Mastopexy for secretory carcinoma of breast in a young female: a case report.

Secretory carcinoma, a triple-negative benign tumor, is one of the rarest malignancies of the breast which rarely metastasizes. Surgical excision via lumpectomy or mastectomy is the mainstay of treatment, but in young patients, mastopexy can be a better option cosmetically. A 26-year-old woman presented with a lump in her right breast that, on ultrasonography, was revealed to be a multi lobulated solid lesion measuring 25 × 16 mm2 in the retro areolar region at a 4 o'clock position. It turned out to be secretory carcinoma of the breast in a tru-cut biopsy. Vertical Mastopexy was opted for the removal and simultaneous reconstruction of the breast, which was followed by adjuvant chemotherapy and radiotherapy. Vertical mastopexy showed that the tumor was removed, and the breast was restored to its original form simultaneously. This procedure gave better results clinically and cosmetically. The patient had an uneventful recovery and is on a regular follow-up.

Assessing the Efficacy and Long-Term Outcomes of Surgical Intervention Versus Radiotherapy: A Comprehensive Systematic Review and Meta-Analysis of Prostate Cancer Treatment Modalities.

There is controversy regarding the most effective primary treatment of choice for prostate cancer (PCa) in terms of patient outcomes, such as surgery or radiotherapy (RT). This study evaluated the comparative efficacy and long-term outcomes of radical prostatectomy (RP) and RT for PCa treatment. A thorough literature review of relevant databases was conducted, focusing on academic and clinical studies published from 2019 onwards. The inclusion criteria included randomized controlled trials (RCTs) and other observational studies comparing survival outcomes in patients treated with surgery and RT. We followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines to provide an overview of the data. We selected 19 studies based on the inclusion criteria. Of the total 19 studies, 12 advocated RP as the preferred treatment to improve survival outcomes in patients with PCa. The results of our synthesis showed that prostate cancer-specific mortality (PCSM) was lower in patients treated with RT. The total effect size for the analysis was calculated as Z=1.19 (p-value=0.23). The heterogeneity in the studies was as follows: Tau2=0.09, Chi2=20.25, df=4, I2=80%. Moreover, overall survival (OS) was shown to be higher in patients who underwent prostatectomy. The combined effect for the analysis was found to be: HR=0.97 (0.93, 1.01). The total effect was calculated as Z=1.33 (p-value= 0.18). The heterogeneity was found to be Tau2=0.00, Chi2=1.33, df=2, and I2=0%. However, overall mortality (OM) was shown to be independent of the treatment modality. RT is the preferred strategy for PCa treatment, as it balances efficacy and long-term outcomes. Clinical decision-making should consider individual patient characteristics and future research should delve into specific subpopulations and long-term outcomes to further refine the treatment guidelines.

The Safety and Efficacy of the Early Use of Sacubitril/Valsartan After Acute Myocardial Infarction: A Meta-Analysis of Randomized Controlled Trials.

Acute myocardial infarction (AMI) is a significant global cause of mortality, necessitating the exploration of innovative treatments against the condition. Angiotensin receptor blockers (ARBs), angiotensin-converting enzyme inhibitors (ACEIs), and angiotensin receptor-neprilysin inhibitors (ARNIs) such as sacubitril/valsartan have demonstrated promise in managing acute heart failure (HF). However, despite favorable evidence from clinical trials for the use of sacubitril/valsartan in AMI, its overall efficacy remains a subject of debate. Hence, we conducted this review and meta-analysis, by adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines and aligned with European Society of Cardiology recommendations, to compare sacubitril/valsartan with traditional ACEI/ARB treatments for AMI. We employed Review Manager 5.4 for statistical analysis, the Risk of Bias Tool 2.0 was utilized for quality assessment, and publication bias was assessed using a funnel plot. A p-value <0.05 was considered statistically significant. Eight randomized controlled trials (RCTs) were included in this meta-analysis. Our findings revealed that participants treated with sacubitril experienced significantly improved outcomes in terms of HF (OR=0.79; 95% CI: 0.66-0.95; p=0.01; I2=23%), N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels (MD = -1.58; 95% CI: -1.78 to -1.37, p<0.00001; I2=97%), and major adverse cardiovascular events (MACE) (OR=0.84; 95% CI: 0.72-0.99; p=0.03; I2=44%). However, left ventricular ejection fraction (LVEF) (MD=3.68; 95% CI: 3.35-4.01, p<0.00001; I2=71%) showed greater improvement in the control group compared to the experimental group. Our meta-analysis suggests that sacubitril offers a favorable balance between safety and effectiveness. Sacubitril significantly improved outcomes in terms of HF, MACE, and NT-proBNP levels when compared to the control group. However, improvement in LVEF was notably higher in the control group over the sacubitril/valsartan group.

