Black hairy tongue syndrome

Black hairy tongue (BHT) is a benign medical condition characterized by elongated filiform lingual papillae with typical carpet-like appearance of the dorsum of the tongue. Its prevalence varies geographically, typically ranging from 0.6% to 11.3%. Known predisposing factors include smoking, excessive coffee/black tea consumption, poor oral hygiene, trigeminal neuralgia, general debilitation, xerostomia, and medication use. Clinical presentation varies but is typically asymptomatic, although aesthetic concerns are common. Differential diagnosis includes pseudo-BHT, acanthosis nigricans, oral hairy leukoplakia, pigmented fungiform papillae of the tongue, and congenital melanocytic/melanotic nevi/macules. Clinical diagnosis relies on visual observation, detailed history taking, and occasionally microscopic evaluation. Treatment involves identification and discontinuation of the offending agent, modifications of chronic predisposing factors, patient’s re-assurance to the benign nature of the condition, and maintenance of adequate oral hygiene with gentle debridement to promote desquamation. Complications of BHT (burning mouth syndrome, halitosis, nausea, gagging, dysgeusia) typically respond to therapy. Prognosis is excellent with treatment of underlying medical conditions. BHT remains an important medical condition which may result in additional burden on the patient and health care system and requires appropriate prevention, recognition and treatment.

Investigation on taste characteristics and sensory perception of soft-boiled chicken during oral processing based on electronic tongue and electronic nose

The sensory perception of food is a dynamic process,which is closely related to the release of flavor substances during oral processing.It’s not only affected by the food material,but also subjected to the individual oral environment.To explore the oral processing characteristics of soft-boiled chicken,the sensory properties,texture,particle size,viscosity,characteristic values of electronic nose and tongue of different chicken samples were investigated.The correlation analysis showed that the physical characteristics especially the cohesiveness,springiness,resilience of the sample determined oral processing behavior.The addition of chicken skin played a role in lubrication during oral processing.The particle size of the bolus was heightened at the early stage,and the fluidity was enhanced in the end,which reduced the chewing time to the swallowing point and raised the aromatic compounds signal of electronic nose.But the effect of chicken skin on chicken thigh with relatively high fat content,was opposite in electronic nose,which had a certain masking effect on the perception of umami and sweet taste.In conclusion,fat played a critical role in chicken oral processing and chicken thigh had obvious advantages in comprehensive evaluation of soft-boiled chicken,which was more popular among people.

Development of a rapid and efficient system for CR genes identification based on hairy root transformation in Brassicaceae

Many economically important crops and vegetables belonging to the cruciferous family are heavily endangered by clubroot disease caused by Plasmodiophora brassicae infection.Breeding of clubroot resistant cultivars based on mapping and cloning of resistant genes is commonly regarded as the most cost-effective and efficient way to fight against this disease.The traditional way of R gene functional validation requires stable transformation that is both time-and labor-consuming.In this study,a rapid and efficient hairy-root transgenic protocol mediated by Agrobacterium rhizogenes was developed.The transformation positive rate was over 80%in Brassica napus showed by GUS reporter gene and this transformation only took 1/6 of the time compared with stable transformation.The system was applicable to different B.napus varieties and other cruciferous crops including Brassica rapa and Brassica oleracea.In particular,two known CR genes,CRA3.7.1 and CRA8.2.4 were used respectively,as example to show that the system works well for CR gene study combined with subsequent P.brassicae infection in B.napus.Most importantly,it works both in over-expression that led to disease resistance,as well as in RNAi which led to disease susceptible phenotype.Therefore,this system can be used in batch-wise identification of CR genes,and also offered the possibility of manipulating key genes within the P.brassicae genome that could improve our knowledge on host-pathogen interaction.

