Notes

Request along with Effectiveness regarding Transnasal Humidified Rapid-Insufflation Ventilatory Swap inside Laryngeal Microsurgery.
ted a therapeutic effect in TNBS-induced colitis, and local, rectal administration of Aloe vera extract was more effective than oral administration.
Melasma is an acquired disorder of facial pigmentation. Its etiology is multifactorial; thus, the management is usually challenging. As a complementary therapy, herbal drugs are often used in the management of melasma. This work was aimed to investigate the efficacy and safety of herbal drugs on melasma in female patients.

This study followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive search was conducted, and all randomised controlled trials (RCTs) on the use of oral herbal drugs as complementary therapy for melasma in female patients were included. A meta-analysis was conducted according to the guidelines of the Cochrane Collaboration using Review Manager 5.4.

Ten eligible trials, with 1015 female melasma patients, were included. All of the included RCTs had some concerns for risk of bias for different reasons, especially for that most of included trials were unblinded. Pooled data suggested phytotherapy plus routine therapy had significantly better efficacy on melasma than routine therapy, in terms of response rate (OR 4.49, 95% CI 3.25 to 6.20,
< 0.00001), reduction of skin lesion score (SMD -0.56, 95% CI -0.79 to -0.33,
< 0.00001), and improvement of serum E2 levels (SMD -1.58, 95% CI -2.62 to -0.55,
0.003). In addition, there was no significant difference in the incidence of AEs between phytotherapy plus routine therapy and routine therapy (OR 0.92, 95% CI 0.53 to 1.58; p 0.76). Overall, herbal drugs used as an adjunct to routine therapy significantly enhanced the efficacy for the treatment of melasma but with a comparable safety profile.

These findings have implications for recommending herbal drugs as a viable complementary treatment option for melasma.
These findings have implications for recommending herbal drugs as a viable complementary treatment option for melasma.
The management of mild cognitive impairment (MCI) is becoming increasingly important. The Korean Medicine Senior Health Promotion Program (KSHPP) was developed in 2016, and it has been in use to date. This study aimed to assess the effectiveness of KSHPP using herbal medicine and acupuncture for treating MCI and the safety of herbal medicine using liver and renal function tests.

We retrospectively reviewed the medical records of the participants with MCI. We assessed the Korean version of the Montreal Cognitive Assessment (MoCA-K), the Mini-Mental State Examination-Dementia Screening (MMSE-DS), and the Geriatric Depression Scale Short Form-Korea version (GDSSF-K) scores before and after KSHPP to determine its effectiveness. To evaluate its safety, the liver and renal function tests were conducted before and after herbal treatment.

We enrolled 1002 participants, and 500 participants satisfied the inclusion criteria. Of 500 patients, 364 (72.8%) were depressed and 136 (27.2%) were not. The mean MoCA-K scohe effectiveness and safety of KSHPP.
Our findings suggest that Korean medicine interventions can improve cognitive function and depression symptoms in patients with MCI. In addition, the results of the liver and renal function tests were analyzed as surrogate outcomes to assess the safety of herbal medicine. Based on these results, we expect that Korean medicine interventions can promote the cognitive and mental health of seniors. However, as there were several study limitations, particularly study design, practice effect, and short follow-up, these results must be interpreted with caution. We need a further long-term study with a rigorous design to retain confidence in the effectiveness and safety of KSHPP.
To study the effects of five
manipulations in rats with deep vein thrombosis (DVT) and to explore how to safely perform
in the treatment of thrombotic diseases.

Seventy-two male Sprague-Dawley (SD) rats were randomly divided into the model, pointing manipulation, plucking manipulation, kneading manipulation, pushing manipulation, and pulling manipulation groups (
 = 12). DVT model was established by incomplete ligation. The
intervention was started on the next day after modeling and applied once a day 10 times by the manipulation simulators. On the 3
and 10
days after intervention, respectively, the effects of
on thrombosis were evaluated based on thrombus elasticity, blood coagulation, fibrinolytic function and blood rheology with the ultrasound elastography, four coagulation tests, enzyme linked immunosorbent assay (ELISA), and hemorheology tests.

