Improving safety: neuraxial blockade guided by thromboelastography for patients with uncertain coagulation profile.

ABSTRACT: Neuraxial blockade procedures are essential for anesthesia and pain management but pose risks in patients with uncertain coagulation profiles. Traditional coagulation tests often fail to predict bleeding risks associated with neuraxial blockade. Thromboelastography (TEG) offers real-time insights into coagulation status, potentially improving safety outcomes. In this case series, six patients underwent neuraxial blockade guided by TEG analysis.An individualized anesthetic plan was formulated based on TEG findings to mitigate bleeding risks while ensuring pain management. Tailoring anesthetic techniques to real-time TEG data improved safety outcomes with minimized bleeding complications and satisfactory pain control. In conclusion, neuraxial blockade guided by TEG enhances safety in patients with uncertain coagulation profiles. Further studies are needed to validate benefits in broader clinical settings.

Local structure investigation of Co-Fe-Si-B ribbons by extended X-ray absorption fine-structure spectroscopy.

In the present work, extended X-ray absorption fine-structure (EXAFS) investigations of Co69FexSi21-xB10 (x = 3, 5, 7) glassy ribbons were performed at the Co K-edge. The magnitude of the first peak of the Fourier transforms of the EXAFS signals is found to increase monotonically with increasing Si concentrations indicating the formation of the localized ordered structure at the atomic scale. The Co-Si coordination number (CN) increases at the expense of the CN of Co/Fe. Smaller interatomic distances are observed in the glassy phase compared with that in the crystalline phase which promotes the stability of the glassy phase. Calculations of the thermodynamic parameter (PHSS), cohesive energy (EC) and the atomic radius difference (δ) parameter show that the alloy composition Co69Fe3Si18B10 has a good glass-forming ability (GFA) with the highest CN of Si compared with other compositions. A linear correlation of CN with that of the GFA parameter (PHSS) exists and the CN also plays a crucial role in the GFA of the glassy alloys. This parameter should be considered in developing different GFA criteria.

Cardiac MRI for the evaluation of cardiac neoplasms.

Primary cardiac neoplasms are extremely rare and are far outnumbered by metastases. These are difficult to diagnose and differentiate clinically due to lack of specific clinical manifestations. Technological advances have revolutionised cardiac imaging, with the cardiac magnetic resonance imaging (CMRI) showing promising results in the non-invasive evaluation of cardiac masses. Further, CMRI may envisage the malignant potential of a lesion based on its location, morphology, and signal characteristics, in addition to determining its impact on cardiac function. With the ever-increasing application of CMRI in the evaluation of neoplasms, comprehensive knowledge of their imaging characteristics becomes crucial.

Evaluation of Effect of Ascorbic Acid on Ferritin and Erythropoietin Resistance in Patients of Chronic Kidney Disease.

OBJECTIVE: This study was planned to evaluate the effect of short term intravenous ascorbic acid on reducing ferritin and erythropoietin resistance in patients of chronic kidney disease (CKD) on maintenance haemodialysis (MHD). METHODS: Forty adult patients [20 patients in group A with increased serum ferritin level (>500 ng/ml), transferrin saturation (TSAT) ≤20% and 20 patients in group B with normal serum ferritin level (<200 ng/ml), TSAT ≤20%] of end stage renal disease (ESRD) with erythropoietin hyporesponsiveness undergoing maintenance hemodialysis were included in the study. Group A was given intravenous (i.v.) ascorbic acid in a dose of 500 mg once a week after each 4 hours session of dialysis for 3 weeks in a month (total 1500 mg/month), for a period of 3 months along with erythropoietin 6000 IU subcutaneous (S/C) twice weekly without iron therapy. Group B was given erythropoietin (6000 IU S/C twice weekly after each hemodialysis) and intravenous (IV) iron 100 mg/week for 3 months. Hematological and renal investigations, erythrocyte sedimentation rate (ESR), high sensitivity C-reactive protein (HsCRP), serum ferritin and TSAT were done at baseline and then one monthly intervals for three months whereas intact parathyroid hormone (iPTH) was measured at the start and end of the study. RESULTS: At the end of 3 months of study, in group A, Hemoglobin (Hb) and TSAT significantly increased while ferritin, HsCRP and erythropoietin resistance index (ERI) decreased significantly. In group B, the increase in Hb and TSAT were not significant statistically while ferritin increased significantly and fall in HsCRP and ERI were not significant statistically. The mean rise in Hb between subsequent months was higher in group A as compared to group B. CONCLUSIONS: Short term i.v ascorbic acid could be a new successful adjuvant in reducing ferritin and erythropoietin resistance and enhancing Hb and TSAT in CKD patients on MHD.

