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Objective: The thyroid gland has a very important role in hematopoiesis. Blood disorders are frequently seen in patients with thyroid dysfunction and anemia is more common in them. Thyroid hormones directly affect blood parameters by stimulating erythrocyte precursors and indirectly by enhancing erythropoietin production. The present study was conducted to evaluate the effect of hypothyroidism on different hematological parameters. Methods: This is a prospective observational study which included a total of two hundred individuals. They are enrolled and divided into two equal groups; each group consists of one hundred individuals. The first group consists of one hundred cases of hypothyroidism, whose blood cell indices are compared with one hundred healthy individuals as a control in the second group. Patients with diabetes mellitus, hyperthyroidism, congenital thyroid disorders, thyroid malignancies, hemolytic anemia’s, aplastic anemia, malignancies, leukemias and blood dyscrasias were excluded from the study. Results: The analysis showed a significant difference in the hemoglobin, RBC count, hematocrit (HCT), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), and red cell distribution width (RDW) (p values 0.000, 0.000, 0.000, 0.000, 0.002, 0.000, and 0.022), respectively, while platelets and WBC showed no significant correlation (p values 0.410 and 0.6420). Conclusion: In this study, most of the hematological parameters in hypothyroid cases are significantly low, except RDW levels which are high among them. Platelet count and WBC are less affected in cases when compared with the controls, and the study indicates that anemia is associated with hypothyroidism. The follow-up of patients with thyroid disorders should include the complete blood count and patients diagnosed with anemia should also be evaluated for thyroid disorders before iron therapy or any other therapies. Cases of anemia which are not responding to treatment should be investigated for the possibility of thyroid dysfunction.

Background: Medical students are using more applications of smartphones in their course besides the primary purpose of communication. The excessive usage of smartphone has given rise to a condition known as “nomophobia”. The objectives of the study are to estimate the prevalence of nomophobia and to evaluate the determinants of nomophobia among participants. Methods: A cross-sectional study was conducted from July to August 2022 among 320 undergraduate medical students of Sri Venkateswara Medical College, Tirupati. NMP-Q questionnaire used as a tool for data collection. Ethical clearance was obtained from the Institutional Ethical Committee and informed consent was taken from the participant. Collected data was coded and entered into a Microsoft excel and analysed using statistical package for the social sciences (SPSS) software version 21.0. Results: Prevalence of nomophobia among study subjects was found to be 100% (320); of which 59% showed moderate nomophobia followed by mild (35%) and severe nomophobia (6%). Nearly 60% of the students are using smart phone for communication, 56% for entertainment and 46% for study purpose. Conclusions: All participants were suffering from nomophobia with different grades of severity. It was significantly associated with age, year of study, number of apps used, average time spent with mobile and messages sent per day. Most of them were using smart phone for communication, entertainment and study purpose.

Although excess production of androgens and glucocorticoids has often been observed in adrenocortical carcinomas, adrenocortical adenoma with such hormonal activity is rare. Herein, we report a 41-year-old woman who presented with hyperandrogenemia and mild autonomous cortisol secretion with an undetectable level of adrenocorticotropic hormone. Imaging demonstrated a 6 cm left adrenal tumor. The histologic diagnosis of the resected adrenal tumor was adrenocortical adenoma. Pre- and post-operative serum samples were used for steroid profiling with liquid chromatography-tandem mass spectrometry (LC-MS/MS). LC-MS/MS analysis of pre-operative serum revealed an abnormal buildup of steroid precursors and androgens. Importantly, circulating levels of 11-oxygenated androgens, including 11β-hydroxytestosterone (11OHT) and 11-ketotestosterone (11KT), were highly elevated. Both androgen and glucocorticoid levels significantly decreased post-operatively. Immunohistochemical analysis of steroidogenic enzymes and cofactor protein supported the tumor's ability to directly produce 11OHT and 11KT. This study is the first to describe and characterize an adrenocortical adenoma that co-secretes glucocorticoids and 11-oxygenated androgens. Significance statement Due to its rarity, biochemical and histologic characteristics of androgen and glucocorticoid co-secreting adrenocortical adenomas are largely unknown. Herein, we report a case of adrenocortical adenoma that caused marked hyperandrogenemia and mild autonomous cortisol secretion. In this study, we investigated serum steroid profiles using liquid chromatography-tandem mass spectrometry (LC-MS/MS) and histologic characteristics of the resected tumor. LC-MS/MS revealed highly elevated levels of 11-oxygenated androgens which have not been well studied in adrenal tumors. The expression patterns of steroidogenic enzymes determined by immunohistochemistry supported the results of steroid profiling and suggested the capacity of the tumor cells to produce 11-oxygenated androgens. Measurement of 11-oxygenated steroids should facilitate a better understanding of androgen-producing adrenocortical neoplasms.

This paper examines the impact of fire on the microstructural, mechanical, and corrosion behavior of wire-arc-sprayed zinc, aluminum, and Zn-Al pseudo-alloy coatings. Steel plates coated with these materials were subjected to temperatures in increments of 100 °C, starting from 300 °C and progressing until failure. Microstructural characterization, microhardness, abrasion resistance, and electrochemical impedance studies were performed on the post-fire coatings. The findings from this study show that heat had a positive impact on the performance of zinc and Zn-Al pseudo-alloy coatings when they were exposed to temperatures of up to 400 °C, while aluminum coatings maintain their performance up to 600 °C. However, above these temperatures, the effectiveness of coatings was observed to decline, due to increased high-temperature oxidation, and porosity, in addition to decreased microhardness, abrasion resistance, and corrosion protection performance. Based on the findings from this study, appropriately sealed thermal-spray-coated steel components can be reused after exposure to fire up to a specific temperature depending on the coating material.

Model Predictive Control (MPC) for grid-connected inverters has been presented in this paper. The standard proportional-integral controller based system is replaced by this control method for a two-level inverter using Euler's approximation technique to improve the inverter's dynamic response. To anticipate the grid-connected inverter's longer-term behaviour, a replacement predictive mathematical model is offered, which is likened to the reference signal to decide the system's cost function. With this MPC approach, the cost functions of the converter are derived using all possible switching vectors. The associated switching vector for the minimal possible function is then chosen to activate the inverter switches throughout the subsequent sampling instant. The suggested scheme is validated in Simulink to verify its effectiveness and performance. In comparison to the PI-based controller, total harmonic distortion (THD) and current error are minimized.

The power crisis faced in India can be overcome by introducing different non-traditional control age tactics. Sunlight-based electricity is the most well-known out-of-the-box technology. Since the sun is the major source of energy for this method, the facility age may vary due to the natural factors like as irradiance, temperature variations, and abrupt impedance of mists, which cannot be controlled or prevented by humans. Irrespective of temperature, irradiance, or shading effects, the Maximum Power Point Tracker (MPPT) method is employed to see the utmost power age point. By applying MPPT methods, the required amount of energy is controlled with a smaller number of boards, lowering the value of adding to a PV framework. This research presents a comparable analysis of two MPPT procedures, Perturb and Observe (P&O) and Incremental Conductance (INC) methods in light of the very fact that these computations are often used due to their low effort and simple recognition when using MATLAB/SIMULINK. To imitate the MPPT algorithm, the basic quantities like voltage and current of a board have been used.

It is difficult to predict the development of carotid stenosis by means of the known risk factors. Using a computational fluid dynamics analysis, we examined the hemodynamic risks for carotid stenosis, focusing on wall shear stress (WSS) disturbances.In 59 patients with unilateral carotid stenosis, the plaque was removed from the original three-dimensional computed tomography angiographic images, and the vessel shape before stenosis was artificially reproduced. A multivariate regression analysis was performed to determine the associations between the degree of area stenosis and hemodynamic and morphologic factors after adjustment for 6 known risk factors.Metrics for WSS disturbances were higher at and distal to a bifurcation in the carotid arteries after plaque removal compared with the normal carotid arteries, and metrics for WSS magnitudes were lower. In the plaque-removed arteries, the degree of stenosis was significantly negatively correlated with the ratio of stenotic to distal values of metrics for WSS disturbances and the diameter ratio of the external to common carotid artery, and positively correlated with the ratio of proximal to stenotic values of metrics for WSS magnitudes.Rapid increases in WSS from the common carotid artery toward the bifurcation, rapid decreases in WSS disturbance from the bifurcation toward the internal carotid artery, and lower diameter ratio of the external to common carotid artery are more likely than other risk factors to cause future severe stenosis. In patients with these hemodynamic risks, underlying diseases should be controlled more strictly, with imaging examinations at shorter intervals.

Background Methods that facilitate muscle quality measurement may improve the diagnosis of sarcopenia. Current research has focused on the phase angle (PhA) obtained through bioelectrical impedance analysis (BIA) as an indicator of cellular health, particularly cell membrane integrity and cell function. The current study therefore aimed to evaluate the relationship between the PhA and muscle quality and muscle‐related parameters and to determine factors associated with the PhA. Moreover, we attempted to determine the cut‐off value of PhA for predicting sarcopenia. Methods First‐year university students (830 male students, 18.5 ± 0.6 years old; 422 female students, 18.3 ± 0.5 years old) and community‐dwelling elderly individuals (70 male individuals, 74.4 ± 5.5 years old; 97 female individuals, 73.1 ± 6.4 years old) were included. PhA and other body composition data were measured using BIA, while muscle quality was calculated by dividing handgrip strength by upper limbs muscle mass. The relationship between PhA and the aforementioned parameters were then analysed, after which the cut‐off value of PhA for predicting sarcopenia was examined. Results Multiple linear regression analysis revealed that age, skeletal muscle mass index (SMI), and muscle quality were independently associated with PhA in both sexes [male (age: standardized regression coefficient (β) = −0.43, P

Smoking is associated with the deteriorating health of the gingiva and periodontium. The long-term beneficial effects of smoking cessation on oral health are well known. However, the effects of short-term smoking cessation on gingival bleeding and periodontal pocket depth are unknown. The purpose of the present study was to determine the effects of short-term smoking cessation on gingival bleeding and periodontal pocket depth.Dentate smokers with a mean age of 56.9 ± 14.4 years at an outpatient smoking cessation clinic participated in this study. A professional dentist checked the periodontal pocket depth and gingival bleeding. Patients visited the smoking cessation clinic on their first visit and 2, 4, 8, and 12 weeks (three months). The gingival assessment was re-performed in those who succeeded in smoking cessation 3 months after the baseline.The baseline data of 83 patients showed that an increase in pocket depth was associated with increasing age and the amount of smoking. A significant increase in gingival bleeding (Short-term smoking cessation increased periodontal pocket depth and gingival bleeding. These findings may reflect healing processes that occur in the healthy gingiva.Study findings will be useful to advise patients during smoking cessation programs. Dentists can inform patients that an initial increase in gingival bleeding and pocket depth could be associated with smoking cessation. Such advice will prevent patients from any apprehension that may cause them to recommence smoking.

Background and Objective Although older patients with coronavirus disease 2019 (COVID-19) are at the high risk of exacerbation that requires treatment with remdesivir, the safety of this medication is unclear in clinical practice, especially among older patients. We aimed to retrospectively evaluate the safety of remdesivir in older patients with COVID-19 who required hospitalization in our institute. Methods We reviewed patients with COVID-19 who were treated with remdesivir at our institute between July 2020 and May 2021. We defined older patients as those aged 80 years or older at admission; all other patients were defined as younger patients. We evaluated the safety of remdesivir by examining the incidence of discontinuation of remdesivir treatment because of adverse events and the incidence of any adverse events. Results A total of 80 patients were included in this study. Compared with younger patients, fewer older patients were treated with remdesivir for more than 5 days: 4 (15.4%) vs 23 (42.6%). Discontinuation of remdesivir because of adverse events occurred in one older patient (3.9%) and four younger patients (7.4%) [p > 0.99]. Remdesivir-induced liver dysfunction was the most frequent adverse event, which occurred in 29 (36.3%) patients. There were no significant differences in the incidence of remdesivir-induced liver dysfunction, renal dysfunction, and fatigue. Conclusions The safety of remdesivir was suggested to be comparable between patients older than 80 years of age and patients younger than 80 years of age. The results of this study may encourage the administration of remdesivir to this older patient group.

Background Smoking and depression are closely related and form a vicious cycle. Yokukansan (YiganSan) is a polyherbal remedy that has the effect of calming neuropsychiatric symptoms such as anger and irritation. To examine the efficacy of Yokukansan during smoking cessation (SC) therapy in smokers with depressive tendencies but without major depressive disorders requiring pharmacotherapy. Methods A multicenter, double-blind, randomized, placebo-controlled, parallel-group comparison trial was conducted between June 2016 and May 2020 at 12 centers of the National Hospital Organization, Japan. This trial targeted smokers who first visited the SC outpatient clinics, did not receive any pharmacological treatment at the psychiatric or psychosomatic department, and scored 39 or more on the self-rating depression scale (SDS). Participants (n = 198) were randomly assigned to either the Yokukansan or placebo groups. The trial drug was initiated with the start of the SC treatment and continued for 12 weeks. The primary outcome was the high success rate of the SC treatment, and the secondary outcomes included changes in scores of the SDS and the Profile of Mood States (POMS) instrument. Results The success rate of the SC treatment was similar between the placebo (63%) and Yokukansan (67%) groups (P = .649). The SDS scores (placebo: mean difference [MD] = -3.5, 95% confidence interval [CI][-5.8, -1.2], d = 0.42; Yokukansan: MD = -4.6, 95%CI[-6.8, -2.3], d = 0.55), and the “tension-anxiety” POMS-subscale scores (placebo: MD = -1.6, 95%CI[-2.5, -0.7], d = 0.52; Yokukansan: MD = -1.6, 95%CI[-2.9, -0.3], d = 0.36) showed significant improvement in both groups after the SC treatment. However, “depression-dejection” improved in the Yokukansan group (MD = -1.9, 95%CI[-3.1, -0.7], d = 0.44) but not in the placebo group (MD = -0.1, 95%CI[-1.0, 0.7], d = 0.04). Significant improvement in “fatigue” was noted in the Yokukansan group (MD = -2.1, 95%CI[-3.4, -0.9], d = 0.47) but not in the placebo group (MD = -0.5, 95%CI[-1.8, 0.8], d = 0.11). The time × group interaction on the improvement in “depression-dejection” was significant (P = .019). Conclusions Yokukansan does not increase the SC treatment’s success rate but has additional positive effects on the psychological states due to the SC treatment in smokers with depressive tendencies but without apparent mental disorders. Trial registration ID: UMIN000027036. Retrospectively registered at UMIN on April 18, 2017.

Succenturiate placenta can be associated with vasa previa, retained placenta, post-partum hemorrhage and infection. Prior knowledge of presence of succenturiate placenta can be helpful to take quick and rational decisions during the labor. We present a case of placenta succenturiate suspected at 34+3 weeks of gestation using findings from ultrasonography.

Synchronous ovarian and endometrial tumor is a rare entity. We report a case of a 38-year woman with an endometrioid variant of synchronous primary endometrial and left ovarian carcinoma. Patient underwent total abdominal hysterectomy with bilateral salphingo-oophorectomy with lymphadenectomy and is disease free till 9 months.

OBJECTIVE A unique clinical course was observed in a patient with resistance to thyroid hormone β (RTHβ) caused by a variant of the THRB gene leading to the replacement of glycine with arginine in codon 347 (p.G347R). He presented with the syndrome of inappropriate secretion of thyrotropin (TSH) (free T4 [fT4]: 32.43 pmol/L, TSH: 4.67 mIU/L), but slowly developed progressive hypothyroidism (fT4: 8.37 pmol/L, TSH: 100.90 mIU/L) that resolved after suspending bezafibrate (BZ) treatment (fT4: 32.18 pmol/L, TSH: 7.14 mIU/L). This study clinically and experimentally evaluated this interesting phenomenon. METHODS A retrospective cohort analysis of non-RTHβ patients was performed at Kyoto University Hospital. Data before BZ treatment were compared to the first data after treatment. Using reporter assays of iodothyronine deiodinases (DIO1, DIO2, DIO3) in HEK293T cells, we performed functional analyses of mutant thyroid hormone receptor β with p.G347R (G347R TRβ). Mice with G347R TRβ were generated by hydrodynamic gene delivery. RESULTS In non-RTHβ patients (n = 7), BZ treatment did not change serum free T3 and TSH but significantly increased fT4 (p = .008). BZ administration increased DIO3 reporter activity in the context of G347R TRβ, whereas did not change DIO1 and DIO2 reporter activity. In the livers of mice with G347R TRβ, BZ administration increased reverse T3 content, which corresponded to an increase in Dio3 messenger RNA. CONCLUSIONS While hypothyroidism associated with BZ treatment did not occur in non-RTHβ patients, it was observed in a patient with RTHβ due to the p.G347R variant. Liver DIO3 upregulation might involve this hypothyroidism.

OBJECTIVE Primary aldosteronism has two main clinically and biologically distinct subtypes: unilateral aldosterone-producing adenoma (APA) and bilateral adrenal hyperplasia (BAH). We aimed to evaluate the changes of each subtype's clinical characteristics over a 13-year period. METHODS This retrospective study involved time-trend analyses to identify changes in the clinical features of APA and BAH at diagnosis (2006-2018). A nationwide database from 41 Japanese referral centers was searched, which identified 2804 primary aldosteronism patients with complete baseline information and adrenal venous sampling (AVS) data. RESULTS The proportion of patients with APA decreased from 51% in 2006-2009 to 22% in 2016-2018. Among the 1634 patients with BAH, trend analyses revealed decreases in hypertension duration (median 7--3 years; P

Context Adrenocorticotropin (ACTH) loading is used to increase the success rate of adrenal vein sampling (AVS). Objective We aimed to determine the effect of intraprocedural cortisol measurement (ICM) on ACTH-stimulated AVS (AS-AVS) owing to a lack of reliable data on this topic. Methods This multicenter, retrospective, observational study took place in 28 tertiary centers in Japan. Among 4057 patients enrolled, 2396 received both basal AVS (B-AVS) and AS-AVS and were divided into 2 groups according to whether ICM was used. The effect of ICM on AS-AVS was measured. Results In patients who underwent both AVS procedures, the ICM group had significantly higher success rates for both B-AVS and AS-AVS than the non-ICM group did. However, the probability of failure of AS-AVS after a successful B-AVS and the probability of success of AS-AVS after a failed B-AVS were not significantly different in the 2 groups. For subtype diagnosis, propensity-score matching revealed no significant difference between the 2 groups, and the discrepancy rate between B-AVS and AS-AVS for subtype diagnosis was also not significantly different. Conclusion ICM significantly increased the success rate of B-AVS and AS-AVS in protocols in which both AVS procedures were performed and had no effect on subtype diagnosis. However, in protocols in which both AVS procedures were performed, the results suggest ICM may not be necessary when performing AS-AVS if ICM is used only when B-AVS is performed. Our study suggests that ICM during AVS plays an important role and should be recommended.

The Internet of Things (IoT) can simply be referred to as the network of things comprising software, sensors, electronics, allowing data to be collected and transmitted. The next step in the field of technology is the Internet of Things, bringing tremendous improvements to manufacturing, medicine, environmental treatment, and urban growth. In shaping this vision, multiple challenges need to be faced, such as technology interoperability problems, protection and data confidentiality standards and, last but not least, the implementation of energy efficient management systems. These devices with minimal human interference are capable of producing, sharing and consuming data. The networking of related as well as heterogeneous devices is often known to be IoT. The Internet of Things allows things to connect and interact with each other, thus minimizing human involvement in simple daily tasks. Addressing protection at all times or at any position for many users, companies, governments, and enterprises is really necessary and responsive. In this paper a secure IOT architecture for routing in a network with RPL Rapid Node Link Routing (RNLR) Model is proposed that performs traffic management and traffic analysis for secure communication using IoT routing protocol. It mainly aims to locate the malicious users in a IOT routing protocols. the proposed mechanism is compared with the state of the art work and compared results shows the proposed work performs well.

Background: Desmopressin orally disintegrating tablet (ODT) was approved in March 2012 in Japan; the post-market safety reports, which warned about adequate initial dose of desmopressin ODT, were published in 2014. However, it is unclear how the warning affected physician and patient behavior. Methods: We performed a retrospective single-center study to compare the clinical situation of Japanese central diabetes insipidus patients before and after the report. Results: Thirty-four patients before October 2014 and 16 patients after November 2014 switched from intranasal desmopressin to desmopressin ODT. The mean follow-up period after the switch to desmopressin ODT was 38 ± 3 months. Patients switching after November 2014 tended to have lower ratios of oral to nasal desmopressin dose at switching and 3 months after the switch (at switching; P = 0.20, 3 months; P = 0.42, respectively), and higher ratios from 6 to 12 months than before October 2014 (6 months; P = 0.93, 9 months; P = 0.52, 12 months; P = 0.80, respectively). Relative doses per initial desmopressin ODT at 9 and 12 months were significantly higher in patients switching after November 2014 than in patients switching before October 2014 (9 months; P = 0.02, 12 months; P = 0.04, respectively). Moreover, logistic regression analysis revealed that the incidence of hyponatremia was dependent on the ratio of nasal to oral desmopressin dose (P = 0.02). In addition, in four out of six patients who had serum sodium level reduced below 130 mEq/L, hyponatremia occurred within 1 month after the switch. Conclusions: A more gradual dose titration after the safety reports was performed, which involved the long-term safety of desmopressin ODT use. Vigilance of hyponatremia in early phase of desmopressin ODT use should be noted. J Clin Med Res. 2021;13(2):92-100 doi: https://doi.org/10.14740/jocmr4399

Acromegaly is characterized by autonomous excessive growth hormone (GH) secretion, generally due to GH-producing pituitary adenoma, and is associated with various systemic comorbidities including diabetes mellitus. Polycystic kidney disease (PKD) is characterized by the growth of numerous cysts in the kidneys that deteriorate renal function. While possible renal effects of excessive GH exposure have been a current issue in experimental medicine, only five cases of coexisting acromegaly and PKD have been reported previously, and little is known regarding the influence of acromegaly on renal disease. We treated a 50-year-old male with diabetes mellitus who showed a sudden and rapid decline of renal function along with increasing proteinuria, which led to diagnoses of PKD and acromegaly. His urinary protein levels were increased together with excessive GH secretion and worsening glycemic control. An increase of total kidney volume was also noted. Transsphenoidal surgery for the pituitary adenoma was successfully performed. Marked improvement of hyperglycemia and proteinuria were observed after the surgery, but renal function was unchanged. The patient's clinical course suggested common aspects of excessive GH secretion as an accelerating factor of the progression of diabetic nephropathy and PKD via direct and indirect pathways. Although coexisting acromegaly and PKD is clinically rare, vigilance for early diagnosis of acromegaly is appropriate in patients with diabetes and/or PKD, especially in those showing unexpected exacerbation of renal dysfunction.

