PREDICTION OF DIFFICULT LARYNGOSCOPY BY ULTRASOUND GUIDED VALUATION OF ANTERIOR NECK SOFT TISSUE THICKNESS.

Background : The major responsibility of the anaesthesiologist is to provide adequate ventilation to the patient. Most vital element for this is the airway. Difficulties in optimal airway management can lead to serious adverse effects and failure can even lead to mortality. We have evaluated the feasibility of sonography as an imaging tool in identifying important airway anatomical structures on the anterior aspect of the neck and correlated the ultrasound-guided measurements of the airway parameters with the Cormack Lehane classification of the direct laryngoscopy for prediction of the difficult airway. Aim : To predict Difficult Laryngoscopy by Ultrasound guided valuation Of Anterior Neck Soft Tissue Thickness. Method : The study was a prospective observational study. For this study, n (no of cases) =100 considering power of 95% from the previous study; including patients between the age group of 18 to 65 years, ASA I to III grades, scheduled for elective surgery and requiring general anaesthesia with directlaryngoscopy and endotracheal intubation. Patient with anticipated difficult airway were excluded. Modified Mallampati score, Neck circumference at the level of the thyroid cartilage, Thyromental distance, BMI, distance from skin to hyoid bone and distance from skin to the anterior commissure of vocal cords using the USG machine followed by MCLS grade on laryngoscopy were noted. Result : With reference to ROC analysis, the optimal cut-offs of DSHB, DSAC, neck circumference and BMI measurements for the prediction of difficult Laryngoscopy is 0.81 cm, 0.92 cm, 35.75cm and 24.8 kg/m2 respectively with the area under the curves being 0.944, 0.970, 0.801 and 0.745 respectively. Similarly, the optimal cut-off value for modifiedMallampati grades for the prediction of difficult Laryngoscopy is Grade II and above with area under the curves being 0.718. We also found that with experience the required time to measure the distances using USG was reduced with experience. Conclusion : We conclude from our study that the BMI, modified Mallampati grade and neck circumference are good predictors of difficult laryngoscopy. However, USG guided measurements at the level of hyoid bone and anterior commissure of vocal cords showed a higher specificity and sensitivity for the prediction of difficult laryngoscopy

Generic local distinguishability and completely entangled subspaces

A subspace of a multipartite Hilbert space is completely entangled if it contains no product states. Such subspaces can be large with a known maximum size, S, approaching the full dimension of the system, D. We show that almost all subspaces with dimension less than or equal to S are completely entangled, and then use this fact to prove that n random pure quantum states are unambiguously locally distinguishable if and only if n does not exceed D-S. This condition holds for almost all sets of states of all multipartite systems, and reveals something surprising. The criterion is identical for separable and for nonseparable states: entanglement makes no difference.Comment: 12 page

2-{[{2-Hy­droxy-3-[2-methyl-5-(propan-2-yl)phen­oxy]prop­yl}(pyridin-2-ylmeth­yl)amino]­meth­yl}phenol

In the title racemic compound, C26H32N2O3, an intra­molecular O—H⋯N hydrogen bond is formed between the phenolic OH group and the tertiary amine N atom. Another O—H⋯N hydrogen bond that is formed between the OH group and the pyridine N atom links the mol­ecules into a polymeric chain extending along the a axis. The structure is further stabilized by intramolecular and intermolecular C—H⋯O interactions

A Survey on Touch Based Data Transfer Using Cloud

Currently, computer technology is completely based on touch screen technology. Any digital device users want to use touch screen technology for easier and faster way to accomplish their work. Transfer of data and keeping it secure is common issue in digital world, so to achieve different and great method for transferring of data, there is need to focus on simpler way to transfer any type of files between two digital devices. Need to provide users functionality to sharing of file over wireless network by using simple touch gesture as well as to provide secure and effective way of data sharing over cloud. In this paper basic techniques which are utilized for data sharing have been studied well and main objective is to provide easy, secure as well as attractive way for sharing of data between digital devices over cloud. This paper focuses on methodologies and primitives which are being used till now for data transfer system

Comparison between Bipolar Hemiarthroplasty and Total Hip Arthroplasty for Unstable Intertrochanteric Fractures in Elderly Osteoporotic Patients

The present study was conducted to compare bipolar hemiarthroplasty (BA) with total hip arthroplasty (THA) in treatment of unstable intertrochanteric fractures in elderly osteoporotic patients. The THA group included 14 males and 26 females with a mean age of 73.4 years, and the BA group included 27 males and 45 females with a mean age of 76.5 years. Significant difference existed between the two groups in operation time, blood loss, transfusion volume and cost of hospitalization, while no remarkable difference was identified in hospitalization period, general complications, joint function, pain, rate of revision and mortality. No dislocation was observed in BA group while 3 occurred in THA group. The results indicated that for unstable intertrochanteric fractures in elderly osteoporotic patients, BA seems to be a better or more reasonable choice compared with THA for the reason of less blood loss, shorter operation time, lower cost and no dislocation

Effects of accelerated versus standard care surgery on the risk of acute kidney injury in patients with a hip fracture : a substudy protocol of the hip fracture Accelerated surgical TreaTment And Care tracK (HIP ATTACK) international randomised controlled trial

