Hepatoprotective activity of polyherbal formulation against carbon tetrachloride-induced hepatotoxicity in rats

The ethanloic extracts of the polyherbal medicinal plants (Asteracantha longifolia, Cyperus rotundus and Bryophyllum pinnatum) were evaluated for hepatoprotective activity in carbon tetrachloride induced liver damage in rats. The ethanolic extract of polyherbal formulation at 250 mg/kg b.w. exhibited a significant protective effect by lowering serum and liver activities of aspartate  transaminase (AST), alanine transaminase (ALT), acid phosphatase (ACP), alkaline phosphatase (ALP), lactate dehydrogenase(LDH), serum bilirubin, serum cholesterol and serum total protein when compared with standard silymarin. The hepatoprotective activity of the extracts may be attributed to increased regeneration of hepatocytes and inhibitory effects on microsomal enzymes.Key words: Polyherbal formulation, carbon tetrachloride, silymarin

Differences in the recommendation of laparoscopic clinical practice guidelines according to the recommendation system-Re-evaluation using GRADE: A pilot study

Summary Background: Guidelines are essential for safe and effective treatment. They usually have multiple statements. Since the supporting information for the guidelines varies widely, the degree to which these statements are recommended also differ. We rely on recommendation systems for grading the recommendations for different statements. All recommendation systems have different grading criteria and they could potentially cause confusion and affect the quality of recommendations. Therefore, there is a need to determine the extent of variation and explore the potential reasons behind it. Methods: A purposive sampling on PubMed was conducted to find four different laparoscopic guidelines using different methods to grade the recommendations. Each statement was then re-evaluated using the GRADE recommendation system. Results: The guidelines used GRADE, Oxford Methodology, SIGN, and ‘bespoke’ systems. The number of statements with similar strength for the different statements as the re-evaluated strengths in the four guidelines were 24.1, 62.2, 35.8 and 50.0% respectively. Conclusion: There were a wide variety of recommendation systems for laparoscopic guidelines and there were differences between the recommendations from the guidelines using GRADE, Oxford Methodology, SIGN and the ‘Bespoke’ system when re-evaluated by GRADE. A systematic review of recent laparoscopic guidelines might provide the extent and the main reasons of the problem

Comparative Outcomes of Resident vs Attending Performed Surgery: A Systematic Review and Meta-Analysis

OBJECTIVE: To determine whether outcomes are different when surgery is performed by resident or attending surgeons, and which variables may affect outcomes. DESIGN: MEDLINE, EMBASE, and the Cochrane Library were searched from inception to May 2014 alongside the bibliographies of all included or relevant studies. Any study comparing outcomes from surgery performed by resident vs attending surgeons was eligible for inclusion. The main outcome measures were surgical complications (classified by Clavien-Dindo grade), death, operative time, and length of stay. Data were extracted independently by 2 authors and analyzed using the random-effects model. RESULTS: The final analysis included 182 eligible studies that enrolled 141 555 patients. Resident performed surgery took longer by 10.2 minutes (95% confidence interval (CI): 8.38-11.95), and had more Clavien-Dindo grade 1 (rate ratio = 1.14, 95% CI: 1.02-1.29) and grade 3a complications (rate ratio = 1.22, 95% CI: 1.04-1.44). Resident performed surgery resulted in fewer deaths (risk ratio = 0.83, 95% CI: 0.70-0.999) with a shorter length of stay of -0.49 days (95% CI: -0.77 to -0.21). Significant heterogeneity was present in 7 of 10 outcomes, which persisted during multiple subgroup analyses. CONCLUSIONS: Resident performed surgery appears to be safe in carefully selected patients. The significant amount of heterogeneity present in the study outcomes prevents generalizability of these results to specific clinical contexts

