The effect of low-fructose diet on anthropometric and metabolic factors: A systematic review and meta-analysis.

AIMS: In recent decades, there has been a rise in the consumption of sugars containing fructose, raising concerns about their association with metabolic disorders and obesity. We conducted a systematic review and meta-analysis of randomized controlled trials to assess the effects of a low-fructose diet on anthropometric and metabolic variables. DATA SYNTHESIS: We conducted a systematic review and meta-analysis of randomized controlled trials to assess the effects of low-fructose diets on anthropometric and metabolic factors. Relevant studies were identified by searching electronic databases such as PubMed, Scopus, and Web of Science up to January 2023. The quality of the included studies was assessed using the Cochrane risk-of-bias tool. Ten trials with varying intervention durations (ranging from 4 to 24 weeks) and a total of 750 participants were included. The analysis revealed that a low-fructose diet had no significant effect on weight but did have a significant impact on body mass index (SMD = -0.2; 95 % CI: -0.37, -0.04, P = 0.017) and waist circumference (SMD = -0.48; 95 % CI: -0.67, -0.29, P < 0.0001). Furthermore, a low-fructose diet significantly affected systolic blood pressure (SMD = -0.24; 95 % CI: -0.39, -0.09, P = 0.002), fasting blood glucose (SMD = -0.23; 95 % CI: -0.40, -0.07, P = 0.005), hemoglobin A1c (SMD = -0.62; 95 % CI: -0.93, -0.31, P < 0.0001), and triglyceride levels (SMD = -0.17; 95 % CI: -0.33, -0.02, P = 0.028). However, it had no significant effect on diastolic blood pressure, insulin levels, or homeostatic model assessment of insulin resistance. Subgroup analysis indicated that a low-fructose diet had a greater effect on healthy participants aged over 50 years. CONCLUSIONS: Meta-analysis results suggest that low-fructose diets significantly reduce body mass index, waist circumference, systolic blood pressure, fasting blood glucose, hemoglobin A1c, and triglyceride levels. Additionally, the results of the current study suggest that a low-fructose diet may be more effective in healthy individuals who are older than 50 years old compared to those younger than 50 years old.

A rare case of aneurysmal bone cyst of the anterior clinoid process in an 18-year-old female mimicking optic neuritis.

BACKGROUND: Aneurysmal bone cyst (ABC) is an uncommon, benign, vascular multicystic bony lesion that most frequently develops in the first two decades of life. The metaphysis of long bones, pelvic, and vertebral column are the most common locations. The precise underlying pathophysiology of ABCs formation remains unclear; however, it is believed that reactive processes subsequent to trauma or vascular disturbance may play an important role. Involvement of the skull base rarely occurs with a prevalence of up to 5% of intracranial ABCs. CASE PRESENTATIONS: An 18-year-old adolescent female with a history of progressive blurred vision since three months ago presented to our office. The brain and orbital MRI demonstrated no abnormal findings. After three months of glucocorticoid treatment with the diagnosis of multiple sclerosis, the visual impairment of the left eye deteriorated abruptly. The patient underwent an MRI and the imaging study demonstrated a well-defined 30 × 22 × 20-mm lesion at the anterior clinoid process with an extension to the optic canal and ethmoid sinus. The patient underwent pterional craniotomy, and the tumor was resected. The histopathological examination was suggestive of ABC. CONCLUSION: ABC and other conditions should be considered in young-age people with an early unilateral decline in vision and imaging studies should be obtained in early stages and during follow-ups.

Loaded paraquaton polymeric nanocapsules and evaluation for cardiotoxicity in Wistar rats.

