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Meat is an important component of the food basket of India and it plays a critical role in meeting protein demand and ensuring the nutritional security of the ever-growing population. Concerns related to environmental impact, shrinking resources, and animal welfare issues continue to haunt the meat industry. Cultured meat on the other hand promises to produce meat without the need to rear the livestock by utilizing fewer resources with minimum impact on the environment. Here, an effort has been made to capture the perception of Indian consumers towards cultured meat by conducting a survey. Results of the survey revealed that about 60.52% of the respondents are willing to buy the cultured meat if made available. It was found that 45.9% of the respondents who are willing to buy cultured meat are ready to pay a premium price range between 10-30%. Among the respondents, 54.0, 59.1 and 66.5% opinedthat cultured meat is a potential alternative to traditional meat in view of challenges like sustainability, nutritional security, and animal welfare, respectively. [ABSTRACT FROM AUTHOR]

The conduct and reporting of studies with a noninferiority hypothesis is challenging because of the complexity involved in their design and interpretation. However, studies with a noninferiority design have increased in popularity. A recently published trial reported on the noninferiority of lidocaine infusion to epidural analgesia in major abdominal surgeries. Apart from needing a critical appraisal, this draws attention to improve our understanding of noninferiority study framework and its unique features. Given the increasing focus on using various analgesic adjuncts and multiple approaches to fascial plane blocks to avoid more definitive and standard approaches, it is imperative that particular attention is paid to appropriate execution and reporting of noninferiority studies. [ABSTRACT FROM AUTHOR]

Introduction: Focal Segmental Glomerulosclerosis (FSGS) is a nephrotic syndrome with a variety of clinicopathological presentations and varied responses to treatment. Hence, this study attempts to classify FSGS based on clinical presentation and pathological findings on kidney biopsy, which is essential for appropriate treatment and avoidance of inappropriate use of immunosuppressants. Aim: To analyse clinicopathological findings and responses to immunosuppressants in FSGS. Materials and Methods: A retrospective cohort study was conducted at Department of Nephrology, Vydehi Institute of Medical Sciences and Research Centre Bengaluru, Karnataka, India, to analyse clinicopathological parameters such as urine analysis, 24-hour urine protein, serum creatinine, serum albumin, lipid profile, renal biopsy details, and response to treatment in 97 patients. The study was planned, analysed, and executed between January 2023 and February 2023. All variables were expressed as mean±standard deviation or percentage. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) software version 16.0. Results: Among a total of 97 patients, 64% were males. Sudden onset oedema was observed in 90% of the cases, while nephrotic proteinuria was seen in 71%. The Not Otherwise Specified (NOS) variant was noted in 60% of the cases. Complete remission was observed in 61%, suggesting a possible primary FSGS. Persistent nephrotic proteinuria with a poor response to therapy was noted in 32%, indicating a possible secondary/genetic FSGS, despite adequate immunosuppressive therapy. Therefore, differentiating between primary and secondary forms of FSGS has therapeutic and prognostic implications. Accurate diagnosis of each form of FSGS is vital to avoid unnecessary immunosuppressive-based therapy and establish appropriate treatment. Conclusion: Resistance to steroid therapy was observed in one-third of FSGS patients. It is likely that unrecognised genetic FSGS or secondary FSGS were included among the study group of primary FSGS, leading to misinterpretation of treatment responses in primary FSGS. Hence, a clinicopathological approach for correctly differentiating between primary FSGS, secondary (maladaptive, viral, or toxic) FSGS, and genetic FSGS helps in making correct treatment decisions. [ABSTRACT FROM AUTHOR]

These practice guidelines are a modular update of the "Practice guidelines for preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration: Application to healthy patients undergoing elective procedures." The guidance focuses on topics not addressed in the previous guideline: ingestion of carbohydrate-containing clear liquids with or without protein, chewing gum, and pediatric fasting duration. [ABSTRACT FROM AUTHOR]

This document is a response to a letter to the editor regarding a study on the use of erector spinae plane blocks (ESPBs) for pain management after open lumbar laminectomy. The authors address the concerns raised in the letter, stating that there was no surgical site infiltration in either group and that the only difference was the administration of ESPBs in the study group. They also discuss the limitations of surgical site infiltration and the need for further research comparing ESPBs with local wound infiltration. The authors acknowledge the need to assess functional pain in future studies and clarify that there is no evidence supporting the claim that pain scores of 3 or less are necessary for early mobilization. They also acknowledge a typographical error in one of the tables and state that they are working with the publishers to correct it. [Extracted from the article]

Guidelines are increasingly being used for clinical decision-making. Such guidelines are usually based on meta-analyses, which are generally derived from RCTs. However, their interpretations are often hindered as they do not always consider current clinical relevance. Analyses of RCTs assessing analgesic efficacy of advanced regional analgesic techniques in knee arthroplasty show that the majority of trials do not include a package of basic analgesics such as paracetamol, NSAIDs or cyclooxygenase-2 specific inhibitors, dexamethasone, and local infiltration analgesia in the comparator group. Consequently, the current approach to analyse meta-analyses of pain interventions is not optimal, and may lead to inadequate or inappropriate conclusions and clinical guidance. [ABSTRACT FROM AUTHOR]

