Standard Mean Deviation Research Articles

A Novel Classification Model Based on Hybrid K-Means and Neural Network for Classification Problems

We propose a new classification model—a new classification model for clustering overlapping problems based on K-Means and neural networks. K-means clustering algorithm belongs to unsupervised learning. It is a classic algorithm for solving clustering problems. Since this algorithm calculates its categories based on distance, the results tend to converge to the local optimal solution and have poor boundary clustering properties. The K-Means classification algorithm defines clusters by the distance between the cluster center value and the target object, and the optimal result is obtained through continuous iteration. Therefore, clustering results are overlapped, and there are often outliers that do not belong to the current cluster, resulting in unsatisfactory clustering results. Our model offers a new method to segment non-ideal data in overlapping regions. Since clustering algorithms cannot effectively identify and classify this part of the data, we split this part of the data and train it using a neural network. The results are then integrated into the clustered data. In the experiment, the k-fold cross-validation method ensures the model stability of the results. We used the accuracy to evaluate the quality of the model, and we used standard deviation and mean deviation to detect clustering results. Five sets of experimental data from the cross-experiment show that compared with the K-Means classification model, the accuracy of our model is effectively improved. Doi: 10.28991/HIJ-2024-05-03-012 Full Text: PDF

Acupressure: a possible therapeutic strategy for anxiety related to COVID-19: a meta-analysis of randomized controlled trials.

From the end of 2019 to December 2023, the world grappled with the COVID-19 pandemic. The scope and ultimate repercussions of the pandemic on global health and well-being remained uncertain, ushering in a wave of fear, anxiety, and worry. This resulted in many individuals succumbing to fear and despair. Acupoint massage emerged as a safe and effective alternative therapy for anxiety relief. However, its efficacy was yet to be extensively backed by evidence-based medicine. This study aimed to enhance the clinical effectiveness of acupoint massage and extend its benefits to a wider population. It undertakes a systematic review of the existing randomized controlled trials (RCTs) assessing the impact of acupoint massage on anxiety treatment, discussing its potential benefits and implications. This research aims to furnish robust evidence supporting anxiety treatment strategies for patients afflicted with COVID-19 disease and spark new approaches to anxiety management. This study evaluates the evidence derived from randomised controlled trials (RCTs), quantifies the impact of acupressure on anxiety manifestations within the general population, and proposes viable supplementary intervention strategies for managing COVID-19 related anxiety. This review included RCTs published between February 2014 and July 2023, that compared the effects of acupressure with sham control in alleviating anxiety symptomatology as the outcome measure. The studies were sourced from the multiple databases, including CINAHL, EBM Reviews, Embase, Medline, PsycINFO, Scopus and Web of Science. A meta-analysis was performed on the eligible studies, and an overall effect size was computed specifically for the anxiety outcome. The Cochrane Collaboration Bias Risk Assessment Tool (RevMan V5.4) was employed to assess bias risk, data integration, meta-analysis, and subgroup analysis. The mean difference, standard mean deviation, and binary data were used to represent continuous outcomes. Of 1,110 studies of potential relevance, 39 met the criteria for inclusion in the meta-analysis. The majority of the studies reported a positive effect of acupressure in assuaging anticipatory anxiety about treatment. Eighteen studies were evaluated using the STAI scale. The acupressure procedures were thoroughly documented, and studies exhibited a low risk of bias. The cumulative results of the 18 trials showcased a more substantial reduction in anxiety in the acupressure group compared to controls (SMD = -5.39, 95% CI -5.61 to -5.17, p < 0.01). A subsequent subgroup analysis, based on different interventions in the control group, demonstrated improvement in anxiety levels with sham acupressure in improving changes in anxiety levels (SMD -1.61, 95% CI: -2.34 to -0.87, p < 0.0001), and blank controls (SMD -0.92, 95% CI: -2.37 to 0.53, p = 0.22). In the clinical research of traditional Chinese medicine treatment of anxiety, acupressure demonstrated effectiveness in providing instant relief from anxiety related to multiple diseases with a medium effect size. Considering the increasing incidence of anxiety caused by long COVID, the widespread application of acupressure appears feasible. However, the results were inconsistent regarding improvements on physiological indicators, calling for more stringent reporting procedures, including allocation concealment, to solidify the findings.

