Search results for: recurrence interval

Authors: Levicatus Mugenyi, Joaniter Nankabirwa, Emmanuel Arinaitwe, John Rek, Niel Hens, Moses Kamya, Grant Dorsey

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Background: Indoor residual spraying (IRS) reduces vector densities and malaria transmission, however, the most effective spraying intervals for IRS have not been well established. We aim to estimate the optimal timing interval for IRS using a modeling approach. Methods: We use a generalized additive model to estimate the optimal timing interval for IRS using the predicted malaria incidence. The model is applied to post IRS cohort clinical data from children aged 0.5–10 years in selected households in Tororo, historically a high malaria transmission setting in Uganda. Six rounds of IRS were implemented in Tororo during the study period (3 rounds with bendiocarb: December 2014 to December 2015, and 3 rounds with actellic: June 2016 to July 2018). Results: Monthly incidence of malaria from October 2014 to February 2019 decreased from 3.25 to 0.0 per person-years in the children under 5 years, and 1.57 to 0.0 for 5-10 year-olds. The optimal time interval for IRS differed between bendiocarb and actellic and by IRS round. It was estimated to be 17 and 40 weeks after the first round of bendiocarb and actellic, respectively. After the third round of actellic, 36 weeks was estimated to be optimal. However, we could not estimate from the data the optimal time after the second and third rounds of bendiocarb and after the second round of actellic. Conclusion: We conclude that to sustain the effect of IRS in a high-medium transmission setting, the second rounds of bendiocarb need to be applied roughly 17 weeks and actellic 40 weeks after the first round, and the timing differs for subsequent rounds. The amount of rainfall did not influence the trend in malaria incidence after IRS, as well as the IRS timing intervals. Our results suggest that shorter intervals for the IRS application can be more effective compared to the current practice, which is about 24 weeks for bendiocarb and 48 weeks for actellic. However, when considering our findings, one should account for the cost and drug resistance associated with IRS. We also recommend that the timing and incidence should be monitored in the future to improve these estimates.

Keywords: incidence, indoor residual spraying, generalized additive model, malaria

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Authors: Manlika Ratchagit

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This paper is concerned with robust mean square stability of uncertain stochastic switched discrete time-delay systems. The system to be considered is subject to interval time-varying delays, which allows the delay to be a fast time-varying function and the lower bound is not restricted to zero. Based on the discrete Lyapunov functional, a switching rule for the robust mean square stability for the uncertain stochastic discrete time-delay system is designed via linear matrix inequalities. Finally, some examples are exploited to illustrate the effectiveness of the proposed schemes.

Keywords: robust mean square stability, discrete-time stochastic systems, hybrid systems, interval time-varying delays, Lyapunov functional, linear matrix inequalities

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Authors: Samane Eftekhari Ranjbar

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Diabetes mellitus, a metabolic disorder characterized by elevated blood glucose levels, ranks among the leading causes of adult mortality. This study investigates the impact of an eight-week high-intensity interval training (HIIT) program combined with sodium nitrite supplementation on TNF- α, MURF1, and PI3K in a type 2 diabetes rodent model. Elevated TNF-α levels have been associated with insulin resistance, while MURF1 and PI3K play roles in muscle atrophy and insulin signaling pathways, respectively. In this experimental study, 15 eight-week-old rats from the Sara Laboratory Center in Tabriz were assigned to one of five groups: healthy control, diabetic control, diabetic with sodium nitrite supplementation, diabetic with eight weeks of intermittent exercise, and diabetic with eight weeks of interval training plus sodium nitrite supplementation. The HIIT protocol was designed to span eight weeks, with five weekly sessions at specified intensities and durations. Sodium nitrite, known for its vasodilatory and cytoprotective properties, was administered via injection. The findings revealed that the HIIT program and sodium nitrite supplementation influenced the examined biomarkers. ANOVA test outcomes indicated statistically significant differences in TNF- α (P=0.001), MURF1 (P=0.001), and PI3K (P=0.001) concentrations among the various groups. The healthy control group exhibited substantially decreased TNF- α, and MURF1 levels, as well as elevated PI3K levels compared to the diabetic control group. The exercise group, in conjunction with sodium nitrite supplementation, demonstrated a significant rise in PI3K levels (P=0.001) and a decline in TNF- α levels (P=0.018) relative to the diabetic control group. These results suggest that the combined intervention may help improve insulin sensitivity and reduce inflammation. However, MURF1 levels, which are related to muscle atrophy, showed no significant difference (P=0.24). In conclusion, in type 2 diabetic rats, an eight-week high-intensity interval training program with sodium nitrite supplementation does not affect MURF1 levels but does influence PI3K and TNF- α levels. This combination may hold potential for improving insulin sensitivity and reducing inflammation in type 2 diabetes patients, warranting further investigation and potential translation to human clinical trials.

Keywords: high-intensity interval training, sodium nitrate supplementation, type 2 diabetes, tumor necrosis factor-alpha, phosphatidylinositol-3-kinase, muscle RING-finger protein-1

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Authors: Manlika Rajchakit

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This paper is concerned with robust mean square stability of uncertain stochastic switched discrete time-delay systems. The system to be considered is subject to interval time-varying delays, which allows the delay to be a fast time-varying function and the lower bound is not restricted to zero. Based on the discrete Lyapunov functional, a switching rule for the robust mean square stability for the uncertain stochastic discrete time-delay system is designed via linear matrix inequalities. Finally, some examples are exploited to illustrate the effectiveness of the proposed schemes.

Keywords: robust mean square stability, discrete-time stochastic systems, hybrid systems, interval time-varying delays, lyapunov functional, linear matrix inequalities

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Authors: M. W. Sun, Y. Zhang, L. M. Zhang, Z. H. Wang, Z. Q. Chen

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In the realm of flight control, the Proportional- Derivative (PD) control is still widely used for the attitude control in practice, particularly for the pitch control, and the attitude dynamics using PD controller should be investigated deeply. According to the empirical knowledge about the unstable flight dynamics, the control parameter combination conditions to generate sole or finite number of closed-loop oscillations, which is a quite smooth response and is more preferred by practitioners, are presented in analytical or numerical manners. To analyze the effects of the combination conditions of the control parameters, the roots of several polynomials are sought to obtain feasible solutions. These conditions can also be plotted in a 2-D plane which makes the conditions be more explicit by using multiple interval operations. Finally, numerical examples are used to validate the proposed methods and some comparisons are also performed.

