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Background: In thoracic lesions, early diagnosis and sorting out into malignant- benign is important regarding the therapeutic decisions and prognosis. Ultrasound guided Transthoracic needle aspiration (TTNA) and Corebiopsy (CNB) are described to be safe accurate high yielding means of diagnosis. The study aims to determine the yield and safety of TTNA in peripheral intrathoracic mass lesions. Materials and Methods: Study was conducted in government teaching institution in Kerala. Patients with intrathoracic peripheral mass lesions which were visualized by USG were subjected to TTNA, and sent for cytopathology. The patients with inconclusive results were subjected to either USG guided or CT guided CNB. The patients were followed up till a conclusive diagnosis obtained. The results were classified as conclusive /definitive or inconclusive. Diagnostic yield and complication rate calculated. Results: USG guided TTNA had an overall diagnostic yield of 65.5%,with 72.15% yield in malignancy. It had high diagnostic yield in lung carcinoma (82.3%) and was a safe procedure with complication rate of 3% only. Combined with USG guided CNB, the overall yield became 86.66% with a cumulative yield of 91.13% in malignancy with no increase in complication rate. Conclusions: Ultrasound guided TTNA is a safe procedure with good yield in peripheral lung malignancies. Ultrasound guided transthoracic needle aspiration and core cut together has a high diagnostic yield in peripheral intrathoracic masses and is accurate in differentiating malignant and benign lesion with a good safety profile. Keywords: Core-needle Biopsy (CNB), Computed tomography ((CT), Transthoracic needle aspiration (TTNA)), Ultrasound (USG).

Demand response modelling have paved an important role in smart grid at a greater perspective. DR analysis exhibits the analysis of scheduling of appliances for an optimal strategy at the user’s side with an effective pricing scheme. In this proposed work, the entire model is done in three different steps. The first step develops strategy patterns for the users considering integration of renewable energy and effective demand response analysis is done. The second step in the process exhibits the learning process of the consumers using Robust Adversarial Reinforcement Learning for privacy process among the users. The third step develops optimal strategy plan for the users for maintaining privacy among the users. Considering the uncertainties of the user’s behavioral patterns, typical pricing schemes are involved with integration of renewable energy at the user’ side so that an optimal strategy is obtained. The optimal strategy for scheduling the appliances solving privacy issues and considering renewable energy at user’ side is done using Robust Adversarial Reinforcement learning and Gradient Based Nikaido-Isoda Function which gives an optimal accuracy. The results of the proposed work exhibit optimal strategy plan for the users developing proper learning paradigm. The effectiveness of the proposed work with mathematical modelling are validated using real time data and shows the demand response strategy plan with proper learning access model. The results obtained among the set of strategy develops 80 % of the patterns created with the learning paradigm moves with optimal DR scheduling patterns. This work embarks the best learning DR pattern created for the future set of consumers following the strategy so privacy among the users can be maintained effectively.

State of health (SOH) and remaining useful life (RUL) are two major key parameters which plays a major role in battery management system. In recent years, various machine learning approaches have been proposed to estimate SOH and RUL effectively for establishing the battery conditions. In the proposed work establishes an effective method to predict the battery aging process with accurate battery health estimation with real time simulations and hardware approach. This paper effectively exhibits a process to estimate SOH and RUL of a Li-Ion 18650 cell which are based on various factors like state of charge, discharge voltage transfers characteristics, internal resistance and capacity. To identify an optimal SOH and RUL machine learning based estimation approach, various battery’s statistical models are developed and implemented on a standalone hardware platform. The experimental results in this real time application shows that SOH is predicted by deep neural network approach which are found to be within the accepted error rate of ±5% and long short time memory neural network model estimates a battery’s RUL effectively with an accuracy of ±10 cycles. This approach exhibits various machine learning models in an realistic hardware platform which establishes optimal battery life.

Background/Objective: The Coronavirus Covid-19 has affected almost all the countries and millions of people got infected and more deaths have been reported everywhere. The uncertainty and fear created by the pandemic can be used by hackers to steal the data from both private and public systems. Hence, there is an urgent need to improve the security of the systems. This can be done only by building a strong cryptosystem. So many researchers started embedding different topics of mathematics like algebra, number theory, and so on in cryptography to keep the system, safe and secure. In this study, a cryptosystem using graph theory has been attempted, to strengthen the security of the system. Method: A new graph is constructed from the given graph, known as a double vertex graph. The edge labeling of this double vertex graph is used in encryption and decryption. Findings: A new cryptosystem using the amalgamation of the path, its double vertex graph and edge labeling has been proposed. From the double vertex graph of a path, we have given a method to find the original path. To hack such an encrypted key, the knowledge of graph theory is important, which makes the system stronger. Applications:The one-word encryption method will be useful in every security system that needs a password for secure communication or storage or authentication. Keywords: Double vertex graphs; path; adjacency matrix; encryption; cryptography

Studies on the clinical profile of urothelial bladder cancer (UBC) have shown significant gender differences, namely, higher occurrence in males (male-to-female ratio of 3.5:1) and an advanced stage of disease at the time of diagnosis with rapid progression of the disease after initial diagnosis seen more commonly in females. The relationship between gender and UBC is complex and probably influenced by biological and epidemiological factors. Potential contributory factors such as sex steroid hormone pathway, gender difference in environmental carcinogen exposure, metabolic enzyme activity, and disparities in the intensity of diagnostic evaluation could probably explain the demographic trends in UBC. This comprehensive review of Medline publications during the period 2009-2019 attempts to identify the possible role of sex hormone receptors in gender variation and sexual dimorphism in the occurrence and progression of UBC. The clinical implications of identifying sex steroid receptors on factors such as disease prognostication and the therapeutic role of anti-androgens in the prevention and progression of UBC are critically reviewed. There is now significant evidence in literature to suggest the possible role of sex steroid hormone receptor-mediated signals in the genesis and progression of UBC. These receptors include androgen receptors, estrogen receptors, progesterone receptors, and various other orphan receptors. Excessive or reduced expression of these receptors, as well as alterations in their upstream or downstream pathways, correlate well with the clinical and therapeutic outcomes of UBC.