The use of gabapentinoids for perioperative pain management after total knee arthroplasty has been the subject of nine systematic reviews and meta‐analyses. A critical analysis of the clinical aspects of the methodology of these publications shows major flaws which limit the interpretation for the recommended use of perioperative gabapentinoids in pain management for unilateral primary total knee arthroplasty. Consequently, readers and authors of systematic reviews and meta‐analyses should critically assess the clinical aspects of the included studies. [ABSTRACT FROM AUTHOR]

Introduction. Cholera is gastroenteritis caused by Vibrio cholerae. It presents with vomiting, severe secretory diarrhoea, and dehydration. It can cause severe complications with severe electrolyte imbalances and oligoanuric acute kidney injury due to acute tubular necrosis secondary to dehydration or infection itself. However, cholera presenting with significant proteinuria and acute kidney injury has not been reported. Hence, this study was conducted. Aims and Objectives. This aim of this study was to assess clinical features, treatment, and prognosis of AKI in cholera patients; to correlate proteinuria with AKI in cholera patients; and to compare cholera patients with normal kidney function and those with AKI. Material and Methods. It was a retrospective observational study involving patients with cholera. Information regarding cholera patients with acute kidney injury, proteinuria, and prognosis were collected. Results. Most of the patients had significant vomiting, moderate-to-severe diarrhoea, dehydration, and hypovolaemic shock. Cholera caused severe complications such as severe electrolyte imbalances including hyponatraemia and hypokalaemia, acute kidney injury, and proteinuria secondary to dehydration or infection. A surprising finding noted was the lack of significant association between the onset of acute kidney injury and usual risk factors such as hypovolaemic shock and dehydration. It was found that proteinuria had influenced the onset of acute kidney injury, but it did not influence recovery. As there was complete recovery in kidney function, none of the cases required kidney biopsy. There was no mortality noted. Conclusions. This study points towards the rare occurrence of proteinuria and acute kidney injury in Vibrio cholerae infection with spontaneous remission of kidney disease with appropriate therapy. [ABSTRACT FROM AUTHOR]

The medical and social impact of being overweight, as well as the difficulty in making long-term changes in diet, physical activity, and pitfalls associated with allopathic management, lure obese individuals to over-the-counter weight-loss herbal products (WHPs). However, the safety of herbals is questionable, as reports from all over the world suggest adulteration with synthetic weight loss agents. Objective: The present study was carried out to develop a rapid and sensitive method to screen potential weight loss adulterants in WHPs. Methodology: We procured 33 licensed brands of WHPs that are available in Puducherry (India) and through web stores. Drug-free spiked herbal matrices were used for internal proficiency testing. Spiked herbal matrices and samples were extracted and centrifuged. The supernatant was collected and subjected to liquid chromatography–tandem mass spectrometry analyses. Isocratic elution was carried out by the mobile phase of methanol: 0.1% v/v formic acid (70%:30% v/v) through a C18 column. Analytes were monitored in electrospray ionization positive and negative modes, and an multiple reaction monitoring (MRM) scan was used. Results: Run time was 12 min. Intra- and inter-day precision was < 15% and recoveries were in the range of 99% to 115%. Limit of quantification (LOQ) of the analytes were in the range of 0.1 to 0.3 ng/ml. Conclusion: We developed a sensitive and rapid validated method for the detection of potential adulterants in WHPs. None of the WHPs analyzed were found to contain adulterants. The proposed method will be useful for routine monitoring. WHPs analyzed in this study were not adulterated indicating that WHPs from licensed sources are reliable. [ABSTRACT FROM AUTHOR]

Introduction: Acute Kidney Injury (AKI) and Chronic Kidney Disease (CKD) are risk factors for COVID-19 infection. Patients with kidney disease also have other co-morbidities like hypertension, diabetes mellitus, cardiovascular disease that are risk factors for poor outcome in COVID-19 infections. Severe COVID-19 has multiorgan involvement including AKI. Compared to normal population, renal failure patients with COVID-19 have extensive lung involvement, need more ventilator support, and have higher mortality. Aim: To assess outcome (mortality, recovery) and association between factors (age, gender, co-morbidities), biochemical parameters with mortality in COVID-19 patients requiring haemodialysis. Materials and Methods: It was a retrospective observational study wherein, data was collected, entered and analysed with Statistical Package for the Social Sciences (SPSS) version 19.0 using medical records of all COVID-19 patients who had renal failure (AKI or CKD) requiring haemodialysis. The study period was from June-September 2020 at Vydehi Institute of Medical Sciences and Research Centre, Bangalore, Karnataka, India. Results: Out of total 68 COVID-19 positive patients, mean age of presentation was 55.08 years and with 75% of the study population were males. Most patients presented with severe COVID-19 illness with tachypnoea and hypoxia. The AKI occurrence and mortality was noted in 44.1% and 47%, respectively. It was noted that medication usage was higher for corticosteroids, oseltamivir, vitamin C, zinc therapy. Conclusion: In the present single centre study involving COVID-19 patients requiring haemodialysis, it was noticed that severe COVID-19 illness, presence of AKI, chronic respiratory illness and high inflammatory markers were associated with higher mortality. [ABSTRACT FROM AUTHOR]

