BACKGROUND Bilateral hip disorder is a common finding that can occur in approximately 42%of the population with osteoarthritis.It is estimated that 25%individuals with osteoarthritis requiring total hip replacement(TH...BACKGROUND Bilateral hip disorder is a common finding that can occur in approximately 42%of the population with osteoarthritis.It is estimated that 25%individuals with osteoarthritis requiring total hip replacement(THR)may require a bilateral replacement.This has resulted in the test of the greatest strategy to run single staged bilateral hip replacement while addressing the outcomes to achieve swift and cost-effective patient recovery.AIM To assess the outcomes and cost effectiveness of bilateral THR(B/L THR)at our tertiary care hospital.METHODS Retrospective observational cross-sectional study was undertaken from Jan 2018 to July 2023 to assess the clinical outcomes of patients who underwent single stage B/L THR.RESULTS Data of 75 patients were analysed.The mean age was 36 years.Our complication rate was 4.0%including acute coronary syndrome,intra-operative acetabular fracture and paralytic ileus.The re-admission rate was 4%.CONCLUSION The choice of sequential or bilateral hip replacement is controversial.While,our study showed that bilateral hip replacement is safe and cost effective.As surgeons,we were careful in patient selection(low American Society of Anesthesiologist score).Though more than 50%of our B/L THR patients were obese[body mass index(BMI)>25],our outcomes were equivalent to normal BMI patients with lower risk of complication as well as early ambulation.Systemic complication deep vein thrombosis and pulmonary embolism were handled prophylactively by close monitoring,use of mechanical and pharmacological agents along with anticoagulants.Patients who require THR,often require them bilaterally and single stage replacement thus offers early restoration of an individual into their activities of daily living with minimal complications.Our findings support the use of single-stage B/L THR as a viable option for bilateral hip disorders,having favourable outcomes.展开更多
The globe faces an urgent need to close the energy demand-supply gap.Addressing this difficulty requires constructing a Hybrid Renewable Energy System(HRES),which has proven to be the most appropriate solution.HRES al...The globe faces an urgent need to close the energy demand-supply gap.Addressing this difficulty requires constructing a Hybrid Renewable Energy System(HRES),which has proven to be the most appropriate solution.HRES allows for integrating two or more renewable energy resources,successfully addressing the issue of intermittent availability of non-conventional energy resources.Optimization is critical for improving the HRES’s performance parameters during implementation.This study focuses on HRES using solar and biomass as renewable energy supplies and appropriate energy storage technologies.However,energy fluctuations present a problem with the power quality of HRES.To address this issue,the research paper introduces the Generalized Dynamic Progressive Neural Fuzzy Controller(GDPNFC),which regulates power flow within the proposed HRES.Furthermore,a unique approach called Enhanced Multi-Objective Monarch Butterfly Optimization(EMMBO)is used to optimize technical parameters.The simulation tool used in the research work is HOMER(Hybrid Optimization of Multiple Energy Resources)-PRO,and the system’s power quality is assessed using MATLAB 2016.The research paper concludes with comparing the performance of existing systems to the proposed system in terms of power loss and Total Harmonic Distortion(THD).It was established that the proposed technique involving EMMBO outperformed existing methods in technical optimization.展开更多
Post-endoscopic retrograde cholangiopancreatography(ERCP)cholecystitis(PEC)is a recognized adverse event associated with ERCP.The incidence of PEC is low in patients undergoing ERCP,but is high in specific subgroups,s...Post-endoscopic retrograde cholangiopancreatography(ERCP)cholecystitis(PEC)is a recognized adverse event associated with ERCP.The incidence of PEC is low in patients undergoing ERCP,but is high in specific subgroups,such as those receiving fully-covered self-expandable metallic stents(SEMS).Several risk factors contribute to PEC,including gallbladder(GB)-related factors like tumor involvement of the orifice of the cystic duct(OCD)or feeding artery,and associated gallstones.Stent-related factors,such as covered stent placement and high axial force stents,and procedure-related factors,including stent placement across the OCD and contrast injection into the GB,further elevate the risk.Prevention strategies focus on modifying techniques,such as careful contrast administration and stent selection(uncovered or low axial force SEMS),and considering prophylactic GB drainage through endoscopic transpapillary GB drainage(ETGBD)or endoscopic ultrasound-guided GB drainage(EUS-GBD),especially in high-risk patients.Treatment options for PEC range from conservative management with antibiotics to more invasive interventions like percutaneous transhepatic GB aspiration or drainage,endoscopic techniques(ETGBD,EUS-GBD),and cholecystectomy.The choice of treatment depends on the severity of cholecystitis,the patient's condition,and other factors.The present review summarizes the currently available literature on the incidence,predictors,prevention,and management of PEC.展开更多
To review the present status of breast cancer(BC) screening/early detection in low- and middle-income countries(LMICs) and identify the way forward, an open focused search for articles was undertaken in Pub Med, Googl...To review the present status of breast cancer(BC) screening/early detection in low- and middle-income countries(LMICs) and identify the way forward, an open focused search for articles was undertaken in Pub Med, Google Scholar and Google, and using a snowball technique, further articles were obtained from the reference list of initial search results. In addition, a query was put up on Research Gate to obtain more references and find out the general opinion of experts on the topic. Experts were also personally contacted for their opinion. Breast cancer(BC) is the most common cancer in women in the world. The rise in incidence is highest in LMICs where the incidence has often been much lower than high-income countries. In spite of more women dying of cancer than pregnancy or childbirth related causes in LMICs, most of the focus and resources are devoted to maternal health. Also, the majority of women in LMICs present at late stages to a hospital to initiate treatment. A number of trials have been conducted in various LMICs regarding the use of clinical breast examination and mammography in various combinations to understand the best ways of implementing a population level screening/early detection of BC; nevertheless, more research in this