Initial Time Research Articles

Clinical characteristics and time of initiation of thrombolytic treatment in patients with Ischemic Cerebrovascular Accident in the Stroke Unit of the Emergency Service of the Hospital de Clínicas

Introducción: la trombólisis intravenosa revolucionó la terapéutica de los pacientes con accidentes cerebrovasculares isquémicos. Objetivo: determinar las características clínicas y tiempo de inicio de tratamiento trombolítico en pacientes con accidente cerebrovascular isquémico en la Unidad de ICTUS del Hospital de Clínicas. Metodología: estudio retrospectivo, observacional, descriptivo, transversal, muestreo no probabilístico, de pacientes con diagnóstico de accidente cerebrovascular isquémico ingresados en la Unidad de ICTUS del Hospital de Clínicas, desde enero del 2015 hasta junio del 2022. Se midieron variables sociodemográficas, tiempo de inicio de tratamiento trombolítico, NIHSS al ingreso, 24 horas y 5 días, escala ASPCT, glicemia, presión arterial sistólica y diastólica, factores de riesgo de enfermedad cardiaca, transformación hemorrágica. Resultados: 10 % de los pacientes cumplieron criterios de trombólisis, edad media 62 ± 1, masculino 59 %. Promedio desde el ingreso hospitalario hasta el goteo del trombolítico fue 44±2 minutos y desde el inicio del cuadro hasta el goteo del trombolítico 195 ± 5 minutos. Los factores de riesgo cardiovascular más frecuentes fueron Hipertensión Arterial y Diabetes Mellitus, en 5 % de los trombolizados ocurrieron transformaciones hemorrágicas sintomáticas. Conclusión: 10 % de los pacientes cumplieron criterios para trombólisis. La media desde el ingreso al hospital hasta el goteo del fibrinolítico fue de 44 minutos y desde el inicio del cuadro hasta el goteo del trombolítico 195 ± 5 minutos. Los factores de riesgo de enfermedad cardiaca más frecuentes fueron la Hipertensión Arterial y Diabetes Mellitus, ocurrió 5% de transformación hemorrágica sintomática.

MEDICINAL BIOMAGNETISM FOR ANALGESIA IN MUSCULOSKELETAL DISORDERS OF THE SPINE – APPLICATION OF STATIC MAGNETIC FIELDS USING THE SPINE PROTOCOL

Introduction: Spinal pain affects approximately 80% of the population at some point of their lives. It’s the second biggest cause of absenteeism in professional or academic environments, directly impinging upon reduced productivity, psychological states and quality of life. Allopathy is the most widely used treatment, however its adverse effects are recurrent. Medicinal Biomagnetism (MB) is a therapy that uses static magnetic fields (SMF) provided from magnets, which have minimal side effects, assisting in the restoration of health, yielding an analgesic effect. Goal: Evaluate the effect of SMF usage by means of the Spine Protocol (SP) from MB applied onto pain deriving from musculoskeletal disorders of the vertebral column. Methodology: Longitudinal study with clinical trials of 15 participants assessed using the Visual Analogue Scale (VAS) and Brief Pain Inventory, followed up after treatment for 30 days. Result: A reduction in pain perception was observed in 91% of the sample, representing 21 treatments of spinal segments, from just 15 minutes of exposure to the SP procedure, with a significative difference for the VAS variables (p=0.0000014). Most participants were female and the most common pain was located around the lumbar segment region. Conclusion: The SP procedure has therapeutic potential in both short and long term for the treatment of acute and chronic pain of any intensity, and it can be considered as a primary or supporting intervention in musculoskeletal disorders of the spine. It has demonstrated a shorter initial time and a longer duration for its analgesic effect when compared with the drug action reported in the literature.

