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A 4.1 kg male neonate with a diagnosis of double-inlet left ventricle with dextro-transposition of the great arteries was intubated shortly after birth due to respiratory insufficiency. The initial management consisted of a successful Stage I hybrid procedure. Persistent respiratory insufficiency led to cross-sectional imaging and bronchoscopy that demonstrated severe airway compression from a dilated main pulmonary artery. A Norwood procedure with Blalock–Thomas–Taussig shunt was performed at 1 month of age to relieve the airway obstruction. The patient was discharged home on room air at 2 months of age. This case highlights a unique single-ventricle anatomic variant with airway compression, which was successfully managed with deferred Norwood palliation.

The thermal properties of paraffin wax were upgraded by utilizing rice husk-derived graphene nanoparticles. In terms of performance, the stability of NPEPCM is an essential aspect. The stability of REPCM is checked using surfactants (CTAB, SDBS, SDS) and sonication time. An increment in the thermal conductivity of paraffin wax was perceived. Maximum conductivity of 0.59 Wm−1K−1 was achieved at 304 K for 1.5 wt% of RGP’s. The maximum thermal conductivity of 0.69 Wm−1K−1 was achieved using pure Graphene at 304 K. Using RGPEPW at different concentrations of RGP’s, the thermal efficiency was calculated for different flow rates of fluid and solar irradiance, and the consequence of the abridged temperature coefficient on the efficiency of FPSC observed. Maximum efficiencies of 67.5 % and 63.9 % were noted for 1 wt% of graphene nanoparticles and 1.5 wt% of RGPs at a 3 Lt/min flow rate, respectively. The improvement of 29.8 % and 22.8 % in the efficiency of FPSC is observed for 1 wt per cent of Graphene and 1.5 wt per cent of RGPs, respectively. Using RGPEPW with a 9.2 % increment in the outlet, the temperature was noticed in the afternoon at a 1.2 Lt/min flow rate. The bioengineering approach gives an understanding of engineering, biology, and environmental science involvement in the present study.

Homogeneous charge compression ignition (HCCI) is a promising technology to reduce NOx and soot emissions in compression ignition (CI) engines. However, this technology lacks combustion control to circumvent the knocking and misfire limitations. Premixed charge compression ignition (PCCI) and reactivity-controlled compression ignition (RCCI) are techniques that use partial homogeneous charge to reduce NOx and soot emissions. Here, combustion is regulated either by controlling the injection timing or fuel reactivity. PCCI uses a part of fuel as premixed to form a partially homogeneous charge and the rest as direct-injected. RCCI, on the other hand, uses a low reactive fuel (LRF) for port injection to form a partially homogeneous charge and a high reactive fuel (HRF) for direct injection. In this work, we studied PCCI and RCCI modes using commercially available fuels like diesel and gasoline, and we compared the results with diesel baseline operation. Adding 40% (by weight) heated diesel port injection to normal diesel operation in PCCI mode at different loads showed a minimum reduction in NOx and smoke emissions by 15% and 6%, respectively, when compared with diesel baseline. This mode was found to be equally efficient with diesel baseline operation at low torque conditions. Similarly, adding 40% (by weight) of gasoline port injection to normal diesel operation in RCCI mode at different loads showed a minimum reduction in NOx and smoke emissions by 20% and 14%, respectively, when compared with diesel baseline. This mode was found to be equally efficient with diesel baseline operation at high torque conditions.

Purpose – Coronary artery disease (CAD) is reported as one of the most common sources of death all over the world. The presence of stenosis (plaque) in the coronary arteries results in the restriction of blood supply, leading to myocardial infarction. The current study investigates the influence of multi stenosis on hemodynamic properties in a patient-specific left coronary artery. Design/methodology/approach – A three-dimensional model of the patient-specific left coronary artery was reconstructed based on computed tomography (CT) scan images using MIMICS-20 software. The diseased model of the left coronary artery was investigated, having the narrowing of 90% and 70% of area stenosis (AS) at the left anterior descending (LAD) and left circumflex (LCX), respectively. Findings – The results indicate that the upstream region of stenosis experiences very high pressure for 90% AS during the systolic period of the cardiac cycle. The pressure drops maximum as the flow travels into the stenotic zone, and the high flow velocities were observed across the 90% AS. The higher wall shear stresses occur at the stenosis region, and it increases with the increase in the flow rate. It is found that the maximum wall shear stress across 90% AS is at the highest risk for rupture. A recirculation region immediately after the stenosis results in the further development of stenosis. Originality/value – The current study provides evidence that there is a strong effect of multi-stenosis on the blood flow in the left coronary artery.

