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Introduction: Recently, the aromatheraphy has been a topic of interest in field of research and is reported to exert psychomodulatory effects through the limbic system. Lavender oil is widely researched for its effects on nervous system and shows calming effects. Aim: To evaluate Auditory Reaction Time (ART) and Visual Reaction Time (VRT) after 30 minutes of inhalational of lavender oil. Materials and Methods: This quasi-experimental study was conducted on 30 healthy volunteers after obtaining the clearance from ethics committee and informed consent from the participant. The audiovisual time was recorded twice for each subject, before and after the intervention i.e., 30 minutes of inhalation of lavender oil using aroma lamp. The data was analysed using Statistical Package for the Social Sciences (SPSS) version 20.0. Results: The present study showed significant prolongation of both ART and VRT (p-value=0.04 and 0.01, respectively) after 30 minutes inhalation of lavender oil from pre-exposure value of ART increased from 0.76±0.25 msec to 0.91±0.31 msec and VRT increased from 0.62±0.20 msec to 0.74±0.18 msec was observed. Conclusion: The prolongation of ART and VRT indicates the inhibitory effect of the inhalational lavender oil on the central neuron especially in the limbic system, through the activation of GABA (gamma-aminobutyric acid) receptors. Hence, it results in calming effect on the brain, inducing relaxation and sedation.

Introduction: Lemongrass oil has become a significant focus in aromatherapy research due to its psychomodulatory effects, which are believed to act through the limbic system- a critical region for emotional control and memory. Research indicates that lemongrass oil can effectively lower anxiety, improve mood and enhance cognitive performance. However, the specific mechanisms by which lemongrass oil influences neuronal excitability and synaptic transmission remain unclear. Aim: To explore Auditory Reaction Time (ART) and Visual Reaction Time (VRT) to gain a better understanding of the neurophysiological effects of lemongrass oil and its potential therapeutic uses following 30 minutes of inhalation of lemongrass oil. Materials and Methods: This quasi-experimental study was conducted on 30 healthy volunteers after obtaining clearance from the ethics committee and informed consent from the participants. The audio visual reaction times were recorded twice for each subject, before and after the intervention- i.e., 30 minutes of inhalation of lemongrass oil using an aroma lamp. The data were analysed using Statistical Package for the Social Sciences (SPSS) version 20.0, and a paired t-test was applied. Results: The present study showed a significant decrease in both ART and VRT (p-value=0.001 and 0.02, respectively) after 30 minutes of inhalation of lemongrass oil. The pre-exposure values of ART (1.01±0.46 msec) decreased to 0.79±0.29 msec, while VRT (0.70±0.29 msec) decreased to 0.63±0.26 msec. Conclusion: The shortened ART and VRT indicate the stimulatory effect of inhaling lemongrass oil on central neurons, especially in the limbic system, through the activation of GABA (gamma-aminobutyric acid) receptors. Hence, this results in increased attention and alertness in the brain.

Introduction: Polycystic Ovary Syndrome (PCOS) is a prevalent endocrine and metabolic disorder in women of reproductive age, characterised by chronic anovulation, high androgen levels, Insulin Resistance (IR), and low-grade inflammation. Women with PCOS face increased risks of cardiac and metabolic issues, along with observed sympathetic overactivity. Aim: To assess the status of autonomic responses in women with and without PCOS through Autonomic Function Tests (AFT). Materials and Methods: The present study was designed as a case-control study, volunteers were recruited from the infertility centre of a tertiary care hospital and studied in the Department of Physiology. The study included 80 infertile women aged between 18 and 40 years. The study participants were divided into two groups: Group P included 40 volunteers with PCOS, while Group N included 40 healthy volunteers without PCOS and without any co-morbid conditions. Autonomic functions, which determine the sympathovagal balance, were evaluated. The data were analysed using IBM Statistical Package for the Social Sciences (SPSS) version 20.0. Results: The cold pressor test failed to raise Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP) in Group P (124.45±8.55 mmHg and 83.75±8.27 mmHg, respectively) as effectively as in Group N (131.40±4.69 mmHg and 89.80±6.79 mmHg, respectively), indicating baroreceptor reflex insensitivity. Similarly, during the hand grip test, the rise in SBP and DBP was significantly lower (p-value

The present study focuses on evaluating the validity of the Relative Purchasing Power Parity (RPPP) theory for India and its four major trading partner nations namely the United States, China, the United Arab Emirates, and Saudi Arabia using monthly time series spanning January 2001 to March 2021. For the purpose of empirical analysis, standard Augmented Dickey Fuller (ADF) and Phillips-Perron (PP) unit root tests, as well as the Johansen-Juselius cointegration technique, have been applied. Firstly, the stationarity of the real exchange rate has been investigated using standard unit root tests. The findings indicate that each country’s real exchange rate is nonstationary signifying the absence of strong PPP. Thereafter, the weak form of PPP was tested in the second stage using the Johansen cointegration test. The findings of the cointegration test confirm the presence of a long-run relationship among bilateral exchange rates, domestic price levels, and foreign price levels for all countries undertaken except for the UAE. Since three economies from among the total four trading partners’ country-pair support the existence of PPP, it can be said that PPP holds for the Indian rupee exchange rate for the economies so considered. The study further signals that India’s trade with the UAE could lead to arbitrage opportunities.

