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Abstract Purpose To compare the anatomical and visual outcomes in eyes with submacular hemorrhage (SMH) treated with a combination of ranibizumab (RBZ) either innovator or biosimilar (Razumab) and intravitreal perfluoropropane gas (C3F8). Methods Treatment naïve neovascular age related macular degeneration (n-AMD) patients with SMH were retrospectively analyzed. Patients received either innovator or biosimilar RBZ (3 loading doses followed by pro re nata regimen) and single injection of intravitreal C3F8. Optical coherence tomography (OCT) was performed at baseline, 1, 3 and 6 months. Changes in best corrected visual acuity (BCVA) and central macular thickness (CMT) were assessed at 6 months. P value ≤ 0.05 was considered statistically significant. Results A total of 67 eyes (35 and 32 eyes in innovator and biosimilar group respectively) were analyzed. BCVA improved from 1.15 ± 0.19 to 0.51 ± 0.23 logarithm of minimum angle of resolution (logMAR) in innovator RBZ group (p 0.05). Mean number of intravitreal injections was marginally higher in innovator group compared to biosimilar RBZ (4.37 ± 0.49 vs. 4.22 ± 0.42; p = 0.18). Conclusion Biosimilar RBZ may act as a viable alternative to innovator RBZ to treat SMH with comparable anatomical and visual outcomes at 6 months.

Introduction: Diabetes Mellitus (DM) causes high blood sugar, leading to complications such as cerebrovascular events, chronic kidney disease, cardiovascular issues and retinopathy. Diabetic Retinopathy (DR) is a key microvascular complication and may indicate other diabetic issues. Studies suggest a link between DR and Cerebrovascular Accidents (CVAs) (strokes), particularly in low and middle-income countries where stroke rates are increasing. Aim: To assess the prevalence of DR among individuals who have experienced CVAs and to explore the relationship between DR and CVAs within the Indian population. Materials and Methods: The present cross-sectional study was conducted in the Department of Ophthalmology, Dr. D. Y. Patil Medical College and Research Centre (tertiary care hospital), Pimpri, Pune, Western Maharashtra, India, from November 2022 to June 2024. The study included 100 patients (200 eyes) aged 40-70 years with CVAs and diabetes. Details regarding age, gender and, detailed ocular and systemic information were recorded. Diagnosis of DM and CVA is done according to standard methods. Intraocular pressure was measured using the Goldmann Applanation Tonometer (GAT) and Optical Coherence Tomography (OCT). DR was classified based on severity into mild, moderate and severe groups. Data were analysed using Statistical Package for Social Sciences (SPSS) software version 26.0. Statistical significance was set at 5%. Results: In the present study, patients with DR had a mean±Standard Deviation (SD) age of 57.13±7.63 years. Among the CVA patients, 79% had DR. A total of 44 (44%) patients had moderate Non Proliferative Diabetic Retinopathy (NPDR), 20 (20%) had mild NPDR and 15 (15%) had severe NPDR. The average age of DR patients was 57.13±7.63 years, compared to 51.48±6.36 years for non DR patients. Haemorrhagic strokes were more common, occurring in 59 (59%) patients. Patients with both DR and CVAs were older and had higher blood sugar and HbA1c levels than those without DR. No association was found between DR and the type of stroke (p-value 0.761). Conclusion: Diabetic retinopathy was present in 79% of stroke patients, with moderate NPDR being the most common type. DR patients were older and had higher blood sugar and HbA1c levels. Haemorrhagic stroke was more prevalent in this group. However, no significant association was found between the types of stroke and DR.

Abstract Background Soft tissue sarcomas are uncommon mesenchymal malignancies that typically manifest as extremity masses. Their highly vascular nature can induce arteriovenous shunting, potentially leading to venous complications. Venous aneurysms, which represent isolated dilations of the venous system, are rare vascular phenomena that can occur throughout the body, with iliac vein involvement being particularly uncommon. While these aneurysms can be primary or secondary in nature, secondary cases predominate and require prompt medical attention due to risks of rupture and thromboembolic events. This case report describes an unusual presentation of thigh soft tissue sarcoma complicated by external iliac venous aneurysm formation, highlighting the importance of early recognition and management of vascular complications in sarcoma patients. Case presentation A middle-aged male in his fifties presented to the emergency department with continuous bleeding from a wound over a right inguinal swelling that had been ongoing for four hours. Initial ultrasound examination revealed a large heterogeneous soft tissue tumor in the subcutaneous plane of the right proximal thigh region with increased vascularity. This was associated with a large fusiform dilatation arising from the proximal portion of the right external iliac vein, showing a 'yin-yang sign' on color Doppler, suggestive of a right external iliac vein aneurysm. These findings were confirmed by contrast-enhanced arteriography, venography, and histopathology. The condition was diagnosed as soft tissue sarcoma and was treated accordingly. Conclusions This case highlights the importance of comprehensive vascular assessment in soft tissue sarcoma patients, as these rare tumors (1% of all malignancies) can cause secondary venous aneurysms through increased retrograde flow. While initial diagnosis relies on duplex ultrasound with color Doppler, additional imaging modalities such as CT venography, real-time venography, and MRI are essential for detailed evaluation. Management options include surgical resection with venorrhaphy, patch repair, venous bypass, or endovascular techniques like coil embolization. This case emphasizes the necessity of early detection and appropriate intervention to prevent potentially life-threatening complications.

Abstract Alzheimer’s Disease (AD) significantly aggravates human dignity and quality of life. While newly approved amyloid immunotherapy has been reported, effective AD drugs remain to be identified. Here, we propose a novel AI-driven drug-repurposing method, DeepDrug, to identify a lead combination of approved drugs to treat AD patients. DeepDrug advances drug-repurposing methodology in four aspects. Firstly, it incorporates expert knowledge to extend candidate targets to include long genes, immunological and aging pathways, and somatic mutation markers that are associated with AD. Secondly, it incorporates a signed directed heterogeneous biomedical graph encompassing a rich set of nodes and edges, and node/edge weighting to capture crucial pathways associated with AD. Thirdly, it encodes the weighted biomedical graph through a Graph Neural Network into a new embedding space to capture the granular relationships across different nodes. Fourthly, it systematically selects the high-order drug combinations via diminishing return-based thresholds. A five-drug lead combination, consisting of Tofacitinib, Niraparib, Baricitinib, Empagliflozin, and Doxercalciferol, has been selected from the top drug candidates based on DeepDrug scores to achieve the maximum synergistic effect. These five drugs target neuroinflammation, mitochondrial dysfunction, and glucose metabolism, which are all related to AD pathology. DeepDrug offers a novel AI-and-big-data, expert-guided mechanism for new drug combination discovery and drug-repurposing across AD and other neuro-degenerative diseases, with immediate clinical applications.

Background: Ultrasonography has revolutionized obstetric care over the past four decades by providing critical information about early pregnancy development and complications. This study focuses on evaluating the role of ultrasound (USG) in detecting embryonic demise and fetal anomalies in early part of pregnancy before targeted imaging for fetal anomalies scan. Aims and Objectives: The primary objective is to assess the sonographic features for early detection of fetal anomalies before 18 weeks of gestation and identify early signs of pregnancy failure or potential complications, enabling timely pregnancy management. Materials and Methods: This observational study was conducted at Maharani Laxmi Bai Medical College, Jhansi, involving pregnant women up to 18-week gestation. Participants underwent routine and targeted USG scans, including color Doppler studies. Data were collected on maternal, embryonic, fetal, and placental variables, and outcomes were monitored through follow-up scans and clinical evaluations. Results: Among 1080 antenatal USG scans, 240 showed abnormal sonographic findings. These were categorized based on gestational age and indications for scans. Notable findings included a higher abortion rate linked to irregular gestational sac borders, enlarged gestational sacs, low implantation, and enlarged yolk sacs. Fetal anomalies such as neural tube defects, anencephaly, and hydrops fetalis had a high correlation with adverse outcomes. Maternal factors, including large fibroids, uterine anomalies, and short cervical canals, were also associated with increased abortion rates. Doppler studies highlighted that a high uterine artery pulsatility index predicted pre-eclampsia and intrauterine growth restriction. Conclusion: Early pregnancy ultrasonography plays a vital role in detecting embryonic demise and fetal anomalies. This study underscores the importance of routine and targeted USG in enhancing pregnancy outcomes through early detection and timely intervention.