In the pointing manipulation group, the strain rate ratio, 6-ketoprostaglandin F1
(6-Keto-PGF1
), and high shear rate were decreased, an elevated as the treatment course of intervention increases. The plucking and kneading manipulations potentially have certain risks in the treatment of DVT in rats.
The pointing, pushing, and pulling manipulations seem to be safe in the early period of thrombosis, but the risk is likely to be elevated as the treatment course of intervention increases. The plucking and kneading manipulations potentially have certain risks in the treatment of DVT in rats.The present study aimed to explore the effects of shikonin (SKN) on the damage of human venous endothelial cells (HUVECs) induced by ox-LDL and the underlying molecular mechanism. The HUVECs were randomly divided into six groups control, ox-LDL, SKN + ox-LDL, SKN + ox-LDL + compound C, SKN + ox-LDL + si-Nrf2, and SKN + ox-LDL + si-HO-1. The MTT method was used to detect cell viability, flow cytometry was used to detect cell apoptosis and reactive oxygen species (ROS) levels, and Western blot was used to detect protein levels. Compared to the control group, the cell viability of the ox-LDL group decreased, the apoptosis rate increased, the level of cleaved caspase-3 was upregulated, and the level of Bcl-2 protein was downregulated. The level of TNF-α, IL-1β, IL-6, vascular cell adhesion molecule-1 (VCAM1), intercellular adhesion molecule-1 (ICAM1), and E-selectin (E-sel) was increased, ROS levels increased, and superoxide dismutase (SOD) level decreased. Moreover, the protein levels of p-AMPK, Nrf2, and HO-1 were decreased. Compared to the ox-LDL group, SKN treatment improves cell viability, alleviates cell apoptosis and oxidative stress injury, and upregulates the protein levels of p-AMPK, Nrf2, and HO-1. Compound C, si-Nrf2, and si-HO-1 administration inhibits the AMPK/Nrf2/HO-1 signaling pathway, increases ROS generation, and inhibits the antagonistic effect of SKN on ox-LDL-induced HUVECs damage. In summary, SKN suppressed ox-LDL-induced ROS production and improved cell viability and cell apoptosis via the AMPK/Nrf2/HO-1 pathway.This study aimed to analyze and summarize the existing evidence regarding herbal medicine treatments for amyotrophic lateral sclerosis (ALS). Studies on herbal medicine treatment in patients with ALS were searched within English, Chinese, Japanese, and Korean databases up to July 31, 2021. In the selected studies, we collected the following information the first author, year of publication, country, language, study methodology, sample size, demographic characteristics of the study participants, disease duration, diagnostic criteria, treatment method, treatment periods, evaluation tools, results, and side effects. The organized data were classified and analyzed narratively. This study included 59 studies. The first clinical study on the effect of herbal medicine was published in 1995; moreover, most studies were conducted in China. Among the 59 selected studies, 47.5% were observational studies, including case reports and case series. Moreover, there was one meta-analysis. The El Escorial criteria were the most commonly used diagnostic criterion for ALS; moreover, the ALS functional rating scale was the most common evaluation tool. Buzhongyiqitang, Sijunzitangjiawei, and Jianpiyifeitang were the most commonly used herbal medicines, with anti-inflammatory, protein aggregation, and anti-oxidant effects. There remain evidence of gaps in the effectiveness of herbal medicine for ALS. To allow effective treatment of patients with ALS using herbal medicine, large-scale and rigorously designed high-quality clinical studies should be performed.This study aimed to evaluate the effects of the treatment with bacuri seed butter (BB) on body weight, growth, body mass index, lipid profile, atherosclerotic indices, and liver function in dyslipidemic hamsters. Freshly weaned, male hamsters were divided into four groups (1) normal group (NG)-maintained with standard chow (AIN-93G); (2) dyslipidemia group (DG)-maintained with hyperlipidemic chow (AIN-93G modified) throughout the follow-up period; (3) bacuri seed butter 25 mg/kg/day (BB-25); and (4) bacuri seed butter 50 mg/kg/day (BB-50). BB groups (25 and 50 mg/kg/day) were also maintained with hyperlipidemic chow throughout the follow-up period, and the treatment started after 21 days receiving a hyperlipidemic diet to induce hypercholesterolemia and maintained for 28 days. No significant differences in triglycerides and total cholesterol were observed for BB-25 and BB-50 groups when compared with NG and DG groups. On the contrary, BB-25 and BB-50 induced both increase of HDL-c (51.40 ± 1.69 and 51.00 ± 2.34, respectively) and decrease of LDL-c (103.80 ± 6.87 and 100.50 ± 3.95, respectively) when compared with DG (41.00 ± 2.94 and 132.70 ± 9.41, respectively). In addition, BB promoted a reduction in the risk of atherosclerotic disease by decreasing (p less then 0.05) the atherogenic index, coronary artery risk index, and LDL/CT ratio (p less then 0.05) and increasing HDL/CT ratio. On the contrary, no changes were observed in total cholesterol and triglyceride levels or in body weight, growth, body mass index, or liver function parameters. Thus, bacuri seed butter at doses of 25 and 50 mg/kg/day has positive repercussions on the lipid profile, more precisely on plasma HDL-c and LDL-c, and additionally promotes reduction in the risk of atherosclerosis in hamsters.
This study aims to systematically evaluate the clinical efficacy of Tongxinluo capsule in the treatment of transient ischemic attack (TIA) and its effect on hemorheology, thereby providing scientific basis for clinical decision making.

A comprehensive and systematic literature retrieval was conducted in the CNKI, Wanfang database, SinoMed, EMbase, and PubMed to screen the randomized controlled trials (RCTs) of Tongxinluo capsule in the treatment of TIA. The retrieval time was from the inception of each database to September 10, 2020. Endnote X9 was used to screen the literature. Cochrane Collaboration tool for assessing risk of bias was used to evaluate the quality of the included studies. Stata16.0 statistical software was used for meta-analysis.

A total of 12 RCTs were included, involving 946 subjects. (1) The clinical efficacy of the Tongxinluo group was better than that of the control group (RR = 1.19, 95% CI (1.09, 1.30),
 
