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Abstract: In this study, the sensitivity of the apparent response of trabecular bone to different constitutive models at the tissue level was investigated using finite element (FE) modeling based on micro‐computed tomography (micro‐CT). Trabecular bone specimens from porcine femurs were loaded under a uniaxial compression experimentally and computationally. The apparent behaviors computed using von Mises, Drucker‐Prager, and Cast Iron plasticity models were compared. Secondly, the effect of bone volume fraction was studied by changing the bone volume fraction of a trabecular bone sample while keeping the same basic architecture. Also, constitutive models' parameters of the tissue were calibrated for porcine bone, and the effects of different parameters on resulting apparent response were investigated through a parametric study. The calibrated effective tissue elastic modulus of porcine trabecular bone was 10 ±1.2 GPa, which is in the lower range of modulus values reported in the literature for human and bovine trabecular bones (4–23.8 GPa). It was also observed that, unlike elastic modulus, yield properties of tissue could not be uniquely calibrated by fitting an apparent response from simulations to experiments under a uniaxial compression. Our results demonstrated that using these 3 tissue constitutive models had only a slight effect on the apparent response. As expected, there was a significant change in the apparent response with varying bone volume fraction. Also, both apparent modulus and maximum stress had a linear relation with bone volume fraction. [ABSTRACT FROM AUTHOR]

This work develops a model for the mechanical response of trabecular bone including plasticity, damage and fracture. It features a resultant lamellar orientation that captures trabecular strut anisotropic elasticity, and introduces asymmetric J2 plasticity with isotropic hardening to capture evolving strut tensile and compressive dissipative properties. A continuum compatibility based damage and fracture criterion is also proposed to model fracture surface generation. We investigated fracture of a trabecular bone network under a compressive load, for which failure modes of both tension and compression were identified at the strut level. The predicted trabecular network response was found to fall within the range of experimental results reported in literature. We also investigated the response of idealized struts under compression, tension and bending using our model. Individual struts were found to exhibit micro-buckling under compression and micro-necking under tension. These instabilities are however masked by the multiplicity and complexity of strut orientations at the trabecular network level. [ABSTRACT FROM AUTHOR]

Antagonistic effects of four isolates of Paecilomyces lilacinus and an isolate of Isaria farinosa on root-knot nematode Meloidogyne javanica were examined under in vitro and greenhouse conditions. Root-knot nematode as well as fungal isolates were identified using morphological and species specific primers. Infection ability of different fungal isolates on the eggs of M. javanica and effects of fungal culture filtrates on egg hatching and mortality of M. javanica juveniles (J2) were tested in vitro. Results indicated that nematode eggs parasitization percent by various fungal isolates and J2 mortality as well as egg hatching inhibition of the culture filtrate of these fungi have variable effects on target nematode. P. lilacinus (isolate P3) showed more efficiency than the other isolates. In greenhouse experiment, effects of P. lilacinus and I. farinosa on tomato plant growth factors and nematode population were tested. Fungal isolates were propagated on sterilized wheat seed and mixed (0.5% w/w) with autoclaved soil. Four leaf seedlings of tomatos were transplanted into each pot and inoculated by4000 eggs and juveniles (J2) after ten days. Pots were kept in greenhouse for two months. Results showed that P. lilacinus isolate P3, P1, P4,and P2 and I. farinosa had 65%, 44%, 42%, 29% and 23% nematode conrol, respectively, indicating a good potential of some isolates in reducing nematode population. [ABSTRACT FROM AUTHOR]

Adoptive cell therapy (ACT) using natural killer (NK) cells has emerged as a promising therapeutic strategy for acute myeloid leukemia (AML), addressing challenges such as chemotherapy resistance and high relapse rates. Over the years, clinical trials and studies have explored various sources of NK cells, including ex vivo expanded NK cell lines, CAR-NK cells, peripheral blood-derived NK cells, and umbilical cord blood-derived NK cells. These therapies have demonstrated varying degrees of therapeutic efficacy, ranging from transient anti-leukemia activity to sustained remission in select patient groups. Toxicity profiles have generally shown favorable safety outcomes, with minimal incidence of severe adverse effects such as cytokine release syndrome (CRS) or graft-versus-host disease (GVHD). However, persistent challenges remain, including limited NK cell persistence, relapse, and heterogeneity in patient responses. This review provides a comprehensive analysis of clinical outcomes and toxicity profiles provided from clinical trials, clinical studies and case reports conducted in the last 15 years to judge on the efficacy, safety and applicability of using NK cells for ACT of AML. Our review highlights the significant potential of NK cell-based therapies for AML, while addressing the technical and biological challenges that must be overcome to enhance their efficacy and safety., Competing Interests: Declarations. Conflict of interest: The authors declare no competing interests., (© 2025. The Author(s).)

