Randomized control trial of intra-peritoneal instillation of bupivacaine versus placebo for post-operative analgesia after laparoscopic hysterectomy

Background: Laparoscopy is an established method to perform major surgeries, with many advantages over open surgeries. Hysterectomy is a common procedure performed with increased use of laparoscopy, having postoperative pain management is a major issue. Effective pain management promotes early ambulation, lowering the risk of DVT and PE.Methods: The present study aimed to assess effect of bupivacaine intraperitoneally during laparoscopic hysterectomy to reduce postoperative pain. 48 women undergoing laparoscopic hysterectomy under ASA I and II general anesthesia were included, divided into 2 groups, group A receiving 0.25% bupivacaine intraperitoneally; group B receiving saline. A blind observer observed both groups for 6 hours post-surgery or until the VAS was 4, whichever came first, need for rescue analgesia, side-effects, and total dose of analgesia required in 24 hours. Diclofenac sodium and paracetamol was used as rescue analgesia for both groups.Results: There was no significant difference reported in demographic parameters between two study groups. The VAS scores at 6, 12 and 24 hours after laparoscopy was significantly lower in group A than group B. There was significant increase in the time required for 1st analgesia, while amount of analgesia required was significantly low in group A as compared to group B. There were significantly more number of patients in group B who needed opioids than group A.Conclusions: Peritoneal bupivacaine instillation after laparoscopic hysterectomy was found to be useful to reduce the pain as compared to use of saline (placebo), significant reduction in need for analgesics in the postoperative period

Association of SUMOlation Pathway Genes With Stroke in a Genome-wide Association Study in India

OBJECTIVE: To undertake a genome-wide association study (GWAS) to identify genetic variants for stroke in an Indian population. METHODS: In a hospital-based case-control study, 8 teaching hospitals in India recruited 4,088 participants, including 1,609 stroke cases. Imputed genetic variants were tested for association with stroke subtypes using both single-marker and gene-based tests. Association with vascular risk factors was performed with logistic regression. Various databases were searched for replication, functional annotation, and association with related traits. Status of candidate genes previously reported in the Indian population was also checked. RESULTS: Associations of vascular risk factors with stroke were similar to previous reports and show modifiable risk factors such as hypertension, smoking, and alcohol consumption as having the highest effect. Single-marker–based association revealed 2 loci for cardioembolic stroke (1p21 and 16q24), 2 for small vessel disease stroke (3p26 and 16p13), and 4 for hemorrhagic stroke (3q24, 5q33, 6q13, and 19q13) at p < 5 × 10(−8). The index single nucleotide polymorphism of 1p21 is an expression quantitative trait locus (p(lowest) = 1.74 × 10(−58)) for RWDD3 involved in SUMOylation and is associated with platelet distribution width (1.15 × 10(−9)) and 18-carbon fatty acid metabolism (p = 7.36 × 10(−12)). In gene-based analysis, we identified 3 genes (SLC17A2, FAM73A, and OR52L1) at p < 2.7 × 10(−6). Eleven of 32 candidate gene loci studied in an Indian population replicated (p < 0.05), and 21 of 32 loci identified through previous GWAS replicated according to directionality of effect. CONCLUSIONS: This GWAS of stroke in an Indian population identified novel loci and replicated previously known loci. Genetic variants in the SUMOylation pathway, which has been implicated in brain ischemia, were identified for association with stroke

HLA-DQA1*05 carriage associated with development of anti-drug antibodies to infliximab and adalimumab in patients with Crohn's Disease

Anti-tumor necrosis factor (anti-TNF) therapies are the most widely used biologic drugs for treating immune-mediated diseases, but repeated administration can induce the formation of anti-drug antibodies. The ability to identify patients at increased risk for development of anti-drug antibodies would facilitate selection of therapy and use of preventative strategies.This article is freely available via Open Access. Click on Publisher URL to access the full-text

New tectonic discrimination diagrams for basic and ultrabasic volcanic rocks through log-transformed ratios of high field strength elements and implications for petrogenetic processes

