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Coronary artery disease (CAD) frequently coexists with severe aortic valve stenosis (AS) in patients planned for transcatheter aortic valve implantation (TAVI). How to manage CAD in this patient population is still an unresolved question. In particular, it is still not known whether fractional flow reserve (FFR) guided revascularization with percutaneous coronary intervention (PCI) is superior to medical treatment for CAD in terms of clinical outcomes. The third Nordic Aortic Valve Intervention (NOTION-3) Trial is an open-label investigator-initiated, multicenter multinational trial planned to randomize 452 patients with severe AS and significant CAD to either FFR-guided PCI or medical treatment, in addition to TAVI. Patients are eligible for the study in the presence of at least 1 significant PCI-eligible coronary stenosis. A significant stenosis is defined as either FFR ≤0.80 and/or diameter stenosis >90%. The primary end point is a composite of first occurring all-cause mortality, myocardial infarction, or urgent revascularization (PCI or coronary artery bypass graft performed during unplanned hospital admission) until the last included patient have been followed for 1 year after the TAVI. NOTION-3 is a multicenter, multinational randomized trial aiming at comparing FFR-guided revascularization vs medical treatment of CAD in patients with severe AS planned for TAVI.

•Of 7944 patients with STEMI, 296 (3.7%) developed NEW-AF within 30 days of STEMI.•NEW-AF following STEMI was associated with poor long-term prognostic outcomes.•OAC therapy in NEW-AF patients was associated with reduced long-term mortality.•NEW-AF patients may benefit from OAC in addition to usual antithrombotic treatment•Future monitoring of NEW-AF patients after STEMI is pivotal to improve prognosis New-onset atrial fibrillation (NEW-AF) following ST-segment elevation myocardial infarction (STEMI) is a common complication, but the true prognostic impact of NEW-AF is unknown. Additionally, the optimal treatment of NEW-AF among patients with STEMI is warranted. A large cohort of consecutive patients with STEMI treated with percutaneous coronary intervention were identified using the Eastern Danish Heart Registry from 1999-2016. Medication and end points were retrieved from Danish nationwide registries. NEW-AF was defined as a diagnosis of AF within 30 days following STEMI. Patients without a history of AF and alive after 30 days after discharge were included. Incidence rates were calculated and multivariate analyses performed to determine the association between NEW-AF and long-term mortality, incidence of ischemic stroke, re-MI, and bleeding leading to hospitalization, and the comparative effectiveness of OAC therapy on these outcomes. Of 7944 patients with STEMI, 296 (3.7%) developed NEW-AF. NEW-AF was associated with increased long-term mortality (adjusted HR 1.48, 95% CI 1.20-1.82, P<.001) and risk of bleeding leading to hospitalization (adjusted HR 1.36, 95% CI 1.00-1.85, P=.050), and non-significant increased risk of ischemic stroke (adjusted HR 1.45, 95% CI 0.96-2.19, P=.08) and re-MI (adjusted HR 1.14, 95% CI 0.86-1.52, P=.35) with a median follow-up of 5.8 years. In NEW-AF patients, 38% received OAC therapy, which was associated with reduced long-term mortality (adjusted HR 0.69, 95% CI 0.47-1.00, P=.049). NEW-AF following STEMI is associated with increased long-term mortality. Treatment with OAC therapy in NEW-AF patients is associated with reduced long-term mortality.

Mounting evidence shows that right ventricle (RV) function carries independent prognostic influence in various disease states. This study aimed to investigate the incidence and impact of permanent RV infarction in patients with inferior ST-segment elevation myocardial infarction (STEMI) and culprit lesion in the right coronary artery (RCA). In this substudy of the DANAMI-3 (DANish Study of Optimal Acute Treatment of Patients with ST-segment Elevation Myocardial Infarction) trial, cardiac magnetic resonance was performed in 291 patients at day 1 and follow-up 3 months after primary percutaneous coronary intervention of 674 patients with STEMI with the culprit lesion in the RCA. Final infarct was assessed using late gadolinium enhancement on cardiac magnetic resonance at 3 months. Patients with permanent RV infarction (20%) had lower ventricular function at follow-up; RV ejection fraction (EF) 47% ±6 versus 50% ± 5 (p <0.005) and left ventricular (LV) EF 56% ± 8 versus 60% ± 9 (p <0.006). Furthermore, patients with permanent RV infarction had a higher incidence of microvascular obstruction 39 (67%) versus 81 (39%) (p <0.001), larger final LV infarct size 16% ±8 versus 10% ± 8 (p <0.001) and larger LV area at risk 33% ± 10 versus 29% ± 9 (p <0.001). Permanent RV infarction was an independent predictor of final LV infarct size (p <0.001) but was not associated with LVEF (β = −0.0; p = 0.13) in multivariable analyses. In conclusion, permanent RV infarction was seen in 20% of patients with inferior STEMI and culprit lesion in RCA and independently predicted final LV infarct size. However, permanent RV infarction did not predict overall LV function. LGE was used to detect infarct location and quantify infarct size.17 LGE in RV free wall on follow-up CMR was considered as permanent infarction. LGE images were obtained 10 minutes after intravenous injection of 0.1-mmol/kg body weight of gadolinium-based contrast (Gadovist; Bayer Schering, Berlin, Germany) using an electrocardiogram (ECG)-triggered inversion-recovery sequence. The inversion time was adjusted to null the signal from the normal myocardium. Short-axis images were acquired from the atrioventricular plane to the apex with adjacent 8-mm slices. The remaining protocol has been described previously.16

