Bioactivities,Mechanisms,Production,and Potential Application of Bile Acids in Preventing and Treating Infectious Diseases

Infectious diseases are a global public health problem,with emerging and re-emerging infectious diseases on the rise worldwide.Therefore,their prevention and treatment are still major challenges.Bile acids are common metabolites in both hosts and microorganisms that play a significant role in controlling the metabolism of lipids,glucose,and energy.Bile acids have historically been utilized as first-line,valuable therapeutic agents for related metabolic and hepatobiliary diseases.Notably,bile acids are the major active ingredients of cow bezoar and bear bile,which are commonly used traditional Chinese medicines(TCMs)with the therapeutic effects of clearing heat,detoxification,and relieving wind and spasm.In recent years,the promising performance of bile acids against infectious diseases has attracted attention from the scientific community.This paper reviews for the first time the biological activities,possible mechanisms,production routes,and potential applications of bile acids in the treatment and prevention of infectious diseases.Compared with previous reviews,we comprehensively summarize existing studies on the use of bile acids against infectious diseases caused by pathogenic microorganisms that are leading causes of global morbidity and mortality.In addition,to ensure a stable supply of bile acids at affordable prices,it is necessary to clarify the biosynthesis of bile acids in vivo,which will assist scientists in elucidating the accumulation of bile acids and discovering how to engineer various bile acids by means of chemosynthesis,biosynthesis,and chemoenzymatic synthesis.Finally,we explore the current challenges in the field and recommend a development strategy for bile-acid-based drugs and the sustainable production of bile acids.The presented studies suggest that bile acids are potential novel therapeutic agents for managing infectious diseases and can be artificially synthesized in a sustainable way.

Revisiting the theoretical prediction of the explosive performance found by the Trauzl test

The Trauzl lead block test allows the determination of the approximate performance of explosives in blasting applications by measuring the volume increase(expansion)that is produced by the detonation of an explosive charge in the cavity of a lead block.In this paper,we reconsider the possibility of interpreting the Trauzl test results in terms of detonation parameters or quantities.The detonation parameters used in the analysis are calculated using the thermochemical code EXPLO5,while the hydrocode AUTODYN is used to simulate the effect of explosive charge density and reaction rate on the results of the Trauzl test.The increase in the volume of the lead block cavity was found to correlate best with the product of the detonation heat and the root of the volume of detonation products.Hydrocode simulation showed that the density of explosive charge and the rate of explosive decomposition affect the dynamics of the interaction of the detonation product and the lead block,and consequently the lead block cavity volume increase.

Biological characteristics and clinical management of uveal and conjunctival melanoma

Uveal and conjunctival melanomas are relatively rare tumors;nonetheless,they pose a significant risk of mortality for a large number of affected individuals.The pathogenesis of melanoma at different sites is very similar,however,the prognosis for patients with ocular melanoma remains unfavourable,primarily due to its distinctive genetic profile and tumor microenvironment.Regardless of considerable advances in understanding the genetic characteristics and biological behaviour,the treatment of uveal and conjunctival melanoma remains a formidable challenge.To enhance the prospect of success,collaborative efforts involving medical professionals and researchers in thefields of ocular biology and oncology are essential.Current data show a lack of well-designed randomized clinical trials and limited benefits in current forms of treatment for these tumors.Despite advancements in the development of effective melanoma therapeutic strategies,all current treatments for uveal melanoma(UM)and conjunctival melanoma(CoM)remain unsatisfactory,resulting in a poor long-term prognosis.Ongoing trials offer hope for positive outcomes in advanced and metastatic tumors.A more comprehensive understanding of the genetic and molecular abnormalities involved in the development and progression of ocular melanomas opens the way for the development of personalized therapy,with various potential therapeutic targets currently under consideration.Increased comprehension of the molecular pathogenesis of UM and CoM and their specificities may aid in the development of new and more effective systemic therapeutic agents,with the hope of improving the prognosis for patients with metastatic disease.