Non-canonical BRAF variants and rearrangements in hairy cell leukemia

Hairy cell leukemia(HCL)is an uncommon mature B-cell malignancy characterized by a typical morphology,immunophenotype,and clinical profile.The vast majority of HCL patients harbor the canonical BRAF V600E mutation which has become a rationalized target of the subsequently deregulated RAS-RAF-MEK-MAPK signaling pathway in HCL patients who have relapsed or who are refractory to front-line therapy.However,several HCL patients with a classical phenotype display non-canonical BRAF mutations or rearrangements.These include sequence variants within alternative exons and an oncogenic fusion with the IGH gene.Care must be taken in the molecular diagnostic work-up of patients with typical HCL but without the BRAF V600E to include investigation of these uncommon mechanisms.Identification,functional characterization,and reporting of further such patients is likely to provide insights into the pathogenesis of HCL and enable rational selection of targeted inhibitors in such patients if required.

Current Research Status of MicroRNAs in Squamous Cell Carcinoma of the Tongue

Tongue squamous cell carcinoma (TSCC) is the most invasive type of oral malignant tumor, posing a serious threat to human life and health. Its pathogenesis is complex and has a high degree of malignancy. Recurrence and metastasis often lead to poor prognosis. MicroRNAs are a type of single stranded small molecule RNA with only 18 - 25 nucleotides, which can regulate the expression of various genes and participate in the occurrence and development of tumors. Studies have found that microRNA expression profiling can serve as a reliable and stable biological indicator for early diagnosis and prognosis of tumors. This article provides a review of the research status of MicroRNAs in squamous cell carcinoma of the tongue.

Lactiplantibacillus plantarum AR113 alleviates microbiota dysbiosis of tongue coating and cerebral ischemia/reperfusion injury in rat

Stroke is one of the leading causes of death and disability worldwide.However,information on stroke-related tongue coating microbiome(TCM)is limited,and whether TCM modulation could benefit for stroke prevention and rehabilitation is unknown.Here,TCM from stroke patients(SP)was characterized using molecular techniques.The occurrence of stroke resulted in TCM dysbiosis with significantly reduced species richness and diversity.The abundance of Prevotella,Leptotrichia,Actinomyces,Alloprevotella,Haemophilus,and TM7_[G-1]were greatly reduced,but common infection Streptococcus and Pseudomonas were remarkably increased.Furthermore,an antioxidative probiotic Lactiplantibacillus plantarum AR113 was used for TCM intervention in stroke rats with cerebral ischemia/reperfusion(I/R).AR113 partly restored I/R induced change of TCM and gut microbiota with significantly improved neurological deficit,relieved histopathologic change,increased activities of antioxidant enzymes,and decreased contents of oxidative stress biomarkers.Moreover,the gene expression of antioxidant-related proteins and apoptosis-related factors heme oxygenase-1(HO-1),superoxide dismutase(SOD),glutathione peroxidase(GSH-Px),nuclear factor erythroid 2-related factor 2(Nrf2),NAD(P)H:quinone oxidoreductase-1(NQO-1),and Bcl-2 was significantly increased,but cytochrome C,cleaved caspase-3,and Bax were markedly decreased in the brain by AR113 treatment.The results suggested that AR113 could ameliorate cerebral I/R injury through antioxidation and anti-apoptosis pathways,and AR113 intervention of TCM may have the application potential for stroke prevention and control.

