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

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 HealthMadisonWIUSA Department of Biomedical Engineering University of Wisconsin-MadisonMadisonWIUSA Department of Orthopedics and Rehabilitation University of Wisconsin-MadisonMadisonWIUSA Department of Materials Science and Engineering University of Wisconsin-MadisonMadisonWIUSA Forward BIO Institute University of Wisconsin-MadisonMadisonWIUSA

After spinal cord injury,there is an extensive infiltration of immune cells,which exacerbates the injury and leads to further neural ***,a major aim of current research involves targeting the immune response as a treatment for spinal cord *** 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 *** 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 *** 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 *** demonstrated pro-inflammatory cytokines including tumor necrosis factorα,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 *** contrast,several anti-inflammatory cytokines and growth factors including interleukin-10 and vascular endothelial growth factor were downregulated by 7 days *** 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 *** a mild injury,11 cytokines demonstrated sexual dimorphisms;however,after a severe contusion only leptin levels were different between female and male *** conclusion,pro-inflammatory cytokines in

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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Comprehensive analysis of uncertainty quantification for the^(58)Ni(n,p)^(58)Co reaction cross section

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Chinese Physics C 2024年第9期48卷 170-175页

作者： Mahesh Choudhary Aman Sharma Namrata Singh Mahima Upadhyay Punit Dubey A.Gandhi Akash Hingu G mishra Sukanya De L.S.Danu Ajay Kumar R.G.Thomas Saurav Sood Sajin Prasad S.Mukherjee I.N.Ruskov Yu.N.Kopatch A.Kumar Department of Physics Banaras Hindu UniversityVaranasi 221005India Horia Hulubei National Institute of Physics and Nuclear Engineering-IFIN-HH Bucharest 077125Romania Department of Physics The Maharaja Sayajirao University of BarodaVadodara 390002India Nuclear Physics Division Bhabha Atomic Research CentreMumbai 400085India Health Physics Division Bhabha Atomic Research CentreMumbai 400085India Department of Electrical Power Engineering Brno University of TechnologyBrno 61600Czech Republic Institute for Nuclear Research and Nuclear Energy Bulgarian Academy of SciencesSofia 1784Bulgaria Joint Institute for Nuclear Research(JINR) Dubna 141980Russia

In this study,we measured the^(58)Ni(n,p)^(58)Co reaction cross section with neutron energies of 1.06,1.86,and 2.85 *** cross section was measured using neutron activation techniques andγ-ray spectroscopy,and it was compared with cross section data available in the ***,we calculated the covariance matrix of the measured cross section for the aforementioned nuclear *** uncertainties of the theoretical calculation for^(58)Ni(n,p)^(58)Co reaction cross section were calculated via Monte Carlo *** this study,we used uncertainties in the optical model and level density parameters to calculate uncertainties in the theoretical cross *** theoretical calculations were performed by using *** this study,we aim to analyze the effect of uncertainties of the nuclear model input as well as different experimental variables used to obtain the values of reaction cross section.

关键词： ^(58)Ni(n p)^(58)Co reaction γ-ray spectroscopy uncertainty quantification of cross section covariance analysis

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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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Performance of Corrosion-Resistant Alloys in Concentrated Acids

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Acta Metallurgica Sinica(English Letters) 2017年第4期30卷 306-318页

作者： Ajit mishra Research and Technology Haynes International 1020 ParkAve Kokomo IN 46902 USA

Nickel alloys containing optimum amounts of chromium （Cr）, molybdenum （Mo） and tungsten （W） are widely used in the chemical processing industries due to their tolerance to both oxidizing and reducing conditions. Unlike stainless steel （SS）, Ni-Cr-Mo （W） alloys exhibit remarkably high uniform corrosion resistance in major concentrated acids, like hydrochloric acid （HC1） and sulfuric acid （H2SO4）. A higher uniform corrosion resistance of Ni-Cr-Mo （W） alloys, compared to other alloys, in concentrated acids can be attributed to the formation of protective oxide film of Mo and W in reducing acids, and Cr oxide film in oxidizing solutions. The localized corrosion resistance of Ni-Cr-Mo （W） alloys, containing high amount Cr as well as Mo （or Mo ＋ W）, is also significantly higher than that of other commercially available alloys. The present study investigates the role of alloying elements, in nickel alloys, to uniform corrosion resistance in concentrated acids （HC1, HC1 ＋ oxidizing impurities and H2SO4） and localized corrosion performance in chloride-rich environments using ASTM G-48 test methodology. The corrosion tests were conducted on various alloys, and the results were analyzed using weight loss technique and electrochemical techniques, in conjunction with surface char- acterization tools.

