The brown bear (Ursus arctos) is the largest terrestrial carnivore in Iran with a rapidly shrinking range. In this study, we assembled the most comprehensive and up-to-date distribution dataset of the brown bear in Iran. We applied Species Distribution Models (SDMs) and corridor mapping to identify this charismatic mammal's suitable habitats and its corridors across the Zagros and Alborz mountains to ensure this Endangered charismatic large carnivore in Iran. We also estimated the coverage of protected areas for the species' suitable habitats. Our data confirmed the presence of the species in 22 of 31 provinces of the country. The total suitable area for the species is 347,728 km2. We showed that significant parts of the suitable areas, 77%, of the brown bear's suitable habitats, are located outside of the protected areas network. Slope and vegetation were the most important variables shaping the species distribution, and dense forests in the absence of mountain areas are not suitable for the species. One practical result of this study is narrow, well-defined corridors which are more feasible to validate in the field, monitor over time, and integrate into conservation planning. While the circuit method can provide valuable insights into corridor mapping, this method always produces wide corridors, which are challenging to prioritize for targeted conservation efforts for carnivores. Thus, we recommend linear corridors for carnivores' conservation planning.
Human papillomavirus (HPV) is a highly prevalent sexually transmitted infection in the world, particularly among young adults shortly after they become sexually active. Beyond its commonality, HPV is a significant public health concern due to its carcinogenic potential. Globally, HPV is responsible for a substantial number of cancer cases annually, including the vast majority of cervical cancers, as well as a notable proportion of other anogenital cancers. To convey the urgent need for comprehensive prevention strategies, this study aimed to assess HPV test positivity and genotype distribution among individuals referred for HPV testing in Tehran, Iran, over a 14-year period (2011-2024), providing the foundational data required to guide future national vaccination and screening programs. This study examined the demographic characteristics of 6418 individuals (5988 women and 430 men) tested for HPV using data and samples collected from patients visiting a Saeed pathology and genetics laboratory between 2011 and 2024. HPV DNA was extracted from genital samples, (cervical/vaginal specimens for women, and penile/urethral swabs and urine for men) representative of both female and male individuals in Tehran, and analyzed for the presence of HPV. Genotyping was performed by real-time PCR (Cobas 4800 and Sansure G26) and Reverse Hybridization (INNO-LiPA and HPV Direct Flow Chip) methods for the identification of high-risk (HR) and low-risk (LR) HPV genotypes. Over the 14-year study period, HPV prevalence was assessed using four diagnostic methods (INNO-LIPA, HybriSpot, COBAS X480, and Sansure Kit), reflecting the evolution of available laboratory assays over time yielding positive detection rates of 55.7%, 61.5%, 17.2%, and 52.1%, respectively. The proportion of positive HPV test results varied across age groups, with the highest prevalence observed in the 20-30 year age group. Within the studied cohort, the HPV positivity rate was 40.8% among female patients and 63.3% among the smaller cohort of male patients. The most frequently detected genotypes overall were 6 (12.3%), 16 (7.1%), 52 (3.6%), and 31 (3.3%), in descending order. Notably, 74.4% (517) of patients reported were asymptomic and were referred for routine screening. Among HPV-positive individuals, 69.5% (163) were asymptomatic. Conversely, 23.0% (106) of HPV- negative individuals reported at least one clinical symptom. Positive HPV rates were 56.3% and 24.5% in single and married subjects, respectively. This study contributes valuable insights into HPV prevalence and genotype distribution in samples collected over a 14-year period in Tehran. The high prevalence of HPV infection, particularly with high-risk Genotypes coupled with the highest prevalence observed in the 20-30 year age group and HPV-16 being common in younger ages, without clinical sign of infection, underscores the necessity for sustained vigilance in monitoring HPV prevalence, early detection through screening, and targeted prevention programs, and comprehensive cervical cancer prevention strategies.
