Chromium (Cr) toxicity significantly threatens sunflower growth and productivity by interfering with enzymatic activity and generating reactive oxygen species (ROS). Zinc quantum dot biochar (ZQDB) and arbuscular mycorrhizal fungi (AMF) have become popular to resolve this issue. AMF can facilitate root growth, while biochar tends to minimize Cr mobility in soil. The current study aimed to explore AMF and ZQDB combined effects on sunflower plants in response to Cr toxicity. Four treatments were applied, i.e. NoAMF + NoZQDB, AMF + 0.40%ZQDB, AMF + 0.80%ZQDB, and AMF + 1.20%ZQDB, under different stress levels of Cr, i.e. no Cr (control), 150 and 200 mg Cr/kg soil. Results showed that AMF + 1.20%ZQDB was the treatment that caused the greatest improvement in plant height, stem diameter, head diameter, number of leaves per plant, achenes per head, 1000 achenes weight, achene yield, biological yield, transpiration rate, stomatal conductance, chlorophyll content and oleic acid, relative to the condition NoAMF + No ZQDB at 200 mg Cr/kg soil. A significant decline in peroxidase (POD), superoxide dismutase (SOD), and catalase (CAT) while improvement in ascorbate peroxidase (APx), oil content, and protein content further supported the effectiveness of AMF + 1.20%ZQDB against Cr toxicity. Our results suggest that the treatment AMF + 1.20%ZQDB can efficiently alleviate Cr stress in sunflowers. Chromium (Cr) toxicity in plants refers to the harmful effects of excessive amounts of chromium on plant growth and development –5. Cr isBiofertilizers –13, suchHelianthus annuus) belongs to the family Asteraceae and are commercially cultivated for their valuable seeds, a rich source of edible oil. Sunflower oil is widely consumed worldwide and is a popular choice for cooking oil due to its favourable fatty acid profile and nutritional benefits [Sunflower . The climate in the research area was arid. The climatic data collected during the experiment is presented in Fig. AMF into the soil, we acquired a commercial inoculum known as Clonex® Root Maximizer. This inoculum primarily contained Glomus species and had an estimated propagule count of 158 per gram. To facilitate effective colonization, we mixed 2.5 g of the inoculum with every 5 kg of soil. Subsequently, this soil-inoculum mixture was applied for the purpose of inoculating the research soil as per the treatment plan .To synthesize zinc (Zn) quantum dots, we followed a modified procedure based on the acid-base reaction method originally developed by Song et al. . The synThe sunflower seeds utilized in this research were procured from a certified seed dealer officially recognized by the Government of Punjab, Pakistan. Prior to sowing, the seeds underwent a surface sterilization process involving treatment with a 5% sodium hypochlorite solution, followed by three consecutive rinses using 95% ethanol. To ensure the elimination of residual sterilizing agents, the seeds were washed three times with sterilized deionized water . The sowThe control group served as the baseline, with no additional treatments applied. In the control group, neither AMF nor zinc quantum dots (ZQDB) were added (NoAMF + NoZQDB). Treatments involved the inoculation of AMF in combination with different concentrations of ZQDB: 0.40%, 0.80%, and 1.20%. Additionally, three distinct Cr stress levels were applied, labeled as control (0Cr), 150Cr (150 mg Cr/kg soil), and 200Cr (200 mg Cr/kg soil) . All theTo meet the nutritional requirements of the plants, a recommended dose of nitrogen (N), phosphorus (P), and potassium (K) at a ratio of 60:40:25 kg/acre  was applied. Various sources of artificial fertilizers were used to supply these essential nutrients. The application of fertilizers was done at different stages of the plant’s growth, including sowing, the first and second irrigation, and the flowering stage, with varying proportions. Each pot’s irrigation was maintained using a moisture meter . The irrigation was provided by monitoring daily to maintain the scale of the instrument Wet = 70% field capacity.After 115 days of sowing, plants were harvested. Ten plants were randomly chosen from each plot for data collection to evaluate the impact of different treatments on plant growth and development. Several parameters, namely plant height, number of leaves per plant, stem diameter, and head diameter, were measured for each selected plant. Three samples, each containing 1000 achenes, were collected from every plot to determine the achene count. Additionally, the weight of 1000 achenes was measured using an electric balance. The entire plot was harvested, and the plants were dried naturally using sunlight. The total biomass comprising the stems and achenes was determined by weighing with a spring balance and then converted to kilograms per hectare (kg/ha). The heads were separated from the plants, and the grains were manually threshed. The weight of all the grains obtained from each plot was measured using an electric balance and expressed in kilograms per hectare (kg/ha).A non-destructive method involving a SPAD meter  was employed to assess the chlorophyll content of the plants.To assess gas exchange parameters, we employed an Infra-Red Gas Analyzer  for the determination of transpiration rate and stomatal conductance (gs).2O2 serving as the substrate [2O2) concentration was determined using a spectrophotometer at 390 nm [To obtain antioxidant enzymes from fresh plant tissue, we utilized a chilled 100 mM phosphate buffer (pH 7.8) containing polyvinyl pyrrolidine  and ethylenediaminetetraacetic acid . The method of  was usedubstrate . Additioubstrate . The redubstrate . Hydroget 390 nm .The oil content of intact seeds was determined using nuclear magnetic resonance (NMR) with the MQC23 instrument manufactured by Oxford Instruments, UK. A standard sample containing 5 g of seeds from various sunflower hybrids with known oil content was used to calibrate the instrument. The analysis of fatty acid profiles, including stearic acid, palmitic acid, linolenic acid, and oleic acid, was conducted using near-infrared spectroscopy (NIRS) .p ≤ 0.05. To aid visualization, cluster plot convex hull and hierarchical cluster plot techniques were employed using OriginPro software [A standard statistical procedure was followed for the statistical analysis. The means were compared using Fisher’s LSD test, with a significance level of software .The control group without any stress treatment had a plant height of 98 cm. The application of AMF + 0.40ZQDB increased the plant height to 106.75 cm, representing a percentage change of ~ 9%. Further increase in the stress treatment to AMF + 0.80ZQDB led to a plant height of 114 cm, resulting in a percentage change of ~ 16%. The highest stress treatment of AMF + 1.20ZQDB resulted in a plant height of 120.5 cm, indicating a percentage change of ~ 23%. Additionally, the study investigated the effect of amendments application on two other stress concentrations, 150Cr and 200Cr. For the 150Cr concentration, the control group (NoAMF + NoZQDB) had a plant height of 89.25 cm. When treated with AMF + 0.40ZQDB, the plant height slightly increased to 91.5 cm, representing a percentage change of ~ 3%. A further increase in stress treatment to AMF + 0.80ZQDB resulted in a plant height of 95 cm, indicating a percentage change of ~ 6%. The highest stress treatment of AMF + 1.20ZQDB for the 150Cr concentration led to a plant height of 96.5 cm, representing a percentage change of ~ 8%. The highest stress treatment of AMF + 1.20ZQDB for the 200Cr concentration resulted in a plant height of 87.75 cm, indicating a percentage change of ~ 15%  displayed a stem diameter of 1.15 cm. When treated with AMF + 0.40ZQDB, the stem diameter increased slightly to 1.18 cm, representing a percentage change of ~ 3%. Further stress treatment with AMF + 0.80ZQDB resulted in a stem diameter of 1.21 cm, indicating a percentage change of ~ 5%. The highest stress treatment of AMF + 1.20ZQDB for the 150Cr concentration led to a stem diameter of 1.24 cm, representing a percentage change of ~ 8%. For the 200Cr concentration, the control group exhibited a stem diameter of 1.02 cm. Treatment with AMF + 0.40ZQDB resulted in a slightly increased stem diameter of 1.06 cm, indicating a percentage change of ~ 5%. Further stress treatment to AMF + 0.80ZQDB led to a stem diameter of 1.09 cm, representing a percentage change of ~ 7%. The highest stress treatment of AMF + 1.20ZQDB for the 200Cr concentration resulted in a stem diameter of 1.11 