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Background There are emerging controversies regarding the priority of T4 + T3 combination therapy over standard care with levothyroxine (LT4) monotherapy in the management of hypothyroid subjects. Combination therapy with a slow-release form of liothyronine (SRT3) and levothyroxine may restore T3 concentrations and provide better outcomes, especially in individuals with persistent complaints despite having normal serum TSH levels. Methods One hundred patients aged ≥ 20 years with hypothyroidism who have achieved and maintained euthyroidism under LT4 monotherapy for at least 3 months will be randomized into two groups of LT4 + SRT3 combined therapy (75 µg LT4 + 25 µg SRT3) and LT4 monotherapy for 48 weeks. Participants will be evaluated at baseline and three subsequent follow-ups, 12, 24, and 48 weeks after treatment allocation. Before and after the intervention, body weight, heart rate, blood pressure, ECG, quality of life (by ThyPRO-39 and SF-12), resting energy expenditure, and body composition will be evaluated. Also, serum TSH, total T3, total T4, free T4, free T3, total cholesterol, LDL, HDL, triglycerides, fasting blood sugar (FBS), insulin, HbA1C, Homeostatic Model Assessment for Insulin Resistance (HOMA-IR), sex hormone-binding globulin (SHBG), enolase, lactate dehydrogenase (LDH), creatin kinase (CK), ferritin, and metabolomics will be assessed at baseline and compared with their corresponding values at 24 and 48 weeks. Epigenetic-related markers will be measured and compared between the responders and non-responders. Conclusion It is expected that LT4 + SRT3 combined therapy more closely mimics the serum levels of T3, T4, and the T3/T4 ratio of euthyroid subjects than LT4 monotherapy, and improves health outcomes and quality of life, especially in hypothyroid patients with persistent symptoms under LT4 monotherapy. Genetic polymorphism sequencing may identify hypothyroid patients who are not responding well to levothyroxine alone. Trial registration  Trial ID: 44220 ID: IRCT20100922004794N12 IRCT ID: IRCT20100922004794N12 Registration date: 2020-02-27 Expected recruitment start date: 2024-10-06 Expected recruitment end date: 2025-10-23

In this study, Sn 1−x Co x O 2 (x = 0.00, 0.02, 0.05, 0.10, and 0.20) thin films with different dopants were deposited by spray pyrolysis technique. Tin chloride and cobalt chloride were dissolved in ethanol and distillated water and next were deposited onto glass substrate at T = 480 °C. Rutile structure of SnO 2 without extra peak was shown in XRD pattern. The lattice parameters and cell volume of the prepared films were calculated. Optical properties of the films evidenced that all films were transparent films and their transparency reduced from 90% to 60%. Field Emission Electron Microscopic (FESEM) system was used to measure the thickness and morphology of surface the films. The grain size and film thickness were found about 200 nm and 300 nm, respectively. The electrical properties studied Vander Pauw technique and low resistivity ( Ω. cm) and high concentration 10 21 /cm 3 were obtained. Furthermore, the results indicated that all the films presented ferromagnetism at room temperature and the lowest dopant had the maximum magnetic saturation. Finally, the room temperature ferromagnetism of the films was explained based on Ruderman–Kittel–Kasuya–Yosida (RKKY) mechanism.

