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Effect of ankle versus thigh tourniquets on post-operative pain in foot and ankle surgery

World Journal of Orthopedics 2024年第2期15卷 163-169页

作者： Ashish Mishra Ahmed Barakat Jitendra Mangwani Jakub Kazda Sagar Tiwatane Sana Mohammed Aamir Shaikh Linzy Houchen-Wolloff vipul kaushik Department of Trauma and Orthopedics University Hospitals LeicesterLeicester LE15WWUnited Kingdom Department of Trauma and Orthopedics Leicester University Hospitals-NHS TrustLeicester LE15WWLeicestershireUnited Kingdom Academic Team of Musculoskeletal Surgery University Hospitals of Leicester NHS TrustLeicester LE39QPUnited Kingdom Department of Anaesthesia York&Scarborough Teaching Hospitals NHS Foundation TrustNorth Yorkshire YO318HEUnited Kingdom Department of Anaesthesia Royal Free London NHS TrustLondon NW32QGUnited Kingdom Department of Trauma&Orthopaedics Breach Candy Hospital TrustMumbai 400026India Department of Physiotherapy University Hospitals of Leicester NHS TrustLeicester LE39QPUnited Kingdom Department of Anasthesia University Hospitals of Leicester NHS TrustLeicester LE15WWUnited Kingdom

BACKGROUND Tourniquets are commonly used in elective extremity orthopaedic surgery to reduce blood loss,improve visualization in the surgical field,and to potentially reduce surgical *** is a lack of consensus in existing guidelines regarding the optimal tourniquet pressure,placement site,and duration of *** is a paucity of data on the relationship between the site of a tourniquet and postoperative pain in foot and ankle *** To explore the relationship between tourniquet site and intensity of post-operative pain scores in patients undergoing elective foot and ankle *** Retrospective analysis of prospectively collected data on 201 patients who underwent foot and ankle surgery in a single institution was *** tourniquet duration,tourniquet pressure and site,and postoperative pain scores using Visual Analogue Score were collected in immediate recovery,at six hours and at 24 h *** plots were used to analyse the data and to assess for the statistical correlation between tourniquet pressure,duration,site,and pain scores using Pearson correlation *** All patients who underwent foot and ankle surgery had tourniquet pressure of 250 mmHg for ankle tourniquet and 300 mmHg for *** was no correlation between the site of the tourniquet and pain scores in recovery,at six hours and after 24 *** was a weak correlation between tourniquet time and Visual Analogue Score immediately post-op(r=0.14,P=0.04)but not at six or 24 h *** This study shows that there was no statistically significant correlation between tourniquet pressure,site and postop pain in patients undergoing foot and ankle *** choice of using a tourniquet is based on the surgeon's preference,with the goal of minimizing the duration of its application at the operative site.

关键词： Lower limb surgery Tourniquet time Tourniquet pressure Tourniquet site Post-operative pain Pain scores

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Oncologic outcomes with and without amniotic membranes in robotic-assisted radical prostatectomy:A propensity score matched analysis

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Asian Journal of Urology 2024年第1期11卷 19-25页

作者： Jonathan Noël Daniel Stirt Marcio Covas Moschovas Sunil Reddy Abdel Rahman Jaber Marco Sandri Seetharam Bhat Travis Rogers Subuhee Ahmed Anya Mascarenhas Ela Patel vipul Patel Advent Health Global Robotics Institute CelebrationFLUSA University of Central Florida College of Medicine OrlandoFLUSA Big and Open Data Innovation Laboratory University of BresciaItaly SUNY Upstate Medical University SyracuseNYUSA Kansas City University College of Medicine Kansas CityMOUSA Harvard University CambridgeMAUSA

Objective:Placement of human placenta derived grafts during robotic-assisted radical prostatectomy(RARP)hastens the return of continence and *** long-term impact on the oncologic outcomes remains to be *** objective was to determine the oncologic outcomes of patients with dehydrated human amnion chorion membrane(dHACM)at RARP compared to a matched ***:In a referral centre,from August 2013 to October 2019,599 patients used dHACM in bilateral nerve-sparing *** excluded patients with less than 12 months follow-up,simple prostatectomy,and unilateral *** with dHACM(amnio group)were 529,and were propensity score matched 1:1 to 2465 patients without dHACM(non-amnio group)and a minimum follow-up of 36 *** the time of RARP,dHACM was placed around the neurovascular bundle in the amnio *** and categorical variables in matched groups was tested by two-sample Kolmogorov-Smirnov test and Fisher's exact test *** measured were biochemical recurrence(BCR),adjuvant and salvage therapy ***:Propensity score matching resulted in two groups of 444 *** incidence functions for BCR did not show a difference between the groups(p=0.3).Patients in the non-amnio group required salvage therapy more frequently than the amnio group,particularly after partial nerve-sparing RARP(6.3%vs.2.3%,p=0.001).Limitations are the absence of prospective ***:The data suggest that using dHACM does not have a negative impact on BCR in *** of cancer specific and overall survival will require follow-up study to increase our understanding of these grafts’impact on prostate cancer biology.

