Naeimehossadat Asmarian

Introduction: Sepsis is a life-threatening condition in intensive care units (ICUs), where any delay in diagnosis and treatment can lead to organ dysfunction, prolonged hospital stay and increased mortality. Early identification of sepsis prior to its clinical manifestation may enable timely intervention and improve outcomes. This review aims to identify, synthesise and categorise predictor variables assessed in adult ICU patients prior to sepsis diagnosis. Methods/design: This protocol, in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) guideline, will involve a comprehensive search of PubMed/Medline, Scopus, Embase, Web of Science, IEEE Xplore and Cochrane Library for English-language studies from database inception. The search is planned to be conducted between March 2026 and June 2026. We will include prospective, retrospective, cohort, case–control and cross-sectional studies, and both randomised and non-randomised designs. Additionally, we will consider secondary analysis of electronic health records, clinical registries and routinely acquired clinical data that determine risk factors and predictive variables that will help in the early identification of sepsis using machine learning, artificial intelligence, computational or statistical methods. Two independent reviewers will perform title and abstract screening followed by full-text review and data extraction. The risk of bias will be evaluated using appropriate tools depending on study design: the Newcastle-Ottawa Scale for observational studies, Cochrane Risk of Bias tool for randomised trials and PROBAST for prediction model studies. We will perform a narrative synthesis structured by variable-type, timing and performance metrics (area under the curve, sensitivity, ORs). Subgroup analyses will be conducted based on study design, sepsis definition, type of ICU (medical, surgical, mixed) and geographic area (high-income and low- and middle-income countries). Ethics and dissemination: Findings from this systematic review will be disseminated through publication in a peer-reviewed journal and/or presentation at scientific conferences. The data used will not include individual patient data, so ethical approval is not required. PROSPERO registration number: CRD420251113781.

Nonalcoholic fatty liver disease (NAFLD) is a common metabolic disorder closely associated with increased oxidative stress and a range of chronic conditions, including male infertility. Previous studies have indicated that Chlorella vulgaris (CV) and Lactobacillus casei (LBC) exert beneficial effects on NAFLD. This study aimed to evaluate the impact of CV and LBC supplementation on testicular dysfunction in a high-fat diet (HFD)-induced NAFLD mouse model, with a focus on the unfolded protein response (UPR) signaling pathway. Male C57BL/6 mice were randomly assigned to five groups: control, NAFLD (HFD for 8 weeks), NAFLD + CV (8 weeks of HFD, followed by 35 days of normal diet supplemented with CV 150 mg/kg), NAFLD + LBC (HFD followed by 35 days of LBC 10⁸ CFU/ml), and NAFLD + CV+LBC (combined treatment). Total antioxidant capacity (TAC), malondialdehyde (MDA), luteinizing hormone (LH), follicle-stimulating hormone (FSH), and testosterone levels were assessed. Expression of UPR- and apoptosis-related genes was quantified, and histopathological evaluations, including the modified Johnson scoring system, were conducted. CV and LBC supplementation significantly increased serum TAC and testosterone, while reducing MDA, LH, and FSH levels (p < 0.05). Treated groups showed upregulation of UPR genes (GRP78, IRE1α, PERK, ATF6) and downregulation of pro-apoptotic markers (Caspase-3, BAX/Bcl-2 ratio). Histopathological analyses revealed improved testicular structure and sperm parameters, particularly in the combined treatment group. CV and LBC ameliorated the testicular dysfunction in NAFLD by mitigating oxidative stress and modulating UPR and apoptosis pathways. These findings suggest a promising therapeutic strategy warranting further clinical investigation.