Role of ACE and IL-1ß Gene Polymorphisms in Erythropoeitin Hyporesponsive Patients with Chronic Kidney Disease with Anemia.

BACKGROUND: Hyporesponse to erythropoietin is a common problem seen in around 5-10% of patients. Recently the focus from these remediable factors has been shifted to the non-modifiable innate factors i.e polymorphism of ACE and IL-1B gene and studies have shown that DD genotype and IL-1B CC genotype have lower erythropoietin requirement. The aim of our study was to evaluate the role of ACE and IL-1B gene polymorphisms in erythropoietin hyporesponse in CKD patients with anemia. METHODS: A total of 50 patients were selected. After taking pre-informed written consent, they were segregated into two groups, group A and B with 25 patients in each group. Group A included CKD stage III-IV patients and Group B included CKD stage V patients who were on regular maintenance. All patients were given erythroepoietin and response was monitored using erythropoietin resistance index (ERI). Genotyping of ACE and IL-1B genes were done and serum levels of ACE and IL-1B were measured. Mean values of ERI were compared between different genotype subgroups and analysed using binary regression analysis. RESULTS: The study group included 6 patients with diabetic nephropathy and out of these 4(66.6%) had DD genotype. On comparing the effect of ACE polymorphism on ERI levels it was seen that the mean ERI values in DD subgroup were significantly lower (16.97±5.35, 21.88±6.25, 22.69±8.35 at 1,3 and 5th month) as compared to ID (18.16±3.39, 24.17±3.66, 32.74±9.95 and II (20.73±5.17, 27.74±7.30, 41.08±13.83 U/Kg/g/dL). In the case of IL-1B the mean ERI values were lowest in the TT subgroup (16.46±4.45, 21.96±5.77,23.98±8.48) as compared to CC (19.49 ±5.62,25.46±7.07, 33.59±12.61) and CT (18.12±4.27,24.14±5.70, 31.89±13.83 U/Kg/g/dL). The mean serum values of ACE were in a decreasing trend i.e DD> ID> II (238.05 ± 52.46, 194.73±50.28 and 162.99±39.71 ng/ml, (p < 0.05). The mean serum values of IL1B in CC, CT and TT were 23.24±28.77, 18.32±16.25, 23.34±13.83 pg/ml (p>0.05). CONCLUSIONS: D allele positively affected the serum ACE level but there was no association between IL-1B genotype and its levels. ACE gene polymorphism has an important role in determining the response to EPO and progression of CKD. Pre-treatment screening for genotype may help in predicting the patients at risk and poor responders.

Gitelman Syndrome: Presenting During Pregnancy with Adverse Foetal Outcome.

Gitelman syndrome (GS) is a rare autosomal recessive salt-losing tubulopathy. The incidence of Gitelman syndrome is 25 cases in 1 million among western population. This patient presented with loose stool, vomiting and sudden onset quadriparesis. Investigations revealed hypokalaemia, metabolic acidosis, hypomagnesaemia, hypocalciuria, hypermagnesuria. Symptoms and hypokalemia improved after starting oral magnesium and potassium supplements. But the patient again presented with symptomatic hypokalemia and delivered a still born foetus with hydrocephalus. Patient was put on potassium sparing diuretics along with supplements and thereafter, has been asymptomatic. There have been very few case reports on Gitelman syndrome in pregnancy and most of them show favourable outcomes. This is a rare case report of a pregnant female with Gitelman syndrome with foetal loss.

Kallman Syndrome.

Kallman syndrome (KS) is a rare genetic disorder characterized clinically by failure to attain puberty or failure to fully complete it along with an absent or impaired sense of smell with absence of bilateral olfactory bulbi and sulci alongwith absent olfactory tracts. Only very few cases of Kallman syndrome have been reported in females in Indian population.

