Allocation Procedure Research Articles

Review of QoS-aware resource allocation schemes for 5g networks

Resource management in wireless networks refers to the processes and techniques used to allocate, control, and optimize the various resources in a wireless communication system to ensure efficient and reliable operation. These resources typically include spectrum (frequency bands), power, time slots, and network infrastructure (e.g., base stations, access points). Effective resource management is crucial for maximizing network performance, ensuring Quality of Service (QoS), and providing a good user experience, especially in environments with limited resources and high demand. Quality of Service (QoS) refers to the ability of the network to provide different levels of service quality to various types of traffic, applications, and users. QoS in 5G is essential due to the diverse range of services the network is designed to support, each with its own specific requirements for performance metrics such as latency, reliability, bandwidth, and availability. In this paper, we study how the QoS-aware resource allocation procedure is handled in wireless networks. Different resource management techniques were studied and also the paper looked at some of the existing QoS-aware resources allocation schemes by highlighting the operation, strength and weakness and the QoS parameters considered by each of the schemes.

Enhancing Cloud Task Scheduling with Multi-Objective Optimization Using K-Means Clustering and Dynamic Resource Allocation

The scheduling and resource allocation procedure is an essential component of cloud resource management. Effective resource allocation is severely hampered by the task arrival rates' erratic and unclear behavior. To prevent under or overusing resources, an effective scheduling strategy is necessary. To improve scheduling and allocation performance, a multi-objective optimization technique is presented for the best resource allocation and task scheduling inside scientific workflow datasets in a heterogeneous environment. In the first stage, the system calculates four key metrics: Communication Cost, Computation Cost, Earliest Finished Time on a particular VM, and Total Task Length for a specific scientific workflow dataset. These metrics provide a comprehensive understanding of the resource requirements and help make informed scheduling decisions. In the second stage, tasks are clustered using the K-Means clustering algorithm. This clustering groups similar tasks together, making managing and scheduling them easier. In the third stage, the proposed resource allocation algorithm allocates the clustered tasks to the appropriate VMs. This step ensures that the tasks are assigned to the best-suited resources, optimizing the overall system performance and resource utilization. By following this multi-stage process, the system aims to achieve optimal resource allocation and task scheduling, thereby improving the efficiency and effectiveness of cloud resource management. The proposed method significantly outperforms PSO, CSO, and GWO by consistently achieving lower Makespan—under 400 units at 50 tasks—while maintaining high resource utilization rates above 0.75, demonstrating superior efficiency in task execution and resource management.

Gendered Contexts? The Effect of Neighbourhood Socio‐Economic Deprivation on Girls' and Boys' Cognitive and Non‐Cognitive Development

ABSTRACTDoes socio‐economic deprivation of adolescents' residential neighbourhoods affect their cognitive and non‐cognitive development? Leveraging data from the National Child Development Study (NCDS) in the UK, this study investigates this question focusing on gender differences. By exploiting the quasi‐exogenous social housing allocation procedures in the UK, I aim to limit issues related to the endogeneity of neighbourhood selection. Results show that living in more deprived areas has overall a negative effect on cognitive and non‐cognitive development. However, neighbourhood deprivation negatively affects girls', as compared to boys', cognitive skills, academic motivation and employability skills, while no significant gender difference is detected for problem behaviour. On the one hand, these findings highlight the importance of taking gender into account in neighbourhood studies and, on the other hand, they suggest that the availability of support within the local area and the quality of institutions should be considered as relevant theoretical mechanisms to understand the role of neighbourhoods on different spheres of adolescent development.

