bluuebunny/crossref_metadata_2025 huggingface dataset:
Therapeutic Potential of Canine Glial Restricted Progenitors Transplanted in Mouse Model of Demyelinating Disease 
Authors: Stanaszek Luiza , Majchrzak Malgorzata , Drela Katarzyna , Rogujski Piotr , Sanford Joanna , Fiedorowicz Michal , Gewartowska Magdalena , Frontczak-Baniewicz Malgorzata , Walczak Piotr , Lukomska Barbara , Janowski Miroslaw
Published: October 2020

Background: Dysfunction of glia contributes to the deterioration of the central nervous system in a wide array of neurological disorders, thus global replacement strategies of glia are very attractive. Human glial restricted precursors (hGRPs) transplanted intraventricularly into neonatal mice extensively migrated and rescued lifespan in half of studied mice, while mouse GRPs (mGRPs) presented no therapeutic benefit. We hypothesized that the intrinsic developmental program (IDP) might be one of the main drivers of cell behaviour after grafting, with long migration distance and late myelination for hGRPs, compared to limited migration and early myelination for mGRPs. We studied in the same experimental setting canine GRPs (cGRP) to determine whether their migration, myelination and subsequent therapeutic potential falls between hGRPs and mGRPs. Additional motivation for selection of cGRPs was a potential for use in veterinary medicine due to growing population of dogs as companion animals. Methods: cGRPs were extracted from the brain of dog foetuses. The cells transplanted (4x105 cells) into anterior or posterior aspect of the lateral ventricle (LV) of neonatal, immunodeficient, dysmyelinated mice (shiverer, MBPshi/shi, rag2-/-). Outcome measures included early cell biodistribution, animal survival and myelination assessed with MRI, immunohistochemistry and electron microscopy. Results: Grafting of cGRP into posterior LV significantly extended animal survival, while no benefit was observed after anterior LV transplantation. In contrast, myelination of the corpus callosum was more prominent in anteriorly transplanted animals. Conclusions: The extended survival of animals after transplantation of cGRPs could be explained by the vicinity of transplant near the brain stem.
Sex Differences in Myocardial Injury After Non-Cardiac Surgery and Postoperative Mortality
Authors: Kwon Jihye , Park Jungchan , Lee Seunghwa , Hyun Cheol Won , Kim Jihoon , Yang Kwangmo , Min Jeong Jin , Lee Jong Hwan , Lee Sangmin Maria , Choi Jin-ho , Lee Sang-Chol , Gwon Hyeon-Cheol , Her Sukyoung , Kim Kyunga , Ahn Joonghyun
Published: October 2020

BackgroundMyocardial injury after non-cardiac surgery (MINS) has recently been accepted as a predictor of mortality. However, the impact of sex difference on the incidence and survival following MINS has not been fully understood. This study aimed to compare the incidence of MINS and mortality in male and female patients during the short and long term periods.MethodsFrom January 2010 to June 2019, consecutive patients with cardiac troponin (cTn) within 30 days after non-cardiac surgery were grouped according to sex. The incidence of MINS and the mortality of the patients with MINS were compared.ResultsOf the total of 33,311 patients, 18,546 (55.7%) patients were male and 14,765 (44.3%) were female. In multivariable analysis, females showed significantly lower incidence of MINS (17.9% vs. 14.2%; odds ratio, 0.76; 95% confidence interval [CI], 0.71-0.81; p < 0.001). In patients with MINS, propensity score-matched analysis showed that 30-day mortality did not differ according to sex, but the mortality in females was significantly lower during the overall follow-up (33.0% vs. 25.7%; hazard ratio, 0.75; 95% CI, 0.66-0.84; p < 0.001).ConclusionThe incidence of MINS appeared to be lower in female than male. In patients with MINS, female may be associated with survival benefit. A further study is needed to confirm this finding.
Integrated Analysis of Immune-Related Genes in High-Risk Neuroblastoma
Authors: Shao FengLing , Wang Zhenni , Wang Shan
Published: October 2020

BackgroundDue to the extremely high mortality rate of children with high-risk Neuroblastoma (NB), there is an urgent need for new indicators to further classify children in the high-risk group for more precise treatment. The purpose of our research is to explore the immune-related genes in NB in the high-risk group, and to further identify and develop a prognostic nomogram based on immune IRG signatures. MethodsThrough bioinformatics analysis to explore the abnormal expression of immune-related genes in the high-risk group. Cox regression and the least absolute shrinkage and selection operator (LASSO) analysis were conducted to identify the immune and overall survival (OS) related mRNA. The accuracy of the risk score is evaluated by Kaplan-Meier method and receiver operating characteristics (ROC) analysis, which is used to build a nomogram in combination with other clinical characteristics.. Quantitative real-time polymerase chain reaction (qRT-PCR) was conducted to detect the accuracy of our results. ResultsA total of 127 common differentially expressed immune genes were found between the high-risk group and the non-high-risk group of the two data sets. Four immune-related genes (IRG) related to prognosis were identified and a risk score was established. Kaplan–Meier survival analysis and time-dependent ROC analysis showed that the 4-IRG risk score has satisfactory predictive potential and achieved consistency in the verification of external data sets. Subsequently, the risk score combined with clinical characteristics draws a nomogram. The reliability of the results was verified on 29 cases of NB tissues by qRT-PCR. ConclusionsOverall, we have developed a powerful multi-gene classifier that can effectively classify NB patients into low- and high-risk groups with poor prognosis, and draw a nomogram for children in the high-risk group. This feature can help select high-risk patients who need more aggressive adjuvant target therapy or immunotherapy.
Rhabdomyolysis is Associated with Hospital Mortality in Patients with COVID-19
Authors: Geng Yan , Du Yong-sheng , Peng Na , Yang Ting , Zhang Shi-yu , Wu Feng-fu , Ma Qiang , Lin Hua-liang , Su Lei
Published: October 2020

