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Background: Despite the well-established potent benefit of mechanical thrombectomy (MT) for large vessel occlusion (LVO) stroke, access to MT has not been studied globally. We conducted a worldwide survey of countries on 6 continents to define MT access (MTA), the disparities in MTA, and its determinants on a global scale. Methods: Our survey was conducted in 75 countries through the Mission Thrombectomy 2020+ global network between November 22, 2020, and February 28, 2021. The primary end points were the current annual MTA, MT operator availability, and MT center availability. MTA was defined as the estimated proportion of patients with LVO receiving MT in a given region annually. The availability metrics were defined as ([current MT operators×50/current annual number of estimated thrombectomy-eligible LVOs]×100 = MT operator availability) and ([current MT centers×150/current annual number of estimated thrombectomy-eligible LVOs]×100= MT center availability). The metrics used optimal MT volume per operator as 50 and an optimal MT volume per center as 150. Multivariable-adjusted generalized linear models were used to evaluate factors associated with MTA. Results: We received 887 responses from 67 countries. The median global MTA was 2.79% (interquartile range, 0.70–11.74). MTA was Conclusions: Access to MT on a global level is extremely low, with enormous disparities between countries by income level. The significant determinants of MT access are the country’s per capita gross national income, prehospital LVO triage policy, and MT operator and center availability.

Introduction: The objective of this work is to determine the role of a multidisciplinary approach in treating the complex high flow head and neck arteriovenous malformations (AVMs), involving radiologists and plastic surgeons for the best possible outcomes. Methods: Between 2018 and 2020, the investigators conducted a retrospective analysis on seven patients with high-flow head and neck AVMs who received treatment at a tertiary care facility. Age at first diagnosis, presenting features, prior therapies, endovascular treatment, surgical treatment, and therapeutic outcomes were all recorded. A comparison of pre-and post-procedure pictures was made to assess the clinical outcomes for all patients. Results: Seven patients with complex high flow head and neck AVMs were jointly managed by performing plastic surgery and interventional radiology. There were male and female, with an average age of 24 years. Each patient underwent embolization followed by surgical resection within a 24-hour window of up to 72 hours. In six out of seven patients, the lesion was removed therapeutically, whereas the seventh required palliative resection. Only one patient, there was a minor wound healing difficulty able to be treated with dressings. Conclusion: The results revealed that embolization alone is not effective to reduce the adverse effects. Incomplete removal of AVM showed the same effect as incomplete removal of a tumour. It may not improve symptoms and may worsen the recurrence, thus multi-modality approach is beneficial. A multidisciplinary approach, aided by the interventional radiologist and enable plastic surgeons to remove the high-flow AVMs effectively.

This manuscript aims to outline how pre-existing resources can be used for stroke care and how public and government awareness can be raised (influencer model). We likewise portray the achievement of the LGH stroke program as an example of advancement. In LGH, reperfusion treatment has begun in recent years and this paper portrays the one of a kind experience in Pakistan. The aim of this study is to do a comparative analysis between Pakistan, Thailand and Egypt and their approaches to stroke care management and treatment. These countries fall under similar economic standing (LMICs) but Egypt and Thailand have relatively better healthcare systems for stroke management as compared to Pakistan. Hence, this paper looks into these differences and presents potential solutions to how stroke care management can be improved in Pakistan. Additionally, current stroke management in Pakistan is reviewed.

To report a case of post-traumatic direct carotid-cavernous fistula (CCF) treated with Merlin’s XCalibur as a standalone treatment. XCalibur is a balloon mounted flow diverter covered with polymer biostable membrane. A single device was deployed across the rent which resulted in the complete exclusion of fistula. This is the second case of its kind to be reported for the treatment of post-traumatic direct CCF with an XCalibur device. The device proved to be effective and safe and did not require any additional coiling, thus this paper has immense value and benefit for the medical community at large as it displays a new technique being successfully used.

A wind diesel hybrid system is an autonomous electricity generating system using wind turbines with diesel generators to obtain a maximum contribution by the intermittent wind resource to the total power produced, while providing continuous high quality electric power. The main goal is to control load frequency and reduce fuel consumption enabling reduced system operating costs and environmental impacts. Frequency control in a power system is done to maintain an adequate balance between the consumed and generated active powers, so that the frequency remains within acceptable limits around the nominal frequency. Load–frequency control (LFC) is of importance in electric power system design and operation. The objective of the LFC in an interconnected power system is to maintain the frequency of each area within limits and to keep tie-line power flows within some pre-specified tolerances by adjusting the MW outputs of the generators so as to accommodate fluctuating load demands.