Keywords: attitude control, dynamic performance, numerical solving method, interval, unstable flight dynamics

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Authors: J. Yan, B. Pieper, B. Bucsky, H. H. Sievers, B. Nasseri, S. A. Mohamed

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In order to optimize the efficacy of medications, the regular follow-up with long-term continuous monitoring of heart rhythmic patterns has been facilitated since clinical introduction of cardiac implantable electronic monitoring devices (CIMD). Extensive analysis of rhythmic circadian properties is capable to disclose the distributions of arrhythmic events, which may support appropriate medication according rate-/rhythm-control strategy and minimize consequent afflictions. 348 patients (69 ± 0.5ys, male 61.8%) with predisposed atrial fibrillation (AF), undergoing primary ablating therapies combined to coronary or valve operations and secondary implantation of CIMDs, were involved and divided into 3 groups such as PAAF (paroxysmal AF) (n=99, male 68.7%), PEAF (persistent AF) (n=94, male 62.8%), and LSPEAF (long-standing persistent AF) (n=155, male 56.8%). All patients participated in three-year ambulant follow-up (3, 6, 9, 12, 18, 24, 30 and 36 months). Burdens of atrial fibrillation recurrence were assessed using cardiac monitor devices, whereby attacks frequencies and their circadian patterns were systemically analyzed. Anticoagulants and regular anti-arrhythmic medications were evaluated and the last were listed in terms of anti-rate and anti-rhythm regimens. Patients in the PEAF-group showed the least AF-burden after surgical ablating procedures compared to both of the other subtypes (p < 0.05). The AF-recurrences predominantly performed such attacks’ property as shorter than one hour, namely within 10 minutes (p < 0.05), regardless of AF-subtypes. Concerning circadian distribution of the recurrence attacks, frequent AF-attacks were mostly recorded in the morning in the PAAF-group (p < 0.05), while the patients with predisposed PEAF complained less attack-induced discomforts in the latter half of the night and the ones with LSPEAF only if they were not physically active after primary surgical ablations. Different AF-subtypes presented distinct therapeutic efficacies after appropriate surgical ablating procedures and recurrence properties in sense of circadian distribution. An optimization of medical regimen and drug dosages to maintain the therapeutic success needs more attention to detailed assessment of the long-term follow-up. Rate-control strategy plays a much more important role than rhythm-control in the ongoing follow-up examinations.

Keywords: atrial fibrillation, CIMD, MAZE, rate-control, rhythm-control, rhythm patterns

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Authors: Jiahao Tian, Michael D. Porter

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Law enforcement agencies are tasked with crime prevention and crime reduction under limited resources. Having an accurate temporal estimate of the crime rate would be valuable to achieve such a goal. However, estimation is usually complicated by the interval-censored nature of crime data. We cast the problem of intensity estimation as a Poisson regression using an EM algorithm to estimate the parameters. Two special penalties are added that provide smoothness over the time of day and day of the week. This approach presented here provides accurate intensity estimates and can also uncover day-of-week clusters that share the same intensity patterns. Anticipating where and when crimes might occur is a key element to successful policing strategies. However, this task is complicated by the presence of interval-censored data. The censored data refers to the type of data that the event time is only known to lie within an interval instead of being observed exactly. This type of data is prevailing in the field of criminology because of the absence of victims for certain types of crime. Despite its importance, the research in temporal analysis of crime has lagged behind the spatial component. Inspired by the success of solving crime-related problems with a statistical approach, we propose a statistical model for the temporal intensity estimation of crime with censored data. The model is built on Poisson regression and has special penalty terms added to the likelihood. An EM algorithm was derived to obtain maximum likelihood estimates, and the resulting model shows superior performance to the competing model. Our research is in line with the smart policing initiative (SPI) proposed by the Bureau Justice of Assistance (BJA) as an effort to support law enforcement agencies in building evidence-based, data-driven law enforcement tactics. The goal is to identify strategic approaches that are effective in crime prevention and reduction. In our case, we allow agencies to deploy their resources for a relatively short period of time to achieve the maximum level of crime reduction. By analyzing a particular area within cities where data are available, our proposed approach could not only provide an accurate estimate of intensities for the time unit considered but a time-variation crime incidence pattern. Both will be helpful in the allocation of limited resources by either improving the existing patrol plan with the understanding of the discovery of the day of week cluster or supporting extra resources available.

Keywords: cluster detection, EM algorithm, interval censoring, intensity estimation

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Authors: Krishna Dahiya, Esha Charaya

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Induction of labour is a common obstetrical intervention. Around 1 in every 4 patient undergo induction of labour for different indications Purpose: To study the efficacy of the combination of Foley bulb and vaginal misoprostol in comparison to vaginal misoprostol alone for cervical ripening and induction of labour. Methods: A prospective randomised study was conducted on 150 patients with term singleton pregnancy admitted for induction of labour. Seventy-five patients were induced with both Foley bulb, and vaginal misoprostol and another 75 were given vaginal misoprostol alone for induction of labour. Both groups were then compared with respect to change in Bishop score, induction to the active phase of labour interval, induction delivery interval, duration of labour, maternal complications and neonatal outcomes. Data was analysed using statistical software SPSS version 11.5. Tests with P,.05 were considered significant. Results: The two groups were comparable with respect to maternal age, parity, gestational age, indication for induction, and initial Bishop scores. Both groups had a significant change in Bishop score (2.99 ± 1.72 and 2.17 ± 1.48 respectively with statistically significant difference (p=0.001 S, 95% C.I. -0.1978 to 0.8378). Mean induction to delivery interval was significantly lower in the combination group (11.76 ± 5.89 hours) than misoprostol group (14.54 ± 7.32 hours). Difference was of 2.78 hours (p=0.018,S, 95% CI -5.1042 to -0.4558). Induction to delivery interval was significantly lower in nulliparous women of combination group (13.64 ± 5.75 hours) than misoprostol group (18.4±7.09 hours), and the difference was of 4.76 hours (p=0.002, S, 95% CI 1.0465 to 14.7335). There was no difference between the groups in the mode of delivery, infant weight, Apgar score and intrapartum complications. Conclusion: From the present study it was concluded that addition of Foley catheter to vaginal misoprostol have the synergistic effect and results in early cervical ripening and delivery. These results suggest that the combination may be used to achieve timely and safe delivery in the presence of an unfavorable cervix. A combination of the Foley bulb and vaginal misoprostol resulted in a shorter induction-to-delivery time when compared with vaginal misoprostol alone without increasing labor complications.