Purpose: To compare the visual outcomes of implantable Collamer lens (ICL) with small incision lenticule extraction (SMILE) in cases of moderate-high myopia. Methods: A prospective comparative study was conducted on 60 eyes of 30 patients with moderate-high myopia (−3D to −8D with astigmatism ≤1 D) at a tertiary eye care center. Patients underwent either SMILE or ICL in both eyes and had a postoperative follow-up of 1 year. Results: The manifest refractive spherical equivalent was −5.22 ± 1.05 D and −5.4 ± 1.17 D in the SMILE and ICL groups, respectively (P = 0.53). The mean sphere and cylinder were comparable between the groups. The mean uncorrected visual acuity improved from 1.18 ± 0.19 logMAR to 0.03 ± 0.07 logMAR in SMILE and 1.14 ± 0.25 logMAR to 0.011 ± 0.04 logMAR in the ICL group. The efficacy for SMILE was 83.3% and that for ICL was 93.3%. Safety and predictability (±0.5D) for both was 100%. A significant increase was observed in ocular aberration with a decrease in modular transfer function in the eyes that underwent SMILE, whereas no significant change in the eyes that underwent ICL. A significant difference was observed in all parameters of ocular aberration except corneal trefoil, corneal astigmatism, and PSF between the two groups at the final follow-up. The contrast sensitivity at final follow-up was higher in ICL cases when compared to SMILE. The quality of vision (QoV) score suggested a better QoV with ICL; however, the difference was not statistically significant. Conclusion: Both SMILE and ICL are safe in patients with moderate-high myopia. The efficacy, contrast sensitivity, and postoperative ocular aberration profile are better in cases undergoing ICL.

Purpose: To compare the corneal biomechanical parameters, visual outcome, and epithelial remodeling after small-incision lenticule extraction (SMILE) and photorefractive keratectomy (PRK) for low to moderate myopia. Design: Prospective, interventional, randomized, comparative study. Methods: Eighty eyes of 40 patients undergoing bilateral SMILE or PRK for low to moderate myopia (

Most degree-seeking undergraduate students at US universities graduate with a higher number of credit hours than is required for graduation, thereby accumulating extra credits. Although existing literature is rich with studies on extra credit accumulation, most of them are limited to comparing overall credit numbers and thus do not consider the usability of individual credits towards the degree program requirements. This limitation can be attributed to the use of inflexible and/or opaque commercial degree audit tools, which curtails the possible scope of analytics on degree audit data. This work uses a custom-built audit tool that determines an optimal match between individual classes and requirements and then decomposes student credits in the following categories: unusable credits that do not match any degree requirement, excess credits that can satisfy at least one requirement but can be removed without changing overall requirement satisfaction, and applied credits that contribute to requirement satisfaction without excess. Thus, extra credits are decomposed into unusable and excess credits. This paper uses this decomposition to investigate (and quantify) numerous possible reasons for extra credit accumulation including transfer credit loss, program change, financial aid retention, hidden requirements, repeated classes, remedial classes, filler classes, and program requirement characteristics. These investigations compare Transfer and Non-Transfer students, compare extra credit accumulation by college, and explore the term-wise accumulation of extra credits. Surprisingly, this analysis suggests that transfer credit loss (i.e., transfer credits not being accepted or not applying to the chosen major) is not a major contributor to extra credits. It also shows that extra credit accumulation by Transfer and Non-Transfer students is very similar, suggesting that the transfer process may have little influence on extra credit accumulation. Finally, it suggests that extra credit accumulation is likely due to multiple factors without a single dominating factor.

Abstract Background Around five billion people globally lack access to safe, timely, and affordable surgical facilities and care in low-income and middle-income countries (LMICs). Global initiatives have been launched, including efforts led by organizations. Also, regional efforts have shed light on the unique challenges faced by different areas within LMICs. Despite these efforts, many countries still face significant challenges, including inadequate infrastructure, limited availability of trained surgical personnel, lack of essential medical equipment, and insufficient financial resources allocated to healthcare and their related possible factors. Here is that we aim to identify the progress made in areas such as capacity building, training programs, infrastructure development, and policy reforms, as well as highlight the gaps that persist, providing a foundation for future research. Such a comprehensive scoping review will be crucial to enhance surgical care services and ultimately improve health outcomes in LMICs. Methods A comprehensive literature search up to November 2024 will be conducted across six major databases. PubMed, Scopus, Ovoid, Web of Science, Cochrane Central, CNKI (China National Knowledge Infrastructure) database. The methodology will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist. The first version of this project will not include a quality appraisal.

Abstract The estrous cycle regulates reproductive events and hormone changes in female mammals and is analogous to the menstrual cycle in humans. Monitoring this cycle is necessary as it serves as a biomarker for overall health and is crucial for interpreting study results. The estrous cycle comprises four stages influenced by fluctuating levels of hormones, mainly estradiol and progesterone. Tracking the cycle traditionally relies on vaginal cytology, which categorizes stages based on three epithelial cell concentrations. However, this method has limitations, including time-consuming training and variability among researchers. This study assesses the feasibility and reliability of two previous image classification models as well as introducing an alternative method of machine learning to address the challenges posed by manual vaginal cytology and image classification. An object detection-based machine learning model, Object Detection Estrous Staging (ODES), was employed to identify cell types throughout the estrous cycle in mice. A dataset of 730 vaginal cytology images with four different stains was used, with 335 images for training, 45 for validation, and 350 for testing. A novel, accurate set of rules for classification was derived by analyzing training images. ODES achieved an average accuracy of 80% in classifying cycle stages, comparable to human accuracy (66%) and previous image classification models (41–79%). The efficiency of ODES, processing 100 test images in just 2.67 minutes, makes it a valuable tool for large-scale neuropsychiatric studies involving female rodents and also encourages the integration of this variable into neurological and psychiatric research. These results demonstrate that ODES offers a fast, reliable, and accessible method for estrous cycle monitoring, potentially improving how researchers approach sex-based variables in neuropsychiatric studies.

The efforts in the field of virtualizing the guitar into well-modelled software systems have faced a lot of practical limitations. The existing guitar simulation programs require additional devices such as Electromyography (EMG) controllers, or Musical Instrument Digital Interface (MIDI)-based recording devices. The EMG-based device is still a work in progress, the device is expensive and it was not very well received by the instrumentalists. There exists a gap in the bridge that joins physical instruments to their software counterparts. In this context, this paper aims to significantly remove the inaccuracies and drawbacks related to the existing solutions by accounting for the individual roles that each hand plays in the act of guitar strumming and consolidating them into a single system. The design of the proposed AirStrum system involves a multi-step process. Initially, a dataset is created by recording images of hand gestures corresponding to the playing of various chords on a guitar. The palm is detected, and its related skeleton image is generated using MediaPipe. Subsequently, a model based on a Convolutional Neural Network (CNN) is trained and validated using the employed dataset to adeptly recognize and classify guitar chords. Additionally, this model incorporates a velocity detection function for the strumming hand. Finally, the proposed system can play different sounds by inferring both the played chord and the strumming velocity from human actions. This comprehensive approach enables a sophisticated virtual guitar experience based on a system that responds dynamically to the users' gestures and strumming techniques. The conducted experiments demonstrate that AirStrum achieves an accuracy of 95.92%, and a brief preliminary survey related to its perceived utility and usability received a positive feedback rate of 58% from eight guitar players.

Abstract In modern power systems, the integration of inverter‐based renewable energy sources has significantly reduced system inertia, leading to heightened frequency fluctuations and potential instability within multi‐area interconnected microgrids. To counter this, a virtual inertia and damping controller utilizing battery energy storage, leveraging the virtual synchronous generator concept is proposed in this paper. This controller supplements inertia by modulating active power flow, thus stabilizing frequency during high renewable energy source penetration periods. Additionally, to enhance load frequency control, a cascaded controller combining adaptive neuro‐fuzzy inference system‐assisted fractional‐order PID with a nonlinear FOPI controller is introduced. It should be noted that improper controller parameters can worsen frequency deviations and system stability. Hence, a whale optimization algorithm optimizes control parameters using the integral time absolute error based objective function. Simulation studies on a modified IEEE 10‐generator 39‐bus power system, considering various disturbances like stochastic load‐generation, nonlinear generation behaviours, and time delay, validate the effectiveness of the proposed controller. Comparative analysis demonstrates the superior resilience of the cascaded control approach in managing contingencies within low‐inertia power systems, with a remarkable performance improvement of 87.9811% compared to existing control methods.