Purpose In this article, we consider the magnetohydrodynamic (MHD) nanofluid flow over a rotating stretchable disk through porous medium. For porous medium, Darcy’s relation is used. It also encompassed the impact of nanoparticles shape on MHD nanofluid flow and heat transfer. The effect of thermal radiation and Joule heating is also being considered. Design/methodology/approach Three categories of nanoparticles are taken into deliberation, i.e. copper, silver and titanium oxide. The nanofluid is made of pure water and various types of sphere- and lamina-shaped nanoparticles. By using appropriate similarity transformation, the governing partial differential equations are transformed to ordinary one. The coupled ordinary differential equations system is tackled numerically by bvp4c method. Findings The impact of various pertinent parameters, i.e. solid volume fraction, Hartman number, thermal radiations parameter, Reynolds number, Eckert number, porosity parameter and ratio parameter, on flow and Nusselt number with a fixed value of Prandtl number at 6.2 is discussed in details. The obtained results are presented in the concluding section. The lamina shape of nanoparticles in silver-water performed an excellent role on temperature distribution. The heat transfer rate of lamina shape in copper-water was found to be greater in the system of flow regime. Originality/value The authors have discussed the shape effect of nanoparticles on MHD nanofluid flow over a rotating stretchable disk through porous medium using three categories of nanoparticles, such as copper, silver and titanium oxide. To the best of the authors’ knowledge, this is the first study on mass and heat transfer nanofluid flow and no such study is yet published in literature. A detailed mathematical analysis has also to be carried out to prove the regularity of model. The authors believe that the numerical results are original and have not been copied from any other sources.

Background Acute or hot cholecystectomy (AC) has been established as a safe and efficacious modality of managing acute biliary pathology. However, it has been performed with caution in the elderly (defined by the world health organisation as patients over the age of 65). The NICE guidance in this area does not preclude this practise on elderly patients. Our acute cholecystectomy service treats patients of all ages according to performance status and fitness for surgery rather than age we audited our results in this age group. Methods All patients over the age of 65 who underwent acute cholecystectomy in the dedicated emergency cholecystectomy lists were audited from the period starting 31st December 2019 to 31st June 2021. Patient demographics, co-morbidies and surgical factors were recorded. The primary outcomes measure was in hospital stay and re-admission, secondary outcome were complications and perioperative mortality. Results 41 elderly patients underwent AC during the audit period, (male 18: female 23). Majority of patients had acute cholecystitis 30(73%). The median inpatient stay following surgery was 2 days(range 2-5 days) and the median admission to surgery time was 6 days (range 5-12 days). Only 3(7%) patients had a subtotal cholecystectomy. There was only 3 complications from surgery which were all between a clavien-dindo score of 2 and 3. There were 3 readmission in the immediate post-operative period. There was one 30-day mortality which was from necrotising pancreatitis as a result of ERCP and not from the operation. Conclusions Acute cholecystectomy in this age group appears to be safe and effective way to treat acute biliary pathology and compares similarly to the outcomes in the younger groups.

BACKGROUND AND PURPOSE Direct injection of Oxygen-Ozone in the cervical discs has proved to be the effective alternative to surgery in patients with cervical disc herniation in many countries around the world. We report our experience with ozonucleolysis with patients effected by pain incervical region (brachialgia)due to disc herniation including post-operative recurrence or disc prolapse. METHODS 6000 patients were treated with single session of Oxygen-Ozone therapy from 2005-2020. All the patients had CT or MRI evidence of cervical disc prolapse with clinical signs of cervical nerve root compression. The procedure was performed under angiofluoroscopy using 22/23 G spinal needle without anesthesia. All the patients received intradiscal injection n of Oxygen-Ozone mixture at Ozone concentration of 30 µgm/ml. Among these patients 4500 were males and 1500 were females between the ages of 20-70 years. Therapeutic outcome was assessed 8 week after treatment by using modified MacNab method. RESULTS A satisfactory therapeutic outcome was obtained. 60% of the patients showed complete recovery with resolution of symptoms. 20% of the patients complained of occasional episodic neck pain and arms pain with no limitation of occupational activity. 5% of cases showed some improvement. 5% of cases had insufficient or noimprovement and went for surgery. 10% of cases never turned up after the first visit. CONCLUSION Intradiscal injection of Ozone for herniated cervical disc has revolutionized percutaneous approach to nerve root diseases making it safer, cheaper and easier to repeat than treatments currently in use.

