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A Study to Observe Pulse Pressure Variation after Induction with Propofol for General Anesthesia

World Journal of Cardiovascular Diseases 2024年第5期14卷 343-350页

作者： Kunal Tewari Vibhu Raghuvanshi Deepak mishra Nitin Pahuja Maj Jyotsna Om Bahadur Thapa Department of Anaesthesiology and Critical Care Armed Forces Medical College Pune India Chauhan Medicity and Trauma Centre Pathankot India Department of Anaesthesiology and Critical Care Command Hospital (Southern Command) Pune India

Background and Aims: Pulse pressure variation (PPV) is a reliable and predictive dynamic parameter presently being utilized for fluid responsiveness. In the operating room, fluid administration based on PPV monitoring helps the physician in deciding whether to volume resuscitate or use interventions in patients undergoing surgery. Propofol is an intravenous induction agent which lowers blood pressure. There are multiple causes such as depression in cardiac output, and peripheral vasodilatation for hypotension. We undertook this study to observe the utility of PPV as a guide to fluid therapy after propofol induction. Primary outcome of our study was to monitor PPV as a marker of fluid responsiveness for the hypotension caused by propofol induction. Secondary outcome included the correlation of PPV with other hemodynamic parameters like heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP);after induction with propofol at regular interval of time. Methods: A total number of 90 patients were recruited. Either of the radial artery was then cannulated under local anaesthesia with 20G VygonLeadercath arterial cannula and invasive monitoring transduced. A baseline recording of heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and PPV was then recorded. Patients were then induced with predetermined doses of propofol (2 mg/kg) and recordings of HR, SBP, DBP, and PPV were taken at 5, 10 and 15 minutes. Results: Intraoperatively, PPV was significantly higher at 5 minutes and significantly lower at 15 minutes after induction. It was observed that there were no statistically significant correlations between PPV and SBP or DBP. PPV was strongly and directly associated with HR. Conclusion: We were able to establish that PPV predicts fluid responsiveness in hypotension caused by propofol induction;and can be used to administer fluid therapy in managing such hypotension. However, PPV was not directly correlated with hypotensi

关键词： Pulse Pressure Variation (PPV) Propofol Fluid Responsiveness

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Characterization of tumors of jaw:Additive value of contrast enhancement and dual-energy computed tomography

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World Journal of Radiology 2024年第4期16卷 82-93页

作者： Deepak Justine Viswanathan Ashu Seith Bhalla Smita Manchanda Ajoy Roychoudhury Deepika.mishra Asit Ranjan Mridha Department of Radiodiagnosis and Interventional Radiology All India Institute of Medical SciencesNew Delhi 110029India Department of Oral and Maxillofacial Surgery All India Institute of Medical SciencesNew Delhi 110029India Department of Oral Pathology and Microbiology All India Institute of Medical SciencesNew Delhi 110029India Department of Pathology All India Institute of Medical SciencesAnsari NagarNew Delhi 110029India

BACKGROUND Currently,the differentiation of jaw tumors is mainly based on the lesion’s morphology rather than the enhancement characteristics,which are important in the differentiation of neoplasms across the *** is a paucity of literature on the enhancement characteristics of jaw *** is mainly because,even though computed tomography(CT)is used to evaluate these lesions,they are often imaged without intravenous *** study hypothesised that the enhancement characteristics of the solid component of jaw tumors can aid in the differentiation of these lesions in addition to their morphology by dual-energy CT,therefore improving the ability to differentiate between various *** To evaluate the role of contrast enhancement and dual-energy quantitative parameters in CT in the differentiation of jaw *** Fifty-seven patients with jaw tumors underwent contrast-enhanced dual-energy *** analysis of the tumor,including the enhancing solid component,was done,followed by quantitative analysis of iodine concentration(IC),water concentration(WC),HU,and normalized *** study population was divided into four subgroups based on histopathological analysis-central giant cell granuloma(CGCG),ameloblastoma,odontogenic keratocyst(OKC),and other jaw tumors.A one-way ANOVA test for parametric variables and the Kruskal-Wallis test for nonparametric variables were *** significant differences were found,a series of independent t-tests or Mann-Whitney U tests were *** Ameloblastoma was the most common pathology(n=20),followed by CGCG(n=11)and *** showed a higher mean concentration of all quantitative parameters than ameloblastomas(P<0.05).An IC threshold of 31.35×100μg/cm^(3) had the maximum sensitivity(81.8%)and specificity(65%).Between ameloblastomas and OKC,the former showed a higher mean concentration of all quantitative parameters(P<0.001),however when comparing unilocular ameloblastomas with OKCs,the latter showed