关键词： Prostatectomy Prostatecancer Robotic Oncology Outcome Allograft Biomaterial Dehydrated human amnionchorion membrane

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Some Characterizations of a Normal Subgroup of a Group and Isotopic Classes of Transversals

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Algebra Colloquium 2016年第3期23卷 409-422页

作者： vipul Kakkar R.P. Shukla Department of Mathematics University of Allahabad Allahabad 211 002 India

Let G be a group and H be a subgroup of G which is either finite or of finite index in G. In this paper, we give some characterizations for the normality of H in G. As a consequence we get a very short and elementary proof of the main theorem of a paper of Lal and Shukla, which avoids the use of the classification of finite simple groups. Further, we study the isotopy between the transversals in some groups and determine the number of isotopy classes of transversals of a subgroup of order 2 in D2p, the dihedral group of order 2p, where p is an odd prime and the isotopism classes are formed with respect to induced right loop structures.

关键词： right loop normalized right transversal right inverse property isotopy

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IRF4 and IRF8： governing the virtues of B lymphocytes

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Frontiers in Biology 2014年第4期9卷 269-282页

作者： vipul SHUKLA Runqing LU Department of Genetics Cell Biology & Anatomy University of Nebraska Medical Center Omaha NE 68198 USA

Interferon regulatory factor 4 （IRF4） and IRF8 are critical regulators of immune system development and function. In B lymphocytes, IRF4 and IRF8 have been shown to control important events during their development and maturation including pre-B cell differentiation, induction of B cell tolerance pathways, marginal zone B cell development, germinal center reaction and plasma cell differentiation. Mechanistically, IRF4 and IRF8 are found to function redundantly to control certain stages of B cell development, but in other stages, they function nonredundantly to play distinct roles in B cell biology. In line with their essential roles in B cell development, deregulated expressions of IRF4 and IRF8 have been associated to the pathogenesis of several B cell malignancies and diseases. Recent studies have elucidated diverse transcriptional networks regulated by IRF4 and IRF8 at distinct B cell developmental stages and related malignancies. In this review we will discuss the recent advances for the roles of IRF4 and IRF8 during B cell development and associated diseases.

关键词： IRF4 IRF8 B lymphocytes transcriptional regulation leukemia and lymphoma B cell development

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Comparative analysis of proficiencies of various textures and geometric features in breast mass classification using k-nearest neighbor

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Visual Computing for Industry,Biomedicine,and Art 2022年第1期5卷 25-43页

作者： Harmandeep Singh vipul Sharma Damanpreet Singh Department of Computer Science and Engineering IKG Punjab Technical UniversityJalandharPunjab 144603India Department of Computer Science and Engineering Sant Longowal Institute of Engineering and TechnologySangrurPunjab 148106India

This paper introduces a comparative analysis of the proficiencies of various textures and geometric features in the diagnosis of breast masses on *** improved machine learning-based framework was developed for this *** proposed system was tested using 106 full field digital mammography images from the INbreast dataset,containing a total of 115 breast mass *** proficiencies of individual and various combinations of computed textures and geometric features were investigated by evaluating their contributions towards attaining higher classification *** state-of-the-art filter-based feature selection algorithms(Relief-F,Pearson correlation coefficient,neighborhood component analysis,and term variance)were employed to select the top 20 most discriminative *** Relief-F algorithm outperformed other feature selection algorithms in terms of classification results by reporting 85.2%accuracy,82.0%sensitivity,and 88.0%specificity.A set of nine most discriminative features were then selected,out of the earlier mentioned 20 features obtained using Relief-F,as a result of further *** classification performances of six state-of-the-art machine learning classifiers,namely k-nearest neighbor(k-NN),support vector machine,decision tree,Naive Bayes,random forest,and ensemble tree,were investigated,and the obtained results revealed that the best classification results(accuracy=90.4%,sensitivity=92.0%,specificity=88.0%)were obtained for the k-NN classifier with the number of neighbors having k=5 and squared inverse distance *** key findings include the identification of the nine most discriminative features,that is,FD26(Fourier Descriptor),Euler number,solidity,mean,FD14,FD13,periodicity,skewness,and contrast out of a pool of 125 texture and geometric *** proposed results revealed that the selected nine features can be used for the classification of breast masses in mammograms.

