Fuzzy Goal Programming Procedure to Bilevel Multiobjective Linear Fractional Programming Problems

This paper presents a fuzzy goal programming (FGP) procedure for solving bilevel multiobjective linear fractional programming (BL-MOLFP) problems. It makes an extension work of Moitra and Pal (2002) and Pal et al. (2003). In the proposed procedure, the membership functions for the defined fuzzy goals of the decision makers (DMs) objective functions at both levels as well as the membership functions for vector of fuzzy goals of the decision variables controlled by first-level decision maker are developed first in the model formulation of the problem. Then a fuzzy goal programming model to minimize the group regret of degree of satisfactions of both the decision makers is developed to achieve the highest degree (unity) of each of the defined membership function goals to the extent possible by minimizing their deviational variables and thereby obtaining the most satisfactory solution for both decision makers. The method of variable change on the under- and over-deviational variables of the membership goals associated with the fuzzy goals of the model is introduced to solve the problem efficiently by using linear goal programming (LGP) methodology. Illustrative numerical example is given to demonstrate the procedure

Antimicrobial resistance pattern and molecular epidemiology of ESBL and MBL producing Acinetobacter baumannii isolated from hospitals in Minia, Egypt

Introduction: Multidrug resistant (MDR) Acinetobacter baumanii (A. baumannii) strains have emerged as novel nosocomial pathogens threatening patients’ lives, especially in intensive-care units (ICUs). This study aims to determine the prevalence of carbapenemase genes and CTX-M-15 and the resistance pattern of carbapenemase producing isolates. Methods: A total of 530 clinical specimens were collected from patients suffering from different infections, antibiotic susceptibility test was performed using kirby-bauer disk diffusion method. ESβL production was detected phenotypically by double-disc synergy test (DDST). Carbapenemase production was tested by Modified Hodge Test (MHT). Then, these isolates were tested for MBL detection by disc potentiation test. Carbapenemase encoding genes (VIM, IMP, GIM and SPM, OXA-51, OXA-23 and OXA-143) and CTX-M-15 were tested by polymerase chain reaction (PCR). Results: Out of 530 samples, 20 bacterial isolates were identified as A. baumannii from different infectious cases, 35% of isolates were ESBL-producers. Eleven isolates were resistant to imipenem (4 isolates) and meropenem (7 isolates). All carbapenem resistant isolates were MHT positive. Nine (45%) isolates were confirmed as A. baumannii by OXA-51 (all were carbapenem resistant). Distribution of IMP, VIM, GIM and SPM, OXA-23, OXA-143 and CTX-M-15 by PCR were 55, 50, 50, 25, 35, 45 and 33% respectively. Conclusion: The high prevalence of resistance genes and the resistance pattern of the isolates indicate that the detection of ESBLs and MBLs phenotypically and genotypically with the study of the resistance pattern of the isolates is critically important for the surveillance of drug resistance in the hospital environment

Caracterización estructural y actividad biológica de sulfolípidos de algas marinas seleccionadas

