Search

Background: The Institute of Medicine has identified patients as a key source of information for assessing the quality of care., Objective: To evaluate the association of physician specialty with the content and quality of follow-up cancer care., Design and Participants: Three hundred three colorectal cancer (CRC) survivors in Northern California were surveyed 2-5 years post-diagnosis., Measurements: Specialty of physician seen most often [primary care physician (PCP), oncologist, surgeon, or gastroenterologist]; other physician specialties seen; patient characteristics; content of visits; patient-centered quality of follow-up care (communication, coordination, nursing, and staff interactions)., Main Results: A minority (16%) of CRC survivors reported that the doctor they most often saw for follow-up cancer care was a PCP, while 60% saw an oncologist. Many CRC survivors (40%) saw >1 physician for follow-up cancer care. Survivors most often seen by PCPs were more likely to have three or more medical comorbidities (70% vs. 51%, p = 0.012) than survivors seen by subspecialty physicians. Survivors seen by PCPs were less likely to report seeing a doctor for medical tests and more likely to report discussing disease prevention (82% vs. 64%, p = 0.012) or diet (70% vs. 48%, p = 0.005) with their doctor. There were no significant specialty differences in patient-centered quality of follow-up cancer care., Conclusions: Cancer survivors' assessment of the quality of care was similar across specialties, while the content of follow-up cancer care varied by physician specialty. These findings provide important information about the potential value of primary care and the need for coordination when delivering care to CRC survivors.

Objective: To determine the effectiveness of the telemedicine-based pulmonary rehabilitation programme in COVID-19 pneumonitis. Design: Prospective intervention study. Setting: Rehabilitation outpatient department, Tertiary-Care institute. Participants: Consecutive sample of patients (N = 50) in recovered COVID-19 infection. Intervention: Six weeks of telemedicine-based pulmonary rehabilitation in recovered patients of COVID-19 infection. Outcome Measures: All patients were clinically assessed by six minutes walk test (6MWT), Modified Medical Research Council Scale (mMRC), 30s-STS and SF 36 at zero week and six weeks post-intervention. Statistical Analysis: Difference in means of pre- and post-intervention was compared using paired t-test. A P value

Background: An anal fissure is a cut or split in the epithelial lining of the anal canal distal to the dentate line. Various topical ointments been described for its treatment. Aim and Objectives: To study Lignocaine (3%) with Zinc (5%) with Hydrocortisone (0.25%) combination (LZH) ointment in comparison to Lignocaine (4%) with Sucralfate (7%) with Metronidazole (1%) combination (LSM) ointment with respect to pain relief, healing, patient satisfaction and safety in acute fissure in ano (AFIA). Material and Methods: This was a prospective randomized study. Sixty patients with AFIA were randomly divided into two groups of 30 patients each. In group A LZH ointment and in group B LSM ointment was prescribed and followed up weekly for six weeks. Results: Our study shows less pain score in group B as compared to group A. The rate of healing was statistically significantly better in group B from 3rd week onwards. The patient satisfaction score was better in group B (P value = 0.0004). No complication was seen in any patient. Conclusion: Our study shows that the LSM ointment in comparison to LZH ointment is associated with early pain relief, better healing, better overall patient satisfaction, and equally safe in patients with AFIA

Background: Globally, ocular morbidities are one of the most underdiagnosed, underreported, and undertreated public health concern. Among estimated 39 billion blind in world, India shares major proportions, with majority of them living in rural population. In India, religious festivals like Kumbh Mela that involve mass gatherings are mainly attended by middle and elderly population who are usually susceptible to various ocular diseases. Therefore, we analyzed the data of our eye camp to document pattern and magnitude of ocular morbidities among pilgrims attending a mega religious festive event. Methods: In a cross-sectional, descriptive study, we included all those patients who participated in a mega eye camp “Netrakumbh” from January to March 2019 at Kumbh Mela, Prayagraj, India and were attended by voluntary ophthalmologist from All India Institute of Medical Sciences, Rishikesh. Presenting chief complaints and detailed history were collected from all participants. All patients underwent comprehensive eye examination including visual acuity, slit lamp biomicroscopic examination, tonometry, etc., Data were compiled and analyzed utilizing SPSS 22.0. Results: A total of 47142 eyes of 23571 persons of all age groups (range 5 years to 70 years) with approximate equal gender distribution attending the mega eye camp were examined. The most common ocular morbidity noticed after ocular examination was refractive error with underlying cause majorly as presbyopia, followed by cataract, after cataract, convergence insufficiency, lids, and adnexal disease, etc. Conclusions: This study highlights the changing pattern of common ocular morbidities presently among middle and elderly populations in developing countries like India.

