bluuebunny/crossref_metadata_2025_split huggingface dataset:
Effect of synthetic and reduced folic acid on methionine metabolism parameters in various experimental models with Wistar rats
Authors: Sazonova A. P. , Milyutina Yu. P. , Bespalova O. N. , Pachuliia O. V. , Zalozniaia I. V. , Korenevsky A. V. 
Published: November 2024

Introduction. Currently, folic acid preparations are administered during preconception period in an empirical manner. Along with synthetic folic acid, there also exists its reduced counterpart 5-methyltetrahydrofolate (5-MTHF). Manufacturers of the latter claim that 5-MTHF overcomes metabolic defects due to c.665C>T gene polymorphism in the methylenetetrahydrofolate reductase (MTHFR), and therefore it is superior to synthetic folic acid (pteroylmonoglutamic acid, PGA). However, no large-scale studies to confirm this hypothesis have been conducted yet.Aim: to assess an effect of various folic acid preparations on methionine metabolism in experimental models with Wistar rats.Materials and Methods. A chronic hyperhomocysteinemia (HHC) was induced in sexually mature female Wistar rats by daily methionine supplementation. After HHC development, experimental animals were administered PGA or 5-MTHF. Some animals without HHC also received folic acid supplements or water. Blood samples were collected at 3 time points (1, 2 weeks and 1.5 months after folate preparation administration) to quantitate level of homocysteine (HC), plasma folic acid and red blood cell count.Results. It was verified that HHC developed in mature Wistar rats after methionine supplementation, with HC level being significantly higher (p < 0.05) than in control group. Use of folic acid supplements during HHC caused by methionine load did not result in lower HC level. In experimental animals administered PGA or 5-MTHF, blood serum folic acid level and red blood cell count did not change upon longer drug administration. No advantage for 5-MTHF vs. synthetic folic acid on HC levels and erythrocyte folate accumulation was observed. Instead of the expected decline in HC level in HHC models related to the examined folate preparations, the opposite effect was obtained. In case of pre-existing non-folate-dependent chronic HHC, HC level increased from time point 1 to time point 3.Conclusion. Chronic non-folate-dependent HHC, induced by chronic oral methionine was self-limiting in experimental models; additional folate supplementation resulted in sharply increased plasma HC level. Experimental models with Wistar rats showed that no further accumulation of folic acid occurs upon its optimal levels in plasma and red blood cells. The study revealed no advantages for 5-MTHF over synthetic folic acid in lowering blood plasma HC level and folic acid accumulation in erythrocytes.
Comparative study of endotracheal tube cuff inflation with air versus alkalinized lidocaine on hemodynamic response during extubation
Authors: Nadkarni Avani S , Shah Pooja Arpan , Chavda Dushyant B , Patel Jatin B , Thomas Sara Mary 
Published: November 2024

The increased use of cuffed endotracheal tube during general anaesthesia has been associated with increased incidences of hemodynamic stress leading to tachycardia and hypertension during emergence from general anaesthesia. Hence it is planned to conduct a study inflating the endotracheal tube cuff with air as compared to inflation with 2% alkalinized lidocaine during intubation to observe the changes in hemodynamic stress response during extubation. This study aimed to compare the effects of endotracheal tube cuff inflation with air versus 2% alkalinized lidocaine on hemodynamic stability during extubation (primary outcome) and to assess associated side effects (secondary outcome). This Randomised prospective observational study was done on 40 patients between the age group of 18 to 65 years of both gender belonging to American Society of Anaesthesiologists (ASA) physical status 1 and 2 undergoing elective surgeries requiring general anaesthesia. They were separated into Group A – cuff inflated with air and Group L – cuff inflated with alkalinized lidocaine prepared by taking 9cc of 2% lidocaine and adding 1cc of sodium bicarbonate and using approximately 4-5 cc to inflate the cuff. Hemodynamic changes at baseline, induction, intraoperatively, during extubation and post-extubation were recorded. Haemodynamic responses were monitored at extubation & 2,4,6,8,10,15 minutes after extubation showed better hemodynamic stability in Group L than Group A. The study suggested that endotracheal tube cuff inflated with alkalinized lidocaine have shown better hemodynamic stress response during extubation and post-extubation.
To evaluate and correlate the effectiveness of epidural depth equation versus pre-procedural US guided epidural block: A randomized controlled trial
Authors: Rana Shelly , Garg Mohini , Verma Versha , Sharma Nanish , Rani Aayushi 
Published: November 2024