Background: The suitability of ambulatory surgery in obese patients remains controversial. This study aimed to investigate the "cutoff" value of body mass index (BMI) associated with increased likelihood of hospital readmissions within the first 24 hours of surgery in patients undergoing ambulatory hernia repair.Materials and Methods: The study used data from the 2012-2016 American College of Surgeons National Surgical Quality Improvement (ACS-NSQIP). Cochran Armitage trend tests were conducted to assess progression in rates hospital readmissions across categories of patient BMI. The minimum p-value method, Kolmogorov-Smirnov goodness of fit tests, logistic regression, and receiver-operating characteristic (ROC) curve analyses were used to investigate the cutoff of patient BMI indicative of increased likelihood of readmissions.Results: A total of 214,125 ambulatory hernia repair cases were identified. Of those, 908 patients (0.42%) had an unexpected hospital admission within the first 24 hours after surgery. The readmission rates did not significantly increase across the categories of BMI. However, some of the reasons for readmission significantly differed by BMI category. Logistic regression analysis revealed no statistically significant association between BMI and hospital readmissions (odds ratio [95% Cl], 0.96 [0.91-1.02] P = .179). An optimal BMI threshold predictive of an increased likelihood of hospital readmissions was not identifiable by any of the statistical methods used.Conclusions: Although reasons for readmission differed by BMI category, there is no clear cutoff value of BMI associated with increased hospital readmission within the first 24 hours after surgery. [ABSTRACT FROM AUTHOR]

Abstract: A one-pot, multi-component, synthetic method for preparation of 2-amino-4-substituted-1,4-dihydrobenzo[4,5]imidazo[1,2-a]pyrimidine-3-carbonitriles has been developed. It was accomplished by mixing 2-aminobenzimidazole, aldehyde and malononitrile in the presence of S-Chit-HAp@Fe3O4 as a nanocatalyst in aqueous medium. The catalyst (S-Chit-HAp@Fe3O4) was synthesized using a co-precipitation method and further characterized by using FT-IR, XRD, FE-SEM, EDX, HR-TEM, TGA and VSM analysis. It was found that the catalyst exhibits magnetic properties and showed high catalytical activity for the synthesis of 2-amino-4-substituted-1,4-dihydrobenzo[4,5]imidazo[1,2-a]pyrimidine-3-carbonitriles.Graphical Abstract: S-Chit-HAp@Fe3O4 nanoparticles catalyzing one-pot, multi-component synthesis of 2-amino-4-substituted-1,4-dihydrobenzo[4,5]imidazo[1,2-a]pyrimidine-3-carbonitriles in aqueous medium has been reported herein. [ABSTRACT FROM AUTHOR]

Regional analgesia is a core component of an optimal multimodal analgesia technique. Several advanced regional analgesic techniques have been evaluated for mastectomy; however, the optimal choice remains unclear. Many randomised clinical trials (RCTs) evaluating various local/regional analgesic techniques do not include basic analgesics (i.e. paracetamol, non-steroidal anti-inflammatory drugs, cyclooxygenase-2 specific inhibitors, and dexamethasone) which precludes objective evaluation of their efficacy. The aim of this scoping review was to assess the use of basic analgesics in RCTs evaluating efficacy of local and regional analgesic techniques in patients undergoing mastectomy. PubMed was searched to identify relevant articles from January 1, 2010 to May 31, 2023. The key finding of this study is that almost 90% (n =82/92) of the RCTs evaluating local/regional analgesic techniques in patients undergoing mastectomy did not administer well accepted basic analgesics in the comparator groups. Consequently, the conclusions of the RCTs assessing local/regional analgesic techniques for mastectomy should be interpreted with caution. Also, clinical guidelines based on meta-analyses of these RCTs could be inadequate or inappropriate. [ABSTRACT FROM AUTHOR]

A species-specific polymerase chain reaction (PCR) was developed for the identification of beef that is cattle (Bos indicus) meat by targeting mitochondrial D-loop region. A pair of beef-specific primers was designed to amplify conserved region of D-loop and possibility of cross-amplification was ruled by taking into account other species comprising of mammals, birds, rodents and fish. The amplified PCR product of 381 bp was evident in raw (n = 20), cooked (60, 80 and 100°C), autoclaved (121°C) and micro-oven processed beef samples. Sensitivity of PCR assay was at 0.1% for detection of beef adulteration and the limit of detection (LOD) of beef DNA was 0.1 picograms (pg). Newly developed beef-specific PCR assay was rapid and sensitive and hence could be applied for the detection of adulteration of meat. [ABSTRACT FROM AUTHOR]

Background The aim of the study was to assess the rate of 30-d hospital readmissions after ambulatory laparoscopic cholecystectomy. Materials and methods The 2009 to 2011 State Ambulatory Surgery and Services and State Inpatient Databases from California, Florida, and New York were analyzed to evaluate the incidence of 30-d readmissions after laparoscopic cholecystectomy performed in outpatient settings. Hospital transfers and the principal diagnoses of hospital readmission were analyzed as secondary outcomes. Multilevel generalized mixed linear regression analyses with fixed and random effects were used to evaluate variables associated with increased likelihood of readmissions. Results A total of 230,745 encounters for ambulatory laparoscopic cholecystectomies performed in 890 ambulatory facilities between 2009 and 2011 in the three states were analyzed. The rate of 30-d readmission was 20.2 per 1000 discharges. The rate of direct transfers from the ambulatory surgery center to an acute care hospital was 0.6 per 1000 discharges. The most common diagnoses of readmission were surgical complications, postoperative pain, infection, and nausea or vomiting. After adjusting for comorbidities, increasing age, male sex, non-Hispanic white race/ethnicity, any nonprivate insurance type, diagnosis of acute cholecystitis, use of intraoperative cholangiography, and having the procedure performed on a weekend were significantly associated with increased odds of 30-d readmissions. Conclusions This large-state data analysis reveals that the unplanned admission and readmission rates after laparoscopic cholecystectomy are very low. Some causes of readmission (e.g., pain, nausea, and vomiting) are modifiable by the intervention of surgeons and anesthesia providers. [ABSTRACT FROM AUTHOR]