Purpose: To compare the visual field (VF) parameters of the new Swedish Interactive Thresholding Algorithm (SITA), SITA Faster (SFR) with that of SITA Standard (SS) on the Humphrey Field Analyzer. Methods: Ninety-seven eyes of 97 subjects (63 glaucoma, 26 glaucoma suspects, and 8 normal eyes) underwent VF examination with SFR and SS strategies on the same day in random order. Agreement in VF parameters between SFR and SS strategies was assessed by Bland and Altman plots. In addition, some subjects underwent a second VF examination with SFR strategy to evaluate its test-retest variability. Results: The median test duration of SS strategy was 6 minutes 14 seconds, whereas SFR was 2 minutes 49 seconds (55% shorter, P

Mesenchymal stem cells (MSCs) are multipotent adult stem cells widely distributed in the bone marrow, umbilical cord, fat, and other tissues and have high proliferation, multi-differentiation, and immunoregulatory abilities. They can inhibit the proliferation of immune cells and the secretion of inammatory factors [26]. Compared with MSCs from other sources, human umbilical cord MSCs (hUCMSCs) have many advantages, such as a wide source, easy access to materials, strong proliferation ability, low immunogenicity, and great differentiation potential. They are most likely to become pluripotent stem cells with clinical application prospects. Wharton's jelly mesenchymal stem cells – WJMSC- provide three classic advantages – ease of collection with no legal or ethical issues, high differentiating potential and low immunogenicity. Shorter doubling time (21) and an extensive ex vivo expansion capacity provides yet another privileged status to these cells compared with embryonic stem cells. Therapeutic potential of these cells lie in their immuno-modulatory properties involving both innate and adaptive immunity. Graft vs Host disease (GvHD), Post transplant scenarios and autoimmune disorders could witness a revolution in treatment approach with greater understanding of the mechanism action of these cells. Regenerative medicine should get an immense benet from proper understanding and utilization of these cells.

The main purpose of this study was to compare the prevalence of choroidal microvascular dropout (CMvD) in primary open-angle glaucoma (POAG) eyes with and without disc hemorrhage (DH).In a cross-sectional study, 44 eyes of 44 control subjects, 32 eyes of 32 POAG patients with DH, and 41 eyes of 41 POAG patients without DH underwent visual fields (VFs), optical coherence tomography (OCT) and OCT angiography (OCTA). Presence of CMvD was evaluated on the choroidal OCTA slab. VF defect in the glaucoma eyes were classified into initial nasal defect, initial parafoveal scotoma, and combined nasal and parafoveal defect.CMvD was detected in 17 POAG eyes with DH (53.1%) and 13 POAG eyes without DH (31.7%; P=0.06). On univariate analysis, CMvD in POAG eyes was associated with DH [odds ratio (OR): 2.44, P=0.06] and measures of glaucoma severity: VF mean deviation (OR: 0.85, P=0.02), retinal nerve fiber layer thickness (OR: 0.95, P=0.03), and peripapillary vessel density (OR: 0.94, P=0.09). On multivariate models that accounted for the measures of glaucoma severity, CMvD in POAG eyes was statistically significantly associated with DH (OR≥3, P0.05). CMvD was more frequently seen in eyes with initial parafoveal scotoma than initial nasal defect both in POAG eyes with DH (P=0.06) and POAG eyes without DH (P0.001).Prevalence of CMvD was significantly greater in POAG eyes with DH compared with POAG eyes without DH. CMvD in POAG eyes was also significantly associated with central VF defects and greater severity of glaucomatous damage.

PURPOSE: To determine the prevalence and factors associated with the presence of choroidal microvascular dropout (CMvD) in primary angle-closure glaucoma (PACG) eyes compared to primary open-angle glaucoma (POAG) eyes.DESIGN: Cross-sectional study.METHODS: Thirty-six POAG eyes (36 patients) and 28 PACG eyes (28 patients) underwent optical coherence tomography angiography (OCTA). Presence of CMvD was evaluated on choroidal OCTA slabs. Visual field (VF) defects in the glaucoma eyes were classified into initial nasal defect (IND), initial parafoveal scotoma (IPFS), and combined nasal and parafoveal defect, and the association between type of VF defect and CMvD was evaluated.RESULTS: CMvD was detected in 21 POAG (58.3%) and 10 PACG (35.7%) eyes (P = .07). CMvD in POAG eyes was associated with pretreatment intraocular pressure (odds ratio [OR] = 0.91/mm Hg higher intraocular pressure, P = .06), VF mean deviation (MD, OR = 0.75/dB higher MD, P = .007), retinal nerve fiber layer thickness (OR = 0.92/mu m increase in thickness, P = .02), and peripapillary vessel density (OR = 0.80/ unit increase in density, P = .01). CMvD in PACG eyes was associated only with VF MD (OR = 0.90/dB higher MD, P = .05). When analyzed in the entire cohort of glaucoma patients (64 eyes), CMvD was significantly associated with POAG (OR > 3.5, P CONCLUSIONS: Prevalence of CMvD was significantly lower in PACG compared to POAG. As in POAG, CMvD in PACG was associated with advanced VF damage and with IPFS on VF. (C) 2018 Elsevier Inc. All rights reserved.

Among the renewable energy applications, the most popular inverters are cascaded multilevel inverters. Irrespective of numerous benefits these inverters face reliability issues due to the presence of more circuit components in the design. This has been a critical challenge for researchers in designing inverters with enhanced reliability by reducing the total harmonic distortion (THD). This paper proposes a 31-level asymmetric cascaded multilevel inverter for renewable energy applications. The proposed topology produces waveforms consisting of the staircase with a high number of output levels with lesser components with low THD. The investigations on the feasibility and performance of MLI under steady-state, transient, and dynamic load disturbances. The results are validated from a 1.6kW system which provides the proposed inverter.