Background: Knee osteoarthritis (KOA) is characterised by altered gait mechanics, which can lead to significant functional impairments. This study aims to investigate plantar pressure distribution during walking and assess functional mobility in patients with early-stage KOA, providing insights for targeted therapeutic interventions., Methods: Eighteen women with KOA were matched with 18 healthy controls for this study. We assessed plantar pressure distribution, relative phase durations during the stance phase, and performance on the Timed Up and Go (TUG) test. Independent sample t-tests were employed to identify group differences, with significance set at p < 0.05., Results: Patients with KOA exhibited significantly lower maximum plantar pressure in the Toe 1 (p < 0.01), medial heel (p < 0.01), and lateral heel (p < 0.01) regions, while demonstrating higher pressure in the Metatarsal 4 (p < 0.01) and midfoot (p < 0.01) areas. Furthermore, KOA patients spent less time in the initial contact (p = 0.01), foot-flat (p < 0.01), and forefoot push-off (p = 0.03) phases but more time in the forefoot plantarflexion phase (p < 0.01). Additionally, KOA patients demonstrated longer TUG times (p < 0.01), indicating reduced functional mobility., Conclusions: Early-stage KOA patients display distinct patterns of plantar pressure distribution and impaired functional mobility compared with healthy controls. These findings highlight the necessity for interventions aimed at addressing altered gait mechanics in KOA, which could help mitigate mobility limitations and enhance patient outcomes., (© 2025 John Wiley & Sons Ltd.)

Background: Midwives as one of the most effective members of the health systems play a key role in delivering health services to mothers and children who are vulnerable groups of the society. This research aimed to investigate the effect of Logotherapy on job satisfaction and Organization-Based Self-Esteem (OBSE) of employed midwives., Materials and Methods: This is a quasi-experimental study with the pretest and posttest design and a control group from all midwives employed in the public hospital of Rasht City in Iran. Fifty-six midwives fulfilling the inclusion criteria were selected and randomly divided into two groups of intervention and control. They filled job satisfaction, OBSE questionnaires, and demographic information checklist, and then, the intervention group attended Logotherapy for six sessions/90 minutes. Finally, both groups answered the instruments as posttest., Results: Results showed that the mean difference between OBSE (F 6,83 = 27, p < 0.05) and job satisfaction (t 2,62 = 27, p < 0.01) scores before and after the sessions in the intervention group was significantly more than the control group., Conclusions: Group Logotherapy increased job satisfaction and OBSE among midwives. It can be recommended for use in the clinical settings for healthcare providers., Competing Interests: Nothing to declare., (Copyright: © 2024 Iranian Journal of Nursing and Midwifery Research.)

The emerging technology of organic light-emitting diodes takes advantage of the thermally activated delayed fluorescence (TADF) mechanism for improved efficiency. Carbazole-based organic molecules are suitable for TADF emission because of charge transfer excitations between the electron-donor carbazole and an electron-acceptor unit. Computational design of new TADF molecules with the desired properties is challenging because charge-transfer excitations cannot be predicted accurately by time-dependent density functional theory. Four groups of carbazole-based donor-acceptor molecules have been studied using multireference ab initio methods to understand the nature of excited electronic states. The state-averaged complete active space self-consistent field (SA-CASSCF) and the N-electron valence state perturbation theory (NEVPT2) were used to calculate energies and oscillator strengths for multiple excited electronic states. The number of active electrons and orbitals and the number of excited states included in state-averaged CASSCF were selected such that the accuracy of ab initio predictions could be improved systematically. The procedure introduced here for the calculation of multiple excited electronic states of TADF candidates can be used to accelerate the computational search for efficient TADF materials.

Competing Interests: None declared.

The organic food industry has experienced rapid growth in recent decades. The industry is relatively new to developing countries compared to developed countries. Since Iran has the potential to produce organic products, it is essential to study factors that influence consumers' intention to buy them. The present study was designed and implemented for this purpose. In this cross-sectional study, 520 adults were selected using multistage sampling. Path analysis was employed to test a hypothesized model of predictors of consumer purchase intention for organic food. Attitude, environmental concern, and sensory characteristics directly impacted the intention to purchase organic food ( p  < .01). Knowledge, perceived price, and household size indirectly affected purchase intention through attitude ( p  < .01). Age indirectly affected purchase intention through health consciousness, environmental concern, perceived price, and sensory characteristics ( p  < .01). Subjective norms, health consciousness, and the perceived convenience of purchase had a positive and significant effect on purchase intention, directly and indirectly, through the mediating influence of attitude ( p  = .000). The educational level also affects purchase intention directly and indirectly through knowledge, health consciousness, environmental concern, and subjective norm ( p  = .000). The most potent total effects belonged to health consciousness, subjective norms, and education, respectively. Overall, the model could explain 47% of the intention variance and 45% of the variance in attitude. Various factors influence Iranian consumers' decision to buy organic food. This information can help professionals make well-informed decisions in policymaking, production, marketing, tourism, and retailing., Competing Interests: The authors state they do not have any competing interests., (© 2024 The Authors. Food Science & Nutrition published by Wiley Periodicals LLC.)