The purpose of the current study was to assess the effect of couple counseling on maternal distraction and attention levels during breastfeeding and nonfeeding childcare in mothers experiencing distractions in Hamadan, western Iran. In this randomized controlled trial, mothers attending comprehensive health centers for routine postpartum care who reported distraction during breastfeeding were enrolled. Participants were assigned via block randomization to an intervention group (standard care plus couple-centered counseling) or a control group (standard care alone). The maternal distraction was measured using the maternal distraction questionnaire at baseline, immediately post-intervention, and at two-, three-, and 4-month follow-ups. The analysis included 64 participants in each group. At 4 months, 40.6% more mothers in the intervention group than in the control group reported not being at all distracted during breastfeeding, with a 36% difference in favor of the intervention group for very high attention. Corresponding figures during childcare were 42.2% and 37.5%, respectively. A significant interaction between time and group was observed for both maternal distraction during breastfeeding and during childcare (p < 0.001). In the intervention group, maternal distraction during breastfeeding decreased from 17.89 ± 2.53 at baseline to 8.31 ± 1.27 at 4 months, and during childcare from 18.03 ± 1.94 to 8.98 ± 2.06. In the control group, these scores decreased only slightly, from 16.84 ± 2.50 to 15.52 ± 2.37 for breastfeeding and from 17.84 ± 2.44 to 15.19 ± 2.29 for childcare. Our study showed that a couple-centered counseling intervention significantly reduced maternal distraction and improved attention during breastfeeding and childcare.
Climate change poses significant risks to smallholder farmers' livelihoods and food security, particularly in vulnerable agricultural regions. This study examines how multidimensional adaptive capacity is associated with household food insecurity among small-scale farmers and determines the socio-economic factors associated with adaptation strategies in western Iran. Using survey data from 296 farming households, a composite multidimensional adaptation indicator was developed, and structural equation modeling was applied to analyze relationships among adaptation dimensions and food security outcomes. The results show that higher adaptive capacity is associated with lower levels of household food insecurity. Among the adaptation dimensions, institutional and knowledge-based strategies and livelihood diversification exhibit the strongest associations with food security, while other strategies contribute to a lesser extent. In addition, key socioeconomic factors, including education, asset ownership, and access to information, are positively associated with adaptation intensity, while reliance on external credit is negatively associated. These findings highlight the importance of considering adaptation as a multidimensional process and provide empirical evidence to support targeted interventions aimed at strengthening farmers' resilience under climate stress.
Today, HIV infection is considered among the most important infectious diseases worldwide. This study aimed to explore the challenges of people living with HIV (PLHIV) on treatment journey. This study was conducted using a qualitative approach and the content analysis method at the Behavioral Diseases Consultation Center and the Positive Club of Kerman, Iran, from September 2023 to August 2024. A total of 27 individuals, including 17 PLHIV, 5 caregivers, and 5 social work and HIV professionals, were recruited using purposive sampling. Data were collected using individual semistructured interviews, field attendance, and note-taking. Data analysis resulted in 1258 primary codes, which were categorized with the theme of challenges of living with HIV into 30 subcategories and 7 main categories, including emotional and psychological tensions, objective and behavioral reflections, social deprivation, unfavorable social policies, changes in life, labeling, poor quality, and insufficient medical services. Due to the numerous problems and challenges faced by PLHIV during their treatment, they need comprehensive support from their families, caregivers, and society. Ensuring access to appropriate medical services and enhancing public awareness and understanding of PLHIV and their caregivers through education are essential. Such measures can contribute to improved treatment adherence, better quality of life, and more effective patient-centered care for PLHIV.
Considering the adverse health effects of exposure to bisphenols and phthalates, the current study assessed the risk of oral exposure to bisphenols (A and S) and phthalates through consumption of six types of carbonated drinks. A total of 180 samples of soft drinks and non-alcoholic beer (three flavors each) in polyethylene terephthalate (PET) bottles and aluminum can packaging were collected from the Iranian market for analysis. Assessment of risk under carcinogenic/non-carcinogenic scenarios was performed using Monte Carlo simulation. The Hazard index (HI) values of bisphenols (A and S) in soft drinks were above one (i.e. moderate risk) only at the 90th percentile for PET packaging and below one at the 50th and 90th percentiles for canned samples. However, HI values for non-alcoholic beer samples in both PET and aluminum can packaging were above one at the 90th percentile. Under the non-carcinogenic scenario for phthalates exposure, the HI values for soft drinks and non-alcoholic beer packaged in aluminum cans and PET bottles were below one at both percentiles, indicating no appreciable risk. Carcinogenic risk assessment for di-2-ethylhexyl phthalate (DEHP) revealed that the Incremental lifetime cancer risk (ILCR) values at both percentiles were below 10-6 across all samples, suggesting negligible carcinogenic risk.
