A Review of Preoperative Embolization Effectiveness in Patients With Arteriovenous Malformations.

BACKGROUND AND OBJECTIVES: Preoperative embolization of arteriovenous malformations (AVMs) remains controversial. This study sought to analyze the cost-effectiveness of preoperative embolization of AVMs. METHODS: Patients who underwent AVM resection at a single institute (January 1, 2015-December 31, 2020) were analyzed. Patients with preoperative embolization (embolization cohort) were compared with those without preoperative embolization (nonembolization cohort). Cost-effectiveness score (CE) was the primary outcome of interest and was determined by dividing the total 1-year cost by effectiveness, which was derived from a validated preoperative to last follow-up change in the modified Rankin Scale utility score. A lower CE signifies a more cost-effective treatment strategy. RESULTS: Of 188 patients, 88 (47%) underwent preoperative embolization. The mean (SD) total cost was higher in the embolization group than in the nonembolization group ($117 594 [$102 295] vs $84 348 [$82 326]; P < .001). The mean (SD) CE was higher in the embolization cohort ($336 476 [$1 303 842]) than in the nonembolization cohort ($100 237 [$246 255]; P < .001). Among patients with Spetzler-Martin (SM) grade I and II AVMs, the mean (SD) CE was higher in the embolization (n = 40) than in the nonembolization (n = 72) cohort ($164 950 [$348 286] vs $69 021 [$114 938]; P = .004). Among patients with SM grade III AVMs, the mean (SD) CE was lower in the embolization (n = 33) than in the nonembolization (n = 25) cohort ($151 577 [$219 130] vs $189 195 [$446 335]; P = .006). The mean (SD) CE was not significantly different between cohorts among patients with higher-grade AVMs (embolization cohort [n = 3] vs nonembolization cohort [n = 15]: $503 639 [$776 492] vs $2 048 419 [$4 794 758]; P = .49). The mean CE for embolized SM grade III aneurysms was nonsignificant in the ruptured group; however, for the unruptured group, CE was significantly higher in the embolization cohort (n = 26; $160 871 [$240 535]) relative to the nonembolization cohort (n = 15; $108 152 [$166 446]) ( P = .006). CONCLUSION: Preoperative embolization was cost-effective for patients with SM grade III AVMs but not for patients with lower-grade AVMs.

Effect of Allium sativum and Olea europaea on serum lipids in patients with diabetes mellitus.

Objective: This study was designed to assess the effects of a combination of Allium sativum and Olea europaea oil on disturbed lipid profiles in patients with type 2 diabetes mellitus (T2DM). Methods: This randomized control trial (RCT) involved 160 patients of either sex (aged 40-60 years) with T2DM and dyslipidemia, and were equally divided into two groups. Group A patients received hypoglycemic and lipid lowering agents (Tab glimepiride 2 mg + metformin HCl 500 mg and Tab rosuvastatin 10 mg once a day orally). Patients in group B were given the same allopathic drugs as group A, in combination with A. sativum and O. europaea oil over a period of 6 months. Blood samples were taken at three stages of the study to allow the analysis of lipid profiles. Results: Analysis showed that after 3 and 6 months of treatment, the mean levels of serum cholesterol, triglycerides (TGs) and low-density lipoprotein (LDL) were reduced in both groups and that there was a highly significant (P < 0.001) decline in group B when compared to group A. High-density lipoprotein (HDL) levels increased in both groups but there was a significant (P < 0.05) increase in the group B when compared to group A. The percentage reduction was highest at 6 months of treatment for cholesterol, TGs, LDL and HDL in group B (41.5%, 45.9%, 60.4% and 58.1%, respectively). Conclusion: The antihyperlipidemic activity observed may be due to the presence of antioxidants in the test substances. Further studies should be conducted with a larger sample size in order to further evaluate the role of A. sativum powder and O. europaea oil in patients with T2DM with dyslipidemia.

Association of Serum Albumin, Globulin, and Transferrin Levels in Children of Poorly Managed Celiac Disease.

Background: Celiac disease (CD) is an autoimmune genetic disorder in which gluten protein causes inflammation of the intestinal enterocytes. CD diagnosis in most cases is delayed or mistreated due to its varied clinical features. We aimed to evaluate the protein profile imbalance in different CD groups of children, which could help aid in the diagnosis and proper management of the disease. Methodology. This was a cross-sectional study with a nonrandom purposive sampling technique. All samples were taken from tertiary care hospitals of Hyderabad, Pakistan. In total, there were 175 children (age 3-15 years) divided into five equal groups (n = 35), namely, group A (control), group B (celiac diagnosed), group C (celiac-like symptoms), group D (celiac with type 1 diabetes mellitus), and group E (type 1 diabetes mellitus only). Clinical symptoms and laboratory parameters were analyzed among all the groups. Sera proteins, albumin, globulins, and transferrin levels were evaluated and compared with healthy individuals. Results: The albumin in serum of celiac groups B and C was 3.0 g/dl and 2.8 g/dl, respectively. While in diabetic patients with CD, it is 2.7 g/dl. The globulin levels were raised among all the celiac groups with typical GIT symptoms. The highest transferrin was observed in group B, celiac patients with severe anemia. Patients were not on GFD, hence had no or less recovery and had chronic symptoms of celiac. Conclusion: The misdiagnosis and poor management of celiac leads to chronic villous atrophy with imbalance in metabolic profile. Serum analysis of albumin, globulins, and transferrin may help in the diagnosis and proper management of the disease to recover the celiac symptoms.

Relationship Between Mobile Digital Sensor Monitoring and Perioperative Outcomes: Systematic Review.

