Effect of strontium fluoride on mechanical and remineralization properties of enamel: An in-vitro study on a modified orthodontic adhesive.

OBJECTIVES: Evaluate the ability of strontium fluoride on bond strength and enamel integrity after incorporation within orthodontic adhesive system as a delivery vehicle. METHODS: Experimental orthodontic adhesive system Transbond™ XT were modified with 1% Sr2+, 0.5% SrF2, 1% strontium, 0.5% Sr2+, 1% F-, 0.5% F-, and no additions were control. Mixing of formulation was monitored using Fourier transform infrared spectroscopy. Small-molecule drug-discovery suite was used to gain insights into Sr2+, F-, and SrF2 binding. Shear bond testing was performed after 6-months of ageing. Enamel blocks were cut, and STEM pictures were recorded. Specimens were indented to evaluate elastic modulus. Raman microscope was used to collect Raman spectra and inspected using a scanning electron microscope. Crystal structural analysis was performed using X-ray diffraction. Effect of material on cellular proliferation was determined. Confocal was performed to evaluate the effect of formulation on biofilms. RESULTS: FTIR of modified adhesives depicted peak changes within range due to various functional groups existing within samples. TEM represented structurally optimized hexagonal unit-cell of hydroxyapatite. Mean shear bond strength is recorded highest for Transbond XT with 1% SrF2. Dead bacterial percentage appeared higher in 0.5% SrF2 and 1% F- specimens. Crystal lengths showed an increase in 0.5% and 1% SrF2 specimens. Phase contrast within TEM images showed a union of 0.5% SrF2 crystal with enamel crystal with higher elastic modulus and highly mineralized crystalline hydroxyapatite. Intensity of ν1 PO43- and ν1 CO32- along with carbonate - / ν1PO43- ratio displayed good association with strontium fluoride. The formulation showed acceptable cell biocompatibility (p < 0.353). All specimens displayed characteristic diffraction maxima of different apatite angles within XRD. SIGNIFICANCE: Experimental results suggested good biocompatibility, adequate mechanical strength, and far-ranging crystallization ability. This would provide a new strategy to overcome the two major challenges of fixed orthodontics, biofilm growth, and demineralization of enamel.

Comparison of Acute Physiology and Chronic Health Evaluation (APACHE) II and American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) scoring system in predicting postoperative mortality in patients undergoing emergency laparotomy: A retrospective study.

Background and Aims: There is paucity of studies on preoperative risk assessment tools in patients undergoing emergency surgery. The present study evaluated the performance of the Acute Physiology and Chronic Health Evaluation (APACHE) II, American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) surgical risk calculator and American Society of Anesthesiologists (ASA) physical status (PS) classification system in patients undergoing emergency exploratory laparotomy. Methods: This retrospective study included 60 adult patients who underwent emergency exploratory laparotomy for perforation peritonitis. The clinical details, ASA PS classification, laboratory investigations and postoperative course of patients were retrieved from their medical records. Based on these details, APACHE II and ACS-NSQIP were calculated for the patients. The study's primary outcome was the accuracy of the preoperative APACHE II, ACS-NSQIP risk calculator and ASA PS class in predicting the postoperative 30-day mortality of patients. Results: The area under the curve (AUC) of APACHE II, ACS-NSQIP score, and ASA PS classification for mortality 30 days after surgery was 0.737, 0.694 and 0.601, respectively. The P value for the Hosmer-Lemeshow (H-L) test of scoring systems was 0.05, 0.25 and 0.05, respectively. AUC for postoperative complications was 0.799 for APACHE II, 0.683 for ACS-NSQIP and 0.601 for ASA PS classification. H-L test of these scoring systems for complications after surgery revealed P values of 0.62, 0.36 and 0.53, respectively. Conclusion: Compared to the ACS-NSQIP and ASA PS classification system, the APACHE II score has a better discriminative ability for postoperative complications and mortality in adult patients undergoing emergency exploratory laparotomy.

Nanozymes: A comprehensive review on emerging applications in cancer diagnosis and therapeutics.