area is badly needed for different LMIC specific contexts. No-tably, very few LMICs have national level programs for BC prevention via screening/early detection and even stage reduction is not on the public health agenda. This is in addition to other barriers such as lack of awareness among women regarding BC and the presence of stigma, inappropriate attitudes and lack of following proper screening behavior, such as conducting breast self-examinations. The above is mixed with the apathy and lack of awareness of policy makers regarding the fact that BC prevention is much more cost-effective and humane than BC treatment. Implementation of population level programs for screening/early detection of BC, along with use of ways to improve awareness of women regarding BC, can prove critical in stemming the increasing burden of BC in LMICs. Use of newer modalities such as ultrasonography which is more suited to LMIC populations and use of m Health for awareness creation and increasing screening compliance are much needed extra additions to the overall agenda of LMICs in preventing BC.展开更多
Patients with locally advanced hepatocellular cancer(HCC)and portal vein tumor thrombosis(PVTT)have a dismal prognosis since limited treatment options are available for them.In recent years,effective systemic therapy,...Patients with locally advanced hepatocellular cancer(HCC)and portal vein tumor thrombosis(PVTT)have a dismal prognosis since limited treatment options are available for them.In recent years,effective systemic therapy,and advances in the understanding of technicalities and effectiveness of ablative therapies especially radiotherapy,have given some hope to prolong survival in them.This review summarized recent evidence in literature regarding the possible role of liver resection(LR)and liver transplantation(LT)in patients with locally advanced HCC and PVTT with no extrahepatic disease.Downstaging therapies have helped make curative resection or LT a reality in selected patients.This review emphasizes on the key points to focus on when considering surgery in these patients,who are usually relegated to palliative systemic therapy alone.Meticulous patient selection based on tumor biology,documented downstaging based on imaging and decrease in tumor marker levels,and an adequate waiting period to demonstrate stable disease,may help obtain satisfactory long-term outcomes post LR or LT in an intention to treat strategy in patients with HCC and PVTT.展开更多
A novel enzymatic method for extraction and preparation of fish collagen from swim bladder revealed the occurrence of α, β and γ bands with approximately 12.1 g/100g collagen corresponding to 89% of collagen and th...A novel enzymatic method for extraction and preparation of fish collagen from swim bladder revealed the occurrence of α, β and γ bands with approximately 12.1 g/100g collagen corresponding to 89% of collagen and thus confirmed the nativity and purity of the fish collagen. FT-IR studies confirmed the retention of all three amide bands of I, II and III, and triple helixcity. UN-crosslinked and UV-crosslinked fish collagen membrane records a very high temperature of helix denaturation at 197℃ and 215℃, shrinkage temperature at 50℃ ± 3.2℃ and 62℃ ± 2.7℃ and tensile strength at 16.89 ± 2.5 and 120.02 ± 1.0 Kg/cm2 respectively. Fish collagen matrix promoted NIH 3T3 and L6 cellular growth and proliferation. The study indicates that availability of pure fish collagen could replace bovine collagen in tissue engineering applications.展开更多
Iron overload is reported to be associated with immune alterations and increased susceptibility to infections. HIV infection is characterized by progressive immunodeficiency leading to invasion by opportunistic pathog...Iron overload is reported to be associated with immune alterations and increased susceptibility to infections. HIV infection is characterized by progressive immunodeficiency leading to invasion by opportunistic pathogens. It was of interest to find out if disease course in HIV type-1 infection could have any relation with alteration in body iron status among individuals with history of oral iron intake. A follow-up study of immunologic and virologic markers in relation to disease progression was undertaken on asymptomatic HIV-1 positive blood donors with history of oral iron intake (subgroup I) compared to those without such history (subgroup II). High serum iron was associated with elevated levels of Th2 category of cytokines, heightened immune activation, faster decline in CD4 + T lymphocyte count and higher viral set point. Pulmonary tuberculosis (PT) was the most common AIDS related illness (ARI) (>70%) recorded among subgroup I compared to non-PT category of ARI. Median ARI free duration (months) was shorter among those who developed PT compared to those developing non-PT category of ARI i.e. 30 (95% CI as 26,32) versus 67(95% CI as 60,71) in subgroup I and 47 (95% CI as 42,49) versus 80 (95% CI as 72,87) in subgroup II (P P < 0.001 for PT versus non-PT in both subgroups). The present study indicates that body iron overload resulting from excess intake of iron may be associated with qualitative defects in cell mediated immunity at early stage of HIV-1 infection that may facilitate subsequent acquisition of pulmonary tuberculosis, shorter ARI free duration and reduced survival.展开更多
The paper presents an overview of heat pipes, especially those used in different space missions. Historical perspectives, principles of operations, types of heat pipes are discussed. Several factors have contributed t...The paper presents an overview of heat pipes, especially those used in different space missions. Historical perspectives, principles of operations, types of heat pipes are discussed. Several factors have contributed to the science and technology of the present state-of-Art heat pipe leading to the development of loop heat pipes, micro and miniature heat pipes and micro loop heat pipes. The paper highlights the advancement of heat pipe for hypersonic cruise vehicles, loop heat pipes with higher conductance in 10 K range, heat pipe switches for temperature control of the spacecraft electronics.展开更多
Endoscopic ultrasound(EUS) guided drainage of pancreatic fluid collections(PFC) has become increasingly popular and become first line management option in many centers. Use of therapeutic echoendoscopes has greatly in...Endoscopic ultrasound(EUS) guided drainage of pancreatic fluid collections(PFC) has become increasingly popular and become first line management option in many centers. Use of therapeutic echoendoscopes has greatly increased the applicability of EUS guided transmural drainage. Drainage is indicated in symptomatic PFCs, PFC related infection, bleed, luminal obstruction, fistulization and biliary obstruction. EUS guided transmural drainage of PFCs is preferred in patients with non bulging lesions, portal hypertension, bleeding tendency and in those whom conventional drainage has failed. In the present decade significant progress has been made in minimally invasive endoscopic techniques. There are newer stent designs, access devices and techniques for more efficient drainage of PFCs. In this review, we discuss the EUS guided drainage of PFCs in acute pancreatitis.展开更多