Genomic signatures of selection,local adaptation and production type characterisation of East Adriatic sheep breeds

Background The importance of sheep breeding in the Mediterranean part of the eastern Adriatic has a long tradition since its arrival during the Neolithic migrations.Sheep production system is extensive and generally carried out in traditional systems without intensive systematic breeding programmes for high uniform trait production(carcass,wool and milk yield).Therefore,eight indigenous Croatian sheep breeds from eastern Adriatic treated here as metapopulation(EAS),are generally considered as multipurpose breeds(milk,meat and wool),not specialised for a particular type of production,but known for their robustness and resistance to certain environmental conditions.Our objective was to identify genomic regions and genes that exhibit patterns of positive selection signatures,decipher their biological and productive functionality,and provide a"genomic"characterization of EAS adaptation and determine its production type.Results We identified positive selection signatures in EAS using several methods based on reduced local variation,linkage disequilibrium and site frequency spectrum(eROHi,iHS,nSL and CLR).Our analyses identified numerous genomic regions and genes(e.g.,desmosomal cadherin and desmoglein gene families)associated with environmental adaptation and economically important traits.Most candidate genes were related to meat/production and health/immune response traits,while some of the candidate genes discovered were important for domestication and evolutionary processes(e.g.,HOXa gene family and FSIP2).These results were also confirmed by GO and QTL enrichment analysis.Conclusions Our results contribute to a better understanding of the unique adaptive genetic architecture of EAS and define its productive type,ultimately providing a new opportunity for future breeding programmes.At the same time,the numerous genes identified will improve our understanding of ruminant(sheep)robustness and resistance in the harsh and specific Mediterranean environment.

Delayed postpancreatectomy hemorrhage as the role of endovascular approach:Four case reports

BACKGROUND Pancreatic resection is still associated with high morbidity rates and delayed postpancreatectomy hemorrhage(PPH)is the most feared complication as it may lead to hemorrhagic shock or serious septic complications.Today,endovascular approach represent safe and efficient method for minimally invasive management of extraluminal PPH.CASE SUMMARY We describe four patients whose postoperative recovery after pancreatic resection was complicated by postoperative pancreatic fistula(POPF)and visceral artery hemorrhage.In all cases endovascular approach was utilized and it resulted in satisfactory outcomes.We discuss modern diagnostic and therapeutic approach in this clinical scenario.CONCLUSION PPH is relatively uncommon,but it is a leading cause of surgical mortality after pancreatic surgery.Careful monitoring and meticulous follow-up are required for all patients post-operatively,especially in the case of confirmed POPF,which is the most significant risk factor for the development of a PPH.Angiography as a diagnostic and therapeutic method may be an optimal first-line treatment for the management of delayed PPHs.In our experience,endovascular treatment for hemorrhagic complications of pancreatic resections has shown satisfactory results.

Challenges and pitfalls of youth-onset type 2 diabetes

The incidence and prevalence of youth-onset type 2 diabetes mellitus(T2DM)are increasing.The rise in frequency and severity of childhood obesity,inclination to sedentary lifestyle,and epigenetic risks related to prenatal hyperglycemia exposure are important drivers of the youth-onset T2DM epidemic and might as well be responsible for the early onset of diabetes complications.Indeed,youth-onset T2DM has a more extreme metabolic phenotype than adult-onset T2DM,with greater insulin resistance and more rapid deterioration of beta cell function.Therefore,intermediate complications such as microalbuminuria develop in late childhood or early adulthood,while end-stage complications develop in mid-life.Due to the lack of efficacy and safety data,several drugs available for the treatment of adults with T2DM have not been approved in youth,reducing the pharmacological treatment options.In this mini review,we will try to address the present challenges and pitfalls related to youth-onset T2DM and summarize the available interventions to mitigate the risk of microvascular and macrovascular complications.

