Cancer treatment has come a long way owing to the developments in various therapeutic modalities from discovery of various anticancer drugs, technological innovations in delivery to personalized treatments. Despite this, Head & Neck Cancer [HNC] is one such cancer that has eluded conventional treatments. To improves the quality of life and preserve vital organ function in patients focus is on therapeutic regimes which would reduce the toxicity. However, use of single approach has not been enough to completely eradicate this malignancy. Therefore, use of adjuvants and combinatorial approaches with molecules from natural compounds which have no or minimal side effects is a growing area of research. In this review we have discussed the potentiality of phytochemicals as adjuvants with chemo or radio therapy as well as nano-formulation as novel therapeutic strategy. We have also tried to delineate the associated challenges in clinical application of these therapies in HNC.

Interactions of antimony-oxide clusters with trypanothione have been modelled to understand their inhibitory activity against leishmaniasis. Trypanothione is essential for the survival of leishmania parasites because it is responsible for maintaining their cellular thiol-disulfide redox regulation. Density functional theory (DFT) calculations show that the SbV oxide clusters form hydrogen bonds from the oxygens to the amine and carboxyl group of the trypanothione. The reaction between trypanothione and the SbV oxide cluster does not break the S-S bond of trypanothione, whereas the reaction with antimony-oxide clusters containing at least one SbIII atom leads to dissociation of the S-S bond of both the oxidized and the reduced form of trypanothione suggesting that antimony-oxide clusters with at least one SbIII atom may destroy trypanothione that is vital for the parasite metabolism.

Spectrum graph theory not only facilitate comprehensively reflflect the topological structure and dynamic characteristics of networks, but also offer signifificant and noteworthy applications in theoretical chemistry, network science and other fifields. Let Ln (8, 4) represent a linear octagonal-quadrilateral network, consisting of n eight-member ring and n four-member ring. The M¨obius graph Qn(8, 4) is constructed by reverse identifying the opposite edges, whereas cylinder graph Q’n (8, 4) identififies the opposite edges by order. In this paper, the explicit formulas of Kirchhoffff indices and complexity of Qn(8, 4) and Q‘n (8, 4) are demonstrated by Laplacian characteristic polynomials according to decomposition theorem and Vieta’s theorem. In surprise, the Kirchhoffff index of Qn(8, 4)(Q’n (8, 4)) is approximately one-third half of its Wiener index as n → ∞.

Intrapartum stillbirths and early neonatal deaths remain stubbornly high in low income countries. Fetal monitoring in labour can reduce these poor outcomes, but limited progress is being achieved in these settings. Intermittent auscultation and continuous electronic fetal monitoring (CEFM) can both be employed to monitor a fetus during labour. There are challenges and limitations with both modalities. We used AI augmented fetal monitoring in a hospital in Malawi and demonstrated substantial reductions in both intrapartum stillbirths and early neonatal deaths with a small increase in the cesarean delivery rate. AI-CEFM should be studied further to achieve better perinatal outcomes.

Asymptomatic and perimenopausal women with cervical endometriosis can expect treatment; Patients with milder symptoms are usually managed conservatively with medications, and those with large lesions or significant clinical symptoms require surgery, which is curative in the vast majority of cases postoperatively. Cervical endometriosis is associated with HPV infection and cervical lesions, but further research is still needed to determine their relationship and mechanism.

Concealed His extrasystoles are a well-known masquerader of AV block. It is therefore necessary to consider pseudo AV block in patients who develop unexpected AV block without a clear etiology. In this report, we present a case of a 46-year-old female who was found to have pseudo-Mobitz II AV block secondary to His extrasystoles diagnosed on surface ECG without requiring invasive electrophysiology study. We also demonstrated in this patient that flecainide can be an effective treatment for His extrasystoles.

An obturator hernia is a rare condition, but important cause of bowel obstruction we reported the case of a 87-year-old woman complaining of a lower right abdominal pain and vomiting due to an obturator hernia diagnosed by a CT scan and treated by an open surgical procedure

Leukemia cutis is a cutaneous manifestation of leukemia. Herein, we present a rare cutaneous manifestation of leukemia cutis in a patient with myeloid leukemia m5, characterized by hyperpigmented red-to-brown patches on face and upper trunk. To our knowledge, hyperpigmented patches secondary to leukemia cutis is rarely described in the literature.

