients.Materials and methods. The purpose of this umbrella review is to explore the current treatments and therapeutic options for COVID-19 patients. Keywords and their combinations were searched across online databases in Embase, PubMed/MEDLINE, Web of Science, and Scopus spanning from July 1, 2020, through March 3, 2023. Publications were selected for data extraction in two steps based on the study inclusion/exclusion criteria. The study adheres to the PRISMA checklist as well as NIH bias risk and quality assessment tool.Results. In this review, 28 relevant articles were selected for the final qualitative synthesis. The majority of included studies had reported on the efficacy of Lopinavir/Ritonavir (n = 4), Ivermectin (n = 3), Baricitinib (n = 2), Tocilizumab (n = 2), Remdesivir (n = 2), ACEI/ARB (n = 2), Vitamin D (n = 2), Molnupiravir (n = 2), Traditional Chinese medicine (TCM) (n = 2), Convalescent plasma transfusion (CPT) (n = 2) and hydroxychloroquine (n = 2) in treating COVID-19. It appeared that Baricitinib, Remdesivir, ACEI/ARB, TCM, and CPT may have beneficial effects on reducing mortality, hospitalization duration, and disease severity in COVID-19 patients. Other interventions, such as Lopinavir/Ritonavir, Ivermectin, Vitamin D, and Hydroxychloroquine did not show clear benefits or had inconclusive results.Conclusion. This umbrella review provides a comprehensive overview of the current evidence on the effectiveness and safety of various pharmacological and non-pharmacological interventions for COVID-19. These results provide an updated overview of the current landscape for COVID-19 treatments, highlighting potential avenues for further research and clinical practice. It is crucial to continue monitoring emerging evidence and conducting rigorous studies to guide the development and optimization of therapeutic strategies against COVID-19.

Abstract Objective The purpose of this study is to investigate the incidence of determinants for virologic failure and to identify predisposing factors to enhance treatment efficacy. Tackling this global public health issue is the key to reducing the rate of virological failure and increasing the success of treatment for those living with HIV. Methods This umbrella review delves into various aspects of current anti-retroviral therapy (ART) which is the primary treatment for human immunodeficiency virus (HIV) infection. Comprehensive searches were conducted in online databases including PubMed, Embase, Scopus, and Web of Science, up to May 26, 2023. Following the screening and selection of relevant articles, eligible articles were included in the data extraction. This study adhered to the PRISMA guideline to report the results and employed the NIH quality and bias risk assessment tool to ensure the quality of included studies. Results In total, 40 review studies published from 2015 to 2023 were included. The bulk of these studies concurred on several major factors contributing to HIV drug resistance and virological failure. Key among these were medication adherence, baseline and therapeutic CD4 levels, the presence of co-infections, and the advanced clinical stage of the infection. Conclusion The resistance to HIV drugs and instances of determinants for virologic failure have a profound impact on the life quality of those infected with HIV. Primary contributors to this scenario include insufficient adherence to treatment, decreased CD4 T-cell count, elevated viral levels, and certain treatment regimens. Implementing appropriate interventions could address these issues. Sub-Saharan Africa exhibits elevated rates of determinants for virologic failure, attributed to the delay in HIV testing and diagnosis, and late initiation of antiretroviral therapy (ART). It is essential to undertake further research aimed at enhancing the detection of resistance in HIV patients and mitigating viral failure by addressing these underlying causes.

Background: Up now, several model were proposed for predicting the outcome of treating brain aneurysm. This study aims to investigate the performance of Machine learning (ML) in predicting the outcome of intracranial aneurysm after endovascular or microsurgical management. Method: This systematic review and meta-analysis was prepared with adhering to Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guideline. The electronic databases of PubMed/Medline, Embase, Scopus, and Web of Science were systematically reviewed up to 5th June 2023. All statistical analysis was done by STATA/mp V.20. Results: Recent studies have utilized ML models to forecast the results of cerebral aneurysm treatment. The models exhibit a sensitivity of 0.88 and a specificity of 0.80, with the latter revealing substantial variability across the various studies. Meanwhile, the sensitivity remained consistent. The models displayed a positive DLR (PLR) of 4.5 and a negative DLR (NLR) of 0.15. The aggregate diagnostic score determined that heterogeneity was negligible, with a value of 3.41. However, the diagnostic odds ratio 30.29 indicated noteworthy heterogeneity among the studies. The pooled AUC of 0.90 showcased the ML's ability to predict cerebral aneurysm treatment outcomes accurately. Conclusion: Predicting treatment outcomes in patients with intracranial aneurysms non-invasively is a promising approach with good diagnostic performance. However, further studies are required to improve the accuracy of ML algorithms, as the pooled metrics had a wide confidence interval. This will not only enhance the reliability of the predictions but also facilitate the integration of these algorithms into daily clinical practice.

