This study evaluates the usability, accessibility, and ergonomic design of six widely used Iranian mobile banking applications for older adults (aged 60 and above) to enhance digital inclusion and promote healthy aging through improved financial access.

An explanatory sequential mixed-methods approach was utilized, integrating quantitative usability testing with the System Usability Scale (SUS) and qualitative heuristic evaluation using the Smartphone's Usability Heuristics (SMASH) framework. Five Human-Computer Interaction (HCI) experts evaluated the applications in a controlled lab setting, while 1,200 older adults from diverse backgrounds participated in usability testing and semi-structured interviews. Statistical analysis involved ANOVA with post hoc Least Significant Difference (LSD) tests to compare SUS scores across applications and age groups, complemented by thematic analysis of qualitative data.

Heuristic evaluation identified 135 usability issues, with error prevention (mean severity: 2.27) and visibility of system status (mean severity: 2.22) being the most critical. SUS scores varied significantly (F(5, 1194)=42.36, P<0.001), ranging from 27.50 (SD=7.18) for Bank E to 59.02 (SD=7.94) for Bank A. Younger older adults (60-63 years) reported higher SUS scores (M=54.2) than those aged 72-75 (M=45.3, P<0.001). Qualitative findings highlighted cultural mismatches and cognitive overload as key barriers.

Poor usability in mobile banking apps widens the digital divide for older adults, hindering financial independence. Tailored designs with simplified interfaces, cultural relevance, and enhanced error prevention can improve digital health literacy, support equitable access and promote mental and social well-being among aging populations.

Background/Objectives: Accurate assessment of dietary behaviors is essential for understanding their impact on health and guiding nutritional policies. Given the escalating prevalence of noncommunicable diseases in the MENA region, the availability of culturally adapted and psychometrically validated Arabic-language instruments is essential for accurate health assessment. This systematic review aims to identify and evaluate studies that have translated, adapted, or validated dietary behavior measurement instruments into Arabic. Methods: Following the PRISMA guidelines and registered in PROSPERO (CRD420251157552), a search was conducted in PubMed, Scopus, and Web of Science. Studies including the validation, translation, or adaptation of instruments into Arabic among Arabic-speaking populations were included. Methodological quality was assessed using the COSMIN checklist. Results: Thirty-two studies were included, published between 2006 and 2025, primarily in Lebanon (n = 14) and Saudi Arabia (n = 6). The instruments measured various concepts: dietary intake, diet quality, eating disorders, etc. While internal consistency and structural validity were frequently assessed with adequate methodological quality, content validity, measurement error, and responsiveness were either under-reported or failed to meet COSMIN standards. Conclusions: Despite an increasing volume of publications, the methodological quality of Arabic instrument validation remains heterogeneous, with significant gaps in the assessment of longitudinal properties. Efforts are needed to improve the rigor of adaptation processes and to evaluate key properties such as responsiveness in order to ensure reliable tools for research and clinical practice in the MENA region.

Oligoasthenoteratozoospermia (OAT) is one of the most common multifactorial causes of male infertility. Platelet-rich plasma (PRP), a biological product, has emerged as a promising regenerative therapy in various fields of medicine, including reproductive health. Therefore, we investigated the effect of PRP administration on sperm DNA fragmentation in OAT men.

The aim was to evaluate the effect of intratesticular injection of PRP on DNA fragmentation index (DFI) in men with idiopathic OAT and assess its potential as a novel therapeutic intervention to enhance sperm DNA integrity.

This randomized controlled trial study involved 160 infertile men diagnosed with OAT without underlying diseases who were referred to the infertility center of Fatemieh Infertility Center, Hamadan, Iran, from July 2023 to July 2024. The participants were randomly assigned to intervention and control groups using a block randomization method. The intervention group received 1-2 cc of PRP in each testicle. Sperm parameters and DFI were measured; a hormonal study was also performed before and after the procedure.

The results revealed a significant difference in concentration (p = 0.030), progressive motility (p < 0.001), DNA fragmentation (p < 0.001), normal morphology (p < 0.001), and also testosterone levels (p < 0.001) between groups after PRP injection.

PRP Injection into the testis appears to be a safe, minimally invasive, and potentially effective therapeutic approach in enhancing sperm quality and reducing DFI in men with OAT.

Accurate application of reference standards (RSs) is essential for correct decision-making in areas governed by such standards. Yet in real-world practice, even fully trained users often apply RSs inconsistently, due to cognitive overload, stress, or other contextual factors, generating misleading evidence. This problem is exemplified by the fact that up to 80% of board-certified hematologists mislabel patients with Sjögren syndrome (SS), a connective tissue disorder (CTD) associated with the greatest risk of lymphoproliferative disorders compared to other CTDs. Embedding RS-based consultations with full objectivity into the decision-making layers of digitalized and non-digitalized settings is critical for improving both decision-making and the quality of resulting evidence. The aim of this proof-of-concept (POC) study is to apply a newly developed framework, the Fully Expert Human-based Retrieval Augmented Generation (FEH-RAG) framework, to provide such a foundation for augmenting SS case labeling in routine daily clinical practice.

In this POC study, using the nine steps of the FEH-RAG framework, seven expert end-users systematically selected the most widely used SS classification criteria (SSCC) and extracted their elements, including items, definitions, item weights, and inter-item relationships. Extracted items were profiled based on their usage in routine clinical practice. A pathway layout and decision tables were developed accordingly. Following pathway generation, the residual misalignment of the outputs with the SSCC was assessed in a cohort of patients at risk of SS. The experts predefined that the residual misalignment rate of the FEH-RAG outputs with the SSCC must be ≤2% (95% confidence, using the rule of three).

The FEH-RAG framework objectively generated RS-based, transparent, and traceable outputs, including decision tables, an SS classification pathway, and a list of misinterpretations of the SSCC. These misinterpretations involved definitions of dry eye and dry mouth, application of secondary SS criteria, handling SS criteria-specific exclusion rules, and interpretation of serological and objective test results. This POC study achieved its expert-defined maximum misalignment threshold of ≤2% with 95% confidence (0 misalignment in 150 consecutive patients at risk of SS).

This POC study established the needed foundation for improving SS case labeling in daily clinical practice across both digital and non-digital settings. As shown here, publishing FEH-RAG outputs while highlighting potential RS misinterpretations offers a transparent and traceable basis for augmenting decision-making in domains governed by RSs.

As obesity, diabetes and other diet-related metabolic disorders continue to rise, non-nutritive artificial sweeteners (NASs) are widely used as sugar substitutes in free-sugar reduction and weight-management strategies, but their effects on the gut microbiota, host metabolism and related health outcomes remain debated. To clarify this evidence landscape, this review synthesizes current knowledge on the effects of major NAS on the gut microbiota and host metabolic and health-related outcome. A bibliometric analysis was conducted to characterize the development, knowledge structure and thematic evolution of this research area. For the eight NAS exposure categories included in this review (saccharin, cyclamate, aspartame, acesulfame potassium, sucralose, neotame, neohesperidin dihydrochalcone and mixed NAS), we performed a compound-specific analysis integrating physicochemical characteristics, regulatory status, and research findings from in vitro, ex vivo, animal and human studies on gut microbiota alterations, host metabolic and health-related outcomes. These findings were further compared through four interpretive dimensions: exposure conditions, research model background, outcome assessment and interpretation of discordant results. Current research evidence does not support a class-wide conclusion that NAS are uniformly harmful or safe. To make research findings searchable, we developed the NAS-MAP knowledge graph, an interactive non-nutritive artificial sweetener-microbiota-associated phenotype knowledge graph. Overall, this review consolidates current knowledge, clarifies the sources of inconsistent findings, and provides a framework for more mechanistically informative studies, standardized evidence reporting, and more precise sweetener-, exposure- and population-specific dietary and public health guidance.

Mobile applications can enhance diabetes self-management by visualizing glucose trends and promoting engagement. However, evidence on their behavioral and clinical effectiveness in environments with constrained resources remains limited. This study evaluated the impact of the Iranian Asan-Chek mobile app on glycemic outcomes and user experiences among adults with type 1 diabetes mellitus (T1DM).

In a 12-week quasi-experimental mixed-methods study, 148 adults with T1DM were recruited. Seventy-four participants used the Bluetooth-enabled Asan-Chek app (intervention group) and 74 performed structured self-monitoring of blood glucose (control group). Primary outcomes included changes in HbA1c and qualitative insights into user engagement and experience. Semi-structured interviews with 15 purposively selected participants (13 app users, 2 controls, varied in age and diabetes duration) explored attitudes, perceived benefits, and barriers. Transcripts were analyzed thematically.