Background Non-pharmacological interventions are the first line of Gestational diabetes mellitus (GDM) management. Community-based interventions are cheaper, more accessible, with higher patient satisfaction. Objectives To systematically review community-based non-pharmacological interventions and evaluate their effectiveness for GDM. Search Strategy Twelve bibliographic databases and reference list of related studies from inception until January 2022. Selection Criteria All primary studies of community-based non-pharmacological interventions for GDM reported in English which investigated any behavioural or clinical outcome(s). Data Collection and Analysis Data were extracted using modified Cochrane’s data extraction template. Studies were evaluated using Cochrane Collaboration’s risk of bias tool. Narrative synthesis was used to summarise findings. This study is registered with PROSPERO (CRD42021257634). Main Results 27 studies involving 6,242 pregnant women with GDM involved self-management programmes, medical nutrition/diet therapy, exercise/physical activity, combined diet and exercise, calcium plus vitamin D supplementation, and continuous glucose monitoring. Self-management programmes were more effective than routine care in improving self-efficacy, two-hour postprandial blood glucose, and lifestyle behaviours but were as effective as routine care in improving infant birth weight. Self-management programmes were superior to or as effective as usual care in improving fasting blood glucose, blood glucose control, glycated haemoglobin, macrosomia, and preterm delivery. Medical nutrition/diet therapy was more effective than usual care in improving postprandial blood glucose levels. Limited/conflicting evidence was found for other outcomes and interventions. Conclusions Community-based non-pharmacological interventions are more effective than placebo; and are more/as effective as usual care. Self-management programmes and medical nutrition/diet therapy had the most promising GDM outcomes.

We describe the case of a laryngeal trauma whose emergency treatment required the technique of cricohyoïdoepiglottopexy.

To the editor: We present a 13-year-old boy with mild persistent asthma and obstructive sleep apnea who initially presented with fever, dyspnea, cough, night sweats and myalgia for 4 days. He reported having an intermittent “hacking cough” for years. Physical examination was significant for diffuse crackles in the right lung base, decreased breath sounds and mild digital clubbing. Initial chest x-ray (CXR) revealed right middle lobe (RML) and right lower lobe (RLL) opacities with right pleural effusion interpreted and treated as community acquired pneumonia. He was followed as an outpatient by his pediatrician and referred to our pediatric pulmonology clinic months later for persistent RLL atelectasis and chronic cough. He was well appearing with similar physical examination findings as described earlier. Laboratory tests including sweat chloride, cystic fibrosis genetic panel, immunoglobulin levels, complement, pneumococcal and tetanus titers were normal.

Stafne bone cavity belongs to the class of pseudocysts as a mandibular radiolucency image with well-defined borders. It is asymptomatic and incidentally discovered. CT scan is the best examination to identify characteristics and content of this image. This study aimed to highlight these radiological features to establish the correct diagnosis

7-Methylxanthine, a derivative of caffeine (1,3,7-trimethylxanthine), is a high-value compound that has multiple medical applications, particularly with respect to eye health. Here, we demonstrate the biocatalytic production of 7-methylxanthine from caffeine using Escherichia coli strain MBM019, which was constructed for production of paraxanthine (1,7-dimethylxanthine). The mutant N-demethylase NdmA4, which was previously shown to catalyze N 3-demethylation of caffeine to produce paraxanthine, also retains N 1-demethylation activity toward paraxanthine. This work demonstrates that whole cell biocatalysts containing NdmA4 are more active toward paraxanthine than caffeine. We used four serial resting cell assays, with spent cells exchanged for fresh cells between each round, to produce 2,120 μM 7-methylxanthine and 552 μM paraxanthine from 4,331 μM caffeine. The purified 7-methylxanthine and paraxanthine were then isolated via preparatory-scale HPLC, resulting in 177.3 mg 7-methylxanthine and 48.1 mg paraxanthine at high purity. This is the first reported strain genetically optimized for the biosynthetic production of 7-methylxanthine from caffeine.