Introduction: COVID-19 caused by SARS-CoV-2, commonly presents with symptoms such as fever and shortness of breath but can also affect other organs. There is growing evidence pointing to potential eye complications. In this article, we aim to systematically review the ocular manifestations of COVID-19. Methods: We conducted a systematic review to explore the ocular manifestations of COVID-19. We searched online databases including PubMed, Embase, Scopus, and Web of Science up to September 4, 2023. After a two-stage screening process and applying inclusion/exclusion criteria, eligible articles were advanced to the data extraction phase. The PRISMA checklist and Newcastle-Ottawa Scale (NOS) were used for quality and bias risk assessments. Results: We selected and extracted data from 42 articles. Most of the studies were cross-sectional (n = 33), with the highest number conducted in Turkey (n = 10). The most frequent ocular manifestation was conjunctivitis, reported in 24 articles, followed by photophobia, burning, chemosis, itching, and ocular pain. Most studies reported complete recovery from these manifestations; however, one study mentioned visual loss in two patients. Conclusion: In general, ocular manifestations of COVID-19 appear to resolve either spontaneously or with supportive treatments. For more severe cases, both medical treatment and surgery have been employed, with the outcomes suggesting that complete recoveries are attainable.

During the recent few decades, the use of various models has been regarded as a promising option to predict groundwater level (GWL) in any given region using a wide variety of data and relevant equations. The lack of trustworthy and comprehensive data is, nevertheless, one of the most significant obstacles that must be overcome in order to analyze and anticipate the depletion of groundwater in the context of water management. Because of this, the implementation of artificial intelligence (AI) models that are able to predict the GWL with high accuracy using a reduced amount of data is unavoidable. In this work, the GWL variations of Lur plain were simulated using GMS model by utilizing the available data and maps. The accuracy of model was assessed at both phases i.e. validation and calibration. Following that, GA-ANN and ICA-ANN approaches, together with ELM, ORELM, and GMDH models, were used in order to fulfill the demand for too smaller volumes by AI procedures. According to the results, the ORELM output had the highest correlation with the observed information, which indicates that it is the most accurate model in this regard. The correlation coefficient for this model was 0.976. Because of this, instead of utilizing a complicated GMS model that needs a significant amount of data for the simulation, an ORELM model can be used to reliably forecast the GWL in the Lur plain. This simple model allows the researchers to accurately predict changes in GWL during rainy and non-rainy years compared to other complicated and time-consuming numerical models.

IntroductionBone density regulation is considered one of the systems affected by thyroid hormones, leading to low bone density that can result in pathologic fractures, including hip fractures. This review aimed to update clinicians and researchers about the current data regarding the relationship between hip fractures and thyroid disorders.MethodsEnglish papers were thoroughly searched in four main online databases of Scopus, Web of Science, PubMed, and Embase. Data extraction was done following two steps of screening/selection using distinct inclusion/exclusion criteria. This study used the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist and the Newcastle-Ottawa Scale (NOS) as bias assessment.ResultsIn total, 19 articles were included in the research. The risk of hip fractures in women with differentiated thyroid cancer (DTC) is higher than hip fractures caused by osteoporosis. Men with hyperthyroidism and subclinical hyperthyroidism are at higher risk for hip fracture. Also, a decrease in serum thyroid stimulating hormone (TSH) may be associated with an increased risk of hip fracture.ConclusionReaching a consensus conclusion regarding the association between subclinical thyroid dysfunction and hip fracture is not feasible due to the heterogenicity of evidence; however, there may be a higher risk of fracture in individuals with subclinical hyperthyroidism.