cm, indicating a percentage change of ~ 9%  displayed a head diameter of 10.06 cm. When treated with AMF + 0.40ZQDB, the head diameter increased to 11.12 cm, representing a percentage change of ~ 11%. Further stress treatment with AMF + 0.80ZQDB resulted in a head diameter of 11.40 cm, indicating a percentage change of ~ 13. The highest stress treatment of AMF + 1.20ZQDB for the 150Cr concentration led to a head diameter of 11.71 cm, representing a percentage change of ~ 17. For the 200Cr concentration, the control group exhibited a head diameter of 9.78 cm. Treatment with AMF + 0.40ZQDB resulted in a head diameter of 10.15 cm, indicating a percentage change of ~ 4%  displayed a number of leaves per plant of 13.61. When treated with AMF + 0.40ZQDB, the number of leaves per plant increased slightly to 13.88, resulting in a percentage change of ~ 2%. Further stress treatment with AMF + 0.80ZQDB resulted in a of 14.17 leaves per plant, indicating a percentage change of ~ 4. The highest stress treatment of AMF + 1.20ZQDB for the 150Cr concentration led to a of 14.65 leaves per plant, representing a percentage change of ~ 8. For the 200Cr concentration, the control group exhibited a of 12.07 leaves per plant. Treatment with AMF + 0.40ZQDB resulted in a of 12.46 leaves per plant, indicating a percentage change of ~ 3. Further stress treatment to AMF + 0.80ZQDB led to a of 12.99 leaves per plant, representing a percentage change of ~ 8. The highest stress treatment of AMF + 1.20ZQDB for the 200Cr concentration resulted in a of 13.13 leaves per plant, indicating a percentage change of ~ 9  displayed a number of achenes per head of 1050.54. When treated with AMF + 0.40ZQDB, the increased to 1088.61 achenes per head, resulting in a percentage change of ~ 4%. Further stress treatment with AMF + 0.80ZQDB resulted in a of 1151.24 achenes per head, indicating a percentage change of ~ 10%. The highest stress treatment of AMF + 1.20ZQDB for the 150Cr concentration led to a of 1176.33 achenes per head, representing a percentage change of ~ 12%. For the 200Cr concentration, the control group exhibited a of 947.21 achenes per head. Further stress treatment with AMF + 0.80ZQDB led to a of 1027.64 achenes per head, representing a percentage change of ~ 9%. The highest stress treatment of AMF + 1.20ZQDB for the 200Cr concentration resulted in a of 1056.78 achenes per head, indicating a percentage change of ~ 12%  exhibited a weight of 31.32 g for 1000 achenes. When treated with AMF + 0.40ZQDB, the weight increased to 32.91 g, resulting in a percentage change of ~ 5%. Further stress treatment with AMF + 0.80ZQDB resulted in a weight of 33.73 g, indicating a percentage change of ~ 8%. The highest stress treatment of AMF + 1.20ZQDB for the 150Cr concentration led to a weight of 34.77 g, representing a percentage change of 11.00%. For the 200Cr concentration, the control group displayed a weight of 28.64 g for 1000 achenes. The highest stress treatment of AMF + 1.20ZQDB for the 200Cr concentration resulted in a weight of 31.49 g, indicating a percentage change of ~ 10%  demonstrated a achene yield of 1682.34 kg/ha. Treatment with AMF + 0.40ZQDB resulted in an increased yield of 1793.06 kg/ha, reflecting a percentage change of ~ 7%. Further stress treatment with AMF + 0.80ZQDB led to a yield of 1850.75 kg/ha, indicating a percentage change of ~ 10%. The highest stress treatment, AMF + 1.20ZQDB, for the 150Cr concentration yielded a of 1922.57 kg/ha, exhibiting a percentage change of ~ 14%. For the 200Cr concentration, the control group exhibited a achene yield of 1558.35 kg/ha. Treatment with AMF + 0.40ZQDB resulted in a yield of 1648.81 kg/ha, signifying a percentage change of ~ 6%. Further stress treatment with AMF + 0.80ZQDB led to a yield of 1709.30 kg/ha, indicating a percentage change of ~ 10%. The highest stress treatment, AMF + 1.20ZQDB, for the 200Cr concentration yielded a of 1729.90 kg/ha, representing a percentage change of ~ 11% , exhibited a biological yield of 7076.73 kg/ha. Treatment with AMF + 0.40ZQDB led to a slight increase in the yield to 7246.34 kg/ha, representing a percentage change of ~ 2%. Further intensifying the stress treatment to AMF + 0.80ZQDB resulted in a yield of 7358.49 kg/ha, indicating a percentage change of ~ 4%. The highest stress treatment, AMF + 1.20ZQDB, showed the most significant impact on biological yield, yielding a of 7426.50 kg/ha, corresponding to a percentage change of ~ 5%. Moreover, the study investigated the impact of amendments application on two additional stress concentrations: 150Cr and 200Cr. The control group for the 150Cr concentration (NoAMF + NoZQDB) displayed a biological yield of 6476.63 kg/ha. Treatment with AMF + 0.40ZQDB resulted in a yield of 6647.62 kg/ha, reflecting a percentage change of ~ 3%. Further stress treatment with AMF + 0.80ZQDB led to a yield of 6810.94 kg/ha, signifying a percentage change of ~ 5%. Further stress treatment with AMF + 0.80ZQDB led to a yield of 5999.88 kg/ha, signifying a percentage change of ~ 5%. The highest stress treatment, AMF + 1.20ZQDB, for the 200Cr concentration yielded a of 6268.22 kg/ha, representing a percentage change of ~ 10% , representing a ~ 6% change. Intensifying the stress treatment to AMF + 0.80ZQDB further increased the chlorophyll content to 16.46 (SPAD), corresponding to ~ 9% change. The highest stress treatment, AMF + 1.20ZQDB, exhibited the most significant impact on chlorophyll content, with a of 16.70 (SPAD) and a percentage change of ~ 10%. The effects of amendments application on chlorophyll content were also examined at two additional stress concentrations: 150Cr and 200Cr. The control group for the 150Cr concentration displayed a chlorophyll content of 14.43 (SPAD). Treatment with AMF + 0.40ZQDB resulted in a slightly increased chlorophyll content of 15.08 (SPAD), indicating a ~ 5% change. Further stress treatment with AMF + 0.80ZQDB led to a chlorophyll content of 15.45 (SPAD), representing a ~ 7% change. The highest stress treatment, AMF + 1.20ZQDB, for the 150Cr concentration yielded a of 15.69 (SPAD), signifying an ~ 9% change. For the 200Cr concentration, the control group exhibited a chlorophyll content of 12.58 (SPAD). Treatment with AMF + 0.40ZQDB resulted in a chlorophyll content of 13.63 (SPAD), corresponding to an ~ 8% change. Further stress treatment with AMF + 0.80ZQDB increased the chlorophyll content to 13.90 (SPAD), indicating a 10.54% change. The highest stress treatment, AMF + 1.20ZQDB, for the 200Cr concentration yielded a of 14.21 (SPAD), representing a ~ 13% change  exhibited a electrolyte leakage of 44.84%. When treated with AMF + 0.40ZQDB, the electrolyte leakage decreased to 42.60%, indicating a ~ -5% change. Intensifying the stress treatment to AMF + 0.80ZQDB further reduced the electrolyte leakage to 39.59%, corresponding to a ~ -12% change. The highest stress treatment, AMF + 1.20ZQDB, showed the most significant impact on membrane stability, with a electrolyte leakage of 35.62% and a ~ -21% change. Similarly, for the 150Cr concentration, the control group displayed a electrolyte leakage of 61.71%. The highest stress treatment, AMF + 1.20ZQDB, resulted in a electrolyte leakage of 48.95%, signifying a ~ -21% change. For the 200Cr concentration, the control group exhibited a electrolyte leakage of 74.06%. Treatment with AMF + 0.40ZQDB reduced the electrolyte leakage to 70.88%, corresponding to a ~ -4% change. Further stress treatment with AMF + 0.80ZQDB led to a electrolyte leakage of 68.47%, indicating a ~ -8% change. The highest stress treatment, AMF + 1.20ZQDB, yielded a electrolyte leakage of 65.77%, representing an ~ -11% change  exhibited a oleic acid percentage of 13.33%. When treated with AMF + 0.40ZQDB, the oleic acid percentage increased to 13.79%, representing a ~ 3% change. Intensifying the stress treatment to AMF + 0.80ZQDB further elevated the oleic acid percentage to 13.99%, indicating a ~ 5% change. The highest stress treatment, AMF + 1.20ZQDB, resulted in a oleic acid percentage of 14.20%, corresponding to a ~ 7% change. Similarly, for the 150Cr concentration, the control group displayed a oleic acid percentage of 11.71%. The highest stress treatment, AMF + 1.20ZQDB, resulted in a oleic acid percentage of 12.99%, signifying a ~ 11% change. For the 200Cr concentration, the control group exhibited a oleic acid percentage of 10.73%. Treatment with AMF + 0.40ZQDB increased the oleic acid percentage to 11.00%, indicating a ~ 3% change. Further stress treatment with AMF + 0.80ZQDB led to a oleic acid percentage of 11.24%, representing a ~ 4% change. The highest stress treatment, AMF + 1.20ZQDB, yielded a oleic acid percentage of 11.48%, corresponding to a ~ 7% change , the percentage of stearic acid was 4.19%. Treatment with AMF + 0.40ZQDB resulted in a slightly increased percentage of 4.38%, corresponding to a percentage change of ~ 5%. Treatment with AMF + 0.40ZQDB increased the percentage to 4.10%, indicating a percentage change of ~ 6%. Further stress treatment with AMF + 0.80ZQDB led to a stearic acid percentage of 4.18%, representing a percentage change of ~ 8%. The highest stress treatment, AMF + 1.20ZQDB, resulted in a stearic acid percentage of 4.25%, signifying a percentage change of ~ 10%. For the 200Cr concentration, the control group displayed a stearic acid percentage of ~ 3%. Treatment with AMF + 0.40ZQDB increased the percentage to 3.76%, indicating a percentage change of ~ 10%. Further stress treatment with AMF + 0.80ZQDB led to a stearic acid percentage of 3.88%, representing a percentage change of ~ 13%. The highest stress treatment, AMF + 1.20ZQDB, yielded a stearic acid percentage of 3.97%, corresponding to a percentage change of ~ 16% , the control group exhibited a POD activity of 2.38 U/mg protein. When 0.40ZQDB was combined with AMF, the POD activity decreased by 8.58% to 2.19 U/mg protein in the control group. Treatment 0.80ZQDB and 1.20ZQDB combined with AMF, the POD activity continued to decline, showing percentage decreases of ~ 12% and ~ 21%, respectively. In the case of 150Cr treatment without AMF and ZQDB (NoAMF + NoZQDB), the POD activity was 1.70 U/mg protein. However, when AMF and 0.40ZQDB were introduced, there was a ~ 5% decrease in POD activity to 1.62 U/mg protein compared to the treatment NoAMF + NoZQDB under 150Cr stress. More ~ 18% and ~ 52% reduction were recorded when 0.80ZQDB and 1.20ZQDB treatments were combined with AMF in 150Cr stress over control treatment (NoAMF + NoZQDB). In the highest stress treatment group, 200Cr without any AMF or ZQDB stress (NoAMF + NoZQDB) resulted in a POD activity of 0.98 U/mg protein. Adding 0.40ZQDB treatment with AMF led to an ~ 11% reduction in POD activity, bringing it down to 0.88 U/mg protein over the control (NoAMF + NoZQDB) under 200Cr stress. The most significant percentage decrease in POD activity was observed in the presence of AMF + 0.80ZQDB and AMF + 1.20ZQDB treatment, with reductions of ~ 35% and ~ 68%, compared to the control group (NoAMF + NoZQDB) in 200Cr stress . With 0.80ZQDB and AMF, SOD activity decreased by 22.11% (124.69 U/mg protein), and with 1.20ZQDB and AMF, there was a ~ 32% decrease (115.62 U/mg protein) in control in comparison to the NoAMF + NoZQDB treatment. In the 150Cr stress group without AMF and ZQDB treatment, SOD activity was 102.34 U/mg protein. Applying 0.40ZQDB and AMF resulted in a ~ 18% decrease in SOD activity (87.03 U/mg protein). In comparison, 0.80ZQDB and AMF led to a substantial ~ 38% decrease (74.42 U/mg protein) over the NoAMF + NoZQDB treatment in 150Cr stress. Treatment 1.20ZQDB, and AMF, caused a remarkable ~ 64% decrease in SOD activity (62.39 U/mg protein) relative to the control NoAMF + NoZQDB under 150Cr stress. For the 200Cr stress group without AMF and ZQDB treatment, SOD activity was 52.16 U/mg protein. Adding 0.40ZQDB and AMF led to an ~ 8% decrease in SOD activity (48.26 U/mg protein). In comparison, 0.80ZQDB and AMF resulted in a ~ 16% decrease (44.81 U/mg protein) from the NoAMF + NoZQDB in 200Cr stress. Treatment 1.20ZQDB and AMF in 200Cr stress showed a substantial ~ 44% decrease (36.30 U/mg protein) over the NoAMF + NoZQDB treatment . The catalase activity was reduced to 8.26 U/mg protein (~ 23% decrease) when subjected to AMF and 0.40ZQDB, further declining to 7.31 U/mg protein (~ 40% decrease) with AMF and 0.80ZQDB, and significantly dropping to 5.68 U/mg protein  with AMF and 1.20ZQDB in comparison to the NoAMF + NoZQDB treatment in 150Cr stress. For the 200Cr treatments, the control group with NoAMF + NoZQDB treatment had a CAT activity 4.49 U/mg protein. However, when AMF and 0.40ZQDB treatment was applied, CAT activity decreased to 2.67 U/mg protein (~ 68% decrease) compared to the NoAMF + NoZQDB under 200Cr stress. With the addition of AMF + 0.80ZQDB, CAT activity was further reduced CAT activity to 1.95 U/mg protein, and with treatment AMF and 1.20ZQDB also showed a reduction in CAT activity under 200Cr stress  content of 0.68 U/mg protein, indicating a percentage change of ~ 115% compared to the control group. Introducing AMF with 0.40ZQDB and 0.80ZQDB further increased the GSH contents to 0.61 U/mg protein and 0.52 U/mg protein, corresponding to percentage changes of ~ 156% and ~ 180%, respectively. The highest GSH content of 0.42 U/mg protein was observed when AMF was combined with 1.20ZQDB, resulting in a remarkable percentage change of ~ 254%. The introduction of AMF with 0.40ZQDB and 0.80ZQDB resulted in GSH contents of 0.82 U/mg protein and 0.88 U/mg protein, corresponding to percentage changes of ~ 245 and ~ 374%, respectively. The combination of AMF and 1.20ZQDB yielded the highest GSH content of 0.97 U/mg protein and an exceptional percentage change of ~ 709% , resulting in a MDA content of 0.95 µmol/g fresh weight  and oil contents (%), highlighting a possible connection between these agricultural yield-related parameters. Additional clusters involve variables related to enzymatic activities such as GHS (U/mg protein), SOD (U/mg protein), and H2O2 (µmol/g fresh weight). This suggests that these parameters may share underlying factors influencing their behaviour. The analysis also reveals clusters related to plant growth and development. For instance, number of leaves/plant and stem diameter (cm) form a cluster, indicating a potential relationship between these growth-related characteristics. Variables related to fatty acid composition, such as linolic acid (%), palmitic acid (%), and oleic acid (%), appear in clusters together, suggesting common factors affecting the composition of these fatty acids in the plant. Moreover, variables linked to physiological and yield-related attributes, including number of achene/head, chlorophyll contents (SPAD), plant height (cm), and head diameter (cm), form clusters, indicating associations between these attributes. The hierarchical cluster analysis culminates in a final cluster consisting of variables with high similarity scores. These variables, transpiration rate, steric acid (%), transpiration rate, and stomatal conductance, are grouped closely, indicating they may share common influences and responses  and APx (U/mg protein) are highly similar, with a similarity score of 0.15291, indicating a potential connection between electrolyte leakage and ascorbate peroxidase activity. Another cluster includes POD (U/mg protein), suggesting that peroxidase activity is related to these variables. A separate cluster involves biological yield  and the release of oxygen (O2) through stomatal openings [The present study investigated the sensitivity of sunflower plants to Cr toxicity. It explored the potential mitigating effects of AMF and ZQDB applications. We assessed a range of growth and yield attributes and physiological responses to understand the impact of Cr stress and the potential benefits of AMF and ZQDB treatments. Our results revealed a significant sensitivity of sunflower plants to increasing Cr concentrations. As the Cr concentration increased, various growth and yield attributes of the sunflower plants showed a declining trend. The most pronounced effect was observed at the highest Cr application rate of 200 mg kgt height . This fit height . Zinc qut height . The sust height , 35. Thet height . The abit height . The inct height . Nutrient height . This ent height . Chromiut height , 40. AMFt height . Transpiopenings . This gaopenings . Second,openings , 43. ZQDopenings . AMF plaopenings . These aopenings . The preopenings . On the openings , 43. Theopenings .AMF, along with 1.20%ZQDB, was an effective amendment for mitigating Cr stress in sunflower plants. The treatment showed great potential to improve the growth, gas exchange attributes, chlorophyll contents, and yield attributes of sunflowers under chromium toxicity. Growers are recommended to add AMF + 1.20%ZQDB to achieve better sunflower growth in Cr-toxic soils. More investigations are suggested on different crops to declare AMF + 1.20%ZQDB as the best amendment against Cr toxicity in different soil textures.


