Breast cancer epidemiology, diagnostic barriers, and contemporary trends in breast nanotheranostics and mechanisms of targeting.

INTRODUCTION: Breast cancer is one of the main causes of mortality in women globally. Early and accurate diagnosis represents a milestone in cancer management. Several breast cancer diagnostic agents are available. Many chemotherapeutic agents in conventional dosage forms are approved; nevertheless, they lack cancer cell specificity, resulting in improper treatment and undesirable side effects. Recently, nanotheranostics has emerged as a new paradigm to achieve safe and effective cancer diagnosis and management. AREA COVERED: This review provides insight into breast cancer epidemiology, barriers hindering the early diagnosis, and effective delivery of chemotherapeutics. Also, conventional diagnostic agents and recent nanotheranostic platforms have been used in breast cancer. In addition, mechanisms of cancer cell targeting and nano-carrier surface functionalization as an effective approach for chemotherapeutic targeting were reviewed along with future perspectives. EXPERT OPINION: We proposed that modified nano-carriers may provide an efficacious approach for breast cancer drug targeting. These nanotheranostics need more clinical evaluations to confirm their efficacy in cancer management. In addition, we recommend the use of artificial intelligence (AI) as a promising approach for early and efficient assessment of breast lesions. AI allows better interpretation and analysis of nanotheranostic data, which minimizes misdiagnosis and avoids the belated intervention of health care providers.

Emerging understandings of the role of exosomes in atherosclerosis.

Atherosclerosis remains a major contributor to cardiovascular disease, the leading cause of global morbidity and mortality. Despite the elucidation of several molecular, biochemical, and cellular aspects that contribute to the etio-pathogenesis of atherosclerosis, much remains to be understood about the onset and progression of this disease. Emerging evidence supports a role for exosomes in the cellular basis of atherosclerosis. Indeed, exosomes of activated monocytes seem to accentuate a positive feedback loop that promotes recruitment of pro-inflammatory leukocytes. Moreover, in addition to their role in promoting proliferation and invasion of vascular smooth muscle cells, exosomes can also induce neovascularization within lesions and increase endothelial permeability, two important features of fibrous plaques. Depending on their sources and cargo, exosomes can also induce clot formation and contribute to other hallmarks of atherosclerosis. Taken together, it is becoming increasingly evident that a better understanding of exosome biology is integral to elucidating the pathogenesis of atherosclerosis, and may thus provide insight into a potentially new therapeutic target for this disease.

One-step nanoscale expansion microscopy reveals individual protein shapes.

The attainable resolution of fluorescence microscopy has reached the subnanometer range, but this technique still fails to image the morphology of single proteins or small molecular complexes. Here, we expand the specimens at least tenfold, label them with conventional fluorophores and image them with conventional light microscopes, acquiring videos in which we analyze fluorescence fluctuations. One-step nanoscale expansion (ONE) microscopy enables the visualization of the shapes of individual membrane and soluble proteins, achieving around 1-nm resolution. We show that conformational changes are readily observable, such as those undergone by the ~17-kDa protein calmodulin upon Ca2+ binding. ONE is also applied to clinical samples, analyzing the morphology of protein aggregates in cerebrospinal fluid from persons with Parkinson disease, potentially aiding disease diagnosis. This technology bridges the gap between high-resolution structural biology techniques and light microscopy, providing new avenues for discoveries in biology and medicine.

Flavonoids, gut microbiota and cardiovascular disease: Dynamics and interplay.

Cardiovascular disease (CVD) remains the leading cause of global morbidity and mortality. Extensive efforts have been invested to explicate mechanisms implicated in the onset and progression of CVD. Besides the usual suspects as risk factors (obesity, diabetes, and others), the gut microbiome has emerged as a prominent and essential factor in the pathogenesis of CVD. With its endocrine-like effects, the microbiome modulates many physiologic processes. As such, it is not surprising that dysbiosis-by generating metabolites, inciting inflammation, and altering secondary bile acid signaling- could predispose to or aggravate CVD. Nevertheless, various natural and synthetic compounds have been shown to modulate the microbiome. Prime among these molecules are flavonoids, which are natural polyphenols mainly present in fruits and vegetables. Accumulating evidence supports the potential of flavonoids in attenuating the development of CVD. The ascribed mechanisms of these compounds appear to involve mitigation of inflammation, alteration of the microbiome composition, enhancement of barrier integrity, induction of reverse cholesterol transport, and activation of farnesoid X receptor signaling. In this review, we critically appraise the methods by which the gut microbiome, despite being essential to the human body, predisposes to CVD. Moreover, we dissect the mechanisms and pathways underlying the cardioprotective effects of flavonoids.

