To evaluate the efficacy of ropivacaine with dexmedetomidine and ropivacaine with dexamethasone in fascia iliaca compartment block for post-operative pain relief in fracture femur surgeries: A comparative randomized study

Background: Patients with femur fracture experience severe post-operative pain. Fascia iliaca compartment block (FICB) is a safe and effective approach for providing post-operative analgesia. Aims and Objectives: The aim of the study was to compare the post-operative pain relief with dexmedetomidine and dexamethasone with ropivacaine in FICB. Materials and Methods: This prospective, double-blinded, randomized controlled, and clinical study was done on 105 patients, with ASA physical status I-II, aged between 18 and 70 years, undergoing surgery for femur fracture. Patients were randomly allocated into three groups. All patients received FICB by landmark technique before spinal anesthesia. Group A patients received 38 mL of 0.25% ropivacaine and dexmedetomidine, Group B received 38 mL of 0.25% ropivacaine and dexamethasone and Group C received 38 mL of 0.25% ropivacaine. Patients were assessed for analgesia during positioning and post-operative period using visual analog scale (VAS). Hemodynamic parameters and time for first rescue analgesia were recorded. Results: The mean VAS score at 6 h after surgery was 0.74±0.95 in Group A, in Group B 2.26±0.95, and in Group C was 4.23±1.17, which was statistically significant (P<0.05). The time for first rescue analgesia was 13.03±1.79 h in Group-A, 8.31±1.11 h in Group B and 5.94±0.87 h in Group C (P<0.001). Conclusion: Addition of dexmedetomidine or dexamethasone to ropivacaine for FICB in femur fracture patients prolongs post-operative analgesia compared to ropivacaine alone

AN ENHANCED SCHEDULING APPROACH WITH CLOUDLET MIGRATIONS FOR RESOURCE INTENSIVE APPLICATIONS

Cloud computing is one of the most advanced technologies to present computerized generation. Scheduling plays a major role in it. The connectivity of Virtual Machines (VM) to schedule the assigned tasks (cloudlet) is a most attractive field to research. This paper introduces a confined Cloudlet Migration based scheduling algorithm using Enhanced-First Come First Serve (CMeFCFS). The objective of this work is to minimize the makespan, cost and to optimize the resource utilization. The proposed work has been simulated in the CloudSim toolkit package. The results have been compared with pre-existing scheduling algorithms with same experimental configuration. Important parameters like execution time, completion time, cost, makespan and utilization of resources are compared to measure the performance of the proposed algorithm. Extensive simulation results prove that introduced work has better results than existing approaches. 99.8% resource utilization has been achieved by CMeFCFS. Plotted graphs and calculated values show that the proposed algorithm is very effective for cloudlet scheduling

A comparative study to assess the effects of intrathecal fentanyl and intrathecal tramadol combined with 0.5% bupivacaine heavy in patients undergoing elective urological surgeries: A prospective randomized study

Background: Urological operations frequently involve the use of spinal anesthesia. In the present scenario, adding different adjuvants to local anesthetic improve its quality and duration has become common. Aims and Objectives: In patients undergoing elective urological procedures, the purpose of this study was to assess the effects of intrathecal fentanyl or tramadol with 0.5% bupivacaine heavy. Materials and Methods: Patients were divided into two groups of 30 patients each, a total of 60 patients aged 20–60 years undergoing elective urological surgeries participated in this prospective, randomized study in which 25 μg fentanyl and 2.5 mL of 0.5% bupivacaine heavy were given to Group F, while 25 mg tramadol and 2.5 mL of 0.5% bupivacaine heavy were given to Group M. The onset and duration of sensory and motor blockage, the duration of analgesia, post-operative Visual Analog Scale score, hemodynamic changes, and adverse effects were evaluated. Results: Fentanyl had a lower mean time of onset for sensory (2:33±0:22 min vs. 4:50±0:33 min) and motor block (3:36±0:28 min vs. 5:52±0:38 min) (P<0.001), the duration of sensory (185.67±3.155 min vs. 152.60±4.264), motor block (172.00±4.177 min vs. 136.40±5.575 min), and post-operative analgesia was longer in the fentanyl group (P<0.001), whereas the incidence of adverse effects such as pruritus, shivering, and nausea was lower in the tramadol group. Conclusion: The quality and duration of spinal anesthesia were found to be significantly increased by the use of fentanyl as an adjuvant in our study. However, tramadol also produced stable hemodynamics and exhibited fewer adverse effects than fentanyl

