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Mohammad Golriz,1,2 Ali Ramouz,1 Sadeq Ali-Hasan-Al-Saegh,1 Saeed Shafiei,1 Ehsan Aminizadeh,1 Ahmed Hammad,1 Markus Mieth,1 Christian Rupp,2,3 Christoph Springfeld,2,4 Katrin Hoffmann,1,2 Markus Büchler,1 Arianeb Mehrabi1,2 1Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Heidelberg, Baden-Württemberg, Germany; 2Liver Cancer Center Heidelberg (LCCH), Heidelberg University Hospital, Heidelberg, Baden-Württemberg, Germany; 3Department of Internal Medicine IV, Gastroenterology & Hepatology, Heidelberg University Hospital, Heidelberg, Baden-Württemberg, Germany; 4National Center for Tumor Diseases, Department of Medical Oncology, Heidelberg University Hospital, Heidelberg, Baden-Württemberg, GermanyCorrespondence: Arianeb Mehrabi, Head of the Division of Liver Surgery and Visceral Transplantation, Department of General, Visceral, and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 420, Heidelberg, 69120, Germany, Tel +49– 6221– 5636223, Fax +49– 6221– 567470, Email arianeb.mehrabi@med.uni-heidelberg.dePurpose: Although surgery is associated with an acceptable cure rate, tumor recurrence is still a challenging issue in hepatocellular carcinoma (HCC) patients. Red blood cell distribution width (RDW) is considered an inflammatory marker for predicting overall mortality in a wide spectrum of malignancies. In the current study, the prognostic role of pre- and postoperative RDW in HCC recurrence after liver resection (LRx) is investigated.Patients and Methods: In 395 patients, RDW levels were evaluated preoperatively as well as six and twelve months after curative LRx. The RDW cutoff values were determined using receiver operating characteristic curves (ROCs) according to the recurrence-free survival (RFS). Survival analyses were performed using the Kaplan–Meier, and differences were compared using the Log rank test.Results: The RFS was significantly higher among patients with low RDW at the 6th month and 12th month, postoperatively (P < 0.001 and P = 0.028). RDW levels of higher than 16.15% at the 6th (HR: 2.047, P < 0.001) and higher than 15.85% at 12th (HR: 3.105, P < 0.002) months after liver resection were independent predictors of RFS.Conclusion: Postoperative RDW values seem to be predictive of tumor recurrence in HCC patients. RDW levels at the 6th and 12th months postoperatively were independent predictors of recurrence after LRx.Keywords: hepatectomy, hepatocellular carcinoma, liver resection, red blood cell distribution width

Georgios Polychronidis,1 Jincheng Feng,2 Anastasia Murtha-Lemekhova,1 Ulrike Heger,1 Arianeb Mehrabi,1 Katrin Hoffmann1 1Department of General, Visceral and Transplant Surgery, Heidelberg University Clinic, Heidelberg, Germany; 2Department of Hepatobiliary Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of ChinaCorrespondence: Katrin HoffmannDepartment of General, Visceral and Transplant Surgery, University of Heidelberg, Im Neuenheimer Feld 420, Heidelberg, 69120, GermanyEmail katrin.hoffmann@med.uni-heidelberg.deBackground: The study aimed to develop a nomogram to predict overall survival (OS) for patients with FLC using a national database.Methods: The Surveillance, Epidemiology, and End Results database of the National Cancer Institute was reviewed to identify FLC cases with histological confirmation between 2004 and 2014. Cox proportional hazards models were used to identify factors associated with OS. The validation of the nomogram was performed using concordance index (C-index) and calibration curves.Results: Out of 170 cases with complete follow-up, 87 received surgery/ablation and 12 received transplantation with significantly higher OS than chemotherapy alone while transplantation combined with chemotherapy showed better survival than solely transplantation. The combination of surgery and chemotherapy showed worse OS than surgery alone. Survival was negatively influenced by T4 stadium (HR = 5.91), while young age and surgery were positive predictive factors. There was no influence of gender, ethnicity or nodal status on survival. The rate of AFP positivity was comparable with and without the presence of distal metastases.Conclusion: FLC survival is greatly dependent upon appropriate surgical management irrespective of tumor stadium.Keywords: fibrolamellar, hepatocellular, carcinoma, SEER

