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2021 ◽  
pp. 175045892110090
Hannah Bellwood ◽  
Kellie M Rozdarz ◽  
John Riordan

Elective lower segment caesarean section patients are routinely instructed to fast from food for 6h before surgery, with clear fluids up until 2h before surgery. We conducted an audit examining the true fasting times of mothers undergoing an elective caesarean section and the incidence of urinary ketones before and after introducing a preop carbohydrate drink (Nutricia preOp 400ml) to be administered to all patients at 6am on the day of surgery. We audited 50 patients prior to introducing the preop carbohydrate drink and 54 patients after the introduction of a carbohydrate drink. We found the mean fasting time from last caloric intake was reduced from 13h 35min to 5h 5min after the introduction of a preoperative carbohydrate drink. We found that the incidence of urinary ketones was 40.4% prior to the introduction of a preoperative carbohydrate drink and 38.3% after the introduction of a preop drink (p = 1). If fasting times were limited to under 4h, the incidence of urinary ketones is 10%. Our audit demonstrates that reducing preoperative fasting times is possible and preventing metabolic derangements may be possible, requiring an approach targeted at keeping fasting times to a minimum.

2021 ◽  
Vol 8 ◽  
Takahiro Shimada ◽  
Carlos M. Duarte ◽  
Abdulaziz M. Al-Suwailem ◽  
Lyndsey K. Tanabe ◽  
Mark G. Meekan

Major aggregations of nesting green turtles (Chelonia mydas) occur in the northern Red Sea, although little is known about the reproductive ecology of this endangered species in the region. To address this issue, we satellite-tracked 30 female green turtles to document their movements and to identify factors driving habitat use at two major rookeries in the Red Sea, Jazirat Mashabah (Mashabah Island) and Ras Al Baridi in Saudi Arabia. Between successive nesting events, turtles displayed high fidelity to nesting beaches and adjacent in-water habitats (inter-nesting habitats). Using generalized linear mixed models, we estimated the mean probability of nesting per beach emergence (nesting success rate) to be 0.628, and the mean duration between a successful nesting event and the successive emergence onto the beach (re-nesting interval) to be 10.8 days at each site. The nesting success rate was relatively high (>0.8) when the preceding daytime land surface temperature (LST) was lower than 37°C but decreased with elevated daytime LST (<0.4 when >47°C). Re-nesting interval was longer at lower water temperatures and towards the end of the nesting season of individuals. Our study improves the robustness of abundance estimates from census data (e.g., track counts) and shows that the protection of nesting and inter-nesting habitats during a breeding season would be an effective conservation strategy for the species. We discuss how global warming could increase energy expenditure due to lowered nesting success, ultimately compromising the reproductive fitness of these populations.

Neeraj Thakur ◽  
S.K. Shukla ◽  
A.H. Ahmad ◽  
N.S. Jadon ◽  
J.L. Singh ◽  

Background: Acute kidney injury causes an abrupt decline in renal filtration and affects animals in a similar way to humans. Diagnosis can be made based on urinalysis, serum biochemistry and various biomarkers. The present study was conducted to evaluate the ameliorative, antioxidant and immunomodulatory potential of vitamin D in rats induced with acute kidney injury. Methods: In the present study, group A rats were taken as healthy control, group B rats were given gentamicin @ 100 mg/kg BW intraperitoneally for 8 days and were considered as disease control and group C rats were treated with Vitamin D @ 0.4 µg/kg/day subcutaneously for 8 days along with intraperitoneal gentamicin injection. Reduced glutathione (GSH), lipid peroxide (LPO), catalase and superoxide dismutase (SOD) were estimated in erythrocytes on day 0, 4 and 8. Tumor necrosis factor alpha (TNF α) and interleukin 10 (IL 10) were also estimated along with urine and serum biochemistry on day 0, 4 and 8. Kidney tissue samples were collected on day 8 for histopathological examination. Result: The mean values of GSH, catalase and SOD were significantly (P less than 0.05) higher whereas the mean value of LPO was significantly (P less than 0.05) lower in group C compared to group B on day 4 and 8. On day 4 and 8, the mean value of TNF α was significantly (P less than 0.05) lower, while the mean value of IL-10 was significantly (P less than 0.05) higher in rats treated with vitamin D as compared to disease control. Histopathological examination along with urine and serum biochemistry revealed protective efficacy of vitamin D in acute kidney injury. Based on the findings of the present study, it is concluded that vitamin D is having ameliorative efficacy along with antioxidant and immunomodulatory potential in case of gentamicin induced acute kidney injury in Wistar rats. However, detailed studies are required to explore the therapeutic potential of vitamin D in clinical cases of kidney diseases.

