Iranian Red Crescent Medical Journal (IRCMJ)

Abstract Background and Objectives: Hospital reimbursement is a critical component of the hospital financial system that directly impacts hospital cash flow and profitability. Given the increasing medical costs and financial pressures, reducing deductions due to errors and mistakes in reimbursement processes is of great importance. The purpose of this study is to accurately and transparently analyze the factors affecting deductions and identify weaknesses in hospital financial and administrative processes.
   Methods: This study was conducted to examine the extent and causes of deductions in inpatient files and to improve the hospital reimbursement process for patients who encountered deductions during the years 2022-2023. The research community includes experts involved in hospital deductions and handling hospital bills, including hospital supervisors and revenue unit experts or financial affairs experts in a selected teaching general hospital in Tehran in 2023. It used the Six Sigma approach as a process optimization method. The intervention was carried out by implementing the phases of the Six Sigma method in the hospital.
   Results: In this study, the reimbursement process was examined from the time of patient admission, recording medical information, calculating costs, sending information to insurance, and finally receiving payments. By implementing the phases of the Six Sigma method, the number of cases examined and the total amount of deductions in the year 2023 have decreased significantly. These changes have also caused the average monthly deduction percentage to decrease from 1.33% in 2022 to 0.82% in 2023.
   Conclusion: The results of this study showed that the use of Six Sigma in improving the hospital reimbursement process significantly reduced financial deductions. Also, by improving the speed of processes, the time for reimbursements was reduced, which led to increased patient satisfaction and reduced financial pressure on the hospital. Overall, the results of the study indicate that the careful implementation of Six Sigma methods can significantly increase hospital productivity and reduce unnecessary costs, while maintaining the quality of services to patients.

Abstract Background and Objectives: Breast cancer patients in Saudi Arabia present with earlier onset, advanced-stage, and aggressive subtypes, highlighting the need for targeted biomarker research. The antigen TAG-72 has shown inconsistent prognostic associations in Middle Eastern populations. This study analyzed TAG-72 expression in breast cancer tissues from a large Saudi cohort to assess its clinicopathological associations and prognostic significance.    Methods: We analyzed 577 breast cancer specimens from King Abdulaziz University Hospital (1996–2012) using clinicopathological variables from medical records. Tissue microarrays were created with validated cores, and TAG-72 expression was assessed via immunohistochemistry (Cell Marque antibody, 1:100 dilution) with standardized scoring (≥5% staining). Statistical analyses included descriptive statistics, logistic regression, and Cox models to evaluate TAG-72’s associations.    Results: Among 577 breast cancer patients (mean age 50.7 ±13.3 years), 86% exhibited no TAG-72 expression, while 14% demonstrated low to high staining. Elevated TAG-72 levels were significantly associated with positive HER2 status (OR (95% CI):1.92 (1.07, 3.45), P=0.028) and non-ductal histology (OR (95% CI): 2.03 (1.01, 4.08), P=0.046). In survival analysis, HER2 positivity (HR (95% CI): 2.30 (1.16, 4.57), P = 0.018), non-ductal subtypes (HR (95% CI): 2.17 (1.06, 4.46), P=0.035), and distant metastasis (HR (95% CI): 4.42 (2.51, 7.78), P<0.001) independently predicted higher mortality risk, while TAG-72 expression showed no significant prognostic association (P=0.190).    Conclusion: TAG-72's clinical utility is limited, showing no significant association with death or most breast cancer parameters, except HER2. This suggests that TAG-72 interpretation in immunohistochemistry for breast cancer should consider HER2's clinical significance in patient management.

Abstract Background and Objectives: Accurate estimation of intraoperative blood loss is essential for safe perioperative management in spinal surgery. Although visual estimation remains widely practiced due to its simplicity, rapidity, and lack of need for special equipment, it is prone to considerable inaccuracy. These limitations can influence transfusion decisions and postoperative outcomes. Therefore, evaluating more objective yet feasible alternatives, such as gravimetric assessment, is clinically important. This study aimed to compare the accuracy of visual estimation and the gravimetric method in assessing intraoperative blood loss and to evaluate their correlation with the reduction in hemoglobin levels 24 hours after surgery.
   Methods: In this diagnostic study, 75 adults scheduled for posterior spinal surgery were randomly assigned using a computer‑generated sequence. Visual estimation was performed by blinded surgical staff based on suction volumes and soaked materials, while gravimetric measurement was conducted by weighing blood‑soaked sponges and suction canisters before and after use. The actual blood loss reference was defined as the postoperative hemoglobin decline measured 24 hours after surgery. Accuracy of each method was evaluated by comparing estimated blood loss against this reference standard using appropriate statistical tests.
   Results: Among patients with postoperative hemoglobin < 12 g/dL, the mean estimated blood loss was 721.5 ± 556.5 mL by visual estimation and 844.5 ± 704.3 mL by the gravimetric method. For those with hemoglobin ≥ 12 g/dL, respective values were 321.8 ± 282.1 mL and 337.9 ± 286.1 mL. The gravimetric approach estimated on average 72 mL higher blood loss than the visual method (mean difference = 72 mL; 95% CI: 21–123 mL; P < 0.001). Diagnostic indices confirmed the superior accuracy of the gravimetric technique (LR⁺ = 2.04, LR⁻ = 0.42, AUC = 0.81), showing improved discrimination of clinically significant intraoperative bleeding compared with visual estimation.
   Conclusion: The gravimetric method provides a more accurate and reliable estimation of intraoperative blood loss compared to visual assessment. Its implementation in spinal surgery could improve patient monitoring and support more informed clinical decision‑making. However, further studies with larger, multicenter cohorts are warranted to validate and generalize these findings.

Abstract    Background and Objectives: The abnormal spindle-like microcephaly-associated gene (ASPM) plays a crucial role in the formation of the mitotic spindle and neurogenesis. ASPM may also contribute to the development of various cancers. Investigate the role of ASPM in bladder urothelial carcinoma (BLCA).    Methods: The expression differences of ASPM between unmatched samples were analyzed with the Welch T-test and between paired samples with the paired sample t-test. Evaluating the effectiveness of ASPM in diagnosing BLCA with ROC analysis. Determining the prognostic factors in the ASPM high-expression group and the low-expression group with Cox regression analysis. The relationship between ASPM and immune cells was analyzed through Spearman correlation.    Results: The ROC curve showed that ASPM had a high diagnostic ability for BLCA. Patients with high expression of ASPM had a shorter progression-free interval (PFI). GO and KEGG analyses revealed that ASPM-related DEGs were associated mainly with ubiquitin-mediated proteolysis. ASPM expression in BLCA was positively correlated with the infiltration of Th2 cells and T helper cells. ASPM was negatively correlated with the infiltration of pDC, NK CD56bright cells and Mast cells. The above findings are merely correlational studies and require further in vitro or in vivo experiments for functional validation.    Conclusion: ASPM is an effective biomarker for diagnosing and predicting PFI in patients with BLCA. Therefore, ASPM is expected to become a potential target for the treatment of BLCA. Further research is still needed to confirm these conclusions, such as conducting in vitro knockout experiments, carrying out prospective cohort studies, or using immunohistochemistry (IHC) for verification.

Abstract Background and Objectives: Hypotension in elderly patients with acute decompensated heart failure (ADHF) limits vasodilator use. Recombinant human brain natriuretic peptide (rhBNP) may improve cardiac function, and combining it with low-dose norepinephrine could maintain perfusion. This study evaluated the efficacy and safety of this approach.    Methods: In this single-center, open-label randomized exploratory trial, 70 elderly patients were assigned to norepinephrine alone or rhBNP plus norepinephrine. Hemodynamics, biomarkers, echocardiography, and short-term outcomes were assessed over 3–7 days, with 30-day follow-up.    Results: The study group showed significant increases in SBP (mean +7 mmHg), DBP (+6 mmHg), MAP (+9 mmHg), SpO₂ (+2%), and LVEF (+5%), and reductions in HR (–6 bpm), RR (–7 bpm), and NT-proBNP (–2000 ng/L; all P<0.05, as assessed by t-test or Wilcoxon rank-sum test). Total bilirubin levels showed a significant reduction (–3 μmol/L; P<0.05). While serum sodium changes were statistically significant, the clinical relevance of the absolute difference was negligible. The study group had increased 24-hour fluid intake and urine output, shorter hospital stays, and higher ARNI prescription rates and dosages at discharge (P<0.05). Overall treatment efficacy at discharge was higher in the study group (94.29% vs. 88.57%, P=0.006), with a significantly lower 30-day readmission rate (14.71% vs. 36.36%, P=0.042). No significant differences were observed in adverse drug reactions or 30-day mortality. Statistical analyses were performed using t-tests, ANOVA, Wilcoxon rank-sum, and chi-square tests, with P<0.05 considered significant.    Conclusion: rhBNP combined with low-dose norepinephrine improved short-term hemodynamics without increasing risk; larger trials are warranted.

Abstract Background and Objectives: Wrestling is a high-intensity competitive sport with a high prevalence of knee injuries, among which anterior cruciate ligament (ACL) tears and other knee pathologies are common and clinically impactful. The wrestlers involved in this study ranged in age from 18 to 35 years old, including both professional and amateur athletes. All participants had achieved remarkable accomplishments in various national and international competitions, such as champions of the National Wrestling Championship and medalists of the Asian Wrestling Championship. These athletes sustained knee injuries during high-intensity training or competition, and were clinically diagnosed with ACL tears or other knee pathologies accordingly. Accurate diagnosis of ACL tears based on magnetic resonance imaging (MRI) is of critical importance for clinical decision-making and rehabilitation planning. However, the conventional manual analysis of MRI images is not only time-consuming but also prone to subjective deviations and diagnostic errors.    Methods: We propose a joint model combining an Improved Political Optimizer (IPO)—a metaheuristic optimization algorithm inspired by political competition and coalition strategies—with a Convolutional Neural Networks (CNN) to detect ACL tears in wrestlers. MRI images undergo standardization, normalization, and data augmentation before CNN automatically extracts deep features of the ACL region. IPO globally optimizes key CNN hyperparameters (e.g., learning rate, convolutional kernel size), enhancing both accuracy and efficiency.    Results: The IPO-optimized CNN achieved 93.5% accuracy, 91.8% sensitivity, and 94.7% specificity, while reducing training time by over 60% compared to traditional methods. Grad-CAM heatmaps confirmed that model attention aligns with expert-identified diagnostic regions.    Conclusion: The proposed IPO–CNN framework offers an accurate, efficient, and interpretable MRI-based solution for ACL tear detection, providing practical support for sports injury diagnosis and rehabilitation.

Abstract Background and Objectives: Flexible bronchoscopy (FB) carries risks such as haemodynamic instability and oxygen desaturation related to sedation. The selection of sedative–analgesic agents can influence patient safety and procedural outcomes, making optimal sedation strategies a key area of research. This retrospective single-center study aimed to compare three sedative–analgesic regimens used during FB with respect to haemodynamic and oxygenation outcomes.    Methods: Medical records of 648 adult patients undergoing FB between 2020 and 2023 were analyzed. Patients were categorized into three groups: midazolam alone (M), midazolam plus fentanyl (MF) and midazolam plus fentanyl plus propofol (MFP). Pre- and post-procedural systolic blood pressure, heart rate and oxygen saturation were compared using appropriate statistical tests and p-values were calculated to determine significance.    Results: A total of 648 patients were analyzed (57.3% female; mean age 61.8 ± 13.9 years). Procedures were performed with the M group (42.3%), MF group (31.2%), or MFP group (26.5%). Mean midazolam doses were 3.4 ± 1.2 mg, 2.5 ± 0.9 mg and 2.3 ± 0.9 mg in M, MF and MFP groups, respectively (P = 0.001). SBP increased by +14.2 mmHg in M, +6.8 mmHg in MF and +11.1 mmHg in MFP (P < 0.001), while HR rose by +8.3, +13.5 and +10.4 bpm, respectively (P < 0.001). SpO₂ declined by 1.1 ± 4.5% in M, 0.14 ± 2.7% in MF and 0.65 ± 3.2% in MFP (P = 0.021). Hypoxia occurred in 5.4%, 1.6% and 1.8% of patients, respectively (P < 0.001). After adjustment for age and sex, the MF group showed a smaller SBP increase and higher HR rise versus M (P < 0.05)    Conclusion: Combined sedation was associated with better hemodynamic stability, fewer hypoxia episodes, and improved procedure tolerance compared to midazolam alone.

Abstract Background and Objectives: Insulin resistance is a major metabolic disorder linked to type 2 diabetes and cardiovascular diseases. Emerging evidence suggests that vitamin D may influence glucose metabolism and insulin sensitivity, while adherence to the Mediterranean diet could support metabolic health. This study examines the association between vitamin D levels, insulin resistance, and adherence to the Mediterranean diet in individuals residing in Northern Cyprus.    Methods: A cross-sectional study was conducted with 117 participants attending the Central State Hospital in Northern Cyprus. Data collection included demographic, anthropometric, and biochemical parameters such as vitamin D levels, insulin resistance (HOMA-IR), and dietary habits assessed using the Mediterranean Diet Quality Scale (KIDMED). Statistical analyses were performed using independent samples t-tests, Chi-Square tests, and correlation analyses via IBM SPSS Statistics 21.0, with significance set at P < 0.05.    Results: A significant association was observed between vitamin D supplementation and insulin resistance (P < 0.001). Among insulin-resistant individuals, 80% reported using vitamin D supplements, whereas 73.7% of non-insulin-resistant individuals did not use supplements. While adherence to the Mediterranean diet was high (77.8% of participants demonstrated optimal adherence), no statistically significant correlation was found between vitamin D levels and dietary adherence.    Conclusion: The findings suggest a potential link between vitamin D supplementation and insulin resistance, warranting further investigation into causality and underlying mechanisms. While adherence to the Mediterranean diet was generally high among participants, its direct effect on vitamin D levels remains inconclusive. Future research should explore longitudinal effects and intervention strategies to optimize metabolic health outcomes.

Abstract Background and Objectives: Sepsis has high morbidity and mortality, and survivors often suffer from cognitive impairment, while the gut microbiota’s link to neurological diseases has prompted investigation into whether probiotics improve sepsis-related cognitive impairment. This study aimed to explore the effect of probiotics on sepsis - related cognitive impairment.
   Methods: 135 sepsis patients in recovery (after antibiotic discontinuation) from Jan 2021 to Jun 2023 were enrolled in this retrospective study, and divided into control group (n = 67) and observation group (n = 68). The control group received conventional treatment plus placebo, while the observation group received probiotic + prebiotic preparations instead of placebo, in addition to conventional treatment. Cognitive function was assessed by Montreal Cognitive Assessment (MoCA) at three time points: enrollment (T0), 6 months (T1), and 1 year (T2) post-treatment. Complications were monitored during the intervention, and complications were evaluated at T1 and T2. Independent/paired t-tests and chi-square test were performed.
   Results: The follow - up loss rate was 16.42% in the control group and 19.12% in the observation group. At enrollment, cognitive function was similar (c2=0.072, P=0.788). Six months after treatment, the observation group had a lower prevalence of abnormal cognitive function than the control group and at the start (c2=4.763, P=0.029). One year later, the two groups had no significant difference in abnormal cognitive function prevalence (c2=3.319, P=0.069), but it was lower than at the start. For complications, there was no difference in cardio - respiratory and kidney diseases (all P>0.05), while the observation group had a lower prevalence of digestive diseases (c2=6.682, P=0.010).
   Conclusion: Sepsis, cognitive impairment and the gut microbiota are closely related. Microbial therapies offer new treatment directions, but this study needs larger samples and multi - center verification.

Abstract Background and Objectives: Idiopathic granulomatous mastitis (IGM) is a rare benign inflammatory disease of the breast whose pathogenesis is not yet fully understood. While the literature reports an association between IGM and arthritis and/or erythema nodosum (EN)  in a small number of patients, the diagnosis and treatment of these individuals are not well-documented. The objective of this study is to present our case series of patients with IGM and EN and/or arthritis, to discuss the incidence, characteristics, and treatment approaches of these cases in more detail.
   Methods: We performed a retrospective analysis of patients who were treated for histologically confirmed IGM at our medical center between 2015 and 2022. Additionally, patients who exhibited concurrent symptoms of EN and arthritis were identified and grouped for further analysis of their treatment regimens and outcomes. Statistical comparisons were performed using chi-square and Fisher’s exact tests; a P < 0.05 was considered statistically significant.
   Results: Our general surgery clinic followed up with 153 patients diagnosed with IGM, who had a mean age of 38.2 ± (8.84) and were mostly women of reproductive age.  The definitive diagnosis was confirmed through incisional biopsy and core needle biopsies. EN was present in 31 (20.2%) patients, and inflammatory arthritis was present in 28 (18.3%) patients. In the 13 patients with this triple association, recurrence rates were higher despite a response to antibiotics and steroids.
   Conclusion: IGM is a challenging disease to diagnose and manage due to its complexity. It can occur concomitantly with EN and arthritis, and we suspect its frequency is higher than previously anticipated. Recognizing these distinct entities emphasizes the need for a multidisciplinary approach to diagnosing the condition.

Abstract Background and Objectives: The detection of pediatric extremity fractures on initial X-rays (XR) in emergency departments can be challenging, particularly in anatomically complex regions such as the ankle, wrist, knee, and elbow. The aim of this study is to determine the accuracy rate of XR compared to computed tomography (CT) in the identification of trauma-related extremity fractures in the pediatric population.    Methods: Patients aged 0-18 years were included in this retrospective study. Patients who were admitted to the emergency department due to extremity trauma between July 1, 2020 and March 31, 2023 and underwent XR and CT imaging were included. The sensitivity, specificity, positive predictive value, negative predictive value, positive likelihood ratio, and negative likelihood ratio of XR in detecting fractures compared to CT were calculated.    Results: A total of 217 patients were included in the study. Fractures were detected in 57 patients (26%) on XR images and in 62 patients (29%) on CT images. The sensitivity, specificity, PPV and NPV of XR in detecting fracture compared to CT were 87%, 98%, 95%, and 95%, respectively (area under the curve [AUC]: 0.926, CI: 0.875-0.977). The sensitivity of XR was calculated to be below 60% in adjacent bone fractures, epiphyseal line fractures, and extension of the fracture into the joint space.    Conclusion: In the pediatric population, the sensitivity of XR is low in detecting epiphyseal line fractures, extension of the fracture into the joint space, and adjacent bone fractures.

Abstract    Background and Objectives: Gastric carcinoma (GC) remains a significant global health challenge with poor prognostic outcomes. Recent research has highlighted the critical role of long non-coding RNAs (lncRNAs) in modulating gene expression, cellular signaling, and chromatin remodeling during tumorigenesis. Among these, Metastasis-associated lung adenocarcinoma transcript 1 (MALAT1) is frequently dysregulated. This review aims to synthesize existing knowledge on the relationship between MALAT1 expression, the molecular mechanisms of GC pathogenesis, and its potential as a clinical biomarker or therapeutic target.
   Methods: This review article compiled and analyzed available literature concerning MALAT1’s biosynthesis, its structure—specifically its unique triple-helix configuration—and its diverse molecular functions. The analysis focused on in-vitro and in-vivo studies investigating MALAT1's role in transcriptional control, post-transcriptional regulation, and its specific pathways within gastric cancer.
  Results: MALAT1 is significantly upregulated in GC tissues, serum, and cell lines. It functions as a molecular scaffold and a competing endogenous RNA (ceRNA), often acting as a "microRNA sponge" to regulate pathways such as PI3K/Akt, Wnt/β-catenin, and various miRNA axes (e.g., miR-122, miR-202). These interactions drive critical oncogenic processes, including cell proliferation, invasion, metastasis via epithelial-to-mesenchymal transition (EMT), and chemotherapy resistance.
  Conclusion: MALAT1 plays a pivotal role in the progression and metastasis of gastric carcinoma. Its elevated expression serves as a potential biomarker for primary diagnosis and prognosis. Furthermore, targeting MALAT1 suppression represents a promising strategy for novel gastric cancer therapies.  
 