Background In peripheral tissues, triiodothyronine (T3) production and consequent thyroid hormone actions are mainly regulated by iodothyronine deiodinases (DIOs) classified into 3 types: D1, D2, and D3. Although thyroid hormone economy in the DIO-deficient mice and patients carrying genetic variants of DIOs was well clarified, a condition of DIOs upregulation was not enough elucidated. We aimed to investigate effects of peripheral DIOs on thyroid hormone economy and consequent thyroid hormone action using novel DIO-overexpressing mice that were not yet generated. Methods We cloned coding sequences of human DIOs with FLAG-tag and HiBiT-tag sequences into a pcDNA3.1 vector. To obtain full-length proteins, we modified these vectors by cloning selenocysteine insertion sequence of each DIO (SECIS vectors). Western blot analyses and HiBiT lytic assay using HEK293T cells revealed that SECIS vectors expressed full-length proteins with substantial activity. Subsequently, in vivo transfections of pLIVE-based SECIS vectors into male C57BL/6J mice were performed by hydrodynamic gene delivery to generate mice overexpressing DIOs (D1, D2, and D3 mice). Results First, we verified that DIOs were successfully overexpressed in the livers using HiBiT lytic assay as well as RT-PCR. Analyses of multiple organs of D3 mice assured that full-length protein was not significantly expressed in the heart, the kidney, and the skeletal muscle. RT-PCR analyses also suggested that the pituitary glands and the thyroid glands were not transfected. We evaluated thyroid hormone economy of DIO-overexpressing mice compared to Empty mice transfected with pLIVE-Empty vector. D1 mice did not have changes in serum thyroid hormone levels, whereas D2 mice had higher serum fT3 levels. Clearer changes were found in D3 mice. They had hypothyroidism with higher serum rT3 levels. Correspondingly, in their livers, rT3 concentration was higher and T3-responsive genes were downregulated. We elucidated by adding the cohort with levothyroxine (LT4) administration because DIO-overexpressing mice had liver T4 insufficiency probably due to consumption by DIOs. Comparisons between the DIO-overexpressing mice with and without LT4 administration revealed that D2 mice presented upregulation of T3-responsive genes by LT4 administration distinct from Empty mice. Conclusions We generated DIO-overexpressing mice that expressed human DIOs predominantly in the liver. They provided physiological evidence to integrate the phenotypes of the knockout mice and specific clinical situations. D2 mice seemed to recruit T3 into the circulation as well as in the liver. D3 mice had an overt phenotype characterized by consumptive hypothyroidism. In addition, D3 mice are expected to be a novel hypothyroidism model that does not involve disruption of thyroidal hormone secretion. DIO-overexpressing mice can be generated by single injections of plasmid vectors of interest and can contribute to progress in the field of thyroid hormone economy and action. Presentation: No date and time listed

Regulatory mechanisms of iodothyronine deiodinases (DIOs) require further elucidation, and conventional methods for evaluating DIOs are unsuitable for high-throughput screening (HTS). Here we explored factors of transcriptional regulation of 3 types of DIOs (DIO1, DIO2, and DIO3) from a chemical library using our designed HTS. We constructed HTS based on a promoter assay and performed a screen of 2480 bioactive compounds. For compounds that were clinically approved, we validated hit compounds through a retrospective cohort study in our department that evaluated changes in thyroid function in patients using the compounds as drug therapy. Furthermore, we verified the involvement of DIOs using mice treated with the compounds. Of the hit compounds, 6 and 7 compounds transcriptionally up- and downregulated DIO1, respectively; 34 transcriptionally upregulated DIO2; and 5 and 2 compounds transcriptionally up- and downregulated DIO3, respectively. The cohort study clarified the clinical effects of some hit compounds: ritodrine increased free triiodothyronine (fT3)/free thyroxine (fT4) ratio and decreased serum thyroid-stimulating hormone (TSH) levels, tadalafil increased serum fT3 levels, and tyrosine kinase inhibitors (TKIs) decreased serum fT3 and fT4 levels and increased serum TSH levels. Following in vivo experiments using treated mice, consistent results were observed in ritodrine, which upregulated DIO2 in the thyroid gland. In conclusion, we completed HTS for DIOs and obtained attractive hit compounds. Our cohort study revealed the clinical significance of ritodrine, sildenafil, and TKIs. We hope our unique method will contribute to analyzing various targets and lists of hit compounds will promote understanding of DIOs.

Aims Hypertension is a strong risk factor for heart failure with preserved ejection fraction. Curcumin has p300-specific histone acetyltransferase inhibitory activity, suppresses cardiomyocyte hypertrophy and fibrosis, and significantly reduces myocardial brain natriuretic peptide (BNP) expression without altering blood pressure in a rat model of hypertensive heart disease. This double-blind, placebo-controlled, randomized study, for the first time, aimed to examine the efficacy of a high-absorption curcumin for the prevention of hypertensive heart disease in humans. Methods and results Patients exhibiting initial signs of hypertensive heart disease with left ventricular ejection fraction ≥60% and stable blood pressure Conclusions A high-absorption curcumin agent did not affect the E/E′ ratio, rather it significantly inhibited the increase in plasma BNP levels in patients with initial signs of hypertensive heart disease.

Lepus nigricollis is a small mammal species mainly found in South Asia. The phylogenetic position of the Sri Lankan wild hare (Lepus nigricollis singhala) is yet to be determined. Therefore, the mitochondrial DNA D-loop of three Sri Lankan wild hare samples was studied. Phylogenetic analyses revealed that Sri Lankan wild hare clustered as a basal separate branch consistent with the phylogenetic position of other isolated populations. The limitation of the current data did not permit us to make any further conclusions; therefore, more research evidence is still required.

Transnational human trafficking and HIV/AIDS are two important social problems that cannot be discussed separately in the current era of globalization, where people are sold and bought across borders in sex industries. Vulnerability of women in the developing countries of South Asia has tremendously contributed toward the increased rate of human trafficking and HIV/AIDS. Due to the transnational nature of these phenomena, these issues have become convoluted and thus challenging to local practitioners or activists. However, there has been a paucity of research investigating these phenomena in tandem. The aim of this article was to conceptually analyze a possible prevention model for explaining the interconnectivity of transnational human trafficking and HIV/AIDS. Three theoretical foundations will be presented through a model explaining the connectedness of these issues and their impact on women’s vulnerability in South Asia: transnationalism, deviant place theory, and the multilevel model of behavioral change. The authors will discuss implications for practice, policy, and research based on their conceptual analysis.