2021 ◽  
Xiaojie Tang ◽  
Jianyi Li ◽  
Chunxiao Wang ◽  
Fang Liu ◽  
Jianwei Guo ◽  

Abstract Background. Various surgical techniques for treating spondylodiscitis have been proposed, but the optimal surgical treatment remains controversial. In this study, we propose a new procedure that is implanting antibiotic-loaded calcium sulfate (CS) beads into the disc after infection site debrided by Quadrant channel combined with percutaneous fixation through a single-stage posterior approach for the treatment of spondylodiscitis. Thus, the purpose of this study is to assess the safety and efficacy of this procedure. Methods. This study collected 32 patients’ clinical data of whom had spine spondylodiscitis treated in our department from July of 2015 to August of 2020. The Demographic data included age, gender, involved segment and complications were collected. The intra-operative details, results of culture, functional outcome, radiologic outcome, and length of hospital stay, laboratory examination were recorded. Results. The mean age of the 32 patients was 61.1 ± 9.7 years old. The mean operative time was 135.0 ± 30.6 minutes, and the mean blood loss was 243.4 ± 92.1 ml. The positive rate of culture was 72%. The mean Visual analogue scale (VAS) and Oswestry Disability Index (ODI) score significantly improved from 7.5 to 1.6 and from 65–10%. Cobb angle was significantly improved and could be maintained at final follow-up. Solid bone fusion was achieved in all patients. There were no recurrences of infection in our study. Conclusions. The procedure we proposed is effective in the treatment of spondylodiscitis, the infection site can be debrided and controlled exactly, and spinal stabilization can also be achieved.

Christopher J Groombridge ◽  
Amit Maini ◽  
Joseph Mathew ◽  
Yesul Kim ◽  
Mark Fitzgerald ◽  

Abstract Objective In the ‘can’t intubate can’t oxygenate’ scenario, techniques to achieve front of neck access to the airway have been described in the literature but there is a lack of guidance on the optimal method for securing the tracheal tube (TT) placed during this procedure. The aim of this study was to compare three different methods of securing a TT to prevent extubation following a surgical cricothyroidotomy. Methods A randomised controlled trial was undertaken. The population studied were emergency physicians (EPs) attending a cadaveric airway course. The intervention was securing a TT placed via a surgical cricothyroidotomy by suture. The comparison was securing the TT using fabric tape with two different tying techniques. The primary outcome was the force required to extubate the trachea. The trial was registered with (ACTRN12621000320853). Results 17 emergency physicians completed intubations using all three of the securing methods on 12 cadavers for a total of 51 experiments. The mean extubation force was 6.54 KG (95 % CI 5.54–7.55) in the suture group compared with 2.28 KG (95 % CI 1.91–2.64) in the ‘Wilko tie’ group and 2.12 KG (95 % CI 1.63–2.60) in the ‘Lark’s foot tie’ group; The mean difference between the suture and fabric tie techniques was significant (p < 0.001). Conclusions Following a surgical cricothyroidotomy in cadavers, EPs were able to effectively secure a TT using a suture technique, and this method was superior to tying the TT using fabric tape.

Food Research ◽  
2021 ◽  
Vol 5 (S3) ◽  
pp. 14-23
M.S. Amalia ◽  
F.F. Dieny ◽  
A. Candra ◽  
Nuryanto ◽  
A.F.A. Tsani

