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As the fifth generation (5G) mobile communication systems are commercially deployed, they bring new services, enhance user experiences, and offer various opportunities to different industries. Despite its advancements, 5G encounters several challenges. To tackle these issues, global industrial, academic, and standards organizations are actively researching on sixth generation (6G) wireless communication systems. 6G networks are envisioned as a transformative shift in the interactions between the physical, digital, and human realms, paving the way for a pervasive human-centered cyber-physical world. 6G is positioned to be a platform that offers communication and beyond communication services considering both performance and value centric technological development approaches. In this paper, we present the way forward towards the design of 6G endto-end (E2E) system as a consolidated view of leading industry stakeholders and academia in the European level 6G flagship project Hexa-X-II. We discuss the key challenges with 5G and how 6G is expected to tackle those by introducing new technological innovations and supporting novel use case requirements. We provide a comprehensive methodology for the design of a 6G E2E system including ten principles, a blueprint, and a structured design process. The architecture design principles prioritize environmental sustainability, digital inclusiveness, and trustworthiness, considering their impact on the 6G E2E system. The blueprint is described corresponding to the infrastructure, network centric application, and application layers, as well as the pervasive functionalities and the relevant technological innovations. Following the design principles and the system blueprint, the design process is demonstrated as two-way approaches (i.e., 1) key performance and value indicators based design process. 2) top-down versus bottom-up alignment process) through the lens of a collaborative robot use case. Through this use case, a special attention is given to the technological enablers that cover management and orchestration functionalities and their 6G enhancement to go beyond the limitations characterizing the previous network generation. In addition, virtual modelling aspects related to digital twining and simulations for 6G E2E system design are also discussed.

Power production, as well as transportation, are two sectors mainly contributing to global warming and pollution. These effects can be lessened through the use of biofuels. However, biofuels are plagued due to low calorific value and high viscosity compared to diesel. However, this can be overcome by proper adjustment of the operating parameters (Compression ratio, Fuel injection timing, Fuel injection Pressure, Engine load). The present study tries to unravel the influence of fuel injection pressure on the performance, combustion, emission, and exergy analysis of the Nahar biodiesel run diesel engine. Five fuel injection pressure (200 bar, 220 bar, 240 bar, 260 bar, 280 bar) and five engine loading conditions (20 %, 40 %, 60 %, 80 %, 100 %) at injection timing of 23° BTDC and compression ratio of 17.5 are considered. The results indicate that the performance, combustion, emission, and exergy parameters improve with the use of higher fuel injection pressure. The maximum BTEs are found to be 24.86 %, 27 %, 28.11 %, 29.22 %, and 31.13 % in biodiesel mode at FIPs of 200 bar, 220 bar, 240 bar, 260 bar, and 280 bar, respectively in comparison to 27.76 % for diesel at standard settings (FIP = 200 bar, CR = 17.5, IT = 23° BTDC) at 100 % load. Furthermore, the effect of addition of nanoparticles and variation of other operating parameters such as injection timing and compression ratio of the engine may enhance the performance and emissions of Nahar biodiesel run diesel engine.

Abstract The influence of humans on the environment is growing drastically and is pervasive. If this trend continues for a longer time, it can cost humankind, social and economic challenges. Keeping this situation in mind, renewable energy has paved the way as our saviour. This shift will not only help in reducing pollution but will also provide immense opportunities for the youth to work. This work discusses about various waste management strategies and discusses the pyrolysis process in details. Simulations were done keeping pyrolysis as the base process and by varying parameters like feeds and reactor materials. Different feeds were chosen like Low-Density Polyethylene (LDPE), wheat straw, pinewood, and a mixture of Polystyrene (PS), Polyethylene (PE), and Polypropylene (PP). Different reactor materials were considered namely, stainless steel AISI 202, AISI 302, AISI 304, and AISI 405. AISI stands for American Iron and Steel Institute. AISI is used to signify some standard grades of alloy steel bars. Thermal stress and thermal strain values and temperature contours were obtained using simulation software called Fusion 360. These values were plotted against temperature using graphing software called Origin. It was observed that these values increased with increasing temperature. LDPE got the lowest values for stress and stainless steel AISI 304 came out to be the most feasible material for pyrolysis reactor having the ability to withstand high thermal stresses. RSM was effectively used to generate a robust prognostic model with high efficiency, R2 (0.9924–0.9931), and low RMSE (0.236 to 0.347). Optimization based on desirability identified the operating parameters as 354 °C temperature and LDPE feedstock. The best thermal stress and strain responses at these ideal parameters were 1719.67 MPa and 0.0095, respectively.