 0.001). (2) The hemorheological characteristics of the Tongxinluo groupnd is relatively safe. Due to the deficiencies of the existing studies, more high-quality studies with rigorous design are required for further verification.Opisthorchis viverrini infection is the major parasitic infection problem in Southeast Asian countries, and long-term infection will lead to cholangiocarcinoma (CCA), the bile duct cancer. The early diagnosis of O. viverrini infection may interrupt the progression of the opisthorchiasis and other related illnesses, especially CCA. The current diagnostic procedure is stool examination by microscope-based methods such as direct smear and concentration techniques but it is limited by low parasite egg numbers. The molecular diagnosis prompts the chance to evaluate the light infection with low number of parasite eggs but is currently inconvenient for routine use due to special equipment requirement and unstable sensitivities. Our present study aims to establish the efficiency of OvNad subunits, the mitochondrial gene, for introducing as a potential diagnostic target by conventional PCR, the cheapest and easiest molecular procedure. A total of 166 stool samples were investigated microscopically by the PBS-ethyl aced NPV even in the light infection that would be a benefit for developing as a routine diagnosis of O. viverrini infection.Animal models play an important role in preclinical studies, especially in tissue engineering scaffolds for cartilage repair, which require large animal models to verify the safety and effectiveness for clinical use. The small ruminant models are most widely used in this field than other large animals because they are cost-effective, easy to raise, not to mention the fact that the aforementioned animal presents similar anatomical features to that of humans. This review discusses the experimental study of tissue engineering scaffolds for knee articular cartilage regeneration in small ruminant models. Firstly, the selection of these scaffold materials and the preparation process in vitro that have been already used in vivo are briefly reviewed. Moreover, the major factors influencing the rational design and the implementation as well as advantages and limitations of small ruminants are also demonstrated. As regards methodology, this paper applies principles and methods followed by most researchers in the process of experimental design and operation of this kind. By summarizing and comparing different therapeutic concepts, this paper offers suggestions aiming to increase the effectiveness of preclinical research using small ruminant models and improve the process of developing corresponding therapies.Mechanical stress promotes human ligamentum flavum cells (LFCs) to synthesize multitype collagens, leading to ligamentum flavum hypertrophy (LFH). However, the mechanism of mechanical stress in the formation of collagen remains unclear. Therefore, we investigated the relationship between mechanical stress and collagen synthesis in the present study. First, LFCs were isolated from 9 patients and cultured with or without mechanical stress exposure for different times. IGF-1, collagen I (col-I), and collagen III (col-III) protein and mRNA levels were then detected via ELISA and qPCR, respectively. Moreover, the activation of pIGF-1R, pAKT, and pS6 was examined by Western blot analysis. To further explore the underlying mechanism, an IGF-1 neutralizing antibody, NVP-AEW541, and rapamycin were used. IGF-1, col-I, and col-III were significantly increased in stressed LFCs compared to nonstressed LFCs. In addition, the activation of pIGF-1R, pAKT, and pS6 was obviously enhanced in stressed LFCs. Interestingly, col-I protein, col-I mRNA, col-III protein, col-III mRNA, and IGF-1 protein, but not IGF-1 mRNA, were inhibited by IGF-1 neutralizing antibody. In addition, col-I and col-III protein and mRNA, but not IGF-1, were inhibited by both NVP-AEW541 and rapamycin. Moreover, the activation of pIGF-1R, pAKT, and pS6 was reduced by the IGF-1 neutralizing antibody and NVP-AEW541, and the activation of pS6 was reduced by rapamycin. In summary, these results suggested that mechanical stress promotes LFCs to produce IGF-1, which facilitates col-I and col-III synthesis via the IGF-1R/AKT/mTORC1 signaling pathway.
The aim of this research was to uncover the biological role and mechanisms of LINC01303 in oral squamous cell carcinoma (OSCC).

Real-time quantitative PCR (qRT-PCR) was used to determine LINC01303 expression in OSCC tissues. Subcellular distribution of LINC01303 was examined by nuclear/cytoplasmic RNA fractionation and FISH experiments. The role of LINC01303 in the growth of TSCCA and SCC-25 was examined by CCK-8 assay, colony formation, transwell invasion assay in vitro, and xenograft tumor experiment in vivo. Dual-luciferase reporter assay was used to verify the interaction between LINC01303 and miR-429. RNA pull-down assay was used to discover miR-429-interacted protein, which was further examined by qRT-PCR, western blot, and rescue experiments.

LINC01303 expression was higher in OSCC tissues compared with adjacent nontumor tissues. LINC01303 was found to be localized in the cytoplasm of OSCC cells. Knockdown of LINC01303 inhibited OSCC cell proliferation and invasion, whereas increasing the expression of LINC01303 showed the opposite effects. Furthermore, LINC01303 served as a miR-429 "sponge" and positively regulated ZEB1 expression. Moreover, LINC01303 promoted OSCC through miR-429/ZEB1 axis both in vivo and in vitro.