Measuring and Mitigating the Risk of Advanced Cyberattackers

Sophisticated cyberattackers (commonly known as advanced persistent threats (APTs)) pose enormous risks to organizations such as financial institutions, industrial and commercial firms, government institutions, and power grids. This study presents a method and an index to measure the vulnerability of organizations to APT risk and shows why a one-size-fits-all solution to mitigate APT risk does not exist. Our vulnerability index is based on a model that describes the optimal behavior of a cyberattacker (APT) with research and development capabilities aspiring to attack a network that manages the organization and a network operator that deploys blocking and detection measures to protect its organization from the attack. We demonstrate how our vulnerability index, which accounts for the network’s structure and the APTs’ resources and strategy, can be used in realistic risk assessments and optimal resource allocation procedures and serve as a benchmark for organizations’ preparedness against APTs’ cyberattacks. We also propose that regulatory agencies of financial (and other) institutions provide the parameters that define an APT’s profile and request, as part of their periodic assessments of the organizations that they regulate, that our (or similar) vulnerability index will be reported to them by the regulated institutions. Finally, the viability of our index in modeling modern cybersecurity defense procedures shows that not only there is no silver bullet defense against all types of APTs, it is also imperative to account for APTs’ heterogeneity because detection and blocking measures can be complements, substitutes, or even degrade each other. For example, when the attacker’s (defender’s) budget is extremely large (small), the defender should deploy only detection measures, strongly advocating Zero Trust practices. Supplemental Material: The online appendix is available at https://doi.org/10.1287/deca.2023.0072 .

Integrated aircraft routing and cargo routing problem for combination airlines

The combination airlines operate both passenger aircraft and freighter aircraft to meet passenger and cargo demand. At present, combination airlines employ a sequential approach to allocating their capacity for passenger and cargo demand. Nevertheless, implementing an integrated resource allocation procedure has the potential to improve overall resource allocation efficiency. In this paper, we introduce an integrated model to help combination airlines integrate their aircraft routing and cargo routing decisions to maximize the expected overall profits derived from both passenger and cargo demand. We considered the stochastic nature of passenger baggage and proposed a set of individual chance constraints to ensure the robustness of the integrated solution. We reformulate the chance constraints using piecewise linear approximation to ensure solution efficiency. In addition, we proposed a column-and-row generation based solution approach that removes the through-connection related constraints at the beginning of the solution process and then adds the columns and rows during the iterations as needed. We proved that the proposed column-and-row generation approach can obtain an optimal solution for the LP relaxation problem. The model and the solution approach were tested in a number of scenarios obtained from a major Chinese combination airline. The computational results show that the combination airline can improve their expected profits by integrating capacity allocation. The results also demonstrated that the proposed column-and-row generation solution approach can decrease the solution time of the integrated model. These findings indicate that the model and the solution method are useful and efficient tools for combination airlines when planning their aircraft and cargo routes.

A Survey of Resource Allocation in V2V Communications

In this paper, a comprehensive analysis of resource allocation in vehicle-to-vehicle (V2V) communication systems is presented, which is crucial for enhancing traffic control and improving road safety and driving enjoyment. A variety of resource allocation strategies are classified and examined in this paper, including game theory-based approaches, spectrum allocation, energy allocation, location-based allocation, and machine learning-based procedures. Open research questions and areas that need further study in the field of V2V communication are highlighted for future benefit. This survey helps readers make informed decisions about system design, implementation, and improvement by providing a comprehensive overview of the latest developments in V2V resource allocation. It also indicates areas that need further research and possible directions to enhance the security, flexibility, and scalability of V2V communication networks.

Efficient Optimization for Time-Constrained Encounter of Spacecraft with Multirevolution Phasing

“Spacecraft encounter” refers to a close flyby or fast proximity between two or more spacecraft in space. It involves the approach of one spacecraft to another, whether for observation, communication, capture, or interception purposes. This paper presents a novel approach to planning orbital encounter missions for spacecraft within a specified time constraint. The proposed method takes advantage of a unique encounter process where the vehicle performs only two in-plane impulses and matches the target location at the encounter position using multirevolution phasing. To ensure the minimum maneuvering fuel consumption from the selection of the encounter position and analyze the optimality of the proposed encounter maneuver, the determination method of the minimal orbital intersection distance is first given by constructing constraint equations in polynomial form. Then, the algorithm framework for determining the optimal encounter maneuvers is established. This scheme allows us to derive the optimal maneuver position, direction, and impulse magnitude, thereby creating a detailed two-layer solution framework for an arbitrary target. Concurrently, the strategy accommodates orbital phase deviations by proffering a rapid correction method that factors in the perturbation environment. To expand this optimal encounter maneuver planning method to multitarget missions, we develop a reduced-order allocation procedure for optimal pairing between vehicles and targets. Through the use of numerical simulations exemplified by one single-target and two multitarget missions, it is evident that the proposed method is both highly efficient and effective for encountering any given target.

An Allocation and Optimization Procedure for ARPANET Network Reliability Using Particle Swarm Optimization

In this paper we study the expansion of the telecommunications industry and the complexity of communications infrastructures. For ARPA networks such as ARPANET, the provision of integrated broadband service is essential. The new technology used in ARPANETs and changing traffic patterns have attracted much research attention to network topological design. Most topological design researchers have proposed techniques based on expensive exchange-based hardware. We presented a realistic ARPA network model in this study. ARPA network architecture includes network optimization. We proposed to apply particle swarm optimization (PSO) to enhance the ARPA network, and we also estimated the appropriate distribution of each system component using an exponential cost function. The results of the study show that the optimizer (PSO) had good results.

How to Balance Prognostic Factors in Controlled Phase II Trials: Stratified Permuted Block Randomization or Minimization? An Analysis of Clinical Trials in Digestive Oncology.

In controlled phase II trials, major prognostic factors need to be well balanced between arms. The main procedures used are SPBR (Stratified Permuted Block Randomization) and minimization. First, we provide a systematic review of the treatment allocation procedure used in gastrointestinal oncology controlled phase II trials published in 2019. Second, we performed simulations using data from six phase II studies to measure the impacts of imbalances and bias on the efficacy estimations. From the 40 articles analyzed, all mentioned randomization in both the title and abstract, the median number of patients included was 109, and 77.5% were multicenter. Of the 27 studies that reported at least one stratification variable, 10 included the center as a stratification variable, 10 used minimization, 9 used SBR, and 8 were unspecified. In real data studies, the imbalance increased with the number of centers. The total and marginal imbalances were higher with SBR than with minimization, and the difference increased with the number of centers. The efficiency estimates per arm were close to the original trial estimate in both procedures. Minimization is often used in cases of numerous centers and guarantees better similarity between arms for stratification variables for total and marginal imbalances in phase II trials.

Several Thoughts on the Protection of the Legitimate Rights and Interests of College Teachers under the Appointment System

This paper focuses on the protection of the legitimate rights and interests of university teachers under the appointment system. By analyzing the existing issues in the protection of the legitimate rights and interests of university teachers under the appointment system, several considerations regarding the protection of the legitimate rights and interests of university teachers are proposed. Currently, there are problems such as insufficient attention to the protection of university teachers' rights in China, slow updates of laws, and insufficient coordination among relevant parties. There are shortcomings in the protection of university teachers' rights by universities, educational administrative authorities, social organizations, and judicial organs. Drawing lessons from advanced practices in other countries and regions, this article proposes several suggestions based on the current situation in China, focusing on the legal relationship between universities and teachers, legal status, position allocation, teacher initiative, and teacher appointment procedures. These suggestions aim to explore feasible solutions for improving the system of protecting the rights and interests of university teachers under the appointment system while maximizing the protection of teachers' rights.

Efficacy of Combination Therapy with External Human Epidermal Growth Factor and Ebastin in 60 Cases of Eczema