This study presents an integrated Life Cycle Sustainability Assessment (LCSA) of the Natural gas-to-methanol (NGTM) and methanol-to-gasoline (MTG) pathways using Aspen HYSYS process modeling, Environmental Life Cycle Assessment (LCA), Social Life Cycle Assessment (SLCA), and Life Cycle Costing (LCC). The results reveal significant variability in sustainability performance across process units. The DME and MTG Reactors Section generates the highest direct greenhouse gas (GHG) emissions at 0.86 million tons CO2-eq, representing 54.9% of total global warming potential, while the Compression Section consumes 2717.5 TJ/year of energy, making it the dominant source of electricity-related indirect emissions. Distillation and Purification withdraws 31,100 Mm3/year of water—approximately 99% of total demand—yet delivers 86.6% of the overall economic surplus despite high operating costs. Social impacts concentrate in the Methanol Reactor Looping and DME and MTG Reactors Sections, with human health burdens of 305.79 and 804.22 DALYs, respectively, due to catalyst handling and high-pressure operations. Sensitivity results show that methanol purity rises from 0.9993 to 0.9994 with increasing methane content, while gasoline output decreases from 3780 to 3520 kg/h as natural gas flow increases. The findings provide process-level evidence to support sustainable development of natural gas-based fuel conversion industries, aligning with Qatar National Vision 2030 objectives for industrial diversification and lower-carbon energy systems.

Background: The risk of breast cancer progression is one of the most difficult factors to predict as it is studied in different populations, patient groups, or time frames, resulting in conflicting estimates of incidence rates reported in the literature. The purpose of this study is to identify predictive factors for breast cancer recurrences in a sample of the Middle Eastern population. Methodology: A cohort retrospective study included all eligible breast cancer patients at the National Guard Health Affairs (NGHA) Hospital in Jeddah, Western region, from 2015 to 2021. Our primary outcome was the progression status of the patients; we adjusted for demographic, clinical, and molecule characteristics of the population. From 2015 to 2021, there were 319 patients diagnosed with breast cancer. Multiple logistic regression analysis was used to estimate predictors of breast cancer progression. Results: One of five breast cancer patients had breast cancer progression (20.83%), while 66.15% of the progression patients were between the ages of 41–65. In multivariate analysis, age, progesterone receptor (PR), family history, and tumor size were significant predictors of breast cancer progression. The age group of 20–40 years was a protective predictor of breast cancer progression, patients in the young age group were less likely to be diagnosed with progression (OR = 0.35; CI = 0.15, 0.81). While negative PRs and tumor size greater than 2 cm were significant predictor factors of breast cancer progression (OR = 2.07; CI = 1.09, 3.91, OR = 2.02; CI = 1.9, 3.78). Conclusion: Although the effect of young age as a protective factor for the progression of breast cancer remains controversial, our study revealed that patients between 41 and 60 years of age had a higher rate of progression. Future larger prospective studies are needed to delineate the role of age and PR hormone receptors in determining the best treatment options for women with breast cancer in the Saudi population.

Women are the “guardians of the kitchen” and central to household food security, yet their role has never been studied across the Hindukush region or Pamiri Knot. This study explores the women’s knowledge (specifically from the Khowar (Kho) and Wakhi linguistic groups) of local food systems and determines their role in ensuring household food security and sustainability in the mountain regions of northern Pakistan. Based on in-depth semi-structured interviews with female informants in the Rech and Broghil valleys of upper Chitral, 91 different types of food products were recorded, including wild and cultivated species. Eremurus stenophyllus and Allium barsczewskii were the commonly utilized plant species, though distinct preferences between the Kho and Wakhi groups were noted. Prominent differences were perceived in using certain cultivated plants among the two ethnic groups. For instance, Kho preferred plants like Beta vulgaris, Zea mays, and Brassica napus as indicated by the use reports, while Wakhi concentrated on Thymus serpyllum, Zygophyllum obliquum and Papaver involucratum. Both groups had shared dairy practices, but cottage cheese and curd were highly cited among Kho, while double-fermented curd and Qurut for Wakhi. The study recorded some new food uses for specific plants, such as Atriplex hortensis, Carthamus tinctorius, Hylotelephium spp., and Saxifraga sibirica. Cross-culture analyses revealed a mosaic pattern of homogenous and heterogenous trends based on reported food species of plants/animals and their use reports. Our findings emphasize the significant role of women in sustaining local food diversity, food sustainability, and the preservation and security of the local food systems, cultural legacy, and household food management. Therefore, inclusive research addressing their social, economic, and environmental issues must be conducted. Furthermore, policies must incorporate women’s traditional knowledge to build resilient food systems.

