scholarly journals P-P54 Interpreting trends in post-operative drain fluid amylase according to type of anastomosis used to form a pancreaticojejunostomy

2021 ◽  
Vol 108 (Supplement_9) ◽  
Author(s):  
Emily Britton ◽  
Reesha Ranat ◽  
James Skipworth ◽  
Ian Pope
Keyword(s):  
Pancreatic Fistula ◽  
Early Identification ◽  
Patient Demographics ◽  
Drain Fluid ◽  
The Mean ◽  
Pancreatic Reconstruction ◽  
Duodenal Resection ◽  
Unnecessary Intervention ◽  
Prospective Database

Abstract Background The formation of the pancreaticojejunostomy during pancreaticoduodenectomy is the most technically challenging aspect of the procedure, with its failure increasing rates of both morbidity and mortality significantly.  Early identification and management of a clinically relevant post-operative pancreatic fistula (CR-POPF) can be critical in reducing the threat of potentially avoidable harm to the patient.  The most used indicator for a CR-POPF is the level of drain fluid amylase.  There are many different techniques for forming the anastomosis, with considerable analysis but no consensus on superiority.   We aimed to look at our centres experience using different techniques and the trends we observed in drain amylases and clinical outcomes. Methods A prospective database of all patients in a single UK centre undergoing pancreatic or duodenal resection has been maintained.  This includes patient demographics, diagnosis pre and post operatively, operative details and duration, complications, and outcomes. All patients undergoing a pancreaticoduodenectomy between 1st January 2020 and 31st July 2021 were identified and their data retrospectively analysed.   Results Thirty-three patients underwent a pancreaticoduodenectomy during the study period.  The pancreatojejunostomy was formed using a duct-to-mucosa anastomosis in twenty-eight patients and using a dunking technique in five patients. The mean of the highest drain fluid amylase on post-operative day one for the patients with a dunking anastomosis was 14804.8 (range 3643-43686), on day three 2376.12 (range 167-8008.6) and of the three patients whose drains were in situ at day 5 it was 522.2 (range 31 to 983. An 83.9% reduction in mean drain amylases was observed between Day One and Day Three, followed by a further 78% reduction between day 3 and day. One patient (20%) had a CR-POPF with a grade B fistula, two others had a biochemical leak.  The mean Day One drain amylases for patients with a duct-to-mucosa anastomosis was 71% lower at 4274.5 (range 15.4 to 41755). However this increased by 11.5% by Day Three to 4766.4 (range 5 to 46300) before falling by 64.7% to 1681.9 (range 5 to 13015) on Day Five.  Eight patients (28.6%) had a CR-POPF – 3 grade B and 5 grade C fistula - and three patients had a biochemical leak. Conclusions In our centre’s experience, the type of anastomosis used to perform the pancreatic reconstruction post pancreaticoduodenostomy significantly impacts the post-operative trend in drain fluid amylase.  This is important for clinicians to appreciate in order to avoid premature suspicion of a CR-POPF and prevent potentially unnecessary intervention.

Novel Formulation Development and Evaluation of Nanoparticles Based in Situ Gelling System for The Ophthalmic Delivery of Ciprofloxacin Hydrochloride

2015 ◽  
Vol 5 (4) ◽  
Author(s):  
Kranti Singh ◽  
Surajpal Verma ◽  
Shyam Prasad ◽  
Indu Bala
Keyword(s):  
Particle Size ◽  
Zeta Potential ◽  
Drug Loading ◽  
In Vitro Release ◽  
Formulation Development ◽  
Ciprofloxacin Hydrochloride ◽  
Potential Value ◽  
The Mean ◽  
In Situ Gelling

Ciprofloxacin hydrochloride loaded Eudragit RS100 nanoparticles were prepared by using w/o/w emulsification (multiple emulsification) solvent evaporation followed by drying of nanoparticles at 50°C. The nanoparticles were further incorporated into the pH-triggered in situ gel forming system which was prepared using Carbopol 940 in combination with HPMC as viscosifying agent. The developed nanoparticles was evaluated for particle size, zeta potential value and loading efficiency; nanoparticle incorporated in situ gelling system was evaluated for pH, clarity, gelling strength, rheological studies, in-vitro release studies and ex-vivo precorneal permeation studies. The nanopaticle showed the mean particle size varying between 263.5nm - 325.9 nm with the mean zeta potential value of -5.91 mV to -8.13 mV and drug loading capacity varied individually between 72.50% to 98.70% w/w. The formulation was clear with no suspended particles, showed good gelling properties. The gelling was quick and remained for longer time period. The developed formulation was therapeutically efficacious, stable and non-irritant. It provided the sustained release of drug over a period of 8-10 hours.