Background: Prevalence of thyroid disorders during pregnancy has a wide geographic variation. There is paucity of data on prevalence of thyroid disorders in Indian pregnant women. Lower Assam consists of people of different culture and ethnicity. In a pilot study done in lower part of Assam among 1st trimester pregnant lady in which the prevalence was alarmingly high. Objective: The objective of the study is to find out prevalence of thyroid disorders among pregnant women in lower Assam. Materials and methods: The study was an out patient department (OPD) based randomized, prospective cohort, observational study over a period of one year. The 880 pregnant women between the age group of 18 to 45 years, who were attending the antenatal OPDs of Fakhruddin Ali Ahmed Medical College, were included in the study. Results: The mean age and thyroid stimulating hormone (TSH) level of study population was 23.70 ± 4.77 years and 2.83±4.02 mIU/ml respectively. The prevalence of thyroid dysfunction was 62.72%. Of this, prevalence of hypothyroidism was 61.70% and that of hyperthyroidism was 1.02%. The majority of the pregnant lady in their 1st trimester was suffering from hypothyroidism (58.6%) (TSH level 2.8± 3.2 mIU/). The prevalence of hypothyroidism is more in pregnant ladies whose age more than 30 yrs (63.8 %). Conclusion: In our study we found that more than 58.6% pregnant women in their first trimester were suffering from hypothyroidism. Thyroid disorders are common in pregnancy, and the screening for thyroid dysfunction should be done early in pregnancy.

BACKGROUND: The prevalence of Triple-Negative breast cancer (TNBC) accounts for a large percentage of breast cancer cases in India. TNBC is associated with poor prognosis, higher mortality rate, ill-defined molecular etiology, and hence limited therapeutic interventions. AIM: The aim of this study is to evaluate the association of certain inflammatory markers with TNBC pathogenesis. MATERIALS AND METHODS: Prospectively collected resected breast cancer tissue samples along with adjacent normal control (n = 100) were prospectively collected in RNA Later. Differential mRNA expression analysis of inflammatory-related genes namely; inducible nitric oxide synthase (iNOS), endothelial nitric oxide synthase (eNOS), cyclooxygenase-2 (COX2), and Nuclear Factor Kappa B (NFκB) and were evaluated in non-TNBC and TNBC tissues samples along with adjacent normal control tissue samples with the help of mRNA specific primers using reverse transcription-polymerase chain reaction. Statistical analysis was performed using SPSSv13.0 software. RESULTS: A total of 60 non-TNBC and 40 TNBC tissue samples along with adjacent normal control were included for the study with informed consent and clinical details. The mean age of the TNBC patients was 39 ± 9 years, All the breast cancer cases were clinically staged as Infiltrating Duct Carcinoma (non-TNBC-invasive ductal carcinoma [IDC] II [n = 29 cases], non-TNBC-IDC III [n = 31 cases], TNBC-IDCII [n = 22 cases], TNBC-IDC III [n = 18 cases]). The results showed an upregulation of all the markers in TNBC cases compared to non-TNBC vis-avis non-neoplastic adjacent control area. Second, significant changes in iNOS mRNA expression were found to be associated with severity of TNBC cases (P = 0.020), while the expression of constitutively expressed eNOS was comparative between IDC-II and IDC-III stages of TNBC. CONCLUSIONS: The present study indicates that the mRNA-based differential expression results showed an upregulation of all the markers (iNOS, eNOS, COX2, and NFκB) in TNBC cases compared to non-TNBC cases vis-a-vis non-neoplastic adjacent control area. Significant changes in iNOS mRNA expression were found to be associated with severity of TNBC cases (P = 0.020), depicting the role of iNOS-induced inflammation in the pathogenesis of TNBC.

