The Incidence and Outcomes for Children with Cleft Palate and/or Lip and CHARGE Syndrome.

OBJECTIVES: Published literature on children with cleft palate and/or lip (CP + /-L) and CHARGE syndrome (CS) is limited. This study investigated cleft characteristics including surgery, and feeding and communication outcomes in children identified with CP + /-L and CS. DESIGN: Retrospective cross-sectional review. SETTING: Regional Referral Centre for Paediatric Cleft Surgery. PATIENTS: All children diagnosed with CP + /-L and CS (based on clinical features and/or CHD7 mutation testing) between 1989-2019. MAIN OUTCOME MEASURES: Cleft type, timing of CP + /-L repair, reasons for 'delayed' repair, feeding methods and communication modality. RESULTS: Twenty-two children with CP + /-L and CS were identified. Cleft sub-types (%) were: Eleven (50%) had bilateral cleft lip and palate (BCLP), six (27%) had unilateral cleft lip and palate (UCLP) and five (23%) had cleft palate (CP). Cleft repair was delayed compared to protocol care for non-syndromic children with CP + /-L. Median age for lip repair + /- vomerine flap was 9 months (range 4-22 months), and palate repair was 21 months (range 11-40 months). Median age for isolated CP repair was 13 months (range 7-23). Surgery for cardiac anomalies (36%) before cleft repair, and (59%) were classed as having severe systemic disease at the time of cleft surgery. Only 27% of the children in this study had both full oral feeding and verbal communication. CONCLUSIONS: Children with CP + /-L and CS had severe cleft types and complex medical problems leading to delayed cleft surgery. Feeding and speech outcomes were better in the children aged over ten years.

Combination of Passive and Active Solar Heating with Thermal Energy Storage.

This study investigated the impact of individual and combination of different sources of heating (passive solar heating, electric oil-heater, and solar air heater) in a pilot-scale building containing phase change material (PCM) for a potential reduction in energy consumption while maintaining thermal comfort. Unlike most of the recent simulations and modelling studies, this impact was tested experimentally using two identical control and test huts located at the University of Auckland. The control hut was equipped with standard gypsum boards while the test hut had gypsum boards containing PCM (PureTemp 20, PT20). The study found that combining both active and passive solar heating with a temperature-controlled electric oil heater demonstrated the ability to provide significant energy savings and maintain thermal comfort in the test hut, most notably overnight. The suggested combination was tested over different weather conditions and with different temperature constraints to maintain thermal comfort and achieve energy savings ranging from 33% to 87.5%.

An improved model for the kinetics of non-oxidative hydrothermal process.

Hydrothermal processing as a post-treatment technology for sludge has attracted great interest globally as it could reduce the amount of sludge considerably. This experimental study developed a comprehensive kinetic model of cellulose degradation via non-oxidative hydrothermal processing at various temperatures (ranges 180-260 °C). Values of activation energies and pre-exponential factors were determined using chemical oxygen demand (COD)-based lumped concentrations. In this study, a new reaction pathway between solid, soluble matter and gaseous products was proposed which not only enables prediction of solid phase degradation but also can predict the formation of various types of products (in liquid and gas phase) during the reaction time. The results show that the reaction rate of cellulose to liquid products (k1=2.7×109exp(-102810RT)) were fast compared to that of for liquid products to gaseous products (k2=4.4×103exp(-64629RT)). Moreover, the model infers that the major part of solid degradation leads to the formation of the gaseous product with the reaction rate constant of k3=5.7exp(-12905RT). The proposed model can provide an opportunity to predict the performance of the non-oxidative hydrothermal processing of organic solid waste.

A Review on the Effect of High Pressure Processing (HPP) on Gelatinization and Infusion of Nutrients.

High pressure processing (HPP) is a novel technology that involves subjecting foods to high hydrostatic pressures of the order of 100-600 MPa. This technology has been proven successful for inactivation of numerous microorganisms, spores and enzymes in foods, leading to increased shelf life. HPP is not limited to cold pasteurization, but has many other applications. The focus of this paper is to explore other applications of HPP, such as gelatinization, forced water absorption and infusion of nutrients. The use of high pressure in producing cold gelatinizing effects, imparting unique properties to food and improving food quality will be also discussed, highlighting the latest published studies and the innovative methods adopted.

Optimization of high pressure processing for microbial load reduction in Diospyros kaki 'Fuyu' pulp using response surface methodology.

Diospyros kaki L., cv. Fuyu is a non-astringent seasonally available persimmon variety from New Zealand having short shelf life. Most of the current preservation techniques like pasteurization, spray drying etc. use high temperature for microbial inactivation, which results in quality reduction. In the present study, response surface methodology having Box-Behnken design used to explore the consequence of pressure (200-600 MPa), time (5-15 min) and temperature (20-45 °C) for controlling microbial load in fruit pulp. A mathematical model created to envision the responses, and the R2 value indicated that the established model proved highly accurate in the prediction of response. The optimization process advocated non-thermal minimal processing of persimmon pulp by high pressure processing at low temperature 20 °C, 400 MPa pressure for 5 min holding time for reducing total plate count and yeast mould count.

Effect of thermal and high pressure processing on stability of betalain extracted from red beet stalks.

Red beet stalks are a potential source of betalain, but their pigments are not widely used because of their instability. In the present work, the applicability of high pressure processing (HPP) and high temperature short time (HTST) thermal treatment was investigated to improve betalain stability in extracts with low and high concentrations. The HPP was applied at 6000 bar for 10, 20 and 30 min and HTST treatment was applied at 75.7 °C for 80 s, 81.1 °C for 100 s and 85.7 °C for 120 s, HPP treatment did not show any improvement in the betalain stability. In turn, the degradation rate of the control and the HTST thermal treatment at 85.7 °C for 120 s of the sample with high initial betalain concentration were 1.2 and 0.4 mg of betanin/100 ml of extract per day respectively. Among the treatments studied, HTST was considered the most suitable to maintain betalain stability from red beet stalks.

An insight on the relationship between food compressibility and microbial inactivation during high pressure processing.

This paper investigates the effect of high pressure liquid food compressibility on S. cerevisae inactivation. Honey with various adjusted sugar with different values of compressibility was selected as a model food. S. cerevisiae cells in different honey concentrations (0-80°Brix), 600 MPa (at ambient temperature) showed an increasing resistance to inactivation with increasing °Brix. D-values of S. cerevisiae at 200, 400 and 600 MPa, for 20 min/80°Brix were 136.99 ± 7.97, 29.24 ± 6.44 and 23.47 ± 0.86 min, respectively. These D-values resulted the Z p -value of 526 ± 39 MPa. A significant correlation (p < 0.05) of cell reduction, °Brix and compressibility was found. Cell reduction in high pressure-treated samples varied linearly with °Brix suggesting that the baroprotective effect of the food was not solely due to sugar content, but also due to its compressibility. This research could have significant implications on the success of HPP (high pressure processing) preservation of foods containing high sugar content.

Preparation and characterization of progesterone dispersions using supercritical carbon dioxide.