The Iran intensive care unit registry (IICUR) was established to systematically collect highquality clinical data from critically ill adult patients nationwide. This registry was created to fill a major gap in Iran by providing the first coordinated national intensive care unit (ICU) data system to support benchmarking, quality improvement, and research. This study aimed to assess the registry’s data quality, representativeness, and performance using internationally recognized evaluation frameworks. This validation study included consecutive adult ICU admissions (aged≥16 years) recorded in the IICUR between October 2017 and October 2024 across 39 ICUs in 16 hospitals from various regions of Iran. Data quality was assessed based on the directory of clinical databases (DoCDat) and Arts et al., frameworks. Evaluated domains included case representativeness, variable completeness, data validation processes, and coding reliability. Statistical analyses were performed using SPSS software (version 24). Overall, 34,550 ICU admissions were registered (36% surgical, 64% medical). The patient’s mean age was 49.4 years, with an average ICU stay of 6.7 days. The registry achieved a median DoCDat score of 3.0 (on a 1–4 scale), indicating strong national coverage, standardized data definitions, and high recruitment completeness. Trauma, neurological, and respiratory disorders were the most common admission causes. ICU and hospital mortality rates were 13.8% and 16.4%, respectively. Despite its strengths, enhanced data validation and postdischarge followup were required. The IICUR demonstrated high methodological standards, providing a robust national platform for benchmarking, policy development, and critical care research in Iran.

Background: The association between triglyceride (TG) levels and bone health in adolescents remains inconsistent, and data from non-Western populations are scarce. Objectives: This study was the first to examine the association between TG levels and dual-energy X-ray absorptiometry (DXA)-derived bone parameters in healthy Iranian youth. Methods: In this cross-sectional study, 478 adolescents (241 boys and 237 girls; aged 9 - 18 years) from Kawar, Iran, underwent anthropometric measurements, fasting TG profiling, and whole-body DXA scans. Univariate and multivariable linear regression analyses were used to evaluate associations between TG levels, expressed per 1-standard deviation (SD) increase, and bone area (cm2), bone mineral content (BMC; g), bone mineral density (BMD; g/cm2), and lean mass (g), with sequential adjustment for age, sex, vitamin D3, and pubertal status according to Tanner stage. Results: The mean TG level was 74.99 ± 51.92 mg/dL. Univariate analyses showed positive associations for 22 of 29 parameters, with the strongest associations observed for pelvic BMD (β = 0.19; 95% CI, 0.11 - 0.28; P < 0.0001) and total lean mass plus BMC (β = 0.17; 95% CI, 0.08 - 0.26; P = 0.0002). In fully adjusted models, significant associations were retained for total BMD (β = 0.08; P = 0.004), pelvic BMD (β = 0.14; P < 0.001), femoral neck BMD (β = 0.11; P = 0.007), and total lean mass (β = 0.10; P < 0.001), with puberty largely explaining the attenuation. Conclusions: Higher TG levels, expressed per 1-SD increase equivalent to 52 mg/dL, were positively associated with adolescent bone mineralization and lean mass accrual, independent of measured confounders. These findings suggest a favorable cross-sectional association during growth. These ethnicity-specific findings highlight cardiometabolic-bone interactions and support the hypothesis that TG levels should be considered in future longitudinal studies of skeletal health in youth. Owing to the cross-sectional design, causal inferences cannot be drawn.

A short cervical length (CL) in placenta accreta spectrum (PAS) may be associated with adverse outcomes. This study aimed to evaluate the impact of CL on m

