Control signaling is mandatory for the operation and management of all types of communication networks,including the Third Generation Partnership Project(3GPP)mobile broadband networks.However,they consume important a...Control signaling is mandatory for the operation and management of all types of communication networks,including the Third Generation Partnership Project(3GPP)mobile broadband networks.However,they consume important and scarce network resources such as bandwidth and processing power.There have been several reports of these control signaling turning into signaling storms halting network operations and causing the respective Telecom companies big financial losses.This paper draws its motivation from such real network disaster incidents attributed to signaling storms.In this paper,we present a thorough survey of the causes,of the signaling storm problems in 3GPP-based mobile broadband networks and discuss in detail their possible solutions and countermeasures.We provide relevant analytical models to help quantify the effect of the potential causes and benefits of their corresponding solutions.Another important contribution of this paper is the comparison of the possible causes and solutions/countermeasures,concerning their effect on several important network aspects such as architecture,additional signaling,fidelity,etc.,in the form of a table.This paper presents an update and an extension of our earlier conference publication.To our knowledge,no similar survey study exists on the subject.展开更多
Developing effective and long-term treatment strategies for rare and complex neurodegenerative diseases is challenging. One of the major roadblocks is the extensive heterogeneity among patients. This hinders understan...Developing effective and long-term treatment strategies for rare and complex neurodegenerative diseases is challenging. One of the major roadblocks is the extensive heterogeneity among patients. This hinders understanding the underlying disease-causing mechanisms and building solutions that have implications for a broad spectrum of patients. One potential solution is to develop personalized medicine approaches based on strategies that target the most prevalent cellular events that are perturbed in patients. Especially in patients with a known genetic mutation, it may be possible to understand how these mutations contribute to problems that lead to neurodegeneration. Protein–protein interaction analyses offer great advantages for revealing how proteins interact, which cellular events are primarily involved in these interactions, and how they become affected when key genes are mutated in patients. This line of investigation also suggests novel druggable targets for patients with different mutations. Here, we focus on alsin and spastin, two proteins that are identified as “causative” for amyotrophic lateral sclerosis and hereditary spastic paraplegia, respectively, when mutated. Our review analyzes the protein interactome for alsin and spastin, the canonical pathways that are primarily important for each protein domain, as well as compounds that are either Food and Drug Administration–approved or are in active clinical trials concerning the affected cellular pathways. This line of research begins to pave the way for personalized medicine approaches that are desperately needed for rare neurodegenerative diseases that are complex and heterogeneous.展开更多
This article revisits the concept of epistemological rupture by questioning the stark division between scientific and non-scientific thought. Drawing on the theory of representation, it contends that both forms of kno...This article revisits the concept of epistemological rupture by questioning the stark division between scientific and non-scientific thought. Drawing on the theory of representation, it contends that both forms of knowledge are socially constructed, moulded by communication, norms and group dynamics. Rather than labelling non-scientific thought as flawed or regressive, the discussion shows how decontextualization and recontextualization processes apply equally to everyday ‘natural' knowledge and formal science,exposing the social and historical contingencies shaping concepts. Consequently, rupture appears less a sudden break than a gradual threshold reached through dialectical transformations in cognition and society. Rather than conferring total superiority on science, ruptures highlight how certain discourses gain legitimacy while others become ‘non-knowledge'. The article concludes that science's dominance reflects broader power relationships and evolving modes of production and validation. By situating epistemological rupture within these processes, it illuminates how different knowledge forms coexist, evolve and sometimes conflict in stratified social fields—ultimately challenging a simplistic binary between scientific progress and supposedly primitive or natural thought. This viewpoint opens new possibilities for examining the shifting boundaries between rational explanations and the shared beliefs shaping collective reality and daily life.展开更多
Particle Swarm Optimization(PSO)has been utilized as a useful tool for solving intricate optimization problems for various applications in different fields.This paper attempts to carry out an update on PSO and gives a...Particle Swarm Optimization(PSO)has been utilized as a useful tool for solving intricate optimization problems for various applications in different fields.This paper attempts to carry out an update on PSO and gives a review of its recent developments and applications,but also provides arguments for its efficacy in resolving optimization problems in comparison with other algorithms.Covering six strategic areas,which include Data Mining,Machine Learning,Engineering Design,Energy Systems,Healthcare,and Robotics,the study demonstrates the versatility and effectiveness of the PSO.Experimental results are,however,used to show the strong and weak parts of PSO,and performance results are included in tables for ease of comparison.The results stress PSO’s efficiency in providing optimal solutions but also show that there are aspects that need to be improved through combination with algorithms or tuning to the parameters of the method.The review of the advantages and limitations of PSO is intended to provide academics and practitioners with a well-rounded view of the methods of employing such a tool most effectively and to encourage optimized designs of PSO in solving theoretical and practical problems in the future.展开更多
This article discusses the innovative use of computed tomography radiomics combined with clinical factors to predict treatment response to first-line transarterial chemoembolization in hepatocellular carcinoma.Zhao et...This article discusses the innovative use of computed tomography radiomics combined with clinical factors to predict treatment response to first-line transarterial chemoembolization in hepatocellular carcinoma.Zhao et al developed a robust predictive model demonstrating high accuracy(area under the curve 0.92 in the training cohort)by integrating venous phase radiomic features with alphafetoprotein levels.This noninvasive approach enables early identification of patients unlikely to benefit from transarterial chemoembolization,allowing a timely transition to alternative therapies such as targeted agents or immunotherapy.Such precision strategies may improve clinical outcomes,optimize resource utilization,and increase survival in advanced hepatocellular carcinoma management.Future studies should emphasize external validation and broader clinical adoption.展开更多
BACKGROUND Congenital hallux varus(CHV)is a rare form of hallux varus deformity,characterized by medial deviation of the first toe at the metatarsophalangeal joint.It may be primary or secondary and presents clinicall...BACKGROUND Congenital hallux varus(CHV)is a rare form of hallux varus deformity,characterized by medial deviation of the first toe at the metatarsophalangeal joint.It may be primary or secondary and presents clinically with pain and asymmetry with footwear.CASE SUMMARY We documented a case of a 6-year-old girl with bilateral CHV,accompanied by adduction of the toes in the left foot.Clinical diagnosis was made by physical examination and X-ray imaging based on Bleck’s classification.Conservative treatment did not show any noticeable improvement,so the child underwent corrective surgeries on both feet.CONCLUSION The patient’s family history is positive,which requires us to take into account the importance of checking for a family history with any complaint of CHV,and both feet must be evaluated to confirm whether the deformity is unilateral or bilateral.展开更多
