Free Period Research Articles

A prospective comparative randomized controlled study of erector spinae plane block using local anesthetics versus general anesthesia for the perioperative control of pain in patients undergoing thoracoscopic procedures

Background: Patients posted for video-assisted thoracoscopic surgeries (VATS) are nowadays managed intraoperatively by general anesthesia (GA) with the use of oral and parenteral analgesics in the post-operative period. Ongoing research points out that the erector spinae plane block (ESP Block) with local anesthetics is a safe technique for the perioperative management of pain in thoracoscopic procedures. Aims and Objectives: Our study aimed at comparing ultrasound guided ESP block using local anesthetics versus GA for perioperative pain management in patients who underwent thoracoscopic procedures. The objectives of this research were to assess the hemodynamic changes in patients undergoing the procedure, to calculate the total amount of analgesics required by patients in the next 24 h, to assess the overall patient satisfaction and complications in the post-operative period. Materials and Methods: In this prospective comparative randomized controlled trial, 40 patients aged 18–65 years planned to undergo VATS were enrolled and randomized to either group G or group E in equal numbers depending on the anesthetic technique employed. Group G patients received GA and Group E patients received ultrasound guided ESP block. Both the groups were compared for hemodynamic stability, pain in postoperative period using visual analog scale (VAS), time to first rescue analgesia requested since induction, total amount of rescue analgesia requested, overall patient satisfaction, and post-operative complications. Results: Better control of hemodynamic parameters, less post-operative pain, prolonged duration of analgesia (P < 0.05), and requirement of lesser amount of rescue analgesics were observed in patients of Group E in comparison with patients of Group G. Side effects such as post-operative nausea and vomiting were more in patients of Group G in the first 24 h (P < 0.05). Conclusion: ESP block with local anesthetics can be used as an effective sole anesthetic technique for VATS <60 min providing a longer pain free post-operative period, lesser rescue analgesic requirement, better patient satisfaction, and lesser post-operative complications.

3,3'-Diindolylmethane plus Eflornithine suppress DNA Replication and Cell Cycle in Esophageal Squamous Cell Carcinoma in vivo.

Esophageal squamous cell carcinoma (ESCC) is a malignant cancer that is responsible for a high mortality rate; it accounts for approximately 90% of the 456,000 esophageal cancer (EC) cases diagnosed annually. Effective natural or synthesized compounds to prevent, treat, and/or inhibit ESCC relapse are desperately needed. The natural di-indole compound 3,3'-diindolylmethane (DIM) is abundant in cruciferous vegetables and shows potent anti-tumor effects in multiple cancers. The synthesized Eflornithine (DFMO) is clinically used to treat African sleeping sickness. We demonstrated that the combination of DIM+DFMO could significantly suppress the ESCC growth in the in vivo study of three patient-derived xenograft (PDX) cases. Then, the corresponding underlying anticancer mechanisms were investigated via the isobaric tags for relative and absolute quantification (iTRAQ) on the proteome level. We found that the DNA Replication and Cell Cycle were the top-2 most significantly downregulated signaling pathways following the DIM+DFMO treatment. Correspondingly and interestingly, these two pathways were the top-2 upregulated ones in clinic ESCC tumors. Moreover, the involved differentially expressed genes (DEGs) including MCM2, MCM3, MCM5, MCM6, MCM7, CDK1, and LIG1 were all inversely downregulated by DIM+DFMO treatment. In the limited clinical study in two ESCC cases, the administration of DIM (250mg) +DFMO (500 mg) once daily showed favorable results, including alleviated swallowing difficulties, decreased blood tumor markers (CA19-9, CA15-3 and AFP), and no severe toxicity in at least one month progression free survival period. We concluded that DIM+DFMO is a promising therapeutic combination for ESCC treatment via the suppression of DNA Replication and Cell Cycle activities. However, these therapeutic effects should be verified in large cohort clinical trials with sufficient cases.