Expect the unexpected:Brown tumor of the mandible as the first manifestation of primary hyperparathyroidism

Hyperparathyroidism(HPT)is a condition in which one or more parathyroid glands produce increased levels of parathyroid hormone(PTH),causing disturbances in calcium homeostasis.Most commonly HPT presents with asymptomatic hypercalcemia but the clinical spectrum may include disturbances reflecting the combined effects of increased PTH secretion and hypercalcemia.Brown tumors are rare,benign,tumor-like bone lesions,occurring in 1.5%to 4.5%of patients with HPT,as a complication of an uncontrolled disease pathway,and are nowadays rarely seen in clinical practice.The tumor can appear either as a solitary or multifocal lesion and usually presents as an asymptomatic swelling or a painful exophytic mass.Furthermore,it can cause a pathological fracture or skeletal pain and be radiologically described as a lytic bone lesion.The diagnosis of a brown tumor in HPT is typically confirmed by assessing the levels of serum calcium,phosphorus,and PTH.Although when present,brown tumor is quite pathognomonic for HPT,the histologic finding often suggests a giant cell tumor,while clinical presentation might suggest other more frequent pathologies such as metastatic tumors.Treatment of brown tumors frequently focuses on managing the underlying HPT,which can often lead to regression and resolution of the lesion,without the need for surgical intervention.However,in refractory cases or when dealing with large symptomatic lesions,surgical treatment may be necessary.

Key challenges of post-liver transplant weight management

Liver transplantation serves as a life-saving intervention for patients with endstage liver disease,yet long-term survival remains a challenge.Post-liver transplant obesity seems to have a significant contribution to this challenge and it emerges as a significant risk factor for graft steatosis,metabolic syndrome and denovo malignancy development.This review synthesizes current literature on prevalence,risk factors and management strategies for post-liver transplant obesity,emphasizing its impact on graft and patient survival.Literature review consultation was conducted in Medline/PubMed,SciELO and EMBASE,with the combination of the following keywords:Weight management,liver transplantation,immunosuppressive therapy,lifestyle interventions,bariatric surgery.Immunosuppressive therapy has a significant influence on long-term survival of liver transplant patients,yet it seems to have lesser effect on post-transplant obesity development than previously thought.However,it significantly contributes to the development of other components of metabolic syndrome.Key predisposing factors for post-transplant obesity development encompass elevated recipient and donor body mass index,a history of alcoholic liver disease,hepatocellular carcinoma,male gender,the absence of cellular rejection and the marital status of the recipient.Tailored immunosuppressive regimens,pharmacotherapy,lifestyle interventions and bariatric surgery represent key components in mitigating post-transplant obesity and improving long-term survival and quality of life in this group of patients.Timely identification and intervention thus hold paramount importance.Further research is warranted to refine optimal management strategies and enhance outcomes in this patient population.

Diagnosis of West Nile virus infections:Evaluation of different laboratory methods

BACKGROUND The diagnosis of West Nile virus(WNV)is challenging due to short-term and low-level viremia,flavivirus cross-reactivity,and long immunoglobulin M(IgM)persistence.AIM To evaluate different methods for WNV detection[reverse transcription-polymerase chain reaction(RT-PCR),IgM/IgG antibodies,IgG avidity]in serum,cerebrospinal fluid(CSF),and urine samples of patients with confirmed WNV infection.METHODS The study included patients with confirmed WNV neuroinvasive infection(n=62),asymptomatic WNV seropositive individuals(n=22),and individuals with false-positive WNV IgM antibodies(n=30).WNV RNA was detected using RT-PCR.A commercial ELISA was used to detect WNV IgM/IgG antibodies with confirmation of cross-reactive samples using a virus neutralization test(VNT).IgG-positive samples were tested for IgG avidity.RESULTS The WNV-RNA detection rates were significantly higher in the urine(54.5%)/serum(46.4%)than in CSF(32.2%).According to the sampling time,the WNV-RNA detection rates in urine collected within 7 days/8-14/≥15 days were 29.4/66.6/62.5%(P=0.042).However,these differences were not observed in the CSF.The median RT-PCR cycle threshold values were significantly lower in urine(32.5,IQR=28-34)than in CSF(34.5,IQR=33-36).The frequency of positive WNV IgM and IgG significantly differed according to the sampling time in serum but not in CSF.Positive IgM/IgG antibodies were detected in 84.3/9.3%of serum samples collected within 7 days,100/71.1%of samples collected 8-14,and 100%samples collected after≥15 days.Recent WNV infection was confirmed by low/borderline avidity index(AI)in 13.6%of asymptomatic individuals.A correlation between ELISA and AI was strong negative for IgM and strong positive for IgG.No significant correlation between ELISA IgG and VNT was found.CONCLUSION The frequency of WNV RNA and antibody detection depends on the sampling time and type of clinical samples.IgG avidity could differentiate recent WNV infections from long-persisting IgM antibodies.