Mortality among hospitalized COVID-19 patients changed markedly across successive epidemic waves as circulating variants shifted, population immunity increased, and health-system pressures fluctuated. These increasingly heterogeneous conditions raise concerns about whether prediction models developed during early phases remain reliable in later epidemic contexts. To develop a wave-aware machine-learning framework that differentiates between stable physiological predictors of mortality and context-dependent predictors whose importance changed across waves. We analyzed 732,654 adult hospitalizations from Iran's national COVID-19 registry across Waves 2-5 and the post-Wave-5 period. All preprocessing, feature selection, and model training were conducted independently within each wave to preserve temporal structure and prevent leakage. A three-stage feature-selection approach Elastic Net shrinkage, Random Forest importance ranking, and Variance Inflation Factor filtering identified both stable and time-varying predictors. Model performance for Logistic Regression, Random Forest, and Deep Neural Networks was evaluated on wave-specific held-out test sets, and temporal robustness was assessed through cross-wave validation. A consistent physiological vulnerability core age, hypoxemia, and major chronic comorbidities was present across all waves. Nonlinear models outperformed Logistic Regression, with Random Forest achieving AUCs up to 0.94 and F1 scores up to 0.68 in within-wave testing. However, early-wave models showed marked degradation when applied to later waves: cross-wave AUC declined moderately (e.g., RF: 0.87 within-wave → 0.80 early→Wave-5), whereas F1 collapsed due to pronounced miscalibration (e.g., RF F1: 0.68 → 0.13 → 0.07). SHAP analyses revealed increasing importance of vaccination-related variables and shifting comorbidity profiles in later waves. Threshold-sweep analyses suggested that the F1-optimal probability threshold varied widely across models and waves, underscoring the impact of temporal drift on threshold-dependent performance. COVID-19 mortality risk was determined by a stable physiological core overlaid by dynamic, wave-specific factors shaped by changing variants, immunity, and hospital strain. The divergence between preserved discrimination and degraded F1 demonstrates that static prediction models are highly susceptible to temporal drift. Drift-aware approaches such as recalibration, periodic refitting, or adaptive thresholding may be essential to maintain clinical utility in evolving epidemic environments. The wave-aware, feature-selection-guided, explainable ML framework presented here offers a generalizable basis for developing temporally robust prediction tools for COVID-19 and other rapidly evolving infectious diseases.
The need for alternative analgesia to opioids in the emergency department (ED) has become increasingly urgent due to the opioid epidemic. Ketamine, traditionally used for sedation, has emerged as a promising alternative for pain control in the acute care setting. This scoping review evaluates the use of intranasal (IN) ketamine compared with intravenous (IV) opioids for analgesic efficacy in treating acute pain in the ED. A search of PubMed, CINAHL and PRIMO databases was conducted for randomized controlled trials (RCTs) published between 2015 and 2025. A total of 561 records were identified, and 8 RCTs evaluating analgesic efficacy as the primary outcome were included in this review. This review was conducted in accordance with the PRISMA-ScR reporting guidelines. Eight RCTs including 846 patients were included (2016-2025), all conducted in Iran, Israel, or Thailand. IN ketamine (0.3-1.5 mg/kg) was most commonly compared with IV morphine (0.1 mg/kg). Across studies, IN ketamine demonstrated comparable reductions in pain scores to IV morphine, with several trials reporting no statistically significant differences at measured time points, although IV morphine was generally associated with faster onset of analgesia. In one study, IV fentanyl produced greater pain reduction than IN ketamine. Adverse effects were generally mild and transient with IN ketamine associated with fewer adverse events compared to IV morphine. IN ketamine may be useful for acute pain management in the ED. However, further research is needed to determine optimal dosing, compare its efficacy with more potent opioids, and evaluate long-term outcomes associated with its use.