Families of Pseudohypoparathyroidism presenting as Seizure.

Pseudohypoparathyroidism (PHP) is a heterogeneous group of disorders characterized by variable insensitivity to parathyroid hormone. We describe two cases of 22 year male and 24 year female who have typical clinical features of Albright's hereditary osteodystrophy (AHO). Laboratory investigation revealed evidence of pseudohypoparathyroidism and skeletal survey showed shortening of the metacarpals and metatarsals.

Oral cavity squamous cell carcinoma: role of pretreatment imaging and its influence on management.

Squamous cell carcinoma (SCC) is the commonest malignancy in the oral cavity. The oral cavity has several subsites. Knowledge of the patterns of disease spread at each subsite with the impact on treatment and prognosis provides a deeper understanding of the role of imaging. Information from imaging helps accurate staging, assess resectability, and plan multimodality treatment. Mandibular erosion, posterior soft tissue extent, and perineural spread influence treatment and prognosis in gingival, buccal, and retromolar trigone (RMT) cancers. Multidetector computed tomography (MDCT) with multiplanar reformations and bone and soft tissue algorithms provides the highest specificity for bone erosion. Hard palate SCC is optimally imaged with contrast-enhanced magnetic resonance imaging (MRI) to detect perineural spread. In oral tongue and floor of the mouth (FOM) SCC, extrinsic muscle invasion, extension across the midline, extent of posterior and inferior spread, and proximity to the hyoid are issues that impact therapeutic options. Contrast-enhanced MRI is the optimal imaging method for staging the primary due to its superior soft tissue resolution. In oral tongue SCCs with tumour thickness ≤4 mm, elective neck dissection can be avoided. For nodal staging (N-staging), all imaging methods are comparable, but fall short of surgical staging. Sentinel lymph node biopsy has a promising role in N-staging. Positron emission tomography (PET)/integrated PET/CT has no role in evaluating the clinically negative neck. PET/CT has a role in pretreatment evaluation of advanced oral cavity SCC for depicting distant metastases and for mapping nodal extent in the clinically positive neck. Diffusion-weighted MRI, dynamic contrast-enhanced MRI, and CT perfusion have a potential role as baseline pretreatment studies for response assessment to chemoradiation in advanced oral cavity SCC.

Contralateral Nodal Relapse in Well-lateralised Oral Cavity Cancers Treated Uniformly with Ipsilateral Surgery and Adjuvant Radiotherapy With or Without Concurrent Chemotherapy: a Retrospective Study.

AIMS: To evaluate the incidence and pattern of contralateral nodal relapse (CLNR), contralateral nodal relapse-free survival (CLNRFS) and risk factors predicting CLNR in well-lateralised oral cavity cancers (OCC) treated with unilateral surgery and adjuvant ipsilateral radiotherapy with or without concurrent chemotherapy. MATERIALS AND METHODS: Consecutive patients of well-lateralised OCC treated between 2012 and 2017 were included. The primary endpoint was incidence of CLNR and CLNRFS. Univariable and multivariable analyses were carried out to identify potential factors predicting CLNR. RESULTS: Of the 208 eligible patients, 21 (10%) developed isolated CLNR at a median follow-up of 45 months. The incidence of CLNR was 21.3% in node-positive patients. CLNR was most common at level IB (61.9%) followed by level II. The 5-year CLNRFS and overall survival were 82.5% and 57.7%, respectively. Any positive ipsilateral lymph node (P = 0.001), two or more positive lymph nodes (P < 0.001), involvement of ipsilateral level IB (P = 0.002) or level II lymph node (P < 0.001), presence of extranodal extension (P < 0.001), lymphatic invasion (P = 0.015) and perineural invasion (P = 0.021) were significant factors for CLNR on univariable analysis. The presence of two or more positive lymph nodes (P < 0.001) was an independent prognostic factor for CLNR on multivariable analysis. CLNR increased significantly with each increasing lymph node number beyond two compared with node-negative patients. CONCLUSION: The overall incidence of isolated CLNR is low in well-lateralised OCC. Patients with two or more positive lymph nodes have a higher risk of CLNR and may be considered for elective treatment of contralateral neck.