The human masticatory system is a complex functional unit characterized by a multitude of skeletal components, muscles, soft tissues, and teeth. Muscle activation dynamics cannot be directly measured on live human subjects due to ethical, safety, and accessibility limitations. Therefore, estimation of muscle activations and their resultant forces is a longstanding and active area of research. Reinforcement learning (RL) is an adaptive learning strategy which is inspired by the behavioral psychology and enables an agent to learn the dynamics of an unknown system via policy-driven explorations. The RL framework is a well-formulated closed-loop system where high capacity neural networks are trained with the feedback mechanism of rewards to learn relatively complex actuation patterns. In this work, we are building on a deep RL algorithm, known as the Soft Actor-Critic, to learn the inverse dynamics of a simulated masticatory system, i.e., learn the activation patterns that drive the jaw to its desired location. The outcome of the proposed training procedure is a parametric neural model which acts as the brain of the biomechanical system. We demonstrate the model’s ability to navigate the feasible three-dimensional (3D) envelope of motion with sub-millimeter accuracies. We also introduce a performance analysis platform consisting of a set of quantitative metrics to assess the functionalities of a given simulated masticatory system. This platform assesses the range of motion, metabolic efficiency, the agility of motion, the symmetry of activations, and the accuracy of reaching the desired target positions. We demonstrate how the model learns more metabolically efficient policies by integrating a force regularization term in the RL reward. We also demonstrate the inverse correlation between the metabolic efficiency of the models and their agility and range of motion. The presented masticatory model and the proposed RL training mechanism are valuable tools for the analysis of mastication and other biomechanical systems. We see this framework’s potential in facilitating the functional analyses aspects of surgical treatment planning and predicting the rehabilitation performance in post-operative subjects.

A numerical analysis of the experiments addressed to studies of hydrodynamic processes in a horizontal steam generator has been performed using the STEG (STEam Generator) code. The main components of the experimental model include a staggered tube bundle, a submerged perforated sheet (SPS) with baffles, and a downcomer. An air–water mixture was used as a two-phase fluid. The working fluid flow in the model was driven by natural circulation induced by air supply to the lower, middle, and upper sections of the tube bundle. The gas void fraction was measured by the γ-radiography method. In addition, pressure drops along the height of the tube bundle and water levels in the model and above SPS were also measured. Each experiment was performed at a prescribed air load on the evaporation surface and water level in the model. The STEG code was developed at the Department of Nuclear Power Plants of NRU MPEI to model thermohydraulic processes in a horizontal steam generator. The mathematical model is based on a two-fluid approach to the description of a two-phase flow using balance mass, momentum, and energy conservation equations and semiempirical closing correlations for interfacial interactions and interactions with various surrounding structures (tube bundle, walls, etc.). The STEG code was used to perform calculations for nine experimental regimes differing in the perforation ratio of the submerged perforated sheet and the supplied air flowrate. The qualitative regularities of the two-phase air–water mixture circulation in the model of a horizontal steam generator and the effect of experimental values of the main parameters on the circulation have been established. Quantitative results of comparison of the predictions with the experiment demonstrate their good agreement since the relative errors in the predicted air void fractions and pressure drops do not exceed 10%.

Outbreaks of Rift Valley fever (RVF), a mosquito-borne viral zoonosis, have previously been associated with unusually heavy rainfall and extensive flooding. The disease is a serious public health problem in Africa and the Middle East, and is a potential global health threat. In Kenya, outbreaks of the disease have disproportionately affected impoverished pastoralist communities. This study sought to assess the knowledge, attitudes and practices (KAP) regarding RVF among the pastoralists of North Eastern Kenya, and to establish the determinants of KAP on RVF. A cross-sectional study involving 392 pastoralists living in Ijara district (Masalani and Ijara wards) was carried out using an interview questionnaire. All respondents interviewed (100%) had heard about RVF disease. They recognized that the disease is dangerous (99%), and had a positive attitude towards vaccination of animals (77%). However, few respondents knew that abortion (11%) and high mortality of young animals (10%) were key signs of RVF in animals. Very few (4%) use any form of protection when handling sick animals to avoid infection. Significant factors associated with knowledge were being in a household with a history of RVF infection (OR = 1.262, 95% CI = 1.099-1.447), having more livestock (OR = 1.285, 95% CI = 1.175-1.404) and the place of residence, Masalani (OR = 0.526, 95% CI = 0.480-0.576). Overall knowledge score on RVF was found to be a significant predictor of good preventive practice of the disease (OR = 1.073, 95% CI = 1.047-1.101). Despite the positive attitude that pastoralist communities have towards the prevention of RVF, there exist gaps in knowledge and good practices on the disease. Therefore there is need for public health education to address these gaps, and to identify and facilitate the removal of barriers to behavioural change related to the prevention of RVF.