BACKGROUND Hip dysplasia is a widespread and debilitating musculoskeletal disorder that affects children.Its prevalence varies across different nations.AIM To evaluate the prevalence of developmental hip dysplasia(DDH...BACKGROUND Hip dysplasia is a widespread and debilitating musculoskeletal disorder that affects children.Its prevalence varies across different nations.AIM To evaluate the prevalence of developmental hip dysplasia(DDH)within the pediatric population of Al Jouf province.METHODS From January 2018 to December 2023,children with DDH from all cities of Al Jouf were included in this retrospective cross-sectional study.The disease prevalence was calculated for the entire province as well as for individual cities within the territory.RESULTS The study included 427 patients with DDH with an overall prevalence of 0.50%,or 5.0 per 1000 live births.At the city level,Sakaka had the highest prevalence at 14.2 per 1000 Live births followed by Qurayyat at 2.2 per 1000 live births.In contrast,cities like Suwayr,Abu Ajram,and Meegowa did not show any incidence of DDH.Significant differences were observed in the sociodemographic characteristics,such as age,sex,and nationality,across the different cities(P<0.05).CONCLUSION The prevalence of DDH in the Al Jouf province is high.The data delivers invaluable insights into the epidemiology of DDH in the Al Jouf locality.The findings highlight the need for targeted screening of DDH across the province.展开更多
Third-space endoscopy(TSE)has emerged as an effective treatment modality for various gastrointestinal motility diseases and gastrointestinal tumors.TSE is based on the concept of working in the submucosa using a mucos...Third-space endoscopy(TSE)has emerged as an effective treatment modality for various gastrointestinal motility diseases and gastrointestinal tumors.TSE is based on the concept of working in the submucosa using a mucosal flap valve technique,which is the underlying premise for all TSE procedures;thus,some complications are shared across the spectrum of TSE procedures.Despite the high safety profiles of most TSE procedures,studies have reported various adverse events,including insufflation-related complications,bleeding,perforation,and infection.Although the occurrence rate of those complications is not very high,they sometimes result in critical conditions.No reports of chylous effusion following TSE procedures,particularly per-oral endoscopic myotomy,have been documented previously.We are presenting the first reported case of chylous pleural effusion after per-oral endoscopic myotomy.Additionally,we aim to present a comprehensive overview,discuss the existing data,and provide insights into pulmonary post-endoscopic complications in light of recent advancements in endoscopic procedures,especially TSE.展开更多
BACKGROUND Children with autism spectrum disorder(ASD)face unique challenges in maintaining oral health due to sensory sensitivities,communication difficulties,and behavioral barriers.These factors,along with limited ...BACKGROUND Children with autism spectrum disorder(ASD)face unique challenges in maintaining oral health due to sensory sensitivities,communication difficulties,and behavioral barriers.These factors,along with limited access to ASD-trained dental professionals,increase their risk of dental caries,periodontal disease,bruxism,and other oral health issues.Despite growing awareness of these challenges,a comprehensive synthesis of evidence-based solutions remains lacking.AIM To review synthesizes existing research on dental problems in ASD,barriers to care,management strategies,and future directions for improved oral health outcomes.METHODS A systematic search of PubMed,Cochrane Library,and Scopus was conducted using predefined search terms.Related to ASD,dental health,and management strategies.Inclusion criteria encompassed studies focusing on children with ASD,dental health issues,and interventions.Data extraction included study design,participant characteristics,key findings,and intervention outcomes.The quality of studies was assessed using appropriate tools such as the Cochrane Risk of Bias Tool and the Newcastle-Ottawa Scale.A narrative synthesis approach,incorporating thematic analysis,was utilized to evaluate the findings.RESULTS A total of 165 studies met the inclusion criteria.Children with ASD exhibited a higher prevalence of dental caries,gingivitis,bruxism,and malocclusion compared to neurotypical peers.Barriers to dental care included sensory sensitivities,communication difficulties,financial constraints,and a shortage of ASD-trained dental professionals.Effective interventions included desensitization programs,behavioral therapy,digital applications,and interdiscip-linary collaboration.Parental education and professional training were crucial for improving oral health outcomes.CONCLUSION Tailored dental care strategies,including sensory adaptations,behavioral interventions,and interdisciplinary collaboration,are essential for children with ASD.Standardized guidelines and long-term studies are needed to refine evidence-based protocols.Future research should explore digital interventions and probiotic applications in ASD dental care.展开更多
BACKGROUND Malakoplakia is a rare chronic granulomatous disease associated with gramnegative infection,predominantly by Escherichia coli.It is induced by defective phagolysosomal activity of the macrophages.Malakoplak...BACKGROUND Malakoplakia is a rare chronic granulomatous disease associated with gramnegative infection,predominantly by Escherichia coli.It is induced by defective phagolysosomal activity of the macrophages.Malakoplakia commonly affects the urinary bladder but has been shown to affect any solid organ,including the native and transplanted kidney.However,isolated malakoplakia of the kidney allograft is rare.Transplant recipients with compromised immune systems are more likely to develop malakoplakia.CASE SUMMARY We report three cases of kidney allograft parenchymal malakoplakia in kidney transplant recipients on immunosuppression that were successfully managed with good outcomes.We described the clinical characteristics of all the kidney allograft malakoplakia cases documented in the literature.A total of 55 cases of malakoplakia were reported in recipients with a history of kidney transplant.A total of 27 recipients had malakoplakia involving the allograft,and others had malakoplakia in other organs.The common presentations included allograft dysfunction,pyelonephritis,and allograft or systemic mass.Most recipients had favorable outcomes with appropriate management that included prolonged antibiotic therapy and adjustment of immunosuppression.We reviewed the published literature on all the cases of malakoplakia in kidney transplant recipients so far and summarized the etiology,management,and outcomes.CONCLUSION This case series provides an overview of the etiology,presentation,pathogenesis,and management of malakoplakia in kidney transplant recipients.展开更多
BACKGROUND The hepatosplenic schistosomiasis(HSS)with portal hypertension can cause vascular complications such as hepatopulmonary syndrome(HPS).HPS increases the risk of mortality in patients with cirrhosis;however,t...BACKGROUND The hepatosplenic schistosomiasis(HSS)with portal hypertension can cause vascular complications such as hepatopulmonary syndrome(HPS).HPS increases the risk of mortality in patients with cirrhosis;however,there is no data on the mortality of patients with HSS and HPS.AIM To perform a survival analysis of patients with HPS related to cirrhotic and non-cirrhotic(schistosomiasis)portal hypertension.METHODS From August 2023 to January 2024,medical records and the official mortality information service of 121 patients who participated in a cross-sectional study on HPS between 2010 and 2012 were analyzed.Survival curves were created using the Kaplan-Meier method,and comparisons were performed using the log-rank test.Cox regression models estimated the hazard ratios(HR).RESULTS Overall,data of 113 patients were analyzed;most(55.8%)had HSS and concomitant cirrhosis(HSS/cirrhosis).Meanwhile,HPS was present in 39(34.5%)patients.Death occurred in 65 patients[57.5%];95%confidence interval(CI):48%-67%.The average time to death was lower in those with HPS when compared to those without HPS(3.37 years vs 5.65 years;P=0.017).According to the cause of liver disease,patients with HSS/cirrhosis died earlier,and their risk of death was twice as high compared with patients with HSS without cirrhosis(HR:2.17;95%CI:1.3-3.60;P=0.003).Meanwhile,there were no differences when comparing the two groups with and without HPS(HR:1.01;95%CI:0.59-1.73;P=0.967).CONCLUSION Patients with HSS and concomitant cirrhosis had a lower survival rate,but there was no difference in survival regardless of the presence of HPS.展开更多