关键词： Mammography Breast cancer Machine learning Classification

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Application of metaheuristic algorithms in interval type-2 fractional order fuzzy TID controller for nonlinear level control process under actuator and system component faults

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International Journal of Intelligent Computing and Cybernetics 2021年第1期14卷 33-53页

作者： Himanshukumar R.Patel vipul A.Shah Instrumentation and Control Engineering Department Faculty of TechnologyDharmsinh Desai UniversityNadiadIndia

Purpose–The two-tank level control system is one of the real-world’s second-order system(SOS)widely used as the process control in *** is normally operated under the Proportional integral and derivative(PID)feedback control *** conventional PID controller performance degrades significantly in the existence of modeling uncertainty,faults and process *** overcome these limitations,the paper suggests an interval type-2 fuzzy logic based Tilt-Integral-Derivative Controller(IT2TID)which is modified structure of PID ***/methodology/approach–In this paper,an optimization IT2TID controller design for the conical,noninteracting level control system is *** to modern optimization context,the flower pollination algorithm(FPA),among the most coherent population-based metaheuristic optimization techniques is applied to search for the appropriate IT2FTID’s and IT2FPID’s *** proposed FPA-based IT2FTID/IT2FPID design framework is considered as the constrained optimization *** responses obtained by the IT2FTID controller designed by the FPA will be differentiated with those acquired by the IT2FPID controller also designed by the ***–As the results,it was found that the IT2FTID can provide the very satisfactory tracking and regulating responses of the conical two-tank noninteracting level control system superior as compared to IT2FPID significantly under the actuator and system component ***,statistical Z-test carried out for both the controllers and an effectiveness of the proposed IT2FTID controller is proven as compared to IT2FPID and existing passive fault tolerant controller in recent ***/value–Application of new metaheuristic algorithm to optimize interval type-2 fractional order TID controller for nonlinear level control system with two type of ***,proposed method will compare with other method and statistical analysis will be presented.

关键词： Actuator fault Flower pollination algorithm Interval type-2 fuzzy logic System component fault TID control

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Type-2 fuzzy logic applications designed for active parameter adaptation in metaheuristic algorithm for fuzzy fault-tolerant controller

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International Journal of Intelligent Computing and Cybernetics 2023年第2期16卷 198-222页

作者： Himanshukumar R.Patel vipul A.Shah Department of Instrumentation and Control Dharmsinh Desai UniversityNadiadIndia

Purpose-In recent times,fuzzy logic is gaining more and more attention,and this is because of the capability of understanding the functioning of the system as per human knowledge-based *** main contribution of the work is dynamically adapting the important parameters throughout the execution of the flower pollination algorithm(FPA)using concepts of fuzzy *** adapting the main parameters of the metaheuristics,the performance and accuracy of the metaheuristic have been improving in a varied range of ***/methodology/approach-The fuzzy logic-based parameter adaptation in the FPA is *** addition,type2 fuzzy logic is used to design fuzzy inference system for dynamic parameter adaptation in metaheuristics,which can help in eliminating uncertainty and hence offers an attractive improvement in dynamic parameter adaption in metaheuristic method,and,in reality,the effectiveness of the interval type2 fuzzy inference system(IT2 FIS)has shown to provide improved results as matched to type-1 fuzzy inference system(T1 FIS)in some latest ***-One case study is considered for testing the proposed approach in a fault tolerant control problem without faults and with partial loss of effectiveness of main actuator fault with abrupt and incipient *** comparison between the type-1 fuzzy FPA and interval type-2 fuzzy FPA is presented using statitical analysis which validates the advantages of the interval type2 fuzzy *** statistical Z-test is presented for comparison of efficiency between two fuzzy variants of the FPA optimization ***/value-The main contribution of the work is a dynamical adaptation of the important parameters throughout the execution of the flower pollination optimization algorithm using concepts of type2 fuzzy *** adapting the main parameters of the metaheuristics,the performance and accuracy of the metaheuristic have been improving in a varied range of applications.

关键词： Interval Type-2 fuzzy logic Flower pollination algorithm Fuzzy fault tolerant controller

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Stable fuzzy controllers via LMI approach for non-linear systems described by type-2 T-S fuzzy model

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International Journal of Intelligent Computing and Cybernetics 2021年第3期14卷 509-531页

作者： Himanshukumar R.Patel vipul A.Shah Instrumentation and Control Engineering Department Faculty of TechnologyDharmsinh Desai UniversityNadiadIndia