The sulfolipid classes (SLs) in the total lipids of five species of marine algae, two species of Rhodophyta (Laurencia popillose, Galaxoura cylindriea), one species of Chlorophyta (Ulva fasciata), and two species of Phaeophyta (Dilophys fasciola, Taonia atomaria) were separated and purified on DEAE-cellulose column chromatography. The SLs component was identified by IR, gas chromatography MS/MS and liquid chromatography MS/MS. The level of SLs contents va ried from 1.25% (in L. papillose) to 11.82% (in D. fasciola) of the total lipid contents. However, no significant differences in sulfate content (0.13 – 0.21%) were observed among all these algae species. All SLs were characterized by high contents of palmitic acid (C 16:0), which ranged from 30.91% in G. cylindriea to 63.11% in T. atomatia. The main constitutes of algal sulfolipids were identified as sulfoquinovosyl-di-acylglycerol and sulfoquinovosyl acylglycerol. The sulfolipids of different algal species exhibited remarkable antiviral activity against herps simplex virus type 1 (HSV-1) with an IC50 ranging from 18.75 to 70. 2 μg mL–1. Moreover, algal sulfolipid inhibited the growth of the tumor cells of breast and liver human cancer cells with IC50 values ranging from 0.40 to 0.67 μg mL–1 for human breast adenocarcinoma cells (MCF7).Se separaron diferentes clases sulfolípidos (SL) a partir de los lípidos totales de cinco especies de algas marinas: una especie de Chlorophyta (Ulva fasciata), dos especies de Phaeophyta (Dilophys fasciola, Taonia atomaria) y dos especies de Rhodophyta (Laurencia popillose, Galaxoura cylindriea) que se purificaron mediante cromatografía en columna de DEAE-celulosa. Los components de SLs fueron identificados por IR, cromatografía de gases MS/MS y cromatografía líquida MS/ MS. Los contenidos de SL en relación al total de lípidos varió de 1,25% (en L. papilosa) al 11,82% (en D. fasciola). Sin embargo, no hay diferencias significativas en el contenido de sulfato observado entre todas estas especies de algas (desde 0,13 hasta 0,21%). Todos los SL se caracterizaron por un alto contenido de ácido palmítico (C16:0), que osciló entre 30,91% en G. cylindriea a 63,11% en T. atomatia. Sulfoquinovosyl-di-acilglicerol y acilglicerol sulfoquinovosyl fueron identificados como los principales constituyentes de los sulfolípidos de estas algas. Los sulfolípidos de las diferentes especies de algas estudiadas mostraron una notable actividad antiviral contra el virus del herpes simple tipo 1 (VHS-1) con una IC50 que osciló entre 18,75 y 70. 2 g mL–1. Por otra parte, los sulfolípidos de estas algas inhibieron el crecimiento de células tumorales de mama y células de cáncer de hígado humano con valores de IC50 que van desde 0,40 hasta 0,67 g mL–1 para las células de adenocarcinoma de mama humano (MCF7)

Unveiling the antitumor potential of novel N-(substituted-phenyl)-8-methoxycoumarin-3-carboxamides as dual inhibitors of VEGFR2 kinase and cytochrome P450 for targeted treatment of hepatocellular carcinoma

Being the sixth most diagnosed cancer and the fourth leading cause of cancer-related deaths worldwide, liver cancer is considered as a serious disease with a high prevalence and poor prognosis. Current anticancer drugs for liver cancer have drawbacks, such as limited efficacy in later stages of the disease, toxicity to healthy cells, and the potential for drug resistance. There is ample evidence that coumarin-based compounds are potent anticancer agents, with numerous analogues currently being investigated in preclinical and clinical studies. The current study aimed to explore the antitumor potency of a new class of 8-methoxycoumarin-3-carboxamides against liver cancer. Toward this aim, we have designed, synthesized, and characterized a new set of N-(substituted-phenyl)-8-methoxycoumarin-3-carboxamide analogues. The assessment of antitumor activity revealed that the synthesized class of compounds possesses substantial cytotoxicity toward Hep-G2 cells when compared to staurosporine, without significant impact on normal cells. Out of the synthesized compounds, compound 7 demonstrated the most potent cytotoxic effect against Hep-G2 cells with an IC50 of 0.75 µM, which was more potent than the drug staurosporine (IC50 = 8.37 µM). The investigation into the mechanism behind the antiproliferative activity of compound 7 revealed that it interferes with DNA replication and induces DNA damage, leading to cell cycle arrest as demonstrated by a significant decrease in the percentage of cells in the G1 and G2/M phases, along with an increase in the percentage of cells in the S phase. Flow cytometric analysis further revealed that compound 7 has the ability to trigger programmed cell death by inducing necrosis and apoptosis in HepG-2 cells. Further explorations into the mechanism of action demonstrated that compound 7 displays a potent dual-inhibitory activity toward cytochrome P450 and vascular endothelial growth factor receptor-2 (VEGFR-2) proteins, as compared to sorafenib drug. Further, detailed computational studies revealed that compound 7 displays a considerable binding affinity toward the binding cavity of VEGFR2 and CYP450 proteins. Taken together, our findings indicate that the newly synthesized class of compounds, particularly compound 7, could serve as a promising scaffold for the development of highly effective anticancer agents against liver cancer