Background Posterior reversible encephalopathy syndrome (PRES) is characterized by reversible neurotoxicity. The symptoms include headache, altered consciousness, seizures, visual disturbances, and focal neurological deficits. The severe variant, known as malignant PRES, is rare and involves diffuse cerebral edema, leading to irreversible damage. Chronic kidney disease (CKD) with impaired blood pressure regulation is a known risk factor for malignant PRES. Case report We report the case of a patient with CKD who presented with hypertensive crisis and later developed malignant PRES in the background of status epilepticus refractory to antiepileptic treatment. Conclusions This case highlights the importance of considering malignant PRES in hypertensive crises and emphasizes the need for further research to elucidate its pathophysiology and develop effective treatment strategies.

Background: Aloscasia macrorrhiza, commonly known as Giant Taro, is a species rich in phytochemicals with diverse pharmacological properties. Phytochemical analysis shows different bioactive compounds like alkaloids, flavonoids, terpenoids, phenolics, and saponins in different components of the plant body, including leaves, stems, and roots. Alocasin, a class of alkaloids, is most prominent in this plant. These substances are likely responsible for different biological activities, as Aloscasia macrorrhiza shows. Aim: This review unveils the phytochemical composition and pharmacological activities of various parts of Aloscasia macrorrhiza. Method: Multiple Literature, including research and review papers, were searched for based on their title, abstracts, and keywords. Keywords like ‘Aloscasia macrorrhiza,’ ‘Phytochemistry,’ ‘Traditional uses,’ and ‘Ethnomedicinal uses’ were used to collect information. Abstracts of articles with relevant titles were screened, and the full text was considered. Only articles published from 2018 to 2024 were considered. Based on their classes and mechanistic actions, this review consolidated these phytoconstituents. Results: These phytoconstituents exhibit a wide array of therapeutic activities, including anti-inflammatory (due to tannins and polyphenols), antimicrobial (due to terpenes and lectins), antioxidant (due to polyphenols), anticancer (due to flavonoids), anti-diabetic (due to flavonoids) effects. Conclusion: This review provides insights to the therapeutic potential of Aloscasia macrorrhiza and hence forms a bridge of understanding between the traditional uses and the modern Pharmacology studies. In the future, further clarification and detailed mechanistic insight can be done. Aloscasia macrorrhiza may have potential therapeutic applications and is subject to further investigation.

Background: Adolescent is a very crucial period of life for the growth and development of the body and mind. Nutrition influences growth and development throughout infancy, childhood and adolescents. Aims and Objectives: The aim of the sudy was to assess the nutritional status in terms of thinness, overweight and obesity and stunting amongst the school-going adolescents and to find out the factors related to nutritional status amongst the study subjects. Methodology: Community-based descriptive cross-sectional study was conducted amongst six rural schools of Bankura-I community development block in Bankura district from July to September 2017. With the help of a pre-designed, pre-tested, semi-structured schedule, a total of 600 adolescent students were interviewed, and clinical examinations were done. The collected information was entered into Microsoft Excel sheet and analysed using SPSS-20. Results: The mean age of the study population was 13.2 ± 2.19 years. About one-third (32.8%) of adolescent students were thin, as per body mass index for age Z-score category. Normal nutritional status was found in the majority of students (63.8%), but overweight and obesity were only 3.4% amongst the adolescent students. Stunting (31.0%) was higher amongst the late adolescents, and also that the percentage of stunting was higher in adolescent girls (35.8%) than boys (15.0%). Stunting was also significantly related with caste, SE class, family type according to number of family members and birth order of study subjects. Conclusions: School-based as well as community-based adolescent-friendly health and nutrition education and services and economic development may improve the overall health and nutritional knowledge and status of adolescents.

INTRODUCTION: Platelet transfusion has been therapeutically used in patients with thrombocytopenia and platelet function defects over the years. The use of advanced techniques may add value in assessing the quality of platelet products. The aim of the study was to assess stored platelet concentrates (PCs) prepared in blood banks for platelet indices, clot strength, and platelet function. MATERIALS AND METHODS: Apart from the routine quality check parameters (platelet count, volume, pH, swirling, and sterility), 24-h-old PCs derived by the platelet-rich plasma method (PRP-PC) were prospectively assessed for various platelet indices using hematology analyzer and clot strength using thromboelastography (TEG). Platelet function (platelet activation and aggregation) was assessed using flow cytometry and compared with freshly prepared PRP. RESULTS: A total of 43 PRP-PCs that were analyzed had a mean volume of 69.1 ± 5.1 mL, a pH of 6.8 ± 0.3, and a platelet count of 738.8 ± 312.9 × 103 cells/μL. Swirling was present in all. The platelet distribution width, mean platelet volume, platelet-large cell ratio, plateletcrit, and immature platelet fraction were 9.4 ± 2.7 fL, 8.7 ± 1.2 fL, 16.9% ± 8.9%, 0.6% ± 0.3%, and 4.4% ± 3.9%, respectively. The r-time, k-time, alpha angle, and maximum amplitude were 15 ± 0.3 min, 2.1 ± 0.4 min, 65.2° ± 2.3°, and 76.1 ± 10.1 mm, respectively. Delayed clot initiation and higher clot strength were observed in in 60% (n = 21) and 71.4% (n = 25) of products, respectively Platelet activation of PRP-PC was significantly lower than PRP (0.4 [0.1%–42%] vs. 10.5 [0.8%–32.4%]; P = 0.002). However, platelet aggregation of PRP-PC was significantly higher than PRP (62.0 [26.7%–88.7%] vs. 33.4 [4.9%–55.8%]; P = 0.003). CONCLUSION: Platelet indices, TEG, and flow cytometry analysis provides useful information to assess the quality of PCs. However, the variable effects of processing and storage on platelet activity need further exploration.

Context: Plantar fasciitis, a prevalent cause of heel pain, poses challenges in treatment due to diverse therapeutic options and variable outcomes. Platelet-rich plasma (PRP) and triamcinolone acetonide (TA) injections have emerged as potential interventions, yet their comparative effectiveness remains debated. Aims: The aim of the study was to compare the effectiveness of PRP and TA injections in relieving pain, improving function, and promoting healing in individuals with plantar fasciitis. Settings and Design: The study design was a prospective, hospital-based, experimental study. Subjects and Methods: A 2-year prospective hospital-based experimental study was conducted, enrolling patients aged 30–60 years with plantar fasciitis. Patients received either PRP or TA injections. Preoperative assessments and 3 months of monitoring were performed. Foot and Ankle Outcome Score (FAOS) survey was utilized for outcome evaluation. Statistical Analysis Used: T-test was applied. Results: Ninety patients were included, with both treatment groups demonstrating significant improvement in foot symptoms. PRP administration showed superiority in descending and ascending stairs, rising from sitting, and walking on flat surfaces compared to TA. FAOS scores indicated significant improvement posttreatment in both groups, with PRP yielding better outcomes than TA. Conclusions: Both PRP and TA injections effectively alleviate foot symptoms in plantar fasciitis patients. However, PRP demonstrates superior outcomes in specific functional activities and quality-of-life components compared to TA. These findings suggest PRP as a preferred intervention in the management of plantar fasciitis.

Dilated Cardiomyopathy (DCM) is a rare but significant complication in patients with primary Sjögren’s Syndrome (pSS), a systemic autoimmune disease that primarily affects the exocrine glands. Cardiac involvement in pSS is uncommon, making the recognition of DCM in these patients crucial for timely intervention. This is a case of a 44-year-old female with well-controlled hypertension who developed progressively worsening shortness of breath, chest pain and bilateral pedal oedema. She also had a two-month history of dry eyes and dry mouth, indicative of sicca symptoms. Clinical examination revealed signs of fluid overload, a pansystolic murmur and sicca features. Electrocardiogram (ECG) and echocardiography demonstrated severe left ventricular dysfunction with an ejection fraction of 15%, consistent with DCM. Laboratory investigations revealed elevated N-terminal pro b-type natriuretic peptide (NT-proBNP) levels and positive anti-Ro52 and anti-La antibodies, pointing to an autoimmune aetiology. Cardiac Magnetic Resonance (CMR) Imaging confirmed non ischaemic DCM, ruling out ischaemic causes. The patient was diagnosed with DCM secondary to pSS. She was treated with diuretics, Angiotensin Converting Enzyme (ACE) inhibitors and immunosuppressive therapy, including methylprednisolone and a tapering course of prednisolone over six months. Significant clinical improvement was observed on follow-up. This case highlights the importance of recognising autoimmune aetiologies, such as pSS, in patients presenting with unexplained cardiomyopathy. Early diagnosis and interdisciplinary management are essential in preventing severe cardiac complications and improving patient outcomes in rare presentations of Sjögren-associated cardiomyopathy

In patients with cirrhosis of the liver, acute variceal bleeding can be fatal. Bleeding colonic varices is a very rare cause of lower gastrointestinal bleeding that can result in massive hemorrhage in patients with cirrhosis. Here we present the case of a 50-year-old gentleman, having cirrhosis of the liver with chronic portal vein occlusion, who presented with massive bleeding per rectum. Contrast computed tomography (CT) revealed a large shunt arising from the superior mesenteric vein forming submucosal colonic varices and joining the right renal vein. He underwent successful obliteration of the varix by antegrade endovascular embolization via the trans-splenic access. Endovascular embolization could be an effective and life-saving treatment option for colonic variceal bleeding.