MAX inactivation deregulates the MYC network and induces neuroendocrine neoplasia in multiple tissues.

The MYC transcription factor requires MAX for DNA binding and widespread activation of gene expression in both normal and neoplastic cells. Surprisingly, inactivating mutations in MAX are associated with a subset of neuroendocrine cancers including pheochromocytoma, pituitary adenoma and small cell lung cancer. Neither the extent nor the mechanisms of MAX tumor suppression are well understood. Deleting Max across multiple mouse neuroendocrine tissues, we find Max inactivation alone produces pituitary adenomas while Max loss cooperates with Rb1 / Trp53 loss to accelerate medullary thyroid C-cell and pituitary adenoma development. In the thyroid tumor cell lines, MAX loss triggers a striking shift in genomic occupancy by other members of the MYC network (MNT, MLX, MondoA) supporting metabolism, survival and proliferation of neoplastic neuroendocrine cells. Our work reveals MAX as a broad suppressor of neuroendocrine tumorigenesis through its ability to maintain a balance of genomic occupancies among the diverse transcription factors in the MYC network. Teaser: MAX inactivation deregulates multiple transcription factors to induce neuroendocrine cancers.

A rare case of pituitary dysfunction with Moyamoya disease.

Moyamoya disease is an idiopathic chronic and progressive vaso-occlusive disease ofthe bilateral intracranial branches of the internal carotid artery. Growth hormone failure, thyroid dysfunction, and low cortisol hormones are consequences of hypopituitarism. A 14-year-old girl with short stature presented with right-sided weakness associated with dysarthria. Ahormonal assay test showed abnormality ofthe anterior pituitary hormones. Magnetic resonance imaging of the brain and pituitary gland showed a reduction in the size of the adenohypophysis. A cerebral vessel angiogram showed multiple areas of stenosis in the right internal carotid artery. Magnetic resonance angiography demonstrated stenosis at the suprasellar region of the bilateral internal carotid artery. Pituitary dysfunction associated with moyamoya disease is rare but must be considered as adifferential diagnosis for any patient with hypopituitarism. Hypothalamopituitary dysfunction as result of carotid ischemia might be associated with moyamoya disease. Such patients require close follow-up and hormonal assay tests.

The Effect of Seminal Plasma on the Equine Endometrial Transcriptome.

The establishment of pregnancy involves a fine-tuned balance between protection and tolerance within the maternal immune system, as the female needs to accept a foreign antigen (the semi-allogenic fetus) while still being able to combat pathogens from the uterus. In the horse, the first uterine exposure to paternal antigens is during mating when sperm is introduced to the tissue and draining lymphatics of the uterus. Additionally, it has been suggested that seminal plasma and its proteins within it play an essential role in preparing the female tract for a suitable immunologic environment but this has not been confirmed in the horse. Therefore, the objective of this study was to evaluate the endometrial transcriptome following insemination either with seminal plasma or with reduced seminal plasma. We hypothesised that reduced seminal plasma would alter the endometrial transcriptome and affect transcripts relating to immunotolerance, antigen presentation and embryo growth and development. To do so, six (n = 6) mares were inseminated in a randomised switch-back design over the course of four oestrous cycles. Mares were rectally palpated and scanned via ultrasonography for the detection of a pre-ovulatory follicle (>35 mm) alongside increasing uterine oedema and relaxed cervix, and then treated with one of four treatment groups including (1) 30 mL lactated Ringers solution (LRS; NegCon), (2) 500 × 106 spermatozoa in conjunction with 30 mL seminal plasma (SP+), (3) 30 mL lactated Ringers solution (LRS; wash out) and (4) 500 × 106 spermatozoa with seminal plasma reduced via gradient centrifugation and resuspended in 30 mL LRS (SP-). Human chorionic gonadotropin (hCG) was administered to standardise the time to ovulation and endometrial biopsies were collected 7 days after insemination. RNA was isolated utilising Trizol, and RNA-Seq was performed by Novogene, with 97.79% total mapping and 40 million read depth. p value was set to <0.05. When comparing SP+ to SP-, 158 differentially expressed genes (DEGs) were identified. Biological processes impacted included antigen processing and regulation, cholesterol synthesis, and immune/inflammatory response. Gene ontology (GO) enrichment analysis using DAVID v6.8 revealed that many of these DEGs were involved in biological process such as antigen presentation (HLA-DM beta chain, HLA-DRB, HLA-DQA and RASGRP1), immune cell signalling (CXCL9, CXCL1, DEFB1 and MIP-2B), embryo growth and development (INHA, KLF2, RDH10, LAMA3 and SLC34A2) and embryo metabolism (ABCA1, ABCA2, APOA1, LDL, INSR, IGFBP2 and IGFBP3). Overall, reduction of seminal plasma from the insemination dose impacted the endometrial transcriptome at the time of early embryonic exposure to the uterine environment. Further work is justified to evaluate these alterations impact on embryo maturation, placental development, pregnancy outcome and development of offspring.

