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Abstract Fuel cells are the most promising energy source for the future energy demand. The automobile industry is looking at the integration of fuel cells with electric vehicles (EV). This integration comes with many challenges like dynamic operational behaviors. For operating the fuel cell with maximum efficiency, this work proposes an Adaptive Neuro Fuzzy Inference System (ANFIS) based Maximum Power Point Tracking (MPPT) method. The hydrogen flow rate, pressure and stack temperature are the parameters considered to track the maximum power point of the fuel cell. The ANFIS-MPPT algorithm has been integrated with the 1.26 kW fuel cell in MATLAB/Simulink® and validated in different scenarios like dynamic variation in hydrogen pressure, stack temperature, load variation. The performance has been observed and compared with the conventional MPPT algorithms of Perturb and Observe (P&O) algorithm and Incremental Conductance (InC) algorithm. The proposed ANFIS-MPPT algorithm improves the power stability by 10–15% than the P&O and InC methods. Also, the proposed ANFIS-MPPT has 30% faster response as compared to the P&O algorithm, and 23% than the InC algorithm. From the analysis, it is observed that the ANFIS, P&O and InC methods are having the response time of 2.5 s, 3.6 s and 4.5 s respectively. Also the ANFIS method delivers the maximum power output of 1.26 kW, whereas the P&O and InC deliver 1.13 kW, 1.19 kW respectively. The detailed simulation analysis and results are presented in this paper.

Abstract Background Physical active lifestyles are essential throughout growth and maturation and may offer potential preventive and therapeutic benefit in patients with juvenile idiopathic arthritis (JIA). Insufficient physical activity (PA), in contrast, can lead to aggravation of disease-related symptoms. This study aimed to i) examine PA levels in children and adolescents with JIA compared to general population controls and ii) investigate correlates of pronounced physical inactivity in order to identify risk groups for sedentary behaviour. Methods Data from children and adolescents with JIA and population controls aged 3 to 17 years documented in the National Pediatric Rheumatologic Database (NPRD) and the German Health Interview and Examination Survey for Children and Adolescents (KiGGS) were used. Self-reported PA was collected from parents/guardians of children up to 11 years of age or adolescents 12 years of age and older. To compare PA-related data, age- and sex-specific pairwise analyses were conducted considering NPRD/KiGGS participants' data from 2017. Correlates of physical inactivity among patients were identified using a linear regression model. Results Data of 6,297 matched-pairs (mean age 11.2 ± 4.2 years, female 67%, patients’ disease duration 4.5 ± 3.7 years, persistent oligoarthritis 43%) were available for evaluation. Almost 36% of patients aged 3–17 years (vs. 20% of controls) achieved the WHO recommended amount of PA, while PA steadily decreased with age (18% of patients aged ≥ 12 years) and varied between JIA categories. Female adolescents and patients with enthesitis-related arthritis were least likely to achieve the minimum recommended level of PA. Physical inactivity was associated with female sex, higher age at disease onset, longer disease duration, more functional disability (C-HAQ) and higher disease activity (cJADAS-10). Conclusions Depending on JIA category, children and adolescents with JIA were similarly or even more likely to achieve the WHO recommended minimum level of PA compared to general population controls. However, since a large proportion of young JIA patients appear to be insufficiently physically active, engagement in targeted efforts to promote PA is urgently needed.

Collaural fistula, also known as cervico-aural fistula, is a rare anomaly that accounts for less than 8% of all branchial cleft anomalies. These fistulas result from incomplete closure of the first branchial cleft during embryonic development. A 21-year-old female exhibited depression on the left-side of her face since childhood, accompanied by a fistula. She had a history of intermittent discharge and a tuft of hair emerging from it. Additionally, the patient reported left ear discharge and an opening in the floor of the External Auditory Canal (EAC). Diagnostic imaging, including X-ray fistulogram, ultrasound, and Magnetic Resonance Imaging (MRI) neck fistulogram, played a crucial role in confirming the diagnosis of a collaural fistula. Surgical intervention involved excision of the fistulous tract and reconstruction of the EAC floor. The patient received antibiotic therapy, resulting in successful postoperative outcomes. The present case highlights the importance of recognising and appropriately managing collaural fistulas. When these fistulas are discovered early, along with a solid grasp of regional embryology and anatomy, there is a chance for better treatment outcomes.

Introduction: Chronic Otitis Media (COM) is a major cause of preventable hearing loss. Tympanoplasty is a crucial surgical step in managing COM and restoring hearing loss. Various prognostic factors are believed to influence the success of graft take-up. The Middle Ear Risk Index (MERI) is a numerical grading system used to assess the severity of the disease and predict the outcome of tympanoplasty for individual patients. Aim: To investigate the role of preoperative MERI in the selection of middle ear surgery. Materials and Methods: This cross-sectional study was conducted on a sample size of 40 patients (40 ears) who were treated at the Department of ENT, Acharya Vinobha Bhave Rural Hospital, Sawangi (Meghe), Wardha, Maharashtra, India, from December 2020 to December 2022. Only patients free from comorbidities and COM-related complications who underwent surgical intervention were included. The patients were evaluated for their MERI score, and the outcome of the surgical intervention was then correlated. Statistical analysis was performed with SPSS version 25.0 at a significance level of p

Objective Interim analysis of the RELIANCE registry, an on-going, non-interventional, open-label, multicentre, prospective study evaluating the long-term safety, dosing regimens and effectiveness of canakinumab in patients with cryopyrin-associated periodic syndromes (CAPS), familial Mediterranean fever (FMF), tumour-necrosis factor receptor-associated periodic syndrome (TRAPS) or mevalonate-kinase deficiency (MKD)/hyperimmunoglobulin-D syndrome (HIDS).Methods From September 2017 for patients with CAPS, and June 2018 for patients with FMF, TRAPS or MKD/HIDS, the registry enrolled paediatric (aged ≥2 years) and adult patients (aged ≥18 years) receiving canakinumab as part of their routine medical care. Safety, canakinumab dose, disease activity and quality of life outcome measures were evaluated at baseline and every 6 months until end of study visit.Results At the analysis cut-off date (December 2020), 168 patients (91 CAPS, 54 FMF, 16 TRAPS and 7 MKD/HIDS) were enrolled. 85 (50.9%) patients were female and 72 (43.1%) were children (SD of canakinumab was observed in the pooled population. The majority of patients were reported as having either absent or mild/moderate disease activity (physician’s global assessment) from baseline to Month 30, with a stable proportion of patients (~70%) in remission under canakinumab treatment. Patient-reported disease activity (Visual Analogue Scale (VAS), Autoinflammatory Disease Activity Index), fatigue (VAS); markers of inflammation (C-reactive protein, serum amyloid A and erythrocyte sedimentation rate) remained well-controlled throughout.Conclusion Data from this analysis confirm the long-term safety and effectiveness of canakinumab for the treatment of CAPS, FMF, TRAPS and MKD/HIDS.