Tongue image feature correlation analysis in benign lung nodules and lung cancer

Objective To analyze the differences in the correlation of tongue image indicators among patients with benign lung nodules and lung cancer.Methods From July 1;2020 to March 31;2022;clinical information of lung cancer patients and benign lung nodules patients was collected at the Oncology Department of Longhua Hos-pital Affiliated to Shanghai University of Traditional Chinese Medicine and the Physical Ex-amination Center of Shuguang Hospital Affiliated to Shanghai University of Traditional Chi-nese Medicine;respectively.We obtained tongue images from patients with benign lung nod-ules and lung cancer using the TFDA-1 digital tongue diagnosis instrument;and analyzed these images with the TDAS V2.0 software.The extracted indicators included color space pa-rameters in the Lab system for both the tongue body(TB)and tongue coating(TC)(TB/TC-L;TB/TC-a;and TB/TC-b);textural parameters[TB/TC-contrast(CON);TB/TC-angular second moment(ASM);TB/TC-entropy(ENT);and TB/TC-MEAN];as well as TC parameters(perAll and perPart).The bivariate correlation of TB and TC features was analyzed using Pearson’s or Spearman’s correlation analysis;and the overall correlation was analyzed using canonical correlation analysis(CCA).Results Samples from 307 patients with benign lung nodules and 276 lung cancer patients were included after excluding outliers and extreme values.Simple correlation analysis indi-cated that the correlation of TB-L with TC-L;TB-b with TC-b;and TB-b with perAll in lung cancer group was higher than that in benign nodules group.Moreover;the correlation of TB-a with TC-a;TB-a with perAll;and the texture parameters of the TB(TB-CON;TB-ASM;TB-ENT;and TB-MEAN)with the texture parameters of the TC(TC-CON;TC-ASM;TC-ENT;and TC-MEAN)in benign nodules group was higher than lung cancer group.CCA further demon-strated a strong correlation between the TB and TC parameters in lung cancer group;with the first and second pairs of typical variables in benign nodules and lung cancer groups indicat-ing correlation coefficients of 0.918 and 0.817(P<0.05);and 0.940 and 0.822(P<0.05);re-spectively.Conclusion Benign lung nodules and lung cancer patients exhibited differences in correla-tion in the L;a;and b values of the TB and TC;as well as the perAll value of the TC;and the texture parameters(TB/TC-CON;TB/TC-ASM;TB/TC-ENT;and TB/TC-MEAN)between the TB and TC.Additionally;there were differences in the overall correlation of the TB and TC be-tween the two groups.Objective tongue diagnosis indicators can effectively assist in the diag-nosis of benign lung nodules and lung cancer;thereby providing a scientific basis for the ear-ly detection;diagnosis;and treatment of lung cancer.

Deep learning-based recognition of stained tongue coating images

Objective To build a dataset encompassing a large number of stained tongue coating images and process it using deep learning to automatically recognize stained tongue coating images.Methods A total of 1001 images of stained tongue coating from healthy students at Hunan University of Chinese Medicine and 1007 images of pathological(non-stained)tongue coat-ing from hospitalized patients at The First Hospital of Hunan University of Chinese Medicine withlungcancer;diabetes;andhypertensionwerecollected.Thetongueimageswererandomi-zed into the training;validation;and testing datasets in a 7:2:1 ratio.A deep learning model was constructed using the ResNet50 for recognizing stained tongue coating in the training and validation datasets.The training period was 90 epochs.The model’s performance was evaluated by its accuracy;loss curve;recall;F1 score;confusion matrix;receiver operating characteristic(ROC)curve;and precision-recall(PR)curve in the tasks of predicting stained tongue coating images in the testing dataset.The accuracy of the deep learning model was compared with that of attending physicians of traditional Chinese medicine(TCM).Results The training results showed that after 90 epochs;the model presented an excellent classification performance.The loss curve and accuracy were stable;showing no signs of overfitting.The model achieved an accuracy;recall;and F1 score of 92%;91%;and 92%;re-spectively.The confusion matrix revealed an accuracy of 92%for the model and 69%for TCM practitioners.The areas under the ROC and PR curves were 0.97 and 0.95;respectively.Conclusion The deep learning model constructed using ResNet50 can effectively recognize stained coating images with greater accuracy than visual inspection of TCM practitioners.This model has the potential to assist doctors in identifying false tongue coating and prevent-ing misdiagnosis.