Evaluating the influences hedgerow on soil erosion and nitrogen loss of purple soil sloping farmland under simulated rainfall

Hedgerow is a vital soil and water conservation technology for sloping farmland that can significantly reduce erosion and nutrient loss via their above- and below-ground parts. The effect of hedgerow on erosion and nutrient loss has been widely investigated, while the respective effects of their above- and below-ground parts are still unclear. Therefore, the purple soil from the Three Gorges Reservoir Area was used, and 3 slope conditions of control check, whole hedgerow and hedgerow roots only combined with 2 slope gradients (15° and 25°) were constructed and the simulated rainfall tests were researched at 3 rainfall intensities (60, 90 and 120 mm h−1). The runoff initiation time, runoff and erosion rates, and loss of nitrogen via runoff and sediment were analysed. In comparison to the control check slope condition, it was indicated that hedgerow increased the runoff initiation time by 43.38 %, decreased runoff and erosion by 15.59 % and 78.37 %, and decreased nitrogen loss via runoff by approximately 40 % and via sediment by approximately 70 % on average, respectively. The average contribution rates of the below-ground part of the hedgerow was 49.89 % for the increase in runoff initiation time, 33.99 % for runoff reduction, and 39.91 % for erosion reduction. In addition, more than 2/3 and 58.49 % of nitrogen loss reduction via runoff and sediment, respectively, was contributed by the above-ground part of the hedgerow. These results are beneficial for comprehending the control mechanism of hedgerow on soil erosion and nitrogen loss, thereby provide a scientific foundation for the sustainable and efficient utilization of soil and water resources on sloping farmland.

"Establishing a Multi-disciplinary Adult Oncology Unit at Muhimbili National Hospital: Lessons Learned, Challenges, and Opportunities Amidst Tanzania's Growing Cancer Burden"

The escalating cancer burden, particularly in low- and middle-income countries such as Tanzania, necessitates innovative strategies. One strategy is to increase access to cancer services through the establishment of treatment in existing referral hospitals that offer multidisciplinary care, as was the case in the opening of the adult oncology unit at Muhimbili National Hospital (MNH) in Tanzania. A comprehensive facility assessment served as the foundation for this expansion, encompassing assessments of the spatial requirements of human resources, equipment, and drug availability. Aiming to ensure optimal resource allocation and effective implementation by capitalizing on existing systems. The main objective of opening the MNH adult oncology unit was to increase coverage and accessibility to comprehensive cancer care services. This initiative has substantially improved patient outcomes, with reduced wait times for oncology care initiation, facilitating seamless care coordination that capitalizes on multidisciplinary treatment planning. The unit has provided benefits to MNH by fostering collaborative efforts, serving as a revenue generation point, and expanding care that aligns with institutional goals. Nonetheless, challenges persist, including space constraints and an inadequate number of trained human resources for oncology care. The successful establishment of the MNH's adult oncology unit exemplifies the significance of stakeholder engagement, adaptability, and collaboration. A comprehensive approach that emphasizes workforce development, community awareness, and infrastructure enhancement offers promise in confronting Tanzania's mounting cancer burden.

ANÁLISIS ADAPTATIVO DE TRAYECTORIAS SINUSOIDALES ALTAMENTE HETEROGÉNEAS

The study of sperm motility offers multiple applications in reproductive medicine, as well as in the aquaculture and livestock industrie. Aiming to achieve a population motility characterization with high precision and automatization, a software was developed in order to obtain good motility parameters from their trajectories: mean velocity, heading frequency and amplitude. The development requires only one adjustable parameter, an initial time window for averaging, which is optimized recursively for each cell. When it is applied to aquatic spermatozoa recorded at 400 fps, it proves to be robust and adaptable to populations with high heterogeneity in their motility parameters.