Background This case represents a 2-month old female infant with a rare and challenging case of Omenn syndrome that was the result of a compound heterozygous mutation in recombination-activating gene 2 , an occurrence infrequently documented in the literature. The presentation was challenging as the patient complained of recurrent infections and generalized rash. Immunological workup demonstrated preserved T cells and extremely high immunoglobulin E levels. This case highlights the significance of considering leaky severe combined immunodeficiency in the differential diagnosis of early life erythroderma and recurrent infections, despite the absence of typical severe combined immunodeficiency findings. Case presentation We report the case of a 2-month-old Palestinian Arab female infant, born to nonconsanguineous parents, with a positive family history of immunodeficiency, who presented with persistent high-grade fever, diffuse erythrodermic rash, recurrent lower respiratory tract infections, and failure to thrive. Physical examination revealed generalized lymphadenopathy and hepatosplenomegaly. Initial laboratory investigations showed eosinophilia and markedly elevated serum immunoglobulin E levels. Immunological workup demonstrated profound B-cell lymphopenia, preserved natural killer cell counts, and a cluster of differentiation 4/cluster of differentiation 8 T-cell imbalance. Chest radiography revealed absence of a thymic shadow. Whole exome sequencing identified compound heterozygous mutations in the recombination-activating gene 2 , confirming the diagnosis of Omenn syndrome. The patient received aggressive antimicrobial therapy and supportive immunologic care. Despite optimal medical management, she succumbed to infection-related complications at 7 months of age, prior to undergoing hematopoietic stem cell transplantation. Conclusion This case underscores the diagnostic and therapeutic challenges in managing Omenn Syndrome, particularly in settings where routine newborn screening for severe combined immunodeficiency is not available. Early recognition and genetic diagnosis are vital to initiate life-saving interventions such as hematopoietic stem cell transplantation. Increased awareness among clinicians regarding atypical presentations of primary immunodeficiency can lead to earlier referrals, improved outcomes, and reduction in diagnostic delays.

Background: Results from contemporary clinical trials of serotonergic psychedelic therapies have led to an increasing focus on their potential clinical use across mental disorders. However, studies examining mechanisms of clinical response to psychedelic therapy in psychiatric populations are limited. This review aimed to synthesize evidence from studies examining biomarkers of clinical response to psychedelic therapies. Data sources and methods: A systematic search of four databases (MedLine, PsycInfo, EMBASE, and Web of Science) for studies investigating treatment response to psychedelic therapies in psychiatric populations that included both clinical outcomes and a related biomarker was conducted on January 10, 2024. Studies were included if they reported on prospective clinical trials involving the use of a psychedelic in participants diagnosed with any Diagnostic and Statistical Manual or International Classification of Diseases mental disorder, where a biological marker was measured and evaluated in association with treatment response. Results: Nine studies investigating the effects of Ayahuasca and psilocybin in major depressive disorder and treatment-resistant depression were included in this review. Several potential biomarkers of response were explored through neuroimaging and blood samples, with significant associations found for serum brain-derived neurotrophic factor, serum C-reactive protein, cerebral activation of the amygdala, and functional connectivity between regions such as the ventromedial prefrontal cortex, anterior cingulate cortex, and posterior cingulate cortex. Conclusion: Results of small studies suggest associations between several putative biomarkers and treatment response to psychedelic therapies. Future trials of psychedelic therapies should integrate biomarker assessment in longitudinal designs to advance the understanding of their mechanism of action in mental disorders. Trial registration: This study protocol was registered to PROSPERO under the number CRD42021291171. Plain language summary Biological markers that predict how well psychedelic treatments work: a review of research Psychedelic therapies, like those using psilocybin and Ayahuasca, are showing promise in treating mental health conditions like depression. However, we still don’t fully understand why these treatments help some people more than others. This review looks at research that has explored biological markers—things we can measure in the brain or body—to see if they can predict who will respond best to these treatments. Studies have found that brain activity and certain proteins in the blood, such as brain-derived neurotrophic factor (BDNF) and C-reactive protein (CRP), may be linked to treatment success. Though the studies are small, they suggest that further research could help us better understand how psychedelics work and improve their use in mental health treatment.