Rumen fluid from slaughtered animals is one of the wastes of slaughterhouses released to the environment that, due to its high nitrogen and phosphorus contents, can lead to soil and groundwater pollution. Meanwhile, it contains ruminal microbes and some bioactive compounds such as enzymes, minerals, vitamins and organic acids. This study was designed to examine the potential of rumen fluid as a feed additive. Therefore, the effects of spray-dried rumen fluid (SDR) with 1% maltodextrin on the performance, blood metabolites and some cytokines of sucking dairy calves during the pre-weaning phase were investigated. Forty male Holstein calves, with a mean weight of 39.4 ± 3.7 kg and 7 ± 1 days old, were randomly assigned to four groups (n = 10 calves per group) in a completely randomized design. Experimental treatments were: control diet with no additive (CON); control diet with 0.5 g/day of SDR (SDR0.5); control diet with 1 g/day of SDR (SDR1); and control diet with 1.5 g/day of SDR (SDR1.5). Daily feed intake and average daily gain of calves were not affected by feeding SDR as a feed additive. Cholesterol concentration was significantly affected by the 20th and 40th days of the experiment and decreased linearly by increasing SDR feeding level. Levels of liver enzymes, including aspartate aminotransferase and alanine aminotransferase, in the blood decreased by feeding SDR at day 40 of the experiment. Serum concentration of interleukin-6 at day 20 was not affected by dried rumen fluid feeding, whereas at day 40, a significant effect was observed among experimental treatments. The lowest value was recorded for SDR1.5 v. control calves. At day 20, the serum concentration of interferon-γ was influenced by supplementing SDR, and the highest value was recorded for SDR1.5 calves. The inclusion of SDR with 1% maltodextrin in suckling dairy calves had beneficial effects on the stimulation of calves’ immune system.

The decision to delivery time is the interval between the decision and the childbirth by emergency caesarean delivery. The Royal College of Obstetricians and Gynecologists and the American College of Obstetricians and Gynecologists recommend that the decision to delivery time interval is less than 30 min. Additionally, the decision to delivery time varies across institutions and countries. The aim of this study was to determine the decision to delivery time and its predictors among women who underwent emergency cesarean delivery at selected hospitals of Northwest Ethiopia, 2023. An institutional-based prospective cohort study was conducted at selected hospitals of Northwest Ethiopia, among women who underwent emergency cesarean delivery from November 1 to January 30, 2023. A total of 285 participants were enrolled, and data collected using structured and pre-tested questionnaires. A systematic sampling technique was used. Data were entered into Epi-Data version 4.6 and then exported to STATA 15 for further analysis. The log rank test was utilized to compare group differences. The time is estimated by using the Kaplan-Meier curve and Cox proportional-hazard regression analysis was carried out to determine the predictors. From 285 participants, 56 (21.8%) women delivered within the recommended 30 min. The overall median survival time was undetermined and the restricted mean survival time was 48.9 min (95% CI: 47.4-50.5). The average decision to delivery time is affected among women who hesitate to accept consent (AHR: 0.17, 95% CI: 0.02-1.25), cord prolapses (AHR: 1.36, 95% CI: 0.46-3.94), rank of surgeon (AHR: 0.42. 95% CI: 0.42-1.08), no free operation room table (AHR: 0.27, 95% CI: 0.28-0.94), regional anesthesia (AHR: 0.56, 95% CI: 0.25-1.28), and use of a bladder flap (AHR: 0.33, 95% CI: 0.16-0.85). Overall decision to delivery times among women who underwent emergency cesarean section at selected hospitals were longer than the recommended time.