Research on Time Inventory Control Model of 3PL Warehousing of Furniture Products under Uncertain Lead Time

3PL warehousing has become an important link between suppliers and retailers in the cross-border e-commerce supply chain. During the COVID-19, product shortage became one of the biggest concerns with the overseas 3PL warehouse integration using ocean shipment. Therefore it has become the focus of the cross-border e-commerce industry and research. Due to the large volume and low-value density, furniture products are generally replenished by ocean transportation. The shortage of such products can be caused by ocean transportation which brings uncertain arrival times and difficult inventory control. This paper, considering the uncertain lead time, uncertain demand, and 3PL warehouse free storage period, introduces a replenishment inventory control model. Utilizing the mathematical dynamic simulation model, it takes refrigerators as a product example into the calculations to prove the validity and accuracy. The experimental results demonstrate that the warehouse free-storage period is a vital factor affecting inventory control for cross-border e-commerce enterprises. When the lead time is uncertain, it is the most optimized solution to use the maximum lead time to determine the maximum inventory.

FRACTAL CHANGE OF FACADES OF HIGH-RISE BUILDINGS ACCORDING TO ARCHITECTURAL PERIODS

In this study, using fractal analysis method, high-rise buildings from different historical periods are analyzed according to a) silhouette and (b) form+ornament+material variables. Purpose: The hypothesis of the study; although tall buildings are often criticized as monotonous and simple glass boxes, it is on the idea that buildings have a high variety and richness of detail when measured numerically. Method: In this direction, eight architectural periods were determined for tall buildings and fractal analyzes were carried out on five well-known structures belonging to each period. Results: All evaluated structures had low fractal values in terms of silhouette variable (DS) and high fractal values in terms of form+ornament+material variable (DFOM). The period with the lowest value in terms of facade detail is the International Period, while the period with the highest value is the Free Form Period. In terms of the detail of the building silhouette, the Technological Period stands out. Conclusion: Contrary to popular belief, tall buildings are rather complex and diverse structures, rather than monotonous and uniform glass boxes. Tall building designs will continue to be important in the future as more complex and diverse structures.

Seller’s replenishment decision for material following quadratic demand with different payment structures

The acquiring cost of any material is often paid by implementing one of the payment practice. Payment is either through cash or else an interest free credit period is availed or advance is given while placing an order. Each of this method has rewards and drawbacks associated with it. In realism, a payment structure which is an amalgamation of these three options is put to use. The present work deals with mathematical modelling of regulating the refilling plan for seller where items adhere to quadratic demand style. The seller acquires an advance-cash-credit payment form from the provider, while forwarding a similar concept of cash-credit to the consumers. For validating the model, numerical exemplar with suitable values of inventory parameters are discussed. Lastly, managerial insights are furnished, by investigating effect of inventory parameters in reference to alteration of one parameter at a time.

Research on Working Condition Diagnosis of Submersible Screw Pump

As the development of each oil field enters the middle and late stage, sand production, wax deposition and the continuous increase of well depth, electric submersible screw pump wells frequently break down, and hidden troubles of equipment can not be found in time, which makes oil wells produce with faults. It increases the wear and tear of equipment, seriously affects the production of oil wells, and causes unnecessary economic losses. Therefore, improving the accuracy of the working condition diagnosis of the electric submersible screw pump production system plays a vital role in improving the overall management level of the electric submersible screw pump well. This can not only enhance the managers’ correct understanding of this kind of oil well system, but also comprehensively monitor the working state of the well. It can find the fault as soon as possible, analyze the cause of the fault, and avoid the accident by adjusting the production parameters, so that the downhole screw pump can work safely, reliably and effectively, and maximize the maintenance free period and economic benefits of the electric submersible screw pump well.