Phasor-Based Myoelectric Synergy Features: A Fast Hand-Crafted Feature Extraction Scheme for Boosting Performance in Gait Phase Recognition.

Gait phase recognition systems based on surface electromyographic signals (EMGs) are crucial for developing advanced myoelectric control schemes that enhance the interaction between humans and lower limb assistive devices. However, machine learning models used in this context, such as Linear Discriminant Analysis (LDA) and Support Vector Machine (SVM), typically experience performance degradation when modeling the gait cycle with more than just stance and swing phases. This study introduces a generalized phasor-based feature extraction approach (PHASOR) that captures spatial myoelectric features to improve the performance of LDA and SVM in gait phase recognition. A publicly available dataset of 40 subjects was used to evaluate PHASOR against state-of-the-art feature sets in a five-phase gait recognition problem. Additionally, fully data-driven deep learning architectures, such as Rocket and Mini-Rocket, were included for comparison. The separability index (SI) and mean semi-principal axis (MSA) analyses showed mean SI and MSA metrics of 7.7 and 0.5, respectively, indicating the proposed approach's ability to effectively decode gait phases through EMG activity. The SVM classifier demonstrated the highest accuracy of 82% using a five-fold leave-one-trial-out testing approach, outperforming Rocket and Mini-Rocket. This study confirms that in gait phase recognition based on EMG signals, novel and efficient muscle synergy information feature extraction schemes, such as PHASOR, can compete with deep learning approaches that require greater processing time for feature extraction and classification.

Characterization of giant endocrine cells in the fundic stomach of African catfish (Clarias gariepinus) demonstrated by histochemical, immunohistochemical and ultrastructure microscopy methods suggesting their role in immunity.

Endocrine cells in the fundic stomach of Clarias gariepinus were characterized in this work using transmission electron microscopy, immunohistochemistry, and histochemistry. Performic acid mixed with alcian blue pH2.5 and silver stain were among the histochemical stains used for endocrine cells. Endocrine cells can be found in the epithelium, lamina propria, submucosa, muscular layer, serosa, and the area between the stomach glands. Endocrine cells with one or more nuclei were found. Endocrine cells were studied using CD3, CD21, and CD68 in an immunohistochemistry analysis. The expression of the lymphocyte marker CD3 by endocrine cells is remarkable. In addition, they had a strong immunological response to CD21 and CD68, which are characteristics of phagocytic cells. Granules of varied sizes and electron densities are packed densely into the cytoplasm of the cells, as seen by transmission electron microscopy. We propose that endocrine cells play a crucial role in immune defense. The role of endocrine cells in the gut's immune system is an area that needs further investigation.

Behçet's Syndrome With Multiple Bilateral Pulmonary Aneurysms Associated With Endomyocardial Fibrosis Presented With Pulmonary Emboli: A Case Report.