CONTEXT: Supercritical fluid methods offer an alternative to conventional mixing methods, particularly for heat sensitive drugs and where an organic solvent is undesirable. OBJECTIVE: To design, develop and construct a unit for the particles from a gas-saturated suspension/solution (PGSS) method and form endogenous progesterone (PGN) dispersion systems using SC-CO2. MATERIALS AND METHODS: The PGN dispersions were manufactured using three selected excipients: polyethylene glycol (PEG) 400/4000 (50:50), Gelucire 44/14 and D-α-tocopheryl PEG 1000 succinate (TPGS). Semisolid dispersions of PGN prepared by PGSS method were compared to the conventional methods; comelting (CM), cosolvent (CS) and physical mixing (PM). The dispersion systems made were characterized by Raman and Fourier transform infrared (FTIR) spectroscopies, X-ray powder diffraction (XRPD), scanning electron microscopy (SEM), PGN recovery, uniformity and in vitro dissolution, analyzed by high-performance liquid chromatography (HPLC). RESULTS: Raman spectra revealed no changes in the crystalline structure of PGN treated with SC-CO2 compared to that of untreated PGN. XRPD and FTIR showed the presence of peaks and bands for PGN confirming that PGN has been incorporated well with each individual excipient. All PGN dispersions prepared by the PGSS method resulted in the improvement of PGN dissolution rates compared to that prepared by the conventional methods and untreated PGN after 60 min (p value < 0.05). CONCLUSION: The novel PGN dispersions prepared by the PGSS method offer the great potential to enhance PGN dissolution rate, reduce preparation time and form stable crystalline dispersion systems over those prepared by conventional methods.

Evaluation of progesterone permeability from supercritical fluid processed dispersion systems.

The aim of this study was to investigate the permeability of unique dispersion systems prepared by supercritical fluid (SCF) processing, to deliver bioidentical progesterone (PGN) across mouse skin. Semisolid dispersions of PGN were made up of either polyethylene glycol (PEG) 400/4000, Gelucire 44/14, d-α-tocopheryl PEG 1000 succinate (TPGS), tanscutol P or myritol 318. SCF dispersion systems were compared with various control formulations; a market cream, aqueous suspension, and three conventionally prepared dispersions – comelted, cosolvent and physically mixed systems. The permeability coefficient in the absence or presence of a permeation enhancer was evaluated using ex vivo mouse skin. The permeation study results for the TPGS/myritol/transcutol P dispersion system prepared using supercritical carbon dioxide (SC-CO2) had a two-fold improvement in transdermal permeation over 24 h compared to the control formulation, 245.7 and 126 µg cm(-2), respectively (p value < 0.05). In this study, the skin integrity and morphology was also investigated for changes due to the formulation constituents using histological examination and Fourier transform infrared spectroscopy. The particles from the gas-saturated suspension method and SC-CO2 together with TPGS/myritol/transcutol P may offer potential advantages over the available cream on the market based on the vastly improved lag time and flux of PGN across the skin.

Do-not-attempt resuscitation policy reduced in-hospital cardiac arrest rate and the cost of care in a developing country.

We aim to study the characteristics and outcomes of patients with a Do-Not-Attempt Resuscitation and to determine its impact on the Cost of In-Hospital Cardiac Arrest. A retrospective study of all adult patients admitted to the hospital from June 2021 to May 2022 who had a Do-Not-Resuscitate order. We abstracted patients' socio-demographics, physiologic parameters, primary diagnosis, and comorbidities from the electronic medical records. We calculated the potential economic cost using the median ICU length of stay for the admitted IHCA patients during the study period. There were 28,866 acute admissions over the study period, and 788 patients had DNR orders. The median (IQR) age was 71 (55-82) years, and 50.3% were males. The most prevalent primary diagnosis was sepsis, 426 (54.3%), and cancer was the most common comorbidity. More than one comorbidities were present in 642 (80%) of the cohort. Of the DNR patients, 492 (62.4%) died, while 296 (37.6%) survived to discharge. Cancer was the primary diagnosis in 65 (22.2%) of those who survived, compared with 154 (31.3%) of those who died (P = 0.002). Over the study period, 153 patients had IHCA and underwent CPR, with an IHCA rate of 5.3 per 1,000 hospital admissions. Without a DNR policy, an additional 492 patients with cardiac arrest would have had CPR, resulting in an IHCA rate of 22.3 per 1000 hospital admissions. Most DNR patients in our setting had sepsis complicated by multiple comorbidities. The DNR policy reduced our IHCA incidence by 76% and prevented unnecessary post-resuscitation ICU care.