The beneficial bacteria coined as probiotics are used as therapeutics to the host and evidences are there to demonstrate to treat bacterial and viral respiratory infections, gastrointestinal diseases, eczema, inflamma...The beneficial bacteria coined as probiotics are used as therapeutics to the host and evidences are there to demonstrate to treat bacterial and viral respiratory infections, gastrointestinal diseases, eczema, inflammation, H. pylori infection, irritable bowel syndrome and allergic symptoms etc. In recent past, probiotics has been reported for the control of intestinal parasite infections as well as few non-gut infections spread among human and veterinary animals. Animal models and in vitro culture systems have been studied regarding cellular interactions between probiotics and pathogens or relevant host cells, though the underlying molecular mechanisms mediating the beneficial effects have not yet fully discovered. Hence, more evidence based studies are warranted to correlate whether probiotics through multiple mechanisms might indeed provide a strain-specific protection against parasites to use it as therapeutics. This article has described the effect of probiotics in some of the intestinal as well as non-gut parasites and suggested the scope of exploring the benefit for protozoan parasite Leishmania, as India is planning for the elimination of the disease.展开更多
BACKGROUND Enhanced recovery after surgery is steadily gaining importance in patients undergoing pancreatic surgery,including pancreatoduodenectomy(PD).While clinical pathways targeting enhanced-recovery can achieve t...BACKGROUND Enhanced recovery after surgery is steadily gaining importance in patients undergoing pancreatic surgery,including pancreatoduodenectomy(PD).While clinical pathways targeting enhanced-recovery can achieve their intended outcome in reducing length of stay,compliance to these pathways,and their relevance is poorly understood.The aim of this systematic review was to assess the impact of deviations from/non-compliance to a clinical pathway on post-PD outcomes.AIM To assess the impact of deviations from/non-compliance to a clinical pathway on post-PD outcomes.METHODS A systematic review of major reference databases was undertaken,according to preferred reporting items for systematic reviews and meta-analysis guidelines,between January 2000 and November 2020 relating to compliance with clinical pathways and its impact on outcomes in patients undergoing PD.A meta-analysis was performed using fixed-effects or random-effects models.RESULTS Eleven studies including 1852 patients were identified.Median overall compliance to all components of the clinical pathway was 65.7%[interquartile range(IQR):62.7%-72.3%]with median compliance to post-operative parameters of the clinical pathway being 44%(IQR:34.5%-52.25%).Meta-analysis using a fixed-effects model showed that≥50%compliance to a clinical pathway predicted significantly fewer post-operative complications[pooled odds ratio(OR):9.46,95%confidence interval(CI):5.00-17.90;P<0.00001]and a significantly shorter length of hospital stay[pooled mean difference(MD):4.32,95%CI:-3.88 to-4.75;P<0.0001].At 100%compliance which was associated with significantly fewer post-operative complications(pooled OR:11.25,95%CI:4.71-26.84;P<0.00001)and shorter hospital stay(pooled MD of 4.66,95%CI:2.81-6.51;P<0.00001).CONCLUSION Compliance to post-PD clinical pathways remains low.Deviations are associated with an increased risk of complications and length of hospital stay.Understanding the relevance of deviations to clinical pathways post-PD presents pancreatic surgeons with opportunities to actively pursue an enhanced-recovery of their patients.展开更多
The study focused on the application of high-resolution mass spectrometry for the identification of impurities in pharmaceutical small molecules. A high-performance liquid chromatography (HPLC) coupled high resolution...The study focused on the application of high-resolution mass spectrometry for the identification of impurities in pharmaceutical small molecules. A high-performance liquid chromatography (HPLC) coupled high resolution mass spectrometer (HRMS) was used for identification of oxidative degradation impurities (DIs) of lansoprazole. The utilization of HRMS facilitates to determine the accurate mass of impurities and their fragment/product ions. A fast mass spectrometer (MS) compatible reverse phase chromatography method was used to investigate the oxidative stressed impurities. HPLC column;C18 (50 × 4.6 mm, 3.5 μm) was used with gradient elution. Spectral data acquired using information dependent acquisition (IDA) with real time dynamic background subtraction algorithm (DBS). Three oxidative impurities: DI-I (m/z 386.0781), DI-II (m/z 402.0734) and DI-III (m/z 386.0785), was observed during this study;interpretation of high resolution spectral data of all three impurities was carried out;elemental composition and molecular structure was proposed for major fragments. In this study mass error was found ≤7.7 parts per million (ppm).展开更多
A reliable,selective and sensitive liquid chromatography tandem mass spectrometry method was developed and validated for the quantification of lamotrigine in human plasma using lamotrigine13C3,d3 as an internal standa...A reliable,selective and sensitive liquid chromatography tandem mass spectrometry method was developed and validated for the quantification of lamotrigine in human plasma using lamotrigine13C3,d3 as an internal standard.Analyte and internal standard were extracted from human plasma by solid-phase extraction and detected in positive ion mode by tandem mass spectrometry with electrospray ionization（ESI） interface.Chromatographic separation was performed on a Chromolith s SpeedROD;RP-18e column（50-4.6 mm i.d.） using acetonitrile：570.1 mM ammonium formate solution（90：10,v/v） as the mobile phase at a flow rate of 0.500 mL/min.The calibration curves were linear over the range of 5.02-1226.47 ng/mL with the lower limit of quantitation validated at 5.02 ng/mL.The analytes were found stable in human plasma through three freeze（-20℃）-thaw（ice-cold water bath） cycles and under storage on bench-top in ice-cold water bath for at least 6.8 h,and also in the mobile phase at 10℃ for at least 57h.The method has shown good reproducibility,as the intra-and inter-day precisions were within 3.0%,while the accuracies were within 76.0% of nominal values.The validated LC-MS/MS method was applied for the evaluation of pharmacokinetic and bioequivalence parameters of lamotrigine after an oral administration of 50mg lamotrigine tablet to thirty-two healthy adult male volunteers.展开更多
