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The use of social media has grown significantly in the last few years. Social media refers to "the websites and online tools that facilitate interactions between users by providing them opportunities to share information, opinions, and interest" (Swar and Hameed, 2017, p. 141). Adolescents have been found to be more vulnerable to addiction and crimes related to social media. Hence, the study has tried to understand the association of social media with the well being of adolescents. The first part of the paper deals with the role and relevance of social media.Further, the literature review depicts a strong connection between social media and individuals' well-being. For the quantitative analysis, various statistical techniques are used. In order to evaluate the association between variables, the composite index has been prepared. Further, the ranking has been given to reflect social media's impact on adolescents' well-being. Lastly, a few recommendations have been made for the state government regarding the well being of the adolescents.

To identify risk factors for the development of new-onset, postoperative diplopia following orbital decompression surgery based on patient demographics, clinical exam characteristics, radiographic parameters, and surgical techniques.We conducted a multi-center retrospective chart review of patients who underwent orbital decompression for thyroid eye disease (TED). Patient demographics, including age, gender, smoking history, preoperative exophthalmometry, clinical activity score (CAS), use of peribulbar and/or systemic steroids, and type of orbital decompression were reviewed. Postoperative diplopia was determined at a minimum of 3 months postoperatively and before any further surgeries. Cross-sectional area ratios of each extraocular muscle to orbit and total fat to orbit were calculated from coronal imaging in a standard fashion. All measurements were carried out using PACS imaging software. Multivariable logistic regression modeling was performed using Stata 14.2 (StataCorp, College Station, TX).A total of 331 patients without preoperative diplopia were identified. At 3 months postoperatively, 249 patients had no diplopia whereas 82 patients developed diplopia. The average postoperative follow-up was 22 months (range 3-156) months. Significant preoperative clinical risk factors for postoperative diplopia included older age at surgery, proptosis, use of peribulbar or systemic steroids, elevated clinical activity score, and presence of preoperative compressive optic neuropathy. Imaging findings of enlarged cross-sectional areas of each rectus muscle to the overall orbital area also conferred a significant risk of postoperative diplopia. Regarding surgical factors, postoperative diplopia was more common among those undergoing medial wall decompression, bilateral orbital surgery, and balanced decompression, whereas endoscopic medial wall decompression was found to be relatively protective.This study identifies risk factors associated with the development of diplopia following orbital decompression using multivariable data. This study demonstrates that several characteristics including age, clinical activity score, the cross-sectional muscle to orbit ratios, in addition to the type of orbital decompression surgery, are predictive factors for the development of new-onset postoperative diplopia.

Ascorbic acid or Vitamin C is very important in our body because of its antioxidant property. But the main problem; that vitamin C uses is to maintain the stability as well as its drug distribution system. Vitamin C also plays a protective role in diabetes, cancer, heavy metal toxicity or poisoning, etc. Vitamin C is found in many sources present in nature, including tomatoes, broccoli, etc. Many factors in the body, as well as outside the body, affect the content of vitamin C in the body or sources like the season, climate, and pollution affect the content in fruits and vegetables besides sex, age, pregnancy, lactation, etc. affect the vitamin C content in the body. It is extensively used in the common cold, wound healing process, cancer, heavy metal poisoning or toxicity, and even in men's fertility. In this article, we focused on the general aspects: its bioavailability, sources, its toxicity and deficiency, and factors affecting vitamin C level as well as its use in humans. In the last, we conclude, the excess or lack of Vitamin C, both conditions have affected the human body in a significant range. It plays a protective role against many disorders and is required for kids, men, women, and even old-aged patients.

The smooth approach and aggressive tumour of the news usable on friendly television networks be able it complicated to equate dishonest and valid facts. The smooth distribution of news indirect giving has increased rapid change progress of allure falsehood. The believe ableness of friendly radio networks is again at stake place the extended of fake facts is prevailing. Thus, it has enhanced a research challenge to as a matter of usual practice check. the news namely a namely allure beginning, content and people or person working in communications for classification it as dishonest or valid. Machine learning has performed a lively part in categorization of the news even though accompanying few disadvantages. This paper reviews miscellaneous Machine learning approaches in discovery of fake and contrived revelation. The disadvantage of and approaches and spontaneity going around executing deep education is too inspected.