Using the Single Minute Exchange of Die (SMED) Method to Minimize Machine Setup Time: A Case Study

PT. GTC is a company that produces automobile tubes facing problems with an increase in demand of up to 20% from the previous year. From 4 existing divisions named mixing, extruding, splicing, and curing, it was found that the extruding division was unable to meet the production targets set by the company. There are several causes, including high setup time. This research aims to reduce setup time by applying the Single Minute Exchange of Die (SMED) method to the production process in the extruding machine-1 that produces automobile tube sizes 5.50-13 and 7.00-14. Converting activities no. 2, 3, and 14 from internal activities to external activities, changing the layout of the die, core, and adjuster key storage table, dies unification, and installing a Temperature Control Unit to control steam to the extruder head can reduce setup time from 45 minutes to 22 minutes or 51% from the initial setup time. These improvements succeeded in increasing the productivity of the extruding division up to 93.9% in January 2023. Keywords: single-minute exchange of die, SMED, setup time, production achievement, unification

Neonatal hypernatremic dehydration in breastfed neonates: a prospective study unmasking the influences of breastfeeding practices and early weight monitoring

Introduction: Hypernatremic dehydration in neonates is an uncommon but serious reason for re-hospitalization, especially in exclusively breastfed neonates. The aim was to study the incidence, associated maternal and neonatal characteristics and risk factors, and presenting features of neonatal hypernatremic dehydration (NHD). Methods: A prospective study design was employed to enroll full-term newborns admitted with serum sodium concentrations of ≥145 mEq/L from April 2022 to March 2023 at a tertiary care rural hospital. Maternal and neonatal characteristics and breastfeeding practices of these mother-baby pairs were recorded and observed. Healthy control for every mother-baby pair was taken. Ethical clearance and informed consent were obtained from mothers. Result: 34 newborns out of total 672 NICU admissions were admitted due to NHD, with an incidence of 4.7%. Primiparous mothers were 23 (67.6%) in the cases and 10 (29.4%) in the control group (p = 0.0017). Disparity in maternal breastfeeding practices of cases, such as delayed initiation time 2.3 h vs. 1.27 h (p < 0.0001), less frequency of breastfeeding 6.5 times vs. 9.3 times (p < 0.0001), and duration of breastfeeding sessions 23.3 min vs. 32 min (p = 0.0014) respectively in cases and controls were found to be potential contributing factors. 61.7% of mothers had breast issues in the cases and 17.6% in the control group (p = 0.0002) with average LATCH score of 4.29 in cases as compared to 8.08 in controls (p < 0.0001) at time of baby’s admission to NICU. The average neonatal age at presentation was six days and average weight loss was 11.4% in cases vs. 2.8% in controls (p < 0.0001). The main presenting features were excessive weight loss 30 (88.2%), lethargy 20 (58.8%), jaundice 18 (52.9%) and fever 14 (41.1%). Conclusion: Neonatal hypernatremic dehydration (NHD) poses a significant clinical challenge, particularly in full-term, exclusively breastfed healthy neonates. We found an incidence of 4.7%. Delayed initiation of breastfeeding, inadequate breastfeeding techniques, and maternal breast-related issues were significant contributors to NHD. Primiparous mothers were found to be at higher risk, emphasizing the need for targeted breastfeeding education and support for primiparous mothers. The study reaffirmed the critical role of frequent and effective duration of breastfeeding and daily weight monitoring for preventing NHD.

Study on the fluidity and mechanical properties of multi-source coal-based solid waste (MCSW) filling material

The backfilling mining technology for multi-source coal-based solid waste (MCSW) aligns with the key challenges and emerging paradigms in the coal industry, aiming at intelligent and cleaner coal mining, high efficiency, and low carbon utilization. This research area has gained considerable attention and significance for promoting high-quality coal mining, low environmental impact, and sustainable development. In this study, a response surface experiment was designed with desulfurization gypsum (DG), gasification slag (GS), and furnace bottom slag (FBS) as factors to analyze the performance of backfill materials with varying compositions. Parameters such as bleeding rate, compactness, viscosity, setting time, and age strength were tested. An optimal composition of backfill materials was obtained, with a MCSW content exceeding 90 %, 28-day strength exceeding 2 MPa, initial setting time between 240 and 480 min, and final setting time ranging from 300 to 600 min. The investigation of the optimal materials involved characterizing the pore structure, microstructure, composition, and silica gel structure through techniques such as X-ray diffraction (XRD) and scanning electron microscopy-energy dispersive spectroscopy (SEM-EDS). Additionally, the study explored micro-interface structures and enhancement mechanisms. After 28 days of curing, the backfill with a composition of DG 0.3, FBS 0.2, GS 0.1 exhibited a compressive strength of 5.18 MPa, with an initial setting time as short as 140 min. This can be attributed to the precipitation of silica gel on the grain surface, which mitigated the segregation effect. The silica gel promoted inter-particle bonding and rapid viscosity, preventing particle settling. This method not only ensures the safe disposal of coal-based solid waste but also contributes to the coordinated development of coal resource exploitation, environmental protection, and reduced carbon footprint.