A species-specific polymerase chain reaction (PCR) was developed for the identification of beef that is cattle (Bos indicus) meat by targeting mitochondrial D-loop region. A pair of beef-specific primers was designed to amplify conserved region of D-loop and possibility of cross-amplification was ruled by taking into account other species comprising of mammals, birds, rodents and fish. The amplified PCR product of 381 bp was evident in raw (n = 20), cooked (60, 80 and 100°C), autoclaved (121°C) and micro-oven processed beef samples. Sensitivity of PCR assay was at 0.1% for detection of beef adulteration and the limit of detection (LOD) of beef DNA was 0.1 picograms (pg). Newly developed beef-specific PCR assay was rapid and sensitive and hence could be applied for the detection of adulteration of meat. [ABSTRACT FROM AUTHOR]

The ordered arrays of nanostructure with vertically aligned tube like structure hold great promise as an electrode material for high-performance energy storage devices. Such binder-free structure of Titanium dioxide (TiO 2 ) has been synthesized by anodization of titanium (Ti) foil. The use of TiO 2 nanotube as an electrode material attain a specific capacitance of 207 F g − 1 at 5 mV s − 1 scan rate in 1 M potassium hydroxide (KOH) electrolyte. Extra ordinary cycling performance with 103% capacitance retention of their initial capacitance for 1500 cycles has been achieved, suggests its promising candidate as highly stable electrode material for supercapacitor application. [ABSTRACT FROM AUTHOR]

Chyluria is excreting chyle in urine leading to white urine. It can cause mild proteinuria. It could be parasitic or non parasitic in origin. It is often mistaken as nephrotic syndrome or urinary tract infection. Normal renal biopsy should prompt for further investigation. Lymphangiography or retrograde pyelogram can establish the diagnosis. Non parasitic chyluria is rare, but do occur like the one reported in this case. Hereby, authors discuss a case of chyluria associated with proteinuria in a 49-year-old male patient, due to non parasitic cause which was successfully treated. Treatment was done with installation of povidone iodine into renal pelvis. The resolution of chyluria and proteinuria suggest that abnormal lymphatic-urinary communications was causing chyluria. [ABSTRACT FROM AUTHOR]

High current density of 1.24 mA/cm 2 was drawn at an applied field of 4.4 V/μm from Ag/TiO 2 nanocomposite. Also the turn-on field has been reduced from 3.9 V/μm to 2.7 V/μm for the emission current density of 10 μA/cm 2 . Ag/TiO 2 nanocomposite was synthesized by using UV-switchable reducing agent. TiO 2 nanotube wall was decorated by Ag nanoparticles with average diameter of 17 nm. To the best of our knowledge this is the first report on the field emission studies of Ag/TiO 2 nanocomposite. Simple synthesis route coupled with superior field emission properties indicate the possible use of Ag/TiO 2 nanocomposite for micro/nanoelectronic devices. [ABSTRACT FROM AUTHOR]

High current density of 9.8 mA/cm 2 was drawn at an applied field of 4.1 V/μm from aligned Cd(OH) 2 nanosheets and low turn-on field of 1.4 V/μm was found for the emission current density of 10 μA/cm 2 . The aligned Cd(OH) 2 nanosheets were synthesized by CBD technique on Cadmium foil. To the best of our knowledge this is the first report on the field emission studies of Cd(OH) 2 nanosheets. Simple synthesis route coupled with superior field emission properties indicate the possible use of Cd(OH) 2 nanosheets for micro/nanoelectronic devices. [ABSTRACT FROM AUTHOR]

Highly dense TiO 2 nanotubes were synthesized by anodization of titanium foil. The TiO 2 nanotubes were characterized by using XRD, FESEM, TEM and HRTEM. GO/TiO 2 and RGO/TiO 2 nanocomposites were synthesized by electrophoresis method using de-ionised water. FESEM images confirm complete covering of the GO and RGO nanosheets on the entire surface of TiO 2 nanotubes. Field emission studies of TiO 2 nanotubes, GO/TiO 2 and RGO/TiO 2 nanocomposites have been carried out. Turn-on field for the emission current density of 10 μA/cm 2 , has been observed to be 2.9 V/μm, 3.3 V/μm and 2.6 V/μm for TiO 2 nanotubes, GO/TiO 2 and RGO/TiO 2 nanocomposites respectively. For the TiO 2 nanotubes, GO/TiO 2 and RGO/TiO 2 nanocomposites, the field enhancement factor (β) were calculated and are found to be 2059, 1482 and 2300. The turn-on field of the RGO/TiO 2 nanocomposite has been found to be superior than other reported values of TiO 2 nanostructures. To the best of our knowledge this is the first report on field emission studies of GO/TiO 2 and RGO/TiO 2 nanocomposites. Simple synthesis route coupled with the superior field emission behavior makes the present emitter more suitable for nano-electronics application. [ABSTRACT FROM AUTHOR]