Objective: To analyze global DNA methylation along with DNA methyltransferases (DNMTs) expression at transcript level in patients with impaired spermatogenesis to dissect its role in pathophysiology of human male infertility. Method: The content of Global methylated cytosine (mC) was determined using ELISA system (Imprint Methylated DNA Quantification Kit, Sigma–Aldrich) in 31 testicular biopsies showing impaired spermatogenesis and 8 with normal spermatogenesis. Real-time reverse transcription-polymerase chain reaction was done to analyze DNMTs (DNMT1, DNMT3A, DNMT3B and DNMT3L) mRNA levels in biopsies with different testicular phenotypes. Results: There was significant increase in levels of global methylation in different impaired testicular phenotypes as compared to normal. Expression analysis revealed significantly increased expression of DNMT1 and its positive correlation with global DNA methylation. Conclusion: In conclusion, increased levels of global methylation in impaired cases might be the one of the contributing factors for aberrant gene expression in infertile patients.

Objective: To investigate –844C>T single nucleotide polymorphism (SNP) present in the promoter of cell death pathway gene FASLG with male infertile phenotype. Methods: Genotyping for SNP FASLG (rs763110) was done by polymerase chain reaction followed by analysis with specific endonuclease (PCR-RFLP). DNA sequencing was used to ascertain PCR-RFLP results. Results: FASLG –844C>T polymorphism, allele and genotype distribution did not differ significantly between patients and controls (OR: 1.03, 95% CI= 0.7638 to 1.3952, P=0.83). Thus SNP-844C>T of the FASLG gene is not associated with male infertility risk in the analyzed patients. Conclusions: Human male infertility is a complex disorder and thus other genetic or environmental factors may be contributing to the complex etiology, and further study in other region of Indian populations will verify whether it is associated with male infertility risk.

Type I interferons (IFNα, IFNβ) are key regulators of innate and adaptive immunity, modulating the severity of both viral and bacterial infections. While type I IFN signaling leads to improved outcomes in viral infections, its role in bacterial infections is more contextual and depends on the specific pathogen and route of infection. Given the limited evidence on whether type I IFN signaling affects enteric bacterial pathogens, we investigated the role of this signaling pathway in Salmonella enterica serovar Typhimurium (S. typhimurium)-induced colitis. Comparing mice deficient in IFNAR1- the common receptor for IFNα and IFNβ- with wild-type mice, we found that type I IFN signaling leads to more rapid death, more severe colonic inflammation, higher serum levels of pro-inflammatory cytokines, and greater bacterial dissemination. Specific ablation of plasmacytoid dendritic cells (pDCs), which are prominent producers of type I IFNs in antiviral responses, did not alter survival after infection. This result established that pDCs do not play a major role in the pathogenesis of S. typhimurium colitis. Flow cytometric analysis of macrophages and conventional dendritic cells (cDCs) during active colitis demonstrated an increase in CD11c- macrophages and CD103+ cDCs in the colon of Ifnar1-/- animals. Interestingly, cells expressing the anti-inflammatory cytokine receptor IL-10R are more abundant within these subsets in Ifnar1-/- than in wild-type mice. Moreover, blockade of IL-10R in Ifnar1-/- mice increased their susceptibility to S. typhimurium colitis, suggesting that altered numbers of these immunoregulatory cells may underlie the difference in disease severity. This cross-talk between type I IFN and IL-10R signaling pathways may represent a key host cellular mechanism to investigate further in order to unravel the balance between pathogenic inflammation and homeostasis of the colon. Taken together, our data clearly demonstrate that type I IFN signaling is pathogenic in S. typhimurium colitis.

Gastrointestinal symptoms such as dyspepsia, vomiting, diarrhea, hepatitis, gastrointestinal bleed, abdominal pain, subacute intestinal obstruction like presentation and acute abdomen are common in acute malaria. However, perforated duodenal ulcer (PDU) complicating acute malaria in a child is a rare occurrence and uncommonly heard of. The exact mechanism of duodenal ulcer perforation in malaria is not clear due to the paucity of reported cases, and it may be multifactorial in etiology. The treatment of PDU in children is similar to adults that is surgical by omental patch repair of the perforation. We present an unusual case of PDU in a pediatric patient of malaria. The search of English literature revealed only one more reported case of PDU associated with malaria.