Behçet's syndrome (BS) is a rare chronic multisystemic inflammatory disorder of unknown etiopathogenesis. BS is classified as a vasculitis of variable vessel size, which can manifest in both arterial and venous blood vessels. BS commonly presents with mucocutaneous and ocular manifestations. Superficial and deep vein thrombosis is present in 50% of patients, with atypical venous thrombosis affecting the inferior vena cava, superior vena cava, hepatic veins with Budd-Chiari syndrome, portal vein, cerebral sinuses, and right atrium and ventricle. Arterial manifestations include in situ thrombosis, pulmonary artery aneurysms, aneurysms of the abdominal aorta, and aneurysms of visceral and peripheral arteries. This article reports a new case of BS in a 28-year-old female patient who presented with severe dyspnea and hemoptysis. Echocardiography and cardiovascular magnetic resonance imaging led to the diagnosis of endomyocardial fibrosis and a large right ventricular thrombus with pulmonary embolism. Computed tomography angiography revealed multiple pulmonary aneurysms and emboli. Rare findings such as endomyocardial fibrosis and Budd-Chiari syndrome were noted. This case highlights the role of medical imaging modalities in diagnosing rare syndromes such as BS, as demonstrated in the current case.

Third sternotomy with modified Bentall/Konno procedure for recurrent multilevel left ventricular outflow tract obstruction in a 15-year-old.

This is a 15-year-old, 73.5 kg male who was born with congenital aortic valve stenosis. He underwent a transcatheter balloon aortic valvuloplasty in the neonatal period, followed by an open aortic valvotomy at 2 months of age. When he was 3 years old, he underwent aortic root replacement with a 15 mm aortic homograft. Recently, he presented with recurrent left ventricular outflow tract obstruction that appeared valvular and subvalvular in nature. We present our technique of repeat aortic root replacement and left ventricular outflow tract enlargement using modified Bentall combined with Konno-Rastan aortoventriculoplasty.

Immunogenicity and efficacy of XBB.1.5 rS vaccine against the EG.5.1 variant of SARS-CoV-2 in Syrian hamsters.

The continued emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) variants necessitates updating coronavirus disease 2019 (COVID-19) vaccines to match circulating strains. The immunogenicity and efficacy of these vaccines must be tested in pre-clinical animal models. In Syrian hamsters, we measured the humoral and cellular immune response after immunization with the nanoparticle recombinant Spike (S) protein-based COVID-19 vaccine (Novavax, Inc.). We also compared the efficacy of the updated monovalent XBB.1.5 variant vaccine with previous COVID-19 vaccines for the induction of XBB.1.5 and EG.5.1 neutralizing antibodies and protection against a challenge with the EG.5.1 variant of SARS-CoV-2. Immunization induced high levels of S-specific IgG and IgA antibody-secreting cells and antigen-specific CD4+ T cells. The XBB.1.5 and XBB.1.16 vaccines, but not the Prototype vaccine, induced high levels of neutralizing antibodies against the XBB.1.5, EG.5.1, and JN.1 variants of SARS-CoV-2. Upon challenge with the Omicron EG.5.1 variant, the XBB.1.5 and XBB.1.16 vaccines reduced the virus load in the lungs, nasal turbinates, trachea, and nasal washes. The bivalent vaccine (Prototype rS + BA.5 rS) continued to offer protection in the trachea and lungs, but protection was reduced in the upper airways. By contrast, the monovalent Prototype vaccine no longer offered good protection, and breakthrough infections were observed in all animals and tissues. Thus, based on these study results, the protein-based XBB.1.5 vaccine is immunogenic and increased the breadth of protection against the Omicron EG.5.1 variant in the Syrian hamster model. IMPORTANCE: As SARS-CoV-2 continues to evolve, there is a need to assess the immunogenicity and efficacy of updated vaccines against newly emerging variants in pre-clinical models such as mice and hamsters. Here, we compared the immunogenicity and efficacy between the updated XBB.1.5, the original Prototype Wuhan-1, and the bivalent Prototype + BA.5 vaccine against a challenge with the EG.5.1 Omicron variant of SARS-CoV-2 in hamsters. The XBB.1.5 and bivalent vaccine, but not the Prototype, induced serum-neutralizing antibodies against EG.5.1, albeit the titers were higher in the XBB.1.5 immunized hamsters. The presence of neutralizing antibodies was associated with complete protection against EG.5.1 infection in the lower airways and reduced virus titers in the upper airways. Compared with the bivalent vaccine, immunization with XBB.1.5 improved viral control in the nasal turbinates. Together, our data show that the updated vaccine is immunogenic and that it offers better protection against recent variants of SARS-CoV-2.