Keywords: Bishop score, Foley catheter, induction of labor, misoprostol

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Authors: Huazhen Lin, Ruihua Xu, Zhibin Jiang

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In this real-world case, timetabling the LRT network as a whole is rather challenging for the operator: they are supposed to create a timetable to avoid various route conflicts manually while satisfying a given interval and the number of rolling stocks, but the outcome is not satisfying. Therefore, the operator adopts a computerised timetabling tool, the Train Plan Maker (TPM), to cope with this problem. However, with various constraints in the dual-line network, it is still difficult to find an adequate pairing of turnback time, interval and rolling stocks’ number, which requires extra manual intervention. Aiming at current problems, a one-off model for timetabling is presented in this paper to simplify the procedure of timetabling. Before the timetabling procedure starts, this paper presents how the dual-line system with a ring and several branches is turned into a simpler structure. Then, a non-linear programming model is presented in two stages. In the first stage, the model sets a series of constraints aiming to calculate a proper timing for coordinating two lines by adjusting the turnback time at termini. Then, based on the result of the first stage, the model introduces a series of inequality constraints to avoid various route conflicts. With this model, an analysis is conducted to reveal the relation between the ratio of trains in different directions and the possible minimum interval, observing that the more imbalance the ratio is, the less possible to provide frequent service under such strict constraints.

Keywords: light rail transit (LRT), non-linear programming, railway timetabling, timetable coordination

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Authors: Sujeet Poudyal

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Introduction: Renal cell carcinoma is the most common malignancy associated with Inferior vena cava (IVC) thrombosis. Radical nephrectomy with tumor thrombectomy provides durable cancer-free survival. Other renal malignancies like Wilms’ tumors are also associated with IVC thrombus. We describe our experience with the management of renal malignancies associated with IVC thrombus. Methods: This prospective study included 28 patients undergoing surgery for renal malignancies associated with IVC thrombus from February 2017 to March 2023. Demographics of patients, types of renal malignancy, level of IVC thrombus, intraoperative details, need for venovenous bypass, cardiopulmonary bypass and postoperative outcomes were all documented. Results: Out of a total of 28 patients, 24 patients had clear cell Renal Cell Carcinoma,1 had renal osteosarcoma and 3 patients had Wilms tumor. The levels. of thrombus were II in eight, III in seven, and IV in six patients. The mean age of RCC was 62.81±10.2 years, renal osteosarcoma was 26 years and Wilms tumor was 23 years. There was a need for venovenous bypass in four patients and cardiopulmonary bypass in four patients, and the Postoperative period was uneventful in most cases except for two mortalities, one in Level III due to pneumonia and one in Level IV due to sepsis. All cases followed up till now have no local recurrence and metastasis except one case of RCC with Level IV IVC thrombus, which presented with paraaortic nodal recurrence and is currently managed with sunitinib. Conclusion: The complexity in the management of renal malignancy with IVC thrombus increases with the level of IVC thrombus. As radical nephrectomy with tumor thrombectomy provides durable cancer-free survival in most cases, the surgery should be undertaken in an expert and experienced setup with a strong cardiovascular backup to minimize morbidity and mortality associated with the procedure.

Keywords: renal malignancy, IVC thrombus, radical nephrectomy with tumor thrombectomy, renal cell carcinoma

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Authors: Anis Al-Yakhiri

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Introduction: The World Health Organization (WHO) classifies malignant epithelial thyroid tumors into four major groups (papillary, follicular, medullar and undifferentiated) . Papillary thyroid carcinoma (PTC) is the most common type, for about eight out of ten thyroid cancers belong to this histological type. Radioactive iodine (RAI) is considered effective for patients with total or nearly total thyroidectomy, but the beneficial effects of RAI are still controversial. War conditions forced us to study alternative methods of using radioactive iodine in the treatment of patients with PTC. Material and methods: Between January 2014 and June 2021, in Al-Yakhiri hospital, 57 Total Thyroidectomy with Radical BilateralNeckDissection (RBND) were performed, 50 for malignant disease,7 for false positive cytology.RBND involves surgical clearance of Levels II-VI. Mean age was 40.7 years old and 92% of the patients were female. 7(14%) patients had hypothyroidism which required preoperative thyroid hormone treatment. The Thyroid Stimulating Hormone- Suppression Therapy (TSH-ST) immediately started after RBND for mostpatients on the first day. It consisted in reducing the level of TSH< 0.1 mIU/L. Results: The Apron flap was used on most operations (40)80% and with lateral extensions had 10(20%). RBND involves surgical clearance of Levels II-VI performed in all operated patients, besides that, 4(8%) of them had resection of sternocleidomastoid muscle (SCM) and accessory nerve (XIn) and internal jugular vein (IJV) withclearance of Levels IB. The PTC was the most common 80.9% (38 patients from 47)by histopathological report. and 4(8%) patients of 50 had resection of sternocleidomastoid muscle (SCM) and accessory nerve (XIn) and internal jugular vein (IJV). The postoperative mortality rate not observed (0%). The postoperative morbidity rate was 22.8% (n =13).Seroma(8.7%),Hypocalcimia(7%), Wound infection(5.3%), Bleeding(1.8%). To suppress TSH and growth of any residual thyroid theTSH-ST (levothyroxine150 – 600mcg)was performed in all patients 57(100%) on the first day afterRBND. We tracked the results of treatment for two years in 30 patients with PTC, only 3 of them received radioactive iodine abroad. Biennial Recurrence rate for PTC appeared in one woman (2%), who had RAI postoperatively in the form of neck lymph nodes metastasis. Conclusion: For patients with PTC, thyroidectomy plus prophylacticRBND is a safe and efficient procedure and it results in lower recurrence rate. Postoperative treatment with exogenous thyroid hormone in doses sufficient to suppress TSH (not less than 150mcg), decreases incidence of recurrence. Total Thyroidectomy with RBND followed by TSH-ST, in our opinion, applicable optimal treatment scheme care for this patient population.