Aim To evaluate the number and nature of reported congenital malformations (CMs) after intrauterine exposure to non-tumour necrosis factor inhibitors (non-TNFis) compared to certolizumab pegol (CZP) Material and methods A retrospective comparative study was conducted in the EudraVigilance (EV) database. EV is a pharmacovigilance database, which can be used for detecting safety signals and generating hypotheses on possible relations between drugs and adverse events. A supposedly safe biologic (CZP) was considered as the reference group. Pregnancy-reports of non-TNFis and CZP were extracted. Odds ratios (ORs) for CMs were calculated for each non-TNFi, versus CZP (quantitative assessment). Then, CM patterns were compared to CZP in consultation with a clinical geneticist (qualitative assessment). Results ORs were not statistically significant except for belimumab and vedolizumab (similar in magnitude). Although qualitative analyses did not show any specific patterns for belimumab but three cases of corpus callosum agenesis (CCA) were identified for vedolizumab (versus null in CZP and other investigated non-TNFis). Two of the CCA cases were associated with other neurological CMs (one cerebral ventriculomegaly with microcephaly and one polymicrogyria). This may indicate that these CCAs are related to undiagnosed genetic alterations or are associated with the underlying maternal disease, although a definite relationship with vedolizumab exposure cannot be ruled out. Conclusion No special safety signal was identified regarding the occurrence of CMs after exposure to non-TNFis, except for vedolizumab. Based on available information, no firm conclusions can be made regarding observed CCAs in the vedolizumab group (it warrants further research)

Lightweight aluminum alloys are widely used in automotive structural parts, and clinching technology is one of the promising techniques for joining aluminum alloys. Since joint failure is mainly caused by fatigue failure, the fatigue properties of the clinched joints directly affect the reliability and safety of the connected specimens. Therefore, the static mechanical and fatigue properties of the Al7075 aluminum alloy single-lap clinched joints were studied using the static strength test and tensile-tensile fatigue test. The F-N curves of the joints were fitted using the straight-line fitting method and the three-parameter power function method. The fractured samples and wear scars were analyzed by scanning electron microscopy (SEM) and an energy dispersive spectroscopic technique (EDS). The results indicated that the neck of the clinched joint and the upper sheet near the joint had maximum fatigue fracture, and the fretting wear debris was mainly composed of alumina and metallic aluminum. The third type of fretting wear mode, i.e., inter-sheet of upper fretting wear mode, was found.

Primary yolk sac tumor of the liver is very rare and can present as multifocal liver lesions. Multifocal nature may mimic other diagnoses such as hepatocellular carcinoma. Early recognition and therapeutic intervention are important as the prognosis of metastatic yolk sac tumors is poor.

Soil water infiltration has always been associated with root architecture. In this study, we used dye infiltration experiments and HYDRUS-1D to quantify the effects of different root architectures on the dynamic of soil water infiltration, volumetric water content, and soil water pressure head. The results provide evidence that root channels acted as preferential flow paths for the infiltration and percolation into the soil. Maize fibrous roots, rubber trees fine roots, and Spartina alterniflora smooth roots easily penetrated the plough layer of the agricultural soil, the hard soil layer of the forest site, and the alternating sandy and mud layers of the intertidal zone, respectively. The initial and final infiltration rates were significantly different between the rooted and rootless soil profiles. The root-induced infiltration events lowered the propagation time of the wetting front across the rooted soil profile by 33%–113% than the rootless soil; and the volumetric water content of the saturated zone increased by 12%–19% in the rooted soil profile relative to the rootless soil. Furthermore, the soil water pressure head increased from negative (i.e. unsaturated) to positive (i.e. saturated) in the saturated soil. This change was more pronounced in maize fibrous root soil, but less pronounced in the rubber fine roots or the S. alterniflora smooth root soil. As a result, indicate that the downward movement, volumetric water content, and soil water pressure head were higher in the rooted soil than the rootless soil profiles, and the degree of roots effects depended on the roots architecture, soil hardness, and soil layer configuration. The findings provide evidence that root channels can act as preferential flow paths for the water infiltration and percolation of water into the soil.

A real-time and accuracy defect detection system is significantly important for the PCB manufacture. This letter introduces a defect detection technology for the PCB manufacture without reference images. We firstly explored the YOLOX method for the defect detection of PCB manufacture. The core characteristics of the YOLOX method consist of decoupled head, data augmentation, anchor-free, and dynamic label assignment. The experimental results demonstrated that YOLOX can effectively improve the production process and promote production efficiency, and can be used for the nonstandardized quality control of PCB manufacture.