In todays era, there are numerous of people depend on cloud. Cloud computing plays a vital role in daily life's i.e. process the data which is used in social networking sites, Associations etc. The demand of both static and dynamic is expanding. The success of Brisk stretchiness is destroyed and the location giving of money demand is a method in a terms of composite load compare. Methodology used in this paper is Hybrid Creation. Hybrid is the best approach to compare load among networks in a critical cloud environment. By combining two methodology i.e. Round Robin and First Come First Serve for distributing the workload as a cloud growth.

BackgroundOrbital inflammatory disease (OID) encompasses a wide range of pathology including thyroid-associated orbitopathy (TAO), granulomatosis with polyangiitis (GPA), sarcoidosis and non-specific orbital inflammation (NSOI), accounting for up to 6% of orbital diseases. Understanding the underlying pathophysiology of OID can improve diagnosis and help target therapy.AimsTo test the hypothesis that shared signalling pathways are activated in different forms of OID.MethodsIn this secondary analysis, pathway analysis was performed on the previously reported differentially expressed genes from orbital adipose tissue using patients with OID and healthy controls who were characterised by microarray. For the original publications, tissue specimens were collected from oculoplastic surgeons at 10 international centres representing four countries (USA, Canada, Australia and Saudi Arabia). Diagnoses were independently confirmed by two masked ocular pathologists (DJW, HEG). Gene expression profiling analysis was performed at the Oregon Health & Science University. Eighty-three participants were included: 25 with TAO, 6 with orbital GPA, 7 with orbital sarcoidosis, 25 with NSOI and 20 healthy controls.ResultsAmong the 83 subjects (mean (SD) age, 52.8 (18.3) years; 70% (n=58) female), those with OID demonstrated perturbation of the downstream gene expressions of the IGF-1R (MAPK/RAS/RAF/MEK/ERK and PI3K/Akt/mTOR pathways), peroxisome proliferator-activated receptor-γ (PPARγ), adipocytokine and AMPK signalling pathways compared with healthy controls. Specifically, GPA samples differed from controls in gene expression within the insulin-like growth factor-1 receptor (IGF-1R, PI3K-Akt (p=0.001), RAS (p=0.005)), PPARγ (p=0.002), adipocytokine (p=0.004) or AMPK (p=ConclusionsAlthough OID includes a heterogenous group of pathologies, TAO, GPA, sarcoidosis and NSOI share enrichment of common gene signalling pathways, namely IGF-1R, PPARγ, adipocytokine and AMPK. Pathway analyses of gene expression suggest that other forms of orbital inflammation in addition to TAO may benefit from blockade of IGF-1R signalling pathways.

Industrial growth depends on the availability of energy sources and energy utilization. For various applications which require effective heat transfer between cold fluid and hot fluid (CF and HF), the heat exchangers (HEs) are widely used. The phenomenon related to quicker heat flow can enhance the thermal performance of HEs, resulting in considerable savings in energy. Hence, various methods are employed to improve heat flow characteristics of HEs. The solid particles having higher thermal conductivity can be used to enhance the heat transfer between CF and HFs. The graphene-based nanoparticles (NPs) possess higher thermal conductivity and have better properties such as low erosion, corrosion, higher stability, and hence it is preferred in various HEs. With the advancement in technology, graphene-based NPs can help to reduce the size of the HEs. In this paper, performance enhancement of HEs due to graphene addition in HEs is summarized. Further, simulated studies were carried out to analyze the performance characteristics of HEs by exploring it by using different boundary conditions. The simulation studies can also be extended to other types of exchangers of different designs. In the present studies, the simulated results are compared with experimental values for HF (Water at 40°C) and CF (Water at 21°C) for various flow rates of CF. After a good agreement, simulation studies are extended to Graphene-Water nanofluid (NF), and the results are presented. The simulation studies have proven their capability in predicting parameters related to performance evaluation of HEs.