Introduction: Renal failure is often seen with Urinary Tract Obstruction (UTO), which could be acute or chronic (obstructive nephropathy). With early diagnosis and treatment, it is often reversible. The data being sparse in literature, hence this study was planned. Aim: The present retrospective study was undertaken to discuss about causes, pathophysiology, site of obstruction, clinical features, diagnostic tests, management and factors affecting renal failure outcomes in cases of obstructive uropathy. Materials and Methods: All outpatient and inpatient cases of obstructive uropathy in 2016 were included and were subjected for renal function tests, radiological investigations. Stenting, diversion surgeries were performed to relieve obstruction. Student's t-test, Levene's test, chi-square/Fisher Exact-test were used for statistical analysis. Results: Of the 107 patients enrolled, bilateral UTO, intrinsic cause, chronic obstruction (>3 months duration), acute on Chronic Kidney Disease (CKD), Acute Kidney Injury (AKI), most common site of obstruction was ureter, seen in 58 (54%), 78 (72%), 71 (66%), 63 (58%), 44 (41%) and 47 (43%) cases respectively. Among co-morbities, history of past Urinary Tract Infection (UTI), past urological surgeries and diabetes mellitus were seen in 70 (65%), 62 (57%), and 62 (57%) cases respectively. Among the aetiology, blood clots, abdomen lymphadenopathy, ureter calculus were seen in 62 (57%), 16 (15%), and 14 (13%) cases respectively. Most common symptom was pain abdomen present in 98 (91%) cases. Among the complications, UTI was seen in 65 (60%). Dialysis therapy and most common urological intervention, ureter stenting was needed in 38 (35%) and 37 (34%) cases respectively. Renal failure recovery, post obstructive diuresis, death were noted in 34 (31%), 25 (23%) and 18 (16%) cases respectively. Conclusion: Comparing with renal failure recovered group, the non recovered group had statistically significant dominant males, were much older, had higher incidence of congenital blocks, acute on CKD, Pelvi-Ureter Junction (PUJ) obstruction, blood clots, abdomen lymphadenopathy, weight loss, abdomen mass, mineral bone disorder, emphysematous Acute Pyelonephritis (APN), lower haemoglobin, leukocytosis, dialysis need and Extracorpeal Shock Wave Lithotripsy (ESWL) therapy. [ABSTRACT FROM AUTHOR]

Textured Vanadium Nitride (VN) nanofibers are prepared from hydrothermally derived V 2 O 5 nanofibers by NH 3 reduction and nitridation approach. The reaction temperature is seen to be a crucial parameter to prepare pure VN phase. VN produced via this route has distinctive structural characteristics. The crystal structure, morphology, and oxidation states of the elements of VN nanofibers are characterized by XRD, FESEM, TEM, HRTEM, and XPS studies. Field emission properties for these textured VN nanofibers have been explored. The field emission properties show the reproducible turn-on field of 3.4 V/μm for the emission current density of 10 μA/cm 2 . The observed turn-on field is found to be quite superior compare to carbide, nitride and oxide nanostructures. High emission current density of 44 μA/cm 2 has been found at a field of 4 V/μm. Emission current stability for the preset current of 5 μA has been recorded for the period of 2 h. Present results indicate the considerable potential for the utilizing VN nanofibers as a cold cathode in the field emitter devices. [ABSTRACT FROM AUTHOR]

Study Objective: To compare the overall characteristics and perioperative outcomes in morbidly obese and nonobese patients undergoing ambulatory surgery in the United States. Design: Retrospective, propensity-matched cohort study. Setting: Academic medical center. Measurements: The association between duration of surgical procedures, postoperative complications, and unplanned hospital admission was assessed in a propensity-matched cohort of morbidly obese and nonobese patients derived from the 2006 National Survey of Ambulatory Surgery. Main Results: Only 0.32% of the ambulatory procedures were performed on morbidly obese patients. The morbidly obese were significantly younger but had a higher burden of comorbidities, were more likely to undergo the procedure in hospital-based outpatient departments (HOPD; 80.1% vs 56.5%; P = 0.004), and had significantly shorter procedures than the nonobese (median [interquartile range], 28 [21-38] vs 42 [22-65]min; P b 0.0001). The incidences of postoperative hypertension, hypotension, hypoxia, cancellation of surgery, and unplanned hospital admissions did not differ significantly between groups. Similarly, adjusted rates of delayed dischargewere similar in morbidly obese and nonobese patients (odds ratio [OR], 0.46; 95%confidence interval [CI], 0.18 - 1.15; P = 0.09). In contrast, morbid obesity was associated with decreased odds of postoperative nausea and vomiting (OR, 0.27; CI, 0.09 - 0.84; P = 0.01). Conclusions: In 2006 in the U.S., the prevalence of ambulatory surgery in the morbidly obese was low, with most of the procedures being performed in the HOPD facilities, suggesting a conservative patient selection. The incidence of adverse postoperative outcomes and delayed discharge, as well as unplanned hospital admission after ambulatory surgery in the morbidly obese, was similar to that reported in the nonobese. [ABSTRACT FROM AUTHOR]