Introduction:Cognitive dysfunction is one of the important systemic effect of Chronic Obstructive Pulmonary Disease that affects various cognitive domains in these patients. Aim: Assessment of cognitive function in specific cognitive domains in COPD with various stages of severity as observed by airflow obstruction. Methods:N=68 COPD patients and N=20 controls were matched for age and education. EEG changes, SpO2 and rSO2 were compared between COPD and control group. Cognitive scores and EEG wave patterncompared among different stages of severity in COPD group. Statistical analysis:Was done using SPSS version 18. Two independent t test was used for bivariate testing between COPD and control group. Chi square test applied to assess the frequency distribution of variables among each group. One way analysis of variance (ANOVA) was used to compare mean values of cognitive scores and Chi square test for number(%) of patients with abnormal scores in cognition and slow waves in EEG across groups with different severity of airflow obstruction (FEV1% Predicted). ResultsOncomparison of EEG slow wave, (rSO2) and (SpO2) among COPD and age matched control group, electroencephalographic(EEG) study in COPD group showed slower wave pattern than their age matched healthy counterpart which was statistically significant at p Conclusions:We found relative frontal hypoxemia and EEG slow wave in COPD group compared to healthy control. With severegrades of disease risk of cognitive impairment was noted. Thus, suggesting that low lung functioning may contribute to cognitive disorders by decreasing the oxygen delivery to brain neurons.&nbsp

PURPOSE: To identify longitudinal changes in peripapillary and parafoveal vessel density (VD) measured by OCT angiography (OCTA) in primary open-angle glaucoma (POAG) eyes with disc hemorrhages (DHs).DESIGN: Prospective cohort study conducted from August 2016 through August 2020 PARTICIPANTS: Eighteen Asian-Indian participants with POAG (18 eyes) who sought treatment at the clinic with a single DH in the peripapillary region were recruited consecutively.METHODS: The study was conducted at a tertiary eye care center. All participants who were recruited underwent a baseline OCT and OCTA, which were repeated every 4 to 6 months.MAIN OUTCOME MEASURES: Peripapillary VD and retinal nerve fiber layer (RNFL) thickness, parafoveal VD and ganglion cell-inner plexiform layer (GCIPL) thickness in the DH sector, and the corresponding mirror-image sector across the horizontal meridian (control) were evaluated over time using linear mixed-effects models.RESULTS: The baseline average RNFL thickness was 79 ± 9 μm. Mean duration of follow-up was 2.6 ± 0.7 years. In the DH sector, all VD and structural parameters showed a significant negative slope (P < 0.01). In the control sector, the slopes of the structural parameters (RNFL and GCIPL thickness) were not significant (P > 0.05), but the rate of change of the peripapillary and parafoveal VDs were significant (P < 0.01). The rate of change of peripapillary VD was greater in the DH sector compared with the non-DH sector (-2.86 ± 0.6%/year vs. -1.71 ± 0.7%/year; P < 0.01). However, the parafoveal VD slopes did not differ significantly between DH and control sectors (-2.9 ± 0.17%/year vs. -2.8 ± 0.8%/year; P = 0.51).CONCLUSIONS: Eyes with POAG harboring a DH showed not only progressive RNFL and GCIPL loss in the DH sector, but also progressive peripapillary and parafoveal VD reduction in the DH and non-DH regions as documented on OCTA.

Wide band gap semiconductors such as TiO2, ZnO, and SnO2 etc., have attracted considerable research interest for their possible applications in emerging areas like Spintronics, photovoltaic and photocatalytic devices . Most important feature of doping is to achieve the room temperature ferromagnetism without altering the host semiconducting nature. SnO2 is one of the wide band gap semiconductor with rutile structure widely used in solar cells, transparent electrodes, gas sensors, LED, touch sensitive screens and transistors . Theoretical study was carried out in Mn doped rutile SnO2 using recently implemented Tran and Blaha's modified Becke-Johnson exchange potential model (TB-mBJ). The routine density functional theory calculations based on local density approximation (LDA) and generalized gradient approximation (GGA) underestimated the band gap of strongly correlated systems whereas TBmBJ exchange potential model was found to predict band structures and properties accurately.

Purpose To determine if the presence of disc hemorrhage (DH) causes any artifactual change in peripapillary vessel density (VD) and retinal nerve fiber layer (RNFL) thickness as measured by OCT. Design Cohort study. Participants Glaucoma patients having a single peripapillary DH. Methods Fifteen glaucoma patients having a single peripapillary DH underwent OCT and OCT angiography. Patients were reviewed every 2 months and scans were repeated on disappearance of the DH. Peripapillary VD and RNFL thickness were evaluated at these 2 time points in the DH sector to determine whether the presence of a DH affects these measurements. The mirror-image sector (e.g., superotemporal sector if DH is inferotemporal) was used as a control. Statistical analysis was carried out using the paired t test. Additionally, the analysis of covariance test was used to determine if there was any difference in the measurements between the visits after controlling for signal strength index (SSI). Main Outcome Measures Peripapillary VD and RNFL thickness were measured in the presence of a DH, and then after DH resolution. Results The mean ± standard deviation (SD) interval between scans was 4.0±0.4 months. The inferotemporal sector was the most common site of DH (66.6%). The mean ± SD intraocular pressure was reduced medically from 16.1±4.7 mmHg at the time of DH to 13.4±4.2 mmHg at the time of DH resolution (P = 0.001). The mean ± SD VD in the DH sector was 52.5±9.7% at the time of DH and 51.1±8.7% on DH resolution (P = 0.30). The mean ± SD RNFL thickness in the DH quadrant was 91±20 μm in the presence of DH and 92±21 μm after DH resolution (P = 0.26). There was no significant difference between the mean VD or the mean RNFL thickness in the DH and control quadrants at these 2 time points after controlling for change in SSI (P > 0.05). Conclusions The presence of a DH does not artifactually alter the VD or RNFL thickness measurements. Therefore, OCT scans obtained in the presence of a DH may be included in series used for studying progression.