BACKGROUND While existing literature on ischiofemoral impingement syndrome(IFI)predominantly emphasizes surgical interventions or generalized physical therapy approaches,there remains a paucity of evidence regarding s...BACKGROUND While existing literature on ischiofemoral impingement syndrome(IFI)predominantly emphasizes surgical interventions or generalized physical therapy approaches,there remains a paucity of evidence regarding structured,multimodal rehabilitation programs targeting biomechanical deficits in IFI.This case report evaluates the efficacy of a multimodal rehabilitation program addressing a critical gap in conservative management strategies.CASE SUMMARY The patient underwent comprehensive physical and clinical examination,including hip X-ray and magnetic resonance imaging investigations.The patient completed the Musculoskeletal Health Questionnaire(MSK-HQ)and numerical pain rating scale(NPRS).The patient underwent a two-month tailored structured physical therapy intervention and repeated the same assessment afterwards.The patient's substantial reduction in pain,reflected by a significant decrease in the patient’s NPRS score from 9 to 3 points,signifies a positive clinical response.This outcome,coupled with the significant improvement in the patient's health-related quality of life according to the MSK-HQ score,which increased from 12 to 48 points,underscores the success of our research.CONCLUSION The study highlights the importance of a comprehensive approach to diagnosing and managing IFI,combining clinical assessment with imaging and implementing a multimodal rehabilitation program for optimal outcomes.展开更多
BACKGROUND Severe acute respiratory syndrome coronavirus 2 induced coronavirus disease 2019(COVID-19)has posed a great challenge to public health worldwide and also increased susceptibility to colorectal cancer(CRC).N...BACKGROUND Severe acute respiratory syndrome coronavirus 2 induced coronavirus disease 2019(COVID-19)has posed a great challenge to public health worldwide and also increased susceptibility to colorectal cancer(CRC).Natural killer(NK)cells serve as the first line of defense in the host’s innate immune system,performing natural killing functions and mediating cytotoxicity against tumors and viruses.Therefore,a better understanding of NK cell cytotoxicity may facilitate the development of treatment strategies for CRC-associated with COVID-19.AIM To investigate the cytotoxic killing function of peripheral NK cells in patients with CRC and severe COVID-19(CRC+patients).METHODS The percentages of circulating NK and NKT cells in CRC+and age-matched patients with CRC were analyzed using flow cytometry.NK cell cytotoxic activity(NKCA)and corresponding NK cytotoxic factor(NKCF)activity in peripheral blood mononuclear cells were evaluated using a Real-Time Cell Analyzer.RESULTS The numbers and percentage of peripheral NK and NKT cells in patients with CRC+were lower than those in patients with CRC.Additionally,compared to patients with CRC,those with CRC+had lower levels of NKCA and NKCF activity in lysed K562 cells.Positive correlations were observed between NKCA and NK cell numbers,NKCA and NK cell percentages,NKCF activity,and NK cell percentages in patients with CRC+.Furthermore,a negative correlation was observed between NKCA and the severity of COVID-19 in patients with CRC.The area under the receiver operating characteristic curve for NKCA was greater than those for the other indices.CONCLUSION CRC+is associated with lower levels of peripheral NK cells and impaired natural cytotoxicity,contributing to the immunopathogenesis of severe COVID-19 rather than immune control.展开更多
Cardiac injury initiates repair mechanisms and results in cardiac remodeling and fi-brosis,which appears to be a leading cause of cardiovascular diseases.Cardiac fi-brosis is characterized by the accumulation of extra...Cardiac injury initiates repair mechanisms and results in cardiac remodeling and fi-brosis,which appears to be a leading cause of cardiovascular diseases.Cardiac fi-brosis is characterized by the accumulation of extracellular matrix proteins,mainly collagen in the cardiac interstitium.Many experimental studies have demonstrated that fibrotic injury in the heart is reversible;therefore,it is vital to understand differ-ent molecular mechanisms that are involved in the initiation,progression,and resolu-tion of cardiac fibrosis to enable the development of antifibrotic agents.Of the many experimental models,one of the recent models that has gained renewed interest is isoproterenol(ISP)-induced cardiac fibrosis.ISP is a synthetic catecholamine,sympa-thomimetic,and nonselectiveβ-adrenergic receptor agonist.The overstimulated and sustained activation ofβ-adrenergic receptors has been reported to induce biochemi-cal and physiological alterations and ultimately result in cardiac remodeling.ISP has been used for decades to induce acute myocardial infarction.However,the use of low doses and chronic administration of ISP have been shown to induce cardiac fibrosis;this practice has increased in recent years.Intraperitoneal or subcutaneous ISP has been widely used in preclinical studies to induce cardiac remodeling manifested by fibrosis and hypertrophy.The induced oxidative stress with subsequent perturbations in cellular signaling cascades through triggering the release of free radicals is consid-ered the initiating mechanism of myocardial fibrosis.ISP is consistently used to induce fibrosis in laboratory animals and in cardiomyocytes isolated from animals.In recent years,numerous phytochemicals and synthetic molecules have been evaluated in ISP-induced cardiac fibrosis.The present review exclusively provides a comprehensive summary of the pathological biochemical,histological,and molecular mechanisms of ISP in inducing cardiac fibrosis and hypertrophy.It also summarizes the application of this experimental model in the therapeutic evaluation of natural as well as syn-thetic compounds to demonstrate their potential in mitigating myocardial fibrosis and hypertrophy.展开更多
Despite the global attention towards pollution,it remains a significant global threat and challenge for both developed and developing countries.Urbanization and economic development influence different types of pollut...Despite the global attention towards pollution,it remains a significant global threat and challenge for both developed and developing countries.Urbanization and economic development influence different types of pollution.Visual pollution is considered a new phenomenon referring to the impact of existing and growing mainstream pollution which impairs an individual’s ability to enjoy visits or views.Recently,Jordanian cities have expanded in response to urbanization and ongoing development.Irbid City has the second largest population in Jordan after the capital Amman City highest population density in Jordan.In the modern era,Irbid City dramatically increased in population and dimension.The growth of the demographic population has been significant and has led to overpopulation,rapid urbanization,and unresolved problems associated with spatial planning and infrastructures leading to different types of pollution including visual pollution.The study area focuses on the city center with the most crowded population through field visits and actual observations.The study technique is descriptive and analytical,with a focus on meticulous monitoring and a follow-up-based questionnaire which is a tool for the study,involving data collection,classification,presentation,analysis,interpretation,and exploration to identify new facts and generalizations that can help solve current issues of visual pollution.The study provides recommendations for Irbid Municipal to eliminate visual pollution,in parallel with stricter supervision from the municipality during the building process to ensure proper implementation of the new rules,adopting an integrated policy for the city with the rest of the social,political,sensory,cultural,economic,and functional aspects,so that this policy is in the short and long term.展开更多
In this paper, we examine the fundamental transformation of Property & Casualty (P&C) insurance through the introduction of Artificial Intelligence. This examination marks the shift from the traditional actuar...In this paper, we examine the fundamental transformation of Property & Casualty (P&C) insurance through the introduction of Artificial Intelligence. This examination marks the shift from the traditional actuarial methods to a dynamically data-driven approach. Some key innovations include the buzz around Large Language Models (LLMs) for customer interaction, Internet of Things (IoT) enabled risk-monitoring in real time and Machine Learning allowing for automated claims processing. The research highlights the early adopters like AXA, Lemonade and Allianz who are actively leveraging AI to reduce claims processing times by 80% while reducing manual labour and increasing customer satisfaction. The most critical of this transformation is the emergence of roles that act like hybrid strategists. Such professionals combine traditional insurance expertise with acumen in technology. In our paper, we discuss the requirement of how AI demands more than just simple adoption. It needs a comprehensive restructuring of organizational culture, better data infrastructure and better ethical frameworks. Development in Explainable AI (XAI) is also noteworthy for maintaining transparency, handling complex risks and addressing regulatory requirements while alignment with customer trust concerns.展开更多