Purpose: To evaluate the clinical features and outcomes of rhabdomyolysis (RM) in patients with COVID-19. Method: A single center retrospective cohort study of 1,014 consecutive hospitalized patients with confirmed COVID-19 at the Huoshenshan hospital in Wuhan, China, between February 17 and April 12, 2020. Results: The overall incidence of RM was 2.2%. Comparing with patients without RM, patients with RM tended to have a higher risk of deterioration, representing by higher ratio to be admitted to the intensive care unit (ICU) (90.9 % vs 5.3%, P<0.001), and to undergo mechanical ventilation (86.4 % vs 2.7% P<0.001). Compared with patients without RM, patients with RM had laboratory test abnormalities, including indicators of inflammation, coagulation activation and kidney injury. Patients with RM had a higher risk of hospital death (P < 0.001). Cox proportional hazard regression model confirmed that RM indicators, including peak creatine kinase (CK) >1000 IU/L (HR=6.46, 95% CI: 3.02-13.86), peak serum myoglobin (MYO) >1000 ng/mL (HR=9.85, 95% CI: 5.04-19.28) were independent risk factors for in-hospital death. Additionally, patients with COVID-19 that developed RM tended to have a delayed virus clearance.Conclusion: RM might be an important factor contributing to adverse outcomes of patients with COVID-19. Early detection and effective intervention of RM may help reduce deaths of patients with COVID-19.
ToAM: A Task-oriented Authentication Model for UAVs Based on Blockchain
Authors: Chen Aiguo , Peng Kun , Sha Zexin , Yang Zhen , Lu Guoming
Published: October 2020

The pervasive collaboration of groups of UAVs has become vogue and popularized due to the reduced cost and widely adoption of these gadgets. It is believed that such collaboration will benefits numerous scenarios like the disaster monitoring and combat in battlefield. In these scenarios where UAVs collaborate to carry out tasks, the efficient and reliable authentication between UAVs is imperative. However, there are some major challenges hindering the authentication, including UAVs' resource limitation, joint using of cross-domain drones, and weakly connected task network environment. Therefore, a novel Task-oriented Authentication Model for UAVs Based on Blockchain (ToAM) is proposed. The framework takes advantage of the tamper-resistant properties of the blockchain, and uses smart contract to achieve decentralized identity authentication and reduce the computing cost of UAVs. Analyzing results demonstrates that the authentication model can achieve lightweight, offline secure identity authentication for UAVs.
Modeling of Forced Flow-thermal Gradient CVI: Effects of Control Parameters and Processing Schemes on a Densification
Authors: WANG Pengfei , Luo Shengfeng , ZHANG Hui , ZHANG Song , ZHENG Lili
Published: October 2020

A two-channel temperature-control infiltration reactor aiming at fabricating thicker and more uniform composites was designed. Unsteady numerical simulations containing hydrodynamics, mass transfer, heat transfer and pore structure evolution were carried out. By analyzing the effects of concentration, velocity and temperature on the porosity distribution, different densification schemes were proposed and compared. Results show that a preform of thickness 0.04 m and initial porosity 0.8 can be densified to a uniform and compact one with the maximum porosity of 0.1 within 300 hours through the three-step densification scheme. This scheme not only assures a low and uniform porosity over the whole preform but also avoids the huge pumping pressure which may cause the preform cracking.
A novel indicator, relative children’s lipid accumulation product (RCLAP) for metabolic syndrome
Authors: Zhang Li , Zhang Zizhe , Wang Bangxuan , Yuan Yongting , Sun Lili , Fu lianguo
Published: October 2020

BackgroundThe children’s lipid accumulation product (CLAP) was associated with MS in Chinese children and adolescents. The study was to develop a more effective indicator, relative children’s lipid accumulation product （RCLAP）associated with MS reflect the density of lipid accumulation among Chinese children and adolescents. MethodsA stratified cluster sampling method was used to recruit 683 students aged 8-15 years in this study. The presence of MS was defined according to the NCEP-ATP III criteria. The t-test, chi-square test, logistic regression models were used to analyze the associations of SBMI, SWHtR, SlnCLAP, SRCLAP-H, SRCLAP-SH, RCLAP-W with MS. Receiver Operating Characteristic (ROC) curves was used to evaluate the predictive efficiency of above indexes for predicting MS. ResultsThe overall prevalence of MS was 4.8% (boys 6.6%, girls 2.8%). In girls, after adjusting for sedentary activity time, WHtR, BMI, CLAP, RCLAP-H, RCLAP-SH and RCLAP-W significantly increased risk of MS (OR(95%CI):15.79 (3.15-79.21), 3.73 (0.87-15.95), Null, 96.13 (11.11-831.97), 96.13 (11.11-831.97), 18.28 (4.24-78.87), respectively). In boys, after adjusting for ages and moderate-to-vigorous physical activity time, WHtR, BMI, CLAP, RCLAP-H, RCLAP-SH and SRCLAP-W significantly increased risk of MS (OR(95%CI): 37.43(11.67-120.10), 68.33(18.51-252.20), 105.86(21.99-509.68), 171.75(33.60-878.00), 133.18(27.65-641.39), 50.13(15.48-162.37, respectively). The AUCs of RCLAP-H and RCLAP-SH for predicting MS were 0.950, 0.948 in girls, and 0.952, 0.952 in boys, which were higher than these of BMI, WHtR, CLAP and RCLAP-W.ConclusionThe relative children，s lipid accumulation products（RCLAP-H and RCLAP-SH ) were more effective indicators for predicting MS than BMI, WHtR and CLAP in Chinese children and adolescents.
Mg alloy surface immobilised with caerin peptides acquires enhanced antibacterial ability and improved corrosion resistance
Authors: Wang Tianfang , Ni Guoying , Furushima Tsuyoshi , Diao Hui , Zhang Pingping , Chen Shu , Fogarty Conor E. , Jiang Zhengyi , Liu Xiaosong , Li Hejie
Published: October 2020

