The Synergistic Effect of Ozonated Oil and Desensitising Toothpaste on Dentinal Tubule Occlusion: An In Vitro Study.

Introduction Dentin hypersensitivity (DH) is the most common problem encountered by clinicians. It can be managed either by blocking neural activities or by occluding tubules. Ozonated oil facilitates the simple passage of desensitizing agents into dentinal tubules. Aim This study aimed to evaluate the effect of ozonated oil on dentinal tubule occlusion before and after the application of desensitizing toothpaste. Materials and methods The study was carried out in Kalinga Institute of Dental Sciences, KIIT (Deemed to be University), Bhubaneswar, India. The sample size of the study was 80. The first group contained specimens for control. The second group comprised specimens treated with ozonated oil. The third group comprised specimens being treated with a desensitizing agent. The fourth group contained specimens treated with both the desensitizing agent and ozonated oil. The specimens then received an acid challenge. The specimens were observed under a scanning electron microscope (SEM) before any therapy, after the application of the therapeutic agents and after the 37.5% ortho-phosphoric acid challenge. Results Inferential statistics to compare between the groups was calculated using one-way analysis of variance (ANOVA) statistics. Post-hoc Tukey's honestly significant difference (HSD) was performed to compare the groups. The mean scores of the partial tubular occlusion of Group 1, Group 2, Group 3 and Group 4 before the acid challenge were 0.035, 0.691, 0.564 and 0.368, respectively. The maximum score was obtained in the case of Group 2, which was statistically significant. The mean scores for partial tubule occlusion after the acid challenge for Group 1, Group 2, Group 3 and Group 4 were 0.055, 0.531, 0.733 and 0.142, respectively. There was evidence of maximum partial tubule occlusion after the acid treatment in the case of Group 3. The mean scores of Group 1, Group 2, Group 3 and Group 4 before the acid challenge were 0.019, 0.309, 0.442 and 0.609, respectively. The maximum score was obtained in the case of Group 4, implying a greater number of total tubular occlusions before the acid challenge. The mean scores of the total tubular occlusions after the acid challenge for Group 1, Group 2, Group 3 and Group 4 were 0.047, 0.465, 0.272 and 0.890, respectively. There was evidence of maximum tubule occlusion in the case of Group 4, which was statistically significant. Conclusion Overall, the application of a desensitizing toothpaste with ozonated oil holds promise as a potentially more effective treatment approach for DH. