bluuebunny/crossref_metadata_2025_split huggingface dataset:
Intimate Adhesion Is Essential for the Pathogen-Specific Inflammatory and Immune Responses in the Gut of Mice Infected with Citrobacter rodentium
Authors: Takahashi Keita , Sugiyama Tsuyoshi , Tokunoh Nagisa , Tsurumi Shun , Koshizuka Tetsuo , Inoue Naoki 
Published: October 2021

Abstract
Citrobacter rodentium is a murine pathogenic bacterium that adheres to intestinal epithelial cells, resulting in loss of microvilli and pedestal formation, and alters multiple cellular processes, including actin dynamics. Translocated intimin receptor (Tir), one of its virulence factors, functions as receptor for intimin, a bacterial adhesin, thereby mediating bacterial adhesion to epithelial cells. Although robust immune responses are induced to eliminate pathogenic bacteria in the host, they are suppressed against harmless commensal bacteria. The mechanism(s) underlying such a differentiation remains unclear. This study sought to determine the roles of intimate adhesion in the induction of specific immune responses upon C. rodentium infection. To this end, microbiota-depleted mice were infected with the Tir-F strain expressing full-length Tir or mutant strains expressing the C-terminal truncated Tir that is defective in intimin binding and host cell actin polymerization. There were no differences in the colonization kinetics and Abs responses against C. rodentium LPS among the strains, whereas Abs against the virulence factors were only produced on Tir-F infection. Although there were no differences in the virulence factors mRNA expression levels, colonic hyperplasia, and bacterial translocation to the systemic organs irrespective of the strain, adhesion to colonic epithelial cells was reduced in the mutant strain–infected mice. Furthermore, transcriptomic analysis indicated that robust inflammatory and immune responses were only induced in the Tir-F–infected group and were suppressed in the mutant-infected groups. Taken together, these findings suggest that Tir-mediated intimate adhesion induces inflammatory and immune responses, resulting in the induction of virulence factor–specific Abs.
Type I IFN–Driven Immune Cell Dysregulation in Rat Autoimmune Diabetes
Authors: Qaisar Natasha , Arowosegbe Adediwura , Derr Alan G , Kucukural Alper , Satish Basanthi , Racicot Riccardo , Guo Zhiru , Trombly Melanie I , Wang Jennifer P 
Published: October 2021

Abstract
Type 1 diabetes is a chronic autoimmune disease, characterized by the immune-mediated destruction of insulin-producing β cells of pancreatic islets. Essential components of the innate immune antiviral response, including type I IFN and IFN receptor (IFNAR)–mediated signaling pathways, likely contribute to human type 1 diabetes susceptibility. We previously showed that LEW.1WR1 Ifnar1−/− rats have a significant reduction in diabetes frequency following Kilham rat virus (KRV) infection. To delineate the impact of IFNAR loss on immune cell populations in KRV-induced diabetes, we performed flow cytometric analysis in spleens from LEW.1WR1 wild-type (WT) and Ifnar1−/− rats after viral infection but before the onset of insulitis and diabetes. We found a relative decrease in CD8+ T cells and NK cells in KRV-infected LEW.1WR1 Ifnar1−/− rats compared with KRV-infected WT rats; splenic regulatory T cells were diminished in WT but not Ifnar1−/− rats. In contrast, splenic neutrophils were increased in KRV-infected Ifnar1−/− rats compared with KRV-infected WT rats. Transcriptional analysis of splenic cells from KRV-infected rats confirmed a reduction in IFN-stimulated genes in Ifnar1−/− compared with WT rats and revealed an increase in transcripts related to neutrophil chemotaxis and MHC class II. Single-cell RNA sequencing confirmed that MHC class II transcripts are increased in monocytes and macrophages and that numerous types of splenic cells harbor KRV. Collectively, these findings identify dynamic shifts in innate and adaptive immune cells following IFNAR disruption in a rat model of autoimmune diabetes, providing insights toward the role of type I IFNs in autoimmunity.
Absence of Fourth Slip of Flexor Digitorum Brevis in Nepalese Population
Authors: Kunwar Ajaya Jang , Sharma Krishna Deo , Maskey Dhiraj 
Published: October 2021

Background:
Flexor digitorum brevis (FDB), the most superficial muscle among the muscles of the sole, comprises four tendons running to the lateral four digits. Each tendon splits into two, providing the gap for the flexor digitorum longus to pass through and are inserted into the second to fifth middle phalanges. Several variations of FDB have been reported earlier around the world but only one study showing the absence of fourth tendon has been reported so far in Nepal that too has conflicting outcome compared to the present study.