Water pollution is one of the most significant environmental issues and problems. Surface water, running water, and rivers are always the most polluted, due to passing through numerous areas. The objective of this study is to investigate the water quality of Euphrates River in central Iraq in terms of aquaculture, as well as how to control the concentrations of pollutants. About 60-km length of Euphrates River was modeled using artificial neural networks (ANN) using qualitative data. The standard range of polluting substances for aquaculture was evaluated, and the effect of implementing the scenario of controlling point sources of pollution and preventing the flow from coming into contact with waste piles and animal excrement were studied. Statistical criteria, including NSE, RMSE, and MAE, were used to evaluate the model performance in the training and testing phases. According to the results, implementing the desired scenario has reduced the concentrations of all pollutants to an acceptable level for aquaculture. The most significant decrease occurred in the regions closest to the industries and factories (0-10 km), while the slightest change occurred in the farthest reaches of the study area (50-60 km). The findings of this study can be used to implement water quality controls at the optimal time and location to influence the Euphrates River general state.

In recent years, various domains have been influenced by the rapid growth of machine learning. Autonomous driving is an area that has tremendously developed in parallel with the advancement of machine learning. In autonomous vehicles, various machine learning components are used such as traffic lights recognition, traffic sign recognition, limiting speed and pathfinding. For most of these components, computer vision technologies with deep learning such as object detection, semantic segmentation and image classification are used. However, these machine learning models are vulnerable to targeted tensor perturbations called adversarial attacks, which limit the performance of the applications. Therefore, implementing defense models against adversarial attacks has become an increasingly critical research area. The paper aims at summarising the latest adversarial attacks and defense models introduced in the field of autonomous driving with machine learning technologies up until mid-2021.

The verse “Our guide said, ‘the pen that designed creation committed no mistakes’/blessed be his saintly and error-covering appraisal” is one of the controversial verses of Hafez that has widely attracted the attention of commentators. The history of the description and interpretation of this verse is about five centuries old. That is, from the time Jalaluddin Davani explained the meaning of this verse in the second half of the ninth century AH, many commentators have attempted to elucidate and clarify its meaning. The existence of these endless disputes motivated the researcher to explain the meaning of the verse based on the textual evidence and also semantic relationship between different parts of the sonnet, via adopting descriptive-analytical method and Michael Riffaterre's model. Riffaterre, with his dual design of heuristic and hermeneutic reading, considers the understanding of the latent meanings of a poem to depend on focusing on the way the main idea is represented in the form of "accumulations" and "descriptive systems" of the text. Accordingly, the sonnet was divided into four sections, and after examining the lexical accumulations of these sections and finding the focal idea or "matrix" of the work, the disputed verse was read to identify and present the most documented interpretation for it. The results showed that the meaning of "covering error", as a praiseworthy attribute in the eyes of the guide, is “not seeing” worldly deficits and vices as errors rather than "ignoring" them as real errors that challenge the existence of a good system. Another point is that if the whole sonnet is read with the focus on the fourth verse, there is strong textual evidence that shows Hafiz composed this sonnet with the genuine intention of requesting Shah Shoja to overlook the mistake that was falsely attributed to him; an error-covering which is the result of not seeing that false accusation as error rather than ignoring that as a real error.

The book Children’s Literature in Iran is a university textbook that covers most of the topics of the Ministry of Science, for two units of “Children’s Literature” course at the undergraduate level. The author of the book is Mohammad Dehrizi, one of the authors of “Writing” book in high school, a graduate of literature and one of the poets and writers of children and adolescents, who has won several national awards. The book was first published in 2009 under the title Iranian Children and Adolescent Literature, and its new edition was published in 2020. The book has many positive aspects, but due to common methodological weaknesses between this book and many books which are written in the realm of children's literature, the present study prefers to critique this book from an approbation point of view, rather than a critical one. A book has a scientific function to the extent that it can present the paradigms of a theory to the reader in a systematic hierarchy. Therefore, the main purpose of this article is to examine the method of systematizing the paradigms introduced in the book. In this regard, the book is reviewed in six areas: education, methodology, content, editing, chaptering, and aesthetics. This research, for the first time in Iran, reviews a book in the field of theoretical literature for children and adolescents.