BACKGROUND As living biodrugs,mesenchymal stem cells(MSCs)have progressed to phase 3 clinical trials for cardiovascular applications.However,their limited immediate availability hampers their routine clinical use.AIM ...BACKGROUND As living biodrugs,mesenchymal stem cells(MSCs)have progressed to phase 3 clinical trials for cardiovascular applications.However,their limited immediate availability hampers their routine clinical use.AIM To validate our hypothesis that cryopreserved MSCs(CryoMSCs)are as safe and effective as freshly cultured MSC counterparts but carry logistical advantages.METHODS Four databases were systematically reviewed for relevant randomized controlled trials(RCTs)evaluating the safety and efficacy of CryoMSCs from various tissue sources in treating patients with heart disease.A subgroup analysis was performed based on MSC source and post-thaw cell viability to determine treatment effects across different CryoMSCs sources and viability status.Weighted mean differences(WMDs)and odds ratios were calculated to measure changes in the estimated treatment effects.All statistical analyses were performed using RevMan version 5.4.1 software.RESULTS Seven RCTs(285 patients)met the eligibility criteria for inclusion in the metaanalysis.During short-term follow-up,^(Cryo)MSCs demonstrated a significant 2.11%improvement in left ventricular ejection fraction(LVEF)[WMD(95%CI)=2.11(0.66-3.56),P=0.004,I2=1%],with umbilical cord-derived MSCs being the most effective cell type.However,the significant effect on LVEF was not sustained over the 12 months of follow-up.Subgroup analysis demonstrated a substantial 3.44%improvement in LVEF[WMD(95%CI)=3.44(1.46-5.43),P=0.0007,I2=0%]when using MSCs with post-thaw viability exceeding 80%.There was no statistically significant difference in the frequency of major cardiac adverse events observed in rehospitalization or mortality in patients treated with ^(Cryo)MSCs vs the control group.CONCLUSION ^(Cryo)MSCs are a promising option for heart failure patients,particularly considering the current treatment options for cardiovascular diseases.Our data suggest that ^(Cryo)MSCs could be a viable alternative or complementary treatment to the current options,potentially improving patient outcomes.展开更多
BACKGROUND Knee osteoarthritis(KOA)is a leading cause of arthritis-related morbidity.Mesenchymal stem cells(MSCs),as living biopharmaceuticals,have emerged as a potential treatment option due to their anti-inflammator...BACKGROUND Knee osteoarthritis(KOA)is a leading cause of arthritis-related morbidity.Mesenchymal stem cells(MSCs),as living biopharmaceuticals,have emerged as a potential treatment option due to their anti-inflammatory and immunomodulatory properties.AIM To compare the safety and efficacy of allogenic MSCs(^(Allo)MSCs)vs autologous MSCs(^(Auto)MSCs)in treating KOA in clinical settings.METHODS We conducted a systematic review and network meta-analysis to compare the safety and efficacy of^(Allo)MSCs vs^(Auto)MSCs in treating KOA.Our systematic search of four databases,including PubMed,Cochrane,Embase,and ClinicalTrials.gov,identified relevant randomized controlled trials(RCTs)reporting MSC-based treatment for KOA and reporting visual analog scale,Western Ontario and McMaster Universities Osteoarthritis scores,and adverse events.We assessed the methodological quality of the studies using the Cochrane Collaboration tool and calculated risk ratios(RRs)and weighted mean differences[with 95%confidence intervals(CIs)].Our statistical analyses used the R-Studio network meta-packages(version 2023.12.0).The study protocol was pre-registered on the International Prospective Register of Systematic Reviews(ID:CRD42024590866).RESULTS Nineteen RCTs involving 1216 patients with KOA met the inclusion criteria of the study.The network metaanalysis showed that^(Allo)MSCs gave a significant re-duction in visual analog scale scores by 14.91 points(95%CI:-24.52 to-5.30)vs 12.95 points with^(Auto)MSCs(95%CI:-24.42 to-1.48).For Western Ontario and McMaster Universities Osteoarthritis score,^(Allo)MSCs led to a significant reduction of 23.12 points(95%CI:-31.15 to-15.10)compared with 12.45 points using^(Auto)MSCs(95%CI:-19.31 to-5.59),thus revealing a significant improvement with^(Allo)MSCs(weighted mean difference:-10.62,95%CI:-21.23 to-0.11).Additionally,^(Auto)MSCs treatment showed a higher risk of joint-related adverse events(RR=1.39,95%CI:1.07-1.79)compared with^(Allo)MSCs(RR=1.13,95%CI:1.01-1.25).CONCLUSION^(Allo)MSCs may offer superior clinical outcomes with a lower risk of adverse events compared with^(Auto)MSCs in the treatment of KOA.However,the need for further RCTs directly comparing the two MSC types is crucial to validate this data,underscoring the importance of our findings in this field.展开更多
Alzheimer’s disease is a neurodegenerative disease resulting from deficits in synaptic transmission and homeostasis.The Alzheimer’s disease brain tends to be hyperexcitable and hypersynchronized,thereby causing neur...Alzheimer’s disease is a neurodegenerative disease resulting from deficits in synaptic transmission and homeostasis.The Alzheimer’s disease brain tends to be hyperexcitable and hypersynchronized,thereby causing neurodegeneration and ultimately disrupting the operational abilities in daily life,leaving patients incapacitated.Repetitive transcranial magnetic stimulation is a cost-effective,neuro-modulatory technique used for multiple neurological conditions.Over the past two decades,it has been widely used to predict cognitive decline;identify pathophysiological markers;promote neuroplasticity;and assess brain excitability,plasticity,and connectivity.It has also been applied to patients with dementia,because it can yield facilitatory effects on cognition and promote brain recovery after a neurological insult.However,its therapeutic effectiveness at the molecular and synaptic levels has not been elucidated because of a limited number of studies.This study aimed to characterize the neurobiological changes following repetitive transcranial magnetic stimulation treatment,evaluate its effects on synaptic plasticity,and identify the associated mechanisms.This review essentially focuses on changes in the pathology,amyloidogenesis,and clearance pathways,given that amyloid deposition is a major hypothesis in the pathogenesis of Alzheimer’s disease.Apoptotic mechanisms associated with repetitive transcranial magnetic stimulation procedures and different pathways mediating gene transcription,which are closely related to the neural regeneration process,are also highlighted.Finally,we discuss the outcomes of animal studies in which neuroplasticity is modulated and assessed at the structural and functional levels by using repetitive transcranial magnetic stimulation,with the aim to highlight future directions for better clinical translations.展开更多
BACKGROUND Gastric signet ring cell carcinoma(SRCC)is a rare,aggressive subtype of gastric cancer characterized by poor prognosis and distinctive biological behavior.Despite advances in gastric cancer treatment,SRCC r...BACKGROUND Gastric signet ring cell carcinoma(SRCC)is a rare,aggressive subtype of gastric cancer characterized by poor prognosis and distinctive biological behavior.Despite advances in gastric cancer treatment,SRCC remains difficult to diagnose early and manage effectively due to its infiltrative pattern and molecular variability.Reliable prognostic markers are critical to guide clinical management.AIM To investigate the prognostic factors,including human epidermal growth factor receptor 2(HER2)expression,associated with survival outcomes in patients with gastric SRCC.METHODS A retrospective analysis of 100 cases diagnosed between 2015 and 2019 was conducted,assessing demographic,clinical,and pathological data.HER2 expression was analyzed using immunohistochemistry,and survival outcomes,including overall survival and disease-free survival,were examined.RESULTS With a median follow-up of 43 months,the median patient age was 50 years,and males exhibited a higher mortality rate(P=0.0107).Elevated serum carbohydrate antigen 19-9 and carcinoembryonic antigen levels were significantly associated with increased mortality(P=0.00149 and P=0.00163,respectively).Advanced tumornode-metastasis stage and lymphovascular invasion were strong predictors of poor outcomes(P<0.001 and P=0.019).HER2 positivity correlated with higher mortality(P=0.00882)but was not significantly linked to recurrence(P=0.53).Surgical treatment significantly improved survival compared with non-surgical approaches(P=0.0226).CONCLUSION These findings highlight the aggressive nature of SRCC with advanced disease stage,elevated tumor markers,and lymphovascular invasion contributing to poor outcomes.HER2 expression,though infrequent,may indicate worse prognosis,reinforcing the role of surgical intervention in survival improvement.展开更多
基金the Deanship of Graduate Studies and Scientific Research at Qassim University for financial support(QU-APC-2024-9/1).
