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Patellofemoral pain syndrome (PFPS) is the most common knee problem that affects the knee in adulthood. It is more common in females twice than in males. It has a multifactorial etiology. The effect of the combination of manual therapy and hip and knee exercises is unconfirmed till now. Therefore, the aim of this study is to investigate the effect of adding manual therapy to knee and hip exercises on pain intensity, self-reported and objective knee function, hip abductors, hip external rotators, and knee extensor strength in addition to calf, and hamstring flexibility in patients with PFPS. This was a double-blind study. Fifty-nine adult patients with PFPS matched with eligibility criteria were sequentially recruited from an outpatient clinic, and faculty students were enrolled in this study and randomized by a generated Excel sheet into two groups either control (30 patients) or manual therapy (29 patients) group. The control group received stretch and open and closed kinetic chain strength exercises, while the manual therapy group received the same exercises as the control plus patellar mobilization, iliotibial band release, and deep friction massage of lateral retinacula. This treatment was performed in the outpatient clinic for 12 sessions in 4 weeks. Fifty-three patients had only been analyzed at the end of treatment. The primary outcomes were knee pain intensity and self-reported knee function. The secondary outcomes were hip and knee muscle strength, calf and hamstring flexibility, and a step-down test. All outcomes were measured before and after 4 weeks of treatment immediately by a blind assessor. Comparing between and within groups were performed using the Multivariate analysis of variance (MANOVA) test. The mean age was 22.64 ± 3.71 years for control group, 21.92 ± 2.39 years for manual therapy group. Both treatment protocols showed significant reduction of pain (ascending ( p  < 0.001; CI: (14.85–39.44)), descending ( p  < 0.001; CI: (15.95–30.62)), squatting ( p  < 0.001; CI: (15.00-38.07)) and sitting ( p  < 0.001; CI: (13.49–37.87))) for control group, while (ascending ( p  < 0.001; CI: (20.37–39.07)), descending ( p  < 0.001; CI: (12.72–32.80)), squatting ( p  < 0.001; CI: (28.98–51.66)) and sitting ( p  < 0.001; CI: (16.72–42.24))) for manual therapy group, improvement in knee function (Kujala: ( p  < 0.001; CI: (-17.02—8.76))) for control group while (Kujala: ( p  < 0.001; CI: (-21.32—12.19))) for manual therapy group, hip and knee muscle strength and flexibility ( p  < 0.05). However, there were non-significant differences between groups in all dependent variables ( p  > 0.05). Manual therapy added to hip and knee exercises may have the same effect as hip and knee exercises without superiority to one of them. Manual therapy improved patients’ clinical outcomes, including pain and function disability, with a higher percentage of change than exercises only. Clinical trial registration : www.clinicaltrials.gov (NCT05665452). Date: 27/12/2022 .

The present work deals with the synthesis of acetoxysulfonamide pyrazole derivatives, substituted 4,5-dihydropyrazole-1-carbothioamide and 4,5-dihydropyrazole-1-isonicotinoyl derivatives starting from substituted vanillin chalcones. Acetoxysulfonamide pyrazole derivatives were prepared from the reaction of chalcones with p-sulfamylphenylhydrazine followed by treatment with acetic anhydride. At the same time 4,5-dihydropyrazole-1-carbothioamide and 4,5-dihydropyrazole-1-isonicotinoyl derivatives were prepared from the reaction of chalcones with either thiosemicarbazide or isonicotinic acid hydrazide, respectively. The synthesized compounds were structurally characterized on the basis of IR, 1H-NMR, 13C-NMR spectral data and microanalyses. All of the newly isolated compounds were tested for their antimicrobial activities. The antimicrobial screening using the agar well-diffusion method revealed that the chloro derivatives are the most active ones. Moreover, the antioxidant and anti-inflammatory activity of these chloro derivatives are also studied using the DPPH radical scavenging and NO radical scavenging methods, respectively.

