The Relationship between Healthy Eating Index and Lipid Profile in Healthy Individuals: A Systematic Review

Background

The Healthy Eating Index (HEI) and Alternate Healthy Eating Index (AHEI) are instruments developed by competing American research teams, aiming to assess the level of adherence to a dietary pattern, claimed to prevent chronic illness conditions such as dyslipidemia. This systematic review evaluated cross-sectional studies examining the association between HEI/AHEI score and the lipid profile in healthy participants.

Methods

The systematic review was Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) compliant, and a search process was conducted through Scopus, Web of Knowledge, Google Scholar, Cochrane, PubMed, and ScienceDirect up to November 2022. Studies assessing the relationship between HEI/AHEI and lipid profile (low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), and triglyceride (TG)) were eligible for inclusion. The statistical differences in outcomes, anthropometric indices, and demographic data were extracted from the selected studies. Also, the quality assessment of studies was performed using the Newcastle-Ottawa scale.

Results

The systematic search presented 17 cross-sectional studies. Most of the studies revealed a significant correlation between HEI score and lipid profile (LDL-C, HDL-C, TG, and TC) (P < 0.05), while a few of them indicated a significant relationship between AHEI score and these factors. Overall, the elevation of HEI/AHEI score was associated with the improvement in lipid profile (P < 0.05), though this association was more obvious for HEI compared with AHEI.

Conclusions

Overall, the results of the study indicated that an improved lipid profile in healthy individuals is associated with a higher score in either HEI or AHEI. Further research in the future is required to confirm the claim.

Comprehensive health risk analysis of heavy metal pollution using water quality indices and Monte Carlo simulation in R software

Rapid urbanization, population growth, agricultural practices, and industrial activities have led to widespread groundwater contamination. This study evaluated heavy metal contamination in residential drinking water in Shiraz, Iran (2021). The analysis involved 80 groundwater samples collected across wet and dry seasons. Water quality was comprehensively assessed using several indices, including the heavy metals evaluation index (HEI), heavy metal pollution index (HPI), contamination degree (CD), and metal index (MI). Carcinogenic and non-carcinogenic risk assessments were conducted using deterministic and probabilistic approaches for exposed populations. In the non-carcinogenic risk assessment, the chronic daily intake (CDI), hazard quotient (HQ), and hazard index (HI) are employed. The precision of risk assessment was bolstered through the utilization of Monte Carlo simulation, executed using the R software platform. Based on the results, in both wet and dry seasons, Zinc (Zn) consistently demonstrates the highest mean concentration, followed by Manganese (Mn) and Chromium (Cr). During the wet and dry seasons, 25% and 40% of the regions exhibited high CD, respectively. According to non-carcinogenic risk assessment, Cr presents the highest CDI and HQ in children and adults, followed by Mn, As and HI values, indicating elevated risk for children. The highest carcinogenic risk was for Cr in adults, while the lowest was for Cd in children. The sensitivity analysis found that heavy metal concentration and ingestion rate significantly impact both carcinogenic and non-carcinogenic risks. These findings provide critical insights for shaping policy and allocating resources towards effectively managing heavy metal contamination in residential drinking water.

Green biosynthesis of magnetic iron oxide nanoparticles using Mentha longifolia for imatinib mesylate delivery

In this work, the rapid, facile, and eco-friendly green process was introduced in the preparation of β-cyclodextrin/magnetic iron oxide nanoparticles by using the aqueous Mentha longifolia extracts of Mentha longifolia. The obtained nanoparticles were characterised by Fourier transform infrared spectroscopy, x-ray powder diffraction, field emission scanning electron microscope, and thermogravimetric analysis. Also, effective factors on the synthesis of magnetic nanocomposites including temperature, concentration of the Mentha longifolia extract, and concentration of FeSO₄ solution were optimised by Taguchi design. Moreover, important effective parameters on the adsorption efficiency; such as adsorbent dosage, pH, contact time, and temperature were investigated. The prepared magnetic nanocomposite was applied as a nanocarrier for imatinib mesylate delivery. In vitro studies confirmed imatinib mesylate release over 6 h. The nanocarrier showed pH-dependent imatinib mesylate release with higher drug release at simulated cancer fluid (pH = 5.6) compared to neural fluid (pH = 7.4). Moreover, the sorption isotherms and kinetics for the magnetic nanocomposite were fitted into Langmuir and pseudo-second order models, respectively. Based on the thermodynamic results, the adsorption of imatinib mesylate onto the nanoadsorbent was found to be spontaneous and exothermic.