Nanozymes, a new class of nanomaterials-based artificial enzymes, have gained huge attraction due to their high operational stability, working efficiency in extreme conditions, and resistance towards protease digestion. Nowadays, they are effectively substituted for natural enzymes for catalysis by closely resembling the active sites found in natural enzymes. Nanozymes can compensate for natural enzymes' drawbacks, such as high cost, poor stability, low yield, and storage challenges. Due to their transforming nature, nanozymes are of utmost importance in the detection and treatment of cancer. They enable precise cancer detection, tailored drug delivery, and catalytic therapy. Through enhanced diagnosis, personalized therapies, and reduced side effects, their adaptability and biocompatibility can transform the management of cancer. The review focuses on metal and metal oxide-based nanozymes, highlighting their catalytic processes, and their applications in the prevention and treatment of cancer. It emphasizes their potential to alter diagnosis and therapy, particularly when it comes to controlling reactive oxygen species (ROS). The article reveals the game-changing importance of nanozymes in the future of cancer care and describes future research objectives, making it a useful resource for researchers, and scientists. Lastly, outlooks for future perspective areas in this rapidly emerging field have been provided in detail.

Carbon Nanosheets Infused with Gold Nanoparticles as an Ultrasensitive Nose for Electrochemical Arsenic Sensing.

Herein, we introduce an eco-friendly electrochemical sensor based on melamine-enriched nitrogen-doped carbon nanosheets decorated with gold nanoparticles (Au-CNSm) for arsenic sensing. An extremely facile, low-toxicity, biocompatible, and affordable hydrothermal technique was adopted for the synthesis of the Au-CNSm nanocomposite. The Au-CNSm-integrated sensing platform was optimized for electrode composition by cyclic voltammetry (CV). Owing to the synergistic effects of melamine-enriched carbon nanosheets (CNSm) and gold nanoparticles (AuNPs), the anodic peak current increased in the Au-CNSm-modified sensing electrode as compared to the CNSm-decorated platform. A wide linear range of 0.0001-100 µM and a low detection limit of 0.0001 µM were obtained. The visual signals can be measured at a very minute concentration of 0.0001 µM (0.1 ppb) on a screen-printed carbon electrode (SPCE) modified with Au-CNSm. Hence, this electrode system clearly outperformed the previously reported studies in terms of linear range, limit of detection (LOD), and electrocatalytic activity for arsenic sensing. Interestingly, the fabricated biosensor can be developed as a point-of-care device for real-time environmental monitoring for public safety. Henceforth, owing to exceptional attributes such as portability, selectivity, and sensitivity, this device offers great promise in modeling a revolutionary new class of electrochemical sensing platforms for an ultrasensitive and reliable detection strategy for arsenite (As(III)).

Recent progress in biomarker-based diagnostics of Helicobacter pylori, gastric cancer-causing bacteria.

The progression of any disease and its outcomes depend on the complicated interaction between pathogens, host and environmental factors. Thus, complete knowledge of bacterial toxins involved in pathogenesis is necessary to develop diagnostic methods and alternative therapies, including vaccines. This review summarizes recently employed biomarkers to diagnose the presence of Helicobacter pylori bacteria. The authors review distinct types of disease-associated biomarkers such as urease, DNA, miRNA, aptamers and bacteriophages that can be utilized as targets to detect Helicobacter pylori and, moreover, gastric cancer in its early stage. A detailed explanation is also given in the context of the recent utilization of these biomarkers in the development of a highly specific and sensitive biosensing platform.

Correlation of pain perception and fentanyl consumption after major abdominal surgery with CGRP 4218T/C polymorphism: A prospective interventional study.

Background and Aims: Genetic polymorphisms contribute to patients' variability in pain perception and response to opioid treatment. The present study evaluated the association of calcitonin gene-related peptide (CGRP) 4218T/C polymorphisms with fentanyl consumption over 24 h postoperatively in patients after major abdominal surgery. Methods: Eighty-five patients undergoing major abdominal surgery under general anaesthesia were recruited. For postoperative analgesia, epidural fentanyl and intravenous paracetamol were provided. The CGRP 4218T/C genotype was analysed, and the association between the genotype of the patient and the total consumption of fentanyl in the first 24 h after surgery was assessed. The association between different genotypes, the severity of postoperative pain and the side effects of opioids were also studied. Results: Our study population distribution included 52.9% of the T/T genotype (wild homozygote), 35.3% of the T/C genotype (heterozygote) and 11.8% of the C/C genotype (mutant homozygote). Mean (standard deviation) total fentanyl consumption in the first 24 h was found to be highest in the C/C group (212.0 [7.5] µg), followed by the T/T group (182.8 [9.9] µg) and was the least in the T/C group (159.6 [7.5] µg). The C/C group reported higher pain scores in all the study periods. There was no significant difference in the side effects of opioids, such as nausea, vomiting, sedation among different genotypes of CGRP 4218T/C. Conclusion: The polymorphism of CGRP 4218T/C affects postoperative pain perception and analgesic consumption. Patients with the C/C genotype had higher postoperative fentanyl consumption and pain scores.

Antimicrobial FiteBac® K21 promotes antimicrobial Potency and wound healing.

Objectives: Successful root canal therapy is dependent on the efficacy of complete instrumentation and adequate use of chemical irrigant to eliminate the biofilm from dentin surface. The aim of the study was to examine antibiofilm and antimicrobial effectiveness of newly formulated Quaternary ammonium silane (QAS/also codenamed K21; against Fusobacterium nucleatum (F. nucleatum) and Enterococcus faecalis (E. faecalis) biofilm on radicular dentin with evaluation of the anti-inflammatory consequence in vivo. Methods: Fourier Transform Infrared Spectroscopy (FTIR) was performed after complete hydrolysis of K21 solution. Human teeth were inoculated with biofilms for 7-days followed by treatment with various irrigants. The irrigant groups were Sodium hypochlorite [NaOCl (6%)], Chlorhexidine [CHX (2%)], K21 (0.5%), K21 (1%) and Saline. Scanning electron microscopy (SEM) was performed for biofilm and resin-dentin penetration. Transmission Electron Microscopy (TEM) of biofilms was done to evaluate application of K21. For in vivo evaluation, Albino wistar rats were injected subcutaneously and sections were stained with haematoxylin/eosin. Macrophage, M1/M2 expression were evaluated along with molecular simulation. Raman measurements were done on dried biofilms. Results: FTIR K21 specimens demonstrated presence of ethanol/silanol groups. Raman band at 1359 cm-1 resemble to -CH2- wagging displaying 29Si atoms in Nuclear Magnetic Resonance (NMR). 0.5%K21 showed cells exhibiting folded membranes. SEM showed staggering amount of resin tags with 0.5% K21 group. TEM showed membrane disruption in K21-groups. K21 groups were initially irritant, which subsided completely afterwards showing increased CD68. K21 and MMP/collagen complex was thermodynamically favourable. Conclusion: K21 root canal irrigant was able to penetrate bacterial wall and can serve as a potential irrigant for therapeutic benefits. Expression of M2 polarized subsets showed K21 can serve in resolving inflammation and potentiate tissue repair.

Clinical evaluation of preoperative three -item questionnaire and pain experienced on infiltration of local anesthetics to predict severity of acute pain after caesarean section.

Background and Aims: Several studies have attempted to identify patients at risk of developing severe pain after caesarean section (CS) by utilizing preoperative experimental pain application and clinical tests. The three-item questionnaire and reported pain intensity on infiltration of local anesthetic (LA) on the back of patient just before administration of spinal anesthesia, are two simple tests previously shown to be promising. We aimed to study utility of these two tools in Indian patients undergoing CS and find their correlation with postoperative pain and analgesic consumption. Material and Methods: A total of 150 parturients undergoing elective CS were enrolled. Preoperatively patients were asked to rate their level of anxiety, anticipated postoperative pain and analgesic need after surgery (three-item questionnaire). The pain intensity reported by patient upon LA injection for spinal anesthesia were recorded. In the postoperative period, pain intensity at rest, evoked pain and need for rescue analgesics were recorded. The correlation between three item questionnaire and pain on LA infiltration to postoperative pain were evaluated. To see relationship between the predictor variables to outcome, a multiple regression analysis was performed. Results: The predictors variables and postoperative pain were found to have mild correlation (r = 0.124 to 0.239). The predictor variables were significantly correlated with postoperative pain at rest but their association was not significant to evoked pain intensity. Multiple regression analysis showed that change in the predictors explains only 7-8% variance in postoperative pain outcomes. Conclusion: The three -item questionnaire and pain intensity reported upon LA infiltration for spinal anesthesia have mild correlation to postoperative pain in Indian parturients undergoing CS. As these variables predicts only 8% variance in pain experienced after CS, further studies are required for accurate prediction and targeted treatment of post CS pain.

Advances in surface-enhanced Raman spectroscopy-based sensors for detection of various biomarkers.