Effect of Lateral Surgery Compared with Posterior Surgery on Lumbar Degenerative Disease: A Meta-Analysis of 41 Cohort Studies

PurposeThe purpose of this study was to compare the efficacy of the lateral approach and posterior approach in the treatment of lumbar degenerative diseases. MethodsThrough a systematic search of relevant articles published on or before July 20, 2023, in the Embase, PubMed and Cochrane libraries, the two authors independently extracted data and used the Newcastle‒Ottawa scale (NOS) to evaluate the quality of the included studies. Using Stata16 software, the continuous variables were presented as the standard mean deviation (SMD), and the bipartite variables were analyzed using the pooled odds ratio (ORs) with 95% confidence interval (CIs). ResultsA total of 13,892 articles were screened, and 10,908 studies were identified after deleting duplicates, of which 41 met the criteria and were included in the meta-analysis. The meta-analysis showed that the lateral approach was superior to the posterior approach in reducing blood loss, operation time and hospital stay. At the same time, compared with the posterior approach, the lateral approach has more advantages in the long-term JOA score and ODI score, adjusting mid-term and long-term LL and short-term and long-term DH. ConclusionLateral and posterior surgery have similar clinical effects in the treatment of lumbar degenerative diseases and can significantly reduce pain and improve postoperative SL. At the same time, the lateral approach has more advantages in improving long-term quality of life, reducing the long-term disability index, adjusting mid-term and long-term LL and short-term and long-term DH.

Pediatric Residents’ Procedural Competency Requirements: A National Needs Assessment of Program Directors and Chief Residents

BackgroundThere is increased learner competition for a shrinking pool of procedural training opportunities and indications in pediatrics. This study aimed to describe pediatric residency program directors’ (PDs) and chief residents’ (CRs) perspectives about whether procedural requirements for pediatric residents should be reformed and individualized. MethodsThis was a survey-based, mixed methods study of PDs and CRs affiliated with the Association of Pediatric Program Directors (APPD). We used descriptive statistics to analyze demographics and perspectives, logistic regressions to examine individual and program factors, and thematic analysis for qualitative data. ResultsForty-seven percent (95/203) of PDs and 16% (64/392) of CRs responded, representing APPD membership across program setting, size, and region (average standard mean deviation 0.28). Ninety-one percent of PD respondents considered one or more of the current Accreditation Council for Graduate Medical Education (ACGME) required procedures nonessential; 74% favored individualizing procedural training. CR responses mirrored PD responses. Program size, setting, and access to procedural teams did not significantly associate with likelihood to favor individualization. ConclusionsThe majority of PD and CR respondents believe that current ACGME procedures should be reformed and individualized to future career goals. This change could allow maximization of limited time in residency in this era of decreased opportunity.

Study of hydrodynamics in FBG using cold model unit: Modelling by MATLAB

The variation of different process parameters like bed height in static condition, diameter of the particles and density of the particles on the hydrodynamic behavior of a fluidized bed gasifier (FBG) in the cold model unit have been studied by using a Perspex material column of inside diameter 0.30 m and 0.15 m for the free board section and dense bed section respectively. A column of 1.95 m height was selected for the proposed experimental work. Experiments were conducted and attempts had also been made for the development of the correlations of Equivalence Ratio and Euler’s number by changing the different process parameters of the process on the basis of DA (dimensionless analysis). The mentioned numbers of the calculated values by DA as well as by MATLAB coding were compared with the experimental values. The percentage deviation such as standard deviation and mean deviation values for Equivalence ratio and Euler’s number were calculated to be 1.89, −0.049 and 2.64, 10.8 respectively which were within the permissible limits and showed a very good approximation. A chi-square test (ξ2) for the said parameters (Equivalence Ratio and Euler’s number) gave 0.0002 and 18685.04 respectively which indicates a satisfactory correlation fit of the process. Hence the developed correlation from this study can be applied for industrial unit as well as for the pilot plant unit over a wide range of parameter with a suitable factor for scale-up.

Credit Risks Management Practices, And Performance of Real Estate Construction Housing Projects in Kenya; A Case of Real Estate Construction Housing Projects in Busia County

Purpose: The purpose of this study was to establish how credit risk management practices influence performance of Real Estate Construction Housing projects in Busia County.&#x0D; Methodology: The data for this study was collected using questionnaires, focus group discussions and interview schedules. Data was analyzed using descriptive and inferential statistics. Descriptive statistics involved quantitative data analysis therefore it used measures of central tendencies such as frequency, percentage, and mean standard deviation, composite mean and composite standard deviation, while inferential statistics involved testing of research hypotheses using spearman correlation and regression analysis.&#x0D; Findings: During data analysis the study found that credit risk influences performance of real estate construction housing projects in Busia County; implying that using the Likert scale, the respondents agreed that credit risk influences performance of real estate construction housing projects in Busia County. The overall correlation coefficient for credit Risk Management and Performance of real estate construction housing projects in Busia County was found to be 0.580 with a p-value of 0.000 &lt; 0.05 implying that from the views of participants in the study the results indicated that there was a significant relationship between Credit Risk Management and Performance of real estate construction housing projects in Busia County; leading to rejection of the null hypothesis and acceptance of the alternative hypothesis. The simple linear regression coefficients as well as the Pearson correlation results indicated that there was significant influence of Credit risk management on Performance of real estate construction housing projects in Busia County.&#x0D; Unique Contribution to Theory, Policy and Practice: The study contributed the theory that revealed that past statistics show that higher interest rates on credit have not necessarily misguided real estate total return performance but property performance has often remained resilient in the face of rising rates. The study also informed the practice that real estate development is a capital intensive investment and thus developers have to explore alternative sources of capital which can be affordable to them. Finally, the study informed the policy makers that to deliver the high numbers of affordable housing units required, the process of land and real estate transactions needs to be much faster.