The relationship of coffee consumption and CVD risk factors in elderly patients with T2DM

Objective

Clinical studies suggest increasing prevalence of cardiovascular disease (CVD) risk factors and diabetes among the elderly. Meanwhile, some food compounds, such as coffee, can also have beneficial effects on CVD risk factors. The aim of the present study was to examine the relationship between coffee consumption and CVD risk factors in the elderly with type 2 diabetes mellitus (T2DM).

Methods

This cross-sectional study was performed during 2017 on 300 elderly people above 60 years of age with T2DM in Isfahan, Iran. Dietary assessment was performed using a food frequency questionnaire. Coffee consumption was classified into three groups including < 1, 1–3, and > 3 cups/day. Partial correlation test was used to investigate the relationship between CVD risk factors and usual coffee consumption.

Results

The mean age and body mass index of participants were 70.04 ± 4.87 years and 24.74 ± 3.34 kg/m² respectively. Coffee consumption had a significant inverse relationship with fasting plasma glucose (FPG) and diastolic blood pressure (DBP) in the elderly with T2DM (r: − 0.117, 0.134; p: 0.046, 0.022). Triglyceride (TG) and high-density lipoprotein cholesterol (HDL-C) had a significant positive relationship with coffee consumption levels (r: 0.636, 0.128; p: 0.028, 0.029). These results were obtained after controlling for potential confounders.

Conclusion

Increasing coffee consumption was linked to improved status of some CVD risk factors including FPG, HDL-C, and DBP in the elderly with T2DM. Nevertheless, increasing coffee consumption was also associated with higher TG level and had no significant effect on other risk factors. Further studies are required to confirm these results.

Association between heavy metals and colon cancer: an ecological study based on geographical information systems in North-Eastern Iran

Background

Colorectal cancer has increased in Middle Eastern countries and exposure to environmental pollutants such as heavy metals has been implicated. However, data linking them to this disease are generally lacking. This study aimed to explore the spatial pattern of age-standardized incidence rate (ASR) of colon cancer and its potential association with the exposure level of the amount of heavy metals existing in rice produced in north-eastern Iran.

Methods

Cancer data were drawn from the Iranian population-based cancer registry of Golestan Province, north-eastern Iran. Samples of 69 rice milling factories were analysed for the concentration levels of cadmium, nickel, cobalt, copper, selenium, lead and zinc. The inverse distance weighting (IDW) algorithm was used to interpolate the concentration of this kind of heavy metals on the surface of the study area. Exploratory regression analysis was conducted to build ordinary least squares (OLS) models including every possible combination of the candidate explanatory variables and chose the most useful ones to show the association between heavy metals and the ASR of colon cancer.

Results

The highest concentrations of heavy metals were found in the central part of the province and particularly counties with higher amount of cobalt were shown to be associated with higher ASR of men with colon cancer. In contrast, selenium concentrations were higher in areas with lower ASR of colon cancer in men. A significant regression equation for men with colon cancer was found (F(4,137) = 38.304, P < .000) with an adjusted R² of 0.77. The predicted ASR of men colon cancer was − 58.36 with the coefficients for cobalt = 120.33; cadmium = 80.60; selenium = − 6.07; nickel = − 3.09; and zinc = − 0.41. The association of copper and lead with colon cancer in men was not significant. We did not find a significant outcome for colon cancer in women.

Conclusion

Increased amounts of heavy metals in consumed rice may impact colon cancer incidence, both positively and negatively. While there were indications of an association between high cobalt concentrations and an increased risk for colon cancer, we found that high selenium concentrations might instead decrease the risk. Further investigations are needed to clarify if there are ecological or other reasons for these discrepancies. Regular monitoring of the amount of heavy metals in consumed rice is recommended.

Dietary Intake of Antioxidants in the Elderly People under Nursing Care: A Case-Control Study

BACKGROUND

Nutrient deficiency such as antioxidants is a common problem in the elderly; it can result in different diseases such as cancer. Accordingly, assessment of the dietary intake of antioxidants is necessary to design a specific plan for solving this problem.