Determinants of Sports Participation in Extramural Competitions by Athletes in Tertiary Institutions in Ekiti State, Nigeria

Determinants of Sports Participation in Extramural Competitions by Athletes in Tertiary Institutions in Ekiti State, Nigeria

Assessment of Postoperative Analgesic Efficacy of Ilioinguinal-Iliohypogastric Block as Compared to Caudal Block in Children Undergoing Inguinal Herniotomy: A Randomised Clinical Study

Introduction: An Inguinal herniotomy is most frequently performed surgery in children under general anaesthesia along with various regional anaesthesia techniques such as ilioinguinal-iliohypogastric block (hernia block) or caudal block. Aim: To compare postoperative analgesic efficacy of hernia block (anatomical landmark guided ilioinguinal- iliohypogastric block) versus caudal block using bupivacaine as a local anaesthetic in children undergoing inguinal herniotomy. Materials and Methods: This single-centre, randomised clinical study was conducted at tertiary medical college and hospital (Lokmanya Tilak Municipal Medical College and General Hospital), Mumbai, Maharashtra, India, from December 2016 to December 2018. The study included 100 children from age 6 months to 6 years with American Society of Anesthesiologists (ASA) grade I and II, posted for elective inguinal herniotomy (unilateral). All children were given either hernia block or caudal block, based on computerized randomisation method. Total 55 patients received hernia block (Group H) with 0.3 mL/kg of 0.25% concentration of bupivacaine and another 45 patients received caudal block (Group C) with 0.75 mL/kg of 0.25% bupivacaine. In the postoperative period, mean pain free period and total duration of rescue analgesia were recorded in both the groups. Chi-square test and Fisher’s-exact test. The p-value <0.05 was indicated as statistically significant. Results: Demographic data was comparable in two groups. The mean drug volume (bupivacaine 0.25%) used in group C was 8.44 ±3.46 mL and in group H was 4.24 ±1.6 mL. The mean pain free period, with in the first 24 hours, in group C was 8.80±6.43 hours and in group H, it was 11.77±8 hours. Rescue analgesia and FLACC score (the Face, Legs, Activity, Cry, Consolability scale) at 0 min, 15 min, 30 min and every hour upto 4 hours was comparable in both the groups. Mean time of discharge of patients receiving either of blocks, FLACC score at the time of discharge were comparable in both the groups. Conclusion: Hernia block was more effective than caudal block based on duration of postoperative analgesia. There was higher margin of safety with lower volume of local anaesthetic used.

Linear instability of periodic orbits of free period Lagrangian systems

<abstract><p>Minimizing closed geodesics on surfaces are linearly unstable. By starting with this classical Poincaré's instability result, in the present paper we prove a result that allows to deduce the linear instability of periodic solutions of autonomous Lagrangian systems admitting an orbit cylinder (condition which is satisfied for instance if the periodic orbit is transversally non-degenerate) in terms of the parity properties of a suitable quantity which is obtained by adding the dimension of the configuration space to a suitably defined spectral index. Such a spectral index coincides with the Morse index of the periodic orbit seen as a critical point of the free period action functional in the case the Lagrangian is Tonelli, namely fibrewise strictly convex and superlinear, and it encodes the functional and symplectic properties of the problem.</p> <p>The main result of the paper is a generalization of the celebrated Poincaré 's instability result for closed geodesics on surfaces and at the same time extends to the autonomous case several previous results which have been proved by the authors (as well as by others) in the case of non-autonomous Lagrangian systems.</p></abstract>

Effect of repeated seizures on spatial exploration and immediate early gene expression in the hippocampus and dentate gyrus