Effect of duloxetine on pain and opioid consumption after total knee and hip arthroplasty: a systematic review and meta-analysis of randomized controlled trials.

Although duloxetine has shown a positive effect on pain relief with hip and knee osteoarthritis, there is no pooled analysis of duloxetine for pain relief and opioid consumption in patients after total hip or knee arthroplasty. This systematic review and meta-analysis aimed to analyze pain control, opioid consumption, and associated adverse events of perioperative administration of duloxetine after total hip or knee arthroplasty. After being registered with PROSPERO (CRD42022323202), the databases of MEDLINE, PubMed, Embase, Web of Science, Cochrane Library, and ClinicalTrials.gov were searched from inception until March 20, 2023, for randomized controlled trials (RCTs). Primary outcomes were the visual Analog Scale (VAS) pain scores at rest (rVAS) and upon ambulation (aVAS). Secondary outcomes were postoperative opioid consumption quantified as oral morphine milligram equivalents (MMEs) and adverse effects of duloxetine. Nine RCTs with 806 cases were included. Duloxetine was associated with lower VAS scores at different times after surgery (24h, two weeks, and ≥ 3months). Compared to placebo, perioperative daily duloxetine use significantly reduced daily opioid MMEs at 24h (standard mean deviation [SMD] -0.71, 95% confidence interval [95% CI] -1.19 to -0.24,P = 0.003), three days (SMD -1.10, 95% CI -1.70 to -0.50,P = 0.0003), and one week (SMD -1.18, 95% CI -1.99 to -0.38,P = 0.004) after surgery. The duloxetine group had a significantly lower rate of nausea (odds ratio 0.62, 95% CI [0.41 to 0.94], P = 0.02) and a higher rate of drowsiness and somnolence (odds ratio 1.87, 95% CI [1.13 to 3.07], P = 0.01) compared to the placebo group. No significant differences were observed in the rates of other adverse events. Perioperative duloxetine significantly decreased postoperative pain and opioid consumption with good safety profiles. Further high quality designed and well-controlled randomized trials are warranted.

The effectiveness of kangaroo mother care in lowering postpartum depression in mothers of preterm and low birth weight babies: a systematic review and meta-analysis.

Kangaroo mother care (KMC) intervention involves skin-to-skin contact between mother and infant. Some studies have shown a decrease in postpartum depression (PPD) in mothers of preterm and low birth weight (LBW) infants. However, the literature is scattered and of variable quality. To conduct a systematic review of available literature and provide a comprehensive picture of the effect of KMC on PPD among mothers of preterm and LBW infants. The study was reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) Guidelines. After PROSPERO registration, a systematic search was conducted using PubMed, Cochrane Central Library, and Google Scholar from the inception of the databases till 14 June 2021. Of the 2944 studies assessed for titles and abstracts, nine studies with 2042 participants were included in the review. Included articles targeted mothers with LBW (<2500g) or preterm infants (<37 weeks), used an authentic PPD tool, and had standard care or an incubator as the control group. Studies not published in English and in which mothers had a previous psychiatric illness were excluded. The risk of bias was assessed using the Cochrane Risk of Bias Tool for randomized control trials and the Newcastle-Ottawa Scale for observational studies. All the results were converted to standard mean deviation and pooled together using a random-effects model with a 95% CI. A P-value of less than 0.05 is considered significant. KMC Intervention was significantly associated with a lower depression score than control groups. The reduction in depression in the intervention (KMC) group was moderate: SMD=-0.38 (-0.68 to -0.08; 95% CI; I 2=86%; P=0.013). No significant difference was found between the PPD scores of both groups using the Edinburgh Postpartum Depression Scale score. The authors conclude that the negative effects of LBW and preterm birth experience on maternal mental health can be avoided to a moderate degree by KMC. Due to a lack of methodological uniformity, different scales for outcome measurement, and discrepancies in intervention features, significantly high heterogeneity was detected. The authors need further larger-scale studies with a uniform study design to better predict the efficacy of KMC better.