Present work was conducted to prepare and evaluate, loaded paraquat nano-hydrogels using chitosan, sodium polytriphosphate, and xanthan via ionic gelification method. The fabricated L-PQ formulations were analyzed for surface morphology and functional groups using SEM and FTIR, respectively. The stability of the synthesized nanoparticle was, also, analyzed in terms of diameter size, zeta potential, dispersion index, and pH. Furthermore, the cardiotoxicity effects of the synthesized nanogels were investigated on Wistar rats in terms of enzymatic activity, echocardiographic, and histological analysis. The proper stability of the prepared formulation was also confirmed by diameter size, zeta potential, dispersion index, and pH. The efficiency of encapsulation was about 90±3.2% and the release of PQ in the loaded nanogel was about 90±2.3%. A decrease in ST (shortening time) segment by formulated PQ, either in peritoneal or gavage exposure pathway, indicates the effectiveness of the capsule layer against the penetration of toxin into the body.

Targeting the vital non-structural proteins (NSP12, NSP7, NSP8 and NSP3) from SARS-CoV-2 and inhibition of RNA polymerase by natural bioactive compound naringenin as a promising drug candidate against COVID-19.

The prevalence of SARS-CoV-2-induced respiratory infections is now a major challenge worldwide. There is currently no specific antiviral drug to prevent or treat this disease. Infection with COVID-19 seriously needs to find effective therapeutic agents. In the present study, naringenin, as a potential inhibitor candidate for RNA Polymerase SARS-CoV-2 was compared with remdesivir (FDA-approved drug) and GS-441,524 (Derivative of the drug remdesivir) by screening with wild-type and mutant SARS-CoV-2 NSP12 (NSP7-NSP8) and NSP3 interfaces, then complexes were simulated by molecular dynamics (MD) simulations to gain their stabilities. The docking results displayed ​scores of -3.45 kcal/mol and -4.32 kcal/mol against NSP12 and NSP3, respectively. Our results showed that naringenin had ΔG values more negative than the ΔG values of Remdesivir (RDV) and GS-441,524. Hence, naringenin was considered to be a potential inhibitor. Also, the number of hydrogen bonds of naringenin with NSP3 and later NSP12 are more than Remdesivir and its derivative. In this research, Mean root mean square deviation (RMSD) values of NSP3 and NSP12with naringenin ligand (5.55±1.58 nm to 3.45±0.56 nm and 0.238±0.01 to 0.242±0.021 nm, respectively showed stability in the presence of ligand. The root mean square fluctuations (RMSF) values of NSP3 and NSP12 amino acid units in the presence of naringenin in were 1.5 ± 0.31 nm and 0.118±0.058, respectively. Pharmacokinetic properties and prediction of absorption, distribution, metabolism, excretion, and toxicity (ADMET) properties of naringenin and RDV showed that ​these two compounds had no potential cytotoxicity.

Anti-inflammatory and tissue repair effect of cinnamaldehyde and nano cinnamaldehyde on gingival fibroblasts and macrophages.

BACKGROUND: Recurrent aphthous stomatitis has a complex and inflammatory origin. Among the great variety of medications it is increasingly common to use herbal medicines due to the adverse side effects of chemical medications. Considering the anti-inflammatory properties of cinnamaldehyde and the lack of studies related to the effectiveness of its nano form; This study investigates the effect of cinnamaldehyde and nano cinnamaldehyde on the healing rate of recurrent aphthous stomatitis lesions. METHODS: In a laboratory experiment, cinnamaldehyde was converted into niosomal nanoparticles. The niosome vesicles diameter and polydispersity index were measured at 25°C using a dynamic light scattering (DLS) Mastersizer 2000 (Malvern Panalytical technologies: UK) and Zetasizer Nano ZS system (Malvern Instruments Worcestershire: UK). After characterizing these particles, the (2,3-Bis-(2-Methoxy-4-Nitro-5-Sulfophenyl)-2H-Tetrazolium-5-Carboxanilide) [XTT] assay was used to assess the toxicity of cinnamaldehyde and nano cinnamaldehyde on gingival fibroblast (HGF) and macrophage (THP-1) cells. By determining the release of TNF-α, IL-6, and TGF-ß cytokines using ELISA kits, the level of tissue repair and anti-inflammatory capabilities of these two substances were evaluated. RESULTS: The size and loading rate of the cinnamaldehyde nanoparticles were established after its creation. The optimized nanovesicle exhibited the following characteristics: particle size of 228.75 ± 2.38 nm, PDI of 0.244 ± 0.01, the zeta potential of -10.87 ± 1.09 mV and the drug encapsulation percentage of 66.72 ± 3.93%. PDIs range was between 0.242-0.274. The zeta potential values at 25°C were from -2.67 to -12.9 mV. The results of the XTT test demonstrated that nano cinnamaldehyde exhibited dose-dependent toxicity effects. Moreover, nano cinnamaldehyde released more TGF-ß and had better reparative effects when taken at lower concentrations than cinnamaldehyde. CONCLUSION: Nano cinnamaldehyde and cinnamaldehyde are effective in repairing tissue when used in non-toxic amounts. After confirmation in animal models, it is envisaged that these substances can be utilized to treat recurrent aphthous stomatitis.