Objective: Infections are an important cause of morbidity and mortality after hysterectomy. Here, we aimed to investigate and evaluate the beneficial effects of metronidazole vaginal gel on the rate of surgical site infections in women undergoing elective abdominal hysterectomy., Methods: This is a randomized prospective, double-blind controlled clinical trial performed in 2020 in Isfahan on 108 candidates for elective hysterectomy. At the beginning of the study, we completed a checklist of the patient's characteristics (patient age, body mass index [BMI], and history of medical conditions such as diabetes, hypertension, anemia, and immune deficiency) and the cause of hysterectomy. All patients were randomized into two groups. The first group received a lubricant vaginal gel single dosage, and the second group received a 0.75% metronidazole vaginal gel single dosage the night before surgery. Patients were visited up to 6 weeks after surgery, and the frequency of infection at the surgical site was determined., Findings: The rates of infection were lower in patients who received metronidazole vaginal gel (5.8%) compared to the control group (11.6%) ( P = 0.03). Patients with an estimated blood loss volume of more than 500 mL had higher rates of infection (13.46%) compared to patients with a bleeding volume of fewer than 500 mL (1.9%) ( P = 0.001). We also found that patients with diabetes (13.5%) and patients with BMI more than 30 kg/m 2 (13.5%) had higher rates of infection compared to patients without diabetes (5.8%) and patients with BMI <30 kg/m 2 (11.5%) ( P = 0.001 for both). Patients with higher hospitalization duration had higher infection rates ( P = 0.009)., Conclusion: Administration of a single dosage of metronidazole vaginal gel before abdominal hysterectomy may reduce surgical site infection and have clinical values., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Journal of Research in Pharmacy Practice.)

Every year, an estimated 21 million girls aged 15-19 years become pregnant in low-income and middle-income countries (LMICs). Policy responses have focused on reducing the adolescent birth rate whereas efforts to support pregnant adolescents have developed more slowly. We did a systematic review of interventions addressing any health-related outcome for pregnant adolescents and their newborn babies in LMICs and mapped its results to a framework describing high-quality health systems for pregnant adolescents. Although we identified some promising interventions, such as micronutrient supplementation, conditional cash transfers, and well facilitated group care, most studies were at high risk of bias and there were substantial gaps in evidence. These included major gaps in delivery, abortion, and postnatal care, and mental health, violence, and substance misuse-related outcomes. We recommend that the fields of adolescent, maternal, and sexual and reproductive health collaborate to develop more adolescent-inclusive maternal health care and research, and specific interventions for pregnant adolescents. We outline steps to develop high-quality, evidence-based care for the millions of pregnant adolescents and their newborns who currently do not receive this., Competing Interests: Declaration of interests FS was supported by an Australian National Health and Medical Research Council (NHMRC) Postgraduate Scholarship (GNT 1150879) and Clifford Family Scholarship. GCP, SMS, and FS are researchers in the NHMRC-funded Centre of Research Excellence in Driving Global Investment in Adolescent Health (GNT 1171981). GCP was supported by an NHMRC Investigator Grant (GNT 1196999). All other authors declare no competing interests. The views expressed in this Health Policy are those of the authors alone and do not represent the policies or views of the affiliated institutions., (Copyright © 2023 Elsevier Ltd. All rights reserved.)

Background: The significance of HTLV-1 proviral load as a prognostic biomarker in HTLV-1-associated myelopathy/tropical spastic paraparesis (HAM/TSP) has been a subject of controversy. This study aims to assess the impact of HTLV-1 proviral load (PVL) on the clinical outcome in patients with HAM/TSP., Methods: An absolute quantitative HTLV-1 PVL RT-qPCR, TaqMan method was developed with 100% sensitivity and specificity. Then, from 2005-2018, the HTLV-1 PVL of 90 eligible newly diagnosed HAM/TSP patients were assessed for demographic, clinical symptoms and their associations with HTLV-1-PVL., Results: The quality control of the designed RT-qPCR showed a sensitivity and specificity of 100%. Spasticity in lower limbs in 58.9% and urinary symptoms in 17.8% of HAM/TSPs were observed. Using this designed RT-qPCR, the HTLV-1-PVL strongly affected spasticity and sphincter disturbance (p=0.05). The multivariate logistic test showed that only the beginning of lower limb weakness along with tremor was associated with PVL (OR: 2.78. 95% CI (0.99-1.02) and p=0.05). Urinary incontinence was prevalent among these patients; however, no association was identified with the HTLV-1 proviral load (PVL)., Conclusions: The absolute RT-qPCR developed for measuring HTLV-1 proviral load (PVL) demonstrated reliable results. Despite a high prevalence of urinary incontinence in these patients, no association was observed with the PVL. Consequently, it appears that HTLV-1 proviral load is specifically associated with developing spasticity in HAM/TSP., Competing Interests: The authors have no conflicts of interest to declare.

Competing Interests: EM was supported using public funding by the National Lottery through Arts Council England. All other authors declare no competing interests.