BACKGROUND: Mother-to-child transmission is the primary cause of HIV cases among children. Antiretroviral therapy (ART) plays a critical role in preventing mother-to-child transmission and reducing HIV progression, morbidity, and mortality among mothers. However, after more than two decades of ART during pregnancy, the comparative effectiveness and safety of ART medications during pregnancy are unclear, and existing evidence is contradictory. This study aimed to assess the effectiveness and safety of different ART regimens among pregnant women living with HIV at preconception or during pregnancy. METHODS: We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Web of Science. We included randomized trials that enrolled pregnant women living with HIV and randomized them to receive ART for at least four weeks. Pairs of reviewers independently completed screening for eligible studies, extracted data, and assessed the risk of bias using the Cochrane risk of bias tool. Our outcomes of interest included low birth weight, stillbirth, preterm birth, mother-to-child transmission of HIV, neonatal death, and congenital anomalies. Network meta-analysis was performed using a random-effects frequentist model, and the certainty of evidence was evaluated using the GRADE approach. RESULTS: We found 14 eligible randomized trials enrolling 9,561 pregnant women. The median duration of ART uptake ranged from 6.0 to 17.4 weeks. No treatment was statistically better than a placebo in reducing the rate of neonatal mortality, stillbirth, congenital defects, preterm birth, or low birth weight deliveries. Compared to placebo, zidovudine (ZDV)/lamivudine (3TC) and ZDV monotherapy likely reduce mother-to-child transmission (odds ratio (OR): 0.13; 95% CI: 0.05 to 0.31, high-certainty; and OR: 0.50; 95% CI: 0.33 to 0.74, moderate-certainty). Moderate-certainty evidence suggested that ZDV/3TC was associated with decreased odds of stillbirth (OR: 0.47; 95% CI: 0.09 to 2.60). CONCLUSIONS: Our analysis provides high- to moderate-certainty evidence that ZDV/3TC and ZDV are more effective in reducing the odds of mother-to-child transmission, with ZDV/3TC also demonstrating decreased odds of stillbirth. Notably, our findings suggest an elevated odds of stillbirth and preterm birth associated with all other ART regimens.

This study investigates the mechanical properties and fracture behavior of polypropylene (PP)-based blend-nanocomposites comprising 30 wt.% ethylenepropylene-diene monomer (EPDM) and 5 wt.% Si[O.sub.2] nanoparticles. Different mixing sequences were employed to prepare the nanocomposites, and the resulting morphology development and dispersion states of modifiers were analyzed. Mechanical performance of the nanocomposites was evaluated through quasi-static and high-speed dynamic fracture tests. The dispersion and distribution of Si[O.sub.2] nanoparticles within the nanocomposites were significantly influenced by the mixing protocol. In impact fracture tests, the presence of nanoparticles exhibited a beneficial efifect on fracture energy, demonstrating a synergistic toughening effect of the soft EPDM and rigid Si[O.sub.2] particles. Conversely, adverse effects were observed in quasi-static tests. Essential work of fracture (EWF) parameters indicated an increase in the yielding component and a decrease in the necking-to-tearing component with Si[O.sub.2] incorporation into the PP/EPDM blends. During impact loadings, the highest improvement in crack propagation resistance was observed in nanocomposites with nanoparticles localized around the rubbery domains forming a network-like structure of EPDM/ Si[O.sub.2]-nanoparticles, Morphologies where rubber domains and nanoparticles were separately distributed in the PP matrix resulted in the lowest fracture parameters. Energy dissipation mechanisms were elucidated, revealing multiple void formation followed by matrix shear yielding as the primary source under both quasistatic and impact fracture conditions. In the latter case, stress-concentrating percolated structures in the PP matrix facilitated the nucleation of dilatational bands evolving into highly stretched void-fibrillar structures upon further loading. These findings contribute valuable insights into tailoring nanocomposite morphologies for enhanced mechanical performance in different loading scenarios. Highlights * Fracture behavior of PP/EPDM/Si[O.sub.2] ternary systems was evaluated by EWF methodology and Izod impact test. * Rubber particles surrounded by silica nanoparticles led to a percolated morphology and as a result to superior impact resistance. * EWF parameters were mostly controlled by the tearing-related parts regardless of phase morphology. * The impact toughness was mainly controlled by the dispersion and distribution characteristics of the Si[O.sub.2] nanoparticles. KEYWORDS blend, EPDM, fracture toughness, nanocomposite, PP, 1 | INTRODUCTION Fracture resistance is a predominant benchmark to make polymeric products desirable for engineering usages. It has been described in literature that an effective strategy to enhance the [...]

