Pre Loading Research Articles

Effectiveness of Prophylactic Ephedrine vs Fluid Preload in Prevention of Hypotension in Spinal Anesthesia for C-Section

Background: Hypotension following spinal block can be reduced or minimized prophylactically left lateral uterine displacement, volume loading with crystalloid solutions, phenylephrine infusion or ephedrine administration. Fluid pre loading does not negate the hypotension entirely but decreases the risk. This however is time consuming and vasopressors are often required to correct associated hypotension. Prophylactic ephedrine administration lowers the risk of hypotension at the expense of reactive hypertension if spinal block fails and subsequent conversion to general anesthesia. Aim: To compare the efficacy of prophylactic use of ephedrine versus fluid (Hartmann’s solution) preload in women undergoing cesarean section under spinal anesthesia at a teaching hospital. Study design: Randomized controlled trial. Place and duration of study: Department of Anesthesiology, Nishtar Hospital Multan, from 1st March 2020 to 30th September 2020. Methodology: A total of 100 women, twenty to forty years of age undergoing cesarean section were included. Patients with known hypertension, eclampsia, bleeding diathesis, injection site infection, deformity of spinal column or patients having valvular heart diseases were excluded. Group A women were given prophylactic ephedrine while Group B were given fluid (Hartmann’s solution) preload. After induction of spinal anesthesia continuous blood pressure monitoring was done for fifteen minutes to diagnose hypotension. Hypotension was noted and recorded by the researcher. Results: The mean age of women in group A was 28.04±6.07 years and in group B was 28.26±6.13 years. Majority of the patients, 56, were between twenty to thirty years of age. The mean BMI in group A was 29.06±3.37kg/m2 and in group B was 29.38±3.50 kg/m2. Efficacy of prophylactic use of ephedrine to prevent hypotension was observed in 37(74%) patients and in 25(50%) patients in fluid preload group undergoing cesarean sections under spinal anesthesia. Conclusion: The frequency of hypotension is lower in parturient undergoing spinal anesthesia with prophylactic use of ephedrine as compared to women having fluid (Hartmann’s solution) preload. Keywords: Spinal anesthesia, Hypotension, Ephedrine

Kai and Zen: Effective Tools for Improving Productivity and Quality: A Case Study of an Indian MSME

Old manufacturing methods have become obsolete and are ineffective in the current era of highly competitive global markets. The customer expectations have seen a dramatic shift in tastes and preferences due to large product availability that keeps on improving with time. Nowadays companies are forced to adopt new manufacturing methods that facilitate growth, notably lean manufacturing tools, and related techniques have seen a positive acceptance worldwide. Furthermore, kaizen is one of the effective tools that are based on the principle of the right use of workers’ potential and capabilities. The present case study is done in an industry engaged in manufacturing child parts which are used in gearbox assembly, transmission, hydraulic lift assembly, etc. for original equipment manufacturers. Henceforth, these issues formed the basis for the current study. Furthermore, a road map was developed that was based on understanding the current manufacturing process, thorough analysis of records, followed by detailed employee interviews. Moreover, this study used a kaizen approach that involved people from the shop floor that lead to many positive suggestions and practical implementation. Finally, this study successfully improved overall product quality and met customer expectations without any major financial investments. The positive findings of this case study saw tangible gains in the form of Withdrawl Nut P252006 additional rework cost reduced from 5.82% to 0.41% and in-house rejection (scrap) cost reduced from 0.84% to 0.03%. Pre Loading Nut P124034 additional rework cost reduced from 5.97% to 0.34% and in-house rejection (scrap) cost from 0.89% to 0.02%.