Background: Tooth-whitening procedures have gained wide popularity among the Saudi population. The present study aimed to assess the knowledge, attitude, and perception about tooth-whitening procedures among Jeddah's general population. Materials and Methods: A face-to-face interview was conducted on randomly selected female patients attending dental clinics. A pretested and structured questionnaire was used to record the response by calibrated interviewers. The responses regarding knowledge, attitude, and perceptions were recorded and subjected to statistical analysis. Results: The findings showed that the prevalence of tooth whitening among the participants was 43.7%, and about 8.7% reported that they did it once every year. In-office bleaching was the most preferred method (31.4%), followed by whitening toothpaste (8.7%). An increased frequency of bleaching was reported by participants belonging to younger age group (P < 0.001). Conclusion: The knowledge related to the mechanism of action and adverse effects was average among the participants. Younger age groups were more concerned about tooth-whitening procedures compared to the older ones.

Background & Purpose: Willingness to take voluntary and constructive actions in an organization depends on the alignment of different stakeholders’ values. This study analyzed the effect of corporate social responsibility on organizational citizen behavior through the mediating roles of occupational involvement, job satisfaction, and employee voice. Methodology: This is an applied descriptive-correlational study, in which the statistical population included 326 employees working at the National Iranian Oil Refining and Distribution Company in Guilan Province. The simple random sampling method was used to select 177 employees as the statistical sample; the confirmatory factor analysis and the structural equation modeling (SEM) technique were used for data analysis in SPSS and LISREL. Findings: Corporate social responsibility has significant relationships with organizational citizen behavior, occupational involvement, job satisfaction, and employee voice. Occupational involvement, job satisfaction, and employee voice affects organizational citizen behavior and has a mediating role in the effect on corporate social responsibility on organizational citizen behavior. Conclusion: Focusing on corporate social responsibility can involve employees in their jobs so that they can actively and voluntarily participate in organizations with their consent to achieve organizational goals.

Perfect coloring is a generalization of the notion of completely regular codes, given by Delsarte. A perfect -coloring of a graph with colors is a partition of the vertex set of into m parts , . . . , such that, for all , every vertex of is adjacent to the same number of vertices, namely, vertices, of . The matrix , is called the parameter matrix. We study the perfect 2-colorings (also known as the equitable partitions into two parts) of the cubic graphs of order less than or equal to 10. In particular, we classify all the realizable parameter matrices of perfect 2-colorings for the cubic graphs of order less than or equal to 10.

Perfect coloring is a generalization of the notion of completely regular codes, given by Delsarte. A perfect m-coloring of a graph G with m colors is a partition of the vertex set of G into m parts A_1, A_2, ..., A_m such that, for all $ i,j \in \lbrace 1, ... , m \rbrace $, every vertex of A_i is adjacent to the same number of vertices, namely, a_{ij} vertices, of A_j. The matrix $A=(a_{ij})_{i,j\in \lbrace 1,... ,m\rbrace }$, is called the parameter matrix. We study the perfect 3-colorings (also known as the equitable partitions into three parts) of the cubic graphs of order 10. In particular, we classify all the realizable parameter matrices of perfect 3-colorings for the cubic graphs of order 10.

At the present time, the main cause of the crisis of human society is rooted in social inequality and lack of justice. Today, planners, especially, geographers by the spatial or distributive justice plan, offers new strategies in the course of distribution of public interests based on the need, deserving and public benefit criteria. In this study, the city of Tehran has been studied as a case study. Since the spatial inequality in the city of Tehran is more evident than in other cities, it has been selected, the aim of the study is spatial analysis and classification of the areas of Tehran city based on the selected indicators. The method of research is descriptive – analytical one that Factor Analysis, Cluster analysis, Diagnostic analysis, Regression and Multi-criteria decision-making methods have been used. The under study indicators include 7 parts of economics, social, physical, cultural, infrastructure, security, green space and pollution. According to the results of factor analysis, the areas of Tehran city classified separately. At the next stage, the areas of Tehran city were classified by using other methods and classified in four levels of developed, upward moderate, downward moderate and underdeveloped by using Cluster analysis. Finally, diagnostic analysis has been used to select the final clustering. The results show that the northern areas of Tehran city are developed in comparison with the other areas and also the gap between the northern areas is too much than others. While southern areas are almost at the same level. Finally, with respect to the regression forecast model, the social and infrastructure sectors have been suggested as the first priority to be developed in the underdeveloped areas. Economical and cultural indicators at the second priority and physical and landscaping sectors are at the next priority. Also, security sector has been proposed at the fourth priority in developed areas.