Keywords: thyroid cancer, Yemen war, absence of radioactive iodine, neck dissection, surgery results

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Authors: Manju Pandey, Nilay Khare, S. C. Shrivastava

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This paper is the final in a series, which has defined two new classes of aggregation operators for triangular and trapezoidal fuzzy numbers based on the geometrical characteristics of their fuzzy membership functions. In the present paper, a new aggregation operator for trapezoidal fuzzy numbers has been defined. The new operator is based on the geometric mean of the membership lines to the left and right of the maximum possibility interval. The operator is defined and the analytical relationships have been derived. Computation of the aggregate is demonstrated with a numerical example. Corresponding arithmetic and geometric aggregates as well as results from the recent work of the authors on TrFN aggregates have also been computed.

Keywords: LR fuzzy number, interval fuzzy number, triangular fuzzy number, trapezoidal fuzzy number, apex angle, left apex angle, right apex angle, aggregation operator, arithmetic and geometric mean

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Authors: Alpana Meena

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Background: Tuberculosis is one of the major causes of death in south-east nations. Anti-TB–induced hepatotoxicity (AIH) is associated with a mortality of 6%–12%. The risk is increased when the drugs are combined. Reintroduction of anti-tuberculosis drugs in patients with AIH has never been studied systematically. The present study was planned to see the clinical profile of patients of AIH and the response to reintroduction of therapy. Methods: The trial was conducted in the Department of Medicine, Maulana Azad Medical College and associated Lok Nayak Hospital, on 32 patients with extra-pulmonary tuberculosis who developed AIH. Patients were randomly allocated into 3 groups. In group 1- Isoniazid (INH) and Rifampicin (RIF) were given at full dosages (weight calculated) from day 1. In group 2- RIF was given at maximum dosage from day 1 and INH at maximum dosage from day 8. In group 3- INH was given at maximum dosage from day 1 and RIF at maximum dosage from day 8. Pyrazinamide was added when above regimens were tolerated. Results: The mean age of presentation was 29.37±13.497 years. The incidence was found to be highest in patients with tubercular meningitis (41%) followed by abdominal, pericardial, disseminated, spinal, and lymph nodes. The mean latent period for development of AIH was 7.84 days ± 6.149 days and the median normalization days for LFT’s was 8.81 ± 4.22 days (3-21). In the study, 21% patients had recurrence of AIH with majority of patients having tolerated the reintroduction of drugs. Pyrazinamide was introduced after establishing isoniazid and rifampicin safety, thus emphasizing the role of gradual reintroduction of ATT to avoid the combined effects of hepatotoxicity. Conclusion: To conclude, the recurrence rate of hepatotoxicity was not statistically significant between the three groups studied (p > 0.05), and thus all 3 hepatotoxic drugs can be reintroduced safely in patients developing AIH.

Keywords: anti-tubercular therapy induced hepatotoxicity, extra-pulmonary tuberculosis, reintroduction regimens, risk factors

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Authors: Rizwan Iqbal

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Introduction: Re-TURBT has been recommended by international guidelines for patients with non-muscle invasive bladder cancer (NMIBC) who are deemed high-risk. Indications for re-TURBTs remain controversial and studies show mixed outcomes. It should be performed when the initial TURBT specimen lacks detrusor muscle, has tumor stage pT1 or G3/high-grade, or where resection is deemed incomplete. This ensures complete resection of tumors that have a high risk of recurrence as well as accurately identifying any tumors which have been upstaged. The aim of this audit was to evaluate the quality of re-TURBTs in a district general hospital. Method: Data were retrospectively collected from 31 patients who had re-TURBTs between April 2021 and September 2022. Data included baseline demographics, time from initial to re-TURBT, quality of operation note, presence of residual tumor, complications, and administration of chemotherapy within 24 hours of the initial TURBT. Data collection remains ongoing at the time of writing. Results: The mean age was 76 years old and 71.0% of patients were male. 32.3% of patients had their re-TURBT within six weeks and 32.3% had intravesical chemotherapy administered within 24 hours of the initial TURBT. 74.2% of initial TURBTs had detrusor muscle present in the specimen. 48.4% of patients had residual disease following re-TURBT. Just one patient had their pathology upstaged at re-TURBT. The use of the TURBT proforma on the operation note was variable, with 51.6% and 38.7% of surgeons using the proforma after the initial and re-TURBT. Conclusion: Re-TURBT improves bladder cancer staging and is necessary in patients who are deemed high-risk in order to identify any upstaging or recurrence of the disease.

Keywords: urology, bladder cancer, turbt, cancer

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Authors: Lubna M. Al-Otaibi

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Mucocele is a common benign neoplasm of the oral cavity and the most common after fibroma. The lesion develops as a result of retention or extravasation of mucous material from minor salivary glands. Extravasation type of mucocele results from trauma and mostly occurs in the lower lip of young patients. The various treatment options available for the treatment of mucocele are associated with a relatively high incidence of recurrence making surgical intervention necessary for a permanent cure. The conventional surgical procedure, however, arouses apprehension in the patient and is associated with bleeding and postoperative pain. Recently, treatment of mucocele with lasers has become a viable treatment option. Various types of lasers are being used and are preferable over the conventional surgical procedure as they provide good hemostasis, reduced postoperative swelling and pain, reduced bacterial population, lesser need for suturing, faster healing and low recurrence rates. Er,Cr:YSGG is a solid-state laser with great affinity to water molecule. Its hydrokinetic cutting action allows it to work effectively on hydrated tissues without any thermal damage. However, up to date, only a few studies have reported its use in the removal of lip mucocele, especially in children. In this case, a 6 year old female patient with history of trauma to the lower lip presented with a soft, sessile, whitish-bluish 4 mm papule. The lesion was present for approximately four months and was fluctuant in size. The child developed a habit of biting the lesion causing injury, bleeding and discomfort. Surgical excision under local anaesthesia was performed using 2780 nm Er,Cr:YSGG Laser (WaterLase iPlus, Irvine, CA) with a Gold handpiece and MZ6 tip (3.5w, 50 Hz, 20% H2O, 20% Air, S mode). The tip was first applied in contact mode with focused beam using the Circumferential Incision Technique (CIT) to excise the tissue followed by the removal of the underlying causative minor salivary gland. Bleeding was stopped using Laser Dry Bandage setting (0.5w, 50 Hz, 1% H2O, 20% Air, S mode) and no suturing was needed. Safety goggles were worn and high-speed suction was used for smoke evacuation. Mucocele excision using 2780 nm Er,Cr:YSGG laser was rapid, easy to perform with excellent precision and allowed for histopathological examination of the excised tissue. The patient was comfortable and there were minimum bleeding and no sutures, postoperative pain, scarring or recurrence. Laser assisted mucocele excision appears to have efficient and reliable benefits in young patients and should be considered as an alternative to conventional surgical and non-surgical techniques.