Study Objective: To assess the effects of fentanyl administered before induction of anesthesia on movement and airway responses during desflurane anesthesia via the Laryngeal Mask Airway (LMA). Design: Randomized, double-blinded, controlled trial. Study Setting: Tertiary-care academic center. Patients: 100 adult, ASA physical status 1, 2, and 3 patients undergoing ambulatory surgery. Interventions: Patients were administered fentanyl 1 μg/kg (n=51) or saline (n=49) 3 to 5 minutes before induction with propofol 2-2.5 mg/kg intravenously (IV), followed by LMA placement. Anesthesia was maintained with desflurane titrated to a bispectral index (BIS) of 50-60 and 50% nitrous oxide in oxygen, and fentanyl 25 μg boluses were titrated to respiratory rate. Measurements: Apnea occurrence and duration of manual ventilation, as well as frequency and severity of movement, coughing, breath holding, and laryngospasm were recorded. Main Results: Two patients in each group were excluded from analysis. The fentanyl pretreatment group had a higher frequency of apnea (94% vs 64%; P=0.0003) and longer duration of manual ventilation (3 [interquartile range (IQR), 1.5-5] min vs 1 [0-1.5] min; P<0.0001) at induction. In contrast, the fentanyl pretreatment group had a lower frequency of movements (16% vs 51%; P=0.0001). The rates of intraoperative breath holding (6.1% vs 8.5%) and laryngospasm (2% vs 4.3%) in the two groups were similar. All subjects experiencing laryngospasm were smokers. Adjusting for smoking status did not affect the differences noted in apnea, duration of manual ventilation, or movement between groups; however, coughing occurrence was statistically higher in the placebo group (P=0.043). Conclusions: Preinduction fentanyl increased the frequency of apnea at induction and duration of manual ventilation, but reduced the frequency of movements. In addition, it reduced intraoperative coughing in smokers. [ABSTRACT FROM AUTHOR]

Despite advances in pharmacologic options for the management of surgical pain, there appears to have been little or no overall improvement over the last two decades in the level of pain experienced by patients. The importance of adequate and effective surgical pain management, however, is clear, because inadequate pain control 1) has a wide range of undesirable physiologic and immunologic effects; 2) is associated with poor surgical outcomes; 3) has increased probability of readmission; and 4) adversely affects the overall cost of care as well as patient satisfaction. There is a clear unmet need for a national surgical pain management consensus task force to raise awareness and develop best practice guidelines for improving surgical pain management, patient safety, patient satisfaction, rapid postsurgical recovery, and health economic outcomes. To comprehensively address this need, the multidisciplinary Surgical Pain Congress™ has been established. The inaugural meeting of this Congress (March 8 to 10, 2013, Celebration, Florida) evaluated the current surgical pain management paradigm and identified key components of best practices. [ABSTRACT FROM AUTHOR]

ABSTRACT Patients with neuromuscular disease pose many anesthetic challenges and are at greater risk for perioperative complications, including respiratory or cardiovascular dysfunction and pulmonary aspiration. Therefore, these patients require special precautions, including interdisciplinary communication between primary care physicians, neurologists, physiatrists, surgeons, and anesthesiologists. Preoperative evaluation and optimization of comorbid conditions is critical. These patients may have adverse response to neuromuscular blocking drugs and the reversal drugs (e.g., neostigmine). They should be used with caution and titrated based on objective neuromuscular monitoring. Drugs that potentiate neuromuscular blocking drugs should also be avoided or their doses limited if possible. The risk of malignant hyperthermia in certain neuromuscular diseases mandates avoidance of triggering agents such as succinylcholine and inhaled anesthetics. Patients with neuromuscular disease may also be sensitive to sedative-hypnotics and opioids, which should be used judiciously. Finally, the postoperative period requires close monitoring due to increased risk of postoperative cardiorespiratory dysfunction. Muscle Nerve 48: 451-460, 2013 [ABSTRACT FROM AUTHOR]

' QTL-hotspot ' is a genomic region on linkage group 04 (CaLG04) in chickpea (Cicer arietinum) that harbours major-effect quantitative trait loci (QTLs) for multiple drought-adaptive traits, and it therefore represents a promising target for improving drought adaptation. To investigate the mechanisms underpinning the positive effects of ' QTL-hotspot ' on seed yield under drought, we introgressed this region from the ICC 4958 genotype into five elite chickpea cultivars. The resulting introgression lines (ILs) and their parents were evaluated in multi-location field trials and semi-controlled conditions. The results showed that the ' QTL-hotspot ' region improved seed yield under rainfed conditions by increasing seed weight, reducing the time to flowering, regulating traits related to canopy growth and early vigour, and enhancing transpiration efficiency. Whole-genome sequencing data analysis of the ILs and parents revealed four genes underlying the ' QTL-hotspot ' region associated with drought adaptation. We validated diagnostic KASP markers closely linked to these genes using the ILs and their parents for future deployment in chickpea breeding programs. The CaTIFY4b-H2 haplotype of a potential candidate gene CaTIFY4b was identified as the superior haplotype for 100-seed weight. The candidate genes and superior haplotypes identified in this study have the potential to serve as direct targets for genetic manipulation and selection for chickpea improvement. [ABSTRACT FROM AUTHOR]