Ultrasound assisted pre-procedural epidural depth estimation has improved the safety and efficacy of epidural block. Currently, the incorporation of pre-procedural ultrasound guided epidural derived equation(EDE) has significantly improved the accuracy of epidural depth estimation especially in the parturients. However, the accuracy of EDE derived epidural depth alone has not been compared to the actual epidural needle depth in non-obstetric patients. This study compared the efficacy of epidural depth equation (EDE) versus pre-procedural US-guided epidural block in patients scheduled for orthopedic surgeries under the combined spinal epidural block (CSE). The primary outcome was the number of attempts for successful epidural insertion, the secondary outcomes were correlations of EDE-calculated epidural depth with actual needle depth and pre-procedural US-guided epidural depth. One hundred patients, 20-60 years, ASA physical status I and II, body mass index (BMI) 18.5–29.9 kg.m were randomized into two groups. In group US (n=50), the pre-procedural US-guided skin to epidural depth was measured and the point of insertion of the epidural needle was marked. Whereas, in group E (n=50), the skin epidural depth was measured using the epidural depth equation (EDE). The epidural block was instituted by the loss of resistance technique in both groups. The primary outcome was the number of attempts for successful epidural insertion, the secondary outcomes were correlations of EDE-calculated epidural depth with actual needle depth and pre-procedural US-guided epidural depth. The needle passes were 1.10±0.08, and 1.18±0.05 in groups US, E respectively (P=0.251). A significantly strong correlation was observed between epidural depth by US and EDE (r2=0.915, P=0.001). Whereas, a weak correlation was observed in the EDE-measured epidural depth and actual needle depth (r=0.402, P =0.04). Although comparable needle attempts were observed in both groups, the weak correlation of epidural depth by EDE with actual needle depth doesn’t support its use alone. The strong correlation of epidural depths by EDE and US encourages EDE assisted with pre-procedural US-guided epidural block.
A comparison of analgesic efficacy between oral pregabalin, gabapentin, and melatonin as non-opioid anaesthesia for robotic-assisted laparoscopic surgeries: A prospective randomized double-blinded clinical study
Authors: Nagendran Nagapriya , Daisy Monica , Nagarajan Girimurugan 
Published: November 2024

Opioid-sparing anesthesia is increasingly used in surgery, though effectiveness varies. Given the anxiety-pain correlation, anxiolytics like gabapentinoids and melatonin may offer benefits. This study compares the preemptive use of pregabalin, gabapentin, and melatonin for postoperative analgesia in robotic-assisted laparoscopic surgeries (RALS). The aim of this study is to investigate postoperative analgesia in patients undergoing robotic-assisted laparoscopic surgeries under non-opioid anesthesia. The objectives are to evaluate perioperative hemodynamics, assess the perioperative sedation score during the surgical procedures, determine the requirement for rescue analgesia in the postoperative period, and measure the perioperative anxiety score in patients undergoing these surgeries. Sixty patients, aged 18-60 with ASA PS grade 1 & 2 and BMI &#60; 35 kg/m², undergoing elective robotic-assisted laparoscopic surgeries (RALS) were randomly assigned to receive pregabalin (Group P), gabapentin (Group G), or melatonin (Group M). After standard pre-anesthetic assessments and premedication, patients received pregabalin 150 mg, gabapentin 900 mg, or melatonin 6 mg one hour before surgery. Hemodynamics and anxiety, VAS, and sedation scores were monitored postoperatively at 1, 2, 6, and 12 hours. Primary outcome was postoperative analgesia assessed by VAS, with rescue analgesia administered for VAS &#62; 4. Baseline characteristics were balanced among groups. Gabapentin significantly reduced VAS scores (1.25 ± 0.44) and extended time to rescue analgesia (9.48 ± 0.69 hours). Anxiety scores and Ramsay sedation scores (1.45 ± 0.51) were comparable, but Group G showed lower sedation. Hemodynamics remained stable. Gabapentin improved postoperative pain outcomes in RALS, supporting its use for individualized pain management in these surgeries. Differences in pain intensity, time to rescue analgesia, and sedation levels highlight the need for personalized approaches. Further research in various surgical contexts is recommended to optimize perioperative care.
Effectiveness of dextrose prolotherapy for chronic musculoskeletal pain: A prospective observational study
Authors: Digraje Sunita Ashok , Chavan Dhanashri Ganesh , Virkar Nilam Dharma , Rustagi Preeti Sachin , Deshmukh Prakash Rajendra 
Published: November 2024