Abstract Background and Objectives: Crush syndrome (CS) is a significant metabolic disorder commonly observed after earthquakes, with inflammatory processes playing a key role in its pathophysiology. This study aimed to evaluate the clinical utility of inflammatory indices, including the Systemic Inflammatory Index (SI), Systemic Inflammation Response Index (SIRI), and Pan-Immune-Inflammatory Value (PIV).    Methods: Our study was conducted retrospectively at a single centre. A total of 278 patients admitted to the emergency department due to post-earthquake trauma were included in the study as the trauma group. This group was further divided into two subgroups: the non-crush trauma group (n=115) and the CS group (n=163). Additionally, 168 patients admitted to the emergency department for non-traumatic causes during the same period were included as the control group. The three groups were retrospectively compared based on SI, SIRI, and PIV values, as well as their predictive ability for key clinical outcomes, including the need for hemodialysis, hospitalization, prediction of CS and mortality. Receiver operating characteristic (ROC) analysis was used to determine the predictive values.    Results: SIRI demonstrated the highest accuracy in predicting CS (AUC = 0.829, P < 0.001). SI was the best predictor of hospitalization (AUC = 0.778, P < 0.001), while SIRI showed superior performance in predicting the need for hemodialysis (AUC = 0.799, P < 0.001).    Conclusion: SI, SIRI and PIV can help clinicians in predicting CS, the need for hemodialysis, critical care and therefore the need for hospitalization.

Abstract Background and Objectives: Psychological resilience plays a crucial role in child development, impacting emotional and behavioral outcomes. Understanding the dynamics of family functioning and parent-child conflict is essential for addressing internalizing problems in children. This study examines the influence of maternal psychological flexibility on internalizing problems in preschool children, while also investigating how family functioning and parent-child conflict mediate this relationship.    Methods: A total of 889 mothers of preschool children participated, completing various assessments, including the Parental Psychological Flexibility Questionnaire, the Strengths and Difficulties Questionnaire (Parent version), the McMaster Family Assessment Device, and the Child-Parent Relationship Scale.    Results: The results indicated that maternal psychological flexibility by itself had no significant effect on children's internalizing problems. However, it was found that family dynamics and conflicts between parents and children served as mediators in this relationship. In essence, these two elements combined to shape how maternal flexibility influenced children's emotional difficulties. Enhancing maternal psychological flexibility can contribute to improved family functioning, reduced parent-child conflict, and ultimately aid in preventing and alleviating children's internalizing problems.    Conclusion: This study used an artificial neural network (ANN) to investigate the relationships between maternal psychological flexibility, family functioning, parent-child conflict and children's internalizing problems. The neural network predictions were verified using cross-validation techniques.

Abstract Background and Objectives: Hospitalized children are particularly vulnerable to medical errors, which can have profound long-term effects on their health and development. Adverse events resulting from these errors contribute to significant morbidity and mortality in pediatric patients. Effective interventions to minimize errors are critical in improving patient safety. This systematic review aims to evaluate the effectiveness of interventions designed to reduce adverse events in pediatric hospital departments.    Methods: Following PRISMA 2020 guidelines, we searched Embase, PubMed, Google Scholar, Scopus, Cochrane Library, and Web of Science for studies published up to September 3, 2024. The search strategy was based on key terms including pediatric adverse events, medical errors, medicinal errors and medication error. We included randomized controlled trials, quasi-experimental studies, and before-and-after studies assessing interventions to reduce adverse events in pediatric departments. The primary outcome was the reduction of medicinal and non-medicinal errors. Risk of bias was assessed using the Cochrane Risk of Bias tool.    Results: A total of 23 studies, covering 22,871 participants from multiple countries, were included. Most studies (n = 19) focused on reducing medicinal errors, while four addressed non-medicinal errors. Interventions such as pharmacist-led strategies, technology-based solutions, educational programs, labelling tools, pictogram-based interventions, checklists, and multifaceted approaches were generally effective. Nineteen studies reported a significant reduction in error rates, while four found no significant impact.    Conclusion: Although various interventions effectively reduced pediatric medical errors, some studies demonstrated limited effectiveness. Factors such as small sample sizes, risk of bias, and observational designs affect the generalizability of findings.

Abstract Background and Objectives: Hypertension and bladder cancer are frequently co-diagnosed in individuals who require blood pressure management and anti-cancer therapies. Immunotherapy has revolutionized cancer treatment. However, the role and clinical significance of the first-line anti-hypertensive drug amlodipine in immunotherapy outcomes remains largely elusive. To evaluate the role of amlodipine in enhancing the efficacy of anti-PD1 immunotherapy and its underlying mechanisms in bladder cancer.
   Methods: Basic research methods were used in the present work. A murine syngeneic bladder cancer and melanoma model was employed to evaluate the therapeutic effect of the combination of amlodipine with anti-PD1. Additionally, immunohistochemistry was utilized to quantify CD8+ T cells and Ki67+ cells. Finally, several in-vitro and in-vivo assays were performed to explore the effects of amlodipine on human bladder cancer cells, and bioinformatics analysis and qPCR were conducted to explore the underlying mechanism.
   Results: Amlodipine enhanced the tumor-inhibitory effects of anti-PD1 therapy, in line with the results in the melanoma model. Furthermore, the results of in-vitro and in-vivo experiments utilizing UMUC3 human bladder cancer cells revealed that amlodipine significantly suppressed tumor progression. Meanwhile, the results of in-vitro and in-vivo experiments demonstrated that amlodipine regulated NFAT2 expression, with the loss of inhibition following NFAT2 knockdown.
   Conclusion: These results indicated that amlodipine suppresses tumor growth by regulating NFAT2 expression and enhancing anti-PD1 therapy effects. Indeed, these findings position amlodipine as an effective adjunctive therapy in bladder cancer treatment. Nevertheless, further mechanistic studies and clinical trials are warranted.

Abstract    Background and Objectives: The global epidemic of childhood obesity is escalating, with China reporting the highest incidence among children. Obesity is associated with respiratory health impairments; however, its relationship with lung function in pediatric populations remains controversial. This study aims to investigate the correlation between lung function and childhood obesity.
   Methods: This retrospective study enrolled 666 Chinese children with obesity aged 5 to 17 years, admitted to a tertiary pediatric hospital in China, comprising 471 boys and 195 girls. Lung function was assessed using standardized spirometry, with abnormalities defined according to American Thoracic Society (ATS)/European Respiratory Society (ERS) recommendations. Multifactorial linear regression analysis and multivariable logistic regression were employed to analyze the correlations between obesity indices and lung function.
   Results: The prevalence of abnormal lung function in children with obesity was 32.88% with a peak in the 10 to 14 age group. Children with severe obesity had higher rates of lung function abnormalities compared to those with mild obesity (41.24% vs. 32.48%, P < 0.05). Obstructive ventilatory defects were more common, particularly in boys. Metabolic comorbidities were frequent, with dyslipidemia (65.75%), hyperuricemia (59.36%), and type 2 diabetes mellitus (T2DM) (45.66%) being the most prevalent. In boys, body composition indices, such as waist circumference instead of BMI, were closely associated with lung function parameters, while in girls, this association was not observed. In boys, severe obesity and hypertension were independently associated with the risk of abnormal lung function; in girls, liver injury, triglycerides (TG), and high-density lipoprotein cholesterol (HDL-C) showed independent associations.
   Conclusion: The high prevalence of abnormal lung function (32.88%) among Chinese children with obesity underscores its clinical significance. Importantly, gender-specific screening—focusing on abdominal obesity in boys and lipid profiles in girls—may enhance the early detection of obesity-related pulmonary impairment.

Abstract Background and Objectives: Intertrochanteric fractures are prevalent in the elderly, contributing significantly to morbidity and healthcare costs. Proximal femoral locking plates (PF-LPs) are used for fixation, particularly in osteoporotic bone, but their outcomes remain debated. This study evaluates the clinical outcomes and complications of PF-LP fixation in elderly patients, emphasizing the role of posteromedial cortex reduction.    Methods: This retrospective study included patients over 60 years with intertrochanteric fractures treated with PF-LP between April 2021 and March 2024. Patients with polytrauma, end-stage disease, or incomplete follow-up were excluded. Analyzed variables included demographics, AO/OTA classification, reduction quality, posteromedial cortex status, and postoperative complications. Treatment failure was defined as the need for revision surgery due to complications like infection, nonunion, varus collapse, implant failure, or screw cut-out.    Results: A total of 197 patients (mean age: 74.3 ± 9.2 years) were analyzed. Treatment failure occurred in 48 patients (24.4%), with higher rates in females, those with type 31A2 fractures, and osteoporotic patients. Negative posteromedial cortex alignment was strongly associated with mechanical failure. Varus collapse and screw cut-out were the most common complications.    Conclusion: PF-LP fixation in elderly intertrochanteric fractures has a significant failure rate, especially in osteoporotic bone with poor posteromedial support. Achieving proper reduction with positive cortical alignment is critical. Surgeons should consider optimized reduction techniques or alternative fixation methods in high-risk cases. Future studies should include control groups using devices like dynamic hip screws or intramedullary nails to compare efficacy.

Abstract Background and Objectives: Acute mesenteric venous thrombosis (AMVT) has complex etiological factors and is difficult to diagnose early, with complications such as intestinal necrosis severely impacting patient survival and prognosis. This study aims to explore the relationship between inflammation and coagulation-related blood indicators and intestinal necrosis in AMVT patients by analyzing these indicators, providing a reference for early identification of intestinal necrosis.
   Methods: A retrospective review of clinical data from 110 AMVT patients between June 2022 and December 2023 was conducted. The patients were categorized into two groups: intestinal necrosis and non-intestinal necrosis. The general information, clinical manifestations, and laboratory examination results were compared. Furthermore, binary logistic regression was used to identify predictive factors for intestinal necrosis, with the predictive accuracy being assessed using ROC curves.
   Results: Among the 110 AMVT patients, 38 had intestinal necrosis and 72 had non-intestinal necrosis. There were no notable disparities in gender, age, or other fundamental characteristics between the two groups (P<0.05). Nevertheless, notable variations were observed in laboratory examination indicators (white blood cell count (WBC), platelet-to-lymphocyte ratio (PLR), mean platelet volume (MPV), D-dimer (D-D)) (P>0.05). WBC, PLR, MPV and D-D were important factors for predicting intestinal necrosis. The AUC of combined application was 0.977, and the predictive sensitivity and specificity were 97.37% and 90.28%, respectively.
   Conclusion: The joint application of WBC, PLR, MPV and D-D can more accurately predict the occurrence of intestinal necrosis in AMVT patients.

Abstract Background and Objectives: Skin soft tissue expansion in adolescents induces psychological stress from appearance changes and prolonged discomfort. Despite MBSR’s proven mental health benefits for teens, its role in mitigating first-stage expansion-related distress remains understudied. This study aimed to evaluate the effect of MBSR therapy on mindfulness and mental health (assessed via SCL-90 and MAAS scales) in adolescents after the first stage of skin expansion; explore whether MBSR influences skin expansion prognosis (including hematoma, infection, leakage, and expansion time); and provide evidence for optimizing psychological intervention protocols in adolescent plastic surgery patients.
   Methods: This single-blind randomized controlled trial (RCT) enrolled 96 adolescent patients, randomly assigning 48 to a control group (routine care) and 48 to an observation group (8-week mindfulness-based stress reduction (MBSR) therapy plus routine care). Baseline (T1) and post-intervention (T2) data on mental health (SCL-90, MAAS) and expansion prognosis (hematoma, infection, leakage, expansion time) were collected. Statistical analyses included independent sample t-tests and paired sample t-tests for continuous data, chi-square tests/Fisher’s exact tests for categorical data, using GraphPad Prism 8.0 (α = 0.05).
   Results: After the intervention, the mindfulness score of the observation group was 66.15 ± 12.11, significantly higher than that of the control group (59.15 ± 8.87, P < 0.001). At this time, the SCL-90 scores of the observation group were significantly lower than those of the control group (P < 0.001). There was no significant difference in the skin expansion prognosis between the two groups, but the expansion time of the observation group was 69.81 ± 9.97 days, seemingly shorter than that of the control group (74.73 ± 15.56 days, P = 0.069).
   Conclusion: MBSR improved adolescents' mindfulness/mental health post-first-stage skin expansion, with trended shorter expansion times (non-significant). It shows promise for compliance/efficiency, though challenges like trained personnel are noted.

Abstract Background: To evaluate the predictive performance of the new, race-neutral 2021 Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation for estimating glomerular filtration rate (eGFR) in forecasting acute kidney injury (AKI) and 90-day all-cause mortality following coronary artery bypass grafting (CABG).
  Methods: This retrospective cohort study utilized data from the MIMIC-IV database, including 2,214 adult patients undergoing their first CABG. Postoperative eGFR was calculated using the CKD-EPI 2021, CKD-EPI 2009, and MDRD equations. LASSO and multivariable logistic regression analyses were performed to identify independent predictors for postoperative AKI (primary outcome) and 90-day mortality (secondary outcome). The predictive accuracy of the models was assessed using the area under the receiver operating characteristic curve (AUC).
  Results: Postoperative AKI occurred in 365 patients (16.5%), and 48 patients (2.2%) died within 90 days. Postoperative eGFR calculated by the CKD-EPI 2021 equation was an independent predictor for both AKI (OR: 0.99, 95% CI: 0.99–1.00) and 90-day mortality (OR: 0.96, 95% CI: 0.95–0.97). The AUC for the CKD-EPI 2021 equation was 0.64 for predicting AKI and 0.80 for predicting 90-day mortality. Its predictive performance for both outcomes was comparable to the CKD-EPI 2009 equation.
  Conclusion: Our results suggested that the race-neutral CKD-EPI 2021 equation seems to be a valid independent predictor of both AKI and short-term mortality after CABG. Its prognostic performance was comparable to the CKD-EPI 2009 formula, supporting its clinical utility for risk stratification in this patient population.

Abstract Background: One of the most common diagnostic and therapeutic methods in heart patients is coronary angiography, which increases the level of anxiety. Anxiety is itself a predisposing factor in heart problems. This study aimed to determine the effect of acupressure at GV20 and BL62 points on anxiety levels in patients undergoing coronary angiography.
   Methods: this randomized clinical trial study was performed on 102 candidates for coronary angiography at Farshchian Heart Hospital in Hamadan, Iran, in 2020. Eligible patients were randomly divided into three groups. The two intervention groups received hypertension one half hour before angiography for 5 minutes at GV20 and BL62 and the control group did not receive any intervention. Patients' anxiety was measured before and one hour after the intervention. Data collection tools were demographic information questionnaire and Spielberger anxiety questionnaire.
   Results: The mean score of anxiety in the three groups before the intervention was significantly different (P<0.05). One hour after the intervention, by adjusting the effect of heterogeneous variables, the level of anxiety in the two experimental groups was significantly lower than the control group (P<0.05), but there was no significant difference between the two experimental groups (P>0.05).
   Conclusion: Acupressure is effective in reducing anxiety in patients undergoing coronary angiography; therefore, it can be suggested as a method to reduce anxiety before angiography.

Abstract Background and Objectives: Total knee arthroplasty (TKA) is often utilized in clinical therapy for knee joint diseases in middle and advanced stages. Nevertheless, because patients have severe pain after surgery and are prone to multiple complications, the recovery efficacy is not ideal. We attempted to clarify perioperative application value of the concept of Enhanced Recovery After Surgery (ERAS) for TKA.
   Methods: A total of 92 patients under treatment with TKA in hospital from July 2021 to June 2022 were chosen and underwent division into control or experimental group in a random manner, with 46 cases each. The control group underwent conventional rehabilitation intervention. The ERAS concept was infiltrated for experimental group. The surgical rehabilitation, postoperative complications, negative emotions, knee-joint function, as well as nursing satisfaction in both groups underwent observation and analysis.
   Results: Before operation, knee-joint function scores presented no difference between both groups (P>0.05). At 2 and 4 weeks after operation, knee-joint function scores in both groups presented improvement (P<0.05), and improvement in experimental group was better than that in controls (P<0.05). The postoperative recovery in experimental group was better than that in controls. After nursing intervention (P<0.05), total complication rate in experimental group was 6.52%, presented a marked depletion relative to 32.61% in controls (P<0.05). After nursing intervention, the total nursing satisfaction rate in experimental group was 97.83%, presented a marked elevation relative to 80.43% in controls (P<0.05). After nursing, the HAMD and HAMA scores in both groups were declined, and those in experimental group presented lower than that in controls (P<0.05).
   Conclusion: Scientific infiltration of ERAS concept in perioperative period of TKA can alleviate physical and mental pain of patients, facilitate their physical recovery, deplete probability of complications, and improve knee function of patients, which has good application value.

Abstract Background and Objectives: Intervertebral Disc Degeneration (IVDD) poses a severe threat to physical and mental health by causing intense pain, neurological damage, and a significant decline in quality of life. There is no radical treatment for disease progression, so our goal was to identify effective drug targets to address the progression of disc degeneration.
   Methods: In the discovery cohort, Mendelian randomization (MR) analysis was employed to identify therapeutic targets associated with IVDD. Summary statistics IVDD were obtained from two datasets: the UK Biobank and the FinnGen study. Cis-expression quantitative trait loci (cis-eQTL) data were obtained from the eQTLGen consortium and utilized as genetic instruments. Colocalization analyses were conducted to assess the likelihood that single nucleotide polymorphisms (SNPs) share common causal genetic variation with both eQTLs and IVDD.
   Results: MR analysis identified 28 drug targets with a causal relationship to IVDD. However, after MR analysis in the replication cohort, only six drug targets retained this causal relationship. Finally, colocalization analysis identified AKR1C2 (ORukb: 0.92; 95% CIukb: 0.89-0.95) as a potential drug target.
 
   Conclusion: Drug-target MR studies offer a promising new direction for IVDD treatment. These studies not only deepen our understanding of the pathological mechanism of IVDD, but also provide reliable targets and theoretical basis for the development of new drugs for the treatment of IVDD.

Abstract  Background and Objectives: Gastrointestinal stromal tumors (GIST) are a rare group of tumors occur from the mesenchymal tissue of the gastrointestinal tract. Many classifications have been developed to assess the survival of GISTs. Aim of this study is to evaluate the effects of tumor characteristics and existing classification systems on survival in GISTs.
   Methods: Study was conducted as a single center retrospective cohort study. We evaluated pathology results and the medical records of patients who had surgery for GIST at Tepecik Training and Research Hospital between 2010 and 2020 retrospectively.
   Results: A total of sixty-eight patients were detected. Thirty-three (48.5%) of the patients were male and the mean age at initial diagnosis was 60.8±11.9 years. Thirty-seven (54.4%) of the primary tumor was localized in the stomach and the median tumor size was 6.8 cm. Mortality rate was higher in patients with irregular tumor contour (P=0.044). Mortality rate was higher in patients with colonic GIST (P=0.026). Armed Forces Institute of Pathology (AFIP) was found as the best classification system that could assess the prognosis (AUC:0.758 (0.644-0.872), P=0.001). Among various factors, only the mitotic index was found as a risk factor in the development of recurrence (HR (95%CI): 1.019 (1.006-1.032), P=0.004).
 
   Conclusion: The best prognostic factor for disease-free survival in GISTs is the mitotic index. In addition, Ki-67 index, tumor size, presence of necrosis and hemorrhage should be considered as other factors that may be related to disease-free survival. Colorectal GISTs have the worst postoperative mortality and recurrence rates.