LINC01303 plays an oncogenic role in OSCC and is a promising biomarker for OSCC patients.
LINC01303 plays an oncogenic role in OSCC and is a promising biomarker for OSCC patients.Sufentanil is a μ-opioid receptor agonist, widely used in intraoperative and postoperative analgesia of esophageal cancer. This study investigated the effects of sufentanil on the proliferation, invasion, and metastasis of esophageal carcinoma cells and its molecular mechanisms. Human esophageal carcinoma cells CaES-17 and Eca-109 were cultured in vitro. Different concentrations of sufentanil (1 and 10 μmol/L) were added to the experimental group. MTT was used to detect the proliferative activity of esophageal carcinoma cells. The migration ability of esophageal carcinoma cells was measured by the scratch test. Transwell was used to detect the invasive ability of esophageal carcinoma cells. The EMT marker expression was detected by qPCR. Meanwhile, effects of sufentanil on NF-κB and Snail expression and nucleation were evaluated. Establish a subcutaneous xenograft tumor model of nude mice with esophageal carcinoma cells and evaluate the antitumor effect of sufentanil. Sufentanil can inhibit the proliferation, invasion, and migration of CaES-17 and Eca-109 cells and has a dose-dependent relationship. The molecular mechanism showed that sufentanil could upregulate the expression of E-cadherin and inhibit the expression of vimentin. Sufentanil can inhibit the expression of NF-κB and Snail, as well as the nuclear expression of NF-κB and Snail. Xenograft tumor model results showed that sufentanil could inhibit tumor proliferation and NF-κB and Snail expression in tumor tissues of nude mice. Sufentanil inhibits esophageal cancer epithelial-mesenchymal transition (EMT) by acting on NF-κB and Snail signaling pathways to inhibit proliferation and metastasis of esophageal cancer.Ovarian cancer (OC) is a common malignant tumor of the female reproductive system and has a high morbidity and mortality rate. The progression and metastasis of OC are complex and involve multiple signaling pathways. The Wnt/β-catenin signaling pathway is closely related to OC, and therefore blocking the activation of the Wnt/β-catenin signaling directly or inhibiting related genes, and molecular targets is of great value in treating OC. Toxicities such as myelotoxicity, cardiotoxicity, genotoxicity, and vasospasm are the major side effects for common anticancer drugs and are well documented. There is, therefore, a need to develop new, effective, safer, and more affordable anticancer drugs from alternative sources. In recent years, plant-derived Chinese medicine monomers have drawn increasing attention due to their high safety, low toxicity, minimal side effects, and antitumor effects. Plant-derived Chinese medicine monomers are effective against multiple targets and can regulate the growth, proliferation, apoptosis, invasion, and migration of OC as well as reverse drug resistance by regulating the Wnt/β-catenin signaling pathway. In this review, we summarize and provide mechanisms and prospects for the use of plant-derived Chinese medicines for the prevention and treatment of OC.The mechanism underlying the poor prognosis of gastric cancer, including its high degree of malignancy, invasion, and metastasis, is extremely complicated. Rho GTPases are involved in the occurrence and development of a variety of malignant tumors. ARHGAP11A, in the Rho GTPase activating protein family, is highly expressed in gastric cancer, but its function and mechanism have not yet been explored. In this study, the effect of ARHGAP11A on the occurrence and development of gastric cancer and the mechanism related to this effect were studied. The expression of ARHGAP11A was increased in gastric cancer cells and tissues, and high ARHGAP11A expression in tissues was related to the degree of tumor differentiation and poor prognosis. Moreover, ARHGAP11A knockout significantly inhibited cell proliferation, cell migration, and invasion in vitro and significantly inhibited the tumorigenic ability of gastric cancer cells in nude mice in vivo. Further studies revealed that ARHGAP11A promotes the malignant progression of gastric cancer cells by interacting with TPM1 to affect cell migration and invasion and the stability of actin filaments. These results suggest that ARHGAP11A plays an important role in gastric cancer and may become a useful prognostic biomarker and therapeutic target for gastric cancer patients.It is important to prevent the increase in the prevalence of diabetes mellitus (DM) worldwide by efficiently managing its controllable risk factors. This study aimed to identify factors associated with the 4-year estimated incidence of type 2 DM (T2DM) by sex and provide basic data for a sex-specific strategic approach to lifestyle modification. We performed a secondary data analysis using raw data from the seventh Korea National Health and Nutrition Examination Survey (KNHANES, 2016-2018). The KNHANES is a descriptive correlational survey designed to examine sex differences in the factors associated with the 4-year estimated incidence of T2DM. This study included 9,614 Korean adults (4,134 men and 5,480 women) aged 40-69 years without a diagnosis of T2DM. For the statistical analysis, a complex sample analysis was performed for sex comparison using the χ 2-test or one-way analysis of variance; a multiple regression analysis was performed to analyze the sex-specific influencing variables of 4-year estimated T2DM incidence. The waist-to-height ratio, an indicator of central obesity in adults, showed the strongest association with the 4-year estimated incidence of T2DM in both groups (male β = 0.33, p ≤ 0.001; female β = 0.38, p ≤ 0.001). The influencing variables were the monthly drinking rate (β = 0.07, p ≤ 0.001) and sleep time (β = -0.03, p less then 0.05) in men and the sedentary time in women (β = 0.03, p less then 0.05). The overall explanatory power of these variables was 11.3% for men and 14.3% for women. Thus, significant sex differences were found in the 4-year estimated incidence of T2DM. Therefore, intervention programs need to be sex-specific to enhance the efficacy of the interventions in reducing the incidence of T2DM, and such intervention programs should be administered with a strategic approach differentiated by sex.
To compare the efficacy of low-carbohydrate diets (LCDs) with low-fat diets (LFDs) in body weight and glycemic control for type 2 diabetes mellitus (T2DM) patients, and their cardiovascular and renal safety.

We searched PubMed, Ovid, Embase databases, Cochrane Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov from inception to April, 2021. Randomized controlled trials (RCTs) which lasted more than 3 months were included. The primary outcomes are the mean change from baseline in glycated haemoglobin (HbA1c) and body weight loss. Secondary outcomes included mean difference in lipid parameters, blood pressures, and serum creatinine.