Immediate early genes (IEGs) are coordinately activated in response to neuronal activity and can cause activation of secondary response genes that modulate synaptic plasticity and mediate long-lasting changes in behaviour. Excessive neuronal stimulation induced by epileptic seizures induce rapid and dramatic changes in IEG expression. Although the impact of acute seizure activity on IEG expression has been well studied, less is known about the long-term effects of chronic seizures on IEG induction during seizure free periods where behavioural and cognitive impairments are frequently observed in people with epilepsy and in animal models of epilepsy. The present study sought out to examine the impact of chronic pentylenetetrazole evoked seizures (PTZ kindling) on spatial exploration induced in IEG expression (c-Fos, ΔFosB, Homer1a, Egr1, Npas4, Nr4a1) in the hippocampus (CA1 and CA3 subfields) and dentate gyrus of rats. Male rats underwent two weeks of PTZ kindling (every 2 days) or received vehicle injections and were placed into a novel open field arena for 30 min either 24 hrs or 4 weeks after the last treatment. Although exploratory activity was similar between PTZ kindled and vehicle controls when examined 24 hrs after the last treatment, we observed a significant reduction in spatial exploration induced expression of c-Fos, Egr1, and ΔFosB in the hippocampus and dentate gyrus, and reduced expression of Nr4a1 in the dentate gyrus and Homer1a in the hippocampus only. When testing was conducted after a 4-week recovery period, only c-Fos continued to show reduced expression after exposure a novel environment in previously PTZ kindled animals. Interestingly, these animals also showed reduced activity in the center region of the open field suggestive of heightened anxiety-like behaviour. Collectively, these results suggest that repeated seizures may lead to longterm downregulation in hippocampal IEG expression that can extend into seizure free periods thereby providing a critical mechanism for the development of cognitive and behavioural deficits that arise during chronic epilepsy

Prevalence and correlates of depression in patients with epilepsy in Sri Lanka.

Depression is one of the most common psychiatric disorders in patients with epilepsy and it is often associated with poor quality of life, increased risk of suicide and poor seizure control, yet remains underdiagnosed and undertreated. The prevalence and associations for depression in patients with epilepsy vary between studies reflecting regional and cultural influences. Therefore, it is important to identify unique attributes within a community on this phenomenon This is the first study from Sri Lanka on the prevalence and correlates of depression in patients with epilepsy. We conducted this cross-sectional study at the Epilepsy clinic, Colombo North Teaching Hospital, Ragama. All consenting patients with a diagnosis of epilepsy followed up at the clinic, during study period, were enrolled. Symptoms of depression were screened with Beck Depression Inventory II and diagnosis was confirmed with a clinical assessment by psychiatrist. Of 150 participants, majority were female 63.3%. (95) and 36.7% (55) of the sample were between 26-45 years. The prevalence of depressive disorder was 22% (33). The prevalence of depression was significantly associated with the recent diagnosis of epilepsy, use of multiple antiepileptic medications and duration of seizure free period (p<0.05). There is a statistically significant association between prevalence of depression with the use of carbamazepine, topiramate, clobazam and phenobarbitone. Regression analysis revealed higher the duration individuals suffering from epilepsy were at lower odds of having depression compared with that of individuals suffering from lower duration of epilepsy. For each year in increase of duration of epilepsy, the odds of depression decreased by 2% (95% CI 0.3% to 5.1%). The prevalence of depression is high in patients with epilepsy. Risk of having depression is higher during the early phase of the illness. Therefore, it is important to screen patients with epilepsy for depressive disorder during the early course of the illness.

Novel left and right ventricular strain analysis to detect subclinical myocardial dysfunction in cardiac allograft rejection.