Due to the presence of actuator disturbances and sensor noise, increased false alarm rate and decreased fault detection rate in fault diagnosis systems have become major concerns. Various performance indexes are proposed to deal with such problems with certain limitations. This paper proposes a robust performance-index based fault diagnosis methodology using input–output data. That data is used to construct robust parity space using the subspace identification method and proposed performance index. Generated residual shows enhanced sensitivity towards faults and robustness against unknown disturbances simultaneously. The threshold for residual is designed using the Gaussian likelihood ratio, and the wavelet transformation is used for post-processing. The proposed performance index is further used to develop a fault isolation procedure. To specify the location of the fault, a modified fault isolation scheme based on perfect unknown input decoupling is proposed that makes actuator and sensor residuals robust against disturbances and noise. The proposed detection and isolation scheme is implemented on the induction motor in the experimental setup. The results have shown the percentage fault detection of 98.88%, which is superior among recent research.

Introduction The first confirmed case of COVID-19 in the United Kingdom (UK) was reported on 29 January 2020. The country saw the peak of infection between March and May of 2020. The result was a change in the practice of how we treat most surgical conditions including cancer. We continued providing service to our colorectal cancer patients at a District General Hospital. The aim of this study was to compare our provision of colorectal cancer service during the peak of the pandemic to that of the pre-COVID time in our hospital. Methods We collected data of all colorectal cancer patients who underwent surgery between 1 March 2020 and 30 April 2020 in our hospital. The comparative data were collected for similar patients during the same time frame in 2019. A detailed data set was compiled on Microsoft Excel (Microsoft Corp, Washington) and analysed using IBM SPSS Statistics for Windows, Version 21.0 (Released 2012. IBM Corp, Armonk, NY). Results The two groups were comparable in demographics including age, BMI, gender, and Charlson comorbidity index. Time from decision- to-treat to surgery, post-operative HDU/ITU stay, and overall length of stay was shorter in the COVID group than the Pre-COVID group without any significant statistical difference. There was no statistically significant difference between the two groups in Calvien-Dindo complications grade 1 and 2. No mortality was reported due to direct or indirect consequences of COVID-19 infection. More open procedures were performed in our department during the first wave of COVID-19 in the UK compared to Pre-COVID time. Conclusions Despite the challenges we faced during the peak of the COVID-19 pandemic, we managed to provide standard care to our colorectal cancer patients with comparable post-operative surgical and oncological outcomes.

The results of this article can be useful in science and technology advancement, such as nanofluidics, micro mixing and energy conversion. The purpose of this article is to examine the impacts of nanoparticle shape on Al2O3-water nanofluid and heat transfer over a non-linear radically stretching sheet in the existence of magnetic field and thermal radiation. The different shapes of Al2O3 nanoparticles that have under contemplation are column, sphere, hexahedron, tetrahedron, and lamina. The governing partial differential equations (PDEs) of the problem are regenerated into set of non-linear ordinary differential equations (ODEs) by using appropriate similarity transformation. The bvp4c program has used to solve the obtained non-linear ordinary differential equation (ODEs). The Nusselt number for all shapes of Al2O3 nanoparticle shapes in pure water with is presented in graphical form. It has reported that the heat transfer augmentation in lamina shapes nanoparticles is more than other shapes of nanoparticle. The relation of thermal boundary layer with shapes of nanoparticles, solid volume fraction, magnetic field and thermal radiation has also presented with the help of graphical representation. It is also demonstrated that lamina shape nanoparticles have showed large temperature distribution than other shapes of nanoparticles.

Introduction: Mechanical thrombectomy has become the cornerstone and standard of care for acute stroke patients. Early reperfusion in patients experiencing acute ischemic stroke is the most important factor. The motivation behind this investigation is to display the aftereffects of mechanical thrombectomy in patients with large vessel occlusion in anterior and posterior circulation and to demonstrate that it lessens the level of handicap 3 months post stroke. Methods: A retrospective analysis was conducted of patients who presented with acute ischemic stroke at our center from 2015 to 2018 and received mechanical thrombectomy using combined manual aspiration with a stent retriever and with large bore catheters without the bridging technique. Result factors including recanalization rate and modified Rankin Scale at 90 days post procedure were assessed. An aggregate of 30 patients were included. Results: About 30 patients presented at the institute and met the inclusion criteria for the study. Successful recanalization (the Thrombolysis in Cerebral Infarction Score [TICI 2B]) was accomplished in 90% of patients, TICI 3 score was accomplished in 56% of the patients. 67% of the patients had good modified Rankin Scale score 0-2 result at 90 days. There were 3 symptomatic hemorrhages and 3 procedure and comorbidity-related deaths (10%). Conclusion: Mechanical thrombectomy using combined manual aspiration with a stent retriever and with large bore catheters alone without the bridging technique is an effective and safe procedure for endovascular revascularization of large vessel occlusion presenting with acute ischemic stroke.