Background: Historical reports suggest that infants born small for gestational age (SGA) are at increased risk for high blood pressure (BP) at older ages after adjustment for later age body size. Such adjustment may be inappropriate since adiposity is a known cause of cardiovascular and metabolic disease., Objectives: To assess the association between SGA births and later BP among preterm births, considering potential background confounders and over-adjustment for later body size., Methods: A database search of studies up to October 2022 included MEDLINE, EMBASE and CINAHL. Studies were included if they reported BP (systolic [SBP] or diastolic [DBP]) (outcomes) for participants born preterm with SGA (exposure) or non-SGA births. All screening, extraction steps, and risk of bias (using the Risk of Bias In Non-randomised Studies of Interventions [ROBINS-I] tool) were conducted in duplicate by two reviewers. Data were pooled in meta-analysis using random-effects models. We explored potential sources of heterogeneity., Results: We found no meaningful difference in later BP between preterm infants with and without SGA status at birth. Meta-analysis of 25 studies showed that preterm SGA, compared to preterm non-SGA, was not associated with higher BP at age 2 and older with mean differences for SBP 0.01 mmHg (95% CI -0.10, 0.12, I 2  = 59.8%, n = 20,462) and DBP 0.01 mm Hg (95% CI -0.10, 0.12), 22 studies, (I 2  = 53.0%, n = 20,182). Adjustment for current weight did not alter the results, which could be due to the lack of differences in later weight status in most of the included studies. The included studies were rated to be at risk of bias due to potential residual confounding, with a low risk of bias in other domains., Conclusions: Evidence indicates that preterm infants born SGA are not at increased risk of developing higher BP as children or as adults as compared to non-SGA preterm infants., (© 2023 The Authors. Paediatric and Perinatal Epidemiology published by John Wiley & Sons Ltd.)

Background: Coronavirus disease 2019 (COVID-19) is an infectious disease that the physiological changes in pregnancy can make pregnant patients more susceptible to more severe forms of this infection. Hence, the treatment of COVID-19 in pregnant women can be challenging. This study was designed to evaluate the safety and efficacy of Remdesivir in pregnant women with COVID-19., Materials and Methods: This study was conducted on 150 pregnant women with moderate to severe COVID-19 infection. Remdesivir was prescribed and continued for 5 or 10 days according to the patient's condition. Maternal and pregnancy outcomes and also recovery rates were evaluated. Moreover, additional variables were examined: age, gestational age, symptoms, O2 saturation and laboratory tests at admission, the interval between symptom initiation and admission to hospital and Remdesivir prescription, hospitalization days, and ICU admission., Results: The mean age was 32.37 years. Cough and dyspnea were the most prevalent symptoms (74% and 68.7%, respectively). At the time of admission, 79 (52.7%) women needed low-flow oxygen support, 67 (44.7%) needed high-flow oxygen support, and 4 (2.7%) were intubated. Fifty-four (36%) patients required ICU care. In patients who died (12 women), Remdesivir was prescribed later than those discharged ( P value, 0.04). Patients with favorable pregnancy outcomes received Remdesivir earlier than those with unfavorable pregnancy outcomes ( P value: 0.008). The recovery rate was 70% (89.9% in the low-flow oxygen, 50.7% in the NIPPV/high flow oxygen, and 0% in the intubated women)., Conclusion: The results suggest that the early prescription of Remdesivir in pregnant women with moderate COVID-19 can improve the outcomes., Competing Interests: There are no conflicts of interest., (Copyright: © 2023 Advanced Biomedical Research.)

Background: Organic farming is a relatively new concept in developing countries compared to developed countries. Understanding the factors affecting consumers' willingness to pay for organic foods is critical to increasing the production of these products. This study aimed to develop and validate a Persian version of the questionnaire for assessing determinants of organic food purchase intention among adults in Tehran, the capital of Iran., Methods: The study was conducted in a two-phased standardized methodology in 2019. During Phase 1, a draft questionnaire was developed based on a comprehensive literature review. In phase 2, validation of the instrument was performed. Participants included a multidisciplinary expert panel comprising 14 members to evaluate content validity, a sample of lay people to assess face validity (n = 20), internal consistency (n = 300), and test-retest reliability (n = 62). The internal consistency and test-retest reliability were measured using the intraclass correlation coefficient (ICC) and Cronbach's alpha., Results: Forty-nine of 57 items had a CVR above 0.51 and were retained in the questionnaire. Three items were added to the questionnaire. The average CVI for the questionnaire was 0.97. Cronbach's α and ICC of the entire questionnaire were 0.86 and 0.93, respectively. Each phase of development progressively improved the questionnaire, resulting in a final 52-item questionnaire divided into 9 dimensions, including knowledge, attitude, subjective norms, health consciousness, environmental concerns, perceived convenience of purchase, perceived cost, sensory characteristics, and purchase intention., Conclusions: The developed questionnaire appears to be a valid and reliable instrument for examining determinants of consumer intentions to purchase organic food., (© 2023. The Author(s).)