Magnesium (Mg) has mechanical properties similar to human bones and Mg alloy is considered ideal medical implant material. However, the high velocity of degradation inside the human inner environment severely hampers the usage of Mg alloys. In this study, caerin peptide 1.9 (F3) and a modified sequence of caerin 1.1 (F1) with anti-bacterial activity, were covalently immobilised on the surface of Mg alloys by plasma chemical click reaction. The in vitro antibacterial activity and corrosion resistance of these caerin peptide-immobilised Mg alloys were investigated in Dulbecco's Modified Eagle Medium (DMEM) solution. Un-immobilised Mg alloy sample, blank drug-sensitive tablet (BASD) and a commonly used antibiotics Tazocin were used for comparison. Results showed that peptide immobilised Mg samples showed significant improved corrosion resistance and prolonged antibacterial effect compared to non-immobilised Mg alloy and free caerin peptides. Furthermore, annealing or extruding treatment of Mg alloys improved the behaviours of corrosion resistance and antibacterial property. These results indicate that coating Mg alloy with caerin peptides improves the corrosion resistance in vitro and increases the alloy’s antibacterial ability. The mechanism underlying the prolonged antibacterial effect for annealed Mg alloys immobilised with the peptides (especially F3) remains unclear, which worth further experimental and theoretical investigation.
Comparison of Continuous Epidural Blockade and Continuous Femoral Nerve Block on Postoperative Pain in Total Knee Replacement Surgeries: A Prospective Randomised Controlled Study
Authors: K. Shanthini  , Nishkala Chandra Sekar  , Kusuma Mathai
Published: October 2020

Background: The use of epidural analgesia in the management of postoperative pain following orthopedic surgeries has evolved as a critical component of a multimodal approach to achieve the goal of pain relief, early mobilization, and improved compliance with physiotherapy resulting in overall improved outcomes. Aim: The aim of this study is to compare continuous femoral nerve block with continuous epidural block technique for postoperative analgesia in patients undergoing elective total knee replacement surgery.Subjects and Methods:The patients belonging to the ASA I to III scheduled for various knee surgeries under spinal anesthesia were enrolled in this study. They were randomly divided into two equal groups of thirty-three patients each. The Group F patients received continuous femoral nerve blockade and in the Group E patients continuous epidural blocked preoperatively.Results:The analgesic efficacy of both continuous femoral nerve block and continuous epidural nerve block was equal as measured by the visual analogue scores. The incidence of Hypotension was more in the Epidural group. The adverse effects due to the Continuous Femoral Nerve block were lower in comparison with the Continuous Epidural block technique.Conclusion:Continuous femoral nerve blockade provides postoperative analgesia equivalent to that obtained with a continuous epidural blocked but with lesser side effects.
Comparative Efficacy of Intrathecal Pethidine with Lignocaine 5% (Heavy) as Sole Anaesthetic Agent for Perineal Operations
Authors: Jitta Sudershan Reddy
Published: October 2020

Background: The discovery of opioid receptors and ligand in the brain and spinal cord lead to the feasibility of their use intrathecally. Pethidine is the only narcotic that has been shown to be effective intrathecally for surgery. This is probably because it as a phenyl-piperidine derivative and has a structure and action similar to that of local anaesthetic.Subjects and Methods:50 patients belonging to ASA grade 1 and 2 physical status were randomly assigned to two groups A and B. Patients in group A received 1 ml of 5% lignocaine (heavy) intrathecally and those in group B gained intrathecal Pethidine (preservative-free) 0.5mg/kg body weight. The time for onset and level of sensory blockade, onset and degree of motor blockade, hemodynamic parameters, time for regression of sensory and motor blockade, duration of postoperative analgesia and side effects were noted and compared in both the groups.Results:Two groups were comparable with respect to age, sex, height and weight. The onset of sensory and motor blockade in-group A was 2.00±1.06min and 2.56±0.88 and in-group B it was 3.56±1.64 min and 7.22±1.11 min respectively, which was statistically significant. Grade I motor paralysis was seen in 2 cases (10%) in group A and 15 cases (75%) in groupB. Grade II motor paralysis was seen in 6 cases (30%) in group A and 5 cases (25%) in group B. Grade III motor paralysis was viewed in 12 cases (60%) in group A and 0 cases(0%) in group B. Grade I and III motor paralysis in the groups were statistically significant (p<0.05). Time for sensory regression at L1 was 65.12±4.83 min in-group A and 94.60±6.88 min in-group B that was statistically very significant (p<0.05). The time for regression of motor blockade was 60.40±3.85 in-group A and 60.20±5.02 in group B, which was statistically not significant (p>0.05). The duration of postoperative analgesia was 122.84±9.37 min in-group A and 320.60±23.02 in group B, which was statistically very significant. The incidence of side effects was comparable in both groups.Conclusion:Pethidine (preservative-free) 0.5mg/kg body weight can be used intrathecally as a sole anaesthetic agent to provide prolonged postoperative analgesia associated with hemodynamic stability and early ambulation in patients undergoing perineal surgeries.
A Comparative Study of Isobaric Levobupivacaine 0.5% versus Isobaric Levobupivacaine 0.5% with 3µg Dexmeditomidine in Spinal Anaesthesia in Patients Undergoing Effective Lower Limb Surgeries
Authors: Spoorthy Uppuleti  , Kuppannagari Subba Reddy
Published: October 2020