Surface enhanced Raman spectroscopy (SERS) allows the ultrasensitive detection of analytes present in traces or even single molecule levels by the generation of electromagnetic fields. It is a powerful vibrational spectroscopic method that is capable to detect traces of chemical and biological analytes. SERS technique is involved in the extremely sophisticated studies of molecules with high specificity and sensitivity. In the vicinity of nanomaterials decorated surfaces, SERS can monitor extremely low concentrations of analytes in a non-destructive manner with narrow line widths. This review article is focused on some recently developed SERS-based sensors for distinct types of analytes like disease-related biomarkers, organic and inorganic molecules, various toxins, dyes, pesticides, bacteria as well as single molecules. This study aims to enlighten the arising sensing approaches based on the SERS technique. Apart from this, some basics of the SERS technique like their mechanism, detection strategy, and involvement of some specific nanomaterials are also highlighted herein. Finally, the study concluded with some discussion of applications of SERS in various fields like food and environmental analysis.

Promoting OCD WEllness and resilience (POWER) study: Rationale, design, and methods.

Obsessive-compulsive disorder (OCD) affects 1-2% of children and is associated with functional impairment and diminished quality of life. Several treatments are efficacious: cognitive behavioral therapy (CBT) with exposure and response prevention, serotonin reuptake inhibitor (SRI) monotherapy, and combined treatment (SRI + CBT). Expert clinician-informed practice parameters suggest that youth with mild to moderate OCD should be treated initially with CBT yet SRIs are frequently employed as the first-line intervention or in combination with psychotherapy in applied practice. Empirical data to guide SRI discontinuation in pediatric OCD are very limited. This study, Promoting OCD Wellness and Resiliency (POWER), aims to address this gap through a two phase, double-blinded, placebo-controlled, randomized controlled non-inferiority trial with the purpose of evaluating whether youth with OCD on an SRI can discontinue their medication after successful CBT augmentation and maintain wellness for a period of 24 weeks during which they receive maintenance CBT that models standard-of-care. In this paper we describe the rationale and methodological design of the POWER study.

Phase 2 randomised placebo-controlled trial of spironolactone and dexamethasone versus dexamethasone in COVID-19 hospitalised patients in Delhi.

BACKGROUND: In this phase 2 randomised placebo-controlled clinical trial in patients with COVID-19, we hypothesised that blocking mineralocorticoid receptors using a combination of dexamethasone to suppress cortisol secretion and spironolactone is safe and may reduce illness severity. METHODS: Hospitalised patients with confirmed COVID-19 were randomly allocated to low dose oral spironolactone (50 mg day 1, then 25 mg once daily for 21 days) or standard of care in a 2:1 ratio. Both groups received dexamethasone 6 mg daily for 10 days. Group allocation was blinded to the patient and research team. Primary outcomes were time to recovery, defined as the number of days until patients achieved WHO Ordinal Scale (OS) category ≤ 3, and the effect of spironolactone on aldosterone, D-dimer, angiotensin II and Von Willebrand Factor (VWF). RESULTS: One hundred twenty patients with PCR confirmed COVID were recruited in Delhi from 01 February to 30 April 2021. 74 were randomly assigned to spironolactone and dexamethasone (SpiroDex), and 46 to dexamethasone alone (Dex). There was no significant difference in the time to recovery between SpiroDex and Dex groups (SpiroDex median 4.5 days, Dex median 5.5 days, p = 0.055). SpiroDex patients had significantly lower D-dimer levels on days 4 and 7 (day 7 mean D-dimer: SpiroDex 1.15 µg/mL, Dex 3.15 µg/mL, p = 0.0004) and aldosterone at day 7 (SpiroDex 6.8 ng/dL, Dex 14.52 ng/dL, p = 0.0075). There was no difference in VWF or angiotensin II levels between groups. For secondary outcomes, SpiroDex patients had a significantly greater number of oxygen free days and reached oxygen freedom sooner than the Dex group. Cough scores were no different during the acute illness, however the SpiroDex group had lower scores at day 28. There was no difference in corticosteroid levels between groups. There was no increase in adverse events in patients receiving SpiroDex. CONCLUSION: Low dose oral spironolactone in addition to dexamethasone was safe and reduced D-dimer and aldosterone. Time to recovery was not significantly reduced. Phase 3 randomised controlled trials with spironolactone and dexamethasone should be considered. TRIAL REGISTRATION: The trial was registered on the Clinical Trials Registry of India TRI: CTRI/2021/03/031721, reference: REF/2021/03/041472. Registered on 04/03/2021.

Mood Disorders in Youth: Complementary and Integrative Medicine.