Effects of SGLT-2 inhibitors on adipose tissue distribution in patients with type 2 diabetes mellitus: a systematic review and meta-analysis of randomized controlled trials

ObjectiveSodium-glucose cotransporter-2 (SGLT-2) inhibitors therapies were reported to affect adipose tissue distribution. However, the available evidence about the effect of SGLT-2 inhibitor on adipose tissue is contradictory. We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) to evaluate the effect of SGLT-2 inhibitors on adipose tissue distribution in patients with type 2 diabetes mellitus (T2DM).MethodsRCTs on SGLT-2 inhibitors on adipose distribution affect in patients with T2DM published in full-text journal databases such as PubMed, Embase, Cochrane Library, and ClinicalTrials.gov databases were searched. The fixed or random effect model was used for meta-analysis, the I2 test was used to evaluate the heterogeneity between studies, and the sensitivity analysis and subgroup analysis were used to explore the source of heterogeneity. Funnel chart and Begg’s test were used to estimate publication bias.ResultsOverall, 18 RCTs involving 1063 subjects were evaluated. Compared with placebo or other hypoglycemic drugs, SGLT-2 inhibitors significantly reduced visceral adipose tissue (standard mean deviation [SMD] = − 1.42, 95% confidence interval [CI] [− 2.02, − 0.82], I2 = 94%, p < 0.0001), subcutaneous adipose tissue (SMD = − 1.21, 95% CI [− 1.99, − 0.42], I2 = 93%, p = 0.003), ectopic liver adipose tissue (SMD = − 0.70, 95% CI [− 1.20, − 0.20], I2 = 73%, p = 0.006). In addition, body weight (mean deviation [MD] = − 2.60, 95% CI [− 3.30, − 1.89], I2 = 95%, p < 0.0001), waist circumference (MD = − 3.65, 95% CI [− 4.10, − 3.21], I2 = 0%, p < 0.0001), and body mass index (BMI) (MD = − 0.81, 95% CI [− 0.91, − 0.71], I2 = 23%, p < 0.0001) were significantly decreased. However, epicardial fat tissue showed an insignificant reduction (SMD = 0.03, 95% CI [− 0.52, 0.58], I2 = 69%, p = 0.71). Subgroup analysis revealed that appropriate treatment duration (16 – 40 weeks) or young patients with nonalcoholic fatty liver disease (NAFLD) and obesity were the decisive factors for SGLT-2 inhibitors to effectively reduce visceral and subcutaneous adipose tissues.ConclusionsOur meta-analysis provides evidence that in patients with T2DM, SGLT-2 inhibitors significantly reduce visceral adipose tissue, subcutaneous adipose tissue, and ectopic liver fat, especially in young T2DM patients with NAFLD and high BMI. Appropriate dosing time (16–40 weeks) may have a more significant and stable beneficial effect on VAT and SAT reduction.

A systematic review and meta-analysis on the efficacy outcomes of selective serotonin reuptake inhibitors in depression in Alzheimer’s disease

BackgroundDepressive symptoms are the most common neuropsychiatric symptoms in patients with Alzheimer’s disease (AD). However, despite being common, no definite consensus recommendations exist for the management of depression in AD.ObjectiveTo assess the effects of selective serotonin reuptake inhibitors (SSRIs) on the alleviation of depressive symptoms in patients with AD.Material and methodsMedline, Scopus, Web of Science, Google Scholar, and PsychINFO were electronically searched from inception until October 2022. Response to therapy and mean depression scores between the treatment (or before) and placebo (or after) groups were the primary outcomes. For depression scores, the standard mean deviation and accompanying 95% confidence interval were determined. The risk of bias was determined using the funnel plot, trim and fill, Egger’s and Begg’s analyses.ResultsSSRIs attenuated depressive symptoms in patients with AD (0.905 SMD, 95%CI, 0.689 to 1.121, p < 0.000). At individual SSRI level, escitalopram, paroxetine, and sertraline significantly alleviated depressive symptoms in AD patients (0.813 SMD, 95%CI, 0.207 to 1.419, p = 0.009, 1.244 SMD, 95%CI, 0.939 to 1.548, p < 0.000, and 0.818 SMD, 95%CI, 0.274 to 1.362, p < 0.000). The funnel plot, trim and fill, Begg’s test (p = 0.052), and Egger’s test (p = 0.148), showed no significant risk of publication bias.ConclusionOur meta-analysis supports the use of SSRIs for the alleviation of depression in patients with AD. However, we recommend larger randomized clinical trials that would compare the efficacy of different SSRIs in AD patients with depression.

