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Hypertension represent the commonest cause of death in 2017. Hypertension is classified into two types which are primary or essential hypertension and secondary hypertension. The perindopril-amlodipine combination showed a significant effect in reduction of the elevated BP and the cardiovascular complications.To evaluate the efficacy and safety of a fixed-dose single-pill combination of perindopril-amlodipine in hypertensive patients.We searched PubMed, Medline, SCOPUS, and Web of Science for relevant clinical trials. Quality appraisal was evaluated according to GRADE and we assessed the risk of bias using Cochrane's risk of bias tool. We included the following outcomes: systolic blood pressure, diastolic blood pressure, pulse pressure, mean blood pressure, heart rate, cough, dizziness, headache, and peripheral edema. We performed the analysis of homogeneous data under the fixed-effects model, while analysis of heterogeneous data was analyzed under the random-effects model. We conducted a meta-regression according to the dose.We included ten clinical trials. The pooled analysis showed that there was a significant reduction of the systolic blood pressure, diastolic blood pressure, pulse plessure, mean blood pressure, and heart rate after the the perindopril-amlodipine combination (MD = 18.96 [14.32, 23.60], P 0.0001), (MD = 11.90 [8.45, 15.35], P 0.0001), (MD = 8.44 [6.91, 9.97], P = 0.0001), (MD = 13.07 [5.86, 20.29], P = 0.0004), and (MD = 2.93 [0.89, 4.96], P = 0.005), respectively. The results of the meta-regression revealed that the efficacy is increased by increasing the dose (P 0.001) CONCLUSION: The use of the perindopril-amlodipine combination had a significant effect on the reduction of SBP, DBP, mean blood pressure, pulse pressure, and HR.

With the rapid digital developments, the practice and study of VR/AR technologies reached almost all the design disciplines by considering different applications. Therefore, there is continuous pressure on design education, where course programs in graphic design, media design, fashion design, and product design must promptly incorporate these new technologies and create complete unity between the various design professions. This paper provides a careful examination of case studies in literature and consideration of utility for the profession through a curriculum of virtual and augmented reality technologies with specifications that suit multiple areas of design (product and graphic design). This approach demystifies these new technologies from the design process to product marketing. Interviews and discussions were conducted with a sample of approximately 100 participants (60% students, 30% design educators, 10% designers, and employers). The study included different universities from UAE, Egypt, and Italy. During the academic year 2020/2021. Furthermore, the results of this research were applied to design the Virtual Reality and its Derivatives course within the new study plan of the Graphic Design Department, College of Mass Communication at Ajman University in the United Arab Emirates.

Background Colorectal cancer (CRC) is one of the most widespread cancers worldwide, leading to roughly half a million deaths yearly. The European Society for Medical Oncology defined oligometastatic CRC as a disease with few metastases affecting a small number of sites (5 or occasionally more metastases involving up to 3 sites). In addition to colonoscopy, magnetic resonance imaging (MRI), and digital rectal examination in patients with rectal cancer, response monitoring of CRC is commonly carried out by CT imaging. The use of PET for response monitoring has not been adapted into colorectal cancer guidelines until 2021. However, 18F-Fluorodeoxyglucose Positron Emission Tomography Computed Tomography (18F-FDG PET/CT) offers a higher efficiency for assessing treatment outcomes than traditional imaging. This study aims to explore the utility of 18F-FDG PET/CT imaging in the assessment of therapy response in patients with oligometastatic colorectal cancer (OMCRC). Results The study comprised 79 OMCRC patients (35 and 44 patients with synchronous and metachronous metastasis respectively). In synchronous disease patients 18F-FDG PET/CT scan showed significant reduction of mean size and standardized uptake value (SUV) of the primary site lesions and the mean SUV of lymph nodes (LNs) and lung metastases (P = 0.00, 0.00,0.00, and 0.002, respectively) while, metachronous disease patients had significant reduction in the mean size and SUV of LNs (1.8 ± 0.7 & 4.7 ± 1.3 versus 1.1 ± 1.0 & 2.9 ± 3.0, P = 0.001 & 0.00 respectively) and the mean SUV of peritoneal metastases (8.7 ± 4.7 versus 6.8 ± 2.4 P = 0.00). Partial metabolic response (PMR) and stable metabolic disease (SMD) were found in more than half of the patients (58.2%). Complete metabolic response (CMR) and Progressive metabolic disease (PMD), on the other hand, were achieved in 41.8% of patients [17 (21.5%) and 16 (20.3%) patients, respectively] with substantially higher CMR rate in metachronous disease than synchronous disease [14.0 (31.8%) versus 3.0 (8.5%) patients, P = 0.015)]. Conclusions 18F-FDG PET/CT can be added as a valuable imaging method for identifying responders and non-responders among OMCRC patients, as it optimizes the selection of patients with CRC for local therapy and has a significant impact on directing their therapy course. Oligometastatic colorectal cancer seems to be a controllable disease with hopeful therapy outcomes, particularly for those with metachronous metastases.