Omega-3 polyunsaturated fatty acids, probiotics, vitamin C, vitamin D, folic acid and L-methyl folate, broad-spectrum micronutrients, N-acetylcysteine, physical activity, herbs, bright light therapy, melatonin, saffron, meditation, school-based interventions, and transcranial photobiomodulation are reviewed, with a focus on their use for treating mood disorders in children and adolescents. For each treatment, all published randomized controlled trials are summarized.

Comparison of oropharyngeal leak pressure of LMA Protector and LMA-ProSeal in different head and neck positions in anaesthetized and paralyzed patients; A prospective randomized study.

Background and Aims: Oropharyngeal leak pressure (OLP) of LMA Protector is reported to be higher compared to other second generation supraglottic devices (SGDs) indicating better seal with patient's airway and hence enhanced safety. To ascertain its benefit in patients undergoing surgeries where head and neck position other than neutral is required, we conducted a prospective randomized study to compare OLP of LMA Protector with LMA-ProSeal (PLMA) with head and neck in neutral, extension, flexion, and rotation position. Methods: 80 American Society of Anesthesiologists (ASA) I-II patients aged more than 18 years undergoing elective surgery under general anaesthesia were recruited. Patients were randomized in the LMA Protector or PLMA group. After induction of anaesthesia, OLP was measured in both the groups in different head and neck position. The insertion characteristics of both SGDs were also recorded and compared. Results: The OLP of LMA Protector and PLMA was found to be comparable in neutral head position (p = 0.08). There was no significant difference in OLP of both devices in extension, flexion, or head rotation. In both the study groups, head extension position led to significant decrease in OLP compared to supine position. With the flexion and rotation positioning of head and neck, significant increase in OLP in each group was noted. Conclusion: The OLP of LMA Protector and PLMA are comparable in different head and neck position. With both the devices, there was significant decrease in OLP with extension whereas significant increase was noted in flexion and rotation of head and neck.

Refractory hypertension after phenylephrine infusion in cesarean section under subarachnoid block.

A 21-year-old female was scheduled to undergo elective cesarean section for breech presentation under the subarachnoid block (SAB). The pre-operative examination was unremarkable and baseline vitals were normal. Under all aseptic precautions and American society of anesthesiologists standard monitoring, SAB was administered with 2.2 ml of 0.5% hyperbaric bupivacaine. Soon after administration of SAB, prophylactic infusion of phenylephrine was started at the rate of 50 µg/min; after pre-treatment with 0.2 mg glycopyrrolate intravenous immediately after the start of the infusion, the patient complained of severe headache. Blood pressure (BP) recorded at that time was 191/102 mm of Hg. Phenylephrine infusion was stopped immediately but the BP remained high and came to within 20% of baseline value only after 9 min of discontinuing the infusion. We report this case of refractory hypertension following phenylephrine infusion in a healthy parturient undergoing elective cesarean section under SAB.

Neurocognitive Correlates of Cerebellar Volumetric Alterations in Youth with Pediatric Bipolar Spectrum Disorders and Bipolar Offspring.

BACKGROUND: Emerging evidence points towards the involvement of the cerebellum in the processing of emotions and pathophysiology of mood disorders. However, cerebellar and related cognitive alterations in youth with pediatric bipolar disorder (PBD) and those at high risk to develop the disorder, such as bipolar offspring (BD-OFF) are not clearly defined. OBJECTIVE: To investigate cerebellar gray and white matter volumes, cognition, and their relationship in youth with PBD and BD-OFF. METHODS: Thirty youth (7 to 17 years, inclusive) with PBD, 30 BD-OFF and 40 healthy controls (HC) were recruited. Study participants underwent a computer-based cognitive battery assessing affective processing, executive function, attention, psychomotor speed, and learning. Three-tesla MRI scan was performed to assess cerebellar white and gray matter volumes. Cerebellar segmentation was performed with FreeSurfer. Statistical analyses include between-group differences in cognitive domains, cerebellar gray, and white matter volumes. Relationships between cerebellar volumes and cognitive domains were examined. RESULTS: Youth with PBD showed greater cerebellar gray matter volumes than both BD-OFF and HC, whereas no differences were present between BD-OFF and HC. Both youth with PBD and BD-OFF showed altered processing of negative emotions and a bias towards positive emotions. In youth with PBD and BD-OFF, greater impairment in the processing of emotions correlated with greater cerebellar gray matter volumes. CONCLUSION: The present findings corroborate hypotheses on cerebellar involvement in the processing of emotions and the pathophysiology of PBD. The presence of cerebellar dysfunction in BD-OFF is unclear.