Background: Intrathecal apha-2 agonists prolong the duration of action of local anesthetics and reduce the required dose. Dexmedetomidine is a 2 receptor agonist and its 2/1selectivity is 8 times higher than that of clonidine. Aim: In this study, we aimed to investigate the effect of adding 3µg dexmedetomidine to Intrathecal Isobariclevobupivacaine0.5% on the onset time and duration of motor and Sensory blocks.Study design: Randomized controlled study.Subjects and Methods:Patients were randomly assigned into two groups. Group L (n=30) patients received 3 mL (15mg) of 0.5% levobupivacaine+0.3mL normal saline and Group LD(n=30) patients received 3mL(15mg)of0.5%levobupivacaine+0.3mL (3mcg dexmedetomidine). Sensory block onset time, block reaching time to T10dermatome, the most elevated dermatome level, two dermatome regression time, sensory block complete regression time as well as motor block on a set time, reaching Bromage3and regressing to Bromage 0 were recorded.Results:Sensory and motor block onset times were shorter in Group LD than in Group L (p<0.001).The regression of the sensory block to S1dermatome andBromage0 was Longer in Group LD than Group L (p<0.001).The two dermatome regression time was Longer in Group LD than Group L (p<0.001). There were no statistically significant Differences between groups in blood pressure and hear trate.There was no statistically Significant difference between groups when adverse effects were compared.Conclusion:We conclude that intrathecal dexmedetomidine addition to Isobaric levobupivacaine 0.5%for spinal anaesthesia shortens sensory and motor block onset time and prolongs Block duration without any significant adverse effects.
Comparison of Pethidine and Dexmedetomidine for the Control of Intraoperative Shivering Under Spinal Anesthesia
Authors: Viral Prakashkumar Patel  , Shital Hardik Halvadia
Published: October 2020

Background: Spinal anesthesia significantly impairs the thermoregulation system by inhibiting tonic vasoconstriction, which plays a significant role in temperature regulation. Various non-pharmacological and pharmacological methods are available for the control of shivering during anesthesia. The present study was done with an aim to compare the two drugs Pethidine and Dexmedetomidine for the control of intraoperative shivering under spinal anesthesia.Subjects and Methods:A prospective randomized study was carried out in the Department of Anaesthesiology, on 100 patients who developed intra-operative shivering following spinal anesthesia for numerous surgical procedures. When patients developed shivering of higher than mentioned grades, they were randomly assigned to one of the 2 study groups: Group D- Dexmedetomidine group receiving single intravenous bolus dose of 0.5mcg/kg over 5 min.  Group P: Pethidine group patients receiving 0.5mg/kg Pethidine IV over 5 min. Patients were intently monitored for the failure of the drug, Recurrence of shivering and side effects like nausea, vomiting, bradycardia (< 50/min), hypotension (>20% of baseline), giddiness and sedation score were recorded.Results:We found the Pethidine group had 62.5% and Dexmedetomidine had 67.5% of grade 3 shivering. The grades of shivering were comparable between the two groups with no statistical difference. We found the dexmedetomidine group had a significant reduction in time required to control shivering and vanishing of shivering after drug.Conclusion:Both dexmedetomidine (0.5mcg/kg) and Pethidine (0.5mg/kg) are effective in treating patients with post-spinal anesthesia shivering but the time taken for control of shivering was shorter with Dexmedetomidine as compared to Pethidine.
A Comparative Study of Effectiveness of Ultrasound-Guided Transversus Abdominis Plane (TAP) Block vs Epidural Analgesia for Post-Operative Pain Relief in Lower Abdominal Surgeries
Authors: Santosh Bhagasra  , Neelam Meena  , Vikas Rajpurohit
Published: October 2020

Background: An increase in the use of regional anesthesia techniques for postoperative pain relief for analgesia following lower abdominal surgeries. Epidural anesthesia considered as the "gold standard" has been established to provide excellent analgesia as well as attenuation of neurogenic contribution to inflammation. The TAP block provides reliable somatic analgesia in lower abdominal incision surgeries. Use of ultrasound helps incorrect localization of the plane and accurate placement of the needle and catheter.Subjects and Methods:In TAP group under USG guidance 20 ml 0.2% Inj. Ropivacaine was deposited on each side of the abdominal wall. In Epidural group 10 ml of 0.2% Inj. Ropivacaine was administered at skin closure.Results:Systolic and diastolic blood pressure levels were significantly lower in group B as compared to group A (p<0.05). . VAS score was significantly higher in group B as compared to group A (P<0.05). It was observed that a significantly higher number of patients in epidural group required rescue analgesia and at higher dosages (p<0.05).Conclusion:TAP block has almost no complications, keeps the patient hemodynamically stable and offers a good early postoperative analgesia (till 24 hours) when compared to a more accepted modality like epidural analgesia.
Comparison of Intra-Articular Bupivacaine and Neostigmine with Bupivacaine and Fentanyl for Post-Operative Analgesia in Arthroscopic Knee Surgeries
Authors: Prachi Singh  , Sandeep Kumar Yadav  , Sumit Kumar  , Manoj Tripathi  , Deepak Malviya
Published: October 2020