Acute severe hypokalemia caused by treatment of tongue squamous cell carcinoma with docetaxel and cisplatin:A case report

BACKGROUND The tongue squamous cell carcinoma(TSCC)is an oral malignant tumor arising from the squamous epithelium of the tongue mucosa,characterized by a high malignant degree,invasive growth,early lymph node metastasis,and poor prognosis.Paclitaxel,represented by docetaxel,is now the standard first-line treatment for head and neck squamous cell carcinoma.Docetaxel,which belongs to the class of drugs known as paclitaxel,is an antitumor drug that inhibits cell mitosis and proliferation.Its adverse effects include myelosuppression,hair loss,gastrointestinal reactions,fluid retention,and allergic reactions.However,hypokalemia is rare,most cases are mild or moderate,and severe hypokalemia is seldom reported.symptoms of adverse effects early.It is necessary to be considerate regarding individual differences between patients when selecting chemotherapy regimens and adhere to the principle of individualized treatment.Following multiple cycles of chemotherapy,patients should be aware of the accumulation of toxic side effects and receive blood tests reviewed within 24 hours of completion.It is essential to monitor electrolyte levels in patients suffering from severe gastrointestinal reactions to avoid complications that may result in death.

Development and validation of tongue imaging-based radiomics tool for the diagnosis of insomnia degree:a two-center study

Background:Traditional Chinese medicine(TCM)is commonly used for the diagnosis and treatment of insomnia,with tongue diagnosis being particularly important.The aim of our study was to develop and validate a novel tongue imaging-based radiomics(TIR)method for accurately diagnosing insomnia severity.Methods:This two-center analysis prospectively enrolled 399 patients who underwent tongue imaging between July and October 2021 and divided them into primary and validation cohorts by study center.Here,we referred to the Insomnia Severity Index(ISI)standard and the degree of insomnia was evaluated as absent,subthreshold,moderate,or severe.For developed the TIR diagnostic tool,a U-Net algorithm was used to segment tongue images.Subsequently,seven imaging features were selected from the extracted high-throughout radiomics features using the least absolute shrinkage and selection operator algorithm.Then,the final radiomics model was developed in the primary cohort and tested in the independent validation cohort.Finally,we assessed and compared the diagnostic performance differences between TCM tongue diagnosis and our TIR diagnostic tool with the ISI gold standard.The confusion matrix was calculated to evaluate the diagnostic performance.Results:Seven tongue imaging features were selected to build the TIR tool,with showing good correlations with the insomnia degree.The TIR method had an accuracy of 0.798,a macro-average sensitivity of 0.78,a macro-average specificity of 0.906,a weighted-average sensitivity of 0.798,and a weighted specificity of 0.916,showing a significantly better performance compared to the average performance of three experienced TCM physicians(mean accuracy of 0.458,P<0.01).Conclusions:The preliminary study demonstrates the potential application of TIR in the diagnosis of insomnia degree and measurement of sleep health.The integration of quantitative imaging analysis and machine learning algorithms holds promise for advancing both of TCM and precision sleep medicine.

Sternocleidomastoid flap for reconstruction of tongue small cell carcinoma: A case report

BACKGROUND The management of tongue carcinoma is excision and radical neck dissection followed with reconstruction.This is a case report of a patient with tongue squamous cell carcinoma(SCC)who underwent the procedure with sternocleidomastoid(SCM)flap reconstruction.CASE SUMMARY A 52-year-old woman without smoking history complained tongue ulcer since 3 years ago.Based on the histopathological examination,the patient was diagnosed with T2N2M0 right tongue SCC and underwent wide excision of tumor;right mandibular;neck dissection and were reconstructed with SCM flap.CONCLUSION SCC of the tongue requires wide excision and dissection of the neck and mandible if infiltration into the surrounding lymph nodes has been found.The SCM flap reconstruction could be used post-surgery.

Advances in Tongue Diagnosis Objectification of Traditional Chinese Medicine

Tongue diagnosis is a non-invasive,efficient,and accurate method for determining a person’s physical condition,and plays an essential role in disease diagnosis and health management.However,tongue diagnosis is easily influenced by the subjective experience of the practitioner and the light environment.In addition,tongue diagnosis lacks clear quantitative indicators and objective records.This all limits the transmission and development of tongue diagnosis.Therefore,the acquisition and analysis of tongue information using image equipment,image processing and computer vision have become a hot research topic for the objectification of tongue diagnosis.This paper reviews the research progress of tongue diagnosis objectification in Traditional Chinese medicine.The tongue image acquisition,color correction,segmentation,feature extraction and analysis,and disease prediction included in the study of tongue diagnosis objectification are reviewed.The shortcomings of current automated tongue diagnosis systems and future research ideas are also summarized to provide a reference for further development of tongue diagnosis objectification.

