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Context: Total knee arthroplasty (TKA) associated with moderate-to-severe surgical site pain postoperatively requires multimodal analgesia for which adductor canal block (ACB) is an effective modality. Aims: The aim of this study was to compare the analgesic efficacy of continuous versus single-shot ACB in patients undergoing unilateral TKA. Settings and Design: It was a prospective randomized controlled trial carried out in a tertiary care hospital. Materials and Methods: Sixty patients (18–65 years) undergoing unilateral TKA were prospectively randomized into continuous (CACB) and single (SACB) shot adductor canal blockade groups. Postoperative ultrasound-guided ACB was given, and the Visual Analog Scale (VAS) scores, time to first rescue analgesia, and total amount of analgesia required in 24 and 48 h were noted. Straight leg raise (SLR) test and maximum knee extension test were performed to check for quadriceps muscle strength. Statistical Analysis: Both the groups were compared using appropriate statistical tests, with P < 0.05 considered statistically significant. Results: In both the demographically comparable groups, VAS scores were similar at 0, 4, 8, and 12 h postsurgery, but higher in the SACB group at 24 (P < 0.0001) and 48 h (P = 0.02), needing rescue analgesia in 4 out of 30 patients. One out of 30 patients of the SACB group could not perform the SLR test on the 1st postoperative day. Knee extension was present in all 60 patients. Conclusions: ACB is a pure sensory block. CACB provides a longer duration of analgesia; however, SACB can be an equally useful alternative in resource-limited settings, to avoid catheter dislodgement, risk of infection, and need for continuous monitoring.

Background and Aim: Head-and-neck cancers (HNCs) are significant causes of morbidity and mortality in both the developed and developing worlds. One of the most common types of HNC is oral squamous cell carcinoma (OSCC). The rationale behind the present study is to analyze the effectiveness of nuclear proliferative markers in comparison to the various grades of OSCC. This study utilizes Anneroth's histopathological multifactorial grading system for squamous cell carcinoma and further tends to compare this histological grading with nuclear proliferative indices of p53 and argyrophilic nucleolar organizer region (AgNOR). The aim of this study was to establish and develop a correlation between the proliferative markers, AgNOR and p53, and the histologic grade of the tumor (Anneroth's grading). Materials and Methods: A total of 60 cases of oral squamous cell carcinoma were taken from October 2020 to September 2022. The histological grading was done according to Anneroth's grading, and a score was given. P53 expression was graded according to the percentage of cells showing p53-positive immunostaining, and scoring was done from 0 to 3. The AgNOR score was calculated by examining 100 nuclei and calculating the mean AgNOR score per nucleus. Results: A significant linear correlation was obtained between the histological grading of OSCC and the proliferative markers (p53 and AgNOR). Conclusion: The analysis of the NOR count provides invaluable assistance in determining tumor aggressiveness and cellular proliferation rates. They can prove to be efficient tools to procure information on the malignant potential of different premalignant lesions. Elevated p53 expression implies greater clinical severity, a higher histological grade, and a poor prognosis for oral squamous cell carcinoma. Hence, the proliferative markers can be used as adjuncts to the histological grading system of OSCC.

Fine needle aspiration cytology (FNAC) is a widely accepted procedure for evaluating breast masses. Cystic lesions in female breasts are common. However, they are incredibly uncommon in male breasts, especially in cytology. Here, we report a rare benign breast cyst diagnosis on FNAC in a 26-year-old male patient without associated gynecomastia. A 26-year-old male patient presented to surgery outpatient department with left breast swelling for 3 months. He had no history of pain, nipple discharge, or fever. The patient, however, was on antitubercular treatment for pulmonary tuberculosis. On physical examination, a small diffuse 5–6 mm lump was palpable in the left breast. Ultrasound revealed a soft small tissue lesion in the superior aspect of the left areola with the suspicious flow on color flow Doppler following which FNAC was advised. Aspiration yielded scanty fluid. On microscopy, smears showed low cellularity comprising few monolayered sheets and small aggregates of benign ductal epithelial cells admixed with a fair number of cystic macrophages in a fluid background. There was no evidence of malignancy. Thus, a cytologic diagnosis of a benign breast cyst was rendered. This is the first case report describing the cytology of a benign breast cyst diagnosed in a male patient as young as 26 without associated gynecomastia. We report this case because of the rarity of this condition and to create awareness that breast cysts should also be kept in mind when dealing with male breast masses, thus avoiding unnecessary surgery, especially in a young men.