Objective: The primary aim of this research endeavor was to meticulously evaluate the efficacy and safety profile of integrating external human epidermal growth factor (EGF) with ebastine in the therapeutic management of eczema, Methods: A comprehensive cohort comprising sixty patients clinically diagnosed with eczema and admitted to our esteemed medical facility during the period spanning from June 2020 to June 2022 was meticulously curated for this investigation. Employing a rigorous randomized allocation procedure, the recruited patients were stratified into two distinct groups: the control group and the study group. The control group, serving as the comparative benchmark, underwent treatment with conventional ebastine therapy, whereas the study group was subjected to a novel therapeutic regimen encompassing the combined administration of external human epidermal growth factor and ebastine. Throughout the study duration, each patient's response to treatment was diligently monitored and meticulously documented. Results: Upon comprehensive analysis of the treatment outcomes, it was unequivocally evident that the therapeutic regimen involving the concomitant administration of external human epidermal growth factor and ebastine yielded markedly superior outcomes in comparison to the conventional ebastine monotherapy. Specifically, the study group exhibited an impressively high effective rate of 96.7%, which starkly contrasted with the comparatively modest effective rate of 73.3% observed in the control group (P < 0.05). Moreover, the incidence of adverse reactions in the study group was notably lower, standing at 13.3%, as opposed to the substantially higher incidence rate of 46.7% documented in the control group (P < 0.05). These compelling findings underscore the profound therapeutic potential and favorable safety profile associated with the innovative combination therapy. Conclusions: In light of the compelling evidence gleaned from this meticulously conducted study, it can be unequivocally concluded that the integration of external human epidermal growth factor with ebastine holds immense promise as a novel therapeutic strategy for the effective management of eczema. These findings advocate for the wider adoption and integration of this innovative therapeutic approach into mainstream clinical practice, thereby signifying a pivotal advancement in the armamentarium against this debilitating dermatological ailment.

Homozygosity in any HLA locus is a risk factor for specific antibody production: the taboo concept 2.0.

In a cooperative study of the University Hospital Leipzig, University of Leipzig, and the Charité Berlin on kidney transplant patients, we analysed the occurrence of HLA-specific antibodies with respect to the HLA setup of the patients. We aimed at the definition of specific HLA antigens towards which the patients produced these antibodies. Patients were typed for the relevant HLA determinants using mainly the next-generation technology. Antibody screening was performed by the state-of-the-art multiplex-based technology using microspheres coupled with the respective HLA alleles of HLA class I and II determinants. Patients homozygous for HLA-A*02, HLA-A*03, HLA-A*24, HLA-B*07, HLA-B*18, HLA-B*35, HLA-B*44, HLA-C*03, HLA-C*04, and HLA-C*07 in the class I group and HLA-DRB1*01, HLA-DRB1*03, HLA-DRB1*07, HLA-DRB1*15, HLA-DQA1*01, HLA-DQA1*05, HLA-DQB1*02, HLA-DQB1*03(7), HLA-DQB1*06, HLA-DPA1*01, and HLA-DPB1*04 in the class II group were found to have a significant higher antibody production compared to the heterozygous ones. In general, all HLA determinants are affected. Remarkably, HLA-A*24 homozygous patients can produce antibodies towards all HLA-A determinants, while HLA-B*18 homozygous ones make antibodies towards all HLA-B and selected HLA-A and C antigens, and are associated with an elevation of HLA-DRB1, parts of DQB1 and DPB1 alleles. Homozygosity for the HLA class II HLA-DRB1*01, and HLA-DRB1*15 seems to increase the risk for antibody responses against most of the HLA class I antigens (HLA-A, HLA-B, and HLA-C) in contrast to HLA-DQB1*03(7) where a lower risk towards few HLA-A and HLA-B alleles is found. The widely observed differential antibody response is therefore to be accounted to the patient's HLA type. Homozygous patients are at risk of producing HLA-specific antibodies hampering the outcome of transplantation. Including this information on the allocation procedure might reduce antibody-mediated immune reactivity and prevent graft loss in a patient at risk, increasing the life span of the transplanted organ.

Numerical simulation of concrete strength based on microstructure and mineral composition analysis using micro-CT and XRD technology