Molecular signaling in cancer stem cells of tongue squamous cell carcinoma:Therapeutic implications and challenges

Head and neck squamous cell carcinoma is the seventh most common cancer worldwide with high mortality rates.Amongst oral cavity cancers,tongue carcinoma is a very common and aggressive oral cavity carcinoma.Despite the implementation of a multimodality treatment regime including surgical intervention,chemo-radiation as well as targeted therapy,tongue carcinoma shows a poor overall 5-year survival pattern,which is attributed to therapy resistance and recurrence of the disease.The presence of a rare population,i.e.,cancer stem cells(CSCs)within the tumor,are involved in therapy resistance,recurrence,and distant metastasis that results in poor survival patterns.Therapeutic agents targeting CSCs have been in clinical trials,although they are unable to reach into therapy stage which is due to their failure in trials.A more detailed understanding of the CSCs is essential for identifying efficient targets.Molecular signaling pathways,which are differentially regulated in the CSCs,are one of the promising targets to manipulate the CSCs that would provide an improved outcome.In this review,we summarize the current understanding of molecular signaling associated with the maintenance and regulation of CSCs in tongue squamous cell carcinoma in order to emphasize the need of the hour to get a deeper understanding to unravel novel targets.

In Vitro and in Silico Insights on the Biological Activities, Phenolic Compounds Composition of Hypericum perforatum L. Hairy Root Cultures

Three Hypericum perforatum hairy root lines(HR B,HR F and HR H)along with non-transformed roots were analyzed for phenolic compounds composition and in vitro enzyme inhibitory properties.In silico molecular modeling was performed to predict the interactions of the most representative phenolic compounds in HR clones with enzymes related to depression,neurodegeneration and diabetes.Chromatographic analyses revealed that HR clones represent an efficient source of quinic acid and hydroxybenzoic acids,epicatechin and procyanidin derivatives,quercetin and kaempferol glycosides,as well numerous xanthones.In vitro antidepressant activity of HR extracts through monoamine oxidase A(MAO-A)inhibition was attributed to the production of oxygenated and prenylated xanthones.The neuroprotective potential of HR extracts was related to the accumulation of quercetin 6-C-glucoside,epicatechin,procyanidins andγ-mangostin isomers as potential inhibitors of acetylcholinesterase(AChE)and butyrylcholinesterase(BChE).Vanillic acid and prenylated xanthones in HR clones as promising inhibitors of tyrosinase additionally contributed to the neuroprotective activity.Five preeminent xanthones in HR(γ-mangostin,mangiferin,garcinone C,garcinone E and 1,3,7-trihydroxy-6-metoxy-8-prenyl xanthone)along with the flavonol quercetin 6-C-glucoside effectively inhibitedα-amylase andα-glucosidase indicating the antidiabetic properties of HR extracts.Transgenic roots of H.perforatum can be exploited for the preparation of novel phytoproducts with multi-biological activities.

Evaluation of Holstein cows with different tongue‑rolling frequencies:stress immunity,rumen environment and general behavioural activity