关键词： Jaw neoplasms Ameloblastomas Dual-energy computed tomography Iodine quantification Mandibular neoplasms Maxillary neoplasms

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Clinical profile and outcomes of hepatocellular carcinoma in primary Budd-Chiari syndrome

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World Journal of Gastrointestinal Oncology 2024年第3期16卷 699-715页

作者： Ankit Agarwal Sagnik Biswas Shekhar Swaroop Arnav Aggarwal Ayush Agarwal Gautam Jain Anshuman Elhence Arun Vaidya Amit Gupte Ravi Mohanka Ramesh Kumar Ashwani Kumar mishra Shivanand Gamanagatti Shashi Bala Paul Subrat Kumar Acharya Akash Shukla Shalimar Department of Gastroenterology and Human Nutrition All India Institute of Medical SciencesNew Delhi 110029DelhiIndia Department of Gastroenterology Seth Gordhandas Sunderdas Medical College and KEM HospitalMumbai 400012MaharashtraIndia Department of Gastroenterology Sir HN Reliance Foundation HospitalMumbai 400004India Department of Liver Transplant and HPB Sir HN Reliance Foundation HospitalMumbai 400004India Department of Gastroenterology All India Institute of Medical SciencesPatna 801507India Professor of Biostatistics National Drug Dependence Treatment Centre(NDDTC)All India Institute of Medical SciencesNew Delhi 110029India Department of Radiodiagnosis All India Institute of Medical SciencesNew Delhi 110029DelhiIndia

BACKGROUND There is scant literature on hepatocellular carcinoma(HCC)in patients with Budd-Chiari syndrome(BCS).AIM To assess the magnitude,clinical characteristics,feasibility,and outcomes of treatment in *** A total of 904 BCS patients from New Delhi,India and 1140 from Mumbai,India were *** prevalence and incidence of HCC were determined,and among patients with BCS-HCC,the viability and outcomes of interventional therapy were *** In the New Delhi cohort of 35 BCS-HCC patients,18 had HCC at index presentation(prevalence 1.99%),and 17 developed HCC over a follow-up of 4601 person-years,[incidence 0.36(0.22-0.57)per 100 person-years].BCS-HCC patients were older when compared to patients with BCS alone(P=0.001)and had a higher proportion of inferior vena cava block,cirrhosis,and long-segment vascular *** median alpha-fetoprotein level was higher in patients with BCS-HCC at first presentation than those who developed HCC at follow-up(13029 ng/mL vs 500 ng/mL,P=0.01).Of the 35 BCS-HCC,26(74.3%)underwent radiological interventions for BCS,and 22(62.8%)patients underwent treatment for HCC[transarterial chemoembolization in 18(81.8%),oral tyrosine kinase inhibitor in 3(13.6%),and transarterial radioembolization in 1(4.5%)].The median survival among patients who underwent interventions for HCC compared with those who did not was 3.5 years vs 3.1 mo(P=0.0001).In contrast to the New Delhi cohort,the Mumbai cohort of BCS-HCC patients were predominantly males,presented with a more advanced HCC[Barcelona Clinic Liver Cancer C and D],and 2 patients underwent liver *** HCC is not uncommon in patients with *** interventions and liver transplantation are feasible in select primary BCS-HCC patients and may improve outcomes.