Analysis of Conflicts of Interest in Studies Related to Robotics in Gastrointestinal and Abdominal Wall Surgery.

BACKGROUND: Industry payments to physicians represent a potential conflict of interest (COI) and can influence the study conclusions. This study aimed to evaluate the accuracy of the COIs reported in major surgical journals. STUDY DESIGN: Studies with at least one American author published between 2016 and 2021 that discussed observational and intervention studies assessing robotic surgery were included in the analysis. The Centers for Medicare & Medicaid Services' Open Payments database was used to collect the industry payments. A COI is defined as receiving funding from a robotics company while publishing research directly related to the company's products. A COI statement was defined as disclosed (or accurate) if the disclosure statement for the study in question acknowledged funding from the robotics companies. A COI was defined as undisclosed (or inaccurate) if the disclosure statement for the study in question did not acknowledge funding from the robotics companies. RESULTS: A total of 314 studies and 1978 authors were analyzed. Only 13.6% of the studies had accurate COI statements, whereas the majority (86.4%) had inaccurate COI disclosures. Additionally, 48.9% of the authors who received funding of $10,000 to $100,000 failed to report this amount in their disclosures, and 18% of the authors who received funding of $100,000 or more did not report it in their disclosures. CONCLUSIONS: There was a significant discordance between the self-reported COI in gastrointestinal and abdominal wall surgeries. This study calls for continued efforts to improve the definitions of what constitutes a relevant COI and encourages a standardized reporting process. It is imperative for investigators to make accurate disclosure statements.

Arthroscopic Stabilisation in Anterior Shoulder Instability: An Analysis of Mid-term Outcome.

OBJECTIVE: To assess the clinical outcome of arthroscopic stabilisation for recurrent anterior glenohumeral joint dislocations. STUDY DESIGN: Case series. Place and Duration of the Study: Ghurki Trust Teaching Hospital, Lahore, from May 2018 to December 2022. METHODOLOGY: Fifty-two patients who underwent arthroscopic repair of Bankart lesion were studied. Those who had concomitant fractures, neurological injury or underwent any surgery on the same shoulder were excluded. The outcome was assessed in terms of improvement in pain, constant and Rowe scores, postoperatively. RESULTS: The mean delay in the procedure after the first dislocation was 65.15+38.23 months, and the mean follow-up period was 26.61+7.55 months. On final follow-up, improvement in pain was statistically significant (p<0.05): (VAS: 2.17+1.77 to 0.69+0.64 at rest and from 4.5+2.24 to 1.58+1.85 at motion). On subjective assessment, 50% of the sample was very satisfied, and an objective assessment showed statistically significant (p<0.05) improvement in Constant score from 65.4 to 78.6. Rowe score not only showed a significant improvement (from 31.6 to 80.3 with p<0.05), but 69.2% of the follow-up scores lied in the good and excellent results range as well. Recurrence was noted in 8 cases (15.3%). CONCLUSION: Significant clinical improvement was seen after arthroscopic stabilisation in anterior shoulder instability. However, further research is required regarding the recurrence rate and restriction in the range of motion. KEY WORDS: Glenohumeral joint, Dislocation, Stabilisation, Shoulder arthroscopy.

Microplastic-Assisted Removal of Phosphorus and Ammonium Using Date Palm Waste Derived Biochar.