BACKGROUND: Monitoring surgical recovery has traditionally been confined to metrics measurable within the hospital and clinic setting. However, commercially available mobile sensors are now capable of extending measurements into a patient's home. As these sensors were developed for nonmedical applications, their clinical role has yet to be established. The aim of this systematic review is to evaluate the relationship between data generated by mobile sensors and postoperative outcomes. OBJECTIVE: The objective of this study is to describe the current use of mobile sensors in the perioperative setting and the correlation between their data and clinical outcomes. METHODS: A systematic search of EMBASE, MEDLINE, and Cochrane Library from inception until April 2019 was performed to identify studies of surgical patients monitored with mobile sensors. Sensors were considered if they collected patient metrics such as step count, temperature, or heart rate. Studies were included if patients underwent major surgery (≥1 inpatient postoperative day), patients were monitored using mobile sensors in the perioperative period, and the study reported postoperative outcomes (ie, complications and hospital readmission). For studies including step count, a pooled analysis of the step count per postoperative day was calculated for the complication and noncomplication cohorts using mean and a random-effects linear model. The Grading of Recommendations, Assessment, Development, and Evaluation tool was used to assess study quality. RESULTS: From 2209 abstracts, we identified 11 studies for review. Reviewed studies consisted of either prospective observational cohorts (n=10) or randomized controlled trials (n=1). Activity monitors were the most widely used sensors (n=10), with an additional study measuring temperature, respiratory rate, and heart rate (n=1). Low step count was associated with worse postoperative outcomes. A median step count of around 1000 steps per postoperative day was associated with adverse surgical outcomes. Within the studies, there was heterogeneity between the type of surgery and type of reported postoperative outcome. CONCLUSIONS: Despite significant heterogeneity in the type of surgery and sensors, low step count was associated with worse postoperative outcomes across surgical specialties. Further studies and standardization are needed to assess the role of mobile sensors in postoperative care, but a threshold of approximately 1000 steps per postoperative day warrants further investigation.

A research on conventional and modern algorithms for maximum power extraction from wind energy conversion system: a review.

In the last few decades, wind energy has become a significant source of the renewable energy system, and it is essential to use wind energy for generating power and run the wind turbine system (WTs) at a higher level. With the rapid penetration of wind energy in the distributed generation system (DGS) and isolated micro-grid (MG), the WT runs at its optimal energy conversion output. For this, WT has to track or drive at the optimal power point tracking algorithm. However, various publications are available on MPPT algorithms for wind energy system (WES) applications, making a choice on exact trackers for a particular algorithm because each tracker has its advantages and disadvantages. Therefore, our primary goal is to review and evaluate the exact tracking algorithm for WES applications in this manuscript. To introduce the power controller, it is essential to track maximum power despite wind energy results. Besides, many algorithms have been evaluated, and their maximum output is achieved compared to their performance. This research paper will help researchers provide an accurate reference for future recommendations by selecting the best tracking algorithms in WES.

Antiseizure drug efficacy and tolerability in established and novel drug discovery seizure models in outbred vs inbred mice.

OBJECTIVE: Initial identification of new investigational drugs for the treatment of epilepsy is commonly conducted in well-established mouse acute and chronic seizure models: for example, maximal electroshock (MES), 6 Hz, and corneal kindling. Comparison of the median effective dose (ED50) of approved antiseizure drugs (ASDs) vs investigational agents in these models provides evidence of their potential for clinical efficacy. Inbred and outbred mouse strains exhibit differential seizure susceptibility. However, few comparisons exist of the ED50 or median behaviorally impairing dose (TD50) of prototype ASDs in these models in inbred C57Bl/6 vs outbred CF-1 mice, both of which are often used for ASD discovery. METHODS: We defined the strain-related ED50s and TD50s of several mechanistically distinct ASDs across established acute seizure models (MES, 6 Hz, and corneal-kindled mouse). We further quantified the strain-related effect of the MES ED50 of each ASD on gross behavior in a locomotor activity assay. Finally, we describe a novel pharmacoresistant corneal-kindling protocol that is suitable for moderate-throughput ASD screening and demonstrates highly differentiated ASD sensitivity. RESULTS: We report significant strain-related differences in the MES ED50 of valproic acid (CF-1 ED50: 90 mg/kg [95% confidence interval (CI) 165-214] vs C57Bl/6: 276 mg/kg [226-366]), as well as significant differences in the ED50 of levetiracetam in the pharmacoresistant 6 Hz test (CF-1: 22.5 mg/kg [14.7-30.2] vs C57Bl/6: >500 mg/kg [CI not defined]). There were no differences in the calculated TD50 of these ASDs between strains. Furthermore, the MES ED50 of phenobarbital significantly enhanced locomotor activity of outbred CF-1, but not C57Bl/6, mice. SIGNIFICANCE: Altogether, this study provides strain-related information to differentiate investigational agents from ASD standards-of-care in commonly employed preclinical discovery models and describes a novel kindled seizure model to further explore the mechanisms of drug-resistant epilepsy.

Input data for mathematical modeling and numerical simulation of switched reluctance machines.

The modeling and simulation of Switched Reluctance (SR) machine and drives is challenging for its dual pole salient structure and magnetic saturation. This paper presents the input data in form of experimentally obtained magnetization characteristics. This data was used for computer simulation based model of SR machine, "Selecting Best Interpolation Technique for Simulation Modeling of Switched Reluctance Machine" [1], "Modeling of Static Characteristics of Switched Reluctance Motor" [2]. This data is primary source of other data tables of co energy and static torque which are also among the required data essential for the simulation and can be derived from this data. The procedure and experimental setup for collection of the data is presented in detail.