Background Ulcerative colitis is an autoimmune reaction to imbalanced colonic microbiome in genetically predisposed patients. There have been four published randomised controlled trials of faecal microbiota transplant versus placebo in ulcerative colitis; three being positive. However, the methodology used varied and mechanistic data were sparse. Objective To identify an optimal faecal microbiota transplant delivery route to test in a future efficacy-powered randomised controlled trial. Design Prospective, multicentre, open-label, parallel-group, randomised pilot study. Participants were randomised in a 1 : 1 ratio to faecal microbiota transplant by nasogastric or by colonoscopy, minimised by partial Mayo score and current smoking status. Setting Three secondary care hospitals in the United Kingdom. Participants Thirty adult patients with mild to moderately active ulcerative colitis (partial Mayo score of ≥4 and ≤8). Interventions Faecal microbiota transplant samples were prepared at the University of Birmingham Microbiome Treatment Centre and administered to participants either via a nasogastric tube on 4 consecutive days repeated after a month (nasogastric) or by colonoscopy followed by 7 weekly enemas (COLON). Each treatment course was from a single matched donor. Participants and researchers underwent qualitative interviews regarding the faecal microbiota transplant experience. Main outcome measure Composite assessment of qualitative and quantitative data based on efficacy, acceptability and safety. Clinical response (primary measure of efficacy) was defined as a ≥3 point and ≥30% reduction in full Mayo score from randomisation to week 8 and a ≥1 point reduction in rectal bleeding subscore or absolute rectal bleeding subscore of 0 or 1. Results Thirty ulcerative colitis patients were randomised: 16 to nasogastric; 14 to COLON. Seven participants in the nasogastric arm and two in the COLON arm withdrew from treatment and clinical follow-up. Eight of 16 (50%) nasogastric participants were adherent compared to 12/14 (86%) COLON participants. Clinical response data were available for 20 of 30 randomised participants. Clinical response was seen in 2/8 (25%) nasogastric participants versus 9/12 (75%) COLON participants: adjusted risk ratio 2.94 (95% CI 0.84 to 10.30). Adverse events were reported in 11/16 (69%) nasogastric participants versus 11/14 (79%) COLON participants. There were three serious adverse events in two nasogastric participants. Faecal microbiota transplant was deemed an acceptable treatment for ulcerative colitis, with greater participant and clinician acceptability for the COLON route. Faecal microbiota transplant responders had a greater reduction in faecal calprotectin compared to non-responders (t-test p = 0.03) and increase in faecal microbiome diversity (Shannon diversity p < 0.01). In the whole cohort, a negative association between faecal calprotectin and diversity was seen (Kendall’s tau z = −2.8231, p = 0.004757). There were increases in faecal acetate (p = 0.05) and butyrate (p = 0.03) after faecal microbiota transplant intervention, but these were not associated with clinical response. A limitation was that this was an open-label pilot study, which was not powered to assess for efficacy of faecal microbiota transplant. Conclusions Faecal microbiota transplant delivered by the colonic route was considered safe and better tolerated than the nasogastric route. The colonic route was preferred by both participants and clinicians. Mechanistic signals indicated reduction in colonic inflammation and increased microbiome diversity in faecal microbiota transplant responders. Future work An efficacy-powered randomised controlled trial. Trial registration This trial is registered as ISRCTN74072945 and EudraCT 2015-005753-12. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Efficacy and Mechanism Evaluation (EME) programme (NIHR award ref: 13/179/01) and is published in full in Efficacy and Mechanism Evaluation; Vol. 11, No. 14. See the NIHR Funding and Awards website for further award information. Plain language summary Ulcerative colitis, a chronic inflammatory condition affecting the colon, results from the body’s immune response to imbalance in colonic microbes (microbiota). Faecal microbiota transplantation involves transferring processed donated stool samples from carefully screened healthy donors to ulcerative colitis patients aiming to correct the imbalance and reduce inflammation. There have been four trials comparing faecal microbiota transplant with placebo (dummy no treatment) to treat ulcerative colitis, and one which investigated faecal microbiota transplant with dietary intervention. Three of these studies showed encouraging benefit for faecal microbiota transplant. However, these studies varied in the methods used, with faecal microbiota transplant delivered either to the stomach or colon, or both. The aim of this study was to identify the best route of faecal microbiota transplant administration before undertaking a large-scale trial comparing faecal microbiota transplant with placebo. Between March 2018 and 30 April 2019 ulcerative colitis patients from three hospitals were randomly allocated to receive faecal microbiota transplant via either a tube inserted through the nose into the stomach on 4 consecutive days repeated after a month (nasogastric group; 16 participants) or by colonoscopy followed by 7 weekly enemas (COLON group; 14 participants). Faecal microbiota transplant was well accepted, with both patients with ulcerative colitis and healthcare staff stating a preference for the colonic route. Only 8 of 16 in the nasogastric group completed the study compared to 12 of 14 in the COLON group. Altogether, 9/12 (75%) in the COLON group improved compared with 2/8 (25%) in the nasogastric group. The majority of participants [11/14 (79%) COLON vs. 11/16 (69%) nasogastric] had mild, short-lived side effects following faecal microbiota transplant. There were three serious adverse events. Faecal calprotectin (indicating colonic inflammation) fell in responders and stool samples showed an increase in the number of microbial species after faecal microbiota transplant. At the end of the study, a recommendation was made by the Independent Oversight Committee to proceed to a large placebo-controlled randomised trial using the colonic route. Scientific summary Background Ulcerative colitis (UC) results from an exaggerated immune response to an imbalanced (dysbiotic) colonic microbiome in genetically predisposed patients. At the inception of this study, there had been four published randomised controlled trials (RCTs) comparing faecal microbiota transplantation (FMT) with placebo to treat UC in adults. Of these four seminal studies, three involved delivery of FMT via the colonic route and one a combination of delivery to the foregut and colon. This latter study was the only one of the four not to show a difference in efficacy compared to placebo. Foregut-delivered FMT is extensively and successfully used in clinical practice to treat Clostridioides difficile infection (CDI). From the results of the UC trials, FMT appeared to have therapeutic potential for UC. However, the methodology employed in these studies was varied and, taking into account the efficacy of FMT delivered to the foregut to treat CDI, there was uncertainty regarding the best route of delivery in the context of UC. Objectives The aims of this pilot study were as follows: to determine which FMT administration route [nasogastric (NG) or colonic (COLON)] should be investigated in a randomised double-blind, placebo-controlled trial to determine whether a full-scale RCT was feasible. In order to achieve these aims, the pilot study had the following clinical objectives. To assess the following: whether FMT by the NG route induces clinical response in patients with active UC whether FMT by the COLON route induces clinical response in patients with active UC tolerability and safety which route of FMT delivery (if any) was suitable to investigate in a full-scale RCT. The aims of the qualitative research were to assess the following: patient and clinician acceptability of FMT (NG route) patient and clinician acceptability of FMT (COLON route). The aims of the nested-mechanistic substudy were to assess the following: whether FMT by either route is associated with a change in faecal calprotectin as a surrogate marker of colonic inflammation changes in the colonic microbiome induced by FMT via each route changes in the metabolome [short-chain fatty acids (SCFAs)] induced by FMT via each route effect of diet (donors) time from stool donation to treatment. Methods In this prospective, multicentre, open-label, parallel group, randomised pilot study, adult patients with mild to moderate active UC (partial Mayo score of ≥4 and ≤8) were recruited from three centres in the UK (Birmingham, Glasgow and St Mark’s, London). Patients were randomised to receive FMT delivered either via a NG tube for delivery to the stomach (foregut-NG) on 4 consecutive days repeated after a month or by a combination of delivery through a colonoscope followed by 7 weekly enemas (hindgut-COLON). All participants underwent a treatment schedule using FMT derived, in each case, from a single donor. The primary outcome was a composite assessment of both qualitative and quantitative data based on efficacy, acceptability and safety. Clinical response (primary measure of efficacy) was defined as a ≥3 point and a ≥30% reduction in full Mayo score from randomisation to week 8 and a ≥1 point reduction in the rectal bleeding subscore or an absolute rectal bleeding subscore of 0 or 1. Patient and clinician acceptability of FMT and preference of treatment route was assessed through semi-structured qualitative research interviews. Interviews also explored reasons for adherence to treatment allocation and patients’ perspectives on FMT and trial experience. Participants were interviewed face to face or by telephone at two time points, first following the screening visit and prior to randomisation, and second after the 12-week follow-up period. Safety was assessed by the number of participants experiencing adverse events (AEs) and serious adverse events (SAEs). For the translational research, stool samples were taken from participants at baseline and then at 2 weekly intervals throughout the study to assess microbiome diversity (by 16S rRNA sequencing) and to examine the effect of FMT on faecal calprotectin. Donor stool samples were also analysed by 16S rRNA sequencing. Biopsy samples were taken from the colon at the time of endoscopy (baseline and week 8) to analyse mucosa-associated microbiome by 16S rRNA sequencing. SCFA levels in stool samples were also measured throughout the study and blood was taken from participants to look for changes in C-reactive protein (CRP) in response to FMT. Donors were asked to fill in a dietary questionnaire in order to look for associations between dietary components in their habitual diet and the efficacy of their donated FMT samples. Results Thirty patients with UC were randomised between March 2018 and April 2019; 16 to NG; 14 to COLON route. Seven participants in the NG arm and two participants in the colonic arm withdrew from the study. Clinical response was achieved in a higher proportion of participants in the colonic arm [9/12 (75%)] compared with the NG arm [2/8 (25%)]; [adjusted risk ratio 2.94 (95% confidence interval, 0.84 to 10.30)]. In the colonic arm, 12/14 (86%) participants were considered adherent compared with 8/16 (50%) in the NG arm. AEs were reported in 11/14 (79%) participants in the colonic arm and 11/16 (69%) in the NG arm. There were three SAEs in two participants in the NG arm, and none in the colonic arm. Qualitative research found a high level of enthusiasm for the trial among both patients and staff. Patients were more positive about the colonic treatment route than the NG route, both before randomisation and after the patients had been through the study. Lower calprotectin levels, implying reduced colonic inflammation, averaged over the last half of the treatment course (weeks 4, 6 and 8), were seen in the responders (N = 11, mean 508.6 mg/kg) versus the non-responders (N = 9, mean 853.6 mg/kg) (p = 0.03). Furthermore, there was a negative association between faecal microbiome alpha diversity [rarefied total operational taxonomic unit (OTU) richness] and calprotectin levels (p < 0.01). This is the first time that change in faecal calprotectin, a widely used clinical inflammatory biomarker in UC, has been reported in response to FMT in inflammatory bowel disease (IBD). With respect to SCFAs, there were significant and large increases observed in the concentration of acetate (45% increase, p = 0.05) and butyrate (57% increase, p = 0.03) across all participants (N = 19) from baseline to week 2 following FMT treatment. This effect was also observed over the course of the entire FMT treatment period from baseline to 8 weeks (N = 16, acetate 21% increase, p = 0.02; butyrate 39% increase, p = 0.08). Significant changes were not observed for the other SCFAs measured, notably propionate (2 weeks p = 0.46, 8 weeks p = 0.36). The observed increase in acetate and butyrate was not associated with clinical response, and in fact when restricted to the responder group (N = 9) changes at both 2 and 8 weeks were no longer significant, although increases were still observed. Across all participants that completed FMT to day 56, and for whom baseline and week 8 DNA was available (N = 13), there was no significant change in faecal microbiome alpha diversity, as measured by rarefied Shannon diversity of 3% OTUs (p = 0.43). However, when restricted to the colonic arm only (N = 8), there was a significant increase in alpha diversity (p = 0.01) observed after FMT. Again, for those participants in the colonic arm that responded to FMT, there was a significant increase in alpha diversity (rarefied Shannon diversity, p < 0.01) compared to those who did not. No differences were seen in alpha diversity of mucosa-associated bacteria pre and post treatment. Donor microbiome diversity, as measured by rarefied 16S rRNA gene Shannon diversity, varied substantially between donors. There was a non-significant positive association between clinical response and donor diversity (p = 0.19) with the treatment arm taken into account. In this pilot study, CRP values were lower at baseline in the colonic arm (4.2 mg/l) compared with the NG arm (11.3 mg/l). Similarly, CRP values at weeks 4, 6 and 8 were also lower in the colonic arm than in the NG arm. With regard to data derived from diet questionnaires administered to donors, higher milk and milk product intakes were associated with higher alpha diversity, but this was not statistically significant. The mean number of days from stool donation to FMT treatment was similar in participants who achieved a clinical response compared with those who did not achieve a clinical response. There was no association between time from stool donation and treatment, and clinical response when added to the primary intention-to-treat analysis model. Conclusion This pilot study suggests that in patients with active UC, FMT delivered via the colonic route appears to be safe and better tolerated with signals suggesting greater efficacy compared to the NG route. The pilot study was welcomed by patients and clinicians, and FMT appears, at least in the short term, to be safe and well tolerated. On review of these data, the Independent Oversight Committee recommended progressing to the planned placebo-controlled randomised trial, which would be powered to assess efficacy, and would have enabled more detailed mechanistic studies to assess for strains engrafting from donors to recipients, which are associated with clinical response. Patients remain very interested in FMT as a potential treatment for UC as this microbiome manipulation affords an alternative therapy to immune system suppression as a means to treat UC. The trial management group involved in this pilot believe that further studies to assess the efficacy of FMT in UC with a focus on understanding mechanisms are warranted as the first step towards developing precision live biotherapeutics for IBD. Trial registration This trial is registered as ISRCTN74072945 and EudraCT 2015-005753-12. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Efficacy and Mechanism Evaluation (EME) programme (NIHR award ref: 13/179/01) and is published in full in Efficacy and Mechanism Evaluation; Vol. 11, No. 14. See the NIHR Funding and Awards website for further award information.

