Efficacy of the three-point cuff palpation technique in preventing endobronchial tube migration during positioning in robotic pelvic surgeries.

Background and Aims: During robotic pelvic surgeries, the shortening of endotracheal tube (ETT) tip-to-carina distance (DTC) during pneumoperitoneum with 45° Trendelenburg position can result in endobronchial tube migration. In the three-point ETT cuff palpation (TPP) technique, maximal ETT cuff distension is felt over the tracheal segment located between the cricoid-thyroid membrane and suprasternal notch, which is likely to provide optimal placement. However, the reproducibility and reliability of the TPP technique in preventing endobronchial tube migration are yet to be evaluated. Hence, we compared three ETT placement techniques: TPP technique, intubation guide mark (IGM) technique and Varshney's formula (VF) for the prevention of endobronchial tube migration during robotic pelvic surgeries. Methods: ETT placement by TPP was compared with IGM and VF techniques in 100 American Society of Anesthesiologists physical class II-III patients, by assessing the serial changes in DTC and incidence of endobronchial tube migration throughout the different phases of pneumoperitoneum and Trendelenburg position using t-test and Chi-square test. Changes in the DTC during various phases were also measured. Results: DTC (mean ± standard deviation) at baseline and during pneumoperitoneum was significantly better in TPP technique (2.80 ± 0.62 cm and 1.96 ± 0.66 cm) as compared to both IGM (2.50 ± 1.27 cm and 1.41 ± 1.29 cm) and VF techniques (1.83 ± 1.13 cm and 0.98 ± 1.18 cm), P < 0.001. During pneumoperitoneum, the mean shortening of DTC was 0.84 ± 0.20 cm, and no endobronchial tube migration was found in TPP technique compared to 20% in IGM and 25% in VF techniques, P < 0.001. Conclusion: TPP is a simple and reliable technique, which provides optimal ETT placement and prevents endobronchial tube migration throughout the different phases of robotic pelvic surgeries.

Mutagenic and Cancer Risk Estimation of Particulate Bound Polycyclic Aromatic Hydrocarbons from the Emission of Different Biomass Fuels.

Smoke samples from combustion of different biomass fuels were analyzed for the particulate bound Polycyclic Aromatic Hydrocarbons (PAHs) due to their carcinogenic and mutagenic nature. Out of 16 priority PAHs, 11 PAHs were detected in the emission of fuels, while the remaining 5 PAHs (chrysene, benzo[b]fluoranthene, benzo[k]fluoranthene, indeno[1,2,3-cd]pyrene, and benzo[g,h,i]perylene) were below the detection limit. The highest emission factor for the sum of all the PAHs was found for coal (353.08 mg kg-1), charcoal (27.28 mg kg-1), and the various wood types. Emission rates of total PAHs ranged from 0.37 to 5.15 mg h-1 with the highest value for bituminous coal (5.15 mg h-1) and lowest for Polyalthia longifolia (0.37 mg h-1). A cancer risk assessment was done for infants, children, and adults using the incremental lifetime cancer risk (ILCR) model via ingestion, inhalation, and dermal contact pathway. The ILCR values ranged from 10-11 to 10-6, and a higher cancer risk was observed for children and adults in comparison to infants. PAH concentrations emitted from biomass emissions shows a direct correlation with mutagenesis to humans, indicating a higher potential for the frameshift mutation as compared to base-pair mutation for dung, bituminous coal, charcoal, Dalbergia sissoo, Psidium guajava, Ziziphus mauritana, Polyalthia longifolia, and Ailanthus trithesa.

Quantitative rise in intraocular pressure in patients undergoing robotic surgery in steep Trendelenburg position: A prospective observational study.

BACKGROUND AND AIMS: Raised intraocular pressure (IOP) is one of the known causes of anterior ischemic optic neuropathy. In the case of robotic urological-gynecological surgeries, patient is kept in steep Trendelenburg supine-lithotomy position. Aim of this study was to observe the quantitative rise in IOP in steep Trendelenburg position (>45°) in robotic-assisted prostatectomy and hysterectomy. MATERIAL AND METHODS: After institutional ethical clearance and written informed consent, 100 patients undergoing robotic surgeries in steep Trendelenburg position were recruited for the study. IOP was measured at different time intervals in steep Trendelenburg position using Schiotz tonometer: Post intubation (T1), post pneumoperitoneum (T2), post steep Trendelenburg (T3), and rest readings were taken 30 min apart. T9 was taken 10 min after patient is made supine and parallel to the ground. Mean arterial pressure (MAP), positive inspiratory pressure (PIP), and end-tidal carbon dioxide (EtCO2) values were recorded at different time points. Descriptive analysis, linear regression analysis, and Freidman's nonparametric tests were used to analyze the results. RESULTS: Ninety-five patients were included for statistical analysis as five patients were excluded due to intraoperative interventions leading to alteration of results. Mean IOP at T1 was 19.181/18.462 mmHg in L/R eye. A gradual rise in IOP was observed with every time point while patient was in steep Trendelenburg position which reverts back to near normal values once the patient is changed to normal position 21.419/20.671: Left/right eye in mm of Hg. Uni and multiple regression analysis showed insignificant P value, thus no correlation between MAP, PIP, and EtCO2 with IOP. CONCLUSION: Steep Trendelenburg position for prolong duration leads to significant rise in intraocular pressure.