Professional driving involves sitting in uncomfortable positions, navigating difficult terrain and roads, and occasionally conducting small repairs and other auxiliary transportation duties while at work for long periods. Drivers who engage in these activities may develop a variety of musculoskeletal disorders (MSDs). MSDs in professional drivers are accompanied by several risk factors. In this study, the various risk factors for MSD have been identified through the literature reviews, discussions with professional drivers, and consultations with ergonomics specialists. This study employed the ordinal priority approach (OPA), a multi-criteria decision-making (MCDM) technique, to rank the identified risk variables for MSD in order of importance. The same OPA method has also been used to identify the group of professional drivers who use eight different types of vehicles and are more likely to develop MSDs. The analyses findings show that the five main risk factors for MSDs among drivers are prolonged sitting, restricted posture, working hours, alcohol consumption, and uncomfortable seating. Additionally, among all drivers regarded as professionals, truck drivers are found to be the most at risk. For the study’s conclusions to be validated, a sensitivity analysis was also carried out. The results of this study are anticipated to help formulate strategies for lowering these hazards through the ergonomic design of drivers’ cabins by automobile OEMs (Original Equipment Manufacturers) and vehicle scheduling by concerned transportation organizations to reduce driver tiredness.

An imperative requirement of a modern machining system is to detect tool wear while machining to maintain the surface quality of the product. Vibration signatures emanating during machining with a single point cutting tool have proven to be good indicators for the tool’s health. The current research undertaken utilizes vibration signatures while turning EN9 and EN24 steel alloy to predict tool life using Artificial Neural Network (ANN). During initial meager experimentation, tool acceleration during machining was recorded, and the width of the flank wear at the end of each run was measured using Tool Makers Microscope. The recorded experimental data is utilized to develop the neural network with the variation of operating parameters and corresponding tool vibration with measured tool flank wear. The endeavor undertaken for the development of ANN flank wear prediction model was effective with a regression coefficient of 0.9964. The proposed methodology of indirect measurement of tool wear is efficient, economical for the machining industry to predict tool life, which in turn avoids catastrophic tool failure.

An existing diesel engine was fitted with a common rail direct injection (CRDi) facility to inject fuel at higher pressure in CRDi mode. In the current work, rotating blades were incorporated in the piston cavity to enhance turbulence. Pilot fuels used are diesel and biodiesel of Ceiba pentandra oil (BCPO) with hydrogen supply during the suction stroke. Performance evaluation and emission tests for CRDi mode were carried out under different loading conditions. In the first part of the work, maximum possible hydrogen substitution without knocking was reported at an injection timing of 15° before top dead center (bTDC). In the second part of the work, fuel injection pressure (IP) was varied with maximum hydrogen fuel substitution. Then, in the third part of the work, exhaust gas recirculation (EGR), was varied to study the nitrogen oxides (NOx) generated. At 900 bar, HC emissions in the CRDi engine were reduced by 18.5% and CO emissions were reduced by 17% relative to the CI mode. NOx emissions from the CRDi engine were decreased by 28% relative to the CI engine mode. At 20%, EGR lowered the BTE by 14.2% and reduced hydrocarbons, nitrogen oxide and carbon monoxide by 6.3%, 30.5% and 9%, respectively, compared to the CI mode of operation.