The eyes and kidneys are the targets for end-organ damage in multiple pathologies. Both these organs develop during the same embryonic stage around the fourth to sixth week of gestation, thus sharing a strong correlation between both eye and kidney diseases. Both the eyes and kidneys can be the target of the systemic disease process; however, the eyes can also be affected as a consequence of renal disease or its treatment. Risk factors such as diabetes, hypertension, and smoking are commonly shared between kidney and eye diseases. Ocular manifestations can be predictive of renal disease, and/or patients with renal disease are at higher risk for developing ocular manifestations. Various congenital anomalies of the eyes and kidneys can also present as an oculorenal syndrome. This article summarizes the ocular pathology, which can be seen in renal diseases.

Purpose – This research study aims to design a novel risk-managed time-series momentum approach. The present study also examines the time-series momentum effect in the Indian equity market. Apart from this, the study also proposes a novel risk-managed time-series momentum approach. Design/methodology/approach – The study considers the adjusted monthly closing prices of the stocks listed on the Bombay Stock Exchange from January 1996 to December 2020 to formulate long-short portfolios. Newey–West t statistics were used to test the significance of momentum returns. The present research has considered standard risk factors, i.e. market, size and value, to evaluate the risk-adjusted performance of time-series momentum portfolios. Findings – The present research reports a substantial absolute momentum effect in the Indian equity market. However, absolute momentum strategies are exposed to occasional severe losses. The proposed time-series momentum approach not only yields 2.5 times higher return than the standard time-series momentum approach but also causes substantial enhancement in downside risks and higher-order moments. Practical implications – The study's outcomes offer valuable insights for professional investors, capital market regulators and asset management companies. Originality/value – This study is one of the pioneers attempting to test the time-series momentum effect in emerging economies. Besides, current research contributes to the escalating literature on risk-managed momentum by suggesting a novel revised time-series momentum approach.

Endometriosis is a prevalent benign condition arising from the female reproductive system and affects about 7%–10% of females. The association of endometriosis with serous borderline ovarian tumors has been a matter of interest in gynecology. Sampson first described the association between endometriosis and carcinoma. The endometriosis-associated ovarian malignancies are clear cell adenocarcinoma and endometrioid adenocarcinoma, whereas serous and mucinous are rare malignancies associated with endometriosis. Here, we present the case report of a 45-year-old female in which endometriosis was associated with borderline serous tumor, since there is a lack of enough confident criteria for diagnosing endometriosis-associated ovarian tumors.

Background: Robotic surgeries have improved perioperative outcomes. We have combined ultrasound (USG) guided bilateral rectus sheath (RS) block along with transverse abdominis plane (TAP) block to assess perioperative opioid requirement, visual analog scale (VAS) score, and modified Post Anesthetic Discharge Scoring System (PADSS) criteria for robotic urological surgeries. Ultrasound (USG)-guided blocks were given bilaterally after induction of general anesthesia. Methods: A total of ten patients scheduled for robotic urological surgeries were administered 30 ml of 0.25% bupivacaine (2.5 mg kg-1) with 0.75 mcg kg-1 of clonidine (10 ml of drug was given for TAP block and 5 ml of drug for RS block on each side) after negative aspiration. Results: Supplemental opioid was not required perioperatively, and 9 out of 10 patients were pain free (VAS score

Endometriosis refers to the implantation and growth of functional endometrial tissue outside the uterus. The common sites include ovaries, pelvic peritoneum, deep pelvic subperitoneal spaces, intestinal system, and urinary system. Endometriosis of a uterine scar is extremely rare. Uterine scar endometriosis has been described in women of reproductive ages following an obstetrical or gynaecological surgery. Despite a varying range of clinical presentations, a probable diagnosis is possible with imaging modalities like ultrasound and Magnetic Resonance Imaging (MRI). Herein the authors report a case of 26-year-old patient complaining of recurrent pelvic pain since five months, MRI diagnosed the scar endometrioma in the uterine wall. The patient has not undergone the advised surgical excision of lesion and has continued the medical management.