Sansevieria trifasciata (Asparagaceae), for wound healing. However, a study on the wound-healing activity of this plant has not been conducted. Therefore, this study aimed to evaluate the hydrogel formulations of S. trifasciata extract (HESt) and its activity in wound healing. The HESt formulations were subjected to physical examination, pH measurement, spreading coefficient, rheological study, stability test, and wound-healing activity. Furthermore, the HPMC and carbopol 940 gel-forming agents were used to obtain this formulation. In the incision wound model, the experiment was divided into 5 groups, each consisting of 4 mice. Groups 1 and 2 served as a negative and positive control (octenidine gel), while 3, 4, and 5 were given HESt formulations of 15%, 20%, and 25% (w/w), respectively, for 15 days. Based on the wound healing activity test, HESt 20% and 25% (w/w) groups showed significant (p < 0.05) wound closure area on day 4 and from day 2 to 16. However, the HESt 15% (w/w) group showed no significant difference in wound-healing activity but had a higher closure than the negative control. Based on the evaluation of the hydrogel, all HESt formulations were reported to have fulfilled the standard requirements. The HESt formulations were also reported to be stable at various temperatures in the stability test. Therefore, S. trifasciata leaves extract has the potential to be developed as a wound-healing drug derived from herbal plants formulated into hydrogel preparations.For centuries, communities have used medicinal plants to treat various diseases, such as  A wound can be defined as a disruption of cellular and anatomical continuity that leads to the loss of protective or physiological tissue function. This disruption is typically caused by physical, chemical, microbial, thermal, or immunological injury to the affected tissue . After tSansevieria trifasciata. It is an evergreen perennial plant forming dense strands, spreading by way of its creeping rhizome, which is sometimes above ground and sometimes underground. Its stiff leaves grow vertically from a basal rosette. Mature leaves are dark green with light gray-green cross-banding and usually range from 70 to 90 cm (2.3–3.0 ft) long and 5-6 cm (2.0–2.4 in) wide, though it can reach heights above 2 m (6 ft) in optimal conditions. This plant is known to contain alkaloids, saponins, steroids, phenolics, and tannins. Previous studies reported that this plant has antioxidant, anti-inflammatory, analgesic, and antibacterial activities [S. trifasciata. The extract cannot be directly applied to the skin and should first be converted into a hydrogel. Concerning the benefits, the hydrogel can bind to around 20–95% of the surrounding water and leave a transparent and elastic film with high adhesive power, resulting in good drug release and skin penetration [S. trifasciata leaves extract hydrogel (HESt) in a mice model with an incisional wound.The healing rate depends on several factors, including the wound size, blood supply to the affected area, infection, and foreign objects. Wound care may involve the administration of local and systemic medications. In addition, several growth factors, such as macrophage-derived, monocyte derived, and platelet-derived growth factors, are needed to accelerate wound healing . Wound ctivities , 15. Howetration . Furtheretration . TherefoS. trifasciata leaves were obtained from Karawang, West Java, Indonesia, in April 2022. The plant was identified at the Technical Implementation Unit of Herbal Materia Medica Laboratory in Batu, Malang, East Java, Indonesia. Furthermore, it was taken to the Phytochemistry Laboratory, Universitas Buana Perjuangan Karawang, for extraction. About 3.0 kg of S. trifasciata powder was macerated using 96% ethanol for 3 × 24 h. The liquid extract was then collected and concentrated using a rotary evaporator (Eyela OSB-2100) at 50°C [The  at 50°C .S. trifasciata extract, phytochemical screening was conducted to identify phytoconstituents such as polyphenols, tannins, flavonoids, saponins, alkaloids, triterpenoids, and steroids [After obtaining the steroids .About 100 mg of sample powder were extracted in 10 mL of 70% methanol for 15 minutes. Furthermore, 0.1 mL of the extract was taken and dissolved in 0.4 mL of methanol and 2.5 mL of Folin–Ciocalteu reagent and kept at 25°C for 3 to 5 minutes, and then 0.8 mL of sodium hydrogen carbonate (75 g/L) was added to the mixture and kept for 60 minutes at 25°C. The absorbance was measured using a spectrophotometer  at 765 nm, and the test results were expressed as gallic acid equivalents (GAEs) .About 100 mg of sample powder were extracted in 10 mL of 70% methanol for 15 minutes. Furthermore, 0.1 mL of the extract was taken and dissolved in 2.4 mL of methanol, 0.1 mL of 10% aluminium chloride, 0.1 mL of 1 M NaCOOH, and 2.3 mL of aquadest and then kept for 30 minutes at 25°C. Meanwhile, the absorbance was measured using a Shimadzu UV-1601 spectrophotometer made in Japan at 432 nm, and the test results were expressed as quercetin equivalents (QEs) .μm PTFE syringe filter. The analysis used a Shimadzu LC-20AT high performance liquid chromatography system with a UV-VIS SPD20A detector and SIL-20HT autosampler made in Japan. Furthermore, 20 μL of the extract were analyzed using a column temperature of 35°C and a flow rate of 0.7 mL/min. A nonpolar C18 column (150 × 4.6 mm) with a 5 μm particle size was used. Eluent A was a 40-minutes gradient program using 1% (v/v) acetic acid in ultrapure water, while eluent B used acetonitrile as follows: 0 to 5 minutes: 10% B, 5 to 15 minutes: 40% B, 15 to 20 minutes: 60% B, 20 to 30 minutes: 90% B, 30 to 40 minutes: 10% B. Subsequently, the absorbance was measured at 272 nm [About 100 mg of sample powder were extracted in 10 mL of 70% methanol for 15 minutes  and filtered using a 0.45 t 272 nm .(HPMC) in aquadest at a temperature of 70°C and stirring using a magnetic heater stirrer  at a speed of 300 rpm. Carbopol 940 dissolved in distilled water was added and stirred until homogeneous. S. trifasciata extract was dissolved in distilled water at various concentrations, mixed with the gel phase, and stirred until homogeneous (mass I). Subsequently, methylparaben and propylparaben were added to glycerin and stirred until homogeneous (mass II). Mass I and II were mixed slowly and stirred until homogeneous [The gel phase was made by mixing hydroxypropyl methylcellulose ogeneous , and theObservations were made on the color, homogeneity, and consistency visually to evaluate the HESt formulations .The pH of all HESt formulations was measured using a pH meter . The formulations were placed in a container, and the electrode was inserted before recording the results .To determine the spreading coefficient, 1 g of each HESt formulation was placed on a transparent glass coated with graph paper. The glass was then covered with a glass plate, given a 5–30 grams load, and left for 60 seconds. Furthermore, the area covered by each HESt formulation was calculated .This study conducted viscosity measurements for all HESt formulations using a cone and plate viscometer with a spindle 7 . The apparatus was connected to a water bath, thermostatically controlled, and maintained at 25°C. All HESt formulations tested for viscosity were placed in a glass with a thermostatic jacket. The spindle was left to move freely within the hydrogel, and the results were recorded. This viscosity test was conducted for 10 minutes at a speed of 100 rpm .HESt formulations were stored at cold (4 ± 2°C), room (27 ± 2°C), and hot (40 ± 2°C) temperatures for 90 days to test the stability. Furthermore, physical appearance, pH, and viscosity measurements were performed at all temperatures .ad libitum. Furthermore, the mice were housed in plastic cages with softwood shavings. The Research Ethics Committee of Universitas Padjadjaran, Bandung, Indonesia, approved the study protocol with reference number 574/UN6.KEP/EC/2022.A total of 20 healthy albino mice of both sexes, weighing 20 to 30 grams, were used. The mice were obtained from Animal House, CV. Mitra Putra Animal, Bandung, Indonesia, and placed in the Pharmacology Laboratory of Universitas Buana Perjuangan Karawang, under a twelve-hour light-dark cycle, with free access to standard pellets and water Before creating the wound, all mice were anesthetized using intramuscular Ketamine HCl with 120 mg/kgBW .n is the number of days .The mice were divided into 5 groups, with 4 in each group. During the experiment, groups 1 and 2 were the negative and positive controls, receiving hydrogel base and octenidine dihydrochloride (0.05% w/w) gel. Meanwhile, groups 3, 4, and 5 were given HESt formulations with concentrations of 15%, 20%, and 25% (w/w) for 15 days after incision wound induction. The wound diameter observations and measurements were performed on each treatment group on days 0, 2, 4, 8, and 16. The percentage of wound closure area was determined by measuring the average diameter in the vertical, horizontal, and diagonal directions using a caliper .(1)% Woup < 0.05 considered significantly different. Meanwhile, statistical analysis was performed using one-way analysis of variance with GraphPad Prism version 8, followed by a post hoc Tukey HSD test.The experiment results were presented as mean ± SEM, with Sansevieria trifasciata by the Technical Implementation Unit of Herbal Materia Medica Laboratory in Batu, Malang, East Java, Indonesia, with No. 074/087/102.20-A/2022, and the extraction yielded a concentrate of 300 g at 10.00%.The plant was identified as S. trifasciata extract showed the presence of secondary metabolites such as polyphenols, saponins, flavonoids, alkaloids, triterpenoids, and steroids  groups showed significant wound closure on day 4 and day 2–16. The HESt 15% (w/w) group showed no significant difference in wound-healing activity but had higher closure than the negative control. The group given the standard drug (octenidine gel) showed significant wound closure only on day 16, and the maximum percentage was observed in animals treated with HESt 25% (w/w) from day 2 to 16 at 30.00%, 42.50%, 65.00%, and 99.37%. The standard drug (octenidine gel) only had a maximum percentage of wound closure on day 16 at 99.37%, as shown in S. trifasciata is claimed to have potential wound-healing activity due to its antioxidant, anti-inflammatory, analgesic, and antibacterial effects [A wound is one major cause of health problems in terms of morbidity and mortality. This has prompted studies to determine the right wound-healing medications for quick skin restoration with disrupted anatomical and functional stability . One way effects , 15.S. trifasciata leaves extract had several secondary metabolite compounds, such as polyphenols, alkaloids, flavonoids, saponins, alkaloids, triterpenoids, and steroids  [S. trifasciata leaves extract exhibits antibacterial activity against skin pathogens such as Pseudomonas aeruginosa [Staphylococcus aureus [Escherichia coli [Candida albicans [The wound-healing activity of the HESt formulations may also be attributed to the presence of gallic acid compounds, which can activate cell migration in human keratinocytes and fibroblasts , reduce  (TGF-β) , as well (TGF-β) . Furtherruginosa , Staphyls aureus , Escherihia coli , and Canalbicans , which calbicans , 51.S. trifasciata leaves extract can be developed as a wound-healing drug derived from a medicinal plant formulated in a hydrogel preparation.Based on the results, all HESt formulations were reported to fulfill the requirements for good hydrogel formulations. Moreover, this study also reported that all the formulations were stable at cold (4 ± 2°C), room (27 ± 2°C), and hot (40 ± 2°C) temperatures for 90 days on observations of color, homogeneity, viscosity, pH, and viscosity in stability test. Therefore, the S. trifasciata.Based on the results, the HESt formulations can improve wound healing activity in the mice incision wound model and exhibit dose-dependent healing activity. Meanwhile, this study showed that HESt 25% (w/w) had better wound-healing activity than the standard drug. They were reported to fulfill the requirements of good hydrogel formulations and were stable at various temperatures during the stability test for 90 days. This study showed that HESt could be developed as a healing drug to treat various human wounds. However, further studies are needed to understand the wound-healing activity mechanism of