Totally, 12 RCTs met inclusion criteria representing 761 patients. Compared with LFDs, treatment with LCDs achieved significant reduced HbA1c by 0.35% (95% CI -0.45, -0.24;
 < 0.00001). LCDs appeared to be more beneficial in decreasing body weight than LFDs (WMD = -2.99 kg; 95% CI -4.36, -1.63;
 < 0.0001), especially in the subgroup that used VLCeen diet interventions and renal safety. Future larger longer-term follow-up clinical trials are needed to provide more evidence about the sustainable effects and safety of LCDs compared with LFDs.
LCDs are superior to LFDs for T2DM patients in improving HbA1c and reducing body weight, with a rewarding effect of some cardiovascular risk factors in a longer-term diabetes management. However, available data are insufficient to evaluate the association between diet interventions and renal safety. Future larger longer-term follow-up clinical trials are needed to provide more evidence about the sustainable effects and safety of LCDs compared with LFDs.
Polycystic ovary syndrome (PCOS) is the most common endocrine metabolic disorder affecting premenopausal women. Besides primary features like anovulation, hyperandrogenism, and polycystic ovaries, women with PCOS present with multiple metabolic, cardiovascular, and psychological disorders. The etiology is multifactorial and the different genetic variants are suggested to play an important role in pathogenesis. Insulin resistance is a ubiquitous finding in PCOS and SNPs in genes involved in the insulin signaling pathway are possible candidates that can explain the development of clinical manifestations of PCOS.

We aimed to investigate the association of INSR His1058 C/T (rs1799817) single nucleotide polymorphism with PCOS in Kashmiri women. The genotypic-phenotypic correlation of the tested SNP with hyperandrogenism, ovulatory dysfunction, and metabolic markers was evaluated.

The allele frequency (OR = 1.00, 95% CI = 0.67-1.48,

 = 0.01,
=0.99) and genotype distribution (

 = 3.73,
=0.15) in INSR C/T polymorphism were comparable with controls. No significant association was found with PCOS in dominant (
=0.194), recessive (
=0.442), and homo vs. het. (
=0.5) genotype models. Genotype-phenotype correlation analysis revealed that variant TT genotype had significantly higher HOMA (
=0.029) and reduced insulin sensitivity QUICKI (
=0.037) values. There was no significant variation in the prevalence of hirsutism, acne, alopecia, menstrual disturbances, acanthosis nigricans, and obesity (all
> 0.05) in different INSR C/T genotypes.

The INSR C/T SNP (rs1799817) does not increase the risk of PCOS in Kashmiri women. This SNP is unlikely to play a significant role in the development and manifestation of clinical symptoms of polycystic ovary syndrome.
The INSR C/T SNP (rs1799817) does not increase the risk of PCOS in Kashmiri women. This SNP is unlikely to play a significant role in the development and manifestation of clinical symptoms of polycystic ovary syndrome.Rituals are an integral part of human life but a wide range of rituals (both religious and non-religious), from self-flagellation to blood brotherhood to ritual sprinkling of holy water, have been associated with transmission of infections. These infections include angiostrongyliasis, anthrax, brucellosis, cholera, COVID-19, cutaneous larva migrans, Ebola, hepatitis viruses, herpes simplex virus, HIV, human T-cell leukemia virus (HTLV), kuru, Mycobacterium bovis, Naegleria fowleri meningoencephalitis, orf, rift valley fever, and sporotrichosis. Education and community engagement are important cornerstones in mitigating infectious risks associated with rituals.The blood-brain barrier (BBB) is a semipermeable and extremely selective system in the central nervous system of most vertebrates, that separates blood from the brain's extracellular fluid. It plays a vital role in regulating the transport of necessary materials for brain function, furthermore, protecting it from foreign substances in the blood that could damage it. In this review, we searched in Google Scholar, Pubmed, Web of Science, and Saudi Digital Library for the various cells and components that support the development and function of this barrier, as well as the different pathways to transport the various molecules between blood and the brain. We also discussed the aspects that lead to BBB dysfunction and its neuropathological consequences, with the identification of some of the most important biomarkers that might be used as a biomarker to predict the BBB disturbances. This comprehensive overview of BBB will pave the way for future studies to focus on developing more specific targeting systems in material delivery as a future approach that assists in combinatorial therapy or nanotherapy to destroy or modify this barrier in pathological conditions such as brain tumors and brain stem cell carcinomas.In the USA, each year, almost 5.4 million people are diagnosed with skin cancer. Melanoma is one of the most dangerous types of skin cancer, and its survival rate is 5%. The development of skin cancer has risen over the last couple of years. Early identification of skin cancer can help reduce the human mortality rate. Dermoscopy is a technology used for the acquisition of skin images. However, the manual inspection process consumes more time and required much cost. The recent development in the area of deep learning showed significant performance for classification tasks. In this research work, a new automated framework is proposed for multiclass skin lesion classification. The proposed framework consists of a series of steps. In the first step, augmentation is performed. For the augmentation process, three operations are performed rotate 90, right-left flip, and up and down flip. In the second step, deep models are fine-tuned. Two models are opted, such as ResNet-50 and ResNet-101, and updated their layers. In the third step, transfer learning is applied to train both fine-tuned deep models on augmented datasets. In the succeeding stage, features are extracted and performed fusion using a modified serial-based approach. Finally, the fused vector is further enhanced by selecting the best features using the skewness-controlled SVR approach. The final selected features are classified using several machine learning algorithms and selected based on the accuracy value. In the experimental process, the augmented HAM10000 dataset is used and achieved an accuracy of 91.7%. Moreover, the performance of the augmented dataset is better as compared to the original imbalanced dataset. In addition, the proposed method is compared with some recent studies and shows improved performance.
Traumatic spinal cord injury (SCI) can continue and transform long after the time of initial injury. Preventing secondary injury after SCI is one of the most significant challenges, and early intervention to return the blood flow at the injury site can minimize the likelihood of secondary injury.

The purpose of this study is to investigate whether laminectomy can achieve the spinal cord blood flow by measuring the spinal blood oxygen saturation intraoperatively without the presence of light.

Between June and August 2021, eight patients were admitted after traumatic spinal cord injury for surgical treatment. We explored the effectiveness of laminectomy and whether the patients required further procedures or not. We used a brain oxygen saturation monitor at the spine injury site under dark conditions.

Eight cervical trauma patients, six males and two females, underwent laminectomy decompression. Three patients' ASIA grade improved by one level, and one patient showed slight motor-sensory improvement. Oxygen saturation was in the normal range.

Performing bony decompression can show good results. Therefore, finding an examination method to confirm the improvement of blood perfusion by measuring oxygen saturation at the injury site after laminectomy is essential to avoid other complications.
Performing bony decompression can show good results. Therefore, finding an examination method to confirm the improvement of blood perfusion by measuring oxygen saturation at the injury site after laminectomy is essential to avoid other complications.Colorectal cancer originates from adenomatous polyps. Adenomatous polyps start out as benign, but over time they can become malignant and even lead to complications and death which will spread to adherent and surrounding organs over time, such as lymph nodes, liver, or lungs, eventually leading to complications and death. Factors such as operator's experience shortage and visual fatigue will directly affect the diagnostic accuracy of colonoscopy. To relieve the pressure on medical imaging personnel, this paper proposed a network model for colonic polyp detection using colonoscopy images. Considering the unnoticeable surface texture of colonic polyps, this paper designed a channel information interaction perception (CIIP) module. Based on this module, an information interaction perception network (IIP-Net) is proposed. In order to improve the accuracy of classification and reduce the cost of calculation, the network used three classifiers for classification fully connected (FC) structure, global average pooling fully connected (GAP-FC) structure, and convolution global average pooling (C-GAP) structure. We evaluated the performance of IIP-Net by randomly selecting colonoscopy images from a gastroscopy database. The experimental results showed that the overall accuracy of IIP-NET54-GAP-FC module is 99.59%, and the accuracy of colonic polyp is 99.40%. By contrast, our IIP-NET54-GAP-FC performed extremely well.The demand forecast of shared bicycles directly determines the utilization rate of vehicles and projects operation benefits. Accurate prediction based on the existing operating data can reduce unnecessary delivery. Since the use of shared bicycles is susceptible to time dependence and external factors, most of the existing works only consider some of the attributes of shared bicycles, resulting in insufficient modeling and unsatisfactory prediction performance. In order to address the aforementioned limitations, this paper establishes a novelty prediction model based on convolutional recurrent neural network with the attention mechanism named as CNN-GRU-AM. There are four parts in the proposed CNN-GRU-AM model. First, a convolutional neural network (CNN) with two layers is used to extract local features from the multiple sources data. Second, the gated recurrent unit (GRU) is employed to capture the time-series relationships of the output data of CNN. Third, the attention mechanism (AM) is introduced to mining the potential relationships of the series features, in which different weights will be assigned to the corresponding features according to their importance. At last, a fully connected layer with three layers is added to learn features and output the prediction results. To evaluate the performance of the proposed method, we conducted massive experiments on two datasets including a real mobile bicycle data and a public shared bicycle data. The experimental results show that the prediction performance of the proposed model is better than other prediction models, indicating the significance of the social benefits.Network open curriculum provides a new solution for general education in local colleges and universities, which makes the network curriculum widely popularized and applied in colleges and universities. However, due to the lack of good curriculum learning evaluation, it is inconvenient for learners to choose. Therefore, this paper proposes to use the BP neural network model to evaluate the learning process of network general education course. Based on the course and user data provided by the existing platform, this paper constructs an online course learning evaluation model and studies the structure and effect relationship among learning experience, learning investment, and learning performance of ordinary online courses based on the preaging process product (3P) model and structural analysis method. Our research shows that curriculum quality is a key factor in analyzing and predicting learning results, which has a great impact on learning achievement. Learning experience is a direct factor affecting academic achievement. Learning experience, as an intermediary variable, indirectly affects e-learning performance. At the same time, it puts forward some suggestions to optimize the learning effect of ordinary online courses. On the one hand, the evaluation model provided in this paper can provide a reference for learners to select online courses; on the other hand, it can also be used as a supplement to the existing subjective evaluation model.Considering the importance of energy in our lives and its impact on other critical infrastructures, this paper starts from the whole life cycle of big data and divides the security and privacy risk factors of energy big data into five stages data collection, data transmission, data storage, data use, and data destruction. Integrating into the consideration of cloud environment, this paper fully analyzes the risk factors of each stage and establishes a risk assessment index system for the security and privacy of energy big data. According to the different degrees of risk impact, AHP method is used to give indexes weights, genetic algorithm is used to optimize the initial weights and thresholds of BP neural network, and then the optimized weights and thresholds are given to BP neural network, and the evaluation samples in the database are used to train it. Then, the trained model is used to evaluate a case to verify the applicability of the model.Slime mould algorithm (SMA) is a population-based metaheuristic algorithm inspired by the phenomenon of slime mould oscillation. The SMA is competitive compared to other algorithms but still suffers from the disadvantages of unbalanced exploitation and exploration and is easy to fall into local optima. To address these shortcomings, an improved variant of SMA named MSMA is proposed in this paper. Firstly, a chaotic opposition-based learning strategy is used to enhance population diversity. Secondly, two adaptive parameter control strategies are proposed to balance exploitation and exploration. Finally, a spiral search strategy is used to help SMA get rid of local optimum. The superiority of MSMA is verified in 13 multidimensional test functions and 10 fixed-dimensional test functions. In addition, two engineering optimization problems are used to verify the potential of MSMA to solve real-world optimization problems. The simulation results show that the proposed MSMA outperforms other comparative algorithms in terms of convergence accuracy, convergence speed, and stability.Kawasaki disease (KD) is a systemic vasculitis of unknown cause which usually diagnosed in small children. However, KD can be present as coronary disease in adults even with no history of the disease in childhood. Here, we describe a case of KD in a 42-year-old male patient presented with severe retrosternal chest pain radiating to the left arm and provisionally diagnosed as acute coronary disease. Coronary artery ectasia and multiple aneurysms have been confirmed by coronary angiography that led to the diagnosis of KD. The patient was treated with Aspirin 81 mg orally once daily, Apixapan 5 mg orally twice daily, Rosuvastatin 40 mg orally once daily, Bisoprolol 5 mg orally once daily, and omeprazole 20 mg orally once daily. The patient was improved and discharged with anticoagulant drugs for life. Physicians should be aware that KD can be present as coronary disease in adults even with no history of the disease in childhood and has a limited treatment options due to unfavorable coronary anatomy.Sigmoid volvulus (SV) recurrence more than 10 times is an extremely rare clinical entity and spontaneous detorsion is a rare outcome of SV. In this paper, we report a case with 19 previous SV attacks, in last of which spontaneous detorsion occurred. Such a multiple-episode history as well as an unexpected recovery was unique in a 1,036-case clinical profession of Ataturk University with SV over a 54.5-year period.In this unprecedented situation of COVID-19 era, the educational institutions have to attune not only the teaching strategies but also the assessment. Similarly, just as COVID precautions have become the "new normal" practice, hence implementation changes during face-to-face examinations may become standard practice in the Post- COVID era. The Objective structured clinical exams (OSCEs) which usually require a face-to-face assessment of skills, posed a special challenge to health professionals in COVID 19. This commentary paper is written on shared experiences of the examination cell principal resource faculty for OSCE and exam coordinators. It addresses how to plan and implement objective, valid, feasible and reliable clinical skills examinations (OSCEs) keeping in place COVID precautions to ensure the utmost wellbeing of all stakeholders involved.Medical errors are relatively common causes of preventable iatrogenic adverse events. We have focused on teaching models in certain courses of study that have been reported to have significant positive impacts on the outcomes of teaching about medical errors. All healthcare organizations must establish suitable models of teaching about patient safety and medical errors as a preventive measure and as an early intervention strategy. Teaching undergraduate medical students and physicians in training how to manage and disclose medical errors helps them develop lifelong skills that can effectively reduce such errors. The literature search was conducted in international databases such as PubMed/MEDLINE and Google Scholar search engine using English equivalent keywords, from 1998 up to April, 2020. The search strategy used the following subject headings terms "Medical error(s)" AND "Teaching". Out of 40 Studies included, 6 studies were selected to have evaluated models of health care training and simulation based teaching of medical errors and patient safety in undergraduate and postgraduate medical education.
To assess the effectiveness of Sofosbuvir (SOF) and Daclatasvir (DCV) in patients with chronic hepatitis C (CHC), compensated cirrhosis (CC) and decompensated cirrhosis (DCLD) either treatment naïve or experienced.