Toxicity of green synthesized TiO2 nanoparticles (TiO2 NPs) on zebra fish.

Nanoparticles (NPs) is usually fabricated by physical and chemical methods which, consequently, may have adverse effects for human and environment. Therefore, novel environmentally friendly synthesis methods for are essential and preferred. The purpose of this study was to synthesize TiO2 NPs using Echinophora cinerea extract and evaluate its toxicity on zebra fish. In the work, extraction phase was performed using a water as solvent. FTIR, XRD, SEM, and DLS analyzes were performed to determine the characteristics of synthesized TiO2 NPs. The effect of different parameters such as pH, extract concentration, TiO2 concentration, and temperature were investigated on TiO2 NP and optimized. Then, the acute toxicity of synthesized TiO2 NPs at different concentrations was investigated for 96 h on zebra fish. The bioassay data was analyzed via probit regression technique. Based on the obtained results, the optimal conditions for the synthesized TiO2 NPs were 9, 20 g/L, 0.4 g/L, and 25 °C for pH, extract concentration, TiO2 concentration and temperature, respectively. Both FTIR and XRD analysis confirmed the stability and structure of the synthesized NPs. According to SEM and DLS analysis, the synthesized NPs were spherical in shape and about 244.7 nm in diameter. Based on bioassay, LC50 for green synthesized TiO2 NPs with Echinophora cinerea extract at 48 h was 300 mg/L, which revealed a less hazardous material.

Death Anxiety and Related Factors Among Iranian Critical Care Nurses: A Multicenter Cross-Sectional Study.

The aim of this study is to investigate death anxiety (DA) and related factors among critical care nurses. Using a cross-sectional research design, 325 critical care nurses in eight hospitals in Iran enrolled in the study. Multiple logistic regression analysis showed that deputy head nurse (OR = 18.299; CI: 1.764-189.817; p = .015), shift morning fixed (OR = 8.061; CI: 1.503-43.243; p = .015), surviving parents (OR = 3.281; CI: 1.072-10.037; p = .037), number of children (OR = 1.866; CI: 1.157-3.010; p = .011), years of working experience (OR = 1.143; CI: 1.048-1.246; p = .003), number of end-of-life patient care in the last 3 months (OR = .900; CI: .828-0.977; p = .012), age (OR = .809; CI: .732-.893; p < .001), CCU nurses (OR = .250; CI: .100-.628; p = .003), and mild stressful life events (SLEs) (OR = .167; CI: .046-.611; p = .007) were significantly related to high DA. Therefore, nurse managers and policymakers should pay special attention to these related factors in developing programs to maintain and promote the health of critical care nurses to improve the quality of nursing care.

Application of InVEST habitat quality module in spatially vulnerability assessment of natural habitats (case study: Chaharmahal and Bakhtiari province, Iran).

