Evaluation of wet-cupping therapy for persistent non-specific low back pain: a randomised, waiting-list controlled, open-label, parallel-group pilot trial

<p>Abstract</p> <p>Background</p> <p>Persistent non-specific low back pain (PNSLBP) is one of the most frequently experienced types of back pain around the world. Wet-cupping is a common intervention for various pain conditions, especially in Korea. In this context, we conducted a pilot study to determine the effectiveness and safety of wet-cupping treatment for PNSLBP.</p> <p>Methods</p> <p>We recruited 32 participants (21 in the wet-cupping group and 11 in the waiting-list group) who had been having PNSLBP for at least 3 months. The participants were recruited at the clinical research centre of the Korea Institute of Oriental Medicine, Korea. Eligible participants were randomly allocated to wet-cupping and waiting-list groups. Following the practice of traditional Korean medicine, the treatment group was provided with wet-cupping treatment at two acupuncture points among the BL23, BL24 and BL25 6 times within 2 weeks. Usual care, including providing brochures for exercise, general advice for PNSLBP and acetaminophen, was allowed in both groups. Separate assessors participated in the outcome assessment. We used the 0 to100 numerical rating scale (NRS) for pain, the McGill Pain Questionnaire for pain intensity (PPI) and the Oswestry Disability Questionnaire (ODQ), and we assessed acetaminophen use and safety issues.</p> <p>Results</p> <p>The results showed that the NRS score for pain decreased (-16.0 [95% CI: -24.4 to -7.7] in the wet-cupping group and -9.1 [-18.1 to -0.1] in the waiting-list group), but there was no statistical difference between the groups (p = 0.52). However, the PPI scores showed significant differences between the two groups (-1.2 [-1.6 to -0.8] for the wet-cupping group and -0.2 [-0.8 to 0.4] for the waiting-list group, p < 0.01). In addition, less acetaminophen was used in the wet-cupping group during 4 weeks (p = 0.09). The ODQ score did not show significant differences between the two groups (-5.60 [-8.90 to -2.30] in the wet-cupping group and -1.8 [-5.8 to 2.2] in the waiting-list group, p = 0.14). There was no report of adverse events due to wet-cupping.</p> <p>Conclusion</p> <p>This pilot study may provide preliminary data on the effectiveness and safety of wet-cupping treatments for PNSLBP. Future full-scale randomised controlled trials will be needed to provide firm evidence of the effectiveness of this intervention.</p> <p>Trial Registration</p> <p>ClinicalTrials.gov: (Identifier: <a href="http://www.clinicaltrials.gov/ct2/show/NCT00925951">NCT00925951</a>)</p> <p>Date of trial registration: June 19th, 2009</p> <p>The date when the first patient was randomised: July 15th, 2009</p> <p>The date when the study was completed: November 27th, 2009</p

Cost-Effective Outage Management in Smart Grid under Single, Multiple, and Critical Fault Conditions through Teaching–Learning Algorithm

A distribution system becomes the most essential part of a power system as it links the utility and utility customers. Under abnormal conditions of the system, a definitive goal of the utility is to provide continuous power supply to the customers. This demands a fast restoration process and provision of optimal solutions without violating the power system operational constraints. The main objective of the proposed work is to reduce the service restoration cost (SRC) along with the elimination of the out-of-service loads. In addition, this work concentrates on the minimal usage and finding of optimal locations for additional equipment, such as capacitor placement (CP) and distributed generators (DGs). This paper proposes a two-stage strategy, namely, the service restoration phase and optimization phase. The first phase ensures the restoration of the system from the fault condition, and the second phase identifies the optimal solution with reconfiguration, CP, and DG placement. The optimization phase uses the teaching&ndash;learning algorithm (TLA) for optimal restructuring and optimal capacitor and DG placement. The robustness of the algorithm is validated by addressing the test cases under different fault conditions, such as single, multiple, and critical. The effectiveness of the proposed strategy is exhibited with the implementation to IEEE 33-bus radial distribution system (RDS) and 83-bus Taiwan Power Distribution Company (TPDC) System

Optimal Allocation of IaaS Cloud Resources through Enhanced Moth Flame Optimization (EMFO) Algorithm