文摘Control signaling is mandatory for the operation and management of all types of communication networks,including the Third Generation Partnership Project(3GPP)mobile broadband networks.However,they consume important and scarce network resources such as bandwidth and processing power.There have been several reports of these control signaling turning into signaling storms halting network operations and causing the respective Telecom companies big financial losses.This paper draws its motivation from such real network disaster incidents attributed to signaling storms.In this paper,we present a thorough survey of the causes,of the signaling storm problems in 3GPP-based mobile broadband networks and discuss in detail their possible solutions and countermeasures.We provide relevant analytical models to help quantify the effect of the potential causes and benefits of their corresponding solutions.Another important contribution of this paper is the comparison of the possible causes and solutions/countermeasures,concerning their effect on several important network aspects such as architecture,additional signaling,fidelity,etc.,in the form of a table.This paper presents an update and an extension of our earlier conference publication.To our knowledge,no similar survey study exists on the subject.
基金funded by NIH-NIA R01AG061708 (to PHO)Patrick Grange Memorial Foundation (to PHO)+1 种基金A Long Swim (to PHO)CureSPG4 Foundation (to PHO)。
文摘Developing effective and long-term treatment strategies for rare and complex neurodegenerative diseases is challenging. One of the major roadblocks is the extensive heterogeneity among patients. This hinders understanding the underlying disease-causing mechanisms and building solutions that have implications for a broad spectrum of patients. One potential solution is to develop personalized medicine approaches based on strategies that target the most prevalent cellular events that are perturbed in patients. Especially in patients with a known genetic mutation, it may be possible to understand how these mutations contribute to problems that lead to neurodegeneration. Protein–protein interaction analyses offer great advantages for revealing how proteins interact, which cellular events are primarily involved in these interactions, and how they become affected when key genes are mutated in patients. This line of investigation also suggests novel druggable targets for patients with different mutations. Here, we focus on alsin and spastin, two proteins that are identified as “causative” for amyotrophic lateral sclerosis and hereditary spastic paraplegia, respectively, when mutated. Our review analyzes the protein interactome for alsin and spastin, the canonical pathways that are primarily important for each protein domain, as well as compounds that are either Food and Drug Administration–approved or are in active clinical trials concerning the affected cellular pathways. This line of research begins to pave the way for personalized medicine approaches that are desperately needed for rare neurodegenerative diseases that are complex and heterogeneous.
文摘This article revisits the concept of epistemological rupture by questioning the stark division between scientific and non-scientific thought. Drawing on the theory of representation, it contends that both forms of knowledge are socially constructed, moulded by communication, norms and group dynamics. Rather than labelling non-scientific thought as flawed or regressive, the discussion shows how decontextualization and recontextualization processes apply equally to everyday ‘natural' knowledge and formal science,exposing the social and historical contingencies shaping concepts. Consequently, rupture appears less a sudden break than a gradual threshold reached through dialectical transformations in cognition and society. Rather than conferring total superiority on science, ruptures highlight how certain discourses gain legitimacy while others become ‘non-knowledge'. The article concludes that science's dominance reflects broader power relationships and evolving modes of production and validation. By situating epistemological rupture within these processes, it illuminates how different knowledge forms coexist, evolve and sometimes conflict in stratified social fields—ultimately challenging a simplistic binary between scientific progress and supposedly primitive or natural thought. This viewpoint opens new possibilities for examining the shifting boundaries between rational explanations and the shared beliefs shaping collective reality and daily life.
文摘Particle Swarm Optimization(PSO)has been utilized as a useful tool for solving intricate optimization problems for various applications in different fields.This paper attempts to carry out an update on PSO and gives a review of its recent developments and applications,but also provides arguments for its efficacy in resolving optimization problems in comparison with other algorithms.Covering six strategic areas,which include Data Mining,Machine Learning,Engineering Design,Energy Systems,Healthcare,and Robotics,the study demonstrates the versatility and effectiveness of the PSO.Experimental results are,however,used to show the strong and weak parts of PSO,and performance results are included in tables for ease of comparison.The results stress PSO’s efficiency in providing optimal solutions but also show that there are aspects that need to be improved through combination with algorithms or tuning to the parameters of the method.The review of the advantages and limitations of PSO is intended to provide academics and practitioners with a well-rounded view of the methods of employing such a tool most effectively and to encourage optimized designs of PSO in solving theoretical and practical problems in the future.
文摘This article discusses the innovative use of computed tomography radiomics combined with clinical factors to predict treatment response to first-line transarterial chemoembolization in hepatocellular carcinoma.Zhao et al developed a robust predictive model demonstrating high accuracy(area under the curve 0.92 in the training cohort)by integrating venous phase radiomic features with alphafetoprotein levels.This noninvasive approach enables early identification of patients unlikely to benefit from transarterial chemoembolization,allowing a timely transition to alternative therapies such as targeted agents or immunotherapy.Such precision strategies may improve clinical outcomes,optimize resource utilization,and increase survival in advanced hepatocellular carcinoma management.Future studies should emphasize external validation and broader clinical adoption.
文摘BACKGROUND Congenital hallux varus(CHV)is a rare form of hallux varus deformity,characterized by medial deviation of the first toe at the metatarsophalangeal joint.It may be primary or secondary and presents clinically with pain and asymmetry with footwear.CASE SUMMARY We documented a case of a 6-year-old girl with bilateral CHV,accompanied by adduction of the toes in the left foot.Clinical diagnosis was made by physical examination and X-ray imaging based on Bleck’s classification.Conservative treatment did not show any noticeable improvement,so the child underwent corrective surgeries on both feet.CONCLUSION The patient’s family history is positive,which requires us to take into account the importance of checking for a family history with any complaint of CHV,and both feet must be evaluated to confirm whether the deformity is unilateral or bilateral.