The Impact of Finerenone on Changes in Pulse Wave Velocity, Arterial Pressure and Heart Related Deaths in Hemodialysis Patients—Study Perspective

The description in the abstract lacks clear logic and a comprehensive summary of this study, so please revise and improve it according to the design theme and main content of this study, and describe it in the order of (research background), purpose/aim, method, results and conclusions. The introduction of the abstract and preface is rather lengthy, but the summary of the whole study and the presentation of the research background are not perfect (mainly because the logic of the context is not clear and orderly), so it will appear a bit messy. Hope to be able to modify (this has been mentioned in the preliminary opinion). Cardiovascular events (CVE) pose a significant threat to individuals with end-stage renal disease (ESRD), yet these patients are often excluded from cardiovascular clinical trials, leaving prognostic factors associated with CVE in ESRD patients largely unexplored. Recent human studies have demonstrated elevated circulating aldosterone levels in ESRD patients, correlating with left ventricular hypertrophy. Additionally, animal models have shown improvements in uremic cardiomyopathy with spironolactone therapy, prompting interest in assessing the efficacy of spironolactone or eplerenone in reducing mortality and improving cardiovascular function in dialysis patients. Clinicians have historically been cautious about prescribing mineralocorticoid receptor antagonists (MRAs) to congestive heart failure patients with chronic kidney disease (CKD) due to hyperkalemia risk. However, the emergence of finerenone, a novel MR antagonist with a favorable safety profile and lower hyperkalemia risk, has renewed interest in MRA therapy in this population. Heart disease, including coronary artery disease, hypertension, and left ventricular failure, is alarmingly prevalent in dialysis patients, contributing significantly to elevated mortality rates compared to the general population. Arterial stiffness, as indicated by pulse wave velocity (PWV), progressively worsens with advancing CKD stages, peaking in severity among ESRD patients undergoing dialysis. High PWV serves as a crucial risk stratification tool in ESRD. Elevated NT-proBNP and BNP levels in ESRD patients are well-documented, with significant associations observed between baseline peptide concentrations and cardiovascular morbidity and mortality. By incorporating finerenone into our study, we aim to investigate its potential benefits in reducing arterial stiffness, lowering blood pressure, and ultimately mitigating heart-related mortality among hemodialysis patients. This study holds substantial implications for hypertension and cardiovascular risk management in this vulnerable patient population. Eligible participants must have been on chronic hemodialysis for at least three months, with ACE inhibitors or angiotensin receptor blockers included in their therapy at maximum tolerable doses. Serum potassium levels 5.7 mmol/L, left ventricular ejection fraction 50%, and PWV higher than age-estimated values are also prerequisites for study entry. Randomized allocation will be conducted using a permuted block design, stratified by center, with allocation communicated via signed study forms during initial examinations. All steps of this research will be conducted in accordance with the principles of the Helsinki Declaration.