Introduction: Between the two techniques of laparoscopic nephrectomy, retroperitoneoscopy has certain distinct advantages over transperitoneal access but may be a more difficult technique to learn. We present our experience of training novices in retroperitoneoscopic nephrectomy with a good outcome, making it a standard of care for nephrectomy at our institute. Methods: The aim of this study was to report the initial experience, learning curve, and outcome of retroperitoneoscopic nephrectomy by novices under a mentored approach. The series included four novice urologists. The data from the initial forty retroperitoneoscopic nephrectomies performed by each of them were reviewed. To assess the learning curve for retroperitoneoscopic nephrectomy, we studied changes in key operative parameters (operative time, blood loss, complications, nonprogression by novices, conversion rate) as a function of the case number. Results: Retroperitoneoscopic nephrectomies were successfully completed by novices in 88.1% (141/160) of the patients. Nine cases (5.6%) required the mentor′s help because of nonprogression, and ten cases (6%) required conversion to open nephrectomy. The median operative time of all surgeons decreased with increased surgical experience. There was some intersurgeon variation in the learning curve ranging from 10 to 30 cases, but all surgeons showed a significant reduction in operative time across consecutive sets of ten cases. Seven cases required mentor help in the initial series (7/80) and only two in later half of cases (2/80). All minor complications were also significantly less in the later series. Conclusions: The present series represents the effectiveness of training in retroperitoneoscopic nephrectomy of novices by a responsible team and with the standard protocol and surgical steps. Through effective mentoring, the steep learning curve associated with retroperitoneoscopic nephrectomy has been overcome, making it standard of care for nephrectomy at our institute.

Introduction: Olanzapine is a commonly used antipsychotic. Prolactin elevation is a common adverse effect of anstipsychotics, and serum prolactin elevation is seen in about 30% patients treated with olanzapine. There are confounding results about dose dependency of olanzapine and prolactin elevation, and also the duration of treatment. Method: Fifty six patients, 36 male and 20 female, who were taking olanzapine for any condition for more than a month at a constant dose were enrolled in the study. Patients’ age, weight, body mass index (BMI), serum prolactin levels, and some biochemical values were recorded. Patients were taken from the review outpatient department (OPD) after due consent. Results: Five each in male and female groups showed elevation of serum prolactin (estimated to be high if >20 ng/dl for males, and >25 ng/dl for females.) In females, the elevation was found at lesser dose of olanzapine (13 mg/day, in males 18 mg/day) and early in the treatment (2.4 months vs. 9.7 months in males). Males tended to show raised prolactin with higher doses of olanzapine (mean 18 mg/day). Females (26.31%) also showed higher prevalence of prolactin elevation compared to males (13.51%). No other parameter was found to modify the prolactin levels. Conclusion: Olanzapine causes elevation of serum prolactin, though lesser degree than some other antipsychotics. Females are more prone to have raised serum prolactin with olanzapine compared to males. However, the elevation seems to be transient. Higher doses of olanzapine tend to cause elevation of serum prolactin. Serum prolactin estimation in patients taking olanzapine may be undertaken to maintain quality life, particularly in females.

In the prospect of finding a lightweight and wear-resistant materials, researchers have considered aluminium-based metal matrix composites (MMC), as aluminium has a wide variety of applications but possesses low wear resistance properties. To enhance the wear resistance of aluminium alloys, ceramic particles are reinforced. In this endeavour, commercially available aluminium alloy is reinforced with 2, 4 and 6 wt% of silicon carbide (SiC) and Vanadium pentoxide (V _2 O _5 ) powder to improve its wear resistance. The intensity of reinforcement in the matrix was uniform, and the Scanning Electron Microscope image showed the grain refinement and grain boundary of the MMC’s. Wear tests were performed for L16 array set, uncertainty analysis of wear measurement is evaluated, and data were used to develop Artificial Neural Network (ANN) model. The efficient ANN model with a regression coefficient of 0.999 was used to make predictions for remaining sets. Experimental and predicted wear results were analysed; it is observed that higher wt% reinforcement of V _2 O _5 increased wear resistance of aluminium compared to SiC. The methodology adapted using ANN for prediction of wear using meagre experimentation, will lay a path for tribologists to predict the wear of novel metal matrix composites in their endeavour of finding wear-resistant materials.