Background: Epistaxis is a common condition but with diverse etiology dependent on geography, season, climate, and demography. Aims and Objectives: To describe the demographic, clinical, and etiological profile and management strategies of epistaxis cases at a tertiary center in U.P. (west). Materials and Methods: Patients were identified from the emergency and outpatient department, and their demographic and clinical details were noted. Local examination was performed, and necessary investigations were carried out. Management strategies were noted. Duration of hospital stay and mortality, if any, was documented. Descriptive analytics were used. Data were represented as numbers and percentages, mean±standard deviation, and median. Results: A total of 189 epistaxis patients were enrolled in the study. The mean age of patients was 32.89±17.92 (range 1–85 years). The sex ratio (M: F) was 2.71. Majority of patients presented to the emergency department (60.3%) within 1 day (64.6%), had single episode (66.7%), the presence of old clot (72%) and the anterior location of bleeding (91.5%). 119 (63%) cases required admission. Nasal endoscopy and computed tomography scan were performed in 49 (25.9%) and 24 (12.7%) cases, respectively. The most common etiology was trauma (49.2%), followed by idiopathic cause (14.8%), hypertension (12.7%), and others. Nasal packing and cauterization were required in 16.4% and 15.9% of cases, respectively. Surgery was required in 5 (2.6%) cases. A minuscule percentage of cases required blood transfusion. There was no mortality. Conclusion: Epistaxis is a common emergency with males predominating over females. Causes are varied. Most patients can be managed conservatively with favorable outcomes if timely intervention is done.

Category: Hindfoot; Other Introduction/Purpose: The Malerba calcaneal osteotomy is a step cut Z-type osteotomy with a lateral wedge resection used to treat hindfoot varus deformity. The osteotomy allows for lateral translation while the wedge resection enables lateral rotation of the calcaneal tuberosity. The technique enables a more powerful correction of hindfoot varus without excessive lateral translation of the calcaneus, which has been shown to cause tarsal tunnel syndrome. Thus far, there have been few published clinical and radiographic outcomes on the Malerba osteotomy. The purpose of this article is to report on patient reported outcome scores (PROMIS), complications, and radiographic improvement in a series of patients treated with this osteotomy. Methods: A prospectively collected foot and ankle registry was queried to retrospectively identify patients who underwent a Malerba osteotomy from February 2016 through January 2022. Patients were included if they were over 18 years of age, underwent a Malerba osteotomy, had preoperative and minimum 1-year postoperative PROMIS scores, and preoperative and postoperative radiographs. 40 patients met the inclusion criteria (average age 54.3 years). PROMIS scores from 6 domains including physical function, pain interference, pain intensity, global physical health, global mental health, and depression were compared preoperatively and postoperatively. Radiographic measures including talonavicular coverage angle (TNCA), calcaneal pitch (CP), and lateral talus-1st metatarsal angle (Meary’s angle) were measured and compared preoperatively and postoperatively. Complications and radiographic union were also recorded. Results: At a mean of 22 months, PROMIS domains including physical function, pain interference, pain intensity, global physical health, and global mental health improved significantly; the depression scale did not significantly change (Table 1). Calcaneal pitch and Meary’s angle significantly improved from 22.9 to 19.1 (p

At the start of the COVID-19 pandemic, the Jim Pattison Diabetes and Pregnancy (JP DAP) clinic quickly switched from in-person to virtual care for patients with gestational diabetes (GDM) to reduce the risk of viral transmission. Poor glycaemic control in pregnancies increases the risk of maternal–fetal complications and thus women with GDM require education, frequent follow-up and treatment to reduce these risks. Delays in care could potentially result in increased maternal–fetal complications. We conducted a prospective, single-centre quality improvement (QI) study of women with GDM who attended the JP DAP clinic and delivered between 1 September 2019 and 31 March 2021. 2123 singleton pregnancies between 1 September 2019 and 31 March 2021 with GDM were analysed for this study. The time of referral to see the endocrinologist was lower than baseline in the first wave but rose significantly in the second wave. No-shows for appointments increased in the first wave but were lower than baseline after the implementation of time slots. There was no special cause variation for maternal–fetal complications pre pandemic, first wave or during the second wave. A patient satisfaction survey reported that 93% of respondents strongly agreed or agreed with the statement ‘I was satisfied with the care provided to me over the telephone appointments’. The GDM education package, online educational videos in Hindi and English and the glucometer smartphone application helped to maintain the time of referral to first endocrinologist appointment in the first wave and therefore were considered an effective substitute for in-person education. Despite the delays in care seen in the second wave, there was no increase in maternal-fetal complications. Our clinic plans to continue using virtual tools for the foreseeable future.