Aims and Objectives:
The purpose of this study was to document the absence of the fourth tendon of FDB to the little toe in the Nepalese community, as well as to highlight the fact that there are variances within the Nepalese setting.

Materials and Methods:
The present study involved an examination of 30 cadavers [male], enabling us in a total of 60 intact feet collected over a 2-year period.

Results:
Out of 60 feet in toto, we found only two (3.33%) of those lacked the fourth tendon of Flexor Digitorum Brevis to the little toe, which was notably lesser than previously reported 100% absence in Nepalese population.

Conclusion:
The disparity in such data could be attributable to the Nepalese community's diversity, which could indicate the presence of ethnic significance. The probable difference due to ethnic diversity in the Nepalese population should be taken into account for the medical procedure
Role of microRNA as a marker in detection of diabetic nephropathy in type-2 diabetic Egyptian patients
Authors: Khamis Said S.A. , Yassin Yassin S. , Tawfeek Ahmed R. , Kasem Heba El Sayed , Ibrahim Sally M. , Ghonamy Elsayed 
Published: October 2021

Background
Diabetic kidney disease (DKD) represents the major cause of chronic kidney disease. New biomarkers for early diagnosis of DKD are of interest. Our objective is to elucidate the significance of microRNA-192 (miRNA-192) and neutrophil gelatinase-associated lipocalin (NGAL) as early predictors of diabetic nephropathy in comparison with albuminuria in type-2 diabetic patients.

Patients and methods
A number of 45 persons in three groups, group 1: 15 healthy persons with no diabetes mellitus (DM). Group 2: 15 patients diagnosed with type-2 diabetes mellitus (T2DM) without albuminuria. Group 3: 15 patients diagnosed with T2DM with albuminuria. Estimation of serum miRNA, NGAL, urine albumin/creatinine ratio, serum creatinine, urea, fasting blood glucose, 2-h postprandial blood glucose, and glycated hemoglobin.

Results
The study showed that the serum miRNA-192 and NGAL levels were significantly higher in patients diagnosed with T2DM with albuminuria in comparison with patients diagnosed with T2DM without albuminuria. There was a significant positive correlation between miRNA-192 and NGAL and urine albumin/creatinine ratio.

Conclusion
Serum NGAL and miRNA-192 may serve as tools to follow up the development and progression of DKD.
Comparison between caudal epidural and ultrasound-guided ilioinguinal-iliohypogastric block with bupivacaine and dexmedetomidine for postoperative analgesia following pediatric inguinal hernia surgeries: A prospective randomized, double-blind study
Authors: Varsha R , Desai Sameer N. , Mudakanagoudar Mahantesh S. , Annigeri Venkatesh M. 
Published: October 2021

Background and Aims:Caudal epidural and ultrasound-guided ilioinguinal, iliohypogastric nerve (IL/IH) blocks are commonly used regional anesthesia techniques for postoperative analgesia in pediatric inguinal surgeries. Dexmedetomidine as an adjuvant has been proven to prolong the duration of both neuraxial and peripheral nerve blocks. We compared the duration of analgesia provided by local anesthetic (LA) and dexmedetomidine for caudal and IL/IH block for pediatric inguinal surgeries.Material and Methods:Forty-six children undergoing inguinal hernia repair were selected for this randomized double-blind study. After general anesthesia, children received either 0.75 mL.kg−1of 0.25% bupivacaine with 1 mcg.kg−1of dexmedetomidine in caudal epidural or 0.25 mL.kg−1of 0.25% bupivacaine with 1 mcg.kg−1of dexmedetomidine in IL/IH block. The pain was assessed up to 24 h postoperatively using face, legs, activity, cry, consolability (FLACC) score. For FLACC ≥4, rescue analgesia was provided using 1 μg/kg of intravenous fentanyl, up to 2 h postoperatively and 10 mg/kg of oral ibuprofen between 2 and 24 postoperative hours. The time for first rescue analgesia was taken as the duration of analgesia.Results:There were no significant differences in the pain scores or analgesic utilization between the groups. The duration of analgesia of caudal and IL/IH blocks was similar (720.3 ± 430.1 min and 808.4 ± 453.1 min, respectively). The time taken for the performance of block was significantly higher for caudal compared to IL/IH (547 ± 93 vs. 317 ± 179 s;P< 0.001).Conclusion:Both caudal epidural and USG-IL/IH block with dexmedetomidine as additive provide the comparable duration of postoperative analgesia with no significant side effects.
Efficacy of dexmedetomidine as an adjuvant in femoral nerve block for post-op pain relief in hip surgery: A prospective randomized double-blind controlled study
Authors: Goel Chetna P. , Desai Sameer 
Published: October 2021

