Explore the vast range of titles available.

This paper assesses dynamical models to construct monthly (January through December for lead times of 0.5–2.5 months) and seasonal (January–March [JFM], April–June [AMJ], July–September [JAS], and October–December [OND] for lead times of 1.5–3.5 months) forecasting of drought based on the standardized precipitation evapotranspiration index (SPEI) over Iran. The air temperature (minimum, maximum, and mean) and precipitation data, as the components of SPEI, are forecasted using six North American Multi‐Model Ensemble (NMME) and European Centre for Medium‐Range Weather Forecasts (ECMWF) SEAS51 as well as their ensemble multi‐model mean (MMM) for a common period from 1991 to 2021. These forecast data are interpolated to stations using inverse distance weighting, and then the SPEI is computed for each model. The observed SPEI is calculated for 67 synoptic stations across Iran. The SPEI forecast skill of the MMM surpasses that of individual models. Additionally, MMM demonstrates improved forecast skill during wet and cold months (November–March) compared to dry and warm months (June–September). There is a statistically significant Pearson correlation coefficient between observed and forecast JFM SPEI in most areas of the study area for lead times of 1.5, 2.5, and 3.5 months at a 5% significance level. Moreover, the SPEI forecast is significant in most areas for JFM, AMJ, and OND for the 1.5‐month lead time. The canonical correlation analysis is employed to investigate the relationship between observed global sea surface temperature anomalies (SSTA) and seasonal SPEI to achieve insights into the source of drought predictability in Iran, as well as how the skill of the MMM forecasts is affected by SSTA. The spatial pattern root mean square error of the MMM forecasts and SSTA is similar. The canonical correlation coefficient between SSTA and observed SPEI is stronger than in JFM, indicating that MMM exhibits promising potential for SPEI forecasts. Drought forecasting is essential for the proactive administration of water resources and the reduction of the effects of drought. MMM forecasts exhibit greater accuracy during wet and cold months compared to dry and warm months in Iran. This is evident in the statistically significant Pearson correlation coefficients between observations and JFM SPEI forecasts at most synoptic stations and across all lead times. Taylor diagrams for JFM between area‐averaged observations and SPEI models at 3.5‐month (a), and the Pearson correlation map for MMM forecasts at 3.5‐month lead times for JFM (b).

This paper investigates the relationship between seasonal precipitation over Iran and low‐level moisture, in terms of vertically integrated specific humidity (VISH) from the surface to 850 hPa. The VISH is calculated from ERA5 data for the domain (10°N–60°N, 15°E–80°E), and the precipitation is calculated from 50 stations across Iran, both for the period 1968–2023. Canonical correlation analysis (CCA) is applied to examine the spatial–temporal relationship between seasonal averages of moisture and precipitation during January–March (JFM), April–Jun (AMJ), and October–December (OND). VISH and precipitation are considered as the simultaneous predictor and predictand fields in the CCA, respectively. The CCA time series are correlated to global sea surface temperatures to assess the connections to large‐scale, potentially predictable modes of variability. The CCA spatial patterns indicate that there is a strong relationship between low‐level moisture and seasonal precipitation, with VISH over the Persian Gulf, Oman Sea, Arabian Sea, and Red Sea positively correlated with precipitation over most areas of Iran, while VISH over the Caspian Sea and Black is negatively correlated. Generally, these relationships are notably low over northwestern areas of Iran and the coastal regions of the Caspian Sea and the prediction skill of CCA remains limited over these regions. In OND, the leading CCA time series exhibits the well‐known connection to the El Niño–Southern Oscillation (ENSO). However, the highest CCA skill is found for JFM precipitation, which does not exhibit an ENSO connection, and so may present an additional source of skill. The first canonical pair of vertically integrated specific humidity (VISH) from the surface to 850 hPa and precipitation for the JFM season, with the VISH pattern in (a), the precipitation pattern in (b). This pair of spatial patterns indicates a positive association between the spatial pattern of the VISH over the Persian Gulf, Oman Sea, Arabian Sea, southern parts of Red Sea, and precipitation for JFM over most areas of Iran. However, the VISH over northern latitudes (38°N–60°N) has a negative association with JFM precipitation over most areas.