Nutrition education and motivational interviewing are methods to increase motivation, as essential factors in increasing physical activity. The purpose of this study was to determine the effect of nutrition education via Instagram and motivational interviewing, on weight loss motivation and physical activity of obese female students. This study was quasi-experimental with a pre-post-controlled group design that involved thirty-seven obese female students aged 18-23 years at Universitas Diponegoro, selected by proportional stratified sampling. Subjects were divided into three groups, P1 was given nutrition education via Instagram for 30 days (ED) and motivational interviewing four times (MI), P2 was given ED only, and the control (K) was given a leaflet. Weight loss motivation was measured using a healthy diet motivation questionnaire, and physical activity (PA) was measured using IPAQ-SF. Data were analyzed using one way ANOVA, Kruskal Wallis, paired t-test, Wilcoxon, and Mann Whitney. There was an increase in the mean of weight loss motivation that highest in group P1 (109.86 into 126.43), followed by group P2 (114.85 into 121.69) and group K (105.30 into 112.90). The highest increase in the mean of total physical activity was in the P1 group (1341 to 2572), the P2 group (1761 to 2378), and the K group decreased (3404 to 1987) in METs units. There was a significant difference in the mean change in total physical activity and moderate physical activity between P1 and P2 groups when compared to the K group.

2021 ◽  
Vol 14 (8) ◽  
pp. 1205-1212
Jian-Bo Mao ◽  
Jia-Feng Yu ◽  
Xin-Yi Deng ◽  
Chen-Yi Liu ◽  

AIM: To analyse macular microvascular alterations in myopic choroidal neovascularization (mCNV) and the efficiency of anti-vascular endothelial growth factor (anti-VEGF) therapy for mCNV by optical coherence tomography angiography (OCTA). METHODS: A total of 123 patients were included in this retrospective study, divided into mCNV group, high myopia (HM) group, and normal group at the Affiliated Eye Hospital of Wenzhou Medical University from January 2017 to January 2019. Superficial vessel density, deep capillary density, foveal avascular zone (FAZ) area, A-circularity index (AI) and vessel density around the 300 μm width of the FAZ region density (FD) and the area of choroidal neovascularization (CNV) lesion (only for mCNV group) were measured on 3×3 mm2 OCTA images. FAZ area was corrected for axial length. Central macular thickness (CMT) was measured on OCT in mCNV group. Compared the parameters on OCTA of 3 groups and pre-anti-VEGF and post-anti-VEGF at 1, 2, 3, and 6mo follow-up in mCNV group. RESULTS: There were significant differences among 3 groups in superficial vessel density, deep capillary density and FD (P<0.05). FAZ area in HM group was smaller than normal group (P<0.05), but there was no significant difference between mCNV group and the other two group. AI increased in mCNV group (P<0.05). The mean CMT, area and flow area of CNV lesion decreased after treatment (P<0.05), while vessel density and FAZ didn’t change. The mean CMT, area and flow area of CNV lesion statistically decreased after anti-VEGF treatment in mCNV group (P<0.05), while superficial vessel density, deep capillary density and FAZ area, AI and FD didn’t change. The mean reduction ratio of lesions was 50.32% (7.07% to 100%). Lesion regression 100% was observed in 2 cases (4.88%). There was a negative correlation between the CNV lesion area and reduction ratio (r=-0.380, P=0.042) and the flow lesion area and reduction ratio (r=-0.402, P=0.030). CONCLUSION: Macular vessel density decreases, FAZ turns smaller and more irregular in mCNV eyes. Anti-VEGF therapy is efficient for mCNV without affecting vessel density and FAZ, but it is unable to completely eliminate CNV lesions in most cases. The bigger mCNV lesions have lower reduction ratio.

2021 ◽  
Vol 14 (8) ◽  
pp. 1168-1173
Ben Chen ◽  
Jia Liu ◽  
Xiu-Ying Zhu ◽  
Yan-Yan Lin ◽  

AIM: To investigate the suitability of a modified Hughes procedure, which consists of conjunctival flap with auricular cartilage grafting in reconstructing large full thickness upper and lower eyelid defect. METHODS: Patients with full thickness eyelid carcinoma involving more than 50% margin length who underwent surgical resection were retrospectively reviewed in the study. The defects were reconstructed using conjunctival flap with auricular cartilage grafting, covered with myocutaneous flap above. Followed-up time ranged from 12 to 24mo. Outcomes were classified as “good”, “fair”, and “poor” by evaluating the margin appearance, eyelid appearance, and complications. RESULTS: A total of 42 patients were enrolled in the study (26 males, 16 females, mean age, 68.6±7.7y, range: 53 to 82y). The mean defect widths measured 23.2±2.9 mm (range, 17 to 28 mm). The mean posterior lamellar defect height was 5.5±1.3 mm (4 to 8 mm). Thirty-seven patients had a “good” outcome (88.1%), 5 patients had a “fair” outcome (11.9%), and no one had a “poor” outcome. CONCLUSION: Conjunctival flap with auricular cartilage grafting and myocutaneous flap grafting is an effective procedure in reconstructing large full thickness upper and lower eyelid defect. It can not only achieve satisfied reconstruction, but also preserve intact tarsal plate of the opposite eyelid, avoiding retraction or entropion.