Additive manufacturing (AM), or 3D printing, has revolutionized the fabrication of complex parts, but assessing their quality remains a challenge. Quality assessment, especially for the interior part geometry, relies on post-print inspection techniques unsuitable for real-time in situ analysis. Vision-based approaches could be employed to capture images of any layer during fabrication, and then segmentation methods could be used to identify in-layer features in order to establish dimensional conformity and detect defects for in situ evaluation of the overall part quality. This research evaluated five image segmentation methods (simple thresholding, adaptive thresholding, Sobel edge detector, Canny edge detector, and watershed transform) on the same platform for their effectiveness in isolating and identifying features in 3D-printed layers under different contrast conditions for in situ quality assessment. The performance metrics used are accuracy, precision, recall, and the Jaccard index. The experimental set-up is based on an open-frame fused filament fabrication printer augmented with a vision system. The control system software for printing and imaging (acquisition and processing) was custom developed in Python running on a Raspberry Pi. Most of the segmentation methods reliably segmented the external geometry and high-contrast internal features. The simple thresholding, Canny edge detector, and watershed transform methods did not perform well with low-contrast parts and could not reliably segment internal features when the previous layer was visible. The adaptive thresholding and Sobel edge detector methods segmented high- and low-contrast features. However, the segmentation outputs were heavily affected by textural and image noise. The research identified factors affecting the performance and limitations of these segmentation methods and contributing to the broader effort of improving in situ quality assessment in AM, such as automatic dimensional analysis of internal and external features and the overall geometry.

Abstract Introduction This study aims to evaluate the ocular and systemic safety profiles of intravitreal biosimilar ranibizumab Ranieyes (Lupin Pharmaceuticals, Mumbai, India) in real-world clinical settings across multiple chorioretinal vascular diseases, including neovascular age-related macular degeneration (nAMD), diabetic macular edema (DME), and retinal vein occlusion (RVO) in adults. Methods We conducted a retrospective, consecutive, interventional, uncontrolled multicenter study using data from three hospital networks in India. A total of 1401 eyes received 2194 injections of Ranieyes between June 2022 and November 2023. Patients were followed for a minimum of 6 months, and data on ocular and systemic adverse events (AEs) were collected and analyzed. Results The study population included 636 male patients and 533 female patients, with a mean age of 58.63 ± 11.54 years. The average number of injections per eye was 1.49 ± 0.23, with the highest frequency in the nAMD group (mean of 2.3 ± 0.23 injections per eye) over 6 months. Non-serious adverse events (nsAEs) were observed in 26.83% of injections, with mild ocular pain and transient blurring of vision being the most common. Serious ocular adverse events were rare, occurring in 0.85% of eyes, with retinal pigment epithelial tear (RPE TEAR) being the most frequent. Systemic adverse events were noted in 5.03% of patients, and all but one were non-serious. One patient developed non-fatal myocardial infarction, the causal relationship of which, however, was not established with the intravitreal agent used. No cases of endophthalmitis were observed. Conclusions This large-scale, real-world study demonstrates that Ranieyes is a safe intravitreal antivascular endothelial growth factor (anti-VEGF) agent across various chorioretinal vascular diseases. The safety profile of Ranieyes is consistent with that of the reference product, making it a viable option in resource-constrained settings.

Background: Diabetes mellitus (DM) affects a substantial proportion of the world’s population and is associated with an increased risk of sudden cardiac death (SCD) due to cardiac arrhythmias, specifically prolonged QT intervals. This study investigates the correlation between glycemic control and cardiac health in 77 diabetic patients. Methods: Patients with both type 1 and type 2 DM aged 14 to 82 years were included. Various clinical and metabolic parameters were evaluated, including glycated hemoglobin (HbA1C). QT intervals were measured using electrocardiograms (ECGs), and patients were categorized based on their QTc intervals. SPSS was used for statistical analysis, including one-way ANOVA tests. Results: The study revealed diverse age and gender representation among diabetic patients. Most patients had type 2 diabetes (87%) with varying illness durations. Patients ranged in age from 14 to 82 years, with a mean of 48.14 16.58 years. The gender distribution was even (49% male and 51% female). Most participants had diabetes for less than five years (57%) and varied treatment histories (71% managed with oral hypoglycemic agents, 17% with insulin, and 12% with a combination). The ECG revealed ST-T alterations (4%) as well as sinus tachycardia (13%) and left ventricular hypertrophy (19%). Conclusion: This study sheds light on the intricate relationship between diabetes, glycemic control, and cardiac health. QTc interval variations were observed even though the clinical and metabolic profiles of the patients varied. The influence of glycemic control on QT intervals and cardiovascular outcomes in diabetic patients requires additional study.

Abstract The variability of renewable energy sources due to weather patterns often leads to a mismatch between power generation and consumption within microgrids (MGs). This challenge is exacerbated when integrating bio‐renewable units, complicating stability maintenance in MGs. This research work introduces a novel solution to address this issue: a composite controller merging an integral terminal sliding mode controller with a recursive backstepping controller for direct current MGs (DCMGs). The proposed DCMG incorporates solar photovoltaic units, wind farms based on permanent magnet synchronous generators, proton exchange membrane fuel cells fuelled by hydrogen gas, an electrolyser, battery energy storage systems, and DC loads. First, a comprehensive mathematical model for the components within the DCMG is developed to design the proposed composite controller. This controller not only overcomes the inherent limitations and convergence issues of conventional SMCs but also ensures stable DC‐bus voltage and maintains power balance across various operational conditions. Moreover, a fuzzy logic‐based energy management system is introduced to regulate power flow, considering factors like battery state of charge and renewable energy sources' total power output. The control Lyapunov function confirms the DCMG system's asymptotic stability. Finally, the proposed controller's effectiveness is validated through simulations on both MATLAB/Simulink and Arduino Mega 2650 processor‐in‐the‐loop platforms under various operational conditions. In both platforms, the proposed controller surpasses an existing controller in terms of settling time, overshoot, and tracking error of the DC‐bus voltage.

Abstract Embryonic stem cells possess the remarkable ability to self-organize into blastocyst-like structures upon induction. These stem cell-based embryo models serve as invaluable platforms for studying embryogenesis and therapeutic developments. Nevertheless, the specific intrinsic regulators that govern this potential for blastoid formation remain unknown. Here we demonstrate an intrinsic program that plays a crucial role in both blastoids and blastocysts across multiple species. We first establish metrics for grading the resemblance of blastoids to mouse blastocysts, and identify the differential activation of gene regulons involved in lineage specification among various blastoid grades. Notably, abrogation of nuclear receptor subfamily 1, group H, member 2 (Nr1h2) drastically reduces blastoid formation. Nr1h2 activation alone is sufficient to rewire conventional ESC into a distinct pluripotency state, enabling them to form blastoids with enhanced implantation capacity in the uterus and contribute to both embryonic and extraembryonic lineages in vivo. Through integrative multi-omics analyses, we uncover the broad regulatory role of Nr1h2 in the transcriptome, chromatin accessibility and epigenome, targeting genes associated with embryonic lineage and the transposable element SINE-B1. The Nr1h2-centred intrinsic program governs and drives the development of both blastoids and early embryos.