Introduction Cancer is a significant worldwide health problem, and targeted drugs like Cabozantinib and Atezolizumab offer new therapeutic options. These drugs enhance patient survival by specifically targeting cancer cells while minimizing damage to healthy tissues. The current research investigates the effectiveness of employing the combination of Cabozantinib and Atezolizumab vs single-agent Cabozantinib. Methods In this study, we searched databases including PubMed/Medline, Scopus, Embase, Cochrane, and Web of Science up to the end of January 2025. The results were categorized into two groups: the intervention group (Cabozantinib plus Atezolizumab) and the control group (Cabozantinib monotherapy) in cancer patients. We evaluated variables such as efficacy outcomes, including Objective Response Rate (ORR) and Disease Control Rate (DCR), as well as adverse events (safety). Data analysis was performed using random-effects models, and Relative Risk (RR) was reported as the effect size. Results Three clinical trials were included in this study. Regarding efficacy outcomes, there was no statistically significant difference in ORR between the intervention group and the control group (RR = 1.11, 95% CI: 0.76-1.61). Similarly, DCR did not differ significantly between groups (RR = 0.98, 95% CI: 0.94-1.03). In terms of safety, the combination therapy was associated with a statistically significant reduction in four treatment-related adverse events: diarrhea (RR = 0.91, 95% CI: 0.83-0.99), nausea (RR = 0.79, 95% CI: 0.65-0.95), vomiting (RR = 0.70, 95% CI: 0.52-0.96), and hypokalemia (RR = 0.28, 95% CI: 0.19-0.40). Conclusion The findings suggest that the combination of Cabozantinib and Atezolizumab does not offer significant improvement in treatment efficacy compared to Cabozantinib alone. However, the combination may be associated with a lower incidence of certain chemotherapy-related adverse events. These exploratory findings may inform future research on treatment strategies for patients who experience intolerance to Cabozantinib monotherapy. Plain Language Summary Cancer treatment often involves using drugs that target the cancer cells, but these treatments can come with side effects. One such treatment is Cabozantinib, which is approved for several types of cancer. Recently, it has been tested with a second drug, Atezolizumab, to see if the combination could be more effective in treating cancer and also reduce side effects. In our study, we looked at research from three clinical trials that compared Cabozantinib alone to the combination of Cabozantinib and Atezolizumab. We wanted to understand if adding Atezolizumab would improve treatment results, like how many patients' cancer shrank or stopped growing (this is called the Objective Response Rate, or ORR) and how well the disease was controlled (the Disease Control Rate, or DCR). We also looked at the side effects of these treatments. The combination therapy did not show a clear improvement in shrinking or controlling the cancer compared to Cabozantinib alone. However, the combination therapy did lead to fewer side effects, such as nausea, vomiting, diarrhea, and low potassium levels, making it a better option for patients who struggle with these side effects from Cabozantinib alone. Our findings suggest that while the combination treatment may not be better at treating cancer, it could be a good choice for patients who cannot tolerate Cabozantinib on its own. More research is needed to better understand who might benefit the most from this combination therapy, especially for patients with certain types of tumors.

Background Mifepristone has demonstrated favorable effects in managing uterine myomas, particularly for patients aiming to preserve fertility. This study evaluates the effect of Mifepristone on uterine parameters, including uterine volume and endometrial thickness, across different dosages. Methods A systematic review and meta-analysis were conducted by searching PubMed, Web of Science, Scopus, Embase, Cochrane Library, and clinical trial registries up to November 30, 2024. Eligible studies were randomized controlled trials (RCTs) comparing Mifepristone with placebo, other drugs, or different Mifepristone dosages in patients with uterine myoma. The primary outcomes were changes in uterine volume and endometrial thickness. Secondary outcomes included symptom relief, such as dyspareunia. Data were pooled using a random-effects model, and effect sizes were expressed as standardized mean differences (SMD) or relative risks (RR) with 95% confidence intervals (CI). Results Fourteen RCTs involving a total of 1260 patients were included. Higher doses of Mifepristone (10 mg daily) compared to lower doses (5 mg daily) were associated with greater, albeit non-significant, reductions in uterine volume (SMD: -0.08, 95% CI: -0.25 to 0.09, p  = 0.35) and a non-significant increase in endometrial thickness (SMD: 0.22, 95% CI: -0.23 to 0.66, p  = 0.34). The 10 mg dose was significantly more effective in resolving dyspareunia (RR: 1.87, 95% CI: 1.59 to 2.20, p  < 0.01). Conclusion Our analysis indicated that Mifepristone was associated with a non-significant reduction in uterine volume among patients with uterine myoma. However, higher daily doses (10 mg) demonstrated greater clinical benefits in relieving dyspareunia, despite minimal changes in uterine size. These findings suggest that higher doses (10 mg daily) may be a consideration for symptom relief, particularly for dyspareunia, despite minimal changes in uterine size. This suggestion is preliminary, given the non-significant primary outcomes and low certainty of evidence for key comparisons.