Longitudinal changes in peri-papillary retinal nerve fiber layer thickness in patients with unilateral branch retinal vein occlusion.

Background: Associations between retinal venous occlusion (RVO), elevated intraocular pressure, and glaucoma have been reported. Further investigations into structural alterations in the fellow eyes of individuals with unilateral RVO have revealed that the peripapillary retinal nerve fiber layer is thinner than in healthy eyes, suggesting that there may be systemic risk factors common to both RVO and glaucoma. We aimed to evaluate changes in peripapillary retinal nerve fiber layer thickness (pRNFLT) among individuals with unilateral branch retinal vein occlusion (BRVO). Methods: This prospective observational study recruited 30 individuals (60 eyes) with newly diagnosed unilateral BRVO and macular edema, and a control group of 30 healthy individuals (30 eyes) with no abnormalities on fundus examination or concurrent systemic comorbidities. After baseline measurements, the participants were reassessed at 6, 12, and 24 months by measuring global and sectoral pRNFLT using spectral-domain optical coherence tomography. Results: The mean age and sex distributions were comparable between the patient and control groups (both P > 0.05). When compared to fellow eyes, global and sectoral pRNFLT in eyes with BRVO were significantly higher at baseline (all P < 0.05). Over time, pRNFLT decreased dramatically, and by the conclusion of the two-year follow-up, there was a significant reduction from baseline in the affected eyes (all P < 0.05). Likewise, affected eyes experienced a significant improvement in best-corrected distance visual acuity and central macular thickness over the two-year follow-up (both P ≤ 0.001). Comparing the global and all-sector pRNFLT of fellow eyes in the patient group with those of normal eyes in the control group, there were no significant differences at any visit, except in the temporal sector, which revealed a significant reduction in pRNFLT at 24 months in the fellow eyes of patients with unilateral BRVO (P = 0.02). Conclusions: Patients with unilateral BRVO experienced a significant reduction in pRNFLT in the affected eyes and, to a lesser extent, in the fellow eyes, compared with that of the control arm, suggesting that they are prone to retinal nerve fiber layer damage. The reduction in pRNFLT in the normal fellow eyes of patients with BRVO may be attributed to age or concurrent systemic comorbidities. Further studies with long follow-up periods are required to shed light on the etiology of functional and structural changes in both the retinal nerve fiber layer and ganglion cell complex in the normal and affected eyes of patients with unilateral BRVO.

Bacterial spore inactivation at 45-65 °C using high pressure processing: study of Alicyclobacillus acidoterrestris in orange juice.

High pressure processing (HPP) is a new non-thermal technology commercially used to pasteurize fruit juices and extend shelf-life, while preserving delicate aromas/flavours and bioactive constituents. Given the spoilage incidents and economic losses due to Alicyclobacillus acidoterrestris in the fruit juice industry, the use of high pressure (200 MPa - 600 MPa) in combination with mild temperature (45 °C-65 °C) for 1-15 min, to inactivate these spores in orange juice were investigated. As expected, the higher the temperature, pressure and time, the larger was the A. acidoterrestris inactivation. The survival curves were described by the first order Bigelow model. For 200 MPa, D(45 °C) = 43.9 min, D(55 °C) = 28.8 min, D(65 °C) = 5.0 min and z-value = 21.3 °C. At 600 MPa, D(45 °C) = 12.9 min, D(55 °C) = 7.0 min, D(65 °C) = 3.4 min and z-value = 34.4 °C. Spores were inactivated at 45 °C and 600 MPa, and at 65 °C only 200 MPa was needed to achieve reduction in spore numbers. Results demonstrated that HPP allowed A. acidoterrestris spore inactivation at lower temperatures (45-65 °C) than conventional thermal processing (85-95 °C) without pressure, yielding a fresher and higher quality preserved food.

Aesthetic sculpting for the natal cleft and buttock lift using an innovative periosteal-dermal suture suspension technique.