scholarly journals 63 Chronic Femoral Osteomyelitis Case Series: Outcomes and Economic Impact at A United Kingdom Based Tertiary Centre

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
E Lau ◽  
Z Arshad ◽  
A Aslam ◽  
A Thahir ◽  
M Krkovic
Keyword(s):  
Economic Impact ◽  
Treatment Protocol ◽  
Case Series ◽  
Consecutive Series ◽  
Financial Loss ◽  
Patient Demographics ◽  
Tertiary Centre ◽  
The Mean ◽  
Eq Vas

Abstract Introduction Osteomyelitis refers to an inflammatory process affecting bone and bone marrow. This study reviews chronic femoral osteomyelitis treatment and outcomes, including economic impact. Method We retrospectively collected data from a consecutive series of 14 chronic femoral osteomyelitis patients treated between January 2013 and January 2020. Data collected include patient demographics, comorbidities, pathogens, complications, treatment protocol and costs. Functional outcome was assessed using EuroQOL five-dimensional interview administration questionnaire (EQ-5D-5L™) and EuroQOL Visual Analogue Scale (EQ-VAS™). Results Of these, 92.9% had one or more osteomyelitis risk factor, including smoking and diabetes. Samples from 78.6% grew at least one pathogen. Only 42.9% achieved remission after initial treatment, but 85.7% were in remission at final follow-up, with no signs of recurrence throughout the follow-up period (mean: 21.4 months). The average treatment cost was £39,249.50 with a net mean loss of £19,080.10 when funding was considered. The mean-derived EQ-5D score was 0.360 and the mean EQ-VAS score was 61.7, lower than their values for United Kingdom’s general population, p = 0.0018 and p = 0.013 respectively. Conclusions Chronic femoral osteomyelitis treatment is difficult, resulting in significant economic burden. With previous studies showing cheaper osteomyelitis treatment at specialist centres, our net financial loss incurred suggests the need for management at specialised centres.

scholarly journals Drain fluid cryo-explant technique for treatment of superior bullous rhegmatogenous retinal detachment in young adults

2021 ◽  
Vol 13 ◽  
pp. 251584142098821
Author(s):  
Kamal A.M. Solaiman ◽  
Ashraf Mahrous ◽  
Hesham A. Enany ◽  
Ashraf Bor’i
Keyword(s):  
Young Adults ◽  
Retinal Detachment ◽  
Rhegmatogenous Retinal Detachment ◽  
Subretinal Fluid ◽  
Secondary Outcome ◽  
Eligibility Criteria ◽  
Retinal Breaks ◽  
Complicated Cataract ◽  
Drain Fluid ◽  
The Mean

Purpose: To evaluate the efficacy of the drain fluid cryo-explant (DFCE) technique for the management of uncomplicated superior bullous rhegmatogenous retinal detachment (RRD) in young adults. Patients and methods: A retrospective study that included eyes with uncomplicated superior bullous RRD in patients ⩽40 years old. DFCE technique consists of sequential drainage of subretinal fluid, intravitreal fluid injection, cryotherapy, and placement of a scleral explant(s). The primary outcome measure was anatomical reposition of the retina after a single surgery. Secondary outcome measures included improvement in best corrected visual acuity (BCVA) and any reported complication related to the procedure. Results: The study included 51 eyes which met the study eligibility criteria. The mean duration of detachment was 19.7 ± 6.4 days. A single retinal break was found in 31 eyes (60.8%), and more than one break were found in 20 eyes (39.2%). The mean number of breaks per eye was 1.72 ± 1.04. The mean detached area per eye was 7.21 ± 3.19 clock hours, and the macula was detached in 22 eyes (43.1%). Flattening of the retina and closure of all retinal breaks was achieved in all eyes after a single surgery. Late recurrence of retinal detachment occurred in two eyes (3.9%) due to proliferative vitreoretinopathy (PVR). No complicated cataract or iatrogenic retinal breaks were detected in all eyes. Conclusion: DFCE technique could be effectively used for treatment of uncomplicated superior bullous RRD in adults ⩽40 years. It is safe and provides good visualization during surgery with no iatrogenic retinal breaks or complicated cataract.

