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Objective: The purpose of this study was to evaluate the clinical efficacy of extracorporeal shock waves combined with traditional Chinese medicine bone-setting manipulation for external humeral epicondylitis. Methods: Ninety-two patients with external humeral epicondylitis were randomly divided into an observation group and a control group. Patients in the control group were treated with extracorporeal shock waves while those in the observation group with traditional Chinese medicine bone-setting manipulation based on the control group. Patients in both groups were evaluated by the Visual Analogue Scale (VAS), Mayo Elbow Performance Score (MEPS), and Disabilities of the Arm, Shoulder, and Hand Questionnaire (DASH) before and after treatment. The inflammatory factors such as IL-6, IL-10, TNF-ɑ, and clinical outcomes were contrasted before and after treatment. Results: There were statistically significant differences in VAS score, MEPS score, and DASH score between the two groups before and after treatment (p < 0.05). The observation group exhibited a more pronounced improvement in each score compared to the control group. Post-treatment, the inflammatory factors of both groups were significantly lower than pre-treatment levels (p < 0.05), with the observation group showing a more noticeable decrease. The overall effectiveness of the observation group was higher than that of the control group, and the difference was statistically significant (p < 0.05).Conclusion: The combination of extracorporeal shock wave therapy and traditional Chinese medicine bone-setting manipulation can effectively alleviate pain symptoms and improve dysfunction caused by external humeral epicondylitis, while also reducing inflammatory factor expression. This combined treatment may prove more effective than extracorporeal shock wave therapy alone.Clinical Trial: Registration: ChiCTR2200066075.

Citrus sinensis is a rich source of bioactive compounds  and has attracted attention due to its medicinal benefits. Historically regarded as agricultural waste, orange peel is rich in flavonoids, polyphenols, tannins, and essential oils with antibacterial, anti-inflammatory, and antioxidant qualities. The phytochemicals in Citrus sinensis peel were used as natural reducing and stabilizing agents in the green synthesis method used in this work to create silver nanoparticles (AgNPs). This method is an environmentally friendly alternative to conventional nanoparticle production, eliminating the need for hazardous chemicals. Based on the study’s results, green-synthesized silver nanoparticles derived from Citrus sinensis peel extract offer a sustainable and biocompatible substitute for biomedical applications. The pharmaceutical and healthcare industries may find therapeutic uses for them due to their exceptional antibacterial, antioxidant, and anticancer properties.

West Africa’s population is projected to reach 500 million by 2050, exacerbating the need for reliable drought detection and management strategies to ensure food and water security. This study investigated drought detection in West Africa using the Standardized Precipitation Index (SPI) and Standardized Precipitation Evapotranspiration Index (SPEI). The objective is to evaluate the performance of SPI and SPEI in detecting droughts and compare their strengths and limitations. The results revealed that both indices detected droughts effectively, but SPEI was more sensitive to evapotranspiration and temperature change. The findings offer valuable insights into climate change impacts, drought monitoring, and sustainable water resource management in the regions under investigation in West Africa.

Background: Nutritional awareness among caregivers plays a crucial role in ensuring optimal pediatric health and development. This study assesses the level of nutritional awareness among caregivers and examines its association with demographic factors.Objectives: This study aimed to assess the knowledge and awareness of caregivers regarding dietary advice and complementary feeding for children under five years at Wad-Albasheir Family Health Center, Um-Bada locality.Methods: A cross-sectional study was conducted among caregivers in selected healthcare facilities. Data were collected using a structured questionnaire and analyzed using SPSS version 23. Descriptive statistics and chi-square tests were used to evaluate associations between variables.Results: The majority of caregivers demonstrated moderate awareness (60%), while 22.5% had low awareness and 17.5% had high awareness. A significant association was observed between education level and awareness (p < 0.05). Employment status also influenced awareness levels, with employed caregivers showing higher knowledge scores.Conclusion: Nutritional awareness is a key determinant of pediatric health. Strengthening educational programs targeting caregivers can improve child nutrition outcomes.

Aims: To present a further example showing an efficiency of a modeling method based on the theory of dynamic systems in pharmacokinetics. Study design:The goals of the current study were twofold: to present (1) a further example showing efficiency of a modeling method based on the theory of dynamic systems in pharmacokinetics, an to perform (2) a next step in tutoring the use of computational and modeling tools from the theory of dynamic systems in pharmacokinetics. The data available in the study by Plusquellec et al. published in the October Issue of the Journal Medical Engineering & Physics were used to exemplify the method considered here. For modeling purpose an advanced mathematical modeling method was employed. Modeling was performed using the computer program named CTDB described in the study by Dedík et al. published in September 2007 issue of the Journal Diabetes Research and Clinical Practice. Main outcome: Modeling results revealed that computational and modeling tools from the theory of dynamic systems can be successfully used in the development of a mathematical model of such a complicated process as is a multiple sites discontinuous gastrointestinal absorption.

Genetic datasets have a large number of features that may significantly affect the disease classification process, especially datasets related to cancer diseases. Evolutionary algorithms (EA) are used to find the fastest and best way to perform these calculations, such as the bat algorithm (BA) by reducing the dimensions of the search area after changing it from continuous to discrete. In this paper, a method of gene selection was proposed two sequent stages: in the first stage, the fuzzy mutual information (FMI) method is used to choose the most important genes selected through a fuzzy model that was built based on the dataset size. In the second stage, the BBA is used to reduce and determine a fixed number of genes affecting the process of classification, which came from the first stage. The proposed algorithm, FMI_BBA, describes efficiency, by obtaining a higher classification accuracy and a few numbers of selected genes compared to other algorithms.