关键词： Budd chiari syndrome Cancer Cirrhosis Thrombosis Liver Varices Transarterial chemoembolization Hepatic venous outflow tract obstruction

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Modelling dynamic pantograph loads with combined numerical analysis

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Railway Engineering Science 2024年第1期32卷 81-94页

作者： F.F.Jackson R.mishra J.M.Rebelo J.Santos P.Antunes J.Pombo H.Magalhaes L.Wills M.Askill School of Computing and Engineering University of HuddersfieldHuddersfieldUK School of Computing and Engineering Institute of Railway ResearchUniversity of HuddersfieldHuddersfieldUK IDMEC Instituto Superior TecnicoUniversidade de LisboaLisbonPortugal ISEL Instituto Politecnico de LisboaLisbonPortugal Hitachi Rail Newton AycliffeUK Wabtec/Brecknell Willis ChardUK

Appropriate interaction between pantograph and catenary is imperative for smooth operation of electric *** heights of overhead lines to accommodate level crossings,overbridges,and tunnels pose significant challenges in maintaining consistent current collection performance as the pantograph aerodynamic profile,and thus aerodynamic load changes significantly with operational *** research aims to analyse the global flow characteristics and aerodynamic forces acting on individual components of an HSX pantograph operating in different configurations and orientations,such that the results can be combined with multibody simulations to obtain accurate dynamic insight into contact ***,computational fluid dynamics simulations are used to investigate the pantograph component loads in a representative setting,such as that of the recessed cavity on a Class 800 *** an aerodynamic perspective,this study indicates that the total drag force acting on non-fixed components of the pantograph is larger for the knuckle-leading orientation rather than the knuckle-trailing,although the difference between the two is found to reduce with increasing pantograph *** the aerodynamic loads acting on individual components with multibody tools allows for realistic dynamic insight into the pantograph *** results obtained show how considering aerodynamic forces enhance the realism of the models,leading to behaviour of the pantograph-catenary contact forces closely matching that seen in experimental tests.

关键词： Pantograph-catenary interaction Pantograph aerodynamics Computational fluid dynamics Pantograph loads Current collection performance

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A Comparative Study between Landmark Based and Real Time Ultrasound Guided Sub Arachnoid Block

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Open Journal of Anesthesiology 2024年第4期14卷 118-125页

作者： Kunal Tewari Om Bahadur Thapa Deepak mishra Manjot Multani Jyotsna Sharma Akash Ray Mohapatra Sandhya Khwaunju Department of Anesthesiology and Critical Care Armed Forces Medical College Pune India Department of Anesthesiology and Critical Care AFMC Pune India

Background: Sub arachnoid block (SAB) performed by traditional landmark palpation technique can be inaccurate. This problem is exacerbated by altered patient anatomy due to obesity and age-related changes. A pre-procedural ultrasound scan of the lumbar spine has been shown to be of benefit in guiding lumbar epidural insertion in obstetric patients. Information on the use of real-time ultrasound (RUS) guided SAB, to date, been limited. This study compared RUS guided SAB to traditional landmark guided technique in patients undergoing spinal anesthesia for different surgical procedures. Methods: This was a prospective, single center, comparative observational study conducted in the department of anesthesiology at our center. 560 patients who underwent spinal anesthesia either by landmark based technique or real-time ultrasound-guided methods. The primary outcome was the first attempt success rate of dural puncture when employing the two methods. Results: Baseline characteristics were similar in the two study groups. The first attempt success rate of dural puncture in landmark guided group was 64.3% compared to 72.6% in the ultrasound guided group. This difference was not statistically significant. The procedure performance time was significantly shorter with landmark palpation compared to use of real-time ultrasound guided method. Conclusion: Use of RUS-guided technique does not significantly improve the first attempt success rate of SAB dural puncture during spinal anesthesia compared to the traditional landmark-guided technique.