Background and Aims: Understanding bone mass accumulation patterns and factors influencing them during growth is important for preventing osteoporosis later in life. This study investigated longitudinal changes in bone mineral content (BMC), bone mineral density (BMD), and bone mineral apparent density (BMAD) during growth, with the aim of estimating the age at which peak bone mass (PBM) is achieved in males and females. It also examined the effects of puberty, age, body mass index (BMI), sex, socioeconomic status (SES), and habitual exercise on these bone parameters during adolescence and early adulthood. Methods: This retrospective cohort study included 159 participants. Bone densitometry was performed using dual‐energy x‐ray absorptiometry (DXA) during two assessments. Anthropometric measurements were obtained, and demographic data, pubertal stage, medical history, SES, and exercise habits were collected through a structured questionnaire administered by a physician. Results: Rates of change in total body BMC (TBBMC) and BMD (TBBMD) decreased with advancing age and pubertal stage, with the highest rates observed at ages 9–11 and Tanner stage 1. Across all ages up to 18 years, males showed significantly higher rates than females. Peak TBBMC and TBBMD occurred at 25.7 and 26.2 years in males, and 24.8 and 24.0 years in females. After adjusting for bone size, BMAD peaks at the femoral neck and lumbar spine were 21.2 and 23.8 years in males, and 24.8 and 24.1 years in females. Linear mixed model analysis indicated that older age, higher BMI, male sex, higher SES (significant for BMD), and greater physical activity positively influenced TBBMC and TBBMD until peak values were reached. Conclusion: Bone accumulation was greater in adolescence than in early adulthood. PBM was generally reached in the mid‐third decade, with females attaining it earlier. Age, sex, BMI, SES, and exercise positively influenced TBBMC and TBBMD during adolescence and early adulthood.

Non-alcoholic fatty liver disease (NAFLD) is a common liver disorder, ranging from simple steatosis to non-alcoholic steatohepatitis (NASH), with no approved pharmacological treatments. Autophagy and endoplasmic reticulum (ER) stress are key pathways in NAFLD pathogenesis. This study investigates the therapeutic potential of Chlorella vulgaris (CV) microalgae and Lactobacillus casei (LBC) probiotics on liver function in a high-fat diet (HFD)-induced NAFLD mouse model. Male C57BL/6 mice were divided into five groups: control, NAFLD (HFD for 8 weeks), NAFLD + CV, NAFLD + LBC, and NAFLD + CV + LBC. Liver enzymes, lipid profiles, oxidative stress markers, inflammatory cytokines, and gene expression related to UPR, autophagy, and apoptosis were measured, along with stereological and histopathological analyses. CV and LBC treatments significantly improved serum ALT, AST, cholesterol, LDL, triglycerides, MDA, LPS, TNF-α, IL-6, and CRP while modulating UPR (GRP78, IRE1α, PERK, ATF6), autophagy (Beclin1, P62, LC3-IIB), and apoptosis (Caspase-3, BAX/Bcl-2 ratio) pathways. In treated groups, stereological analysis showed reduced liver weight, volume, and histopathological damage (p < 0.05). The combination of Chlorella vulgaris (CV) and Lactobacillus casei (LBC) enhanced liver function, reduced oxidative stress, and modulated the expression of UPR, autophagy, and apoptosis pathways at the mRNA level in NAFLD mice, leading to improved overall outcomes (p < 0.05). Chlorella vulgaris and Lactobacillus casei exhibit therapeutic potential for NAFLD, warranting further investigation for clinical applications.

In the female population, breast cancer is the most common cancer and a leading cause of cancer death. This study was designed to investigate the geographical pattern of breast cancer risk in different counties of Fars province in the south of Iran from 2001 to 2018. In this historical cohort study, data of Shiraz Population-Based Cancer Registry between 2001 and 2018 was used. The geographical variations of breast cancer incidence rate in 36 counties of Fars province were analyzed using the Bayesian spatiotemporal model. Overall, the averages of relative risk (RR), temporal trend (TT), and δ_i for breast cancer were 1.59, 1.025, and 0.00 in the total female population; 1.21, 1.002, and 0.00 in the young female population (under 40 years of age); and 1.54, 1.02, and 0.00 in the female population with invasive ductal carcinoma (IDC), respectively. The steady increase in RR of breast cancer and IDC during 2001-2018 was observed in most counties located in the non-central part of the Fars geographic map. Moreover, a steady increase of young breast cancer RR was observed mainly in southern regions and some northern cities of Fars province. Between 2001 and 2018 in Fars province, a steady annual increase of approximately 2% was observed in the total female population for all types of breast cancer, including IDC. High-risk areas, TTs, and changing patterns of breast cancer incidence were determined in this region. Furthermore, areas with a high risk of young breast cancer were identified, which requires special attention.