Chilaiditi syndrome is a condition in which the colon or rarely the small bowel is interposed temporarily or permanently between the liver and the diaphragm. Usually it is an asymptomatic and incidental radiographic finding, but may present with a variety of symptoms. We report a case of Chilaiditi syndrome with small bowel interposition who presented with chest pain, initially suspected to be myocardial infarction. Further Investigations revealed normal cardiac functions and gas under the right hemidiaphragm suggestive of pneumoperitoneum. After careful inspection of radiograph it was found to be gas filled small bowel between liver and diaphragm, which was later confirmed by ultrasound examination. The patient was successfully managed conservatively.

Coronary circulation if significantly diseased usually develop collaterals between the distal portion of the diseased vessel and the normal artery to accomplish flow in vessel distal to the diseased segment. These collaterals can be intracoronary or intercoronary. Coronary collaterals have to be differentiated from intercoronary continuity, which is a very rare variant of coronary circulation usually seen in angiographically normal looking arteries. In our patient, although proximal left anterior descending artery revealed significant lesion but intercoronary continuity was seen between normal right coronary artery and left circumflex artery on angiography.

Interleukin (IL)-1 signaling plays a critical role in intestinal immunology. Here, we report that the major population of intestinal lamina propria lymphocytes expressing IL-1 receptor 1 (IL-1R1) is the lymphoid tissue inducer (LTi)-like cell, a type of innate lymphoid cell. These cells are significant producers of IL-22, and this IL-22 production depends on IL-1R1 signaling. LTi-like cells are required for defense against Salmonella enterica serovar Typhimurium. Moreover, colonic LTi-like cell numbers depend on the presence of the intestinal microbiota. LTi-like cells require IL-1R1 for production of protective cytokines and confer protection in infectious colitis, and their cell numbers in the colon depend upon having a microbiome.

Acetyl coenzyme A carboxylase B gene (ACACB) single nucleotide polymorphism (SNP) rs2268388 is reproducibly associated with type 2 diabetes (T2DM)-associated nephropathy (DN). ACACB knock-out mice are also protected from obesity. This study assessed relationships between rs2268388, body mass index (BMI) and gene expression in multiple populations, with and without T2DM. Among subjects without T2DM, rs2268388 DN risk allele (T) associated with higher BMI in Pima Indian children (n = 2021; p-additive = 0.029) and African Americans (AAs) (n = 177; p-additive = 0.05), with a trend in European Americans (EAs) (n = 512; p-additive = 0.09), but not Germans (n = 858; p-additive = 0.765). Association with BMI was seen in a meta-analysis including all non-T2DM subjects (n = 3568; p-additive = 0.02). Among subjects with T2DM, rs2268388 was not associated with BMI in Japanese (n = 2912) or EAs (n = 1149); however, the T allele associated with higher BMI in the subset with BMI≥30 kg/m(2) (n = 568 EAs; p-additive = 0.049, n = 196 Japanese; p-additive = 0.049). Association with BMI was strengthened in a T2DM meta-analysis that included an additional 756 AAs (p-additive = 0.080) and 48 Hong Kong Chinese (p-additive = 0.81) with BMI≥30 kg/m(2) (n = 1575; p-additive = 0.0033). The effect of rs2268388 on gene expression revealed that the T risk allele associated with higher ACACB messenger levels in adipose tissue (41 EAs and 20 AAs with BMI>30 kg/m(2); p-additive = 0.018) and ACACB protein levels in the liver tissue (mixed model p-additive = 0.03, in 25 EA bariatric surgery patients with BMI>30 kg/m(2) for 75 exams). The T allele also associated with higher hepatic triglyceride levels. These data support a role for ACACB in obesity and potential roles for altered lipid metabolism in susceptibility to DN.

