We developed a novel analytical method to measure the D‐ and L‐isomers of aspartic acid (AA) in the eye lens of beluga whales (Delphinapterus leucas) for age determination. The method was based on hydrolysis of the eye lens under acidic conditions followed by direct injection onto a Chirobiotic T (25 cm × 4.6 ID, 5 μm particle size) high performance liquid chromatography analytical column and detection by tandem mass spectrometry operated in the negative ionization mode. The detection limit of the method was 550 pg for each isomer, the repeatability expressed as the relative standard deviation was 8% and the linear dynamic range was from 0.05 mM to 1 mM. The validated method was used to estimate, for the first time, the rate of racemization (Kasp) of the two AA isomers and also the ratio of D/L at age 0, (D/L)0, in 34 beluga whales from the Canadian Arctic. At a mean ocular lens temperature of 17.8°C, respective Kasp and (D/L)0 were 3.48 ± 1.47 × 10−3/yr and 0.010 ± 0.005. We evaluated factors that impact Kasp and affect uncertainty in age estimation and outline the steps required to incorporate the method in wildlife management decisions.
OBJECTIVES
We sought to compare the effects of conventional wire cerclage with that of the band and plate fixation of the sternum.
METHODS
A parallel randomized open-label trial with 1:1 allocation ratio compared healing after adult cardiac surgery using ‘figure-of-8’ stainless steel wire cerclage or a band and plate system (plates). The primary end point was maximal sternal edge displacement during active coughing of ≥2 mm in ≥2 of 4 sites measured with ultrasound by 2 assessors blinded to the other at 6 weeks postoperatively. Secondary end points at 12 weeks included ultrasound assessment, computed tomography (CT) scan and multidimensional assessment of quality of recovery using the Postoperative Quality of Recovery Scale.
RESULTS
Of 50 patients, 26 received plates and 24 wires. Two patients died and 1 withdrew consent leaving 25 plates and 22 wires for primary end point analysis. Operations included 37 coronary, 5 valve and 8 combined coronary and valve procedures. At 6 weeks, less sternal movement was observed in patients with plates than those with wires, 4% (1/25) vs 32% (7/22), P = 0.018. Agreement between observers was high, kappa = 0.850. At 12 weeks, less ultrasound motion was seen in patients with plates, 0% (0/23) than those with wires, 25% (5/20), P = 0.014. Recovery from pain was higher for patients with plates 92% (22/24) than those with wires 67% (14/21), P = 0.004. CT bone edge separation was less for plates 38% (9/24) than wires 71% (15/21), P = 0.036. CT mild bone synthesis or greater was similar between patients with plates 21% (5/24) and wires 14% (3/21), P = 0.71.
CONCLUSIONS
Patients receiving the band and plate system had significantly less sternal edge motion than those receiving wires, 6 and 12 weeks after cardiac surgery and experienced less pain.
Clinical trial registration
clinicaltrials.gov NCT03282578.
The aim in this systematic review was to determine the effect of point-of-care ultrasound (POCUS) on the clinical decision-making process and patient outcomes in adults admitted to the general medicine ward. A comprehensive search was performed in MEDLINE (Ovid), EMBASE (Ovid), PubMed, the Cochrane Library, ClinicalTrials.gov, Scopus, LILACS and Cinahl. Articles had to fulfill the inclusion criteria of randomised or non-randomised studies assessing the impact of POCUS on the diagnosis, management, length of hospital stay or mortality of patients admitted to the internal medicine ward. Six studies were included involving a total of 1836 patients. The influence of POCUS on the diagnosis was reported as a change in the main diagnosis or the addition of a relevant diagnosis in up to 18% and 24% of the cases, respectively. Impact on the management plan was reported in 37% to 52.1% of the participants. Three studies documented the impact of POCUS on the length of stay. Two of them reported no difference between groups, and the other reported a significant reduction of 1 d of the hospital stay. In conclusion, POCUS appears to have positive effects on the clinical decision-making process with impacts on optimal patient management and possible reduction in the hospital length of stay.
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