Purpose:To study sectoral vessel density (VD) and structural alterations in the peripapillary and parafoveal hemiretina corresponding to perimetrically intact regions of glaucomatous eyes with hemifield defects and to compare these with healthy eyes using optical coherence tomography.Methods:This cross-sectional study included 37 eyes with open-angle glaucoma having visual fields defects restricted to 1 hemifield and 45 age-matched controls. Peripapillary VD and retinal nerve fiber layer (RNFL) thickness were measured in 8 sectors. Parafoveal VD and ganglion cell complex thickness were measured in the superior and inferior hemispheres of the macula. These parameters were compared between the intact hemiretinae of glaucomatous eyes and corresponding sectors of healthy eyes using the t test.Results:Within the perimetrically intact regions of glaucomatous eyes, the mean VD and RNFL thickness were significantly reduced in inferotemporal, superonasal, and nasal upper peripapillary sectors as compared with healthy eyes (P

Purpose: To compare the vessel density measurements of optic nerve head, peripapillary and macular regions in severity-matched primary open-angle glaucoma (POAG) eyes with and without disc hemorrhage (DH) using optical coherence tomography (OCT) angiography, and to compare their diagnostic abilities with that of the rim area, retinal nerve fiber layer and the ganglion cell complex thickness measurements on OCT.Methods: In a cross-sectional study, 66 eyes of 46 control subjects, 34 eyes of 33 POAG patients with DH (median mean deviation=-3.7 dB) and 63 eyes of 43 POAG patients without DH (median mean deviation=-3.8 dB) underwent imaging with spectral domain OCT. Area under receiver operating characteristic curves (AUC) and 5sensitivities at 90% specificity of vessel density and structural measurements in POAG eyes with DH were compared with those in POAG eyes without DH.Results: Most of the vessel density and structural measurements were similar (P>0.05) in POAG eyes with and without DH. Whole enface vessel density of the disc scan and inferotemporal peripapillary vessel density showed the best AUC and sensitivity at 90% specificity both in POAG eyes with DH (0.82, 56% and 0.75, 59%) and without DH (0.91, 73% and 0.83, 67%). AUCs and sensitivities of vessel density and structural measurements of POAG eyes with and without DH were statistically similar (P>0.05).Conclusions: OCT angiography measured vessel densities and their diagnostic abilities in POAG eyes with and without DH were similar. This suggests that the cause of DH in POAG is unlikely to be vascular abnormality.

To evaluate the sectoral and global structure-structure (vessel density-retinal nerve fiber layer thickness) and structure-function (vessel density-visual sensitivity loss) relationships of peripapillary vessel density measurements on optical coherence tomography angiography in primary open-angle glaucoma and to determine if fractional polynomial (FP) models characterize the relationships better than linear models.In a cross-sectional study, structure-structure and structure-function relationships of peripapillary vessel densities were determined in 227 eyes of 143 subjects (63 control and 164 primary open-angle glaucoma eyes) who had undergone standard automated perimetry and optical coherence tomography testing within 6 months of each other, using linear and FP models. FP model evaluates the relationship between the dependent and the best-fitting fractional powers of the independent variable. Strength of relationship was reported as coefficient of determination (R).R values for structure-structure associations using linear models (0.53 for superotemporal sector, 0.61 for inferotemporal, and 0.53 for average measurements) were significantly less (P0.05) than that determined using FP models (0.57, 0.65, and 0.55, respectively). R values for structure-function associations using linear models (0.35 for superotemporal vessel density-inferotemporal visual sensitivity loss, 0.49 for inferotemporal vessel density-superotemporal visual sensitivity loss, and 0.39 for average vessel density-average visual sensitivity loss) were significantly less than that determined using FP models (0.43, 0.58, and 0.47, respectively).The inferotemporal peripapillary vessel density showed the strongest association with the corresponding retinal nerve fiber layer thickness and visual sensitivity loss in the global and sectoral regions studied. The FP models were significantly better than linear models in describing these relationships.

In recent past, numerous multilevel architectures came into existence. In this background, cascaded multilevel inverter (CMLI) is the promising structure. This type of multilevel inverters synthesizes a medium voltage output based on a series connection of power cells which use standard low-voltage component configurations. This characteristic allows one to achieve high-quality output voltage and current waveforms. However, when the number of levels increases switching components and the count of dc sources are also increased. This issue became a key motivation for the present paper. The present paper is devoted to investigate different types of CMLI which use less number of switching components and dc sources and finally proposed a new version of Multi-cell based CMLI. In order to verify the proposed topology, MATLAB – simulations and hardware verifications are carried out and results are presented.

AimsTo compare the peripapillary vessel density (VD) measurements of high-density (HD) and non-HD optical coherence tomography angiography (OCTA) scans in normal and glaucoma eyes, and to evaluate the intrasession repeatability of VD measurements of HD scans.MethodsIn a cross-sectional study, 46 normal (33 subjects) and 89 glaucoma (64 patients) eyes underwent 3 HD and 1 non-HD optic nerve head OCTA scans in the same session. Agreement in VD measurements between HD and non-HD scans was assessed using Bland and Altman analysis. Repeatability of the VD measurements of HD scans was assessed using within-subject coefficient of repeatability (CRw) and variation (CVw).ResultsThe mean difference in the VDs ranged between 0.7% (temporal sector VD) and 2.0% (inferonasal sector VD), with HD scans showing significantly greater VD values than non-HD scans. The 95% limits of agreement (LoA) in glaucoma eyes ranged between −2.0% and 5.0% for whole enface VD and between −4.8% and 9.6% for superotemporal VD. CRw (%) and CVw (%) of VD measurements of HD scans ranged from 3.0 to 4.9 and from 2.0 to 3.1 in normal eyes. The same ranged from 3.2 to 6.7 and from 2.6 to 4.8, respectively, in glaucoma eyes.ConclusionsVD of HD scans was higher than that of non-HD scans. The wide 95% LoA indicates that the VD measurements of HD and non-HD scans cannot be used interchangeably. Test–retest repeatability of VDs on HD scans was as high as 6%. These results should be considered while using OCTA for longitudinal evaluation of glaucoma.

