The study of dispersion by indicator dilution techniques in blood and other fluids flowing through tubes and bifurcating networks

Imperial Users onl

Optimalus galios paskirstymas mikrotinkle

Internationally, power demand is booming so, renewable energy based distributed generator and Microgrid spider network will increasingly play a decisive role in electricity production, distribution and most advantageous level power sharing. A Microgrid comprises of various sort of load and disseminated generators that work as a solitary controllable framework. Presently a day, control gadgets are on edge about wellbeing when the utility network associated with Microgrid or other inexhaustible assets at interconnected or islanded mode. The main goal of this thesis is to inspect and propose using a multi-input DC-DC power converter for grid connected hybrid Microgrid system to reduce the cost and share the power at optimal level. In the system, it consists of the multi-input DC-DC converter and full-bridge DC-AC IGBT inverter. If the fluctuation is more in the output of renewable energy resources than maximum power point tracking algorithm is used by input sources of PV and the wind. The integration of DC bus and Hybrid Microgrid renewable power supply system implemented and simulated using MATLAB/SIMULINK as compared to use directly AC bus. Methods that have been used to control stability in Microgrid by load sharing are analysed in this thesis. Also in this thesis, a price-based demand response is proposed using to share power in Microgrid. By utilizing this technique it is less demanding to keep up security amongst request and era. It is an imperative about dynamic and receptive power control in the power framework, particularly when the diverse sort of Microgrid sustainable power source assets associated with the utility network. As a result, how the modelling of the power grid infrastructure with Microgrid connected renewable energy resources are controlled and discussed here and the result of controlling load, frequency, voltage and current are achieved here. On the basis of parameters results the power sharing is possible at optimal level with system balancing and reduce the cost

Bland embolization of benign liver tumors: Review of the literature and a single center experience

Transarterial embolization has shown promise as a safe, effective, and less invasive treatment modality for benign liver lesions (hemangioma, focal nodular hyperplasia (FNH), and hepatic adenoma (HA)) with fewer complications compared to surgical intervention. There is no consensus regarding the most appropriate embolization material(s) for the treatment of benign liver tumors. The purpose of this study was to review the current literature regarding the transarterial embolization of benign liver tumors and to share our single center experience. This was a non-blinded, retrospective, single-institution review of the bland embolization of benign liver tumors. Clinical data and imaging before and after embolization were used to evaluate lesion response to transarterial embolization. Twelve patients were included in the study. Five patients with six hemangiomas were treated. Pain was a presenting complaint in all five of these patients. The median change in tumor volume was -12.4% and ranged from -30.1% to +42.3%. One patient with two FNH lesions was treated, and both lesion volumes decreased by more than 50%. Six patients with 10 adenomas were treated. Pain was a presenting complaint in three patients, and five patients had a lesion \u3e5 cm. The median change in tumor volume was -67.0% and ranged from -92.9% to +65.8%. Bland transarterial embolization of liver hemangiomas, FNH, and HA can be an effective and minimally invasive treatment modality to control the size and/or symptoms of these lesions. There is a variable response depending on tumor type and the embolization materials used

Coblation for metastatic vertebral disease

PURPOSEPlasma-mediated radiofrequency ablation (coblation) creates a cavity for directed polymethylmethacrylate deposition through molecular dissociation, providing a safe and efficacious cementoplasty for patients with high-risk, painful vertebral body metastatic disease. The purpose of this study was to retrospectively review and report details regarding the feasibility, safety, and efficacy of coblation and cementoplasty for treating painful advanced vertebral body metastatic disease.MATERIALS AND METHODSFifteen patients with painful metastatic vertebral body fractures with a posterior cortical defect and/or epidural tumor extension underwent percutaneous coblation and cementoplasty. Each patient’s medical record was reviewed for technical success, imaging outcome, complications, and palliative effect.RESULTSOf the 15 cases, 14 were completed successfully. Postprocedure imaging studies demonstrated adequate cement deposition within the targeted vertebral body without cement extravasation or fracture progression during the 1–3 months follow-up period. Pain relief was achieved in all patients, and no neurological damage was reported (mean follow-up, 141.1±132.5 days).CONCLUSIONPercutaneous image-guided coblation-mediated cavity creation prior to vertebroplasty allows for safe, efficacious cement deposition in patients with metastatic foci. Future studies prospectively comparing this procedure with other standard-of-care regimens are warranted