This study analyzes linear trends and change points in meteorological variables including (a) sea surface temperature (SST) anomalies using three data sets: (1) level 4 of the optimum interpolated SST (OISST) of the Advanced Very High Resolution Radiometer (AVHRR), (2) the Objectively Analyzed Air-Sea Fluxes (OAFluxSST) project, and (3) the observed Improved Extended Reconstructed SST version 4 (ERSST); (b) evaporation (Evap); (c) air temperature at 2 m (AT2m); (d) wind speed at 10 m (wind10m); (e) specific humidity at 2 m (hum2m); and (f) precipitation used from Multi-Source Weighted-Ensemble Precipitation (MSWEP) over the south of the Caspian Sea (SCS) for the period 1982–2016. A significant upward trend is observed in annual SST anomalies over the SCS at the 5% level such that OISST, OAFluxSST, and ERSST data sets, respectively, indicating warming rates of about 1.2, 1.3, and 1.9 °C during the study period. Also, a significant upward trend is observed in annual Evap, AT2m, wind10, and hum2m at the 5% level. Both the Student t parametric and Mann-Whitney nonparametric Change Point Models (CPMs) suggested occurrence of common change point for annual OISST in 1994 over the SCS. For the same year, the applied Mann-Whitney test detected change point in annual OAFluxSST. The detected change point for OISST coincides with the change points of the annual hum2m and AT2m anomalies of synoptic stations (Bandar Anzali, Babolsar, and Ramsar), located at the southern coast of the Caspian Sea. The applied CPMs suggested significant change point in Evap in 1997, as evidenced by the increase of 60 mm in the mean annual value. The annual wind10m time series have a change point in 1995. The likelihood ratio test (LRT) confirms the CPM results. For example, the LRT indicates that the annual OISST and OAFluxSST anomalies over the periods 1983–1994 and 1995–2016 are drawn from normal distributions with different means such that difference in annual OISST and OAFluxSST anomalies means before and after 1994 are 0.89 and 0.83 °C, respectively.

Hepatic hydatid disease, a manifestation of cystic echinococcosis caused by , remains endemic in many regions and poses a persistent therapeutic challenge. Although surgery is often employed for definitive management, recurrence, procedural risks, and anatomical constraints have led to growing interest in minimally invasive alternatives such as percutaneous aspiration and endoscopic interventions. We report a 52-year-old male with an incidentally detected hepatic hydatid cyst who initially underwent surgical cystectomy and cholecystectomy. Twenty-five days postoperatively, the patient developed new abdominal fullness, and repeat imaging revealed a cystic lesion in the left hepatic lobe measuring 13.4 × 9.9 cm, reported radiologically as recurrence. The patient underwent endoscopic ultrasound (EUS)-guided fine-needle aspiration and lavage of the cyst cavity with 20 mL of 96% ethanol. The procedure was well tolerated with no adverse events, and follow-up imaging at 6 months confirmed complete cyst resolution. This case demonstrates the technical feasibility and clinical safety of EUS-guided ethanol ablation as a minimally invasive alternative for recurrent hepatic hydatid cysts. It highlights the expanding therapeutic potential of EUS beyond conventional indications and supports further exploration of this technique in selected cases.