Response of photosynthesis,growth,and acorn mass of pedunculate oak to diff erent levels of nitrogen in wet and dry growing seasons

The objective was to examine the effects of optimal leaf nitrogen levels>2.0%and suboptimal levels<2.0%,nitrogen nutrition on net photo synthetic rate,stem diameter increment,height growth increment and acorn mass of pedunculate oak during 2010 in the absence of drought stress and during 2011 under the impact of moderate drought stress.According to the results,moderate drought stress significantly reduced net photo synthetic rate,stem diameter increment and height growth increment,while acorn mass was not affected.Suboptimal nitrogen nutrition significantly reduced the net photo synthetic rate and stem diameter increment only in the wet year,acorn mass in both wet and dry years,while height growth increment was not significantly reduced by suboptimal nitrogen nutrition in either year.The results indicate that optimal nitrogen levels can stimulate photo synthetic rate and stem diameter increment of pedunculate oak only in the absence of moderate drought stress.Moreover,the results show that moderate drought stress is a more dominant stressor for photosynthesis and growth of pedunculate oak than suboptimal nitrogen nutrition,while for acorn development,it is the more dominant stressor.

Maternal choledochal cysts in pregnancy:A systematic review of case reports and case series

BACKGROUND Choledochal cysts(CC)are cystic dilatations of the biliary tract,usually diagnosed during childhood,with an estimated incidence in the general population of 1:100000.Complications related to CC include rupture,biliary obstruction,and cholangitis.Maternal CC in pregnancy are rarely reported,and there are no guidelines on optimal management.AIM To systematically review maternal CC diagnosed during pregnancy or postpartum with regard to the clinical presentation of CC,the mode of treatment and delivery,and maternal outcomes.METHODS A literature search of cases and case series of maternal CC in pregnancy and postpartum was conducted using MEDLINE/PubMed,Web of Science,Google Scholar,and Embase.There were no restrictions on language or publication year.Databases were lastly accessed on September 1,2022.RESULTS Overall,71 publications met the inclusion criteria,reporting 97 cases.Eighty-eight cases were diagnosed during pregnancy and nine in the puerperium.The most common symptoms were abdominal pain(81.2%)and jaundice(60.4%).Interventions for CC complications were required in 52.5%of the cases,and 34%of pregnancies were induced.Urgent cesarean section(CS)was done in 24.7%.The maternal mortality was 7.2%,while fetal mortality was inconsistently reported.Cholangitis,CC>15 cm,and bilirubin levels>80 mmol/L were associated with a higher likelihood of urgent CS and surgical intervention for CC.Bilirubin levels positively correlated with CC size.There was no correlation between age and cyst dimension,gestational age at cyst discovery,and CC size.CONCLUSION Although rare,maternal CC in pregnancy should be included in the evaluation of jaundice with upper abdominal pain.Symptomatology and clinical course are variable,and treatment may range from an expectative approach to emergent surgical CC treatment and urgent CS.While most cases were managed by conservative measures or drainage procedures,CC>15 cm and progressive cholangitis carry the risk of CC rupture and septic complications,which may increase the rates of unfavorable maternal and fetal outcomes.Therefore,such cases require specific surgical and obstetric interventions.

Prevalence of posttraumatic stress disorder following acute coronary syndrome and clinical characteristics of patients referred to cardiac rehabilitation