METHODS

This case-control study was conducted on 152 old people (≥60 years) with and without nursing care in nursing care centers in Isfahan, Iran, in 2017. Nutritional assessment was performed by an expert nutritionist using semi-quantitative validated Food Frequency Questionnaire. Nutrition IV software was used as food analyzer. Analysis of covariance and independent t-test were used for data analysis.

RESULTS

The mean age of the participants was 68.6 ± 4.9 and 68.9 ± 6.1 years in case and control groups, respectively, and the percentage of male/females in these groups was 46.3%/53.7% and 51.4%/48.6%, respectively. Dietary intake of energy, vitamin E, and selenium was significantly higher (P = 0.041; 0.007; 0.017) while beta-carotene intake was significantly lower in the elderly under nursing care than in the control (P = 0.002).

CONCLUSIONS

The findings indicated that nursing care leads to improved intake of energy, vitamin E, and selenium, while diminished beta-carotene intake in the elderly. Intake of vitamin E, A, C, zinc, and selenium was high among elderly people with and without care, compared with the dietary reference intake. It seems that further studies are required to confirm these findings.

Dietary Intake of Vitamin D and Its Relation with Blood Pressure in the Elderly Population

Background

Population studies have demonstrated that there is an inverse association between dietary intake of vitamin D and the mean blood pressure in elderly in particular. So, we investigated the correlation between vitamin D intake and the mean blood pressure in the elderly with and without nursing care.

Methods

Based on a cross-sectional design, this study was conducted on 152 old people with and without nursing care. Assessment of the dietary intake of nutrients was done by an expert dietitian using food frequency questionnaire and nutritionist IV software analyzer. Also, the mean blood pressure was extracted from participants' files. The independent samplet-test, Chi-square test, and partial correlation test were used for data analysis.

Results

Mean ± SD age, weight, height, body mass index (BMI) of participants, and the percentage of male/females were 68.7 ± 5.5 years, 63.5 ± 7.9 kg, 162.5 ± 7.1 cm, 24.1 ± 3.4 kg/m² and 48.7/51.3, respectively. Also, a significant negative relationship was observed between vitamin D intake and systolic blood pressure in all participants (P value = 0.028, r = -0.179). There was no significant correlation between vitamin D intake and diastolic blood pressure (P value = 0.558, r = -0.048).

Conclusions

The findings revealed that the nursing care can improve dietary intake of vitamin D in the elderly population. Also, a negative correlation was found between vitamin D intake and systolic blood pressure among all the elderly.

The efficiency of UV/S2O8 2- photo-oxidation process in the presence of Al2O3 for the removal of dexamethasone from aqueous solution: kinetic studies

This study aimed to investigate the efficiency of the UV/S₂O₈ ^2- photocatalytic process in the presence of Al₂O₃ nanoparticles for the removal of dexamethasone from aqueous solution. In this experimental study, the variables pH, persulfate concentration, initial concentration of dexamethasone, the catalyst dose were studied in order to investigate the process efficiency. Furthermore, the efficiency of UV/S₂O₈ ^2- in the presence and absence of catalyst was investigated. The Al₂O₃ nanoparticle catalyst was characterized using X-ray diffraction (XRD) and Fourier transform infrared spectroscopy (FTIR) analyses and scanning electron microscopy (SEM) image. The results showed that a decrease in pH and the initial concentration of dexamethasone increased the process efficiency. Given the increased concentrations of the persulfate and Al₂O₃, the removal efficiency was partially increased. In UV/S₂O₈ ^2-/Al₂O₃ under optimum conditions (pH = 3, t = 30 minutes, dexamethasone concentration = 20 mg/L, 0.5 mM of persulfate, and UV radiation = 55 watts), 94% of the dexamethasone was removed. The kinetic response showed that the reaction data corresponded to the pseudo-first-order kinetic model. The results showed that the UV/S₂O₈ ^2- photochemical process can efficiently remove dexamethasone from aqueous solution in the presence of Al₂O₃ catalyst and the mineralization efficiency reached about 98%. Therefore, this process is recommended due to its high efficiency and availability for the removal of pharmaceutical compounds.