Radiologic orbital imaging provides important information in the diagnosis and management of orbital inflammation. However, the diagnostic value of orbital imaging is not well elucidated. This study aimed to investigate the diagnostic accuracy of orbital imaging to diagnose orbital inflammatory diseases and its ability to detect active inflammation. We collected 75 scans of 52 patients (49 computed tomography (CT) scans; 26 magnetic resonance (MR) imaging scans). Clinical diagnoses included thyroid eye disease (TED) (41 scans, 31 patients), non-specific orbital inflammation (NSOI) (22 scans, 14 patients), sarcoidosis (4 scans, 3 patients), IgG4-related ophthalmic disease (IgG4-ROD) (5 scans, 3 patients), and granulomatosis with polyangiitis (GPA) (3 scans, 1 patient). Two experienced neuroradiologists interpreted the scans, offered a most likely diagnosis, and assessed the activity of inflammation, blinded to clinical findings. The accuracy rate of radiological diagnosis compared to each clinical diagnosis was evaluated. Sensitivity and specificity in detecting active inflammation were analyzed for TED and NSOI. The accuracy rate of radiologic diagnosis was 80.0% for IgG4-ROD, 77.3% for NSOI, and 73.2% for TED. Orbital imaging could not diagnose sarcoidosis. Orbital CT had a sensitivity of 50.0% and a specificity of 75.0% to predict active TED using clinical assessment as the gold standard. The sensitivity/specificity of orbital MR was 83.3/16.7% for the detection of active NSOI. In conclusion, orbital imaging is accurate for the diagnosis of IgG4, NSOI, and TED. Further studies with a large number of cases are needed to confirm this finding, especially with regard to uncommon diseases. Orbital CT showed moderate sensitivity and good specificity for identifying active TED.

PURPOSE We undertook this study to evaluate the incremental cost per quality-adjusted life-year (QALY) gained with use of adjuvant trastuzumab as compared with chemotherapy alone among patients with nonmetastatic breast cancer in India. METHODS We used a Markov model to estimate the incremental cost of using trastuzumab (for 1 year, 6 months, or 9 weeks) as compared with chemotherapy alone using a societal perspective, excluding indirect productivity losses. Although the outcomes (QALYs) in the standard chemotherapy arm were estimated after calibrating the model as per survival data from 2 Indian cancer registries, effectiveness estimates from the HERA trial and a joint analysis of the NSABP B-31 and NCCTG N9831 trials were used to estimate the consequences of 1-year trastuzumab use. The cost of treatment was estimated using national standard treatment guidelines and real-world use estimates for different treatment modalities as per data from Indian cancer registries. Probabilistic sensitivity analysis was undertaken to evaluate parameter uncertainty. RESULTS For 1 year of trastuzumab use, the incremental benefit per patient, incremental cost per QALY gained, and probability of being cost effective using HERA trial estimates were 1.29 QALYs, 178,877 Indian national rupees (INRs; US$2,558), and 4%, respectively, whereas the corresponding figures using joint analysis estimates were 1.69 QALYs, INR 134,413 (US$1,922), and 57.3%, respectively. CONCLUSION Use of trastuzumab for 1 year is not cost effective in India at the current price. However, trastuzumab use for 9 weeks is cost effective and should be included in clinical guidelines and reimbursement policies. A price reduction of 15% to 35% increases the probability of 1-year trastuzumab use being cost effective, to 90%.

The authors describe a rare presentation of invasive fungal rhino-orbital cellulitis caused by Saksenaea vasiformis in an immunocompetent child. The patient was initially diagnosed and treated as Mucoraceae, which has a high mortality rate and is primarily seen in immunocompromised patients. Though of the same order, Mucorales, the families Mucoraceae and Saksenaeacae, may be difficult to differentiate on histologic examination and must be distinguished by fungal culture and speciation. Our patient responded well to sino-orbital debridement and systemic treatment with amphotericin and posaconazole.

Introduction: Breathe Well-being Diabetes Reversal Program (BDRP) provides personalized Lifestyle Management (LSM) including coaching on diet and exercise as needed by individuals with type 2 diabetes mellitus (T2DM) along with tracking their blood glucose levels, weight, and physical activity. Objective: To evaluate the effectiveness of BDRP for achieving remission in individuals with T2DM in India. Methodology: This observational study had three cohorts (1:1:1) who were treated with: (1) BDRP with doctor-prescribed medication, (2) BDRP with doctor-prescribed medication and personalized stress reduction module, and (3) Only doctor-prescribed medication (control group) . Program adherence level was categorized as high (H: >70%) , medium (M: ≥50%- Results: The study included 181 individuals with an average age of 53.1 years, of which 1 (55.8%) were male. Overall, 46.7% (28) and 54.1% (33) individuals in cohorts 1 and 2 showed H and M adherence. Cohorts 1 and 2 showed 1.0% and 1.3% average HbA1c reduction vs. 0.3% with cohort 3 (overall population) after 4 months. At 4 months, in cohort 1, HbA1c levels Conclusion: BDRP was effective in achieving remission in individuals with T2DM in India. BDRP with personalized stress reduction module had better outcomes comparatively. Digital therapeutics could be a potential approach in achieving diabetes remission in Indian settings. Disclosure P.K.Goyal: None. S.K.Patra: Employee; Breathe Well-being. A.Kaicker: None. R.Verma: None. S.Goel: Employee; Breathe Well-being. S.Rehman: None. R.Jangid: None. V.Madhusudhana: None.