Establishing a telemedicine program for interventional radiology: a study of patient opinion and experience

PURPOSEThe COVID-19 pandemic forced healthcare officials to implement new policies, such as the use of virtual consultations over office-based medical appointments, to reduce the transmission of the virus. The purpose of this study is to quantitatively compare patients’ experiences with virtual outpatient telemedicine encounters at a single academic institution in Interventional Radiology (IR) and in-person visits during the course of the COVID-19 pandemic. METHODSThe TeleENT Satisfaction Questionnaire and the Medical Communication Competence Scale (MCCS) were used to survey patients’ satisfaction with both in-person and virtual office visits. RESULTSNinety respondents (38 in-person, 52 virtual) acknowledged numerous benefits of virtual visits versus in-person office visits including reductions in time, cost, and potential viral transmission risk during the COVID-19 pandemic. No statistically significant difference was noted, based on a Likert scale from 1 to 7, between in-person and virtual visits (all p > 0.05) for scheduling related factors. No statistically significant difference was noted in any of the MCCS subscales between the two cohorts in regards to medical information communication (all p > 0.05). A majority of patients with virtual encounters (82.7%) stated that it was easy to obtain an electronic device for use during the telemedicine visit, and 73.1% of patients felt that setting up the telemedicine encounter was easy.CONCLUSIONThis study demonstrates that telemedicine is an acceptable alternative to in-office appointments and could increase access to IR care outside of the traditional physician-patient interaction. With telemedicine visits, patients can communicate their concerns and obtain information from the doctor with noninferior communication compared to in-person visits

Concomitant Use of Single Antiplatelet Therapy With Edoxaban or Warfarin in Patients With Atrial Fibrillation: Analysis From the ENGAGE AF‐TIMI48 Trial

Background: We studied the concomitant use of single antiplatelet therapy (SAPT) on the efficacy and safety of the anti‐Xa agent edoxaban in patients with atrial fibrillation (AF). Methods and Results: ENGAGE AF‐TIMI 48 was a randomized trial that compared 2 dose regimens of edoxaban with warfarin. We studied both the approved high‐dose edoxaban regimen (HDER; 60 mg daily reduced by one half in patients with anticipated increased drug exposure), as well as a lower‐dose edoxaban regimen (LDER; 30 mg daily, also reduced by one half in patients with anticipated increased drug regimen). SAPT (aspirin in 92.5%) was administered at the discretion of the treating physician. Cox proportional hazard regressions stratified by SAPT at 3 months with treatment as a covariate were performed. The 4912 patients who received SAPT were more frequently male, with histories of coronary artery disease and diabetes, and had higher CHADS 2Vasc and HAS BLED scores than did the 14 977 patients not receiving SAPT. When compared to patients not receiving SAPT, those receiving SAPT had a higher incidence of major bleeding; (adjusted hazard ratio [HR adj]=1.46; 95% CI, 1.27–1.67, P<0.001). SAPT did not alter the relative efficacy of edoxaban compared to warfarin in preventing stroke or systemic embolic events (SEEs): edoxaban versus warfarin without SAPT, hazard ratio (HR adj for HDER)=0.94; (95% CI: 0.77–1.15) with SAPT, HR adj=0.70 (95% CI: 0.50–0.98), P interaction (P int)=0.14. (HR adj for LDER versus warfarin without SAPT=1.19 (95% CI 0.99–1.43) With SAPT, 1.03 (95% CI, 0.76–1.39) P int=0.42. Major bleeding was lower with edoxaban than warfarin both without SAPT, HR adj for HDER=0.80 (95% CI, 0.68–0.95), and with SAPT, HR adj=0.82 (95% CI, 0.65–1.03; P int=0.91). For LDER without SAPT (HR adj=0.56 [95% CI 0.46–0.67]) and with SAPT (HR adj=0.51 [95% CI 0.39–0.66]). Conclusions: Patients with AF who were selected by their physicians to receive SAPT in addition to an anticoagulant had a similar risk of stroke/SEE and higher rates of bleeding than those not receiving SAPT. Edoxaban exhibited similar relative efficacy and reduced bleeding compared to warfarin, with or without concomitant SAPT. Clinical Trial Registration URL: http://www.clinicaltrials.gov/. Unique identifier: NCT00781391