文摘BACKGROUND Hip dysplasia is a widespread and debilitating musculoskeletal disorder that affects children.Its prevalence varies across different nations.AIM To evaluate the prevalence of developmental hip dysplasia(DDH)within the pediatric population of Al Jouf province.METHODS From January 2018 to December 2023,children with DDH from all cities of Al Jouf were included in this retrospective cross-sectional study.The disease prevalence was calculated for the entire province as well as for individual cities within the territory.RESULTS The study included 427 patients with DDH with an overall prevalence of 0.50%,or 5.0 per 1000 live births.At the city level,Sakaka had the highest prevalence at 14.2 per 1000 Live births followed by Qurayyat at 2.2 per 1000 live births.In contrast,cities like Suwayr,Abu Ajram,and Meegowa did not show any incidence of DDH.Significant differences were observed in the sociodemographic characteristics,such as age,sex,and nationality,across the different cities(P<0.05).CONCLUSION The prevalence of DDH in the Al Jouf province is high.The data delivers invaluable insights into the epidemiology of DDH in the Al Jouf locality.The findings highlight the need for targeted screening of DDH across the province.
文摘Third-space endoscopy(TSE)has emerged as an effective treatment modality for various gastrointestinal motility diseases and gastrointestinal tumors.TSE is based on the concept of working in the submucosa using a mucosal flap valve technique,which is the underlying premise for all TSE procedures;thus,some complications are shared across the spectrum of TSE procedures.Despite the high safety profiles of most TSE procedures,studies have reported various adverse events,including insufflation-related complications,bleeding,perforation,and infection.Although the occurrence rate of those complications is not very high,they sometimes result in critical conditions.No reports of chylous effusion following TSE procedures,particularly per-oral endoscopic myotomy,have been documented previously.We are presenting the first reported case of chylous pleural effusion after per-oral endoscopic myotomy.Additionally,we aim to present a comprehensive overview,discuss the existing data,and provide insights into pulmonary post-endoscopic complications in light of recent advancements in endoscopic procedures,especially TSE.
文摘BACKGROUND Children with autism spectrum disorder(ASD)face unique challenges in maintaining oral health due to sensory sensitivities,communication difficulties,and behavioral barriers.These factors,along with limited access to ASD-trained dental professionals,increase their risk of dental caries,periodontal disease,bruxism,and other oral health issues.Despite growing awareness of these challenges,a comprehensive synthesis of evidence-based solutions remains lacking.AIM To review synthesizes existing research on dental problems in ASD,barriers to care,management strategies,and future directions for improved oral health outcomes.METHODS A systematic search of PubMed,Cochrane Library,and Scopus was conducted using predefined search terms.Related to ASD,dental health,and management strategies.Inclusion criteria encompassed studies focusing on children with ASD,dental health issues,and interventions.Data extraction included study design,participant characteristics,key findings,and intervention outcomes.The quality of studies was assessed using appropriate tools such as the Cochrane Risk of Bias Tool and the Newcastle-Ottawa Scale.A narrative synthesis approach,incorporating thematic analysis,was utilized to evaluate the findings.RESULTS A total of 165 studies met the inclusion criteria.Children with ASD exhibited a higher prevalence of dental caries,gingivitis,bruxism,and malocclusion compared to neurotypical peers.Barriers to dental care included sensory sensitivities,communication difficulties,financial constraints,and a shortage of ASD-trained dental professionals.Effective interventions included desensitization programs,behavioral therapy,digital applications,and interdiscip-linary collaboration.Parental education and professional training were crucial for improving oral health outcomes.CONCLUSION Tailored dental care strategies,including sensory adaptations,behavioral interventions,and interdisciplinary collaboration,are essential for children with ASD.Standardized guidelines and long-term studies are needed to refine evidence-based protocols.Future research should explore digital interventions and probiotic applications in ASD dental care.
文摘BACKGROUND Malakoplakia is a rare chronic granulomatous disease associated with gramnegative infection,predominantly by Escherichia coli.It is induced by defective phagolysosomal activity of the macrophages.Malakoplakia commonly affects the urinary bladder but has been shown to affect any solid organ,including the native and transplanted kidney.However,isolated malakoplakia of the kidney allograft is rare.Transplant recipients with compromised immune systems are more likely to develop malakoplakia.CASE SUMMARY We report three cases of kidney allograft parenchymal malakoplakia in kidney transplant recipients on immunosuppression that were successfully managed with good outcomes.We described the clinical characteristics of all the kidney allograft malakoplakia cases documented in the literature.A total of 55 cases of malakoplakia were reported in recipients with a history of kidney transplant.A total of 27 recipients had malakoplakia involving the allograft,and others had malakoplakia in other organs.The common presentations included allograft dysfunction,pyelonephritis,and allograft or systemic mass.Most recipients had favorable outcomes with appropriate management that included prolonged antibiotic therapy and adjustment of immunosuppression.We reviewed the published literature on all the cases of malakoplakia in kidney transplant recipients so far and summarized the etiology,management,and outcomes.CONCLUSION This case series provides an overview of the etiology,presentation,pathogenesis,and management of malakoplakia in kidney transplant recipients.
文摘BACKGROUND The hepatosplenic schistosomiasis(HSS)with portal hypertension can cause vascular complications such as hepatopulmonary syndrome(HPS).HPS increases the risk of mortality in patients with cirrhosis;however,there is no data on the mortality of patients with HSS and HPS.AIM To perform a survival analysis of patients with HPS related to cirrhotic and non-cirrhotic(schistosomiasis)portal hypertension.METHODS From August 2023 to January 2024,medical records and the official mortality information service of 121 patients who participated in a cross-sectional study on HPS between 2010 and 2012 were analyzed.Survival curves were created using the Kaplan-Meier method,and comparisons were performed using the log-rank test.Cox regression models estimated the hazard ratios(HR).RESULTS Overall,data of 113 patients were analyzed;most(55.8%)had HSS and concomitant cirrhosis(HSS/cirrhosis).Meanwhile,HPS was present in 39(34.5%)patients.Death occurred in 65 patients[57.5%];95%confidence interval(CI):48%-67%.The average time to death was lower in those with HPS when compared to those without HPS(3.37 years vs 5.65 years;P=0.017).According to the cause of liver disease,patients with HSS/cirrhosis died earlier,and their risk of death was twice as high compared with patients with HSS without cirrhosis(HR:2.17;95%CI:1.3-3.60;P=0.003).Meanwhile,there were no differences when comparing the two groups with and without HPS(HR:1.01;95%CI:0.59-1.73;P=0.967).CONCLUSION Patients with HSS and concomitant cirrhosis had a lower survival rate,but there was no difference in survival regardless of the presence of HPS.
