The global epidemics of obesity and type II diabetes highlight the need for reliable tools to predict surgical outcomes, particularly diabetes remission. The applicability of the Advanced DiaRem (Ad-DiaRem) score to Iranian patients undergoing Roux-en-Y gastric bypass (RYGB) remains uncertain due to cultural, genetic, and environmental differences. This study aimed to validate the predictive value of the Ad-DiaRem score in an Iranian cohort.

This mixed cohort study included 280 diabetic adults who underwent RYGB from 2016 to 2023. Ad-DiaRem scores were calculated based on preoperative clinical variables. Diabetes remission was defined as HbA1c < 6.5% (or fasting blood glucose < 126 mg/dL) at least three months post-surgery without diabetes medications. Various cut-offs were tested, and the Ad-DiaRem's predictive performance was assessed using sensitivity, specificity, accuracy, and receiver operating characteristic (ROC) analysis.

Remission episodes were recorded in 57.9% of patients. Those achieving remission had significantly lower median Ad-DiaRem scores (6 vs. 9). At the cut-off score of 7, Ad-DiaRem showed 51.9% sensitivity, 78.0% specificity, 76.4% positive predictive value, 54.1% negative predictive value, and 62.9% accuracy for predicting remission. The area under the ROC curve (AUC) was 66.7%.

In Iranian patients, the Ad-DiaRem score demonstrated limited predictive performance for diabetes remission after RYGB, with lower accuracy than previously reported in other populations. Recalibration of Ad-DiaRem components is necessary, and development of population-specific scoring systems validated in larger cohorts with longer follow-up is recommended.

Previous observational studies have reported an increased risk of venous thromboembolism (VTE) among non-steroidal anti-inflammatory drug (NSAID) users compared with non-users. However, these studies may have been subject to bias due to unmeasured confounders related to patient conditions requiring NSAIDs. We employed an active comparator new user cohort design, using acetaminophen as the active comparator.

New users of either NSAIDs or acetaminophen aged 18-65 years were identified from a Japanese health insurance claims database. The adjusted hazard ratio (aHR) of VTE among new NSAID and acetaminophen users within 60 days of prescription was calculated using propensity score overlap weighting and Cox regression. To examine how a naïve comparison between users and non-users of NSAIDs might affect the results, we repeated the analysis using non-users of NSAIDs as the comparator group instead of acetaminophen users.

Among 4,282,421 new NSAID users and 2,728,202 new acetaminophen users, 1504 (0.022%) developed VTE during follow-up. New NSAID users had a significantly lower incidence of VTE compared with new acetaminophen users (aHR, 0.70; 95% confidence interval [CI], 0.62-0.80). When compared with non-users, NSAID users had a significantly higher incidence of VTE (aHR, 3.18; 95% CI, 2.85-3.55).

Although new NSAID users had a lower incidence of VTE than new acetaminophen users, they had a higher incidence compared with non-users. Assuming that acetaminophen does not increase VTE risk, these findings suggest that NSAIDs themselves may not increase VTE risk.

The cardiometabolic benefits of caloric restriction (CR) often overlap with those of intermittent fasting (IF), creating clinical uncertainty. This meta-analysis updates and refines the evidence on the effects of a monotherapeutic CR diet (MCRD) on cardiometabolic parameters in adults at high cardiovascular risk, compared with a usual diet. A systematic search of four databases through May 2025 identified 17 randomized controlled trials (1,066 participants) with low to moderate risk of bias, all involving populations with a mean baseline BMI ≥30 kg/m². The results indicate that MCRD significantly reduced body weight (MD: -6.29 kg; 95% CI: -7.51, -5.06), waist circumference (MD: -5.09 cm; 95% CI: -6.48, -3.70), body fat (MD: -4.89 kg; 95% CI: -5.92, -3.87), central abdominal fat (MD: -0.7 kg; 95% CI: -0.97, -0.43), and lean body mass (MD: -1.34 kg; 95% CI: -2.14, -0.53). Significant metabolic improvements were observed, with reductions in fasting insulin (MD: -2.22 μIU/L; 95% CI: -3.83 to -0.61), HbA1c (MD: -0.31%; 95% CI: -0.61 to -0.01), HOMA-IR (MD: -0.97; 95% CI: -1.86 to -0.09), and both systolic (MD: -6.06 mmHg; 95% CI: -9.46 to -2.65) and diastolic blood pressure (MD: -3.79 mmHg; 95% CI: -6.34 to -1.25). No significant effects were observed on lipid profiles, glucose levels, or hs-CRP. Meta-regression showed that caloric intake reduction, longer intervention duration, and older age significantly covariate on weight reduction. While beneficial, MCRD requires complementary strategies for optimal health. Further research is needed to clarify its unique mechanisms and distinguish them from the overlapping effects of IF.

A novel index, termed the right ventricle (RV)-pulmonary artery (PA) index, was established by integrating the longitudinal strain of the right ventricular free wall (RVFWLS) and the right ventricular ejection fraction (RVEF), both evaluated using three-dimensional speckle-tracking echocardiography (3D-STE), with the stiffness of the pulmonary artery (PAS). This approach aims to enhance our understanding of the underlying mechanisms associated with heart failure with preserved ejection fraction (HFpEF).