In big data sector, social media plays an important role for providing the biggest amount of unstructured data. Twitter is one such social media platform for dissipating unverified information during the time of disaster like cyclones, earthquake and flood. Veracity is the degree to which the information is accurate and trusted. The main objective of this paper is to identify the veracity of the rumour and find the source of the rumour. The authors analyse the PHEME data set in which the Sydneysiege event is chosen for analysis. This paper proposes a novel and hybrid rumour source–detector approach which combines the merits of graph and tree data structures. It identifies the source node traversing through general tree and predicts the rumour-spreading possibilities with general graph using spanning tree.

Introduction: Emergency nephrectomy has been the time-honored treatment of choice for emphysematous pyelonephritis (EPN), a fatal gas-forming necrotizing infection. Recent years have seen a shift toward nonextirpative approach aimed to achieve higher rates of renal salvage, limiting the indications for nephrectomy to severe grades of the disease. This study aimed at analyzing the role of initial renal preserving measures algorithmically applied across grades of EPN. Materials and Methods: We prospectively analyzed the clinical data and outcome of 36 consecutive patients of EPN in 5 years' study period, treated by renal preserving measures, which include aggressive resuscitation, parenteral antibiotics, effective drainage of infected fluid/gas, and relieving the urinary tract obstruction. Huang-Tseng computed tomography-based classification system was used to categorize the patients as well as to employ suitable treatment modality. Results: The mean age of the patients was 57.5 ± 12 years with female preponderance (2:1). Diabetes mellitus (97%) was the most common associated factor. Escherichia coli was (72%) the most frequent causative organism found. Urinary tract obstruction was seen in 27 patients (75%) attributable to ureteric calculi, renal papillary necrosis, ureteric stricture, and fungal bezoar in the descending order of frequency. Only 2 (6%) out of 36 patients managed according to our hospital renal salvage protocol required salvage nephrectomy. The overall survival rate was 94%. Conclusion: Our hospital-based algorithmic renal preserving strategy not only improved the survival but also decreased the need for nephrectomy.

Introduction: Renal cell carcinoma (RCC) is known to invoke both immunological and inflammatory responses. While the neutrophils mediate the tumor-induced inflammatory response, the lymphocytes bring about the various immunological events associated with it. The neutrophil-to-lymphocyte ratio (NLR) is a simple indicator of this dual response. We investigated the association between preoperative NLR and histopathological prognostic variables of RCC intending to find out whether it can be of value as a red flag capable of alerting the clinician as to the biological character of the tumor under consideration. Methods: Preoperative NLR and clinicopathological variables, namely histological subtype, nuclear grade, staging, lymphovascular invasion, capsular invasion, tumor necrosis, renal sinus invasion, and sarcomatoid differentiation of 60 patients who underwent radical or partial nephrectomy, were analyzed to detect the association between the two. Results: We found that mean preoperative NLR was significantly higher in clear-cell carcinomas (3.25 ± 0.29) when compared with nonclear-cell carcinomas (2.25 ± 0.63). There was a linear trend of NLR rise as the stage of the disease advanced. A significant rise in preoperative NLR was noted in tumors with various high-risk histopathological features such as tumor size, capsular invasion, tumor necrosis, and sarcomatoid differentiation. Conclusion: Preoperative measurement of NLR is a simple test which may provide an early clue of high-risk pathological features of renal cell cancer.

In the area of farming, use of appropriate method of irrigation is crucial and it is clearly defined that drip irrigation is highly commercial and effective. In the normal conventional drip irrigation system, the farmers have to regularly keep an eye on irrigation schedule and timetable, which is varied for diverse crops. The central theme of the paper makes the irrigation automated. The use of low budget sensors and the small control unit makes this venture a low budget solution, which can be subscribed even by a meager agriculturalist. This idea is best suited for the places where scarcity of water takes place and it, also, has to be used in restricted quantity. Any states of India and the rest of the world can afford this modest and low budget solution for irrigation and obtain good yield on Crops.

Introduction: Visual Prostate Symptom Score (VPSS) was introduced to overcome the drawbacks of the International Prostate Symptom Score (IPSS). However, this score also has potential for improvement. Materials and Methods: The primary objective of this study was to evaluate the utility of VPSS in patients with benign enlarged prostate (BEP) after uroflowmetric validation of the stream component. The secondary objective was to improve VPSS by adding a new severity grading and to assess if the "new upgraded VPSS" can replace IPSS in terms of ease of completion without assistance and the time taken. Results: Of 115 patients, 42.60% of them were of thea age group between 61– 70 years; mean ± standard deviation age was 64.75 years ± 8.042 (range 48– 90 years). Nineteen (16.52%) patients, who had education level ≥10th grade completed IPSS without assistance.. One hundred and eight (93.91%) patients completed VPSS without assistance (P = 0.000). None of those (0/6) with no formal education (but able to read and write) could complete the IPSS without assistance, whereas 66.67% completed the VPSS without assistance. Six minutes and two minutes was the average time taken to complete IPSS (4– 10 min) and VPSS (1– 3 min), respectively. Responses to different variables of VPSS were statistically significant (P < 0.001) compared to the IPSS. Correlation between the severity grading of the two scores was statistically significant (P < 0.001), with a statistically significant positive correlation between VPSS and IPSS (r = +0.582, P < 0.001). The new severity grading system developed on par with the IPSS, improvising the existing VPSS, showed statistically significant positive correlation to the IPSS (r = +0.587, P < 0.001). Conclusions : VPSS correlated well with IPSS. The "new improvised VPSS" developed by incorporating severity grading is a potential tool that can replace IPSS by overcoming its limitations.