Developing a strategic marketing plan for physical and occupational therapy services: a collaborative project between a critical access hospital and a graduate program in health care management.

The purpose of this study was to develop a marketing plan for the Physical and Occupational Therapy (PT/OT) department at a Critical Access Hospital (CAH). We took the approach of understanding and analyzing the rural community and health care environment, problems faced by the PT/OT department, and developing a strategic marketing plan to resolve those problems. We used hospital admissions data, public and physician surveys, a SWOT analysis, and tools to evaluate alternative strategies. Lack of awareness and negative perception were key issues. Recommended strategies included building relationships with physicians, partnering with the school district, and enhancing the wellness program.

Metal solubilization from powdered printed circuit boards by microbial consortium from bauxite and pyrite ores.

With the current rapid developments in technology, there is an increasing accumulation of outdated electronic equipment. The primary reason for this increase is the low rate of recycling due to the complex nature of such waste. Bioleaching offers a promising solution for this problem. Study was conducted on the solubilization of heavy metals from electronic waste (e-waste). For this purpose, a microbial consortium from bauxite and pyrite ore samples was obtained using a simple "top down" approach. Essentially, printed circuit boards (PCB) were obtained and used as representative samples of e-waste. Various concentrations (1-5%) of PCB powder were subjected to bioleaching, and the effects on metal solubilization, changes in pH and concentration of ferrous iron produced were assessed. It was observed that a maximum of 96.93% Cu and 93.33% Zn was solubilized by microbial consortium from 10 g/l of PCB powder, whereas only 10.26% Ni was solubilized from 30 g/l of PCB powder. For lead, only 0.58% solubilization was achieved from 20 g/l of PCB powder. An analysis of the precipitate formed during bioleaching using scanning electron microscopy with energy dispersive x-ray analysis revealed the presence of Tin (59.96%), Cu (23.97%), Pb (9.30%) and Fe (5.92%).

Investigating the effect of CoCl2 administration on diabetic nephropathy and associated aortic dysfunction.

AIM: Endothelial dysfunction appears to be a consistent finding in diabetic nephropathy. The study aimed to investigate the effect of cobalt chloride in the amelioration of endothelial dysfunction in uninephrectomized diabetic rats. METHODS: We examined the effect of CoCl(2) (10 mg/kg, i.p., OD = once a day) treatment on contractile responses to angiotensin II (10(-10) to 10(-6)M) in an aortic preparation of control rats and uninephrectomized diabetic control rats. Blood glucose, plasma urea, creatinine, uric acid, aortic endothelial nitric oxide synthase (eNOS), nitrate/nitrite (NOx), superoxide dismutase, catalase and reduced glutathione levels were checked in the different groups. RESULTS: A significant attenuation of the augmented responses to angiotensin II was observed in CoCl(2)-treated animals along with a fall in plasma urea, creatinine and uric acid levels. A significant reduction in blood glucose and an increase in aortic eNOS and NOx levels along with antioxidants levels were observed. CONCLUSION: Chronic hypoxia augments angiotensin II responses in the thoracic aorta of uninephrectomized diabetic control rats. CoCl(2) attenuates these enhanced vascular responses with a significant decrease in blood glucose signifying stabilization of the hypoxia-inducible factor in the alleviation of endothelial dysfunction in diabetic nephropathy.

Deep muscle-proteomic analysis of freeze-dried human muscle biopsies reveals fiber type-specific adaptations to exercise training.

Skeletal muscle conveys several of the health-promoting effects of exercise; yet the underlying mechanisms are not fully elucidated. Studying skeletal muscle is challenging due to its different fiber types and the presence of non-muscle cells. This can be circumvented by isolation of single muscle fibers. Here, we develop a workflow enabling proteomics analysis of pools of isolated muscle fibers from freeze-dried human muscle biopsies. We identify more than 4000 proteins in slow- and fast-twitch muscle fibers. Exercise training alters expression of 237 and 172 proteins in slow- and fast-twitch muscle fibers, respectively. Interestingly, expression levels of secreted proteins and proteins involved in transcription, mitochondrial metabolism, Ca2+ signaling, and fat and glucose metabolism adapts to training in a fiber type-specific manner. Our data provide a resource to elucidate molecular mechanisms underlying muscle function and health, and our workflow allows fiber type-specific proteomic analyses of snap-frozen non-embedded human muscle biopsies.