The recent concern with the role of Fermi energy (EF) as a determinant of the properties of a superconductor (SC) led us to present new EF-dependent equations for the effective mass (m*) of superconducting electrons, ...The recent concern with the role of Fermi energy (EF) as a determinant of the properties of a superconductor (SC) led us to present new EF-dependent equations for the effective mass (m*) of superconducting electrons, their critical velocity, number density, and critical current density, and also the results of the calculations of these parameters for six SCs the Tcs of which vary between 3.72 and 110 K. While this work was based on, besides an idea due to Pines, equations for Tc and the gap at T = 0 that are explicitly EF-dependent, it employed an equation for the dimensionless construct that depends on EF only implicitly;k in this equation is the Boltzmann constant, θ is the Debye temperature, and P0 is the critical momentum of Cooper pairs. To meet the demand of consistency, we give here derivation of an equation for y that is also explicitly EF-dependent. The resulting framework is employed to (a) review the previous results for the six SCs noted above and (b) carry out a study of NbN which is the simplest composite SC that can shed further light on our approach. The study of NbN is woven around the primary data of Semenov et al. For the additional required inputs, we appeal to the empirical data of Roedhammer et al. and of Antonova et al.展开更多
Field experiments were conducted in oil and edible sunflower to study the effects of potassium(K) fertilization on achene yield and quality, and to estimate the nutrient internal efficiency(IE) and nutrient requiremen...Field experiments were conducted in oil and edible sunflower to study the effects of potassium(K) fertilization on achene yield and quality, and to estimate the nutrient internal efficiency(IE) and nutrient requirement in sunflower production. All trials in edible sunflower and 75% trials in oil sunflower showed positive yield responses to K fertilization. Compared with control without K fertilization, the application of K increased achene yield by an average of 406 kg ha–1for oil sunflower and 294 kg ha–1for edible sunflower. K application also increased 1 000-achene weight and kernel rate of both oil and edible sunflower. K fertilization improved the contents of oil, oleic acid, linoleic acid and linolenic acid in achenes of oil sunflower, and increased contents of oil, total unsaturated fatty acid and protein in achenes of edible sunflower. The average agronomic efficiency of K fertilizer was 4.0 for oil sunflower and 3.0 kg achene kg–1K2O for edible sunflower. The average IE of N, P and K under balanced NPK fertilization was 22.9, 82.8, and 9.9 kg kg–1for oil sunflower, and 27.3, 138.9, and 14.3 kg kg–1for edible sunflower. These values were equivalent to 45.5, 14.1, and 108.1 kg, and 39.0, 8.0, and 71.7 kg of N, P and K, respectively, in above-ground dry matter required for production per ton of achenes. The average harvest index of N, P and K was 0.47, 0.56 and 0.05 kg kg–1in oil sunflower, and 0.58, 0.58 and 0.14 kg kg–1in edible sunflower.展开更多
The NHS is right now confronting huge pressures relating to demand and capacity in radiology. The purpose of this research has been to provide information about MRI usage, details of operational aspects of MRI service...The NHS is right now confronting huge pressures relating to demand and capacity in radiology. The purpose of this research has been to provide information about MRI usage, details of operational aspects of MRI services, and to ascertain the planning intentions of NHS radiology services to keep up and create MRI capacity. The report expands on using Discrete Event Simulation (DES) to inspect and plan the utilisation of NHS hospital resources for the radiology department to help a 24 hr service that is available to outpatients which will help with diminishing patient waiting time, better resource usage, understanding the capacity and demand. Consequently, this research examines to adjust staff and resources with the demand of the MRI. The research was investigated using DES in various scenarios to find which resources are inactive;patients are treated slowly. DES helped in discovering resource utilisation and outpatient throughout the system. It additionally helped in distinguishing the bottlenecks in patient flow. The DES simulation results demonstrated that time for the outpatient in the system is less and more outpatients have been treated too. There is a higher level of outpatient patients leaving the system under 120 minutes. The report uncovered an MRI report interpretation time. Reception room time and MRI waiting room time are decreased significantly. It additionally exhibited with an expanded outflow of outpatients, resources, for example, MRI capacity and radiographer utilisation expanded.展开更多
Background:This paper analyzes India’s gradual transition towards a cashless economy.Methods:We present a theoretical model that evaluates decisions by consumers and sellers to adopt cashless payments.We then use dat...Background:This paper analyzes India’s gradual transition towards a cashless economy.Methods:We present a theoretical model that evaluates decisions by consumers and sellers to adopt cashless payments.We then use data from surveys conducted in 2011 and 2014(from World Bank’s Global Findex),as well as household and enterprise surveys conducted in 2009-2010 to estimate the amount of cashless transactions prevalent in India and identify the avenues that are successful and those that are not.We analyze instruments(cards versus point-of-sale versus mobile),micro units(individuals versus households versus retailers),and sectors to identify and estimate the enablers and bottlenecks.Results:We find that the most crucial enabler of cashless payments are inflows of funds into the accounts.Conclusion:Based on our findings,we suggest possible policy interventions.展开更多
Purpose: Haemocoagulase is a topical haemostatic agent which provides the adequate haemostasis after minor oral surgical procedures and it has also been proved to be beneficial in promoting wound healing. The aim of t...Purpose: Haemocoagulase is a topical haemostatic agent which provides the adequate haemostasis after minor oral surgical procedures and it has also been proved to be beneficial in promoting wound healing. The aim of this study was to check the efficacy of haemocoagulase in stopping the bleeding and its effect over wound healing after the minor oral surgical procedure. Material & Method: This study is comprised of 150 surgical sites in 75 patients. The subjects were divided into 2 groups in which Group 1 consists of 50 surgical sites in 25 patients and Group II consists of 100 surgical sites in 50 patients. Group I comprised of the group of simple extraction. In these patients one tooth socket was selected as haemocoagulase site and the other socket was the control group in which no drug was used to control haemorrhage. Group II comprised of the group of patients with bilateral impactions. 50 sockets and surgical sites were sprinkled with Haemocoagulase, and 50 sockets and surgical sites were used as control side in which no drug was used to control haemorrhage. Results: In Group I bleeding was stopped with the average time of 1.35 minutes, while at control side bleeding was stopped with the average time of 2.25 minutes. In Group II bleeding was stopped with average time for haemostasis being 1.46 minutes, while at control side the bleeding was stopped in an average time of 2.43 minutes. Conclusion: Haemocoagulase after minor oral surgery not only provides faster haemostasis but also enhances healing.展开更多
