Search

In this article, Aluminum (Al2219) as a matrix, and particles of n-B4C and MoS2 were chosen as reinforcements. By means of the stir casting technique, the unhybrid and hybrid nano metal matrix composites were prepared. The turning experiment was done through CCD design of experiment with TiN coated carbide insert using a Computer Numerically Controlled Lathe. Also, for turned inserts tool wear measurement was done using a Mitutoyo profile projector with digital readout. By ANOVA the significant contribution for tool wear of each parameter can be identified and the confirmation test is performed in sort to validate the tool wear results. Furthermore, the formation of chips during turning nano MMCs (unhybrid and hybrid) are studied for different feed rates (f) and cutting speeds (v) at 0.5 mm constant depth of cut. The outcome showed that both increases in cutting speed and feed rate increase the tool wear. For Al 2219, unhybrid and hybrid nano metal matrix composites feed rate is the important factor. The value of tool wear of the Al2219 matrix is minimal and for unhybrid nano composite is maximum. The leading wear mechanism in unhybrid nano composite is abrasion. Moreover, with the addition of 2%MoS2 in the hybrid nanocomposite the tool wears is decreased. The development of Build Up Edge (BUE) was seen on the flank face of the cutting tool for hybrid nanocomposite at 0.5 mm depth of cut, (v = 114.64 m/min) and (f = 0.441 mm/rev). The obtained % error among the modeled and experimental values is <5% and it is well within the limit. The analysis of chip formation was studied for nanocomposites at lower as well as higher feed rates, cutting speeds, and constant depth of cut during turning. [ABSTRACT FROM AUTHOR]

Purpose: Healthy corneas resist colonization by virtually all microbes yet contact lens wear can predispose the cornea to sight-threatening infection with Pseudomonas aeruginosa . Here, we explored how lens wear changes corneal epithelium transcriptional responses to P. aeruginosa and its impact on bacterial gene expression., Methods: Male and female C57BL/6J mice were fitted with a contact lens on one eye for 24 h. After lens removal, corneas were immediately challenged for 4 h with P. aeruginosa . A separate group of naïve mice were similarly challenged with bacteria. Bacteria-challenged eyes were compared to uninoculated naive controls as was lens wear alone. Total RNA-sequencing determined corneal epithelium and bacterial gene expression., Results: Prior lens wear profoundly altered the corneal response to P. aeruginosa , including: upregulated pattern-recognition receptors ( tlr3, nod1 ), downregulated lectin pathway of complement activation ( masp1 ), amplified upregulation of tcf7 , gpr55, ifi205, wfdc2 (immune defense) and further suppression of efemp1 (corneal stromal integrity). Without lens wear, P. aeruginosa upregulated mitochondrial and ubiquinone metabolism genes. Lens wear alone upregulated axl, grn, tcf7, gpr55 (immune defense) and downregulated Ca2 + -dependent genes necab1, snx31 and npr3 . P. aeruginosa exposure to prior lens wearing vs. naïve corneas upregulated bacterial genes of virulence ( popD ), its regulation ( rsmY , PA1226) and antimicrobial resistance ( arnB , oprR )., Conclusion: Prior lens wear impacts corneal epithelium gene expression altering its responses to P. aeruginosa and how P. aeruginosa responds to it favoring virulence, survival and adaptation. Impacted genes and associated networks provide avenues for research to better understand infection pathogenesis.