Abstract    Background and Objectives: Atherosclerosis is a complex disease with systemic inflammation, lipid dysregulation and end-organ dysfunction. This study examines the clinical, hematological, biochemical and lifestyle factors associated with disease severity through inflammatory markers, biochemical indicators and cardiovascular risk prediction models.
   Methods: The study is a retrospective observational cohort study which evaluated 433 patients (234 of whom were mild/moderate atherosclerosis and 190 with severe disease). Clinical parameters, inflammatory markers and biochemical indicators were measured and the diagnostic value of these markers was evaluated by Multiple Logistic Regression (MLR) and Receiver Operating Characteristic (ROC) analysis.
   Results: Severe atherosclerosis patients had a higher BMI, inflammatory markers (CRP, IL-6, TNF-) and dyslipidemia (higher TG, TC, LDL and lower HDL). Onset renal (BUN, creatinine) and liver (ALT, AST) markers were high for severe cases. IL-1, IL-6, Lp-PLA2, CRP and ratio of inflammation (NLR, PLR) were strongly correlated with higher China-PAR and Gensini risk scores. Non-significant factors were smoking, diabetes, and hypertension, after accounting for confounders. IL-6 (AUC = 0.88) and CRP, Lp-PLA2, Hypertension (AUC = 0.86) were the best performing markers. Inflammatory ratios such as NLR (AUC = 0.80) were also very good predictors, whereas markers such as NLPR (AUC = 0.48) and lifestyle factors such as smoking (AUC = 0.47) were not.
   Conclusion: Inflammatory markers CRP, IL-1β, IL-6 and Lp-PLA2, demonstrate robust diagnostic and prognostic utility in atherosclerosis severity. Systemic inflammatory metrics provide valuable insights into disease progression and risk stratification. These findings support the integration of biomarkers in personalized atherosclerosis management strategies.

Abstract Background and Objectives: Direct oral anticoagulants including rivaroxaban are now the standard treatment for anticoagulation in patients with atrial fibrillation (AF). Rivaroxaban is primarily metabolized by P-glycoprotein and cytochrome P450 (CYP450) pathways and its efficacy can be affected by mutations in genes encoding these proteins/transporters. The present study evaluates whether CYP3A4/5 polymorphisms have an association with anti-factor-Xa activity in Iranian patients with AF undertaking rivaroxaban.
   Methods: This is a prospective observational single center study in which patients with AF receiving standard doses of rivaroxaban are included. Genotyping of polymorphisms CYP3A4*1B (rs2740574), CYP3A4*22 (rs35599367) and CYP3A5*3 (rs776746) is assessed and the association of these polymorphisms with anti-factor-Xa activity is determined. Association of anti-factor-Xa activity with polymorphisms is determined via linear regression analysis measured by SPSS software.
   Results: The study includes 92 patients of which 25 patients (27.2%) had at least one allele (two of them were mutant and the rest were heterozygote). Sixteen patients had heterozygote CYP3A5*3, 9 patients had CYP3A4*1B, and 1 patient had CYP3A4*22. Our data shows CYP3A4/5 polymorphism has a negative association with anti-factor-Xa activity both before (B1: -1.20, [95% CI: -0.68 to -1.72], P < 0.001) and after (B1: -1.15, [95% CI: -0.60 to -1.70], P < 0.001) adjustment for age and estimated glomerular filtration rate.
   Conclusion: There is a negative association between CYP3A4/5 polymorphism and anti-factor-Xa activity in patients with AF receiving rivaroxaban and CYP3A4/5 polymorphism results in lower anti-factor-Xa activity in this population. The possible effects of this association on clinical outcomes have yet to be determined.

Abstract Background and Objectives: Resilience has become a crucial concept in disaster management. However, attaining a comprehensive and accurate understanding of resilience requires a thorough and deep knowledge within a specific context and field of activity. The present study aimed to explore the resilience of Iranian Red Crescent Society (IRCS) aid workers during disasters.
   Methods: This qualitative study employed a directed content analysis approach to explore the components of resilience among IRCS. Data were collected through semi-structured interviews with purposively sampled participants from Tehran, Semnan, and Golestan provinces between November and December 2024, continuing until data saturation was reached. All interviews were audio-recorded, transcribed verbatim, and analyzed using MAXQDA 2022 software. The initial coding scheme and interview questions were informed by a prior systematic review on resilience in disaster aid workers. The research team, comprised of experts in public health, disaster management, and qualitative research, ensured methodological rigor throughout the study.
   Results: This study highlights that resilience in the Iranian Red Crescent is enhanced by individual factors such as self-care and self-efficacy, as well as organizational support, including robust social networks and clear leadership, crucial for maintaining effectiveness amid disaster challenges.
   Conclusion: The present study demonstrates that resilience among Iranian Red Crescent responders is shaped by both individual and organizational factors. Strengthening self-care, social support, and organizational resources is essential for sustaining responder well-being and effectiveness in disaster contexts. These findings provide a foundation for targeted strategies to enhance resilience in disaster and emergency aid workers.

Abstract Background and Objectives: The integration of Evidence-Based Medicine (EBM) into clinical practice has become increasingly essential for improving patient care and surgical outcomes across various medical disciplines, including urology. The aim of this study is to investigate whether there are differences in adherence to clinical guidelines for transurethral lithotripsy (TUL) and transurethral resection of bladder tumor (TURBT), as well as in two hospital indicators—length of stay(LOS) and drug costs—between physicians trained in evidence-based medicine (EBM) and those who are untrained.
   Methods: This study employed a quantitative descriptive design within the urology department at Imam Reza Hospital in Tabriz. A total of 325 patient records were analyzed. The sample size, collected over a three-month period (September 22 to December 20) was determined based on the number of additional visits recorded during this time, in consultation with clinical experts. Data were analyzed using SPSS 24 through descriptive and inferential statistics.
   Results: For TUL, physicians who had received training demonstrated significantly shorter lengths of hospital stay, lower medication costs, and reduced prescriptions of Meropenem compared to untrained physicians, with all differences being statistically significant (P<0.001). Similarly, for TURBT, trained physicians showed higher rates of adherence to guideline-recommended Mitomycin prescriptions (P=0.008) and cytology requests (P=0.04).
   Conclusion: This study demonstrates that targeted training programs improved physicians’ adherence to CGs for TUL and TURBT, resulting in reduced LOS and lower medication costs. These findings underscore the importance of personalized educational strategies to support the effective implementation of clinical guidelines.
 

Abstract Background and Objectives: Skeletal dysplasias (SDs) are a rare group of genetic disorders that disrupt bone and cartilage development, often leading to short stature, limb deformities, and functional impairments. Despite their clinical significance, upper limb involvement in SDs remains relatively underexplored in the literature, with few reviews focusing specifically on this aspect. This study aims to review the patterns, genetic bases, and clinical implications of upper limb manifestations across various SDs, to support early diagnosis and improve management strategies.
   Methods: A comprehensive literature review was conducted through PubMed, Web of Science, Scopus, and Google Scholar, with no date restrictions. Search terms included "upper extremity," "skeletal dysplasia," and the names of specific disorders. Relevant clinical studies, case reports, and recommendations were selected and critically analyzed.
   Results: Upper limb abnormalities are common across different types of skeletal dysplasia, presenting with varying degrees of bone shortening, joint contractures, and hand deformities. Despite the heterogeneity in presentation, overlapping genetic and pathophysiological mechanisms were identified, particularly mutations affecting bone growth pathways. Advances in genetic diagnosis have improved the recognition and classification of these conditions, offering prospects for personalized treatment. However, phenotypic variability and diagnostic challenges persist.
   Conclusion: Recognizing upper limb manifestations is essential for the timely diagnosis and management of skeletal dysplasias. Genetic insights continue to drive advancements in therapy, yet a multidisciplinary approach remains crucial due to the complexity and diversity of these disorders.

Abstract Background and Objectives: Breast cancer is among the most prevalent cancers in women, ranking as the second cause of women’s death from cancer after lung cancer. Known as the most important lipophilic antioxidant, vitamin E plays a key role in preventing cancer. This study aims to analyze the serum levels of vitamin E and its effects on breast cancer.
   Methods: In this case–control study, 42 women with breast cancer were compared with 50 healthy women. The enzyme-linked immunosorbent assay (ELISA) test with a ZellBio kit (made in Germany) was employed to measure the serum levels of vitamin E. The T-test, Anova, and  Pearson correlation were used in SPSS 26 to determine the significant differences of data.
   Results: The mean age (± standard deviation) of the case group was 46.9 (± 7.01), whereas that of the control group was 40.8 (± 4.7) with a significant difference (P=0.000). Moreover, the mean vitamin E serum level of the case group was significantly lower than that of the control group (P=0.002). The findings also indicated that the serum level of vitamin E had no significant association  with the cancer stage, cancer grade, tumor size, estrogen status, progesterone status, and HER2.
   Conclusion: The serum levels of vitamin E are lower in patients with breast cancer than in a healthy population.

Abstract    Background and Objectives: Relapsing-remitting multiple sclerosis (RRMS) is a chronic immune-mediated disease characterized by recurrent neurological dysfunction. Ocrelizumab, a high-efficacy disease-modifying therapy, has shown significant benefits in reducing relapses and slowing disability progression. However, the relationship between spinal cord lesion dynamics and long-term outcomes in ocrelizumab-treated patients remains underexplored. This study aimed to evaluate lesion metrics in RRMS patients undergoing ocrelizumab treatment, focusing on longitudinal changes in total lesion burden, lesion disappearance dynamics, and their correlation with Expanded Disability Status Scale (EDSS) progression
   Methods: A retrospective longitudinal study was conducted on 84 female RRMS patients from Sina and Shahid Dr. Chamran medical centers in Tehran, Iran. Cervical MRI and clinical assessments were performed at baseline and 12-month follow-up. Lesion metrics, including total lesion number, lesion length, and lesioned segments per subject, were analyzed. Statistical models assessed associations between MRI findings and EDSS changes.
   Results: At baseline, lesion burden was significantly associated with EDSS scores (P < 0.05). However, no significant longitudinal correlation was observed between lesion dynamics and disability progression. While ocrelizumab stabilized lesion burden and clinical outcomes, age emerged as an important predictor of EDSS progression (OR = 1.06, P = 0.02), underscoring its role in long-term disease evolution.
   Conclusion: This study highlights the prognostic value of baseline spinal cord lesion assessment but suggests that lesion stability alone does not predict disability progression under ocrelizumab treatment. Age-related factors may play a more critical role in the MS disease course, emphasizing the need for multidimensional biomarkers integrating neurodegenerative and inflammatory mechanisms.

Abstract Background and Objectives: Maternal Mortality Ratio (MMR) is a key indicator of a nation's health. While Iran has seen a decrease in MMR, further improvements are possible. This study aimed to identify the causes and risk factors associated with maternal mortality in Ahvaz, Iran, to inform targeted interventions.
   Methods: A case-control study was conducted in Ahvaz from 2017 to 2023, involving 100 cases of maternal deaths and 117 controls (mothers with successful pregnancies). Data on personal characteristics, pregnancy and childbirth-related indicators were collected using a researcher-made checklist and analyzed using Chi-square and t-tests. Moreover, adjusted logistic regression was used to identify independent risk factors.
   Results: The mean age of the case group (31.31 ± 6.58 years) is slightly higher than the control group (30.14 ± 5.02 years) (P=0.14). Hemorrhage (31%) and infectious diseases (30%) were the leading causes of maternal deaths. Lower education levels (P<0.05), anemia (OR: 4.33, p=0.038), diabetes (OR: 4.48, P=0.023), eclampsia (OR: 19.18, P=0.001), bleeding (OR: 27.98, P=0.003), and a history of previous abortions (OR: 4.76, P=0.002) were significantly associated with increased odds of maternal mortality. While access to midwife services showed a protective effect, it was not statistically significant (OR: 0.12, P=0.091).
   Conclusion: We found that maternal mortality in Ahvaz is largely influenced by preventable factors such as anemia, hypertension, preeclampsia, and hemorrhage. Additionally, low education and limited access to healthcare services played a significant role in this issue. Strategies to reduce maternal mortality should focus on improving prenatal care, early diagnosis and treatment of pregnancy-related complications, increasing maternal awareness, and enhancing access to quality healthcare services, particularly in underserved communities.

Abstract Background and Objectives: Previous studies have highlighted the anti-diabetic drugs as repurposing candidates for Atrial fibrillation (AF), but the disease-modifying effects are still unclear. In this study, the drug-target Mendelian randomization (MR) analysis was utilized to investigate the relationship between various anti-diabetic drugs and AF.
   Methods: Using a study design involving MR, we scrutinized the association between various anti-diabetic medications and the risk of AF. Genetic summary information for diabetes and AF was acquired from UK Biobank (UKBB), Finngen, and several independent genome-wide association studies (GWASs). Rigorous replication validation procedures were meticulously carried out to ensure the robustness of our findings. Moreover, detailed information on drug targets was collected from the “Chembl” database.
   Results: The Thiazolidinediones drug called "Rosiglitazone" and the Amino Acid drug called "Tyrosine" have been found to be associated with a significantly higher risk of AF. This heightened risk is attributed to the activation of specific proteins: Rosiglitazone activates CRHBP (Corticotropin Releasing Hormone Binding Protein), while Tyrosine activates MPO (Myeloperoxidase) and CA1 (Carbonic Anhydrase 1). Importantly, these protein activations were linked to a notably higher incidence of AF, a finding that was consistently confirmed in external validation datasets. No pleiotropy or genetic confounding was detected in the sensitivity studies.
   Conclusion: The genetic variation in the targets of "Rosiglitazone" and "Tyrosine" is associated with a higher likelihood of developing AF. This groundbreaking discovery is expected to significantly contribute to the progress of correlational research on early clinical prevention and the core mechanism of AF medication therapy.

Abstract    Background and Objectives: Breast cancer is one of the common problems of women, and anemia is another serious disorder that is associated with this condition. In this study, we aimed to examine anemia in breast cancer patients and its relationship with their various pathological factors and tumor grade, and stage at different ages.
   Methods: In this retrospective case-control study, the information of patients who were diagnosed with breast cancer and underwent surgery at Razi Hospital in Rasht, and their tissue samples were examined in the pathology laboratory, was collected. In this way, the patients were divided into anemic and non-anemic groups, and their pathology reports and laboratory parameters were examined and statistically analyzed.
   Results: In this investigation, a total of 90 patients' pathology reports and laboratory findings were examined. Of the participants, 72 were identified as anemic, while 18 were non-anemic. The mean age of the cohort was 11.81±54.83. The study demonstrated a substantial correlation between anemia and advanced tumor stage (P < 0.001) as well as higher tumor grade (P = 0.001). Among anemic patients, prominent proportions exhibited nipple involvement (80%), simultaneous skin involvement (40%), vascular invasion (71%), lymphatic invasion (84%), neuronal invasion (57%), and necrosis in their pathological samples (41%). On the other hand, within the non-anemic group, none of the patients displayed nipple involvement, while smaller percentages had skin involvement (22%), vascular invasion (17%), lymphatic invasion (28%), neuronal invasion (17%), and necrosis in the pathological membrane (11%).
   Conclusion: Anemic patients had a significantly higher degree of tumor at the time of diagnosis, and their tumor was at a higher stage than that of non-anemic patients. Vascular invasion, lymphatic invasion, and neuronal invasion in pathological samples were significantly less in the non-anemic group, and generally, based on multiple analyses, and in the matched model, hematocrit variable and lymphatic invasion had the greatest predictive effect.

Abstract Background and Objectives: In the last month of 2019, the novel Coronavirus (COVID-19) emerged in Wuhan, China, and raised worldwide attention. The clinical manifestation of COVID-19 ranges from respiratory to organ failure. In this regard, cardiovascular complications have caused significant concern due to the increasing reports.
   Methods: In this study, we aimed to investigate the cardiovascular complications caused by COVID-19 in patients admitted to Ghaem Hospital in Mashhad, between June 2020 and June 2021. All patients with a definite diagnosis of COVID-19 admitted to the hospital with cardiac consultation were included and followed using patient files and the Hospital Information System (HIS).
   Results: Of the 3,628 patients with a confirmed COVID-19 diagnosis, 54.4% were men and 45.5% were women, with an average age of 68.34 ± 15.47 years. About 15% of these patients required cardiac consultation, and cardiovascular complications were identified in 154 patients (27.2%) who had cardiac consultations. The most common complications were coronary artery ischemia (37.7% of cases), atrial fibrillation (22.7%), and heart failure (11.7%). Mortality among those with cardiovascular complications was significantly higher than in those without, with 55.8% of ICU patients succumbing compared to 36% in the general ward.
   Conclusion: Based on the results obtained from the present study, the mortality rate in patients who underwent cardiac consultation is significantly higher, also, it appears that coronary artery ischemia is the most common cardiac complication following AF (atrial fibrillation) and heart failure.

Abstract Background and Objectives: Effective evaluation is a critical component of disaster preparedness exercises, yet there is a notable lack of structured frameworks to support evaluators in complex scenarios. This study aims to design a structured framework based on critical systems methodologies to conduct the activities of the disaster exercise evaluators.
   Methods: An embedded mixed method study was carried out in three phases: first, identifying evaluator activities using document review and interviews with 12 experts selected through purposive sampling and using qualitative content analysis; second, developing the framework using Team Syntegrity and Social Network Analysis; and third, validating it by an operational exercise in Tehran using quantitative exercise evaluation results from a purposive selection of 30 evaluators and analysis using Ucinet & NetDraw software.
   Results: Evaluator activities were initially grouped into six groups. These activities were further refined and 30 key activities integrated into a structured framework consisting of four core phases aligned with the disaster exercise timeline: 1) concept and planning, 2) exercise conduct, 3) exercise evaluation, and 4) post-exercise evaluation. The application of the framework during an emergency accommodation exercise held in Tehran revealed valuable insights for planners in 12 areas of learning based on the findings of the quantitative and qualitative analysis presented.
   Conclusion: The proposed framework demonstrates the potential to enhance communication, role clarity, and learning outcomes across all phases of the exercise cycle. Future efforts should focus on adapting evaluation methods to account for exercise complexity and integrating systems thinking to enhance learning and preparedness capabilities.

Abstract    Background and Objectives: Both arthritis and low bone mineral density (LBMD) conditions are emerging as leading global causes of disability. Therefore, the study aims to report the associations between sex hormones, arthritis, and LBMD among different sexes and age groups, and provide a basis for the prediction of arthritis and LBMD.While in different sexes and ages, the associated sex hormone indicators vary to predict arthritis and LBMD. The results of this study may help clinicians monitor specific arthritis and LBMD by measuring sex hormone levels at an early stage.
   Methods: In this cross-sectional analysis, data for this analysis were obtained from the 2013-2016 NHANES dataset including a total of 4950 participants, available on the official NHANES website. We compared categorical and continuous variables using chi-squared test or T-test. And binary logistic regression was conducted to analyze the association between sex hormone with arthritis and LBMD groups. Furthermore, to evaluate the performance of the indices, we examined the receiver operating characteristic curves (ROC).
   Results: In this cross-sectional analysis, we observed that elder people (above 35) tend to be more associated with arthritis and LBMD problems in general, particularly the female group. Estradiol (E2) and (total testosterone) TT/E2 are the two most important indicators in the elder female. E2 is the protective factor to female arthritis (OR=0.99, 95%CI(0.99,1.00), P=0.030) and LBMD (OR=0.99, 95%CI(0.98, 0.99), P<0.001); while TT/E2 is the risk factor to female arthritis (OR=1.06, 95%CI(1.00,1.13), P=0.046) as well as LBMD (OR=1.13, 95%CI(1.03, 1.23), P=0.007).
   Conclusion: Our findings indicated that estradiol and aromatase activity exert a protective effect against arthritis and LBMD, while the free androgen index (FAI) was found to have a protective effect against arthritis in males. This study explored a sex hormone regimen by extensively examining the associations between sex hormones and the dual health issues of arthritis and LBMD.
 