文摘BACKGROUND While existing literature on ischiofemoral impingement syndrome(IFI)predominantly emphasizes surgical interventions or generalized physical therapy approaches,there remains a paucity of evidence regarding structured,multimodal rehabilitation programs targeting biomechanical deficits in IFI.This case report evaluates the efficacy of a multimodal rehabilitation program addressing a critical gap in conservative management strategies.CASE SUMMARY The patient underwent comprehensive physical and clinical examination,including hip X-ray and magnetic resonance imaging investigations.The patient completed the Musculoskeletal Health Questionnaire(MSK-HQ)and numerical pain rating scale(NPRS).The patient underwent a two-month tailored structured physical therapy intervention and repeated the same assessment afterwards.The patient's substantial reduction in pain,reflected by a significant decrease in the patient’s NPRS score from 9 to 3 points,signifies a positive clinical response.This outcome,coupled with the significant improvement in the patient's health-related quality of life according to the MSK-HQ score,which increased from 12 to 48 points,underscores the success of our research.CONCLUSION The study highlights the importance of a comprehensive approach to diagnosing and managing IFI,combining clinical assessment with imaging and implementing a multimodal rehabilitation program for optimal outcomes.
文摘BACKGROUND Severe acute respiratory syndrome coronavirus 2 induced coronavirus disease 2019(COVID-19)has posed a great challenge to public health worldwide and also increased susceptibility to colorectal cancer(CRC).Natural killer(NK)cells serve as the first line of defense in the host’s innate immune system,performing natural killing functions and mediating cytotoxicity against tumors and viruses.Therefore,a better understanding of NK cell cytotoxicity may facilitate the development of treatment strategies for CRC-associated with COVID-19.AIM To investigate the cytotoxic killing function of peripheral NK cells in patients with CRC and severe COVID-19(CRC+patients).METHODS The percentages of circulating NK and NKT cells in CRC+and age-matched patients with CRC were analyzed using flow cytometry.NK cell cytotoxic activity(NKCA)and corresponding NK cytotoxic factor(NKCF)activity in peripheral blood mononuclear cells were evaluated using a Real-Time Cell Analyzer.RESULTS The numbers and percentage of peripheral NK and NKT cells in patients with CRC+were lower than those in patients with CRC.Additionally,compared to patients with CRC,those with CRC+had lower levels of NKCA and NKCF activity in lysed K562 cells.Positive correlations were observed between NKCA and NK cell numbers,NKCA and NK cell percentages,NKCF activity,and NK cell percentages in patients with CRC+.Furthermore,a negative correlation was observed between NKCA and the severity of COVID-19 in patients with CRC.The area under the receiver operating characteristic curve for NKCA was greater than those for the other indices.CONCLUSION CRC+is associated with lower levels of peripheral NK cells and impaired natural cytotoxicity,contributing to the immunopathogenesis of severe COVID-19 rather than immune control.
基金United Arab Emirates University,Grant/Award Number:12R104 and 12R121。
文摘Cardiac injury initiates repair mechanisms and results in cardiac remodeling and fi-brosis,which appears to be a leading cause of cardiovascular diseases.Cardiac fi-brosis is characterized by the accumulation of extracellular matrix proteins,mainly collagen in the cardiac interstitium.Many experimental studies have demonstrated that fibrotic injury in the heart is reversible;therefore,it is vital to understand differ-ent molecular mechanisms that are involved in the initiation,progression,and resolu-tion of cardiac fibrosis to enable the development of antifibrotic agents.Of the many experimental models,one of the recent models that has gained renewed interest is isoproterenol(ISP)-induced cardiac fibrosis.ISP is a synthetic catecholamine,sympa-thomimetic,and nonselectiveβ-adrenergic receptor agonist.The overstimulated and sustained activation ofβ-adrenergic receptors has been reported to induce biochemi-cal and physiological alterations and ultimately result in cardiac remodeling.ISP has been used for decades to induce acute myocardial infarction.However,the use of low doses and chronic administration of ISP have been shown to induce cardiac fibrosis;this practice has increased in recent years.Intraperitoneal or subcutaneous ISP has been widely used in preclinical studies to induce cardiac remodeling manifested by fibrosis and hypertrophy.The induced oxidative stress with subsequent perturbations in cellular signaling cascades through triggering the release of free radicals is consid-ered the initiating mechanism of myocardial fibrosis.ISP is consistently used to induce fibrosis in laboratory animals and in cardiomyocytes isolated from animals.In recent years,numerous phytochemicals and synthetic molecules have been evaluated in ISP-induced cardiac fibrosis.The present review exclusively provides a comprehensive summary of the pathological biochemical,histological,and molecular mechanisms of ISP in inducing cardiac fibrosis and hypertrophy.It also summarizes the application of this experimental model in the therapeutic evaluation of natural as well as syn-thetic compounds to demonstrate their potential in mitigating myocardial fibrosis and hypertrophy.
文摘Despite the global attention towards pollution,it remains a significant global threat and challenge for both developed and developing countries.Urbanization and economic development influence different types of pollution.Visual pollution is considered a new phenomenon referring to the impact of existing and growing mainstream pollution which impairs an individual’s ability to enjoy visits or views.Recently,Jordanian cities have expanded in response to urbanization and ongoing development.Irbid City has the second largest population in Jordan after the capital Amman City highest population density in Jordan.In the modern era,Irbid City dramatically increased in population and dimension.The growth of the demographic population has been significant and has led to overpopulation,rapid urbanization,and unresolved problems associated with spatial planning and infrastructures leading to different types of pollution including visual pollution.The study area focuses on the city center with the most crowded population through field visits and actual observations.The study technique is descriptive and analytical,with a focus on meticulous monitoring and a follow-up-based questionnaire which is a tool for the study,involving data collection,classification,presentation,analysis,interpretation,and exploration to identify new facts and generalizations that can help solve current issues of visual pollution.The study provides recommendations for Irbid Municipal to eliminate visual pollution,in parallel with stricter supervision from the municipality during the building process to ensure proper implementation of the new rules,adopting an integrated policy for the city with the rest of the social,political,sensory,cultural,economic,and functional aspects,so that this policy is in the short and long term.
文摘In this paper, we examine the fundamental transformation of Property & Casualty (P&C) insurance through the introduction of Artificial Intelligence. This examination marks the shift from the traditional actuarial methods to a dynamically data-driven approach. Some key innovations include the buzz around Large Language Models (LLMs) for customer interaction, Internet of Things (IoT) enabled risk-monitoring in real time and Machine Learning allowing for automated claims processing. The research highlights the early adopters like AXA, Lemonade and Allianz who are actively leveraging AI to reduce claims processing times by 80% while reducing manual labour and increasing customer satisfaction. The most critical of this transformation is the emergence of roles that act like hybrid strategists. Such professionals combine traditional insurance expertise with acumen in technology. In our paper, we discuss the requirement of how AI demands more than just simple adoption. It needs a comprehensive restructuring of organizational culture, better data infrastructure and better ethical frameworks. Development in Explainable AI (XAI) is also noteworthy for maintaining transparency, handling complex risks and addressing regulatory requirements while alignment with customer trust concerns.