To analyse the influencing factors of anxiety, disease uncertainty and acute stress response in patients with acute ischaemic stroke, and to verify the mediating role of anxiety in the post-epidemic era.240 patients with acute ischaemic stroke were selected from a tertiary hospital in Wuhan City and investigated by questionnaire and convenience sampling methods.The total anxiety score, disease uncertainty and acute stress reaction were at moderate levels. Anxiety was positively correlated with illness uncertainty, and anxiety and acute stress response were negatively correlated. Multiple linear regression analysis showed that Sickness uncertainty, acute stress response, age, and work status influenced anxiety. Anxiety mediated the prediction of Sickness uncertainty and acute stress response, with the mediating effect accounting for 35.6% of the total effect.Disease uncertainty in patients with acute ischaemic stroke in the post-epidemic era directly affects the acute stress response and indirectly through anxiety. There a2.2.1.This study is a cross-sectional study in a non-experimental study.2.2.The subjects of this study were acute ischaemic stroke patients in a tertiary care hospital in Wuhan, China.2.2.1.(1) Meeting the diagnostic criteria of the Chinese guidelines for the diagnosis and treatment of acute ischaemic stroke.(2) Patients with acute ischaemic stroke of first onset.(3) clear consciousness.2.2.2.(1) Combination of severe organic lesions of other organs.(2) Pre-existing psychological and psychiatric disorders.(3) Unwillingness to cooperate in the middle of the procedure.2.2.3.The rough estimation method proposed by Li Zheng  was used2.3.General Information Questionnaire, Illness Uncertainty Inventory (MUIS-A) , Acute S2.4.This study is based on the psychological stress model (resilience in process model), and Jiang Qianjin proposed the concept of ‘stress multifactor system’ through the study of multiple factors of psychological stress , 27, tha2.5.Based on psychological stress theory, this study makes the following hypotheses (1) illness uncertainty has a direct predictive effect on anxiety; (2) illness uncertainty has a direct predictive effect on acute stress response; (3) acute stress response has a direct predictive effect on anxiety; (4) acute stress response has a mediating role in illness uncertainty and anxiety, and the framework of this study is shown in 2.5.1.anxiety is seen as being most often generated by concurrent and equivalent activation of fear (or frustration) and reward system. If uncertainty disappears, anxiety should give way to satisfaction or joy (if winning) or some negative emotions ranging from sadness to fear. The more active reward system is in a situation of uncertainty, the higher should be anxiety-related arousal .In reinforcement sensitivity theory, Gray proposed several conceptual neural systems, which include: behavioural approach system (BAS), which is a positive behavioural feedback system; behavioural inhibition system (BIS), which is a negative behavioural feedback system; confrontation/flight system (FFS), which has the same function as the behavioural inhibition system but differs from the behavioural inhibition system in that it is more sensitive to conditioned aversions. a negative behavioural feedback system; and the fight/flight system (FFS), which has the same function as the behavioural inhibition system, but differs from the behavioural inhibition system in that it is more sensitive to unconditional aversions and is responsible for the regulation of emotions such as fear and anxiety. Gray et al.  revised 2.6.We communicated with the study subjects and their families, explained the purpose and significance of the study and the method of filling out the questionnaires, and collected the questionnaires on the spot. 320 questionnaires were distributed in this study, 300 were collected, 288 were valid and 12 were invalid, with a valid recovery rate of 96%.This study used SPSS26.0 for data analysisn) and percentage (%), and the measurement data were expressed by mean ± standard deviation.(1) The general information of the patients and the count data in the scores of each scale were expressed by frequency (t-test and ANOVA.(2) Differences between different patients in terms of scores of each scale were analysed by two independent samples (3) Pearson’s correlation analysis was used to explore the relationship between anxiety, disease uncertainty, and acute stress response.(4) Multiple linear regression analysis was used to explore the effects between the three.(5) ProceSS3.5 macro program was used to further test the mediating effect of anxiety between illness uncertainty and acute stress response.3.3.1.per capita monthly income of the family was mostly in the number of people in the range of 2,000-4,000, occupying 54.4, 69.6% of the health care payment method was urban workers’ insurance, the self-assessment of the economic pressure was moderate, and the number of children >2 or ≤ 2 had a small difference. 57.1% had average knowledge of the disease. See Males accounted for 58.3 percent of the total and females for 41.7 percent. The age distribution was over 50 years old, Han Chinese patients accounted for 64.6 percent, and married patients accounted for 86.7 percent. The place of residence was mostly urban, occupying 76.2%, the cultural level was mainly at junior high school, high school or secondary school level, the working status was mostly retired, occupying 60.4%, the 3.2.3.2.1.Compared to the complexity dimension scores, the uncertainty dimension scores were high with a total score (48.59 ± 4.96) and the total disease uncertainty score (77.64 ± 6.89), 98.3% of the patients had a moderate level of disease uncertainty. Only 1.7% of patients were at a high level. The details are shown in 3.2.2.per capita income per month is less than 2,000 yuan, and most of them are self-paying patients with a score of 81.36 ± 5.73 points, self-assessed economic pressure, the difference in the number of children is small, and the patients do not understand their own diseases, with a score of 80.62 ± 6.41 points, see Age in the 60–70 years old disease uncertainty scored the highest score of 79.00 ± 5.86 points, ethnic minorities scored 79.04 ± 7.09 points, patients without spouses scored 79.04 ± 7.09 points, literacy in primary school culture scored 79.67 ± 6.00 points, joblessness scored 80.40 ± 7.10 points, most of the place of residence in rural areas, 3.3.3.3.1.The scores for each dimension were as follows, dissociative symptoms 24.69 ± 6.67) with the highest score, hypervigilant symptoms (17.71 ± 5.12), avoidance symptoms (15.23 ± 4.53), re-experiencing symptoms (15.63 ± 4.39), impairment of social functioning (4.54 ± 1.64) with the lowest score, and the total score of acute stress reaction (77.80 ± 20.29) points, detailed results are shown in 9 ± 6.67 3.3.2.per capita monthly income was less than 2,000 yuan, scored 82.86 ± 18.48 points, and most of them were self-funded patients, self-assessed economic pressure, the difference in the number of children is small, patients do not understand their own disease, score 82.56 ± 18.64 points, see Age ≥ 70 years of age had the highest acute stress score of 82.90 ± 16.19 points, patients without spouses scored 84.97 ± 22.45 points, literacy in primary school culture scored 85.95 ± 14.48 points, joblessness scored 83.35 ± 18.34 points, the 3.4.3.4.1.Thirty four were patients with no anxiety (14.2%), 99 with mild anxiety (41.3%). Ninety one with moderate anxiety (37.9%). Sixteen patients with severe anxiety (6.6%) accounted for a smaller percentage. See 3.4.2.Age ≥ 70 years old had the highest anxiety score, 60.83 ± 6.64 points, literacy in primary school education score 61.98 ± 6.51 points, jobless status score 61.02 ± 8.03 points, and most of them were self-paying patients with a score of 61.92 ± 6.32 points, and self-assessment of economic stress was high, 61.21 ± 7.37 points. The difference in the number of children was small, and the patients were unaware of their disease, scoring 59.91 ± 7.72 points, as shown in 3.5.R2 = 0.401, the coefficient of adjustment R2 = 0.356, and the ANOVA results with F = 8.760 and p = 0.000 indicate that the four included independent variables were able to explain 40.1% of the variance in anxiety symptoms of the study subjects, as detailed in The regression equation was: anxiety’ Y = 27.918 + 6.242 × age − 9.123 × work status +0.274 × disease uncertainty +0.144 × acute stress response. The coefficient of determination 3.6.The results of the analysis showed that acute stress response partially mediated the prediction of anxiety by illness uncertainty. The variance of anxiety explained by acute stress response was sqrt (0.320–0.167) = 0.391 (39.1%), and the contribution of the mediating effect to the total effect was: Effect M = ab/c = 1.041 × 0.157/0.450 = 0.363 (36.3%), and the details are shown in 4.4.1.per capita monthly household income are also better able to cope with acute ischaemic stroke and disability, which is largely similar to the results reported by Ni (The more severe the sense of disease uncertainty was in patients over 60 years old, rural health insurance, no spouse, ethnic minority, and no knowledge of the disease. This is basically consistent with the findings of Wang Xiaoxiao  and otheed by Ni  and Kim ed by Ni .4.2.Older, spouseless patients, with no one to support them emotionally and spiritually and with only one person to support them financially, can develop a strong sense of isolation, triggering acute stress reactions, which is consistent with the findings of Wu Wei et al. . Highly 4.3.The incidence of anxiety was significantly higher in patients who were older, had two or more children, were self-paying, had rural health insurance, had low education, and did not understand the disease . We hypo4.4.Sickness uncertainty is positively correlated with post-traumatic stress disorder, which is consistent with related scholars’ studies , and sic4.5.Age is an influencing factor for patients’ anxiety, and we hypothesise that it may be due to the decreased psychological flexibility of the elderly and the accumulated physical and mental burdens that aggravate their feelings of loneliness and helplessness. The inability to adapt to a new social role after retirement and a severe sense of loss may trigger other physical illnesses. Failure to understand the development and regression of the disease, resulting in negative psychological anxiety. Stimulating the organism to produce stress mechanisms, patients have strong stress reactions and anxiety due to unacceptability and difficulty in adapting.4.6.The acute stress response partially mediates the prediction of anxiety by disease uncertainty, with the acute stress response explaining 39.1% of the variance in anxiety and the mediating effect contributing 36.3% of the total effect. When patients have illness uncertainty, different levels of acute stress responses affect patients’ anxiety levels, acute stress responses positively predict patients’ anxiety symptoms, and it was found that the stronger the patients’ illness uncertainty, the more pronounced the acute stress responses, thus aggravating patients’ anxiety to some extent, which is basically consistent with the findings of Hammen  on the pThe main hypothesis of the present study was confirmed, There was a positive correlation between anxiety and illness uncertainty, a positive correlation between anxiety and acute stress response, a positive correlation between illness uncertainty and acute stress response, and a partial mediating role of anxiety in illness uncertainty and acute stress response. There is such a relationship as illness uncertainty → anxiety → acute stress response.The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.Ethical approval was not required for the study involving humans in accordance with the local legislation and institutional requirements. Written informed consent to participate in this study was not required from the participants or the participants’ legal guardians/next of kin in accordance with the national legislation and the institutional requirements.HT is responsible for literature review, data collection, data statistics, and writing.


