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Mobile stroke care expedites intravenous thrombolysis and endovascular thrombectomy

Stroke & Vascular Neurology 2022年第3期7卷 209-214页

作者： Matthew T Bender Thomas K Mattingly Redi Rahmani Diana Proper Walter A Burnett Jason L Burgett Joshua LEsperance Jeremy T Cushman Webster H Pilcher Curtis G Benesch Adam G Kelly tarun bhalla Department of Neurosurgery University of Rochester Medical CenterRochesterNew YorkUSA Department of Emergency Medicine University of Rochester Medical CenterRochesterNew YorkUSA Department of Neurology University of Rochester Medical CenterRochesterNew YorkUSA

Background The number of mobile stroke programmes has increased with evidence,showing they expedite intravenous thrombolysis.Outstanding questions include whether time savings extend to patients eligible for endovascular therapy and impact clinical outcomes.Objective Our mobile stroke unit(MSU),based at an academic medical centre in upstate New York,launched in October 2018.We reviewed prospective observational data sets over 26 months to identify MSU and non-MSU emergency medical service(EMS)patients who underwent intravenous thrombolysis or endovascular thrombectomy for comparison of angiographic and clinical outcomes.Results Over 568 days in service,the MSU was dispatched 1489 times(2.6/day)and transported 300 patients(20%of dispatches).Intravenous tissue plasminogen activator(tPA)was administered to 57 MSU patients and the average time from 911 call-to tPA was 42.5 min(±9.2),while EMS transported 73 patients who received tPA at 99.4 min(±35.7)(p<0.001).Seven MSU patients(12%)received tPA from 3.5 hours to 4.5 hours since last known well and would likely have been outside the window with EMS care.Endovascular thrombectomy was performed on 21 MSU patients with an average 911 call-to groin puncture time of 99.9 min(±18.1),while EMS transported 54 patients who underwent endovascular thrombectomy(ET)at 133.0 min(±37.0)(p=0.0002).There was no difference between MSU and traditional EMS in modified Rankin score at 90-day clinic follow-up for patients undergoing intravenous thrombolysis or endovascular thrombectomy,whether assessed as a dichotomous or ordinal variable.Conclusions Mobile stroke care expedited both intravenous thrombolysis and endovascular thrombectomy.There is an ongoing need to show improved functional outcomes with MSU care.

关键词： intravenous throm endovascular

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Comparison of flow rate accuracy and consistency between the on-Q, baxter, and ambu pain infusion devices

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World Journal of Anesthesiology 2014年第1期3卷 119-123页

作者： Michelle Le Riger tarun bhalla David Martin Jacob Bettesworth Joseph D Tobias Departments of Anesthesiology and Pain Medicine Nationwide Children’s Hospital and the Ohio State University Columbus OH 43205 United States Departments of Pediatrics Nationwide Children’s Hospital and the Ohio State University Columbus OH 43205 United States

AIM: Providing analgesia via peripheral nerve catheters attached to an infusion pump is an effective pain management option in children.METHODS: Portable infusion pumps are being used with increased frequency in pediatric patients. Because these pumps are infusing potentially toxic doses of medications, the accuracy and consistency of these devices becomes very important in this patient population. This study is a comparison of the actual delivery volume of local anesthetic of three elastomeric infusion devices approved for patient use in the ambulatory setting. Three brands of disposable elastomeric infusion devices were used(Five On-Q, Five Baxter, and Five Ambu pumps). Each was filled with 200 m L of Ropivicaine 0.1% and connected to a single, end hole infusion catheter and set to infuse at 12 m L/h. The devices were run simultaneously. The fluid delivered was measured every hour with a graduated column over a tenhour period. The ambient temperature was also recorded.RESULTS: There were statistically significant differences in the output from each elastomeric device over the 10 h infusion period when compared to the nominal rate of 12 m L/h. The output from the Ambu and Baxter pumps was less than that set on the regulator, while the output from the On-Q pump was greater than that set on the regulator. The results remained statistically significant after adjusting the nominal rate to correct for differences in temperature. The Ambu infusion device was the most consistent, while the Baxter infusion device was the most accurate. This emphasizes the importance of health care providers understanding the infusion profile of the pump being used for continuous peripheral nerve block, as these alterations in flow could result in inadequate analgesia, early reservoir exhaustion, excessive muscle weakness or potential toxicity, especially when used in pediatric patients.CONCLUSION: This investigation demonstrates that three modern elastomeric infusion pumps have significantly different output than the nominal rate set on