PURPOSE: To compare the therapeutic effect of sodium hyaluronate (SH)–trehalose (Trehalube, Microlabs, Bangalore, India, SH 0.1% and trehalose 3%) or SH (0.1% Hylotears, Raymed, Chandigarh, India) alone in patients with dry eye disease (DED). MATERIALS AND METHODS: Patients were randomized into two groups: SH-trehalose (SH 0.1% and trehalose 3%) or SH (0.1% Hylotears) alone. The Ocular Surface Disease Index (OSDI) questionnaire was used to assess patient's symptoms. Patients were followed up at 4 and 8 weeks, and OSDI score, tear film break-up time (TBUT), tear film height (TFH), Schirmer's test, and conjunctival staining were evaluated at each visit. RESULTS: A total of 384 patients were included in the study, 192 patients in each arm. The mean age of participants was 37.62 + 14.4 years and 225 were women (56%). The improvement in Schirmer's test was significantly better in the SH-trehalose group at 8 weeks (5.26 + 4.3 mm, 95% confidence interval = 4.6–5.9 mm) compared to the SH group (3.71 + 3.9, 95% confidence interval = 3.15–4.28 mm). The TBUT and TFH showed slight improvement at 4 weeks in both groups, but not at 8 weeks. There were no group differences at all-time points in terms of conjunctival staining and OSDI-based grades of DED. CONCLUSION: It was found that treating dry eye with SH-trehalose leads to greater improvement in the Schirmer's values and TBUT after 8 weeks of sustained use in patients with DED, and this was more pronounced in those with severe DED.

While the impetus to develop lithium metal solid-state batteries is clear, identifying a practical manufacturing process is challenging. Herewith, authors study the underlying mechanisms controlling in-situ anode formation that could enable viable lithium-free manufacturing.

The aim of this review article is to summarize the available literature on physiologic and pathologic ocular changes during pregnancy and the effect of diseases in pregnancy. A literature search was conducted using PUBMED, MEDLINE, and Cochrane library in English. In addition, the cited references in the published articles were manually reviewed for the relevant results. Pregnancy encompasses a multitude of changes in all body systems, including the visual system of the female. The changes can be physiological, i.e., changes occurring in the lids and adnexa, cornea, conjunctiva, changes in tear film composition and intraocular pressure, retina, choroid, and visual field. Pathological changes in a pregnant woman's eye include changes related to preeclampsia and eclampsia, central serous chorioretinopathy, retinal artery or vein occlusions, and disseminated intravascular coagulation. Preexisting diseases like diabetic retinopathy, Graves' disease, idiopathic intracranial hypertension, various inflammatory conditions can undergo changes in their course during pregnancy. Ophthalmic medications can have an effect on both mother and the baby and hence should be used cautiously. In addition, intrauterine infections play a major role in causing inflammation in the eye of the baby. Hence, vaccination of the mother prior to pregnancy plays an important role in preventing intrauterine infections in the neonate. A regular eye examination in the perinatal period plays a vital role in recognizing ophthalmic pathologies which might require a prompt medical intervention. Pathological ocular diseases should be discriminated from physiologic changes to establish an individualized treatment or preventive plan. This approach to ocular benefits of treatment to the mother should always weigh against the potential harm to the fetus.

Purpose: To investigate choroidal hyper-reflective foci (HRF) in subjects with retinal dystrophy [Stargardt's disease (SGD) and retinitis pigmentosa (RP)] and their association with demographics, visual acuity, choroidal thickness (CT), and choroidal vascularity index (CVI). Methods: Single center retrospective study of subjects with previously diagnosed SGD or RP. Swept-source optical coherence tomography images were analyzed for the presence of choroidal HRFs and CVI using previously validated automated algorithm. A Spearman's rank correlation coefficient was used to evaluate the correlation between the number of HRF and various baseline parameters including age, visual acuity, intraocular pressure, and other optical coherence tomography (OCT) parameters (CT, choroidal area, and CVI) were evaluated in these subjects. Results: This study included 46 eyes (23 subjects) and 55 eyes (28 subjects) with previously diagnosed RP and SGD, respectively. In the RP group, the mean number of HRFs was 247.9 ± 57.1 and mean CVI was 0.56 ± 0.04. In SGD group, mean HRF was 192.5 ± 44.3 and mean CVI was 0.41 ± 0.04. Mean HRF was significantly greater in the RP group (0.02), however, the mean CVI was not statistically different. In RP, mean HRF were correlated only with CVI (r = 0.49; P = 0.001), however, in SGD, it correlated with only choroidal area (r = 0.27; P = 0.04). Conclusion: Choroidal HRF were present in both RP and SGD subjects with more HRFs in those with RP. These HRFs were associated with alteration in choroidal vascularity, which further adds into the pathogenesis of these diseases.