Special attention was given to the benzene dynamics to establish patterns related to the health impact and leukemia. An assessment of the exposure was performed using EPA’s ExpoFIRST v. 2.0 for computing the inhalation Average Daily Dose (ADD) and Lifetime Average Daily Dose (LADD). The health impact was estimated based on several indicators such as lifetime cancer risk (LCR), Hazard Quotient (HQ), Disability-Adjusted Life Years (DALY), and Environmental burden of disease (EBD). Overall, the annual average of all stations was almost similar between years i.e., 3.46 in 2019, 3.41 in 2020, and 3.63 µg/m3 in 2021, respectively. The average of all stations during the lockdown period was 2.67 µg/m3, which was lower than the multiannual average of the 2019–2021 period, i.e., 3.5 µg/m3. Significant correlations were present between benzene and other pollutants such as NOx (r = 0.57), PM10 fraction (r = 0.70), and toluene (r = 0.69), and benzene and temperature (r = −0.46), humidity (r = 0.28), and wind speed (r = −0.34). Regarding the ADD, in all scenarios, the most affected age categories are small children, despite a lower outdoor exposure time. From birth to <70 years, the ADD varied depending on the exposure scenario resulting in 3.27 × 10−4, 5.6 × 10−4, and 4.04 × 104 mg/kg-day, and 3.95 × 10−4, 10.6 × 10−4, and 6.76 × 10−4 mg/kg-day for the LADD, respectively. The Integrated Lifetime Cancer Risk (ILTCR) values were 14.1 × 10−5 in winter, 9.04 × 10−5 in spring, 8.74 × 10−5 in summer, and 10.6 × 10−4 in autumn. The ILTCR annual averages were 1.08 × 10−4 (2019), 1.07 × 10−4 (2020), 1.04 × 10−4 (2021), and 1.06 × 10−4 for the entire period. The resulting ILTCR values point out very risky conditions, with the annual averages reaching the definite cancer risk category. The corresponding burden based on the DALY’s loss due to leukemia in Ploieşti was estimated at 0.291 (2 μg/m3 benzene), 0.509 (3.5 μg/m3 benzene), 0.582 (4 μg/m3 benzene), and 0.873 DALYs per 100,000 inhabitants (6 μg/m3 benzene), respectively. The current study provides useful insights for a better understanding of the exposure levels to benzene and associated health impact in Ploieşti despite the limitations determined by the data hiatus and incomplete or missing information regarding the health impact.This study examines the levels of benzene and the potential health impact during three years of continuous monitoring (2019–2021), including the COVID-lockdown period from 2020 in a city that is an important Romanian center for petroleum refining and associated product manufacturing. The dataset contains benzene, toluene, NOx, PM Air pollution occurs when harmful substances are emitted into the air altering the air’s physical, chemical, and biological properties. Air pollution is one of the most serious environmental issues in terms of human health and the surrounding environment and is associated with significant economic burdens on the global economy because of premature death, diseases, lost earnings, and increased health care expenditures, all of which constrain productivity and economic growth .6H6) is more carcinogenic to humans, frequently favoring the occurrence of myeloid leukemia due to the myelotoxicity of benzene ), and additional parameters related to location/activity and receptor characteristics . Benzene was defined in the contaminants section by entering the contaminant concentration and units, permeability coefficient (0.14 cm/h under standard conditions at 26 °C ), and moThe health impact was estimated based on several indicators such as lifetime cancer risk (LCR), Hazard Quotient (HQ), Disability-Adjusted Life Years (DALY), and environmental burden of disease (EBD). We used the equations presented by Begou and Kassomenos  for the Data inferences were performed using SPSS software  and MATLAB . p < 0.05). We used the IDW algorithm in ArcGIS Desktop 10.8.2 to obtain interpolation maps for benzene spatial distribution.Descriptive statistics provided the main features of the dataset regarding the health and exposure variables determined in various sampling sites of the city. The t-test was used to evaluate the differences in means between years and between pre- and post-lockdown and lockdown in 2020. Correlations between the variables were tested using the Pearson product-moment correlation , while the highest was reached in Brazi, at the PH-4 station that is located at 11 km in the south of Ploieşti (4.64 µg/m3). Interestingly, the other remaining stations had similar multiannual average values (3.4–3.6 µg/m3) suggesting similar conditions of dispersion due to local topography and meteorology (plain and wind regime).Regarding the spatial variation, the lowest multiannual average was in the east of the city 2.34 µg/m3 in 2021. Most of the stations experienced a diminishing of the maximum values from 2019 to 2021, except the stations located outside the city. The maximum hourly concentrations recorded between 2019 and 2021 were high, especially at Brazi station (PH-4), where the value was 190.29 µg/mThe time series of monthly averages for all six stations were aggregated to have a better image of the trends in the studied area. 3), while the highest was in January (~5 µg/m3). The t-test results showed no significant difference in means between the pairs of years, i.e., 2019–2020 , 2019–2021 , and 2020–2021 . Higher concentrations occurred in October and December 2019 and in January 2020, mainly because of longer periods of atmospheric calm that favored the stagnation of emissions. After January 2020, the time series from February to December 2020 was almost similar to the one from 2021.Cold months tend to reach higher concentrations, compared to warm ones. In 2020, there was a slight reduction between April and July compared to the other two years potentially related to the lockdown restrictions. Based on the aggregated monthly averages, the lowest concentration of benzene was in May (~3 µg/m3) recorded on 29 July 2021 (4:00 a.m.) at the PH-4 station with layers computed every 25 min (3 h). It was noted that the dispersion of pollutants had an elliptic form oriented toward the south that did not affect the city. This was confirmed by the data recorded from the remaining stations, which showed usual values from 4:00 a.m. to 12 a.m.  (6 µg/m3) .COVID-19 became a pandemic starting in March 2020, determining numerous restrictions on socio-economic activities, traveling, and commuting, and significant modifications in human behavior all over the world. In Romania, the lockdown period was considered between 13 March and 15 May 2020 based on the emitted official decisions .3, which was lower than the multiannual average of the 2019–2021 period (3.5 µg/m3) or compared to the average of individual years from 3.t-test showed significant results for the pre-lockdown–lockdown  and pre-lockdown–post-lockdown  pairs. The difference in means of lockdown and post-lockdown was not significant , but, interestingly, the average of the post-lockdown period in 2020 (2.55 µg/m3) was lower than the one recorded during lockdown.A comparison between the differences in means of the lockdown and pre-lockdown (from 1 January to 12 March) and post-lockdown (from 16 May to 31 December 2020) using a 10 fraction (r = 0.70), toluene (r = 0.69), benzene and temperature (r = –0.46), humidity (r = 0.28), and wind speed (r = –0.34). Negative correlations (p > 0.01) were found between benzene and temperature and wind speed, respectively.3, which was the multiannual average value of the analyzed period. Eleven age bins were assessed by using the default parameters from the tool for an exposure frequency of 100 days/year for a better reference. The second scenario took into account a concentration of 6 µg/m3, which was recorded in Brazi at PH-4 in 2021, also considering default exposure and 100 days frequency. The third scenario was defined for a 3 h daily exposure in outdoor conditions (180 min) for all age bins . The three hours of daily exposure was calculated as average daily current time spent outdoors (2 h × non-working day) + (3 ½ hours × working day)/7 for summer and winter and the mean of this was calculated to obtain a total daily current time spent outdoors [Using the ExpoFIRST tool, the ADD and LADD (mg/kg-day) were calculated for three scenarios that may potentially occur. The first one considers a concentration of 3.5 µg/moutdoors . More deoutdoors ,28. For The simulations pointed out that the most affected age categories could be as follows:−4 mg/kg-day), Birth to < 1 month (4.99 × 10−4), 3 years to < 6 years (3.87 × 10−4), and 21 years to < 70 years (3.58 × 10−4), respectively;In Scenario 1: 6 months to < 1 year (5.43 × 10−4 mg/kg-day), 3 years to < 6 years (6.63 × 10−4), 21 years to < 70 years (6.13 × 10−4) and 6 years to < 11 years (5.69 × 10−4), respectively;In Scenario 2: 6 months to < 1 year (9.31 × 10−4 mg/kg-day), 1 year to < 2 years (8.41 × 10−4), 2 years to < 3 years (7.73 × 10−4) and 1 month to < 3 months (7.11 × 10−4). In Scenario 3: Birth to < 1 month  occurs in scenario 2, then scenario 3 retrieves 6.76 × 10−4, and scenario 1 retrieves 3.95 × 10−4 mg/kg-day, respectively.Regarding the LADD, the highest value (10.6 × 103). The highest HQ for the exposed population was computed for PH-4 15.5 × 10−2 and the lowest was retrieved at PH-6 with a value of 7.8 × 10−2. Therefore, the residents’ health may not be affected by the potential non-carcinogenic effects of short-term exposure to ambient benzene.