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Background Enhanced Recovery After Surgery (ERAS) is a multimodal perioperative care bundle aimed at the early recovery of patients. Well accepted in gastric and pelvic surgeries, there is minimal evidence in neurosurgery and neurocritical care barring spinal surgeries. We wished to compare the length of intensive care unit (ICU) or high dependency unit (HDU) stay of patients undergoing elective craniotomy for supratentorial neurosurgery: ERAS protocol versus routine care. The secondary objective was to compare the postoperative pain scores, opioid use, glycemic control, and the duration of postoperative hospital stay between the two groups. Methods In this pragmatic non-randomized controlled trial (CTRI/2017/07/015451), consenting adult patients scheduled for elective supratentorial intracranial tumor excision were enrolled prospectively after institutional ethical clearance and consent. Elements-of-care in the ERAS group were- Preoperative –family education, complex-carbohydrate drink, flupiritine; Intraoperative – scalp blocks, limited opioids, rigorous fluid and temperature regulation; Postoperative- flupiritine, early mobilization, removal of catheters, and initiation of feeds. Apart from these, all perioperative protocols and management strategies were similar between groups. The two groups were compared with regards to the length of ICU stay, pain scores in ICU, opioid requirement, glycemic control, and hospital stay duration. The decision for discharge from ICU and hospital, data collection, and analysis was by independent assessors blind to the patient group. Results Seventy patients were enrolled. Baseline demographics – age, sex, tumor volume, and comorbidities were comparable between the groups. The proportion of patients staying in the ICU for less than 48 h after surgery, the cumulative insulin requirement, and the episodes of VAS scores > 4 in the first 48 h after surgery was significantly less in the ERAS group – 40.6% vs. 65.7%, 0.6 (±2.5) units vs. 3.6 (±8.1) units, and one vs. ten episodes ( p  = 0.04, 0.001, 0.004 respectively). The total hospital stay was similar in both groups. Conclusion The study demonstrated a significant reduction in the proportion of patients requiring ICU/ HDU stay > 48 h. Better pain and glycemic control in the postoperative period may have contributed to a decreased stay. More extensive randomized studies may be designed to confirm these results. Trial registration Clinical Trial Registry of India ( CTRI/2018/04/013247 ), registered retrospectively on April 2018.

The objective of this work is to design a new iterative method based on Armijo’s type-modified extragradient method for solving the inclusion problem ( A + B ) - 1 ( 0 ) , where A is a maximal monotone vector field and B is a continuous monotone vector field. The proposed method requires one projection at each iteration, reducing the cost of computational viewpoint and improving the convergence rate. A convergence theorem is established for the proposed extragradient method, significantly improving existing results. We provide concrete examples of Hadamard manifolds and convergency for numerical confirmation. Moreover, we demonstrate convergence results for the variational inequality problems in which the vector field’s monotonicity can be removed.

Kovar alloy is widely used in electronics, aerospace, and precision applications due to its thermal expansion compatibility with ceramics and glass, yet its difficult machinability demands optimized WEDM parameters for improved performance. To address this challenge, the present study aims to evaluate the influence of key WEDM factors and identify optimal machining conditions for Kovar. Experiments were conducted using a Taguchi L 27 orthogonal array considering servo voltage, pulse on-time, pulse off-time, and wire feed rate as machining parameters, and their effects on cutting speed, machining time, and surface roughness were systematically analyzed. A hybrid multi-criteria decision making approach combining AHP-based weighting with VIKOR compromise ranking was employed alongside the R-method for comparative validation. Results show that the parameter set Ton: 121 µs, Toff: 49 µs, SV: 20 V, and WF: 4 m/min. achieved the best overall machining performance. Importantly, both the AHP-VIKOR method and the R-method identified the same optimal settings, demonstrating strong agreement and confirming the robustness of the hybrid optimization framework. The study highlights the scientific contribution of integrating statistical ranking with structured multi-criteria analysis to enhance decision quality in multi-response WEDM optimization for Kovar alloy.

Curcumin has been shown to inhibit the growth of various types of cancer cells; however, at concentrations much above the clinically achievable levels in humans. The concentration of curcumin achieved in the plasma after oral administration in humans was estimated to be around 1.8  μ M . Here, we report that treatment of BxPC-3 human pancreatic cancer cells with a low and single exposure of 2.5  μ M curcumin for 24 h causes significant arrest of cells in the G2/M phase and induces significant apoptosis. Immunoblot studies revealed increased phosphorylation of H2A.X at Ser-139 and Chk1 at Ser-280 and a decrease in DNA polymerase- β level in curcumin-treated cells. Phosphorylation of H2A.X and Chk1 proteins are an indicator of DNA damage whereas DNA polymerase- β plays a role in the repair of DNA strand breaks. Normal immortalised human pancreatic ductal epithelial (HPDE-6) cells remained unaffected by curcumin treatment. In addition, we also observed a significant increase in the phosphorylation of Chk1 at Ser-345, Cdc25C at Ser-216 and a subtle increase in ATM phosphorylation at Ser-1981. Concomitant decrease in the expressions of cyclin B1 and Cdk1 were seen in curcumin-treated cells. Further, curcumin treatment caused significant cleavage of caspase-3 and PARP in BxPC-3 but not in HPDE-6 cells. Silencing ATM/Chk1 expression by transfecting BxPC-3 cells with ATM or Chk1-specific SiRNA blocked the phosphorylation of ATM, Chk1 and Cdc25C and protected the cells from curcumin-mediated G2/M arrest and apoptosis. This study reflects the critical role of ATM/Chk1 in curcumin-mediated G2/M cell cycle arrest and apoptosis in pancreatic cancer cells.