HbA1c decreased by 0.62% in the app group and by 0.41% in the control group (both P < 0.001), without any notable divergence between the intervention and control participants (P = 0.202). Changes in BMI, insulin requirements, and glycemic variability during the course of the study exhibited no statistical disparity between the two groups. Qualitative analysis uncovered three motifs: (i) heightened self efficacy and perceived control arising from instant feedback; (ii) stronger motivation prompted by color coded trend charts and reminders and (iii) usability and economic barriers: interface complexity, data driven anxiety, test strip cost, and finger prick fatigue.

Over twelve weeks, qualitative results highlighted that the Asan-Chek app provided motivational and behavioral advantages for individuals with T1DM but did not outperform structured SMBG in attaining HbA1c targets. Addressing challenges through optimized app interface, comprehensive user training, affordable supplies via reimbursement, and AI-driven feedback may help convert these behavioral gains into lasting glycemic improvement.

Diabetes mellitus causes microvascular alterations that contribute to the development of diabetic retinopathy. Hemodynamic changes in retrobulbar circulation may occur before clinically detectable retinal damage.

This study aimed to compare Doppler hemodynamic indices of the ophthalmic artery (OA) and central retinal artery (CRA) between diabetic participants and non-diabetic controls.

This cross-sectional observational study included 76 participants (38 diabetic participants and 38 non-diabetic controls), comprising 152 eyes analyzed at the eye level. Color Doppler imaging was used to measure peak systolic velocity (PSV), end-diastolic velocity (EDV), resistive index (RI), and systolic/diastolic (S/D) ratio in the OA and CRA. Group comparisons were performed using an independent samples t-test, with statistical significance set at p < 0.05.

Diabetic participants demonstrated significantly higher vascular resistance in retrobulbar arteries. OA-RI was significantly higher in diabetic participants (0.80 ± 0.03) than in non-diabetic controls (0.71 ± 0.01; p < 0.001). CRA-RI was similarly elevated (0.70 ± 0.04 vs. 0.62 ± 0.01; p < 0.001). Retrobulbar blood flow velocities were significantly reduced in diabetic participants, including OA-PSV (19.38 ± 2.71 vs. 29.18 ± 1.42 cm/s; p < 0.001) and OA-EDV (3.84 ± 1.04 vs. 8.49 ± 0.53 cm/s; p < 0.001). CRA-PSV (9.02 ± 1.23 vs. 13.28 ± 0.64 cm/s; p < 0.001) and CRA-EDV (2.87 ± 0.82 vs. 5.05 ± 0.33 cm/s; p < 0.001) were also significantly reduced. S/D ratios were significantly elevated in both vessels among diabetic participants.

Diabetes is associated with increased vascular resistance and reduced blood flow velocities in the OA and CRA. These findings suggest that color Doppler imaging may help identify early hemodynamic alterations in the ocular circulation associated with diabetic retinal disease.

Microvascular hypercoagulability is a primary driver of diabetic peripheral neuropathy (DPN). This study aimed to evaluate comprehensive whole-blood viscoelastic profiles using the Sonoclot analyzer across distinct clinical stages of DPN.

This cross-sectional study consecutively enrolled 289 hospitalized patients with type 2 diabetes mellitus (T2DM). Based on the Toronto Clinical Neuropathy Score (TCNS) and nerve conduction studies, participants were classified into non-DPN, subclinical DPN (sDPN), and confirmed DPN groups. Sonoclot-derived parameters were quantitatively assessed. Multivariable logistic regression, restricted cubic spline (RCS) analysis, and receiver operating characteristic (ROC) curve analysis were performed to evaluate diagnostic performance.

Among the 289 participants, 93 (32.2%) were diagnosed with sDPN and 70 (24.2%) with confirmed DPN. CR levels did not differ significantly between the non-DPN and sDPN groups, whereas markedly elevated CR levels were observed in patients with confirmed DPN. After adjustment for age, diabetes duration, HbA1c, BMI, and platelet count, CR remained independently associated with DPN (odds ratio 1.154, 95% CI 1.075-1.239). RCS analysis demonstrated a significant nonlinear association between CR levels and the presence of DPN. ROC analysis identified an optimal CR cutoff value of 31.1 (AUC = 0.729), with a sensitivity of 47.1% and a specificity of 98.9%. The moderate sensitivity suggests limited utility as a standalone screening marker.

Sonoclot-derived CR is independently associated with clinically confirmed DPN. Longitudinal studies are required to clarify the temporal nature of this association.