Effect of Decaffeinated Coffee-enriched Chlorogenic Acid on Blood Glucose Levels in Healthy Controls: A Systematic Review

As an important group of health problems, glucose metabolism disorders are associated with a number of diseases as well as mortality rate. Recently, studies have demonstrated that the consumption of decaffeinated coffee-enriched chlorogenic acid (CGA) can reduce the risk of diabetes and blood glucose rise, while the results of some previous studies have shown an opposite effect. Hence, a systematic search was conducted based on literature search and appropriate keywords through PubMed, Google Scholar, Web of Knowledge, Science direct, Medline, Cochrane, and Scopus databases from 2003 to 2018. After searching, 1593 articles were found. Then, we excluded papers based on the duplication and relevant for title and abstract, whereas 25 relevant articles remained for checking eligibility criteria. Since only randomized clinical trials studies (RCTs) could be included in the current study, six RCTs remained in end-stage for qualitative synthesis. The results of reviewed studies showed no significant effect of decaffeinated coffee-enriched CGA on blood glucose concentration. Although recent studies have suggested the effectiveness of decaffeinated coffee-enriched CGA on blood glucose in animals, and there are various mechanisms for this effect, and the result of our review showed that there is not sufficient evidence for this claim in healthy humans. Hence, further research in this area seems necessary.

Dataset on assessment of physical and chemical quality of groundwater in rural drinking water, west Azerbaijan Province in Iran

Analyzing the quality of drinking water and comparing it with standards, provides useful information regarding in the state of water supply and health protection to consumers. In the current research, the quality of drinking water in the cities of West Azerbaijan province has been investigated. In the current study, the results of drinking water analysis in 17 counties of West Azerbaijan province (except Urmia city), including 355 analyzes were conducted in 2016. The results were analyzed by SPSS software and compared with the national standard. Based on the analysis, the hardness of drinking water in the West Azerbaijan province ranged from 22 to 912 mg/L as calcium carbonate, and the average of the experiment was measured to be 136 ± 327 mg/L as calcium carbonate. The TDS values in this study were 39–1710 mg/L, and on average 397.7 ± 265.8 mg/L. Also, based on the analyzes performed in this study, the Fluoride concentration was from 0 to 3.45 mg/L, and on average 323.376 ± 0.05 mg/L and the Nitrate concentration was 0–218 mg/L and on average 3.58 ± 1.1 mg/L.

Data on aluminum concentration in drinking water distribution network of rural water supply in Sistan and Baluchistan province, Iran

The aim of this study is to determine the Aluminum concentration in groundwater resources of Sistan and Baluchestan province, Iran. See the data in this article. For the purpose of this study, a total of 871 water samples were collected and values of quality parameters including pH, turbidity, total dissolved solids (TDS) and Aluminum concentration were measured (with two-time repetitions) according to Standard Methods for the Examination of Water and Wastewater, during the year 2016. The mean, maximum, minimum of Aluminum concentrations in all groundwater resources of Sistan and Baluchistan province, were: 0.015, 0.059, 0.0004 mg/l, respectively and also, the standard deviation was 0.012. Moreover, employing GIS software, the geo-statistical distribution of Aluminum concentration in groundwater aquifer in Sistan and Baluchestan was mapped.

Microbiological dataset of rural drinking water supplies in Zahedan, Iran

The residual chlorine and microbial quality of drinking water in the Zahedan villages by a number of1221 samples from all 168 villages were collected between 2014–2015. Then the samples were evaluated using 9-tube fermentation methods and portable chlorine method test. Based on the microbial coliform and fecal coliform indices, the data indicated that the maximum and minimum controlling of the bacteria in the distribution network were in the winter (90.62%) and autumn (85.56%), respectively. Also in the reservoirs, the maximum and minimum controlling of the bacteria were in winter (93.49%) and autumn (87.35%), respectively. The residual chlorine was prepared in almost all of seasons.

Data on quality indices of groundwater resource for agricultural use in the Jolfa, East Azerbaijan, Iran

The aim of this study was to evaluate the groundwater quality Indices of Groundwater resource for Agricultural Use in jolfa city (Iran) during one decade (2003-2013). Data showed in the first and end year of the study period, the Mean±SD of Sodium Adsorption Ratio (SAR) and Sodium Percentage (Na%) indices 5455.77±3878.02, 3638.69±3565.19 and 51.49±15.65, 41.58±17.69, respectively. The data indicate that the, in terms of sodium percentage and sodium adsorption ratio, the water quality in this area is not suitable for irrigation.