In this paper, a novel class of rational cubic fractal interpolation function (RCFIF) has been proposed, which is characterized by one shape parameter and a linear denominator. In interpolation for shape preservation, the proposed rational cubic fractal interpolation function provides a simple but effective approach. The nature of shape preservation of the proposed rational cubic fractal interpolation function makes them valuable in the field of data visualization, as it is crucial to maintain the original data shape in data visualization. Furthermore, we discussed the upper bound of error and explored the mathematical framework to ensure the convergence of RCFIF. Shape parameters and scaling factors are constraints to obtain the desired shape-preserving properties. We further generalized the proposed RCFIF by introducing the concept of signature, giving its construction in the form of a zipper-rational cubic fractal interpolation function (ZRCFIF). The positivity conditions for the rational cubic fractal interpolation function and zipper-rational cubic fractal interpolation function are found, which required a detailed analysis of the conditions where constraints on shape parameters and scaling factor lead to the desired shape-preserving properties. In the field of shape preservation, the proposed rational cubic fractal interpolation function and zipper fractal interpolation function both represent significant advancement by offering a strong tool for data visualization.

The study was conducted to evaluate the systemic adverse effects of smokeless tobacco (SLT) on hematological as well as other biochemical parameters and find out if any correlation between them which may be worthy of creating awareness among the masses against its usage. The current observational study was carried out among 250 tobacco chewers, and complete hemogram, LFT profile, and electrolyte profile were studied. The mean values of hemoglobin (Hb) gram % was 12.74 ± 1.6, total leucocyte count (TLC/cu mm) is 6608.33 ± 1752.083, and platelet count lakh cell/cu mm is 2.55 ±0.806. The mean values of Na+ mmol/1 of the S. electrolyte profile was 132 ± 18.05 and K+ mmol/1 was 3.89 ± 0.538. The study deliberates imperative perception into smokeless tobacco-mediated effects on body systemic functions and reports a crucial part into SLT-mediated effects on biochemical profile and metabolism which can be revealed in promoting tobacco cessation.