Background and Aims:To determine whether the addition of dexmedetomidine either in peripheral block or via systemic route leads to prolongation of the duration of analgesia is inconclusive. The present study aimed to assess the duration of postoperative analgesia with dexmedetomidine used as an additive with bupivacaine for ultrasound-guided femoral nerve block (FNB) and to compare it with intramuscular dexmedetomidine along with FNB.Material and Methods:A prospective, double-blind randomized clinical trial involving adult patients undergoing elective hip surgery, performed under subarachnoid block. When sensory block receded to T12 after the surgery, FNB was given for postoperative analgesia. Patients were randomized into three groups; Group A received FNB with 40 mL 0.25% bupivacaine and 0.5 mL saline as IM injection, Group B received FNB with 39.5 mL of 0.25% bupivacaine + 0.5 mL (50 mcg) of dexmedetomidine in the affected limb and 0.5 mL saline IM injection, and Group C received FNB with 40 mL of 0.25% bupivacaine and 0.5 mL (50 mcg) of dexmedetomidine as IM injection. Postoperative pain was assessed and for pain with VAS score >3, intravenous tramadol was given as rescue analgesia. Chi-square test for categorical variables and one-way ANOVA for continuous variables.Results:The mean duration of analgesia in groups A, B, and C was 671, 676, and 490 min, respectively which was not significant. A 24 h analgesic requirement was also not different between the groups.Conclusion:The use of dexmedetomidine perineurally or systemically did not prolong the duration of analgesia as compared to bupivacaine alone for femoral nerve block.
Optimum time of LMA ProSeal removal in adult patients undergoing isoflurane anesthesia: A randomized controlled trial
Authors: Maitra Souvik , Baidya Dalim K. , Goswami Devalina , Muthiah Thilaka , Ramachandran Rashmi , Subramanian Rajkumar 
Published: October 2021

Background and Aims:Optimum timing of laryngeal mask airway (LMA) removal after general anesthesia with isoflurane is debatable. The objective was to investigate the potential benefits of removing LMA ProSeal at ≤0.4 Minimum alveolar concentration (MAC) isoflurane over awake and “deep plane” extubation after short duration laparoscopic gynecological surgery.Material and Methods:In this prospective randomized trial 90 adult female patients undergoing elective laparoscopic surgery under general anesthesia using LMA ProSeal™ as airway device were included. At the end of surgery, LMA ProSeal™ was removed when the patient was awake, could open mouth following verbal command (Group A); at MAC ≤0.4 (Group B); or at MAC of 0.6 (Group C). Adverse airway events like nausea, vomiting, airway obstruction, coughing, bucking, laryngospasm were noted. Statistical analyses were done by SPSS statistical software (IBM SPSS Statistics for Mac OS X, Version 21.0. IBM Corp, Armonk, NY).Results:Baseline demographic characteristics were comparable in all three groups. Coughing or bucking at the time of LMA removal was higher in group A (P= 0.004). Snoring and airway obstruction after LMA removal was significantly higher in group C compared to group A and group B (P= 0.002 andP= 0.011, respectively). There was significant change in mean arterial pressure and heart rate between before and after LMA removal on group A (P= 0.008 andP< 0.001, respectively) but not in other groups.Conclusion:MAC ≤0.4 can be considered optimum depth of anesthesia for removal of LMA Proseal in adult patients undergoing isoflurane anesthesia.
A comparison of preincisional and postincisional ultrasound guided transversus abdominis plane block
Authors: Ambooken Emy , Chirayath Joe John , Raghavan P. 
Published: October 2021