BackgroundRecently, the high prevalence of young Japanese people who are underweight has received attention because of its potential impact on healthy life expectancy. Sarcopenia, defined as the presence of low muscle mass and function, is often observed in the underweight. However, few reports have described the prevalence and characteristics of sarcopenia in youth.MethodsIn this cross-sectional study, we measured skeletal muscle mass using a multifrequency bioelectrical impedance analysis device and handgrip strength (HGS) and administered questionnaires on dietary habits and physical activity to 1,264 first-year university students aged 18-20 years (838 males and 426 females). Sarcopenia was diagnosed based on the presence of both low skeletal muscle mass (SMI) and weak HGS according to the Asian Working Group for Sarcopenia.ResultsA total of 145 males (17.3%) and 69 females (16.2%) were diagnosed as underweight. Low SMI was diagnosed in 75 males (8.9%) and 18 females (4.2%), and weak HGS was diagnosed in 28 males (3.3%) and 10 females (2.3%). Then, sarcopenia was diagnosed in 8 males (1.0%) and 5 females (1.2%). There was a significantly higher prevalence of low SMI and/or weak HGS in underweight individuals compared with individuals in the other BMI ranges. The multivariate analyses indicated that SMI and HGS were significantly associated with BMI in both sexes. Furthermore, after adjusting for BMI, both SMI and HGS were significantly associated with physical activity in males, and SMI was significantly associated with energy intake and frequency of breakfast intake in females.ConclusionsFirst-year university students showed a high incidence of being underweight with low SMI and/or weak HGS, but the prevalence of sarcopenia was low in both sexes. BMI, energy intake, frequency of breakfast intake, and physical activity were independently associated with skeletal muscle mass and strength in youth.

This research examined domestic violence services and programs provided in rural and urban Pennsylvania. It identified the potential gaps in services and assessed programs adequacies from the perspective of program leaders. The study examined the needs and characteristics of both agencies and their clients. In addition, barriers to effective delivery of domestic violence services in Pennsylvania was examined. A Structured questionnaire was used as a primary method of data collection and explored answers for research question on the challenges and opportunities Domestic Violence agencies’ leaderships experiences in providing services. Sampling frame included 60 service providers from Pennsylvania, of which 45 agencies serving the survivors of Domestic Violence participated. Funding for this research was provided by a University grant and the partnership with Pennsylvania Coalition Against Domestic Violence provided technical assistance and access to agencies. The agency leaders who agreed to participate were contacted and both in person and telephonic interviews were conducted. The interview lasted for about 45 -60 minutes. The study found that there is a wide consensus among leaders that transportation and transitional housing services are inadequate in their program service areas while services like crisis hotline, general advocacy and case management are exceptional. Over 50% of the agencies did not comment on the adequacies of the services such as Job Coaching, Immigrations services, Divorce/Custody representation, and Criminal Court representation. The results have several policy implications regarding federal and state government programs, specifically considerations to fund transportation, transitional housing and legal advocacy services.

C-type natriuretic peptide (CNP) is the third member of the natriuretic peptide family. Unlike other members, i.e., atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP), which are cardiac hormones secreted from the atrium and ventricle of the heart, respectively, CNP is regarded as an autocrine/paracrine regulator with broad expression in the body. Because of its low expression levels compared to ANP and BNP, early studies failed to show its existence and role in the heart. However, recent studies have revealed the physiological and pathophysiological importance of CNP in the heart; in concert with the distribution of its specific natriuretic peptide receptor-B (NPR-B), CNP has come to be regarded as the major heart-protective natriuretic peptide in the failed heart. NPR-B generates intracellular cyclic guanosine 3′,5′-monophosphate (cGMP) upon CNP binding, followed by various molecular effects including the activation of cGMP-dependent protein kinases, which generates diverse cytoprotective actions in cardiomyocytes, as well as in cardiac fibroblasts. CNP exerts negative inotropic and positive lusitropic responses in both normal and failing heart models. Furthermore, osteocrin, the intrinsic and specific ligand for the clearance receptor for natriuretic peptides, can augment the effects of CNP and may supply a novel therapeutic strategy for cardiac protection.

BACKGROUND Cessation of smoking can markedly reduce the incidence of cardiovascular disease, improve health economics, and benefit society. Aromatherapy has the potential to be a novel option as an adjuvant therapy for smoking cessation that may alleviate depressive symptoms. However, research on the efficacy of aromatherapy as an adjuvant therapy for smoking cessation is scarce. OBJECTIVE The aim of this study was to examine the potential effects of aromatherapy on psychological states in smokers with depressive tendencies and to determine if it is reasonable to proceed to the next step (ie, a phase III trial). METHODS This is a pre-post single-arm clinical trial. Smokers with depression will be subjected to aromatherapy during smoking cessation treatment for 12 weeks. We will evaluate changes in scores on the Zung Self-Rating Depression Scale and the Profile of Mood States from pretreatment screening to 4 weeks and 12 weeks after the start of aromatherapy. Moreover, we will compare the group treated with aromatherapy with the group that received standard treatment in our previous randomized controlled trial (ie, the control group in that study). Furthermore, we will compare successful smoking cessation rates after 12 weeks. In addition, we will conduct an exploratory analysis of the efficacy of aromatherapy. The target sample size is 100, which is the number of subjects expected to be enrolled in this study during the 2-year study period. RESULTS This study was approved by the Kyoto Medical Center Institutional Review Board (IRB approval No. 19-016). Enrollment started on July 1, 2019. As of May 2022, 76 patients have been recruited. In the original plan, recruitment should have been finished on June 30, 2021. However, the number of subjects decreased due to the COVID-19 pandemic, and the study inclusion period was extended by 1 year (ie, until the end of June 2022) with the approval of the IRB on May 17, 2021. Analyses of the results will be completed subsequently. CONCLUSIONS This study has some limitations. This is not a rigorous validation study because it compares the same subjects who received standard treatment in a previous study. Moreover, the sample size and methods of statistical analysis were not fully set with prior consideration of statistical rigor. To address these limitations, we plan to conduct a phase III trial that will reflect the exploratory findings of this study. This is the first study to evaluate the psychological effects of aromatherapy during a smoking cessation program, and it may help improve the quality of treatment for smoking cessation in the future. CLINICALTRIAL UMIN Clinical Trials Registry UMIN000043102; https://tinyurl.com/tn3hvt9w INTERNATIONAL REGISTERED REPORT DERR1-10.2196/38626