Microplastics (MPs) are emerging environmental pollutants worldwide, posing potential health risks. Moreover, MPs may act as vectors for other contaminants and affect their fate, transport, and deposition in the environment. Therefore, efficient and economical techniques are needed for the removal of contemporary MPs and contaminants from the environment. The present research study investigated the sorption of phosphorus (P) and ammonium (NH4+) onto date palm waste-derived biochar (BC) from an aqueous solution in the presence of polyamide (PA) and polyethylene (PE) MPs. The BC was prepared at 600 °C, characterized for physio-chemical properties, and applied for P and NH4+ removal via isotherm and kinetic sorption trials. The results of the sorption trials demonstrated the highest removal of NH4+ and P was obtained at neutral pH 7. The highest P sorption (93.23 mg g-1) by BC was recorded in the presence of PA, while the highest NH4+ sorption (103.76 mg g-1) was found with co-occurring PE in an aqueous solution. Sorption isotherm and kinetics models revealed that P and NH4+ removal by MP-amended BC followed chemisorption, electrostatic interaction, precipitation, diffusion, and ion exchange mechanisms. Overall, co-existing PA enhanced the removal of P and NH4+ by 66% and 7.7%, respectively, while co-existing PE increased the removal of P and NH4+ by 55% and 30%, respectively, through the tested BC. Our findings suggested that converting date palm waste into BC could be used as a competent and economical approach to removing P and NH4+ from contaminated water. Furthermore, microplastics such as PE and PA could assist in the removal of P and NH4+ from contaminated water using BC.

Sustainable wastewater purification with crab shell-derived biochar: Advanced machine learning modeling & experimental analysis.

Detoxifying ecologically persistent dyes is vital for environmental and human well-being. Herein, crabshell waste is transformed into porous carbon (CB900) through pyrolysis, achieving a remarkable removal rate of 90.5% (CR-RR) and adsorption capacity (∼256.36 mg g-1, qCR). Employing XGBoost modeling, with a robust R2 âˆ¼0.996, proved its superiority over others in predicting CR adsorption. PSO-XGB optimization led to an optimal configuration: 0.051 g adsorbent, 460.56 mg L-1 CR concentration, pH 3.16, and a 94.01 min contact time, resulting in 68.39% CR-RR and 822.15 mg g-1 qCR, simultaneously; sensitivity analysis unveiled the pivotal role of pH and adsorbent dose. CB900 exhibited physical, spontaneous, endothermic following both Langmuir and Freundlich isotherms. Remarkably, CB900 effectively eliminated various contaminants, including chromium and sulfasalazine antibiotic. Pilot-scale CB900 production cost via pyrolysis was $8.5/kg, a fraction of commercial powdered activated carbon, underscoring its economic viability and potential as a sustainable solution for the elimination of toxic contaminants from aqueous environments.

Comparison of Outcomes Between Metabolic Dysfunction-Associated Fatty Liver Disease and Non-alcoholic Fatty Liver Disease: A Meta-Analysis.

Non-alcoholic fatty liver disease (NAFLD) encompasses a range of conditions, from fatty liver to cirrhosis. In response to evolving research and to better reflect the complex metabolic underpinnings, the term metabolic dysfunction-associated fatty liver disease (MAFLD) has been proposed. The aim of this meta-analysis was to compare cardiovascular events and all-cause mortality between NAFLD and MAFLD patients. The present study was conducted following the Preferred Reporting of Systematic Review and Meta-analysis (PRISMA) guidelines. We systematically searched PubMed, EMBASE, and the Web of Science to identify studies that compared cardiovascular outcomes in MAFLD and NAFLD from inception to July 31, 2023. Outcomes assessed in this meta-analysis included all-cause mortality, cardiovascular mortality, and cardiovascular events. A total of 11 studies were included in this meta-analysis. The risk of cardiovascular mortality was significantly higher in patients with MAFLD patients compared to NAFLD patients (risk ratio (RR): 1.48, 95% confidence interval (CI): 1.11 to 1.98). The risk of all-cause mortality was higher in MAFLD patients compared to NAFLD, and the difference was statistically significant (RR: 2.80, 95% CI: 2.39 to 3.28). The risk of cardiovascular events was significantly higher in MAFLD patients compared to NAFLD (RR: 1.18, 95% CI: 0.86 to 1.61). The key findings underscore that individuals diagnosed with MAFLD face a notably higher risk of all-cause mortality, cardiovascular mortality, and cardiovascular events when compared to those with NAFLD.