Background The tongue-rolling behaviour of cows is regarded as an outward sign of stressed animals in a low welfare status.The primary aim of this observational study was to evaluate the association between the frequency of tongue-rolling behaviour and its physiological function.The secondary aim was to explore the relationship between general activities and the frequency of tongue-rolling behaviour of cows.A total of 126 scan sampling behavioural observations were collected over 7 d on 348 Holstein cows with the same lactation stage in the same barn.The tongue-rolling frequency was defined as the number of tongue-rolling observations as a percentage to the total observations per individual cow.According to their tongue-rolling frequency,the cows were grouped into the CON(no tongue-rolling),LT(frequency 1%),MT(frequency 5%),and HT(frequency 10%)groups.Six cows from each group were randomly selected for sampling.Serum samples,rumen fluid,milk yield,and background infor-mation were collected.The general behaviour data during 72 continuous hours of dairy cows,including eating time,rumination time,food time(eating time+rumination time),and lying time,were recorded by the collar sensor.Results Cortisol(P=0.012),γ-hydroxybutyric acid(P=0.008),epinephrine(P=0.030),and dopamine(P=0.047)levels were significantly higher in tongue-rolling groups than in the CON group.Cortisol levels and tongue-rolling frequency had a moderate positive correlation(linearly r=0.363).With the increase in tongue-rolling frequency,the rumen pH decreased first and then increased(P=0.013),comparing to the CON group.HT cows had significantly less food time than CON cows(P=0.035).The frequency of tongue-rolling had a moderate negative relationship with rumination time(r=-0.384)and food time(r=-0.492).Conclusions The tongue-rolling behaviour is considered as a passive coping mechanism,as the stress response in cows with high tongue-rolling frequency increased.Food intake and rumination activities were all closely related to the occurrence of tongue-rolling behaviour.

Mortal condition in an unusual localization,analysis of isolated tongue and tongue base abscesses

BACKGROUND Tongue abscess(TA)is a very rare clinical condition and its treatment is very important.Surgical drainage is at the forefront in the treatment.Our study includes patients with tongue and tongue base abscesses.AIM To discuss the clinical and laboratory findings of these patients emphasizing the underlying causes and treatment options with the largest patient series in the English literature.METHODS We included patients with isolated TA who applied to our clinic between January 1,2020 and January 1,2023.Those who lack the recorded data,those who are not between the ages of 18-66,those who have not undergone surgery-interventional procedure,and those who have infection and/or abscess in another place were excluded from the study.RESULTS There were two female(18%)and nine male(82%)patients in our series consisting of 11 patients.Their ages ranged from 18 to 66,and the mean±SD was 48.63±16.3.Considering the localization of the abscess,three anterior abscesses(27%),two lateral abscesses(18%),and six abscesses at the base of the tongue(54%)were detected.CONCLUSION Tongue abscesses can cause acute upper airway obstruction and respiratory collapse.It may be necessary to act quickly for the tracheotomy procedure and this procedure can usually be performed under local anesthesia as intubation cannot be achieved.When we encounter an abscess in an unexpected organ,difficulties may be encountered in the management of the patient.

Effect of Interferon Regulatory Factor 1 on Proliferation,Invasion and Migration of Tongue Squamous Carcinoma Cells and Its Mechanism

[Objectives]This study was conducted to investigate the effect of interferon regulatory factor on the invasion and migration of tongue squamous carcinoma cells. [Methods]The expression level of IRF1 in tongue squamous carcinoma tissues was detected by real-time quantitative PCR and immunohistochemistry. Plasmids for overexpression and knockdown of IRF1 were constructed. The effects of overexpression and knockdown of IRF1 on the proliferation, invasion and migration of Tca8113 cells were examined in Tca8113 cells. [Results] IRF1 expression was abnormally reduced in tongue squamous carcinoma tissues, and both real-time quantitative PCR and immunohistochemistry showed significantly lower expression than that of paraneoplastic controls. The overexpression and knockdown plasmids of IRF1 were successfully constructed. Growth curve assays showed that overexpression of IRF1 inhibited the proliferation of Tca8113 cells, while knockdown of IRF1 promoted the proliferation of Tca8113 cells. Scratch assay showed that overexpression of IRF1 inhibited the migration of Tca8113 cells, while knockdown of IRF1 promoted the migration of Tca8113 cells. Transwell assay showed that overexpression of IRF1 inhibited the invasion of Tca8113 cells, while knockdown of IRF1 promoted the invasion of Tca8113 cells. [Conclusions] In the development of tongue squamous carcinoma, IRF1 functions as an anti-oncogene, and the expression level of IRF1 was reduced in tongue squamous carcinoma tissues.