Nitric oxide increases cyclic GMP levels, AMP-activated protein kinase (AMPK)alpha1-specific activity and glucose transport in human skeletal muscle.

AIMS/HYPOTHESIS: We investigated the direct effect of a nitric oxide donor (spermine NONOate) on glucose transport in isolated human skeletal muscle and L6 skeletal muscle cells. We hypothesised that pharmacological treatment of human skeletal muscle with N-(2-aminoethyl)-N-(2-hydroxy-2-nitrosohydrazino)-1,2-ethylenediamine (spermine NONOate) would increase intracellular cyclic GMP (cGMP) levels and promote glucose transport. METHODS: Skeletal muscle strips were prepared from vastus lateralis muscle biopsies obtained from seven healthy men. Muscle strips were incubated in the absence or presence of 5 mmol/l spermine NONOate or 120 nmol/l insulin. The L6 muscle cells were treated with spermine NONOate (20 micromol/l) and incubated in the absence or presence of insulin (120 nmol/l). The direct effect of spermine NONOate and insulin on glucose transport, cGMP levels and signal transduction was determined. RESULTS: In human skeletal muscle, spermine NONOate increased glucose transport 2.4-fold (p < 0.05), concomitant with increased cGMP levels (80-fold, p < 0.001). Phosphorylation of components of the canonical insulin signalling cascade was unaltered by spermine NONOate exposure, implicating an insulin-independent signalling mechanism. Consistent with this, spermine NONOate increased AMP-activated protein kinase (AMPK)-alpha1-associated activity (1.7-fold, p < 0.05). In L6 muscle cells, spermine NONOate increased glucose uptake (p < 0.01) and glycogen synthesis (p < 0.001), an effect that was in addition to that of insulin. Spermine NONOate also elicited a concomitant increase in AMPK and acetyl-CoA carboxylase phosphorylation. In the presence of the guanylate cyclase inhibitor LY-83583 (10 micromol/l), spermine NONOate had no effect on glycogen synthesis and AMPK-alpha1 phosphorylation. CONCLUSIONS/INTERPRETATION: Pharmacological treatment of skeletal muscle with spermine NONOate increases glucose transport via insulin-independent signalling pathways involving increased intracellular cGMP levels and AMPK-alpha1-associated activity.

Post-transcriptional gene silencing of ribosomal protein S6 kinase 1 restores insulin action in leucine-treated skeletal muscle.

Excessive nutrients, especially amino acids, impair insulin action on glucose metabolism in skeletal muscle. We tested the hypothesis that the branched-chain amino acid leucine reduces acute insulin action in primary myotubes via a negative feedback mechanism involving ribosomal protein S6 kinase 1 (S6K1). The effect of S6K1 on glucose metabolism was determined by applying RNA interference (siRNA). Leucine (5 mM) reduced glucose uptake and incorporation to glycogen by 13% and 22%, respectively, compared to the scramble siRNA-transfected control at the basal level. Leucine also reduced insulin-stimulated Akt phosphorylation, glucose uptake and glucose incorporation to glycogen (39%, 39% and 37%, respectively), and this reduction was restored after S6K1 silencing. Depletion of S6K1 enhanced basal glucose utilization and protected against the development of impaired insulin action, in response to excessive leucine. In conclusion, S6K1 plays an important role in the regulation of insulin action on glucose metabolism in skeletal muscle.

Biology of the mealybug, Phenacoccus solenopsis on cotton in the laboratory.

