The purpose of this study was to evaluate if ultrasound derived measures of diaphragm thickening, rather than diaphragm motion, can be used to predict extubation success or failure.
Sixty-three ...mechanically ventilated patients were prospectively recruited. Diaphragm thickness (tdi) was measured in the zone of apposition of the diaphragm to the rib cage using a 7-10 MHz ultrasound transducer. The percent change in tdi between end-expiration and end-inspiration (Δtdi%) was calculated during either spontaneous breathing (SB) or pressure support (PS) weaning trials. A successful extubation was defined as SB for >48 h following endotracheal tube removal.
Of the 63 subjects studied, 27 patients were weaned with SB and 36 were weaned with PS. The combined sensitivity and specificity of Δtdi%≥30% for extubation success was 88% and 71%, respectively. The positive predictive value and negative predictive value were 91% and 63%, respectively. The area under the receiver operating characteristic curve was 0.79 for Δtdi%.
Ultrasound measures of diaphragm thickening in the zone of apposition may be useful to predict extubation success or failure during SB or PS trials.
Highlights • AD patients have disturbed sleep, including increased sleep fragmentation. • Sleep and wake patterns in 5XFAD mice, a model of AD, were examined. • 5XFAD mice of both sexes were found to ...have reduced sleep bout lengths. • Female 5XFAD were more severely affected, and had reduced total sleep as well. • Sleep alterations in 5XFAD mice may be relevant to human AD sleep disturbances.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Paste backfilling is an incipient underground mine backfill technology in India. It facilitates maximum use of mill tailings with enhanced stability of the underground workings and minimises ...rehandling of water, as well as provides bulk disposal of mining solid waste. Binder type and dosage plays an important role in paste backfill performance. This paper highlights environmentally friendly utilisation of solid wastes like lead–zinc mill tailings and lead–zinc smelter fuming furnace slag (FFS) as paste backfilling for an underground metalliferous mine. Various experiments were conducted to study the effect of use of FFS as a fractional replacement for ordinary portland cement (OPC) in paste backfilling. The physico-chemical properties of both the lead–zinc mill tailings and fuming furnace slag (FFS) have been examined. In the first set of experiments, raw slag (FFS) was used for paste backfill preparation and experimentation for uniaxial compressive strength (UCS) development, whereas in the second set of experiments, FFS was crushed to -75 μm (80 wt%) and used for the study. Multiple regression analysis of strength development was also conducted up to fifth order. The regression analysis is in accordance with the strength development and justifies the significance of OPC, crushed fuming furnace slag (CFFS) and waste chemistry on the strength gain with curing time. Use of crushed fuming furnace slag as OPC replacement in paste backfill showed encouraging results of strength development in contrast to raw FFS. Also, the economic analysis revealed that the paste backfilling cost per tonne reduced significantly with slag replacement in the binder phase.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
MgO nanorods, hierarchical nanostructures and nanoflakes were synthesized by precipitation, reflux and hydrothermal methods, respectively. The SEM and FESEM images suggested the formation of nanorods ...with diameter around 400–500nm, hierarchical nanostructures containing plates with thickness around 100–200nm and nanoflakes with diameter around 300–500nm. XRD and FTIR confirmed the formation of single phase MgO with well crystalline nature. The hierarchical MgO nanostructures possessed higher specific surface area (147.5m2/g) than MgO nanorods (48.45m2/g) and nanoflakes (110.9m2/g). The prepared nanomaterials were used as adsorbents to remove organic dyes such as Malachite green and Congo red from aqueous media. The percentage of removal of Malachite green by MgO nanorods, hierarchical nanostructures and nanoflakes are 95.1, 99.98 and 97.42%, respectively, and percentage of removal of Congo red by MgO nanorods, hierarchical nanostructures and nanoflakes are 86.28, 99.94 and 92.68%, respectively. The hierarchical MgO nanostructure exhibited excellent adsorption performance for removal of Malachite green and Congo red with maximum sorption capacities of 1205.23 and 1050.81mg/g, respectively.
•MgO nanorods, hierarchical nanostructures and nanoflakes were prepared.•Hierarchical MgO nanostructures possessed high specific surface area (147.5m2/g).•The hierarchical MgO nanostructures were regarded as superb adsorbents.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Arthroscopic rotator cuff repair (ARCR) provides excellent clinical outcomes but is often associated with significant postoperative pain. The use of intraoperative anesthesia in conjunction with ...multimodal pharmacologic strategies is a widely accepted approach for managing surgical pain and reducing opiate use. The purpose of this study was to determine whether using a combined field and suprascapular nerve block with liposomal bupivacaine (LB) in addition to an interscalene block would provide greater pain relief and a reduction in opiate consumption compared with an interscalene block alone.