The investigation of mechanical properties in porous materials, such as concrete, has been a significant area of interest in the fields of civil engineering and architecture. Traditional macroscopic mechanical testing methods are limited due to destructive experimental conditions, time-consuming procedures, and the inability to characterize internal structures. To overcome these limitations, researchers have utilized microscopic factors with micro-CT and simulation models. Different simulation methods demand mechanical parameters to effectively model the constituent materials; however, there exists variability in the amount and standard values of these input parameters, which leads to a decrease in the reliability of the obtained results. In order to tackle this issue, a novel approach is proposed, which integrates mineral component analysis using X-ray diffraction (XRD) and establishes coefficients to minimize the number of necessary input parameters. Simulation results demonstrate excellent agreement with experimental measurements, accurately reproducing the stages of elastic deformation, failure, and fracture in the stress-strain curve of concrete. Our findings reveal that changes in the concrete skeletal structure, microstructure, and mineral composition significantly influence compressive strength. Coarse aggregates and high-mechanical-performance minerals, in particular, have a substantial impact. Additionally, the mechanical properties show a significant linear relationship with the strength reduction coefficient of aggregates and concrete cores. In conclusion, the proposed method, combining CT scanning and XRD with FDEM, proves to be a reliable and practical approach for accurately assessing the mechanical properties of concrete. This methodology simplifies the intricate processes associated with the time-intensive parameter calibration, leading to a more efficient parameter allocation procedure. As a result, this method enhances concrete design, promotes a better understanding of parameter impacts, and enables accurate prediction of concrete behavior across diverse scenarios.

Alleinerziehende in der Betreuungsplatzvergabe: Status quo und Handlungsempfehlungen

Abstract Single parents and their children benefit particularly from early childhood education and childcare programmes. Nevertheless, almost a third of single parents in Germany who need childcare for their children under the age of three are unable to find it. Although around 70 % of day care providers claim to take the single-parent criterion into account when allocating slots, the prevailing allocation procedures cannot guarantee that this is implemented. This article shows how transparent allocation criteria can be designed nationwide and how their implementation can be realised through suitable, centralised, municipal allocation systems. Particularly in (western) German regions with a high unmet demand for institutional childcare, single-parent status should be considered as an independent criterion in addition to other factors such as employment and child age.

Healthcare Resource Allocation Optimization

Assuring high-quality patient care and making the best use of the resources at hand requires the efficient allocation of healthcare resources. This study uses a thorough examination of patient admission data, treatment plans, and staff availability to tackle the complex problem of optimizing healthcare resource allocation. We want to reduce wait times, optimize resource use, and eventually improve patient outcomes in healthcare facilities by integrating these essential elements. Our strategy makes use of cutting-edge data analytics tools, such as optimization algorithms and predictive modelling, to find underlying patterns and trends in patient demand, treatment regimens, and staffing needs. Our goal is to create prediction models that anticipate patient admissions, treatment requirements, and staffing levels by analysing historical data and real-time inputs. This will allow for proactive resource allocation techniques. The study's conclusions have important ramifications for healthcare administration since they provide practical advice on how to improve patient care delivery, cut wait times, and make the most use of the resources at hand. Healthcare institutions can enhance resource allocation procedures to meet the changing demands of patient care while guaranteeing the optimal use of resources by integrating technology, data-driven decision-making, and evidence-based practices. In summary, this study lays the groundwork for future investigations and innovations in hospital administration and operations while also supporting current initiatives to enhance healthcare resource allocation procedures. Healthcare organizations can improve patient outcomes and achieve operational excellence while providing high-quality, patient-centred care by adopting data-driven approaches and utilizing technology.

DEEP LEARNING FOR VISUAL RECOGNITION

The design and development of an advanced object detection system are presented in this work, which was guided by a thorough literature review and feasibility assessment. The literature review emphasises how object detection techniques have evolved, highlighting the shift from conventional techniques to deep learning approaches. Important developments are highlighted, such as feature pyramid networks, anchor-based localization, and region-based and single-stage detectors. Furthermore, offered are insights about assessment metrics, transfer learning, and data augmentation. A feasibility study assesses the suggested systems operational, technological, and financial viability and finds that it is highly feasible in each of these areas. The architecture of the system is modular and scalable, including backend services, data management, an object detection engine, and a user interface among its constituent parts. Specifications for both functional and non-functional needs are provided, which direct the development of the system. The development phases, resource allocation, development process, and quality assurance procedures are all outlined in the implementation plan. Through the integration of deep learning techniques, the suggested system seeks to achieve high-performance object identification capabilities that are appropriate for a variety of applications while being scalable, reliable, and user-friendly.

Impacts of earthquake damage on commercial life: A RS and GIS based case study of Kahramanmaraş earthquakes

Earthquakes have negative impacts on societies, both socially and economically, and can disrupt daily life in the affected region. The economic impact of earthquakes is typically analyzed by economists through material losses. However, considering the role and importance of geospatial information, this study aims to develop a new method to analyze the negative impact of earthquakes on economic life by detecting the physical damage in commercial land uses. Within this context, the study uses Geographic Information Systems (GIS) and remote sensing capabilities to detect damaged commercial units based on Point of Interest (POI) data in the Antakya and Defne districts of Hatay, one of the 11 provinces heavily destroyed in Kahramanmaraş earthquakes in Türkiye that occurred on February 6, 2023, with magnitudes of 7.7 and 7.6 Mw. The study, utilizing Geographic Information Systems (GIS) and remote sensing technologies, has provided valuable information on the extent of earthquake-related economic losses in the Antakya and Defne districts of Hatay. Analysis of the point of interest (POI) data shows that 55 % of commercial locations, particularly those in metropolitan centers, were negatively impacted. This significant number emphasizes the deep susceptibility of commercial infrastructure to seismic events and emphasizes the vital necessity for specific recovery and resilience approaches. Methodological novelties enable quick identification of critical services needed for urgent disaster response and improve the accuracy of damage estimates, which are crucial for optimizing resource allocation procedures and providing decision-makers with comprehensive spatial data for strategic planning. The study highlights the importance of geospatial technologies in fully understanding the economic impacts of earthquakes and the role of commercial disruption on disaster preparedness, response, and recovery.

The Impact of Three-Month Quercetin Intake on Quality of Life and Anxiety in Patients With Type II Diabetes Mellitus: An Early Data Analysis From a Randomized Controlled Trial.

Diabetes is a high-prevalence, major chronic metabolic disease demanding effective interventions. Quercetin, a phytochemical with potential health benefits, has garnered interest for its therapeutic properties. This study was designed to capture the early efficacy and clinical safety aspects following quercetin administration in patients with type II diabetes mellitus (T2DM). The main study involved a randomized allocation procedure to assign non-insulin-treated patients attending the 4th Health Unit of Heraklion to intervention and control groups based on age and sex. The intervention group (n=50) received 500 mg of quercetin daily for 12 + (8 free intervals) + 12 weeks, alongside their usual treatment, while the control group (n=50) did not. After randomization, for the intermediary 12-week follow-up, data from 38 patients (intervention: 20; control: 18) were analyzed in this report. All subjects provided informed consent for the collection of anthropometric measurements, vital signs, daily habits data, and PiKo-6 spirometric readings. Additionally, participants responded to the Short Anxiety Screening Test (SAST) and the 36-Item Short Form Health Survey (SF-36) questionnaires. Thirty-eight participants were included (60% men and 40% women in the intervention group; 38.9% men and 61.1% women in the control group). In the treatment arm, Forced Expiratory Volume in the first second (FEV1) measured with PiKo-6 showed a Δ%- change for the intervention arm: +6.8%, control: -0.2% (p=0.059), systolic blood pressure; intervention: -7.4%, control: -3.7% (p=0.117), waist circumference; intervention: -1.5% control: -0.7% (p=0.455) and night-time sleep; intervention: +5.3%, control: +1.4% (p=0.926) were favourably influenced. The treatment group exhibited significant enhancements in both anxiety levels assessed by the anxiety symptoms scale (SAST-10, p=0.026) and quality of life evaluated by the SF-36 (p<0.001). Positive evidence is emerging for a pleiotropic effect of quercetin intake in patients with T2DM, specifically in terms of anxiety reduction and amelioration of life quality, in just 12 weeks of administration and without adverse effects, indicating clinical safety and underscoring its potential for integration in T2DM supportive care.