Groundwater quality assessment for drinking and agriculture purposes in Abhar city, Iran

The main objective of this study is to assess the quality of groundwater for drinking consume and agriculture purposes in abhar city. The analytical results shows higher concentration of electrical conductivity (100%), total hardness (66.7%), total dissolved solids (40%), magnesium (23%), Sulfate (13.3%) which indicates signs of deterioration as per WHO and Iranian standards for drinking consume. Agricultural index, in terms of the hardness index, 73.3% of the samples in hard water category and 73.3% in sodium content were classified as good. Therefore, the main problem in the agricultural sector was the total hardness Water was estimated. For the RSC index, all 100% of the samples were desirable. In the physicochemical parameters of drinking water, 100% of the samples were undesirable in terms of electrical conductivity and 100% of the samples were desirable for sodium and chlorine parameters. Therefore, the main water problem in Abhar is related to electrical conductivity and water total hardness.

Solid waste production and its management in dental clinics in Gorgan, northern Iran

BACKGROUND

Waste produced in dental clinics has been the topic of investigations for many years. These waste materials have important health impacts and are hazardous to humans and the environment.

OBJECTIVE

To investigating solid waste production and its management in dental clinics in Gorgan, northern Iran.

METHODS

In this cross-sectional study, 45 of 143 public dental practices and 5 of 25 private dental practices were selected and studied. From each clinic, 3 samples were taken and analyzed at the end of successive working days (Tuesday and Wednesday). Samples were manually sorted into 50 components. The measured components were then classified on the basis of their characteristics, hazard potentials, and WHO classification.

RESULTS

The total annual amount of dental waste produced in public and private dental practices in Gorgan was 12 015.1 and 3135.0 kg, respectively. Production percentages of infectious, domestic, chemical and pharmaceutical, and toxic waste in public dental practices were 38.4%, 33.7%, 6.6%, and 0.6%, respectively. The percentages for private practices were 8.7%, 10.6%, 1.1%, and 0.1%, respectively.

CONCLUSION

Dental waste management in Gorgan is inadequate; dental waste is not properly segregated, collected, and disposed, as demanded by the WHO. Employees in dentist offices must be trained in correct handling of waste products and the associated risks.

Family screening for a novel ATP7B gene mutation, c.2335T>G, in the South of Iran

BACKGROUND

Wilson disease (WD) is a rare autosomal recessive disorder, which leads to copper metabolism, due to mutations in ATP7B gene. The gene responsible for WD consists of 21 exons that span a genomic region of about 80 kb and encodes a copper transporting P-type ATPase (ATP7B), a protein consisting of 1465 amino acids. Identifying mutation in ATP7B gene is important to find carrier individuals for proper counseling. A novel mutation in exon 8 of ATP7B gene, c.2335T>G (p.Trp779Gly), with severe neuropsychiatric condition in the South of Iran, was recently identified. The aim of this study was to screen 120 individuals from a large family using a simple amplification refractory mutation system PCR (ARMS-PCR) for carrier screening in the South of Iran.

MATERIALS AND METHODS

120 individuals from family relatives of an index case in the Nasr Abad, south of Iran, were studied for screening of the c.2335T>G mutation. One patient with homozygous mutation and one homozygous normal individual were used as controls in this experiment.

RESULTS

Altogether, 16 out of 120 (13.3%) individuals within this region had heterozygous mutation. One individual with homozygote mutation was also identified.

CONCLUSION

Identification of carriers in families with affected individuals is of great importance for counseling before marriage. The results of this study can be used for further counseling programs in this population.