Case Report Of A Rare Incidentaloma Of The Adrenal Gland-Schwannoma.

The Schwannoma is a benign growth of the nerve sheath cells most commonly seen in the vestibulocochlear nerve. Its prevalence in the adrenal gland is 1-3%. Here we discuss a case that presented as an incidentaloma of the right adrenal gland in a young male patient who had vague abdominal symptoms and a normal hormonal profile. He underwent an excisional biopsy of the right adrenal gland due to the large size of the lesion (more than 4cm). The histopathology report helped to establish the diagnosis of Schwannoma. Incidentaloma is defined as a lesion of the adrenal gland encountered on any radiological investigation carried out for symptoms that are not associated with adrenal pathologies. After discovering such lesions, it is imperative to perform radiological and hormonal investigations in an organised manner to plan further management of such cases.

Comparison Between Dexmedetomidine and Propofol for Sedation on Outcomes After Cardiac Surgery in Patients Requiring Mechanical Ventilation: A Meta-Analysis of Randomized-Control Trials.

The aim of this study was to compare outcomes between dexmedetomidine and propofol for sedation after cardiac surgery in patients requiring mechanical ventilation. This meta-analysis was performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Online databases, including EMBASE, PubMed, and the Cochrane Library, were comprehensively searched to identify relevant randomized controlled trials (RCTs) comparing the safety and efficacy of dexmedetomidine and propofol in patients undergoing cardiac surgery and requiring mechanical ventilation. The examined outcomes included the mean length of intensive care unit (ICU) stay in hours, duration of mechanical ventilation in hours, length of hospital stay in days, and number of patients diagnosed with delirium. A total of 14 studies were included in the present meta-analysis while 1360 patients undergoing cardiac surgery were involved in these studies. Pooled results showed that the duration of mechanical ventilation was lower in the dexmedetomidine group compared to the propofol group (mean difference (MD): 0.75, 95% confidence interval (CI): 0.06-1.44, p-value: 0.03). We also found a significantly low length of stay in ICU in the dexmedetomidine group compared to the propofol (MD: 0.89, 95% CI: 0.04-1.74, p-value: 0.04). The length of hospital stay was also significantly lower in patients receiving dexmedetomidine as compared to the propofol group (MD: 0.51, 95% CI: 0.32-0.70, p-value<0.001). Risk of delirium was significantly higher in patients receiving propofol compared to patients receiving dexmedetomidine (RR: 2.02, 95% CI: 1.48-2.74, p-value<0.001). In conclusion, our meta-analysis provides evidence of the beneficial impacts of dexmedetomidine on clinical outcomes in patients undergoing cardiac surgery. Dexmedetomidine was associated with a significant reduction in the duration of mechanical ventilation, length of stay in the intensive care unit (ICU) and hospital, and the risk of delirium.

Scavenging microplastics and heavy metals from water using jujube waste-derived biochar in fixed-bed column trials.