A nearly perfect metamaterial absorber is proposed that can find utility in terahertz sensing applications.The design consists of two concentric elliptical ring resonators(ERRs)whose parameters are appropriately set t...A nearly perfect metamaterial absorber is proposed that can find utility in terahertz sensing applications.The design consists of two concentric elliptical ring resonators(ERRs)whose parameters are appropriately set to achieve dual band absorption with near perfect absorption.The first absorption band at 3.62 THz having a Q-factor of 51.7 was caused due to the currents in the outer and inner ERR.The second absorption peak at 3.814 THz having a Q factor of 1411.11 was a consequence of currents flowing across the gap between the two concentric resonators.Furthermore,it is observed that the absorption bands are sensitive to the variation in refractive index of the surrounding medium.The sensitivity's in the absorption bands are 3 THz/RIU and 3.59 THz/RIU respectively.A sensor is proposed based on this design to detect harmful gases,which is demonstrated for detection of Methane and Chloroform.High Q-factor and high sensitivity of the narrow band makes the design an excellent sensor for detecting variations in the refractive index.展开更多
文摘BACKGROUND Bilateral hip disorder is a common finding that can occur in approximately 42%of the population with osteoarthritis.It is estimated that 25%individuals with osteoarthritis requiring total hip replacement(THR)may require a bilateral replacement.This has resulted in the test of the greatest strategy to run single staged bilateral hip replacement while addressing the outcomes to achieve swift and cost-effective patient recovery.AIM To assess the outcomes and cost effectiveness of bilateral THR(B/L THR)at our tertiary care hospital.METHODS Retrospective observational cross-sectional study was undertaken from Jan 2018 to July 2023 to assess the clinical outcomes of patients who underwent single stage B/L THR.RESULTS Data of 75 patients were analysed.The mean age was 36 years.Our complication rate was 4.0%including acute coronary syndrome,intra-operative acetabular fracture and paralytic ileus.The re-admission rate was 4%.CONCLUSION The choice of sequential or bilateral hip replacement is controversial.While,our study showed that bilateral hip replacement is safe and cost effective.As surgeons,we were careful in patient selection(low American Society of Anesthesiologist score).Though more than 50%of our B/L THR patients were obese[body mass index(BMI)>25],our outcomes were equivalent to normal BMI patients with lower risk of complication as well as early ambulation.Systemic complication deep vein thrombosis and pulmonary embolism were handled prophylactively by close monitoring,use of mechanical and pharmacological agents along with anticoagulants.Patients who require THR,often require them bilaterally and single stage replacement thus offers early restoration of an individual into their activities of daily living with minimal complications.Our findings support the use of single-stage B/L THR as a viable option for bilateral hip disorders,having favourable outcomes.
文摘The globe faces an urgent need to close the energy demand-supply gap.Addressing this difficulty requires constructing a Hybrid Renewable Energy System(HRES),which has proven to be the most appropriate solution.HRES allows for integrating two or more renewable energy resources,successfully addressing the issue of intermittent availability of non-conventional energy resources.Optimization is critical for improving the HRES’s performance parameters during implementation.This study focuses on HRES using solar and biomass as renewable energy supplies and appropriate energy storage technologies.However,energy fluctuations present a problem with the power quality of HRES.To address this issue,the research paper introduces the Generalized Dynamic Progressive Neural Fuzzy Controller(GDPNFC),which regulates power flow within the proposed HRES.Furthermore,a unique approach called Enhanced Multi-Objective Monarch Butterfly Optimization(EMMBO)is used to optimize technical parameters.The simulation tool used in the research work is HOMER(Hybrid Optimization of Multiple Energy Resources)-PRO,and the system’s power quality is assessed using MATLAB 2016.The research paper concludes with comparing the performance of existing systems to the proposed system in terms of power loss and Total Harmonic Distortion(THD).It was established that the proposed technique involving EMMBO outperformed existing methods in technical optimization.
文摘Post-endoscopic retrograde cholangiopancreatography(ERCP)cholecystitis(PEC)is a recognized adverse event associated with ERCP.The incidence of PEC is low in patients undergoing ERCP,but is high in specific subgroups,such as those receiving fully-covered self-expandable metallic stents(SEMS).Several risk factors contribute to PEC,including gallbladder(GB)-related factors like tumor involvement of the orifice of the cystic duct(OCD)or feeding artery,and associated gallstones.Stent-related factors,such as covered stent placement and high axial force stents,and procedure-related factors,including stent placement across the OCD and contrast injection into the GB,further elevate the risk.Prevention strategies focus on modifying techniques,such as careful contrast administration and stent selection(uncovered or low axial force SEMS),and considering prophylactic GB drainage through endoscopic transpapillary GB drainage(ETGBD)or endoscopic ultrasound-guided GB drainage(EUS-GBD),especially in high-risk patients.Treatment options for PEC range from conservative management with antibiotics to more invasive interventions like percutaneous transhepatic GB aspiration or drainage,endoscopic techniques(ETGBD,EUS-GBD),and cholecystectomy.The choice of treatment depends on the severity of cholecystitis,the patient's condition,and other factors.The present review summarizes the currently available literature on the incidence,predictors,prevention,and management of PEC.