Health-promoting behaviors are crucial for maternal and fetal well-being during pregnancy, yet many women face barriers to adopting these practices. Mobile health technologies offer innovative solutions by providing personalized interventions. This study evaluated the effectiveness of a comprehensive mHealth application in promoting health behaviors among pregnant women. In a two-arm, parallel-group, randomized controlled trial, 80 pregnant women aged 18-45 years with gestational age between 18 and 36 weeks were recruited from prenatal clinics affiliated with Mashhad University of Medical Sciences, Mashhad, Iran between May and September 2023. Participants were randomly assigned (1:1) using computer-generated sequence and centralized allocation concealment to either an intervention group receiving the mHealth app or a control group receiving standard prenatal care. The app, developed by healthcare professionals, provided multimedia resources and step-by-step guidance on health responsibility, exercise, nutrition, spiritual improvement, interpersonal relations, and stress management. Data were collected at baseline and after four weeks using the Health Promoting Lifestyle Profile II. Statistical analyses, following the intention-to-treat principle, included analysis of covariance to assess the intervention effect while controlling for baseline scores, independent t-test, and chi-square test using SPSS Version 22. Missing data were addressed using Multiple Imputation. Both groups were homogeneous in terms of personal and obstetric characteristics at baseline. The intervention group exhibited significant improvements in health-promoting behaviors compared to the control group, with higher HPLP-II scores (mean difference: 29.5, P = 0.004). Significant improvements were observed across all HPLP-II subscales, including health responsibility, exercise, nutrition, spiritual improvement, interpersonal relations, and stress management. The effectiveness of intervention was consistent across various demographic subgroups. The mHealth intervention significantly enhanced health-promoting behaviors among pregnant women, demonstrating the practical application of mHealth tools in supporting healthier lifestyles during pregnancy. These findings suggest that mHealth technologies can be effectively integrated into prenatal care to improve maternal and fetal outcomes. Future research should explore the long-term impacts and broader applicability of such interventions across diverse populations. The trial was registered at https://irct.behdasht.gov.ir (identifier: IRCT ID: IRCT20180412039276N2) on May 23, 2022.
Many yoga poses involve supporting part or all of the body weight on the shoulder girdle and arms, which impose high loadings on the shoulder girdle. The present study aims to investigate the differences in electromyographic (EMG) activity of shoulder muscles in female yoga athletes with and without scapular dyskinesis (SD) during two yoga poses. This cross-sectional analytical survey study included 24 female athletes aged 18-40 years with (N = 12) and without (N = 12) scapular dyskinesis from a yoga club in Tehran, Iran. EMG (Aktos; Myon, Inc.) data were collected to measure the peak activation of the shoulder girdle muscles, including: upper trapezius, lower trapezius, serratus anterior, infraspinatus, posterior deltoid, and teres major of the dominant side, explicitly focusing on their electrical activity during the two yoga poses, Chakrasana and Pincha Mayurasana. An independent T-test and Mann-Whitney U test were used to analyze inferential statistics with a significance level of p ≤ 0.05. The results showed there is no significant difference between the with SD and without SD groups in the activity of the upper trapezius, serratus anterior, posterior deltoid, and teres major muscles during Chakrasana and Pincha Mayurasana poses (P ≥ 0.005). In contrast, the two groups had significant differences in the lower trapezius (P = 0.033) and infraspinatus (P = 0.045). Specifically, lower trapezius activity was greater in the SD group, whereas infraspinatus activity was greater in the non-SD group. This study suggests that scapular dyskinesis influences the activity of the infraspinatus and lower trapezius muscles during Chakrasana and Pincha Mayurasana poses. The data highlight the importance of targeted neuromuscular interventions to address muscular imbalances in the shoulder complex, especially in populations exposed to overhead and inverted movements, such as yoga practitioners.
While emerging evidence from Western populations suggests that higher carbohydrate quality (assessed by indices incorporating fiber, glycemic index, whole grains, and solid carbohydrate sources) is inversely associated with cardiovascular risk factors, prospective evidence from Middle Eastern populations regarding the association between carbohydrate quality and cardiovascular disease (CVD) remains limited and inconsistent. We included 2,648 participants free of CVD, from the participants of the 3th phase of Tehran Lipid and Glucose Study (TLGS). Dietary intake was assessed at baseline (2006-2008) using a validated 168-item food frequency questionnaire. Carbohydrate quality index (CQI) was calculated based on four components: dietary fiber intake, dietary glycemic index, whole grain to total grain ratio, and solid carbohydrate to total carbohydrate ratio. The CQI and its components were calculated and categorized into tertiles. Incident CVD was defined as coronary heart disease, stroke, or cardiovascular death occurring during follow-up. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs), with sequential adjustment for demographics, lifestyle factors, dietary factors, and potential mediators (BMI, diabetes, hypertension). Sensitivity analyses were conducted by (1) omitting the whole grain ratio from the CQI to yield a 3-component Modified CQI, and (2) constructing a Population-Adapted Index (PAI) replacing whole grain with legume intake. During a median follow-up of 10.6 years, 171 CVD cases (6.5%) were identified. After multivariable adjustment, no significant association was observed between CQI and incident CVD (T3 vs. T1: HR = 0.83, 95% CI: 0.57-1.21). Individual CQI components also showed null associations. Sensitivity analyses using a Modified CQI (without whole grain) and a Population-Adapted Index (incorporating legume intake) yielded consistent null associations (Modified CQI T3 vs. T1: HR = 0.66, 95% CI: 0.39-1.13; PAI T3 vs. T1: HR = 0.93, 95% CI: 0.57-1.50, fully adjusted). In this prospective study of Iranian adults, we observed no statistically significant association between CQI and incident CVD. However, statistical power was limited for detecting subtle associations (MDHR = 0.801 per SD at 80% power), and larger prospective studies are needed.