Recent studies have identified links between phospholipid composition and altered cellular functions in animal models of obesity, but the involvement of phospholipid biosynthesis genes in human obesity are not well understood. We analyzed the transcript of four phospholipid biosynthesis genes in adipose and muscle from 170 subjects. We examined publicly available genome-wide association data from the GIANT and MAGIC cohorts to investigate the association of SNPs in these genes with obesity and glucose homeostasis traits, respectively. Trait-associated SNPs were genotyped to evaluate their roles in regulating expression in adipose. In adipose tissue, expression of PEMT, PCYT1A, and PTDSS2 were positively correlated and PCYT2 was negatively correlated with percent fat mass and body mass index (BMI). Among the polymorphisms in these genes, SNP rs4646404 in PEMT showed the strongest association (p = 3.07E-06) with waist-to-hip ratio (WHR) adjusted for BMI. The WHR-associated intronic SNP rs4646343 in the PEMT gene showed the strongest association with its expression in adipose. Allele "C" of this SNP was associated with higher WHR (p = 2.47E-05) and with higher expression (p = 4.10E-04). Our study shows that the expression of PEMT gene is high in obese insulin-resistant subjects. Intronic cis-regulatory polymorphisms may increase the genetic risk of obesity by modulating PEMT expression.

Understanding the post-treatment physical and mental function of older adults from ethnic/racial minority backgrounds with cancer is a critical step to determine the services required to serve this growing population. The double jeopardy hypothesis suggests being a minority and old could have compounding effects on health. This population-based study examined the physical and mental function of older adults by age (mean age = 75.7, SD = 6.1), ethnicity/race, and cancer (breast, prostate, colorectal, and gynecologic) as well as interaction effects between age, ethnicity/race and HRQOL. There was evidence of a significant age by ethnicity/race interaction in physical function for breast, prostate and all sites combined, but the interaction became non-significant (for breast and all sites combined) when comorbidity was entered into the model. The interaction persisted in the prostate cancer group after controlling for comorbidity, such that African Americans and Asian Americans in the 75–79 age group report lower physical health than non-Hispanic Whites and Hispanic Whites in this age group. The presence of double jeopardy in the breast and all sites combined group can be explained by a differential comorbid burden among the older (75–79) minority group, but the interaction found in prostate cancer survivors does not reflect this differential comorbid burden.

Acetyl Coenzyme A carboxylase β (ACACB) is the rate-limiting enzyme in fatty acid oxidation, and continuous fatty acid oxidation in Acacb knock-out mice increases insulin sensitivity. Systematic human studies have not been performed to evaluate whether ACACB variants regulate gene expression and insulin sensitivity in skeletal muscle and adipose tissues. We sought to determine whether ACACB transcribed variants were associated with ACACB gene expression and insulin sensitivity in non-diabetic African American (AA) and European American (EA) adults.ACACB transcribed single nucleotide polymorphisms (SNPs) were genotyped in 105 EAs and 46 AAs whose body mass index (BMI), lipid profiles and ACACB gene expression in subcutaneous adipose and skeletal muscle had been measured. Allelic expression imbalance (AEI) was assessed in lymphoblast cell lines from heterozygous subjects in an additional EA sample (n = 95). Selected SNPs were further examined for association with insulin sensitivity in a cohort of 417 EAs and 153 AAs.ACACB transcribed SNP rs2075260 (A/G) was associated with adipose ACACB messenger RNA expression in EAs and AAs (p = 3.8×10(-5), dominant model in meta-analysis, Stouffer method), with the (A) allele representing lower gene expression in adipose and higher insulin sensitivity in EAs (p = 0.04). In EAs, adipose ACACB expression was negatively associated with age and sex-adjusted BMI (r = -0.35, p = 0.0002).Common variants within the ACACB locus appear to regulate adipose gene expression in humans. Body fat (represented by BMI) may further regulate adipose ACACB gene expression in the EA population.