关键词： Pediatric anesthesia Pain Regional anesthesia Pain pumps Acute pain

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Exploring the association between hypertension and cognitive impairment:Evidence-based insights

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Chronic Diseases and Translational Medicine 2024年第2期10卷 153-155页

作者： tarun Kumar Suvvari Rangaraya Medical College KakinadaAndhra PradeshIndia Squad Medicine and Research VizagAndhra PradeshIndia

To the Editor,Hypertension,also known as high blood pressure(BP),affects millions of people worldwide.Beyond its well-documented cardiovascular consequences,hypertension has been uncovered an association with cognitive impairment.1 This is a growing concern,as the number of people with hypertension is expected to increase in the coming years,particularly in developing countries.

关键词： hypertension impairment cardiovascular

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Efficacy of stromal vascular fraction for knee osteoarthritis:A prospective,single-centre,non-randomized study with 2 years follow-up

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World Journal of Orthopedics 2024年第5期15卷 457-468页

作者： Madhan Jeyaraman Naveen Jeyaraman tarun Jayakumar Swaminathan Ramasubramanian Rajni Ranjan Saurabh Kumar Jha Ashim Gupta Department of Orthopaedics ACS Medical College and HospitalDr MGR Educational and Research InstituteChennaiTamil Nadu 600077India Department of Biotechnology School of Engineering and TechnologySharda UniversityGreater NoidaUttar Pradesh 201310India Department of Orthopaedics and Regenerative Medicine South Texas Orthopaedic Research InstituteLaredoTX 78045United States Department of Orthopaedics KIMS-Sunshine HospitalHyderabadTelangana 500032India Department of Orthopaedics Government Medical CollegeOmandurar Government EstateChennaiTamil Nadu 600002India Department of Orthopaedics School of Medical Sciences and ResearchSharda UniversityGreater NoidaUttar Pradesh 201306India Department of Zoology Kalindi CollegeUniversity of DelhiNew Delhi 110008India Department of Orthopaedics and Regenerative Medicine Regenerative OrthopaedicsNoida 201301Uttar PradeshIndia Department of Orthopaedics and Regenerative Medicine Future BiologicsLawrencevilleGA 30043United States Department of Orthopaedics and Regenerative Medicine BioIntegrateLawrencevilleGA 30043United States

BACKGROUND Current osteoarthritis(OA)treatments focus on symptom relief without addressing the underlying disease process.In regenerative medicine,current treatments have limitations.In regenerative medicine,more research is needed for intra-articular stromal vascular fraction(SVF)injections in OA,including dosage optimization,long-term efficacy,safety,comparisons with other treatments,and mechanism exploration.AIM To compare the efficacy of intra-articular SVF with corticosteroid(ICS)injections in patients with primary knee OA.METHODS The study included 50 patients with Kellgren-Lawrence grades II and III OA.Patients were randomly assigned(1:1)to receive either a single intra-articular SVF injection(group A)or a single intra-articular ICS(triamcinolone)(group B)injection.Patients were followed up at 1,3,6,12,and 24 months.Visual analog score(VAS)and International Knee Documentation Committee(IKDC)scores were administered before the procedure and at all followups.The safety of SVF in terms of adverse and severe adverse events was recorded.Statistical analysis was performed with SPSS Version 26.0,IBM Corp,Chicago,IL,United States.RESULTS Both groups had similar demographics and baseline clinical characteristics.Follow-up showed minor patient loss,resulting in 23 and 24 in groups A and B respectively.Group A experienced a notable reduction in pain,with VAS scores decreasing from 7.7 to 2.4 over 24 months,compared to a minor reduction from 7.8 to 6.2 in Group B.This difference in pain reduction in group A was statistically significant from the third month onwards.Additionally,Group A showed significant improvements in knee functionality,with IKDC scores rising from 33.4 to 83.10,whereas Group B saw a modest increase from 36.7 to 45.16.The improvement in Group A was statistically significant from 6 months and maintained through 24 months.CONCLUSION Our study demonstrated that intra-articular administration of SVF can lead to reduced pain and improved knee function in patients with primary knee OA.More adequately powe

关键词： Knee osteoarthritis Adipose tissue Stromal vascular fraction Regenerative medicine Orthobiologics

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Helicobacter pylori isolated from gastric juice have higher pathogenic potential than biopsy isolates

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Genes & Diseases 2024年第1期11卷 34-37页