Early detection of acute cellular rejection (ACR) by echocardiography shows potential clinical benefit as ACR remains a significant contributor to morbidity and mortality. This retrospective, longitudinal study sought to investigate the use of novel left (LV) and right ventricular (RV) strain analysis to detect biopsy proven ACR. 46 heart transplant patients (Mean age 46 ± 16years) with biopsy proven ACR were grouped according to biopsy results: 1R-ACR (n = 36) and 2R-ACR (n = 10). Serial two-dimensional transthoracic echocardiography with strain analysis was performed. Echocardiographic parameters were serially measured: (1) rejection free period (0R-ACR); (2) pre-ACR period (pre-ACR); (3) during ACR (1R-ACR or 2R-ACR) and (4) post-ACR (Post-ACR). Significant reductions for LV Global Longitudinal Strain (LV GLS) and LV Early diastolic Strain rate (LV ESr) were observed between 0R-ACR and pre-ACR (LV GLS 0R-ACR: 17.3% vs Pre-2R ACR: 15.4%, p = 0.016; LV ESr 0R-ACR: 1.00/s vs Pre-2R ACR: 0.74/s, p = 0.007) with LV ESr demonstrating the highest sensitivity (92%) and specificity (81%) to predict ACR. LV ESr and the E/LV ESr ratio were significantly different (p = 0.0001; p = 0.016) during pre-1R ACR period vs 0R whereas LV GLS showed no significant differences for grade 1R-ACR. Diastolic mechanical dispersion showed significant increases in dispersion during ACR for the 1R-ACR group and early significant increases pre-2R ACR. Systolic and diastolic RV strain parameters showed a similar trend for both ACR groups. Systolic and diastolic strain parameters can detect myocardial dysfunction before biopsy confirmed 2R-ACR. Early diastolic strain rate parameters are most sensitive detecting subclinical myocardial dysfunction pre-ACR. Novel strain parameters are potentially useful clinical tool for prediction of early ACR in heart transplant.

Analysis of IEEE 802.15.4-Based Delay and Slot Duration Adjustment Combination Methods on Wireless Sensor Networks

IEEE 802.15.4 is one of the standards of the Wireless Sensor Network (WSN) which is at the Medium Access Control (MAC) layer. IEEE 802.15.4 is also technology and protocol within a computer network that can connect all device quickly, has a large capacity and low power consumption. The challenge of Wireless Sensor Network is how to improve the Wireless Sensor Network network performance matrix (goodput, bandwidth utilization, and energy consumption) both in the Contention Access Period (CAP) and in the Contention Free Period (CFP) based on the IEEE 802.15.4 standard. This research is an analysis combination of adjustment delay and slot duration methods to increase goodput, bandwidth utilization and reduce energy consumption in Wireless Sensor Networks in the allocation guaranteed time slots on fixed data simulated using Castalia Simulator software. The problem of this research is whether the combination method can improve the performance matrix of Wireless Sensor Networks on fixed data compared to other methods (SUDAS, ADES, IEEE 802.15.4 Standard). This reserch it aims to determine the performance matrix of combination methods is when compared to other methods (Superframe Duration Adjustment Scheme (SUDAS), Adjustment Delay Scheme (ADES), IEEE 802.15.4 standard) using quantitative approach research methods. Based on the data obtained, the goodput of the combined method increased by 10%, 416%, and 513% respectively compared to the SUDAS method, ADES method, and IEEE 802.15.4 standards. Bandwidth utilization of the combination methods increased by 0.025, 0.223 and 0.232, respectively compared to the SUDAS method, the ADES method, and the IEEE 802.15.4 standard. And the consumption of the combination methods are respectively reduced by 1.02%, 8.72% and 9.08% compared to the SUDAS, ADES and IEEE 802.15.4 standards. With the combination method of delay adjustment and slot duration it is able to optimize the performance of the Wireless Sensor Network compared to other methods.

One year outcome and predictors of treatment outcome in central serous chorioretinopathy: Multimodal imaging based analysis.