Natal cleft contouring poses a reconstructive challenge. Buttock aesthetics and the need for careful scar placement are part of the challenge faced by plastic surgeons. Various steps of the reconstructive ladder can be used with varying outcomes. We report a patient who underwent natal cleft reconstruction using a new suture technique and had a cosmetically pleasing outcome.

Denaturation kinetics and storage stability of Osteopontin in reconstituted infant milk formula.

Osteopontin (OPN) is a multifunctional whey protein with numerous health benefits and is recommended to supplement Infant Milk Formula (IMF) with it. For the first time, the denaturation kinetics and storage stability of bovine OPN were studied in reconstituted IMF. The effect of thermal treatments (63-90 °C) and High Pressure Processing (HPP) were investigated. OPN showed higher retention (around 90%) after both LTLT (Low Temperature Long Time) and HTST (High Temperature Short Time) treatments, however higher temperature and longer treatment induced substantial denaturation indicating UHT may not suit OPN-added items. Significant denaturation occurred at higher pressure (>400 MPa), and more pronounced OPN denaturation was observed after HPP at elevated temperature. OPN remained stable during4 °Cstorage for 14 days. This investigation deduced thermal stability of OPN as α-Lac > OPN > LF, whereas the pressure resistance observed as α-Lac > LF > OPN > ß-Lg.

The conservative management of self-inflicted chemical burns: Case report and literature review.

Introduction: Chemical burns, particularly injuries related to psychiatric illnesses, are underreported in the literature. We present two cases of self-inflicted alkali chemical burns managed conservatively. Frequent clinical review of the burn was aimed to ensure appropriate healing and compliance with the treatment plan based on regular dressing changes. Case 1: A 24-year-old woman presented during the first day of the initial injury with a minor self-inflicted chemical burn to the right forearm. The causative agent was an oven cleaner containing sodium hydroxide triggering an alkali-based burn. The surface area of the injury was 0.5% total body surface area (TBSA) full-thickness burn. The patient had a complex psychiatric history diagnosed with personality disorder, anxiety and depression. Case 2: A 55-year-old woman presented with a self-inflicted left forearm full-thickness burn (0.5% TBSA). This was five days after the initial injury from an oven cleaner containing sodium hydroxide. The patient had a psychiatric history of anxiety and depressive disorder.The mainstay of burn management was conservative with regular dressing changes and a topical agent. Telemedicine via a designated email address was given to the patient for virtual clinical burn review and any urgent issues. Photograph of the initial burn was taken, and clinic visits were scheduled to determine healing progress. Conclusion: Self-inflicted chemical burns are to be managed within a multidisciplinary setting including early psychiatric involvement. We advocate a holistic approach to determine conservative or operative management, taking into account patient factors, burn complexity and clinician's judgement to streamline the treatment plan. Lay Summary: Chemical burns due to self-harm are rare to see in clinical practice. A review of two cases secondary to intentional burns sustained using an oven cleaning material. Patients had psychiatric issues and were on medications to control symptoms. Close observation with regular dressings and topical cream would allow burns to heal without the need for an operation. Our recommendation would be to treat these burns with dressings and regular follow up in the clinic or virtually till healed.

Exploring the Perceptions Surrounding Hospital Chaplains in Patient Care and Healing.

The authors distributed a questionnaire to various hospital staff to explore perceptions surrounding the role of chaplains in patient care and healing through assessing opinions, beliefs, and knowledge. Results revealed a poor understanding of the role of the hospital chaplain in the UK. The authors therefore advocate education programs to increase awareness of the varied role of the hospital chaplain in fulfilling patient spiritual needs to increase referral practices, leading to improved patient outcomes.

High-Energy Ball Milling for High Productivity of Nanobiochar from Oil Palm Biomass.