Keywords: Erbium, excision, laser, lip, mucocele

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Authors: Steven D. P Moore

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A novel method referred to asKýklos(Ky) dimensional geometry is proposed as an entity specific core geometric dimensional measurement system. Ky geometric measures can constructscaled multi-dimensionalmodels using regular and irregular sets in IRn. This entity specific-derived geometric measurement system shares similar fractal methods in which a ‘fractal transformation operator’ is applied to a set S to produce a union of N copies. The Kýklos’ inputs use 1D geometry as a core measure. One-dimensional inputs include the radius interval of a circle/sphere or the semiminor/semimajor axes intervals of an ellipse or spheroid. These geometric inputs have finite values that can be measured by SI distance units. The outputs for each interval are divided and subdivided 1D subcomponents with a union equal to the interval geometry/length. Setting a limit of subdivision iterations creates a finite value for each 1Dsubcomponent. The uniqueness of this method is captured by allowing the simplest 1D inputs to define entity specific subclass geometric core measurements that can also be used to derive length measures. Current methodologies for celestial based measurement of time, as defined within SI units, fits within this methodology, thus combining spatial and temporal features into geometric core measures. The novel Ky method discussed here offers geometric measures to construct scaled multi-dimensional structures, even models. Ky classes proposed for consideration include celestial even subatomic. The application of this offers incredible possibilities, for example, geometric architecture that can represent scaled celestial models that incorporates planets (spheroids) and celestial motion (elliptical orbits).

Keywords: Kyklos, geometry, measurement, celestial, dimension

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Authors: Catrin Morgan, Atholl Johnston

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Creatine supplementation should theoretically increase total muscle creatine and so enhance the generation of intramuscular phosphocreatine and subsequent ATP formation. The use of creatine as a potential ergogenic aid in sport has been an area of significant scientific research for a number of years. However the effect of creatine supplementation and swimming performance is a relatively new area of research and is the subject of this review. In swimming creatine supplementation could help maintain maximal power output, aid recovery and increase lean body mass. After investigating the underlying theory and science behind creatine supplementation, a literature review was conducted to identify the best evidence looking at the effect of creatine supplementation on swimming performance. The search identified 27 potential studies, and of these 17 were selected for review. The studies were then categorised into single sprint performance, which involves swimming a short distance race, or repeated interval performance, which involves swimming a series of sprints with intervals of rest between them. None of the studies on the effect of creatine controlled for the multiple confounding factors associated with measurement of swimming performance. The sample size in the studies was limited and this reduced the reliability of the studies and introduced the possibility of bias. The studies reviewed provided insufficient evidence to determine if creatine supplementation is beneficial to swimming performance. However, what data there was supported the use of creatine supplementation in repeated interval swimming rather than in single sprint swimming. From a review of the studies, it was calculated on average, there was a 1.37% increase in swimming performance with the use of creatine for repeated intervals and a 0.86% increase in performance for single sprint. While this may seem minor, it should be remembered that swimming races are often won by much smaller margins. In the 2012 London Olympics the Men’s 100 metres freestyle race was won by a margin of only 0.01 of a second. Therefore any potential benefit could make a dramatic difference to the final outcome of the race. Overall more research is warranted before the benefits of creatine supplementation in swimming performance can be further clarified.

Keywords: creatine supplementation, repeated interval, single sprint, swimming performance

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Authors: Ahmed Abdallatif

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Background: Patients with malignant germ cell tumors have age distribution in two peaks, with the first one during infancy and the second after the onset of puberty. Gonadal germ cell tumors are the most common malignant ovarian tumor in females aged below twenty years. Sacrococcygeal and retroperitoneal abdominal tumors usually presents in a large size before the onset of symptoms. Methods: Patients with pediatric germ cell tumors presenting to Children’s Cancer Hospital Egypt and National Cancer Institute Egypt from January 2008 to June 2011 Patients underwent stratification according to risk into low, intermediate and high risk groups according to children oncology group classification. Objectives: Assessment of the clinicopathologic features of all cases of pediatric germ cell tumors and classification of malignant cases according to their stage, and the primary site to low, intermediate and high risk patients. Evaluation of surgical management in each group of patients focusing on surgical approach, the extent of surgical resection according to each site, ability to achieve complete surgical resection and perioperative complications. Finally, determination of the three years overall and disease-free survival in different groups and the relation to different prognostic factors including the extent of surgical resection. Results: Out of 131 cases surgically explored only 26 cases had re exploration with 8 cases explored for residual disease 9 cases for remote recurrence or metastatic disease and the other 9 cases for other complications. Patients with low risk kept under follow up after surgery, out of those of low risk group (48 patients) only 8 patients (16.5%) shifted to intermediate risk. There were 20 patients (14.6%) diagnosed as intermediate risk received 3 cycles of compressed (Cisplatin, Etoposide and Bleomycin) and all high risk group patients 69patients (50.4%) received chemotherapy. Stage of disease was strongly and significantly related to overall survival with a poorer survival in late stages (stage IV) as compared to earlier stages. Conclusion: Overall survival rate at 3 three years was (76.7% ± 5.4, 3) years EFS was (77.8 % ±4.0), however 3 years DFS was much better (89.8 ± 3.4) in whole study group with ovarian tumors had significantly higher Overall survival (90% ± 5.1). Event Free Survival analysis showed that Male gender was 3 times likely to have bad events than females. Patients who underwent incomplete resection were 4 times more than patients with complete resection to have bad events. Disease free survival analysis showed that Patients who underwent incomplete surgery were 18.8 times liable for recurrence compared to those who underwent complete surgery, and patients who were exposed to re-excision were 21 times more prone to recurrence compared to other patients.