Disrupted white matter microstructure correlates with impulsivity in children and adolescents with bipolar disorder.

Altered white matter (WM) microstructure likely occurs in children with bipolar disorder (BD) with impulsivity representing one of the core features. However, altered WM microstructures and their age-related trendlines in children with BD and those at high-risk of developing BD, as well as correlations of WM microstructures with impulsivity, have been poorly investigated. In this study, diffusion MRI, cognitive, and impulsivity assessments were obtained from children/adolescents diagnosed with BD, offspring of individuals with BD (high-risk BD) and age-matched healthy controls. A novel atlas-based WM skeleton measurement approach was used to quantify WM microstructural integrity with all diffusion-tensor-imaging (DTI) metrics including fractional anisotropy, axial, mean and radial diffusivity to survey entire WM tracts and ameliorate partial volume effects. Among all DTI-derived metric measures, radial diffusivity quantifying WM myelination was found significantly higher primarily in corpus callosum and in the corona radiata in children with BD compared to controls. Distinguished from age-related progressively decreasing diffusivities and increasing fractional anisotropy in healthy controls, flattened age-related trendlines were found in BD group, and intermediate developmental rates were observed in high-risk group. Larger radial diffusivity in the corpus callosum and corona radiata significantly correlated with shorter response times to affective words that indicate higher impulsivity in the BD group, whereas no such correlation was found in the healthy control group. This work corroborates the progressive nature of pediatric BD and suggests that WM microstructural disruption involved in affective regulation and sensitive to impulsivity may serve as a biomarker of pediatric BD progression.

An ultrasensitive electrochemical DNA biosensor for monitoring Human papillomavirus-16 (HPV-16) using graphene oxide/Ag/Au nano-biohybrids.

A DNA-based electrochemical biosensor has been developed herein for the detection of Human papillomavirus-16 (HPV-16). HPV-16 is a double-stranded, non-enveloped, epitheliotropic DNA virus which responsible for cervical cancer. In this proposed biosensor, an indium tin oxide (ITO) coated glass electrode was modified for sensing HPV-16 using graphene oxide and silver coated gold nanoparticles. Subsequently, HPV-16 specific DNA probes were immobilized on a modified ITO surface. The synthesized nanocomposites were characterized by FE-SEM and UV-VIS spectroscopy techniques. Electrochemical characterization was performed by using cyclic voltammetry and electrochemical Impedance Spectroscopy methods. The hybridization between the probe and target DNA was analyzed by a reduction in current, mediated by methylene blue. The biosensor showed a qualitative inequity between the probe and target HPV-16 DNA. The developed biosensor showed high sensitivity as 0.54 mA/aM for the detection of HPV-16. In a linear range of 100 aM to 1 µM with 100 aM LOD, the proposed biosensor exhibited excellent performance with the rapid diagnosis. Thus, the results indicate that the developed HPV DNA biosensor shows good consistency with the present approaches and opens new opportunities for developing point-of-care devices. The diagnosis of HPV-16 infection in its early stage may also be possible with this detection system.

Comparison of gum elastic bougie-guided insertion of LMA ProtectorTM versus the conventional method in achieving oesophagal patency - A randomised comparative study.

Background and Aims: The passage of a Ryle's tube through the drain port on the laryngeal mask airway (LMA) ProtectorTM has been reported to be arduous despite the larger gastric channel. There are no studies on the evaluation of the guided insertion of LMA ProtectorTM to achieve adequate gastrointestinal drainage function. Methods: This randomised study included 132 patients who underwent surgery under general anaesthesia. The gum elastic bougie (GEB)-guided insertion of LMA ProtectorTM (group I) was compared with the conventional method (group II), and the alignment of the tip of the drain tube with the oesophagus was assessed. The insertion characteristics of the device, accuracy of LMA ProtectorTM placement, haemodynamic parameters, and post-operative airway morbidity following the insertion of the device were also compared between the two groups. Results: The first-attempt success rate for the placement of LMA ProtectorTM and the patency of oesophagus was higher in group I patients than in group II (100% vs 84.8%; P < 0.001). However, the time taken for device insertion and associated haemodynamic changes were significantly longer in group I. The patients in group I had better visualisation of laryngeal structures. The GEB-assisted insertion of LMA ProtectorTM resulted in less incidence of blood staining at the cuff of the device. Conclusion: GEB-guided insertion of LMA ProtectorTM achieved better oesophageal patency than the conventional insertion method. This method also had higher first-attempt success at the placement of the device and was observed to be less traumatic.