Background Cervical cancer (CC) remains the fourth most prevalent malignancy among women globally, with a disproportionate burden in low‐ and middle‐income countries, where it is often diagnosed at advanced or metastatic stages. Aims Despite an increasing number of case reports and institutional studies on brain metastases (BMs) arising from CC, current understanding of their epidemiology, clinical presentation, and prognostic implications remains fragmented and lacks comprehensive synthesis. Methods We executed a systematic and unrestricted search of five major databases, PubMed/Medline, Scopus, Embase, Web of Science, and Google Scholar, covering all records up to April 19, 2025. Studies were eligible for inclusion if they provided a clear report on the incidence of BMs among CC patients. The quality and risk of bias of the selected studies were independently appraised using the Joanna Briggs Institute (JBI) assessment criteria. For statistical analysis, we utilized STATA version 17, implementing random‐effects meta‐analytical models to estimate the aggregated incidence along with corresponding 95% confidence intervals (CIs). Results A total of 17 studies encompassing 33 datasets were included in the final analysis. The global pooled incidence of BMs among cervical cancer patients was estimated at 0.65% (95% CI: 0.46–0.85). Incidence was highest in Turkey (1.83%, 95% CI: 0.91–2.75) and lowest in South Africa (0.22%, 95% CI: 0.0–0.47). Among histologic subtypes, neuroendocrine carcinoma exhibited the highest pooled incidence of BMs at 10.60% (95% CI: 0.0–21.63), followed by adenocarcinoma at 0.89% (95% CI: 0.14–1.64). The pooled mean survival time following the diagnosis of BMs was 6.80 months (95% CI: 5.08–8.52), while the mean interval from the initial cervical cancer diagnosis to the development of BMs was 28.15 months (95% CI: 24.27–32.03). Conclusion Although BMs in cervical cancer are rare, they are associated with dismal survival outcomes and poor prognosis. These findings underscore the importance of vigilant surveillance in high‐risk patients and may inform the development of more targeted and effective therapeutic and preventive strategies.

Objective Stroke is a leading cause of death and disability worldwide, with its prevalence increasing due to risk factors such as hypertension, diabetes, and hyperlipidemia. Pregnancy-related stroke (PRS), a severe pregnancy complication, particularly during the postpartum period, has shown rising incidence rates, occurring at 30 per 100,000 pregnancies, three times higher than in the general young adult population. This study systematically reviews and analyzes global and regional data regarding the incidence and risk factors of PRS. Methods Comprehensive searches of PubMed/MEDLINE, Scopus, EMBASE, and Web of Science databases were performed until December 20, 2024. Studies reporting any type of stroke occurring during pregnancy (from the time of confirmation to one year postpartum) were included. Study quality was evaluated using the Joanna Briggs Institute (JBI) checklist, and data analysis was conducted with STATA version 17. A random-effects meta-analysis was employed to calculate pooled incidence rates per 100,000 pregnancies, with 95% confidence intervals (CIs). Heterogeneity was assessed using Cochran’s Q test and quantified with the I² statistic. Risk factors for PRS were also evaluated using univariate regression. Results A total of 33 studies involving 270,136,827 pregnant women from 10 countries met inclusion criteria. The global cumulative incidence of PRS was 25.38 (95% CI: 21.02–30.63) per 100,000 pregnancies. Regional analysis revealed the highest incidence in the South-East Asia region (66.31; 95% CI: 44.22–99.42) and the lowest in the European region (12.88; 95% CI: 7.73–21.46). Based on 22 included studies, the pooled maternal mortality rate due to PRS was estimated at 1.55 per 100,000 pregnancies (95% CI: 1.04–2.32). Risk factors significantly associated with PRS included migraine, dyslipidemia, alcohol use, tobacco smoking, sickle cell disorders, coagulopathy, cardiovascular diseases, preeclampsia/eclampsia/gestational hypertension, and postpartum hemorrhage. Conclusion PRS, with a global incidence of 25.38 per 100,000 pregnancies, remains a critical health concern, particularly in regions with limited resources. However, a lack of data from many countries limits a comprehensive global understanding. The identification of key risk factors, such as preeclampsia, cardiovascular disorders, and postpartum hemorrhage, highlights the need for targeted preventive strategies. Improved data collection, early detection, and timely intervention are essential to reducing the burden of PRS worldwide. Trial registration The PROSPERO registration code is CRD420251152299.