Mitochondria contain two membranes, the outer and inner membrane. The outer membrane fulfills crucial functions for the communication of mitochondria with the cellular environment like exchange of lipids via organelle contact sites, the transport of metabolites and the formation of a signaling platform in apoptosis and innate immunity. The translocase of the outer membrane (TOM complex) forms the entry gate for the vast majority of precursor proteins that are produced on cytosolic ribosomes. Surveillance of the functionality of outer membrane proteins is critical for mitochondrial functions and biogenesis. Quality control mechanisms remove defective and mistargeted proteins from the outer membrane as well as precursor proteins that clog the TOM complex. Selective degradation of single proteins is also an important mode to regulate mitochondrial dynamics and initiation of mitophagy pathways. Whereas inner mitochondrial compartments are equipped with specific proteases, the ubiquitin-proteasome system is a central player in protein surveillance on the mitochondrial surface. In this review, we summarize our current knowledge about the molecular mechanisms that govern quality control of proteins at the outer mitochondrial membrane.

Introduction: Laryngeal Mask Airway ProSeal (LMA-P) is considered a gold standard among second generation supra glottis airway devices as an effective, safe and reusable ventilatory device. Ambu Aura Gain (AAG) is a newer single use second generation airway device with a soft inflatable cuff and preformed shape. Aim: To compare the clinical effectiveness and oral pharyngeal seal pressures between LMA ProSeal and AAG in children receiving controlled ventilation. Materials and Methods: This study was conducted in 100 paediatric patients in age group of 1 to 12 years, weighing 5 to 30 kg, fulfilling the criteria of American Society of Anaesthesiologists (ASA) Physical Status I and II and undergoing elective surgical procedures. Patients were randomised into two groups. Secondary objective was to compare the ease, success and total time for achieving effective ventilation and ease of placement of gastric tube and fibreoptic visualisation of glottis view in both the groups. Quantitative variables were compared using Independent t-test/Mann-Whitney Test and qualitative variables were compared using Chi-Square test/Fisher’s-Exact test. Results: The median (IQR) Oropharyngeal Seal Pressure (OSP) was much higher with AAG 22 cm (21-23) of water as compared to LMA ProSeal 21 cm (20-22) of water and the difference was statistically significant (p-value

The datasets presented in this article are related the research paper entitled “A Linear Classifier Approach for Identifying Security Requirements in Open Source Software Development” Wang et al. (2018) [1]. This article describes requirements collected from three open-source software (OSS) projects and labels of security requirements. The datasets are made available to support automated security requirements analyzing tools development as well as tools’ evaluation. Keywords: Security requirements, Open-source software

A Correction to this paper has been published: https://doi.org/10.1038/s41467-020-20374-y

Surgery for advanced breast malignancy in the last trimester of pregnancy is uncommon. We present successful management of a 32-year-old woman, 30 weeks pregnant with stage 3 breast malignancy, for surgery followed by normal labor and chemotherapy. Surgery and intraoperative period were uneventful. Patient had uterine contractions 36 h postsurgery, which were managed timely with active interventions and tocolytics. Risk of premature labor following nonobstetric surgery in pregnant patients is estimated to be 8.3%, but majority of the studies have been carried out in second trimester following appendectomy. There is insufficient data in literature regarding the estimation and duration of persistence of risk of premature labor in these patients. No guidelines are available regarding how long they need to be monitored for premature labor. There is some evidence, although little that risk of premature labor persists for 7 days postsurgery. In the absence of convincing studies and guidelines, we recommend postoperative monitoring for at least 7 days in patients undergoing major surgeries for malignancies in last trimester. Multidisciplinary approach is required to manage these patients.

Blunt neck trauma with an associated laryngotracheal injury is rare. We report a patient with blunt neck trauma who came to the emergency room and was sent to ward without realizing the seriousness of the situation. He presented later with respiratory distress and an anesthesiologist was called in for emergency airway management. Airway management in such a situation is described in this report.