Background: The post-operative pain in knee arthroscopy procedures can be attributed to irritation of free nerve endings of synovial tissue, anterior fat pad, and joint capsule during surgical excision and resection1.  In the recent years, new interest has focused on the cholinergic system that modulates pain perception and transmission. The present study is designed to compare the efficacy of intra- articular Bupivacaine and Neostigmine with Bupivacaine and Fentanyl for pain relief following arthroscopic surgeries.Subjects and Methods:Prospective, Interventional, Randomised study was conducted over 90 patients scheduled for elective arthroscopic knee surgery, who were randomly allocated into three equal groups of 30 patients each. Group I-Bupivacaine with Neostigmine, Group II-Bupivacaine with Fentanyl and Group III-Bupivacaine alone. The study drug combinations were administered Intra-articularly at the conclusion of surgery. Hemodynamic variables and Pain were observed immediately after completion of surgery (Baseline) and thereafter at fixed intervals. The duration of effective analgesia was measured from the “baseline” until the first use of rescue analgesic. The number of rescue analgesics given in 24 hours were also recorded. The statistical analysis was done using SPSS (Statistical Package for Social Sciences) Version 15.0 statistical Analysis Software.Results:Requirement for first analgesia was significantly earlier in Group III (146.00±71.66 minutes) as compared to Group II (236.00±111.34 minutes) and Group I (648.00±228.55 minutes). Majority of patients of Group I (90.0%) required rescue analgesia only once while in was twice in Group II (90.00%) and thrice in Group III (86.67%).Conclusion:Intra-articular administration of Neostigmine in combination with Bupivacaine provided a better post-operative analgesic effect with a lower incidence of side effects and lesser requirement of rescue analgesia.
A Comparative Study of Dexmedetomidine and Fentanyl on Airway Reflexes and Hemodynamic Responses to Tracheal Extubation in Nasal Surgeries
Authors: Saurabh Misra  , Rajeev Tiwari  , Shivendu Shekhar Ojha
Published: October 2020

Background: Extubation at light levels of anesthesia or sedation can stimulate reflex responses via tracheal and laryngeal irritation. The present study was conducted to compare dexmedetomidine and fentanyl on airway reflexes and hemodynamic responses to tracheal extubation in nasal surgeries.Subjects and Methods:The present study was conducted on 60 patients of ASA grade I and Grade II of both genders. Patients were divided into 2 groups of 30 each. Group I were dexmedetomidine 0.5 μg/kg in 100 mL of isotonic saline and group II patients received fentanyl 1 μg/kg in 100 mL of isotonic saline intravenously. Parameters such as duration of surgery and duration of anesthesia (minutes) were recorded. Extubation time, awakening time and orientation time was recorded.Results:The ASA grade I was seen in 20 in group I and 14 in group II, ASA grade II was seen in 10 in group I and 16 I group II. Group I comprised of 14 males and 16 females, group II had 17 males and 13 females. Mean duration of surgery in group I was 172.4 minutes and in group II was 174.6 minutes in group II. Mean duration of anesthesia was 194.2 minutes in group I and 198.6 minutes in group II. The difference was non- significant (P> 0.05). The mean extubation time in group I was 7.2 minutes and 5.6 minutes in group II, awakening time was 10.2 minutes in group I and 10.8 minutes in group II and orientation time was 14.3 minutes in group I and 15.2 minutes in group II.Conclusion:Authors found that dexmedetomidine 0.5 μg/kg IV, administered before extubation, was more effective in attenuating airway reflex responses to tracheal extubation as compared with fentanyl 1 μg/kg IV.
Comparison of 0.5% Levobupivacaine Versus 0.5% Isobaric Levobupivacaine with 3mcg Dexmedetomidine in Spinal Anaesthesia- A Comparative Study
Authors: Rajeev Tiwari  , Saurabh Misra  , Shivendu Shekhar Ojha
Published: October 2020

Background: Effective postoperative pain control is an essential component of the care of the surgical patient. The present study was conducted to compare levobupivacaine 0.5% versus isobaric levobupivacaine 0.5% with 3mcg dexmedetomidine in spinal anaesthesia.Subjects and Methods:The present study was conducted on 80 patients of ASA Grade-I and Grade-II of both genders. They were divided into 2 groups of 40 each. Group I were those who received 3 ml of 0.5% isobaric levobupivacaine with 0.3 ml of normal saline and group II patients received 3 ml of 0.5% isobaric levobupivacaine with  3µg of dexmedetomidine. Parameters such as onset of sensory blockade at T10 dermatome and onset of motor blockade motor blockade, maximum level of sensory and motor blockade attained and the time taken for the same, total duration of sensory blockade and motor blockade were recorded.Results:Group I, ASA grade I was seen in 25 and II in 15, in group II, ASA grade I was seen in 22 and II in 18 patients. Group I comprised of 18 males and 22 females, group II had 20 males and 20 females. Mean duration of surgery in group I was 58.2 minutes in group I and 56.4 minutes in group II. Mean heart rate was 82.3 per minute in group I and 81.6 per minute in group II. The mean time required to obtained sensory block in group I was 10.4 minutes and in group II was 7.4 minutes. The mean time for motor block in group I was 8.2 minutes and in group II was 5.4 minutes. The mean time required to obtain motor block in group I was 16.5 minutes and in group II was 16.1 minutes.Conclusion:Authors found that addition of intrathecal dexmedetomidine to 0.5% isobaric levobupivacaine shortens sensory and motor block onset time and prolongs block duration.
Systematic Approach to Evaluate the Potential of Dexmedetomidine in Attenuating the Pressor Response and the Quality of Intubation during Laryngoscopy
Authors: Neha Varhney  , Tapan Agrawal  , Roma Sharma  , Nangia Sanjeev Kumar , Mangwana Pramod
Published: October 2020