There has been a growing pressure of human activities, especially road network, on natural habitats of the world, which has led to habitat degradation and loss of ecosystem services. To mitigate the impacts of human activities, appropriate studies quantifying ecosystem services and assessing ecological impacts of road network are essential. The main goal of this study was modeling habitat quality and habitat degradation of Chaharmahal and Bakhtiari province in the southwestern part of Iran, which is among the most important habitats for wild sheep (Ovis orientalis) classified as vulnerable on the IUCN Red List. In this study, we used the habitat quality module of the InVEST software (Integrated Valuation of Environmental Services and Tradeoffs), which was driven from land use/cover data, information on anthropogenic threats, and expert knowledge. We tested the reliability of the habitat quality values by comparing them with the distribution map of wild sheep obtained from the Department of the Environment. Then, to have a more comprehensive assessment of the roads' effects on the natural habitats of this province, considering ecosystem services model, the Spatial Road Disturbance Index (SPROADI) was applied as a landscape index. The results of this study revealed that the east and north eastern parts of the study area which were among the most suitable habitats for wild sheep were highly affected by road network. Overall, findings of our study provided useful information on the spatially explicit distribution of habitat quality and degradation which were a valuable input for conservation planning and enhancing ecosystem services.

Cd and Pb bioaccumulation in Eurasian watermilfoil (Myriophyllum spicatum) in relation to the role of metal contents in wetland sediments.

The Choghakhor Wetland in Chaharmahal and Bakhtiari Province (Iran) has a significant role in maintaining water and sediment quality, because the wetland acts as a sink for contaminants that can pollute the aquatic ecosystem and affect human health. The present study uses a simple geostatistical technique to investigate the spatial variability of Cd and Pb in the Choghakhor Wetland to link the spatial variations of sediments to heavy metal contents in Myriophyllum spicatum. It was hypothesized that the heavy metal contents in the Choghakhor Wetland sediments impacted the concentration values in macrophytes. The value of heavy metals in sediments ranges from 0.54- to 1.84-µg/g dry weight (dw) for Cd, and from 1.32- to 2.46-µg/g dw for Pb, with a mean value of 1.12- and 1.82-µg/g dw, respectively. The mean value of Cd and Pb was 1.14- and 1.67-µg/g dw, respectively, in the aquatic macrophyte Myriophyllum spicatum, with corresponding ranges of 0.9-1.83-µg/g dw and 1.33-1.95-µg/g dw. There was a spatial structure in the Cd and Pb contents in the wetland sediments, with lower contents in the northern zone despite the values quantified in the south. We observed a direct spatial relationship between the Cd content in sediments and the Cd concentration in M. spicatum, and confirmed an effect of plant uptake for Cd. However, there were no significant differences between Pb in sediments and Pb in samples of M. spicatum, which implied that other factors like discharged industrial waste could also affect the accumulation of metals in plants. It can be concluded that spatial patterns indicated differences in the territory of the sediment Cd content at the Choghakhor Wetland localization in association with sediment enrichment. However, it was surprising that Pb did not show this pattern despite anthropic pressure.

The study of inter-specific relationships of Bromus genus based on SCoT and ISSR molecular markers.

The genus of Bromus is one of the most important collection of rangeland plants, which are distributed in a wide range of natural areas of Iran. Interspecific relationships were evaluated in 90 accessions of 18 Bromus species based on 15 ISSR and 15 SCoT primers. SCoT markers separated the accessions better than ISSR marker. In addition, there was a high interspecific diversity between surveying germplasm. The sections of Bromus genus completely separated based on DNA molecular markers. SCoT markers could separate the accessions in each species. The primers of SC5 and SC35 from SCoT marker and UBC861, UBC857 and UBC844 primers from ISSR marker were identified as the best primers in revealing of genetic diversity between accessions. The sections of Ceratochloa, Genea, Pnigma and Bromus were monophyletic and were placed in one cluster. The section Bromus had a direct relationship with section Genea. In other words, section Ceratochloa has a direct relationship with Pnigma. B. tectorum and B. sericeus. B. sterilis had the most distance with other species in section Genea. B. squarrosus and B. japonicus had the most similarity and B. briziformis with B. danthoniae and B. scoparius with B. rechingeri had a moderate relationship in section Bromus. B. tomentosus and B. persicus had the highest similarity and B. riparius with B. biebersteinii and B. tomentellus with B. inermis had a moderate similarity in section Pnigma.

Sound transmission loss through triple-walled cylindrical shells with porous layers.