Introduction: The smell dysfunction in COVID-19 patients has remained an unexplained topic. The blood parameters' variability in COVID-19 patients with anosmia has been studied in few literatures. The study is aimed to find the association of anosmia with the blood grouping and C-reactive protein (CRP) levels in coronavirus-infected patients. Materials and Methods: Database from Medical Records Department of a Tertiary Care Teaching Hospital in Northern India was searched from July 2020 to December 2020. Every fifth file was selected using the stratified random sampling. Laboratory-confirmed COVID-19 cases by reverse transcription-polymerase chain reaction files were included. Blood grouping and CRP levels were assessed and statistically correlated. Results: A total of 103 patients of coronavirus-associated infection with anosmia were included among which 52 (50.48%) patients were from moderate category of AIIMS-ICMR joint task Force's clinical guidelines. A total of 44 (42.71%) patients had moderate levels of elevated CRP. The blood Group B-type was found most commonly in 35 (33.98%) patients. The correlation of severity of COVID-19 infection with CRP was found to be statistically significant (Chi-square test statistic was 31.203 and P = 0.00023) in patients presenting with smell dysfunction. Conclusion: Anosmia was found to a suggestive symptom for the early identification of coronavirus-infected cases. In this study, CRP levels showed statistically significant association with anosmia in COVID-19 patients. Predilection for specific blood groups serves as platform for further research.

Shigellosis (bacillary dysentery) is a severe gastrointestinal infection with a global incidence of 90 million cases annually. Despite the severity of this disease, there is currently no licensed vaccine against shigellosis. Shigella’s primary virulence factor is its type III secretion system (T3SS), which is a specialized nanomachine used to manipulate host cells. A fusion of T3SS injectisome needle tip protein IpaD and translocator protein IpaB, termed DBF, when admixed with the mucosal adjuvant double-mutant labile toxin (dmLT) from enterotoxigenic E. coli was protective using a murine pulmonary model. To facilitate the production of this platform, a recombinant protein that consisted of LTA-1, the active moiety of dmLT, and DBF were genetically fused, resulting in L-DBF, which showed improved protection against Shigella challenge. To extrapolate this protection from mice to humans, we modified the formulation to provide for a multivalent presentation with the addition of an adjuvant approved for use in human vaccines. Here, we show that L-DBF formulated (admix) with a newly developed TLR4 agonist called BECC438 (a detoxified lipid A analog identified as Bacterial Enzymatic Combinatorial Chemistry candidate #438), formulated as an oil-in-water emulsion, has a very high protective efficacy at low antigen doses against lethal Shigella challenge in our mouse model. Optimal protection was observed when this formulation was introduced at a mucosal site (intranasally). When the formulation was then evaluated for the immune response it elicits, protection appeared to correlate with high IFN-γ and IL-17 secretion from mucosal site lymphocytes.

Power production through combustion of fuels plays a vital role in the progress of a nation. In liquid fuels, biodiesel has emerged as a potential replacement of fossil fuel. In this regard, the improvement of fuel properties or adjustment of the operating parameters can improve the efficiency and lower the emission for a biodiesel run diesel engine. In this regard, the current study focuses on the use of novel nano blended biodiesel, prepared by blending titanium dioxide nano particles along Eichhornia Crassipes biodiesel. Three different biodiesel blends are prepared having composition of titanium dioxide by 50 ppm, 100 ppm and 150 ppm which is tested in a four stroke, single cylinder, naturally aspirated water cooled diesel engine of 3.5 kW rated power for different loading conditions for performance, emission, and combustion evaluation. Further, at the same engine conditions, the biodiesel blend having 150 ppm of titanium dioxide is tested at fuel injection pressure of 220 bar. The findings suggests that the brake thermal efficiency improves and emissions lowers with the addition of nano particles at high fuel injection pressure. The maximum improvement of brake thermal efficiency of 1.01% in comparison to diesel mode has been found for nano blended biodiesel composition of 150 ppm of titanium dioxide at fuel injection pressure of 220 bar under full loading condition. For the same fuel injection pressure of 220 bar and same nano blended biodiesel composition, the hydrocarbon and carbon monoxide emission were found to minimum at 60% load.