Background: Onset of hemodynamic changes is often associated with procedures such as laryngoscopy and tracheal intubation. This poses an increased risk of fatality in high-risk patients with diseases such as cardiovascular diseases. Several attempts utilizing singular parameters have been used to combat this clinical manifestation. In this study, we have used a holistic approach, in combination with the pre-recommended parameters, to attenuate the pressor responses during the procedure. Subjects and Methods: Sixty adult patients were randomized into two groups, receiving two different doses of dexmedetomidine (0.5 µg or 1 µg) per kilogram of the bodyweight. In addition, the quality of the intubation was also assessed using the scoring system adapted from McNeil et al., 2000. Longitudinal monitoring of various physiological parameters such as systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR) and O2 saturation (SpO2) was performed at four different time points during the procedure. Results: Our results revealed that dexmedetomidine administration results in a transient decrease in these parameters in the patients from both the groups, with more prominent effects in the Group I patients, received 1 µg/kg of dexmedetomidine. Moreover, at time-point T3 (60 sec after intubation), a transient increase was observed in almost all the tested parameters. The assessment of the intubating conditions revealed no significant differences among the groups. Conclusion: A higher dosage of dexmedetomidine (1 µg/kg) showed better management of hemodynamic responses during laryngoscopy and intubation.
Isolated Oropharyngeal Muscle Spasm in a Young Child post Extubation: A Case Report
Authors: Singla Deepak , Abullais Raheeq Gowda  , Krishna Vamshi , Tandon Shipra
Published: October 2020

Agitation during emergence from anaesthesia is a  documented phenomenon reported in children especially during immediate postoperative period; also Voluntary breath holding1and laryngospasm. This can lead to complications like postoperative distress, excessive crying, and anxiety. Here we report a case of postoperative respiratory distress in an 8 years old child of cerebral palsy developing  severe oropharyngial spasm in the immediate postoperative period. Patient had no preoperative predisposing factors or intaraoperative events that could cause bronchospasm, laryngospasm, inadequate neuromuscular reversal or voluntary holding in the immediate postoperative period. Timely  recognition and management of the condition prevented catastrophic complications like severe desaturation, hypoxic injury, negative pressure pulmonary edema or cardiac arrest.
A Comparative Study of Intravenous Clonidine and Dexmedetomidine on Characteristics of Bupivacaine Spinal Anesthesia
Authors: Bamel Shailender , Kad Nandita , Vinit  , Popli Shilpa , Chahal Devender
Published: October 2020

Background: Spinal anesthesia with bupivacaine is administered routinely for lower abdominal and lower limb surgeries. The ensuing nerve block is sufficient to ensure patient’s well being, while motor block facilitates the surgeon’s work. In patients receiving spinal anaesthesia, with local anesthetic agents like bupivacaine, the addition of another drug as adjuvant prolongs the analgesia. The present study is designed to study the effect of dexmedetomidine (D) and Clonidine (C) on the duration of motor and sensory block as well as postoperative analgesia by intrathecal bupivacaine in patients undergoing lower limb orthopedic surgery. Subjects and Methods: This study was carried out on 90 patients in the age group of 18 to 50 years, belonging to the American Society of Anesthesiologists(ASA) physical status I and II presenting for lower limb orthopedic surgery were included in the study. Patients were divided randomly into 3 groups. Group D received 1μg kg-1of dexmedetomidine, group C received 2 μg kg-1 of clonidine and group NS Control group received an equivalent amount of normal saline. Results: From the current study we observed that single dose of 1 μg kg-1 dexmedetomidine over 20 minutes started 20 minutes after spinal block and a single dose of 2 μg kg-1 Clonidine resulted in a significant prolongation of time to two-segment regression, postoperative analgesia,  sensory block and motor block with the maintenance of hemodynamic parameters. Intravenous dexmedetomidine was more effective than Clonidine at the prolongation of time to two-segment regression, postoperative analgesia, sensory block and motor block of spinal anesthesia with 0.5% hyperbaric bupivacaine. Conclusion:  Dexmedetomidine (1μg kg-1) in comparison to Clonidine (2 μg kg-1) and placebo is far more effective in the motor blockade, sensory blockade and duration of postoperative analgesia.
The Study Isobaric 0.75% Ropivacaine 3.5ml (26.25mg) Intrathecally for Lower Limb Surgeries to Evaluate Perioperative Hemodynamic Stability
Authors: Thakur Kunwar Singh , Sharma Utsav , Goyal Preeti , Choudhary Bhanu
Published: October 2020