Sound transmission loss through triple-walled sandwich cylindrical shells in the presence of an external mean flow is analytically examined. Love's theory and a simplified method based on Biot's theory are considered to describe the motions of thin isotropic shells and wave propagation in the porous material cores, respectively. The random incidence transmission loss in a diffuse field is calculated numerically by considering the limiting incidence angle due to the total internal reflection. The analytical model and numerical code are validated against both experimental and analytical results reported by previous studies. The transmission loss of triple-walled structure in the diffuse sound field is compared with its double-walled counterpart at the same weight. The results generally show a superior performance in the sound insulation for the triple-walled shell, considerably at mid-high and high frequencies, in comparison with its double-walled counterpart at the same weight. The effects of sandwich shell configuration and air gap depth are also investigated on the sound transmission loss.

The value of (18) F-fluorodeoxyglucose positron emission tomography for prediction of treatment response in gastrointestinal stromal tumors: a systematic review and meta-analysis.

BACKGROUND: Early detection of response to treatment is critically important in gastrointestinal stromal tumors (GIST). Therefore, the present systematic review and meta-analysis assessed the value of (18) f-fluorodeoxyglucose positron emission tomography ((18) FDG-PET) on prediction of therapeutic response of GIST patients to systemic treatments. METHODS: The literature search was conducted using PubMed, SCOPUS, Cochrane, and Google Scholar databases, and review article references. Eligible articles were defined as studies included confirmed GIST patients who underwent (18) FDG-PET as well as assessing the screening role of it. RESULTS: Finally, 21 relevant articles were included. The analysis showed the pooled sensitivity and specificity of 18FDG-PET in evaluation of response to treatment of GIST patient were 0.90 (95% CI: 0.85-0.94; I(2) = 52.59, P = 0.001) and 0.62 (95% CI: 0.49-0.75; I(2) = 69.7, P = 0.001), respectively. In addition, the pooled prognostic odds ratio of (18) FDG-PET for was 14.99 (95% CI, 6.42-34.99; I(2) = 100.0, P < 0.001). The Meta regression showed that sensitivity of (18) FDG-PET was higher if the sample size of study was equal or more than 30 cases (sensitivity = 0.93; 95% CI: 0.89-0.97), when using PET/CT (sensitivity = 0.92; 95% CI: 0.89-0.97), and self-design criteria (sensitivity = 0.93; 95% CI: 0.87-1.0). CONCLUSION: The present meta-analysis showed (18) FDG-PET has a significant value in predicting treatment response in GIST patients.

Nutrition and lung cancer: a case control study in Iran.

BACKGROUND: Despite many prospective and retrospective studies about the association of dietary habit and lung cancer, the topic still remains controversial. So, this study aims to investigate the association of lung cancer with dietary factors. METHOD: In this study 242 lung cancer patients and their 484 matched controls on age, sex, and place of residence were enrolled between October 2002 to 2005. Trained physicians interviewed all participants with standardized questionnaires. The middle and upper third consumer groups were compared to the lower third according to the distribution in controls unless the linear trend was significant across exposure groups. RESULT: Conditional logistic regression was used to evaluate the association with lung cancer. In a multivariate analysis fruit (Ptrend < 0.0001), vegetable (P = 0.001) and sunflower oil (P = 0.006) remained as protective factors and rice (P = 0.008), bread (Ptrend = 0.04), liver (P = 0.004), butter (Ptrend = 0.04), white cheese (Ptrend < 0.0001), beef (Ptrend = 0.005), vegetable ghee (P < 0.0001) and, animal ghee (P = 0.015) remained as risk factors of lung cancer. Generally, we found positive trend between consumption of beef (P = 0.002), bread (P < 0.0001), and dairy products (P < 0.0001) with lung cancer. In contrast, only fruits were inversely related to lung cancer (P < 0.0001). CONCLUSION: It seems that vegetables, fruits, and sunflower oil could be protective factors and bread, rice, beef, liver, dairy products, vegetable ghee, and animal ghee found to be possible risk factors for the development of lung cancer in Iran.

Mechanical properties of human kidney cells and their effects on the atomic force microscope beam vibrations.