Background Better tools for post‐chemotherapy amenorrhea risk assessment are needed for fertility preservation decision‐making. Our aim was to determine the predictors of amenorrhea risk at 12 and 18 months post‐chemotherapy in women with breast cancer. Methods 142 women with breast cancer were longitudinally followed for their menstrual changes at 6, 12, and 18 months after the completion of adjuvant chemotherapy with an Anthracycline‐Cyclophosphamide‐based (AC‐based) or Cyclophosphamide‐Methotrexate +5‐Fluorouracil regimen. Pre‐ and/or post‐chemo AMH levels, age, BMI, tamoxifen use, regimen type, and germline BRCA pathogenic variant (gBRCApv) status were evaluated for the prediction of amenorrhea at 6–18 months. Results In multivariable‐adjusted logistic regression, age (p = 0.03) and AMH (p = 0.03) at 12 months, and gBRCApv status (p = 0.03) at 18 months were significant predictors of amenorrhea (areas under the ROC curve of 0.77 and 0.76, for 12 and 18 months, respectively) among 102 evaluable subjects. An undetectable AMH immediately post‐chemotherapy was predictive of amenorrhea with <18 month follow‐up. In longitudinal analysis estimating time trends, baseline AMH and gBRCApv status was associated with the risk of amenorrhea over 6–18 months; the AMH >2.0 ng/mL group showed attenuated time‐trend risk of amenorrhea versus AMH ≤2.0 group (ratio of ORs = 0.91, 95% CI = 0.86–0.97, p = 0.002), while the gBRCApv + showed a steeper time trend, versus the controls (ratio of ORs = 1.12, 95% CI = 1.04–1.20, p = 0.003). Conclusions In addition to the pre‐ and post‐treatment AMH levels, gBRCApv status is a novel potential predictor of amenorrhea at 12 and 18 months after chemotherapy. The higher likelihood of amenorrhea in women gBRCApv suggests that they are more prone to losing their fertility post‐chemotherapy. In a prospective longitudinal analysis in women with breast cancer, we found that pre‐ and post‐chemo AMH and BRCA pathogenic variant status are predictors of post‐chemotherapy amenorrhea risk. This is the first time that an association between BRCA pathogenic variants and amenorrhea risk is established. The information provided in this article can be used in guiding fertility preservation decisions.

PurposeTo determine the longitudinal impact of adjuvant chemotherapy and tamoxifen-only treatments on the reproductive potential of women with breast cancer by using a sensitive ovarian reserve marker anti-Mullerian hormone (AMH) as a surrogate.MethodsOne-hundred-and-forty-two women with a primary diagnosis of breast cancer were prospectively followed with serum AMH assessments before the initiation, and 12, 18 and 24 months after the completion of adjuvant chemotherapy or the start of tamoxifen-only treatment. The chemotherapy regimens were classified into Anthracycline-Cyclophosphamide-based (AC-based) and Cyclophosphamide-Methotrexate + 5-Fluorouracil (CMF). Longitudinal data were analyzed by mixed effects model for treatment effects over time, adjusting for baseline age and BMI.ResultsBoth chemotherapy regimens resulted in significant decline in ovarian reserve compared to the tamoxifen-only treatment (p < 0.0001 either regimen vs. tamoxifen for overall trend). AMH levels sharply declined at 12 months but did not show a significant recovery from 12 to 18 and 18 to 24 months after the completion of AC-based or CMF regimens. The degree of decline did not differ between the two chemotherapy groups (p = 0.53). In contrast, tamoxifen-only treatment did not significantly alter the age-adjusted serum AMH levels over the 24-month follow up. Likewise, the use of adjuvant tamoxifen following AC-based regimens did not affect AMH recovery.ConclusionsBoth AC-based regimens and CMF significantly compromise ovarian reserve, without a recovery beyond 12 months post-chemotherapy. In contrast, tamoxifen-only treatment does not seem to alter ovarian reserve. These data indicate that the commonly used chemotherapy regimens but not the hormonal therapy compromise future reproductive potential.

Background Gamma (γ) ray, an electromagnetic radiation, is occasionally accompanying the emission of an alpha or beta particle. Exposure to such radiation can cause cellular changes such as mutations, chromosome aberration and cellular damage which depend upon the total amount of energy, duration of exposure and the dose. Ionizing radiation can impair spermatogenesis and can cause mutations in germ cells. In general, type B spermatogonia are sensitive to this type of radiation. The current study was carried out to evaluate the protective role of hesperidin (H), as a polyphenolic compound, on rat testis injury induced by γ-radiation. Methods Rats were divided into groups including C group (control rats), R (irradiated) group (rats irradiated with γ-radiation), Vehicle (V) group (rats administered with dimethylsulfoxide “DMSO”), H group (rats administered with H only), HR and RH groups (rats treated with H before and after exposure to γ-radiation, respectively). Malondialdehyde (MDA: the end product of lipid peroxidation “LPO”) and xanthine oxidase (XO: it generates reactive oxygen species “ROS”) in testes homogenate as well as nitric oxide (NO: as ROS) in mitochondrial matrix were determined. The apoptotic markers including DNA-fragmentation (DNAF) in testes homogenate and calcium ions (Ca 2+ ) in mitochondrial matrix were determined. Superoxide dismutase (SOD) and catalase (CAT) activities in testes homogenate, while reduced glutathione “GSH” in nuclear matrix were determined. Also histopathological examination for testes tissues through electron microscope was studied. Results Exposure of rats to γ-radiation (R group) increased the levels of MDA, NO, DNAF, Ca 2+ and XO activity, while it decreased GSH level, SOD and CAT activities as compared to the C groups; γ-radiation increased oxidative stress (OS), LPO, apoptosis and induced testes injuries. These results are in agreement with the histopathological examination. In contrast, treatment with H before or after exposure to γ-radiation (HR and RH groups, respectively) decreased the levels of MDA, NO, DNAF and Ca 2+ but increased GSH level and the activities of SOD, CAT and XO as compared to R group and this indicates that H decreased OS, LPO and apoptosis. Also, the histopathological results showed that H improved testis architecture and this is related to the antioxidant and anti-apoptotic activities of H contents. Protection is more effective when H is given before rather than after exposure. Finally, administration of H to healthy rats for a short period had no adverse affect on testes cells. Conclusion Hesperidin showed antioxidant and anti-apoptotic activities. It has a protective role against OS, injury and apoptosis induced by γ-radiation in testes. Protection is more effective when H is given before rather than after exposure. Graphical Abstract .