AimsTo compare the intrasession repeatability of peripapillary and macular vessel density measurements of optical coherence tomography angiography (OCTA) in normal and glaucoma eyes, and to evaluate the effect of signal strength of OCTA scans on the repeatability.MethodsIn a cross-sectional study, three optic nerve head scans each of 65 eyes (30 normal, 35 glaucoma eyes) and three macular scans each of 69 eyes (35 normal, 34 glaucoma eyes) acquired in the same session with OCTA were analysed. Repeatability was assessed using within-subject coefficient of repeatability (CRw) and variation (CVw). Effect of signal strength index (SSI) on repeatability was evaluated with repeated-measures mixed-effects models.ResultsCRw (%) and CVw (%) of peripapillary measurements in normal eyes ranged between 3.3 and 7.0, and 2.5 and 4.4 respectively, and that in glaucoma eyes between 3.5 and 7.1, and 2.6 and 6.6. For the macular, these measurements ranged between 4.1 and 6.0, and 3.3 and 4.7 in normal eyes and 4.3 and 6.9, and 3.7 and 5.6 in glaucoma eyes. Repeatability estimates of most measurements were similar in normal and glaucoma eyes. Vessel densities of both peripapillary and macular regions significantly increased with increase in SSI of repeat scans (coefficients ranging from 0.15 to 0.38, pConclusionsRepeatability estimates of OCTA measured peripapillary and macular vessel densities were similar in normal eyes and eyes with glaucoma. SSI values of the scans had a significant effect on the repeatability of OCTA with the vessel density values increasing in scans with higher SSI values.

In the present paper, single phase multilevel inverter using switched capacitor units is proposed. The switched capacitor unit (SCU) is used in the multilevel inverter will increase the dc supply voltage at the input without using transformer by operating the capacitors in parallel and in series. The SCU comprises one dc source, two semiconductor switches, power diode, and capacitor. The proposed topology does not require the charge balancing operations, which results reducing the cost of the overall circuit. In addition to that, it does not required H-bride module to alter the polarity of the output voltage, which will lead to minimum required semiconductor power switches. The proposed topology is compared with the conventional similar architectures in terms of power semiconductor switches, power diodes, dc power supplies. Finally, to confirm the proposed architecture performance, simulation results are presented.

Cloud computing is basically an internet based computing, whereby shared configurable resources are provided to cloud service consumers as services on demand. As an increasing growth of cloud computing, many enterprises provide different cloud services to cloud service consumers. From cloud service consumer's perspective, it is difficult to choose an appropriate cloud service that satisfies their QoS requirements. As requirements of one cloud service consumer will vary from another, dynamic ranking has to be used to satisfy the requirements of different cloud service consumers. A simple model is needed to address the dynamic ranking of cloud services. The dynamic ranking and selection of cloud services is solved using Linear Programming(LP) model. This project considers quantifiable attributes such as processor speed, cost, etc. and some non-quantifiable attributes to rank various cloud services according to the requirements of cloud service consumer using Linear Programming(LP) technique.

The present work addresses to evolving a sub-press equipment using rubber for counter force by which only two actions would be required to ensure fine piercing of 03�mm thickness, 25�mm diameter (shear area of 235�mm2) (a) Al, (b) EDD steel, (c) alpha brass and (d) 304 stainless steel sheet as opposed to five actions demanded with rigid tools (conventional-fine cutting). The errors with optimal conditions of impingement and rubber counter forces were compared with those reported in literature with rigid tools. The results obtained from the present work were quite promising. Errors were close to those achievable with rigid tools. For smooth shear of 95�% and above, the individual forces were registered and evaluated for a shear area of 235�mm2, so that, with this normalization, evaluation of individual forces for other material, thickness and perimeter could be enabled. Analogue parameters of the individual forces using that of commercially pure Al as the basis were then evaluated. These were evolved and furnished for both the ultimate tensile strength (Rm) as well as strength coefficient K of the flow equation of the form ?F�=�K�נ?n. Such analogue parameters for Rm and K were compared and found to have a correlation factor of 0.93�0.99 reflecting the reliability of the present work. The techno-economics has thus been shown. � 2015, The Indian Institute of Metals - IIM.

PURPOSE: To evaluate the vessel density measurements of the optic nerve head (ONH), peripapillary, and macular regions on optical coherence tomography (OCT) angiography in eyes with primary angle closure (PAC) and primary angle closure glaucoma (PACG), and to compare their diagnostic abilities with the ONH rim area, peripapillary retinal nerve fiber layer (RNFL) thickness, and the macular ganglion cell complex (GCC) thickness measurements on OCT in PACG.DESIGN: Cross-sectional study.METHODS: Seventy-seven-eyes of 50 control subjects, 65 eyes of 45 patients with PACG, and 31 eyes of 22 PAC patients with a history of high intraocular pressure underwent imaging with OCT. Area under receiver operating characteristic curves (AUC) and sensitivities at fixed specificities of vessel densities were compared with structural measurements.RESULTS: All the vessel density and structural measurements were significantly lower (P .05) to that of the controls; the superotemporal RNFL, however, was significantly thinner in the PAC group (127 mu m vs 135 P = .01). The AUC and sensitivity at 95% specificity of vessel densities within the ONH (0.76 and 42%) and macular region (0.69 and 18%) in PACG were significantly lower P CONCLUSIONS: These results suggest that structural changes in PACG occur earlier than the reduction in retinal vessel densities. (C) 2017 Elsevier Inc. All rights reserved.

Author(s): Rao, Harsha L; Pradhan, Zia S; Weinreb, Robert N; Riyazuddin, Mohammed; Dasari, Srilakshmi; Venugopal, Jayasree P; Puttaiah, Narendra K; Rao, Dhanaraj AS; Devi, Sathi; Mansouri, Kaweh; Webers, Carroll AB | Abstract: PurposeTo compare the diagnostic abilities of vessel density measurements of the optic nerve head (ONH), peripapillary and macular regions on optical coherence tomography (OCT) angiography in eyes with primary open angle glaucoma (POAG) with that of the ONH rim area, peripapillary retinal nerve fiber layer (RNFL) thickness and the macular ganglion cell complex (GCC) thickness measurements.MethodsIn a cross sectional study, 78 eyes of 50 control subjects and 117 eyes of 67 POAG patients underwent vessel density and structural measurements with spectral domain OCT. POAG was diagnosed based on the masked evaluation of optic disc stereo photographs. Area under receiver operating characteristic curves (AUC) and sensitivities at fixed specificities of vessel densities in ONH, peripapillary and macular regions were compared with rim area, RNFL and GCC thickness.ResultsThe AUC (sensitivity at 95% specificity) of average vessel densities within the ONH, peripapillary and macular region were 0.77 (31%), 0.85 (56%) and 0.70 (18%) respectively. The same of ONH rim area, average RNFL and GCC thickness were 0.94 (83%), 0.95 (72%) and 0.93 (62%) respectively. AUCs of vessel densities were significantly lower (pl0.05) than that of the corresponding structural measurements. Pre-treatment IOP (coefficient: 0.08) affected (pl0.05) the AUC of ONH vessel density but not of any other vessel density or structural measurements.ConclusionsDiagnostic abilities of ONH, peripapillary and the macular vessel densities in POAG were significantly lower than ONH rim area, peripapillary RNFL and macular GCC measurements respectively. At fixed levels of glaucoma severity, the diagnostic ability of the ONH vessel density was significantly greater in eyes with higher pre-treatment IOP.