−6 and 7.8 × 10−6 as the increase in the lifetime risk when an individual is continuously exposed to 1 µg/m3 of benzene in the air over his lifetime. −5 in winter, 9.04 × 10−5 in spring, 8.74 × 10−5 in summer, and 10.6 × 10−4 in autumn. The ILTCR annual averages were 1.08 × 10−4 (2019), 1.07 × 10−4 (2020), 1.04 × 10−4 (2021), and 1.06 × 10−4 for the entire period. The U.S. EPA estimated a range between 2.2 × 10−4 “definite cancer risk”; from 1 × 10−5 to 1 × 10−4 “probable cancer risk”; from 1 × 10−5 to 1 × 10−6 “possible cancer risk; and <1 × 10−6 “acceptable”. The resulting ILTCR values point out very risky conditions with the annual averages reaching the definite cancer risk category. For interpreting the results, the U.S. EPA has classified the risk intervals for the ILTCR as follows: >1 × 10https://www.uicc.org/news/globocan-2020-new-global-cancer-data accessed on 27 July 2023). The 5-year prevalence is 27.37 per 100,000 inhabitants. We defined a scenario considering the number of 29 deaths from leukemia at a total population of 180,000 inhabitants, resulting in a DALY of 378.8 for a standard life expectancy of 72.8 years (EUROSTAT-https://ec.europa.eu/eurostat/statistics-explained/images/0/02/Table01_Life_expectancy_at_birth_2021.png accessed on 27 July 2023). Years lived with disability (YLD) was not included in the calculation of DALY by considering all cases of leukemia to be fatal, and consequently, the YLD equaled zero [In Romania, there is no exact situation regarding the incidence and mortality of hematological diseases and there are no official functional registers that could provide this information. The number of deaths in 2020 was 1277, most likely attributed to cases of acute leukemia , 0.509 (3.5 μg/m3 benzene), 0.582 (4 μg/m3 benzene), and 0.873 DALYs per 100,000 inhabitants (6 μg/m3 benzene), respectively. 3. Compared with the figures retrieved from the literature . The multiannual aggregated average of the period was 3.5 µg/mterature , there a–2021. ThAnother issue was the occurrence of high concentrations of benzene for short periods. At a normal air temperature gradient , gases and dust have an upward evolution and are subject to an accentuated dilution. In the case of thermal inversions, the layers of colder air, blocked below the warm air, prevent the formation of convection currents (ascents) and block the emitted pollutants, which disperse horizontally, in situations of atmospheric calm, slowly draining towards the points lower where they form large accumulations. These inversions, which often occur in the area, especially during cold months, favor the phenomenon of atmospheric pollution and excessive exposure of the population ,45,46,47The results showed negative correlations between benzene concentrations and temperature and wind speed, which explains a reduction of ambient concentrations when temperature and wind speed increase. Temperature has a marginally significant influence on the dispersion of benzene and other VOCs, which is stronger than the relative humidity effect . During The local newspapers often describe such pollution episodes signaled by the citizens from the impacted areas. According to the official data , 85% of −6  [Based on the computation performed in this work, we found increased the ADDs and LADDs, especially for the children category, and a concerning incremental probability of an individual developing cancer over a lifetime exposure to the potential carcinogen being much higher than the U.S. EPA standard of 1 × 10ifetime) .In 2018, which is the latest public report, the mortality in Ploieşti from malign tumors was 142 per 100,000 inhabitants and 28 from respiratory malign tumors (15–64 years age bin), and 359 per 100,000 inhabitants and 78 (>65 years), respectively . https://www.aril.ro accessed on 27 July 2023) is helping the patients and this help could be supported by proper legislative actions. A recent law (No. 293/2022) was enforced in Romania for the prevention and fight against cancer [The Romanian Association against Leukemia . Extrapolating the data to the country’s population, we can estimate a number of approximately 800–1000 new cases per year, corresponding to an incidence of 4.44–5.55 per 100,000 inhabitants/year [Statistics from other countries report an average incidence of chronic lymphocytic leukemia (CLL) of 4.2 per 100,000 inhabitants/year (nts/year .Currently, in Romania there is no public information related to the specific mortality rate for patients, the rate of treated patients, the types of treatment, and their progression-free survival, data that are necessary to assess the management of patients in Romania. This extremely useful data could be obtained from a dedicated national disease registry. Recent studies underlined the key role of benzene in determining harmful effects on residents of refinery areas related to hematological and hypersensitivity fields, pathological spheres only seemingly disconnected from each other , and theThe current study provides useful insights for a better understanding of the exposure levels to benzene and the associated health impact in Ploieşti, despite the limitations determined by the data hiatus and incomplete or missing information regarding the health impact. Future work will consider an assessment of the multipollutant effects on health by including other VOCs in the analysis .-Initiation of a public register with data regarding the cases with diagnostics related to air pollution;-Application of the best measures and technologies to reduce air pollution and protect the health of the population in areas with increased industrial pollution;-Informing the population about air quality and individual protection measures;-Reducing the level of pollution generated by road traffic and encouraging green technologies.The present study pointed out that the Ploieşti area was affected by elevated concentrations of benzene that impacted the health of the residents. Overall, the computations showed an increased risk of developing cancers and a relevant environmental burden of disease. Consequently, the air quality plan should be improved by following several guidelines:


Mycobacterium tuberculosis infection is transmitted among humans via airborne droplets. The drugs used in the initial treatment regimen for tuberculosis (TB) cross the placenta, raising some concerns regarding their safety during pregnancy may provide a more valid approach for evaluating the relative influence of various risk factors. Adverse events of anti-tuberculous (anti-TB) drug during pregnancy remain uncertain and controversial issues.We performed a systematic analysis to study the adverse events connected with anti-TB drugs usage during pregnancy. The risk of bias in the included studies was assessed using the Cochrane Collaboration criteria. Interstudy heterogeneity was assessed via Cochran's test. Assuming heterogeneity, a random-effects model was applied. Outcomes were pooled using the inverse variance method. Besides, a funnel plot was created to assess publication bias. We used Egger's linear regression test of funnel plot asymmetry, modified to accommodate inter-study heterogeneity. Effect estimates and confidence intervals for all studies were depicted on a forest plot.The prevalence of total adverse events for all anti-TB drugs was 25.9 %. According to the drug category, the prevalence of total adverse events was 50 % for ethambutol, 32.6 % for the six-month directly observed treatment short-course (DOTS), 31.4 % for the nine-month DOTS, and 13.7 % for isoniazid.There is a high rate of reported adverse events associated with anti-TB drugs usage during pregnancy. We concluded that more high-quality clinical studies and research works are needed to reach a conclusive decision on the safety of the treatment of TB among pregnant women. About 1.7 million TB-infected patients died in 2004 . The higTuberculosis is primarily transmitted through the inhalation of airborne droplets containing Mycobacterium tuberculosis . The risThe drugs used in the initial treatment regimen for TB cross the placenta, raising some concerns regarding their safety during pregnancy .Despite There are inadequate documents concerning the safety, applicability, and outcomes of medical treatments in pregnant women with TB .In fact,22.1Human studies reporting the use of anti-TB drugs in pregnant women were sought in the PubMed, Scopus, Embase, and Cochrane databases. The search strategy included the terms “pregnancy or pregnant” and “tuberculosis or TB” or “isoniazid, rifampin, ethambutol, or pyrazinamide", looked up in the subject, abstract, and keywords. Studies published from the inception of the databases to December 30, 2022, were included in the current study. The literature search was limited to articles in English. The titles and abstracts of all retrieved papers were screened regarding their relevance to the topic, with the full text of relevant manuscripts being subsequently assessed for eligibility. Articles that were not available online in the form of full text were requested from the corresponding author via email.2.2Human studies reporting the use of anti-TB drugs by pregnant women with or without comorbidities  were included. Animal studies, reviews, letters, commentaries, case studies, and clinical cohorts without appropriate controls were excluded. In the case of duplicated reports, the ones with more presented data were used in the data extraction.2.3The screening of full-text papers for data extraction was carried out independently by two reviewers based on a predefined protocol including bibliographic information, location and design of the study, mean age of the enrolled participants, the number of enrolled participants in each group, the intervention, and the comparison.2.4Two reviewers independently assessed the risk of bias among the included studies. We assessed the risk of bias of the included studies using Cochrane Collaboration criteria. Detection bias, performance bias, attrition bias, selection bias , and reporting bias were assessed along with other forms of bias.2.5Inter-study heterogeneity was assessed using Cochran's test with a significance level of less than 0.1. Assuming heterogeneity, a random-effects model was applied. Outcomes were pooled using the inverse variance method. Besides, a funnel plot was created to assess publication bias. We also made use of Egger's linear regression test of funnel plot