Foreign bodies of the esophagus are part of the traumatic emergencies in ENT. They are most often encountered in children, whereas in adults they occur in a particular context and are rarely overlooked.This was a 48-year-old patient from a neighboring country referred by a colleague for a history of neglected laryngeal contusion with infectious cervical fistula evolving for 2 years. Further questioning revealed a notion of accidental ingestion of dentures. The first endoscopy was of capital interest in especially in the diagnosis and management of this long-retained foreign body. The extraction under general anesthesia was done by a combined endoscopic and external approach. The postoperative course was marked by superinfection and swallowing disorders.Cervical suppurations secondary to esophageal foreign bodies are rare, especially in adults. Clinicians should consider this possibility in the face of any chronic cervical suppuration that resists treatment.

The paper presents and develops the issue of Cumulative Effect Assessment (CEA) in the Environmental Impact Assessment (EIA) screening procedure established by the State and Regional regulations In Italy. In the period 2001-15 in the territory of the Venice province (north east Italy, Veneto region) n. 328 projects (and the related environmental preliminary/definitive studies) were applied to competent Authorities (6% to the State, 39% to the Region and 55% to the Province). All the Environmental Impact Studies (EISs) and Environmental Preliminary Studies (EPSs) referring to the this territory officially applied to competent Authorities in the period 2001-2010, have been analysed with focus on the identification and assessment of cumulative effects (CEs); the projects considered and analysed for this purpose comprise a total of n. 181 EIA screening and ordinary procedures; the remaining 147 projects in the period 2011-15 (for a total of 328) are here considered only for statistical reason to an update assessment of project typologies in the same territory. The methodology applied for the analysis of the sample of environmental studies in the period 2001-10 refers to that presented by Cooper and Sheate (2002) with modifications. The investigation has been developed looking for the way in which the topic is performed by practitioners in the environmental studies as from qualitative as well as quantitative point of view. Specific attention has been paid to waste management plants which are always subject to EIA screening procedure since 2008 according to Directive 97/11/EEC and in case to the whole EIA procedure. The approach proposed by Lombardia Region (North Italy; 2010) for EIA screening procedure of waste management plants has been applied to identify CEs and modified according to the characteristics of the considered territory; it allows the performance of the project-based approach and must be completed with a regional-based approach (Dubè, 2003). The proposed approach can be useful in case of waste management and IPPC (Integrated Pollution Prevention and Control, Directive 96/61/EEC, amended with Directives 2008/1/EC and 2010/75/EU) plants to define the financial warranties required for the authorization of operative activity of the plants to cover potential environmental damages produced in cases of accidents and other conditions as required in Europe (art. 14 Directive 2004/35/EC on environmental liability). Several project categories were chosen and their EISs analysed as an exemplificative case according to the potential generation of cumulative impacts and the characteristics of the territory. With reference to the completed procedures where the competent Authority presented a final judgement, it has been observed that the CEA has been seldom developed due to not compulsory legal requirements as already observed by Burris and Canter (1997). Moreover, when it is considered, the methodology is limited and not systemized. Indices of impact have been identified according to emission for the main environmental components focussed with the analysis of the pressure factors of the plants. The study points out the need to analyse and evaluate the cumulative effects (CEs) at a strategic level (within the Strategic Environmental Assessment-SEA- procedure) with a view to preparing the study for EIA/EPS framework procedure for the projects derived from the corresponding plan/program. A sound knowledge of the considered territory and in particular of its pressure sources is of main importance for CEA assessment and impacts’ prevention. Geographic Information Sytesm (GIS) application is strongly needed for pressure sources’ census and control data storing

Xanthogranulomatosis is an uncommon disease affecting non-Langerhans histiocytes. Laryngeal involvement is very rare.We describe the clinical case of an adult patient with disseminated xanthogranulomas affecting the supraglottic region of the larynx, leading to thickening and immobility of the epiglottis. The patient experienced inspiratory dyspnea on exertion. A transoral supraglottic epiglottectomy was performed, and a tracheostomy was subsequently required.

Ethnomedicine, synonymous with traditional medicine, is a crucial healthcare system practiced by various ethnic groups worldwide, especially among those with limited access to modern Western medicine. This study explores the rich bio-cultural diversity of the North Central Western Ghats in Karnataka, India, which harbors diverse ethnomedicinal practices. The region's tropical forests are home to an extensive array of plant species, with over 600 endemic to southern India and 95 exclusively endemic to Karnataka. The research focuses on documenting and analyzing the traditional knowledge of local communities regarding the use of plants for treating various human diseases. However, this task presents significant challenges and requires collaborative efforts from the government, NGOs, and Herbal Drug Companies. Over the last decade, ethnomedicinal studies have seen a rise, but there is still limited understanding of ethnomedicine's role in the traditional healthcare system in India. The forests of North Central Western Ghats, including Agumbe, Arbail Ghat, Chorla Betta, and others, exhibit a combination of deciduous and evergreen vegetation. These forests hold a variety of medicinal plants, adding to the region's bio-cultural richness. Scientific validation of the locally used ethnomedicinal plants further supports the development of herbal drug formulations with the support of the Ministry of Ayush, enabling the conservation and sustainable utilization of threatened and endangered species. The study emphasizes the importance of preserving traditional healers' knowledge and promoting collaboration for the preservation of ethnomedicinal practices in the region.