Impact of hydration on vocal loading using phonetogram measures

<p><strong>Background:</strong> Vocal loading is a phenomenon that affects the vocal folds and voice parameters. Prolonged vocal loading may cause vocal fatigue. Hydration is one of the easiest precautions to reduce the effect of vocal loading. Voice range profile is an analysis of a participant’s vocal intensity and fundamental frequency ranges. Speech range profile is a graphical display of frequency intensity interactions occurring during functional speech activity. Phonetogram software can analyse VRP and SRP.</p><p><strong>Methods:</strong> Total sixty normophonic participants (thirty male and thirty female) were included in this study. Phonetogram, version 4.40 by Tiger DRS, software used to measure the voice range profile and speech range profile. For VRP, participants were asked to produce vowel /a/ and a passage reading task was given for SRP measurement.</p><p><strong>Results:</strong> All sample recording were done at pre vocal loading task, VLT and after hydration. Parameter that were used to measure the effects were Fo-range, semitone, max-F, min-F, SPL range, max-I, min-I, area (dB). Result showed that after VLT all other parameters like Fo-range, semitone, max-F, min-F, SPL range, max-I, min-I, area (dB) in VRP and SRP were reduced except min-F VRP in male, min-I VRP and min-I SRP in both male and female participants. After hydration all other parameters were improved except max-F VRP and min-F VRP in female, max-I VRP, min-F VRP and area VRP.</p><p><strong>Conclusions:</strong> This study concluded that vocal loading has negative impact on vocal fold tissue and mass. </p>

Effects of bone morphogenic protein-2 loaded on the 3D-printed MesoCS scaffolds.

The mesoporous calcium silicate (MesoCS) 3D-printed scaffold show excellent bioactivity and can enhance the bone-like apatite formation. The purpose of this study aims to consider the effects of the different loading methods on the novel grafting materials which composed of bone morphogenetic protein-2 (BMP-2) loaded MesoCS scaffold by employing 3D-printing technique. The MesoCS scaffold were fabricated by fused deposition modeling. In this study, there are two methods of loading BMP-2: (1) the pre-loading (PL) method by mixing MesoCS and BMP-2 as a raw material for a 3D-printer, and (2) the direct-loading (DL) method by soaking the 3D-printed MesoCS scaffold in a BMP-2 solution. The characteristics of MesoCS scaffold were examined by transmission electron microscopy (TEM), X-ray diffraction (XRD) and scanning electron microscopy (SEM). Their physical properties, biocompatibility, and osteogenic-related ability were also evaluated. The 3D MesoCS/PCL scaffolds showed excellent biocompatibility and physical properties. After soaking in simulated body fluid, the bone-like apatite layer of the PL and DL groups could be formed. In addition, the DL group released fifty percent more than the PL group at the end of the first day and PL showed a sustained release profile after 2 weeks. The 3D MesoCS/PCL porous scaffolds were successfully fabricated via a 3D printing system and were tested invitro and were found to show good cellular activity for cell behavior although the PL method was not favorable for clinical application in relation with the preservation of BMP-2. With regards to different growth factor loading methods, this study demonstrated that PL of BMP-2 into MesoCS prior to printing will result in a more sustained drug release pattern as compared to traditional methods of scaffolds directly immersed with BMP-2.

Punching behavior of strengthened and repaired RC slabs with CFRP

This study investigated the punching behavior of reinforced concrete slabs strength with carbon-fiber-reinforced polymer (CFRP). We tested a total of thirteen RC slabs, each having 965 mm length, 680 mm width, and 60 mm thickness, each slab was reinforced with two layers of CFRP of area (40 × 40 cm2). The variables in the experimental program were: pre loading (60% and 80%) of ultimate load (load of control slab) and orientation of the fiber of CFRP (0°, 45°, (0°/90°) and (45°/135°)). Test results showed that the capacity of ultimate load of strength of the slabs is increase (23%–65%) compared with slab unreinforced. The results illustrate that carbon-fiber-reinforced polymer (CFRP) reinforcement is perfect in reducing the deflection (3%–48%). The CFRP strengthening is perfect in reducing the strain.