scholarly journals Investigation of dominant traveling 10-day wave components using long-term MERRA-2 database

2021 ◽  
Vol 73 (1) ◽  
Author(s):  
Chunming Huang ◽  
Wei Li ◽  
Shaodong Zhang ◽  
Gang Chen ◽  
Kaiming Huang ◽  
...  
Keyword(s):  
Flow Instability ◽  
Transmission Condition ◽  
Wave Number ◽  
Mean Flow ◽  
Excited Wave ◽  
Propagating Waves ◽  
Zonal Wave Number ◽  
The Mean

AbstractThe eastward- and westward-traveling 10-day waves with zonal wavenumbers up to 6 from surface to the middle mesosphere during the recent 12 years from 2007 to 2018 are deduced from MERRA-2 data. On the basis of climatology study, the westward-propagating wave with zonal wave number 1 (W1) and eastward-propagating waves with zonal wave numbers 1 (E1) and 2 (E2) are identified as the dominant traveling ones. They are all active at mid- and high-latitudes above the troposphere and display notable month-to-month variations. The W1 and E2 waves are strong in the NH from December to March and in the SH from June to October, respectively, while the E1 wave is active in the SH from August to October and also in the NH from December to February. Further case study on E1 and E2 waves shows that their latitude–altitude structures are dependent on the transmission condition of the background atmosphere. The presence of these two waves in the stratosphere and mesosphere might have originated from the downward-propagating wave excited in the mesosphere by the mean flow instability, the upward-propagating wave from the troposphere, and/or in situ excited wave in the stratosphere. The two eastward waves can exert strong zonal forcing on the mean flow in the stratosphere and mesosphere in specific periods. Compared with E2 wave, the dramatic forcing from the E1 waves is located in the poleward regions.

Estimating Global Ocean Heat Content Changes in the Upper 1800 m since 1950 and the Influence of Climatology Choice*

2014 ◽  
Vol 27 (5) ◽  
pp. 1945-1957 ◽  
Author(s):  
John M. Lyman ◽  
Gregory C. Johnson
Keyword(s):  
Heat Content ◽  
Ocean Heat Content ◽  
Global Ocean ◽  
Ocean Temperature ◽  
Vertical Separation ◽  
Ocean Heat Uptake ◽  
Expendable Bathythermograph ◽  
Heat Uptake ◽  
The Mean

Abstract Ocean heat content anomalies are analyzed from 1950 to 2011 in five distinct depth layers (0–100, 100–300, 300–700, 700–900, and 900–1800 m). These layers correspond to historic increases in common maximum sampling depths of ocean temperature measurements with time, as different instruments—mechanical bathythermograph (MBT), shallow expendable bathythermograph (XBT), deep XBT, early sometimes shallower Argo profiling floats, and recent Argo floats capable of worldwide sampling to 2000 m—have come into widespread use. This vertical separation of maps allows computation of annual ocean heat content anomalies and their sampling uncertainties back to 1950 while taking account of in situ sampling advances and changing sampling patterns. The 0–100-m layer is measured over 50% of the globe annually starting in 1956, the 100–300-m layer starting in 1967, the 300–700-m layer starting in 1983, and the deepest two layers considered here starting in 2003 and 2004, during the implementation of Argo. Furthermore, global ocean heat uptake estimates since 1950 depend strongly on assumptions made concerning changes in undersampled or unsampled ocean regions. If unsampled areas are assumed to have zero anomalies and are included in the global integrals, the choice of climatological reference from which anomalies are estimated can strongly influence the global integral values and their trend: the sparser the sampling and the bigger the mean difference between climatological and actual values, the larger the influence.