Allergic diseases are allergen-induced immunological disorders characterized by the development of type 2 immunity and IgE responses. The prevalence of allergic diseases has been on the rise alike cardiovascular disease (CVD), which affects arteries of different organs such as the heart, the kidney and the brain. The underlying cause of CVD is often atherosclerosis, a disease distinguished by endothelial dysfunction, fibrofatty material accumulation in the intima of the artery wall, smooth muscle cell proliferation, and Th1 inflammation. The opposed T-cell identity of allergy and atherosclerosis implies an atheroprotective role for Th2 cells by counteracting Th1 responses. Yet, the clinical association between allergic disease and CVD argues against it. Within, we review different phases of allergic pathology, basic immunological mechanisms of atherosclerosis and the clinical association between allergic diseases (particularly asthma, atopic dermatitis, allergic rhinitis and food allergy) and CVD. Then, we discuss atherogenic mechanisms of type 2 immunity and allergic inflammation including acute allergic reactions (IgE, IgG1, mast cells, macrophages and allergic mediators such as vasoactive components, growth factors and those derived from the complement, contact and coagulation systems) and late phase inflammation (Th2 cells, eosinophils, type 2 innate-like lymphoid cells, alarmins, IL-4, IL-5, IL-9, IL-13 and IL-17).

Fast gadolinium-based contrast agent challenge test searching for an alternative contrast mediaTo the Editor,Gadolinium-based contrast agents (GBCA) are used in contrast-enhanced magnetic resonance imaging. Hypersensitivity reactions (HSR) to GBCA are scarce, with an incidence of 0.07% and a recurrence rate of 30%, being urticaria the most common presentation (91%), with 0.52/10000 of severe reactions reported1. Recommendation of an alternative GBCA without checking tolerance is dangerous, due to high cross-reactivity between them2. Moreover, premedication is not enough1, showing an overall rate of breakthrough reactions of 39%3.Allergy studies to achieve a safe recommendation in HSR to GBCA have been performed. Negative predictive value of skin-tests to GBCA has been estimated in 84%1. Therefore, more than 10% of patients could react using an alternative negative skin-tested GBCA, and thus, good tolerance to GBCA should be confirmed through a drug challenge-test (DCT)4. These tests are usually performed at graded administrations, and with observation periods between doses1,5. However, since GBCA is usually given as a bolus during radiologic exams, DCT at slow rates cannot be extrapolated to further administrations. Trying to avoid this limitation, we study the tolerance of an alternative GBCA, by means of a fast DCT, approaching the infusion rates used in clinical practice.In accordance with the safety warnings to avoid linear GBCA, we have only used the macrocyclic drugs gadobutrol (Gb) and gadoteric acid (Ga). After obtaining signed informed consent from the patients, skin pricktests (SPT) with undiluted macrocyclic GBCA commercial solutions were done. When SPT at 20 min yielded negative results, intradermal tests (IDT) with 1:10 dilutions were performed, with subsequent readings at both 20 min and 24 hours.A fast DCT with negative skin-tested GBCA was then performed, following our methodology to study HSR to iodinated contrast media, previously described elsewhere6. Doses were 0.2 mg/kg for Ga and 0.1 mg/kg for Gb. First, one third of the total dose of Ga was administered at a rate of 120 cc/hour and, immediately after, the remaining 2/3 at 80 cc/hour. In case of Gb, infusion rates were half those of Ga, i.e., 1/3 at 60 cc/hour and 2/3 at 40 cc/hour. Total infusion time was 8 minutes for both of them. Well-tolerated GBCA was finally recommended for subsequent examinations, and its tolerance was recorded if it was used later.Study results of sixteen patients that were enrolled are summarized in Table 1. They were 12 women and 4 men, with median age of 45.5 years (range 28-73). Adverse reactions to GBCA were immediate in 13 patients (12 urticaria or exanthema, and 1 anaphylaxis), and delayed exanthema in the remaining 3. Gb was involved in 11 reactions, and unknown GBCA in the other 5. Most of the patients (14/16) had been previously exposed to GBCA.Median delay to perform the allergy study was 10 months (range 2-72 months). All skin-tests were negative, except in one patient who showed an immediate positive SPT to Gb, which had been the GBCA involved in the adverse reaction. In our study, we have estimated a negative predictive value of skintests to GBCA of 89%. DCT were negative in 14 patients (12 with Ga, and 2 with Gb). Finally, 15 out of 16 patients had an alternative GBCA, avoiding the use of premedication. In fact, tolerance has been confirmed in 7 of them in subsequent examinations.Safety of our protocol has been confirmed because our 2 positive DCT showed only mild reactions (delayed exanthema and immediate urticarial, both with Ga), and also by including a patient with previous anaphylaxis to GBCA.Here we present a prospective protocol to identify a safe alternative GBCA, including DCT at high infusion rates. Further studies will be necessary on this item/to check this.