Transportation 4.0 enables smart planning in urban and interurban transportation networks by leveraging intelligent technologies, such as Internet of Things (IoT), cloud computing, information system integration, and artificial intelligence, to facilitate real-time vehicle assignment and routing. Nevertheless, Transportation 4.0 planning involving vehicle smart assignment and routing, particularly in healthcare logistics, has been less addressed in the literature. However, this study takes an initial step toward intelligent planning of emergency medical services by proposing an Intelligent Emergency Information System (IEIS) for real-time ambulance assignment and routing. As part of data analytics in the designed IEIS, an integer linear mathematical model is proposed to optimize total travel times in the ambulance assignment and routing problem based on deterministic real-time input data in two phases: reaching the patients and transporting them to hospitals. The proposed mathematical model is solved in a case study of Amol city, Iran, incorporating 25 street nodes, nine ambulance nodes, six call nodes, and five hospital nodes, using the CPLEX solver. Although designing and implementing the suggested conceptual model of IEIS was not applicable in the case study, to evaluate the impact of real-time parameter updates, two scenarios involving real-time inclusion of a new call node and an ambulance breakdown are examined. Accordingly, the model was re-solved, producing updated ambulance assignments and routing in each scenario, even by rearranging the ambulances' missions. Results validated the flexibility of the proposed mathematical model in optimizing two-phase ambulance assignment and routing under real-time input updates.
Patients with medial frontal gliomas often retain motor function despite tumor infiltration of canonical planning hubs, a paradox suggesting unmapped compensatory networks. We used task-based connectivity analysis to reveal demand-dependent reorganization invisible to standard mapping, aiming to identify distributed systems critical for surgical preservation. Twenty-five WHO Grade IV left medial frontal glioma patients and 25 controls performed visually-paced finger-tapping (2 Hz) during 3 T fMRI. Generalized psychophysiological interaction (gPPI) analysis mapped task-modulated connectivity within sensorimotor, subcortical, cerebellar, and frontoparietal networks. Brain-behavior correlations assessed functional relevance. Canonical sensorimotor coupling and Putamen-Thalamus integration were silenced in patients. Contrary to traditional plasticity models predicting contralesional recruitment, compensation operated through unexpected pathways: Caudate-dominated subcortical connectivity (F = 42.42, p-FDR < 0.05) emerged exclusively in patients, correlating with motor accuracy (ρ = 0.44, p = 0.028); anterior cerebellar feedback circuits (Lobules III/VIII) were recruited; and enhanced frontoparietal engagement indicated cognitive supervision of movement. Patients who exhibited this canonical reorganization pattern, comprising 68% of the cohort, significantly outperformed those who did not (p = 0.014). Preservation of visual network connectivity supported externally-guided timing as a compensatory scaffold. Medial frontal gliomas induce a shift from automatic to cognitively-supervised motor control, mediated by a Caudate-cerebellar-frontoparietal axis that acquires functional significance specifically under task demand. These compensatory networks undetectable at rest represent critical surgical targets. Approximately one-third of patients did not engage this reorganization and showed corresponding performance deficits, suggesting the value of individualized preoperative connectivity mapping. This represents one of the first task-based gPPI evidence demonstrating Caudate-dominated subcortical compensation specifically replacing canonical Putamen-Thalamus motor circuits in WHO Grade IV medial frontal gliomas.