Background: The purpose of the study is Isobaric 0.75% Ropivacaine 3.5ml (26.25mg) Intrathecally for Lower Limb Surgeries to Evaluate Perioperative Hemodynamic. Fifty patients admitted to our hospital undergoing lower extremity surgeries under spinal anesthesia. Subjects and Methods: Pre-anesthetic assessment was done prior to the day of surgery which included past history of chronic illness and medication, drug therapy (especially corticosteroids, anti hypertensive, anti coagulant, anti diabetic, anti convulsant medications), drug sensitivity and past anesthetic experience along with routine investigations including, haemoglobin, random blood sugar, serum urea, serum creatinine, and serum electrolytes, chest X-ray, ECG. Fifty patients admitted to our hospital undergoing lower extremity surgeries under spinal anesthesia included in the study. Results: Patients in the age group 18 – 60 years were selected including 45 males and 5 females. Thirty-Nine patients had an ASA grade I and 11 patients had an ASA grade II. The duration of surgeries ranged from 45 to 270 minutes & there were no significant changes in the pulse rate perioperatively. Conclusion: A study was conducted in 50 patients belonging to ASA grade I and II posted for lower limb surgeries. They received 3.5ml of 0.75% isobaric Ropivacaine in L2-3 interspace. All patients were preloaded with 1000 ml of ringer lactate. Following institution of subarachoid block sensory characteristics such as onset of sensory block, maximum level achieved, duration of sensory block and request for first dose of rescue analgesics were studied. We found the requirement for postoperative analgesics was 218.97 minutes. Hemodynamic parameters were stable in most of the patients. Postoperative side effects included shivering, nausea. Thus we conclude that isobaric 0.75% ropivacaine 26.25 mg, 3.5 ml when administered intrathecally in L2-3 interspace provides an adequate sensory block for lower limb surgeries, which makes it a good choice for lower limb surgeries with benefits of early ambulation.
Comparative Study of Caudal Bupivacaine and Bupivacaine with Clonidine in Infra Umbilical Surgeries in Children
Authors: Swetha J Gouda  , P.V. Margi
Published: October 2020

Background: Caudal epidural analgesia is one of the most commonly performed regional blocks in paediatric anaesthesia for intra and post-operative analgesia. Addition of opioids like morphine, fentanyl is associated with side effects like respiratory depression, urinary retention, etc. Clonidine, an α2 agonist is known for its analgesic effects with lesser side effects. Hence, this study was conducted to know the efficacy and safety of addition of clonidine to bupivacaine in a single shot caudal block in children.Subjects and Methods:This study was conducted among 60 children in the age group of 5 – 10 years coming for various elective infraumbilical surgical procedures. They were divided into two groups of 30 each. Group A received caudal 0.25% bupivacaine (1ml/kg) and group B received caudal 0.25% bupivacaine (1ml/kg) with clonidine (1.5µg/kg). The various parameters studied were hemodynamic changes, duration of analgesia and incidence of side effects.Results:The groups were similar in age, sex and weight. The hemodynamic parameters like heart rate, blood pressure, respiratory rate were also similar between the two groups after administering caudal block. The mean duration of analgesia in group B (433.5 ± 60 min) was significantly longer (p< 0.05) than group A (250.33 ±41 min). Conclusion:This study showed that the addition of clonidine in the dose of 1.5µg/kg to 0.25% bupivacaine (1ml/kg) improved the analgesic duration and efficacy after a single shot caudal block with minimal side effects in children.
A Prospective Study of Single Breath Vital Capacity Inhalation Induction with High Concentration of Sevoflurane (Sbvc-Hc) for LMA Insertion in Adults for Short Surgical Cases
Authors: Kailash Prabhudev  , Naveen Kumar K
Published: October 2020

Background: Sevoflurane is a new volatile anesthetic agent with rapid induction and recovery. A randomized study was carried to access conditions for LMA insertion using Sevoflurane in 25 ASA I & II patients undergoing short duration surgeries.Subjects and Methods:This prospective study was conducted at Department of Anesthesiology and Critical Care, SVS Medical College and Hospital, Mahabubnagar, Telangana, India. After obtaining the institutional ethics committee and written informed consent from the patients, 25 subjects of either sex were included in this study. Age of the subjects was 18 to 60 years. Patients received injection Fentanyl 1 – 2mcg/kg prior to induction. All patients were pre-oxygenated for 3 min with 100% oxygen using a fresh gas flow of 81/min. All patients received inhalational induction with 8% Sevoflurane and O2 flow at 8 L/min with single vital capacity breathe technique. Loss of verbal contact was considered as the desired endpoint for induction, which was assessed by the response to calling out the patient’s name. Then the time of loss of eyelash reflex and jaw relaxation was assessed by anesthesiologist. After adequate jaw relaxation, LMA insertion was attempted.Results:The mean loss of verbal contact was 65.40±9.67second, while the mean for time for loss of eyelash reflex and jaw relaxation were found to be 81.20±9.39 seconds and 103.20 ±12.07 seconds respectively. The mean time for LMA insertion was 122.00±15.61 and the mean attempts for successful LMA insertion was 1.12±0.33. LMA insertion was easy in 23 cases as against difficult in 2 cases. In 2 cases transient cough and biting were recorded. LMA insertion was excellent and satisfactory in 88.0 and 12 percent. However, the mean heart rate at 5 minute after induction showed a significant fall at 5 minutes after induction. The mean values of SBP, DBP and MAP did not differ significantly at pre and induction. However, a significant decrease in SBP was noticed at 1, 2 and at 5 minutes.Conclusion:Sevoflurane is an smooth inhalation anesthesia with rapid onset with adequate jaw relaxation for insertion of LMA in Adults for short duration surgeries. Sevoflurane has got good hemodynamic profile with lesser complications owing to choice of inhalation agent for insertion of LMA.
Assessment of Transversus Abdominis Plane Block in Abdominal Surgery by Total Requirement of Diclofenac as a Post-Operative Analgesia Drug
Authors: Jigna R Shah  , Apoorva Moghe  , Maulik Humbal
Published: October 2020