Objective: The objective of this study was to determine the most effective coping mechanism to deal with auditory hallucinations that reduces the frequency of voice-hearing and associated distress. In the present randomized controlled trial, each of the three coping mechanisms of attentional avoidance, attentional focusing, and mindfulness were used in one group and the fourth group was the control group. Method : A total of 64 patients with schizophrenia, categorized in three groups of attentional avoidance, attentional focusing and mindfulness and one control group, were asked to listen to an ambiguous auditory task depending on the type of their coping mechanism. After determining the baseline of distress, the task was performed in duplicate for each group. After playing the auditory task for the first time, participants were asked to rate out the level of their distress and compliance with instructions, and they were asked to estimate the likely number of words they had heard. After the second time, they were asked to note the words they hear during the task and rate out their distress and compliance with instructions again at the end of the task. Results: There was a significant difference between groups in terms of distress with a medium effect size of 0.47. The post hoc analysis revealed that mindfulness group reported less distress compared to the attentional focusing group (P = 0.017) and the control group (P = 0.027). Also, a significant difference existed between groups in terms of the frequency of the identified words, with a moderately strong effect size of 0.59, and a very good statistical power of 0.99. The post hoc analysis showed that attentional avoidance (P = 0.013) and attentional focusing (P = 0.011) groups heard fewer words than the control group. Conclusion: Attention is a good target for treating psychotic patients with auditory hallucinations. Also, manipulation of attention can affect the frequency of auditory hallucinations and associated distress., Competing Interests: None., (Copyright © 2023 Tehran University of Medical Sciences.)

Objective: Bread constitutes a significant energy source and provides protein and some essential micronutrients to a large population worldwide, including Iran. So, its quality characteristics are important for health. This study aimed to identify the views and experiences of various stakeholders involved in the wheat- flour- bread chain about factors affecting the quality of this chain and strategies for its improvement in Iran., Results: Main suggested strategies in the field of raw materials were managing and planning for the production of high-quality wheat, measuring the quality factors of grain before purchasing by the government, allocating wheat quotas to flour mills based on the quality of the flour produced, and aerating and storing flour in silos to reduce its moisture. Holding training courses for bakery workers, improving the economic situation of bakers, and standardizing bread-making devices were the most important strategies in the bakery field. Assigning a specific unified management apparatus to deal with bread issues was also an effective and essential strategy. Findings show the need to implement strategies in various fields to improve wheat- flour- bread chain quality. This study provides helpful information to guide policy decisions and planning to enhance bread quality and promote public health., (© 2022. The Author(s).)

The effective management of multidrug-resistant tuberculosis (MDR-TB) and the need for rapid and accurate screening of rifampin (RIF) and isoniazid (INH)-resistant Mycobacterium tuberculosis (Mtb) isolates are the most fundamental and difficult challenges facing the global TB control. The present study aimed to compare the diagnostic accuracy of high-resolution melting-curve analysis (HRMA) in comparison to multiplex allele-specific PCR (MAS-PCR) and xpert MTB/RIF as well as the conventional drug-susceptibility test (DST) and gene sequencing for the detection of INH and RIF resistance in the Mtb isolates. In the present study, a total of 431 Mtb isolates including 11 MDR (%2.55), 7 INH resistance (%1.62), two RIF resistance (%0.46), and 411 sensitive isolates were phenotypically confirmed. HRMA assay identified katG gene mutations and the mabA-inhA promoter region in 15 of 18 INH-resistant samples and rpoB gene mutations were successfully evaluated in 11 out of 13 RIF-resistant samples. The sensitivity and specificity of the HRMA method were 83.3% and 98.8% for INH and 84.6% and 99% for RIF, respectively. The most common mutation in RIF-resistance-determining region (RRDR) occurred at codon 531 (TCG → TTG)(84.6%) and then at codon 513 (CAA → GTA)(7.6%) and 526 (CAC → TAC) (7.6%), which resulted in the amino-acid changes. Also, 88.8% of INH-resistant samples had mutations in the katG gene and the mabA-inhA promoter region, of which the highest mutation occurred at codon 315 (AGC → ACC) of the katG gene. In conclusion, all these results indicated that the sensitivity and specificity of the HRM method were increased when the katG gene and the mabA-inhA promoter region were used as a target., (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)

Mesenchymal stem cells (MSCs) are at the forefront of research for a wide range of diseases, including osteoarthritis (OA). Despite having attracted the attention of orthopedists, current MSC therapy techniques are limited by poor MSC implantation in tissue defects and lack of lateral tissue integration, which has restricted the efficacy of cell therapy to alleviate OA symptoms only. Here, we developed targeted MSC therapy for OA cartilage using a cell-tissue matchmaking nanoconstruct (C-TMN). C-TMN, as an MSC vehicle, consists of a central iron oxide nanoparticle armed with two types of antibodies, one directed at the MSC surface and the other against articular cartilage. We treated rat OA articular cartilage with intra-articular injections of C-TMN with and without exogenous MSCs. We observed substantial improvements in both symptomatic and radiographic OA caused by C-TMN, which was independent of exogenous MSCs. This new approach could predict a promising future for OA management., (© 2022. The Author(s).)