Orthodontic tooth movement through regenerative sites: A 25-year systematic review

This systematic review aimed to investigate the efficacy of orthodontic tooth movement (OTM) through bone regenerated with osteoconductive grafts, together with the risk of root resorption (RR), in relation to the material and the timing of force initiation. Following PRISMA-ScR guidelines, three major electronic databases were searched (PubMed, EMBASE, and Cochrane). Only studies which reported on the primary outcome (OTM rate) were included. Investigations with fewer than 3 participants/groups and an absence of controls were excluded. The final sample consisted of 16 randomized and controlled clinical trials. Among them, 9 reported on RR (the secondary outcome). The articles showed substantial heterogeneity and low-moderate quality. Most studied OTM through alloplasts (7) and xenografts (8), 3 addressed allografts, 3 autografts and 6 analyzed 2 grafts. Timing for force initiation varied from 0 to 13 weeks post-grafting. Based on limited evidence, it can be cautiously concluded that most graft materials have either no impact or slightly impair OTM, with no significant increase in RR. Xenografts might impede OTM and increase RR risk. The optimal timing for force application depends on the state of bone healing. Future studies are mandatory for deciding on the ideal graft and timing for optimal OTM in each clinical setup.

Enhanced afterglow properties in reddish-orange Ca2SnO4:Sm3+ phosphors by NH4Cl or CaCl2 flux

Red long persistent phosphors are the key to achieving full-spectrum afterglow luminescence. However, their low initial brightness and short afterglow time are currently urgent problems to be solved. In this study, the reddish-orange long persistent phosphor Ca2SnO4:Sm3+ was successfully prepared via the high-temperature solid-state reaction method using NH4Cl and CaCl2 as the flux, respectively. It was proved that CaCl2 lowered the decomposition temperature of CaCO3 and form a liquid phase, accelerating the formation of the Ca2SnO4 phase. The afterglow time of Ca2SnO4:Sm3+ with 5 wt% NH4Cl or 5 wt% CaCl2 was respectively 12 or 24 times longer than that without any flux. 5 wt% CaCl2 addition exhibited the longest afterglow time, lasting over 83 min. It concluded that CaCl2 induced the increase in shallow trap concentration was the main reason for extending afterglow time. In addition, a phosphorescent mechanism model was proposed that the electron trap (Sm. Ca) and the hole trap (V″ Ca) played a crucial role in the energy storage of Ca2SnO4:Sm3+. Ca2SnO4:Sm3+ as a red long persistent phosphor has the potential to make full-spectrum afterglow luminescence a reality.

The Use of Natural Zeolites in Cement-Based Construction Materials—A State of the Art Review

Natural zeolite is a honeycomb-structured aluminosilicate mineral with an open crystalline structure which makes it suitable for a variety of applications. Given the beneficial effects of zeolites on the properties of cementitious materials, the present paper aims to summarize the recent findings reported in the scientific literature on the use of zeolites in cement-based construction materials. This paper limits the analysis to natural zeolites. The influence of natural zeolites on the workability and setting time of cement-based construction materials revealed that increasing the zeolite content led to a reduction in workability compared to the control mixes. At the same time, the initial and final setting times of cement pastes showed a decreasing trend with an increase in the replacement percentage. The slow pozzolanic reaction of clinoptilolite zeolite results in lower flexural strength and compressive strength values of mortars at the age of 28 days. Blending zeolites with other supplementary cementitious materials resulted in improved values of the mechanical properties of mortar and concrete. The findings regarding the impact of zeolite on the durability of concrete suggest that zeolite shows promise as a viable alternative to cement, with positive effects on various aspects of durability. The majority of the durability factors are interconnected. The presence of conflicting findings is particularly significant in this context, highlighting the need for a comprehensive approach to address these challenges in the future.