The aim of this numerical research is to study the stagnation point flow of the electrical magnetohydrodynamic micropolar nanofluid with slip conditions past a stretching sheet. The phenomenon of linear thermal radiation, Ohmic and internal heating, has also been considered in the energy equation. The modelled PDEs are converted into ODEs via similarity transformation, and converted ODEs are tackled via the shooting technique. The features of assorted parameters on the axial and angular velocities and energy and concentration fields are sketched. The numerical values of the Sherwood and Nusselt numbers have been computed numerically and displayed in the form of tables. Our analysis shows that the heat transfer rate is decreased as the thermal slip parameter and the diffusion slip parameter are enhanced. The present study illustrates that the energy and concentration distribution are decreased with each of the mass free convection parameter, stagnation parameter, and thermal free convection parameter.

Aim of study The shape effects of nanoparticles are very significant in fluid flow and heat transfer. In this paper, we discuss the effects of nanoparticles shape in nanofluid flow between divergent-convergent channels theoretically. In this present study, various shapes of nanoparticles, namely sphere, column and lamina in zinc oxide-water nanofluid are used. The effect of the magnetic field and joule dissipation are also considered. Research methodology The system of nonlinear partial differential equations (PDEs) is converted into ordinary differential equations (ODES). The analytical solutions are successfully obtained and compared with numerical solutions. The Homotopy perturbation method and NDsolve method are used to compare analytical and numerical results respectively. Conclusion The results show that the lamina shape nanoparticles have higher performance in temperature disturbance and rate of heat transfer as compared to other shapes of nanoparticles.

Objective: To evaluate the result of a coiling of middle cerebral artery aneurysms without auxiliary techniques. Material and Methods: This study was conducted from June 2010 to September 2019 in the Department of Neuroradiology, Punjab Institute of Neurosciences, Lahore. There were a total of 500 patients with unilateral and bilateral cerebral aneurysms at the MCA level that have been included in this study which comprise of both sexes. Results: There was a total of 500 patients, which comprised of 200 (40%) men and 300 (60%) women. Their ages ranged from 22 to 65 years. The majority number of patients was in their fifth 180 (30%) and sixth decade 150 (30%) of life. In our study, a successful coiling was performed in 490 (98%) patients with minimal re-canalization of MCA aneurysms. In 10 (2%) procedure was unsuccessful due to vasospasm. Conclusion: The conventional coiling in middle cerebral artery aneurysms can be effective and safe without auxiliary techniques.

The focus of the present paper is to analyze the shape effect of gold (Au) nanoparticles on squeezing nanofluid flow and heat transfer between parallel plates. The different shapes of nanoparticles, namely, column, sphere, hexahedron, tetrahedron, and lamina, have been examined using water as base fluid. The governing partial differential equations (PDEs) are transformed into ordinary differential equations (ODEs) by suitable transformations. As a result, nonlinear boundary value ordinary differential equations are tackled analytically using the homotopy analysis method (HAM) and convergence of the series solution is ensured. The effects of various parameters such as solid volume fraction, thermal radiation, Reynolds number, magnetic field, Eckert number, suction parameter, and shape factor on velocity and temperature profiles are plotted in graphical form. For various values of involved parameters, Nusselt number is analyzed in graphical form. The obtained results demonstrate that the rate of heat transfer is maximum for lamina shape nanoparticles and the sphere shape of nanoparticles has performed a considerable role in temperature distribution as compared to other shapes of nanoparticles.