Introduction Inflammation, dehydration, hypotension and bleeding may all contribute to the development of acute kidney injury (AKI). Accelerated surgery after a hip fracture can decrease the exposure time to such contributors and may reduce the risk of AKI. Methods and analysis Hip fracture Accelerated surgical TreaTment And Care tracK (HIP ATTACK) is a multicentre, international, parallel-group randomised controlled trial (RCT). Patients who suffer a hip fracture are randomly allocated to either accelerated medical assessment and surgical repair with a goal of surgery within 6 hours of diagnosis or standard care where a repair typically occurs 24 to 48 hours after diagnosis. The primary outcome of this substudy is the development of AKI within 7 days of randomisation. We anticipate at least 1998 patients will participate in this substudy. Ethics and dissemination We obtained ethics approval for additional serum creatinine recordings in consecutive patients enrolled at 70 participating centres. All patients provide consent before randomisation. We anticipate reporting substudy results by 2021. Trial registration number NCT02027896; Pre-results

Effects of accelerated versus standard care surgery on the risk of acute kidney injury in patients with a hip fracture : A substudy protocol of the hip fracture Accelerated surgical TreaTment and Care tracK (HIP ATTACK) international randomised controlled trial

Introduction Inflammation, dehydration, hypotension and bleeding may all contribute to the development of acute kidney injury (AKI). Accelerated surgery after a hip fracture can decrease the exposure time to such contributors and may reduce the risk of AKI. Methods and analysis Hip fracture Accelerated surgical TreaTment And Care tracK (HIP ATTACK) is a multicentre, international, parallel-group randomised controlled trial (RCT). Patients who suffer a hip fracture are randomly allocated to either accelerated medical assessment and surgical repair with a goal of surgery within 6 hours of diagnosis or standard care where a repair typically occurs 24 to 48 hours after diagnosis. The primary outcome of this substudy is the development of AKI within 7 days of randomisation. We anticipate at least 1998 patients will participate in this substudy. Ethics and dissemination We obtained ethics approval for additional serum creatinine recordings in consecutive patients enrolled at 70 participating centres. All patients provide consent before randomisation. We anticipate reporting substudy results by 2021. Trial registration number NCT02027896; Pre-results

Induction of apoptosis of human primary osteoclasts treated with extracts from the medicinal plant Emblica officinalis

<p>Abstract</p> <p>Background</p> <p>Osteoclasts (OCs) are involved in rheumatoid arthritis and in several pathologies associated with bone loss. Recent results support the concept that some medicinal plants and derived natural products are of great interest for developing therapeutic strategies against bone disorders, including rheumatoid arthritis and osteoporosis. In this study we determined whether extracts of <it>Emblica officinalis </it>fruits display activity of possible interest for the treatment of rheumatoid arthritis and osteoporosis by activating programmed cell death of human primary osteoclasts.</p> <p>Methods</p> <p>The effects of extracts from <it>Emblica officinalis </it>on differentiation and survival of human primary OCs cultures obtained from peripheral blood were determined by tartrate-acid resistant acid phosphatase (TRAP)-positivity and colorimetric MTT assay. The effects of <it>Emblica officinalis </it>extracts on induction of OCs apoptosis were studied using TUNEL and immunocytochemical analysis of FAS receptor expression. Finally, <it>in vitro </it>effects of <it>Emblica officinalis </it>extracts on NF-kB transcription factor activity were determined by gel shift experiments.</p> <p>Results</p> <p>Extracts of <it>Emblica officinalis </it>were able to induce programmed cell death of mature OCs, without altering, at the concentrations employed in our study, the process of osteoclastogenesis. <it>Emblica officinalis </it>increased the expression levels of Fas, a critical member of the apoptotic pathway. Gel shift experiments demonstrated that <it>Emblica officinalis </it>extracts act by interfering with NF-kB activity, a transcription factor involved in osteoclast biology. The data obtained demonstrate that <it>Emblica officinalis </it>extracts selectively compete with the binding of transcription factor NF-kB to its specific target DNA sequences. This effect might explain the observed effects of <it>Emblica officinalis </it>on the expression levels of interleukin-6, a NF-kB specific target gene.</p> <p>Conclusion</p> <p>Induction of apoptosis of osteoclasts could be an important strategy both in interfering with rheumatoid arthritis complications of the bone skeleton leading to joint destruction, and preventing and reducing osteoporosis. Accordingly, we suggest the application of <it>Emblica officinalis </it>extracts as an alternative tool for therapy applied to bone diseases.</p

Rationale and design of the hip fracture accelerated surgical treatment and care track (hip attack) trial : A protocol for an international randomised controlled trial evaluating early surgery for hip fracture patients

Introduction Annually, millions of adults suffer hip fractures. The mortality rate post a hip fracture is 7%-10% at 30 days and 10%-20% at 90 days. Observational data suggest that early surgery can improve these outcomes in hip fracture patients. We designed a clinical trial - HIP fracture Accelerated surgical TreaTment And Care tracK (HIP ATTACK) to determine the effect of accelerated surgery compared with standard care on the 90-day risk of all-cause mortality and major perioperative complications. Methods and analysis HIP ATTACK is a multicentre, international, parallel group randomised controlled trial (RCT) that will include patients ≥45 years of age and diagnosed with a hip fracture from a low-energy mechanism requiring surgery. Patients are randomised to accelerated medical assessment and surgical repair (goal within 6 h) or standard care. The co-primary outcomes are (1) all-cause mortality and (2) a composite of major perioperative complications (ie, mortality and non-fatal myocardial infarction, pulmonary embolism, pneumonia, sepsis, stroke, and life-threatening and major bleeding) at 90 days after randomisation. All patients will be followed up for a period of 1 year. We will enrol 3000 patients. Ethics and dissemination All centres had ethics approval before randomising patients. Written informed consent is required for all patients before randomisation. HIP ATTACK is the first large international trial designed to examine whether accelerated surgery can improve outcomes in patients with a hip fracture. The dissemination plan includes publishing the results in a policy-influencing journal, conference presentations, engagement of influential medical organisations, and providing public awareness through multimedia resources. Trial registration number NCT02027896; Pre-results