An algorithm for flexible transshipments with perfect synchronization

Direct and instant deliveries have gained popularity among customers, but have also increased the burden on cities due to rising transport incidents, especially as delivery vehicles often drive empty when returning to their origin. Flexible transshipments with perfect synchronization would allow loads to be transshiped between these vehicles without the need for storage facilities. This may increase their average proximity to their origin and reduce the proportion of empty rides. We present a problem-specific algorithm with three sub-steps to solve this concept. The first evaluates the relational position between two deliveries and, based on 36 structured cases, decides which pairs to exclude from the solution space. The second formulates the optimization problem to find the best transshipment location while considering time-limit constraints and transfer times. Finally, we apply the request-pair combination problem to graph theory to determine the lowest overall travel time. In our paper, we consider a continuous problem definition which allows flexible transshipments, and assume unit-sized capacity per vehicle and a maximum of one transshipment per request.We show that our algorithm reduces the initial total travel time of direct deliveries by 9.6% in a numerical simulation, and by 11% in a case study using food delivery data from the city of Bordeaux. We also demonstrate that the total time is best reduced by increasing time constraints rather than adding requests to increase the chance of transshipments. Our algorithm not only helps to reduce travel time, but also improves sustainability, mitigates driver shortages and is easy to implement.

Green and effective route to convert chromium-free leather waste into protein retarding material for building gypsum

Leather manufacturing generates a large amount of leather solid waste, among which the effective treatment of leather waste scraps rich in protein resources has always been a challenge for the tanning industry. In this paper, a green and convenient method was devised for the first time to prepare protein retarding material (PRM) for gypsum from chrome-free tanned leather waste. Aldehyde tanned leather scraps as the main chrome-free leather waste were directly hydrolyzed through high-pressure hydrothermal treatment without any chemicals to obtain PRM. Compared with chemical treatment (acid or alkaline hydrolysis), high-pressure hydrothermal method avoided the decrease of protein product purity due to without the help of acid and alkali. The results showed that PRM obtained from leather waste had a significant effect on prolonging the initial setting time and delaying the release of hydration heat of gypsum. With the dosage or molecular weight of PRM increased, this retarding effect on gypsum was more remarkable. SEM, XRD, and FTIR analysis indicated that the presence of PRMs inhibited the hydration process of gypsum hemihydrate to gypsum dihydrate. Through polypeptide-calcium chelation, PRMs could bind free Ca2+ ions dissolved from gypsum to delay them from participating in the hydration reaction. The larger molecular weight or the more dosage of PRM, the stronger ability to bind calcium ions in gypsum. Chemical structure characterization and molecular dynamics simulation of PRM-Ca chelate further proved that PRMs mainly through carboxyl groups on molecular chain combined with Ca2+ in gypsum system to inhibit hydration reaction, thereby fulfilling the retardation demand. This study indicated that PRM from leather scraps can be a promising candidate for gypsum retardation, which provides a path for the efficient utilization of leather waste.

Optimal Bell's Palsy Treatment: Steroids, Antivirals, and a Timely and Personalized Approach.