The present study investigated the effects of dietary crocin supplementation on growth, physiological homeostasis, immune competence, and disease resistance in the oriental river prawn (Macrobrachium nipponense). Juvenile prawns (initial weight: 1.35 ± 0.06 g) were fed experimental diets containing 0.00, 0.05, 0.10, 0.15, or 0.20 g kg-1 crocin for 60 days. Crocin supplementation resulted in significant improvements in final weight (FW), weight gain (WG), specific growth rate (SGR), feed conversion ratio (FCR), hepatosomatic index (HSI), and survival rate. Hemato-biochemical profiling demonstrated pronounced reductions in urea, uric acid, glucose, creatinine, and triglyceride levels, alongside elevated high-density lipoprotein (HDL) and low-density lipoprotein (LDL) concentrations. Key immune indicators, including albumin (ALB), total protein (TP), lysozyme (LYZ), phenoloxidase (PO), total hemocyte count (THC), and phagocytic activity, were significantly enhanced, whereas crustacean hyperglycemic hormone (CHH) levels and micronucleus (MN) frequency were markedly suppressed. Antioxidant enzyme activities were substantially elevated, accompanied by a notable decline in malondialdehyde (MDA) content. Dietary crocin also enhanced digestive enzyme activities and promoted a favorable shift in intestinal microbiota, characterized by increased lactic acid bacteria (LAB). Moreover, crocin supplementation facilitated carotenoid deposition and improved muscle physicochemical properties. Transcriptional analysis revealed robust upregulation of genes associated with growth, metabolism, and immune function. Importantly, prawns fed the diet containing 0.10 g/kg crocin exhibited the highest post-challenge survival against Aeromonas hydrophila. Collectively, these findings demonstrate that crocin acts as a potent multifunctional carotenoid, enhancing growth performance, immune resilience, oxidative balance, and disease resistance.
Prophylactic cement augmentation at the uppermost instrumented vertebra (UIV) and the adjacent supravertebra (UIV + 1) is commonly used during long-segment fusion for adult spinal deformity to reduce the risk of proximal junctional failure. While this strategy may protect against osteoporotic fracture, its impact on adjacent soft tissues-particularly the intervertebral disc-remains poorly characterized. Acute disc herniation (ADH) at the proximal junction represents a rare but potentially catastrophic complication. In this retrospective cohort study, 173 patients underwent long-segment posterior spinal fusion (≥5 levels) with prophylactic polymethylmethacrylate (PMMA) cement augmentation at UIV/UIV + 1 between January 2016 and January 2024. Nine patients developed ADH at the proximal junction. After 1:3 propensity score matching on age, T score, UIV level, and preoperative pelvic incidence-lumbar lordosis mismatch, 9 ADH cases were compared with 27 matched controls without ADH. Radiographic parameters at UIV/UIV + 1 (UIV Cobb angle, adjacent segment Cobb angle, disc slope, and disc height) were measured preoperatively and at ADH diagnosis (or equivalent follow-up in controls). Baseline characteristics were well balanced between matched groups, with no significant differences observed for matched or unmatched variables (all P > 0.05) except for smoking, which was more prevalent in the ADH group (P = 0.03). ADH patients presented with acute neurological deterioration, including lower-extremity weakness, gait instability, myelopathy, and urinary dysfunction, often requiring urgent revision surgery. Radiographically, the ADH group demonstrated significantly greater junctional deterioration: UIV Cobb angle increased by approximately +20.3° ± 8.5° compared with +1.2° ± 7.8° in controls (P < 0.001); adjacent segment Cobb increased by +18.5° ± 6.5° vs +1.7° ± 4.8° (P < 0.001); and disc height decreased by -3.5 ± 2.0 mm vs -0.9 ± 1.1 mm (P = 0.006). Disc slope change was similar between groups (P = 0.42). Despite preserved bone quality, ADH was associated with profound junctional collapse and rapid neurological decline, suggesting a biomechanical failure mechanism driven by PMMA-related overstiffening. Strategies that preserve a gradual stiffness transition at the proximal junction may be necessary to mitigate this risk. Although rare, acute proximal junctional disc herniation can result in rapid neurological deterioration following long-segment fusion with prophylactic UIV/UIV+1 cement augmentation. Spine surgeons should maintain a high index of suspicion for this complication in patients presenting with new neurological symptoms and consider strategies that minimize abrupt stiffness transitions at the proximal junction.