The study comprised 80 patients diagnosed with HFpEF, 60 high-risk patients without clinical heart failure (HF), and 50 healthy controls. Clinical data and pulmonary stiffness measurements were collected, and right ventricular function was evaluated using 3D-STE. Furthermore, the corresponding RV-PA coupling parameters were established. Statistical analyses were conducted using SPSS version 26.0 and R software, employing one-way ANOVA, the Kruskal-Wallis H test, Pearson and Spearman correlation coefficients, multivariable linear regression, and receiver operating characteristic (ROC) curve analysis.

Patients with HFpEF exhibited elevated levels of PAS, dilated right heart structures, and impaired right ventricular (RV) function when compared to both high-risk and control groups. PAS was identified as an independent risk factor for RV dysfunction. Stratified diagnostic analysis revealed that the novel coupling index, RVEF/PAS, demonstrated exceptional diagnostic performance during the initial screening phase (AUC = 0.813) and maintained robust discriminatory power during the differentiation stage of the high-risk population (AUC = 0.757). Both newly developed indices, RVEF/PAS and RVFWLS/PAS, exhibited significant positive correlations with tricuspid annular plane systolic excursion (TAPSE)/PASP (r = 0.536, p = 0.004; r = 0.449, p = 0.019). The proposed stratified diagnostic model, characterized by a "primary screening-refined discrimination" approach based on parameter characteristics, offers a novel strategy for the early detection of HFpEF.

The 3D-STE method reliably assesses right ventricular function in patients with HFpEF, while pulmonary arterial compliance is effectively evaluated through PAS. The novel RV-PA coupling indices, namely RVEF/PAS and RVFWLS/PAS, are developed by integrating these techniques, providing a stratified diagnostic strategy for the early detection of HFpEF. PAS is appropriate for initial screening in primary care settings, whereas RVEF/PAS offers precise diagnostic support in medical centers. Collectively, these methods establish a novel non-invasive tool system for evaluating interactions between the right heart and pulmonary vasculature.

Aortic dissection is a life-threatening cardiovascular emergency with limited pharmacological options. This study focuses on elucidating the multi-target and multi-pathway mechanisms through which morusin mitigates aortic dissection progression, integrating network pharmacology, single-cell transcriptomics and experimental validation. Multi-database analysis identified 281 morusin targets and 1741 ad-related genes, with 84 overlaps. Enrichment analyses highlighted IL-17, HIF-1 and MAPK signalling pathways as potential regulatory hubs. Protein-protein interaction network analysis identified seven key targets, all showing high binding affinity to morusin in molecular docking. Single-cell transcriptomics revealed cell-type-specific dysregulation, notably MAPK8 upregulation in fibroblasts and immune cells. In vitro, morusin dose-dependently inhibited AngII-induced vascular smooth muscle cell proliferation and modulated IL-17 pathway gene expression. In vivo, morusin attenuated aortic dilation and reduced morbidity and mortality in a BAPN-induced AD mouse model. These findings suggest that morusin mitigates AD progression by targeting key inflammatory and apoptotic pathways, supporting its potential as a multi-target therapeutic candidate.

Treatment response remains one of the key challenges in managing patients with obsessive-compulsive disorder (OCD). This study aimed to investigate the efficacy of combining neurofeedback with pharmacotherapy in treating OCD. We conducted a single-blind, randomized clinical trial at Farschian Hospital in Hamadan, Iran. Forty-five patients with OCD were randomly assigned to three groups (n = 15 per group): experimental, placebo, and control. The experimental group received 25 neurofeedback sessions (three 45-minute sessions per week) alongside pharmacotherapy. The placebo group followed a similar protocol but without actual neurofeedback administration. The control group received pharmacotherapy alone. Data were analyzed using SPSS-22. The results demonstrated a significant improvement in the mean total obsession score, including both thought and compulsion subscales (p < 0.01). The experimental group showed significantly greater improvement in all outcome measures compared to both control groups (p < 0.05). No significant difference was observed between the placebo and control groups (p > 0.05). These findings suggest that combining neurofeedback with pharmacotherapy significantly reduces OCD symptom severity compared to either treatment alone. Neurofeedback may serve as an effective, novel, and non-invasive complementary therapy for OCD when combined with standard pharmacological treatment.Trial registration The trial was registered at the Iranian registry of clinical trials ( www.irct.ir ; registration number: IRCT2015030321313N1).

Fear of childbirth (FoC), particularly its severe form (tokophobia), is a significant public health concern associated with adverse maternal and neonatal outcomes. While previous meta-analyses have provided global prevalence estimates, significant knowledge gaps remain due to limited studies. This study aimed to provide an updated global prevalence estimate of severe FoC and explore sources of heterogeneity and associated risk factors.