The optimal treatment approach for patients with Bell's palsy, a condition characterized by acute facial nerve palsy, remains unclear. The present study was designed to provide insights into the most effective treatment strategies, whether steroids alone or steroids plus antiviral agents, as well as the optimal timing of treatment initiation. To investigate the impact of treatment modalities and timing on the recovery rates of Bell's palsy patients and to assess the roles of individual factors. This retrospective analysis included 1504 patients with Bell's palsy who visited Kyung Hee University Hospital. Patients were divided based on the treatment modality (steroid monotherapy vs. combined steroid and antiviral therapy) and the timing of treatment initiation (≤72 vs. >72 h). The primary outcome was the recovery rate, as assessed by the House-Brackmann (HB) grade. Secondary outcomes included factors such as age, electroneurography (ENoG) and electromyography (EMG) results, and comorbid conditions. A combined comparison of patients treated with steroids plus antivirals and steroids alone, stratified by treatment start time, showed that recovery rates were highest in patients who received steroid monotherapy initiated within 72 h (OR 2.36; p < 0.05). Patients with severe Bell's palsy tended to benefit more from combined therapy when treatment was initiated within 72 h. The recovery rate was higher in patients who received steroid monotherapy than combined therapy (86.32% vs. 79.25%, p < 0.05). Initiating treatment beyond 72 h was associated with a higher recovery rate than starting treatment within 72 h (85.69% vs. 76.92%, p < 0.05). An evaluation of the factors affecting recovery showed that patients aged 20 to 39 years had a higher recovery rate than other age groups (OR 1.47; p < 0.05). Fairly predictive EMG results were associated with significantly higher recovery rates (OR 3.52; p < 0.05). These findings underscore the importance of individualized treatment approaches in Bell's palsy management. Steroid monotherapy remains effective, although combined treatment may have potential advantages, especially in patients with more severe disease. The best treatment results were achieved when steroid treatment was administered within 72 h. Our results suggest that there may be more flexibility in the application of the 72 h treatment period if we consider the time of treatment initiation alone, but this should take into account patient behavior patterns and the limitations of retrospective analysis. Further research is warranted to validate these findings and refine treatment recommendations for patients with Bell's palsy.

Recycling of marble and granite waste in concrete by incorporating nano alumina

This study aims to evaluate the effect of using single and combined marble dust (MD), granite dust (GD) and nano alumina (NA) on the performance of Portland cement concrete. MD and GD were separately replaced by different percentages of cement (2, 4, 6, 8 and 10 wt%). Furthermore, NA was used as addition by different percentages (0.25, 0.5, 0.75, 1.0 and 1.25 wt%) in the individual mixtures. The optimal ratios for MD, GD and NA were used to design two concrete mixtures with combined 6%MD+ 1%NA and 6%GD+ 1%NA. The physical properties (consistency, initial and final setting times), the workability (slump cone test), the mechanical properties (compressive, splitting tensile and flexural strengths) and microstructure analysis (X-Ray Diffraction (XRD), Scanning Electron Microscope (SEM) and Energy-Dispersive X-ray (EDX)) were carried on the single and combined mixtures in addition to control mix. Results revealed a rise in the water quantity needed to achieve standard consistency, along with a reduction in both initial and final setting times, as the content of GD and NA increased. However, in comparison to the control mix, minor effects in the consistency or the setting times was observed when various MD contents were used. Regarding workability, its consistently decreased in all cases in correlation with the surface area of the materials utilized. The highest reduction was observed when employing NA, characterized by the largest surface area, followed by GD, and then MD, which had a marginal effect on workability. For hardened concrete, there was an improvement in strengths of samples with replacing individually MD and GD content up to 6% at all curing ages, followed by a decrease in strengths when the content reached 10% of cement replacement compared to control sample. Concrete mixtures with addition of NA showed significant improvement in strengths at all percentages of addition until reached the maximum increase in strength at 1% then slightly decreased. Concrete with combined (6%MD+1%NA) and (6%GD+1%NA) show significantly improved mechanical properties and compact microstructure enriched with C-S-H in comparison to concrete samples using 6%MD, 6%GD and 1%NA separately.

Management of Severe Malnutrition Post-bariatric Surgery Using Artificial Nutrition.