Background Orbital compartments harbor a variety of tissues that can be independently targeted in a plethora of disorders resulting in sight-threatening risks. Orbital inflammatory disorders (OID) including Graves’ ophthalmopathy, sarcoidosis, IgG4 disease, granulomatosis with polyangiitis, and nonspecific orbital inflammation constitute an important cause of pain, diplopia and vision loss. Physical examination, laboratory tests, imaging, and even biopsy are not always adequate to classify orbital inflammation which is frequently deemed “nonspecific”. Tear sampling and testing provide a potential “window” to the orbital disease process through a non-invasive technique that allows longitudinal sampling as the disease evolves. Using PubMed/Medline, we identified potentially relevant articles on tear proteomics published in the English language between 1988 and 2021. Of 303 citations obtained, 225 contained empirical data on tear proteins, including 33 publications on inflammatory conditions, 15 in glaucoma, 15 in thyroid eye disease, 1 in sarcoidosis (75)(75) and 2 in uveitis (77,78)(77,78). Review articles were used to identify an additional 56 relevant articles through citation search. In this review, we provide a short introduction to the potential use of tears as a diagnostic fluid and tool to investigate the mechanism of ocular diseases. A general review of previous tear proteomics studies is also provided, with a focus on Graves' ophthalmopathy (GO), and a discussion of unmet needs in the diagnosis and treatment of orbital inflammatory disease (OID). The review concludes by pointing out current limitations of mass spectrometric analysis of tear proteins and summarizes future needs in the field.

A 68-year-old woman with a recent history of blurring in the left eye had undergone mastectomy for breast cancer 20 years ago. A series of bone metastases started 5 years after her diagnosis. Examination of the optic nerve head of the left eye revealed an isolated peripapillary mass. Indocyanine green angiography displayed vessels within the mass, and fluorescein angiography demonstrated hyperfluorescence of the mass from vascular leakage plus lobular spots of blocked fluorescence. B-scan ultrasound revealed a hyperechoic-elevated nodular mass on the optic disc. Spectral-domain optical coherence tomography displayed a mass of spherules. Magnetic resonance imaging of the brain demonstrated metastatic tumors. She was diagnosed with an optic disk metastasis from her breast carcinoma.

Rationale: The contributions of diverse cell populations in the human lung to pulmonary fibrosis pathogenesis are poorly understood. Single-cell RNA sequencing can reveal changes within individual cell populations during pulmonary fibrosis that are important for disease pathogenesis. Objectives: To determine whether single-cell RNA sequencing can reveal disease-related heterogeneity within alveolar macrophages, epithelial cells, or other cell types in lung tissue from subjects with pulmonary fibrosis compared with control subjects. Methods: We performed single-cell RNA sequencing on lung tissue obtained from eight transplant donors and eight recipients with pulmonary fibrosis and on one bronchoscopic cryobiospy sample from a patient with idiopathic pulmonary fibrosis. We validated these data using in situ RNA hybridization, immunohistochemistry, and bulk RNA-sequencing on flow-sorted cells from 22 additional subjects. Measurements and Main Results: We identified a distinct, novel population of profibrotic alveolar macrophages exclusively in patients with fibrosis. Within epithelial cells, the expression of genes involved in Wnt secretion and response was restricted to nonoverlapping cells. We identified rare cell populations including airway stem cells and senescent cells emerging during pulmonary fibrosis. We developed a web-based tool to explore these data. Conclusions: We generated a single-cell atlas of pulmonary fibrosis. Using this atlas, we demonstrated heterogeneity within alveolar macrophages and epithelial cells from subjects with pulmonary fibrosis. These results support the feasibility of discovery-based approaches using next-generation sequencing technologies to identify signaling pathways for targeting in the development of personalized therapies for patients with pulmonary fibrosis.