To evaluate the follow up and treatment outcome of central serous chorioretinopathy (CSCR) based on the new multimodal imaging-based classification and identify the predictors for anatomic and visual outcome. Retrospective, multicentric study on 95 eyes diagnosed with CSCR and a follow up of at least 12 months were included. Eyes with macular neovascularization, atypical CSCR or any other disease were excluded. At the baseline, observation was advised to 70% eyes with simple CSCR whereas photodynamic therapy (PDT) was performed in 49% eyes with complex CSCR. Over the follow up, decrease in CMT was significantly higher in simple CSCR as compared to complex CSCR (P = 0.008) and the recurrences were significantly more in eyes with lower CMT at baseline (P = 0.0002). Median time of resolution of SRF was 3 months and 6 months in simple and complex CSCR respectively (P = 0.09). For the 12 months follow up, the median fluid free period was greater (P = 0.03) while number of interventions performed was lesser in eyes with simple CSCR as compared to complex CSCR (P = 0.006). Multiple regression analysis showed baseline best corrected visual acuity (BCVA) and baseline persistent SRF to be significantly predictive of BCVA and persistent SRF at 12 months (P < 0.0001, 0.04) respectively. Complex CSCR more often required PDT, was associated with shorter fluid free interval and longer time for SRF resolution. Baseline BCVA and persistent SRF were predictive of final visual and anatomical outcome. The new multimodal imaging based classification is helpful in establishing objective criteria for planning treatment approaches for CSCR.

Optimized Land Use through Integrated Land Suitability and GIS Approach in West El-Minia Governorate, Upper Egypt

Land evaluation is imperative for its efficient use in agriculture. Therefore, this study aimed at assessing the suitability of a region in West El-Minia for cultivating some of the major crops using the geographical information system (GIS). The results focus on allocating space for cultivating sugar beet and utilizing the free period of sugar beet in other crops. This exploitation helps to maintain the quality of the land and increase its fertility by using crop rotation with integrated agricultural management. A machine learning technique was implemented using the random forest algorithm (RF) to predict soil suitability classes for sugar beet using geomorphology, terrain attribute and remote sensing data. Fifteen major crops were evaluated using a suitability multicriteria approach in GIS environment for crop rotation decisions. Soil parameters were determined (soil depth, pH, texture, CaCO3, drainage, ECe, and slope) to characterize the land units for soil suitability. Soils of the area were found to be Entisols; Typic Torrifluvents, Typic Torripsamments and Typic Torriorthents and Aridsols; Typic Haplocacids, Calcic Haplosalids and Sodic Haplocalcids. Overall, the studied area was classified into four suitability classes: high “S1”, moderate “S2”, marginal “S3”, and not suitable “N”. The area of each suitability class changed depending on the crop tested. The highest two crops that occupied S1 class were barley with 471.5 ha (representing 6.8% of the total study area) and alfalfa with 157.4 ha (2.3%). In addition, barley, sugar beet, and sorghum occupied the highest areas in S2 class with 6415.3 ha (92.5%), 6111.3 ha (88.11%) and 6111.3 ha (88.1%), respectively. Regarding the S3 class, three different crops (sesame, green pepper, and maize) were the most highly represented by 6151.8 ha (88.7%), 6126.3 ha (88.3%), and 6116.7 ha (88.2%), respectively. In the end, potato and beans occupied the highest areas in N class with 6916.9 ha (99.7%) and 6853.5 ha (98.8%), respectively. The results revealed that the integration of GIS and soil suitability system consists of an appropriate approach for the evaluation of suitable crop rotations for optimized land use planning and to prevent soil degradation. The study recommends using crop rotation, as it contributes to soil sustainability and the control of plant pests and diseases, where the succession of agricultural crops on a scientific basis aims at maintaining the balance of nutrients and fertilizers in the soil.

Influence of period of weed interference and age of pepper (Capsicum annuum L. cv. Cayenne pepper) seedlings on pepper fruit quality and marketability

The field trials were conducted in the early and late wet seasons of 2012 at the Federal University of Agriculture, Abeokuta, Ogun State, Nigeria. The objective of the study was to evaluate influence of period of weed interference on fruit quality and marketability of pepper fruit under different seedling ages. Split-plot arrangement in a randomized complete block design with three replicates was adopted in the trials. The main plot treatments were ages of pepper seedlings at transplant, four and six weeks after sowing (WAS). Sub-plot treatments consisted of 10 periods of weed interference. Data collected on weed cover score, cumulative dry weed weight, dry plant biomass, number of leaves, fruit girth, fruit length, marketable fruit count and yield as well as non-marketable fruit count and yield were subjected to analysis of variance and treatment means were separated using least significant difference at p ≤ 0.05. The results showed that six week old pepper seedling had higher plant biomass, number of leaves and marketable fruit yield than the four week old. Also, pepper growth parameters, pepper fruit quality and marketability increased with weed free period and decreased with weed infestation period. Uncontrolled weed infestation for whole season caused 98.4% and 91.8% reduction in pepper marketability in the early wet and late wet season, respectively.