Background and Aims:Transversus abdominis plane blocks are part of the multimodal analgesia used for lower abdominal surgeries. Our aim of this study was to compare the analgesic efficacy of preincisional and postincisional TAP blocks in patients undergoing total abdominal hysterectomies.Material and Methods:54 American Society of Anesthesiologists physical status I and II patients aged between 30 and 60 years who underwent a total abdominal hysterectomy under spinal anesthesia in our hospital were chosen for the study. Alternate patients satisfying the inclusion criteria were either given a preincisional or postincisional transversus abdominis plane block bilaterally. Postoperatively, the numeric pain intensity scale was observed, along with nausea, vomiting, and sedation scores.Results:Pain scores were significantly lower (P< 0.05) in the preincisional TAP block group from the 2ndpostoperative hour onwards till 12 h, and thereafter it was comparable between both the groups. The total morphine requirement was significantly less in the preincisional TAP group (P-value 0.001). Also, the mean time to the first request for morphine was significantly longer in patients belonging to the preincisional TAP block group (P-value of 0.002). There were no significant differences in the sedation scores postoperatively, except at the 4thhour, where it was significantly higher (P-value of 0.024) in the postincisional TAP group. Post operative nausea and vomiting was significantly higher and so the dose of the antiemetic used was also observed to be more in the postincisional TAP block group.Conclusion:Preincisional TAP blocks are more effective than postincisional ones with better analgesia and lesser side effects, for total abdominal hysterectomies.
Effect of dexmedetomidine on characteristics of ultrasound-guided supraclavicular brachial plexus block with levobupivacaine-A prospective double-blind randomized controlled trial
Authors: Reddy Bhumireddy Suneel , Gaude Yogesh K. , Vaidya Shriram , Kini Gurudas K. , Budania Lokvendra S. , Eeshwar M. V. 
Published: October 2021

Background and Aims:Levobupivacaine, a less cardiotoxic s-isomer of bupivacaine, is proved to be similar to bupivacaine, hence, proposed as a safer alternative for nerve blocks. We aimed to evaluate the effect of perineural and intravenous dexmedetomidine on characteristics of ultrasound-guided supraclavicular brachial plexus block (BPB) performed with levobupivacaine. The aim of this study is to evaluate the effect of perineural and intravenous dexmedetomidine on characteristics of ultrasound-guided supraclavicular BPB performed with levobupivacaine.Material and Methods:A prospective, randomized double-blind control trial done on 120 patients undergoing elective upper limb surgical procedures under supraclavicular BPB. The enrolled patients were allocated to one of the three groups: Group L - 0.5% levobupivacaine +0.9% normal saline (NS) IV infusion; Group LDI - 0.5% levobupivacaine + dexmedetomidine (1 mcg/kg) in NS IV infusion; and Group LDP - 0.5% levobupivacaine +1 mcg/kg of dexmedetomidine perineural + NS IV infusion. The onset and duration of sensory and motor blockade were recorded in minutes. One-way ANOVA was used to observe any differences between the groups, and post hoc comparisons were conducted after Bonferroni correction for multiple comparisons.Results:The onset of sensory and motor blockade in Group LDP was significantly shorter than Group L and Group LDI. The duration of sensory blockade in Group LDP was significantly longer than Group LDI and Group L. The duration of motor blockade in Group LDP was prolonged compared to Group LDI and Group L.Conclusions:When dexmedetomidine is added as adjunct to levobupivacaine in supraclavicular BPB, onset of sensory and motor blockade is faster in perineural group, whereas duration of sensory and motor blockade and duration of analgesia are more prolonged when used perineurally than intravenously.
What is the minimum effective anesthetic volume (MEAV90) of 0.2% ropivacaine required for ultrasound-guided popliteal-sciatic nerve block?
Authors: David Sandeep N. , Varghese Davies C. , Valiaveedan Sebastian 
Published: October 2021

Background and Aims:Popliteal-Sciatic nerve block under Ultrasound Guidance (USG) using a local anesthetic agent like Ropivacaine is an established technique for providing analgesia and muscle relaxation for lower limb surgeries with minimal untoward events. Establishing the minimal volume of 0.2% ropivacaine required to provide intraoperative and postoperative analgesia will further reduce the drug requirements and adverse effects toward the patient.Material and Methods:This randomized prospective observational blinded study was done in a tertiary care referral hospital in South India over 9 months from August 2017 till April 2018. The block was performed on all recruited patients under ultrasound guidance with a starting volume of 16 ml 0.2% ropivacaine. Duration of time for loss of pin-prick sensation around the sole of the foot (tibial nerve) and the lateral malleolus (common peroneal nerve) was noted. If successful, the volume of the drug for subsequent patients was randomized by lottery method to either be kept the same or reduced. If the block failed, the subsequent patient recruited would have an increased volume of drug injected.Results:By Probit regression analysis using the biased coin up-and-down method we found that 9.3 ml (MEAV90) of 0.2% ropivacaine was sufficient for providing adequate analgesia. Factors such as patient age or weight had no role in efficacy of the block. There were no adverse effects such as allergy to the drug or systemic toxicity noted in the studied patients.Conclusion:9.3 ml of 0.2% ropivacaine is sufficient to provide analgesia (assessed by pin-prick) in 90% of patients undergoing popliteal-sciatic block for lower limb surgeries.
Intraperitoneal nebulization of ropivacaine for control of pain after laparoscopic cholecystectomy -A randomized control trial
Authors: Sandhya Sai , Puthenveettil Nitu , Vinodan K 
Published: October 2021