Introduction: Underutilization of hepatocellular cancer (HCC) surveillance has been reported, although data evaluating interventions to improve surveillance are sparse. We assessed the effect of a population-based HCC surveillance program on HCC surveillance utilization and outcomes., Methods: In this retrospective cohort study, we assessed preinclusion and postinclusion HCC surveillance patterns among 597 patients with hepatitis C virus cirrhosis enrolled in a program at an integrated health system between 2013 and 2020. Adequate surveillance was defined as at least 5 surveillance studies within 36 months pre-enrollment and postenrollment; a secondary outcome was proportion of time covered by surveillance over 36 months. Tumor size, stage, and receipt of curative therapy were compared between HCC detected on the first imaging examination (prevalent HCC) and surveillance-detected HCC (incident HCC). We performed Kaplan-Meier analysis and multivariable competing risk analysis to characterize the association between surveillance and mortality., Results: The surveillance program significantly improved surveillance completion (77.6% vs 5.0%, P < 0.001) and proportion time covered (80.9% vs 15.8%, P < 0.001). Compared with prevalent HCC, surveillance-detected cases were more likely unifocal (77.8% vs 44.8%, P < 0.001), early-stage (85.2% vs 44.8%, P < 0.001), with smaller maximum diameter (median 2.3 vs 3.2 cm), and more likely to undergo curative therapy (92.5% vs 72.4% P = 0.010). Survival was improved compared with prevalent cases hazard ratio (HR) 0.23 (0.11-0.51) after adjusting for age and Model for End Stage Liver Disease score., Discussion: Implementation of a population-based program resulted in significant improvement in HCC surveillance use and clinical outcomes among patients with hepatitis C virus cirrhosis. These findings may inform similar interventions by other healthcare systems., (Copyright © 2024 by The American College of Gastroenterology.)

Caloric restriction improves metabolic health but is often complicated by bone loss. We studied bone parameters in humans during a 10-day fast and identified candidate metabolic regulators of bone turnover. Pro-collagen 1 intact N-terminal pro-peptide (P1NP), a bone formation marker, decreased within 3 days of fasting. Whereas dual-energy x-ray absorptiometry measures of bone mineral density were unchanged after 10 days of fasting, high-resolution peripheral quantitative CT demonstrated remodeling of bone microarchitecture. Pathway analysis of longitudinal metabolomics data identified one-carbon metabolism as fasting dependent. In cultured osteoblasts, we tested the functional significance of one-carbon metabolites modulated by fasting, finding that methionine - which surged after 3 days of fasting - affected markers of osteoblast cell state in a concentration-dependent manner, in some instances exhibiting a U-shaped response with both low and high concentrations driving putative antibone responses. Administration of methionine to mice for 5 days recapitulated some fasting effects on bone, including a reduction in serum P1NP. In conclusion, a 10-day fast in humans led to remodeling of bone microarchitecture, potentially mediated by a surge in circulating methionine. These data support an emerging model that points to a window of optimal methionine exposure for bone health.

Objective: Given recent COVID-19 restrictions on in-person visiting subinternships and interviews, this study sought to evaluate the program information that was most influential to future plastic surgery applicants as they researched residency programs on social media., Design and Setting: An electronic survey targeting medical students interested in plastic surgery was deployed to assess the importance of various information sources in forming perceptions of residency programs. Applicants were invited to participate through an Instagram "Story" (where the survey was embedded) and through an electronic survey link sent via email to interested program applicants and interviewees., Participants and Results: There were 83 respondents, among which 92% were current medical students planning to apply to Plastic Surgery. The most utilized resources that informed program interest were: mentors (86%), peers/partners (60%), and geographic location preference (55%). Among social media content, applicants most desired posts about resident life (66%) and team bonding activities (61%). Overall, 72% of respondents agreed/strongly agreed that social media played a role in informing their interest to apply to a specific residency program., Conclusion: The study demonstrated that prospective plastic surgery applicants expect programs to have a social media presence, and thus, programs should invest time and thought in their social media strategy. While electronic sources are not the most important sources of information rated among applicants, social media plays an influential role in guiding interest in specific programs. To best inform applicant perspectives during the recruiting process, programs should prioritize content that gives a picture of "resident life" and team dynamics., (Published by Elsevier Inc.)

Regenerative peripheral nerve interface (RPNI) surgery has been demonstrated to be an effective tool as an interface for neuroprosthetics. Additionally, it has been shown to be a reproducible and reliable strategy for the active treatment and for prevention of neuromas. The purpose of this article is to provide a comprehensive review of RPNI surgery to demonstrate its simplicity and empower reconstructive surgeons to add this to their armamentarium. This article discusses the basic science of neuroma formation and prevention, as well as the theory of RPNI. An anatomic review and discussion of surgical technique for each level of amputation and considerations for other etiologies of traumatic neuromas are included. Lastly, the authors discuss the future of RPNI surgery and compare this with other active techniques for the treatment of neuromas., Competing Interests: The authors have no financial interest to declare in relation to the content of this article., (Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc. on behalf of The American Society of Plastic Surgeons.)