Association between high-mobility group box 1 levels and febrile seizures in children: a systematic review and meta-analysis

The relationship between High-mobility group box 1 (HMGB1) and febrile seizures (FS) in children remains unclear. This study aimed to apply meta-analysis to reveal the correlation between HMGB1 levels and FS in children. Databases including PubMed, EMBASE, Web of science, Cochrane library, CNKI, SinoMed and WanFangData were searched for relevant studies. Pooled standard mean deviation and 95% confidence interval were calculated as effect size since the random-effects model was used when I2 > 50%. Meanwhile, between-study heterogeneity was determined by performing subgroup and sensitivity analyses. A total of 9 studies were finally included. Meta-analysis showed that the children with FS had significantly higher HMGB1 levels compared with healthy children and children with fever but no seizures (P<0.05). Additionally, subgroup analysis showed that the HMGB1 level in children with complex FS was higher than those with simple FS (P<0.05), and children with duration >15 min were higher than those with duration ≤15min (P<0.05). There were no statistical differences between children with or without a family history of FS (P>0.05). Finally, children with FS who converted to epilepsy exhibited higher HMGB1 levels than those who did not convert to epilepsy (P<0.05). The level of HMGB1 may be implicated in the prolongation, recurrence and development of FS in children. Thus, it was necessary to evaluate the precise concentrations of HMGB1 in FS patients and to further determine the various activities of HMGB1 during FS by well-designed, large-scale, and case-controlled trials.

The efficacy of telemedicine for pain management in patients with cancer: a systematic review and meta-analysis.

Pain is the most common cancer-related symptom, but it is often undertreated. Telemedicine is widely used in cancer treatment, but its effectiveness is uncertain. We aimed to evaluate the impact of telemedicine intervention on pain in patients with cancer. Methodological quality and risk-of-bias evaluation were conducted, and the sources of heterogeneity were explored through subgroup analysis and sensitivity analysis. PubMed, Embase, Web of Science, Cochrane Library, and clinical trial databases were searched up to 16 August 2022. Randomized controlled trials of the impact of telemedicine intervention regarding pain in patients with cancer were included, and the results related to pain were extracted. Twenty-one randomized controlled trials were selected from 1810 articles. A total of 1454 patients received telemedicine interventions, and 2213 received conventional medical services. Telemedical intervention had a positive effect on improving pain intensity [standard mean deviation (SMD) = -0.28, 95% confidence interval (CI): -0.49 to -0.06, p = 0.01] and pain interference (SMD = -0.41, 95% CI: -0.54 to -0.28, p < 0.00001), with statistical difference between the two groups. The subgroup analysis results showed that the telemedicine subgroup based on an application (SMD = -0.54, 95% CI: -0.91 to -0.18, p = 0.004) and the subgroup with intervention time ⩾ 6 months (SMD = -0.33, 95% CI: -0.52 to -0.13, p = 0.001), both demonstrated significant improvement regarding pain intensity, with significant statistical difference between the two groups. When the follow-up time was ⩾ 6 months, there was no significant difference (SMD = -0.24, 95% CI: -0.55 to 0.07, p = 0.13). Compared with conventional medical services, telemedicine intervention can improve the pain of patients with cancer and is effective and acceptable regarding symptom monitoring. Integrating telemedicine interventions into cancer pain management may be a feasible option. But its long-term effects still need to be confirmed with more high-quality randomized controlled trials in the future. https://www.crd.york.ac.uk/PROSPERO/; CRD42022361990.

Serum Zinc Ion Concentration Associated with Coronary Heart Disease: A Systematic Review and Meta-Analysis.

Aim Coronary heart disease is a major cause of mortality in developed and developing countries. Changes in the trace element concentration in the human body are one of the main reasons for the transition of the human body from a healthy to a diseased state. In this meta-analysis, we have studied the relationship between the reduction in serum zinc ion concentration and coronary heart disease. Methods We used PubMed and Cochrane (as of June 30, 2021) databases for the literature search. Per the requirements of this systematic review, case-control studies involving serum zinc ion concentration and coronary heart disease were searched, and the quality of the included studies was evaluated before the meta-analysis. Results A total of 3,981 cases were found across seven articles. The standard mean deviation (SMD) of serum zinc ion concentration was −0.22 [−0.28, −0.15], z = 6.52, and P < 0.05 indicated that the difference was statistically significant. The forest plot results show that I2 = 34% < 50%, and the Q test showed P=0.17 > 0.1. These results suggest a lack of heterogeneity among the selected articles. Results from the funnel chart indicated that this study was free from publication bias. Conclusion The results of this meta-analysis reveal that a decrease in serum zinc ion concentration is related to the occurrence of coronary heart disease. Clinically, monitoring the serum zinc ion levels is proven to be of great significance for patients with coronary heart disease.