Allergic diseases are becoming a major healthcare issue in many developed nations, where living environment and lifestyle are most predominantly distinct. Such differences include urbanized, industrialized living environments, overused hygiene products, antibiotics, stationary lifestyle, and fast-food based diets tend to reduce microbial diversity and lead to impared immune protection, which further increase the development of allergic diseases. In the same time, studies also showed that modulating microbiomes can ameliorate allergic symptoms. Therefore, in this paper, we aimed to review recent findings on the potential role of the human microbiome in the gastrointestinal tract, surface of skin and respiratory tract for the development of allergic diseases. Furthermore, we addressed a potential therapeutic or even preventive strategy for such allergic diseases by modulating the human microbial composition.

[Background] Ovarian teratomas are the most common ovarian tumors in children. Fertility-sparing surgery (FSS) is often recommended owing to its advantage of fertility preservation. We examined the validity of FSS in pediatric patients with ovarian teratomas. [Procedure] We retrospectively reviewed the medical records of patients who underwent initial surgery for ovarian teratomas in our department between 1972–2021. Patients were divided into two groups: oophorectomy (OVX) group and FSS group. Clinical characteristics, perioperative characteristics, and outcomes were compared between the groups. [Results] Forty-six patients underwent initial surgery (OVX: 25 patients; FSS: 21 patients). There were no differences between the groups in terms of age, pathological diagnosis, affected side, ovarian torsion, postoperative complications, recurrence rate, or length of postoperative follow-up. Regarding pathological diagnosis, immature teratomas were found only in the OVX group (p = 0.0161). The tumor size was larger in the OVX group (p = 0.0104). Regarding perioperative findings, operation time was longer in the FSS group (p = 0.0071) and bleeding volume was higher in the OVX group (p = 0.0070). The number of days until the start of oral intake and the length of hospital stay postoperatively were shorter in the FSS group (p = 0.0002 and p < 0.0001, respectively). [Conclusion] We demonstrated the advantages of FSS, including its minimally invasive approach and comparable outcomes in terms of tumor recurrence; the operation time was longer. Since both FSS and OVX are associated with a risk of tumor recurrence, long-term follow-up in anticipation of adult transition is necessary.

This is an invited commentary. I did not think abstracts were required for commentaries.

Objective: We aimed to explore the relationship between the bedside assistant’s seniority in RALH for cervical cancer and perioperative outcomes and postoperative complications. Design: Retrospective, Single-center, Case-control study Setting: The First Affiliated Hospital of Guangxi Medical University Population: A total of 76 patients diagnosed with FIGO stage IA- IIA cervical cancer received robotic-assisted radical hysterectomy with pelvic lymphadenectomy between January 2020 and January 2022. Methods: The enrolled objects were divided into three groups, according to the length of time the bedside assistant involving in gynecological work, which was ≤ 5 years (group 1), 5-10 years (group 2), and ≥ 10 years (group 1). Dates of operative time, estimated blood loss, length of stay and postoperative complications were analyzed by SPSS. Main outcome measures: The total operation time was calculated from the preparation time to closure time. Results: A statistically significant difference was observed among the data of operative time (P=0.002). Pairwise comparison between group 3 and group 1, 2 noted that there were significant differences. The operative time of group 3 was shorter than group 1 and group 2 (p=0.001, p=0.002 respectively). However, no significant differences were observed in terms of the length of stay (P=0.398), estimated blood loss (P=0.314), postoperative complications within 42 days (P=0.444), and postoperative complications after 42 days (P=0.223) between these three groups were not statistically significant. Conclusion: BA’s experience had no positive influence on perioperative surgical outcomes and postoperative complications, except for a shorter operative time only when they incorporated into gynecology ≥ ten years.