Purpose: Previously, using a murine model, we reported that contact lens (CL) wear induced corneal parainflammation involving CD11c+ cells after 24 h and Ly6G+ cells (neutrophils) after 5-6 days. Here, we investigated the role of IL-17 and γδ T cells in the CL-induced neutrophil response., Methods: CL-wearing C57BL/6 wild-type (WT) mice were compared to lens-wearing IL-17A/F single or double gene knock-out mice, or mice treated with UC7-13D5 monoclonal antibody to functionally deplete γδ T cells. Contralateral eyes served as no lens wear controls. Corneal Ly6G+ and γδ T cell responses were quantified as was expression of genes encoding pro-inflammatory cytokines IL-17A/F, IL-β, IL-18 and expression of IL-17A/F protein., Results: After 6 days lens wear, WT corneas showed Ly6G+ cell infiltration while remaining free of visible pathology. In contrast, lens-wearing corneas of IL-17AF (-/-), IL-17A (-/-) mice and γδ T cell-depleted mice showed little or no Ly6G+ cell infiltration. No Ly6G+ cell infiltration was detected in contralateral eye controls. Lens-wearing WT corneas also showed a significant increase in γδ T cells after 24 h that was maintained after 6 days of wear, and significantly increased cytokine gene expression after 6 days versus contralateral controls: IL-18 & IL-17A (∼3.9 fold) and IL-23 (∼6.5-fold). Increased IL-17A protein (∼4-fold) was detected after 6 days lens wear. γδ T cell-depletion abrogated these lens-induced changes in cytokine gene and protein expression., Conclusion: Together, these data show that IL-17A and γδ T cells are required for Ly6G+ cell (neutrophil) infiltration of the cornea during contact lens-induced parainflammation., (Copyright © 2023 Elsevier Inc. All rights reserved.)

Within epithelial cells, Pseudomonas aeruginosa depends on its type III secretion system (T3SS) to escape vacuoles and replicate rapidly in the cytosol. Previously, it was assumed that intracellular subpopulations remaining T3SS-negative (and therefore in vacuoles) were destined for degradation in lysosomes, supported by data showing vacuole acidification. Here, we report in both corneal and bronchial human epithelial cells that vacuole-associated bacteria can persist, sometimes in the same cells as cytosolic bacteria. Using a combination of phase-contrast, confocal, and correlative light-electron microscopy (CLEM), we also found they can demonstrate biofilm-associated markers: cdrA and cyclic-di-GMP (c-di-GMP). Vacuolar-associated bacteria, but not their cytosolic counterparts, tolerated the cell-permeable antibiotic ofloxacin. Surprisingly, use of mutants showed that both persistence in vacuoles and ofloxacin tolerance were independent of the biofilm-associated protein CdrA or exopolysaccharides (Psl, Pel, alginate). A T3SS mutant (Δ exsA ) unable to escape vacuoles phenocopied vacuole-associated subpopulations in wild-type PAO1-infected cells, with results revealing that epithelial cell death depended upon bacterial viability. Intravital confocal imaging of infected mouse corneas confirmed that P. aeruginosa formed similar intracellular subpopulations within epithelial cells in vivo . Together, these results show that P. aeruginosa differs from other pathogens by diversifying intracellularly into vacuolar and cytosolic subpopulations that both contribute to pathogenesis. Their different gene expression and behavior (e.g., rapid replication versus slow replication/persistence) suggest cooperation favoring both short- and long-term interests and another potential pathway to treatment failure. How this intracellular diversification relates to previously described "acute versus chronic" virulence gene-expression phenotypes of P. aeruginosa remains to be determined. IMPORTANCE Pseudomonas aeruginosa can cause sight- and life-threatening opportunistic infections, and its evolving antibiotic resistance is a growing concern. Most P. aeruginosa strains can invade host cells, presenting a challenge to therapies that do not penetrate host cell membranes. Previously, we showed that the P. aeruginosa type III secretion system (T3SS) plays a pivotal role in survival within epithelial cells, allowing escape from vacuoles, rapid replication in the cytoplasm, and suppression of host cell death. Here, we report the discovery of a novel T3SS-negative subpopulation of intracellular P. aeruginosa within epithelial cells that persist in vacuoles rather than the cytoplasm and that tolerate a cell-permeable antibiotic (ofloxacin) that is able to kill cytosolic bacteria. Classical biofilm-associated markers, although demonstrated by this subpopulation, are not required for vacuolar persistence or antibiotic tolerance. These findings advance our understanding of how P. aeruginosa hijacks host cells, showing that it diversifies into multiple populations with T3SS-negative members enabling persistence while rapid replication is accomplished by more vulnerable T3SS-positive siblings. Intracellular P. aeruginosa persisting and tolerating antibiotics independently of the T3SS or biofilm-associated factors could present additional challenges to development of more effective therapeutics.