Background: Amongst various techniques of TAP block, landmark technique via the triangle of Petit seems to hold considerable promise for patients undergoing surgical procedures involving abdominal wall incisions. The aim of this study is to evaluate transversus abdominis plane [TAP] block in abdominal surgery by total requirement of diclofenac as postoperative analgesia drug.Subjects and Methods:Present study was carried out at Department of Anesthesia, GMERS medical college, Sola, Ahmedabad, Gujarat, India from May 2014 to May 2015. According to formula based nomogram, sample size for proposed study would be: Study group (n=30): patient received TAP block with injection bupivacaine (0.25%) 20 ml. Control group (n=30): patient not received TAP block and was given injection diclofenac on demand for post-operative analgesia as per institute protocol for routine surgery. Sensory block was assessed by sterile pin prick method in the midaxillary line on both sides of chest. Postoperative pain was assessed by using the visual analogue scale.Results:Majority of the patient were in age group of 30 to 50 in both group. VAS score was significantly higher in control group as compared to the study group at all the time. First dose of rescue analgesia required in study group was at 669.66± 346 min and in control group was 220.33 ± 139.24 min which was statistically significant. Diclofenac requirement in study group was one time in 22 patient and two time in 8 patient which was significantly less as compare to control group in which diclofenac requirement was one time in 2 patient and two time in 5 patient and three time in 23 patient in 24 hour.Conclusion:TAP block is a promising new technique for postoperative pain management in surgery involving the anterior abdominal wall as a part of multimodal analgesia. Further studies are warranted to support this finding before establishing it in routine clinical practice in different type of surgical procedures.
CT Scan Evaluation of Prevalence of Paradoxical Middle Turbinate In Adult Population of Bihar
Authors: Raag Reeti  , Md Jawed Akhtar  , Avanish Kumar  , Binod Kumar  , Rajiv Ranjan Sinha
Published: October 2020

Introduction: Middle turbinate overlying the middle meatus is the most important anatomic area in the lateral wall of the nose. It is a thinsheet of bone which curves in different planes very similar to a dried leaf. Paradoxical Middle Turbinate (PMT) is the abnormal curvatureof middle turbinate, where the convex surface faces laterally instead of its usual medial curvature and may block the drainage pathway ofmiddle meatus. The present study aimed at observing the prevalence of the paradoxical middle turbinate in the adult population of Bihar. Subjects and Methods: This was a retrospective study being conducted on 150 patients who presented to the Department of Radiodiagnosis. Their CT scans were analysed for the presence of paradoxical middle turbinate. The results were analysed as percentage and ‘p’ value was calculated using Fischer’s Exact Test. Results: Prevalence of Paradoxical Middle Turbinate was observed in 28 cases i.e. 18.6% cases; 16 in males and 12 in females. ‘p’ value was 0.677 on applying Fisher’s Exact test. Conclusion: Anatomical variations of the paranasal sinus region like paradoxical middle turbinate are quite common cause of diseases involving paranasal sinuses and they must be searched for by the surgeons planning any endoscopic sinus surgery. This study attempted to provide the prevalence of the paradoxical middle turbinate which will definitely help the FESS surgery and its outcomes.
Morphometry of the Human Placenta in Mining and Non-Mining Areas in Northwestern Tanzania; A Comparative Cross-Sectional Study
Authors: Mary Ndibalema  , Erisa Mwaka  , Peter Rambau  , Ian Munabi  , William Buwembo
Published: October 2020

Introduction: Placenta morphometry varies with increased heavy metal concentrations among other factors. There is limited knowledge on the effect of perceived heavy metal exposure due to mining activities on placenta morphometry specific to the Tanzanian population. The study thus aimed to determine the morphometric characteristics of the human placenta and the association between placental weight with maternal factors in mining and non-mining areas in Northwestern Tanzania. Subjects and Methods: This was a comparative cross-sectional study conducted in Mwanza and Geita regions of Northwestern Tanzania representing the mining and non-mining areas, respectively. Included in the study were placentas from 490 mothers, residing in the respective areas throughout pregnancy. Comparison of the placenta morphometric variables between the two groups was made using the independent sample t-test, and association between the maternal factors and placenta weight was done using multi-level linear analysis. Results: The mean placenta weight in the non-mining and mining areas was 465.9±101.2 g and 443.6±82.7g, and the mean thickness was 1.52±0.32cm and 1.61±0.38cm respectively. The mean diameter in the non-mining and mining areas was 19.0±1.9cm, the mean cotyledon number was 20±5 and 19±4, and the mean cord length was 49.0±12.7cm and 50.1 ±10.4cm respectively. With the exception of cord length, the differences in the morphometric parameters in the non-mining and mining areas were significant p<0.5.  Increase in maternal weight on booking and maternal age were associated with corresponding increase in placenta weight. Conclusion: The findings of this study seem to suggest that heavy metal exposure due to mining activities does affect placenta growth.
Microvasculature of Anterior Cruciate Ligament by Immunohistochemistry using VE-Cadherin
Authors: Jahira Banu T  , Yogesh Ashok Sontakke
Published: October 2020

Introduction: The anterior cruciate ligament (ACL) is one of the knee stabilizer and acts to prevent excessive anterior mobility as well as rotational movement. The ACL is extending from the lateral femoral condyle to the anterior intercondylar area of tibia. During excessive movement or abnormal mobility affecting the knee joint, the ACL is under tension and prone for injury. The injured ACL was managed by surgery as it was an option for treatment owing to its poor vascularity. The distribution of the blood vessels within the ACL was not clear and only few studies reported in the past. The present study focused on distribution of blood vessels in the ACL. Subjects and Methods: The ACL microvasculature was assessed using 48 cadaveric ACL tissues using immunohistochemistry. The antibody against the transmembrane protein VE-Cadherin was targeted to study the blood vessels. Results: It was observed that the middle part of the ACL was less vascular compared with the peripheral parts of ACL. Conclusion: The knowledge of the ACL vasculature may help in planning surgeries of ACL to reduce postoperative complications.