Use of exogenous estrogens in manipulating the androgenestrogen equilibrium was one of the earliest therapeutic strategies developed to treat prostate cancer which followed close on heels the discovery of hormone dependence of this tumor. Despite its well-documented benefit, estrogen therapy fell out of favor with the advent of other forms of androgen deprivation therapy (ADT) as the former registered a higher incidence of cardiovascular complications and poorer overall survival. Clearer understanding of the mechanism of action of estrogen coupled with the adoption of alternative routes of administration has triggered a renewed interest in estrogen therapy. Since then, many studies have not only proved the therapeutic benefit of estrogens but also explored the ways and means of minimizing the dreaded side effects deterring its use. Further, the fact that estrogen therapy offered a clear advantage of reduced cost of treatment over other treatments has led many countries to readopt it in the treatment of advanced prostatic cancer. We reviewed the published data on the use of estrogens in CRPC, which may affect its revival as an efficacious treatment option having minimal side effects, with modified dosage and route of administration. Estrogen therapy would be a less expensive option having equivalent or even better therapeutic effect than ADT in advanced carcinoma of prostate.

High voltage direct current transmission (HVDC) system is preferred for bulk power transmission over a long distance. HVDC system consists of two converters on either ends of the system which are acting as a rectifier and an inverter. These converters are sensitive and are exposed to various internal faults such as back fire, arc through, misfire and commutation failures. In this paper, a fast technique is employed to detect these internal faults by employing wavelet analysis combined with artificial neural network. Wavelets are used to extract the transients in fault currents and artificial neural network is employed for automatic classification of faults. Performance of the classifier is tested for various internal of the converter and is found satisfactory.

The economic progress of every developing country, India being one of them, mainly depends upon the development of its industrial as well as agricultural sectors. Owing to the limitations of the agricultural sector in contributing adequately to the economy, the industrial sector has assumed greater importance in our country. Realising the importance of industrial sector for economic development, our planners, in their successive five-year plans designed for planned development, have aimed at accelerating industrial development through rapid industrialisation and rationalisation by exploiting and effectively utilising the rich natural and physical resources of the country.

Management of fracture dimmature teeth presents a special challenge to dentists. Apexification, Apexogenosis or Regeneration are the only options for conserving such tooth. Traditional apexification with calcium hydroxide is associated with certain difficulties, like longer treatment time, risk of tooth fracture and incomplete calcification of apical bridge. Treatment outcome of regenerations are not much convincing. Moreover, as all these treatments take longer time to show their outcome. Thus use of a biocompatible material which can form a physical apical barrier with tissue healing properties became a material of choice for treating these types of cases. Although various such materials are available, MTA has got all its favourable properties to serve as an immediate apical barrier. This case report demonstrates application of MTA apical plug followed by custom made post and core for the re-construction of maxillary central incisor. The patient was evaluated for a period of one year and peri-apical radiographs demonstrate complete healing of the peri-apical lesion. This new technique is advantageous in teeth with open apex and thin radicular dentin, where treatment can be completed in fewer visits.

RF circuits play a vital role in high data rate communication systems. Although at the design stage several considerations are made to ensure that the designed circuit functions as per desired specifications, the effect of process variations on the circuit's performance is less understood. The parametric variations arising from the various stages of fabrication play a significant role in determining the device characteristics. In this paper, in order to analyze the effect of process variations, we consider a bottom---up approach beginning at the component level for active and passive elements and then move to the circuit level in an RF circuit consisting of both analog and digital components. We take Low Noise Amplifier (LNA) and a Phase Frequency Detector (PFD) which is one of the important building blocks of a Phase Locked Loop (PLL) as case studies for circuit level analysis. In the case of LNA, the performance is analyzed in terms of the S-parameters, gain and Noise Factor on different topologies and for a PFD, an analytical model is developed and the analysis is carried out using the Monte Carlo method to verify the robustness of the circuit elements towards phase noise. Our hierarchical multi-phase analysis technique is shown to provide valuable insights into designing robust RF circuits.

The optical absorption spectrum and dielectric constant of Cu doped TiO2 was studied theoretically using Time-Dependent Density-Functional Perturbation Theory to enhance the optical response of the material in visible region.

Background: The clinical presentation and etipathogenesis of aortic aneurysms in Indians, their location and risk factors associated with these lesions have not been studied. This study aims to correlate clinical picture and the histopathological diagnosis in patients. Methods: This retrospective study included 52 patients who underwent surgery between Jan. 1990 and Dec. 2000. A detailed history, clinical examination, radiological investigations and histopathological examination were performed and recorded. Results: Age ranged from 9–76 years, with a male to female ratio of 2:3:1. Majority (46%) of aneurysms were located in the ascending aorta. Mean age was 47 years for women and 32 years in men. Chest & back pain were common symptoms in dissecting aneurysms. Annuloaortic ectasia was commonest cause of ascending aortic aneurysms (58%) in younger patients while atherosclerosis was the leading cause for aortic arch aneurysms in older patients. Conclusion: The etipathogenesis of aortic aneurysms is related to the location of the aneurysms and the age of the patients. Dyslipidemia & hypertension (diastolic pressure more than 100 mmHg) were the only significant risk factors associated with aneurysms.

Background: Several recent modifications in technical, operative and perfusion techniques have enabled good operative results and final outcome for patients with aneurysms of the aortic arch. Although surgical procedures for this disease still remain a formidable challenge, availability of improved prosthetic grafts, myocardial protection techniques, brain protection protocols and better blood bank facilities ensure minimal postoperative morbidity and mortality.