Abstract Metformin is an antihyperglycemic used to treat type 2 diabetes mellitus (T2DM). Patients with T2DM are at increased risk of cardiovascular disease. We explored the association between metformin use and cardiovascular magnetic resonance (CMR) derived stress myocardial blood flow (MBF), myocardial perfusion reserve (MPR) and major adverse cardiovascular events (MACE; all cause death, MI, stroke, heart failure hospitalisation and coronary revascularisation) in patients with T2DM. Multi-centre study of patients with T2DM, and healthy controls, underwent quantitative myocardial perfusion CMR using an artificial intelligence supported process. Multivariable regression analysis, and cox proportional hazard models of propensity score weighted patients quantified associations between metformin use, MBF, MPR, all cause death and MACE. Analysis included 572 patients with T2DM (68% prescribed metformin) with median follow-up 851 days (IQR 935 − 765). Metformin use was associated with an increase of MPR of 0.12 [0.08–0.40], p = 0.004. There were 82 MACE events (14.3%) including 25 (4.4%) deaths of which 16 were in those not prescribed metformin (8.7%), compared to 9 in patients prescribed metformin (2.3%): adjusted hazard ratio 0.24 (95% CI 0.08–0.70, p = 0.009). MACE events were similar between groups. This multicentre, inverse probability weighting propensity score analysis study showed that in patients with T2DM, metformin use is associated with higher MPR and improved all cause survival.

This research work aims to investigate the tensile properties, micro-hardness and microstructural changes of AA2014-T6 cold metal transfer (CMT) weldments in as-weld and post-weld heat treatment (PWHT) conditions. X-ray radiography test is conducted to inspect the internal defects and confirmed that the welded structures were free from macro/micro defects. The welded structures are tested to evaluate the tensile properties, micro-hardness and microstructural changes in both the conditions. The ultimate tensile strength (UTS) of CMT1 and CMT2 is observed as 316 and 241 MPa, respectively in as-weld condition whereas the UTS value of CMT1 & CMT2 is 376 and 325 MPa, respectively after heat treatment. The welding strength is improved by 18.9 and 34.8% in CMT1 & CMT2 respectively when the samples were subjected to heat treatment process. The average hardness value of 105 and 106 HV is observed in CMT1 & CMT2, respectively in as-weld condition. Whereas, the hardness number is increased to 128 and 121 HV in CMT1 & CMT2, respectively when the samples were subjected to heat-treatment. After PWHT, the weld zone is more homogeneous than when it was first welded, indicating that PWHT has been effective in reducing thermal stresses and promoting the formation of a more homogeneous microstructure.

Neuroretinitis is a potentially vision-threatening condition characterised by the swelling of the optic disc, followed by the development of a macular star due to the spread of fluid to the surrounding peripapillary retina. The present case report describes a rare case of unilateral neuroretinitis in a 36-year-old male who presented with an acute, painless decrease in vision in the right eye. The patient exhibited classic signs of neuroretinitis, such as optic disc oedema and a macular star. A systemic work-up ruled out most infectious and inflammatory causes, while serological tests for Cat Scratch Disease (CSD) showed highly reactive results. He was immediately started on appropriate oral antibiotics and steroids for six weeks, after which he experienced significant visual recovery. Managing neuroretinitis involves early investigation, addressing the underlying infection and mitigating the inflammatory response. Challenges include the need for accurate and timely diagnosis, often requiring serological tests and imaging studies. Notably, the present case underscores the importance of considering Bartonella henselae infection in the differential diagnosis of neuroretinitis, particularly in patients with a history of cat exposure. The rarity of such presentations in otherwise healthy young individuals highlights the need for increased awareness and prompt diagnostic evaluation to ensure optimal outcomes and prevent long-term visual impairment.

Struma ovarii (SO), also known as monodermal ovarian teratoma, is a rare and an uncommon histological diagnosis and a kind of mature dermoid cyst in which thyroid tissue makes up more than 50% of the total component. Boettlin originally reported this tumor in 1889. Although it had been previously documented, Ludwig Pick in 1901 described that this tumor was made up of thyroid tissue. While it is usually benign, its potential to produce thyroid hormones and the rare possibility of malignancy make it an interesting and clinically significant condition. Early diagnosis and appropriate management, often involving surgical removal, are key to ensuring the best outcomes for patients with SO. Definitive diagnosis is based on histopathological examination. This case report is presented due to its rarity and its variable clinical and radiological presentation.

Background: The data on Leydig cell hypoplasia (LCH) resulting from biallelic Luteinizing hormone/chorionic gonadotropin receptor (LHCGR) inactivating variants is limited to case series. Methods: We aim to describe our patients and perform systematic review of the patients with LHCGR inactivating variants in the literature. Detailed phenotype and genotype data of three patients from our centre and 85 (46,XY: 67; 46,XX: 18) patients from 59 families with LHCGR-inactivating variants from literature were described. Results: Three 46,XY patients (age 6–18 years) from our center, with two reared as females, had two novel variants in LHCGR. Systematic review (including our patients) revealed 72 variants in 88 patients. 46,XY patients (n = 70, 56 raised as females) presented with pubertal delay (n = 41) or atypical genitalia (n = 17). Sinnecker score ≥3 (suggesting antenatal human chorionic gonadotropin (hCG) inaction) was seen in 80% (56/70), and hCG-stimulated testosterone was low (

Abstract Epitaxial quantum dot (QD) scintillator crystals with picosecond-scale timing and high light yield have been created for medical imaging, high energy physics and national security applications. Monolithic photodetector (PD) integration enables the sensing of photons generated within the waveguiding crystal and allows a wide range of scintillator-photodetector coupling geometries. Until recently, these doubly novel devices have suffered from complex, high variance responses to monoenergetic sources which significantly reduces their precision and accuracy. The principles governing the overall device response have now been discerned and embodied by an expression derived within a geometrical optics framework which considers optical properties, surface roughness and photodetector coupling geometry. Response variation due to these factors was sufficiently reduced to obtain material-related energy resolution values of 2.4% with alpha particles. These findings place energy resolution alongside luminescence timescale, photon yield, and radiation hardness as outstanding properties of these engineered materials.

Abstract This research paper aims to optimize the TIG welding parameters to join dissimilar metals of AA5083 and AA7075 using the Taguchi technique. The TIG welding current and root gap of butt geometry configuration are considered input parameters, and welding characteristics such as tensile strength, 0.2% of yield strength, hardness, and impact energy are output responses. The base metals are joined according to the Taguchi L-09 design of experiments. The welded samples were inspected using the X-ray radiography method for internal defects. Tensile properties, hardness number, and impact energy of different welding coupons were evaluated by conducting the uni-axial testing, a Brinell hardness test, and an Izod impact test, respectively. A better weld strength of 224 MPa was observed at 210 A welding current, and the root gap of 1.5 mm was maintained. Better hardness and impact energy values were observed when the root gap of 1.5 mm and welding current of 220 A were maintained. The root gap is the primary factor influencing tensile strength enhancement, which accounts for 44.78% of the effect, followed by 40.5% welding current. Root gap is the parameter that affects the tensile properties, hardness number, and impact toughness the most. The findings of this paper suggest the optimal parameters for welding AA5083 and AA7075 dissimilar base metals, which are suitable for complex structures requiring both durability and resistance to harsh environments.

Abstract Since the beginning of humanity, people have used wild medicinal plants for the treatment of various diseases. Nowadays, researchers and scientists pay attention to exploring new tools to maximize the efficacy of natural products from natural resources, and among these tools formulation of nanoparticles is very promising. The green synthesis of metal/metal oxide nano-solutions using the Deverra tortuosa extract has still not been explored well. This study aims to prepare many metal/metal oxide nanoparticle solutions such as ZnO-NPs, SeO2-MNPs, and Ag-NPs via the methanol extract of D. tortuosa as safe, easy, green, and economic approach as well as characterize the chemical components of D. tortuosa plant by GC-MS spectroscopy analysis. The synthesized M-NPs solutions were characterized by UV–visible (UV–Vis) spectroscopy, Transmission Electron Microscope (TEM), zeta potential, Fourier Transform Infrared (FT-IR) spectroscopy, and phytochemical analyses. The potential antioxidant capacity was estimated for the methanol extract of this plant along with the metal/metal oxide nanoparticles solutions by DPPH assay. In addition, the cytotoxic activity was in vitro assessed for the inspected samples against various tumor and normal cell lines applying MTT assay. The application of the D. tortuosa methanolic extract resulted in NPs with a range of 11.79–85.9 nm which was characterized by UV-Vis spectroscopy, TEM, zeta potential, and FT-IR spectroscopy that revealed various functional groups of the tested samples. The GC-MS analysis of the D. tortuosa methanolic extract showed the presence of 31 chemical compounds with 2-methyl-3-oxocyclopent-1-ene-1-carboxylic acid, methyl oleate, and 6-allyl-4,5-dimethoxybenzo[d][1,3]-dioxole as major constituents. The extract showed considerable antioxidant activity as well as antimicrobial activity that was assessed also against varied bacterial and fungal species. Remarkable potencies for the investigated metal/metal oxide nanoparticle solutions hinder the growth of the tumor cell lines, in addition to the growth of the microbial species. Based on the determined biological activities of the produced NPs, future study is recommended to characterize the pure authentic compounds that are identified within the D. tortuosa as major compounds as well as evaluate their modes of action.