Abstract Objective: To review and study implementation of an automated hand hygiene reminder system (AHHRS). Design: Prospective, nonrandomized, before-after quality improvement pilot study conducted over 6 months. Setting: Medical-surgical unit (MSU) and medical intensive care unit (MICU) at a public hospital in New York City. Participants: There were 2,642 healthcare worker observations in the direct observation (DO) period versus 265,505 in the AHHRS period, excluding AHHRS observations collected during the 1-month crossover period when simultaneous DO occurred. Intervention: We compared hand hygiene adherence (HHA) measured by DO prior to the pilot and after AHHRS implementation. We compared changes in HHA and potential cross-contamination events (CCEs) (room exit and subsequent entry without HHA) from baseline for each biweekly period during the pilot. Results: Engagement, education/training, data transparency, and optimization period resulted in successful implementation and adoption of the AHHRS. Observations were greater utilizing AHHRS than DO (265,505 vs 2,642, P < .01). Due to the expected Hawthorne effect, HHA was significantly less for AHHRS than DO in MSU (90.99% vs 97.21%, P < .01) and MICU (91.21% vs 98.65%, P < .01). HHA significantly improved from 86.47% to 89.68% in MSU (P < .001) and 85.93% to 91.24% in the MICU (P < .001) from the first biweekly period of AHHRS utilization to the last. CCE decreased from 73.42% to 65.11% in the MSU and significantly decreased from 81.22% to 53.19% in the MICU (P < .05). Conclusions: We describe how an AHHRS approach was successfully implemented at our facility. With ongoing feedback and system optimization, AHHRS improved HHA and reduced CCE over time.