The statistically correct handling of compositional data requires log-ratio transformation whereas the multivariate technique of linear discriminant analysis (LDA) assumes a normal distribution of the transformed variables. In addition to other requirements, both these aspects were considered for proposing five new discriminant function diagrams based on log-ratios of five high-field strength elements � (TiO2)adj, Nb, V, Y, and Zr. A representative world database of 1877 analyses of basic and ultrabasic magmas from four tectonic settings of island arc, continental rift, ocean-island, and mid-ocean ridge, was used. After identifying discordant outliers in log-transformed ratios using single outlier tests, 1793 analyses proved to be normally distributed in terms of the following four variables: ln(Nb/(TiO2)adj), ln(V/(TiO2)adj), ln(Y/(TiO2)adj), and ln(Zr/(TiO2)adj). Use of LDA of the complete dataset of 1877 analyses divided into 1477 analyses for training set and 400 for testing set provided high success rates of 78.5�92.2% and 81.7�93.0% for the discrimination of the four tectonic settings based on the training and testing sets, respectively. However, using LDA of the normally distributed 1793 analyses divided into 1393 for training set and 400 for testing set, we obtained new diagrams that showed still higher success rates of 80.2�93.5% and 84.0�94.0%, respectively. The advantage of fulfilling the requirement of normal distributions of log-ratio variables resides in the observation that an overall net gain in success rates of 0.5�3.3% was achieved when the LDA was correctly applied to discordant-outlier-free log-transformed ratios (1793 analyses) than to the complete data set (1877 analyses). The application of these discrimination diagrams to ophiolites from Taitao Peninsula (southern Chile), Gabal Gerf complex (northeastern Africa), Jormua (northeastern Finland) and Macquarie Island (southwest Pacific) indicated tectonic setting of mid-ocean ridge, transitional between island arc and mid-ocean ridge, mid-ocean ridge and continental rift, respectively. Although only a few rock samples from a study of south-central Sweden could be identified as mafic, the present diagrams indicated an arc setting for this area. The application to three case studies from Turkey, being a country with highly complex geological history, suggested continental rift setting for Kula Quaternary basic volcanic rocks, inconclusive evidence for Jurassic volcanic rocks from eastern Pontides, arc setting for Tauride belt ophiolite, and continental rift setting for East Anatolian and Dead Sea fault zones, the latter application being based on probability calculations for each sample without any need to plot the samples in the discrimination diagrams. The use of normal discordant outlier-free samples of log-transformed ratios from each area in our new discrimination diagrams reinforced these conclusions for all areas, providing somewhat better discrimination in those cases in which such discordant observations were observed. We suggest that the new diagrams be used for tectonic discrimination of basic and ultrabasic rock samples that are confirmed to have discordant outlier-free normally distributed log-transformed variables. Basic and ultrabasic character of the rock samples could be determined from computer program SINCLAS and the discordant outliers of logtransformed variables identified from DODESSYS, whereas the use of new diagrams proposed during 2004-2011 would be facilitated from program TecD.El manejo estadísticamente correcto de datos composicionales requiere transformaciones logarítmicas de relaciones de composiciones, mientras que la técnica multivariable de análisis discriminante lineal (LDA) supone una distribución normal de las variables transformadas. Adicionalmente a otros requerimientos, ambos aspectos fueron tomados en cuenta para proponer cinco nuevos diagramas de funciones discriminantes basados en relaciones-log de cinco elementos de alta fuerza de campo � (TiO2)adj, Nb, V, Y y Zr. Una base mundial representativa de datos de 1877 análisis de magmas básicos y ultrabásicos de cuatro ambientes tectónicos de arco de isla, rift continental, isla oceánica y cresta midoceánica, fue empleada. Después de identificar valores discordantes en las relaciones log-transformadas mediante pruebas de discordancia de tipo sencillo, 1793 análisis demostraron ser distribuidos en forma normal en términos de las cuatro variables siguientes: ln(Nb/(TiO2)adj), ln(V/(TiO2)adj), ln(Y/(TiO2)adj) y ln(Zr/(TiO2)adj). El uso de LDA con el conjunto de datos completos de 1877 análisis divididos entre 1477 análisis para el entrenamiento y 400 para la prueba proporcionó altos valores de éxito de 78.5�92.2% y 81.7�93.0% para la discriminación de los cuatro ambientes tectónicos basados en los conjuntos de entrenamiento y prueba, respectivamente. Sin embargo, usando LDA de los 1793 análisis distribuidos normalmente divididos entre 1393 análisis para el entrenamiento y 400 para el de prueba, obtuvimos diagramas nuevos que demostraron aún más altos valores de éxito de 80.2�93.5% y 84.0�94.0%, respectivamente. La ventaja de cumplir con el requerimiento de distribuciones normales de las variables log-transformadas reside en la observación de que se obtuvo una ganancia neta de 0.5�3.3% en los valores de éxito cuando el LDA fue aplicado correctamente a relaciones log-transformadas libres de valores discordantes (1793 análisis) en comparación con el conjunto completo de datos (1877 análisis). La aplicación de estos diagramas discriminantes a ofiolitas de la Península de Taitao (sur de Chile), complejo Gabal Gerf (noreste de África), Jormua (noreste de Finlandia) e Isla Macquarie (suroeste del Pacífico), indicó el ambiente tectónico de cresta mid-oceánica, transicional entre el arco de isla y cresta mid-oceánica, cresta mid-oceánica y rift continental, respectivamente. Aunque solamente pocas muestras de rocas de un estudio sobre Suecia sur-central pudieron ser identificadas como máficas, los diagramas propuestos indicaron un ambiente de arco para esta área. La aplicación a tres estudios de Turquía, siendo un país con un historial geológico sumamente complejo, sugirieron el ambiente de rift continental para las rocas volcánicas cuaternarias de Kula, evidencia inconclusa para rocas volcánicas jurásicas de Pontides oriental, ambiente de arco para ofiolitas de cinturón de Tauride y rift continental para zonas de este de Anatolia y las fallas del Mar Muerto, la última aplicación se basó en los cálculos de las probabilidades para cada muestra sin la necesidad de graficar los resultados en los diagramas de discriminación. El uso de las muestras de relaciones log-transformadas libres de valores discordantes de cada área en nuestros nuevos diagramas discriminantes confirman estas conclusiones para todas las áreas, proporcionando una discriminación mejor en todos aquellos casos en donde se observaron estos valores discordantes. Sugerimos que los diagramas nuevos sean usados para la discriminación tectónica de muestras de rocas básicas y ultrabásicas con una distribución normal de las variables log-transformadas, libres de valores discordantes. La naturaleza básica y ultrabásica de las muestras a utilizar deberá ser determinada con el programa computacional SINCLAS y los valores discordantes de las variables log-transformadas identificadas con el programa DODESSYS, mientras que el uso de los nuevos diagramas propuestos entre 2004 y 2011 podría ser facilitado por el programa TecD