In the present investigation, the mechanical properties of normal and carcinomatous cells of kidney tissue (HEK-293, ACHN, respectively) were investigated using atomic force microscopy (AFM). Initially, the elastic modulus of ACHN cells was measured following chemotherapy with the anti-cancer drug Cisplatin and plasma treatment. The MTT assay was employed to ascertain the most effective dosages for incubation periods of 12, 24, 48, 72, and 96 h, guided by the IC50 concentration for cell viability during chemotherapy treatment. Analysis at these specified time points revealed a progressive increase in the elastic modulus of ACHN cells when subjected to Cisplatin-based chemotherapy. Specifically, the elastic modulus increased by 1.847, 4.416, 6.035, 8.029, and 9.727 times in comparison to untreated cells at 12, 24, 48, 72, and 96 h, respectively. ACHN cells were subsequently treated with plasma for 30 and 60 s for 24 and 48-h incubation periods. The plasma treatment increased the ACHN cell's elastic modulus. In the subsequent phase of the research, a combination of theoretical (finite element method [FEM]) and experimental methodologies was employed to investigate the resonant frequencies and magnitude of the frequency response function (FRF) concerning the movement of the AFM cantilever. This examination was conducted using ACHN cells as specimens, both before and after exposure to chemotherapy and plasma treatments. The results showed that higher sample elastic modulus increased the resonant frequency, indicating that treated cells had a higher resonant frequency than untreated cells. In conclusion, the FEM and experimental results were compared and found to be in good agreement. HIGHLIGHTS: Using Cisplatin anti-cancer drug increases the elastic modulus of ACHN cell. Applying plasma treatment increases the elastic modulus of ACHN cell. For both of the chemo and plasma therapies, increasing the incubation time increases the influence of therapies oh the cell mechanics. Using finite element modeling (FEM) the real dynamic behavior of atomic force microscope cantilever by considering human kidney cells as the soft samples is possible.

Enhancing nutrient absorption through the influence of mangrove ecosystem on flow rate and retention time in salt marshes.

This study investigates the impact of pneumatophores (the aerial roots of Avicenna marina) on water flow rate, retention time, contact time, and consequently on nutrient absorption through the sediment in sub-tropical salt marshes. The goal is to realize how the density of mangroves in salt marshes influences the kinematic factors of streamflow at estuaries. To this end, a field experiment was carried out to assess nutrient and organic compound levels in the sediment and water samples, spanning six sampling stations along the Chabahar River discharging to the Chabahar Bay, Iran. Then, we delved into the influence of altering environmental parameters, such as density and geometry, on the kinematic features of the flow through statistical analysis and hydraulic modeling. The results showed that the aerial roots reduce the flow rate and increase both retention and contact times. The longest retention time was observed at station #5 due to increased vegetation density and decreased instream velocity. In addition, measurements of total organic matter, total organic carbon, and total nitrogen indicated that an extended contact time resulted in increased absorption flux to the stream by sediments. As a result, pneumatophores can serve as an effective sink for organic matter in ecotones in salt marshes.

The Effect of Selenium, Zinc, and their Combined Supplementation on Cardiometabolic Biomarkers-comparing their Effects in the Energy Restriction and High-fat Diet Methods in Obese Rats.

INTRODUCTION: The fat distribution in the body determines the risk of cardiometabolic problems such as heart disease and diabetes. Some dietary supplements, such as selenium and zinc, possess lipolytic and anti-angiogenic functions, which may be a useful strategy in reducing the risk of cardiometabolic complications. This study evaluated the effect of zinc (Zn), selenium (Se), and their combined supplementation on cardiometabolic risk factors in male Wistar rats in two nutritional models, including caloric restriction (CR) and high-fat diet (HFD). METHODS AND MATERIALS: The 48 male Wistar rats were divided into three diet groups (HFD and CR and normal diet (ND)). The HFD group was subdivided into four groups (N=8 rats in each group) that received (HFD+Se), (HFD+Zn), (HFD+Zn+Se), and HFD alone as the control group, respectively. After 8 weeks of intervention, biochemical tests were performed on serum levels, including measurement of lipid profile (triglyceride, Cholesterol, LDL and HDL) and glycemic indices (fasting blood sugar, insulin and insulin sensitivity markers). RESULTS: The results showed that supplementation significantly improved the lipid profile (P <0.001). A comparison of glucose homeostasis indices in the study groups also showed a significant difference. The serum level of glucose was higher in the HFD group than in the intervention groups (P <0.001). Also, the rate of improvement of lipid profile and glycemic indexes in the group receiving the combination of two supplements showed a better trend than those receiving zinc and selenium alone. However, the values were statistically significant only for glucose homeostasis indices (P <0.001). CONCLUSION: Although obesity is a multifactorial condition, controlling other risk factors, zinc and selenium and their combined supplementation can lead to promising solutions for the treatment of obesity-induced glucose and lipid homeostasis disorders.