Nonalcoholic fatty liver disease (NAFLD) is a known outcome of hepatosteatosis. Free fatty acids (FFA) induce the unfolded protein response (UPR) or endoplasmic reticulum (ER) stress that may induce apoptosis. Recent data indicate ER stress to be a major player in the progression of fatty liver to more aggressive lesions. Autophagy on the other hand has been demonstrated to be protective against ER stress-induced cell death. We hypothesized that exendin-4 (GLP-1 analog) treatment of fat loaded hepatocytes can reduce steatosis by autophagy which leads to reduced ER stress-related hepatocyte apoptosis.Primary human hepatocytes were loaded with saturated, cis- and trans-unsaturated fatty acids (palmitic, oleic and elaidic acid respectively). Steatosis, induced with all three fatty acids, was significantly resolved after exendin-4 treatment. Exendin-4 sustained levels of GRP78 expression in fat-loaded cells when compared to untreated fat-loaded cells alone. In contrast, CHOP (C/EBP homologous protein); the penultimate protein that leads to ER stress-related cell death was significantly decreased by exendin-4 in hepatocytes loaded with fatty acids. Finally, exendin-4 in fat loaded hepatocytes clearly promoted gene products associated with macroautophagy as measured by enhanced production of both Beclin-1 and LC3B-II, markers for autophagy; and visualized by transmission electron microscopy (TEM). Similar observations were made in mouse liver lysates after mice were fed with high fat high fructose diet and treated with a long acting GLP-1 receptor agonist, liraglutide.GLP-1 proteins appear to protect hepatocytes from fatty acid-related death by prohibition of a dysfunctional ER stress response; and reduce fatty acid accumulation, by activation of both macro-and chaperone-mediated autophagy. These findings provide a novel role for GLP-1 proteins in halting the progression of more aggressive lesions from underlying steatosis in humans afflicted with NAFLD.

In Ayurveda, every individual is believed to possess a unique entity known as Prakriti, which distinguishes them from others physically, physiologically, and psychologically. This entity also determines an individual's response to a particular stimulus, and it is believed that such responses are not solely determined by genetics. The present research aims to validate the Ayurvedic concept of Prakriti from a modern molecular perspective to strengthen the personalized and precise treatment approach. A study was conducted to investigate the role of the KCNJ11gene in the susceptibility of individuals to type 2 diabetes mellitus (T2DM) with their metabolic status. The research involved allele mining on three major Prakriti groups - Vata, Pitta, and Kapha - in 112 patients with T2DM and 112 healthy individuals. The KCNJ11 gene, responsible for insulin secretion membrane pore formation, was analyzed to determine the susceptibility of different Prakriti types to T2DM. The MutPred tool predicted the molecular cause of disease-related amino acid substitution. According to the study, only Pitta and Kapha Prakriti were diagnosed with diabetes, while all three Prakriti types were present in the control group of healthy individuals. A protein model was prepared, and the changes resulting from mutations were observed for each group in their protein sequence, both as synonymous and non-synonymous mutations. Ultimately, these changes contributed to the manifestation of T2DM. Based on the findings, it appears that Prakriti groups may experience changes in protein function due to nonsynonymous mutations and differences in amino acids at the protein level.

Abstract In bread wheat, a literature search gave 228 QTLs for six traits, including resistance against spot blotch and the following five other related traits: (i) stay green; (ii) flag leaf senescence; (iii) green leaf area duration; (iv) green leaf area of the main stem; and (v) black point resistance. These QTLs were used for metaQTL (MQTL) analysis. For this purpose, a consensus map with 72,788 markers was prepared; 69 of the above 228 QTLs, which were suitable for MQTL analysis, were projected on the consensus map. This exercise resulted in the identification of 16 meta-QTLs (MQTLs) located on 11 chromosomes, with the PVE ranging from 5.4% (MQTL7) to 21.8% (MQTL5), and the confidence intervals ranging from 1.5 to 20.7 cM (except five MQTLs with a range of 36.1–57.8 cM). The number of QTLs associated with individual MQTLs ranged from a maximum of 17 in MQTL3 to 8 each in MQTL5 and MQTL8 and 5 each in MQTL7 and MQTL14. The 16 MQTLs, included 12 multi-trait MQTLs; one of the MQTL also overlapped a genomic region carrying the major spot blotch resistance gene Sb1. Of the total 16 MQTLs, 12 MQTLs were also validated through marker-trait associations that were available from earlier genome-wide association studies. The genomic regions associated with MQTLs were also used for the identification of candidate genes (CGs) and led to the identification of 516 CGs encoding 508 proteins; 411 of these proteins are known to be associated with resistance against several biotic stresses. In silico expression analysis of CGs using transcriptome data allowed the identification of 71 differentially expressed CGs, which were examined for further possible studies. The findings of the present study should facilitate fine-mapping and cloning of genes, enabling Marker Assisted Selection.