The current production method of nanobiochar (NBC), an emerging, environmentally friendly nanocarbon material, is tedious and lengthy. Therefore, in this study we aimed to improve the productivity of NBC via high-energy ball milling by manipulating the grinding media and processing time. The particle size distribution of the resulting NBC measured using dynamic light scattering showed that grinding media with steel balls of different sizes were more effective at producing NBC than small uniform steel balls, which failed to produce NBC even after 90 min of milling. Average NBC particles of around 95 nm were achieved after only 30 min of ball milling, and the size was further reduced to about 30 nm when the milling was prolonged to 150 min. Further prolonging the milling duration led to agglomeration, which increased the size of the biochar nanoparticles. The thermogravimetric analysis (TGA) data showed that the duration of milling and particle size did not cause noticeable differences in the thermal stability of the NBC. Based on the FTIR analysis, the chemical structure of the NBC was not affected by the ball milling. The results showed that 60 min of high-energy ball milling is sufficient to produce NBC particles of 75 nm, with a large surface area and high thermal stability. This could prove beneficial in a myriad of applications, ranging from agriculture to composite fabrication.

Emerging application of biochar as a renewable and superior filler in polymer composites.

Biochar is conventionally and widely used for soil amendment or as an adsorbent for water treatment. Nevertheless, the need for transition to renewable materials has resulted in an expansion of biochar for use as a filler for polymer composites. The aim is to enhance the physical, chemical, mechanical and rheological properties of the polymer composite. The reinforcement of biochar into a polymer matrix however is still new, and limited reports are focusing on the effects of biochar towards polymer composite properties. Hence, this review highlights the unique properties of biochar and its effect on the crystallization, thermal, flammability, electrical conductivity, and mechanical properties of polymer composites. This review does not solely summarize recent studies on biochar-polymer-based composites, but also offers insights into a new direction of biochar as a renewable and superior polymer filler in the future.

Emerging Developments on Nanocellulose as Liquid Crystals: A Biomimetic Approach.

Biomimetics is the field of obtaining ideas from nature that can be applied in science, engineering, and medicine. The usefulness of cellulose nanocrystals (CNC) and their excellent characteristics in biomimetic applications are exciting and promising areas of present and future research. CNCs are bio-based nanostructured material that can be isolated from several natural biomasses. The CNCs are one-dimensional with a high aspect ratio. They possess high crystalline order and high chirality when they are allowed to assemble in concentrated dispersions. Recent studies have demonstrated that CNCs possess remarkable optical and chemical properties that can be used to fabricate liquid crystals. Research is present in the early stage to develop CNC-based solvent-free liquid crystals that behave like both crystalline solids and liquids and exhibit the phenomenon of birefringence in anisotropic media. All these characteristics are beneficial for several biomimetic applications. Moreover, the films of CNC show the property of iridescent colors, making it suitable for photonic applications in various devices, such as electro-optical devices and flat panel displays.

Angioleiomyoma of the knee: case series and an unusual cause of knee pain.

We present a consecutive series of five patients with angioleiomyoma, a rare benign soft tissue tumor around the knee. Between 2005 and 2010, five patients with histopathologically confirmed diagnosis of angioleiomyoma of the knee underwent surgical excision. All five patients were Afro-caribbean in origin. The presenting feature was burning medial knee pain localized to a tender hyperesthetic swelling around the knee. The mean age of presentation was 45 years (range, 42 to 51 years), and the mean duration of symptom was 34 months (range, 12 to 96 months). Although magnetic resonance imaging (MRI) scans were helpful in locating and delineating the tumors, true diagnosis was established only by histopathology. All patients underwent surgical excision with complete resolution of symptoms. No recurrences were seen at an average follow-up of 16 months (range, 3 to 24 months). The treatment of these tumors, especially around the knee, is frequently delayed due to their late presentation and lack of awareness of this clinical condition. We recommend a high index of suspicion in patients, especially of Afro-caribbean origin, presenting with painful hyperesthetic subcutaneous swelling around the knee. Early investigation by MRI expedites the diagnosis, and surgical excision results in complete resolution of symptoms.