Abstract Background Home blood pressure measurements have equal or even greater predictive value than clinic blood pressure measurements regarding cardiovascular outcomes. With advances in home blood pressure monitors, we face an imminent flood of home measurements, but current electronic health record systems lack the functionality to allow us to use this data to its fullest. We designed a data visualization display for blood pressure measurements to be used for shared decision making around hypertension. Methods We used an iterative, rapid-prototyping, user-centred design approach to determine the most appropriate designs for this data display. We relied on visual cognition and human factors principles when designing our display. Feedback was provided by expert members of our multidisciplinary research team and through a series of end-user focus groups, comprised of either hypertensive patients or their healthcare providers required from eight academic, community-based practices in the Midwest of the United States. Results A total of 40 participants were recruited to participate in patient (N = 16) and provider (N = 24) focus groups. We describe the conceptualization and development of data display for shared decision making around hypertension. We designed and received feedback from both patients and healthcare providers on a number of design elements that were reported to be helpful in understanding blood pressure measurements. Conclusions We developed a data display for substantial amounts of blood pressure measurements that is both simple to understand for patients, but powerful enough to inform clinical decision making. The display used a line graph format for ease of understanding, a LOWESS function for smoothing data to reduce the weight users placed on outlier measurements, colored goal range bands to allow users to quickly determine if measurements were in range, a medication timeline to help link recorded blood pressure measurements with the medications a patient was taking. A data display such as this, specifically designed to encourage shared decision making between hypertensive patients and their healthcare providers, could help us overcome the clinical inertia that often results in a lack of treatment intensification, leading to better care for the 35 million Americans with uncontrolled hypertension.

Lateral flow assay (LFA) is emerging as one of the most popular paper-based biosensors in the field of the diagnostic industry. LFA fills all the gaps between diagnosis and treatment as it provides beneficial qualities to users such as quick response, Point-of-care appeal, early detection, low cost, and effective and sensitive detections of various infectious diseases. These benefits increase LFA’s dependability for disease management because rapid and accurate disease diagnosis is a prerequisite for effective medication. Only 2% of overall healthcare expenditures, according to Roche Molecular Diagnostics, are spent on in vitro diagnostics, even though 60% of treatment choices are based on this data. To make LFA more innovative, futuristic plans have been outlined in many reports. Thus, this review reports on very knowledgeable literature discussing LFA and its development along with recent futuristic plans for LFA-based biosensors that cover all the novel features of the improvement of LFA. LFA might therefore pose a very significant economic success and have a significant influence on medical diagnosis.

Immunotherapy using monoclonal antibodies targeting the PD-1/PD-L1 interaction has shown enormous success for various cancers. Despite their encouraging results in clinics, antibody-based checkpoint inhibitors have several limitations, such as poor tumor penetration. To address these limitations of monoclonal antibodies, there is a growing interest in developing low-molecular-weight checkpoint inhibitors, such as antibody fragments. Several antibody fragments targeting PD-1/PD-L1 were recently discovered using phage libraries from camel or alpaca. However, animal-derived antibody fragments may elicit unwanted immune responses, which limit their therapeutic applications. For the first time, we used a human domain antibody phage library and discovered anti-human PD-L1 human single-domain antibodies (dAbs) that block the PD-1/PD-L1 interaction. Among them, the CLV3 dAb shows the highest affinity to PD-L1. The CLV3 dAb also exhibits the highest blocking efficacy of the PD-1/PD-L1 interaction. Moreover, the CLV3 dAb significantly inhibits tumor growth in mice implanted with CT26 colon carcinoma cells. These results suggest that CLV3 dAb can be potentially used as an anti-PD-L1 inhibitor for cancer immunotherapy.

Abstract Background Nearly half of US adults with diagnosed hypertension have uncontrolled blood pressure. Clinical inertia may contribute, including patient-physician uncertainty about how variability in blood pressures impacts overall control. Better information display may support clinician-patient hypertension decision making through reduced cognitive load and improved situational awareness. Methods A multidisciplinary team employed iterative user-centered design to create a blood pressure visualization EHR prototype that included patient-generated blood pressure data. An attitude and behavior survey and 10 focus groups with patients (N = 16) and physicians (N = 24) guided iterative design and confirmation phases. Thematic analysis of qualitative data yielded insights into patient and physician needs for hypertension management. Results Most patients indicated measuring home blood pressure, only half share data with physicians. When receiving home blood pressure data, 88% of physicians indicated entering gestalt averages as text into clinical notes. Qualitative findings suggest that including a data visualization that included home blood pressures brought this valued data into physician workflow and decision-making processes. Data visualization helps both patients and physicians to have a fuller understanding of the blood pressure ‘story’ and ultimately promotes the activated engaged patient and prepared proactive physician central to the Chronic Care Model. Both patients and physicians expressed concerns about workflow for entering and using home blood pressure data for clinical care. Conclusions Our user-centered design process with physicians and patients produced a well-received blood pressure visualization prototype that includes home blood pressures and addresses patient-physician information needs. Next steps include evaluating a recent EHR visualization implementation, designing annotation functions aligned with users’ needs, and addressing additional stakeholders’ needs (nurses, care managers, caregivers). This significant innovation has potential to improve quality of care for hypertension through better patient-physician understanding of control and goals. It also has the potential to enable remote monitoring of patient blood pressure, a newly reimbursed activity, and is a strong addition to telehealth efforts.