Purpose-The purpose of this paper is to stabilize the type-2 Takagi-Sugeno(T-S)fuzzy systems with the sufficient and guaranteed stability *** given conditions efficaciously handle parameter uncertainties by the upper and lower membership functions of the type-2 fuzzy sets(FSs).Design/methodology/approach-This paper reports on a relevant study of stable fuzzy controllers and type-2 T-S fuzzy systems and reported that the synthesis of controller for nonlinear systems described by the type-2 T-S fuzzy model is a key problem and it can be resolve to convex problems via linear matrix inequalities(LMIs).Findings-The multigain fuzzy controllers are established to improve the solvability of the stability conditions,and the authors design multigain fuzzy controllers which have extensive information of upper and lower membership ***,the authors derive the traditional stability condition in terms of *** simulation examples illustrate the effectiveness and robustness of the derived stabilization ***/value-The uncertain MIMO nonlinear system described by Type-2 Takagi-Sugeno(T-S)fuzzy model,and successively LMI approach used to determine the system stability *** proposed control approach will give superior fault-tolerant control permanence under the actuator fault[partial loss of effectiveness(LOE)].Also the controller robust against the unmeasurable process ***,the statistical z-test are carried out to validate the proposed control approach against the control approach proposed by Himanshukumar and vipul(2019a).

关键词： Takagi-Sugeno(T-S) Type-2 fuzzy logic system Linear matrix inequalities fuzzy control

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Fecal diversion in complex anal fistulas:Is there a way to avoid it?

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World Journal of Clinical Cases 2021年第25期9卷 7306-7310页

作者： Pankaj Garg vipul D Yagnik Sushil Dawka Colorectal Surgery Garg Fistula Research InstitutePanchkula 134113HaryanaIndia Colorectal Surgery Indus International HospitalMohali 140201PunjabIndia Surgical Gastroenterology Nishtha Surgical Hospital and Research CenterPatan 384265GujaratIndia Surgery SSR Medical CollegeBelle Rive 744101Mauritius

Temporary fecal diversion by a diverting colostomy or ileostomy is occasionally performed for serious complex *** main indications are highly complex and extensive cryptoglandular anal fistula,anal fistula associated with severe anorectal Crohn’s disease,recurrent rectovaginal fistula,radiation-induced fistula and anal fistula with associated necrotizing *** purpose of stoma formation is to divert the fecal stream away from the anorectum and the perianal region so as to control the infective process and prevent trauma to the operated repaired *** the fistula has healed,the diverting stoma is ***,two questions are ***,is it certain that the same disease would not relapse(or the fistula would not recur)once the colostomy is closed?Second,is there a non-surgical method which can obviate the need for a diverting colostomy?An attempt is made to answer both these questions in this review.

关键词： Anal fistula Fecal diversion Diverting stoma Colostomy Crohn’s disease Rectovaginal fistula

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LC and LC–MS/MS studies for the identification and characterization of degradation products of acebutolol

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Journal of Pharmaceutical Analysis 2018年第6期8卷 357-365页

作者： Uday Rakibe Ravi Tiwari Anand Mahajan vipul Rane Pravin Wakte Department of Chemical Technology Dr.Babasaheb Ambedkar Marathwada University Department of Pharmaceutical Sciences SVKM's NMIMS Department of Pharmaceutical Analysis Goa College of Pharmacy

The aim of the present investigation was to demonstrate an approach involving use of liquid chromatography(LC) and liquid chromatography-mass spectrometry(LC–MS) to separate, identify and characterize very small quantities of degradation products(DPs) of acebutolol without their isolation from the reaction mixtures. The drug was subjected to oxidative, hydrolytic, thermal and photolytic stress conditions as per International Conference on Harmonization(ICH) guideline Q1 A(R2). Among all the stress conditions the drug was found to be labile in hydrolytic(acidic & basic) and photolytic stress conditions, while it was stable in water-induced hydrolysis, oxidative and thermal stress conditions. A total of four degradation products were formed. A C18 column was employed for the separation of all the DPs on a gradient mode by using high-performance liquid chromatography(HPLC). All the DPs were characterized with the help of their fragmentation pattern and the masses obtained upon LC–MS/MS and MSnanalysis. All the hitherto unknown degradation products were identified as 1-(2-(2-hydroxy-3-(isopropylamino)propoxy)-5-(amino)phenyl)ethanone(DP-I), N-(4-(2-hydroxy-3-(isopropylamino)propoxy)-3-acetylphenyl)acrylamide(DP-II), 1-(2-(2-hydroxy-3-(isopropylamino)propoxy)-5-(hydroxymethylamino)phenyl)ethanone(DP-III) and 1-(6-(2-hydroxy-3-(isopropylamino)propoxy)-2,3-dihydro-2-propylbenzo[d]oxazol-5-yl)ethanone(DP-IV). Finally the in-silico carcinogenicity and hepatotoxicity predictions of the drug and all the DPs were performed by using toxicity prediction softwares viz., TOPKAT, LAZAR and Discovery Studio ADMET. The results of in-silico toxicity studies revealed that acebutolol(0.967) and DP-I(0.986) were found to be carcinogenic, while acebutolol(0.490) and DP-IV(0.437) were found to be hepatotoxic.

关键词： Acebutolol Stress testing LC LC–MS/MS Degradation pathway In-silico toxicity

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