BACKGROUND AND PURPOSE: Direct injection of Oxygen-Ozone in to the discs has proved to be the effective alternative for surgery in patients with disc herniation in many countries around the world. We report our experience with ozonucleolysis with patients effected by lower backache, sciatica and pain cervical region (brachalgia) due to disc herniation including post operative recurrence or disc prolapse. MATERIAL & METHODS: Twenty-Three Thousand patients were treated with single two multiple sessions of Oxygen Ozone therapy. All the patients had CT or MRI evidence of annulus tear/ disc prolapse with clinical signs of nerve root compression. The procedure was performed under angio fluoroscopy using 22/23 G spinal needle without any form of anesthesia. All the patients received intra discal injection of Oxygen Ozone mixture with and without periganglionic infiltration at a ozone concentration 30 mcgr/mL. Among these patients 14000 were males and 9000 were females between the age of 14-80 years. Therapeutic outcome was assessed 5 months after treatment by using modified MacNab method. RESULTS: A satisfactory therapeutic outcome was obtained. 55% of the patients showed complete recovery with resolution of symptoms. 20% of the patients complained of occasional episodic pain and with no limitation of occupational activity. 15% of cases showed insufficient improvement. 5% of cases had insufficient improvement and went for surgery. 10% of cases never turned up after the first visit. CONCLUSION: Intradiscal with and without periganglionic injection of Ozone for herniated discs has revolutionized percutaneous approach to nerve root diseases making it safer, cheaper and easier to repeat than treatments currently use in Pakistan.

Solar power has prominently been showing potential as a means to sustainable, dispatchable and affordable source of energy while attracting huge attention for scientists as a viable alternative for next-generation energy usage. Solar Salt, KNO3-NaNO3 (40–60 wt%) mixture, has been considered indispensable as it is the most technologically mature molten salt for CSP plants. However, molten salt-based heat transfer fluids (HTF) and/or thermal energy storage (TES) media have been facing critical challenging issues of severe corrosion and lower specific heat capacity. Considering these problems, more effective studies should be conducted to explore the alternative nitrate salt mixtures, chlorides, fluorides and carbonates focusing on the widening thermal stability range, and to enhance thermal properties and to lower corrosion rate. Thereafter, scientists and engineers would be able to incorporate these variations of molten salts with an economical industrial way into CSP applications. In this context, the present review thoroughly investigates the Solar Salt, HitecXL, Hitec, LiNaKNO3, NaKMg chloride, NaKZn chloride, LiNaK fluoride and (LiNaK)2CO3 salts in terms of their basic thermal properties, corrosion rate and their contingent behaviour on nanoparticles; regardless of discrepancies and incompatibilities. Moreover, this article highlighted some corrosion mitigation approaches that could enhance the efficacy of molten salts for next-generation CSP plants. Also, there is a still need to further investigate the long-term thermal stability of molten salt-based nanofluids by researchers on an urgent basis.

Graphene nanofluids have attracted the attention of many researchers because of a variety of remarkable properties such as extraordinary electronic transport properties, high thermal conductivity, and large specific surface areas. This paper investigates the shape effects of nanoparticles on the Marangoni boundary layer of graphene&ndash, water nanofluid flow and heat transfer over a porous medium under the influences of the suction parameter. The graphene&ndash, water nanofluid flow was contained with various shapes of nanoparticles, namely sphere, column, platelet, and lamina. The problem is modeled in form of partial differential equations (PDES) with boundary conditions. The governing transport equations are converted into dimensionless form with the help of some suitable nondimensional variables. The solution of the problem was found numerically using the NDSolve technique of Mathematica 10.3 software. In addition, the numerical solutions were also compared with analytical results. The homotopy analysis method (HAM) is used to calculate the analytical results. The results show that lamina-shaped nanoparticles have better performance on temperature distribution while sphere-shaped nanoparticles are more efficient for heat transfer than other shapes of nanoparticles.

Mobile Adhoc Networks (MANETs) consist of a set of mobile nodes that form a dynamically changing network without the use of an existing infrastructure. Every node in the network acts as the peer to its immediate neighbor. Each node is thus responsible for relaying data to neighboring nodes for ensuring communication between distant nodes. This information dissemination mechanism pattern consumes extra node energy thus making energy a critical parameter for ensuring increased network lifetime. This paper proposes a new energy and mobility aware routing protocol referred to as Mobility and Energy Aware AODV (MEAODV) protocol. The proposed protocol has shown through simulations to achieve 4–5% increase in Packet Delivery Ratio, 20–24% reduction in Convergence time and 10 to 15% increase in Network Lifetime when compared to most promising stability based variants of AODV, PersonalizedAODV (RAODV) and MulticastAODV (MAODV-X).