Conformational changes in a replication origin induced by an initiator protein

The replication initiator protein of the plasmid R6K binds to seven contiguous 22 bp direct repeats that form an indispensable part of the three replication origins α, β, and γ. Binding of the initiator to the direct repeats induced a marked bending of the region of γ replication origin. Binding of the initiator also promoted unwinding of the origin DNA by at least two turns. Distamycin appeared to antagonize the binding of the initiator to the seven 22 bp direct repeats. At the appropriate DNA and protein concentrations the initiator enhanced topoisomerase-induced catenation of the origin containing supercoiled DNA but not of DNA lacking the origin sequence. Thus, the initiator protein caused significant changes in the secondary and tertiary structures of the replication origin

Mild serotonin syndrome: A report of 12 cases

Serotonin syndrome (SS) is an under diagnosed and under reported condition. Mild SS is easily overlooked by physicians. Every patient with mild SS is a potential candidate for developing life-threatening severe SS because of inadvertent overdose or the addition of the second serotonergic drug. Herein, we describe 12 patients with mild SS observed over 12 months in neurology outpatient clinic. It is a retrospective chart review of 12 consecutive patients who had hyperreflexia with tremor (defined as mild SS Hunter′s criteria) and had received serotonergic agents in the past 5 weeks. Only four patients (33%) reported tremor as a presenting or main feature. The presenting features in another eight patients were: Dizziness, generalized body pain, headache, and seizure. Five patients responded to the removal of the offending agents and got a complete response in 2-7 days. There were no or minimal responses in another seven patients to the removal of the serotonergic drugs. Cyproheptadine was started in these patients, at the dose of 8 mg three times daily. Response started within 1-3 days of initiation of the drug and the complete responses were noted in 5-14 days. There were no side effects from cyproheptadine in any patient. We suggest that any patient on serotonergic drug developing new symptoms should be examined for the presence of tremor, hypertonia, hyperreflexia, and clonus to look for mild SS. In addition, every patient on any serotonergic drug should be examined for the presence of mild SS before escalating the dose or before adding a new one

EFFECT OF MCKENZIE METHOD WITH TENS ON LUMBAR RADICULOPATHY A RANDOMIZED CONTROLLED TRIAL

Background: Lumbar radiculopathy is a disease of the spinal nerve root generally accompanied by radicular pain in dermatomal distribution and/or neurologic symptoms. The previous studies were focusing on finding the disability and pain caused due to Lumbar Radiculopathy. This study is focusing on the disability, pain, range of motion of the spine and SLR. The objective of the study is to evaluate the effectiveness of Mckenzie method with TENS on reducing symptoms and disability of Lumbar radiculopathy. Methods: In the present prospective study patients with Lumbar radicular pain due to disc herniation or prolapse at level L4, L5 & S1 were randomized into two groups – Group A and Group B. the study included 40 patients, with 20 in each group. The selection criteria was based on the following - with age group 22-55years, both sexes – male and female, with radicular pain in L4, L5 & S1 dermatomes, disabling leg pain for 6-12 weeks duration, evidence of disc herniation confirmed on MR imaging. The radicular pain was measured using the SLR test, pain was measured using the VAS scale of 0 – 100, disability was measured using the MODI and Lumbar Spine ROM was measured using the MMST. Group-A were treated with McKenzie methods with TENS and Group-B were treated with general exercise with TENS. Results: This study showed that there was a significant reduction of pain on the VAS, improvement in SLR, lumbar spine range of motion using MMST and disability using MODI for both the groups. The statistical analysis found that experimental group showed earlier control of all the outcome measures when compared to controlled group at the end of the 6th week. Conclusion: After 6 weeks of Mckenzie method with TENS intervention for 30 minutes for 5 days in week the statistical analysis concluded that the experimental group had significantly faster rates of reducing the symptoms of lumbar radiculopathy and reducing the disability due to lumbar radiculopathy