Abstract Background The Asia-Pacific (APAC) region includes a significant proportion of the global population currently living with overweight and obesity. This modelling analysis was conducted to quantify the incidence of obesity-related comorbidities and change in obesity-related costs over 10 years with a hypothetical 10% weight loss in Australia, South Korea, Thailand, and India. Methods An epidemiological-economic model was used to describe current prevalence and direct medical costs of ten obesity-related comorbidities, including type 2 diabetes and hypertension, in adults aged 20–69 years living with obesity, and estimate incidence and costs over 10 years. Incidence reduction and the associated savings by 2032 were then estimated for a 10% weight-loss scenario. Results The total estimated medical costs for the ten obesity-related comorbidities in 2022 were 2.9, 7.5, 10.2, and 23.3 billion USD in Australia, South Korea, Thailand, and India, respectively. Costs increase to 6.9, 18.4, 23.5, and 44.3 billion USD in 2032, if insufficient action is taken. A 10% weight reduction would result in estimated savings of 0.3, 1.2, 2.2, and 3.0 billion USD in Australia, South Korea, Thailand, and India, respectively, in 2032, with cumulative savings over the 10-year period of 1.8, 7.0, 13.0, and 17.4 billion USD. Incidence of comorbidities were estimated to rise less in the weight-loss scenario. Conclusions The financial, societal, and health benefits of a substantial but achievable 10% weight loss in adults living with obesity, and the consequences of insufficient action, are pronounced in the APAC region. To achieve sustained weight loss in the real world, policy actions for addressing barriers to obesity management are required.

Abstract It is tough and complex to forecast wind speed due to its intermittent and stochastic nature as well as sudden and abrupt variations in the wind speed. Further, it is required to handle the variety of scenarios e.g. cyber‐attacks, unexpected power device malfunction, communication/sensor outages etc. that can cause the missing data.This paper proposes and employs a de‐noising autoencoder algorithm for wind speed forecasting to ensure the handling of missing data information. At the next step, the data is processed via variational mode decomposition technique to mitigate the noise and improves the model's prediction accuracy. Furthermore, the bi‐directional long‐short term memory deep learning approach is tied with convolution neural network to increase prediction accuracy and anticipating the sudden/abrupt changes in wind speed accurately. Finally, actual wind speed related data is examined to scrutinize meticulousness of projected forecast methodology particularly during sudden/abrupt changes in the wind speed. The parameter indicators of the wind speed forecasting technique exhibit the capability of improved predictions under the diversified conditions.

Background: Disaster mental health is a critical yet neglected aspect in India. Primary care physicians (PCPs) play a crucial role in mitigating mental health challenges following disasters. This study conducted a knowledge, attitude, and practice (KAP) survey among PCPs in Karnataka to assess their disaster mental health preparedness. Methods: A cross-sectional online survey was conducted from February to May 2023 targeting PCPs across 29 districts of Karnataka in a convenient snowball sampling method. The questionnaire review included KAP questions on disaster mental healthcare. A total of 324 PCPs responded. Results: Knowledge scores were moderate (mean: 7.05), attitudes were positive (mean: 9.15), and practices were poor (mean: 0.32). Significant correlations were found between clinical experience and knowledge/attitudes/practices (rho 0.358, P < 0.001; rho 0.147, P = 0.007; rho 0.232, P = 0.003). Conclusion: There is a large gap between theoretical knowledge and practical preparedness in disaster mental health. Training programs and government initiatives are essential to improve preparedness among PCPs.

Morbid obesity in infancy or early childhood is a challenging disease to manage. Here, we present the case report of the successful management of a 2-year-old girl child with morbidly obesity who was bedridden and had sleep apnoea and underwent laparoscopic sleeve gastrectomy. Bariatric surgery in this age group comes with a lot of decision-making challenges and technical and ethical considerations, and literature is scant on paediatric bariatric surgery. We describe the case and associated challenges in detail in this report.

Background “Kayakalp” is a National initiative to give awards to those public health facilities that demonstrate high level of cleanliness, hygiene, and infection control. It encourages every public health facility in the country to work toward standards of excellence to help the facilities to maintain cleanliness and hygiene. Objective The objective of the study was to find out baseline data, assess different key areas, and to compare the performance of different parameters mentioned in the Kayakalp program. Materials and Methods An observational cross-sectional study was conducted in two hospitals (one medical college and one district hospital) of West Bengal during 2020–2021. The study population consisted of staffs and admitted patients. Direct observation, record review, staff interview, and patient interview were done using the Kayakalp assessment checklist, relevant hospital records, etc. Assessment of performance was based on seven key parameter-hospital upkeep, sanitation and hygiene, hospital support service, waste management, infection control, hygiene promotion, and feedback mechanism. Collected data were entered in Microsoft Office Excel data sheet and analyzed there. The presentation of data was done using the principles of descriptive statistics in tabular form and bar diagrams. Results The studied district hospital scored much higher (total score 371) than the medical college (total score 237) in almost all key areas. Different component-wise following scores were noted among those two hospitals: hospital upkeep (55.4% vs. 37.7%), sanitation and hygiene (59.3% vs. 26%), hospital support service (57.5% vs. 47.5%), waste management (60% vs. 43.3%), infection control measures (61% vs. 59%), and hygiene promotion (51.3% vs. 35%). There was no system for feedback mechanism from the public on cleanliness in the studied medical college care hospital. Conclusion All health institutions should be under the Kayakalp program for improvement in the quality of patient care-related services.

Zinc and cadmium pollutants cause a significant environmental effect that cannot be ignored. Due to their considerable amount in an aqueous environment, industries are seeking suitable adsorbents that are environmentally friendly and inexpensive for removing metals from wastewater before disposing of them in surface waters. This research employed original MXene (MX) and chitosan-modified MXene (CSMX) to extract zinc (Zn(II)) and cadmium (Cd(II)) metal ions from water-based solutions. The composite material produced was analyzed using techniques such as X-ray Diffraction (XRD), Scanning Electron Microscopy (SEM), Fourier Transform Infrared Spectroscopy (FTIR), and Brunauer-Emmett-Teller (BET). The effects of contact duration, pH of the solution, and initial concentration of metal ions on the adsorption process of Zn(II) and Cd(II) onto both MX and CSMX composites were investigated. MX and prepared CSMX composite presented a high adsorption capacity for both studied heavy metals, which were 91.55 and 73.82 mg/g for Zn(II) and Cd(II) onto MX, 106.84 and 93.07 mg/g for Cd(II) and Zn(II) onto CSMX composite, respectively. Furthermore, the maximum competitive adsorption capacities for Zn(II) onto MX and CSMX composites are 77.29 and 93.47 mg/g, and for are Cd(II) 60.30 and 79.66 mg/g, respectively. Hence, the removal capacities for both single and competitive metal ions were superior to CSMX composite. However, the adsorption capacities after five successive regeneration sequences were only dropped by 13.2% for Zn(II) and 17.4% for Cd(II) onto the CSMX composite compared to the first cycle. These results confirm that both metals could be efficiently terminated from wastewater, which makes the prepared CSMX composite a favorable candidate adsorbent in practical applications.

Electric vehicles (EVs) are becoming more prevalent, but their high energy demands are straining Bangladesh's power infrastructure. Assuring the necessary charging demand without impacting the power grid is a significant challenge to the widespread deployment of EVs. Despite having a few solar-powered electric vehicle charging stations (EVCSs), Bangladesh needs more EVCSs to keep up with the rising demand. This study introduces grid-tied EVCS based on solar and wind for three major coastal cities in Bangladesh that will deliver charging stations' excess energy to the grid. This investigation utilizes lithium iron phosphate (LFP) batteries as energy storage. A derivative-free approach, hybrid optimization of multiple energy resources (HOMER), performs the comprehensive analysis. Python is employed for heatmap analysis and different data visualization. The lowest energy cost (0.114 $/kWh or 12.54 BDT/kWh) and the net present cost-NPC ($470621 or 51768310 BDT) are found for Grid/PV/Wind/Battery based EVCS from the research findings. Furthermore, this completely renewable EVCS reduces excess electricity in the system from 56 % to 2 %, resulting in a 74 % decrease in energy cost. The profitability index and payback period results validate the feasibility of the proposed EVCS. Sensitivity reports show that NPC, battery throughput, and electric production increase with an increase in EV load. Contrariwise, energy cost and excess electricity decrease with increased grid sale capacity.