Chemical characteristics and in situ ruminal parameters of barley for cattle: Comparison of the malting cultivar AC Metcalfe and five feed cultivars

2008 ◽  
Vol 88 (4) ◽  
pp. 711-719 ◽  
Author(s):  
Kenton J Hart ◽  
Brian G Rossnagel ◽  
Peiqiang Yu
Keyword(s):  
Nutritive Value ◽  
Degradation Kinetics ◽  
Starch Degradation ◽  
Barley Cultivars ◽  
Degradation Rates ◽  
Key Words Barley ◽  
In Situ Degradation ◽  
The Mean ◽  
Pass Through

The objective of this study was to compare the most widely grown barley cultivar in Canada, AC Metcalfe, a malting type barley, with five feed cultivars. Barley cultivars were grown at one location during 3 consecutive years and barley samples were milled to pass through a 1-mm screen and analysed to determine nutritive value. Additional samples were passed through a roller mill with a gap set at 1.12 mm and incubated ruminally for 0, 2, 4, 8, 12, 24, and 48 h in 3 dry Holstein cows fitted with rumen cannulae. The rate and extent of rumen digestion were estimated. AC Metcalfe had a higher (P < 0.001) concentration of NDF, and lower (P < 0.05) concentrations of non structural carbohydrates, starch, ADF, total digestible nutrients, and fermentable cell wall carbohydrates compared with the mean of the feed cultivars. The malting cultivar had a higher (P < 0.001) soluble DM fraction, lower (P < 0.05) CP and starch degradation rates, and a lower (P < 0.001) ruminally degradable starch concentration compared with the mean of the five feed cultivars. The results demonstrate that there are only small differences in terms of chemical composition and in situ degradation kinetics between the malting cultivar AC Metcalfe and the five feed cultivars of barley reported here. Key words: Barley, energy, protein, ruminants

Oxidation Behaviors of TiB2-TiCX and TiB2-TiCX/15SiC Ceramics

2010 ◽  
Vol 105-106 ◽  
pp. 179-183 ◽  
Author(s):  
De Gui Zhu ◽  
Hong Liang Sun ◽  
Yu Shu Wang ◽  
Liang Hui Wang
Keyword(s):  
Oxidation Resistance ◽  
Effective Temperature ◽  
Hot Isostatic Pressing ◽  
Ceramic Composites ◽  
Optical Micrograph ◽  
Different Temperatures ◽  
The Mean ◽  
Mean Time ◽  
Oxidation Behaviors

Fully dense samples of TiB2-TiCX and TiB2-TiCX/15SiC ceramic composites were fabricated by in-situ synthesis under hot isostatic pressing from TiH2, B4C and SiC powders. Their oxidized behaviors at different temperatures were tested. Optical micrograph studies and thermo-gravimetric analyses show that the highest effective temperature of oxidation resistance is 700°C for TiB2-TiCX, and 1100°C for TiB2-TiCX/15SiC. The weight gain of TiB2-TiCX/15SiC below 1100°C is quite low, and it rises up suddenly when the temperature reaches 1200°C. Thus, the highest effective temperature of oxidation resistance is 1100°C for TiB2-TiCX/15SiC. The oxidation dynamic curves of TiB2-TiCX/15SiC ceramics accord with the parabola’s law. The activation energy of TiB2-TiCx/15SiC (189.87kJ.mol-1) is higher than that of TiB2-TiCx (96.44kJ.mol-1). In the oxidation process of TiB2-TiCx/15SiC, TiB2 reacts with oxygen and generates TiO2 and B2O3 at first. A layer of whole homogeneous oxide film cannot be formed, in the mean time, the oxidation of TiC begins. When temperature goes up to 1000°C, TiC phase is totally oxidized. SiC is oxidized to SiO2 at about 900°C, Meanwhile, TiO2 forms denser film than B2O3, which grows and covers the surface of the material, and gives better property of oxidation resistance.

The Impact of Medical Comorbidities on Patient Satisfaction in Chronic Rhinosinusitis

2021 ◽  
pp. 000348942110157
Author(s):  
Amarbir S. Gill ◽  
Joshua Hwang ◽  
Angela M. Beliveau ◽  
Jeremiah A. Alt ◽  
Edward Bradley Strong ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Hearing Impairment ◽  
Chronic Rhinosinusitis ◽  
Medical Comorbidities ◽  
Patient Demographics ◽  
Significant Difference ◽  
Comorbidity Index ◽  
The Mean ◽  
Therapy Compliance ◽  
The Impact