In this study, a novel approach was developed for the simultaneous determination of levonorgestrel (LEV) and ethinyl estradiol (EE) in synthetic mixtures and pharmaceutical tablet formulations using spectrophotometric analysis combined with intelligent system and signal processing technique. Two strategies were employed: a fuzzy inference system (FIS), and a hybrid method integrating discrete wavelet transform (DWT)-a core signal processing tool-with principal component analysis (PCA) and FIS. The FIS method yielded average recoveries of 101.77% and 97.84% for LEV and EE, respectively, with root mean square error (RMSE) of 1.795 and 2.654. In DWT approach, wavelet families such as Daubechies 4 (db4), Demeyer, and Haar were used to decompose the absorbance spectra, and PCA was applied for dimensionality reduction. The extracted features were then processed using the FIS. Among all wavelets, the Demeyer family demonstrated superior performance, achieving mean recoveries of 100.24% for LEV and 99.68% for EE, with RMSE values of 0.4944 and 0.6074, respectively. Application to commercial tablet formulation showed that the DWT-PCA-FIS method outperformed the standalone FIS model, providing mean recoveries above 97% and relative standard deviation (RSD) below 1% for both compounds. Results were compared with high-performance liquid chromatography using ANOVA, and no significant differences were found. These results indicate that the proposed intelligent and signal processing-based approaches can serve as effective alternatives to conventional chromatographic methods due to their simplicity, low cost, and ability to operate without the need for sample preparation.
Long-term health effects of low- and no-calorie sweeteners (LNCSs) have not been established. This review aimed to evaluate the associations between different types of LNCSs and a wide range of health outcomes from observational studies and randomized controlled trials (RCTs). We systematically searched PubMed/MEDLINE, Embase, CINAHL, and Google Scholar from inception to December 2024 for meta-analyses. LNCSs were categorized into artificial sweeteners and other non-sugar sweeteners (NSSs), including non-nutritive sweeteners and sugar alcohols, along with their corresponding beverages. The A Measurement Tool Assessment Systematic Reviews 2 (AMSTAR 2) tool was used in this study. The credibility of observational evidence was evaluated using a classification system. The certainty of evidence from RCTs was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Eligible meta-analyses were reanalyzed using random-effects models and presented as estimated odds ratios (eOR) or standard mean differences (SMDs) with 95% confidence intervals (CIs). A total of 29 meta-analyses (AMSTAR 2: high, 22; moderate, 2; low, 3; and critically low, 2) with 24 observational studies and 6 RCTs, covering 50,034,327 participants, were included. Among the 135 associations, observational studies indicated that higher intake of NSSs was associated with increased risk of being overweight (eOR, 1.84; 95% CI, 1.30 to 2.61; credibility of evidence [CE], IV), having metabolic syndrome (eOR, 1.31; 95% CI, 1.21 to 1.42; CE, I), type 2 diabetes (eOR, 1.14; 95% CI, 1.02 to 1.29; CE, IV), and hypertension (eOR, 1.13; 95% CI, 1.07 to 1.19; CE, II). In contrast, RCTs showed that NSS consumption significantly decreased body weight in populations with overweight or obesity (SMD, -0.50; 95% CI, -0.70 to -0.30; GRADE, high). Our findings indicate that the use of LNCSs and their corresponding beverages is associated with potential health risks and modest benefits. International Prospective Registration of Systematic Reviews (PROSPERO) Identifier: CRD420251006761.
Long-term herbicide programs in Mediterranean perennial systems have imposed sustained selection pressure on weed populations, promoting the evolution of multiple resistance. We investigated resistance mechanisms in Chenopodium album (Ca) and C. vulvaria (Cv) from southern Spain following more than two decades of glyphosate-based management. We aimed to (i) confirm resistance to atrazine, tribenuron-methyl (TM), glyphosate, and 2,4-D; (ii) distinguish between target-site and metabolic resistance; and (iii) characterize the biochemical and molecular basis of cross- and multiple-herbicide resistance. Screening assays revealed high survival (78-100%) of resistant (R) populations to acetolactate synthase (ALS)-, photosystem II (PSII)-, auxinic-, and 5-enolpyruvylshikimate-3-phosphate synthase (EPSPS)-inhibiting herbicides. Dose-response assays confirmed resistance, with resistance indices (RI) of 6.7 and 5.1 for atrazine, 19.0 and 17.3 for TM, 7.0 and 13.9 for glyphosate, and 6.0 and 6.9 for 2,4-D in CaR and CvR, respectively. Radiolabelled and analytical metabolism assays demonstrated enhanced herbicide metabolism in R populations: atrazine (94-95% vs. 13-16% in S), TM (68-69% vs. 24-25%), 2,4-D (64-65% vs. 2-4%), and glyphosate (39-43% vs. 8-9%). Malathion partially reversed resistance to atrazine, TM, and 2,4-D, supporting cytochrome P450 (CYP450) involvement. In contrast, glyphosate metabolism was independent of CYP450 or glutathione S-transferases inhibition. Biochemical assays showed no differences in PSII or ALS sensitivity (I₅₀ RI ≈ 1), whereas EPSPS inhibition assays revealed a tenfold increase in I₅₀ in CvR. Sequencing identified a Pro-106-Ser substitution in EPSPS exclusively in CvR. Enhanced metabolism predominates in the R Chenopodium spp. populations, with coexistence of metabolic and target-site mechanisms in CvR, increasing the risk of further cross-resistance under continued herbicide reliance.