In this study, the effect of resistance spot welding (RSW) and laser beam spot welding (LBSW) processes on evolution of microstructure, load endurance capabilities, heat affected zone (HAZ) softening, and corrosion resistance of ultra-high-strength (UHSS) steel joints welded in lap joint design is investigated. The UHSS sheets of dual phase 1000 grade (UHSDP1000) having 1.20 mm thickness were joined using the RSW and LBSW parameters optimized by response surface methodology (RSM). The microstructural features of welding regions of RSW and LBSW joints were studied using optical microscopy (OM). The load endurance capabilities of RSW and LBSW joints were assessed using the tensile shear failure load (TSFL) and cross-tensile failure load (CTFL) tests. The ruptured surfaces of TSFL and CTFL tested samples were examined utilizing scanning electron microscopy (SEM). The microhardness distribution of divergent regions of RSW and LBSW joints was evaluated and imputed to the TSFL and CTFL failure of joints. The corrosion resistance of RSW and LBSW joints was analyzed using potentiodynamic corrosion and immersion corrosion tests. The RSW joints showed 183% and 62.79% greater TSFL and CTFL endurance capabilities than LBSW joints. The TSFL and CTFL endurance capabilities of LBSW joints are inferior to RSW joints due to the smaller load bearing area. It causes the stress concentration in FZ and HAZ of LBSW joints. The RSW joints and LBSW joints disclosed TSFL and CTFL failure in button pull out rupture mode with tearing of HAZ. The failure of RSW and LBSW joints in HAZ is due to the softening caused by martensitic tempering and coarsening of grains. The LBSW joints disclosed inferior resistance to corrosion than RSW joints due to the higher martensite content which contributes to greater fraction of favorable pitting sites and decreased corrosion resistance.

The automotive and aerospace sectors are progressively employing the magnesium (Mg) alloy of the grade AZ31B because of its excellent castability, low density, and high ratio of strength to weight. Nevertheless, the limited ability of AZ31B alloy to withstand corrosion limits their use in several fields of technology. In order to solve this problem, the AZ31B alloy is coated utilizing an AA2024/Al2O3 metal matrix composite (MMC) coating that is applied by the cold spray coating (CS) method. The primary goal of this work is the parametric optimization of CS process for maximizing adhesive strength of MMC-coated Mg-alloy substrate. Response surface methodology (RSM) is implemented to find the optimum CS parameters, including feed rate of powder – FRP (g/min), standoff distance of gun – SDG (mm) and processing temperature – TEMP (°C). The regression-based parametric adhesion strength prediction (ASP) model was formulated using the RSM and statistically validated using analysis of variance (ANOVA). Employing 3D surface of responses, the influence of CS parameters on the adhesion strength of an MMC-coating was assessed. The findings revealed that when the MMC-coating was cold sprayed on the Mg-alloy using FRP of 22 g/min, SDG of 12 mm, and TEMP of 520 °C, the maximum adhesion strength of MMC-coating was 70 MPa (actual). Given less than 2% error at 95% confidence, the parametric ASP model correctly predicted the adhesion strength of the MMC-coating. The ANOVA findings showed that FRP (g/min) had significant effect on adhesive strength of MMC-coating followed by SDG (mm) and TEMP (°C). The MMC-coating applied using the RSM optimized CS parameters showed 70.73% superior adhesive strength owing to the lower porosity formation of 2 vol% which offers greater interfacial area. The ASP equation was formulated using the “best fitting line” approach and validated using ANOVA for predicting the adhesive strength (MPa) from the porosity formation (vol%) in the MMC-coating.

Abstract This study investigates olfaction, a complex and not well-understood sensory modality. The chemical mechanism behind smell can be described by so far proposed two theories: vibrational and docking theories. The vibrational theory has been gaining acceptance lately but needs more extensive validation. To fill this gap for the first time, we, with the help of data-driven classification, clustering, and Explainable AI techniques, systematically analyze a large dataset of vibrational spectra (VS) of 3018 molecules obtained from the atomistic simulation. The study utlizes image representations of VS using Gramian Angular Fields and Markov Transition Fields, allowing computer vision techniques to be applied for better feature extraction and improved odor classification. Furthermore, we fuse the PCA-reduced fingerprint features with image features, which show additional improvement in classification results. We use two clustering methods, agglomerative hierarchical (AHC) and k-means, on dimensionality reduced (UMAP, MDS, t-SNE, and PCA) VS and image features, which shed further insight into the connections between molecular structure, VS, and odor. Additionally, we contrast our method with an earlier work that employed traditional machine learning on fingerprint features for the same dataset, and demonstrate that even with a representative subset of 3018 molecules, our deep learning model outperforms previous results. This comprehensive and systematic analysis highlights the potential of deep learning in furthering the field of olfactory research while confirming the vibrational theory of olfaction.

Abstract Psoriasis is a chronic, non-contagious, immune-mediated skin disorder. Inflammation of the skin’s surface is characterised by scaly white, red, or silvery spots that occur due to the hyper-proliferation of keratinocytes in the epidermal layer. Primarily, pharmaceutical drugs or immune therapy are used to treat psoriasis. We are all aware that, certain therapeutic strategies can have some adverse effects, and over time, that hidden inflammation may manifest. This article introduces a mathematical model for psoriasis, formulated by employing a set of nonlinear ordinary differential equations (ODEs) that describe the densities of T-cells, dendritic cells (DCs), keratinocytes, and mesenchymal stromal cells (MSCs) as basic cell populations. A tumor necrosis factor- $$\alpha$$ α ( $$TNF-\alpha$$ T N F - α ) inhibitor has been imposed from the initial stage of the treatment regime, using the optimal control theoretic approach, and the numerical results have been observed. After 80 days of monitoring using only biologic $$TNF-\alpha$$ T N F - α inhibitors, if this approach did not provide the intended outcomes (when severity arises), stem cells are administered a few times in a pulsed manner as a cell replacement technique in addition to this anti $$TNF-\alpha$$ T N F - α medicine. We have observed the combined therapeutic benefit of stem cell replacement with a $$TNF-\alpha$$ T N F - α inhibitor from a mathematical point of view. The theoretical analysis and the numerical results revealed that stem cell transplantation, along with a $$TNF-\alpha$$ T N F - α inhibitor, is a promising psoriasis treatment option moving forward.

Nowadays metal oxide nanoparticles and transition metal dichalcogenides play a vital role in various areas like optical sensors, solar cells, energy storage devices, gas sensors and biomedical applications. In the current research work, we synthesized ZrSe2 nanoparticles by hydrothermal method. The ZrSe2 nanoparticles were synthesis using precursors such as ZrOCl2.8H2O and Na2SeO3.5H2O in the addition of surfactant cetyl trimethyl ammonia bromide CTAB and reductant hydrazine hydrate, respectively. By using synthesized ZrSe2 nanopowder thick films were developed on a glass substrate using the screen printing method. The structural properties of ZrSe2 powder were studied by X-ray diffraction (XRD). The X-ray diffraction analysis revealed that the hexagonal crystal structure and crystalline size were found to be 55.75 nm. The thick films of ZrSe2 were characterized by field emission scanning electron microscopy (FESEM) and energy dispersive X-ray analysis (EDAX). The surface morphological analysis of ZrSe2 nanostructured thick film shows hierarchical nanoparticles. The energy band gap of synthesized powder was calculated using a Tauc plot from UV-visible spectroscopy. The gas-sensing properties of ZrSe2 thick films were studied. The developed ZrSe2 thick films show maximum sensitivity and selectivity towards the ammonia NH3 gas at an operating temperature of 120 °C and the gas concentration was 500 ppm. The developed thick films show fast response and recovery time.Nowadays metal oxide nanoparticles and transition metal dichalcogenides play a vital role in various areas like optical sensors, solar cells, energy storage devices, gas sensors and biomedical applications. In the current research work, we synthesized ZrSe2 nanoparticles by hydrothermal method. The ZrSe2 nanoparticles were synthesis using precursors such as ZrOCl2.8H2O and Na2SeO3.5H2O in the addition of surfactant cetyl trimethyl ammonia bromide CTAB and reductant hydrazine hydrate, respectively. By using synthesized ZrSe2 nanopowder thick films were developed on a glass substrate using the screen printing method. The structural properties of ZrSe2 powder were studied by X-ray diffraction (XRD). The X-ray diffraction analysis revealed that the hexagonal crystal structure and crystalline size were found to be 55.75 nm. The thick films of ZrSe2 were characterized by field emission scanning electron microscopy (FESEM) and energy dispersive X-ray analysis (EDAX). The surface morphological analysis of ZrSe2 nanostructured thick film shows hierarchical nanoparticles. The energy band gap of synthesized powder was calculated using a Tauc plot from UV-visible spectroscopy. The gas-sensing properties of ZrSe2 thick films were studied. The developed ZrSe2 thick films show maximum sensitivity and selectivity towards the ammonia NH3 gas at an operating temperature of 120 °C and the gas concentration was 500 ppm. The developed thick films show fast response and recovery time.