BACKGROUND Studies have demonstrated that patients who have experienced acute coronary syndrome(ACS)have an increased risk of developing posttraumatic stress disorder(PTSD)and experiencing worse survival outcomes than those who do not develop PTSD.Nevertheless,the prevalence rates of PTSD following ACS vary widely across studies,and it is noteworthy that in most cases,the diagnosis of PTSD was based on self-report symptom questionnaires,rather than being established by psychiatrists.Additionally,the individual characteristics of patients who develop PTSD after ACS can differ widely,making it difficult to identify any consistent patterns or predictors of the disorder.AIM To investigate the prevalence of PTSD among a large sample of patients undergoing cardiac rehabilitation(CR)after ACS,as well as their characteristics in comparison to a control group.METHODS The participants of this study are patients who have experienced ACS with or without undergoing percutaneous coronary intervention and are enrolled in a 3-wk CR program at the largest CR center in Croatia,the Special Hospital for Medical Rehabilitation Krapinske Toplice.Patient recruitment for the study took place over the course of one year,from January 1,2022,to December 31,2022,with a total of 504 participants.The expected average follow-up period for patients included in the study is about 18 mo,and currently ongoing.Using self-assessment questionnaire for PTSD criteria and clinical psychiatric interview,a group of patients with a PTSD diagnosis was identified.From the participants who do not have a PTSD diagnosis,patients who would match those with a PTSD diagnosis in terms of relevant clinical and medical stratification variables and during the same rehabilitation period were selected to enable comparability of the two groups.RESULTS A total of 507 patients who were enrolled in the CR program were approached to participate in the study.Three patients declined to participate in the study.The screening PTSD Checklist-Civilian Version questionnaire was completed by 504 patients.Out of the total sample of 504 patients,74.2%were men(n=374)and 25.8%were women(n=130).The mean age of all participants was 56.7 years(55.8 for men and 59.1 for women).Among the 504 participants who completed the screening questionnaire,80 met the cutoff criteria for the PTSD and qualified for further evaluation(15.9%).All 80 patients agreed to a psychiatric interview.Among them,51 patients(10.1%)were diagnosed with clinical PTSD by a psychiatrist according to Diagnostic and Statistical Manual of Mental Disorders criteria.Among the variables analyzed,there was a noticeable difference in the percentage of theoretical maximum achieved on exercise testing between the PTSD and non-PTSD groups.Non-PTSD group achieved a significantly higher percentage of their maximum compared to the PTSD group(P=0.035).CONCLUSION The preliminary results of the study indicate that a significant proportion of patients with PTSD induced by ACS are not receiving adequate treatment.Furthermore,the data suggest that these patients may exhibit reduced physical activity levels,which could be one of the possible underlying mechanisms in observed poor cardiovascular outcomes in this population.Identifying cardiac biomarkers is crucial for identifying patients at risk of developing PTSD and may derive benefits from personalized interventions based on the principles of precision medicine in multidisciplinary CR programs.

Pedestrianisation and Parking Policy as a Solution towards Green Transport Plan： A Case Study of Zagreb

Strategy of development trends in this moment and at this stage of the traffic comes from understanding the possibilities of the implementation of measures to raise the quality of movement and life in the city. It also includes planning and implementation of targeted interventions in the transport network or facilities. Mobility is a complex process in the area, starting from the departure from the apartment, using various means of transportation, a number of activities in different goals until to return to the location of the apartment. It thus requires extensive transport infrastructure in the form of walkways, bicycle paths, street and railway network. At the same time, reshaping of public transport facilities is needed in which the pedestrian, biker and green concept shall be the main elements of the new spatial conditions. Pedestrian zones development in the city means to create pedestrian areas and green islands in all the places in the city where possible. This process is essential for the transformation of public spaces, in particular, transport corridors. To accomplish the concept of the green transport plan, the need for change in the parking policy is emphasized. This should be an integral part of the city planning and should go hand in hand with the traffic policy.

Biochemical and Physiological Responses of Arabidopsis thaliana Leaves to Moderate Mechanical Stimulation