Background: The aim of fistula surgery is to eradicate the disease while preserving anal sphincter function. The efficacy of the Surgisis® anal fistula plug (Cook Medical, Bloomington, IN, USA) in the treatment of trans-sphincteric fistula-in-ano has been variably reported. Objectives: To undertake a randomised comparison of the safety and efficacy of the Surgisis anal fistula plug in comparison with surgeon’s preference for the treatment of trans-sphincteric anal fistulas. Design: A randomised, unblinded, parallel-arm, prospective, multicentre clinical trial. Setting: Hospitals in the UK NHS involving colorectal surgeons accredited by the Association of Coloproctology of Great Britain and Ireland. Participants: Adult patients suffering from trans-sphincteric fistula-in-ano of cryptoglandular origin. Interventions: Patients were randomised on a 1 : 1 basis to either the fistula plug or the surgeon’s preference [e.g. fistulotomy, cutting seton, advancement flap or ligation of intersphincteric fistula tract (LIFT) procedure]. Main outcome measures: The primary outcome measure was quality of life as measured by the Faecal Incontinence Quality of Life (FIQoL) questionnaire at 12-month follow-up. Secondary outcome measures included clinical and radiological fistula healing rates, faecal incontinence rates, complications rates, reintervention rates and cost-effectiveness. Results: Between May 2011 and March 2016, 304 participants were recruited (152 fistula plug vs. 152 surgeon’s preference). No difference in FIQoL score between the two trial groups was seen at the 6-week, 6-month or 12-month follow-up. Clinical evidence of fistula healing was reported in 66 of 122 (54%) participants in the fistula plug group and in 66 of 119 (55%) participants in the surgeon’s preference group at 12 months. Magnetic resonance imaging (MRI) showed fistula healing in 54 of 110 (49%) participants in the fistula plug group and in 63 of 112 (56%) participants in the surgeon’s preference group. Variation in 12-month clinical healing rates was observed: 55%, 64%, 75%, 53% and 42% for fistula plug, cutting seton, fistulotomy, advancement flap and LIFT procedure, respectively. Faecal incontinence rates were low at baseline, with small improvement in both groups post treatment. Complications and reinterventions were frequent. The mean total costs were £2738 [standard deviation (SD) £1151] in the fistula plug group and £2308 (SD £1228) in the surgeon’s preference group. The average total quality-adjusted life-years (QALYs) gain was much smaller in the fistula plug group (0.829, SD 0.174) than in the surgeon’s preference group (0.790, SD 0.212). Using multiple imputation and probabilistic sensitivity analysis, and adjusting for differences in baseline EuroQol-5 Dimensions, three-level version utility, there was a 35–45% chance that the fistula plug was as cost-effective as surgeon’s preference over a range of thresholds of willingness to pay for a single QALY of £20,000–30,000. Limitations: Limitations include a smaller sample size than originally calculated, a lack of blinding that perhaps biased patient-reported outcomes and a lower compliance rate with MRI at 12-month follow-up. Conclusions: The Surgisis anal fistula plug is associated with similar FIQoL score to surgeon’s preference at 12-month follow-up. The higher costs and highly uncertain and small gains in QALYs associated with the fistula plug mean that this technology is unlikely to be considered a cost-effective use of resources in the UK NHS. Future work: Further in-depth analysis should consider the clinical and MRI characteristics of fistula-in-ano in an attempt to identify predictors of fistula response to treatment. Trial registration: Current Controlled Trials ISRCTN78352529. Funding: This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 23, No. 21. See the NIHR Journals Library website for further project information.

Introduction: Polycystic Ovarian Syndrome (PCOS) is a hormonal disorder of female reproductive system causing infertility, irregular menstrual cycle and hormonal imbalance characterised by hyperestrogenemia, hyperprolactinemia, increased Anti Mullerian Hormone (AMH) and Thyroid Stimulating Hormone (TSH). Apart from the role in female reproductive system, these hormones are shown to have neuromodulatory role, affecting the neuronal activity. Thus, the auditory and visual reaction time may be affected in the women with polycystic ovaries. Aim: To evaluate the auditory and visual reaction time, in patients with polycystic ovarian syndrome. Materials and Methods: The study was designed as a casecontrol study where the 80 otherwise healthy women, attending infertility OPD, were recruited for the study and divided into groups viz., PCOS (n=40) and NPCOS (n=40). The subjects from both the groups were evaluated for their anthropometric data, hormone levels {Serum estrogen, Serum prolactin, Serum TSH, Serum AMH} using COBAS-6000 analyser along with the auditory and visual reaction time using RTM-608 (Medicaid). The observations were recorded and analysed using paired t-test. Results: Auditory reaction time had significantly decreased (p=0.012) while visual reaction time was non-significantly reduced in Group PCOS as compared to Group NPCOS. Conclusion: The altered hormonal profile in PCOS i.e., hyperestrogenemia and hyperprolactinemia exerts enhanced neuromodulatory action through neural ERα receptors and tuberoinfundibular dopaminergic neurons in hypothalamus, thus resulting in increased neuronal excitability and decreased reaction time in patients with PCOS.

Introduction: Idiopathic Guttate Hypomelanosis (IGH) macules are hypo pigmented lesions occurring due to decreased functioning of melanocytes due to photosensitivity or persistent irritation of skin in middle aged and elderly. Aim: To find out the efficacy of placental extracts when used as an adjunct with 88% phenol for the treatment of IGH macules. Materials and Methods: A total of 40 patients were randomly divided into two groups (n=20 in each group), viz group P, (the control group, treated with only 88% phenol) and Group PP (study group, treated with Placental extracts along with 88% phenol). Spot peeling was done with 88% phenol in both the groups while group PP was advised to use placental extract at night for 3 months. Patients of both groups were assessed both subjectively and objectively after every session and at the end of 3 months of initiation of therapy. The statistical analysis was done using Chi-square test, Z-test and a p-value

Introduction: Tobacco consumption is a serious health hazard and most important avoidable cause of death worldwide. Tobacco is recognized as lethal toxin, ripping off 7-11 minutes of human life with each cigarette through harmful compounds and inducing free radical synthesis and a high rate of lipid peroxidation. These free radicals are scavenged by the endogenous antioxidants viz. S. Glutathione (S.GSH) and S.αLipoic acid (S. α-LA), thus preventing the endothelial damage. Aim: The present study was designed with an aim to find out the lipid peroxidative stress through S. Malondialdehyde (S.MDA) and its correlation with antioxidant levels like S. Glutathione (S. GSH) and S. α- Lipoic acid (S. α- LA) among tobacco users (in both smokers and chewers). Materials and Methods: A case control cross-sectional study was carried out in the Department of Physiology among 200 subjects; aged 18-50 years of both sexes which were chosen randomly from institutional campus and healthy volunteers. The subjects were broadly divided into two groups (A & B); group A comprised of tobacco users (n=150) with history of smoking cigarette/biddies and chewing tobacco daily, for at least one year and group B had controls (non tobacco users) (n=50). S. MDA, S.GSH and S. α-LA levels were estimated by standardized methods. The data was analysed by unpaired student t-test and Pearson’s correlation coefficient (r) for finding the correlation between antioxidants and S.MDA in group-A and group-B. Results: The present study reports the significantly higher (p