文摘To review the present status of breast cancer(BC) screening/early detection in low- and middle-income countries(LMICs) and identify the way forward, an open focused search for articles was undertaken in Pub Med, Google Scholar and Google, and using a snowball technique, further articles were obtained from the reference list of initial search results. In addition, a query was put up on Research Gate to obtain more references and find out the general opinion of experts on the topic. Experts were also personally contacted for their opinion. Breast cancer(BC) is the most common cancer in women in the world. The rise in incidence is highest in LMICs where the incidence has often been much lower than high-income countries. In spite of more women dying of cancer than pregnancy or childbirth related causes in LMICs, most of the focus and resources are devoted to maternal health. Also, the majority of women in LMICs present at late stages to a hospital to initiate treatment. A number of trials have been conducted in various LMICs regarding the use of clinical breast examination and mammography in various combinations to understand the best ways of implementing a population level screening/early detection of BC; nevertheless, more research in this area is badly needed for different LMIC specific contexts. No-tably, very few LMICs have national level programs for BC prevention via screening/early detection and even stage reduction is not on the public health agenda. This is in addition to other barriers such as lack of awareness among women regarding BC and the presence of stigma, inappropriate attitudes and lack of following proper screening behavior, such as conducting breast self-examinations. The above is mixed with the apathy and lack of awareness of policy makers regarding the fact that BC prevention is much more cost-effective and humane than BC treatment. Implementation of population level programs for screening/early detection of BC, along with use of ways to improve awareness of women regarding BC, can prove critical in stemming the increasing burden of BC in LMICs. Use of newer modalities such as ultrasonography which is more suited to LMIC populations and use of m Health for awareness creation and increasing screening compliance are much needed extra additions to the overall agenda of LMICs in preventing BC.
文摘Patients with locally advanced hepatocellular cancer(HCC)and portal vein tumor thrombosis(PVTT)have a dismal prognosis since limited treatment options are available for them.In recent years,effective systemic therapy,and advances in the understanding of technicalities and effectiveness of ablative therapies especially radiotherapy,have given some hope to prolong survival in them.This review summarized recent evidence in literature regarding the possible role of liver resection(LR)and liver transplantation(LT)in patients with locally advanced HCC and PVTT with no extrahepatic disease.Downstaging therapies have helped make curative resection or LT a reality in selected patients.This review emphasizes on the key points to focus on when considering surgery in these patients,who are usually relegated to palliative systemic therapy alone.Meticulous patient selection based on tumor biology,documented downstaging based on imaging and decrease in tumor marker levels,and an adequate waiting period to demonstrate stable disease,may help obtain satisfactory long-term outcomes post LR or LT in an intention to treat strategy in patients with HCC and PVTT.
文摘A novel enzymatic method for extraction and preparation of fish collagen from swim bladder revealed the occurrence of α, β and γ bands with approximately 12.1 g/100g collagen corresponding to 89% of collagen and thus confirmed the nativity and purity of the fish collagen. FT-IR studies confirmed the retention of all three amide bands of I, II and III, and triple helixcity. UN-crosslinked and UV-crosslinked fish collagen membrane records a very high temperature of helix denaturation at 197℃ and 215℃, shrinkage temperature at 50℃ ± 3.2℃ and 62℃ ± 2.7℃ and tensile strength at 16.89 ± 2.5 and 120.02 ± 1.0 Kg/cm2 respectively. Fish collagen matrix promoted NIH 3T3 and L6 cellular growth and proliferation. The study indicates that availability of pure fish collagen could replace bovine collagen in tissue engineering applications.
文摘Iron overload is reported to be associated with immune alterations and increased susceptibility to infections. HIV infection is characterized by progressive immunodeficiency leading to invasion by opportunistic pathogens. It was of interest to find out if disease course in HIV type-1 infection could have any relation with alteration in body iron status among individuals with history of oral iron intake. A follow-up study of immunologic and virologic markers in relation to disease progression was undertaken on asymptomatic HIV-1 positive blood donors with history of oral iron intake (subgroup I) compared to those without such history (subgroup II). High serum iron was associated with elevated levels of Th2 category of cytokines, heightened immune activation, faster decline in CD4 + T lymphocyte count and higher viral set point. Pulmonary tuberculosis (PT) was the most common AIDS related illness (ARI) (>70%) recorded among subgroup I compared to non-PT category of ARI. Median ARI free duration (months) was shorter among those who developed PT compared to those developing non-PT category of ARI i.e. 30 (95% CI as 26,32) versus 67(95% CI as 60,71) in subgroup I and 47 (95% CI as 42,49) versus 80 (95% CI as 72,87) in subgroup II (P P < 0.001 for PT versus non-PT in both subgroups). The present study indicates that body iron overload resulting from excess intake of iron may be associated with qualitative defects in cell mediated immunity at early stage of HIV-1 infection that may facilitate subsequent acquisition of pulmonary tuberculosis, shorter ARI free duration and reduced survival.
文摘The paper presents an overview of heat pipes, especially those used in different space missions. Historical perspectives, principles of operations, types of heat pipes are discussed. Several factors have contributed to the science and technology of the present state-of-Art heat pipe leading to the development of loop heat pipes, micro and miniature heat pipes and micro loop heat pipes. The paper highlights the advancement of heat pipe for hypersonic cruise vehicles, loop heat pipes with higher conductance in 10 K range, heat pipe switches for temperature control of the spacecraft electronics.
文摘Endoscopic ultrasound(EUS) guided drainage of pancreatic fluid collections(PFC) has become increasingly popular and become first line management option in many centers. Use of therapeutic echoendoscopes has greatly increased the applicability of EUS guided transmural drainage. Drainage is indicated in symptomatic PFCs, PFC related infection, bleed, luminal obstruction, fistulization and biliary obstruction. EUS guided transmural drainage of PFCs is preferred in patients with non bulging lesions, portal hypertension, bleeding tendency and in those whom conventional drainage has failed. In the present decade significant progress has been made in minimally invasive endoscopic techniques. There are newer stent designs, access devices and techniques for more efficient drainage of PFCs. In this review, we discuss the EUS guided drainage of PFCs in acute pancreatitis.