Mechanical stimulation of plants can be caused by various abiotic and biotic environmental factors.Apart from the negative consequences,it can also cause positive changes,such as acclimatization of plants to stress conditions.Therefore,it is necessary to study the physiological and biochemical mechanisms underlying the response of plants to mechanical stimulation.Our aim was to evaluate the response of model plant Arabidopsis thaliana to a moderate force of 5 N(newton)for 20 s,which could be compared with the pressure caused by animal movement and weather conditions such as heavy rain.Mechanically stimulated leaves were sampled 1 h after exposure and after a recovery period of 20 h.To study a possible systemic response,unstimulated leaves of treated plants were collected 20 h after exposure alongside the stimulated leaves from the same plants.The effect of stimulation was assessed by measuring oxidative stress parameters,antioxidant enzymes activity,total phenolics,and photosynthetic performance.Stimulated leaves showed increased lipid peroxidation 1 h after treatment and increased superoxide dismutase activity and phenolic oxidation rate after a 20-h recovery period.Considering photosynthetic performance after the 20-h recovery period,the effective quantum yield of the photosystem II was lower in the stimulated leaves,whereas photochemical quenching was lower in the unstimulated leaves of the treated plants.Nonphotochemical quenching was lower in the stimulated leaves 1 h after treatment.Our study suggested that plants sensed moderate force,but it did not induce pronounced change in metabolism or photosynthetic performance.Principal component analysis distinguished three groups–leaves of untreated plants,leaves analysed 1 h after stimulation,while stimulated and unstimulated leaves of treated plants analysed 20 h after treatment formed together the third group.Observed grouping of stimulated and unstimulated leaves of treated plants could indicate signal transduction from the stimulated to distant leaves,that is,a systemic response to a local application of mechanical stimuli.

Spontaneous gastric hematoma as a rare cause of acute abdomen:A case report

BACKGROUND Spontaneous gastric hematoma is an exceedingly rare condition characterized by the accumulation of blood within the gastric wall without any apparent iatrogenic or traumatic cause.Coagulopathies are the most frequent cause of gastric he-matomas.However,other causes include amyloidosis,pancreatitis,visceral vas-cular aneurysms,endoscopy complications and others.The pathophysiology of spontaneous gastric hematoma is not completely understood.However,it is postulated that it is caused by disruption of submucosal vessels that leads to dissection of the muscularis layer and formation of false lumen.The rarity of this condition increases the challenge of diagnosis,and there is no standard treatment protocol.CASE SUMMARY We present the case of a spontaneous gastric hematoma in a 22-year-old male.He presented to our emergency department complaining of pain in the left flank area lasting for 2 wk.There was no history of trauma,antico-agulant medications or endoscopy procedures.His hemoglobin and hematocrit levels were slightly lower than normal.Multi-slice computed tomography,ultrasound and endoscopy confirmed a gastric intramural hematoma.We recommended conservative treatment because there was no hemodynamic instability nor significant bleeding.The patient responded well,and there were no unexpected events.At the 3-mo follow-up,the ultrasound exa-mination revealed complete regression of the hematoma.CONCLUSION After reviewing the literature and our experience,we recommend that more of these cases should be treated conservatively.The tendency to treat these cases with potentially burdensome procedures such as total or subtotal gastrectomy should be significantly reduced.

Prognostic role of metformin in diabetes mellitus type 2 patients with hepatocellular carcinoma:A systematic review and meta-analysis

BACKGROUND Hepatocellular carcinoma(HCC)is among the commonest malignancies associated with significant cancer-related death.The identification of chemopreventive agents following HCC treatments with the potential to lower the risk of HCC adverse course is intriguing.Metformin,a first-line agent used in the treatment of type 2 diabetes mellitus(T2DM),has been associated with inhibition of HCC growth.AIM To determine whether metformin can prevent adverse events(i.e.,death,tumor progression,and recurrence)after any HCC treatment in T2DM patients.METHODS A systematic review of the published literature was undertaken focused on the role of metformin on outcomes in patients with T2DM and HCC receiving any tumor therapy.A search of the PubMed and Cochrane Central Register of Controlled Trials Databases was conducted.RESULTS A total of 13 studies(n=14886 patients)were included in this review.With regard to the risk of death,a decreased risk was reported in cases receiving metformin,although this decrease was not statistically significant[odds ratio(OR)=0.89,P=0.42].When only patients treated with curative strategies were considered,a more marked correlation between metformin and favorable cases was reported(OR=0.70,P=0.068).When analyzing palliative treatment,there was no statistical significance in terms of the correlation between metformin and favorable cases(OR=0.74,P=0.66).As for the risks of progressive disease and recurrence,no obvious correlation between metformin use and reduced risk was reported.When sub-analyses were performed for patients from different regions,the results for patients from Eastern countries showed a tendency for decreased risk of death in T2DM cases receiving metformin(OR=0.69,P=0.17),but the same was not seen in patients from Western countries(OR=1.19,P=0.31).CONCLUSION Metformin failed to show a marked impact in preventing adverse effects after HCC treatment.A trend was reported in T2DM cases receiving curative therapies in relation to the risk of death,especially in patients from Eastern regions.Great heterogeneity was reported among the different studies.Further large studies are required to definitively clarify the real impact of metformin as a chemopreventive agent for HCC.