作者： Budhadev Baral Dharmendra Kashyap Nidhi Varshney tarun Prakash Verma Ajay Kumar Jain Debi Chatterji Vinod Kumar Amit Mishra Awanish Kumar Hem Chandra Jha Infection Bioengineering Group Department of Biosciences and Biomedical EngineeringIndian Institute of Technology IndoreSimrolIndoreMadhya Pradesh 453552India Choithram Hospital and Research Center IndoreMadhya Pradesh452014India Department of Metallurgy Engineering and Materials Science Indian Institute of Technology IndoreSimrolIndoreMadhya Pradesh 453552India Department of Bioscience&Bioengineering Indian Institute of Technology JodhpurNH 65 Nagaur RoadJodhpur DistrictKarwarRajasthan 342037India Department of Biotechnology National Institute of Technology RaipurGE RoadRaipurChhattisgarh 492010India

Persistent gastritis induced by Helicobacter pylori(H.pylori)is the strongest known risk factor for gastric cancer(GC).H.pylori is prevalent in about 50%world's population,while it causes cancer in less than 2%of exposed individuals.1 Our studies found that H.pylori infection can induce oncogenic properties in AGS cells by deregulating multiple factors associated with the cell cycle,apoptosis,and other important events associated with cancer progression.

关键词： H.pylori pylori Helicobacter

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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 body.There is a paucity of literature on the enhancement characteristics of jaw tumors.This is mainly because,even though computed tomography(CT)is used to evaluate these lesions,they are often imaged without intravenous contrast.This 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 pathologies.AIM To evaluate the role of contrast enhancement and dual-energy quantitative parameters in CT in the differentiation of jaw tumors.METHODS Fifty-seven patients with jaw tumors underwent contrast-enhanced dual-energy CT.Morphological 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 IC.The 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 used.If significant differences were found,a series of independent t-tests or Mann-Whitney U tests were used.RESULTS Ameloblastoma was the most common pathology(n=20),followed by CGCG(n=11)and OKC.CGCG 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 significantly higher WC.Also,ameloblastoma had

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

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Phenazine-based supramolecular photosensitizing assemblies:A“smart”selectivity control on catalytic activity of Pd(Ⅱ)nanoparticles

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聚集体(英文) 2023年第1期4卷 173-183页

作者： Aditya Singh Manoj Kumar Vandana bhalla Department of Chemistry UGC Sponsored-Centre of Advance Studies-ⅡGuru Nanak Dev UniversityAmritsarPunjabIndia

Photosensitizing supramolecular assemblies based on a phenazine derivative(PPA)have been developed,which show a strong affinity toward Pd2+ions to generate supramolecular ensemble PPA@Pd nanoparticles(NPs).The PPA@Pd NPs catalyse the Suzuki cross-coupled reaction under mild conditions(aerial conditions,mixed aqueous media,and visible light radiations).Although PPA@Pd NPs exhibit a strong affinity for arylboronic acid and could catalyse homocoupling of arylboronic acid,the preference of PPA assemblies for aryl halide directed the course of reactions toward the formation of cross-coupled products.The electron-rich PPA assemblies not only facilitate the oxidative addition step through photoinduced electron transfer to Pd^(2+)ions but also bring the reactants closer to the catalytic sites by selective interactions with aryl halides in the presence of arylboronic acid under visible light irradiation.The efficiency of PPA@Pd NPs to catalyse the Suzuki crosscoupled reaction has been demonstrated for the synthesis of unsymmetrically substituted terphenyl derivatives.

关键词： ensemble homocoupling phenazine photosensitizing supramolecular assemblies Suzuki cross-coupled

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Hybrid Bio-based Composites from Waste Chicken Feather and Betel Nut Fiber: A Study on the Mechanical and Thermal Properties

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Journal of Bionic Engineering 2022年第1期19卷 268-277页

作者： Gitashree Gogoi Chayanika Chowdhury tarun K.Maji Department of Chemical Sciences Tezpur UniversityAssam784028India