Background Cessation of smoking can markedly reduce the incidence of cardiovascular disease, improve health economics, and benefit society. Aromatherapy has the potential to be a novel option as an adjuvant therapy for smoking cessation that may alleviate depressive symptoms. However, research on the efficacy of aromatherapy as an adjuvant therapy for smoking cessation is scarce. Objective The aim of this study was to examine the potential effects of aromatherapy on psychological states in smokers with depressive tendencies and to determine if it is reasonable to proceed to the next step (ie, a phase III trial). Methods This is a pre-post single-arm clinical trial. Smokers with depression will be subjected to aromatherapy during smoking cessation treatment for 12 weeks. We will evaluate changes in scores on the Zung Self-Rating Depression Scale and the Profile of Mood States from pretreatment screening to 4 weeks and 12 weeks after the start of aromatherapy. Moreover, we will compare the group treated with aromatherapy with the group that received standard treatment in our previous randomized controlled trial (ie, the control group in that study). Furthermore, we will compare successful smoking cessation rates after 12 weeks. In addition, we will conduct an exploratory analysis of the efficacy of aromatherapy. The target sample size is 100, which is the number of subjects expected to be enrolled in this study during the 2-year study period. Results This study was approved by the Kyoto Medical Center Institutional Review Board (IRB approval No. 19-016). Enrollment started on July 1, 2019. As of May 2022, 76 patients have been recruited. In the original plan, recruitment should have been finished on June 30, 2021. However, the number of subjects decreased due to the COVID-19 pandemic, and the study inclusion period was extended by 1 year (ie, until the end of June 2022) with the approval of the IRB on May 17, 2021. Analyses of the results will be completed subsequently. Conclusions This study has some limitations. This is not a rigorous validation study because it compares the same subjects who received standard treatment in a previous study. Moreover, the sample size and methods of statistical analysis were not fully set with prior consideration of statistical rigor. To address these limitations, we plan to conduct a phase III trial that will reflect the exploratory findings of this study. This is the first study to evaluate the psychological effects of aromatherapy during a smoking cessation program, and it may help improve the quality of treatment for smoking cessation in the future. Trial Registration UMIN Clinical Trials Registry UMIN000043102; https://tinyurl.com/tn3hvt9w International Registered Report Identifier (IRRID) DERR1-10.2196/38626

Background: Infertility is a condition where couple failure to conceive after 1 year of regu­lar unprotected coitus. At least 50 million couples worldwide experience infertility. Several adverse consequences of infertility like tension, hostility, anxiety, depression, self-blame and suicidal ideation are now being increasingly recognized. This study was designed to assess the awareness regarding infertility among women attending Chitwan Fertility Center. Methods: A cross sectional analytical study design was used and population for study includes those married women who had failure to conceive and visited to Chitwan infertility centre. The data was collected through semi-structured interview schedule. Collected data was coded and entered and analyzed in Microsoft office Excels and SPSS 20 version by using descriptive and in­ferential statistics. Results: In present study, among 96 respondents, majority of the respondents 45.8% were from age group of 25-30 years. Most of the respondents 56.3% had completed bachelor level and above level education. Majority of women 87.5% had good awareness on infertility. There was no signifi­cant association between level of awareness and socio-demographic variables. Conclusions: It can be concluded that the awareness about infertility among the participants at­tending Chitwan fertility center is relatively good. Most of the participants were educated, dura­tion of marriage was also 5-10years and most of them came to the infertility center for the treat­ment and management of infertility that might be the reason they have good awareness regarding infertility. But there is still misconception in some of the participants.

Background. Ophthalmic viscoelastic devices (OVDs) used during small-incision cataract surgery have numerous advantages. However, OVDs have longer retention time in an eye after surgery resulting in intraocular pressure (IOP) spikes. The purpose of this study is to analyze and quantify the effect of various OVDs on both IOP and best corrected visual acuity (BCVA) by systematically reviewing the literature and performing meta-analysis. Methods. Numerous databases from January 1, 1985, to present were systematically searched. Thirty-six (3893 subjects) of 3313 studies identified were included for analysis. Standardized mean difference (SMD) was computed, and meta-analysis was performed. Results. A total of 3313 records were retrieved including 1114 from database search and 2199 from grey literature search. Significant increase in postoperative IOP in 1-day follow-up with Healon (SMD = 0.37, CI: [0.07, 0.67]), Viscoat (SMD = 0.29, CI: [0.13, 0.45]), Provisc (SMD = 0.46, CI: [0.17, 0.76]), and Soft Shell (SMD = 0.58, CI: [0.30, 0.86]) was computed. On the other hand, results implied a nonsignificant increase in postoperative IOP with Healon GV (SMD = 0.07, CI: [−0.28, 0.41]), Healon5 (SMD = 0.15, CI: [−0.33, 0.64]), 2% HPMC (SMD = 0.32, CI: [−0.0, 0.64]), and OcuCoat (SMD = 0.26, CI: [−0.37, 0.9]). Additionally, a nonsignificant reduction in postoperative IOP was inferred with Viscoat + Provisc (SMD = −0.28, CI: [−2.23, 1.68]). Conclusion. Improvement in IOP was shown with Viscoat + Provisc. Additionally, IOP nonsignificant upsurge was observed with Healon GV, Healon5, 2% HPMC, and OcuCoat compared to significant upsurge with Healon, Viscoat, and Soft Shell.

The selective arterial calcium stimulation test (SACST) is one of the most useful localization tests for insulinoma but can cause false-positive and/or unexpected multi arterial positive results that hamper clinical decisions. There are also several adverse effects, such as nausea and hypoglycemia, at the conventional dose (0.025 mEq/kg) of calcium injection. We herein report five consecutive insulinoma cases in which low-dose (0.005-0.007 mEq/kg) calcium injection for SACST led to successful insulinoma localization. No adverse effects of SACST were observed. In conclusion, a low-dose SACST can be a favorable option as an insulinoma localization test in terms of accuracy and safety.