文摘BACKGROUND As living biodrugs,mesenchymal stem cells(MSCs)have progressed to phase 3 clinical trials for cardiovascular applications.However,their limited immediate availability hampers their routine clinical use.AIM To validate our hypothesis that cryopreserved MSCs(CryoMSCs)are as safe and effective as freshly cultured MSC counterparts but carry logistical advantages.METHODS Four databases were systematically reviewed for relevant randomized controlled trials(RCTs)evaluating the safety and efficacy of CryoMSCs from various tissue sources in treating patients with heart disease.A subgroup analysis was performed based on MSC source and post-thaw cell viability to determine treatment effects across different CryoMSCs sources and viability status.Weighted mean differences(WMDs)and odds ratios were calculated to measure changes in the estimated treatment effects.All statistical analyses were performed using RevMan version 5.4.1 software.RESULTS Seven RCTs(285 patients)met the eligibility criteria for inclusion in the metaanalysis.During short-term follow-up,^(Cryo)MSCs demonstrated a significant 2.11%improvement in left ventricular ejection fraction(LVEF)[WMD(95%CI)=2.11(0.66-3.56),P=0.004,I2=1%],with umbilical cord-derived MSCs being the most effective cell type.However,the significant effect on LVEF was not sustained over the 12 months of follow-up.Subgroup analysis demonstrated a substantial 3.44%improvement in LVEF[WMD(95%CI)=3.44(1.46-5.43),P=0.0007,I2=0%]when using MSCs with post-thaw viability exceeding 80%.There was no statistically significant difference in the frequency of major cardiac adverse events observed in rehospitalization or mortality in patients treated with ^(Cryo)MSCs vs the control group.CONCLUSION ^(Cryo)MSCs are a promising option for heart failure patients,particularly considering the current treatment options for cardiovascular diseases.Our data suggest that ^(Cryo)MSCs could be a viable alternative or complementary treatment to the current options,potentially improving patient outcomes.
文摘BACKGROUND Knee osteoarthritis(KOA)is a leading cause of arthritis-related morbidity.Mesenchymal stem cells(MSCs),as living biopharmaceuticals,have emerged as a potential treatment option due to their anti-inflammatory and immunomodulatory properties.AIM To compare the safety and efficacy of allogenic MSCs(^(Allo)MSCs)vs autologous MSCs(^(Auto)MSCs)in treating KOA in clinical settings.METHODS We conducted a systematic review and network meta-analysis to compare the safety and efficacy of^(Allo)MSCs vs^(Auto)MSCs in treating KOA.Our systematic search of four databases,including PubMed,Cochrane,Embase,and ClinicalTrials.gov,identified relevant randomized controlled trials(RCTs)reporting MSC-based treatment for KOA and reporting visual analog scale,Western Ontario and McMaster Universities Osteoarthritis scores,and adverse events.We assessed the methodological quality of the studies using the Cochrane Collaboration tool and calculated risk ratios(RRs)and weighted mean differences[with 95%confidence intervals(CIs)].Our statistical analyses used the R-Studio network meta-packages(version 2023.12.0).The study protocol was pre-registered on the International Prospective Register of Systematic Reviews(ID:CRD42024590866).RESULTS Nineteen RCTs involving 1216 patients with KOA met the inclusion criteria of the study.The network metaanalysis showed that^(Allo)MSCs gave a significant re-duction in visual analog scale scores by 14.91 points(95%CI:-24.52 to-5.30)vs 12.95 points with^(Auto)MSCs(95%CI:-24.42 to-1.48).For Western Ontario and McMaster Universities Osteoarthritis score,^(Allo)MSCs led to a significant reduction of 23.12 points(95%CI:-31.15 to-15.10)compared with 12.45 points using^(Auto)MSCs(95%CI:-19.31 to-5.59),thus revealing a significant improvement with^(Allo)MSCs(weighted mean difference:-10.62,95%CI:-21.23 to-0.11).Additionally,^(Auto)MSCs treatment showed a higher risk of joint-related adverse events(RR=1.39,95%CI:1.07-1.79)compared with^(Allo)MSCs(RR=1.13,95%CI:1.01-1.25).CONCLUSION^(Allo)MSCs may offer superior clinical outcomes with a lower risk of adverse events compared with^(Auto)MSCs in the treatment of KOA.However,the need for further RCTs directly comparing the two MSC types is crucial to validate this data,underscoring the importance of our findings in this field.
基金supported by the Hefei Comprehensive National Science Center Hefei Brain Project(to KW)the National Natural Science Foundation of China,Nos.31970979(to KW),82101498(to XW)the STI2030-Major Projects,No.2021ZD0201800(to PH).
文摘Alzheimer’s disease is a neurodegenerative disease resulting from deficits in synaptic transmission and homeostasis.The Alzheimer’s disease brain tends to be hyperexcitable and hypersynchronized,thereby causing neurodegeneration and ultimately disrupting the operational abilities in daily life,leaving patients incapacitated.Repetitive transcranial magnetic stimulation is a cost-effective,neuro-modulatory technique used for multiple neurological conditions.Over the past two decades,it has been widely used to predict cognitive decline;identify pathophysiological markers;promote neuroplasticity;and assess brain excitability,plasticity,and connectivity.It has also been applied to patients with dementia,because it can yield facilitatory effects on cognition and promote brain recovery after a neurological insult.However,its therapeutic effectiveness at the molecular and synaptic levels has not been elucidated because of a limited number of studies.This study aimed to characterize the neurobiological changes following repetitive transcranial magnetic stimulation treatment,evaluate its effects on synaptic plasticity,and identify the associated mechanisms.This review essentially focuses on changes in the pathology,amyloidogenesis,and clearance pathways,given that amyloid deposition is a major hypothesis in the pathogenesis of Alzheimer’s disease.Apoptotic mechanisms associated with repetitive transcranial magnetic stimulation procedures and different pathways mediating gene transcription,which are closely related to the neural regeneration process,are also highlighted.Finally,we discuss the outcomes of animal studies in which neuroplasticity is modulated and assessed at the structural and functional levels by using repetitive transcranial magnetic stimulation,with the aim to highlight future directions for better clinical translations.
文摘BACKGROUND Gastric signet ring cell carcinoma(SRCC)is a rare,aggressive subtype of gastric cancer characterized by poor prognosis and distinctive biological behavior.Despite advances in gastric cancer treatment,SRCC remains difficult to diagnose early and manage effectively due to its infiltrative pattern and molecular variability.Reliable prognostic markers are critical to guide clinical management.AIM To investigate the prognostic factors,including human epidermal growth factor receptor 2(HER2)expression,associated with survival outcomes in patients with gastric SRCC.METHODS A retrospective analysis of 100 cases diagnosed between 2015 and 2019 was conducted,assessing demographic,clinical,and pathological data.HER2 expression was analyzed using immunohistochemistry,and survival outcomes,including overall survival and disease-free survival,were examined.RESULTS With a median follow-up of 43 months,the median patient age was 50 years,and males exhibited a higher mortality rate(P=0.0107).Elevated serum carbohydrate antigen 19-9 and carcinoembryonic antigen levels were significantly associated with increased mortality(P=0.00149 and P=0.00163,respectively).Advanced tumornode-metastasis stage and lymphovascular invasion were strong predictors of poor outcomes(P<0.001 and P=0.019).HER2 positivity correlated with higher mortality(P=0.00882)but was not significantly linked to recurrence(P=0.53).Surgical treatment significantly improved survival compared with non-surgical approaches(P=0.0226).CONCLUSION These findings highlight the aggressive nature of SRCC with advanced disease stage,elevated tumor markers,and lymphovascular invasion contributing to poor outcomes.HER2 expression,though infrequent,may indicate worse prognosis,reinforcing the role of surgical intervention in survival improvement.