Background: Multimodal pain therapy including cyclo-oxygenase-2 inhibitors can result in optimal pain management with decreased opioid use and fewer opioid-related adverse events. Patient reported outcomes (PROs) help identify benefits in reduced opioid use and increased pain control. Methods: In this randomized, double-blind trial, patients (n = 1062) undergoing major non-cardiac elective surgery received either parenteral parecoxib for 3 days or placebo then oral valdecoxib or placebo for a total of 10 days, with both arms being allowed additional opioid analgesia. Clinically meaningful opioid-related adverse events were assessed daily using the Opioid-Related Symptom Distress Scale (OR-SDS). Pain severity and interference with function were evaluated daily using the modified Brief Pain Inventory exploratory form (mBPI-e). Additional validation work was undertaken to understand the psychometric properties of the two PROs. Detailed clinical results were reported elsewhere. Results: Patients receiving parecoxib/valdecoxib achieved significantly better pain control and consumed 37% and 28% less opioid medication than the placebo group on day 2 and day 3, respectively. Over the 10-day treatment period, patients receiving parecoxib/valdecoxib consumed 31% less opioid medication. This coincided with significantly fewer (p < 0.0001) OR-SDS clinically meaningful events (CMEs) and lower mBPI-e scores from days 2-10 in the parecoxib/valdecoxib group compared with the placebo group. On day 3, the percentage of patients reporting one, two or three CMEs in the parecoxib/valdecoxib versus placebo group was 11.6% versus 13.0%, 2.3% versus 5.1%, and 0.8% versus 2.3%, respectively. The mean (± standard error) mBPI-e pain severity scores over days 2-10 were 2.47 - 0.04 for the parecoxib/valdecoxib group and 3.01 ± 0.04 for the placebo group, and the mean mBPI-e pain interference scores were 1.73 ± 0.04 and 2.19 ± 0.04, respectively. Conclusions: Patients receiving parecoxib/valdecoxib had less pain interference on physical functioning, required less opioid medication and experienced fewer clinically meaningful opioid-related adverse events than patients receiving placebo. [ABSTRACT FROM AUTHOR]

The article reports on the preoperative identification, patient selection and preparation, choice of anesthetic technique, and postoperative management of adult patients with obstructive sleep apnea (OSA) scheduled for ambulatory surgery. It discusses the definition, pathophysiology and consequences of OSA, and the effects of anesthesia and surgery on perioperative sleep.

Abstract: Study Objective: The objective of this study was to examine the utility of the transesophageal echo-Doppler device in evaluating hemodynamic changes during laparoscopic cholecystectomy. Design: This was a prospective, controlled, observational open study. Setting: The study took place in a university hospital. Patients: Twenty patients with ASA physical statuses II and III undergoing laparoscopic cholecystectomy were enrolled into the study. Interventions and Measurements: A standardized general anesthetic and surgical technique was used for all patients. Similar depth of hypnosis (using bispectral index monitoring) was maintained in all patients. Hemodynamic parameters including mean arterial pressure (MAP), cardiac index (CI), left ventricular (LV) ejection time interval indexed to the heart rate, maximum acceleration, peak velocity, and systemic vascular resistance (SVR) were recorded at predetermined intervals: before incision, after peritoneal CO2 insufflation and head-up tilt, every 10 minutes thereafter, and after deflation of the abdomen and return to supine position. Main Results: The transesophageal echo-Doppler probe placement was achieved in 3 to 5 minutes in all patients, and the probe position was maintained after creation of pneumoperitoneum and change in positioning. Induction of pneumoperitoneum and head-up tilt resulted in a significant increase in MAP and SVR (P < .05) that remained higher until deflation. The CI, LV ejection time interval indexed to the heart rate (a measure of LV filling), and maximum acceleration (a measure of contractility and global ventricular function) remained stable. Conclusions: The transesophageal echo-Doppler device can be used during laparoscopic cholecystectomy. The LV function, as determined by measurement of CI and maximum acceleration, was preserved during laparoscopic cholecystectomy despite significant increases in afterload (ie, MAP and SVR). [Copyright &y& Elsevier]

The recovery care after ambulatory surgery is in a state of flux. There is increasing emphasis on rapid discharge home after ambulatory surgery. Discharge after surgery should be based on clinical criteria rather than based on time. Recent studies suggest that the insistence on oral intake and voiding before discharge is unnecessary and can delay discharge. This article reviews the recent developments in the recovery process after ambulatory surgery. [Copyright &y& Elsevier]

: Study objectiveTo compare the frequency of adverse effects of remifentanil and fentanyl in a large and diverse patient population.: DesignProspective, randomized, open-label study.: SettingMulticenter study including academic and community hospitals.: Patients2,438 adult patients (1,496 outpatients and 942 inpatients) scheduled for elective surgical procedures under general endotracheal anesthesia of at least 30-minute duration.: InterventionsPatients were randomly assigned to receive either intravenous (IV) remifentanil (n = 1,229) 0.5 μg/kg/min for induction and tracheal intubation followed by an infusion rate of 0.25 μg/kg/min or fentanyl (n = 1,209) administered according to the anesthesiologist’s usual practice. Anesthesia was maintained with propofol and/or isoflurane (with or without nitrous oxide) titrated according to protocol. Transition analgesia with either morphine or fentanyl was administered in the remifentanil and, at the anesthesiologist’s discretion, in the fentanyl group.: MeasurementsThe overall nonspecific and specific (i.e., opioid-related) adverse effects were recorded.: Main resultsRemifentanil was associated with more intraoperative hypotension than fentanyl (p< 0.05). All four cases (0.3%) of muscle rigidity occurred in the remifentanil-treated outpatients. There were no significant differences between the two drugs with respect to other adverse events (i.e., episodes of hypertension, bradycardia, respiratory depression, and apnea).: ConclusionsIn the doses used, both remifentanil and fentanyl have a similar frequency of adverse effects except for the higher frequency of hypotension associated with the use of remifentanil. [Copyright &y& Elsevier]

Presents a study which described and compared some types of depressed-collector designs for the development of continuous-wave gyrotrons for heating fusion plasmas. Applications of gyrotrons and gyroklystrons; Summary.

An important goal of the Surface Water and Ocean Topography (SWOT) mission is to provide river width, height, slope to estimate global river discharges. To appraise the feasibility of SWOT data over India, the present study utilizes the SWOT simulator from Centre National D'Etudes Spatiales (CNES) to generate a long time-series (three years) of SWOT observations over the Mahanadi River basin in India. Two independent sources of river geometry are used in this study, namely satellite-based and hydrodynamic model-based estimates. Satellite-based river geometry is derived using a web-based User Interface (UI) developed in-house to generate time series of accurate river width shapefiles from Sentinel-1 satellite imagery. To compare these results, a 1D unsteady flow analysis is carried out over the Mahanadi River to simulate channel water depth and inundation extent using the Hydrologic Engineering Center's River Analysis System (HEC-RAS) model. The simulated observations are used in this study to assess the potential error in SWOT channel water depth measurements. Results indicate a good spatial correlation between the water surface area derived from Sentinel and HEC-RAS models with a correlation of 0.74. The simulated data shows a bias of 20 cm compared to gauge observations. This study is conducted as a proof of concept in demonstrating the ability of simulated SWOT data in capturing river water surface elevation with respect to the conventional HEC-RAS model. It also implements a new tool in google earth engine (GEE) to generate input to SWOT simulator. [ABSTRACT FROM AUTHOR]

Milk is a source of essential nutrients, but food safety across the milk supply chain has emerged as an integral part of food trade. Of the several food safety hazards, antimicrobial-resistant Staphylococcus species have emerged as one of the major microbial hazards with significant public health concerns. The present cross-sectional study was undertaken with the objective to isolate Staphylococcus species from the milk supply chain, characterize isolates for antimicrobial resistance, and trace the origin of isolates using molecular techniques. Samples collected from the formal and informal milk supply chains showed prevalence of Staphylococcus species of 4.3% (n=720); isolates were identified as coagulase-positive (S. aureus 67.7% and S. intermedius 6.4%) and coagulase-negative (S. lentus 9.6%, S. sciuri 3.2%, S. xylosus 3.2%, S. schleiferi 3.2%, S. felis 3.2%, and S. gallinarum 3.2%) species. Staphylococcus isolates showed antimicrobial resistance to methicillin (32.2%), β-lactam (41.9%), and macrolide-lincosamide-streptogramin B (3.2%). Staphylococcus isolates phenotypically resistant to methicillin also carried the mecA gene and displayed diverse pulsed field gel electrophoresis (PFGE) profiles, indicating their diverse origins in the milk supply chain. Based on the similarity of PFGE profile, the origin of one of the Staphylococcus isolates was traced to the soil in contact with milch cows. The findings of this study highlight the need for more comprehensive microbial risk analysis studies across the milk supply chain, capacity building, creation of awareness among stakeholders about the judicious use of antimicrobials, and protection of public health using a One-Health approach. [ABSTRACT FROM AUTHOR]

Presents the designs of single-stage depressed collectors for high-power pulsed gyroklystron amplifiers. Description of the depressed collector design; Implementation of energy recovery in high-power pulsed devices; Conclusions.

Given the growing concern for the safety, cost and adequacy of blood supply, there is an increasing need for appropriate blood product utilization. Despite a number of consensus guidelines for the transfusion of allogeneic blood products, inappropriate blood transfusion continues. We discuss the quality assurance process for improvement in transfusion therapy including audit of blood transfusion. Audits identify areas of problems in transfusion practice which can be corrected by education of doctors, formulation of practice guidelines and algorithms. To improve the effectiveness of the audit programmes, the frequency of audits has to be maintained and there should be continual reinforcement of policies. [ABSTRACT FROM AUTHOR]

A cold alcoholic extract of human and albino rat skin, epidermis and dermis, contains prostaglandin (PG) activity as measured by rabbit duodenum assay in presence of antihistaminic, anticholinergic and antiserotonin drugs. The PG on purification by TLC are almost entirely recovered in the region of PGE's. The normal human thigh skin (biopsy) contains 760 to 2140 nanograms PG (expressed as PGE1) per gram wet skin. The albino rat skin, epidermis and dermis, contains 732 ± 107, 1539 ± 289 and 582 ± 74 nanograms per gram wet tissue of PG (expressed as PGE1) respectively. UV-irradiation of albino rat by erythemal doses (2-8 MED) results in a several fold increase in both epidermal and dermal PG. It is suggested that skin prostaglandin may play an important role in elicitation of erythema following UV-irradiation. [ABSTRACT FROM AUTHOR]