Introduction: Acute viral encephalitis syndrome including dengue encephalitis (DE) is an important tropical illness with a guarded prognosis. The cerebral blood flow may be affected in acute viral encephalitis. Transcranial Doppler (TCD) sonography can quantitatively determine intracranial vascular flow dynamics in acute viral encephalitis. Aim: We aimed to investigate the intracranial blood flow characteristics in patients with DE and compare with nondengue acute viral encephalitis patients. Materials and Methods: In this prospective study, all the cases of acute viral encephalitis including dengue were enrolled over 18 months and followed up at 3 months. TCD was performed to determine the mean velocity pulsatility index (PI) and resistive index (RI) across the middle cerebral artery, anterior cerebral artery, posterior cerebral artery (PCA), vertebral artery, and basilar artery and compared it among dengue versus nondengue group as well as outcome at 3 months. Results: Out of 39 patients, 19 were diagnosed with DE, whereas 20 patients suffered from the nondengue group. The elevated PI and RI in the left PCA were found to statistically significant (P = 0.001 and 0.008, respectively) in the DE group. There was no significant difference in any other TCD indices in any other vessel among both the groups. In addition, an initial low Glasgow Outcome Scale (GOS) and higher brain imaging abnormality were significantly associated with poor GOS of

Abstract A novel collaborative and continual learning across a network of decentralised healthcare units, avoiding identifiable data-sharing capacity, is proposed. Currently available methodologies, such as federated learning and swarm learning, have demonstrated decentralised learning. However, the majority of them face shortcomings that affect their performance and accuracy. These shortcomings include a non-uniform rate of data accumulation, non-uniform patient demographics, biased human labelling, and erroneous or malicious training data. A novel method to reduce such shortcomings is proposed in the present work through selective grouping and displacing of actors in a network of many entities for intra-group sharing of learning with inter-group accessibility. The proposed system, known as Orbital Learning, incorporates various features from split learning and ensemble learning for a robust and secure performance of supervised models. A digital embodiment of the information quality and flow within a decentralised network, this platform also acts as a digital twin of healthcare network. An example of ECG classification for arrhythmia with 6 clients is used to analyse its performance and is compared against federated learning. In this example, four separate experiments are conducted with varied configurations, such as varied age demographics and clients with data tampering. The results obtained show an average area under receiver operating characteristic curve (AUROC) of 0.819 (95% CI 0.784–0.853) for orbital learning whereas 0.714 (95% CI 0.692–0.736) for federated learning. This result shows an increase in overall performance and establishes that the proposed system can address the majority of the issues faced by existing decentralised learning methodologies. Further, a scalability demo conducted establishes the versatility and scalability of this platform in handling state-of-the-art large language models.

Introduction: Despite recent advancements in hypertension management, a significant portion of the population in India still has uncontrolled blood pressure (BP), particularly post percutaneous coronary intervention (PCI). This paper fulfils the gap between post-PCI and hypertension management, ensuring hypertension is well-controlled before, during, and after PCI. Methods: Cardiologists (interventional, n = 256; noninterventional, n = 336) throughout India who treated hypertensive patients, post PCI were invited to participate in a survey and virtual meetings. The perception and practices in managing these patients and strategies to improve BP control were captured. Results: Out of 593 cardiologists, 57.5% opined that heart failure (HF) was more common in patients with hypertension indicated for PCI. The target BP after PCI for patients aged 65 years was recommended to be 121–130/80 mmHg by 39% of experts while 131–140/90 mmHg by 33.2% of experts, respectively, with a target heart rate of 60–80 bpm. Angiotensin II receptor blockers (ARBs) were considered the most effective antihypertensive agent in different comorbid conditions. Metoprolol and bisoprolol were the most preferred cardio-selective beta-blockers for both post-PCI and HF. A combination of ARBs and beta-blockers after the intervention was suggested in hypertensive patients with coronary artery disease and diabetes mellitus (57.0%), stroke (41.1%), and HF (44.9%). Conclusions: Managing BP and heart rate in patients with hypertension post-PCI is important. In monotherapy, ARBs followed by beta-blockers and angiotensin-converting enzyme inhibitors, were the most preferred antihypertensive agents in these patients with different comorbid conditions. While a combination of ARB and beta-blocker was preferred in patients with PCI and multiple comorbidities.