Keywords: extragonadal, germ cell tumors, gonadal, pediatric

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Authors: Norm Josephy, Lucy Kimball, Victoria Steblovskaya

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Hedging of a portfolio of European options under proportional transaction costs is considered. Our discrete time financial market model extends the binomial market model with transaction costs to the case where the underlying stock price ratios are distributed over a bounded interval rather than over a two-point set. An optimal hedging strategy is chosen from a set of admissible non-self-financing hedging strategies. Our approach to optimal hedging of a portfolio of options is based on theoretical foundation that includes determination of a no-arbitrage option price interval as well as on properties of the non-self-financing strategies and their residuals. A computational algorithm for optimizing an investor relevant criterion over the set of admissible non-self-financing hedging strategies is developed. Applicability of our approach is demonstrated using both simulated data and real market data.

Keywords: extended binomial model, non-self-financing hedging, optimization, proportional transaction costs

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Authors: H. Hadjeris, R. B. Ghoul, Lekhlaf, M. Nebbal

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Introduction: Adenoid cystic carcinomas of the lacrimal gland or orbital cylindroma constitute the second cause of epithelial tumors of this gland. It is a malignant tumor usually developed at the expense of the salivary glands; its orbital location is exceptional. It is a rare clinical entity, formidable by its malignancy and local aggressiveness; the recurrence rate is high. Materials and methods: Clinical case: 63 years old woman who presents with irreducible no pulsatile painful left exophthalmos with inflammatory chemosis and a decrease in visual acuity with a moderate intracranial hypertension syndrome that has been evolving for 03 months. Antecedent; a biopsy of the tumor was made; the histological examination was in favor of an adenoid cystic carcinoma of the lacrimal gland. Lesion assessment: computed tomography and brain MRI: show an intra and extra-conical mass; with sinus (ethmoido-frontal) and cerebral (left frontal) extension strongly enhanced after injection of contrast product surrounded by edema around the lesion, associated with left frontal bone lysis extension assessment: unremarkable treatment: Patient operated by left frontotemporal approach, a total exenteration was performed with macroscopically complete excision of the frontal lesion and wide frontal craniectomy with craniofacial reconstruction, followed by complementary radiotherapy. Results: The patient was seen again after 3 months in consultation; she does not present any signs in favor of a recurrence. Conclusion: Adenoid cystic carcinomas of the lacrimal gland are rare malignant tumors; they are very infiltrating and invasive. The prognosis is strongly linked to the treatment time.

Keywords: adenoid cystic, lacrimal gland, orbital location, fronto-temporal approac

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Authors: A. Kherraf, M. Bouziane, A. Drighil, L. Azzouzi, R. Habbal

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Objective: Myxomas are rare heart tumors most commonly found in the left atrium. The purpose of this observation is to report a rare case of myxoma of the right atrium revealed by pulmonary embolism. Observation: A 34-year-old patient with no history presented to the emergency room with sudden onset dyspnea. Clinical examination showed arterial pressure at 110/70mmHg, tachycardia at 110bpm, and 90% oxygen saturation. The ECG enrolled in incomplete right bundle branch block. The radio-thorax was normal. Echocardiography revealed the presence of a large homogeneous intra-OD mass, contiguous to the inter-atrial septum, prolapsing through the tricuspid valve, and causing mild tricuspid insufficiency, with dilation of the right ventricle and retained systolic function with PAPs estimated at 45mmHg. A chest scan was performed, revealing the presence of right segmental pulmonary embolism. The patient was put under anticoagulant and underwent surgical resection of the mass; its pathological examination concluded to a myxoma. The post-operative consequences were simple, without recurrence of the mass after one year follow-up. Discussion: Myxomas represent 50% of heart tumors. Most often, they originate in the left atrium, and more rarely in the right atrium or the ventricles. Myxoma of the right atrium can be responsible for life-threatening pulmonary embolism. The most predictive factor for embolization remains the morphology of the myxomas; papillary or villous myxomas are the most friable. Surgery is the standard treatment, with regular postoperative follow-up to detect recurrence. Conclusion: Myxomas of the right atrium are a rare location for these tumors. Pulmonary embolism is the main complication and should routinely involve careful study of the right chambers on echocardiography.

Keywords: pulmonary embolism, myxoma, right atrium, heart tumors

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Authors: Lakmali Anthony, Madeline Gillies

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Background: Colorectal cancer (CRC) is usually managed with surgical resection. Many of the outcomes traditionally used to define successful operative management, such as resection margin, do not adequately reflect patients’ experience. Patient-reported outcomes (PRO), such as Health-Related Quality of life (HRQoL), provide a means by which the impact of surgery for cancer can be reported in a patient-centered way. HRQoL has previously been shown to be impacted by psychosocial, behavioral and disease-specific characteristics. This exploratory cross-sectional study aims to; (1) describe postoperative HRQoL in patients who underwent primary resection in a regional Australian hospital; (2) describe the prevalence of anxiety, depression and clinically significant fear of cancer recurrence (FCR) in this population; and (3) identify demographic, psychosocial, disease and treatment factors associated with poorer self-reported HRQoL. Methods: Consecutive patients who had resection of colorectal cancer in a single regional Australian hospital between 2015 and 2022 were eligible. Participants were asked to complete a survey instrument designed to assess HRQoL, as well as validated instruments that assess several other psychosocial PROs hypothesized to be associated with HRQoL; emotional distress, fear of cancer recurrence, social support, dispositional optimism, body image and spirituality. Demographic and disease-specific data were also collected via medical record review. Results: Forty-six patients completed the survey. Clinically significant levels of fear of recurrence as well as emotional distress, were present in this group. Many domains of HRQoL were significantly worse than an Australian reference population for CRC. Demographic and disease factors associated with poor HRQoL included smoking and ongoing adjuvant systemic therapy. The primary operation was not associated with HRQoL; however, the operative approach (laparoscopic vs. open) was associated with HRQoL for these patients. All psychosocial factors measured were associated with HRQoL, including cancer worry, emotional distress, body image and dispositional optimism. Conclusion: HRQoL is an important outcome in surgery for both research and clinical practice. This study provides an overview of the quality of life in a regional Australian population of postoperative colorectal cancer patients and the factors that affect it. Understanding HRQoL and awareness of patients particularly vulnerable to poor outcomes should be used to aid the informed consent and shared decision-making process between surgeon and patient.