Abstract Background and Objectives: Severe acute pancreatitis (SAP) is a serious illness with high risks of complications and death. This study looks into how clinical features, inflammation, and biochemical markers in patients with SAP are related to survival and disease severity.
   Methods: The study is a single-center, prospective observational study that reviewed the records of 332 patients, including 202 with acute pancreatitis (AP) and 130 with SAP. We analyzed various clinical, blood, and biochemical markers, including white blood cells (WBC), platelet count, albumin, creatinine, C-reactive protein (CRP), and inflammatory cytokines (IL-6, TNF-α). We used statistical tests including multinomial and binary logistic regression and ROC analysis to find out which factors are linked to survival, disease severity (BISAP score), and prognosis in both groups.
   Results: There were no major differences between the AP and SAP groups in terms of age, sex, or lifestyle habits. However, SAP patients had higher levels of WBC, CRP, creatinine, BUN, triglycerides, and inflammatory markers, pointing to widespread inflammation and organ issues. Higher levels of BUN [HR = 1.04, 95% CI (0.88-1.24)], creatinine [HR = 0.95, 95% CI (0.83-1.09)], CRP [HR = 1.03, 95% CI (0.99-1.21)], IL-6 [HR = 1.08, 95% CI (0.95-1.09)], and TNF-α [HR = 1.13, 95% CI (0.95-1.23)] were strongly linked to lower survival rates in SAP patients. BISAP scores were closely tied to ALT, IL-6, TNF-α, and triglycerides, with IL-6 and TNF-α showing the strongest connection to disease severity.
   Conclusion: The study shows that markers of inflammation like IL-6 and TNF-α, along with kidney function markers such as BUN and creatinine, are important in predicting the severity and survival of SAP. These findings emphasize the need for early tracking of these markers.

Abstract Background: The significant growth in healthcare costs has caused policymakers and managers to seek ways to properly manage hospital revenues and costs. Therefore, awareness of various activities, their costs, whether these costs are necessary or unnecessary, and the prevention of unnecessary cases, or at least their reduction is necessary to improve hospital efficiency.
 Objectives: To systematically identify the factors influencing the provision of inappropriate services in emergency departments.
   Methods: This study was conducted as a systematic review in 2024.The required data were collected by searching in PubMed, Scopus, Web of Knowledge, Embase, and Google Scholar search engine. The study was conducted without any time limit. Manual searches of relevant journals and examination of reference lists of the final articles were also conducted. PRISMA reporting guidelines were followed.
   Results: 13 studies were included in the review. Based on the analysis of information obtained from the articles, the highest number of inappropriate services provided in the emergency department pertains to imaging services (radiography, CT scans, angiography), accounting for 46% of inappropriate services. Antibiotic prescriptions, with 38%, are identified as the second most common inappropriate service. The factors influencing the provision of inappropriate services in the emergency department were divided into three categories: those related to the service provider, the service receiver, and environmental and contextual condition.
   Conclusion: Identifying the necessary services and commensurate with the real needs of the patients in emergency departments a challenging matter. In addition to this, investigating the root causes and developing practical guidelines that reduce the waste of resources and at the same time keep the quality and safety of the services provided to the patients should be considered.

Abstract Background and Objectives: Given the limitations of standalone enteral or parenteral nutrition, we hypothesized that combining both with PDCA nursing might enhance recovery and reduce complications This study assessed the effects of Plan-Do-Check-Act nursing alongside combined enteral and parenteral nutrition on patients undergoing laparoscopic radical gastrectomy.
   Methods: A randomized controlled trial (RCT) study from August 2019 to July 2022, 92 patients were randomly divided into two groups. The control group received routine nursing with early enteral nutrition, whereas the intervention group received PDCA (Plan-Do-Check-Act) nursing with both early enteral and parenteral nutrition. We compared the recovery of gastrointestinal function, postoperative recovery, pain levels, psychological status, complication rates during hospitalization, nutritional status, immune function, and patient satisfaction with nursing care. The comparison of groups was tested by the Chi-square Pair and Independent independent samples t-test.
   Results: The results of this study showed that the intervention group had a faster improvement in gastrointestinal function and physical recovery compared to the control group, and this improvement was statistically significant between the two groups (P≤0.05). Also, the quality of life scores, nutritional indices and immune indices were significantly higher in the intervention group, and the severity of pain, anxiety, depression, and the incidence of complications were also reported to be lower, and these differences between the two groups were statistically significant (P≤0.05). Patients' satisfaction with nursing care was also higher in this group (P≤0.05).
   Conclusion: These findings suggest that Plan-Do-Check-Act nursing combined with dual nutritional support enhances postoperative outcomes, supporting its broader clinical application.

Abstract Background and Objectives: When individuals are injured in accidents, the intervention of bystanders to control bleeding is critical, as it can significantly reduce mortality. This study sought to evaluate the knowledge and attitudes of female bystanders regarding bleeding control through a customized questionnaire survey.
   Methods: A cross-sectional survey was conducted in January 2025 using a self-structured questionnaire distributed electronically to female participants across all regions of Saudi Arabia. Data analysis was conducted using Microsoft Excel, presenting results in the form of numerical values and percentages.
   Results: The knowledge and attitudes of the 462 participants were satisfactory, with 83.1% agreeing that bleeding is the primary cause of preventable death, 62.1% acknowledging the necessity of bystanders’ intervention for saving lives, and 91.1% expressing willingness to participate in bleeding control courses.
   Conclusion: The findings of our study indicated a generally satisfactory level of knowledge and attitude among the female population in Saudi Arabia; however, there remain areas for improvement in awareness, confidence, and expertise. This study is one of the first to examine Saudi women's bleeding control after their recent authorization to drive. To enhance their capacity to manage hemorrhage, it is imperative for women to participate in requisite educational programs at the institutional level and to involve diverse community members of different ages and backgrounds through campaigns in public venues, such as shopping centers and parks.

Abstract Background and Objectives: Malnutrition and excessive inflammation are common in elderly patients with femoral neck fractures and may impair postoperative fracture healing.The aim of this study is to investigate the effects of early enteral nutritional support on the dynamic levels of inflammatory factors in patients with femoral neck fractures.
   Methods: This prospective observational cohort study included 115 patients with femoral neck fractures. Patients were divided into two groups: the early enteral nutrition group (EN group, n=61) and the conventional treatment group (n=54). Enzyme-linked immunosorbent assay (ELISA) was used to determine the levels of cytokines. ROC curve analysis was used to evaluate the predictive value of inflammatory factors for delayed healing, and logistic regression was used to identify independent risk factors associated with delayed healing.
   Results: After 72 hours of nutritional intervention, the EN group showed significantly higher serum albumin (35.90±4.67 g/L vs. 31.68±3.36 g/L, P<0.001), higher total protein (64.01±5.95 g/L vs. 61.57±5.60 g/L, P=0.026), lower visual analog scale (VAS) scores (1.70±0.29 vs. 2.21±0.31, P<0.001), and a lower proportion of delayed healing (8.2% vs. 29.6%, P<0.001) compared to the conventional treatment group. From the second day after surgery, serum levels of IL-6, IL-8, and IL-17 were significantly lower in the EN group at multiple time points. ROC curve analysis showed that IL-17 had the highest predictive value for delayed healing (AUC=0.793, cutoff=55.67 pg/ml, sensitivity=76.2%, specificity= 63.8%).
   Conclusion: We found that early enteral nutrition support significantly improved nutritional markers, reduced inflammatory responses, and reduced the proportion of patients with delayed healing in femoral neck fractures.

Abstract Background and Objectives: Previous studies have discussed the advantages of different anesthesia techniques in carotid artery surgery. However, there is not enough data comparing local anesthesia and block techniques. In this retrospective study, pain management during and after carotid endarterectomy cases is performed with regional and infiltration (tumescent) anesthesia.
   Methods: Endarterectomy cases performed in our clinic between 2022 and 2023 were examined. The patient's age, gender, comorbidities, type of anesthesia (infiltration anesthesia, deep cervical plexus block), and postoperative pain levels of the patients were evaluated.
   Results: Body Mass Index (BMI) means of patients were statistically significant and higher in cervical block patients compared to infiltration patients (P<0.05). Operation pain was significantly correlated with BMI (r=0.346; r<0.01) and medicine usage (r=-0.252; P<0.05). Pain after 24h was significantly correlated with operation duration (r=-0.296; P<0.05) and medicine usage (r=-0.286; P<0.05). The effect of medicine on operation pain was insignificant at a multivariate level (P>0.05), whereas the effect of BMI was significant (B=0.055; P<0.05) with controlling anesthesia type. Pain level according to BMI was significant with 0.717 Area Under Curve (AUC) value meaning 71.7% pain predictive value of BMI. Patients having a BMI over 22.85 had high pain with 93.2% positive predictive and 42.9% negative predictive level. Effects of medicine and operation duration on VAS after 24 hours were insignificant at the univariate level (P>0.05).
   Conclusion: Although there is no medical justification, retrospectively, cervical block was preferred more in patients with high BMI. High BMI predicts intraoperative pain, suggesting tailored analgesia for obese patients." Further researches are needed to understand cervical block preference for higher BMI and its effects on operation pain.

Abstract Background and Objectives: Metabolic syndrome is common in nonalcoholic fatty liver disease (NAFLD), and the serum uric acid to creatinine (sUA/Cr) ratio may indicate risk differently in men and women. This study explored the interplay that existed between the ratio of sUA/Cr and NAFLD risk with metabolic syndrome (MetS) across different genders.
   Methods: The cross-sectional study included 795 women and 2879 men who underwent physical examinations, consumed < 140 g/week and 210 g/week of alcohol, respectively, and tested negative for viral hepatitis. Participants were categorized based on the presence of NAFLD, identified through abdominal ultrasound. A logistic regression (LR) analysis was conducted to examine variables linked to NAFLD, estimating the adjusted odds ratio (OR) and performing an ROC curve analysis.
   Results: In our study of 2621 NAFLD participants (524 women and 2097 men), women with NAFLD exhibited significantly higher baseline levels of age, BMI, SBP, TG, TC, FPG, ALT, AST, GGT, LDL, sUA, and sUA/Cr compared to those without NAFLD. Similarly, men with NAFLD had significantly elevated baseline as females except for age, SBP, AND LDL, unlike their non-NAFLD counterparts. The results reveal that women with NAFLD exhibit significantly higher sUA/Cr levels compared to those without the condition, with an adjusted OR of 1.181 for each unit increment in sUA/Cr. In females with MetS, the SUA/Cr AUC was 0.608 (95% CI: 1.038 to 1.344), with a cut-off point of 5.50 and P < 0.001. The sUA/Cr were not associated with NAFLD presence in males.
   Conclusion: The study demonstrates a significant interplay between increased sUA/Cr and ultrasound-diagnosed NAFLD with MetS in healthy adults. The sUA/Cr could represent a dependable indicator to predict NAFLD in females with MetS.

Abstract Background and Objectives: Iran’s pharmaceutical sector has faced persistent challenges in ensuring equitable access, affordability, and supply continuity—exacerbated by sanctions and macroeconomic instability. In 2022, the government launched the Darooyar plan to reform drug subsidies, shifting from subsidized foreign exchange to insurance-based reimbursement. This study explores the historical evolution of pharmaceutical policy in Iran and identifies key barriers in the implementation of Darooyar.
   Methods: A mixed-methods approach was used. First, a scoping review of academic literature, policy documents, and official reports from 1979 to 2024 was conducted to trace long-term policy trends. Second, a qualitative study was carried out, including 18 semi-structured interviews with policymakers, insurance officials, pharmacists, health experts, researchers, and patients to examine the implementation process and its challenges, with interview data analyzed using thematic analysis.
   Results: The historical analysis revealed four main policy patterns: state-driven pricing, prolonged subsidy dependency, economic volatility, and fragmented governance. Interview findings highlighted five major challenges to Darooyar’s execution: limited coordination among institutions, financial liquidity problems for manufacturers, increased cost pressures on providers, rising out-of-pocket expenses for patients, and insufficient digital infrastructure for monitoring and oversight.
   Conclusion: Although Darooyar represents a significant policy shift, its impact has been constrained by entrenched structural and operational barriers. To enhance reform effectiveness, Iran must prioritize intersectoral coordination, stabilize insurance financing, invest in integrated digital systems, and align pharmaceutical governance with broader health system goals. A strategic, system-oriented approach is essential to achieve equitable and sustainable access to medicines.

Abstract Background and Objectives: Effective postoperative pain management is crucial, particularly in spine surgeries, which often result in significant discomfort. Adequate pain control facilitates early ambulation and reduces hospitalization duration. Chronic pain patients undergoing lumbar fusion surgery present additional challenges due to altered pain perception and prolonged opioid use. This study compares the efficacy of ketorolac and ketamine, in combination with morphine, for postoperative analgesia.
   Methods: This double-blind randomized clinical trial included lumbar fusion surgery candidates at Imam Khomeini Hospital, Sari. Patients were randomly assigned to three groups receiving ketorolac and morphine (Group A), ketamine and morphine (Group B), or morphine alone (Group C) via PCA pump. Pain intensity (NRS score) at rest and first movement, PCA bolus usage, hospitalization duration, demographic variables, nausea, vomiting, and surgery duration were recorded at multiple time points postoperatively.
   Results: A total of 120 patients (mean age: 52.5 years, 55% male) were analyzed. No significant differences were observed in hospitalization duration, gas passage time, or demographic variables. However, pain intensity at movement and multiple time points postoperatively, as well as PCA bolus usage, were significantly lower in Groups A and B compared to Group C. Group B had a lower incidence of nausea and vomiting in the first 2 hours postoperatively.
   Conclusion: Ketorolac or ketamine combined with morphine provides superior analgesia compared to morphine alone, with ketorolac demonstrating the most effective pain relief without severe complications.

Abstract Background and Objectives: Anemia is one of the most important health-related challenges worldwide. Unenhanced brain CT scans can be used to correlate dural sinus density with hemoglobin level. This study investigates the predictive capability of dural sinus density, measured through unenhanced CT scans, to evaluate anemia in patients.
   Methods: Patients who underwent unenhanced brain CT within 24 hours of hemoglobin test were selected for the study. The density of 5 regions of interest (ROI) in the dural sinuses was obtained and correlation with Hb level was analyzed.
   Results: In our study with a sensitivity of 94% and a specificity of 95%, Dural sinus density proves to be an effective screening tool, using 36.5 HU as a cut-off. This cut-off makes for good sensitivity for further evaluation with blood tests. The analysis reveals a strong positive linear correlation between mean Hounsfield units (HU) and hemoglobin (Hb) levels, enabling the formulation of a predictive regression equation (Hb=1.604+(0.309×mean HU)).
   Conclusion: Dural sinus density shows a strong relationship to the Hb level .By excluding confounding variables and utilizing a robust methodology, the findings advocate for the integration of automated Hb estimation via AI tools in CT imaging, which could significantly enhance clinical decision-making and patient outcomes. Overall, the study underscores the potential of Dural sinus density as a rapid and non-invasive indicator of anemia, aiming to reduce morbidity and mortality associated with this condition.

Abstract Background and Objectives: Tuberculosis (TB) remains the leading cause of mortality from infectious diseases globally. Effective prevention and control depend on coordinated efforts among various organizations. This study analyzes stakeholders involved in TB prevention and control in Iran.
   Methods: Using Varvasovszky and Brugha’s framework, a qualitative stakeholder analysis was conducted, focusing on roles, interests, positions, power, and influence. Stakeholders included governmental institutions, NGOs, healthcare organizations, and international bodies. Data were gathered through semi-structured interviews with 29 key stakeholders, analyzed using MAXQDA V.11 and Policymaker V.5 software.
   Results: 22 stakeholders were identified, grouped into governmental, semi-governmental, and international organizations. The Ministry of Health, Masih Daneshvari National Research Institute of Tuberculosis, Prisons Organization, and World Health Organization (WHO) showed high interest, significant influence/power, and strong support for TB policies. Conversely, Islamic Republic of Iran Broadcasting (IRIB), Ministry of Education, Islamic Consultative Assembly, Armed Forces, Ministry of Sports and Youth, NGOs, International Organization for Migration (IOM), and Relief Committee displayed low interest, low influence, and weak support. The United Nations Development Programme (UNDP), WHO, United Nations High Commissioner for Refugees (UNHCR), and Welfare Organization exhibited high interest and moderate influence. The Red Crescent Society, despite low interest, had high influence and strong support. The Association for the Support of Patients with Special Diseases showed high interest, low influence, and strong support.
   Conclusion: Effective TB prevention and control require robust stakeholder coordination. Enhanced management among stakeholders can significantly improve TB program outcomes.

Abstract    Background and Objectives: Hip replacement surgery (HRS) is an effective treatment for advanced hip arthritis, yet traditional postoperative care can delay recovery. This study evaluates a perioperative accelerated rehabilitation nursing model tailored for HRS, focusing on rapid rehabilitation to enhance outcomes.
   Methods: A retrospective cohort study was conducted with 200 patients who underwent unilateral total HRS at our facility between January 2022 and December 2023. Patients were divided into a control group receiving standard care (n = 112) and an intervention group receiving additional accelerated rehabilitation nursing (n = 88) over 12 weeks. Outcomes measured preoperatively and at 10 days postoperatively included physical and mental stress levels (measured one day before and after surgery), Harris Hip Scores, pain levels (VAS, NRS), Activities of Daily Living (ADL), quality of life, complications, and patient satisfaction. Statistical analysis included t-tests for continuous variables, chi-square tests for categorical data, and ANCOVA for post-intervention outcomes controlling for baseline values (α= 0.05).
   Results: The intervention group showed improved postoperative Harris Hip Scores (58.19 vs. 56.29, P=0.009) and reduced pain (VAS: 2.47 vs. 2.76, P=0.003; NRS: 2.77 vs. 3.07, P=0.005). Enhanced ADL scores (62.75 vs. 61.17, P=0.045) and reduced complications (6 vs. 49, P<0.001) were observed. Patient satisfaction increased significantly (59.09% very satisfied vs. 47.32%, P=0.006). Serum cortisol and stress scale scores were higher postoperatively in the intervention group, indicating increased stress (cortisol: P=0.025; SAS: P=0.008; SDS: P=0.018).
   Conclusion: The perioperative accelerated rehabilitation nursing model significantly enhances recovery outcomes and patient satisfaction in HRS, while increasing physiological stress levels.

Abstract    Background and Objectives: Levosimendan, a calcium sensitizer with inotropic and vasodilatory properties, has demonstrated efficacy in managing acute decompensated heart failure (ADHF). However, its proarrhythmic profile, particularly in the older adult population, where inotropic therapy is often used cautiously due to increased vulnerability to cardiac complications, remains poorly characterized. This study provides novel insights into the incidence and risk factors for arrhythmias, especially atrial fibrillation, among older adults with ADHF treated with levosimendan, a population frequently excluded from large, randomized trials.
   Methods: A retrospective propensity score-matched analysis included 424 patients aged ≥65 years with ADHF and left ventricular ejection fraction ≤40%. Patients were divided into levosimendan and control groups. The primary outcome was in-hospital occurrence of AF, ventricular fibrillation (VF), or premature contractions (APCs/VPCs). Logistic regression identified independent risk factors for arrhythmia.
   Results: After matching, 312 patients were analyzed. Arrhythmia incidence was higher in the levosimendan group (20.5%) versus control (16.7%). Levosimendan use was independently associated with increased AF risk (OR: 2.368; 95% CI: 1.022–5.487; P = 0.044). No significant link was found between levosimendan and VF or APCs/VPC. Patients with AF had longer hospital stays, though in-hospital mortality did not differ significantly across arrhythmia types.
   Conclusion: Levosimendan is linked to an increased risk of AF in older ADHF patients, highlighting the need for close cardiac monitoring. Despite this association, it remains a valuable treatment option for ADHF

Abstract Background and Objectives: Red blood cell alloantibodies are a major cause of peri- and post-transfusion problems, especially in frequently transfused individuals. To obviate this, it is essential to ensure of the compatibility between donors and recipients with regard to potential antigenic variations and their corresponding alloantibodies. This study aimed to assess the incidence of unexpected red blood cell alloantibodies among healthy blood donors at a referral center in southeastern Iran.
   Methods: This retrospective investigation was conducted from February 2024 to July 2024 at the Kerman Blood Transfusion Center, involving 400 healthy blood donors. Sera from these blood donors were subjected to antibody screening using commercial red cell alloantibody screening and identification panels. Additionally, donor phenotyping was conducted for ABO, Rh, and Kell blood group systems. Data analysis employed escriptive statistics to determine frequencies and percentages.
   Results: Unexpected alloantibodies were detected in 11 out of 400 donors screened (2.75%), including 7 with alloantibodies and 4 with autoantibodies. Regarding blood groups phenotypes, "D" and "k" antigens were positive in 94.25% and 96% of the donors, respectively. Regarding ABO phenotyping, O, B, A, and AB had the respective frequencies of 38%, 26%, 25.25%, and 10.75%. The most common alloantibodies were anti-M (0.75%), anti-D (0.5%), and anti-Lewis (0.5%).
   Conclusion: Both warm- and cold-reacting alloantibodies were found among healthy donors, suggesting that caution ought to be taken in donor blood typing, especially for the ABO group system. Also, antibody screening and identification should be considered in donated blood units to minimize transfusion-related risk in recipients.