Long-term survival after TAVR in patients with low flow-low gradient vs high gradient aortic valve stenosis

Abstract Introduction Transcatheter aortic valve replacement (TAVR) has become the treatment of choice in elderly patients affected by severe aortic stenosis (AS). In patients with low-flow low-gradient (LFLG) AS, a clear benefit of TAVR over conservative treatment has been demonstrated. Notwithstanding, patients with classical LFLG (cLFLG) AS have shown worse early post-procedural outcomes compared to those with high-gradient (HG) AS. Purpose Given the absence of data, we aimed to evaluate long-term survival (up to 10 years) after TAVR in patients with cLFLG and paradoxical LFLG (pLFLG) AS as compared to those with HG-AS. Methods Consecutive patients undergoing TAVR at our center with a minimum 5-year follow up (i.e. treated between June 2007 and December 2016) were considered for this analysis. According to baseline echocardiography, patients were divided in three groups: 1) HG-AS (MG &amp;gt;40 mmHg); 2) cLFLG-AS (MG &amp;lt;40 mmHg, EF &amp;lt;50%); and 3) pLFLG-AS (MG &amp;lt;40 mmHg, EF &amp;gt;50%). The study endpoint was post-procedural all-cause mortality. To test differences in long-term outcomes among groups, survival curves using the Kaplan Meier estimator were plotted and compared with the log-rank test. To adjust for possible baseline confounders, a propensity score weighted survival analysis was then performed (standard mean deviation &amp;lt;0.1 for all the considered covariates). Results A total of 574 subjects were included in the analysis (419 [73%] HG-AS; 91 [15%] pLFLG-AS; and 64 [11%] cLFLG-AS). Median survival time was 4.8 years [IQR 2.3–6.2], with a maximum of 12.3 years. Patients with cLFLG-AS presented higher baseline cardiovascular risk compared to those with both HG-AS and pLFLG-AS. At unadjusted survival analysis, patients with cLFLG-AS showed the worst long-term prognosis after TAVR (overall log-rank test p=0.023). However, after propensity weighted adjustment, the long-term survival of patients with cLFLG-AS was similar to those with HG-AS (p=0.77). Patients with pLFLG and HG-AS presented similar survival rate. Unadjusted (Panels A and C) and adjusted (Panels B and D) survival curves are reported in Figure 1. Out of 64 patients with cLFLG-AS, 43 (67%) presented an improvement in LV-EF (&amp;gt;15% from the baseline value) within the first year after TAVR. LV-EF improvement, but not baseline LV-EF, was apparently related to longer post-TAVR survival (Figure 2). Conclusion In the current study, patients with cLFLG-AS had worse long-term survival after TARV as compared to either HG or pLFLG-AS subjects. This difference was not present after adjusting for possible baseline confounders. Thus, the low-flow state condition per se might have a lower impact on long term prognosis of TAVR patients than previously hypothesized. Post-TAVR LV-EF recovery was common among patients with cLFLG-AS and was associated with improved long-term survival. Funding Acknowledgement Type of funding sources: None.

Adjuvant Application of Shenmai Injection for Sepsis: A Systematic Review and Meta-Analysis.

Objective To compare the efficacy and safety of Shenmai injection plus regular treatment versus regular treatment alone in the treatment of sepsis. Methods Review Manager 5.3 was used. Databases including PubMed, Cochrane Library, Wan-FANG, VIP, CNKI, and CBM were searched for the relative control and randomized studies till June 2022. Primary outcomes were 28-day mortality; case fatality rate; APACHE II score; and levels of procalcitonin, tumor necrosis factor-α, interleukin-6, and C-reaction protein. Secondary outcomes were measurements related to inflammatory reactions, coagulation function, immune function, and organ function. Results In total 21 studies with 1469 patients were included. Shenmai injection plus regular treatment of sepsis significantly decreased 28-day mortality rate (odds ratio: 0.36 (0.20, 0.63); p=0.0004) and case fatality rate (odds ratio: 0.32 (0.19, 0.54), p < 0.0001) and significantly further reduced APACHE II score (standard mean deviation: −1.14 (−1.30, 0.99); p < 0.00001). Procalcitonin reduction was similar in the two groups (standard mean deviation: −0.59 (−1.64, 0.46); p=0.27). Tumor necrosis factor-α (standard mean deviation: −1.96 (−2.79, −1.13); p < 0.00001), interleukin-6 (standard mean deviation: −1.52 (−2.13, −0.91); p < 0.00001), and C-reaction protein (standard mean deviation: −2.37 (−4.26, −0.49); p=0.01) levels were significantly further decreased in the Shenmai injection group. Most of the measurements related to inflammatory reaction, coagulation function, immune function, and organ function were significantly regulated in the Shenmai injection group. Furthermore, there was no adverse event, and two study groups had similar adverse event rates. Conclusion Shenmai injection as adjuvant therapy shall be effective and safe in the treatment of sepsis. However, further investigation is still warranted especially regarding safety. Adjuvant application of Shenmai injection in sepsis is worth further investigation.