The study enrolled 50 patients with full-thickness rotator cuff tears undergoing primary ARCR surgery. Patients were randomized to receive intraoperative LB (n = 25) or not (n = 25) and given postoperative “pain journals” to document visual analog scale pain scores and to track their daily opioid consumption during the first 5 postoperative days.
Patients in the LB group reported statistically and clinically lower pain scores during postoperative days 1 and 2 (P < .0001 and P = .03, respectively). In addition, patients in the LB group consumed significantly fewer narcotics than the control group during the 5-day period, demonstrating a 64% reduction in total narcotic consumption (P = .002).
The findings of this study suggest that the addition of LB to multimodal anesthetic protocols significantly reduces the acute perioperative pain experienced following rotator cuff repair and the number of narcotic pills consumed in the first 5 days after ARCR. Furthermore, the findings provide guidelines for postoperative narcotic prescribing to reduce the quantity of opiates prescribed.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Summary
Objective Vitamin D is essential for skeletal health and prolonged deficiency results in infantile rickets and adult osteomalacia. The aim of this study is to determine the vitamin D status ...in pregnancy and to evaluate the effects of daily and of single‐dose vitamin D supplementation.
Design A prospective randomized study at St Mary's Hospital London.
Patients A total of 180 women (Indian Asian, Middle Eastern, Black and Caucasian) were recruited at 27 weeks gestation and randomized into three treatment groups: a single oral dose of 200 000 IU vitamin D, a daily supplement of 800 IU vitamin D from 27 weeks until delivery and a no treatment group.
Measurements Vitamin D (25‐hydroxyvitamin D), PTH and corrected calcium levels in mothers at 27 weeks and at delivery and cord 25‐hydroxyvitamin D and corrected calcium levels.
Results The final maternal 25‐hydroxyvitamin D levels were significantly higher in the supplemented group daily dose (median) 42 (IQR 31–76) nmol/l, stat dose (median) 34 (IQR 30–46) nmol/l vs. median 27 (IQR 27–39) nmol/l in the no treatment; P < 0·0001 and significantly fewer women with secondary hyperparathyroidism in the supplemented group (10% in daily dose vs. 12% in stat dose vs. 27% in the no treatment; P < 0·05). Cord 25‐hydroxyvitamin D levels were significantly higher with supplementation daily dose median 26 (IQR 17–45) nmol/l, stat dose median 25 (IQR 18–34) nmol/l vs. median 17 (IQR 14–22) nmol/l in no treatment; P = 0·001.
Conclusion Single or daily dose improved 25‐hydroxyvitamin D levels significantly. However, even with supplementation, only a small percentage of women and babies were vitamin D sufficient. Further research is required to determine the optimal timing and dosing of vitamin D in pregnancy.
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BFBNIB, FZAB, GIS, IJS, KILJ, NLZOH, NUK, OILJ, SAZU, SBCE, SBMB, UL, UM, UPUK
Depression is common in patients with Alzheimer's disease (AD) and mild cognitive impairment (MCI). Patients with depression have an earlier onset and rapid progression of cognitive decline. Medial ...temporal lobe atrophy (MTA) is common in AD and MCI, and some degree of atrophy is found in almost all patients. In the present study, an attempt was made to know if MTA is more common in patients with AD/MCI with depression than those without it.
Patients reporting to the outpatient department of a neurology centre of a tertiary care hospital were recruited for the present study. After initial general physical and neurological examination, they were evaluated using National Institute of Neurological and Communicative Disorders and Stroke and Related Disorders Association criteria for diagnosis of AD. Clinical Dementia rating scale was used for the diagnosis of MCI. Cornell scale for depression in dementia (CSDD) was used.
We found 20 cases with depression as per CSDD out of a sample of 37 patients (male:female = 30:7). There were 26 patients with AD and 11 with MCI. The mean age of all patients was 72.33 ± 6.45 years. The mean mini mental status examination score was 19.00 ± 6.73. The mean time since diagnosis was 4.19 ± 3.26 years. The mean Scheltens visual rating scale score for right MTA was 2.08 ± 0.95 and was 2.05 ± 0.94 for the left. Both scores did not differ statistically when analyzed using paired t-test (p > 0.05). However, difference in those with depression (2.36 ± 0.95) from those without depression (1.60 ± 0.74) was significant (p < 0.05).
MTA scores were higher in those with AD/MCI with depression than those without it.