Explanations for police misconduct often center on a narrow notion of "problem officers," the proverbial "bad apples." Such an individualistic approach not only ignores the larger systemic problems of policing but also takes for granted the group-based nature of police work. Nearly all of police work is group-based and officers' formal and informal networks can impact behavior, including misconduct. In extreme cases, groups of officers (what we refer to as, "crews") have even been observed to coordinate their abusive and even criminal behaviors. This study adopts a social network and machine learning approach to empirically investigate the presence and impact of officer crews engaging in alleged misconduct in a major U.S. city: Chicago, IL. Using data on Chicago police officers between 1971 and 2018, we identify potential crews and analyze their impact on alleged misconduct and violence. Results detected approximately 160 possible crews, comprised of less than 4% of all Chicago police officers. Officers in these crews were involved in an outsized amount of alleged and actual misconduct, accounting for approximately 25% of all use of force complaints, city payouts for civil and criminal litigations, and police-involved shootings. The detected crews also contributed to racial disparities in arrests and civilian complaints, generating nearly 18% of all complaints filed by Black Chicagoans and 14% of complaints filed by Hispanic Chicagoans.

Abstract Background Immunotherapy using checkpoint inhibitors, especially PD-1/PD-L1 inhibitors, has now evolved into the most promising therapy for cancer patients. However, most of these inhibitors are monoclonal antibodies, and their large size may limit their tumor penetration, leading to suboptimal efficacy. As a result, there has been a growing interest in developing low-molecular-weight checkpoint inhibitors. Methods We developed a novel biopanning strategy to discover small peptide-based anti-PD-L1 inhibitors. The affinity and specificity of the peptides to PD-L1 were examined using various assays. Three-dimensional (3D) spheroid penetration study was performed to determine the tumor penetration capability of the peptides. Anti-tumor activity of the peptides was evaluated in mice bearing CT26 tumor cells. Results We discover several anti-PD-L1 peptide inhibitors to block PD-1/PD-L1 interaction. The peptides exhibit high affinity and specificity to human PD-L1 protein as well as PD-L1-overexpressing human cancer cells MDA-MB-231 and DU-145. Molecular docking studies indicate that the peptide CLP002 specifically binds to PD-L1 at the residues where PD-L1 interacts with PD-1. The peptide also blocks the CD80/PD-L1 interaction, which may further enhance the immune response of tumor-infiltrating T cells. Compared to antibody, the peptide CLP002 exhibits better tumor penetration in a 3D tumor spheroid model. The peptide CLP002 restores proliferation and prevents apoptosis of T cells that are co-cultured with cancer cells. The peptide CLP002 also inhibits tumor growth and increases survival of CT26 tumor-bearing mice. Conclusions This study demonstrated the feasibility of using phage display to discover small peptide-based checkpoint inhibitors. Our results also suggested that the anti-PD-L1 peptide represents a promising low-molecular-weight checkpoint inhibitor for cancer immunotherapy.

Future wireless networks are expected to be ultra-dense and heterogeneous not just in terms of the number and type of base stations but also in terms of the number of users and the application types they access. Such a network architecture will require mobility management mechanisms that adapt rapidly to these highly dynamic network characteristics. In particular, the optimality of the handover signaling within these future network architectures will be extremely critical given their density and heterogeneity. In this paper, the optimality is relevant for both the total amount of signaling created and the total delay per handover process. In this paper, we first present a novel and optimized message mapping and signaling mechanism for the handover preparation and failure phases. We also develop a novel handover failure aware preparation signaling methodology, which accounts for the possibility of a handover failure and grants additional enhancements to the handover preparation and failure signaling phases. Through the analytical framework provided in this paper, we conduct studies to quantify the performance gains promised by the proposed mechanisms. These studies cover myriad handover scenarios as identified by 3GPP and use the statistics from cellular network operators and vendors. We then develop the idea and analytical framework for network wide analysis, in which the network wide processing cost and network occupation time for various handover failure rates are computed. Finally, we propose an evolutionary network architecture that facilitates the proposed signaling mechanism as well as assists operators in maintaining a manageable capital expenditure. It combines the current day and 3GPP proposed 5G network architecture with the software-defined networking approach. As a result, we argue that the proposed mechanisms are viable and outperform the legacy handover signaling mechanisms in terms of latency incurred, total network occupation time, number of messages generated, and total bytes transferred.