Comparative analysis of diagnostic accuracy of different brain biopsy procedures

Background: Image-guided procedures such as computed tomography (CT) guided, neuronavigator-guided and ultrasound-guided methods can assist neurosurgeons in localizing the intraparenchymal lesion of the brain. However, despite improvements in the imaging techniques, an accurate diagnosis of intrinsic lesion requires tissue sampling and histological verification. Aims: The present study was carried out to examine the reliability of the diagnoses made on tumor sample obtained via different stereotactic and ultrasound-guided brain biopsy procedures. Materials and Methods: A retrospective analysis was conducted of all brain biopsies (frame-based and frameless stereotactic and ultrasound-guided) performed in a single tertiary care neurosciences center between 1995 and 2005. The overall diagnostic accuracy achieved on histopathology and correlation with type of biopsy technique was evaluated. Results: A total of 130 cases were included, which consisted of 82 males and 48 females. Age ranged from 4 to 75 years (mean age 39.5 years). Twenty per cent (27 patients) were in the pediatric age group, while 12% (16 patients) were 60-years of age. A definitive histological diagnosis was established in 109 cases (diagnostic yield 80.2%), which encompassed 101 neoplastic and eight nonneoplastic lesions. Frame-based, frameless stereotactic and ultrasound-guided biopsies were done in 95, 15 and 20 patients respectively. Although the numbers of cases were small there was trend for better yield with frameless image-guided stereotactic biopsy and maximum diagnostic yield was obtained i.e., 87% (13/15) in comparison to conventional frame-based CT-guided stereotactic biopsy and ultrasound-guided biopsy. Conclusions: Overall, a trend of higher diagnostic yield was seen in cases with frameless image-guided stereotactic biopsy. Thus, this small series confirms that frameless neuronavigator-guided stereotactic procedures represent the lesion sufficiently in order to make histopathologic diagnosis

Palladium-Catalyzed, Highly Regio-, Stereo-, and Enantioselective Anti-Carboxylation of Unactivated Internal Allenes

Presented herein is the first report of a directing group-controlled, palladium-catalyzed, regio-, stereo-, and enantioselective anti-carboxylation of unactivated, internal allenes enabled via the synergistic interplay of rationally designed bidentate directing groups, palladium catalyst, and multifunctional acetate ligand. The corresponding trans allyl ester was obtained in excellent yields with exclusive delta-regioselectivity and anti-carboxypalladation stereocontrol. The pair of palladium catalysts coordinated with the bidentate directing group control regio-, and stereo- and enantioselectivity in the desired transformation. The potential of this concept has been demonstrated by the development of the first example of a chiral version of this transformation by using axial-to-central chirality transfer with high yields and good enantioselectivities. Several control experiments were conducted to validate the ligand-assisted nucleopalladation process and the rationale behind the racemization of chiral allenes. Detailed investigations, including kinetic studies, order studies, and DFT studies, were performed to elucidate the mechanism of this transformation, indicating that the anti-carboxypalladation step was the rate-limiting as well as the stereo- and enantio-determining step

A study of proliferative markers and tumor suppressor gene proteins in different grades of ependymomas

Ependymomas are CNS tumors that originate from the spinal canal and walls of the ventricular system. Considerable controversy continues to exist with regard to their prognostic factors; age and extent of resection are the only statistically significant prognostic factors yet identified. The authors report a retrospective study of a homogenous population of 119 patients harbouring ependymomas between 1991 and 2002. All clinico-radiological and follow-up data were analyzed and a pathologic review was performed by two pathologists. Immunohistochemical staining for MIB-1, Topo IIα, p53 and MDM2 was performed. Histopathologic grades show relationship with MIB1 and Topo II labelling indices and cut-off values of 5% can differentiate between anaplastic and lower grades. p53 and MDM2 proteins expression are not common in ependymomas; however, they are seen in higher grades only and may be involved in the tumor progression