文摘The beneficial bacteria coined as probiotics are used as therapeutics to the host and evidences are there to demonstrate to treat bacterial and viral respiratory infections, gastrointestinal diseases, eczema, inflammation, H. pylori infection, irritable bowel syndrome and allergic symptoms etc. In recent past, probiotics has been reported for the control of intestinal parasite infections as well as few non-gut infections spread among human and veterinary animals. Animal models and in vitro culture systems have been studied regarding cellular interactions between probiotics and pathogens or relevant host cells, though the underlying molecular mechanisms mediating the beneficial effects have not yet fully discovered. Hence, more evidence based studies are warranted to correlate whether probiotics through multiple mechanisms might indeed provide a strain-specific protection against parasites to use it as therapeutics. This article has described the effect of probiotics in some of the intestinal as well as non-gut parasites and suggested the scope of exploring the benefit for protozoan parasite Leishmania, as India is planning for the elimination of the disease.
文摘BACKGROUND Enhanced recovery after surgery is steadily gaining importance in patients undergoing pancreatic surgery,including pancreatoduodenectomy(PD).While clinical pathways targeting enhanced-recovery can achieve their intended outcome in reducing length of stay,compliance to these pathways,and their relevance is poorly understood.The aim of this systematic review was to assess the impact of deviations from/non-compliance to a clinical pathway on post-PD outcomes.AIM To assess the impact of deviations from/non-compliance to a clinical pathway on post-PD outcomes.METHODS A systematic review of major reference databases was undertaken,according to preferred reporting items for systematic reviews and meta-analysis guidelines,between January 2000 and November 2020 relating to compliance with clinical pathways and its impact on outcomes in patients undergoing PD.A meta-analysis was performed using fixed-effects or random-effects models.RESULTS Eleven studies including 1852 patients were identified.Median overall compliance to all components of the clinical pathway was 65.7%[interquartile range(IQR):62.7%-72.3%]with median compliance to post-operative parameters of the clinical pathway being 44%(IQR:34.5%-52.25%).Meta-analysis using a fixed-effects model showed that≥50%compliance to a clinical pathway predicted significantly fewer post-operative complications[pooled odds ratio(OR):9.46,95%confidence interval(CI):5.00-17.90;P<0.00001]and a significantly shorter length of hospital stay[pooled mean difference(MD):4.32,95%CI:-3.88 to-4.75;P<0.0001].At 100%compliance which was associated with significantly fewer post-operative complications(pooled OR:11.25,95%CI:4.71-26.84;P<0.00001)and shorter hospital stay(pooled MD of 4.66,95%CI:2.81-6.51;P<0.00001).CONCLUSION Compliance to post-PD clinical pathways remains low.Deviations are associated with an increased risk of complications and length of hospital stay.Understanding the relevance of deviations to clinical pathways post-PD presents pancreatic surgeons with opportunities to actively pursue an enhanced-recovery of their patients.
文摘The study focused on the application of high-resolution mass spectrometry for the identification of impurities in pharmaceutical small molecules. A high-performance liquid chromatography (HPLC) coupled high resolution mass spectrometer (HRMS) was used for identification of oxidative degradation impurities (DIs) of lansoprazole. The utilization of HRMS facilitates to determine the accurate mass of impurities and their fragment/product ions. A fast mass spectrometer (MS) compatible reverse phase chromatography method was used to investigate the oxidative stressed impurities. HPLC column;C18 (50 × 4.6 mm, 3.5 μm) was used with gradient elution. Spectral data acquired using information dependent acquisition (IDA) with real time dynamic background subtraction algorithm (DBS). Three oxidative impurities: DI-I (m/z 386.0781), DI-II (m/z 402.0734) and DI-III (m/z 386.0785), was observed during this study;interpretation of high resolution spectral data of all three impurities was carried out;elemental composition and molecular structure was proposed for major fragments. In this study mass error was found ≤7.7 parts per million (ppm).
文摘A reliable,selective and sensitive liquid chromatography tandem mass spectrometry method was developed and validated for the quantification of lamotrigine in human plasma using lamotrigine13C3,d3 as an internal standard.Analyte and internal standard were extracted from human plasma by solid-phase extraction and detected in positive ion mode by tandem mass spectrometry with electrospray ionization（ESI） interface.Chromatographic separation was performed on a Chromolith s SpeedROD;RP-18e column（50-4.6 mm i.d.） using acetonitrile：570.1 mM ammonium formate solution（90：10,v/v） as the mobile phase at a flow rate of 0.500 mL/min.The calibration curves were linear over the range of 5.02-1226.47 ng/mL with the lower limit of quantitation validated at 5.02 ng/mL.The analytes were found stable in human plasma through three freeze（-20℃）-thaw（ice-cold water bath） cycles and under storage on bench-top in ice-cold water bath for at least 6.8 h,and also in the mobile phase at 10℃ for at least 57h.The method has shown good reproducibility,as the intra-and inter-day precisions were within 3.0%,while the accuracies were within 76.0% of nominal values.The validated LC-MS/MS method was applied for the evaluation of pharmacokinetic and bioequivalence parameters of lamotrigine after an oral administration of 50mg lamotrigine tablet to thirty-two healthy adult male volunteers.
文摘The recent concern with the role of Fermi energy (EF) as a determinant of the properties of a superconductor (SC) led us to present new EF-dependent equations for the effective mass (m*) of superconducting electrons, their critical velocity, number density, and critical current density, and also the results of the calculations of these parameters for six SCs the Tcs of which vary between 3.72 and 110 K. While this work was based on, besides an idea due to Pines, equations for Tc and the gap at T = 0 that are explicitly EF-dependent, it employed an equation for the dimensionless construct that depends on EF only implicitly;k in this equation is the Boltzmann constant, θ is the Debye temperature, and P0 is the critical momentum of Cooper pairs. To meet the demand of consistency, we give here derivation of an equation for y that is also explicitly EF-dependent. The resulting framework is employed to (a) review the previous results for the six SCs noted above and (b) carry out a study of NbN which is the simplest composite SC that can shed further light on our approach. The study of NbN is woven around the primary data of Semenov et al. For the additional required inputs, we appeal to the empirical data of Roedhammer et al. and of Antonova et al.