Introduction: Use of Digital therapeutics can act as a valuable tool enabling more personalized care among diabetics. The Breathe Diabetes Management Program (BDMP) delivers personalized interventions encouraging them to track their blood glucose level, weight, and physical activity. Objective: To assess BDMP app in type 2 diabetics in achieving healthy outcomes in Indian population. Methodology: The group of participants (N=181, A1C >6.5%) was divided into 3 groups - (1) patients treated with the BDMP plus Doctor-prescribed medication (n=60), (2) patients treated with the BDMP plus Doctor-prescribed medication plus Stress Reduction module (n=61) and (3) patients only taking the Doctor-prescribed medication (control group with n=60). Results: At the end of the 16 weeks, patients from Group 1 showed 81.6% program completion rate, 46.01% program adherence, an average of 5.64% of baseline body weight loss, an average of 0.68% reduction in A1C and Penn State Worry Questionnaire (PSWQ) score average change from 56.3 to 44.5 (score ranges 16-80, higher score indicates higher worry). Patients from Group 2 showed 88.5% program completion rate, 51.95% program adherence, an average of 6.02% of baseline body weight loss, average of 0.74% reduction in A1C and a PSWQ score average change from 58.6 to 40.8. Patients from Group 3 showed an average of 0.38% of baseline body weight loss, average of 0.28% reduction in A1C and a PSWQ score average change from 56.2 to 55.5. The difference between all the groups was found to be statistically significant (p Conclusion: The BDMP helped the patients of Group 1 in significant weight loss, reduction in A1C, and improved stress levels. BDMP along with the Stress Reduction module in Group 2 produced even better outcomes. The results suggest that Digital Therapeutics is a scalable and sustainable solution to the growing problem of type 2 diabetes, and that mental well-being should be considered a part of the solution. Disclosure P. K. Goyal: None. R. Verma: None. A. Kaicker: None. S. Deka: None. S. Palukuri: None. B. Chandolia: None.

This paper focuses on optimization of charging station capacities and locations. The proliferation of electric vehicles is inextricably linked to the deployment of charging infrastructure. Currently, there are issues with locating and sizing when it comes to the building of electric vehicle charging stations. In order to find out the capacity of charging stations, a mathematical model was developed, which includes a site survey, EV density, electricity demand analysis, load modeling, costing analysis, EV battery charging time and power quality. The proposed approach was tested in MATLAB/Simulink environment.

Wireless sensor network (WSN) is among the latest technologies that promise an emerging future in diverse fields due to its unique capabilities which are to monitor and gather data from different environments by sensors deployed at remote locations. A secure network is a vital necessity of every application. Securing the sensor network that is wirelessly connected becomes an immensely demanding affair because of the limited resources it possesses. The functionality of such networks can be influenced by numerous security threats. In this review paper, a brief description about various security requirements and constraints in a WSN is discussed along with the types of attacks in different layers. Focus is also given on the strengths and limitations of some popular WSN security protocols to enable application designers to choose the appropriate protocol for their applications.

The authors describe a rare presentation of invasive fungal rhino-orbital cellulitis caused by

Im Rahmen der Industrie 4.0 kann es zu einer Uberforderung von Arbeitspersonen durch eine Vielzahl unterschiedlicher Software-Systeme kommen. Der Beitrag beschreibt die menschzentrierte Konzeption einer Cockpit-Applikation, die sehr unterschiedliche, arbeitsbezogene Softwareinhalte ordnet, einfach zusammenfasst und Mitarbeiter damit entlasten kann. Sie wurde fur eine heterogene Nutzergruppe entwickelt und enthalt arbeitsbezogene Funktionen, individualisierbare Inhalte, standardisierte Kommunikationsmoglichkeiten und soziale Aktivitaten. Durch einen „App-Store“ kann sie an verschiedene Mitarbeiter angepasst werden. Nach zwei Iterationen und insgesamt drei Evaluationen mit Usability-Experten und Unternehmensvertretern zeigte sich eine gute Nutzerakzeptanz.

Infantile nystagmus syndrome (INS) is one of the most common forms of nystagmus. It can occur in isolation or with other ocular anomalies. While nystagmus is usually sporadic, familial cases exist and are most commonly X-linked with incomplete penetrance and variable expressivity. There are over 45 mutations reported in the FRMD7 gene. This review describes the possible underlying mechanisms of infantile nystagmus syndrome, clinical characterization, and principles of management including behavioral, refractive, pharmacological, and surgical options as well as determines the genetic basis of INS in one large Caucasian family with a novel mutation in FRMD7. Newer generation optical coherence tomography (OCT) allows for accurate phenotypical characterization of genetic subtypes of INS. Further studies into identifying unknown genetic mutations involved in infantile nystagmus syndrome will allow for development of cellular and animal models to help classify INS and guide future therapies.