OBJECTIVE: To determine the efficacy of the Synaptic 2000 in reducing total knee replacement postoperative pain in a prospective randomized controlled trial.

Introduction: Relugolix is an oral GnRH receptor antagonist used in combination with radiation therapy in the treatment of unfavorable prostate cancer. It has been shown to achieve rapid and profound testosterone suppression (total testosterone <20 ng/dL) without the need for bothersome injections. Such low testosterone levels may impact sexual functioning and perceptions. Objective: Given the potential benefits of Relugolix over other androgen deprivation therapies (ADTs), this prospective study sought to assess neoadjuvant Relugolix-induced sexual dysfunction prior to the initiation of stereotactic body radiation therapy (SBRT). Methods: Prospective, patient-reported data was collected from a male cohort diagnosed with localized prostate cancer and subsequently treated with neoadjuvant Relugolix and SBRT. Relugolix was initiated at least 2 months prior to SBRT. Sexual function and bother were assessed via the sexual domain of the validated Expanded Prostate Index Composite (EPIC-26) survey which includes five function questions (erections and orgasm) and one overall bother question. Individual scores ranged from 0-100 with higher scores reflecting improved function/less bother. EPIC-26 was collected for each patient at pre-Relugolix baseline and one hour prior to SBRT initiation. Individual items were evaluated for statistical significance (paired t-test, p < 0.05) and clinical significance by minimally important difference (MID, +/- 0.5 SD from baseline score). Results: Between July 2021 and January 2023, 49 patients with localized prostate cancer were treated with neoadjuvant Relugolix (4-6 months) and SBRT (36.25-40 Gy in 5 fractions) at Georgetown University Hospital per institutional protocol IRB 12-1775. The median age was 73 years. 27% of patients were black and 26.1% were obese (BMI ≥30 kg/m2). Patients initiated Relugolix at a median of 3.6 months prior to SBRT. 82% of patients had intermediate risk disease. All individual EPIC sexual function scores declined in a similar manner following neoadjuvant Relugolix therapy. These declines were both statistically and clinically significant. There was no statistically or clinically significant change in the EPIC sexual overall bother score. Conclusions: In concordance with known side effects of ADT, neoadjuvant Relugolix was associated with a significant decline in self-reported sexual function. However, patients indicated only a minimal and non-significant increase in bother. Relugolix was well-tolerated as patients on Relugolix did not subjectively find their sexual dysfunction troublesome. Future investigations should compare outcomes while on Relugolix directly to GnRH agonist-induced sexual dysfunction. Disclosure: No. [ABSTRACT FROM AUTHOR]