A new generation of computing resources is available to customers via IaaS, PaaS, and SaaS administrations, making cloud computing the most significant innovation in recent history for the general public. A virtual machine (VM) is configured, started, and maintained across numerous physical hosts using IaaS. In many cases, cloud providers (CPs) charge utility customers who have registered their premises with the utility registration authorities. Given the opposing aims of increasing customer demand fulfillment while decreasing costs and optimizing asset efficiency, efficient VM allocation is generally considered as one of the most difficult tasks for CPs to overcome. This paper proposes the Enhanced Moth Flame Optimization (EMFO) algorithm to provide a unique strategy for assigning virtual machines to suit customer requirements. The recommended approach is applied on Amazon’s EC2 after three distinct experiments are assumed. The utility of the proposed method is further shown by the use of well-known optimization techniques for effective VM allocation. The app was created using a Java-based programming language and then run on the Netbeans IDE 12.4 platform

Long-Range Acoustic Communication Using Differential Chirp Spread Spectrum

Here, we propose a new modulation method using chirp spread spectrum (CSS) modulation to indicate the result of long-range acoustic communication (LRAC). CSS modulation had outstanding matched filter characteristics even though the channel was complex. The performance of the matched filter depends on the time&ndash;bandwidth product. We studied the method of using the same modulation method while increasing the amount of the time&ndash;bandwidth product. When differential encoding is applied, the de-modulation is made using the difference between the current symbol and the previous symbol. If the matched filter is applied using both the current and the previous symbol, such as the use of two symbols, the amount of the time&ndash;bandwidth product can be doubled, and this method can make the output of the matched filter larger. The proposed method was verified in lake and sea experiments, in which the experimental environment was analyzed and compared with the result using the channel impulse response (CIR) of the lake and sea. The lake experiment was conducted over a distance of about 100&ndash;300 m between the transmitter and receiver and at a depth of ~40 m. As a result of the communication, the conventional method&rsquo;s bit error rate (BER) was 1.22&times;10&minus;1, but the proposed method&rsquo;s BER was 1.98&times;10&minus;2. The sea experiment was conducted over a distance of ~90 km and at a depth of ~1 km, and the conventional method BER in this experiment was 1.83&times;10&minus;4, while the proposed method&rsquo;s BER was 0

The Preparation and Physiochemical Characterization of <i>Tenebrio molitor</i> Chitin Using Alcalase

Chitin is mostly produced from crustaceans, but it is difficult to supply raw materials due to marine pollution, and the commonly used chemical chitin extraction method is not environmentally friendly. Therefore, this study aims to establish a chitin extraction process using enzymes and to develop edible insect-derived chitin as an eco-friendly new material. The response surface methodology (RSM) was used to determine the optimal conditions for enzymatic hydrolysis. The optimal conditions for enzymatic hydrolysis by RSM were determined to be the substrate concentration (7.5%), enzyme concentration (80 μL/g), and reaction time (24 h). The solubility and DDA of the mealworm chitosan were 45% and 37%, respectively, and those of the commercial chitosan were 61% and 57%, respectively. In regard to the thermodynamic properties, the exothermic peak of mealworm chitin was similar to that of commercial chitin. In the FT-IR spectrum, a band was observed in mealworm chitin corresponding to the C=O of the NHCOCH3 group at 1645 cm−1, but this band showed low-intensity C=O in the mealworm chitosan due to deacetylation. Collectively, mealworm chitosan shows almost similar physical and chemical properties to commercial chitosan. Therefore, it is shown that an eco-friendly process can be introduced into chitosan production by using enzyme-extracted mealworms for chitin/chitosan production

A case of hypereosinophilic syndrome presenting with intractable gastric ulcers

We report a rare case of hypereosinophilic syndrome (HES) presenting with intractable gastric ulcers. A 71-year-old man was admitted with epigastric pain. Initial endoscopic findings revealed multiple, active gastric ulcers in the gastric antrum. He underwent Helicobacter pylori (H pylori) eradication therapy followed by proton pump inhibitor (PPI) therapy. However, follow-up endoscopy at 4, 6, 10 and 14 mo revealed persistent multiple gastric ulcers without significant improvement. The proportion of his eosinophil count increased to 43% (total count: 7903/mm3). Abdominal-pelvic and chest computed tomography scans showed multiple small nodules in the liver and both lungs. The endoscopic biopsy specimen taken from the gastric antrum revealed prominent eosinophilic infiltration, and the liver biopsy specimen also showed eosinophilic infiltration in the portal tract and sinusoid. A bone marrow biopsy disclosed eosinophilic hyperplasia as well as increased cellularity of 70%. The patient was finally diagnosed with HES involving the stomach, liver, lung, and bone marrow. When gastric ulcers do not improve despite H pylori eradication and prolonged PPI therapy, infiltrative gastric disorders such as HES should be considered