Diagnostic accuracy of the tongue blade test combined with clinical signs to detect maxillary and mandibular fractures in the emergency department

BACKGROUND: To evaluate the diagnostic accuracy of clinical signs combined with the tongue blade test(TBT) to detect maxillary and mandibular fractures.METHODS: A cross-sectional study enrolled patients with maxillary and mandibular injuries in the emergency department. Physical examination and the TBT were performed, followed by radiological imaging(facial X-ray or computed tomography [CT]). The diagnostic accuracy was calculated for individuals and a combination of clinical findings at predicting maxillary and mandibular fractures.RESULTS: A total of 98 patients were identified, of whom 31.6% had maxillary fractures and9.2% had mandibular fractures. The combination of malocclusion, tenderness on palpation and swelling with positive TBT had 100% specificity to detect maxillary and mandibular fractures. In the absence of malocclusion, the combination of tenderness on palpation and swelling with positive TBT produced a specificity of 97.8% for maxillary fracture and a specificity of 96.2% for mandibular fracture. A clinical decision tool consisting of malocclusion, tenderness on palpation, swelling and TBT revealed a specificity of 100% and a positive predictive value of 100%.CONCLUSION: The clinical decision tool is potentially useful to rule out mandibular fractures,thus preventing unnecessary radiation exposure.

Simulated Annealing with Deep Learning Based Tongue Image Analysis for Heart Disease Diagnosis

Tongue image analysis is an efficient and non-invasive technique to determine the internal organ condition of a patient in oriental medicine,for example,traditional Chinese medicine(TCM),Japanese traditional herbal medicine,and traditional Korean medicine(TKM).The diagnosis procedure is mainly based on the expert’s knowledge depending upon the visual inspec-tion comprising color,substance,coating,form,and motion of the tongue.But conventional tongue diagnosis has limitations since the procedure is inconsistent and subjective.Therefore,computer-aided tongue analyses have a greater potential to present objective and more consistent health assess-ments.This manuscript introduces a novel Simulated Annealing with Transfer Learning based Tongue Image Analysis for Disease Diagnosis(SADTL-TIADD)model.The presented SADTL-TIADD model initially pre-processes the tongue image to improve the quality.Next,the presented SADTL-TIADD technique employed an EfficientNet-based feature extractor to generate useful feature vectors.In turn,the SA with the ELM model enhances classification efficiency for disease detection and classification.The design of SA-based parameter tuning for heart disease diagnosis shows the novelty of the work.A wide-ranging set of simulations was performed to ensure the improved performance of the SADTL-TIADD algorithm.The experimental outcomes highlighted the superior of the presented SADTL-TIADD system over the compared methods with maximum accuracy of 99.30%.

Recurrence of unilateral angioedema of the tongue:A case report

BACKGROUND Angioedema is a disorder characterized by edema of the face,lips,tongue,and extremities due to increased vascular permeability.Angioedema of the tongue usually occurs bilaterally,and the incidence of unilateral angioedema of the tongue is rare.This study reports a rare case of unilateral angioedema of the tongue with no identifiable cause and repeated recurrence even after discontinuation of an angiotensin-converting enzyme inhibitor.CASE SUMMARY The patient was a 65-year-old woman with pre-existing hypertension and hyperlipidemia and had been receiving 20 mg/d of lisinopril.She was diagnosed with angioedema due to unilateral swelling of the tongue.No airway obstruction was observed,and the symptoms improved following the administration of 0.3 mg of epinephrine intramuscularly and 125 mg of methylprednisolone intravenously.Although lisinopril was discontinued,unilateral angioedema of the tongue continued to recur every 2-5 mo,with the symptoms improving following the administration of prednisolone and an antihistamine.Daily oral administration of 500 mg of tranexamic acid after dinner prevented the recurrence of angioedema.CONCLUSION Careful monitoring and identification of the underlying mechanism play a crucial role in the treatment of angioedema.