Impact of Isotretinoin on Blood Lipids and Liver Enzymes: A Retrospective Cohort Study in Saudi Arabia.

Background: Isotretinoin is an effective treatment for acne but can cause side effects such as changes in blood lipids and liver enzymes. Laboratory monitoring is essential during treatment, but there is variation in monitoring practices. Aim: This study aims to investigate the relationship between isotretinoin therapy and its effects on complete blood count in Saudi Arabia to improve patient outcomes. Methods: The study was a retrospective cohort study conducted at King Khalid University Hospital in Riyadh, Saudi Arabia, between January 2016 and December 2020. Following the inclusion and exclusion criteria, 515 patients were randomly selected for the study. The data was analyzed using SPSS, and descriptive statistics and paired samples t-tests were employed to analyze the data. Results: In this study, 515 patients were enrolled. Of these participants, 76.7% (n=395) were females and 23.3% (n=120) were males. The mean age of the study participants was 23.98±7.4 years and ranged between 16 and 65 years. The mean dose of Isotretinoin administered was 27.65±9.6 mg/day, with a range of 10-60 mg/day. The mean BMI of the study participants was 24.3±4.1 kg/m2, ranging from 14.3 to 44.8 kg/m2. Regarding the effect of Isotretinoin on laboratory measures, significant statistical differences were found in hemoglobin measurements (t=-3.379, p=0.001), platelets (t=-3.169, p=0.002), neutrophils (%) (t=3.107, p=0.002), total cholesterol (t=-13.017, p=0.000), AST (t=-6.353, p=0.000), ALT (t=-4.352, p=0.000), HDL (t=2.446, p=0.015), and LDL (t=-12.943, p=0.000). However, there were no significant statistical differences in the measurements of WBC, neutrophils (count), or triglycerides. In the Chi-square analysis and Fisher's Exact test to identify the interaction between BMI, dose, and gender on abnormal lab results, significant interaction was found between participants' BMI and abnormal HDL measurements (p=0.006). Furthermore, there were significant interactions between Isotretinoin dose (either less than 30 mg/day or 30 mg/day or more) and abnormal neutrophil count (p=0.04), abnormal HDL measurements (p=0.010), and abnormal triglycerides measurements (p=0.020). Moreover, a statistically significant interaction was found between participants' gender and abnormal hemoglobin measurements (p=0.006), abnormal total cholesterol (p=0.016), abnormal AST measurements (p=0.001), abnormal ALT measurements (p=0.000), abnormal HDL measurements (p=0.000), and abnormal triglycerides measurements (p=0.007). Conclusion: In conclusion, the study found that isotretinoin therapy has significant effects on several laboratory measures, including hemoglobin, platelets, neutrophils, total cholesterol, AST, ALT, HDL, and LDL. The study also revealed significant interactions between BMI, dose, gender, and abnormal lab results.

Modifying Naturally Occurring, Nonmammalian-Sourced Biopolymers for Biomedical Applications.

Natural biopolymers have a rich history, with many uses across the fields of healthcare and medicine, including formulations for wound dressings, surgical implants, tissue culture substrates, and drug delivery vehicles. Yet, synthetic-based materials have been more successful in translation due to precise control and regulation achievable during manufacturing. However, there is a renewed interest in natural biopolymers, which offer a diverse landscape of architecture, sustainable sourcing, functional groups, and properties that synthetic counterparts cannot fully replicate as processing and sourcing of these materials has improved. Proteins and polysaccharides derived from various sources (crustaceans, plants, insects, etc.) are highlighted in this review. We discuss the common types of polysaccharide and protein biopolymers used in healthcare and medicine, highlighting methods and strategies to alter structures and intra- and interchain interactions to engineer specific functions, products, or materials. We focus on biopolymers obtained from natural, nonmammalian sources, including silk fibroins, alginates, chitosans, chitins, mucins, keratins, and resilins, while discussing strategies to improve upon their innate properties and sourcing standardization to expand their clinical uses and relevance. Emphasis will be placed on methods that preserve the structural integrity and native biological functions of the biopolymers and their makers. We will conclude by discussing the untapped potential of new technologies to manipulate native biopolymers while controlling their secondary and tertiary structures, offering a perspective on advancing biopolymer utility in novel applications within biomedical engineering, advanced manufacturing, and tissue engineering.

Ketogenic Diet and Its Potential Role in Preventing Type 2 Diabetes Mellitus and Its Complications: A Narrative Review of Randomized Controlled Trials.

Diabetes mellitus is a global health crisis affecting millions. Nutrition plays a vital role in its management and prevention. While carbohydrate reduction is beneficial for glycemic control, various dietary approaches exist. The ketogenic diet, characterized by very low carbohydrate intake, has shown promise in weight management and blood sugar control. However, its potential for preventing type 2 diabetes mellitus (T2DM) remains largely unexplored. To evaluate the ketogenic diet's potential in preventing T2DM, this review searched the PubMed database for studies published between 2013 and 2023. Findings suggest that the diet can effectively aid weight loss and improve blood glucose levels. Some evidence indicates reduced reliance on diabetes medications. However, effects on cholesterol levels are inconsistent, and long-term adherence challenges exist. Additionally, potential micronutrient deficiencies and safety concerns require careful consideration. While the ketogenic diet offers potential benefits, further research is needed to establish its efficacy and safety as a long-term prevention strategy for T2DM. However, the results of the present study indicate the need for further research in this area, utilizing rigorous methodology.

Impact of the culturally adapted kids in control of food (KICk OFF) educational program on glycemic control and BMI in adolescents with type 1 diabetes in Kuwait: A retrospective study.

AIMS: To examine the effectiveness of the culturally adapted Kids in Control Of Food (KICk OFF) structured educational program on glycemic control and BMI z-scores (BMIz) in adolescents with type 1 diabetes in Kuwait. METHODS: We conducted a retrospective analysis of 161 adolescents aged 11-16 years with type 1 diabetes who participated in the culturally adapted KICk OFF program at Dasman Diabetes Institute from 2019 to 2023. Changes in glycated hemoglobin (HbA1c) and BMIz were assessed from baseline to six months post-program using paired t-tests and Wilcoxon signed-rank tests, respectively. RESULTS: After six months post-program, there was a significant reduction in HbA1c levels (mean ± standard deviation) from 9.3 ± 1.8 % (78 ± 20 mmol/mol) to 8.9 ± 1.7 % (74 ± 19 mmol/mol), P <0.0001. The greatest improvements observed in participants with baseline HbA1c >9.5 % (reduction of 0.70 % [8 mmol/mol]) and those with HbA1c 7.5-9.5 % (reduction of 0.32 % [4 mmol/mol]). There was a slight increase in median BMIz by 0.08 (interquartile range -0.04-0.22). CONCLUSIONS: The culturally adapted KICk OFF program shows a potential in improving glycemic control among adolescents with type 1 diabetes, particularly in those with initially suboptimal control. Future research through randomized controlled trials and over longer periods is recommended to validate these results.

The Matrix Approach to Patellar Instability.

Patellar instability is a challenging orthopedic condition affecting both pediatric and adult populations. The diagnosis and treatment of this condition present challenges for surgeons because of the multitude of classifications and treatment options available in the literature, leading to potential confusion in treatment strategies. Nonoperative treatments often prove ineffective, with reported recurrence rates nearing. Consequently, numerous surgical interventions have been developed in pursuit of improved outcomes. However, the results of these early interventions have not been universally successful, resulting in over 100 surgical interventions being recommended for patellofemoral instability, and none of which have achieved universal success. This hesitancy among surgeons to recommend surgery can leave patients inadequately treated. This article aims to share our matrix approach to patellar instability, developed over the past decade. By providing insights into the condition, we hope to stimulate interest among aspiring surgeons and facilitate a comprehensive understanding of the diagnosis and management of patellofemoral instability.

Predicting High-Strength Concrete's Compressive Strength: A Comparative Study of Artificial Neural Networks, Adaptive Neuro-Fuzzy Inference System, and Response Surface Methodology.

Machine learning and response surface methods for predicting the compressive strength of high-strength concrete have not been adequately compared. Therefore, this research aimed to predict the compressive strength of high-strength concrete (HSC) using different methods. To achieve this purpose, neuro-fuzzy inference systems (ANFISs), artificial neural networks (ANNs), and response surface methodology (RSM) were used as ensemble methods. Using an ANN and ANFIS, high-strength concrete (HSC) output was modeled and optimized as a function of five independent variables. The RSM was designed with three input variables: cement, and fine and coarse aggregate. To facilitate data entry into Design Expert, the RSM model was divided into six groups, with p-values of responses 1 to 6 of 0.027, 0.010, 0.003, 0.023, 0.002, and 0.026. The following metrics were used to evaluate model compressive strength projection: R, R2, and MSE for ANN and ANFIS modeling; R2, Adj. R2, and Pred. R2 for RSM modeling. Based on the data, it can be concluded that the ANN model (R = 0.999, R2 = 0.998, and MSE = 0.417), RSM model (R = 0.981 and R2 = 0.963), and ANFIS model (R = 0.962, R2 = 0.926, and MSE = 0.655) have a good chance of accurately predicting the compressive strength of high-strength concrete (HSC). Furthermore, there is a strong correlation between the ANN, RSM, and ANFIS models and the experimental data. Nevertheless, the artificial neural network model demonstrates exceptional accuracy. The sensitivity analysis of the ANN model shows that cement and fine aggregate have the most significant effect on predicting compressive strength (45.29% and 35.87%, respectively), while superplasticizer has the least effect (0.227%). RSME values for cement and fine aggregate in the ANFIS model were 0.313 and 0.453 during the test process and 0.733 and 0.563 during the training process. Thus, it was found that both ANN and RSM models presented better results with higher accuracy and can be used for predicting the compressive strength of construction materials.

Hybrid stage 1 Norwood combined with reverse Blalock-Taussig shunt and sutureless repair of total anomalous pulmonary venous connections.

The patient is a 35-week-old, 2.6-kg neonate who was diagnosed prenatally with hypoplastic left heart syndrome and a supracardiac variant of total anomalous pulmonary venous connection. We present the technique of stage 1 hybrid palliation combined with repair of total anomalous pulmonary venous connection. Due to the risk of retrograde aortic arch obstruction from the ductal stents, a reverse Blalock-Taussig shunt was performed as well.

Prevalence and Factors Associated With Using Complementary Medicine Among Adults With Type 2 Diabetes in Primary Healthcare Centers of Al-Ahsa, Eastern Saudi Arabia.

Background and aim Type 2 diabetes mellitus (T2DM) is a major health problem in Saudi Arabia. The use of complementary and alternative medicine (CAM) for the management of T2DM is increasing, but there is limited research on its safety and efficacy. This study aimed to investigate the prevalence and factors associated with CAM use among patients with T2DM attending primary healthcare centers in Al-Ahsa, Saudi Arabia. Methods A cross-sectional study was conducted between January and March 2024 to assess CAM use among T2DM patients in Al-Ahsa. Data were collected through telephone interviews using a validated questionnaire covering demographics, diabetes information, and CAM use. A total of 499 participants completed the questionnaire. Results CAM use was reported by 106 (21.2%) participants, with fenugreek (51, 48.1%), cinnamon (48, 45.3%), and blackseed (29, 27.4%) being the most common. Key factors associated with CAM use included residence in the Eastern or Northern Region, older age, having diabetic complications, and lower frequency of doctor visits. Only 24 (22.6%) participants consulted their doctor about CAM, and 83 (78.3%) believed that CAM could prevent diabetes progression. Conclusion This study provides insights into the use of CAM among T2DM patients in Al-Ahsa, Saudi Arabia. The findings highlight the need for larger-scale longitudinal research to better understand the patterns and potential benefits and/or harms of CAM use. Developing targeted interventions and promoting evidence-based integration of CAM into the healthcare system could optimize patient care and encourage patient-provider communication regarding these therapies.