Background: Type 2 diabetes affects 10.5% of adults globally, with sexual dysfunction being one of the complications, of which erectile dysfunction is the most commonly reported one with the prevalence ranging from 35% to 90%. There are a few studies exploring links between sexual dysfunction, depressive symptoms, and marital satisfaction, which is the reason we undertook the study. Aim: To study the prevalence of sexual dysfunction, depressive symptoms, and marital satisfaction in male patients with diabetes and correlation between the three parameters. Methods: A total of 120 male patients with type 2 diabetes were assessed for sexual dysfunction using ICD-10 criteria and International Index of Erectile Function, depressive symptoms using Beck Depression Inventory, and marital satisfaction using Dyadic Adjustment Scale (DAS). Results: The mean age of patients at diagnosis of diabetes was 42.32 ± 7.48 years, and the mean duration of diabetes was 7.35 ± 3.76 years. Mean HbA1c was 9.05 ± 2.25% with only 22 patients having good glycemic control. Eight-eight patients reported sexual dysfunction with lack of genital response, premature ejaculation, and orgasmic dysfunction being common. Thirty-two patients had depressive symptoms, with borderline clinical depressive symptoms and moderate depressive symptoms in 14 patients each. Marital satisfaction was affected with the total mean DAS score being 93.95 ± 18.34. There was a negative correlation seen between sexual function and depressive symptoms and also between sexual function and increasing age, with a positive correlation seen between sexual function and marital satisfaction. Poor glycemic control was significantly associated with clinically diagnosed erectile and orgasmic dysfunction. Conclusions: Sexual dysfunctions, depressive symptoms, and marital distress are highly prevalent in patients with type 2 diabetes, warranting timely detection and management. The three parameters are significantly correlated with each other, and poor glycemic control is significantly associated with sexual dysfunction. Psychiatric liaison would improve outcomes.

Catastrophic spontaneous spinal epidural hematoma (SSEH) following thrombolysis poses a complex intersection of neurosurgical and cardiological challenges. This case report presents the institutional experience of a 66-year-old female who developed rapid-onset compressive myelopathy after thrombolysis for inferior wall myocardial infarction with injection streptokinase. SSEH, although rare, demands prompt recognition due to its potential for permanent neurologic injury and mortality. The discussion highlights the clinical significance, anatomical considerations, and multidisciplinary approach requisite for accurate diagnosis and effective management of SSEH. The conclusion underscores the necessity for clinicians, particularly cardiologists administering thrombolytic therapies, to consider SSEH in postthrombolysis patients presenting with neurological deficits.

Abstract Background In 2022, fewer than half of persons with tuberculosis (TB) had access to molecular diagnostic tests for TB due to their high costs. Studies have found that the use of artificial intelligence (AI) software for chest X-ray (CXR) interpretation and sputum specimen pooling can each reduce the cost of testing. We modeled the combination of both strategies to estimate potential savings in consumables that could be used to expand access to molecular diagnostics. Methods We obtained Xpert testing and positivity data segmented into deciles by AI probability scores for TB from the community- and healthcare facility-based active case finding conducted in Bangladesh, Nigeria, Viet Nam, and Zambia. AI scores in the model were based on CAD4TB version 7 (Zambia) and qXR (all other countries). We modeled four ordinal screening and testing approaches involving AI-aided CXR interpretation to indicate individual and pooled testing. Setting a false negative rate of 5%, for each approach we calculated additional and cumulative savings over the baseline of universal Xpert testing, as well as the theoretical expansion in diagnostic coverage. Results In each country, the optimal screening and testing approach was to use AI to rule out testing in deciles with low AI scores and to guide pooled vs individual testing in persons with moderate and high AI scores, respectively. This approach yielded cumulative savings in Xpert tests over baseline ranging from 50.8% in Zambia to 57.5% in Nigeria and 61.5% in Bangladesh and Viet Nam. Using these savings, diagnostic coverage theoretically could be expanded by 34% to 160% across the different approaches and countries. Conclusions Using AI software data generated during CXR interpretation to inform a differentiated pooled testing strategy may optimize TB diagnostic test use, and could extend molecular tests to more people who need them. The optimal AI thresholds and pooled testing strategy varied across countries, which suggests that bespoke screening and testing approaches may be needed for differing populations and settings.

Abstract Background Pericardiocentesis offers a definitive diagnostic and a life-saving therapeutic modality through removal of pericardial fluid and relief of high intrapericardial pressure. Percutaneous pericardiocentesis has been performed via different approaches depending on different institutional experiences. In this paper, we present our institutional experience and review the current literature of the different approaches for performing percutaneous pericardiocentesis. Materials and methods We evaluated consecutive patients who underwent echocardiographic-guided pericardiocentesis via the apical approach for pericardial effusion between the period of April 1st, 2022, and April 1st, 2023, at University of Arkansas for Medical Sciences (UAMS). Health records were reviewed for clinical presentations, available imaging findings, procedural outcomes, and short-term follow up. Results A total of eight consecutive cases of pericardiocentesis via the apical approach were found. Seven were successful. No complications were reported. Six patients had evidence of tamponade physiology on echocardiogram. Conclusion Historically, pericardiocentesis has been most performed via the subxiphoid approach. However, an ultrasound-guided apical approach offers a safe and effective alternative and may be preferable in patients with challenging anatomies.

Abstract Despite advances in antimicrobial and anti-inflammatory treatment, inflammation and its consequences remain a major challenge in the field of medicine. Inflammatory reactions can lead to life-threatening conditions such as septic shock, while chronic inflammation has the potential to worsen the condition of body tissues and ultimately lead to significant impairment of their functionality. Although the central nervous system has long been considered immune privileged to peripheral immune responses, recent research has shown that strong immune responses in the periphery also affect the brain, leading to reactive microglia, which belong to the innate immune system and reside in the brain, and neuroinflammation. The inflammatory response is primarily a protective mechanism to defend against pathogens and tissue damage. However, excessive and chronic inflammation can have negative effects on neuronal structure and function. Neuroinflammation underlies the pathogenesis of many neurological and neurodegenerative diseases and can accelerate their progression. Consequently, targeting inflammatory signaling pathways offers potential therapeutic strategies for various neuropathological conditions, particularly Parkinson’s and Alzheimer’s disease, by curbing inflammation. Here the blood–brain barrier is a major hurdle for potential therapeutic strategies, therefore it would be highly advantageous to foster and utilize brain innate anti-inflammatory mechanisms. The tricarboxylic acid cycle-derived metabolite itaconate is highly upregulated in activated macrophages and has been shown to act as an immunomodulator with anti-inflammatory and antimicrobial functions. Mesaconate, an isomer of itaconate, similarly reduces the inflammatory response in macrophages. Nevertheless, most studies have focused on its esterified forms and its peripheral effects, while its influence on the CNS remained largely unexplored. Therefore, this study investigated the immunomodulatory and therapeutic potential of endogenously synthesized itaconate and its isomer mesaconate in lipopolysaccharide (LPS)-induced neuroinflammatory processes. Our results show that both itaconate and mesaconate reduce LPS-induced neuroinflammation, as evidenced by lower levels of inflammatory mediators, reduced microglial reactivity and a rescue of synaptic plasticity, the cellular correlate of learning and memory processes in the brain. Overall, this study emphasizes that both itaconate and mesaconate have therapeutic potential for neuroinflammatory processes in the brain and are of remarkable importance due to their endogenous origin and production, which usually leads to high tolerance.