This study examines a novel SIR epidemic model that takes into account the impact of environmental white noise. According to the study, white noise has a significant impact on the disease. First, we establish the solution’s existence and uniqueness. Following that, we explain that the stochastic basic production R0 is a threshold that determines the extinction or persistence of the disease. When noise levels are high, we acquire R0<1, which causes the sickness to disappear. A sufficient condition for the existence of a stationary distribution is archived when the noise intensity is high, which suggests the infection is prevalent when R0>1. Finally, numerical simulations are used to explain the key findings.

Studying determinant factors for effective learning communities has become a priority for sustainable education in Yemen. Yet, comprehensive knowledge of academic self-efficacy (ASE), academic commitment (AC), and learning outcomes (LOs) variables is limited in higher education, particularly. This research aimed to examine the role of these variables in enhancing the learning attainments of Yemeni university students by studying the direct impacts of ASE and AC on LOs, the influence of ASE on AC, and, lastly, how AC mediates the relationship between ASE and LOs. The research employed a meticulously validated measurement model encompassing 12 ASE items, 10 LOs items, and 27 AC items, using robust statistical methods such as EFA, CFA, and SEM. The study engaged 611 students aged 19–27. Empirical findings confirmed the significant impact of ASE on AC and LOs, as well as the impact of AC on LOs, both of which serve as vital factors in the academic context. Moreover, the research identified an indirect influence of ASE on LOs mediated through AC. On the other hand, the results concerning the demographic variables indicated significant differences between gender and age groups, as well as between age and educational level groups. However, no differences were found when comparing gender and level groups or when considering gender, age, and level together for ASE and LOs. In contrast, for students' AC, all comparisons were significant except for the gender and age comparison. The study offers valuable insights into educational practices and policies and concludes with practical recommendations to enhance the academic environment, informed by these study outcomes.

An obituary for academic Rula Quawas who died on 25 July 2017, is presented. Among other things, she is remarkable for assuring knowledge of the absolute essentialness of her words and phrases, big and small who protected her female brood fiercely.

This study explores the impact of using kidneys from very-aged donors to address the organ shortage, focusing on risk factors for graft loss and delayed graft function (DGF), independent of recipient factors. Data were sourced from the French multicentric prospective DIVAT cohort and retrospectively analyzed. The study included adult recipients transplanted between 2007 and 2018 receiving kidneys from brain-deceased donors over 70. The primary endpoint was death-censored graft survival, and secondary endpoint DGF. Among 1036 patients with a median follow-up of 3.96 years (2.01–6.31), donor hypertension (HR 1.46 95% CI (1.09–1.95), cold ischemia time (HR 1.03 per hour 95% CI (1.01–1.06) and HLA mismatches (after adjustment on DGF, HR 1.98 (1.45–2.71)) were significant risk factors for graft loss. Considering DGF, donor serum creatinine (HR 1.01 95% CI (1.01–1.01) per μmol/L), warm and cold ischemia times (HR 1.01 95% CI (1.0–1.01) per minute and HR 1.05 95% CI (1.02–1.08) per hour) and the use of SCOT preservation solution (HR 3.90 95% CI (1.26–11.84)) were deleterious, while hypothermic perfusion machine was protective (HR 0.65 95% CI (0.43–0.99)). The findings emphasize the paucity of modifiable variables associated with long-term outcomes in very-aged donors and the need for peri-transplant preservation strategies.