Aims and Objective: The aim of the present study was to ascertain the reliability of using salivary glucose in diagnosing and monitoring the blood glucose levels in type 1 diabetic patients and also to evaluate the salivary glucose in fasting and postprandial states and correlate with the blood glucose levels and hemoglobin A1c values., Materials and Methods: The study was conducted on 79 Type 1 diabetic patients and 100 healthy controls. The blood and salivary glucose levels were evaluated in both study and control groups using glucose-oxidase peroxidase method., Results: There was significantly higher level of salivary glucose in diabetics than in controls. There was a positive moderate-to-strong correlation between stimulated and unstimulated salivary glucose to blood glucose in both fasting and postprandial states. The cutoff values for stimulated and unstimulated fasting salivary glucose was 5.8 mg/dl and 5.6 mg/dl, respectively. The cutoff value for stimulated and unstimulated salivary glucose in postprandial state was 10.3 mg/dl and 9.5 mg/dl, respectively., Conclusion: Salivary glucose appears to be a reliable biofluid to assess the blood glucose levels and can be a reliable alternative to blood glucose in Type 1 diabetes mellitus patients., Competing Interests: There are no conflicts of interest., (Copyright: © 2022 Journal of Pharmacy and Bioallied Sciences.)

Background: Antimicrobial resistance (AMR) is a global public health threat. The indiscriminate use of antibiotics in the animal health sector contributes to increasing rates of AMR and studies involving dairy farmers in India have found knowledge levels regarding antibiotics and AMR to be very low. The purpose of this study was to assess different methods to raise awareness and knowledge about AMR and antibiotic use among dairy farmers, paravets (veterinary assistants), and veterinarians., Materials and Methods: The study was conducted in September-December of 2018 in some parts of Haryana, Assam, Karnataka, and West Bengal. It had two parts: an intervention meeting (September-October 2018) which consisted of focus group discussions (FGD) with farmers, key informant interviews (KII) with veterinary professionals along with distribution of information packages, and then a follow-up survey (November-December 2018). The villages were randomly allocated to either one of the four intervention approaches (1-FGD/KII and information package on AMR; 2-FGD/KI and information on animal health; 3- FGD/KII and information package on animal health plus information on AMR; or 4- only the FGD/KII). A follow-up survey was done to assess the effect of interventions., Results: In total, 274 dairy farmers and 51 veterinary professionals (21 veterinarians and 30 paravets) participated in the follow-up survey. Many of the farmers and veterinary professionals who participated in the follow-up survey had been part of the intervention meetings. The average knowledge score of farmers was 7.8. It was found that the knowledge score was higher amongst farmers who had participated in the intervention meetings ( p < 0.05), had received intervention approach 2 ( p = 0.03) or approach 3 ( p = 0.01), and amongst female farmers ( p = 0.03) compared to male. The veterinary professionals had good knowledge but lacked interest in training the farmers about antimicrobial resistance., Conclusion: Our research demonstrated that a higher percentage of farmers and veterinary professionals who attended the intervention meeting had improved knowledge. Dairy farmers should be regularly educated on antibiotic usage and how to avoid misusing them. Also, veterinary experts should be provided with tools and strategies to educate farmers on the use of antimicrobials., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2022 Sharma, Mutua, Deka, Shome, Bandyopadhyay, Shome, Kumar, Grace, Dey and Lindahl.)