Introduction: Hypertension has turned out to be the major cause of morbidity among the life style diseases. Studies in human and animal models have documented an independent association of hyperuricaemia with early hypertension. Hyperuricaemia is a modifiable and treatable risk factor, which might reduce the incidence of Essential Hypertension (EHT). Aim: Hence, the present study was designed to find out the association between hyperuricaemia and EHT in the population of Southern Rajasthan as there is a dearth of literature on Indian scenario especially in Rajasthan. Materials and Methods: A cross-sectional, case control study was carried out in the Department of Physiology among 125 subjects; aged 20-50 years of both sexes, which were chosen randomly from Medicine OPD and healthy volunteers. The subjects were broadly divided into two groups (A & B); group A comprised of newly diagnosed cases of EHT (n=75) and group B had healthy normotensive controls (n=50). S. Uric Acid (SUA), Serum creatinine and fasting blood glucose levels were estimated by using the respective kit methods on semi autoanalyser in both groups. S. creatinine and fasting blood glucose levels were estimated to exclude renal disorder and diabetes mellitus respectively. The data was analysed by student t-test, chi-square test and Odds Ratio. Results: The mean SUA level in group A was significantly higher than group B (6.56 ± 0.76, 4.91 ± 0.97 mg/dl, p

Introduction: There is a high prevalence of leprosy in certain areas of our country. The main problem with leprosy is the prevalence of disability in untreated patients. Aims: To know the clinical profile of leprosy patients and to find out the risk factors for disabilities. Methods: A retrospective study of 10 years was conducted from April 2003 to March 2014 was conduced. Results: There were 137 MB (75.6%) and 44 PB (24.4%) cases. There were 35 (19.33%) MB patients with disability and 5 (2.76%) PB patients with disability. There were 5 cases (2.7%) with childhood leprosy. The percentage of defaulters was 9 (4.97%). The Patients were grade II disability were 19.4% and patients with grade I disability were 2.8%. Regarding the nerve involvement in leprosy, ulnar nerve was most commonly involved in 45 (24.86%) patients, lateral popliteal nerve in 20 (11.04%) patients, posterior tibial nerve in 15 (8.28%) patients and median nerve was involved in 12 (6.62%) patients. Conclusions: The multibacillary patients are more susceptible to neuritis as compared to the paucibacillary patients. The occurence of neuritis is a significant risk factor for disabilities in leprosy. Early diagnosis and treatment is important to reduce the load of infection.

The present study aims at exploring the determinants of Foreign Institutional Investors’ (FIIs) investment in India. Returns on Indian stock market have positive impact whereas US stock market returns have no significant influence on FIIs investment to India. Stock market risk has negative influence on FIIs inflows to India. Market capitalization and stock market turnover of India have significant positive influence only in short-run. Among macroeconomic determinants, economic growth of India has positive impact on FIIs investment both in long-run and shortrun. But all other macroeconomic factors have significant influence only in long-run like inflation in US has positive influence whereas inflation in India has negative influence on FIIs investment. Further, US interest rate has adverse impact on FIIs investment while liberalization policies of India exhibited significant contribution to FIIs inflows. Study concludes that FIIs inflows in India are determined by both stock market characteristics and macroeconomic factors.

Mutations in APC/β-catenin resulting in an aberrant activation of Wnt/β-catenin pathway are common in colorectal cancer (CRC), suggesting that targeting the β-catenin pathway with chemopreventive/anticancer agents could be a potential translational approach to control CRC. Using human CRC cell lines harboring mutant (SW480) versus wildtype (HCT116) APC gene and alteration in β-catenin pathway, herein we performed both in vitro and in vivo studies to examine for the first time whether silibinin targets β-catenin pathway in its efficacy against CRC. Silibinin treatment inhibited cell growth, induced cell death, and decreased nuclear and cytoplasmic levels of β-catenin in SW480 but not in HCT116 cells, suggesting its selective effect on the β-catenin pathway and associated biologic responses. Other studies, therefore, were performed only in SW480 cells where silibinin significantly decreased β-catenin-dependent T-cell factor-4 (TCF-4) transcriptional activity and protein expression of β-catenin target genes such as c-Myc and cyclin D1. Silibinin also decreased cyclin-dependent kinase 8 (CDK8), a CRC oncoprotein that positively regulates β-catenin activity, and cyclin C expression. In a SW480 tumor xenograft study, 100- and 200-mg/kg doses of silibinin feeding for 6 weeks inhibited tumor growth by 26% to 46% (P < .001). Analyses of xenografts showed that similar to cell culture findings, silibinin decreases proliferation and expression of β-catenin, cyclin D1, c-Myc, and CDK8 but induces apoptosis in vivo. Together, these findings suggest that silibinin inhibits the growth of SW480 tumors carrying the mutant APC gene by down-regulating CDK8 and β-catenin signaling and, therefore, could be an effective agent against CRC.