Zero-Inflated Count Regression Models in Solving Challenges Posed by Outlier-Prone Data; an Application to Length of Hospital Stay.

Introduction: Ignoring outliers in data may lead to misleading results. Length of stay (LOS) is often considered a count variable with a high frequency of outliers. This study exemplifies the potential of robust methodologies in enhancing the accuracy and reliability of analyses conducted on skewed and outlier-prone count data of LOS. Methods: The application of Zero-Inflated Poisson (ZIP) and robust Zero-Inflated Poisson (RZIP) models in solving challenges posed by outlier LOS data were evaluated. The ZIP model incorporates two components, tackling excess zeros with a zero-inflation component and modeling positive counts with a Poisson component. The RZIP model introduces the Robust Expectation-Solution (RES) algorithm to enhance parameter estimation and address the impact of outliers on the model's performance. Results: Data from 254 intensive care unit patients were analyzed (62.2% male). Patients aged 65 or older accounted for 58.3% of the sample. Notably, 38.6% of patients exhibited zero LOS. The overall mean LOS was 5.89 (± 9.81) days, and 9.45% of cases displayed outliers. Our analysis using the RZIP model revealed significant predictors of LOS, including age, underlying comorbidities (p<0.001), and insurance status (p=0.013). Model comparison demonstrated the RZIP model's superiority over ZIP, as evidenced by lower Akaike information criteria (AIC) and Bayesians information criteria (BIC) values. Conclusions: The application of the RZIP model allowed us to uncover meaningful insights into the factors influencing LOS, paving the way for more informed decision-making in hospital management.

Starter protein content and supplemental soybean oil or hydrogenated palm fatty acids in Holstein dairy calves: growth performance, protozoa population, and nitrogen utilization efficiency.

The study hypothesized that a 24% protein starter diet supplemented with inert fat (palm fatty acids; PLFs) instead of triglyceride-rich soybean oil (SBO) would promote the growth of dairy calves. The effects of different protein contents (20 vs 24% CP) and fat sources (SBO vs PLF at 2.5% DM) on growth, digestibility, blood metabolites, rumen protozoa and urinary nitrogen in dairy calves were investigated. A total of 52 female dairy calves (mean age 3 days and BW 40.7 kg) were allocated to the following treatments in a completely randomized design: (1) 20% CP starter diet supplemented with SBO (20CP-SBO), (2) 20% CP starter diet supplemented with PLF (20CP-PLF), (3) 24% CP starter diet supplemented with SBO (24CP-SBO), and (4) 24% CP starter diet supplemented with PLF (24CP-PLF). Calves were weaned on day 53, and the study ended on day 73. The 24CP diets enhanced starter feed intake, average daily gain (ADG), withers height, hip width, organic matter (OM) digestibility, and preweaning blood glucose compared to the 20CP diets. In contrast, SBO supplementation reduced feed intake, ADG, withers height, OM and CP digestibility, and pre- and postweaning blood glucose and beta-hydroxybutyrate levels, while increasing preweaning aspartate aminotransferase, compared to PLF. SBO supplementation led to lower urinary excretion of purine derivatives and microbial protein synthesis postweaning, and a reduction in protozoa population both pre- and postweaning. Calves fed PLF had higher starter intake than those fed SBO, regardless of the diet being 20CP or 24CP. Calves fed the 24CP-PLF diet had the highest ADG, while calves fed the 20CP-SBO diet had the lowest ADG. Calves fed the 20CP-SBO diet had lower feed efficiency than calves fed the other diets during the preweaning period and throughout the experimental period. Calves fed the 24CP-PLF diet had higher hip heights at weaning and on day 73 than calves fed the other diets. Calves fed the 20CP-SBO diet had lower neutral detergent fiber digestibility than calves fed the other diets. Calves fed the 24CP-SBO diet had higher postweaning blood urea nitrogen concentration than calves fed the other diets. Feeding the 20CP-SBO diet to dairy calves decreased urinary allantoin excretion and rumen microbial protein synthesis but increased urinary nitrogen excretion during the preweaning period. Our results suggest that PLF is more suitable than SBO in calf diets, especially when calves fed 24% CP, possibly due to improved nutrient digestibility.

