Comparison of Intravenous Dexmedetomidine and Intravenous Fentanyl to Attenuate the Hemodynamic Stress Response to Tracheal Extubation: A Prospective Double Blinded Randomized Controlled Study

BACKGROUD: Endotracheal extubation can be associated with hypertension, tachycardia, arrhythmias, myocardial ischemia, raised intracranial pressures due to sympathetic stimulation. AIM OF THE STUDY: To compare the efficacy of intravenous dexmedetomidine with intravenous fentanyl to decrease the stress response to tracheal extubation in patients undergoing elective general surgeries. MATERIALS AND METHODS: 180 patients of either sex, ASA grade I -II normotensives, aged 18-65 years undergoing elective general surgeries of 60-180 minutes duration under general anaesthesia were randomized into 3 groups. Anaesthetic technique was standardized. Patients in Group N, F and D received intravenous infusion of 100 ml of 0.9% normal saline, Fentanyl 1μg/kg and dexmedetomidine 0.5μg/kg respectively 10 minutes before extubation for a period of 10 minutes. Heart rate, systolic blood pressure, diastolic blood pressure, mean arterial pressure and SPO2 were recorded before, during and after extubation. RESULTS: Lesser increase in heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure were noted after extubation in dexmedetomidine group than the fentanyl group which were statistically significant. Extubation quality was better with dexmedetomidine group. Ramsay sedation and aldrete scores were similar in all 3 groups. Hypotension and bradycardia were more with dexmedetomidine group than the fentanyl group but none required intervension. CONCLUSION: Dexmedetomidine 0.5μg/kg infusion administered 10 minutes before tracheal extubation was better compared to fentanyl 1μg/kg infusion in attenuating the hemodynamic stress response with comparable adverse effects. Hence, dexmedetomidine infusion can be a safer alternative to fentanyl infusion for attenuating extubation stress response

Demand Response Implementation in an Optimization Based SCADA Model Under Real-Time Pricing Schemes

Advancement of renewable energy resources, development of smart grids, and the effectiveness of demand response programs, can be considered as solutions to deal with the rising of energy consumption. However, there is no benefit if the consumers do not have enough automation infrastructure to use the facilities. Since the entire kinds of buildings have a massive portion in electricity usage, equipping them with optimization-based systems can be very effective. For this purpose, this paper proposes an optimization-based model implemented in a Supervisory Control and Data Acquisition, and Multi Agent System. This optimization model is based on power reduction of air conditioners and lighting systems of an office building with respect to the price-based demand response programs, such as real-time pricing. The proposed system utilizes several agents associated with the different distributed based controller devices in order to perform decision making locally and communicate with other agents to fulfill the overall system’s goal. In the case study of the paper, the proposed system is used in order to show the cost reduction in the energy bill of the building, while it respects the user preferences and comfort level.The present work was done and funded in the scope of the following projects: H2020 DREAM-GO Project (Marie Sklodowska-Curie grant agreement No 641794); Project GREEDI (ANI|P2020 17822); and UID/EEA/00760/2013 funded by FEDER Funds through COMPETE program and by National Funds through FCT.info:eu-repo/semantics/publishedVersio

A study on Electron Beam Welding of Stainless steel (03X12H10MTPY) with Russian copper alloy

Modern age demand for flexible design and high quality structures. Different properties are essential for different parts and use of dissimilar metals joints gives possibilities of flexible design and products by using each material efficiently. EBW is one of the most widely used application in industries for joining dissimilar materials .The advantages of EBW welding is its high energy density, high depth to width ratio, low HAZ and result in very strong weld and low residual stress .The quality of weld depend upon the parameter accelerating voltage, beam current, focus current, welding speed, beam shifts and vacuum levels. The beam shift, focus current and vacuum level are fixed parameters .The primary objective of the project is to optimizing the parameter to obtain best quality weld based on Taguchi L9 array. Micro-indentation hardness and Electron spectroscopy is also carried out in selected welding sets to study the joint characteristics. It is observed that the optimum parameter levels for 3mm penetration in both parent metal are Accelerating voltage 50KV, beam current 38mA, welding speed 1 m/min

Positional identification of variants of Adamts16 linked to inherited hypertension

A previously reported blood pressure (BP) quantitative trait locus on rat Chromosome 1 was isolated in a short congenic segment spanning 804.6 kb. The 804.6 kb region contained only two genes, LOC306664 and LOC306665. LOC306664 is predicted to translate into A Disintegrin-like and Metalloproteinase with Thrombospondin Motifs-16 (Adamts16). LOC306665 is a novel gene. All predicted exons of both LOC306664 and LOC306665 were sequenced. Non-synonymous variants were identified in only one of these genes, LOC306664. These variants were naturally existing polymorphisms among inbred, outbred and wild rats. The full-length rat transcript of Adamts16 was detected in multiple tissues. Similar to ADAMTS16 in humans, expression of Adamts16 was prominent in the kidney. Renal transcriptome analysis suggested that a network of genes related to BP was differential between congenic and S rats. These genes were also differentially expressed between kidney cell lines with or without knock-down of Adamts16. Adamts16 is conserved between rats and humans. It is a candidate gene within the homologous region on human Chromosome 5, which is linked to systolic and diastolic BP in the Quebec Family Study. Multiple variants, including an Ala to Pro variant in codon 90 (rs2086310) of human ADAMTS16, were associated with human resting systolic BP (SBP). Replication study in GenNet confirmed the association of two variants of ADAMTS16 with SBP, including rs2086310. Overall, our report represents a high resolution positional cloning and translational study for Adamts16 as a candidate gene controlling B

Positional identification of variants of Adamts16 linked to inherited hypertension

A previously reported blood pressure (BP) quantitative trait locus on rat Chromosome 1 was isolated in a short congenic segment spanning 804.6 kb. The 804.6 kb region contained only two genes, LOC306664 and LOC306665. LOC306664 is predicted to translate into A Disintegrin-like and Metalloproteinase with Thrombospondin Motifs-16 (Adamts16). LOC306665 is a novel gene. All predicted exons of both LOC306664 and LOC306665 were sequenced. Non-synonymous variants were identified in only one of these genes, LOC306664. These variants were naturally existing polymorphisms among inbred, outbred and wild rats. The full-length rat transcript of Adamts16 was detected in multiple tissues. Similar to ADAMTS16 in humans, expression of Adamts16 was prominent in the kidney. Renal transcriptome analysis suggested that a network of genes related to BP was differential between congenic and S rats. These genes were also differentially expressed between kidney cell lines with or without knock-down of Adamts16. Adamts16 is conserved between rats and humans. It is a candidate gene within the homologous region on human Chromosome 5, which is linked to systolic and diastolic BP in the Quebec Family Study. Multiple variants, including an Ala to Pro variant in codon 90 (rs2086310) of human ADAMTS16, were associated with human resting systolic BP (SBP). Replication study in GenNet confirmed the association of two variants of ADAMTS16 with SBP, including rs2086310. Overall, our report represents a high resolution positional cloning and translational study for Adamts16 as a candidate gene controlling BP

Global wealth disparities drive adherence to COVID-safe pathways in head and neck cancer surgery

Peer reviewe

Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries