Chitosan Nanogel with Mixed Food Plants and Its Relation to Blood Glucose in Type 2 Diabetes: A Systematic and Meta-Analysis Review of Observational Studies

This systematic review with metanalysis evaluated and analyzed the beneficial effects of certain plants food in type 2 diabetes (T2D) when consumed alone or in combination with chitosan. The main objective of the paper was to examine the relation of chitosan nanogel and mixed food plant (MFP) to control T2D. The databases included Medline, Scopus, PubMed, as well as Cochrane available between the month of January 1990 to January 2021. The eligibility criteria for selecting studies were case-controlled studies that included unripe plantain, bitter yam, okra, and chitosan either used-alone or in combination with non-specified food plants (NSFP). Two-fold autonomous critics retrieved the information required and evaluated the risk of bias of involved studies. Random-effect meta-analyses on blood glucose controls, were performed. Results of 18 studies included: seven that examined unripe plantains, one bitter yam, two okras, and eight chitosan, found regarding the decrease in blood glucose level. Meta-analysis of the results found a large proportion of I2 values for all studies (98%), meaning heterogeneity. As a consequence, the combined effect sizes were not useful. Instead, prediction interval (PI) was used (mean difference 4.4 mg/dL, 95% PI −6.65 to 15.50 and mean difference 3.4 mg/dL, 95% PI −23.65 to 30.50) rather than the estimate of its confidence interval (CI). These studies were at 50% high risk of bias and 50% low risk of bias and there was judged to be an unclear risk of bias due to the insufficient information from the included study protocol (moderately low). The intervention lasted between three and 84 days, indicating potency and effectiveness of the intervention at both short and long durations. Due to the moderately low quality of the studies, the findings were cautiously interpreted. In conclusion, the current evidence available from the study does support the relation of chitosan with mixed unripe plantain, bitter yam and okra for the management of T2D. Further high-quality case-controlled animal studies are required to substantiate if indeed chitosan nanogel should be cross-linked with the specified food plant (SFP) for the management T2D

Pneumothorax following ERCP: Report of Two Cases with Different Pathophysiology

In the last thirty years, the widespread use of endoscopic retrograde cholangiopancreatography (ERCP) has radically changed the management of patients with diseases of the extrahepatic biliary tract and pancreas. Pneumothorax is a rare complication of ERCP. We report two cases of pneumothorax following elective ERCP for ductal stone clearance. The first patient was a 45-year-old female, who developed respiratory distress, abdominal pain, and profoundly abdominal distention immediately after the procedure. Imaging studies revealed the presence of a right-side pneumothorax, pneumomediastinum, pneumoperitoneum, and pneumoretroperitoneum. The second patient was a 94-year-old female, who developed tension pneumothorax with clinical signs of shock during the procedure. Imaging studies revealed the presence of a right-side pneumothorax without free air in the mediastinum and retroperitoneal space. The imaging findings suggest that the occurrence of this rare complication in our patients was caused by entirely different pathophysiological mechanisms. Both patients were successfully treated with chest tube insertion, and no further intervention was required. Clinicians should be aware of this serious complication because delayed diagnosis may involve significant morbidity and mortality risks

Adipose tissue-derived WNT5A regulates vascular redox signaling in obesity via USP17//RAC1-mediated activation of NADPH oxidases

Obesity is associated with changes in the secretome of adipose tissue (AT), which affects the vasculature through endocrine and paracrine mechanisms. Wingless-related integration site 5A (WNT5A) and secreted frizzled-related protein 5 (SFRP5), adipokines that regulate noncanonical Wnt signaling, are dysregulated in obesity. We hypothesized that WNT5A released from AT exerts endocrine and paracrine effects on the arterial wall through noncanonical RAC1-mediated Wnt signaling. In a cohort of 1004 humans with atherosclerosis, obesity was associated with increased WNT5A bioavailability in the circulation and the AT, higher expression of WNT5A receptors Frizzled 2 and Frizzled 5 in the human arterial wall, and increased vascular oxidative stress due to activation of NADPH oxidases. Plasma concentration of WNT5A was elevated in patients with coronary artery disease compared to matched controls and was independently associated with calcified coronary plaque progression. We further demonstrated that WNT5A induces arterial oxidative stress and redox-sensitive migration of vascular smooth muscle cells via Frizzled 2–mediated activation of a previously uncharacterized pathway involving the deubiquitinating enzyme ubiquitin-specific protease 17 (USP17) and the GTPase RAC1. Our study identifies WNT5A and its downstream vascular signaling as a link between obesity and vascular disease pathogenesis, with translational implications in humans