Background: Patient satisfaction has a significant bearing on medical therapy compliance and patient outcomes. The purpose of this study was to (1) describe patient satisfaction, as characterized by the Patient Satisfaction Questionnaire-18 (PSQ-18), in the care of patients with chronic rhinosinusitis (CRS) and (2) analyze the impact of comorbidities on satisfaction using the functional comorbidity index (FCI). Methods: Patient demographics, disease severity measures, and PSQ-18 scores for patients with CRS presenting to a tertiary rhinology clinic between November 2019 and April 2020 were collected and analyzed. FCI was calculated retrospectively using the electronic medical record; individual comorbidities were tabulated. Spearman’s correlations followed by multivariate regression was used to assess the relationship between medical comorbidities and PSQ-18. Results: Sixty-nine patients met criteria for analysis. There were no significant differences in age, gender, and Sinonasal Outcomes Test-22 scores between CRS patients with (CRSwNP) and without (CRSsNP) nasal polyps. There was no significant difference in the mean FCI for patients with CRSwNP versus CRSsNP (5.1 and 4.3, respectively) ( P = .843). Similarly, there was no significant difference in the mean sum PSQ-18 score (78/100 in both) between these cohorts ( P = .148). The mean sum PSQ-18 score was not significantly associated with anxiety ( P = .728), depression ( P = .624), or FCI ( P = .282), but was significantly associated with hearing impairment ( P < .001). Conclusion: Patient satisfaction in the care of CRS is generally high with a diagnosis of comorbid hearing impairment demonstrating a negative association with satisfaction in this cohort.

Time to achieve best postoperative visual acuity following Boston keratoprosthesis surgery

2021 ◽  
pp. bjophthalmol-2020-317483
Author(s):  
Jonathan El-Khoury ◽  
Majd Mustafa ◽  
Roy Daoud ◽  
Mona Harissi-Dagher
Keyword(s):  
Visual Acuity ◽  
Contributing Factors ◽  
Time Duration ◽  
Patient Demographics ◽  
Snellen Visual Acuity ◽  
Boston Type 1 Keratoprosthesis ◽  
The Mean ◽  
Retroprosthetic Membrane

Background/aimsTo evaluate the time needed for patients with Boston type 1 keratoprosthesis (KPro) to reach their best-corrected visual acuity (BCVA) and all contributing factors.MethodsWe retrospectively reviewed 137 consecutive eyes from 118 patients, measured how long they needed to reach their BCVA and looked at factors that might affect this time duration including patient demographics, ocular comorbidities and postoperative complications.ResultsThe mean follow-up was 5.49 years. The median time to BCVA postoperatively was 6 months, with 47% of patients achieving their BCVA by 3 months. The mean best achieved logMAR visual acuity was 0.71, representing a gain of 6 lines on the Snellen visual acuity chart. Postoperative glaucoma, retroprosthetic membrane (RPM) and endophthalmitis prolonged this duration. We found no correlation between the following factors and time to BCVA: gender, age, indication for KPro surgery, primary versus secondary KPro, number of previous penetrating keratoplasties, previous retinal surgery, intraoperative anterior vitrectomy and preoperative glaucoma.ConclusionIn our retrospective cohort, the majority of subjects reached their BCVA between 3 and 6 months after KPro implantation. This duration was significantly prolonged by the development of postoperative glaucoma, RPM and endophthalmitis.

Relationship between the gas production profiles of mixtures of hay and maize and the patterns of rumen fermentation observed in sheep fed those mixtures

1998 ◽  
Vol 1998 ◽  
pp. 63-63
Author(s):  
C. Rymer ◽  
D.I. Givens
Keyword(s):  
Growth Rate ◽  
Feed Intake ◽  
Rumen Fermentation ◽  
Gas Production ◽  
Post Feeding ◽  
Molar Proportion ◽  
Rumen Ph ◽  
The Mean

The gas production (GP) technique has been developed to assess dynamics of ruminant digestion. Relationships have been observed between a feed's GP profile and in vivo parameters such as digestibility (Khazaal et al., 1993), feed intake and growth rate (Blümmel and Ørskov, 1993), and in situ degradability (Sileshi et al., 1997). However, there are few studies which relate GP data to the in vivo pattern of rumen fermentation (in terms of the rate of pH decline 2 h post-feeding and the mean rumen pH, concentration of total VFA and molar proportion of individual VFA). The object of this experiment was to determine whether such a relationship existed between a feed's GP profile and the pattern of rumen fermentation observed in animals fed that feed.

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