Tension modeling of package binding belts in cargo spacecraft

At the site of cargo package binding in cargo spacecraft, the binding belt tension is loaded with a ratchet device. It is determined by experience of operators, therefore it’s difficult to quantify the force and the reliability of the binding belt is low. Based on the dimension analysis method, a semi-quantitative model was established between the binding belt tension and the ratchet force of the fastening device. The motion of the binding process was carefully observed and analyzed based on Analysis of Therbligs. On this basis, the standard packing process is developed, which improves the repeatability of loading and packing pre loading. A loading test platform for cargo loading is built with small tension sensor and tension tester, and a large number of tension data and ratchet force data are obtained. Based on the least-squares linear data fitting, four coupling models for the four binding belts were established. The coupling model verification experiments show that the calculated values are in good agreement with the measured values, and the errors are mostly lower than 5%. The model can be applied to the quantification of the binding belt tension.

Comparison of the effects of pre loading with 6% hydroxy-ethyl starch 130/0.4 versus Ringer lactate in preventing spinal anaesthesia induced hypotension in Caesarean section

Background: Hypotension after spinal anaesthesia is preventable by adequate pre-loading with colloids or crystalloids. Women posted for emergency caesarean section are more vulnerable for hypotension as they are not preloaded adequately due to time constraints. The idea of the study is to maintain haemodynamics by administering preload solution without any delay. Here 6% Hydoxyethyl starch (HES) is compared with Ringer lactate (RL) as a preloading solution. Materials and Methods: 50 pregnant women posted for emergency caesarean section were randomly allocated into 2 groups – Group H of 25 women received 500 ml of 6% HES and Group R of 25 women received 500 ml of RL intravenously as preload prior to spinal anaesthesia. The requirement of ephedrine to counter hypotension and the changes in the haemodynamic parameters were noted. Statistical analysis was done using Student’s ‘t’ test, Fisher’s test and Chi square test, and p

A Comparative Study Of Preloading Efficacy Of Ringer’s Lactate V/S 6% Heta Starch Solutions In Preventing Hypotensionfollowing Spinal Anaesthesia

Hypotension during spinal anaesthesia is common and can cause significantmorbidity and mortality. Prior to spinal anaesthesia fluid administration isrecommended to reduce the incidence of hypotension and this is referred to aspreloading. Crystalloids and colloids are routinely tried as pre loading fluids but there is still considerable debate over their effectivenessas a pre loading. A comparative study was under taken to compare the hemodynamic changes of Ringers lactate v/s Hydroxy ethyl starch in 60 ASA grade-I &II patients posted for lower abdominal and lower limb elective surgeries and allocated into two groups. Each patient was administrated either Ringer's lactate solution at 10 ml/ Kg body or 6% Hydroxy ethyl starch at 10 ml/ Kg over a period of 20 minutes before spinal anaesthesia. Following spinal anaesthesia mean arterial pressure were recorded at regular intervals.We found that hydroxy ethyl starch is more effective than lactated Ringer's solution as a pre loading fluid in prevention of hypotension following spinal anesthesia. However, we also concluded that incidence of hypotension was only reduced but not completely eliminated in this study.

Alcohol ‘Pre-loading’: A Review of the Literature

To review the international literature concerning pre-loading (PL); this is drinking before going out to pubs and bars. A literature review conducted in May 2013 using the EBSCO database entering the following search terms 'pre-loading', 'front-loading', 'pre-partying' and 'pre-drinking'. Thereafter, the reference lists were checked for further relevant articles. The review consisted of 40 articles of which 11 were excluded because PL was not the primary unit of analysis or they did not fulfil a quality assurance criterion. Despite being an internationally widespread development to date, most of the research on this has been from the USA and UK. The majority of US studies have been concerned with PL in a college and high school setting, while the research in the UK has mainly concentrated on the correlation/relationship between PL and what takes place when drinkers enter pubs and bars later in the evening. A consistent finding was that PL is associated with greater alcohol consumption, intoxication and alcohol-related risks. The price of alcohol and achieving intoxication were the main motivations for PL. However, other reasons included a chance to meet members of the opposite sex or own friends in surroundings that encouraged interaction rather than intoxication. PL should be regarded as part of a wider drinking culture and understood within the context of what individuals require from a night out or staying in when drinking. There is little evidence to suggest that PL is a risk factor for admissions to accident and emergency services.