An Energy-Efficient Protocol for Internet of Things Based Wireless Sensor Networks

The performance of Wireless Sensor Networks(WSNs)is an important fragment of the Internet of Things(IoT),where the current WSNbuilt IoT network’s sensor hubs are enticing due to their critical resources.By grouping hubs,a clustering convention offers a useful solution for ensuring energy-saving of hubs andHybridMedia Access Control(HMAC)during the course of the organization.Nevertheless,current grouping standards suffer from issues with the grouping structure that impacts the exhibition of these conventions negatively.In this investigation,we recommend an Improved Energy-Proficient Algorithm(IEPA)for HMAC throughout the lifetime of the WSN-based IoT.Three consecutive segments are suggested.For the covering of adjusted clusters,an ideal number of clusters is determined first.Then,fair static clusters are shaped,based on an updated calculation for fluffy cluster heads,to reduce and adapt the energy use of the sensor hubs.Cluster heads(CHs)are,ultimately,selected in optimal locations,with the pivot of the cluster heads working among cluster members.Specifically,the proposed convention diminishes and balances the energy utilization of hubs by improving the grouping structure,where the IEPAis reasonable for systems that need a long time.The assessment results demonstrate that the IEPA performs better than existing conventions.

The Impact of Fabric Weave and Anisotropy on the Poisson’s Ratio in Technical Fabrics

Poisson’s ratio changes during the tensile stress of technical fabric samples due to the anisotropy of technical fabrics.This paper examines the effects of the type of weave and the anisotropic characteristics of the technical fabric on maximum tensile force,corresponding elongation,work-to-maximum force,elasticity modulus,and Poisson’s ratio when axial tensile forces are applied to samples cut at various angles in the direction of the weft yarns of the technical fabric.In the lab,3 cotton fabric samples of constant warp and weft density with different structural weave types(plain weave,twill weave,atlas weave)were subjected to the tensile force until they broke at the following angles:0°,15°,30°,45°,60°,75°,90°.Based on the different measured values of technical fabric stretching in the longitudinal direction and lateral narrowing,Poisson’s ratio is calculated.The Poisson’s ratio was calculated up to a relative elongation of the fabric of 8%,as the buckling of the fabric occurs according to this elongation value.According to the results presented in this paper,the type of weave of the fabric,the direction of tensile force,and the relative narrowing of the technical fabrics all play important roles in the Poisson’s ratio value.The Poisson’s ratio curve of a technical fabric under tensile stress(i.e.elongation)is primarily determined by its behaviour in the opposite direction of the elongation.The change in the value of the Poisson’s ratio is represented by a graph that first increases nonlinearly and then decreases after reaching its maximum value.

Primary Gastric Synovial Sarcoma Diagnosed by Endoscopic Surveillance of a Gastric Ulcer

Primary gastric synovial sarcoma is rare and challenging to diagnose. We present a case of a gastric ulcer that was diagnosed as primary gastric synovial sarcoma only after surveillance endoscopy with repeat biopsies. The diagnosis was established with the identification of the pathognomonic chromosomal translocation t(X;18)(p11;q11). The patient was treated with wedge resection and has remained disease-free on surveillance imaging and endoscopy. This case demonstrates the difficulty in diagnosing primary gastric synovial sarcoma and the benefits of early disease detection.