Diabetes mellitus (DM), which affects over 500 million individuals (7%) globally, is associated with male reproductive dysfunction in more than 15% of affected individuals. The preclinical mechanisms by which hypoglycemic phytochemical compounds alleviate reproductive dysfunction in this population are scattered. A detailed systematic review of the preclinical evidence, with a focus on mechanisms of action and application potential, is currently necessary. The objectives were to analyze preclinical evidence on the therapeutic potential and mechanistic pathways through which hypoglycemic phytochemicals improve male reproductive function in diabetes mellitus.

The protocol was registered in PROSPERO prior to screening, and PRISMA guidelines 2020 were followed. Papers included in the search were published from October 2010 to October 2025 and were identified using the PubMed, Connecting Repositories, and Google Scholar databases.

Only 35 studies published between 2012 and 2025 that investigated improvements in male reproductive dysfunction in preclinical settings were reviewed.

The hypoglycemic phytochemicals improved diabetes-induced reproductive dysfunction through their effects on oxidative stress, sperm parameters, spermatogenesis, testicular morphology, testosterone, follicle-stimulating hormone, and luteinizing hormone. There were variations in the outcomes measured and methodologies. The majority of hypoglycemic phytochemicals reduced reactive oxygen species, which may be inadequate in humans, where there is also a psychological impact on erection.

The review showed that hypoglycemic phytochemicals have the potential to improve male reproductive dysfunction in preclinical models of diabetes mellitus. The synthesis highlights the beneficial effects on glycemic control, sperm quality, hormonal regulation, oxidative stress, and testicular histology via integrated metabolic and reproductive mechanisms. Standardized phytochemicals should be used to study efficacy and safety before clinical trials.

https://www.crd.york.ac.uk/PROSPERO/view/CRD420251230781, identifier CRD420251230781.

Prior investigations have suggested a relationship in which vitamin D may be linked to distal symmetric polyneuropathy (DSPN), but these results are inconsistent. Moreover, few studies have examined the linear relationship between vitamin D levels and the severity of DSPN and no definitive clinical threshold has been identified. This study therefore investigated the connection between the level of serum 25-hydroxyvitamin D [25(OH)D] and the risk and severity of DSPN with special regard to the establishment of a clinically significant cutoff point to classify the risks.

This multicenter cross-sectional study included 569 adults with type 2 diabetes mellitus (T2DM) from four hospitals in Fujian Province, China, between June 2022 and May 2023. Serum 25(OH)D₂, 25(OH)D₃, and total 25(OH)D levels were measured by liquid chromatography-tandem mass spectrometry (LC-MS/MS). DSPN and its severity were assessed by using a standardized five-item neurological examination and the Michigan Neuropathy Screening Instrument (MNSI). Multivariable logistic regression was applied to examine the relationship between 25(OH)D and DSPN. Propensity score matching (PSM) was performed to minimize baseline imbalances and validate the robustness of the findings. Restricted cubic splines (RCS) were employed to construct a dose-response curve and identify a possible threshold.

Compared with non-DSPN individuals (n = 148), those with DSPN (n = 421) had significantly lower concentrations of 25(OH)D (23.95 ± 5.14 vs. 32.31 ± 5.97 ng/mL) and 25(OH)D₃ (22.88 ± 5.11 vs. 31.19 ± 5.70 ng/mL) (P < 0.001). By contrast, 25(OH)D₂ concentrations presented no evident intergroup difference (P = 0.645). Quartile analysis demonstrated a significant downward trend in the risk of DSPN with increasing 25(OH)D levels (P for trend < 0.001). After controlling for potential confounders, 25(OH)D continued to exert an independent protective effect, and this conclusion remained valid even after propensity score matching. RCS analysis revealed that 25(OH)D and DSPN risk had a linear negative relationship, and a nonlinear relationship was observed with the severity of neuropathy with an turning point at about 26.1 ng/mL. Additional examination revealed that the severity of DSPN increased significantly as the level of 25(OH)D dropped below this point.

25(OH)D was inversely associated with the risk of DSPN, and exhibited a nonlinear relationship with neuropathy severity. Notably, when 25(OH)D levels dropped below 26.1 ng/mL, the severity of DSPN appeared to accelerate markedly. Therefore, 25(OH)D levels have the potential to be a readily accessible and clinically useful indicator to screen and categorize DSPN risk in the early stages.