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.

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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.AvailabilityThe tool and source code of PPS-CBM is available at http://keralabs.org

Background and Aims: During robotic pelvic surgeries, the shortening of endotracheal tube (ETT) tip-to-carina distance (D TC ) 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 D TC 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 D TC during various phases were also measured. Results: D TC (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 D TC 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.