Effect of antioxidants on stabilization of meat products fortified with n-3 fatty acids

The effects of an n-3 oil emulsion, with and without added antioxidants, on lipid oxidation in n-3 polyunsaturated fatty acid (PUFA)-fortified meat products were studied. An emulsion of n-3 PUFAs was prepared (25% algal oil, 2.5% whey protein isolates, 10mM sodium citrate, 0.2% potassium sorbate, 500ppm of 70% mixed tocopherols, 100μM EDTA, pH 3, pasteurized at 75°C for 30min) and incorporated into fresh ground turkey, and fresh pork sausage (20% fat) to achieve a concentration of 500mg n-3 PUFA/110g meat. An antioxidant combination containing rosemary (0.2% w/w; radical quencher), citrate (0.5% w/w; sequestrant) and erythorbate (1g/kg product; reductant) was prepared and incorporated into ground turkey patties (5cm dia, 1.5cm thick) or fresh pork sausages (5cm dia, 1.5cm thick). Meat products were stored at 4°C or -18°C and analyzed for color (L*, a*, b* values), lipid oxidation (TBARS and lipid hydroperoxides) and n-3 PUFA profile. a* Values of refrigerated ground turkey patties decreased with storage, and an antioxidant combination effect was observed after 4 days (P<0.05). For fresh pork sausages at 4°C, control+antioxidant (CON+ANTI), and n-3+antioxidant (n-3+ANTI) groups showed greater a* values than controls (CON) indicating that the antioxidant combination stabilized meat color. TBARS and lipid hydroperoxides of both n-3 PUFA-enhanced meat products increased with storage (P<0.05); there were no significant changes in TBARS or lipid hydroperoxides for treatments containing the antioxidant combination (P<0.05). The actual level of n-3 PUFA incorporation in both meat products was greater than 87%; n-3 PUFA concentrations did not change within any treatment during storage (P>0.05). These results provide support for including antioxidant protection in n-3 PUFA fortified meat products.

Double-blind comparison of fluoxetine and nortriptyline in the treatment of moderate to severe major depression

BACKGROUND

Depression is an international public health problem. Impairment in social and occupational functioning, increased comorbidity with other psychiatric and medical conditions, and an increased risk of mortality are a few of its consequences. Some psychiatrists have the impression that selective serotonin re-uptake inhibitors may not work as well as tricyclic anti-depressants in severe depression and/or melancholia. On the contrary, there is a general belief that selective serotonin re-uptake inhibitors are superior to the tricyclic anti-depressants in having fewer side-effects, particularly cardiovascular effects. The objective of this double-blind study was to compare the efficacy and safety of fluoxetine and nortriptyline in patients with moderate to severe major depression.

METHODS

A total of 48 adult outpatients who met the Diagnostic and Statistical Manual of Mental Disorders (DSM IV), forth edition for major depression, based on the structured clinical interview for DSM IV participated in the trial. Patients had a baseline Hamilton Rating Scale for Depression score of at least 20. In this double-blind, single-center trial, patients were randomly assigned to receive nortriptyline 150 mg/day (group 1) or fluoxetine 60 mg/day (group 2) for 6-weeks. The outcome of the two groups was assessed using Hamilton Depression Rating Scale, a side-effect checklist and a regular ECG assessment.

RESULTS

The results suggest that the efficacy of nortriptyline is superior to fluoxetine in this group of major depressed patients. No significant differences were observed between dropout rates in the two groups but anti-cholinergic side-effects were significantly more frequent with nortriptyline than with fluoxetine but there was no significant difference in cardiovascular effects in particular QTc prolongation.

CONCLUSION

The results of the current study suggest that nortriptyline was more effective than fluoxetine in the treatment of moderate to severe depression. A larger study is warranted.

Unraveling the 10 micron "silicate" feature of protostars: the detection of frozen interstellar ammonia

We present infrared spectra of four embedded protostars in the 750-1230 cm-1 (13.3-8.1 microns) range. For NGC 7538 IRS 9, a new band is reported at 1110 cm-1 (9.01 microns, and several others may be present near 785, 820, 900, 1030, and 1075 cm-1 (12.7, 12.2, 11.1, 9.71, and 9.30 microns). The band 1110 cm-1 is attributed to frozen NH3. Its position and width imply that the NH3 is frozen in a polar, H2O-rich interstellar ice component. The NH3/H2O ice ratio inferred for NGC 7538 IRS 9 is 0.1, making NH3 as important a component as CH3OH and CO2 in the polar ices along this line of sight. At these concentrations, hydrogen bonding between the NH3 and H2O can account for much of the enigmatic low-frequency wing on the 3240 cm-1 (3.09 microns) H2O interstellar ice band. The strength of the implied NH3 deformation fundamental at 1624 cm-1 (6.158 microns) can also account for the absorption at this position reported by ISO.