Excessive extracellular matrix accumulation, primarily as a result of hepatic stellate cell activation, is a hallmark of hepatic fibrosis, a progressive outcome of chronic liver injuries. Recent research studies suggest that stem cells, hepatocytes, and extracellular vesicles may provide therapeutic advantages due to their anti-inflammatory, antioxidative, and regenerative activities. This study aimed to comparatively evaluate the therapeutic efficacy of these agents in a rat model of carbon tetrachloride (CCl4)-induced hepatic fibrosis. Liver fibrosis was induced in male Wistar rats via intraperitoneal CCl4 injections for 8 weeks. Then the animals were intravenously administrated stem cells, hepatocytes, hepatocyte-derived exosomes, or stem cell-derived exosomes. Also, a fibrosis, a sham, a intact, and a PBS-treated group were consider the controls. After treatment, protein expression (alpha-smooth muscle actin (α-SMA), desmin), oxidative stress markers (superoxide dismutase, glutathione peroxidase, malondialdehyde), serum biochemical parameters (aspartate aminotransferase, alanine aminotransferase, glucose, uric acid, cholesterol, triglycerides), and fibrosis-related gene expression (matrix metalloproteinase 2 (MMP2), platelete-derived growth factor receptor beta (PDGFRB), transforming growth factor-beta (TGF-β), thymosin beta-10 (TMSB10) and transmembrane protein 176B (TMEM176B)) were assessed. Significant liver damage, changed metabolic parameters, increased oxidative stress, and upregulated fibrosis markers were all observed in the fibrosis group. On the contrary, all treatments caused considerable improvements, though exosomes derived from stem cells demonstrated the most significant effects. Along with improved histopathological features, this group exhibited significant decreases in oxidative damage, liver enzymes, and profibrotic marker expression. Liver fibrosis was considerably reduced by stem cells, hepatocytes, and particularly their exosomes. Exosomes made from stem cells demonstrated the strongest therapeutic effect, confirming their potential as a viable noncellular hepatic fibrosis treatment approach.
Retention of a foreign body in the vagina can occur intentionally or unintentionally. This condition can lead to a variety of clinical symptoms. We present a case involving a 39-year-old multiparous woman with an obstetric history comprising four pregnancies, three term vaginal deliveries and one spontaneous miscarriage, who was hospitalized on January 17, 2024, for acute management of profuse vaginal discharge and pyrexia secondary to the intravaginal retention of a wool-like foreign body. Clinical examination revealed a woolen foreign body in the cervix, inserted 4 years earlier as a traditional method to influence fetal sex. Pelvic ultrasound showed a spongy mass (50 × 30 mm) in the vaginal canal. Vaginoscopy and hysteroscopy performed under general anesthesia facilitated the identification and extraction of a 50 × 50 mm malodorous, wool-like foreign body embedded 5 mm within the cervical stroma. Biopsies confirmed a foreign body reaction with acute and chronic inflammation, reactive epithelial changes, and keratin-like fibers infiltrating the cervical stroma. Intraoperative assessment revealed no extension to the uterine cavity or urinary bladder. The patient was administered a 72-h course of empirical antibiotic therapy, achieved complete clinical resolution, and was subsequently discharged with recommendations for ambulatory follow-up. The retention of a foreign body within the vaginal vault may engender a spectrum of clinical manifestations and sequelae, contingent upon the nature of the foreign material and the duration of its persistence. Prolonged indwelling of such objects can precipitate histopathologic alterations in contiguous tissues, potentially mandating surgical extirpation and serial surveillance evaluations.