Keywords: surgery, colorectal, cancer, PRO, HRQoL

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Authors: Radwa Talaat Mohammed El-Shorbagy, Alaa El-Din Balbaa, Khaled Ayad, Waleed Red

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Introduction: Ankle sprain is a common lower limb injury that is complicated by high recurrence rate. The cause of recurrence is not clear; however, changes in motor control have been postulated. Objective: To determine the contribution of proximal hip strategy to dynamic balance control in patients with recurrent ankle sprain. Methods: Fifteen subjects with recurrent ankle sprain (group A) and fifteen healthy control subjects (group B) participated in this study. Abductor-adductors as well as flexor-extensor hip musculatures control was abolished by fatigue using the Biodex Isokinetic system. Dynamic balance was measured before and after fatigue by the Biodex Balance system Results: Repeated measures MANOVA was used to compare between and within group differences. In group A fatiguing of hip muscles (flexors-extensors and abductors-adductors) increased overall stability index (OASI), anteroposterior stability index (APSI) and mediolateral stability index (MLSI) significantly (p=0.00) whereas; in group B fatiguing of hip flexors-extensors increased significantly OASI and APSI only (p= 0.017, 0.010; respectively) while fatiguing of hip abductors-adductors has no significant effect on these variables. Moreover, patients with ankle sprain had significantly lower dynamic balance after hip muscles fatigue compared to the control group. Specifically, after hip flexor-extensor fatigue, the OASI, APSI and MLSI were increased significantly than those of the control values (p=0.002, 0.011, and 0.003, respectively) whereas fatiguing of hip abductors-adductors increased significantly in OASI and APSI only (p=0.012, 0.026, respectively). Conclusion: To maintain dynamic balance, patients with recurrent ankle sprain seem to relay more on the hip strategy.

Keywords: ankle sprain, hip muscles fatigue, dynamic balance

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Authors: Lee Myung-Won, Kwak Keun-Chang

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This paper is concerned with knowledge representation and extraction of fuzzy if-then rules using Interval Type-2 Context-based Fuzzy C-Means clustering (IT2-CFCM) with the aid of fuzzy granulation. This proposed clustering algorithm is based on information granulation in the form of IT2 based Fuzzy C-Means (IT2-FCM) clustering and estimates the cluster centers by preserving the homogeneity between the clustered patterns from the IT2 contexts produced in the output space. Furthermore, we can obtain the automatic knowledge representation in the design of Radial Basis Function Networks (RBFN), Linguistic Model (LM), and Adaptive Neuro-Fuzzy Networks (ANFN) from the numerical input-output data pairs. We shall focus on a design of ANFN in this paper. The experimental results on an estimation problem of energy performance reveal that the proposed method showed a good knowledge representation and performance in comparison with the previous works.

Keywords: IT2-FCM, IT2-CFCM, context-based fuzzy clustering, adaptive neuro-fuzzy network, knowledge representation

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Authors: Mahsa Pishdar

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Food traceability through the supply chain is facing increased demand. IoT and blockchain are among the tools under consideration in the Industry 4.0 era that could be integrated to help implementation of the Circular Economy (CE) principles while enhancing food traceability solutions. However, such tools need intellectual system, and infrastructureto be settled as guidance through the way, helping overcoming obstacles. That is why the critical success factors for implementing Industry 4.0 and circular economy principles in food traceability concept are analyzed in this paper by combination of interval type 2 fuzzy Worst Best Method and Measurement Alternatives and Ranking according to Compromise Solution (Interval Type 2 fuzzy WBM-MARCOS). Results indicate that “Knowledge of Industry 4.0 obligations and CE principle” is the most important factor that is the basis of success following by “Management commitment and support”. This will assist decision makers to seize success in gaining a competitive advantage while reducing costs through the supply chain.

Keywords: food traceability, industry 4.0, internet of things, block chain, best worst method, marcos

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Authors: Xi Yu, Lili Gu, Huizhu Wang, Xiao Wei, Dandan Sheng, Xiaoyan Jiang, Min Hong

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Introduction: Hypersensitivity disease is difficult to cure completely because of its recurrence, yupingfengsan (YPFS) is used to treat the diseases with the advantage of reducing the recurrence,but the precise mechanism is not clear. Previous studies of our laboratory have shown that the extract of YPFS can inhibit Th2-type allergic contact dermatitis(ACD) induced by FITC.Besides, thymic stromal lymphopoietin(TSLP) have been proved to be a master switch for allergic inflammation. Based on these studies, we want to establish a mouse model of TSLP production based on Th2 cell-mediated allergic inflammation to explore the regulating mechanisms of YPFS on TSLP in Th2 cell-mediated allergic inflammation. Methods: Th2-type ACD mouse model: The mice were topically sensitized on the abdomens (induction phase) and elicited on its ears skin 6 day later (excitation phase) with FITC solution, and the ear swelling was measured to evaluate the allergic inflammation；A mouse model of TSLP production based on Th2 cell-mediated allergic inflammation (TSLP production model): the skin of the ear was sensitized on two consecutive days with FITC solution causing the production of TSLP；Mice were treated with YPFS extract，ELISA、Real-time PCR and Western-blotting were using to examine the mRNA and protein levels of TSLP\TSLPR and TLRs ect. Results: YPFS extract can attenuates Th2-type allergic inflammatory in mice；in TSLP production model, YPFS can inhibit the expression of TSLP、 TSLPR、TLRs and MyD88, So we deduce the possible mechanisms of YPFS to play a role of intervention is through TLRs- MyD88 dependent and independent pathway to reduce TSLP production.

Keywords: YPFS, TSLP, TLRs, Th2-type allergic contact dermatitis

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Authors: H. Mousavi, M. Sharifi, H. Pourvaziri

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Redundancy Allocation Problem (RAP) is a well-known mathematical problem for modeling series-parallel systems. It is a combinatorial optimization problem which focuses on determining an optimal assignment of components in a system design. In this paper, to be more practical, we have considered the problem of redundancy allocation of series system with interval valued reliability of components. Therefore, during the search process, the reliabilities of the components are considered as a stochastic variable with a lower and upper bounds. In order to optimize the problem, we proposed a simulated annealing based on cloud theory (CBSAA). Also, the Monte Carlo simulation (MCS) is embedded to the CBSAA to handle the random variable components’ reliability. This novel approach has been investigated by numerical examples and the experimental results have shown that the CBSAA combining MCS is an efficient tool to solve the RAP of systems with interval-valued component reliabilities.