Background Opioids administered as bolus doses or continuous infusions are widely used for major and daycare surgeries. Opioid-free anesthesia is multimodal anesthesia and analgesia that does not use opioids, benefiting patients from opioid-related adverse effects. We compared the postoperative analgesic requirements of patients scheduled for elective laparoscopic cholecystectomy under opioid-free and opioid-based anesthesia. Methods Study included 88 patients aged 18–60 years with American Society of Anesthesiologists physical status 1 and 2 who underwent elective laparoscopic cholecystectomy. Participants were randomly divided into two groups with 44 in each. The opioid-free group was administered an intravenous bolus of ketamine and dexmedetomidine, whereas fentanyl was used in opioid group. Primary outcome was to compare the total amount of fentanyl consumed by both groups during 6 h postoperative period. Episodes of postoperative nausea and vomiting (PONV) and vital signs were noted throughout the postoperative period to analyze the secondary outcomes. Results Both groups had similar demographic characteristics. The opioid-free group required lesser analgesia within the first 2 h (61.4 ± 17.4 vs. 79.0 ± 19.4 of fentanyl, P < 0.001), which was statistically significant. However, fentanyl consumption was comparable between the groups at 6 h (152 ± 28.2 vs. 164 ± 33.4, P = 0.061). Compared with 4.5% of the participants in the opioid-free group, 34% of those in the opioid-based group developed moderate PONV. Conclusions Opioid-free anesthesia in patients undergoing laparoscopic cholecystectomy reduced the requirement of analgesia in first two-hour postoperative period and was associated with decreased PONV.

Abstract Plasmonic coatings can absorb electromagnetic radiation from visible to far-infrared spectrum for the better performance of solar panels and energy saving smart windows. For these applications, it is important for these coatings to be as thin as possible and grown at lower temperatures on arbitrary substrates like glass, silicon, or flexible polymers. Here, we tune and investigate the plasmonic resonance of titanium nitride thin films in lower thicknesses regime varying from ~ 20 to 60 nm. High-quality crystalline thin films of route-mean-square roughness less than ~ 0.5 nm were grown on a glass substrate at temperature of ~ 200 °C with bias voltage of − 60 V using cathodic vacuum arc deposition. A local surface-enhanced-plasmonic-resonance was observed between 400 and 500 nm, which further shows a blueshift in plasmonic frequency in thicker films due to the increase in the carrier mobility. These results were combined with finite-difference-time-domain numerical analysis to understand the role of thicknesses and stoichiometry on the broadening of electromagnetic absorption.

Abstract The persistent challenges posed by pollution and climate change are significant factors disrupting ecosystems, particularly aquatic environments. Numerous contaminants found in aquatic systems, such as ammonia and metal toxicity, play a crucial role in adversely affecting aquaculture production. Against this backdrop, fish feed was developed using quinoa husk (the byproduct of quinoa) as a substitute for fish meal. Six isonitrogenous diets (30%) and isocaloric diets were formulated by replacing fish meal with quinoa husk at varying percentages: 0% quinoa (control), 15, 20, 25, 30 and 35%. An experiment was conducted to explore the potential of quinoa husk in replacing fish meal and assess its ability to mitigate ammonia and arsenic toxicity as well as high-temperature stress in Pangasianodon hypophthalmus. The formulated feed was also examined for gene regulation related to antioxidative status, immunity, stress proteins, growth regulation, and stress markers. The gene regulation of sod, cat, and gpx in the liver was notably upregulated under concurrent exposure to ammonia, arsenic, and high-temperature (NH3 + As + T) stress. However, quinoa husk at 25% downregulated sod, cat, and gpx expression compared to the control group. Furthermore, genes associated with stress proteins HSP70 and DNA damage-inducible protein (DDIP) were significantly upregulated in response to stressors (NH3 + As + T), but quinoa husk at 25% considerably downregulated HSP70 and DDIP to mitigate the impact of stressors. Growth-responsive genes such as myostatin (MYST) and somatostatin (SMT) were remarkably downregulated, whereas growth hormone receptor (GHR1 and GHRβ), insulin-like growth factors (IGF1X, IGF2X), and growth hormone gene were significantly upregulated with quinoa husk at 25%. The gene expression of apoptosis (Caspase 3a and Caspase 3b) and nitric oxide synthase (iNOS) were also noticeably downregulated with quinoa husk (25%) reared under stressful conditions. Immune-related gene expression, including immunoglobulin (Ig), toll-like receptor (TLR), tumor necrosis factor (TNFα), and interleukin (IL), strengthened fish immunity with quinoa husk feed. The results revealed that replacing 25% of fish meal with quinoa husk could improve the gene regulation of P. hypophthalmus involved in mitigating ammonia, arsenic, and high-temperature stress in fish.