This was a prospective, observational study, conducted from January 2017 to December 2018 at Jinnah Postgraduate Medical Centre, Karachi. All patients above 12 years of age with detectable HCV RNA PCR were included. Patients were divided into three groups CHC, CC and DCLD. SOF and DCV for 12 or 24 weeks were given. Ribavirin (RBV) was given to treatment experienced and cirrhotic patients. Primary outcome was End of Treatment Response (ETR) and secondary outcome was Sustained Virological Response (SVR) at post treatment week 12 or 24.

Total 300 patients with mean age of 40.49 ± 13.86 were enrolled. Majority were females 174 (58%). CHC were 200 (66.6%) while cirrhotic were 100 (33.4%). Treatment naïve patients were 267 (89%) and 33 (11%) patients were experienced. Most common genotype was 3 (83%). ETR was achieved in 292 (97.33%) and SVR in 265 (88.33%) patients respectively.

SOF plus DCV with or without RBV is a highly effective treatment for chronic HCV and is still used in many centers of Pakistan. This regimen has excellent results for GT-3. The outcomes are mainly influenced by the presence or absence of cirrhosis.
SOF plus DCV with or without RBV is a highly effective treatment for chronic HCV and is still used in many centers of Pakistan. This regimen has excellent results for GT-3. The outcomes are mainly influenced by the presence or absence of cirrhosis.
Hospital readmission has become a focus of national attention as a potential indicator of healthcare quality and has a significant financial impact on healthcare system. Limited data is available regarding readmissions to Internal Medicine specialty from our sub-continent. It is, therefore, essential to determine the frequency and factors leading to readmissions, in order to avoid preventable readmissions and improve quality of healthcare provision.

This retrospective study reviewed adult discharges from Internal Medicine specialty between October 2018 and February 2019 at Aga Khan University Hospital. Out of 1,835 discharges, 491 were randomly selected after excluding expiries. The frequency, factors and outcomes of readmission were noted. The studied outcomes included length of stay and in-hospital mortality.

Out of 491 patients, 15.3% were readmitted within 30-days of their discharge. Most of the readmitted patients were females (56%) and elderly with a mean age 67.1±14.9 years. Majority of the patient who got readmitted had multi-morbidities (68%) and were of functional Class-II (39%).The mean length of stay for index and readmission was between 4-7days. Eighty-percent readmissions were discharged as planned, 13% on request and seven-percent left against medical advice in their index admission. The most common causes of readmission were persistence of symptoms (43%) and nosocomial infection (29%). Avoidable causes included hospital-associated pneumonia, urinary tract infections and septic shock. Mortality in readmitted patients was 12%.