Extensive production and utilization of plastic products have resulted in the generation of microplastics (MPs), subsequently polluting the environment. The efficiency of biochars (BCs) derived from jujube (Ziziphus jujube L.) biomass (300 °C and 700 °C) for nylon (NYL) and polyethylene (PE) removal from contaminated water was explored in fixed-bed column trials. The optimum pH for the removal of both MPs was found 7. Both of the produced biochars demonstrated >99% removal of the MPs, while the sand filter exhibited a maximum of 78% removal of MPs. BC produced at 700 °C (BC700) showed 33-fold higher MPs retention, while BC produced at 300 °C (BC300) exhibited 20-fold higher retention, as compared to sand filters, indicating the higher efficiency of BC produced at higher pyrolysis temperature. Entrapment into the pores, entanglement with flaky structures of the BCs, and electrostatics interactions were the major mechanism for MPs retention in BCs. The efficiency of MPs-amended BCs was further explored for the removal of Pb(II) and Cd(II) in fixed-bed column trials. BC700 amended with PE and NYL exhibited the highest 50% breakthrough time (2114.23 and 2024.61 min, respectively, for Pb(II) removal and 2107.92 and 1965.19 min, respectively, for Cd(II) removal), as compared to sand filters (38.07 and 60.49 min for Pb(II) and Cd(II) removal, respectively). Thomas model predicted highest adsorption capacity was exhibited by BC700 amended with PE (584.34 and 552.80 mg g-1, for Pb(II) and Cd(II) removal, respectively), followed by BC700 amended with NYL (557.65 and 210.59 mg g-1 for Pb(II) and Cd(II) removal, respectively). Therefore, jujube waste-derived BCs could be used as efficient adsorbents to remove PE and NYL from contaminated water, while MPs-loaded BCs can further be utilized for higher adsorption of Pb(II) and Cd(II) from contaminated aqueous media. These findings suggest that BC could be used as an efficient adsorbent to remove the co-existing MPs-metals ions from the environment on a sustainable basis.

Assessing spatiotemporal trends of total and extreme precipitation in a subtropical highland region: A climate perspective.

This study used a dataset of 30 years (1990-2020) of daily observations from 24 meteorological stations in the northern highlands of Pakistan to assess trends in extreme precipitation indices. The RClimDex model was used to analyze the indices, and the Modified Mann-Kendal test and the Theil-Sen slope estimator were applied to determine trends and slopes, respectively. The results showed a significant decrease in total annual precipitation amount (PRCPTOT) with varying rates of negative trend from -4.44 mm/year to -19.63 mm/year. The total winter and monsoon precipitation amounts were also decreased during the past three decades. The intensity-based precipitation indices (RX1Day, RX5Day, R95p, R99p, and SDII) showed a significant decrease in extreme intensity events over time, while the count of consecutive dry days (CDD) and consecutive wet days (CWD) indicated a significant decrease in duration at multiple stations. The annual counts of days with precipitation more than or equal to 10 mm (R10), 20 mm (R20), and 25 mm (R25) exhibited a significant decrease in frequency of extreme precipitation events, with the decrease more pronounced in the northern parts of the study domain. The findings of this study indicate a significant decline in the intensity, frequency, and extent of precipitation extremes across the northern highlands of Pakistan over the past 30 years.

Ticagrelor Versus Clopidogrel in Patients With Acute Coronary Syndrome and on Dialysis: A Meta-Analysis.

This study aims to compare the safety and efficacy of clopidogrel and ticagrelor in patients with acute coronary syndrome (ACS) and undergoing dialysis. This study was conducted per the guidelines of the Preferred Reporting of Systematic Reviews and Meta-Analyses (PRISMA). A comprehensive search was performed using electronic databases, including PubMed, EMBASE, and Web of Science, to identify relevant studies comparing clopidogrel and ticagrelor in patients undergoing dialysis. To ensure the inclusion of all relevant articles, a combination of the following keywords, along with medical subject heading (MeSH) terms, was used: "clopidogrel," "ticagrelor," "acute coronary syndrome," and "dialysis." The primary endpoint of this meta-analysis was the incidence of major adverse cardiovascular events (MACE), which consisted of cardiovascular death, myocardial infarction, stroke, and revascularization. The secondary endpoint was all-cause mortality. The occurrence of any bleeding events (including major and nonmajor bleeding events) and major bleeding events was chosen as the safety endpoints. A total of four studies were included in the pooled analysis. The pooled sample size was 5,417 patients, including 892 in the ticagrelor group and 4525 in the clopidogrel group. The findings indicate that ticagrelor, compared to clopidogrel, is associated with a significantly higher risk of MACEs, all-cause death, and major bleeding events. The findings suggest that clopidogrel may be a better choice for individuals with ACS undergoing dialysis due to its lower risk of MACE, all-cause death, and major bleeding events compared to ticagrelor.