Objective: We aimed to evaluate treatment responses and recurrence rate of atypical endometrial hyperplasia (AEH) and endometrial endometrioid adenocarcinoma (EA) with Stage IA Grade 1 to megestrol in Iranian patients who are candidates for medical treatments., Methods: In a retrospective cohort study that was conducted on 50 patients with AEH and 22 patients with EA who were referred to the oncology clinic of Imam Khomeini Hospital, Tehran, Iran, during 2006-2016, we recruited all patients with AEH or EA of Stage IA Grade 1 and their disease was diagnosed during endometrial curettage with or without hysteroscopy. Patients were initially treated with 160 mg of megestrol daily, along with aspirin up to 3 months, and then after 3-4 weeks of discharge of the drugs, patients underwent curettage with hysteroscopy., Findings: The patients with AEH had 31 complete responses and five progressive diseases, and the patients with EA had seven complete responses and seven progressive diseases. After treatment, 25 cases with AEH and 5 cases with EA had an intention to get pregnant, whereas eight patients with AEH and 1 case with endometrial cancer became pregnant. Recurrence occurred in the 2 cases with AEH and 2 cases with endometrial cancer which the time of recurrence in the patients with AEH was longer than in patients with endometrial cancer ( P = 0.011)., Conclusion: Megestrol is an effective therapeutic agent in endometrial hyperplasia or low-grade endometrial cancer patients who are willing to conserve their childbearing., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Journal of Research in Pharmacy Practice.)

Background: In March 2021, a coronavirus disease 2019 (COVID-19) outbreak was declared at a large long-term care and short stay facility in British Columbia, Canada-well after introduction of the vaccination program in long-term care facilities that resulted in a dramatic decline in the number of outbreaks in this type of setting. The objective of this study is to provide the descriptive epidemiology of this outbreak, in the context of partial immunization of both residents and staff at the facility., Methods: The cases' information was extracted from a provincial information system (Panorama). Descriptive analysis was performed using Microsoft Excel and SAS. Outbreak management controls included, but were not limited to, asymptomatic testing and efforts to increase vaccination., Results: Twenty-six cases among the 241 resident and three cases among the 418 staff (corresponding to attack rates of 10% and less than 1%, respectively) were identified. The attack rate in residents was considerably lower than the average attack rate for COVID-19 outbreaks in long-term care facilities before the vaccine rollout. Seventeen resident cases were either partially or fully immunized. Four of the eight hospitalized cases and two of the three deceased cases were partially immunized. Seventeen cases were temporary stay residents. The three staff cases were not vaccinated. Ten cases were identified as part of asymptomatic testing., Conclusion: Introduction of vaccination at facilities contributed to lower attack rates and higher numbers of asymptomatic cases in this outbreak. Screening asymptomatic individuals identified additional cases among vaccinated residents. Findings underscore the importance of achieving high vaccine coverage, including among temporary stay residents, to prevent virus introduction and subsequent unrecognized transmission opportunities., Competing Interests: Competing interests: None.

Background: Patients with knee osteoarthritis (OA) are always faced with functional limitations in daily activities due to knee pain. They are also at risk of falling because of compensatory kinetics and kinematics changes in walking, which is why they are seeking complementary therapies to deal with their problems., Objective: The present research aimed to evaluate whether Swedish massage is effective in relieving the symptoms of knee OA and improving the gait spatiotemporal parameters of patients with knee OA., Methods: Thirty adult women with knee OA participated in this study voluntarily. The intervention group (n = 15) received Swedish massage on their quadriceps for 20-30 min per session (12 sessions). During this period, the control group (n = 15) received their regular treatment. Osteoarthritis symptoms were evaluated by the Western Ontario and McMaster Universities Osteoarthritis Index. The spatiotemporal parameters of gait were also captured by the motion analysis system during barefoot walking., Results: The intervention group demonstrated significantly more pain relief and improved function compared to the control group. A significant increase was observed in the gait speed, total support time, and single support time (P < 0.05). Moreover, there was a significant decrease in the step width and initial double support time of the patients after receiving Swedish massage (P < 0.05)., Conclusion: It can be concluded that Swedish massage may positively affect pain relief and function improvement in patients with knee OA. Also, Swedish massage was found to improve the spatiotemporal parameters in the patients. This may have important clinical implications regarding the rehabilitation of patients with knee OA., Competing Interests: Declaration of competing interest The authors whose names are listed immediately below certify that they have NO affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript., (Copyright © 2021 Elsevier Ltd. All rights reserved.)

Despite numerous applications of nanofibrous alginate (Alg) mat, its facile fabrication via electrospinning is still challenging. The low alginate content compared to the carrier polymer and existence of impurities are the main drawbacks of existing approaches. The purpose of this research is both to study and improve alginate electrospinnability by focusing on the effect of inter- and intramolecular hydrogen bonding. Based on hard and soft acids and bases (HSAB) theory, the Na + cations (carboxylate counter-cation) were substituted with a harder acid, Li + cation, to increase the strength of ionic interaction and decrease the density of hydrogen bonding. Viscosity and electrical conductivity measurements as well as FTIR and 1 H NMR revealed a lower intramolecular hydrogen bonding density in Li-Alg. SEM images showed improvement of alginate electrospinnability for Li-Alg compared to the salts of Na-Alg and K-Alg. This study sheds more light on underlying reasons hindering alginate electrospinning and introduces a simple method for fabrication of nanofibers with high alginate content., (Copyright © 2021 Elsevier B.V. All rights reserved.)