Bariatric surgery (BS) results in major and sustained weight loss and improves comorbidities in patients with obesity but can also lead to malnutrition, especially through severe malabsorption and/or surgical complications. Little is known about the efficacy of artificial nutrition (AN) in this setting. In this case series, we describe data from consecutive severely malnourished patients after BS (resectional and non-resectional), managed by AN at our hospital unit over a 4-year period. Between January 2018 and June 2022, 18 patients (mean ± SD age 42.2 ± 10.4 years, 94% women) required AN following BS complications. At the time of AN initiation, more than half of the patients (53%) had multiple revisional surgeries (up to four). Mean BMI was 49.7 ± 11.3 kg/m2 before BS and 29.6 ± 9.6 kg/m2 when AN was initiated. Most patients (n=16, 90%) received enteral nutrition. AN management resulted in weight regain (+4.7kg ± 8.0, p=0.034), increased serum albumin (+28%, p=0.02), pre-albumin (+88%, p=0.002), and handgrip strength (+38%, p=0.078). No major AN complication nor death was observed. Median total AN duration was 4.5 months [1-12]. During follow-up, the cumulative duration of hospitalization was 33 days [4-88] with a median of 2.5 hospitalizations [1-8] per patient. Malnutrition can occur after any BS procedure, and AN when required in this setting appears safe and effective on nutritional parameters. It is important to recognize the potential risk factors for malnutrition, which include excessive weight loss resulting from surgical complications, eating disorders, multiple revisional BS, and pregnancy.

Bilateral adrenal infarction and insufficiency associated with antiphospholipid syndrome and surgery: a case report

BackgroundAntiphospholipid syndrome causes systemic arterial and venous thromboses due to the presence of antiphospholipid antibodies. Adrenal insufficiency is a rare complication of antiphospholipid syndrome that may result in fatal outcomes if left untreated. Therefore, we report adrenal insufficiency as a rare complication of bilateral adrenal infarction associated with antiphospholipid syndrome and trauma surgery.Case presentationA 64-year-old male patient underwent surgery for a left traumatic hemothorax. He concurrently had antiphospholipid syndrome and was receiving warfarin. Postoperatively, the patient complained of severe lumbar back pain despite resuming anticoagulation therapy, and he experienced paralytic ileus and shock. Abdominal contrast-enhanced computed tomography revealed adrenal swelling and increased surrounding retroperitoneal adipose tissue density. Diffusion-weighted abdominal magnetic resonance imaging showed high-intensity areas in the bilateral adrenal glands. Cortisol and adrenocorticotropic hormone levels were 3.30 μg/dL and 185.1 pg/dL, respectively. Subsequently, the patient was diagnosed with bilateral adrenal infarction and acute adrenal insufficiency, and hydrocortisone was immediately administered. Adrenal insufficiency improved gradually, and the patient was discharged after initiating steroid replacement therapy.ConclusionsThe timing of postoperative anticoagulant therapy initiation remains controversial. Therefore, adrenal insufficiency due to adrenal infarction should be monitored while anticoagulant therapy is discontinued in patients with antiphospholipid syndrome.

Early Weight-Bearing After Fibula Free Flap Surgery

Despite the widespread use of fibula free flap (FFF) surgery for head and neck reconstruction, there are no studies assessing if early weight-bearing (EWB) affects postoperative recovery, and the timing of weight-bearing initiation following FFF surgery varies considerably across institutions. Therefore, it is important to understand the effect of EWB in these patients and whether it could improve postoperative recovery. To assess the association of EWB after FFF surgery with donor-site complications, length of stay, and discharge to home status. This retrospective cohort study took place at Massachusetts Eye and Ear, a single tertiary care institution in Boston, Massachusetts. A total of 152 patients who received head and neck reconstruction with a fibula osteocutaneous free flap between January 11, 2010, and August 11, 2022, were included. EWB on postoperative day 1 vs non-EWB on postoperative day 2 or later. Patient characteristics, including demographic characteristics and comorbidities, surgical characteristics, donor-site complications, length of stay, and discharge disposition, were recorded. Descriptive statistics and multivariate logistic regressions were used to compute effect sizes and 95% CIs to compare postoperative outcomes in EWB and non-EWB groups. A total of 152 patients (median [IQR] age, 63 [55-70] years; 89 [58.6%] male) were included. The median (IQR) time to postoperative weight-bearing was 3 (1-5) days. Among all patients, 14 (9.2%) had donor-site complications. EWB on postoperative day 1 was associated with shorter length of stay (adjusted odds ratio [AOR], 0.10; 95% CI, 0.02-0.60), increased rate of discharge to home (AOR, 7.43; 95% CI, 2.23-24.80), and decreased donor-site complications (AOR, 0.11; 95% CI, 0.01-0.94). Conversely, weight-bearing 3 or more days postoperatively was associated with an increased risk of pneumonia (AOR, 6.82; 95% CI, 1.33-34.99). In this cohort study, EWB after FFF surgery was associated with shorter length of stay, increased rate of discharge to home, and decreased donor-site complications. These findings support the role of early mobilization to optimize postoperative recovery after FFF surgery.