Malaria is a major public health concern in tropics and subtropics. Accurate malaria prediction is critical for reporting ongoing incidences of infection and its control. Hence, the purpose of this investigation was to evaluate the performances of different models of predicting malaria incidence in Marodijeh region, Somaliland. The study used monthly historical data from January 2011 to December 2020. Five deterministic and stochastic models, i.e. Seasonal Autoregressive Moving Average (SARIMA), Holt-Winters' Exponential Smoothing, Harmonic Model, Seasonal and Trend Decomposition using Loess (STL) and Artificial Neural Networks (ANN), were fitted to the malaria incidence data. The study employed Root Mean Square Error (RMSE), Mean Absolute Error (MAE), Mean Absolute Percentage Error (MAPE) and Mean Absolute Scaled Error (MASE) to measure the accuracy of each model. The results indicated that the artificial neural network (ANN) model outperformed other models in terms of the lowest values of RMSE (39.4044), MAE (29.1615), MAPE (31.3611) and MASE (0.6618). The study also incorporated three meteorological variables (Humidity, Rainfall and Temperature) into the ANN model. The incorporation of these variables into the model enhanced the prediction of malaria incidence in terms of achieving better prediction accuracy measures (RMSE = 8.6565, MAE = 6.1029, MAPE = 7.4526 and MASE = 0.1385). The 2-year generated forecasts based on the ANN model implied a significant increasing trend. The study recommends the ANN model for forecasting malaria cases and for taking the steps to reduce malaria incidence during the times of year when high incidence is reported in the Marodijeh region.

The well-known probiotic GRAS Saccharomyces boulardii (CNCM I-745) was used for the first time to produce glutathione (GSH). The culture conditions affecting GSH biosynthesis were screened using a Plackett-Burman design (PBD). Analyzing the regression coefficients for 12 tested variables; 6 of them, including yeast extract, glucose, peptone and cysteine; temperature and agitation rate had a positive significant effect on GSH production with a maximum production of 192 mg/L. The impact of addition time of cysteine was investigated in 19 experiments during the growth time course (0-36 h), the best addition time was 8h post-inoculation producing 235 mg/L of GSH. The most significant variables were further explored at 5-levels using Central Composite Rotatable Design (CCRD), giving a maximum production of GSH (552 mg/L). Using baffled flasks, the GSH was increased to 730 mg/L, i.e 1.32-folds increment than obtained using CCRD. The two rate-limiting genes of GSH biosynthesis “γ-glutamyl cysteine synthetase (gsh1) and GSH-synthetase (gsh2) were amplified and sequenced to validate the GSH biosynthetic potency of S. boulardii. The sequences of genes showed 99% similarity with gsh1 and gsh2 genes of S. cerevisiae. Glutathione peroxidase was purified and characterized from S. boulardii with molecular mass and subunit structure of 80 kDa and 35 kDa as revealed from native and SDS-PAGE, ensuring its homodimeric identity. The activity of GPx was reduced by 2.5-folds upon demetallization confirming its metalloproteinic identity. The enzyme was strongly inhibited by hydroxylamine and DTNB, ensuring the implication of surface lysine and cysteine residues on the enzyme active site domains.