Whole cycle non-hyperaemic pressure ratios have better stability than diastolic ratios after percutaneous coronary intervention due to changes in diastolic coronary haemodynamics

Abstract Background Post percutaneous intervention (PCI) fractional flow reserve (FFR) value of ≥0.90 is an accepted marker of procedural success, and similarly, a cut-off of ≥0.95 has recently been proposed for post-PCI instantaneous wave free ratio (iFR). However, the stability of non-hyperaemic pressure ratios (NHPRs) and microcirculatory resistance post-PCI, is not well characterised. as submaximal hyperaemia post-PCI may affect them. Purpose We performed this study to assess stability and reproducibility of NHPRs measured immediately post-PCI and repeated at 30 minutes post-PCI. Methods Seventy-seven patients undergoing pressure wire guided PCI (age 63.77±10.67 years, male 71%,) had haemodynamic assessment done immediately post-PCI and after a recovery period 30 minutes (Figure A, B). Manual offline analysis was performed to derive resting pressure ratios during whole cycle: average ratio of distal coronary pressure to proximal aortic pressure at rest (Pd/Pa) and resting full cycle ratio (RFR); and during diastolic phase: average diastolic pressure ratio (dPR) and mathematically calculated iFRmat, measured by average Pd/Pa during wave free period (WFP) (from 25% into diastole until 5 msec before the end of diastole). We also measured coronary flow velocity by thermo-dilution time (Tmn) and basal microvascular resistance (BMR = Pa × Tmn × [(Pd − Pw) / (Pa − Pw)] baseline) corrected for coronary wedge pressure (Pw). Test-retest statistics was performed between NHPRs values immediately post-PCI and at 30 minutes. Moreover, crossover of NHPRs across the cut-off value of 0.95 was analysed to assess clinical utility of these indices for procedural success. p value of &amp;lt;0.05 was deemed statistically significant. Results There were no differences in the baseline characteristics of the study patients. Sub-maximal hyperaemia was demonstrated by Tmn of 0.54 sec (0.32, 0.75) immediately post-PCI which settled by 30 minutes, Tmn of 0.67 sec (0.43, 0.91), p=0.01 (Figure C). The median BMR increased from 49.25 mmHg sec (32.74, 61.61) to 59.60 mmHg sec (39.24, 76.91) at 30 minutes, p=0.04 (Figure D). Despite this, there were no significant differences in the values of resting whole cycle ratios (Pd/Pa and RFR) as well as diastolic ratios (dPR and iFRmat), with whole cardiac cycle NHPRs having best stability post-PCI (Table). Furthermore, crossover above or below the cut-off value of 0.95 occurred in approximately 1 in 5 diastolic NHPRs measurements but was three-fold lower for whole cycle NHPRs. Conclusion NHPRs remain stable post-PCI, despite submaximal hyperaemia being detected and may legitimately be used immediately post-PCI to determine procedural success. However, the test-retest reproducibility and clinical utility of diastolic NHPRs (dPR and iFR) was inferior to whole cycle NHPRs (Pd/Pa and RFR). Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): NIHR