Effects of Anionic Emulsifiers and Emulsified Asphalt on Hydration and Microstructure of Cement.

Cement-emulsified asphalt (CEA) has been widely used in slab ballastless track and asphalt pavement cold recycling projects because of its high stiffness and toughness. In CEA material, emulsifiers and asphalt affect the cement's hydration process and microstructure. Thus, to further investigate the effects of anionic emulsifiers (AEs) and anionic emulsified asphalt (AEA) with different demulsification rates on the hydration process and microstructure of cement, two types of AE (rapid-setting and slow-setting) and their corresponding AEA were used to prepare modified cement pastes. First, it was confirmed that the AEs and AEA delayed cement hydration by measuring the setting time, X-ray diffraction (XRD) patterns, and electrical resistivity of the cement paste. Then, the microstructure of the cement paste was determined with mercury intrusion porosimetry (MIP) and a scanning electron microscope (SEM), and it was found that AEs and AEA have varying degrees of inhibitory effects on the formation of the cement paste microstructure. Finally, based on the energy dispersive spectrometer (EDS) element content of the cement paste and Fourier transform infrared spectroscopy (FTIR) on the two AEs, the inhibition mechanism of AE and AEA with different demulsifier rates on the cement hydration process was analyzed. The experimental results showed that both AEs and AEA delayed the hydration process of cement to varying degrees and altered the microstructure of cement, and slow setting anionic emulsified asphalt (SAEA) had the greatest impact on the hydration process and microstructure of cement. Compared to pure cement paste, the initial setting time of cement paste mixed with SAEA was delayed by 73.9%, and the final setting time was delayed by 66.7%. After adding SAEA, the most probable aperture of the cement paste increased from 62.50 nm to 71.19 nm after one day of hydration. Due to the fact that there were more carboxyl groups with negative charges, more -COO- was adsorbed onto the surface of cement particles in the slow-cracking anionic emulsifier (SAE); compared with the rapid-setting anionic emulsifier (RAE) and the rapid-setting anionic emulsified asphalt (RAEA), the SAE and the SAEA had a stronger delaying effect on the hydration reaction of cement.

Aroma Profile of Merlot Red Wine Stored in Stainless-Steel Tanks and Wooden Barrels with Different Toasting Methods.

Stainless-steel tanks and wooden barrels are the most common wine ageing and storage vessels. Wooden barrels are often toasted to improve their chemical composition and influence on wine. The aim of this study was to investigate the changes in Merlot red wine aroma from the 2020 and 2021 vintages during 12-month storage (with sampling every 3 months) in a stainless-steel tank (SST), Excellence oak barrels with medium (EMT), medium plus (EMT+) and medium long (EMLT) toasting and a Premium oak barrel with medium toasting (PMT). The results showed that even slight differences in the time and temperature of medium toasting influenced the extraction of aroma compounds from wood to wine. The changes in individual aroma compounds depended on the vessel type, toasting level, initial wine composition and storage time. An increase in the total concentration of compounds with smoky, spicy and woody notes occurred in both wine vintages stored in wooden barrels, especially during longer storage. In samples from SST, floral, fruity and herbal aromas were more pronounced, according to the gas chromatography and sensory evaluators. Sensory evaluators rated the samples according to the 100-point test, and after 12 months of storage, 2020 and 2021 vintage Merlot stored in PMT obtained the highest points.