The present work is an attempt to develop bio-based hybrid composites by incorporating Betel nut Fiber(BF)and Chicken feather Fiber(CF)at different ratios in modified soybean oil matrix by compression molding technique.The ratio of the fiber and resin was taken as 30:70.Epoxidised soybean oil(ESO)was modified by using methacrylic acid and methacrylic anhydride.The ratio of CF and BF was varied from 2:1 to 1:2 respectively.The influence of hybrid fibers and fiber ratio on various properties of the composites was investigated.The obtained results showed that composites prepared with 1:1 ratio of CF and BF exhibited highest tensile strength compared to the other composites prepared by using different ratios of CF and BF.The surface morphology of the composites was studied by Scanning Electron Microscopy(SEM),where surface roughness was found to be decreased after incorporation of hybrid fibers.Thermogravimetric analysis was carried out to study the behaviour of the composites at high temperature,where thermal stability was found to enhance for hybrid composites compared to the composites prepared with single fibers.Also properties like water vapour uptake capacity and volumetric swelling were measured and found to be decreased for the hybrid composites.An overall improvement in properties was observed for composites having 1:1 ratio of CF:BF.Hence,it is concluded that 1:1 weight ratio of CF and BF is the optimum mixing ratio to enhance the various properties of the hybrid composites.

关键词： Hybrid composites Betel nut fiber Chicken feather fiber Mechanical properties Thermal properties

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Encrusted cystitis and ascites due to urethral calculus

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Asian Journal of Urology 2022年第2期9卷 197-198页

作者： tarun Jindal Satyadip Mukherjee Department of Uro-oncology Tata Medical CentreKolkataIndia

Dear editor,A 55-year-old man presented with dyspnea and involuntary dribbling of urine for 1 month.He had history of straining during micturition and weak urinary stream for a year.On examination,he was disoriented and had abdominal distension.Ultrasound revealed marked ascites,pleural effusion,bilateral hydroureteronephrosis,and distended bladder with prostatic urethral calculus.A non-contrast computerized tomography scan additionally showed thickened bladder wall with florid mucosal calcification suggestive of encrusted cystitis and a 2.9 cm×2.5 cm calculus in the prostatic urethra extending to the bulbar urethra(Fig.1).His hemoglobin was 6 g/dL;urea and creatinine were elevated(114 mg/dL and 8.4 mg/dL,respectively);and the leucocyte count was 16.3×109/L.After initial resuscitation,ultrasound guided supra-pubic catheterization was performed.The urine pH was 8.4 while the microscopy revealed numerous pus cells,bacteria,and inorganic crystals.A nephrology consultation was taken and considering the clinical picture of encrusted cystitis,he started on intravenous vancomycin.He also received a session of hemodialysis.The patient died of cardiovascular collapse on the second post admission day.The urine culture report,obtained posthumously,revealed Corynebacterium urealyticum corroborating the diagnosis of encrusted cystitis.The strain was multidrug resistant and showed only sensitivity to teicoplanin and vancomycin.

关键词： bladder urine ascites

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Liver dysfunction during COVID-19 pandemic:Contributing role of associated factors in disease progression and severity

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World Journal of Hepatology 2022年第6期14卷 1099-1110页

作者： tarun Sahu Babita Pande Manasa PL Henu Kumar Verma Department of Physiology All India Institute of Medical SciencesRaipur 492001ChhattisgarhIndia Center for Basic Sciences Pt.Ravishankar Shukla UniversityRaipur 492001ChhattisgarhIndia Department of Immunopathology Institute of Lungs Health and ImmunityMunich 85764BavariaGermany

In December 2019,a new strain of coronavirus was discovered in China,and the World Health Organization declared it a pandemic in March 2020.The majority of people with coronavirus disease 19(COVID-19)exhibit no or only mild symptoms such as fever,cough,anosmia,and headache.Meanwhile,approximately 15%develop a severe lung infection over the course of 10 d,resulting in respiratory failure,which can lead to multi-organ failure,coagulopathy,and death.Since the beginning of the pandemic,it appears that there has been consideration that preexisting chronic liver disease may predispose to deprived consequences in conjunction with COVID-19.Furthermore,extensive liver damage has been linked to immune dysfunction and coagulopathy,which leads to a more severe COVID-19 outcome.Besides that,people with COVID-19 frequently have abnormal liver function,with more significant elevations in alanine aminotransferase and aspartate aminotransferase in patients with severe COVID-19 compared to those with mild/moderate disease.This review focuses on the pathogenesis of severe acute respiratory syndrome coronavirus-2(SARS-CoV-2)infection in the liver,as well as the use of liver chemistry as a prognostic tool during COVID-19.We also evaluate the findings for viral infection of hepatocytes,and look into the potential mechanisms behind SARS-CoV-2-related liver damage.

关键词： SARS-CoV-2 COVID-19 Liver function Hepatic injury Viral infection

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