Textbooks have a fundamental role in English Language Teaching (ELT) classes; they can provide valid, valuable, and self-regulated sources for both learners and teachers. ELT textbook evaluation is essential for language learning and teaching. Accordingly, evaluating and assessing textbooks has a crucial role in confirming if they satisfy the needs of students, teachers, administrators, textbook publishers, and curriculum developers. In this regard, this article elaborates on textbook evaluation, then briefly overviews the various approaches toward evaluating ELT textbooks and material from the perspective of McDonough et al. (2013), Richards (2014), and Tomlinson (2013). Additionally, this article introduces criteria for material evaluation and it demonstrates how criteria can be established for evaluating English language textbooks.

BACKGROUND: There is no systematic review on the prevalence of HIV drug resistance (HIVDR) in Iran. We aimed to estimate the prevalence of HIVDR among people living with HIV (PLHIV) in Iran. We assessed HIVDR prevalence in antiretroviral therapy (ART) naïve PLHIV (i.e., those without a history of ART) and PLHIV receiving ART. METHOD: We systematically searched Scopus, PubMed, Web of Science, Embase, Iranian databases (Iranian Medical Research Information System, Magiran, and Scientific Information Database), the references of studies, and Google Scholar until March 2023. A random-effects model was used to calculate a point estimate and 95% confidence interval (95% CI) for the prevalence of HIVDR in PLHIV. RESULTS: Among 461 potential publications, 22 studies were included in the meta-analysis. The pooled prevalence of acquired HIVDR in PLHIV receiving ART was 34% (95% CI: 19, 50) for nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs), 27% (95% CI: 15, 41) for non-nucleoside reverse transcriptase inhibitors (NNRTIs), and 9% (95% CI: 3, 18) for protease inhibitors (PIs). The pooled prevalence of acquired HIVDR in treatment failure PLHIV was 50% (95% CI: 31, 69) for NRTIs, 49% (95% CI: 29, 69) for NNRTIs, 11% (95% CI: 2, 24) for PIs, and 1% (95% CI: 0, 4) for integrase inhibitors (INIs). The pooled prevalence of transmitted HIVDR in ART-naïve people was 3% (95% CI; 1, 6) for NRTIs, 5% (95% CI: 2, 9) for NNRTIs, and 0 for PIs and INIs. CONCLUSION: The prevalence of HIVDR was relatively high in both ART-naïve PLHIV and those receiving ART. Without universal pretreatment HIVDR testing and more frequent routine HIV viral load testing among PLHIV who are on ART, the HIVDR prevalence might increase in PLHIV in Iran.

Abstract Cadmium (Cd) contamination poses significant risks to agricultural productivity and human health, particularly through its accumulation in staple crops such as bread wheat (Triticum aestivum L.). This study evaluated Cd accumulation and tolerance among six bread wheat cultivars exposed to six Cd concentrations (0, 2.5, 5, 10, 15, 20, and 25 mg kg−1 soil). Phenotypic assessments and quantitative real-time PCR (qRT-PCR) were conducted to analyze the expression patterns of TaNRAMP and TaZIP genes in various tissues and developmental stages of wheat, which play crucial roles in Cd uptake and transport. Results demonstrated significant variability in Cd accumulation. The Barat cultivar exhibited the lowest accumulation in grain (ranging from 0.21 to 8.8 mg kg−1) and the highest tolerance. In contrast, Kavir and Pishtaz displayed elevated Cd levels in both grain and straw, while Parsi accumulated more Cd in straw at lower concentrations (56.9 mg kg−1 in Cd concentration of 10 mg kg−1 soil). The gene expression analysis revealed that most cultivars showed increased expression of TaNRAMP genes, particularly TaNRAMP2 in Cd concentration of 10 mg kg−1 soil, which facilitates Cd uptake from the soil, and TaZIP genes, such as TaZIP4 and TaZIP7, involved in transporting Cd within the plant. Notably, the expression of TaZIP1 was significantly lower in cultivars with high Cd accumulation, suggesting a potential regulatory mechanism for Cd tolerance. Furthermore, cultivars exhibiting higher Cd levels correlated with increased expression of stress-responsive genes, indicating a broader response to Cd stress. These findings highlight Barat’s potential for bread-making applications due to its low Cd accumulation, while Morvarid and Pishtaz which show reduced Cd content in the straw even under high Cd exposure are better suited for animal feed. This research underscores the genetic variability of wheat cultivars in response to Cd stress and provides essential insights into the molecular mechanisms underlying Cd accumulation, offering valuable information for breeding programs aimed at developing Cd-tolerant varieties to ensure food security in contaminated regions.