Vertical triband flag sign for differential diagnosis of Rathke's cleft cyst.

Background: The Rathke cleft cyst (RCC) is a type of cystic growth that is benign, circular, and well-defined with an incidence rate of 4 %. This study aims to identify a useful diagnostic imaging sign that can aid in the differentiation of RCC from other cystic lesions. Methods: We retrospectively analyzed the records of 42 symptomatic RCC patients who were referred to our facility between 2016 and 2023. The data for the study were obtained from our electronic database. All magnetic resonance imaging (MRI) studies were performed using a 1.5-T superconducting magnetic scanner. All patients underwent endonasal transsphenoidal surgical resection. All MRIs were reviewed and evaluated by a neurosurgeon and a neuroradiologist. Results: There were 8 (19 %) males and 34 (81 %) females with a mean age of 37.2-years. Our study identified a distinct imaging characteristic in 38 of the cases, which we have named the "vertical triband flag sign", due to the growth of the cyst developing a specific appearance. The flag sign was mostly observed only in the T1-images (71.5 %), while in four cases the sign was spotted only in T2-images, and in four cases it appeared in both T1 and T2. In 4 cases, the flag sign was not observed in which further investigations revealed that these cases were suprasellar or small sellar RCCs. The dot sign, which is a characteristic finding in RCCs was only observed in one of our cases. Conclusion: Early diagnosis of RCCs may be facilitated by utilizing the vertical triband flag sign.

Ginseng supplementation and cardiovascular disease risk factors: a protocol for GRADE-assessed systematic review and dose-response meta-analysis.

INTRODUCTION: Heart diseases constitute a significant global public health concern. Cardiovascular diseases (CVDs) are characterised by disruptions in blood circulation and are notably prevalent among adults exposed to Westernised diets. Ginseng, a medicinal plant, has been recognised for its healing properties and has a history of use spanning thousands of years. This systematic review aims to evaluate the efficacy of ginseng in modifying risk factors for CVD, including lipid profiles, glycaemic control, anthropometric indices, inflammation indicators, blood pressure, oxidative stress, liver function tests, adipokines and heart rate among individuals aged 18 and above, encompassing both genders. METHODS AND ANALYSIS: We will conduct an electronic search for articles published from inception to September 2023 using a predefined search strategy in PubMed, Scopus, Web of Science, CENTRAL and EMBASE. Our search will focus exclusively on randomised controlled clinical trials involving both healthy and unhealthy participants. The process of reviewing articles, extracting pertinent information and assessing the quality of studies using the Cochrane risk of bias tool will be carried out independently by two reviewers. Any discrepancies will be resolved through discussion with a third party. If a sufficient number of eligible studies are identified, a meta-analysis will be conducted using these outcomes. ETHICS AND DISSEMINATION: This study serves as the procedural framework for a comprehensive examination and does not require ethical approval. Additionally, the study adhered to the guidelines outlined in the Declaration of Helsinki. Ethical approval for the study was obtained from the Ethics Committee of Golestan University of Medical Sciences (IR.GOUMS.REC.1402.298). PROSPERO REGISTRATION NUMBER: CRD42023465688.