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Mortality of emergency abdominal surgery in high-, middle- and low-income countries

Background: Surgical mortality data are collected routinely in high-income countries, yet virtually no low- or middle-income countries have outcome surveillance in place. The aim was prospectively to collect worldwide mortality data following emergency abdominal surgery, comparing findings across countries with a low, middle or high Human Development Index (HDI). Methods: This was a prospective, multicentre, cohort study. Self-selected hospitals performing emergency surgery submitted prespecified data for consecutive patients from at least one 2-week interval during July to December 2014. Postoperative mortality was analysed by hierarchical multivariable logistic regression. Results: Data were obtained for 10 745 patients from 357 centres in 58 countries; 6538 were from high-, 2889 from middle- and 1318 from low-HDI settings. The overall mortality rate was 1⋅6 per cent at 24 h (high 1⋅1 per cent, middle 1⋅9 per cent, low 3⋅4 per cent; P < 0⋅001), increasing to 5⋅4 per cent by 30 days (high 4⋅5 per cent, middle 6⋅0 per cent, low 8⋅6 per cent; P < 0⋅001). Of the 578 patients who died, 404 (69⋅9 per cent) did so between 24 h and 30 days following surgery (high 74⋅2 per cent, middle 68⋅8 per cent, low 60⋅5 per cent). After adjustment, 30-day mortality remained higher in middle-income (odds ratio (OR) 2⋅78, 95 per cent c.i. 1⋅84 to 4⋅20) and low-income (OR 2⋅97, 1⋅84 to 4⋅81) countries. Surgical safety checklist use was less frequent in low- and middle-income countries, but when used was associated with reduced mortality at 30 days. Conclusion: Mortality is three times higher in low- compared with high-HDI countries even when adjusted for prognostic factors. Patient safety factors may have an important role. Registration number: NCT02179112 (http://www.clinicaltrials.gov)

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

A Decomposition Approach based on Taylor Series for Solving Bi-Level Large Scale Quadratic Problems with Fuzzy Numbers

This paper presented a decomposition approach and TOPSIS approach to solve a bi-level large-scale quadratic programming problem (BLLSQPP) with fuzzy parameters in the objective function based on Taylor series and compare between a decomposition algorithm and TOPSIS approach. The basic idea of the proposed approach is to convert the fuzzy number nature of this problem into equivalent deterministic nature. Then the Taylor series will be combined with decomposition algorithm to obtain the satisfactory solution for problem under investigation. To demonstrate the power of the proposed approach, a numerical example is solved and compared with the solutions of the Technique for Order Preference by Similarity Ideal Solution (TOPSIS) approach

Short-Term Efficiency of Using Sustainable BFRP Bars in Post-Tensioning Systems for One-Way RC Slab

Basalt Fiber Reinforced Polymer (BFRP) bars are manufactured from sustainable natural materials. BFRP Young’s modulus constitutes weak performance to the serviceability limits in the structural reinforced concrete (RC) elements, but using post-tensioning systems controls the serviceability limits. Nine RC slabs were tested under a four-point bending scheme. However, the efficiency of using the BFRP post-tensioning system bars as a main reinforcement of RC slabs was evaluated in two different stress levels of 10% and 50% of the rupture strength of the bars. The near-surface mounted (NSM) external strengthening post-tensioning BFRP system by two different stress levels of 10% and 30% of the rupture strength was investigated. Additionally, the hybrid reinforcement performance of both steel and BFRP bars was studied. The relevant results showed that the post-tensioning BFRP systems significantly enhanced the ultimate load and vertical deflection of the RC slabs if the stress level was 50% and 30% for the internally reinforced and externally strengthened slabs, respectively. BFRP bars in hybrid RC slabs achieved more energy absorption. At the same reinforcement area, the internal bonded BFRP bars can achieve a higher ultimate load than the unbonded external BFRP bars by 11%. Furthermore, the increment rate in prestressing losses for RC slabs with higher prestressing levels of BFRP bars was less than that of slabs with lower prestressing levels of BFRP bars. Consequently, the efficiency of the external post-tensioning system was 95.78% for the RC slab with a 50% stress level after 1000 hrs, and it’s recommended as a design guideline