Keywords: redundancy allocation problem, simulated annealing, cloud theory, monte carlo simulation

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Authors: Kuei-Yu Chien, Nai-Wen Kan, Wan-Chun Wu, Guo-Dong Ma, Shu-Chen Chen

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Purpose: The purpose of this study was to investigate the responses of systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), rating of perceived exertion (RPE) and lactate following continued high-intensity interval exercise in water and on land. The results of studies can be an exercise program design reference for health care and fitness professionals. Method: A total of 20 volunteer postmenopausal women was included in this study. The inclusion criteria were: duration of menopause > 1 year; and sedentary lifestyle, defined as engaging in moderate-intensity exercise less than three times per week, or less than 20 minutes per day. Participants need to visit experimental place three times. The first time visiting, body composition was performed and participant filled out the questionnaire. Participants were assigned randomly to the exercise environment (water or land) in second and third time visiting. Water exercise testing was under water of trochanter level. In continuing jump testing, each movement consisted 10-second maximum volunteer jump for two sets. 50% heart rate reserve dynamic resting (walking or running) for one minute was within each set. SBP, DBP, HR, RPE of whole body/thigh (RPEW/RPET) and lactate were performed at pre and post testing. HR, RPEW, and RPET were monitored after 1, 2, and 10 min of exercise testing. SBP and DBP were performed after 10 and 30 min of exercise testing. Results: The responses of SBP and DBP after exercise testing in water were higher than those on land. Lactate levels after exercise testing in water were lower than those on land. The responses of RPET were lower than those on land post exercise 1 and 2 minutes. The heart rate recovery in water was faster than those on land at post exercise 5 minutes. Conclusion: This study showed water interval jump exercise induces higher cardiovascular responses with lower RPE responses and lactate levels than on-land jumps exercise in postmenopausal women. Fatigue is one of the major reasons to obstruct exercise behavior. Jump exercise could enhance cardiorespiratory fitness, the lower-extremity power, strength, and bone mass. There are several health benefits to the middle to older adults. This study showed that water interval jumping could be more relaxed and not tried to reach the same land-based cardiorespiratory exercise intensity.

Keywords: interval exercise, power, recovery, fatigue

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Authors: Aisling Eves, Andrew Pieri, Ross McLean, Nerys Forester

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Background: DCIS accounts for 20% of malignancies diagnosed by the breast screening programme and is primarily managed by surgical excision. There is variable guidance on defining excision margins, and adjuvant treatments vary widely. This study aimed to investigate the clinical outcomes for patients following surgical excision of small volume DCIS. Methods: This single-centreretrospective cohort study of 101 consecutive breast screened patients diagnosed with DCIS who underwent surgical excision. All patients diagnosed with DCIS had radiological abnormalities <15mm. Clinical, radiological, and histological data were collected from patients who had been diagnosed within a 5 year period, and ASCO guidelines for margin involvement of <2mm was used to guide the need for re-excision. Outcomes included re-excision rates, radiotherapy usage, and the presence of invasive cancer. Results: Breast conservation surgery was performed in 94.1% (n=95). Following surgical excision, 74(73.27%)patients had complete DCIS excision (>2mm margin), 4(4.0%) had margins 1-2mm, and 17(16.84%)had margins <1mm. The median size of DCIS in the specimen sample was 4mm. In 86% of patients with involved margins (n=18), the mammogram underestimated the DCIS size by a median of 12.5mm (range: 1-42mm). Of the patients with involved margins, 11(10.9%)had a re-excision, and 6 of these (50%) required two re-excisions to completely excise the DCIS. Post-operative radiotherapy was provided to 53(52.48%)patients. Four (3.97%) patients were found to have invasive ductal carcinoma on surgical excision, which was not present on core biopsy – all had high-grade DCIS. Recurrence of DCIS was seen in the same site during follow-up in 1 patient (1%), 1 year after their first DCIS diagnosis. Conclusion: Breast conservation surgery is safe in patients with DCIS, with low rates of re-excision, recurrence, and upstaging to invasive cancer. Furthermore, the median size of DCIS found in the specimens of patients who had DCIS fully removed in surgery was low, suggesting it may be possible that total removal through VAE was possible for these patients.

Keywords: surgical excision, breast conservation surgery, DCIS, Re-excision, radiotherapy, invasive cancer

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Authors: Lakmali Anthony, Bushra Oathman, Anshini Jain, Raaj Chandra

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Introduction: Abscesses are traditionally treated by incision and drainage with the packing of the residual abscess cavity until healing. This method requires regular visits from community nurses for continuous wound packing upon discharge from the hospital and causes considerable patient discomfort. Whether abscess cavity packing offers any advantage over non-packing has not yet been adequately studied to the best of our knowledge. This study aims to determine if there are differences in clinical outcomes of time to healing, fistula formation and recurrence of abscess between abscess cavity packing vs. non-packing groups. Methods: This study was a single-center, single-blind, randomized controlled trial where patients were randomized into packing and non-packing arms. All patients over 18 years presenting to Eastern Health with an abscess requiring incision and drainage in the theatre were invited to participate. Those with underlying conditions that cause recurrent abscesses were excluded. Data were collected from December 2018 to April 2020. Results: There were 63 patients who had abscesses treated with incision and drainage that were enrolled in the study, 52 of which were suitable for analysis. Demographic characteristics were similar in both groups. The packing group had a significantly longer time to heal compared to the non-packing group. Rates of fistula formation and recurrence of abscess were low and there were no statistically significant differences between groups. The packing group had more patients with delayed healing (defined as >60 days) and required more follow-up visits compared to the non-packing group. Conclusion: This pilot study indicates that abscesses can not only be managed safely with incision and drainage alone without the need for continuous abscess cavity packing but also that non-packing may offer clinical benefits to patients with earlier healing of abscesses compared to continuous cavity packing.

Keywords: abscess packing, subcutaneous, perianal, pilonidal

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