关键词： Nickel-chromium-molybdenum-tungsten Corrosion-resistant alloys Reducing acid Oxidants Localized corrosion Surface characterization

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Corrosion Study of Base Material and Welds of a Ni-Cr-Mo-W Alloy

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Acta Metallurgica Sinica(English Letters) 2017年第4期30卷 326-332页

作者： Ajit mishra Haynes International Inc. 1020 West Park AvenueKokomo IN 46904 USA

Alloys containing chromium （Cr） and molybdenum （Mo）, as the major alloying elements, are widely used in various industries where the material experiences corrosive environments. Chromium （Cr）, when added in an optimum amount, forms a Cr203 passive film which protects the underlying metal in aggressive solutions. Molybdenum （Mo） forms its oxides in the low pH solutions, thus, enhances the uniform corrosion resistance of an alloy in reducing acids and assists in inhibition to localized corrosion. Minor alloying elements, like tungsten （W） and copper （Cu）, also improve the overall corrosion resistance of an alloy in specific solutions. In the present study, corrosion resistance behavior of commercial iron- based alloys （316L SS, 254 SMO and 20Cb3） and nickel-based alloys （Mone1400, Alloy 625 and C-276） was studied in the acidic solutions. While the corrosion behavior of wrought alloys has been widely studied, there is little to no information on the corrosion performance of their welds, typically being the weak regions for corrosion initiation and propagation. Therefore, an attempt was undertaken to investigate the uniform and localized corrosion performance of base metal, simulated heat-affected zone and all-weld-metal samples of a Ni-Cr-Mo-W alloy, C-276. The study was conducted in aggressive acidic solutions. Various corrosion and surface analytical techniques were utilized to analyze the results.

关键词： Iron-chromium-molybdenum Nickel-chromium-molybdenum-tungsten All-weld-metal Heat-affected-zone Acids Acidified ferric chloride Potentiodynamic Scanning electronmicroscopy (SEM)

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Geochemistry of Late Archaean shaly BIF formed by oxic exogenic processes: an example from Ramagiri schist belt,Dharwar Craton, India

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Chinese Journal Of Geochemistry 2015年第3期34卷 362-378页

作者： Meenal mishra School of Sciences Indira Gandhi National Open University

The central block of the auriferous Ramagiri schist belt, in the Eastern Dharwar Craton, India consists of bimodal volcanics(mafic-felsic), shaly BIF and metasedimentary rocks. Geochemical studies of the associated shaly BIF have indicated the enrichment of the major and trace elements such as Si O2, Al2O3, Ti O2, K2 O, Mg O, Fe2O3(T),Zr, Y, Cr, Ni, alkali and alkaline earth elements indicates that the clastic component of the shaly BIF had their contribution from the contemporaneous bimodal *** concave chondrite normalized REE patterns share ubiquitously anomalous positive cerium anomaly, absence of positive europium anomaly and the overall HREE enrichment. The REE patterns resemble those from the modern day sea water, except for positive Ce anomaly. The data suggests that arc related bimodal volcanism had been the plausible source of Fe, silica, REE and other trace elements. The coherent behaviour of Fe, Ti, Mn and P with the REEs indicates that they got incorporated from Fe–Ti–Mn bearing primary minerals and secondary products like clays. The variability of REE patterns in the BIF formation samples probably results from the differences in scavenging efficiency. The BIF bears signatures of mixing of the contemporaneous clastic and chemical processes, as well as the changes accompanying diagenesis and *** precipitation of Fe did not stop during the sedimentation in an island arc related tectonic setting. The BIF strongly lacks the signatures from hydrothermal input. The presence of positive cerium anomalies and the absence of positive europium anomalies in the shaly banded ironformations imply that iron oxidation during BIF deposition took place in shallow waters rather than at depth, at oxicanoxic boundary.

关键词：地球化学二氧化硅克拉通晚太古代岩带印度力作用双峰式火山岩

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