Background and Aims: Moderate to severe postburn contractures (PBCs) of the neck lead to multiple areas of difficulty in airway management. Awake flexible fiberscope guided intubation with cuffed endotracheal tube (ETT) is considered the "gold standard" for securing the airway in these cases. Supraglottic airway devices (SADs), if at all used, are used either as rescue devices or as conduits for ETT. This case series looks at the possibility of using SADs as a planned airway securing device in these cases., Material and Methods: We managed 24 cases of moderate to severe PBC neck using six types of pre shaped SADs as the first choice airway device. These SADs were placed after either airway topicalization (19 cases) or general anesthesia (GA) (5 cases). Once SAD placement was confirmed, all the patients received GA and muscle relaxant. Tests for proper placement and function and fiberscopy (conducted in four cases) were performed at various times during the procedure. The SADs were removed once the patients were fully awake., Results: SADs could be placed in one attempt in all the cases. The time taken to hand over the patients to surgeons was 12-20 min. SADs maintained their proper placement and function in spite of changing airway dimensions during contracture release. The patients tolerated the SADs well right until the time they were fully awake. The SADs could be successfully removed on the operation table in all the cases., Conclusion: Pre shaped SADs secure the airway quickly and are free from the risk of intraoperative displacements and allow uneventful emergence in moderate and severe PBC neck cases and need to be considered as the first choice in these cases., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Journal of Anaesthesiology Clinical Pharmacology.)

Blind nasal intubation (BNI) has been around for over a century now. Many clinicians advocate it as an "old-is-gold" skill, which can be performed without any adjuncts in cases where visualization of larynx is a problem. Even today, BNI not only comes handy in resource-limited centers, it may also come to the rescue of airway managers in well-equipped centers. However, in the century since it was first described, there have been other major developments in the field of airway management and BNI as a skill has taken a backseat when it comes to a priority order. More so because it is limited by modalities to teach and train as most of the available manikins, which are otherwise phenomenal when it comes to imitating anatomy and overall attention to detail of a human airway, suffer terribly in one basic aspect needed to teach, train, and learn BNI-"they" cannot breathe! Attempts have been made to fabricate some manikins on these lines. But what if they can not only breathe but breathe out CO 2 as well! We describe a simple method whereby we created a "CO 2 breathing" manikin and tested it in an Airway Management Workshop with 105 participants, and then evaluated it under controlled conditions in 20 volunteers. We got very encouraging results and realized that our manikin makes the teaching and training of BNI very interesting and attractive by simulating the actual clinical scenario. We feel that it has the potential of reinventing the valuable skill of BNI., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Journal of Anaesthesiology Clinical Pharmacology.)

Background and Aims: The supraglottic airway devices (SADs) that allow direct (without an intermediary device like Aintree or airway exchange catheters) tracheal intubation can be invaluable for field use in conditions ideally managed by intubation. Whilst fiberscope-guided intubation is the method of choice, if these 'direct-intubation' SADs could provide high success rates for blind tracheal intubation, their scope of use can increase tremendously. Our study assesses intubating laryngeal mask airway (ILMA), i-gel and Ambu AuraGain for blind tracheal intubation in adults., Material and Methods: Ninety adults undergoing elective surgery were randomized into three equal groups. After induction of anesthesia, the group-specific SAD was inserted and on achieving adequate ventilation, blind tracheal intubation was attempted over two attempts. Success rates and time of achieving adequate device placement and tracheal intubation through these were evaluated. Data were analyzed using SPSS version 17.0 and P < 0.05 was considered statistically significant., Results: All three devices could achieve adequate ventilation within two allowed attempts. Successful tracheal intubation rates were significantly better with ILMA than i-gel on first attempt (87% vs. 27%, P < 0.001) and after second attempt that was supplemented with optimization maneuvers (100% vs. 40%, P < 0.001). No patient could be intubated through Ambu AuraGain within two attempts. Time taken for successful tracheal intubation did not differ significantly ( P = 0.205) with ILMA or i-gel., Conclusion: Out of ILMA, I-gel and Ambu AuraGain, ILMA is the best device for blind tracheal intubation in adults with normal airways., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Journal of Anaesthesiology Clinical Pharmacology.)