Bypass of the Proximal Gut Has Weight Loss Independent Effects on Glycemic Control

Introduction The reported remission of type 2 diabetes in patients undergoing Roux-en-Y gastric bypass has brought the role of the gut in glucose metabolism in focus. We aimed to explore the role of the proximal gut on glucose handling.Methods A comparative controlled investigation of oral versus gastrostomy glucose loading in patients who had previously undergone gastric bypass and had a gastrostomy tube in the gastric remnant for feeding. A standard glucose load was administered either orally (day 1) or via the gastrostomy tube (day 2). Plasma levels of glucose, insulin, glucagon-like peptide 1 (GLP-1) and peptide YY (PYY) were measured pre and post glucose loading. Results Exclusion of the proximal small gut from glucose passage induced lower plasma glucose responses and higher plasma insulin, GLP-1 and PYY responses compared to glucose via a gastrostomy (p<0.05). Conclusions Exclusion of glucose passage through the proximal small gut results in enhanced insulin and gut hormone responses and suggests a weight loss independent effect explaining the improved glycaemic control after gastric bypass. The gut plays a central role in glucose metabolism and represents a target for future antidiabetes therapies.

Multiple Factors Lead to a Low Referral Rate for Bariatric Surgery in an Urban Primary Care Setting

Introduction The reported remission of type 2 diabetes in patients undergoing Roux-en-Y gastric bypass has brought the role of the gut in glucose metabolism in focus. We aimed to explore the role of the proximal gut on glucose handling.Methods A comparative controlled investigation of oral versus gastrostomy glucose loading in patients who had previously undergone gastric bypass and had a gastrostomy tube in the gastric remnant for feeding. A standard glucose load was administered either orally (day 1) or via the gastrostomy tube (day 2). Plasma levels of glucose, insulin, glucagon-like peptide 1 (GLP-1) and peptide YY (PYY) were measured pre and post glucose loading. Results Exclusion of the proximal small gut from glucose passage induced lower plasma glucose responses and higher plasma insulin, GLP-1 and PYY responses compared to glucose via a gastrostomy (p<0.05). Conclusions Exclusion of glucose passage through the proximal small gut results in enhanced insulin and gut hormone responses and suggests a weight loss independent effect explaining the improved glycaemic control after gastric bypass. The gut plays a central role in glucose metabolism and represents a target for future antidiabetes therapies.

Experimental study of monotonically loaded wide spaced reinforced masonry shear walls

Although wide spaced reinforced masonry (WSRM) walls perform well in places where the cyclonic wind pressure dominates the design, their behaviour under inplane loading is not fully understood. To understand the behaviour of the WSRM walls in the elastic, and pre and post peak loading stages, six full-scale single leaf, clay block WSRM shear walls were constructed and tested under monotonic loading. Spacing ratio (spacing at central region to the end region) of the vertical reinforcement within each wall was considered as the primary variable. The response of the WSRM walls to inplane loading is also compared with unreinforced masonry (URM) and end-core reinforced masonry (ECRM) walls. Ultimate shear capacity, ductility and stiffness degradation evaluated from the monotonically loaded walls are reported in this paper. It has been observed that the WSRM shear walls possess good levels of ductility and do not exhibit rapid stiffness degradation. It has been shown that the WSRM shear walls with spacing ratio around unity exhibit substantially improved post-cracked deformation characteristics.

Effect of Pre-loading on Impact Fracture.

An impact fracture test was performed on S 45 C near the transition temperature. The impact fracture test showed that a brittle fracture was always accompanied by a preceding ductile crack. The generation of the ductile crack occupied the majority of the absorbed energy in the impact test. Therefore, the generation of a ductile crack by an other pre-loading process was considered to be harmful for the impact strength. In this report, tests were performed to investigate the effects of preloading such as pre-impact, large straining and low cycle fatigue on the absorbed energy. Test results showed that a ductile crack deeper than 0.15 mm generated by pre loading substantially reduced the absorbed energy.