基金financial support from the International Plant Nutrition Institute of USA (IPNI-2015-CHN-C14)the earmarked fund for China Agriculture Research System (CARS-14)
文摘Field experiments were conducted in oil and edible sunflower to study the effects of potassium(K) fertilization on achene yield and quality, and to estimate the nutrient internal efficiency(IE) and nutrient requirement in sunflower production. All trials in edible sunflower and 75% trials in oil sunflower showed positive yield responses to K fertilization. Compared with control without K fertilization, the application of K increased achene yield by an average of 406 kg ha–1for oil sunflower and 294 kg ha–1for edible sunflower. K application also increased 1 000-achene weight and kernel rate of both oil and edible sunflower. K fertilization improved the contents of oil, oleic acid, linoleic acid and linolenic acid in achenes of oil sunflower, and increased contents of oil, total unsaturated fatty acid and protein in achenes of edible sunflower. The average agronomic efficiency of K fertilizer was 4.0 for oil sunflower and 3.0 kg achene kg–1K2O for edible sunflower. The average IE of N, P and K under balanced NPK fertilization was 22.9, 82.8, and 9.9 kg kg–1for oil sunflower, and 27.3, 138.9, and 14.3 kg kg–1for edible sunflower. These values were equivalent to 45.5, 14.1, and 108.1 kg, and 39.0, 8.0, and 71.7 kg of N, P and K, respectively, in above-ground dry matter required for production per ton of achenes. The average harvest index of N, P and K was 0.47, 0.56 and 0.05 kg kg–1in oil sunflower, and 0.58, 0.58 and 0.14 kg kg–1in edible sunflower.
文摘The NHS is right now confronting huge pressures relating to demand and capacity in radiology. The purpose of this research has been to provide information about MRI usage, details of operational aspects of MRI services, and to ascertain the planning intentions of NHS radiology services to keep up and create MRI capacity. The report expands on using Discrete Event Simulation (DES) to inspect and plan the utilisation of NHS hospital resources for the radiology department to help a 24 hr service that is available to outpatients which will help with diminishing patient waiting time, better resource usage, understanding the capacity and demand. Consequently, this research examines to adjust staff and resources with the demand of the MRI. The research was investigated using DES in various scenarios to find which resources are inactive;patients are treated slowly. DES helped in discovering resource utilisation and outpatient throughout the system. It additionally helped in distinguishing the bottlenecks in patient flow. The DES simulation results demonstrated that time for the outpatient in the system is less and more outpatients have been treated too. There is a higher level of outpatient patients leaving the system under 120 minutes. The report uncovered an MRI report interpretation time. Reception room time and MRI waiting room time are decreased significantly. It additionally exhibited with an expanded outflow of outpatients, resources, for example, MRI capacity and radiographer utilisation expanded.
文摘Background:This paper analyzes India’s gradual transition towards a cashless economy.Methods:We present a theoretical model that evaluates decisions by consumers and sellers to adopt cashless payments.We then use data from surveys conducted in 2011 and 2014(from World Bank’s Global Findex),as well as household and enterprise surveys conducted in 2009-2010 to estimate the amount of cashless transactions prevalent in India and identify the avenues that are successful and those that are not.We analyze instruments(cards versus point-of-sale versus mobile),micro units(individuals versus households versus retailers),and sectors to identify and estimate the enablers and bottlenecks.Results:We find that the most crucial enabler of cashless payments are inflows of funds into the accounts.Conclusion:Based on our findings,we suggest possible policy interventions.
文摘Purpose: Haemocoagulase is a topical haemostatic agent which provides the adequate haemostasis after minor oral surgical procedures and it has also been proved to be beneficial in promoting wound healing. The aim of this study was to check the efficacy of haemocoagulase in stopping the bleeding and its effect over wound healing after the minor oral surgical procedure. Material & Method: This study is comprised of 150 surgical sites in 75 patients. The subjects were divided into 2 groups in which Group 1 consists of 50 surgical sites in 25 patients and Group II consists of 100 surgical sites in 50 patients. Group I comprised of the group of simple extraction. In these patients one tooth socket was selected as haemocoagulase site and the other socket was the control group in which no drug was used to control haemorrhage. Group II comprised of the group of patients with bilateral impactions. 50 sockets and surgical sites were sprinkled with Haemocoagulase, and 50 sockets and surgical sites were used as control side in which no drug was used to control haemorrhage. Results: In Group I bleeding was stopped with the average time of 1.35 minutes, while at control side bleeding was stopped with the average time of 2.25 minutes. In Group II bleeding was stopped with average time for haemostasis being 1.46 minutes, while at control side the bleeding was stopped in an average time of 2.43 minutes. Conclusion: Haemocoagulase after minor oral surgery not only provides faster haemostasis but also enhances healing.
文摘A nearly perfect metamaterial absorber is proposed that can find utility in terahertz sensing applications.The design consists of two concentric elliptical ring resonators(ERRs)whose parameters are appropriately set to achieve dual band absorption with near perfect absorption.The first absorption band at 3.62 THz having a Q-factor of 51.7 was caused due to the currents in the outer and inner ERR.The second absorption peak at 3.814 THz having a Q factor of 1411.11 was a consequence of currents flowing across the gap between the two concentric resonators.Furthermore,it is observed that the absorption bands are sensitive to the variation in refractive index of the surrounding medium.The sensitivity's in the absorption bands are 3 THz/RIU and 3.59 THz/RIU respectively.A sensor is proposed based on this design to detect harmful gases,which is demonstrated for detection of Methane and Chloroform.High Q-factor and high sensitivity of the narrow band makes the design an excellent sensor for detecting variations in the refractive index.