Introduction: Management of high grade proximal tibia or tibial plateau fractures is often associated with complications. The use of wire fixators for the definitive treatment of such fractures entails a minimally invasive technique of insertion that gives good fracture reduction and stability combined with minimal postoperative complications. Aim: To assess the outcome of treatment of such fractures by the use of Joshi’s external stabilization system (JESS), which is a wire based, circular external fixator system. Materials and Methods: A prospective, uncontrolled study was done using JESS on 20 consecutive patients of high energy fractures of the tibial plateau, classified according to the Schatzker’s classification as type VI. Results: In this series, road traffic accidents accounted for most of the injuries (n=12), while pedestrian accidents (n=4), injury due to fall from height (n=3) and injury due to fall while playing (n=1) were the other modes of injury. The mean patient age was 39.4 years. The mean follow up period was 24 weeks. In this study, using Knee society score evaluation, excellent results were seen in 12 patients (60%), good results were seen in 5 patients (25%), fair in 2 patients (10%) and bad in 1 patient (5%). Complications seen were, pin tract infections in two cases (10%) which resolved with dressings and oral antibiotics and one case of non-union (5%), in which the tibial plateau fracture extended into proximal 1/3 of the tibial shaft with severe comminution. No other complication was encountered. Conclusion: JESS is a simple, inexpensive and useful technique in the management of high grade tibial plateau fractures.

In this paper, a novel class of rational cubic fractal interpolation function (RCFIF) has been proposed, which is characterized by one shape parameter and a linear denominator. In interpolation for shape preservation, the proposed rational cubic fractal interpolation function provides a simple but effective approach. The nature of shape preservation of the proposed rational cubic fractal interpolation function makes them valuable in the field of data visualization, as it is crucial to maintain the original data shape in data visualization. Furthermore, we discussed the upper bound of error and explored the mathematical framework to ensure the convergence of RCFIF. Shape parameters and scaling factors are constraints to obtain the desired shape-preserving properties. We further generalized the proposed RCFIF by introducing the concept of signature, giving its construction in the form of a zipper-rational cubic fractal interpolation function (ZRCFIF). The positivity conditions for the rational cubic fractal interpolation function and zipper-rational cubic fractal interpolation function are found, which required a detailed analysis of the conditions where constraints on shape parameters and scaling factor lead to the desired shape-preserving properties. In the field of shape preservation, the proposed rational cubic fractal interpolation function and zipper fractal interpolation function both represent significant advancement by offering a strong tool for data visualization. [ABSTRACT FROM AUTHOR]

Postgraduate Certificate of Education (PGCE) mathematics students work in groups to create lesson plans and resources about the historical and crosscultural roots of mathematics, with written reflections on celebrating diversity. Last years' lesson activities included: 'The Game AYO', 'Yoruba Number System', 'Towers of Hanoi', 'Crop Circles' and 'Tangrams, Sudoku and Kenken'. The students reflected on the implications on their classroom teaching with pupils, relating to unconscious bias and decolonisation of the national curriculum. At the summer British Society for Research into Learning Mathematics (BSRLM) workshop 2021, ideas were shared from university colleagues and students at York St. John University and for classroom teaching. BSRLM colleagues contributed to the Padlet for initial teacher education. Collaborative curriculum development practice takes place with student teachers, involving lesson planning of activities for classroom practice in placement schools. Reflections about critical mathematics education is outlined with feedback from pupils. Learning about contributions to mathematics from people from around the world can help pupil engagement and interest, whilst addressing diversity, inclusion and social justice issues. [ABSTRACT FROM AUTHOR]

A 37-year-old male, with a 5-year history of liposarcoma of the right thigh, was incidentally diagnosed with two huge thoracic metastases following a fall. One of these masses, measuring 22 cm, was located in the right chest apex, adjacent to a second 20 cm mass situated in the anterior mediastinum, partially invading the left chest. The patient underwent surgical intervention for mass resection that commenced with a hemi-clamshell incision, but was then extended by completing the lower median sternotomy in order to create a T shaped incision. This type of incision provides ample access for large mediastinal tumors that extensively extend into one side of the thoracic cavity, encompass the anterior mediastinum, and partially reach into the opposite cavity. It enhances visualization, facilitates access to vital organs, allows for precise surgical maneuvers, minimizes the risk of inadvertent tissue damage, and enables thorough oncological resection. [ABSTRACT FROM AUTHOR]