Phenacoccus solenopsis Tinsley (Hemiptera: Pseudococcidae) has been the current topic of research for insect taxonomists and applied entomologists in India due to its invasiveness, rapid spread, morphological and biological variations and the need for establishing an effective control strategy. The biology of the mealybug P. solenopsis was studied on cotton under laboratory conditions between August and October of 2009 with mean temperature and relative humidity of 23.3­30.2° C and 40.5­92.5% RH, respectively, in central India. Neonate crawlers that emerged from a field population were collected and constituted the study population. The developmental period from immature crawler to adult stage was greater for males (18.7 ± 0.9 days) compared to females (13.2 ± 1.8 days), probably due to the additional molt to the pupal stage in males. Survival of second instars was lower (45.5%) than first and third instars (71.4%). Females showed dynamic patterns of fecundity with the number of crawlers produced per female ranging between 128 and 812, with a mean of 344 ± 82. The reproductive period lasted 30.2 ± 8.2 days. Parthenogenesis with ovoviviparity (96.5%) was dominant over the oviparous (3.5%) mode of reproduction. Adult females lived 42.4 ± 5.7 days. Males accounted for less than 5% of the population, and lived 1.5 ± 0.1 days. The life history parameters of P. solenopsis adult females are discussed relative to the appearance of symptoms on the cotton crop, and the importance of making management interventions during the effective reproductive period of the insect.

Re-revision total hip arthroplasty: Epidemiology and factors associated with outcomes.

INTRODUCTION: The epidemiology of re-revision total hip arthroplasty (THA) is not yet well-understood. We aim to investigate the epidemiology and risk-factors that are associated with re-revision THA. METHODS: 288 revision THA were analyzed between 1/2012 and 12/2013. Patients who underwent two or greater revision THA were included. Hips with first-revision due to periprosthetic joint infection (PJI) were excluded. Failure was defined as reoperation. RESULTS: 51 re-revision patients were available. Mean age was 59.6 (±14.2 years), 32 (67%) females, average BMI of 28.8 (±5.4), and median ASA 2 (23; 55%). The most common re-revision indications were acetabular component loosening (15; 29%), PJI (13; 25%) and instability (9; 18%). The most common indications for first revision in the re-revision population were acetabular component loosening (11; 27%), polyethylene wear (8; 19%) and instability (8; 19%). There was an increased risk of re-revision failure if the re-revision involved exchanging only the head and polyethylene liner (RR = 1.792; p = 0.017), instability was the first-revision indication (RR = 3.000; p < 0.001), and instability was the re-revision indication (RR = 1.867; p = 0.038). If isolated femoral component revision was indicated during the re-revision, there was a decreased risk of failure (RR = 0.268, p = 0.046). 1-year re-revision survival was 54% (23/43). DISCUSSION: Acetabular component loosening, instability, and PJI were the most common indications for re-revision. Revision due to instability is a recurrent problem that leads to re-revision failure. There was a higher infection rate in the re-revision population compared to published revision PJI. A better understanding of the indications and patient factors that are associated with re-revision failures can help align surgeon and patient expectations in this challenging population.

PAA Modified Upconversion Nanoparticles for Highly Selective and Sensitive Detection of Cu2+ Ions.

Detection of the Cu2+ ions is crucial because of its environmental and biological implications. The fluorescent-based organic sensors are not suitable for Cu2+ detection due to their short penetration depth caused by the UV/visible excitation source. Therefore, we have demonstrated a highly sensitive and selective near-infrared (NIR) excitable poly(acrylic acid) (PAA) coated upconversion nanoparticles (UCNPs) based sensor for Cu2+ detection. We construct the PAA modified Na(Yb, Nd)F4@Na(Yb, Gd)F4:Tm@NaGdF4 core-shell-shell structured UCNPs based sensor via a co-precipitation route. The upconversion emission intensity of the PAA-UCNPs decreases linearly with the increase in the Cu2+ concentration from 0.125 to 3.125 µM due to the copper carboxylate complex formation between Cu2+ and PAA-UCNPs. The calculated detection limit of the PAA-UCNPs based sensor is 0.1 µM. The PAA-UCNPs based sensor is very sensitive and selective toward detecting the Cu2+ ions, even when the Cu2+ co-exist with other metal ions. The EDTA addition has significantly reversed the upconversion emission quenching by forming the EDTA-Cu2+ complex based on their greater affinity toward the Cu2+. Therefore, the PAA-UCNPs based sensor can be a promising candidate for Cu2+ detection because of their higher sensitivity and selectivity under 980 nm NIR excitation.