Design of a Capacitorless DRAM Based on a Polycrystalline-Silicon Dual-Gate MOSFET with a Fin-Shaped Structure

In this study, a capacitorless one-transistor dynamic random-access memory (1T-DRAM) cell based on a polycrystalline silicon dual-gate metal-oxide-semiconductor field-effect transistor with a fin-shaped structure was optimized and analyzed using technology computer-aided design simulation. The proposed 1T-DRAM demonstrated improved memory characteristics owing to the adoption of the fin-shaped structure on the side of gate 2. This was because the holes generated during the program operation were collected on the side of gate 2, allowing an expansion of the area where the holes were stored using the fin-shaped structure. Therefore, compared with other previously reported 1T-DRAM structures, the fin-shaped structure has a relatively high retention time due to the increased hole storage area. The proposed 1T-DRAM cell exhibited a sensing margin of 2.51 μA/μm and retention time of 598 ms at T = 358 K. The proposed 1T-DRAM has high retention time and chip density, so there is a possibility that it will replace DRAM installed in various applications such as PCs, mobile phones, and servers in the future

Analysis for DC and RF Characteristics Recessed-Gate GaN MOSFET Using Stacked TiO₂/Si₃N₄ Dual-Layer Insulator

The self-heating effects (SHEs) on the electrical characteristics of the GaN MOSFETs with a stacked TiO2/Si3N4 dual-layer insulator are investigated by using rigorous TCAD simulations. To accurately analyze them, the GaN MOSFETs with Si3N4 single-layer insulator are conducted to the simulation works together. The stacked TiO2/Si3N4 GaN MOSFET has a maximum on-state current of 743.8 mA/mm, which is the improved value due to the larger oxide capacitance of TiO2/Si3N4 than that of a Si3N4 single-layer insulator. However, the electrical field and current density increased by the stacked TiO2/Si3N4 layers make the device’s temperature higher. That results in the degradation of the device’s performance. We simulated and analyzed the operation mechanisms of the GaN MOSFETs modulated by the SHEs in view of high-power and high-frequency characteristics. The maximum temperature inside the device was increased to 409.89 K by the SHEs. In this case, the stacked TiO2/Si3N4-based GaN MOSFETs had 25%-lower values for both the maximum on-state current and the maximum transconductance compared with the device where SHEs did not occur; Ron increased from 1.41 mΩ·cm2 to 2.56 mΩ·cm2, and the cut-off frequency was reduced by 26% from 5.45 GHz. Although the performance of the stacked TiO2/Si3N4-based GaN MOSFET is degraded by SHEs, it shows superior electrical performance than GaN MOSFETs with Si3N4 single-layer insulator

Evaluation of Blood Tumor Mutation Burden for the Efficacy of Second-Line Atezolizumab Treatment in Non-Small Cell Lung Cancer: BUDDY Trial

This study aimed to investigate the feasibility of blood-based biomarkers, including blood tumor mutation burden (bTMB), to predict atezolizumab efficacy in relapsed and advanced non-small cell lung cancer (NSCLC). Stage IV NSCLC patients who had previously received platinum-doublet chemotherapy were recruited and received 1200 mg of atezolizumab every three weeks. Blood was collected to obtain plasma cell-free DNA (cfDNA) before the first cycle (C0) and at the fourth cycle (C4). bTMB was measured by CT-ULTRA in patients with cfDNA over 10 ng. The objective response rate (ORR) of the enrolled 100 patients was 10%, and there was no difference in ORR according to bTMB (cutoff: 11.5 muts/Mb) at C0 (high bTMB: 8.1% vs. low bTMB: 11.1%). However, the C4/C0 bTMB ratio was significantly lower in the durable clinical benefit (DCB) patients. The cfDNA concentration at C0, the C4/C0 ratio of the cfDNA concentration, the highest variant allele frequency (hVAF), and the VAF standard deviation (VAFSD) were significantly lower in the DCB patients. In the multivariate analysis, a high cfDNA concentration at C0 (cutoff: 8.6 ng/mL) and a C4/C0 bTMB ratio greater than 1 were significantly associated with progression-free survival. These results suggest that baseline levels and dynamic changes of blood-based biomarkers (bTMB, cfDNA concentration, and VAFSD) could predict atezolizumab efficacy in previously treated NSCLC patients