Abstract Background Unintended pregnancy, a pregnancy that have been either unwanted or mistimed, is a serious public health issue. The present study aims to design and implement interventions to improve unplanned pregnancy experiences. Methods/design This exploratory sequential mixed method study will be conducted in three phases: qualitative, intermediate, and quantitative. The qualitative phase will use qualitative conventional content analysis with in-depth and semi structured individual interviews to explain and define the components and elements of pregnancy experiences of unplanned pregnancies, which include mothers with unplanned pregnancies, their spouses, and prenatal care providers, who will be selected purposefully. Additionally, in the initial phase, the study will employ literature reviews alongside qualitative findings to elucidate the components and elements of pregnancy experiences and their improving interventions. In the second phase, appropriate interventions (prioritized and feasible) will be determined through an expert panel using the Delphi technique. In the third phase, the intervention program agreed upon in the previous phase will be implemented in the form of a randomized controlled clinical trial. Discussion The implementation of the interventions could be beneficial in changing attitudes and achieving positive experiences in unplanned pregnancies. It is anticipated that the design and implementation of the intervention program aimed at improving the experiences of unplanned pregnancies will be effective in minimizing adverse maternal and neonatal outcomes. Trial registration Iranian Registry of Clinical Trials (IRCT): (IRCT20170506033834N12/Date of registration: 2024‑02‑12)

Abstract Gallbladder cancer (GBC) presents as an aggressive malignancy with poor patient outcome. Like other epithelial cancers, the mechanisms of GBC cancer progression remain vague and efforts in finding targeted therapies fall below expectations. This study combined proteomic analysis of formalin-fixed paraffin-embedded (FFPE) GBC samples, functional and molecular characterization of potential oncogenes and identification of potential therapeutic strategies for GBC. We identified Carcinoembryonic Antigen-related Cell Adhesion Molecule 6 (CEACAM6) as one of the significantly most upregulated proteins in GBC. CEACAM6 overexpression has been observed in other cancer entities but the molecular function remains unclear. Our functional analyses in vitro and in vivo mouse models revealed that CEACAM6 supported the initial steps of cancer progression and metastasis by decreasing cell adhesion and promoting migration and invasion of GBC cells. Conversely, CEACAM6 knockdown abolished GBC aggressiveness by increasing cell adhesion while reducing cell migration, cell proliferation, and colony formation. BirA-BioID followed by mass-spectrometry revealed Integrin Beta-1 (ITGB1) and Protein Kinase C Delta (PRKCD) as direct molecular and functional partners of CEACAM6 supporting GBC cell migration. ERK and AKT signaling and their downstream target genes were regulated by CEACAM6 and thus the treatment with AKT inhibitor capivasertib or ERK inhibitor ulixertinib mitigated the CEACAM6-induced migration. These findings demonstrate that CEACAM6 is crucially involved in gallbladder cancer progression by promoting migration and inhibiting cell adhesion through ERK and AKT signaling providing specific options for treatment of CEACAM6-positive cancers.

Abstract This retrospective study aimed to assess different macular neovascular network characteristics in relation to changes in best corrected visual acuity (BCVA) over 3 and 12 months following treatment. Using optical coherence tomography angiography, we reviewed the medical records of 46 treatment-naïve patients with neovascular age-related macular degeneration (nAMD) who received intravitreal aflibercept injections. The change in BCVA from baseline to 3 months and 12 months after treatment was recorded. The mean vessels percentage area, junctions density, lacunarity, and fractal dimension were significantly correlated with the change of BCVA from baseline to month 3 (P = 0.003, 0.046, 0.007, and 0.005 respectively). Fractal dimension and vessels percentage area were correlated with the change of BCVA from baseline to month 12 (P = 0.023 and 0.023 respectively). The findings suggest that baseline characteristics of macular neovascular complexes may serve as predictors for BCVA changes following treatment with aflibercept in nAMD patients.