Background: Aortic valve replacement with mechanical valves is associated with a small but constant risk of valve thrombosis and thromboembolic and hemorrhagic complications. The surgical outcome of patients with Aortic Stenosis who had aortic valve replacement with mechanical valves is reported here. Methods: Between January 1990 and October 1999, 275 patients underwent prosthetic valve replacement for isolated aortic stenosis. The age ranged between 13 years and 75 years and 230 were males. The cause of aortic stenosis was rheumatic in 185 patients (67.3%), followed by bicuspid aortic valve in 75 patients (27.3%) and degenerative in 15 patients (5.4%). Results: The early mortality was 1.5%. The follow up was 96% complete and ranged from 1 to 104 months (mean 54±24.5months). Six patients (2.2%) developed prosthetic valve endocarditis. Paravalvular leak occurred in 3 (0.9%) patients. Valve thrombosis occurred in 10 patients (1.0% per patient year). The actuarial survival was 81±7% at 5 years and 64±13% at 8 years. Event free survival was 40±14% at 8 years. Conclusion: With current operative techniques and myocardial preservation aortic stenosis patients are at low risk for surgery. However, long term survival is limited due to prosthesis related complications.

Background Japanese encephalitis (JE) is a vaccine-preventable acute disease. We report the results of a phase 2/3 trial of JENVAC, a Vero cell-derived vaccine developed using an Indian strain of JE virus (JEV). Methods JENVAC was administered in 2 doses 28 days apart, and immunogenicity was compared to that from a single dose of SA-14-14-2, the only approved JE vaccine and regimen at the time in India. Results After both the doses, seroconversion and seroprotection were >90% for JENVAC. For SA-14-14-2, seroconversion and seroprotection were 57.69% and 77.56%, respectively, on day 28 and 39.74% and 60.26%, respectively, on day 56. The geometric mean titers at day 28 and day 56 were 145.04 and 460.53, respectively, for JENVAC and 38.56 and 25.29, respectively, for SA-14-14-2. With a single dose of JENVAC, seroprotection titers lasted at least 12 months in >80% of the subjects. Following receipt of 2 doses, 61.17% of subjects retained seroprotection titers at 24 months, and immunogenicity criteria were higher than that for SA-14-14-2 at 12, 18, and 24 months each. Sera from JENVAC subjects neutralized JEV genotypes I, II, III, and IV equally well. Adverse events were not significantly different between the 2 vaccines. Conclusions JENVAC elicits long-lasting, broadly protective immunity. Clinical trials registration CTRI/2011/07/001855.

Purpose To demonstrate the use of a spectral-domain optical coherence tomography (SDOCT) integrated surgical microscope in glaucoma surgery. Methods An SDOCT system was used to interface directly with an ophthalmic surgical microscope, to allow real-time intraoperative SDOCT (iOCT) imaging during glaucoma procedures like phaco-trabeculectomy, Ahmed glaucoma valve (AGV) implantation, gonio-synechiolysis, and bleb needling. The various surgical steps during glaucoma surgeries where iOCT can be of potential help in guiding the surgeon were recorded. Results High-resolution, cross-sectional images of the relevant structures were achieved with the iOCT system in all procedures. The surgeon could determine the depth of the scleral dissection, the intrastomal bed, the path of the AGV tube in the eye, the release of peripheral anterior synechiae and the efficacy of needling with respect to breakage of loculations; most of these are technically 'blind' procedures, where the outcomes are determined postoperatively. Metallic instruments cast a shadow on tissues below, thereby restricting the use of the device in its current state. Conclusions The iOCT system provided high quality, intraoperative, real-time imaging, which could possibly improve the safety and efficacy of the surgical procedures in glaucoma. Further studies and modifications to the iOCT are required to better understand and increase the uptake of this technology in daily practice. Translational relevance The iOCT, with further advancements in its technology, could potentially provide the surgeon both quantitative and qualitative, real-time depth and tissue proximity details, thus improving the safety and accuracy of glaucoma surgery.

Reoperations for valvular heart disease are associated with a higher overall mortality than the primary operations. In this retrospective analysis, we present our experience of reoperative valvular heart surgery over a period of 25 years. From January 1975 to July 2000, 13039 operations were performed for valvular heart disease. Of these 665 were reoperations. The mean age of the patients at the primary operation was 24.0±10.2 years (range: 8 to 65 years) and at re-operation was 35.6±11.6 years (range: 9 to 65 years) with an interval of 9.4±2.2 years (range: 0.2 to 25 years) between the 2 procedures. Four hundred and forty reoperations were performed following a previous closed mitral valvotomy and procedures included, redo closed mitral valvotomy (n=28), mitral valve replacement (n=30), open mitral commissurotomy (n=51), mitral valve repair (n=9), homograft mitral valve replacement (n=2), double valve replacement (n=47), aortic valve replacement (n=2) and homograft aortic valve replacement plus open mitral commissurotomy (n=l). Eighty six patients underwent reoperations following mitral valve replacement. Valve thrombosis (n=50) and endocarditis (n=10) were principle causes of reoperation. Forty three patients required reoperation following failed mitral valve repair, 19 following open mitral commissurotomy and 8 following homograft mitral valve replacement. Sixty five patients underwent reoperation following aortic valve operations: prosthetic aortic valve replacement in 43, homograft aortic valve replacement in 5, aortic valve repair in 10, and Ross procedure in 7. Majority of patients were operated through midsternotomy. Aortic cannulation was possible in all but 4 patients in whom femoral artery cannulation was required. Operative mortality following reoperations was 7.5% (n=50). Peri-operative bleeding, low cardiac output and infective endocarditis were major causes of operative deaths. Other post-operative complications included cerebrovascular accident (n=3), acute renal failure (n=10) and jaundice (n=25). Fifteen patients developed significant wound infection. Patients undergoing operation for valvular heart disease frequently require reoperation. Reoperative valvular heart surgery is safe and can be undertaken with acceptable mortality and morbidity.