Pre-operative vs. post-operative stereotactic radiosurgery for operative metastatic brain tumors: study protocol for a phase III clinical trial

Background and ObjectivesAlmost one third of cancer patients in the United States will develop brain metastases on an annual basis. Surgical resection is indicated in the setting of brain metastases for reasons, such as maximizing local control in select patients, decompression of mass effect, and/or tissue diagnosis. The current standard of care following resection of a brain metastasis has shifted from whole brain radiation therapy to post-operative stereotactic radiosurgery (SRS). However, there is a significant rate of local recurrence within one year of postoperative SRS. Emerging retrospective and prospective data suggest pre-operative SRS is a safe and potentially effective treatment paradigm for surgical brain metastases. This trial intends to determine, for patients with an indication for resection of a brain metastasis, whether there is an increase in the time to a composite endpoint of adverse outcomes; including the first occurrence of either: local recurrence, leptomeningeal disease, or symptomatic radiation brain necrosis - in patients who receive pre-operative SRS as compared to patients who receive post-operative SRS.MethodsThis randomized phase III clinical trial compares pre-operative with post-operative SRS for brain metastases. A dynamic random allocation procedure will allocate an equal number of patients to each arm: pre-operative SRS followed by surgery or surgery followed by post-operative SRS.Expected outcomesIf pre-operative SRS improves outcomes relative to post-operative SRS, this will establish pre-operative SRS as superior. If post-operative SRS proves superior to pre-operative SRS, it will remain a standard of care and halt the increasing utilization of pre-operative SRS. If there is no difference in pre- versus post-operative SRS, then pre-operative SRS may still be preferred, given patient convenience and the potential for a condensed timeline.DiscussionEmerging retrospective and prospective data have demonstrated some benefits of pre-op SRS vs. post-op SRS. This study will show whether there is an increase in the time to the composite endpoint. Additionally, the study will compare overall survival; patient-reported outcomes; morbidity; completion of planned therapies; time to systemic therapy; time to regional progression; time to CNS progression; time to subsequent treatment; rate of radiation necrosis; rate of local recurrence; and rate of leptomeningeal disease.Trial registration numberNCT03750227 (Registration date: 21/11/2018).

The 50% effective dose of hydromorphone and morphine for epidural analgesia in the hemorrhoidectomy: a double-blind, sequential dose-finding study

BackgroundAlthough previous studies have showed that epidural morphine can be used as a complement to local anesthetics for analgesia after postcesarean delivery under spinal anesthesia, there is little known about the analgesic dosage of epidural morphine and hydromorphone for hemorrhoidectomy. Therefore, we conducted this study to examine the potency ratio of hydromorphone to epidural morphine as well as effective analgesic dose for 50% patients (ED50) undergoing elective hemorrhoidectomy.Methods80 patients under elective hemorrhoidectomy with combined spinal and epidural anesthesia(CSEA) in department of anesthesia, Dongguan Tungwah hospital. To assess the ED50, patients were treated with epidural morphine or epidural hydromorphone randomly using a biased coin method-determined dose with a sequential allocation procedure. Following surgery, standardized multimodal analgesia was administered to all patients. A pain response score of ≤ 3 (on a scale of 0–10) was determined to be the effective dose after 24 h following CSEA. The ED50 in both groups were determined using the probit regression and isotonic regression method. We also measured pain intensity by patient interview using a 10 point verbal numeric rating scale prospectively at 6, 12 and 24 h after CSEA, and adverse effects were also noted.ResultsThe ED50 was 0.350 mg (95% CI, 0.259–0.376 mg) in hydromorphone group and 1.129 mg (95% CI, 0.903–1.187 mg) in morphine group, respectively, estimated by isotonic regression method. Regression analysis with the probit, the ED50 of epidural hydromorphone was 0.366 mg (95% CI, 0.276–0.388 mg) and epidural morphine was 1.138 mg (95% CI, 0.910–1.201 mg). Exploratory findings showed that there was no difference between the most frequent dosages of epidural hydromorphone or epidural morphine in the occurrence of nausea, vomiting and pruritus. When administered with epidural opioids at ED50 doses or higher, 97.5% (39/40) of epidural morphine patients and 97.5% (39/40) epidural hydromorphone of patients were satisfied with their analgesia.ConclusionEffective hemorrhoidectomy analgesia requires a 3:1 ratio of epidural morphine to epidural hydromorphone. Both drugs provide excellent patient satisfaction.