Isolated tear of the flexor retinaculum at the hook of the hamate: introduction of the 'hook line' sign

10.11622/smedj.2019116SINGAPORE MEDICAL JOURNAL609491-49

An integrative approach to analyze microarray datasets for prioritization of genes relevant to lens biology and disease

Microarray-based profiling represents an effective method to analyze cellular or tissue-specific gene expression on the genome-level. However, in comparative analyses between control and mutant samples, microarrays often identify a large number of differentially expressed genes, in turn making it challenging to isolate the select “high-priority candidates” that are most relevant to an observed mutant phenotype. Here, we describe an integrative approach for mouse mutant lens microarray gene expression analysis using publically accessible systems-level information such as wild-type mouse lens expression data in iSyTE (integrated Systems Tool for Eye gene discovery), protein–protein interaction data in public databases, gene ontology enrichment data, and transcription factor binding profile data. This strategy, when applied to small Maf Mafg−/−:Mafk+/− mouse lens microarray datasets (deposited in NCBI Gene Expression Omnibus database with accession number GSE65500) in Agrawal et al. 2015 [1], led to the effective prioritization of candidate genes linked to lens defects in these mutants. Indeed, from the original list of genes that are differentially expressed at ±1.5-fold and p < 0.05 in Mafg−/−:Mafk+/− mutant lenses, this analysis led to the identification of thirty-six high-priority candidates, in turn reducing the number of genes for further study by approximately 1/3 of the total. Moreover, eight of these genes are linked to mammalian cataract in the published literature, validating the efficacy of this approach. Additionally, these high-priority candidates contribute valuable information for the assembly of a gene regulatory network in the lens. In sum, the pipeline outlined in this report represents an effective approach for initial as well as downstream microarray expression data analysis to identify genes important for lens biology and cataracts. We anticipate that this integrative strategy can be extended to prioritize phenotypically relevant candidate genes from microarray data in other cells and tissues

HIFuzz: Human Interaction Fuzzing for small Unmanned Aerial Vehicles

Small Unmanned Aerial Systems (sUAS) must meet rigorous safety standards when deployed in high-stress emergency response scenarios. However, tests that execute perfectly in simulation can fail dramatically in real-world environments. Fuzz testing can be used to increase system robustness by providing malformed input data aimed at triggering failure cases. In this paper, we apply fuzzing to support human interaction testing. Initial tests are run in simulation to provide broad coverage of the input space in a safe environment; however, they lack the fidelity of real-world tests. Field tests provide higher fidelity but can result in costly or dangerous crashes. We, therefore, propose and demonstrate HiFuzz, which executes large numbers of fuzz tests in simulation and then down-selects tests for deployment in human-in-the-loop simulations and safety-aware physical field tests. We apply \hf to a multi-sUAS system and show that each test level serves a unique purpose in identifying known and unknown failures associated with human interactions

Integrating Health Care Delivery and Data Collection in Rural India Using a Rapidly Deployable eHealth Center

<p>Integrating Health Care Delivery and Data Collection in Rural India Using a Rapidly Deployable eHealth Center</p