The increasing prevalence and burden of musculoskeletal conditions has led to an interest in effective nonsurgical solutions, which are more cost efficient and minimally invasive. Prolotherapy is an alternative therapeutic procedure used for management of chronic musculoskeletal conditions which involves injection of irritant solution into affected area. Primary objective of this study was to assess effectiveness of prolotherapy in relieving pain. This study was undertaken to assess the effectiveness of prolotherapy with Inj. Ropivacaine 0.25% & Dextrose 12.5% in patients with chronic musculoskeletal pain. The primary objective was to evaluate reduction in pain 3 months after procedure. Secondary objectives were to assess number of sessions of prolotherapy required, patient satisfaction and complications if any.Seventy patients of either sex aged 18 years and above, diagnosed with a chronic musculoskeletal pain condition, who were selected for the prolotherapy as the treatment modality, were included in the study. All patients received prolotherapy with 0.25% ropivacaine and 12.5% in the involved area. A Wilcoxon signed-rank test showed that there was statistically significant difference in mean VAS, 3 months after prolotherapy as compared to mean VAS pre-procedure. The mean VAS reduced from 6.61 ± 0.95 at the beginning of the study, reduced to 0.88 ± 1.95 by the end of the study (p = 0.000.) Maximum volume of drug required for adequate pain relief by prolotherapy was 30 cc with the mean of 17.53 ± 7.28. 58.3% of the study population needed 2 sessions of prolotherapy while 10% required 3 sessions. 80% of patients, had more than 50% pain relief at the end of 3rd month after prolotherapy. Prolotherapy using 12.5% Dextrose + 0.25% Ropivacaine offers minimally invasive, cost effective and safe management option for patient with chronic musculoskeletal pain.
Evaluation of local anaesthetic with adjuvants for postoperative analgesia through ultrasound-guided Fascia Iliaca compartment block in hip procedures
Authors: Thangaraju Thamizhmathi , Kumar Prem , Daisy T Monica 
Published: November 2024

Hip surgeries often result in significant postoperative pain, affecting early mobilization and rehabilitation. The Fascia Iliaca compartment block (FICB), guided by ultrasound, is a regional anaesthesia technique that can reduce this pain. The addition of adjuvants to local anaesthetics may enhance the block's duration and quality. This study evaluates the efficacy and safety of adding dexamethasone and dexmedetomidine as adjuvants to 0.25% ropivacaine for postoperative analgesia in hip procedures. The study aims to compare the duration and quality of postoperative analgesia of ropivacaine and ropivacaine with additives such as dexmedetomidine and dexamethasone for ultrasound-guided fascia iliaca compartment block in patients undergoing three different lower limb orthopaedic procedures. To assess and compare the duration of post-operative analgesia between 0.25% ropivacaine, ropivacaine with dexmedetomidine and ropivacaine with dexamethasone.: To assess and compare the time of requirement of rescue analgesia between the three groups This prospective, randomised, double-blind, placebo-controlled trial involved 60 patients undergoing hip surgeries including Total hip replacement (THR), Dynamic Hip Screw (DHS), and Proximal Femoral Nailing (PFN) divided equally into three groups. Group A received 0.25% ropivacaine with dexamethasone, Group B received 0.25% ropivacaine with dexmedetomidine, and Group C received 0.25% ropivacaine with a placebo. The primary outcomes measured were the duration of analgesia and postoperative pain scores. Secondary outcomes included the need for rescue analgesia and the incidence of side effects. Patients who received dexmedetomidine or dexamethasone experienced significantly longer durations of analgesia and lower postoperative pain scores in the first 24 hours compared to those who received the placebo. Additionally, the need for rescue analgesia was reduced, and the incidence of side effects was comparable between the groups receiving adjuvants and the placebo group. The order of better analgesia and prolonged duration was best with ropivacaine and dexmedetomidine, next best with ropivacaine and dexamethasone when compared to ropivacaine without adjuvant.
Dexmedetomidine - lidocaine nebulisation for awake nasotracheal intubation: An observational cross-sectional study
Authors: Chauhan Amit Kumar , Yadav Neeru , Ramakrishnan Priya , Saini Sunil 
Published: November 2024