asymmetry, modified to accommodate inter-study heterogeneity. Effect estimates and confidence intervals (0.95 CI) for all studies were depicted on a forest plot. All analyses were performed using version 2.0 of the Comprehensive Meta-Analysis (CMA) software .33.1We identified a total of 95 records after searching the databases. After the removal of 40 duplicates, the title and abstracts of 55 records were screened. Subsequently, 32 papers were excluded and 23 were prepared for full-text screening. A total of 13 records were excluded based on eligibility criteria in this stage. Finally, 10 studies were included in our current analysis .Fig. 1PR3.2According to the geographical area, three studies were conducted in the USA, three in South Africa, one in Hungary, one in Mexico, one in India, and one was multinational . The basic characteristics included in the studies are summarized in 3.3The risk of bias among the included studies based on Cochrane Collaboration is summarized in 3.43.4.12 = 94.6 %, P < 0.001). According to the drug category, the prevalence of total adverse events was 50 % for ethambutol, 32.6 % for the six-month directly observed treatment short-course (DOTS), 31.4 % for the nine-month DOTS, and 13.7 % for isoniazid . According to the drug category, the prevalence of neonatal death was 3.8 % for isoniazid, 12.9 % for isoniazid plus rifapentine, and 8.2 % for bedaquiline .According to the drug category, the prevalence of abortion was 4.1 % for isoniazid, 22.6 % for isoniazid plus rifapentine, 2.0 % for bedaquiline, 2.2 % for the six-month DOTS, and 3.5 % for the nine-month DOTS . According to the drug category, the prevalence of congenital anomalies was 1.6 % forisoniazid and 3.2 % for isoniazid plus rifapentine . According to the drug category, the prevalence of hepatitis was 0.8 % for isoniazid, 1.6 % for isoniazid plus rifapentine, 2.2 % for the six-month DOTS, and 1.2 % for the nine-month DOTS . In terms of the drug category, bedaquiline was responsible for most cases of LBW (40.8 %), after which cameisoniazid (7.8 %)  .Fig. 7Th3.4.72 = 90.4 %, P < 0.001). According to the drug category, the prevalence of stillbirth was 1.8 % for isoniazid and 6.1 % for bedaquiline . Categorically, bedaquiline was responsible for the highest rate of preterm delivery (26.5 %), followed by isoniazid/rifapentine (22.6 %), isoniazid (17.9 %), six-month DOTS (3.4 %), and nine-month DOTS (2.3 %)  .Fig. 9Th3.4.92 = 98.2 %, P < 0.001)  .Fig. 10T3.4.10P = 0.005, I2 = 17.6 %, P = 0.303)  .Fig. 11T3.4.11Publication bias was not observed among the included studies according to the results of both the Egger test (P = 0.173) and Begg's test (P = 0.721).4Mycobacterium tuberculosis [Active TB is the prime cause of maternal mortality throughout the world . Pregnanrculosis ,24.During pregnancy, TB is almost mild and subclinical with no or non-specific symptoms; after delivery, new and more severe clinical manifestations present, which is called immune reconstitution syndrome (IRS) ,26.Due to the mild symptoms of TB during pregnancy and its similarity to pregnancy symptoms like fatigue and shortness of breath, the diagnosis of the disease is challenging and is mostly confirmed after delivery . On the Both the mother and child benefit from early diagnosis and suitable treatment of TB, especially before delivery . Before First-line TB drugs including isoniazid, rifampicin, pyrazinamide, and ethambutol are considered safe during pregnancy and are recommended by the World Health Organization (WHO) ,38.In coA previous report by Hamada et al. evaluated the safety of isoniazid preventive treatment in pregnant and postpartum women through a meta-analysis. In a total of nine studies, they found pregnant women receiving isoniazid to be at an elevated risk of hepatotoxicity. However, the results were reported to be inconsistent and heterogeneous. Our meta-analysis showed that the rate of total adverse events was 29 % lower in the isoniazid group than in the control group receiving other types of treatment.The key strengths of our systematic review and meta-analysis were the application of a systematic search with well-defined eligibility criteria, systematic data extraction, and thorough analysis. This study was the first meta-analysis accumulating the available evidence on the safety of all anti-TB drugs for pregnant women. One previous meta-analysis evaluated the safety of only isoniazid in the treatment of these patients. Besides the mentioned strengths, this meta-analysis suffered multiple limitations. The most important limitation of the study was the lack of enough high-quality studies comparing each anti-TB drug against a placebo or the lack of intervention. Another limitation was that a high number of studies were conducted on pregnant women infected by HIV and receiving other medications that may complicate the incidence of adverse events, meaning that conclusions should be drawn with caution.In this study, given the inadequate evidence regarding the safety of medical treatment in pregnant women with TB, we performed a systematic review and meta-analysis of the adverse events associated with anti-TB drug usage during pregnancy. The prevalence of total adverse events for all anti-TB drugs was 25.9 %. According to the drug category, the prevalence of total adverse events was 50 % for ethambutol, 32.6 % for the six-month DOTS, 31.4 % for the nine-month DOTS, and13.7 % for isoniazid. However, despite the high rate of reported adverse events observed, untreated TB may cause a greater hazard to a pregnant woman and her fetus than its medications. Hence, more high-quality clinical studies are needed to reach a conclusive decision on the safety of treatment of TB during pregnancy.No data was used for the research described in the article.No ethical clearance was needed for this publication because all information and data were published previously and were anonymized.Diqing Wu: Writing – review & editing, Writing – original draft, Methodology, Formal analysis, Data curation, Conceptualization. Xiaobei Li: Writing – review & editing, Writing – original draft, Methodology, Formal analysis, Nitesh Kumar Poddar, Writing – review & editing, Writing – original draft, Data curation. Hui Wan: Writing – review & editing, Writing – original draft, Methodology, Formal analysis. Ashwag Shami: Writing – review & editing, Writing – original draft, Data curation. Hassan H. Alhassan: Writing – review & editing, Writing – original draft, Data curation. Maher M. Al-Enazi: Writing – review & editing, Writing – original draft, Data curation. Abdulqadir J. Nashwan: Writing – review & editing, Writing – original draft. Shahanavaj Khan: Writing – review & editing, Writing – original draft, Supervision.The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.


Accurately measuring glomerular filtration rate (GFR) is important to ensure the timely detection of alterations in GFR and to adapt pharmacotherapy and fluid therapy accordingly. In nonstable situations, GFR assessment by the most widely used marker, serum creatinine (SCr) is hampered by its long half-life because of a large volume of distribution  and systemic errors from muscle mass. In addition, in neonates, SCr-based GFR assessment is complicated by the influence of maternal creatinine because creatinine crosses the placenta.However, in neonates, the value of cysC as a marker for GFR has never been investigated with gold standard measured GFR (mGFR). In a large cohort of children with chronic kidney disease, age-dependent and sex-dependent clinical cysC equations to estimate GFR were developed, indicating nonsignificant bias and high accuracy of these equations when compared to iohexol-based mGFR.n = 42) and 6.0 (range 0.1–17.2) years for children (n = 57). Median cysC levels were 1.2 (IQR 1.1–1.4) mg/l for neonates, and 0.8 (IQR 0.6–1.2) mg/l for children. Neonates had a median mGFR of 29.2 (IQR 22.3–35.5) ml/min per 1.73 m2, and children had a mediam mGFR of 82.2 (IQR 43.3–115.5) ml/min per 1.73 m2. According to the Kidney Disease Improving Global Outcomes criteria, 26 patients were diagnosed with acute kidney injury . In neonates, the relationship between cysC and mGFR was statistically significant, but poor , whereas in children, this relationship was stronger (r = −0.77 (95% CI −0.86 to −0.62), P < 0.001)  days for neonates (< 0.001) a.Figure 2) and unacceptably poor accuracy (2). Of all cysC-based eGFR equations, eGFR Schwartz and Pierce yielded the highest accuracy and agreement with mGFR. Visualization of the relationship between bias and age in neonates indicates that bias is age-dependent and highest in neonates below the age of 5 days .n = 20), cysC was correlated with inulin-based mGFR, .n = 135), cysC-based eGFR was not superior to SCr-based eGFR in diagnosing acute kidney injury.r = 0.390, P = 0.054).Only one other study investigated the correlation between cysC levels and mGFR in neonates, albeit in preterms. In neonates (gestational ages 28–34 weeks, postnatal ages 4–7 days; In conclusion, to the best of our knowledge, we are the first to report cysC levels in combination with mGFR in critically ill term-born neonates and children. We demonstrate that neonates significantly differ from children with regard to their cysC and iohexol-based mGFR correlation. Our results showed a poor correlation in neonates, whereas in children this was moderate. We believe that none of the currently available cysC-based equation should be recommended in the context of critically ill pediatric patients. Furthermore, future cysC studies should not consider the pediatric population as a whole, but rather need to address the influence of age on this GFR marker. In addition, improvement and harmonization of assay-specific equations is needed. Together, this may ensure the timely detection of GFR alterations and thereby enable GFR-adapted drug dosing in this vulnerable population.All the authors declared no competing interests.