Introduction: Studies have demonstrated that injectable GnRH receptor agonists further suppress cancer progression when paired with radiotherapy (RT) in patients with intermediate- to high-risk prostate adenocarcinoma. Relugolix is a newly available oral GnRH receptor antagonist that achieves swift and profound castration (total testosterone <20 ng/dl) at high rates, which may shape patients' health-related quality of life. The main objective of this prospective study was to explore the effects of neoadjuvant relugolix on health-related quality of life in prostate cancer patients immediately prior to stereotactic body radiation therapy (SBRT)., Methods: Patients treated at Georgetown between January 2021 and September 2023 with neoadjuvant relugolix per an institutional protocol were included in the study (IRB 12-1775). The five-item EQ-5D-3L, a well-established tool for quantifying patient-reported health status, was administered to each patient at baseline (prior to relugolix treatment) and again 1 h before the start of SBRT. Higher EQ Visual Analog Scale (VAS) overall scores reflected better quality of life (range 0 to 100). In line with the questionnaire framework, individual elements (mobility, self-care, usual activities, pain/discomfort, and anxiety/depression) were rated on a three-point scale from 1 (no problems) to 3 (severe problems). McNemar's test and paired-sample t-test were performed to analyze changes pre- and post-relugolix treatment. Our investigation determined clinical significance based on minimally important difference (MID) calculated as 0.5 times the baseline standard deviation., Results: Among the 87 patients, average age was 71 years, 42% were non-white, and 24% were considered obese (BMI ≥30 kg/m²). Relugolix was initiated a median of 4 months before SBRT initiation (IQR: 3.9-5.4), with 87% of patients reaching profound castration (<20 ng/dl). The VAS overall score was notably higher at baseline (mean ± SD: 82 ± 10) compared to the paired score before RT (79 ± 14, p = 0.02), although this difference was not clinically significant. No statistically or clinically significant changes were observed in any of the five individual items., Conclusion: The use of neoadjuvant relugolix prior to prostate radiation therapy had no clinically significant impact on patient-reported health-related quality of life. Moreover, no statistically significant reductions were observed in any of the five individual health-related quality of life measures. As a key direction for future research, relugolix-associated changes to healthy-related quality of life should be contrasted to those brought about by injectable GnRH agonists., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The author(s) declared that they were an editorial board member of Frontiers, at the time of submission. This had no impact on the peer review process and the final decision., (Copyright © 2025 Koh, Koh, Hsueh, Gallagher, Danner, Zwart, Ayoob, Kumar, Carrasquilla, Leger, Dawson, Suy and Collins.)

Introduction: Androgen deprivation therapy has been shown to improve cancer control when combined with radiotherapy. Relugolix is an oral GnRH receptor antagonist that achieves rapid profound testosterone suppression, which may increase the perception and/or impact of fatigue. This study sought to evaluate neoadjuvant relugolix-induced fatigue in prostate cancer patients prior to the start of stereotactic body radiation therapy (SBRT)., Methods: Relugolix was initiated at least two months before SBRT. The 13-item Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) questionnaire was collected at baseline and one hour prior to SBRT initiation. A five-point scale was used to score individual items. Overall scores range from 0-52 and individual item scores were converted to 0-100, with higher scores reflecting less fatigue. Five "experience" items explored self-perceptions of fatigue, and eight "impact" items sought to evaluate the effect of fatigue on daily activities. Items were evaluated for statistical significance (paired t-test, p < 0.05) and clinical significance (minimally important difference (MID); 0.5 standard deviation from baseline)., Results: Between March 2021 to December 2023, 89 men were treated at Georgetown with neoadjuvant relugolix and SBRT. Mean age was 71 years (range: 49-87). Median initiation of relugolix was 4.5 months prior to SBRT (range: 2-14.2 months). 93% patients achieved castration (testosterone levels ≤ 50 ng/dL) and 85% patients achieved profound castration (testosterone levels ≤ 20 ng/dL). 87 patients completed the FACIT-F questionnaire, with an average overall score of 45.6 at baseline and 41.0 at SBRT initiation. This difference was statistically and clinically significant (p < 0.01, MID = 3.55). Patients experienced an increase in fatigue for 12 of 13 items, with statistically significant changes for 11 items. Three of five experience items showed a clinically significant increase in fatigue. Only two of eight impact items were clinically significant., Discussion: Our study shows that relugolix significantly increases fatigue, affecting multiple areas of life. While the fatigue does not appear to generally impact a patient's ability to carry out normal activities, patients demonstrate frustration with being too tired for these activities. It is essential for clinicians to counsel prostate cancer patients on the impact of neoadjuvant relugolix on quality-of-life issues like fatigue., Competing Interests: SC serves as a clinical consultant to Sumitomo Pharma/Pfizer Inc. ND is on the Speaker Bureau for Sumitovant Biopharma. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Hsueh, Gallagher, Koh, Shah, Danner, Zwart, Ayoob, Kumar, Leger, Dawson, Suy and Collins.)