Upregulation of CCNB2 and Its Perspective Mechanisms in Cerebral Ischemic Stroke and All Subtypes of Lung Cancer: A Comprehensive Study

Cyclin B2 (CCNB2) belongs to type B cell cycle family protein, which is located on chromosome 15q22, and it binds to cyclin-dependent kinases (CDKs) to regulate their activities. In this study, 103 high-throughput datasets related to all subtypes of lung cancer (LC) and cerebral ischemic stroke (CIS) with the data of CCNB2 expression were collected. The analysis of standard mean deviation (SMD) and summary receiver operating characteristic (SROC) reflecting expression status demonstrated significant up-regulation of CCNB2 in LC and CIS (Lung adenocarcinoma: SMD = 1.40, 95%CI [0.98–1.83], SROC = 0.92, 95%CI [0.89–0.94]. Lung squamous cell carcinoma: SMD = 2.56, 95%CI [1.64–3.48]. SROC = 0.97, 95%CI [0.95–0.98]. Lung small cell carcinoma: SMD = 3.01, 95%CI [2.01–4.01]. SROC = 0.98, 95%CI [0.97–0.99]. CIS: SMD = 0.29, 95%CI [0.05–0.53], SROC = 0.68, 95%CI [0.63–0.71]). Simultaneously, protein-protein interaction (PPI) analysis indicated that CCNB2 is the hub molecule of crossed high-expressed genes in CIS and LC. Through Multiscale embedded gene co-expression network analysis (MEGENA), a gene module of CIS including 76 genes was obtained and function enrichment analysis of the CCNB2 module genes implied that CCNB2 may participate in the processes in the formation of CIS and tissue damage caused by CIS, such as “cell cycle,” “protein kinase activity,” and “glycosphingolipid biosynthesis.” Afterward, via single-cell RNA-seq analysis, CCNB2 was found up-regulated on GABAergic neurons in brain organoids as well as T cells expressing proliferative molecules in LUAD. Concurrently, the expression of CCNB2 distributed similarly to TOP2A as a module marker of cell proliferation in cell cluster. These findings can help in the field of the pathogenesis of LC-related CIS and neuron repair after CIS damage.

Comparison of Ganglion Cell Layer and Ganglion Cell/Inner Plexiform Layer Measures for Detection of Early Glaucoma

To test the hypothesis that macular ganglion cell layer (GCL) measurements detect early glaucoma with higher accuracy than ganglion cell/inner plexiform layer (GCIPL) thickness measurements. Cross-sectional study. The first cohort included 58 glaucomatous eyes with visual field mean deviation (MD) ≥ -6 dB and 125 normal eyes. The second cohort included 72 glaucomatous and 73 normal/glaucoma suspect (GS) eyes with scans able to create GCL/GCIPL deviation maps. In the first cohort, 8× 8 GCL and GCIPL grids were exported and 5 superior and inferior sectors were defined. Global and sectoral GCL and GCIPL measures were used to predict glaucoma. In the second cohort, proportions of scan areas with abnormal (< 5% and < 1% cutoffs) and supernormal (> 95% and > 99% cutoffs) thicknesses on deviation maps were calculated. The extents of GCL and GCIPL abnormal areas were used to predict glaucoma. Extents of abnormal GCL/GCIPL regions and areas under receiver operating characteristic curves (AUROC) for prediction of glaucoma were compared between GCL or GCIPL measures. The average ± standard deviation MDs were -3.7 ± 1.6 dB and -2.7 ± 1.8 dB in glaucomatous eyes in the first and second cohorts, respectively. Global GCIPL thickness measures (central 18°× 18° macular region) performed better than GCL for early detection of glaucoma (AUROC, 0.928 vs. 0.884, respectively; P=0.004). Superior and inferior sector 3 thickness measures provided the best discrimination with both GCL andGCIPL (inferior GCL AUROC, 0.860 vs. GCIPL AUROC, 0.916 [P= 0.001]; superior GCL AUROC, 0.916 vs. GCIPL AUROC, 0.900 [P= 0.24]). The extents of abnormal GCL regions at a 1% cutoff in the central elliptical area were 17.5± 22.2% and 6.4 ± 10.8% in glaucomatous and normal/GS eyes, respectively, versus 17.0 ± 22.2% and 5.7± 10.5%, respectively, for GCIPL (P= 0.06 for GCL and 0.002 for GCIPL). The extents of GCL and GCIPL supernormal regions were mostly similar in glaucomatous and normal eyes. The best performance for prediction of glaucoma in the second cohort was detected at a P value of < 1% within the entire scan for both GCL and GCIPL (AUC, 0.681 vs. 0.668, respectively; P= 0.29). Macular GCL and GCIPL thicknesses are equivalent for identifying early glaucoma with current OCT technology. This is likely explained by limitations of inner macular layer segmentation and concurrent changes within the inner plexiform layer in early glaucoma.