Factors precipitating breakthrough seizures in childhood epilepsy

Abstract Background: Breakthrough seizures occur in 37% of epilepsy patients even though remission has been attained. Counseling on precipitating factors form an integral part of treatment along with anti-epileptic drugs (AEDs). Identification of precipitating factors may help in reducing unnecessary hospitalization and complications of breakthrough seizures. Materials and Methods: This retrospective study was conducted in a tertiary healthcare center in Puducherry. All children with epilepsy admitted with breakthrough seizures from January 2017 to December 2019 were included in the study. Those with neonatal seizures, diagnosis of either Neurocysticercosis or tuberculoma, cases without seizure free period of 6 months and case records without adequate details were excluded. Data regarding precipitating factors were collected from case records and analyzed using SPSS version 24.0 software. Results: Of the 80 children included in the study, mean age was 4.98 (±3.52) years and 56.3% were less than 5 years of age. In total, 90% (n = 72) of the participants had generalized epilepsy, of which 67 had generalized seizures, four had absence seizures and one had atonic seizures. Majority (85%) reported at least one possible precipitating factor for breakthrough seizures and common ones were fever (27.5%) and non-compliance to medication (26.25%). Most common reason for non-compliance was forgetting to take medication (38%). Also illiterate mothers and multiple AEDs had a significant association with non-compliance (P &lt; 0.05). Conclusion: The results of our study stress the need on adequate counseling about possible precipitants and prescription on minimum AEDs whenever possible. Parents need to ensure strict adherence to AEDs and avoidance of trigger factors.

PCA-ANN integrated NSGA-III framework for dormitory building design optimization: Energy efficiency, daylight, and thermal comfort

“Framework” and “case-study” are the two most prominent features in the optimization of architectural building design. The first can improve the speed of the process, the accuracy and integration of the outcome. The second can evolve the design knowledge of the various types of buildings in practice. This paper presents the “PCA-ANN integrated NSGA-III” framework that is a fast, accurate, and integrated solution for practical, erosive, and complicated building performance optimization problems, especially when the case study is a multi-type building such as a dormitory. The novelty and contribution of this paper exist in all three phases of its research framework. First, the dormitory building was parametrically modeled as a case study in two conventional dormitory building types. Second, an artificial model called PCA-ANN is presented in which problems that have a more complicated and practical case study with a multi-type building can be solved simply, integratively, and accurately. Third, the capabilities of NSGA-III are introduced and showed that it could be more accurate in comparison with NSGA-II, and then NSGA-III was integrated with the PCA-ANN model to solve the many-objective problem posed in this study. R2 score for PCA-ANN in the best-presented structure reached 0.99. In the overall best building alternative, energy efficiency and daylight performance for the whole year and thermal comfort performance in the free running period improved by 41.27%, 42.24%, and 15.57%, respectively, compared to its reference model. The presented framework can be applied and generalized to building energy optimization problems in practical and complex cases.

Research on reasonable development strategy of offshore buried hill fractured reservoir

In order to improve the overall production degree of offshore buried hill fractured reservoir, expand the swept volume of water flooding, and improve the reservoir development effect, according to the actual reservoir characteristic parameters, numerical simulation software and three-dimensional physical model are used to study the reasonable pressure level, injection production mode and water flooding strategy of Oilfield A. The results show that, according to the pressure sensitivity experiment and numerical simulation analysis, the reasonable formation pressure is 70% of the original pressure for the buried hill fractured reservoir, and higher recovery can be achieved at this pressure level. By comparing different injection and production mode schemes, it is determined that under the weak injection and forcible production mode, the swept volume of reservoir water flooding is the largest, the water free recovery period of production wells is longer, and the water cut rising rate is low. The reservoir development is divided into four stages. For different stages, depressurization production, pulse water flooding, cyclic water flooding and asynchronous water flooding strategies are adopted respectively. Compared with the conventional stable water flooding strategy, the balanced development of fractures and matrix can be realized, so as to improve the full cycle development effect of the reservoir. The application of the development strategy results in this study to oilfield production practice has played an obvious role in improving the development effect of fractured reservoir, which has field practical significance and can provide reference for the development of similar fractured reservoir.