Objectives: Human papillomaviruses (HPV) are the main etiology of invasive cervical cancer. Together HPV and viral hepatitis account for the cause of 25% of cancers in developing countries. To evaluate the association between population movements and the spread of HPV, this study looked at prevalence, genotypes, and phylogenetic assessment of HPV in Great Khorasan, a pilgrimage-tourism province in northeast Iran., Methods: From March 2013 to July 2018, 567 samples were collected from three groups in Khorasan: Razavi and North Khorasan provinces (highly mobile population); South Khorasan province (conservative and desert); and diverse group (tourists)., Results: HPV prevalence was 48.4% in Razavi and North Khorasan (first group); 19.9% in South Khorasan (second group); and 33.6% in the diverse group. The four most common HPV genotypes were HPV-6, 11, 51 and 16, in the first group; HPV-6, 11, 16 and 58 in the second group; and HPV-6, 11, 16 and 53/89 in the diverse group. The most frequent genotypes that are known as high risk for cervical cancer were HPV-51 in the first group, HPV-16 in the second group and the diverse group. Among low-risk genotypes, HPV-6, and HPV-11 were more frequent in all groups. DNA sequencing and phylogenetic analysis of 20 HPV-positive samples showed that the distributions of the HPV genotypes were HPV-6 (50%), 11 (10%), 67 (5%), 16 (15%), 31 (10%), 54 (5%), and 89 (5%)., Conclusions: The findings show that areas associated with population movement should be frequently monitored for infectious diseases, while conservative and less populated areas have less risk for virus spread and endemicity. Health authorities should focus more on the establishment of HPV diagnostic facilities, screening, vaccination, and enhancement of public knowledge in these regions., (Copyright © 2020 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Human T-lymphotropic virus type-1 (HTLV-1) is a retrovirus that causes the neurological disorder HTLV-1 associated myelopathy/ tropical spastic paraparesis (HAM/TSP) and/or adult T-cell leukemia/lymphoma (ATLL). Iran is one of the endemic regions of the HTLV-1 in the Middle East. To infer the origin of the virus in Iran and to follow the movements of human population and routes of virus spread to this country, phylogenetic and phylodynamic analyses were performed. To this purpose, the long terminal repeat (LTR) region of HTLV-1 was used. New LTR sequences were obtained from 100 blood samples which infected with HTLV-1. Moreover, all Iranian LTR sequences which have been reported so far, were obtained from GenBank database. Sequences were aligned and maximum-likelihood and Bayesian tree topologies were explored. After identification of Iranian specific cluster, molecular-clock and coalescent models were used to estimate time to the most recent common ancestor (tMRCA). Bayesian Skyline Plots (BSP), representing population dynamics HTLV-1 strains back to the MRCA, were estimated using BEAST software. Phylogenetic analysis demonstrated that the Iranian, Kuwaiti, German, Israelite and southern Indian isolates are located within the widespread "transcontinental" subgroup A clade of HTLV-1 Cosmopolitan subtype a. Molecular clock analysis of the Iranian cluster dated back their respective tMRCA to be 1290 AC with a 95% HPD confidence intervals (918, 1517). BSPs indicated a rapid exponential growth rate in the effective number of infections prior the 15th century. Our results support the hypothesis of a multiple introductions of HTLV-1 into Iran with the majority of introductions occurring in prior the 15th century, at the same time the Mongol invasion of Iran. Our results further suggest that HTLV-1 introduction into Iran was facilitated by the commercial/migratory linkage as known as the ancient Silk Road which linked China to Antioch (now in Turkey)., (Copyright © 2020. Published by Elsevier B.V.)