关键词： Sub Arachnoid Block (SAB) Real Time Ultrasound (RUS)

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The secondary injury cascade after spinal cord injury: an analysis of local cytokine/chemokine regulation

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Neural Regeneration Research 2024年第6期19卷 1308-1317页

作者： Daniel J.Hellenbrand Charles M.Quinn Zachariah J.Piper Ryan T.Elder Raveena R.mishra Taylor L.Marti Phoebe M.Omuro Rylie M.Roddick Jae Sung Lee William L.Murphy Amgad S.Hanna Department of Neurosurgery University of Wisconsin-Madison School of Medicine and Public Health Department of Biomedical Engineering University of Wisconsin-Madison Department of Orthopedics and Rehabilitation University of Wisconsin-Madison Department of Materials Science and Engineering University of Wisconsin-Madison Forward BIO Institute University of Wisconsin-Madison

After spinal cord injury, there is an extensive infiltration of immune cells, which exacerbates the injury and leads to further neural degeneration. Therefore, a major aim of current research involves targeting the immune response as a treatment for spinal cord injury. Although much research has been performed analyzing the complex inflammatory process following spinal cord injury, there remain major discrepancies within previous literature regarding the timeline of local cytokine regulation. The objectives of this study were to establish an overview of the timeline of cytokine regulation for 2 weeks after spinal cord injury, identify sexual dimorphisms in terms of cytokine levels, and determine local cytokines that significantly change based on the severity of spinal cord injury. Rats were inflicted with either a mild contusion, moderate contusion, severe contusion, or complete transection, 7 mm of spinal cord centered on the injury was harvested at varying times post-injury, and tissue homogenates were analyzed with a Cytokine/Chemokine 27-Plex assay. Results demonstrated pro-inflammatory cytokines including tumor necrosis factor α, interleukin-1β, and interleukin-6 were all upregulated after spinal cord injury, but returned to uninjured levels within approximately 24 hours post-injury, while chemokines including monocyte chemoattractant protein-1 remained upregulated for days post-injury. In contrast, several anti-inflammatory cytokines and growth factors including interleukin-10 and vascular endothelial growth factor were downregulated by 7 days post-injury. After spinal cord injury, tissue inhibitor of metalloproteinase-1, which specifically affects astrocytes involved in glial scar development, increased more than all other cytokines tested, reaching 26.9-fold higher than uninjured rats. After a mild injury, 11 cytokines demonstrated sexual dimorphisms; however, after a severe contusion only leptin levels were different between female and male rats. In conclus

关键词： astrocytes chemokines cytokines inflammation macrophages microglia secondary damage spinal cord injury

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Comparison of efficacy of lung ultrasound and chest X-ray in diagnosing pulmonary edema and pleural effusion in ICU patients: A single centre, prospective, observational study

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Open Journal of Anesthesiology 2024年第3期14卷 41-50页

作者： Kunal Tewari Sumanth Pelluru Deepak mishra Nitin Pahuja Akash Ray Mohapatra Jyotsna Sharma Om Bahadur Thapa Manjot Multani Department of Anesthesiology and Critical Care Armed Forces Medical College Pune India Department of Anesthesiology and Critical Care Military Hospital Bhopal India

Background and Aims While chest X-ray (CXR) has been a conventional tool in intensive care units (ICUs) to identify lung pathologies, computed tomography (CT) scan remains the gold standard. Use of lung ultrasound (LUS) in resource-rich ICUs is still under investigation. The present study compares the utility of LUS to that of CXR in identifying pulmonary edema and pleural effusion in ICU patients. In addition, consolidation and pneumothorax were analyzed as secondary outcome measures. Material and Methods This is a prospective, single centric, observational study. Patients admitted in ICU were examined for lung pathologies, using LUS by a trained intensivist;and CXR done within 4 hours of each other. The final diagnosis was ascertained by an independent senior radiologist, based on the complete medical chart including clinical findings and the results of thoracic CT, if available. The results were compared and analyzed. Results Sensitivity, specificity and diagnostic accuracy of LUS was 95%, 94.4%, 94.67% for pleural effusion;and 98.33%, 97.78%, 98.00% for pulmonary edema respectively. Corresponding values with CXR were 48.33%, 76.67%, 65.33% for pleural effusion;and 36.67%, 82.22% and 64.00% for pulmonary edema respectively. Sensitivity, specificity and diagnostic accuracy of LUS was 91.30%, 96.85%, 96.00% for consolidation;and 100.00%, 79.02%, 80.00% for pneumothorax respectively. Corresponding values with CXR were 60.87%, 81.10%, 78.00% for consolidation;and 71.3%, 97.20%, 96.00% for pneumothorax respectively. Conclusion LUS has better diagnostic accuracy in diagnosis of pleural effusion and pulmonary edema when compared with CXR and is thus recommended as an effective alternative for diagnosis of these conditions in acute care settings. Our study recommends that a thoracic CT scan can be avoided in most of such cases.