Thresholds for surfactant use in preterm neonates: a network meta-analysis

Objective: To perform a network meta-analysis of randomised controlled trials of different surfactant treatment strategies for respiratory distress syndrome (RDS) to assess if a certain fraction of inspired oxygen (FiO2) is optimal for selective surfactant therapy. Design: Systematic review and network meta-analysis using Bayesian analysis of randomised trials of prophylactic versus selective surfactant for RDS. Setting: Cochrane Central Register of Controlled Trials, MEDLINE, Embase and Science Citation Index Expanded. Patients: Randomised trials including infants under 32 weeks of gestational age. Interventions: Intratracheal surfactant, irrespective of type or dose. Main outcome measures: Our primary outcome was neonatal mortality, compared between groups treated with selective surfactant therapy at different thresholds of FiO2. Secondary outcomes included respiratory morbidity and major complications of prematurity. Results: Of 4643 identified references, 14 studies involving 5298 participants were included. We found no statistically significant differences between 30%, 40% and 50% FiO2 thresholds. A sensitivity analysis of infants treated in the era of high antenatal steroid use and nasal continuous positive airway pressure as initial mode of respiratory support showed no difference in mortality, RDS or intraventricular haemorrhage alone but suggested an increase in the combined outcome of major morbidities in the 60% threshold. Conclusion: Our results do not show a clear benefit of surfactant treatment at any threshold of FiO2. The 60% threshold was suggestive of increased morbidity. There was no advantage seen with prophylactic treatment. Randomised trials of different thresholds for surfactant delivery are urgently needed to guide clinicians and provide robust evidence. PROSPERO registration number: CRD42020166620

Global existence of solutions to Keller--Segel chemotaxis system with heterogeneous logistic source and nonlinear secretion

We study the following Keller-Segel chemotaxis system with logistic source and nonlinear secretion. For this system, we prove the global existence of solutions under suitable assumptions

Further Results on (a, d) -total Edge Irregularity Strength of Graphs

ليكن  رسمًا بيانيًا بسيطًا على رؤوس l وحواف m مع إجمالي h -  وضع العلامات  . فان   تسمى (ا,د)- وسم غير منتظم للحافة الإجمالية إذا وجد تطابق متقابل وليكن   معرفة بواسطة   لكل   , حيث  . كذلك قيمة  يقال لها وزن الحافة . يشار الى (ا,د)-اجمالي قوة عدم انتظام الحواف للرسم البياني G ب  وهي اقل h التي يقبلها G   للحافة -(ا,د) الغير منتظمة للعلامة-h . في هذه المقالة تم فحص,  لبعض عائلات الرسم البياني الشائعة. بالاضافة الى ذلك تم حل المسالة المفتوحة  بشكل ايجابي. م تسمى ρ (أ ، د) - وسم غير منتظم للحافة الإجمالية إذا كان هناك تطابق واحد لواحد ، قل ψ: E (G) → {a ، a + d ، a + 2d ،… + a + (m- 1) د} محدد بواسطة ψ (uv) = ρ (u) + ρ (v) + ρ (uv) لجميع uv∈E (G) ، حيث a≥3 ، d≥2. أيضًا ، يُقال إن القيمة ψ (uv) هي وزن حافة الأشعة فوق البنفسجية. يشار إلى قوة عدم انتظام الحافة الإجمالية (أ ، د) للرسم البياني G بواسطة (a ، d) -tes (G) وهي أقل h التي يقبلها G (أ ، د) - علامة h غير منتظمة للحافة. في هذه المقالة ، يتم فحص (أ ، د) -tes (G) لبعض عائلات الرسم البياني الشائعة. بالإضافة إلى ذلك ، يتم حل المشكلة المفتوحة (3،2) - tes (K_ (m ، n)) ، m ، n> 2 بشكل إيجابي.Consider a simple graph   on vertices and edges together with a total  labeling . Then ρ is called total edge irregular labeling if there exists a one-to-one correspondence, say  defined by  for all  where  Also, the value  is said to be the edge weight of . The total edge irregularity strength of the graph G is indicated by  and is the least  for which G admits   edge irregular h-labeling.  In this article,   for some common graph families are examined. In addition, an open problem is solved affirmatively