Additive Manufacturing (AM) is a novel manufacturing method where a component is fabricated by accumulating material layer-by-layer therefore facilitating customized near-net-shape components while maximizing design freedom. A metal AM technology suited for large-scale component fabrication that has been emerging in recent years and is commonly referred to as Wire and Arc AM (WAAM) uses Gas Metal Arc Welding (GMAW) technology to deposit material and large-scale robotic serial manipulator systems (reach >1 m cubed). One of the requirements for applying GMAW welding technology to AM is to identify and optimize deposition parameters in order to achieve a desired deposition quality measured in terms of geometrical, mechanical and metallurgical consistency. In this work, deposition process parameters qualitatively and quantitatively influencing the geometrical, mechanical and metallurgical consistency are identified and statistically validated. A deposition parameter combination is found that optimizes the quality of single-track wall benchmark components made from low-carbon steel. Moreover, correlations are found between accumulated heat during fabrication and the geometrical variations of the benchmark components due to bead slumping. Additionally, correlations between microstructure variations and geometrical variations are found. Finally, based on the presented analyses, in-situ temperature monitoring methods are proposed in order to achieve optimal component quality.

Cysticercosis cellulosa cutis is caused by larval stage of Taenia solium. It most commonly affects central nervous system, muscle, and subcutaneous tissue. Here, we report a case of 70-year-old female who was misdiagnosed on ultrasound as abscess and was treated with no improvement. Later, she was diagnosed on FNAC as cutaneous cysticercosis. Hence, we report this case because of its uncommon clinical presentation and diagnostic difficulty.

Study DesignRetrospective analysis.PurposeTo compare results of laminectomy in multisegmental compressive cervical myelopathy (CSM) with lordosis versus segmental kyphosis.Overview of LiteratureLaminectomy is an established procedure for decompression in CSM with cervical lordosis. However in patients with segmental kyphosis, it is associated with risk of progression of kyphosis and poor outcome. Whether this loss of sagittal alignment affects functional outcome is not clear.MethodsWe retrospectively reviewed 68 patients who underwent laminectomy for CSM from 1998 to 2009. As per preoperative magnetic resonance images, 36 patients had preoperative lordosis (Group 1) and 32 had segmental kyphosis (Group 2). We studied age at the time of surgery, duration of preoperative symptoms, recovery rate, magnitude of postoperative backward shifting of spinal cord and loss of sagittal alignment.ResultsMean follow up was 5.05 years (range, 2–13 years) and mean age at the time of surgery 61.88 years. Group 1 had 20 men and 16 women and Group 2 had 19 men and 13 women. Mean recovery rate in Group 1 was 60.32%, in Group 2 was 63.7% without any statistical difference (p-value 0.21, one tailed analysis of variance). Two patients of Group 1 had loss of cervical lordosis by five degrees. In Group 2 seven patients had progression of segmental kyphosis by 5–10 degrees and two patients by more than 10 degrees. Mean cord shift was more in Group 1 (mean, 2.41 mm) as compared to Group 2 (mean, –1.97 mm) but it had no correlation to recovery rate. Patients with younger age (mean, 57 years) and less duration of preoperative symptoms (mean, 4.86 years) had better recovery rate (75%).ConclusionsClinical outcome in CSM is not related to preoperative cervical spine alignment. Thus, lordosis is not mandatory for planning laminectomy in CSM. Good outcome is expected in younger patients operated earliest after onset of symptoms.

Study DesignRetrospective analysis.PurposeWe evaluated the functional, neurological, and radiological outcome in patients with thoracic and thoracolumbar tuberculosis operated through the transpedicular approach.Overview of LiteratureFor surgical treatment of thoracic and thoracolumbar tuberculosis, the anterior approach has been the most popular because it allows direct access to the infected tissue, thereby providing good decompression. However, anterior fixation is not strong, and graft failure and loss of correction are frequent complications. The transpedicular approach allows circumferential decompression of neural elements along with three-column fixation attained via pedicle screws by the same approach.MethodsA total of 47 patients were diagnosed with tuberculosis of the thoracic or thoracolumbar region from August 2012 to August 2013. Of these, 28 patients had progressive neurological deterioration or increasing back pain despite conservative measures and underwent transpedicular decompression and pedicle screw fixation with posterior fusion. Antituberculosis therapy was given till signs of radiological healing were evident (9–16 months). Functional outcome (visual analog scale [VAS] score for back pain), neurological recovery (Frankel grading), and radiological improvement were evaluated preoperatively, immediate postoperatively, and at 3 months, 6 months, and 1 year.ResultsMean VAS score for back pain improved from 8.7 preoperatively to 1.1 at 1 year follow-up. Frankel grading preoperatively was grade B in 7, grade C in 11, and Grade D in 10 patients, which improved to grade D in 6 and grade E in 22 patients at the last follow-up. Radiological healing was evident in the form of reappearance of trabeculae formation, resolution of pus, fatty marrow replacement, and bony fusion in all patients. Mean correction of segmental kyphosis postoperatively was 10.5°. Mean loss of correction at final follow-up was 4.1°.ConclusionsTranspedicular decompression with instrumented fusion is a safe and effective approach for management of patients with thoracic and thoracolumbar tuberculosis.