A systematic review and meta-analysis was conducted following PRISMA and MOOSE guidelines. We searched international and Persian databases from inception until June 2025 for cross-sectional and cohort studies reporting severe FoC prevalence in pregnant women using validated tools with defined cutoffs. Two reviewers independently performed data extraction and quality assessment using the Newcastle-Ottawa Scale. Random-effects models were used for meta-analysis, with heterogeneity assessed via I² statistic. Subgroup analyses and meta-regressions explored variation sources. Risk factors were synthesized descriptively, though nulliparity and unplanned pregnancy allowed meta-analysis.

From 67 included studies (n = 905,504 participants), the pooled prevalence of severe FoC was 16.5% (95% CI: 13.8-19.5%), with significant heterogeneity (I² = 99.45%). Assessment tools and cutoffs were major heterogeneity sources (p < 0.001), with prevalence ranging from 3.7% to 58.7%. Country of study was also a significant moderator (p < 0.001). Meta-regression showed no significant association with maternal age, gestational age, nulliparity percentage, or publication year. Key risk factors included previous traumatic birth, anxiety/depression symptoms, and inadequate social support. Nulliparous women had higher odds of severe FoC (OR = 1.36, 95% CI: 1.04-1.76), as did those with unplanned pregnancy (OR = 1.85, 95% CI: 1.29-2.65).

Severe FoC affects approximately one in six women globally. The substantial heterogeneity, largely due to methodological variations, underscores the need for standardized assessment protocols. Identified associations with factors such as previous traumatic birth and anxiety highlight the condition's multifactorial nature, emphasizing the importance of targeted screening and evidence-based interventions aligned with Sustainable Development Goal (SDG) 3 to improve maternal mental health.

Substance use (SU) problems are critical public health concerns. This study investigated how childhood risk factors and cannabis age of onset (CAO) in adolescence predict later SU problems, using data from the two cohorts of the Quebec Longitudinal Study of Child Development (N = 306; 57% female; N = 1489; 54% female), followed from birth to age 23. A direct association between early CAO and increased cannabis use problems was found in males (cohort 1: β = -0.47; cohort 2: β = -0.22), but not in females. In both sexes, CAO was indirectly associated with later cannabis use problems via increased adolescent cannabis use frequency (cohort 1: ab = -0.41; cohort 2: ab = -0.35). Similar indirect associations were observed between CAO and other SU problems (including tobacco and alcohol), via adolescent cannabis use frequency (cohort 1: ab = -2.63). Parental cannabis use, adverse childhood experiences, and childhood externalizing behaviors (i.e., physical aggression and ADHD symptoms) were associated with early CAO and subsequent CU problems. These findings support developmental models linking early risk exposures to maladaptive substance use pathways and underscore the importance of prevention strategies targeting early cannabis initiation and modifiable early-life risk factors to reduce long-term SU-related problems.

To describe the sociodemographic characteristics and comorbidities of people who died from dementia between 2013 and 2023 in England.

We analysed death certificates reported in England from 2013 to 2023. We report the number, age, sex, country of origin and socioeconomic status of people who died with a dementia diagnosis recorded (as a primary or contributory cause); the dementia subtype diagnoses and recorded comorbidities. We tested the hypothesis that number of comorbid disorders would be higher in more deprived areas.

There were 987 719 certificates in this period that recorded dementia as a cause of death, of which 693 663 (70.2%) recorded dementia as the primary cause of death. In total, 62.2% (n = 614 419) of those who died from dementia were women, 65% (n = 643 026) were aged 85+, and most (846 584, 85.7%) were born in England. Fifteen percent (n = 149 447) of included death certificates recorded dementia as sole cause of death; others included up to 10 other contributory conditions (median = 1; IQR:1-2), of which influenza and pneumonia (183 203; 18.5%), ischaemic heart diseases (114 871; 11.6%), cancers (107 444; 10.8%), hypertensive diseases (99 517; 10%) and diabetes (98 517; 10%) were the most common. After controlling for age and sex, death certificates of people living in areas with higher deprivation included a higher number of comorbidities (β = -0.04, P < .001).

Policies to reduce inequities in dementia care need to account for the more complex health needs of people with dementia living in more deprived areas towards the end of life.

Prior research has documented associations between environmental noise and mental health; however, the impact of building vibration noise remains unclear. This study aimed to test a mediation model evaluating whether specific noise types mediate the association between housing type and mental health among adults in Taiwan.

Cross-sectional data of 776 participants obtained from an online survey conducted from December 1, 2024 to May 31, 2025 were analyzed. The participants rated subjective levels of road-traffic noise, railway noise, and building vibration noise. Mental health outcomes included sleep quality, depressive symptoms, anxiety symptoms, and suicidality. Mediation analysis with nonparametric bootstrapping (5000 resamples) was used to test mediation.

Residing in an apartment/condominium had a significantly indirect mediating effect on poorer mental health (estimates of the indirect effect: 0.225, P < 0.001 for sleep quality, 0.431, P < 0.001 for anxiety, 0.412, P < 0.001 for depression, and 0.062, P = 0.024 for suicide risk), and this association was mediated by higher levels of building vibration noise. However, road-traffic and railway noise did not show significant mediation effects.

Building vibration noise appears to be a key pathway linking living in an apartment/condominium to adverse mental health outcomes.