Abstract The catastrophic explosion at Shahid Rajaee Port in Bandar Abbas on April 26, 2025, resulted in 57 fatalities and over 1,500 injuries, revealing critical vulnerabilities in Iran’s port emergency response systems. The Iranian Red Crescent Society (IRCS) responded swiftly, deploying 50 teams and employing aerial firefighting and medical assistance. However, shortcomings such as inadequate segregation of hazardous materials, aging infrastructure, and limited inter-agency coordination hampered effective crisis management.
This commentary examines the IRCS response and draws lessons from major global port disasters, including Beirut (2020) and Tianjin (2015). It advocates for stricter enforcement of the International Maritime Dangerous Goods (IMDG) Code, the integration of advanced technologies such as AI-based monitoring, and the enhancement of fire safety infrastructure. Strengthening these areas—alongside improved training and international collaboration—is essential for bolstering rapid response capabilities. The lessons from Shahid Rajaee highlight the urgent need for modernization and strategic planning to ensure safer, more resilient port operations in Iran and beyond.
  

Abstract Background and Objectives: The rising frequency of natural and human-made disasters underscores the need for effective disaster risk governance and enhanced social participation. This study employs a scoping review methodology to identify key components and strategies influencing social participation in disaster risk governance.
   Methods: The scoping review follows the Arksey and O’Malley framework. Data were collected from PubMed, Web of Science, ProQuest, Embase, Scopus, and Google Scholar, covering the period from 2000 to December 30, 2024. Additional manual searches were conducted in selected journals and relevant articles. A structured data extraction form was used, and Endnote X21 managed references. Content analysis was applied for textual data examination.
   Results: Among 7,323 initially identified articles and reports, 15 were selected for final review. Most studies focused on social participation during disaster preparedness and response phases. The findings highlight the significance of inter-organizational collaboration, crisis communication, capacity building, government and NGO roles, technology use, and resource allocation in enhancing social participation and disaster management effectiveness. Major barriers include public distrust in government institutions, communication and information challenges, structural limitations, and financial constraints.
   Conclusion: Social participation is crucial for strengthening disaster risk governance and community resilience. Key strategies include leveraging modern technologies, improving crisis communication, and fostering collaboration between governmental and civil organizations. However, challenges such as public distrust and structural constraints hinder implementation. To address these issues, policymakers and disaster managers should adopt integrated strategies combining top-down and bottom-up approaches while investing in essential infrastructure.

Abstract Background and Objectives: Trauma is a major global health concern, with severity ranging from minor injuries to life-threatening conditions. While some patients can be managed on an outpatient basis, others require urgent intervention. Timely and accurate triage is essential to reduce mortality and morbidity in severe cases. To support rapid clinical decision-making, especially in prehospital and emergency settings, several trauma scoring systems have been developed to stratify risk and prioritize care. This study aimed to compare the predictive performance of five commonly used trauma scoring systems in estimating 28-day mortality in adult trauma patients.
   Methods: This retrospective study included adult trauma patients (≥18 years) transported by 112 ambulance services to Kütahya Health Sciences University Emergency Department between December 1, 2019, and December 31, 2021. Prehospital Index (PHI), triage-Revised Trauma Score (T-RTS), Glasgow Coma Scale (GCS), Mechanism-GCS-Age-Arterial Pressure (MGAP), and Modified Rapid Emergency Medicine Score (mREMS) were calculated. The association of scores with 28-day mortality was investigated. Receiver operating characteristic (ROC) analysis was used to determine the predictive value.All statistical analyses were conducted using Statistical Package for the Social Sciences (SPSS) software.
   Results: Exactly 4,142 trauma patients were included in this study. Approximately 62% of the patients were male (n=2,567), and 3.4% (n=141) of them died in the first 28 days. The mean age of the surviving patients was 41.2±22.8 years, and the mean age of the non-survivor patients was 72.3±20.6 years (P<0.001). The mechanism of trauma was blunt trauma in 92.4% of the patients in the survivor group (n=3,699) and 97.9% in the non-survivor group (n=138) (P=0.013). It was observed that the mREMS, MGAP, GCS, RTS, and T-RTS scores were predictive of mortality in the first 28 days (P<0.001), whereas the PHI score was not (P=0.1501). The score with the highest predictive value was the mREMS (Area Under the Curve (AUC): 0.902; P<0.001; 95% Confidence Interval (CI): 0.892–0.910).
   Conclusion: The mREMS and MGAP scores were superior to other systems in predicting short-term mortality in trauma patients.

Abstract Background and Objectives: Transradial coronary angiography is well-liked due to its minimally invasive nature and quicker recovery. However, there are some occasional complications, such as catheter kinking and entrapment, that can lead to vascular injury and longer procedure times. In this report, we describe a new, non-invasive technique that employs a blood pressure cuff to manage catheter entrapment when conventional maneuvers are unsuccessful.
Case Presentation: An 84-year-old woman with a history of coronary artery disease, hypertension, dyslipidemia, anemia, and hypothyroidism presented with persistent palpitations and chest pain radiating to her neck that was getting worse.  A transradial coronary angiography was planned. The catheter was deeply kinked and trapped in the radial artery during transradial coronary angiography.  The deployment of a gooseneck snare and hand repositioning, two common recovery procedures, were unsuccessful.  In order to get around this problem, a blood pressure cuff was placed close to the entrapment site and gradually inflated. This changed the dynamics of the radial artery lumen and allowed the entrapped catheter to be released without the need for surgery.
Conclusion (Clinical Key Message): The creative use of a blood pressure cuff is a practical, non-invasive way to end catheter entrapment during transradial coronary angiography, as this instance illustrates.  This procedure highlights the value of flexibility and creativity in interventional cardiology by providing a readily available, affordable option without the possibility of further arterial damage.
 

Abstract    Background and Objectives: Cetuximab is commonly used as a chemotherapy drug for treating laryngeal cancer. Selenium, known for its antioxidant properties, is also believed to enhance the effectiveness of certain chemotherapeutic agents. This study aimed to evaluate how cetuximab and selenium influence the activation of the Transient Receptor Potential Melastatin 2 (TRPM2) channel.
   Methods: An observational study was conducted using cultured human laryngeal cancer cells (Hep-2). The cells were divided into seven experimental groups. Cumene hydroperoxide was used to stimulate the cells and activate TRPM2 channels, while antranilic acid was applied in certain groups to inhibit these channels. Measurements included cytosolic calcium levels, apoptosis, intracellular reactive oxygen species (ROS), mitochondrial depolarization, caspase-3 and caspase-9 activities, as well as immunohistochemical (IHC) staining. Statistical analysis was performed using GraphPad Prism 7.04, and data are presented as mean ± standard deviation.
   Results: Compared to the cetuximab-only group, cells treated with both cetuximab and selenium showed significantly higher levels of apoptosis, intracellular calcium, ROS, and caspase-3 and caspase-9 activities (P<0.001). Inhibition of TRPM2 channels by antranilic acid significantly reduced apoptosis in these groups (P<0.05 and P<0.001).
   Conclusion: The pro-apoptotic effect of cetuximab on laryngeal cancer cells appears to be mediated through TRPM2 channels. Selenium enhances this apoptotic response by promoting TRPM2 channel activation and increasing calcium influx. These findings highlight selenium’s regulatory role in apoptosis and calcium entry via TRPM2 channels.

Abstract Background and Objectives: Frailty is common in hemodialysis patients, affecting quality of life and clinical outcomes. Early identification can guide interventions, yet reliable predictive models for frailty risk remain limited. To determine the incidence of frailty in hemodialysis patients and develop a nomogram model for predicting frailty risk, aiding early identification and intervention.
   Methods: A cross-sectional study with 400 hemodialysis patients collected clinical data, laboratory indicators, social support, depression, anxiety, and sleep quality. Frailty was assessed using the Fried Frailty Phenotype scale. Univariate and logistic regression analyses identified risk factors for frailty, which informed a predictive nomogram model. Model performance was evaluated via ROC curve, calibration curve, and decision curve analysis (DCA).
   Results: Frailty incidence was 44.00%. Significant differences were observed between frailty and non-frailty groups in age, sex, education, diabetes, cardiovascular disease, serum albumin, social support, depression, anxiety, and sleep quality (P < 0.05). Logistic regression revealed that older age (OR=1.086, P=0.002), cardiovascular disease (OR=2.741, P=0.030), low serum albumin (OR=5.569, P<0.001), depression (OR=26.578, P<0.001), anxiety (OR=13.471, P<0.001), and poor sleep quality (OR=2.992, P=0.014) were significant risk factors. The nomogram demonstrated high predictive accuracy (AUC: 0.974 training, 0.980 validation). Calibration and DCA curves confirmed its reliability and clinical utility.
   Conclusion: Age, cardiovascular disease, serum albumin, depression, anxiety, and sleep quality were key risk factors. The nomogram offers a practical and accurate tool for early frailty identification and intervention.

Abstract Background and Objectives: Atherosclerosis (AS) is a major cause of cardiovascular disease with complex immune-mediated pathogenesis. This study aimed to identify hub immune-related genes involved in AS and investigate their causal mechanisms using comprehensive bioinformatics and experimental approaches.
   Methods: Differentially expressed immune-related genes (DE-IRGs) were identified from GSE20129 dataset (48 AS, 71 controls) using bioinformatics analysis (|log2 fold change| > 1.0, adjusted p-value < 0.05). Functional enrichment, protein-protein interaction network analysis, and immune cell infiltration analysis were performed. A nomogram model for AS risk prediction was developed and validated internally. Mendelian randomization (MR) analysis explored causal relationships between hub genes and AS. STAT1 function was experimentally validated using siRNA knockdown in RAW264.7 cells treated with LPS (100 ng/mL, 24h) followed by qPCR, migration, and cytokine assays.
   Results: We identified 125 DE-IRGs primarily involved in cytokine signaling and leukocyte functions. Ten hub DE-IRGs were identified, with STAT1 having the highest connectivity. The nomogram model demonstrated good predictive performance (calibration curve with minimal deviation). MR analysis revealed a potential causal relationship between STAT1 levels and AS susceptibility (OR=0.916, 95%CI=0.835-1.004, P=0.042). Experimental validation showed STAT1 knockdown significantly reduced LPS-induced inflammatory cytokine production and macrophage migration.
   Conclusion: This study provides valuable insights into the molecular pathogenesis of AS through integrated bioinformatics, MR analysis, and experimental validation. The identified hub genes, particularly STAT1, represent promising candidates for targeted interventions in AS management and prevention.

Abstract    Background and Objectives: Acute appendicitis is one of the most widespread causes of acute abdomen and one of the most common indications for abdominal surgery worldwide. This study was performed to examine the practicability of laboratory data in differentiating complicated appendicitis (CA) and uncomplicated appendicitis (UA) in different age groups and to investigate age-related differences such as histopathological diagnosis, mortality, intensive care unit (ICU) admission, and length of hospital stay.
   Methods: In this retrospective study, 785 patients over the age of two with a preliminary diagnosis of acute appendicitis were included over a five-year study period. Positive appendectomy patients identified as a result of pathological examinations were divided into two subgroups, CA and UA. The patients were also divided into groups based on their age at the time of presentation to the emergency department: 2–17 years (Group A), 18–64 years (Group B), and 65 years and older (Group C).
   Results: White blood cell (WBC), neutrophil, neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), neutrophil-to-white blood cell ratio (NWR), C-reactive protein (CRP), alanine aminotransferase (ALT), and direct bilirubin values, as well as the length of hospitalization, were all greater in the CA group compared to the UA group, while lymphocyte values were lower. All the differences were statistically significant (For NLR,NWR, CRP,length of hospitalization P<0.001;  for WBC, neutrophil, PLR, ALT, direct bilirubin values and lymphocyte P<0.05). There was no difference between the pediatric patients and those in the 18-64 age group in terms of length of hospitalization, ICU admission, or mortality.
   Conclusion: NLR and PLR calculation is an easily available, simple, and low-cost method for estimating the probability of complications in the early period in patients with appendicitis.

Abstract Background and Objectives: The diagnosis and treatment of comorbid tumors and heart disease presents significant challenges. To analyze the global research status of nuclear medicine imaging technology in patients with tumors and heart disease from 1963 to 2024, and to predict future development trends.
   Methods: Relevant literature on nuclear medicine imaging technology in the field of tumors comorbid with heart disease published from 1963 to March 2024 was retrieved from the Web of Science (WoS) core database and organized using Microsoft Office Excel 2019. All studies were indexed in the SCIENCE Citation Index Expanded (SCI-EXPANDED) and Social Science Citation Index (SSCI) dataset. Literature visualization analysis was performed using VOSviewer 1.6.15 and the Bibliometrix package of R software.
   Results: A total of 419 articles published between 1963 and 2024 were included in the study. The Netherlands (n=88), the United States (n=24), and the United Kingdom (n=22) were the main contributing countries in this research field. The dominance of these major contributing countries in nuclear medicine imaging research highlights their key role in fostering international collaboration on a global scale. The Journal of Nuclear Medicine was the primary source of literature, with scintigraphy (n=57), therapy (n=46), and breast cancer (n=36) being the main keywords in this field. Early studies (1963–2004) focused on scintigraphy and anthracycline-induced cardiotoxicity. Post-2005, research shifted to breast cancer and hybrid imaging (e.g., PET-CT) for therapy monitoring. 2015–2024 prioritizes cardiotoxicity (81.9% dominance), particularly linked to immunotherapies, with SPECT re-emerging for precision risk stratification.
   Conclusion: Nuclear medicine techniques in the field of oncological comorbidities and chronic heart failure can guide personalised treatment.

Abstract  Background and Objectives: Low back pain (LBP) subgroups exhibit distinct movement patterns. This study compared lumbar and hip kinematics during forward bending in two LBP subgroups—active extension pattern (AEP) and flexion pattern (FP)—versus healthy controls, using the O'Sullivan Classification System.
   Methods: In this cross-sectional study, 32 participants (11 AEP, 10 FP, 11 controls) were assessed. LBP subgroups were classified by physiotherapists based on pain patterns and movement behaviors. Kinematic data (lumbar/hip range of motion [ROM], lumbar-to-hip [L/H] ratios, and lumbar angles) were captured via 3D motion analysis. Statistical comparisons used ANOVA and LSD tests (P<0.05).
   Results: The AEP group showed greater total forward-bending ROM (P=0.039) and larger lumbar ROM (P=0.021) than controls. Significant differences in initial (P=0.005) and end-range lumbar angles (P=0.054) were observed between AEP and controls. No group differences were found in L/H ratios across movement intervals.
   Conclusion: This study highlights the importance of subgrouping LBP patients based on movement and postural patterns, as identified by the O'Sullivan Classification System. AEP patients displayed unique kinematics, including increased lumbar mobility and preserved lordosis during bending, unlike FP patients and controls. Additionally, the study suggests that initial and end-range lumbar angles are more clinically useful than L/H motion ratios for differentiating LBP subgroups.

Abstract    Background and Objectives: The hematopoietically expressed homeobox protein (HHEX) is closely related to the occurrence and development of a variety of neoplasms. The aim of this study was to explore the role of HHEX expression in nasopharyngeal carcinoma (NPC) tissue and its clinical significance.
   Methods: In this retrospective cohort study, we examined the expression of HHEX, the sensitivity of 8 common chemotherapeutic agents, in 76 NPC tissue specimens. The relationship between HHEX expression and clinical pathological factors, chemotherapy sensitivity and prognosis were analyzed by t test, chi-square test, analysis of variance, rank sum test, Spearman correlation analysis, log-rank test and multivariable Cox proportional hazard models.
   Results: HHEX expression was significantly upregulated in NPC tissues compared with chronic inflammatory tissues (P<0.001). HHEX expression was negatively correlated with T stage (r=-0.55, P<0.001), N stage (r=-0.36, P=0.006), M stage (r=-0.27, P=0.022) and clinical stage (r=-0.63, P<0.001). Chemotherapy resistance to paclitaxel was significantly lower in NPC tissue with high HHEX expression than that with low HHEX expression (P=0.004). The periods of progression-free survival in patients with low HHEX expression were significantly shorter than those in patients with high HHEX expression (P=0.041).
   Conclusion: HHEX was highly expressed in NPC tissue and may be involved in the NPC occurrence and development process. The levels of HHEX expression may possess significant prognostic value for individuals suffering from NPC. Monitoring of HHEX expression in these patients could provide critical insights into their sensitivity to chemotherapeutic agents and contribute to the evaluation of overall treatment outcomes.

Abstract Background and Objectives: Lower limb deep vein thrombosis (DVT) poses a significant risk to patients undergoing orthopedic surgeries. The aim of the present study was to develop a customized intervention plan and construct a risk prediction model for lower limb DVT in these patients.
   Methods: We used a convenience sampling method due to its practicality and efficiency in clinical settings to enrol orthopaedic inpatients. The samples were divided into two groups: a training set (n=183) collected between January 2020-December 2021 for model development and a validation set (n=83) collected from February-July 2022 for validation of risk prediction model. Model performance was assessed using accuracy, sensitivity, specificity, and the area under the ROC curve (AUC).
   Results: The model correctly identified 61 out of 83 patients, achieving 73.49% accuracy in identifying both DVT-positive and DVT-negative cases, with a sensitivity of 81.82% (9/11) for detecting DVT-positive patients and a specificity of 72.22% (52/72) for identifying non-DVT patients. The AUC (0.807, 95% CI: 0.671–0.894) reflects that the model had strong discriminatory ability, though some uncertainty remains, as reflected in the confidence interval with a Jorden index of 0.491 which balances sensitivity and specificity to optimize the model’s predictive power. The Sensitivity (83.4%) and Specificity (75.2%) of the model shows that it can effectively detect DVT cases while minimizing false positives. Multivariate regression analysis revealed that independent risk factors (occurrence rate<5%) included age (>60 years), post-surgery bedridden status (>5days), and spinal surgeries.
   Conclusion: This study developed a risk prediction model for lower limb DVT in critically ill orthopaedic patients. Key risk factors, including advanced age, prolonged post-surgery bedridden status, and spinal surgeries. Larger multi-center studies are needed for validation.