Patchouli oil is a high‐value essential oil used in cosmetic, food, and pharmaceutical industries. In this work, supercritical fluid extraction of patchouli oil with various operating process parameters (pressure, temperature, flow rate, and particle size) were studied and the results were modeled using the broken and intact cell model (BICM). From the experimental studies, it was found that the extraction rate was improved at higher pressures and flow rates, where the mass transfer resistances in the liquid and solid phase were decreased; however, the increase in temperature had an inverse effect on extraction rate and mass transfer. In the case of particle size, a moderate size of 0.3 to 0.6 mm gave the optimal extraction rate. The BICM predictions showed good agreements with experimental data and gave valuable insights regarding the mass transfer mechanism of the extraction process, including mass transfer coefficients and extraction periods governed by convection and diffusion.

As the current standardization for the 5G networks nears completion, work towards understanding the potential technologies for the 6G wireless networks is already underway. One of these potential technologies for the 6G networks is reconfigurable intelligent surfaces. They offer unprecedented degrees of freedom towards engineering the wireless channel, i.e., the ability to modify the characteristics of the channel whenever and however required. Nevertheless, such properties demand that the response of the associated metasurface is well understood under all possible operational conditions. While an understanding of the radiation pattern characteristics can be obtained through either analytical models or full-wave simulations, they suffer from inaccuracy and extremely high computational complexity, respectively. Hence, in this paper, we propose a neural network-based approach that enables a fast and accurate characterization of the metasurface response. We analyze multiple scenarios and demonstrate the capabilities and utility of the proposed methodology. Concretely, we show that this method can learn and predict the parameters governing the reflected wave radiation pattern with an accuracy of a full-wave simulation (98.8–99.8%) and the time and computational complexity of an analytical model. The aforementioned result and methodology will be of specific importance for the design, fault tolerance, and maintenance of the thousands of reconfigurable intelligent surfaces that will be deployed in the 6G network environment.

Background: Warts (verruca) are caused by human papilloma virus (HPV), which is known to affect the skin and mucosae. Over two hundred strains of HPV have been identified to date, among which few strains cause cutaneous lesions. Various treatment modalities have been elucidated in treating verruca lesions, yet the best therapeutic option is yet to be determined. Objectives: To evaluate the efficacy and safety of topical 50% hydrogen peroxide (H2O2), 100% trichloroacetic acid (TCA), and 5% 5-fluorouracil (5-FU) as a topical application in the treatment of warts. Methods: This was a prospective, interventional, clinical trial that included sixty patients with warts randomly allotted into three groups. Group A and group B were treated every week with topical 50% H2O2 and 100% TCA, respectively, and group C with 5% 5-FU under tape occlusion twice a day. The treatment was executed for a maximum period of eight weeks. The patients were evaluated with the Physician Wart Assessment (PWA) every two weeks of treatment and at three months after treatment completion. Results: At the end of the eight weeks of treatment, 13 patients (65%) in the H2 O2 group, 11 patients (55%) in the TCA group, and 8 patients (40%) in the 5% 5-FU group displayed complete clearance of warts (PWA grade 0). In our study, side effects were significantly higher in the TCA group (70%) and in the 5% 5-FU group (60%), notably lower in the H2O2 group (30%) (p = 0.011). The most frequent side effect was irritation (25%), which was reported in all groups. No relapse was encountered at three months of treatment completion. Conclusion: According to our study, H2 O2 and TCA have the advantage of earlier action over 5% 5-FU. However, H2O2 remarkably stands as a safer therapeutic option concerning the clearance of lesions, patient tolerability, and side effects. [ABSTRACT FROM AUTHOR]