关键词： Chest X ray (CXR) Consolidation Pulmonary edema Pleural effusion Lung ultrasound (LUS) Pneumothorax

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Effect of ankle versus thigh tourniquets on post-operative pain in foot and ankle surgery

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World Journal of Orthopedics 2024年第2期15卷 163-169页

作者： Ashish mishra Ahmed Barakat Jitendra Mangwani Jakub Kazda Sagar Tiwatane Sana Mohammed Aamir Shaikh Linzy Houchen-Wolloff Vipul Kaushik Department of Trauma and Orthopedics University Hospitals LeicesterLeicester LE15WWUnited Kingdom Department of Trauma and Orthopedics Leicester University Hospitals-NHS TrustLeicester LE15WWLeicestershireUnited Kingdom Academic Team of Musculoskeletal Surgery University Hospitals of Leicester NHS TrustLeicester LE39QPUnited Kingdom Department of Anaesthesia York&Scarborough Teaching Hospitals NHS Foundation TrustNorth Yorkshire YO318HEUnited Kingdom Department of Anaesthesia Royal Free London NHS TrustLondon NW32QGUnited Kingdom Department of Trauma&Orthopaedics Breach Candy Hospital TrustMumbai 400026India Department of Physiotherapy University Hospitals of Leicester NHS TrustLeicester LE39QPUnited Kingdom Department of Anasthesia University Hospitals of Leicester NHS TrustLeicester LE15WWUnited Kingdom

BACKGROUND Tourniquets are commonly used in elective extremity orthopaedic surgery to reduce blood loss,improve visualization in the surgical field,and to potentially reduce surgical *** is a lack of consensus in existing guidelines regarding the optimal tourniquet pressure,placement site,and duration of *** is a paucity of data on the relationship between the site of a tourniquet and postoperative pain in foot and ankle *** To explore the relationship between tourniquet site and intensity of post-operative pain scores in patients undergoing elective foot and ankle *** Retrospective analysis of prospectively collected data on 201 patients who underwent foot and ankle surgery in a single institution was *** tourniquet duration,tourniquet pressure and site,and postoperative pain scores using Visual Analogue Score were collected in immediate recovery,at six hours and at 24 h *** plots were used to analyse the data and to assess for the statistical correlation between tourniquet pressure,duration,site,and pain scores using Pearson correlation *** All patients who underwent foot and ankle surgery had tourniquet pressure of 250 mmHg for ankle tourniquet and 300 mmHg for *** was no correlation between the site of the tourniquet and pain scores in recovery,at six hours and after 24 *** was a weak correlation between tourniquet time and Visual Analogue Score immediately post-op(r=0.14,P=0.04)but not at six or 24 h *** This study shows that there was no statistically significant correlation between tourniquet pressure,site and postop pain in patients undergoing foot and ankle *** choice of using a tourniquet is based on the surgeon's preference,with the goal of minimizing the duration of its application at the operative site.

关键词： Lower limb surgery Tourniquet time Tourniquet pressure Tourniquet site Post-operative pain Pain scores

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Paradigm shift in transfusion practices during early COVID-19 pandemic:A single center retrospective study

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World Journal of Virology 2024年第2期13卷 78-86页

作者： Sumukh Arun Kumar Sushmita Prabhu Ankushi Sanghvi Maya Gogtay Mithil Gowda Suresh Harshit Khosla Yuvaraj Singh Ajay Kumar mishra Susan George Department of Internal Medicine Saint Vincent HospitalWorcesterMA 01608United States Department of Hematology and Oncology University of Nebraska Medical CenterOmahaNE 68198United States Hospice and Palliative Care UTHSC and McGovern School of MedicineTexasTX 77030United States Department of Gastroenterology and Hepatology UMass Chan Medical SchoolWorcesterMA 01655United States Division of Cardiology Saint Vincent HospitalWorcesterMA 01608United States