Abstract Background and Objectives: Timely thrombolytic therapy is very important after acute ischemic stroke (AIS). However, a significant proportion of patients experience significant delays at presentation. To explore the status and influencing factors of the pre-hospital delay in patients with AIS and to provide a reference basis and practical strategies for the prevention of AIS and the treatment of patients.
   Methods: A total of 100 patients with AIS who visited the emergency department and neurology department of Ningxia Medical University General Hospital from December 2020 to February 2021 were enrolled in this study. Questionnaire survey method were used to collect the following information: gender, age and other general information; the relevant conditions and treatment measures at the onset of stroke; patients' cognition of stroke risk factors. Logistic regression was used to analyze the related factors of pre-hospital delay.
   Results: There were 76 patients (76%) with a delay beyond the time window (6 h). Univariate analysis showed that occupation, type of labour, time of onset, location of onset and the hospital of first diagnosis were all related to the occurrence of the delayed pre-hospital delay visit (P < 0.05). Logistic regression analysis suggested that the first visit to the non-third-class hospital (odds ratio = 3.676, 95% confidence interval = 0.476–2.128) was the main influencing factor for the pre-hospital delay.
   Conclusion: The delay rate of patients with AIS is high in Yinchuan, so it is necessary to improve the residents' cognition of stroke, improve the patients' vigilance in seeking medical treatment after its onset, reduce the factors in the patients' delay in seeking medical treatment before hospitalisation and shorten the time before coming to the hospital. Patients should seek hospital treatment as soon as possible.

Abstract Gastric arteriovenous malformations (Gastric AVMs) are a rare etiology of upper gastrointestinal (GI) bleeding, and often present with ambiguous endoscopic findings. We hereby present the case of a 63-year-old man with recurrent upper GI bleeding, that was initially misdiagnosed as a submucosal tumor (SMT) following the initial gastroscopy, but was later diagnosed as a gastric AVM. Following the gastroscopy, the patient was treated with endoscopic hemostasis using metal clips. A re-bleeding episode prompted a second endoscopy 3 months following the procedure. This endoscopy revealed a donut-like ulcerated SMT lesion. Endoscopic ultrasonography (EUS) demonstrated a thickened mucosal layer with internal hypoechoic and anechoic regions, which indicated a vascular lesion. The presence of abundant blood flow within the lesion was confirmed on Doppler ultrasound. Digital subtraction angiography (DSA) corroborated these findings, demonstrating a characteristic donut-like image at the lesion site. The patient subsequently underwent laparoscopic-assisted partial gastrectomy, and had no postoperative bleeding episodes. Histopathological examination confirmed the diagnosis of gastric AVM.

Abstract  Background and Objectives: Early revascularization of occluded coronary arteries in patients with ST-elevation myocardial infarction (STEMI) has been shown to reduce mortality. Currently, physicians rely on electrocardiographic (ECG) features to identify the most likely location of occlusion in coronary arteries. We sought to more accurately predict these culprit arteries using deep learning.
   Methods: This retrospective case-control study was conducted to diagnose culprit lesion based on ECG using artificial intelligence (AI) in patients with STEMI referred to Imam Khomeini Hospital and Tehran Heart Center, Tehran, Iran. In this study, 804 patients who underwent coronary angiography (CAG) in STEMI setting were included. Subsequently, the ECG and angiography data of these patients were reevaluated, and AI experts analyzed the ECG and CAG using the EfficientNet_B7 algorithm, a deep learning approach that employs convolutional neural networks for high accuracy and computational efficiency. Finally, the presented model was analyzed.
   Results: This study evaluated a cohort of 804 patients. The proposed architecture, based on the EfficientNet_B7 algorithm, effectively integrates Transfer Learning and EfficientNet techniques to optimize data pre-processing prior to network input. A learning rate of 1×10−4 was employed to facilitate gradual weight updates, while a batch size of 32 was selected, thereby minimizing the risks of overfitting and underfitting. The training dataset was divided into 70% for training, 15% for validation, and 15% for testing, with the network's error function determined using Binary Cross Entropy loss. These findings underscore the potential of AI-driven approaches in enhancing diagnostic accuracy. Utilizing an AI model for ECG signal analysis, we achieved an impressive overall prediction accuracy of 98%. The model demonstrated a sensitivity of 96% and precision of 98% in identifying the left anterior descending (LAD) artery as the culprit vessel.
   Conclusion: Deep learning has the potential to enhance the diagnosis of culprit vessel in patients with STEMI. Our model successfully detected LAD occlusion in STEMI with 98% accuracy, 96% sensitivity, and 98% F1-score.

Abstract Background and Objectives: As altitude increases, the physiology of the lungs and heart changes. We want to study how altitude affects right ventricular function using the TAPSE/PASP ratio, a non-invasive measure of right ventricular contractility and its interaction with the pulmonary artery. To contribute to clinicians' understanding of how the right ventricle adapts to changes in oxygen pressure by assessing its function at different altitude levels.    Methods: Our study was a prospective observational cross-sectional study involving 190 participants. These participants were divided into two groups based on altitude: 95 from Malatya (950 meters) and 95 from Balıkesir (70 meters). We used echocardiography to measure TAPSE and PASP and then calculated the TAPSE/PASP ratio. The statistical analysis employed a combination of descriptive measures and inferential tests, which included Chi-square tests and multiple linear regression analysis, to identify the predictors of outcomes.    Results: TAPSE and TAPSE/PASP ratios were significantly higher in the high-altitude group (950 meters) than those at lower altitudes (70 meters) (P<0.001, t= -7.96 and P<0.001, t= -7.97, respectively.) The TAPSE/PASP ratio is significantly predicted by altitude in the regression model (ß=0.474, P<0.001). The change in altitude explains about 28% of the variance in the TAPSE/PASP ratio.    Conclusion: Currently, assessing right ventricular function involves TAPSE and PASP values and the TAPSE/PASP ratio. Our study revealed significant differences in TAPSE and the TAPSE/PASP ratio at different altitudes, providing enhanced insights into right ventricular function across these levels.

Abstract    Background and Objectives: Interleukin 8 (IL-8) is a major mediator involved in the development and progression of liver cancer. In this study, we assess whether IL-8 controls the expression of MMP-9 during the progression of liver cancer.
   Methods: The expression levels of IL-8, MMP-9, CXCR1, and CXCR2 in liver cancer cells with/without IL-8 knockdown or IL-8 treatment were determined by qRT-PCR and western blotting. Wound healing and Transwell assays were performed to assess the effects of IL-8-and IL-8/MMP-9-blocking antibodies on cell migration and invasion. The effects of GROα and CXCR2-neutralizing antibody on MMP-9 expression were also evaluated.
   Results: IL-8 and MMP-9, which were highly expressed in Huh-7 cells, were reduced by IL-8 knockdown. IL-8 treatment enhanced the expression levels of IL-8, MMP-9, CXCR1, and CXCR2. IL-8-neutralizing antibody inhibited liver cancer cell motility. MMP-9-neutralizing antibody counteracted IL-8 promotion of malignant characteristics. The IL-8-induced MMP-9 release was partially reversed by CXCR2-neutralizing antibody, but not CXCR1-neutralizing antibody. Furthermore, GROα-mediated MMP-9 release was counteracted by CXCR2-neutralizing antibody.
   Conclusion: The present study showed that IL-8 increased MMP-9, CXCR1, and CXCR2 expression and enhanced motility in Huh-7 liver cancer cells. These results suggested that IL-8 promotes liver cancer cell migration and invasion by upregulating MMP-9, primarily through the CXCR2 signaling pathway.

Abstract Background and Objectives: The popularity of hyperbaric oxygen therapy (HBOT) among athletes for speeding up recovery from sports injuries has been increasing recently. We aimed to systematically investigate the effect of HBOT on outcomes related to ankle function in acute ankle sprain.
   Methods: A literature search was conducted using population, intervention, comparison and outcomes (PICO) method in PubMed, Scopus, Web of Science, ProQuest, Google scholar, and Science Direct databases to obtain literature published until January 2025. The studies quality was examined through modifies Downs and Black checklist. A narrative analysis was performed since meta-analysis could not be conducted.
   Results: Five studies involving 122 individuals in the range of 18 and 34 years with a history of lateral ankle sprains were selected for final evaluation, all of whom received HBOT during the acute phase of their injuries. The HBOT was administered within the first 24 to 36 hours after the injury occurred. The quality of the studies varied, with three receiving a poor score and two receiving a good score. The outcome measures related to ankle function included ankle edema, pain levels, active and passive range of motion, overall ankle functionality, and the time taken to achieve recovery. There was a general consensus that follow-up visits after HBOT—especially when conducted at absolute atmospheric (ATA) pressure above 2—indicated significant improvement in these outcome measures compared to the initial visit for patients with lateral ankle sprains during the acute phase. However, there were discrepancies among the limited studies regarding the priority of HBOT compared to standardized physiotherapy.
   Conclusion: While the studies had some limitations in number and scientific quality, this review indicated that HBOT can be an effective intervention for improving ankle function in the acute phase of a lateral ankle sprain if administered within the first 24 to 36 hours following the injury.

Abstract Background and Objectives: Posterior Reversible Encephalopathy Syndrome (PRES) is an acute neurological syndrome distinguished by a variety of clinical features and characteristic neuroimaging findings associated with focal cerebral edema. Heterogeneous etiologies are encountered, with acute hypertension due to renal disorders being the principal risk factor.
Objectives: The primary aim of this study was to provide a comprehensive review of the available information regarding Posterior Reversible Encephalopathy Syndrome, including its clinical manifestations and risk factors in children.
   Methods: An extensive search of the PubMed database was conducted for relevant articles published from January 2010 to December 2024. Correlated data from eligible articles were extracted and described.
   Results: The principal neuroimaging finding of Posterior Reversible Encephalopathy Syndrome (PRES) is bilateral cerebral vasogenic edema, predominantly located in the occipital and posterior parietal white matter. Several mechanisms contribute to this condition, including dysfunction of cerebral autoregulation due to severe acute hypertension and breakdown of the blood-brain barrier resulting from endothelial injury. The combination of acute neurological manifestations, neuroimaging findings of vasogenic edema, and the presence of related provoking disorders raises suspicion for PRES. The mainstay of treatment is supportive care. In most patients, total resolution of abnormal clinical findings and imaging features occurs.
   Conclusion: Although many clinical features of pediatric PRES are similar to those in adults, there are notable differences, particularly regarding neuroimaging findings. The spectrum of clinical and neuroimaging findings of PRES in children is not widely recognized. Early diagnosis of the syndrome, identification of related risk factors, and appropriate management are crucial and can be life-saving.

Abstract Background and Objectives: Considering the high prevalence of substance abuse, this study focused on the relationship between substance use and acceptance of antihypertensive treatment.
   Methods: This study is a cross-sectional descriptive analysis. Data was collected using three questionnaires: demographic, Hill-Bone, and DAST-20. In this research, chi-square test and independent t-test were used for data analysis, and if the assumptions of independent t-test were not met, Mann-Whitney test was used. Cramer's V has also been used to examine the intensity of the relationship between two qualitative variables.
   Results: In the results of this study, the prevalence of substance consumption was higher in men with a frequency percentage of 37.5%, compared to women with a frequency percentage of 13%. The frequency of opium consumption was higher among substance users compared to other substances. Hookah consumption reduces the acceptance level of treatment, but in individuals whose blood pressure is controlled, the acceptance level of treatment was higher (P<0.05).
   Conclusion: There was no strong association between substance use and acceptance of antihypertensive treatment.

Abstract Aortic valve stenosis (AS) is the most prevalent valvular heart disease in developed countries, posing substantial clinical and economic burdens. Since its introduction in 2002, transcatheter aortic valve implantation (TAVI) has revolutionized treatment, necessitating meticulous risk assessment. Predictive analytics, particularly machine learning (ML), holds promise for forecasting health outcomes based on historical and real-time data. However, no systematic review has yet evaluated the application of predictive analytics in AS patients undergoing TAVI. To address this gap, a systematic search of Scopus, Web of Science, and PubMed/MEDLINE was conducted, identifying relevant studies published up to August 1, 2022. Seven studies met the inclusion criteria and were assessed using Qiao’s checklist for ML-based research quality. Findings were reported in accordance with PRISMA 2020 guidelines. The studies underscored the complexities of predicting post-TAVI mortality in AS patients, even with ML approaches. Some employed single ML techniques, while others utilized multiple algorithms, including artificial neural networks, Random Forest, Gradient Boosting, logistic regression, and automated ML. Input variables ranged from echocardiographic measurements and laboratory results to clinical symptoms and medical history. While mortality prediction was the primary focus, some studies also explored outcomes such as aortic regurgitation, valve sizing, and dyspnea improvement. Validation strategies included train/test splits, k-fold cross-validation, and leave-one-out methods. However, most studies relied on retrospective, single-center data with limited sample sizes and lacked external validation. Despite these constraints, ML-based algorithms show promise for enhancing cardiologists’ decision-making, provided their limitations are adequately addressed.

Abstract Background and Objectives: This study aims to identify novel genetic targets in thyroid cancer (TC) by conducting a comprehensive analysis of microarray datasets and investigating the genetic factors that drive TC development. By uncovering these factors, we provide valuable insights for future research and treatment.
   Methods: We performed a meta-analysis of three TC datasets from the GEO database, including data from 100 healthy controls and 220 TC samples. These datasets were processed using R, fol-lowed by batch correction and differential expression analysis. We then conducted DEG, eQTL, MR, GSEA, GO, and KEGG analyses to identify gene-disease associations.
   Results: Validation of the target genes confirmed their significant roles in TC pathogenesis and pro-gression. Specifically, gene expression analysis revealed 42 upregulated genes and 42 downregulated genes in TC samples. To explore the role of these genes further, we applied Mendelian randomization (MR) analysis, which identified four co-expressed genes—LAMP5, MTSS1, CEACAM1, and PRDX6—that were strongly associated with TC. These genes are involved in various biological processes, including macrophage activation and neural system modulation. Additionally, cell type-specific analysis revealed a unique immune cell landscape in TC, emphasizing the critical role of immune responses in disease progression. Notably, the MR findings were validated by variance analysis in the validation cohort, further strengthening the reliability of our results.
   Conclusion: This evidence not only validates our methodological approach but also reveals new mecha-nisms underlying TC pathogenesis, paving the way for targeted therapeutic interventions. Our findings offer significant insights into the molecular mechanisms of TC and highlight the potential for targeted therapies.

Abstract Background and Objectives: Circular RNAs (circRNAs) are gaining attention as potential biomarkers and regulators in various biological processes, including cancer. Their role in breast cancer and chemotherapy response monitoring is particularly promising. This study investigates the expression profiles of hsa_circ_0008717/circABCB10 and hsa_circ_0065173 in the peripheral blood of breast cancer patients before and after chemotherapy, aiming to identify non-invasive possible biomarkers for treatment response.
   Methods: The expression levels of hsa_circ_0008717/circABCB10 and hsa_circ_0065173 were quantified in peripheral blood samples obtained from breast cancer patients using SYBR-Green Real-Time RT-qPCR before and after chemotherapy.
   Results: Both hsa_circ_0008717/circABCB10 and hsa_circ_0065173 were exclusively expressed in breast cancer patient’s blood. Elevated levels were significantly associated with lymph node involvement and metastasis (P<0.0001) and advanced disease stages. While hsa_circ_0008717/circABCB10 levels did not significantly change before and after chemotherapy (P=0.24), hsa_circ_0065173 expression decreased significantly post-chemotherapy (P<0.004).
   Conclusion: The expression of hsa_circ_0008717/circABCB10 and hsa_circ_0065173 in blood samples shows promise as diagnostic biomarkers and prognostic indicators for breast cancer. Notably, hsa_circ_0065173 appears to be a potential candidate for monitoring chemotherapy response.
 

Abstract  Background and Objectives: Adjuvant therapy is very important to reduce mortality in patients with resected pancreatic cancer. The aim of this study was to compare adjuvant modified fluorouracil, leucovorin, irinotecan, and oxaliplatin (mFOLFIRINOX) combination chemotherapy with gemcitabine plus capecitabine (GEMCAP) chemotherapy, by using real life data.
   Methods: This is a retrospective study. A total of 87 patients with pathologically diagnosed pancreatic adenocarcinoma between January 2021 and December 2023 were included in the study. Modified FOLFIRINOX regimen was compared with GEMCAP regimen. Kaplan-meier analysis was used for Disease-Free Survival (DFS) and Overall Survival (OS).
   Results: Of the total 87 patients, 52 were treated with mFOLFIRINOX, and 35 received the GEMCAP. The median DFS of patients receiving FOLFIRINOX was 20 months (95% Cl, 17.27-22.72), while the median DFS of patients receiving GEMCAP was 15 months (95% Cl, 12.32-17.64). mFOLFIRINOX treatment was significantly different from GEMCAP treatment (P<0.001).  The median OS of patients receiving mFOLFIRINOX was 43 months (95% Cl, 39.46-46.53), while those receiving GEMCAP had a median OS of 31 months (95% Cl, 28.79-33.20). The median OS of patients receiving mFOLFIRINOX was significantly better than that of patients receiving GEMCAP (P≤0.001).
   Conclusion: In resected pancreatic cancer patients, mFOLFIRINOX provided a statistically significant disease-free survival and overall survival benefit compared to GEMCAP treatment. Due to its higher toxicity rates, mFOLFIRINOX is recommended as a treatment option for patients who are younger and have good performance status.

Abstract Background and Objectives: End-of-life care (EOLC) constitutes a vital aspect of the responsibilities undertaken by intensive care nurses, positioning them uniquely to collaborate with families in delivering compassionate care to patients approaching the end of their lives. Therefore, this study aims to determine the effect of stress on the quality of end-of-life care provided by Jordanian nurses working in intensive care units.
   Methods: Cross sectional survey was conducted from November 2022 until May 2023 using Nursing Stress Scale (NSS) and Specific quality end-of-life care questionnaires. Intensive Care nurses in eight government hospitals (N=200) were recruited in this study. A linear regression test was used to identify the effect of stress levels and death anxiety levels on the quality of EOLC.
   Results: The study yielded a comprehensive response rate of 72%, revealing a notable prevalence of stress among Intensive care nurses. Despite high stress levels, these nurses demonstrated commendable performance in delivering End-of-Life Care, with mean scores indicating proficiency (Mean±SD=74±22, 15.26±7.15, respectively). Noteworthy findings from the analysis indicated a low impact of stress on the quality of end-of-life care (β=0.379, SE, 0.68, P <0.001).
   Conclusion: Despite facing numerous stress-inducing factors during their work, Jordanian intensive care nurses exhibit resilience. Even in the face of moderate to high stress levels and the existence of various obstacles that may hinder the provision of quality End-of-Life Care, these nurses consistently deliver commendable care to patients approaching the end of their lives.

Abstract    Background and Objectives: Developing inhibitors against factors VIII and IX in hemophilia A and B is a major complication, leading to serious clinical consequences and increased healthcare burden. Managing these patients remains a challenge in resource-limited settings. This study evaluated the impact of management strategies on the severity of joint complications in patients with inhibitors.
   Methods: This retrospective cohort included 60 patients with severe hemophilia A: 12 with inhibitors receiving bypassing agents on an on-demand regimen and short-term prophylaxis for target joints, and 48 without inhibitors receiving FVIII as long-term prophylaxis. Patients were followed between February 2021 and February 2022 at a major hemophilia comprehensive care center in Iran. Hemarthrosis events and joint damage were assessed through range of motion limitations (LOM) and the Arnold-Hilgartner radiographic grading system. Independent samples t-tests and Mann-Whitney U tests were used for analysis.
   Results: Hemarthrosis was more frequent in the inhibitor group (64 vs. 36 events). A higher percentage of inhibitor patients experienced hemarthrosis (75% vs. 39.6%, P = 0.028) and developed target joints (50% vs. 12.5%, P = 0.002). LOM was significantly greater in the inhibitor group (33.3% vs. 8.3%, P = 0.023). Ankle and knee joints were most affected in inhibitor patients, while nearly half of the non-inhibitor group’s hemarthroses occurred in the ankle.
   Conclusion: Hemophilia patients with inhibitors on an on-demand regimen develop more joint complications than those without inhibitors receiving long-term prophylaxis. These findings highlight the need for implementing prophylaxis in inhibitor patients to prevent joint damage and improve long-term outcomes.