Optimal airway topicalisation is the key to successful and smooth awake intubation in anticipated difficult airway. Dexmedetomidine nebulisation has been used effectively as premedication and could be a useful adjunct to lidocaine for awake fiberoptic intubation (AFOI). This study evaluated the efficacy of dexmedetomidine-lidocaine nebulisation for AFOI.To compare the efficacy of Dexmedetomidine with lignocaine versus Plain Lignocaine nebulization to achieve successful airway placement for awake fiberoptic intubation (AFOI). To assess the degree of patient comfort during the procedure on basis of cough score, gaging reflex score, intubating conditions, vocal cord position, patient behaviour and to assess the hemodynamic stability and the time taken for AFOI. 96 adult patients, ASA grades I-III with anticipated difficult intubation requiring AFOI for elective surgery were enrolled. Patients received nebulisation with dexmedetomidine 1mcg/kg + 4ml of 4% lidocaine (Group A, n=48) & 4ml of 4% plain lidocaine (Group B, n=48). Outcomes were assessed by an independent observer. Primary outcome of cough and gag reflex was assessed on basis of four-point intubation condition assessment score. Secondary outcomes assessed were patient comfort using five-point intubation comfort scale, three-point behaviour scale, hemodynamic stability, additional sedation, lidocaine aliquots, intubation attempts and complications. Fischer exact test was used for categorical variables and Mann -Whitney / independent student t-test for continuous variables.P values &#60; 0.05 was considered statistically significant.: Both groups displayed similar demographic profiles. While all patients were successfully intubated, Group A exhibited better intubating condition grades (p&#60;0.001) and lower cough scores compared to Group B (p&#60;0.001). Patient comfort (p&#60;0.001) and hemodynamic stability (p&#60;0.05) was better in Group A. Only 3 patients in Group A required additional sedation compared with 19 patients in Group B (p&#60;0.001). This study demonstrated superior efficacy of dexmedetomidine- lidocaine nebulisation in providing optimal intubating conditions for AFOI.
High flow nasal oxygenation and videolaryngoscopy - the two saviours in a case of Prader-Willi syndrome: A case report
Authors: Gaba Prachi , Singh Aparna , Sharma Kush , Gupta Lalit 
Published: November 2024

Prader-Willi syndrome (PWS) is a rare genetic disorder characterized by hypothalamic-pituitary abnormalities, hypotonia, hyperphagia, and a high risk of morbid obesity, which complicates both general and regional anesthesia. Patients with PWS face additional challenges, including disturbances in thermoregulation, arrhythmias, cor pulmonale, and convulsions. These factors make anesthetic management particularly challenging, necessitating careful planning and monitoring.We report the anesthetic management of a 7-month-old infant with genetically confirmed PWS who underwent bilateral orchidopexy under general anesthesia. The patient’s preoperative evaluation revealed significant hypotonia and a predisposition to respiratory complications. During the procedure, advanced airway management techniques, including the use of C-MAC and high-flow nasal oxygenation (HFNO), were employed to alleviate the risk of difficult airway and respiratory failure. The anesthesia team meticulously monitored the patient's vital signs and thermoregulation throughout the surgery to prevent arrhythmias and other complications associated with PWS.The successful anesthetic management of a child with Prader-Willi syndrome requires a multidisciplinary approach, thorough preoperative planning, meticulous intraoperative monitoring, and vigilant postoperative management to minimize the risk of complications in this vulnerable patient population.
DESDE EL PRINCIPIO ES UNA MADRE: EL PAPEL DE LAS MUJERES ZENÚ EN LAS LUCHAS POR LA TIERRA
Authors: Hernández Zharic 
Published: November 2024

: Esta investigación aborda el papel de las mujeres Zenú del resguardo San Andrés de Sotavento en la lucha por la tierra. Se analiza cómo las percepciones sociales sobre la defensa de la tierra han mutado desde la tenencia del territorio ancestral a la lucha contra el extractivismo y las consecuencias de la crisis climática, entendiendo estas violencias como parte del capitalismo y la colonización moderna, que se encuentran interrelacionadas. Por ello, mediante la construcción de relatos con un enfoque interseccional, se evidencian experiencias individuales y proyectos grupales que construyen imaginarios del territorio y sus conflictos. Asimismo, se presenta una aproximación al valor de la economía del cuidado y las estrategias comunitarias de resistencia, buscando resaltar los aportes invisibilizados de las mujeres en esta larga lucha. Palabras Claves: genero; economía del cuidado; crisis climática; conflictos territoriales; resguardo indígena.
PASSWORD HASHING METHODS AND ALGORITHMS ON THE .NET PLATFORM
Authors: Fedorchenko Volodymyr , Yeroshenko Olha , Shmatko Oleksandr , Kolomiitsev Oleksii , Omarov Murad 
Published: November 2024