Background Testicular cancer is the second most frequent form of male genital tumors. Globally, testicular malignancy has risen over the last forty years. Among malignant testicular tumors, germ cell tumors represent approximately 95% of all tumors. They are classified into seminomatous and non-seminomatous tumors as they differ in clinical features, therapy, and prognosis. Despite the increasing value of whole-body fluorodeoxyglucose positron emotion tomography/computerized tomography (18FDG-PET/CT) for all malignancies, the practical function of this imaging method in testicular germ cell tumors is still unknown. We aim to assess the diagnostic performance of18FDG-PET/CT dual-time-point imaging (DTPI) in the detection and characterization of recurrent testicular cancer lesions. Results 18FDG-PET/CT DTPI showed higher specificity (SP) in lesions' delectability and characterization for local, nodal, and distant lesions than the single-time-point imaging (STPI) (97.6%, 93.8%, and 97% versus 95.2%, 68.8%, and 84.8%, respectively) and higher sensitivity (SN) for nodal and distant lesions (97% and 93.8% versus 87.8% and 87.5%, respectively). The mean SUVmaxD and the RI values—not the SUVmaxE—of the malignant lesions were significantly greater than the benign lesions (p 0.001*). Conclusions 18FDG-PET/CT DTPI and its related indices (SUVmaxD and the RI) are more accurate, sensitive, and specific than the STPI in the characterization of recurrent lesions in testicular cancer patients.

Much research has focused on task offloading in fog-enabled IoT networks. However, there is an important offloading issue that has hardly been addressed—the impact of different virtualization modes on task response (TR) time. In the present article, we bridge this gap, introducing three virtualization modes, and characterizing the TR time under each. In each mode the virtual machines (VM) at the fog are customized differently, leveraging VM elasticity. In the perfect virtualization mode, the VM is customized to match exactly the computational load of the incoming task. This ensures that each task, regardless of which VM it goes to, will have the same service time. In the semiperfect virtualization mode, a less stringent, thus more practical, alternative, the VM is customized to match roughly the computational load of the incoming task. This results in a uniformly distributed task service time. Finally, in the baseline virtualization mode, the VM is customized to just be fast, with no regard to the computational load of the incoming task. This mode, which just re-scales the processing time of the task, is the default in existing research, and is re-introduced here for only comparison purposes. We characterize the TR time for the three modes leveraging M/G/1 and M/G/m queueing models, with the queueing stability condition identified for each mode. The obtained analytical results are successfully validated by discrete event Monte Carlo simulation. The numerical results show that the first mode results in the shortest TR time, followed by the second mode, then the third mode. That is, if virtualization is managed adequately, significant improvement in TR time can be gained.

Morning increase and nighttime decrease in blood pressure (BP) have been associated with cardiovascular (CV) morbidity and mortality in general and diabetic subjects. We aimed to study the association between morning blood pressure surge (MBPS) and left ventricular hypertrophy (LVH) in normotensive type 2 diabetes mellitus (T2DM) patients. This comparative cross-sectional study included 90 normotensive T2DM patients divided according to the presence of diastolic function into two groups. Normotensive T2DM patients were subjected to ambulatory blood pressure monitoring (ABPM) to detect the MBPS and echocardiography to assess left ventricular mass index (LVMI) and diastolic function. Data were analyzed using SPSS and stepwise multiple regression and binary logistic regression analysis was performed to detect the associated independent variables for increase in LVMI. Finally, a receiver operating characteristic (ROC) curve was performed to assess a cut-off value for MBPS. A total of 31% of patients had diastolic dysfunction (DD). There was a strong positive correlation between LVMI and MBPS (r = 0.609, p-value < 0.001). Stepwise multiple regression analysis showed that MBPS was the first independent predictor associated with increased LVMI. Binary logistic regression analysis for the status of diastolic function showed an odds ratio (OR) of 1.26 and 1.11 at 95% confidence interval (CI) for MBPS and age respectively. ROC curve for prediction of DD based on the degree of MBPS showed a fair area under curve and a cut-off value of 25.5 mmHg with 85.7% sensitivity and 61.3% specificity. Higher levels of MBPS are associated with increased LVMI and DD in normotensive T2DM patients. This has potential implication as it might be a significant predictor for discovery of subclinical hypertension in early stages of diabetes mellitus and can help in the prevention of heart failure development.