Chemical characteristics and mutagenic activity of PM2.5 at a site in the Indo-Gangetic plain, India.

Airborne fine particulate matter PM2.5 was collected from May 2010 to December 2012 at Agra, a semi-urban site in north-central India. PM2.5 samples were chemically characterized for 16 polycyclic aromatic hydrocarbons by gas chromatography. PM2.5 values varied between 8.4 and 300 µg m(-3) with 55% of the values exceeding the 24h average NAAQ (National Ambient Air Quality) standard of 65 µg m(-3). Particle associated total PAHs ranged between 8.9 and 2,065 ng m(-3) with a mean value of 880.8 ng m(-3) during the sampling period, indicated an alarming level of pollution in Agra. Strong relationship was observed between PM2.5 and total PAHs (r=0.88), suggesting an increasing PAHs concentration with increasing PM2.5 mass. On a mass basis 3-ring and 4-ring compounds were dominant. Seasonal variation in mass concentration of PAHs was observed with high concentration in winter followed by post monsoon, summer and monsoon. This seasonal pattern could be attributed to differences in source strength and climatic conditions. PAHs concentration were also observed to be negatively correlated with the meteorological parameters i.e. temperature, solar radiation, relative humidity and wind speed. Molecular diagnostic ratios revealed vehicular emissions and combustion of wood and coal as the probable sources. The estimated carcinogenicity of PAHs in terms of benzo(a)pyrene toxic equivalency (B[a]PTEQ) was assessed and confirmed that benzo[a]pyrene was the dominant PAH contributor (3.64%). Health risk of adults and children by way of PAHs was assessed by estimating the lifetime average daily dose (LADD) and corresponding incremental lifetime cancer risk (ILCR) using USEPA guidelines. The assessed cancer risk (ILCR) was found to be within the acceptable range (10(-6)-10(-4)). The particulate samples indicated the presence of both base pair and frame shift mutagens using TA98 and TA100 strains of Salmonella typhimurium. Enhanced mutagenic response was observed in the presence of enzyme activation.

A novel sequence and context based method for promoter recognition.

UNLABELLED: Identification of promoters in DNA sequence using computational techniques is a significant research area because of its direct association in transcription regulation. A wide range of algorithms are available for promoter prediction. Most of them are polymerase dependent and cannot handle eukaryotes and prokaryotes alike. This study proposes a polymerase independent algorithm, which can predict whether a given DNA fragment is a promoter or not, based on the sequence features and statistical elements. This algorithm considers all possible pentamers formed from the nucleotides A, C, G, and T along with CpG islands, TATA box, initiator elements, and downstream promoter elements. The highlight of the algorithm is that it is not polymerase specific and can predict for both eukaryotes and prokaryotes in the same computational manner even though the underlying biological mechanisms of promoter recognition differ greatly. The proposed Method, Promoter Prediction System - PPS-CBM achieved a sensitivity, specificity, and accuracy percentages of 75.08, 83.58 and 79.33 on E. coli data set and 86.67, 88.41 and 87.58 on human data set. We have developed a tool based on PPS-CBM, the proposed algorithm, with which multiple sequences of varying lengths can be tested simultaneously and the result is reported in a comprehensive tabular format. The tool also reports the strength of the prediction. AVAILABILITY: The tool and source code of PPS-CBM is available at http://keralabs.org.

Characterization of polycyclic aromatic hydrocarbons in emissions of different mosquito coils.

Emission rates and emission factors of particulate matter and polycyclic aromatic hydrocarbons (PAHs) were determined in the emissions of three prevalent mosquito coil brands available in the market in India, under controlled conditions in an environmental chamber. The emission rates varied between the brands and ranged between 2.0 ± 1.9 to 27.1 ± 1.5 µg h(-1) for brand A, 3.4 ± 1.1 to 32.3 ± 1.2 µg h(-1) for brand B and 3.1 ± 1.0 to 72.2 ± 1.1 µg h(-1) for brand C for different compounds. Five and six ring PAHs were not detected, however four and three ring PAHs dominated. Three ring PAHs contributed 24 %, 42 % and 29 %, while four ring compounds contributed 53 %, 35 % and 61 % to total PAHs in the three brands. Carcinogenic PAH compounds were also present in the emissions, indicating the potential risks associated with the inhalation of coil smoke.