BACKGROUND The advent of coronavirus disease 2019(COVID-19)unveiled the worst national blood crisis that the United States had witnessed in over a *** the pandemic influencing the different stages of the acquisition of blood products outside the hospital setting,we aimed to explore the possible barriers contributing to the shortage of blood products within the medical *** COVID era and pre-COVID *** We conducted a retrospective cross-sectional study on hospitalized patients distinguishing the pattern of blood transfusion during the COVID and pre-COVID era in a community *** was tabulated to include the number of red blood cell(RBC)transfusions and if transfusions met restrictive blood transfusion criteria as per institutional ***-square was applied to test the statistical association between qualitative *** t test and Mann Whitney U test were applied respectively to test the mean difference of quantitative *** A total of 208 patients were included in the study,of which 108 were during COVID era and 100 were during pre-COVID *** leading reason for admission in both the COVID era and pre-COVID era transfused patients was shortness of breath(53.7%and 36%P=0.001),followed by gastrointestinal bleeding(25.9%and 21%P=0.001).There was a higher percentage of RBC transfusions in the intensive care unit in the COVID-era group than in the pre-COVID era group(38.9%vs 22%,P=0.008).The restrictive transfusion criteria were met in 62%vs 79%in the COVID and pre-COVID eras,respectively(P=0.008).CONCLUSION The COVID-era group received RBC transfusions with less stringent adherence to restrictive blood transfusion practices in comparison to pre-COVID era group.

关键词： Blood transfusion Restrictive transfusion COVID-19 Pre-COVID-19 Blood shortage Pandemic

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Two-Stent Strategy for Bifurcation Lesions in Percutaneous Transluminal Coronary Angioplasty: Real-World Evidence

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World Journal of Cardiovascular Diseases 2024年第3期14卷 140-156页

作者： Dilip Kumar Amit Malviya Animesh mishra Rabin Chakraborty Sanjeev S. Mukherjee Soumya Patra Arindam Pande Rana Rathor Roy Debopriyo Mondal Ashesh Halder Sumit Shanker Medica Superspecialty Hospital 127 Eastern Metropolitan Bypass Nitai Nagar Mukundapur Kolkata West Bengal India North Eastern Indira Gandhi Regional Institute of Health & Medical Sciences (NEIGRIHMS) Mawdiangdiang Shillong Meghalaya India

Background: Bifurcation lesions pose a high risk for adverse events after percutaneous coronary intervention (PCI). Evidence supporting the benefits of the two-stent strategy (2SS) for treating coronary bifurcation lesions in India is limited. This study aimed to evaluate the clinical outcomes of various 2SSs for percutaneous transluminal coronary angioplasty for bifurcation lesions in India. Materials and Methods: This retrospective, observational, multicentric, real-world study included 64 patients over 8 years. Data on demographics, medical history, PCI procedures, and outcomes were recorded. Descriptive statistics were computed using the SPSS software. Results: Patients (n = 64) had an average age of 65.3 ± 11.1 years, with 78.1% males. Acute coronary syndrome was reported in 18.8%, chronic stable angina in 40.6%, and unstable angina in 34.4% of participants. Two-vessel disease was observed in 98.4% of patients, and 99.4% had true bifurcation lesions. The commonly involved vessels were the left anterior descending artery (50%), left circumflex coronary artery (34.4%), and first diagonal artery (43.8%). Mean percent diameter stenosis was 87.2% ± 10.1%. The mean number of stents used was 2.00 ± 0.34. The 2SS techniques included the T and small protrusion (TAP) (39.1%), double kissing (DK) crush (18.8%), and the culotte techniques (14.1%). Procedural and angiographic success rate was 92.18%. Major adverse cardiovascular events at 1-year follow-up occurred in 7.8% of cases. Conclusion: The 2SS for bifurcation lesions showed favorable in-hospital and follow-up outcomes. Findings can serve as a resource for bifurcation angioplasty in India. Larger real-world studies with robust methodology are needed to validate these results.

关键词： Bifurcation Stenting Coronary Bifurcation Lesions Percutaneous

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