Abstract Background and objective One of the most important aspects of health is social health. Addressing social health and social accountability is possible by education of social determinants of health (SDH) to medical students. The aim of current study is to integrate the SDH variables to patient’s history-taking in medical education during clerkship stage as an action research and scholarship in education. Pediatric patients were selected as the target population for this study. Methods The present study is an action-research including three phases of the program's design, implementation, and evaluation. The present paper reports the results of phase I including the following steps; rapid scoping review and expert panel for development of history-taking form. The goal of this phase was to prepare an SDH checklist for history-taking in the Pediatrics Ward of Firoozabadi Teaching Hospital, Iran University of Medical Sciences, Tehran, Iran. The checklist of history-taking was evaluated in terms of measurability, feasibility, priority, and clarity using a 5-choice Likert scale. Results According to the results of the scoping review and consensus-based methods, the preliminary version of the program was prepared including the SDH history-taking checklist. A total of 21 items were selected after two expert panel rounds. The overall absolute agreement was 0.704 (95% CI: 0.587 – 0.793) which was significantly higher than 0.5 (P

Purpose: The purpose of this research is to identify the key components of knowledge technology mastery from the point of view of experts.Methodology: In order to collect information, library and field methods have been considered. First, the performance evaluation components of knowledge technologies were obtained by Delphi method. Then, to compare these components, a questionnaire was distributed among faculty members and doctoral students of information science and epistemology in Tehran state universities, and AHP method was used to analyze the data. Spss 25 and Expert Choice 11 software were used for data analysis.Findings: In the Delphi phase, 10 main financial indicators, system quality, system infrastructure, knowledge technology service quality, knowledge technology architecture, user interface, user satisfaction about the system, the value of work results, perceived benefits and benefits of the system , being up-to-date was detected. the financial component is in the first degree, system quality in the second degree, system infrastructure in the third degree, user interface in the fourth degree, knowledge technology architecture in the fifth degree, knowledge technology service quality in the sixth degree, user satisfaction about the system. In the seventh grade, the value of the results obtained from the eighth grade card, and the perceived advantages and benefits of the system and being up-to-date were ranked in the ninth grade.Value: The results of this research can be used to evaluate the performance of knowledge technologies.Conclusion: through evaluation, it is possible to help advance and improve the performance of the organization.

Abstract Background Basal cell carcinoma is the most prevalent skin cancer, most characterized by local aggressiveness but with low metastatic potential, and bone metastasis is quite heterogeneous, thus the incidence profile is variable size from 0.0028% to 0.5%. We have this patient with an unusual example of basal cell carcinoma with bone metastases to add to the scarce report on this matter. Case description Here we document a 48-year-old Persian man with a background of being exposed to the sun for a long time. He was diagnosed with an ulcer on the cheek, which was clinically characterized and further confirmed by biopsy as morpheaform basal cell carcinoma. Following the first round of excision, multiple relapses eventually metastasized to the bone. The latter was found on follow-up radiologic scans. This case is characterized by the aggressive nature of the disease and the heterogeneity of basal cell carcinoma growth, thus challenging the conventional view of basal cell carcinoma behavior. Treatment included surgical excision of the primary lesion, which was treated with radiotherapy afterward. However, the skeleton improved slowly during follow-up, and palliative care was eventually pursued to control symptoms and improve quality of life. Conclusions This was a rare case of basal cell carcinoma metastasis to non-bone organs, which reminded us to consider basal cell carcinoma metastasis, especially in the case of atypical basal cell carcinoma. Therefore, risk-aware patient management is essential. Moreover, these findings highlight the role of further research into the mechanisms of basal cell carcinoma metastasis, leading to improved therapeutic strategies that may lead to potential improvements in patient outcomes.

Introduction: Acinetobacter baumannii, a non-fermenting Gram-negative coccobacillus, exhibits high resistance to antimicrobial compounds. Biofilm formation is a crucial feature in many Acinetobacter species, contributing to their antibiotic resistance. The present study aimed to investigate the prevalence of ompA, csuA, bap and pgaB genes in clinical isolates of Acinetobacter baumannii with biofilm formation ability. Methods: In this cross-sectional study, 49 isolates of Acinetobacter baumannii were collected from patients hospitalized in the health centers of Borujerd City. Acinetobacter baumannii isolates were confirmed by biochemical tests. In these isolates, the biofilm production ability was investigated by microtitreplate method. Then, using PCR method and specific primers, ompA, csuA, bap and pgaB genes were identified.The collected data were analyzed descriptively and analytically using SPSS version 16 software. Data analysis was done with Chi-square test, Fisher's exact test, and P