2021 ◽  
Vol 14 (8) ◽  
pp. 1199-1204
Gustavo Espinoza ◽  
Angelica Pedraza-Concha ◽  
Ignacio Rodríguez-Una ◽  
Maria Fernanda Acuna ◽  

AIM: To describe the safety and efficacy of patterned laser trabeculoplasty (PLT) as an adjunctive treatment in primary open angle glaucoma (POAG) and ocular hypertension (OHT) after 18-month follow-up in Hispanic population. METHODS: A single-center, retrospective study was conducted. All patients with OHT or POAG undergoing PLT from June 2016 to August 2016 were included in the study. Investigated parameters were intraocular pressure (IOP), the number of IOP-lowering medications, best corrected visual acuity (BCVA), laser parameters and postoperative adverse events. Primary efficacy outcome measures were the proportion of eyes achieving an IOP reduction ≥20% at 18mo versus baseline medicated IOP or a reduction in the number of medications while maintaining IOP values. RESULTS: From 40 PLT-treated eyes (mean baseline IOP 20.3±1.7 mm Hg), 24 patients were analyzed (age 63.4±7.3y). The mean IOP reductions from baseline across visits (months 1, 3, 6, 9, 12, and 18) ranged from 14.1% to 20.8%. Success rate after 18-month follow-up was 61.7% with a mean IOP of 16±3.2 mm Hg (P<0.001). The number of glaucoma IOP-lowering medications per eye (preoperative 2.1±1.1 and postoperative 2.3±1.1, P=0.86) and the mean BCVA (preoperative 0.10±0.22 and postoperative 0.11±0.22 logMAR, P=0.42) remained stable. Adverse events comprised transitory IOP spikes in 4 eyes (10%) and peripheral anterior synechiae in 7 eyes (17.5%). CONCLUSION: Mid-term results of PLT show that this procedure may be an efficacious and safe technique to approach medically uncontrolled OHT or POAG patients.

2021 ◽  
Vol 20 (1) ◽  
Jeremy Y. Ng ◽  
Saad Ahmed ◽  
Catherine Jiayi Zhang

Abstract Background Given the high prevalence of dietary and herbal supplement (DHS) use in tandem with the growing ease of internet access, patients commonly search online for consumer health information about these products. One common reason for DHSs use includes weight loss. Healthcare providers need to be aware of the quality of online information about DHSs for weight loss so they can adequately counsel their patients and provide them with guidance surrounding the identification of high-quality information resources. This study aimed to assess the quality of online DHSs consumer health information for weight loss that a “typical” patient might access online. Methods Six search terms were used to generate the first 20 websites on the Google search engine in four countries: Australia, Canada, the United Kingdom, and the United States (n = 480 websites). After applying exclusion criteria, eligible websites were quality assessed using the DISCERN instrument. This tool is comprised of 16 questions, each evaluated on a 5-point scale. The averages and standard deviations for each DISCERN instrument item, in addition to overall summed scores between 15 and 75 were calculated. Results Across 87 eligible websites, the mean summed score was 44.80 (SD = 11.53), while the mean overall DISCERN score of each website was 2.72 (SD = 0.99). In general, websites detailed and achieved their specified aims and described treatment benefits. However, most websites failed to describe the impact of treatment on overall quality of life and the impact of a no treatment option. The highest-scoring websites were largely government or health portal websites, while the lowest-scoring websites were largely commercial in nature. Conclusion High variability in DISCERN instrument scores was found across all websites assessed. Healthcare providers should be aware of the fact that their patients may be accessing misinformation online surrounding the use of DHSs for weight loss. Therefore, it is important for healthcare providers to ensure that they are providing their patients with guidance on how to identify high-quality resources online, in order that safe, effective, and evidence-based decisions are made surrounding the use of DHSs for weight loss.

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