Objective The psychological status is a key factor in smoking continuance. However, details on short-term changes in mild depressive states after smoking cessation (SC) are still unknown. The purpose of the present study was to investigate these short-term changes. Methods A total of 989 patients who visited our SC Clinic were assessed using the Zung Self-Rating-Depression-Scale (SDS), an official instrument to measure depressive tendencies. The participants were classified into normal and neurotic groups based on their SDS scores during their initial visit; they were assessed again 2, 4, 8, and 12 weeks thereafter. Results The majority of patients in the neurotic group were women. These patients were also younger, with a higher nicotine dependence, and presented with a lower successful SC rate than the patients in the normal group. A decrease in SDS scores after starting the SC treatment was observed only in the neurotic group, especially during the first two weeks. In patients who continued to smoke, no improvement in depressive tendencies was noted in this period. Conclusion Depressive tendencies of patients with neurosis improve in the initial stages of the SC treatment (i.e., within two weeks after starting the treatment). This finding fills the mentioned knowledge gap regarding the effects of SC on mild depressive states in the short term.

In this paper, Maximum power point is tracked in both solar and wind energy conversion system using MPPT controller and also analyzed the performance of the renewable energy system with MPPT and without MPPT controller. Among all the renewable resources, Solar and Wind are the most popular resources due to its ease of availability. Alone PV system or Wind system cannot completely meet load demands.Hence photovoltaic and wind system are hybridized and optimized to satisfy the load demand. This paper proposed a standalone hybrid renewable energy system which employs incremental conductance algorithm for photovoltaic system and perturb and observe algorithm for wind energy conversion system is implemented. Usage of this system combines the advantages of each generation system and provides electrical power to meet various load conditions. Maximization and stabilization of power from the system with and without MPPT controller is designed and analyzed in MATLAB/Simulink environment.

In existing method separate DC-DC and DC-AC converter topologies are required to supply DC and AC loads in which efficiency is poor. In the proposed work single converter topology of interleaved hybrid converter is used to provide simultaneous AC and DC output. Battery is used to supply load in absence of solar power. Artificial Neural Network control strategy is used to provide gating signals for the converter which improves the overall performance and stability of the system.AC and DC output from the interleaved hybrid converter are obtained using MATLAB/Simulink

Electroencephalography (EEG) is almost contaminated with many artifacts while recording the brain signal activity. Clinical diagnostic and brain computer interface applications frequently require the automated removal of artifacts. In digital signal processing and visual assessment, EEG artifact removal is considered to be the key analysis technique. Nowadays, a standard method of dimensionality reduction technique like independent component analysis (ICA) and wavelet transform combination can be explored for removing the EEG signal artifacts. Manual artifact removal is time-consuming; in order to avoid this, a novel method of wavelet ICA (WICA) using fuzzy kernel support vector machine (FKSVM) is proposed for removing and classifying the EEG artifacts automatically. Proposed method presents an efficient and robust system to adopt the robotic classification and artifact computation from EEG signal without explicitly providing the cutoff value. Furthermore, the target artifacts are removed successfully in combination with WICA and FKSVM. Additionally, proposes the various descriptive statistical features such as mean, standard deviation, variance, kurtosis and range provides the model creation technique in which the training and testing the data of FKSVM is used to classify the EEG signal artifacts. The future work to implement various machine learning algorithm to improve performance of the system.

特集「欧州難民・移民危機の再検討」

本研究では圧力センサ内蔵BLEビーコンを用いた在席・離席管理手法を提案する。圧力センサ内蔵BLEビーコンを用いることで、執務者の負担を減らし、プライバシー面も考慮した。圧力センサ内蔵BLEビーコンのバッテリー消費を考慮し、適切な電波強度、送信間隔を設定するために、検証を行った。また、執務者の在席・離席をセンシングし、正しく在離席を検知できることを確認した。さらに在離席状況を分析する際に必要なログデータを蓄積するシステムを構築した。提案システムをオフィスを模擬した実験室において一週間稼働させ、在離席のログデータを取得した。ログデータを分析することでオフィスにおいて好まれる座席と好まれない座席の傾向を分析することができた。, In this research, we propose a seat presence / absence management method using BLE beacon with built-in pressure sensor. By using the BLE beacon with integrated pressure sensor, we reduced the burden on the officer and also considered the privacy side. I sensed the presence / absence of an office worker and confirmed that I could detect my seat properly. In addition, we built a system that accumulates log data necessary for analyzing the situation of resident seats. The proposed system was operated for one week in a laboratory simulating office, Log data from system was acquired. Analyzing the log data allowed us to analyze the trends in the office preferred seats and undesirable seats.

The mobile devices usage has been widespread, which directly impacts the increase of mobile communication, the increased usage of Mobile Ad-hoc networks(MANETs) has brought a rapid growth in the technology development. MANETs can be deployed in any environment conveniently as it comes under the category of ad-hoc networks which is infrastructureless. Due to flexibility of deployment features, it is compatible with other networks like PAN, LAN, etc.,. MANET is applicable in many applications like rescue of emergency disasters, military operations and other special environments where wired system may not support and of urgency. Since, MANETs are having the property of infrastructureless, nature of topology of network being dynamic, and lack of authority certification leads to certain problems with regard to security from attackers. In MANETs high attention should also be given to security parameter along with other parameters for efficient routing. With the aim of facing the possibility of malicious node attacks, the proposed paper presents the technique of detecting the malicious nodes attacks caused form two major attacks like blackhole and wormhole attacks are detected and prevented by Cooperative Bait Detection Scheme (CBDS). Once those attacks are prevented, the routing efficiency in MANETs for Chicken Swam Optimization based A* algorithm is improved, which is a computer algorithm that is broadly deployed in path finding and graph traversal. The comparative examination of Optimized A*, Ad-hoc On-Demand Distance Vector (AODV) with the proposed model against attacks, enhances the performance.