Web applications, which are widely used to provide services and collect information, have become a major target for attackers, especially with the emergence of government services that process sensitive data. The .NET software platform, popular for developing web applications, includes built-in hashing algorithms (HA) and key generation functions (KDF) to protect passwords. However, these were developed over two decades ago for different levels of threats. More modern alternatives, such as Bcrypt, Scrypt, and Argon2, offer improved protection against modern GPU, ASIC, and FPGA attacks, but require third-party implementation. Given the critical role of password protection in protecting user information, this research investigates the effectiveness of various hashing mechanisms on the .NET platform, which is an urgent need for securing modern web applications. The subject of study in the article is the features of hashing algorithms built-in and available in the libraries of the .NET software platform for password protection as the main aspect of user authentication. The purpose of the work is to compare and analyse the hashing algorithms built-in and available in the libraries of the .NET software platform for password protection as the main aspect of user authentication. Objectives: to review built-in algorithms such as MD5, SHA and PBKDF2, as well as third-party implementations of modern key derivation functions such as Bcrypt, Scrypt and Argon2, and to investigate their performance and cryptographic strength. Methods used: This included measuring hashing speeds for different password sets and analysing attack resistance using tools such as Hashcat and data from independent security research. The results show that while built-in algorithms such as MD5 and SHA256 are fast, they do not provide protection against modern threats such as rainbow table attacks and GPU-accelerated brute-force attempts. PBKDF2, which is standard in ASP.NET Core Identity, provides better security but is vulnerable to attacks using specialised hardware. Among the modern algorithms, Argon2 demonstrated the best balance of security and performance, providing protection against GPU, ASIC, and FPGA-based attacks. Conclusions. The study concluded that Argon2 is the recommended algorithm for password hashing on the .NET platform, while Bcrypt is a suitable alternative for legacy applications. PBKDF2 with a high number of iterations can still provide strong protection. A promising direction for further research may be to determine whether modern memory-intensive key derivation functions can be used to improve password security in .NET applications.
Development and Validation of Objective and Subjective Osteoporosis Knowledge Instruments Among Chinese Orthopaedic Surgeons
Authors: Mo Jian , Mo Ying , He Jiale , Yang Bu , Jiang Xieyuan , He Lei , Lu Shuai , Wu Wenbin , Pang Mao , Feng Feng , Xie Peigen , Fan Shunwu , Rong Limin 
Published: November 2024

Background:
Clinicians must be knowledgeable about osteoporosis so that they can convey information regarding the prevention of fragility fractures to their patients. The purposes of this study were to develop objective and subjective knowledge instruments for osteoporosis and fragility fractures and then test their reliability and validity among Chinese orthopaedic surgeons.

Methods:
A 2-round procedure was used to develop the objective and subjective knowledge instruments. A cross-sectional online survey was distributed to 293 orthopaedic surgeons; 189 surgeons returned the questionnaires. We examined internal consistency, test-retest reliability, criterion validity, and discriminant validity; we also compared the subjective knowledge level with the objective knowledge level among surgeons.

Results:
Our results showed that the Subjective Knowledge Scale (SKS) regarding Osteoporosis and Fragility Fractures had a high Cronbach alpha coefficient (0.915), and the objective Osteoporosis Knowledge Test for Clinicians (OKTC) had an adequate Kuder-Richardson 20 coefficient (0.64). Item analyses were conducted, and a short version of the OKTC (the OKTC-SF) was developed. The SKS, the OKTC, and the OKTC-SF all showed good test-retest reliability, criterion validity, and discriminant validity. The percentage of surgeons with a high subjective knowledge level was higher than the percentage of surgeons who selected the correct answer for several corresponding questions related to objective knowledge.

Conclusions:
The SKS, the OKTC, and the OKTC-SF all demonstrated good reliability and validity. However, the orthopaedic surgeons may have overestimated their knowledge level regarding osteoporosis. Targeted continuing medical education that is based on individual knowledge level is needed to improve the undertreatment of osteoporosis among patients with fragility fractures.