Adverse Biochemical and Physiological Effects of Metformin in Diabetic Type-2 Patients, A Comparative Clinical Study

Task: The aims and objectives of present study were to highlight the efficacy and adverse side effects of metformin in patients with diabetes type-2 and this study was conducted from December 2021to May 2022 in different medical and diabetic centers of Pakistan. Materials and methods: Subjects: 700 male and female subjects were selected for this study. Division of individuals: 100 normal individuals were in Control group, further 600 individuals were divided into three different groups. In group-X, 200 diabetic type-2, patients were taking 2000 mg/day metformin and in group-Y, 200 diabetic type-2, patients were taking 1500 mg/day metformin while in group-Z, 200 diabetic type-2, patients were taking 500 mg/day metformin respectively. Parameters: Fasting and random serum glucose levels, blood lactic acid levels, serum creatinine levels, myoglobin blood levels and blood hemoglobin levels. Analysis: Microlab and Spectrophotometry kit, regent method were used for the measurement of different parameters. Bio-statistical presentation: All collected raw data were interoperated bio-statistically through the application of SPSS version 2000, in which all parameters were described with the application of standard mean deviation and significant (p&lt;0.05) regression.

The Assessment of Forensic Disguising Markers for Food Poisoning and their Control Measures. A Health Awareness Study

Aims and objectives: To uncover the disguising markers of food poising and their Control Measures to spread public awareness for betterment of human health through forensic applications. Materials and Methods: Study design: Present study was conducted from December 2021to June 2022 in Lahore. Sample size and collections: Various food samples were collected from 10 different restaurants. 5 different food products were collected from each restaurant for analysis of biological markers while non-biological markers were observed on the location at a data collection Performa. Chemical analysis: In case of food poising the forensic chemical analysis are based on biochemical and physiological tests such as bacterial Count in collected food samples through plate count method and spectrophotometric (turbid metric) analysis. Determined Parameters: In this study both biological parameters, such as bacterial Count and non-biological parameters like, hygiene, quality of water, utensils quality, cooking style and cooking environment were considered. Results presentations: Raw data of each parameter was represented bio-statistically with the applications of SPSS in which regressions of standard mean deviation and significant (P&lt;0.05) were considered comparatively. Results: It has seen that mostly all food samples taken from different restaurants have bacterial flora. These bacterial count may be so harmful for human life. It was concluded by considering non-biological parameters that the hygienic conditions, cooking place and way of cooking were not according to the standard health levels recommended by food authority. Especially quality of raw material and utensils were not standardized. All the results were significant as compared with the given standard levels of each parameter. A remarkable changes were noted in different parameters regarding food quality for further elaboration results are represented graphically in fig-1. Conclusion: Infectious organisms including bacteria, viruses and parasites or their toxins are the most common causes of food poisoning. Infectious organisms or their toxins can contaminate food at any point of processing or production. Contamination can also occur at home if food is incorrectly handled or cooked. Keywords: Bacteria, Viruses, Parasites, Contamination, Food Poisoning.

The Impact of Orthodontic fixed appliance and clear plastic aligner in periodontal health; A comparative clinical study

Objective: To find out the periodontal health of patients with fixed orthodontic and clear aligner treatment with a follow-up of three months supportive periodontal therapy. Study Setting: After receiving approval from the hospital's ethical committee the study was conducted at Department of Dentistry Faryal Dental College, Sheikhupura from September 2021 to February 2022. Material and Methods: For this study 40 individuals were selected and divided them into 2 different groups regarding age and mode of treatment. In Group E, 20 individuals were of age in between 15-30 years and they used multi-bracket fixed therapy while in Group F, 20 individuals of age in between 15- 30 years were used treatment with clear aligners. Results: Results of current study were significant (P &lt; 0.05) regarding logistic regression model of descriptive statistics of dependent variables measured for periodontal therapy after 3 month follow-up respectively. Percentage standard mean deviation (Mean±SD) levels of recovery rate, patient compliance, probing depth, plaque index, bleeding on probing and gingival recession for fixed appliance brackets and clear aligners were (56.21± 11.11, 31.14± 11.11, 13.04± 10.01, 26.10± 3.10, 15.21± 10.12, 01.12± 13.11),( 59.22± 1.01, 43.11± 01.10, 14.01± 11.21, 22.10± 3.10, 6.11± 10.11, 06.12± 14.11) noted respectively. Conclusion: The results of current study were significant (P &lt; 0.05) regarding logistic regression model of descriptive statistics of dependent variables measured for periodontal therapy after 3 month follow-up respectively. Patient compliance with clear aligner treatment was higher than fixed appliance brackets. Key words: Fixed orthodontic appliance, clear aligner, periodontal diseases