Cost-effectiveness analysis (CEA) provides information on how much extra do we need to spend per unit gain in health outcomes with introduction of any new healthcare intervention or treatment as compared to the alternative. This information is crucial to make decision regarding funding any new drug, diagnostic test or determining standard treatment protocol. It becomes even more important to consider this evidence in resource constrained low-income and middle-income country settings. Generating evidence on costs and consequences of a treatment or intervention could be performed in the setting of a randomized controlled trial, which is the perfect platform to evaluate efficacy or effectiveness. However, we argue that randomized controlled trial (RCT) offers an incomplete setting to generate comprehensive data on all costs and consequences for the purpose of a CEA. Hence, it is needed to use a decision model, either in combination with the evidence from RCT or alone. In this article, we demonstrate the application of decision model-based economic evaluation using 2 separate techniques - a decision tree and a Markov model. We argue that application of a decision model allows computation of health benefits in terms of utility-based measure such as a quality-adjusted life year or disability-adjusted life year which is preferred for a CEA, measure distal costs and consequences which are much more downstream to the application of intervention, allows comparison with multiple intervention and comparators, and provides opportunity of making use of evidence from multiple sources rather than a single RCT which may have limited generalizability. This makes the use of such evidence much more acceptable for clinical use and policy relevant.

An infant presented with bilateral disk edema and an acute left sixth cranial nerve (CN VI) palsy because of pseudotumor cerebri (PTC). PTC is rare in infants where it is often associated with endocrine abnormalities, medications, viral infections, systemic conditions, and nutritional etiologies such as vitamin A toxicity. We report a case of PTC in an infant associated with hypervitaminosis A with an unlikely source-a common prenatal vitamin.

An 11-year-old female presented with orbital cellulitis, bacterial sinusitis, enlarged left superior ophthalmic vein, dural venous sinuses, and internal jugular vein. The patient underwent endoscopic sinus surgery and was started on intravenous antibiotics and anticoagulation with limited improvement in orbital signs and symptoms. A magnetic resonance imaging/magnetic resonance venography of the orbits and brain revealed a dilated left superior ophthalmic vein with absence of flow but no clearly discernible orbital abscess. Intravenous corticosteroids resulted in dramatic improvement of pain, hypoglobus, proptosis, and extraocular motility, all of which rapidly recurred on discontinuation. Serial imaging revealed progression of what eventually manifested as a well-defined, rim-enhancing peri-superior ophthalmic vein abscess, which was incised and drained with prompt resolution of orbital cellulitis and complete visual recovery.

Ontologically distinct populations of macrophages differentially contribute to organ fibrosis through unknown mechanisms. We applied lineage tracing, spatial methods and single-cell RNA-seq to a spatially-restricted model of asbestos-induced pulmonary fibrosis. We demonstrate that while tissue-resident interstitial macrophages, tissue-resident alveolar macrophages, and monocyte-derived alveolar macrophages are present in the fibrotic niche, only monocyte-derived alveolar macrophages are causally related to fibrosis. Monocyte-derived alveolar macrophages were specifically localized to fibrotic regions in the proximity of fibroblasts where they expressed molecules known to drive fibroblast proliferation, including PDGFA. Moreover, we identified autocrine M-CSF/M-CSFR signaling in monocyte-derived alveolar macrophages as a novel mechanism promoting their self-maintenance and persistence in the fibrotic niche. Pharmacological blockade of M-CSF signaling led to disappearance of the established population of monocyte-derived alveolar macrophages. Thus, our data indicate that monocyte-derived alveolar macrophages are specifically recruited to the fibrotic niche where they are maintained by autocrine signaling and drive fibrosis by stimulating fibroblast proliferation.

Routing plays an essential role to achieve the success in a vehicular ad-hoc networks (VANETs) environment, which is difficult due to dynamic topology and high mobility of VANET environment. In this paper, we propose an efficient Junction-based Routing Table Maintenance (JRTM) to improve the position-based routing protocol for the vehicle to vehicle (V2V) VANET urban area environment. JRTM protocol is capable to attain healthier communication constancy and lesser communication cost. The method of a routing table updating can assist a vehicle to find its own fixed route information, which assists to discover appropriate transmit vehicle nodes in a additional effective mode, and the maintenance repetition in a routing table will significantly decrease the chance of discover no appropriate transmit vehicle nodes. The simulation outcome shows that our protocol attains greater performance as compared with other junction-based routing protocols.