The Use of Mechanical Bowel Preparation and Oral Antibiotic Prophylaxis in Elective Colorectal Surgery: A Call for Change in Practice

Elective colorectal surgery is associated with one of the highest rates of surgical site infections (SSIs), which result in prolonged length of stay, morbidity, and mortality for these patients and have a significant financial burden to healthcare systems. In an effort to reduce the frequency of SSI rates associated with colorectal surgery, the 2018 World Health Organisation (WHO) guidelines recommend the routine use of mechanical bowel preparation (MBP) and oral antibiotic prophylaxis (OAP) in adult patients undergoing elective colorectal surgery. However, this recommendation remains a topic of debate internationally. The National Institute of Clinical Excellence (NICE) guidelines, last revised in 2019, recommend against the routine use of MBP and do not address the issue of OAP. In this communication, we reviewed the current guidelines and examined the most recent evidence from randomised-control trials (RCTs) and meta-analyses on the effect of MBP and OAP on SSI rates since the 2019 NICE guideline review. This recent evidence clearly demonstrated an SSI-risk-reduction benefit with the additional use of OAP and the combination of MBP and OAP in this group of patients, and we therefore highlight the need for change of the current NICE guidelines

Idiopathic Unilateral Adrenal Haemorrhage and Adrenal Mass: A Case Report and Review of the Literature

We report an unusual case of idiopathic unilateral adrenal haemorrhage (AH) in a 55-year-old patient. This rare case had two characteristics that made it worth of report. First, idiopathic adrenal haemorrhage is very uncommon, and second it was presented as a huge, 23 cm diameter and 2,123 gr weight, “silent” adrenal mass. It is important to distinguish a benign lesion like this from a neoplasm, although we were not able to identify it preoperatively and the diagnosis was only made after the excised specimen was examined by a group of experienced histopathologists. Only a few similar published cases, to our knowledge, are described in the worldwide literature and even fewer of this size

Propensity to export and effects on cluster development: A comparative study of the Cyprus and Greek solar thermal clusters

Access to sophisticated demand is critical for cluster upgrading in developing countries. Despite this, the role of exports in cluster development has not been adequately researched. This study tries to answer two questions; what are the factors that increase the propensity of a cluster to successfully engage in exports and how exports affect cluster upgrading. In order to isolate the effect of exports, two clusters are studied, the Cyprus and the Greek solar thermal clusters. Despite the fact that these two clusters emerged in similar environments, today they present some distinct differences which could be explained by the different levels of success in exporting. Our findings suggest that the export vision shared among cluster participants, and the collaboration to achieve the vision are of critical importance in penetrating sophisticated export markets. This study highlights the positive influence of exports on cluster development and provides managers and policy makers with an indication of which factors contribute to successful exporting

Propensity to export and effects on cluster development: a comparative study of the Cyprus and Greek solar thermal clusters

Access to sophisticated demand is critical for cluster upgrading in developing countries. Despite this, the role of exports in cluster development has not been adequately researched. This study tries to answer two questions; what are the factors that increase the propensity of a cluster to successfully engage in exports and how exports affect cluster upgrading. In order to isolate the effect of exports, two clusters are studied, the Cyprus and the Greek solar thermal clusters. Despite the fact that these two clusters emerged in similar environments, today they present some distinct differences which could be explained by the different levels of success in exporting. Our findings suggest that the export vision shared among cluster participants, and the collaboration to achieve the vision are of critical importance in penetrating sophisticated export markets. This study highlights the positive influence of exports on cluster development and provides managers and policy makers with an indication of which factors contribute to successful exporting.diamond model; cluster upgrading; exports; Cyprus; Greece; solar thermal systems; developing countries; clusters; cluster development; solar energy.

Demonstration Abstract: Crowdsourced Indoor Localization and Navigation with Anyplace

Abstract—In this demonstration paper, we present the Anyplace system that relies on the abundance of sensory data on smartphones (e.g., WiFi signal strength and inertial measurements) to deliver reliable indoor geolocation information. Our system features two highly desirable properties, namely crowdsourcing and scalability. Anyplace implements a set of crowdsourcing-supportive mechanisms to handle the enormous amount of crowdsensed data, filter incorrect user contributions and exploit WiFi data from heterogeneous mobile devices. Moreover, Anyplace follows a big-data architecture for efficient and scalable storage and retrieval of localization and mapping data. Keywords—Crowdsourcing, indoor localization, navigation. I