The causes of readmission is multi-factorial, including advanced age, multi-morbidities, persistence of symptoms and nosocomial infections. Early follow-ups should be advised to prevent avoidable readmissions.
The causes of readmission is multi-factorial, including advanced age, multi-morbidities, persistence of symptoms and nosocomial infections. Early follow-ups should be advised to prevent avoidable readmissions.
To observe the therapeutic effect of rha FGF combined with vitamin B complex on severe recurrent aphthous ulcers (RAUs).

Ninety patients with severe RAU (grade III and IV) admitted to Chinese PLA General Hospital from May 2018 to May 2019 were selected and divided into two groups using a random number table, 45 patients/group. Patients in the control group gargled with a mixture of vitamin B complex (250 ml of 9% normal saline +250 ml of vitamin B complex +160,000 U of gentamicin +25 ml of lidocaine) after oral cleaning; patients in the observation group gargled with a mixture of the same ratio after oral cleaning and then sprayed rhaFGF on their oral ulcers. The clinical symptoms and treatment effects of the 2 groups within 1 week of medication were compared.

The total effective rate of treatment was 97.78% in the observation group and 82.22% in the control group; the difference was statistically significant (P <0.05). The time to ulcer pain disappearance and eating recovery and the ulcer healing time in the observation group were significantly shorter than those in the control group (P <0.05).

rhaFGF combined with vitamin B complex has a significant therapeutic effect for patients with severe RAU; it can relieve pain and illness faster and shorten the healing time of ulcers.
rhaFGF combined with vitamin B complex has a significant therapeutic effect for patients with severe RAU; it can relieve pain and illness faster and shorten the healing time of ulcers.
To compare the diagnostic accuracy of procalcitonin (PCT), C- reactive protein (CRP), total leukocyte count (TLC) and lactate in critically ill patients admitted with suspicion of sepsis.

It was a cross sectional study conducted at the department of Chemical Pathology and Endocrinology AFIP, Rawalpindi, in collaboration with Medical and surgical intensive care units (ICU) of CMH Rawalpindi from January 2019 to December 2019. A total of 126 patients of both genders with age above 18 years and fulfilling the inclusion criteria of systemic inflammatory response syndrome (SIRS) were inducted in the study.

Out of 126 patients 82 (65%) patients have positive blood culture results. Male predominance was noted in patients with positive blood culture. Out of 82 patients with positive blood culture results 69(84%) patients have positive PCT results as well whereas 13(15%) patients with positive blood culture results have negative PCT values. 57(69%) patients had Gram negative bacterial infection and 25(30%) patients had Gram positive bacterial infection. Significant difference was noted between the medians of PCT in blood culture positive and blood culture negative group (p value< 0.05) whereas no significant difference was found between medians of CRP, TLC and lactate between blood culture positive and blood culture negative patients (p value > 0.05). ROC curve analysis of PCT, CRP and TLC were done, keeping blood culture as reference standard, PCT showed largest area under the curve (AUC) and clearly outperformed TLC and CRP. PCT showed AUC of 0.781 as compared to CRP and TLC, which was 0.568 and 0.617 respectively. PCT showed sensitivity of 93.9%, specificity of 47.7%, positive predictive value (PPV) of 77% and negative predictive value (NPV) of 80.8%.

Higher NPV makes it a reliable marker for screening out sepsis in suspected cases.
Higher NPV makes it a reliable marker for screening out sepsis in suspected cases.
To compare the effect of blunt and sharp incision of uterus at cesarean section on intra-operative haemorrhage.

This trial was conducted at the Department of Obstetrics and Gynaecology, Pakistan Ordinance Factory Hospital, Wah Cantt from 14
January to 13
July 2012. Total 80 women planned for lower segment cesarean section through Pfannensteil incision were randomized to either blunt uterine incision (Group-A, n=40) or sharp uterine incision (Group-B, n=40). The fall in Haemoglobin and HCT was compared in two groups and analyzed with help of SPSS version 10.

Both groups were similar in terms of demographic features like age, parity, gestational age and indication for cesarean section. The participants in Group-A reveled significantly less drop of mean Hb concentration as compared to Group-B (1.47±1.08 and 1.95±0.85 respectively, P value 0.031). Similarly, the fall in mean HCT was significantly less in Group-A in comparison to Group-B (3.21±1.3 and 4.21±2.17 respectively, P-value 0.015).

Blunt expansion of uterine incision during caesarean section is associated with less fall in Haemoglobin and HCT as compared to sharp expansion.
Blunt expansion of uterine incision during caesarean section is associated with less fall in Haemoglobin and HCT as compared to sharp expansion.
To investigate the efficacy and postoperative complications of lattice carbon dioxide laser in the treatment of postmenopausal patients with mild to moderate stress urinary incontinence.

A total of 30 postmenopausal female patients with mild to moderate stress urinary incontinence, recruited from the Affiliated Hospital of Hebei University from September to November 2019, were selected as the study subjects and treated with lattice carbon dioxide laser therapy. Treatment was given at intervals of one month. The degree of urinary incontinence, the urinary incontinence questionnaire (ICI-Q-SF) score, and the urinary incontinence quality of life scale (I-QOL)) Score, surgical satisfaction, one hour pad test and postoperative complications before treatment and after each treatment of all patients were respectively recorded and compared.

Compared with those before treatment, the grade of urinary incontinence and ICI-Q-SF scores of these 30 patients after each treatment were lower, and their I-QOL scores were higher.
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