Abstract Background and Objectives: Breast cancer is the most common cancer in women worldwide and poses a major public health challenge. Early detection and effective treatment are essential for better survival and outcomes. Traditional diagnostic and treatment approaches have evolved over time, and recent advancements in artificial intelligence (AI), including screening, diagnosis, treatment, and prognosis, have shown great promise in revolutionizing breast cancer care.
   Methods: The PubMed, Web of Science, and Scopus databases were searched using terms such as “artificial intelligence”, “machine learning”, “breast cancer”, and “breast neoplasm”, prioritizing recent publications.
   Results: AI’s ability to assist in medical imaging, predict cancer risk, and integrate with other screening methods is transforming traditional practices. Studies have demonstrated AI’s potential to match or even surpass that of human experts in cancer detection, increasing diagnostic accuracy and aiding in classifying tumor subtypes and grades. AI-driven predictive models are instrumental in predicting disease progression and treatment outcomes, allowing for more personalized therapeutic interventions. The adoption of AI in mammography has been shown to reduce radiologists’ workload while maintaining or improving diagnostic performance. AI models in ultrasound imaging enhance the differentiation of benign and malignant lesions, thus reducing unnecessary biopsies. In MRI, AI aids in precisely detecting and characterizing breast lesions, outperforming traditional methods.
   Conclusion: AI has significantly enhanced breast cancer care by improving diagnostic accuracy, aiding in early detection, and enabling personalized treatment. Its integration into screening and imaging processes is revolutionizing traditional practices, offering promising advancements in both clinical outcomes and healthcare efficiency.

Abstract Background and Objectives: The objective of this research is to establish a scientific map, conduct a structural analysis, and investigate the subject's evolution in order to identify emerging trends in articles concerning the correlation between blood groups and cancer.
   Methods: The Web of Science, Scopus, and PubMed databases were used to gather all publications from June 2003 to December 2023 that discussed the relationship between blood types and cancer. The R-package Biblioshiny was utilized to do bibliometric analysis.
   Results: A total of 2,951 papers were examined and evaluated. Since 2013, the number of publications related to blood groups and cancer has decreased. The most influential journals are Transfusion, Plos One, and Bone Marrow Transplantation. The United States, China, and Japan lead the field, with the US National Cancer Institute making significant contributions. The word cloud reveals frequent discussion topics such as ABO blood group, kidney transplant, gastric cancer. The theme evolution map from 2003 to 2015 shows significant discussion on transfusion, transplantation, Helicobacter pylori, bone marrow, and liver transplantation. From 2016 to 2023, the prevailing subjects include liver transplantation, ABO blood group, Helicobacter pylori, ovarian cancer, and chemokines.
   Conclusion: The scientometric analysis revealed a changing trend in research output, showing a notable increase until 2013, followed by a decline. The thematic analysis indicates a shift in research focus over time, moving from topics like transfusion, transplantation, and Helicobacter pylori to liver transplantation, the ABO blood group system, ovarian epithelial cancer, and chemokines.

Abstract    Background and Objectives: Non-small cell lung cancer (NSCLC) remains a leading cause of cancer mortality, with poor prognosis for advanced stages. Thoracoscopic segmentectomy offers a treatment option, yet recurrence poses a significant challenge. This study investigates the prognostic utility of serum biomarkers Macrophage Inhibitory Cytokine-1 (MIC-1) and Cystatin C (CysC) in patients with advanced NSCLC post-segmentectomy.
   Methods: A retrospective analysis was conducted on 300 patients who underwent thoracoscopic segmentectomy from June 2017 to September 2023. Patients were grouped into non-recurrent (n=188) and recurrent (n=112) categories. Serum levels of MIC-1 and CysC were measured and analyzed using SPSS v29.0. Additional variables such as demographic data, pathological state, blood components, tumor markers, and inflammatory factors were evaluated by logistic regression analysis.
   Results: Recurrent patients showed significantly elevated serum MIC-1 and CysC levels compared to non-recurrent patients, with MIC-1 at 1366.95±214.25 pg/ml vs 903.23±113.12 pg/ml (P<0.001) and CysC at 0.89±0.23 mg/L vs 0.66±0.12 mg/L (P<0.001). Elevated levels of tumor markers CEA (OR=1.07, 95% CI, 0.49 to 1.80, P=0.042), NSE (OR=1.07, 95% CI, 0.67 to 1.90, P=0.005), AFP (OR=1.09, 95% CI, 0.76 to 1.86, 0.026), CA125 (OR=1.08, 95% CI, 0.86 to 1.53, P=0.004) and inflammatory factors MMP-2 (OR=1.03, 95% CI, 0.59 to 1.75, P=0.022), IL-8 (OR=1.02, 95% CI, 0.78 to 1.78, P=0.043), IL-6 (OR=1.10, 95% CI, 0.85 to 2.01, P=0.025) were also associated with recurrence. No significant differences were observed in age, gender, body mass index, or perioperative factors such as operation time and bleeding.
   Conclusion: The findings underscore the potential of MIC-1 and CysC as prognostic biomarkers for recurrence in advanced NSCLC following thoracoscopic segmentectomy.

Abstract Background and Objectives: The use of cone-beam computed tomography (CBCT) for accurate diagnosis is increasing; however, there is a significant gap in the literature regarding the reasons for CBCT requests in maxillofacial surgery. This study aimed to analyze the CBCT referral process of patients who applied for maxillofacial surgery clinic by assessing the request reasons for CBCT imaging.
   Methods: Patients with insufficient conventional images who were admitted to the oral surgery department between January 2018 and June 2019 were retrospectively analyzed. Patients were classified based on their CBCT referral reasons. The mean ages of female and male patients were statistically compared using the independent samples t-test. The distribution of mean ages by gender was assessed using the Kruskal-Wallis test, while the mean ages of patients for the top three reasons for requesting CBCT were compared using the Chi-Squared test.
   Results: A total of 2376 patients were grouped based on their CBCT referral reasons. The most frequent reason was the evaluation of impacted mandibular third molar with 823 (34.6%) patients. 365 (15.36%) patients were referred to CBCT for the various odontogenic cysts and benign tumors, and 357 (15.02%) patients were referred to CBCT for an implant evaluation. The least frequent reasons were for the calcified areas with 9 (0.4%) patients, and for the sleep apnea with 3 (0.13%) patients.
   Conclusion: As a result, the most common need for CBCT in maxillofacial surgery practice was to evaluate the position of the impacted mandibular third molar.

Abstract Background and Objectives: The pathogenesis of irritable bowel syndrome with diarrhea (IBS-D) is not fully clear. This study aims to explore the underlying disease mechanisms of IBS-D using bioinformatics approaches.
   Methods: Raw sequencing data related to IBS-D were downloaded from the GEO database (datasets GSE14841, GSE36701, GSE146853, and GSE166869), followed by differential gene expression analysis using R. Disease-related genes associated with IBS-D were identified from five databases: Genecards, Disgenet, TTD, Drugbank, and OMIM. Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis, and protein-protein interaction (PPI) analysis were performed on the identified genes. Further disease correlation analysis of key genes was conducted using the Comparative Toxicogenomics Database (CTD).
   Results: A total of 481 differentially expressed genes (305 upregulated, 176 downregulated) were identified from the GEO datasets. Enrichment analysis suggested that the pathogenesis of IBS-D may involve multiple molecular mechanisms, including immune response, chromatin remodeling, and viral infections. Across the disease databases, 228 IBS-D-related genes were found (Genecards: 222, Drugbank: 6). GEO dataset and the disease database had a total of 4 intersecting genes (CCL2, MUC1, CASR, PRKCA). Related disease analysis of the key 4 genes by CTD database revealed that IBS-D was associated with Chemical and Drug Induced Liver Injury, Fatty Liver, Hepatomegaly, Liver Cirrhosis, Liver Diseases, Liver Neoplasms existed in correlation.
   Conclusion: CCL2, MUC1, CASR and PRKCA may be involved in the pathological process of IBS-D through IL-17 signaling pathway and bile secretion regulation, and their co-occurrence with liver diseases in the CTD database suggests that the mechanism of intestinal-hepatic interactions is worth exploring in depth.
 

Abstract Background and Objectives: Mental impairment disrupt the brain's regular performance, as the nutrition has playing a crucial role in its prevention. Amino acids, fundamental components of proteins, serve as vital precursors to neurotransmitters, the dysfunction of which is closely linked to various brain disorders. The aim of this study was to explore the association between the consumption of different categories of food proteins derived from plants and animals and overall mental health status.
   Methods: The current cross-sectional study involved 200 healthy adults selected through random sampling from the Sabzevar Persian cohort study. Assessment of their mental health was done using a 28-items General Health Questionnaire (GHQ), as well as dietary information was gathered using a food frequency questionnaire (FFQ), which was analyzed by N4 nutritional software to determine the daily quantity of protein obtained from animal and plant sources. Statistical analysis was performed utilizing SPSS 20 software.
   Results: Totally, 124 (62%) of the subjects were male and 76 (38%) were female. Notably, the findings indicated a negative relationship between processed meat consumption and mental health (r=-0.114, P<0.05); however, no significant association was detected between the mental health and consumption of animal or plant-based proteins.
   Conclusion: It is concluded that the intake of animal and plant proteins except processed meat does not impact mental health of apparently healthy subjects.

Abstract Background and Objectives: Obesity is growing one of the health problems in the world and is becoming pandemic. We aimed to evaluate the inflammatory parameters associated with cardiovascular diseases in morbid obese patients by comparing neutrophil/lymphocyte (NLR), platelet/lymphocyte (PLR), and monocyte/ High-density lipoprotein (HDL) (MHR) ratios with the healthy group.
   Methods: This is a retrospective observational study. A hundred patients who were diagnosed with morbid obesity by applying to Adana Training and Research Hospital Endocrinology and Metabolism Diseases polyclinic between January 2019 and December 2020 will be screened retrospectively. Seventy-two patients who were not diagnosed with obesity and any disease affecting the cardiovascular system will form the control group. Neutrophil/lymphocyte, platelet/lymphocyte, monocyte/HDL ratios of both groups will be calculated, recorded and evaluated. Statistical analysis was performed using SPSS 25.0 software.
   Results: Compared to the control group, platelet (P=0.001), neutrophil (P=0.001), lymphocyte (P=0.001), glucose (P=0.001), and insulin levels (P=0.030), BMI (P=0.001), NLR (P=0.020), and MHR (P=0.005) were statistically significantly higher in the morbid obese group. The risk factors found to be significantly associated with morbid obesity in the multiple logistic regression analysis included insulin level (P=0.010, OR (95% CI): 1.037 (1.009-1.068)) and MHR (P=0.008, OR (95% CI): 18.726 (4.876-32.576)).
   Conclusion: NLR and MHR are both cost-effective and straightforward to compute. Particularly, MHR could serve as a valuable indicator for anticipating cardiovascular ailments in individuals with obesity. We think that morbid obesity has an effect on inflammatory parameters associated with cardiovascular diseases.
 

Abstract    Background and Objectives: With the increasing number of bariatric surgeries (BS), ethical issues are increasing.  This study aimed to evaluate the challenges of medical ethics and best decisions in patients with incidental findings during laparoscopic BS.
   Methods: This study was a hybrid research including qualitative and quantitative approach investigating patients’, surgeons’, and medical ethics specialists’ (MES’s) opinions about six scenarios explaining six different incidental findings during BS, conducted during 2020-2021, in Tehran, Iran.
   Results: 63 participants (38 female, and 25 male), with a mean age of 34.76±7.16 years including 45 patients, 12 surgeons, and 6 MESs participated in the study. While in malignant or suspicious cases, the opinions of these groups were aligned, in benign scenarios there were some differences among surgeons’ views and MES and patients’ opinions.
   Conclusion: In conclusion, our study has demonstrated that the majority of surgeons would rather perform the agreed surgical plan in case of benign/non-lethal findings. The surgeons would also terminate the surgery in inconclusive/ highly suspicious states.

Abstract Background and Objectives: Rheumatoid arthritis (RA) is a chronic inflammatory autoimmune disease that can lead to joint damage and disability. Early and accurate prediction of its prognosis is crucial for timely intervention and improvement of patient outcomes. This work evaluated the accuracy of the musculoskeletal ultrasound combined with serum inflammatory factor (SIF) detection method in predicting the prognosis of RA.
Methods: This was a research report. 80 patients with RA treated at Affiliated Northwest University, Third Hospital of Xi’an from February 2022 to May 2023 were recruited. Based on the prognosis, they were allocated into a good prognosis (GP) group (n=42) and a poor prognosis (PP) group (n=38). Musculoskeletal ultrasound, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and tumor necrosis factor-alpha (TNF-α) were measured in all patients. The Rheumatoid Arthritis Disease Activity Index (RADAI) was recorded before and after the patients were treated, and the accuracy of different indicators in predicting RA prognosis was compared. Data analysis was performed using SPSS 26.0. For categorical data, chi-square tests were conducted; for continuous data, t-tests were used. A P-value of <0.05 was considered statistically significant.
Results:Musculoskeletal ultrasound showed that the blood flow parameter grading in the GP group was significantly different compared to the PP group (P=0.009), and the synovial proliferation parameter grading in the GP group also showed a significant difference when compared to the PP group (P=0.024). The levels of ESR, CRP, and TNF-α in patients increased with the increasing grades of synovial proliferation/blood flow parameters. Significant differences were observed in ESR (P=0.011), CRP (P=0.026), and TNF-α (P=0.009) levels among patients with different synovial proliferation parameter grades (P<0.05). After treatment, the RADAI score (P=0.038), CRP (P=0.002), ESR (P=0.011), and TNF-α (P=0.031) levels in the GP group were significantly lower than those in the PP group (P<0.05). The AUC for musculoskeletal ultrasound combined with CRP, ESR, and TNF-α in predicting PP in RA was significantly higher than that of musculoskeletal ultrasound (P=0.026), ESR (P=0.006), CRP (P=0.045), or TNF-α (P=0.033) alone (P<0.05).
Conclusion:Musculoskeletal ultrasound jointed with SIFs demonstrated good accuracy and clinical significance in predicting the prognosis of RA.

Abstract Background and Objectives: Intraoperative acquired pressure injuries (IAPI) remains a critical preventable complication, necessitating systematic investigation of modifiable risk factors to optimize perioperative patient safety. To investigate the incidence and risk factors of IAPI in surgical patients, and to provide clinical reference for the prevention and treatment of patients with IAPI.
   Methods: Retrospective analysis of the clinical data of 354 patients who underwent surgical treatment (surgical duration >2H) from 1 May 2020 to 1 March 2022 in the Department of Surgery of the People's Hospital. The CORN Intraoperative Acquired Pressure Injury Risk Assessment Scale was used to collect factors such as patient-related demographic data, type of surgery, and intraoperative characteristics. Statistical methods were applied for descriptive analysis, univariate analysis, and multivariate logistic regression analysis.
   Results: The incidence of IAPI in surgical patients was 12.99%, with stage I being the most common (91.24%). The sites with a higher frequency of IAPI were sacrococcygeal (36.96%), foot (19.57%), and head and face (10.87%), in that order. Anaesthesia classification (P=0.023, OR=1.324, 95%CI: 1.002-1.529), body mass index(BMI) (P=0.001, OR=1.898, 95%CI: 1.68-2.154), skin condition of the compression site (P=0.000, OR=1.799, 95%CI: 1.385-2.512), preoperative limb activity (P=0.050, OR=1.210, 95%CI: 1.001-1.469), high-risk disease (diabetes mellitus) (P=0.000, OR=1.529, 95%CI: 1.398-1.993), intra-operative hemorrhage (P=0.001, OR=0.742, 95%CI: 0.532-0.779) and actual duration of surgery (P=0.000, OR=1.934, 95%CI: 1.397-2.267) were risk factors for IAPI.
   Conclusion: There are many risk factors for intraoperative acquired pressure injury. We recommend individualised prevention and control measures for patients at high risk of developing IAPI, which can reduce the incidence of IAPI to some extent.

Abstract Background and Objectives: Severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2) responsible for the COVID-19 outbreak, is an RNA virus of the genus Beta-Coronavirus. This study aimed to investigate the relationship between blood group antigens and susceptibility to infection, clinical manifestations, and prognosis of patients with COVID-19 identified in the city of Sanandaj.
   Methods: In this study 420 COVID-19 patients (confirmed with PCR testing) in Sanandaj (Iran) took part in the study in 2020. The demographic, symptoms, hospitalization status, comorbidity, mortality rate of the patients were registered based on their medical records. Blood type of the patients were also determined testing their blood samples. The data were then analyzed using STATA 16 software.
   Results: The findings showed that the mean age of the participants was 58.7±18.32 years. The O blood group distribution was significantly related to the mean term of hospitalization (P<0.001). The mortality rate was significantly different between different groups of blood types AB (OR=3.50, 95% CI=1.01-12.13, P=0.048). There were no significant differences between the other blood group patient groups (P>0.05). Also, among the clinical symptoms, the prevalence of cough, diarrhea, headache, joint pain, and abdominal pain was higher in people with anti-A antibodies.
   Conclusion: The results of the study showed that patients with blood group O did not have a high mortality rate, despite a long hospitalization duration, and blood group AB was at higher risk of infection and mortality compared to other blood groups.

Abstract Background and Objectives: Hospitals are the most vital part of the health system that must provide quality services in any condition. The aim of this study was to identify the indicators of resilience of hospital service quality during pandemics.
   Methods: A scoping review was conducted according to PRISMA-ScR statement guidelines in 2025. A structured search was conducted in the Web of Science, PubMed, Scopus, and ProQuest databases, as and the Google Scholar search engine from January 01, 2000 to January 10, 2025. A Data extraction form was used for data collection. Inclusion criteria include all qualitative, quantitative or mixed methods articles focused on the hospital’s quality of service indicators. Content analysis was applied for data analysis.
   Results: A total of 2663 articles were yielded; 79 articles were finally included in the study. The study design of included articles were Our findings identified 349 initial concepts, 89 unique concepts and 10 themes, including continuous access to care, physical capacity, human resources, efficiency, Effectiveness, safety, inter-sectoral coordination, communication, education, and planning and evaluation.
   Conclusion: This scoping review has mapped the indicators used in assessing the resilience of hospital service quality over two decades globally. The identified indicators can be appropriate solutions to improve the resilience of hospitals in pandemic conditions. These findings can provide valuable information for policymakers and decision-makers for managing the quality of services at hospitals during pandemics.

Abstract    Background and Objectives: Dynamic neuromuscular stabilization (DNS) is an exercise protocol that has recently attracted attention of many researchers in field of chronic pain control.
Objectives: To investigate the effectiveness of DNS exercises on the thickness of core muscles and level of pain and disability in people with non-specific low back pain (NSLBP).
   Methods: In a randomized clinical trial, 44 people with NSLBP with an age range between 30 and 50 years were randomly divided into two groups: intervention and control, with 22 in each group. The control group received routine physical therapy exercises, while the intervention group performed DNS exercises. The thickness of transverse abdominis and multifidus muscles was assessed during the abdominal hallowing maneuver and in the standing position using ultrasound. Pain and functional disability were assessed using the visual analog scale and Roland-Morris disability questionnaire, respectively. The outcomes were measured in both groups before and after 8 weeks of interventions.
   Results: The results showed that after the 8-week intervention, the multifidus muscle thickness during muscle contraction and in the standing position, as well as transverse abdominis thickness in the standing position, were significantly greater in the DNS group compared to the control group (P<0.001). However, there was no significant difference in the TrA percentage thickness change during abdominal hallowing between the DNS and control groups. Additionally, pain and disability scores were significantly decreased in the DNS group compared to the control group after the intervention (P<0.001).
   Conclusion: The study suggests that use of DNS exercises in people with NSLBP can help improve the activity level of core muscles and stability of lumbar vertebrae, which are both important components of physiotherapy goals for patients with NSLBP.

