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Purpose: The purpose of this study is to design and implement an intelligent online proctoring system (IOPS) by using the advantage of artificial intelligence technology in order to monitor the online exam, which is urgently needed in online learning settings worldwide. As a pilot application, the authors used this system in an authentic university online exam and checked the proctoring result. Design/methodology/approach: The IOPS adopts the B/S (Browser/Server) architecture. The server side is implemented with programming language C and Python and stores the identification data of all examinees and their important behavior change status, including facial expression, eye and mouth movement and speech. The browser side collects and analyzes multimodal data of the examinee writing the online test locally and transfers the examinee's most important behavior status change data to the server. Real-time face recognition and voice detection are implemented with the support of open-source software. Findings: The system was integrated into a Web-based intelligent tutoring system for school mathematics education. As a pilot application, the system was also used for online proctored exam in an undergraduate seminar in Peking University during the epidemic period in 2020. The recorded log data show that all students concentrated themselves on the exam and did not leave the camera and did not speak. Originality/value: During the epidemic period of the novel coronavirus outbreak, almost all educational institutions in the world use online learning as the best way to maintain the teaching and learning schedule for all students. However, current online instruction platforms lack the function to prevent the learners from cheating in online exams and cannot guarantee the integrity and equality for all examinees as in traditional classroom exams. The literature review shows that the online proctoring system should become an important component of online exams to tackle the growing online cheating problem. Although such proctoring systems have been developed and put on the market, the practical usage of such systems in authentic exams and its effect have not been reported. Those systems are heavyweight and commercial product and cannot be freely used in education. The light-weight IOPS developed by the authors could meet the need for online exam as a stable and practical approach and could contribute to the growing online learning and distance learning.

Background: The complications of large‐volume fat grafting (LVFG) for breast augmentation remain unpredictable and include palpable breast nodules, oil cysts, and calcifications. Aims: This study was aimed to provide an optimal treatment option for breast nodules after LVFG and evaluate their pathological characteristics. Patients/Methods: We effectively performed complete resection of breast nodules in 29 patients after LVFG using a minimal skin incision with the vacuum‐assisted breast biopsy (VABB) system under ultrasound guidance. And we further carried on histologic examination of excised nodules and evaluated their pathological characteristics. Results: The breast nodules were excised thoroughly with cosmetic effect satisfactorily. Interestingly, subsequent histologic examination showed that type I and VI collagens were strongly expressed in the fibrotic area and type IV collagen were positively expressed around the blood vessel. Furthermore, we found that the type VI collagen+ area appeared around mac2+ macrophages and α‐SMA+ myofibroblasts. Conclusions: The VABB system may be the optimal treatment option for breast nodules after LVFG. And type VI collagens may serve as a biomarker of grafted adipose tissue fibrosis. The relationship between macrophages, fibroblasts, and collagen formation may be therapeutic targets for regulating fibrosis. [ABSTRACT FROM AUTHOR]

Background: Skin filler is an option for treating skin aging and wrinkles; however, currently used fillers are limited by poor biocompatibility, rapid degradation, and possible hypersensitivity reactions. Autologous adipose tissue-derived products have been recognized as promising options for skin rejuvenation.Objectives: This study aimed to develop a novel adipose-derived product for skin filling.Methods: Adipose collagen fragment (ACF) was prepared through pulverization, filtration, and centrifugation. The macrography, structure, types of collagen, and cell viability of ACF were evaluated by immunostaining, western blotting, and cell culture assays. ACF, nanofat, and phosphate-buffered saline (9 spots/side, 0.01 mL/spot) were intradermally injected in the dorsal skin of 36 female BALB/c nude mice; the skin filling capacity and the collagen remodeling process were then investigated. Twenty-one female patients with fine rhytides in the infraorbital areas were enrolled and received clinical applications of ACF treatment. Therapeutic effects and patients' satisfaction scores were recorded.Results: The mean [standard deviation] yield of ACF from 50 mL of Coleman fat was 4.91 [0.25] mL. ACF contained nonviable cells and high levels of collagen I, collagen IV, and laminin. Fibroblasts and procollagen significantly increased in ACF and ACF-treated dermis (P < 0.05). Overall, 85.7% of patients were satisfied with the therapy results, and no infections, injection site nodules, or other unwanted side effects were observed.Conclusions: ACF significantly improved dermal thickness and collagen synthesis and may serve as a potential autologous skin filler. [ABSTRACT FROM AUTHOR]

Background: The vestibular system not only supports reflex function at the brainstem level, but is also associated with higher levels of cognitive function. Vertigo due to vestibular disorders may lead to or be associated with cognitive dysfunction. Patients with deficits of both vestibular as well as cognitive function may be at particularly high risk for events like falls or certain diseases, such as Alzheimer's. Objective: To analyze the current state of research and trends in the global research literature regarding the correlation between vestibular disorders, vertigo, and cognitive impairment. Methods: We utilized Bibliometrix package to search databases including PubMed, Web of Science, etc for search terms. Results: Databases were searched up to December 15, 2022, and a total of 2222 publications were retrieved. Ultimately, 53 studies were included. A total of 261 authors published in 38 journals and conferences with an overall increasing annual growth rate of 6.94%. The most-published journal was Frontiers in Neurology . The most-published country was the United States, followed by Italy and Brazil. The most-published institution was Johns Hopkins University with a total of 13 articles. On performing trend analysis, we found that the most frequent focus of research in this field include the testing of vestibular perception, activation of the brain-related cortex, and the influence of stimulus-triggered vestibular snail reflex on visual space. The potential focal points are the risk of falling and the ability to extract spatial memory information, and the focus of research in recent decades has revolved around balance, falling, and Alzheimer's disease. Conclusions: Vestibular impairment in older adults affects cognitive function, particularly immediate memory, visuospatial cognition, and attention, with spatial cognition being the most significantly affected. In the future, virtual reality-based vestibular rehabilitation techniques and caloric stimulation could be potential interventions for the treatment of cognitive impairment., Competing Interests: Declaration of Conflicting InterestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Objectives: To investigate the role of m.4435A>G and YARS2 c.572G>T (p.G191V) mutations in the development of essential hypertension., Methods: A hypertensive patient with m.4435A>G and YARS2 p.G191V mutations was identified from previously collected mitochondrial genome and exon sequencing data. Clinical data were collected, and a molecular genetic study was conducted in the proband and his family members. Peripheral venous blood was collected, and immortalized lymphocyte lines constructed. The mitochondrial transfer RNA (tRNA), mitochondrial protein, adenosine triphosphate (ATP), mitochondrial membrane potential (MMP), and reactive oxygen species (ROS) in the constructed lymphocyte cell lines were measured., Results: Mitochondrial genome sequencing showed that all maternal members carried a highly conserved m.4435A>G mutation. The m.4435A>G mutation might affect the secondary structure and folding free energy of mitochondrial tRNA and change its stability, which may influence the anticodon ring structure. Compared with the control group, the cell lines carrying m.4435A>G and YARS2 p.G191V mutations had decreased mitochondrial tRNA homeostasis, mitochondrial protein expression, ATP production and MMP levels, as well as increased ROS levels (all P <0.05)., Conclusions: The YARS2 p.G191V mutation aggravates the changes in mitochondrial translation and mitochondrial function caused by m.4435A>G through affecting the steady-state level of mitochondrial tRNA and further leads to cell dysfunction, indicating that YARS2 p.G191V and m.4435A>G mutations have a synergistic effect in this family and jointly participate in the occurrence and development of essential hypertension.