Background The integration of immune checkpoint inhibitors with anti-angiogenic therapy has transformed the management of advanced malignancies. Atezolizumab (ATZ), a PD-L1 inhibitor, combined with Bevacizumab (BEV) and chemotherapy, may exert synergistic antitumor effects via immune activation and vascular normalization. However, the comparative efficacy and safety of this triplet regimen across cancer types remain uncertain. Methods A systematic search of PubMed, Embase, Scopus, the Cochrane Library, and major clinical trial registries was conducted from inception to July 31, 2025, to identify randomized controlled trials (RCTs) evaluating ATZ + BEV + chemotherapy versus BEV + chemotherapy alone. Primary endpoints included objective response rate (ORR), disease control rate (DCR), progression-free survival (PFS), and overall survival (OS). Safety outcomes encompassed all-grade and grade III-IV adverse events based on CTCAE. Pooled risk ratios (RRs) and hazard ratios (HRs) were calculated using a random-effects model. Evidence certainty was assessed via GRADE. Results A total of eight RCTs comprising 3707 participants were analyzed. Incorporation of ATZ into the treatment protocol led to a notable increase in ORR (RR = 1.10; 95% CI: 1.00–1.21) and produced significant gains in both PFS (adjusted HR = 0.73; 95%CI: 0.63–0.84) and OS (adjusted HR = 0.83; 95%CI: 0.76–0.92). In contrast, changes in DCR were modest and did not achieve statistical significance (RR = 1.02; P  = 0.324). The addition of ATZ did not substantially elevate the frequency of most adverse events relative to BEV plus chemotherapy alone. However, a statistically significant increase was observed in diarrhea (RR = 1.24; 95%CI: 1.06–1.46), predominantly driven by low-grade events, and in grade III-IV nausea (RR = 1.66; 95%CI: 1.03–1.84). Rates of other grade III-IV toxicities were generally comparable between treatment groups. Sensitivity analyses and assessments for publication bias supported the stability of the results, and the overall certainty of the evidence was judged to be high. Conclusion The ATZ + BEV + chemotherapy regimen demonstrated OS benefits in multiple malignancies, although the magnitude of benefit appears to vary across tumor types. Toxicity was generally manageable, although selective increases in low-grade gastrointestinal events and grade III-IV nausea were observed. Immune-related adverse event profiles differed among indications. These findings support the biologic rationale for concurrent immune and angiogenic targeting; however, tumor-specific factors should be considered when integrating this strategy into contemporary oncology practice. Future biomarker-driven studies are warranted to refine patient selection and optimize therapeutic sequencing.

Background: This was a retrospective cephalometric study to develop a more precise estimation of soft tissue changes related to underlying tooth movment than simple relatioship betweenhard and soft tissues. Materials and Methods: The lateral cephalograms of 61 adult patients undergoing orthodontic treatment (31 = premolar extraction, 31 = nonextraction) were obtained, scanned and digitized before and immediately after the end of treatment. Hard and soft tissues, angular and linear measures were calculated by Viewbox 4.0 software. The changes of the values were analyzed using paired t-test. The accuracy of predictions of soft tissue changes were compared with two methods: (1) Use of ratios of the means of soft tissue to hard tissue changes (Viewbox 4.0 Software), (2) use of stepwise multivariable regression analysis to create prediction equations for soft tissue changes at superior labial sulcus, labrale superius, stomion superius, inferior labial sulcus, labrale inferius, stomion inferius (all on a horizontal plane). Results: Stepwise multiple regressions to predict lip movements showed strong relations for the upper lip (adjusted R2 = 0.92) and the lower lip (adjusted R2 = 0.91) in the extraction group. Regression analysis showed slightly weaker relations in the nonextraction group. Conclusion: Within the limitation of this study, multiple regression technique was slightly more accurate than the ratio of mean prediction (Viewbox4.0 software) and appears to be useful in the prediction of soft tissue changes. As the variability of the predicted individual outcome seems to be relatively high, caution should be taken in predicting hard and soft tissue positional changes.