Background and Aims:Use of high dose opioids following laparoscopic surgery delays discharge from the hospital. Unlike intraperitoneal instillation, nebulization has been reported to provide a homogeneous spread of local anesthetics and provide better analgesia. In our study, we aimed to assess the efficacy of intraperitoneal nebulization of local anesthetic in alleviating postoperative pain in patients undergoing laparoscopic cholecystectomy.Material and Methods:This randomized control double-blinded study was conducted after obtaining approval from the hospital ethics committee and informed consent from patients undergoing laparoscopic cholecystectomy under general anesthesia. Patients recruited were divided into two equal groups of 20 each. Group B received intraperitoneal nebulization with 4 ml of 0.75% ropivacaine and Group C received intraperitoneal nebulization with 4ml of saline before surgical dissection. Postoperative pain score using a numeric rating scale was monitored until 24 h, the need for rescue analgesics and associated complications were noted. Chi-square test, Student's test, and Mann–WhitneyUtest were used for statistical analysis.Results:The pain score was significantly less in Group B during rest and deep breathing up to 24 h with aPvalue <0.05. The pain score on movement was also less in Group B and this difference was statistically significant at 6 and 24 h(P= 0.004 and 0.005, respectively). Tramadol consumption was less in Group B and was statistically significant at 24 h withPvalue of 0.044. No adverse events were noted.Conclusion:Intraperitoneal nebulization of ropivacaine is effective and safe in providing postoperative analgesia in patients undergoing laparoscopic cholecystectomy.
Implementation of a risk-stratified approach to prevent postoperative nausea and vomiting in an institution with high baseline rates of prophylaxis
Authors: Murugappan Kadhiresan R. , Moric Mario , Wang Xuanji , Kruse Jessica , Mueller Ariel , Boone Myles D. , Barboi Cristina 
Published: October 2021

Material and Methods:We conducted an observational study on a cohort of patients undergoing elective surgery before and after the implementation of a quality improvement initiative including a risk-stratified approach to prevent PONV. The primary outcome was the number of prophylactic interventions administered. Secondary outcome included the repetition of ineffective medications and the need for rescue medication in the post-anesthesia care unit (PACU).Results:A total of 636 patients were included; 325 patients during the control period and 311 after the intervention. The educational program failed to reduce the amount of prophylactic antiemetics administered (2.0 vs. 2.6,P< 0.001) and the repeat administration of ineffective medications for rescue (16% vs. 20%,P= 0.15). More patients in the intervention group required rescue medication compared to the control group (16.9% vs. 9.7%;P= 0.04).Conclusion:Implementation of best practices to combat PONV remains elusive. Our results indicate that difficulties in changing provider behavior also apply to institutions with high prophylactic antiemetic administration rates.
Elektrik Güç Sistemleri için Kontrollü Kesici Tasarımı
Authors: BOZDAĞ İsmail , EFE Serhat Berat 
Published: October 2021

Günümüzde güç sistemlerinin tasarımı yapılırken ilk olarak maliyet kalemlerinin, daha sonra ise ilgili sistem üzerinde yaşanabilecek arızaların minimum seviyelerde tutulması hedeflenmektedir. Geçmiş yıllarda yapılan ve günümüzde de halen işletilen dağıtım şebekeleri içerisinde radyal ve müstakil çıkışları barındıran birden fazla havai hatlar mevcuttur. Söz konusu hatlar üzerinde ise kuş çarpmaları, izolatör arızaları, nem vb. nedenlerden dolayı sıkça arızalar meydana gelmektedir.
Bu çalışmada, bir güç sisteminin farklı noktalarında yaşanan arızaların etkilerinin incelenmesi ve bu arızaların, sistemin farklı noktalarına etki etmeden tasarlanan kontrollü kesici ile sönümlendirilmesi amaçlanmıştır.
Kontrollü kesici tasarımının uygulanması, iletim ve dağıtım şebekelerinde teçhizat ömürlerinin artması ve birden fazla besleme noktası olan bir güç sistemi içerisinde arıza bölgelerinin sadece birkaç milisaniye süre ile izole edilmesi açısından büyük önem arz etmektedir.