Electromagnetic wave-absorbing materials (EMAMs) and structures are crucial in aerospace and electronic communications due to their ability to absorb electromagnetic waves. The development of materials that are lightweight, sustainable, and cost-effective, exhibiting high-performance absorption across a broad frequency spectrum, is therefore important. However, homogeneous electromagnetic absorbing materials require assistance to meet all these criteria. Therefore, developing multi-layer absorbing coatings is essential for enhancing performance. The present study uses 21 different composites of varying weight fractions of polypropylene, graphene nanoplatelets, and multiwall carbon nanotubes nanocomposites to develop multi-layer absorbing materials and optimize their performance. These multi-layer carbon polymer nanocomposites were meticulously constructed using evolutionary algorithms like Non-sorted Genetic Algorithm-II and Particle Swarm Optimization to achieve ultra-broadband electromagnetic wave absorption capabilities. Among the designed electromagnetic absorbing materials, a two-layer model, i.e., 1.5 wt% MWCNT/PP/epoxy with a thickness of 1.052 mm and 2.7% GNP/PP/epoxy with a thickness of 4.456 mm totaling 5.506 mm, was identified as optimal using NSGA-II. The structure has exhibited exceptional absorption performance with a minimum reflection loss of −21 dB and a qualified bandwidth extending to 4.2 GHz. PSO validated and optimized this structure, confirming NSGA-II's efficiency and effectiveness in quickly obtaining optimal solutions. This broadband absorber design combines the structure design and material functioning through additive manufacturing, allowing it to absorb well over a wide frequency range. [ABSTRACT FROM AUTHOR]

In robotic arm controllers, the ability to shift signal levels is crucial for interfacing between different voltage domains in a processor. The level shifter (LS) has been used to convert signals operating near threshold voltage to signals operating well above the threshold voltage. Researchers have developed current mirror-based LSs to employ current mirrors, which duplicate the current from one transistor and accurately replicate it in another, ensuring precise current matching. In this research, a dynamic inverter-based level shifter (DIBLS) with an error correction circuit is implemented. One of the main issues addressed by DIBLS is the problem of current disagreement. Current disagreement arises when multiple circuit components attempt to draw current from a common source, which leads to operational problems. Furthermore, DIBLS includes a feedback inverter controlled by the output node; this feedback inverter likely plays a pivotal role in controlling and stabilizing the output voltage of operation of the LS. The results demonstrate that DIBLS offers notable advantages on increased operational speed. This speed improvement has been achieved by circumventing the threshold voltage drop associated with the feedback of the inverter and by ensuring complete output swing, addressing stability issues. Voltage shifting between 0.3 V and 1.2 V at 1 MHz having power consumption is 16.57 nW, delay 0.22 ns, and energy per transition 32.25 fJ. The entire process is executed in 45 nm in CMOS technology. [ABSTRACT FROM AUTHOR]

A crucial component of digital integrated circuits with numerous power domains is the level shifter (LS). The traditional topologies are currently the mirror LS and cross-coupled LS. For full-swing level conversions from extremely low voltage to the nominal voltage of the supply, ahybrid LS is proposed in this paper, which is a combination of the current mirror LS and cross-coupled LS with a swing-aware output inverter. The proposed LS circuit is designed to ensure full swing, static current-free, and limited current-contention level conversions by preserving the benefits of the current mirror and cross-coupled LS, and using them to eliminate each other's shortcomings. The proposed hybrid LS is designed and implemented by using 45-nm technology in Cadence Virtuoso tool. Pass transistors and current limiters with multiple thresholds are included for the suggested LS. The proposed LS provides voltage conversion from 0.10 V to 1.20 V. At alevel-shifting voltage of 0.20 V, the proposed hybrid LS at 1 MHz input frequency demonstrates a delay of 8.38 ns, an average power consumption of 3.81 µW, and an energy per transition of 26.64 fJ. Additionally, the suggested LS has low delay, good supply voltage scaling, and delay scalability. [ABSTRACT FROM AUTHOR]

A 4.1 kg male neonate with a diagnosis of double-inlet left ventricle with dextro-transposition of the great arteries was intubated shortly after birth due to respiratory insufficiency. The initial management consisted of a successful Stage I hybrid procedure. Persistent respiratory insufficiency led to cross-sectional imaging and bronchoscopy that demonstrated severe airway compression from a dilated main pulmonary artery. A Norwood procedure with Blalock-Thomas-Taussig shunt was performed at 1 month of age to relieve the airway obstruction. The patient was discharged home on room air at 2 months of age. This case highlights a unique single-ventricle anatomic variant with airway compression, which was successfully managed with deferred Norwood palliation. [ABSTRACT FROM AUTHOR]