Objective To study and document the epidemiological data, various morphological expressions, and causative medications for tinea incognito, to identify the causative agent, and also to evaluate the laboratory methods' efficacy in substantiating the diagnosis clinically. Methods It was conducted over a period of two years with a sample size of hundred cases of tinea incognito who had used topical or systemic steroids, topical immunosuppressants, and other indigenous preparations for a period of at least four weeks. Skin scrapings from the patients were examined for fungal elements under KOH mount, and fungal cultures were performed for species identification, and the derived results were analyzed. Patients at the end of three weeks and six weeks were re-assessed. Results In our study, clinical presentation mimicked various dermatoses, of which eczematous like was the most common type, followed by psoriasiform. KOH was positive among 69% of the patients, and positivity for fungal culture was seen in 48%, out of which Trichophyton mentagrophytes constituted 56.25% of the cases, followed by Trichophyton rubrum (25%). Conclusion Although this entity has been known for years, it still causes perplexity in diagnosis and treatment. Health education in order to create public awareness about dermatophytosis is indeed the need of the hour. [ABSTRACT FROM AUTHOR]

Objective To evaluate the effectiveness of intralesional Bacille Calmette Guerin (BCG) immunotherapy in the treatment of warts in immunocompetent patients. Methods In our study, the sample size included 30 patients with multiple, recalcitrant, and recurrent warts. After taking informed consent, the patients were injected intralesionally with 0.1 ml BCG vaccine into the oldest wart at an interval of 3 weeks for a maximum of three sessions. Patients were evaluated every three weeks for a response, side effects and were followed up to 6 months for recurrences. For assessment of response, the grading scale was used. Results In our study, out of 30 patients, a good response was seen in 80%, while a partial response in 6.7%, and poor response in 13.3% of patients, and no recurrence was seen in 80% of patients in a follow-up of 6 months. In our study, 90% of patients had pain, 70% flu-like symptoms, 6.7% abscess, 6.7% ulceration, and 10% no adverse effects. Conclusion Intralesional BCG immunotherapy is a promising, simple, safe, and cost-effective modality for multiple, recalcitrant, and recurrent warts. [ABSTRACT FROM AUTHOR]

Background Seborrheic keratosis (SK) is a common benign skin lesion, ranging from light tan to dark brown. Common techniques for SKs removal involve cryosurgery, electrosurgery, curettage, surgical excision, and chemicals like TCA. Recently FDA has approved hydrogen peroxide 40% for the treatment of SKs. However, there is a lack of clinical studies evaluating the efficacy and complication rates of these procedures, so we have taken up the study. Aims and Objectives To study and compare the effectiveness of 40% hydrogen peroxide (HP) and 50% trichloroacetic acid (TCA) in the treatment of seborrheic keratoses. Methods The study was conducted in our department of Dermatology at Dr. PSIMS & RF for a period of 6 months from March to August 2019. The sample size included 40 patients, and after taking informed consent, the study population was divided into two groups by systematic random sampling. One group was treated with 40% H2O2, and the other group with 50% TCA. After the first session, SKs with a Physician's Lesion Assessment (PLA) scale higher than 0 were treated for a maximum of three sessions at two weeks interval and followed up for one month after the last session. Results After completion of all sessions, patients treated with hydrogen peroxide achieved a PLA scale of 0 (total clearance) in 45%, whereas in TCA, it was 25%, with significant p-value (<0.0001). Conclusion Thus 40% H2O2 provides a novel, standardized, easily available, and non-invasive, method to treat SKs that is convenient to patients when compared to 50% TCA. [ABSTRACT FROM AUTHOR]

Aims and Objective To study the size, echotexture, morphologic alteration and vascularity of peripheral nerves in patients with leprosy by HRUS. Material and Methods The study was conducted in the departments of Dermatology and Radiology at Dr. PSIMS & RF over a period of 6 months from March 2018 to August 2018. Sample size included 30 clinically diagnosed cases of Hansen's disease as per Ridley-Jopling classification and these patients were subjected to HRUS and CD to study the nerve involvement. Results Of the 30 leprosy patients scanned all of them had morphological alterations like increased focal hypoechoic areas, loss of fascicular architecture, thickened epineurium and 3 cases with clinical evidence of reaction showed increased endoneural vascularity. Conclusion HRUS is a noninvasive, cost effective tool that gives significant information on nerve structure, morphology and vascularity in the nerve and this adds a new dimension in diagnosing leprosy particularly pure neuritic type and assessment of nerve damage which can prevent disabilities. [ABSTRACT FROM AUTHOR]

Trichoscopy is a non-invasive scalp and hair dermoscopy. In our daily dermatology practice, many eponyms are used. The present article highlights various eponyms in trichoscopy described in dermatology.