Adequate Vitamin D is essential for dental and skeletal health in children and adult. The purpose of this study was to assess the correlation of serum Vitamin D level with external-induced apical root resorption (EARR) following fixed orthodontic treatment. In this cross-sectional study, the prevalence of Vitamin D deficiency (defined by25-hydroxyvitamin-D) was determined in 34 patients (23.5% male; age range 12-23 years; mean age 16.63 ± 2.84) treated with fixed orthodontic treatment. Root resorption of four maxillary incisors was measured using before and after periapical radiographs (136 measured teeth) by means of a design-to-purpose software to optimize data collection. Teeth with a maximum percentage of root resorption (%EARR) were indicated as representative root resorption for each patient. A multiple linear regression model and Pearson correlation coefficient were used to assess the association of Vitamin D status and observed EARR. < 0.05 was considered statistically significant. The Pearson coefficient between these two variables was determined about 0.15 ( = 0.38). Regression analysis revealed that Vitamin D status of the patients demonstrated no significant statistical correlation with EARR, after adjustment of confounding variables using linear regression model ( > 0.05). This study suggests that Vitamin D level is not among the clinical variables that are potential contributors for EARR. The prevalence of Vitamin D deficiency does not differ in patients with higher EARR. These data suggest the possibility that Vitamin D insufficiency may not contribute to the development of more apical root resorption although this remains to be confirmed by further longitudinal cohort studies.

Purpose The optimal extent of pelvic lymph node dissection (PLND) during radical cystectomy (RC) in patients with urothelial carcinoma of the bladder (UCB) is the subject of ongoing debate. In this study, we compared local recurrence-free and overall survival, in addition to complication rates, after extended PLND (ePLND) compared to standard PLND (sPLND). Methods We reviewed the charts of 314 patients who underwent RC for UCB between 2008 and 2013. ePLND was performed in 105 patients, and 105 matched patients who underwent standard PLND (sPLND) were selected based on clinical parameters. Local recurrence-free and overall survival rates were assessed using Kaplan–Meier survival analysis, and Cox proportional hazards models were used to assess potential determinants of these outcomes. Complications were assessed at 30 and 90 days using the Clavien–Dindo reporting system. Results More lymph nodes were removed by ePLND (median 21) compared to sPLND (median 9; P  < 0.001), but the rate of nodal involvement was not different. In multivariable analysis, ePLND was associated with a better local recurrence-free survival (HR = 0.63, P  = 0.005), but was not an independent predictor of overall survival (HR = 1.06, P  = 0.84). Estimated blood loss was greater with ePLND (1047.3 vs. 584.5 ml P  < 0.001), but there was no significant difference in complications. Conclusions Extended PLND appears to reduce the risk of local recurrence, but was not an independent predictor of overall survival in this cohort. ePLND was associated with greater blood loss compared to sPLND, but not with other perioperative complications.

•Abdominal method is capable of reducing both systolic and diastolic measurements.•Auricular acupuncture could have short-lived adverse effects on both SBP and DBP.•Abdominal electroacupuncture is a highly effective treatment for the ones who are at risk of developing hypertension. Hypertension is an important risk factor of cardiovascular disease (CVD), which is associated with premature death, myocardial infarction, stroke, peripheral vascular disease, and renal disease. The goal of the present study was to use a randomized controlled clinical trial to explore and compare the effectiveness of abdominal and auricular acupuncture on blood pressure in 440 subjects with and without obesity. Four hundred participants were recruited and randomized to one of four groups: cases and controls receiving auricular acupuncture (204 subjects) and cases and controls receiving abdominal electroacupuncture (196 subjects). Blood pressure and anthropometric parameters were measured before and after the intervention period. In order to match the initial diet of the groups, participants were required to follow an isocaloric diet for two weeks before the trial, and a low-calorie diet for 6 weeks during the intervention period. We observed a significant time dependent improvement in the systolic blood pressure measurements in the abdominal intervention group, although this improvement was more pronounce in the first period of study. Of note, in the auricular intervention group, a significant increasing in the level of SBP was detected. Importantly no statistically significant changes were found in the corresponding sham groups. Our findings demonstrated that abdominal electro-acupuncture for 6 weeks reduced both systolic and diastolic blood pressure and auricular acupuncture had a short-term adverse effect on both SBP and DBP.