Background: Effective maternal service delivery for adolescent mothers is essential in achieving the targets for maternal mortality under the Sustainable Development Goals. Yet little is known about levels of maternal service coverage in adolescents compared with adult mothers., Method: We used data from 283 Demographic and Health Surveys or Multiple Cluster Indicator Surveys for 105 countries between 2000 and 2019 to estimate the levels and trends of inequality in coverage of five maternal health services between adolescent girls (aged 15-19) and adult mothers (aged 20-34), including receiving four or more antenatal care visits, delivering with skilled birth attendants and receiving a postnatal check-up within 24 hours of delivery., Results: We analysed data from 0.9 million adolescent girls and 2.4 million adult mothers. Using the most recent data, we found adolescent girls had poorer coverage across all indicators, with receipt of four or more antenatal care visits 6.5 (95% CI 6.3 to 6.7) percentage points lower than adult mothers, delivery with skilled birth attendants 3.6 (95% CI 3.4 to 3.8) lower and having a postnatal check-up within 24 hours of delivery 3.2 (95% CI 2.8 to 3.6) lower. The coverage was 54.2% (95% CI 53.9 to 54.5) among adolescents for four or more antenatal care visits, 69.7% (95% CI 69.4 to 70.0) for delivery with skilled birth attendants and only 30.0% (95% CI 29.3 to 30.7) for receiving a postnatal check-up within 24 hours of delivery. Country-specific coverage of the maternal services increased over time in most countries, but age-related differences persisted and even worsened in some, particularly in the Western Pacific (eg, Vietnam, Lao, Cambodia and Philippines)., Conclusion: Even though their pregnancies are of higher risk, adolescent girls continue to lag behind adult mothers in maternal service coverage, suggesting a need for age-appropriate strategies to engage adolescents in maternal care., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Classical 3β-HSD deficiency due to mutations in the HSD3B2 gene is responsible for a rare form of congenital adrenal hyperplasia (CAH) and is identified by varying degrees of salt wasting. Preimplantation genetic diagnosis (PGD) was performed in a couple carrying mutation c.690 G>A in the HSD3B2 gene. Four polymorphic short tandem repeat markers closely linked to the HSD3B2 gene (D1S185, D1S453, D1S514, D1S540) for linkage analysis in conjunction with the direct mutation analysis were used in embryo genotyping. Two CODIS STRs (VWA and THO1) were also used to confirm embryo zygosity and rule out possible contaminations. Finally, SRY and AMYLOGENIN markers were used for embryo sex determination. PGD was performed by fluorescent multiplex seminested polymerase chain reaction and sequencing. Six embryos were tested and one male carrier embryo was transferred, resulting in the birth of a healthy boy.

Objectives: Coronary artery disease (CAD) is known as a life threatening disease, worldwide. In this study the role of HTLV-1 infection was evaluated on cardiac involvement in an endemic region of northeastern Iran., Materials and Methods: Serologic and molecular tests for HTLV-1 infection were carried out in subjects who had coronary angiography. A real-time PCR, TaqMan method, to quantify HTLV-1 proviral load (PVL), and routine hematological and biochemical tests were performed for study subjects., Results: Twenty nine patients were HTLV-1+CAD+ and 13 cases were HTLV-1+CAD-. Although, there were no significant differences for risk factors like FBS, HDL, triglyceride, systolic and diastolic blood pressure (Cbp, Dbp), waist circumference (WC), hip circumference (WL), cholesterol ( P =0.003), and LDL ( P =0.007) levels, and monocyte count ( P =0.05) had meaningful differences. The mean HTLV-1 PVL in HTLV-1+CAD+ subjects was 992.62±120 which was higher compared with HTLV-1+CAD- group (406.54±302 copies/104 PBMCs). Moreover, HTLV-1 PVL in males (833±108) was lower compared with females (1218±141 copies/104 PBMCs) ( P =0.05). Patients with HTLV-1-PVL of more than 500 copies/104 had more diffused atherosclerosis plaque than patients with less than 500 (OR=6.87, 95% CI=1.34-35.05; P =0.016). Furthermore, patients with diffused coronary atherosclerosis had significantly higher levels of HTLV-1 PVL than patients with middle, proximal, and normal location of coronary sclerotic lesions ( P <0.05)., Conclusion: Taken together, in endemic area, HTLV-1 infection, more likely is a facilitating factor for heart complications and the high HTLV-1 PVL might affect CAD manifestations.

Background: A graduating medical doctor is expected to be competent in physical examinations across all systems. The exploration of how gender affects the development of clinical skills has not been explored in an Arab context, despite cultural restrictions that make it more difficult for students and doctors to examine the opposite sex., Methods: A cross sectional survey was undertaken of graduating final year medical students in Northern Jordan. We asked about students' perceptions regarding factors that may impact the development of clinical skills potentially related to gender, and asked about the frequency of examinations performed during their training for intimate and general physical examinations on all patients, as well as patients of the opposite sex. We also asked about the students' confidence in performing the examinations (3-point Likert-scale). Comparison of male and female proportions was done using Chi square tests analysis., Results: One hundred eighty-eight final year students from 481 students (41%) completed the survey, 99 males and 89 females. The greatest factor given for impacting a student's clinical examination of a patient of the opposite sex was cultural or religious traditions. Overall male students perform more clinical examinations than female students, with the odds of a male conducting more than 10 cardiovascular examinations on any patient compared to female students being 2.07 (1.13-3.79) and as high as 3.06 (1.53-6.18) for thyroid examinations. However, females were significantly more likely to examine male patients than vice versa (0.49 (0.27-0.88) for cardiovascular and 0.39 (0.21-0.71) for respiratory examinations). The gender division was more prominent for intimate examinations, with a lower odds of males conducting breast 0.11 (0.04-0.28) and vaginal examinations 0.22 (0.02-1.98) and more male students conducting prostate examinations OR 11.00 (1.39-87.03) and male genitalia examinations OR 16.31 (3.75-70.94). Overall a large proportion of students had never performed common intimate clinical examinations at all., Conclusions: In our context, clinical exposure to both intimate and general clinical examinations differs significantly between male and female students. A greater awareness and more research on the influence of gender on clinical skill attainment in conservative cultures is needed with appropriate adaption of clinical teaching., Trial Registration: Non interventional thus not required.