Comparison of the Effectiveness and Safety of Chlorthalidone and Hydrochlorothiazide in Patients With Hypertension: A Meta-Analysis.

The aim of this study was to compare the effectiveness and safety of chlorthalidone and hydrochlorothiazide in patients with hypertension. The present meta-analysis was reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Our search for relevant articles was conducted on PubMed, Scopus, and CINAHIL databases from their inception until March 31, 2023. Keywords used to search for relevant articles included "hydrochlorothiazide," "chlortalidone," "hypertension," "cardiovascular," and "blood pressure." The outcomes assessed in this meta-analysis included changes in systolic blood pressure (SBP) and diastolic blood pressure (DBP). Myocardial infarction, stroke, and all-cause mortality were also assessed. For safety analysis, we evaluated the risk of hypokalemia between the two groups. Any disagreement between the two authors in the data extraction process was resolved through discussion. Eight studies fulfilled the inclusion criteria included in the present meta-analysis. Our analysis showed that chlorthalidone was superior to hydrochlorothiazide in controlling both SBP and DBP, with no significant heterogeneity reported. However, there was no significant difference between the two groups in terms of the risk of myocardial infarction, stroke, all-cause mortality, and hospitalization due to heart failure. The hypokalemia rate was reported to be higher with chlorthalidone compared to hydrochlorothiazide.

Targeting ARID1A-Deficient Cancers: An Immune-Metabolic Perspective.

Epigenetic remodeling and metabolic reprogramming, two well-known cancer hallmarks, are highly intertwined. In addition to their abilities to confer cancer cell growth advantage, these alterations play a critical role in dynamically shaping the tumor microenvironment and antitumor immunity. Recent studies point toward the interplay between epigenetic regulation and metabolic rewiring as a potentially targetable Achilles' heel in cancer. In this review, we explore the key metabolic mechanisms that underpin the immunomodulatory role of AT-rich interaction domain 1A (ARID1A), the most frequently mutated epigenetic regulator across human cancers. We will summarize the recent advances in targeting ARID1A-deficient cancers by harnessing immune-metabolic vulnerability elicited by ARID1A deficiency to stimulate antitumor immune response, and ultimately, to improve patient outcome.

Bulbar Dysfunction in Idiopathic Normal Pressure Hydrocephalus: A Case Report.

Normal pressure hydrocephalus (NPH) is a rare condition characterized by pathologically enlarged ventricles and a normal cerebrospinal fluid (CSF) opening pressure measured by lumbar puncture. NPH typically presents as a triad of cognitive decline, gait disturbance, and urinary incontinence. Rarely, NPH can present with bulbar involvement, particularly with difficulty swallowing. Here, we present a case of NPH in a 75-year-old man who presented with an episode of choking and a recent onset of swallowing difficulties with a three-month history of ataxia and progressive memory loss. His CT scan revealed ventriculomegaly, which was consistent with the clinical presentation of NPH and was further confirmed by a normal opening pressure on the CSF tap. Furthermore, ventriculoperitoneal shunts showed a marked improvement in patients' dysphagia and the classical triad of NPH symptoms. Through this case report, we want to highlight that NPH can present as a difficulty in swallowing.

Comparative Outcomes of Radical Cystectomy in Muscle-Invasive Bladder Cancer: A Systematic Review and Meta-Analysis.