Background: Suicide is a major public health concern and is considered one of the leading causes of death globally. Previous suicidal attempts can be considered as a predictor of underlying psychiatric illness. Identifying factors behind suicidal attempt can help mental health professionals for early diagnosis and treatment as well as designing effective suicide prevention strategies. Aim: The aim of the study is to assess sociodemographic, clinical characteristics, and prevalence of psychiatric morbidities among patients with attempted suicide. Methods: A cross-sectional study was conducted in the emergency department of tertiary care hospital; patients of attempted suicide attending emergency from January 1, 2014, to January 1, 2020, constituted the sample for the study. Data were collected using semi-structured questionnaire which contained sociodemographic and clinical variables. All the subjects were administered mini-international neuropsychiatric interview (MINI), MINI Kid was applied for subjects <18 years, and MINI Plus was applied for subjects above 18 years. Patients were diagnosed according to the ICD-10 Classification of Mental and Behavioral Disorders for research. Results: Suicide attempt was seen more commonly in males, and the most common age group is between 21 and 40 years residing in urban settings. The most common method was consumption of unknown substances (75.35%). Factors leading to suicide are multidimensional in nature. 30.4% of the patients had impulsive traits. 86.5% of people who attempted suicide had a history of psychiatric illness. Detailed assessment of patients for psychiatric illness and psychosocial factors is crucial for planning suicide prevention strategies and policymaking. Conclusions: Young population is at high risk for suicide. More than 80% of these have diagnosable psychiatric illness.

In the present study, the multi-walled carbon nanotubes (MWCNTs) and graphene nanoparticles were used as a reinforcement to fabricate glass fibre polymer composite at different orientations (unidirectional glass fibres 0° and 90°; woven glass fibres 0°/90° and 45°/45°). The composites were developed using hand lay-up-assisted vacuum bagging method at 1 torr pressure. The concentrations of nanoparticles (~diameter 5–20 nm) were varied in the range of 0.1–0.3 wt% in the matrix. The mechanical properties like impact strength, tensile strength and fatigue strength were carried out on Izod and Charpy machine, universal testing machine and computer-controlled machine under sinusoidal wave, respectively. It is observed that the glass fibre/epoxy composite blended with MWCNTs/graphene by 0.2 wt% has shown higher fatigue life by 56%, higher tensile strength by 36% and higher capability of energy absorption by 927.7% in notched type and lower capability of energy absorption by 155.43% in un-notched type, as compared to pure composite. The increment in properties is due to the better bonding between fillers and matrix. However, the increase of MWCNTs and graphene nanoparticles by wt% in composite laminates have shown lower fatigue strength because of the agglomeration of MWCNTs particles in matrix that caused the propagation of fatigue cracks under cyclic loading. Further, the damage behaviour of composite materials was analysed using scanning electron microscopy. It is found that a different damage behaviour in each composite is observed which is attributed to the matrix cracking, fibre rupture, fibre pullout, fibre split and fibre de-bonding.

Stone columns, a ground improvement technique, can enhance load-bearing capacity and reduce settlements but often lack sufficient friction and bonding with cohesive soils. Dolochar, a novel cementitious additive derived from the sponge iron industry, presents promising potential in addressing these limitations. This study investigates the effectiveness of dolochar-stabilized stone columns in improving the performance of foundation. Undisturbed clay samples with varying liquidity indices (I C ) of 0.3, 0.65, and 0.8 were collected and characterized through a comprehensive suite of geotechnical tests, including specific gravity, dry and wet sieve analysis, liquid and plastic limit, compaction test, triaxial compression test, and direct shear test. Stone columns fabricated with different dolochar at L/D Ratios of (2.5, 4, 6 & 8) were installed in prepared soil specimens within a pressure-controlled apparatus at varying different percentages of dolochar (5%, 10%, 15%, 20%, 25%, and 30%) relative to the soil area. At each and every percentage settlement of the column has been observed at mentioned liquidity-indices on dolochar treated stone columns and surrounding soil to evaluate their mechanical behavior. The influence of dolochar and area replacement ratio on the overall system performance was observed, with higher dolochar content and larger replacement ratios leading to greater stiffness and reduced settlements.