Background Propionibacterium acnes infection is a significant problem after shoulder surgery. Residual P. acnes is found on the skin up to 29% of the time immediately after surgical skin preparation ...and in 70% of dermal biopsy specimens. These residual bacteria may be a source for infection. Identifying more ideal skin preparation may help reduce the risk of infection. The purpose of this study was to evaluate the effect that topical benzoyl peroxide (BPO), with chlorhexidine skin preparation, would have on the presence of P. acnes cultured at the time of shoulder surgery. We hypothesized that adding topical BPO to our skin preparation would reduce the number of positive P. acnes cultures identified during surgery. Methods Fifty patients undergoing first-time shoulder surgery were treated with topical 5% BPO cream 48 hours before surgery. After skin preparation, 13 samples per subject were obtained. Cultures were held for 14 days. Results Fifty patients underwent arthroscopic shoulder surgery; 650 culture specimens were obtained. The skin was positive at the initiation of surgery in 6% of cases. Tissue samples were positive in 6%. The skin was positive in 10% at the end of surgery. None of these rates of positive culture were different from the 4% rate observed with a control swab. Conclusion Application of BPO is an effective way to reduce P. acnes on skin at the beginning and, importantly, at the end of a surgical procedure. This may result in a lower risk for postoperative infection.
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UL, UM, UPCLJ, UPUK
Machine learning (ML) has not yet been used to identify factors predictive for post-operative functional outcomes following arthroscopic rotator cuff repair (ARCR). We propose a novel algorithm to ...predict ARCR outcomes using machine learning. This is a retrospective cohort study from a prospectively collected database. Data were collected from the Surgical Outcome System Global Registry (Arthrex, Naples, FL, USA). Pre-operative and 3-month, 6-month, and 12-month post-operative American Shoulder and Elbow Surgeons (ASES) scores were collected and used to develop a ML model. Pre-operative factors including demography, comorbidities, cuff tear, tissue quality, and fixation implants were fed to the ML model. The algorithm then produced an expected post-operative ASES score for each patient. The ML-produced scores were compared to actual scores using standard test-train machine learning principles. Overall, 631 patients who underwent shoulder arthroscopy from January 2011 to March 2020 met inclusion criteria for final analysis. A substantial number of the test dataset predictions using the XGBoost algorithm were within the minimal clinically important difference (MCID) and substantial clinical benefit (SCB) thresholds: 67% of the 12-month post-operative predictions were within MCID, while 84% were within SCB. Pre-operative ASES score, pre-operative pain score, body mass index (BMI), age, and tendon quality were the most important features in predicting patient recovery as identified using Shapley additive explanations (SHAP). In conclusion, the proposed novel machine learning algorithm can use pre-operative factors to predict post-operative ASES scores accurately. This can further supplement pre-operative counselling, planning, and resource allocation. Level of Evidence: III.
The objective was to identify predictors of mortality in hospitalized patients with Crimean-Congo hemorrhagic fever (CCHF). A case-control study was conducted on patients hospitalized with CCHF from ...2012 to 2022. Risk factors for mortality in CCHF patients were analyzed using logistic regression. A total of 86 patients with a median age of 36 years (interquartile range IQR, 27–36 years) were included, and the majority were males (78, 90.7%). Thirty-one patients (36%) were cases, whereas 55 (64%) were control patients. Based on univariate logistic regression analysis, patients who were in an age group of ≥40 years (odds ratio OR: 4.85; 95% CI: 1.8–12.4) or with presence of gum bleeding (OR: 2.66; 95% CI: 1.0–6.8), unit increase in white blood cell count (WBC) (OR: 1.09; 95% CI: 1.00–1.07), serum glutamate-pyruvate transaminase of ≥500 U/L (OR: 3.68; 95% CI: 1.4–9.3), serum glutamic-oxaloacetic transaminase (SGOT) of ≥1,000 U/L (OR: 8.72; 95% CI: 2.6–28.3), prothrombin time (PT) of ≥120 seconds (OR: 9.85; 95% CI: 3.2–29.8), international normalized ratio of ≥5 (OR: 15.8; 95% CI: 2.0–125.3), or acute respiratory distress syndrome (ARDS) (OR: 28.27; 95% CI: 5.84–136.9) were found to be significantly associated with mortality in CCHF. Factors found to be independently associated with mortality on multivariate analysis included ARDS (adjusted OR aOR: 27.7; 95% CI: 4.0–190.5), unit increase in WBC (aOR: 1.02; 95% CI: 1.02–1.26), SGOT of ≥1,000 U/L (aOR: 23.6; 95% CI: 2.32–241.7), and PT of ≥120 seconds (OR: 10.2; 95% CI: 2.00–52.4). CCHF is a rare but fatal disease, and patients with ARDS and increased WBC, high SGOT level, and increased PT indicative of liver injury and coagulopathy at the time of hospitalization are at high risk for mortality.
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