Advancements in the study of refractory insomnia suggest a paradigm shift in modern treatment methodologies towards diversification and personalization. Traditional pharmacotherapies, such as benzodiazepines, are noted for their dependency risks. However, new-age drugs like Dexmedetomidine are garnering attention for their safety profile and protective effects on sleep architecture. Cognitive Behavioral Therapy (CBT), as a non-pharmacological intervention, has proven effective, though it requires long-term engagement. Anesthesia-induced sleep therapy, an innovative approach, has demonstrated potential in treating insomnia. Multimodal treatments that integrate pharmacological, non-pharmacological, and novel methods, such as stellate ganglion block and Enhanced External Counterpulsation (EECP), offer comprehensive treatment strategies. However, the long-term safety and side effects of these emerging therapies remain areas for further investigation. Future research should focus more on evaluating the combined effects and safety of these treatments, exploring various therapeutic combinations and personalized approaches. This will aid in a deeper understanding of the long-term outcomes and mechanisms of these emerging therapies, thereby facilitating the provision of more effective and safer treatment options for refractory insomnia.
Nasal leukoplakia is a type of precancerous lesion. The rate of malignant transformation of nasal leukoplakia can be reduced by its early detection, diagnosis, treatment, and prevention. The nasal mucosa (including the nasal septum; upper, middle, and inferior turbinate; upper, middle, and inferior meatus; nasopharynx, and nasal sinuses) develop leukoplakia. Studies have reported that the development of leukoplakia in the oral and laryngeal mucosa is high; in contrast, nasal leukoplakia is rare. A case of nasal septum leukoplakia was reported by Jones in AMA Arch Otolaryngol in 1955; however, the paper title and most instances of the word �leukoplakia� in the paper are misspelt as �leucoplakia�; on surgical resection, the case was diagnosed as leukoplakia of the nasal septum.1 Ever since, we have not come across any research report on nasal leukoplakia. We believe that clinicians in otolaryngology and related departments will pay attention to cases of nasal leukoplakia. Study of the epidemiology, etiology and pathogenesis, clinical characteristics, diagnosis, pathological characteristics, and treatment and preventive measures of nasal leukoplakia may identify new information that could be used as a reference by clinicians to reduce the rate of malignant progression of nasal leukoplakia.
In the last two decades, major car manufacturing companies are exploring the possibilities of joining magnesium with aluminium, via friction welding technique for many crucial automotive applications. Our primary objective, an experimental investigation has been carried out to study the behaviour of dissimilar joints. The microscopic structure at the welded joint interface was analysed using an optical microscopy and scanning electron microscope. It was found that, by increasing the value of friction time, the value of the tensile strength increases and the result of tensile strength is found to be 120 MPa at a friction time of 10 secs. Micro hardness was found to be higher at the interface of the weldment due to the development of a brittle intermetallic compound. Micro structural studies using SEM reveals, distinct zones such as an unaffected parent metal zone, the heat affected zone, a thermo-mechanically affected zone and a fully deformed plasticised zone.
This paper proposes use of high gain Negative self lift luo DC-DC converter to step up the low voltage from PV panel and fed to microgrid system as in marine ships to reduce to demand on fossil fuels and carbon emission control. Negative luo converter has the advantage of smaller size, weight, high frequency switching and stable output over positive luo converters and traditional Boost converters. In this paper the comparison of positive and negative luo converter is done and based on the results, negative output is concluded based on performance.
SS 430 thin plates are extensively used in medical equipment, decorative products and kitchen appliances. In this research work, the 16 straight cutting profiles on SS 430 plates were done by using Nd:YAG laser cutting processes. Experimental works were conducted to examine the influence of processing conditions of laser cutting such as power, cutting velocity and gas pressure on response characteristics like HAZ (heat affected zone) size, recast layer thickness and micro hardness. A novel integrated Taguchi-entropy weighted based Grey relational analysis (GRA) approach has been employed to attain the supreme qualities of laser cutting in this effort. The entropy method is used to measure the weight to each response characteristics. Additionally, ANOVA technique is used to identify the significant process parameters. The obtained results point out that these approaches convincing to optimize the laser cutting practices.
This article presents a new approach to compensation for manufacturing errors in real time. This approach is based on the insertion of the mathematical models into a G-code form in NC programming. Compensated errors in this work are errors due to cutting tool wear, errors due to tool path, and errors due to positioning. We used the lagrange method to model errors due to the trajectory and wear of the cutting tool and the small displacement method for positioning.
The purpose of this study was to examine the effects of warm-up intensity on total oxygen uptake and VO2 kinetics (time constants) during sub¬¬¬maximal exercise in the Iranian national female futsall player’s. The participants of this study were ten Players of Iranian futsal national team (mean± SD: age,22.5±3.2yrs;weight,56.04±6.17kg;height,163±3.68cm;bodyfat%,23.5±3.8;BMI, 21.07± 2.22kg/m2; VO2max, 46.05± 4.61 ml.kg-1.min-1 ). After measuring of VO2max and LT in first session, the subjects performed two protocols of warm up (moderate and heavy intensity) and one protocol with¬out warm up before sub¬maximal exercise (80%LT) in three separated sessions. Respiratory gas exchange measured by Gas Analyzer during the exercise. Repeated measures ANOVA and LSD test were applied for statistical analysis. Total oxygen uptakes were not significant difference after three conditions. After moderate and heavy warm up, third time constants significantly reduced in compare to with¬out warm-up (p<0/05). also oxygen uptake/time ratio in third time constants significantly increased after moderate and heavy warm up respect to with¬out warm-up (p<0/05). The results suggest that warm up causes reducing the time of reaching to steady state of O2 uptake in sub maximal exercise and this effect is independent to warm up intensity.
Fuzzy set theory plays a vital role in many fields. There are varieties of models involving fuzzy matrices to deal with different complicated aspects of medical diagnosis. Today is a world of uncertainty with its associated problems, which can be well handled by soft set theory. In this paper, a new technique named fuzzy max-min average composition method is proposed to construct the decision method for the analysis of Students Problems that affects their studies using Intuitionistic fuzzy soft matrices and its operations. Sanchez’s approach for decision making is studied and the concept is generalized by the application of Intuitionistic fuzzy soft set theory.
In recent years the Wire electrical discharge machining process plays a vital role in machining Hardened alloy. In this study Monel 400 alloy was chosen as a workpiece, while machining this hardened alloy it commonly shows poor surface finish and corner inaccuracy. In order to improve the machining performance the Multi pass cutting was introduced. Here multi- pass cutting is performed by rough cut followed by two trim cuts. The control factors such as offset distance, corner angle, flushing nozzle height, pulse on time, pulse off time, open circuit volts and wire tension are selected as process parameters for the responses such as cutting speed, surface roughness and corner error. By using Taguchi design the experimentation were carried out and the results were analyzed. The result shows that the surface finish and corner accuracy were improved if the machining had done with single trim cut. And also result reveals that if the number cut increases beyond the single trim cut it affects the productivity and accuracy. Hence this study proves that the single trim cut is enough for achieve a better results. On the other hand the effects of process parameters during Single trim cut and multiple cuts are compared and reported.