Muscle-invasive bladder cancer poses a significant clinical challenge that necessitates effective therapeutic interventions. Radical cystectomy is a primary treatment option, but a comprehensive understanding of its outcomes is crucial for informed clinical decision-making. This systematic review and meta-analysis aimed to investigate and summarize the outcomes associated with radical cystectomy as a primary treatment for muscle-invasive bladder cancer with a focus on survival rates, complications, and quality of life. A systematic search across databases-PubMed, Google Scholar, and others-covered studies from 2017 onwards. Included were studies reporting survival rates, complications, and quality of life post-radical cystectomy in muscle-invasive bladder cancer patients, including randomized controlled trials, cohort, and observational studies. Multidimensional analysis revealed promising findings regarding the efficacy of radical cystectomy in muscle-invasive bladder cancer. Survival outcomes, including overall survival and disease-specific mortality, have demonstrated significant improvements, particularly in recent randomized controlled trials and cohort studies. Complications associated with the surgical procedure, such as positive surgical margins and lymph node yields, were generally acceptable. Quality of life outcomes post-radical cystectomy exhibited positive trends, although variations were noted in the emotional and social domains. This review underscores radical cystectomy's role in enhancing overall survival and reducing disease-specific mortality in muscle-invasive bladder cancer. Despite reported complications, recent studies support its acceptable risk profile. Detailed examination of various factors contributes to a comprehensive understanding of the procedure. These findings emphasize the importance of individualized treatment approaches in the management of muscle-invasive bladder cancer, considering both oncological efficacy and perioperative outcomes. Radical cystectomy remains fundamental in urological oncology, with ongoing advancements refining its significance.

Data-Driven Non-Linear Current Controller Based on Deep Symbolic Regression for SPMSM.

This study designs a simple current controller employing deep symbolic regression (DSR) in a surface-mounted permanent magnet synchronous machine (SPMSM). A novel DSR-based optimal current control scheme is proposed, which after proper training and fitting, generates an analytical dynamic numerical expression that characterizes the data. This creates an understandable model and has the potential to estimate data that have not been seen before. The goal of this study was to overcome the traditional linear proportional-integral (PI) current controller because the performance of the PI is highly dependent on the system model. Moreover, the outer speed control loop gains are tuned using the cuckoo search algorithm, which yields optimal gain values. To demonstrate the efficacy of the proposed design, we apply the control design to different test cases, that is varied speed and load conditions, as well as sinusoidal speed reference, and compare the results with those of a traditional vector control design. Compared with traditional control approaches, we deduce that the DSR-based control design could be extrapolated far beyond the training dataset, laying the foundation for the use of deep learning techniques in power conversion applications.

Multi-Class Skin Lesions Classification Using Deep Features.

Skin cancer classification is a complex and time-consuming task. Existing approaches use segmentation to improve accuracy and efficiency, but due to different sizes and shapes of lesions, segmentation is not a suitable approach. In this research study, we proposed an improved automated system based on hybrid and optimal feature selections. Firstly, we balanced our dataset by applying three different transformation techniques, which include brightness, sharpening, and contrast enhancement. Secondly, we retrained two CNNs, Darknet53 and Inception V3, using transfer learning. Thirdly, the retrained models were used to extract deep features from the dataset. Lastly, optimal features were selected using moth flame optimization (MFO) to overcome the curse of dimensionality. This helped us in improving accuracy and efficiency of our model. We achieved 95.9%, 95.0%, and 95.8% on cubic SVM, quadratic SVM, and ensemble subspace discriminants, respectively. We compared our technique with state-of-the-art approach.

The Co-Existence of Agranulocytosis and Stevens-Johnson Syndrome (SJS) in Carbamazepine Therapy: A Case Report.

The therapeutic significance of carbamazepine in individuals with trigeminal neuralgia, epilepsy, and bipolar disorder is well recognized. Although it has high effectiveness, it raises the patient's risk for some adverse effects. The relationship between carbamazepine usage and agranulocytosis is well-established. Agranulocytosis is characterized by an unusually low number of neutrophils. This disorder poses a grave hazard to the patient since they are more likely to get potentially lethal bacterial or fungal infections. Moreover, carbamazepine is one of the most common causes of Stevens-Johnson syndrome (SJS), a severe skin condition with a high mortality rate. In cases where agranulocytosis and Stevens-Johnson syndrome coexist, the prognosis is relatively poor. We report a rare case of a patient who developed agranulocytosis and Stevens-Johnson syndrome after taking carbamazepine. Neutrophils accounted for 2.1% of the patient's differential leukocyte count. Furthermore, Naranjo's scale found a score of 8 for Stevens-Johnson syndrome, placing it in the "probable" category, while a score of 9 for agranulocytosis indicated that it was a confirmed adverse reaction to carbamazepine.