Abstract Background and Objectives: The global increase in the elderly population has led to a significant rise in chronic diseases such as diabetes and hypertension. In Türkiye, individuals aged 65 and older are projected to constitute 11% of the population by 2025. These demographic shifts highlight the importance of understanding age-related biochemical changes in common chronic conditions.
Objectives: This study aimed to examine the relationship between diabetes, hypertension, and selected oxidative stress parameters in individuals aged 65 and older, with the goal of identifying clinically relevant markers.
   Methods: This cross-sectional study included 296 participants aged ≥65 who presented to Kula State Hospital in 2023. Individuals with smoking history, alcohol use, antioxidant supplementation, or other chronic diseases were excluded. Blood samples were analyzed for total thiol, malondialdehyde (MDA), total antioxidant capacity (TAC), total oxidant capacity (TOC), catalase, paraoxonase (PON1), arylesterase (ARE), and 8-hydroxy-2'-deoxyguanosine (8-OHdG) using commercial kits. Independent-samples t-tests and Pearson or Spearman correlations were used. All assays were performed in duplicate with quality control; coefficient of variation values were <10%.
   Results: Statistically significant differences were found between the control, diabetic, and hypertensive groups in oxidative stress markers, particularly MDA, 8-OHdG, and PON1. Diabetic individuals showed elevated oxidative damage and reduced antioxidant defenses.
   Conclusion: Oxidative stress markers were significantly altered in elderly individuals with diabetes and hypertension. While these associations are notable, the cross-sectional design precludes causal inference. Routine assessment of oxidative stress may aid in risk stratification and management of elderly patients.
 

Abstract    Background and Objectives: Ultrasound imaging is crucial for breast cancer diagnostics but is prone to subjectivity, causing delays and errors. This study aims to improve diagnostic efficiency and reduce reliance on human interpretation by introducing a novel breast tumor diagnosis technique using a squid game optimization-inspired neural network (SGO-NN).
   Methods: The proposed method combines a Siamese neural network (SNN) with SGO techniques to detect tumor variations in ultrasound images. Publicly available breast ultrasound images were preprocessed with a Gaussian filter to enhance quality and remove extraneous information. The Adaptive Watershed Transformation (AWT) approach was used for segmentation, and significant texture characteristics were extracted using the gray-level statistical matrix (GLSM) method. The SGO-NN technique was then trained to identify breast tumors.
   Results: The SGO-NN method achieved high performance with sensitivity (94.80%), recall (93.50%), accuracy (91.30%), specificity (93.20%), and precision (92.70%). This performance surpassed existing methods, including Convolutional Neural Networks (CNN), Cubic-Support Vector Machine (C-SVM), and Extreme Gradient Boosting (XG-BOOST).
   Conclusion: The SGO-NN method accurately recognizes breast cancers from ultrasound images and outperforms existing methods. This advancement shows significant potential for improving diagnostic processes, reducing human error in medical imaging, and broadening the application of automated diagnostics. Future work should focus on improving computational efficiency, enhancing interpretability through explainable AI approaches, and integrating modern imaging technologies for more accurate and accessible diagnosis.

Abstract Background and Objectives: Previous studies on Red Blood Cell Distribution Width (RDW)  and Systemic Immune Inflammatory Index (SII)  have focused on the prognosis of breast cancer, but few studies have explored its diagnosis. The study aimed to determine the clinical value of the RDW and SII in preoperative peripheral blood in differentiating benign from and malignant breast diseases.
   Methods: Patients with breast disorders who visited our hospital for the first time between June 2021 and June 2022 were enrolled.The expression levels of RDW, SII, NLR, PLR and LMR were compared between the two groups. These indicators were analyzed useing the ROC. Analysis indicators included the optimal value, AUC, sensitivity, specificity,and their combination. Subsequently, binary logistic regression was performed to establish the RDW+SII diagnostic model. Finally, the correlation between the RDW and SII and related pathological parameters was analyzed.
   Results: Except for LMR, the RDW, SII, NLR, and PLR in the breast cancer group than those in the benign breast disease group, and the differences were statistically significant. According to the ROC curve analysis, the AUC of tne RDW was 0.668, which was the highest among the five indicators.The best critical value of the RDW in identifying benign and malignant breast masses was 13.00, with a sensitivity of 57.42% and a specificity of 71.28%.The optimal critical value of the RDW+SII diagnostic model established by binary logistic regression was 0.38, with a sensitivity of 79.78%, a specificity of 50.54%, and an AUC of 0.705. The RDW and RDW+SII diagnostic models were associated with the TNM stage of breast cancer.
   Conclusion: The RDW and RDW+SII diagnostic models based on preoperative peripheral blood have guiding significance for the diagnosis and evaluation of breast cancer.

Abstract Background and Objectives: Due to the difficulties associated with the separation, damage, cremation, and commingling of skeletal remains, it is of great importance in forensic medicine to assess the accuracy and reliability of sex estimates derived from different skeletal components. For this purpose, this study aimed to classify gender using machine learning (ML) algorithms and a multilayer perceptron classifier (MLPC) based on morphometric data of the dens axis obtained from computed tomography (CT) images.
   Methods: Retrospectively, measurements were taken from CT images of 300 male and 300 female individuals aged between 18–65 years, including dens axis height (DAH), anteroposterior (APDDA) and anterosuperior lengths (ASDDA), dens axis angle (DAA), clivodental angle (CDA), and Boogard angle (BOO). Machine learning models such as Extra Tree Classifier (ETC), Random Forest (RF), Decision Tree (DT), Gaussian Naive Bayes (GaussianNB), k-Nearest Neighbors (k-NN), Linear Discriminant Analysis (LDA), Quadratic Discriminant Analysis (QDA), and Logistic Regression (LR) were used. MLPC was chosen as artificial neural networks (ANN) model.
   Results: Significant differences were found between genders in all dens axis parameters except BOO (p<0.05). The highest accuracy rate in ML algorithm modeling was found to be 0.80 with LDA, RF, k-NN algorithms, and MLPC. The parameter with the highest impact on gender classification was the dens axis anterosuperior length.
   Conclusion: It was found that the parameters obtained from the dens axis using MLCP and ML algorithms have sufficient accuracy rates the classification of sex. It was concluded that in forensic medicine, in cases of deterioration, loss, and deficiencies in bone sources for biological identity determination, the morphometric features of the dens axis can be considered for gender prediction.

Abstract Background and Objectives: Thrombosis and thrombocytopenia have occurred in patients following vaccination with the coronovirus disease (COVID-19) vaccine (Vaxzevria). However, the ocurrence of hypercholesterolemia had not yet been reported after COVID-19 vaccination. Proprotein convertase subtilisin/kexin type 9 (PCSK9) reduces hepatic uptake of low-density lipoprotein (LDL) through degradation of LDL receptor, and leads to an increase in serum LDL levels. PCSK9 was reported to be higher in patients with sepsis and COVID-19 infection, compared with those who had sepsis but no COVID-19 infection. Whether there are some pathophysiologic mechanism or interaction between vaccine antibodies and PCSK9 remains unclear. In this report, we present the first case of acquired severe hypercholesterolemia after COVID-19 vaccine and discuss the relevant pathophysiologic process behind this phenomenon..
   Case presentation: We presented a case of acquired severe hyperlipidemia in a 43-year-old Taiwanese woman without hyperlipidemia history after COVID-19 vaccination.
    Conclusion: COVID-19 vaccination may result in acquired severe hypercholesterolemia in healthy individuals. Statin therapy was shown to be effective in lowering LDL-C levels and should be the first-line treatment in order to lower the incidence of cardiovascular events..
  

Abstract Background and Objectives: In low and middle-income countries, there are high rates of transtibial amputations due to trauma. However, the low satisfaction with patellar tendon-bearing (PTB) socket fitting contributes to a low percentage of prosthesis users in these regions. The experience of a prosthetist is crucial for successful socket fitting. This study aimed to describe a mold modification characteristics performed by a skilled prosthetist to reduce the reliance on individual prosthetist skill.
   Methods: To describe mold modification characteristics, scans were taken of the stump and socket of 5 individuals with transtibial amputations who received prostheses from a skilled prosthetist and reported satisfaction. Geometric differences between stump and socket scans were investigated. The study examined mold modifications in weight-bearing areas, including the mid patellar tendon (MPT), popliteal fossa (PF), lateral tibial flare (LTF), medial tibial flare (MTF), and non-weight-bearing areas, such as the fibular head (FH), distal anterior of tibia (DAT), distal posterior of tibia (DPT), and tibial crest (TC).
   Results: The study found that in the FH, DAT, DPT, and TC regions, the socket height exceeded the stump by 1.2 mm, 8.8 mm, 6.8 mm, and 4.2 mm, respectively. In the PF, MPT, MTF, and LTF regions, the socket depth exceeded the stump by 9.3 mm, 10.3 mm, 4.1 mm, and 4.8 mm, respectively.
   Conclusion: This descriptive study and the identified patterns represent an initial step toward defining characteristics for an appropriate socket design. This knowledge can help mitigate the impact of individual prosthetist skill on socket fit satisfaction.

Abstract Background and Objectives: Coronary artery ectasia (CAE) is an uncommon vascular disorder involving the dilatation of coronary arteries, often linked to underlying inflammatory processes and impaired vascular function. Chemerin, an adipokine associated with inflammatory processes, metabolic control, and immune function, has been linked to cardiovascular disease mechanisms. This study explores its possible contribution to the development of CAE.
   Methods: A total of 100 participants were selected from 2,568 patients who underwent coronary angiography. Participants were divided into two groups: 50 patients with isolated CAE and 50 individuals with normal coronary anatomy. Serum chemerin levels, laboratory and clinical parameters were compared.
   Results: Serum chemerin levels (P<0.001) and high-sensitivity C-reactive protein (hs-CRP) levels (P<0.001) were higher in the CAE group compared to control group. Multivariate logistic regression analysis defined elevated chemerin (P<0.001) and hs-CRP (P=0.001) as independent predictors of CAE. ROC curve analysis revealed a serum chemerin cut-off value of 116 ng/mL for predicting CAE with 82% sensitivity and specificity (AUC: 0.877; 95% CI: 0.808–0.946).
   Conclusion: The findings of this study reveal a notable correlation between increased chemerin concentrations and the presence of CAE, indicating that chemerin could be an important factor in its underlying pathophysiology.

Abstract Background and Objectives: Bicuspid aortic valve, the most common congenital heart anomaly, is often associated with aortic pathologies aortic pathologies. Various surgical treatment alternatives have been reported for bicuspid aortic valve associated with ascending aortic aneurysms. In this study, we evaluate whether aortic valve repair is an effective alternative to replacement in the patients with bicuspid aortic valve.
   Methods: Patients, operated for aortic aneurysm and aortic valve insufficiency, between January 2015 and May 2022 were retrospectively analyzed. Patients were divided in two groups according to surgical procedures of the aortic valve. Patients, received aortic valve repair, constituted Group 1 and patients who had undergone aortic valve replacement were in Group 2. Preoperative, intraoperative and postoperative follow-up parameters were evaluated in the patients’ files.
   Results: Twenty-one patients with bicuspid aortic valve and ascending aortic aneurysm were operated during the study period. There were 8 patients (38.1%) in Group 1 and 13 patients (62.9%) in Group 2. Aortic cross-clamping time (P:0.006), cardiopulmonary bypass time (P: 0.022) and inotropic support usage (P:0.013) were found to be statistically significantly higher in Group 2. In postoperative follow-up period; intubation (P:0.011), intensive care (P: 0.034) and hospital staying times (P: 0.014), as well as the frequency of cerebrovascular events (P: 0.009) were found to be statistically significantly higher in Group 2.
   Conclusion: Aortic valve repair might safely be performed in bicuspid aortic valve accompanied by ascending aortic aneurysms with acceptable results. Our results are encouraging to prefer valve repair technique as first option in the patients with aortic insufficiency accompanying with aortic aneurysms.

Abstract Extracorporeal membrane oxygenation (ECMO) is a kind of medical technological device for lung and/or heart support. It was designed for supportive therapy rather than disease modifying intervention. There are various therapeutic ways related to the disease while using ECMO. Veno-venous way is mainly used for respiratory disorders whereas veno-arterial way is mainly used in both respiratory and cardiac disorders. Currently, most of the ECMO equipments use a dedicated oxygenator and a power driven centrifugal pump. A new ECMO model which uses solely pneumatic power as an energy source was introduced recently. Therefore, there is no requirement of external energy source such as a motor or electricity. In this study we presented the first case in Turkey available in the literature which the latter technology was used to achieve heart and lung support after the patient’s third cardiac operation. The patient was followed up for three days on ECMO treatment and discharged without any problem.

Abstract Background and Objectives: Renal diseases constitute a substantial global health burden, highlighting the critical need for efficient and timely treatments to optimize patient outcomes. Early diagnosis of chronic kidney disease (CKD) may be challenging due to its latent nature, which increases the risk of renal damage. Early detection is crucial to halt or reduce the progression of CKD. This research provides an Intelligent Medical Decision Support System (IMDSS) for regulating the course of kidney injury, based on the Deep Attention-Based Spectral Convolutional Neural Network (DA-SCNN) method.
   Methods: The study uses the UCI CKD dataset. Min-max normalization is used to normalize the characteristics of the input, resulting in consistent scaling and accelerating the convergence of the Deep Learning (DL) model. In feature selection, Recursive Feature Elimination (RFE) is employed to identify the most advantageous traits for the best possible model performance. Spectral convolutional layers and attention approaches are incorporated in the DA-SCNN architecture to identify important patterns in the data.
   Results: The research evaluates the proposed approach by comparing it with existing protocols for treating renal sickness using performance metrics including sensitivity, specificity, accuracy, and precision. The results demonstrate that the DA-SCNN model achieves significantly higher performance with 97% accuracy, 89% precision, 94% sensitivity, and 96% specificity, outperforming conventional methods such as Deep Belief Network (77% accuracy), Long Short-Term Memory (89% accuracy), and Gated Recurrent Unit (85% accuracy).
   Conclusion: This study contributes to the advancement of IMDSS in renal healthcare and provides a way for improved patient outcomes and customized treatment regimens.

Abstract Background and Objectives: Although the COVID-19 pandemic has been declared over, endemic cases continue, and hospitals still play a pivotal role in managing the disease. This study aims to assess the readiness and capacities of hospitals in Ilam Province, Iran, in managing COVID-19.
   Methods: This cross-sectional facility-based survey was conducted in November 2023 across all 13 hospitals in Ilam Province. The adopted version of the tool developed by the World Health Organization (WHO) was used to collect and analyze the data.
   Results: Of the 3,975 total hospital staff, 99.4% had received at least one dose of the COVID-19 vaccine, and 99.1% had received at least two doses. 4.8% of staff were diagnosed with COVID-19 the previous month, with the highest infection rate among nurses (6.1%) and the lowest among radiology staff (0%). Up-to-date national guidelines, policies, and standard operating procedures for infection prevention and control (IPC) regarding COVID-19 were available in all hospitals. The average scores for hospital readiness in training and supportive supervision, IPC, and availability of medicines and equipment were 10.7 out of 11, 24.6 out of 26, and 23.9 out of 28, respectively.
   Conclusion: The status of inpatient COVID-19 management capacities in hospitals of Ilam Province is generally favorable. However, the availability of necessary medicines and equipment requires more attention.

Abstract Background and Objectives: The COVID-19 pandemic has significantly impacted global health systems, placing immense pressure on intensive care units (ICUs). Understanding the associated risk factors of ICU hospitalization, discharge, and mortality in COVID-19 patients is crucial for improving patient care. This article investigates the population-based incidence of hospitalization in ICU, discharge, mortality, and relevant risk factors in COVID-19 patients.
   Methods: This retrospective cohort study conducted on COVID-19 patients referred to Masih Daneshvari Hospital in Tehran from April to November 2021. Multi-state models used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for potential risk factors in five transitions: Hospital admission to ICU (I), Hospital admission to discharge (II), Hospital admission to mortality (III), ICU to discharge (IV), and ICU to mortality (V).
   Results: The results, which included 442 COVID-19 patients, showed that diastolic blood pressure (DBP), phosphorus, and respiratory rate intensified transition rate I by 2% (HR=1.02, 95%CI:(1.00,1.04)), 25% (HR=1.25, 95%CI:(1.01,1.54)), and 9% (HR=1.09, 95%CI:(1.03,1.16)), respectively. Aging had a protective effect by 21% (HR=0.79, 95%CI:(0.63,0.98)) in transition rate II. An increase in Calcium level intensified transition rate IV by 77% (HR=1.77, 95%CI:(1.05,2.71)). Aging, creatinine, and uric acid increased the hazard ratio of transition V by 2.61 (HR=2.61, 95%CI:(1.28,5.32)), 2.13 (HR=2.13, 95%CI:(1.19,3.79)), and 1.2 times (HR=1.20, 95%CI:(1.04,1.38)), respectively.
   Conclusion: DBP, phosphorus, and respiratory rate intensified ICU admission rates, aging decreased hospital discharge rates, while creatinine and uric acid were linked to higher ICU mortality in COVID-19 patients. These findings offer valuable insights for improving patient care and ICU resource management.

Abstract Background and Objectives: The unexpected presence of antibodies is a crucial concern for the safety of blood transfusions and can complicate compatibility testing, possibly delaying the identification of a suitable blood unit. This retrospective study aimed to assess the prevalence of unexpected antibodies and their association with patient characteristics within the general population in Taif City, Saudi Arabia.
   Methods: Antibody screening was performed on 21,183 patients from January 1, 2022 to December 31, 2023. Patient demographics, results of unexpected antibody identification, and blood groups were collected from medical records. Chi-square tests were used to evaluate the associations between unexpected antibodies and various factors.
   Results: Of 21,183 patients screened, 105 (0.50%) had positive results. Among those, 7 (6.7%) had autoantibodies and 98 (93.3%) had alloantibodies in their plasma. The majority of patients were female (94, 89.5%), with only 11 (10.5%) being male. The most common antibody was anti-E, in 25 (23.8%) patients, followed by anti-K, anti-c, and anti-M at 19 (18.1%), 9 (8.6%), and 8 (7.6%) patients, respectively. Multiple antibodies (anti-E and anti- N) were detected in one patient (1%). Associations were identified between the presence of the unexpected antibodies and gender, history of pregnancy, history of transfusion, and Rh phenotype (P<0.001).
   Conclusion: In our study, the frequency of unexpected antibodies was 0.50%. We suggest implementing a mandatory extended phenotyping policy (Rh and Kell) for patients who need multiple transfusions.

Abstract Background and Objectives: Colorectal cancer is a major health problem worldwide, and major complications after rectal cancer surgery seriously affect patient prognosis. This study aimed to investigate the relationship between body composition parameters and major complications after rectal cancer surgery using the CoreSlicer artificial intelligence-based application.
   Methods: A retrospective study was conducted on 271 patients who underwent surgery for rectal cancer between January 2014 and December 2018. The study included analyses of muscle and fat tissue areas using the CoreSlicer application with computerized tomography imaging data in the preoperative period. Patients included in the study were compared between two groups: those with and without major complications (III and above) according to the Clavien-Dindo classification. Data were evaluated using the IBM SPSS Statistics 25.0 program. Since the data were non-parametric, groups were compared using the Mann-Whitney U test. A value of P<0.05 was considered statistically significant.
   Results: The mean age of the 210 patients included in the study was 63.7 ± 12.46 years, and 60% (126 patients) were male. The major complication rate was 12.9% (27 patients). No significant difference was found between the groups in terms of the right and left psoas muscle and total muscle areas (P=0.393, P=0.442, and P=0.431, respectively). Similarly, subcutaneous and visceral fat tissue areas did not differ in complication development.
   Conclusion: No statistical association was found between major complications and body composition parameters. However, the study's findings indicate that muscle functions should also be evaluated instead of muscle volume. It is thought that dynamic monitoring of preoperative muscle loss may improve the prediction of complications.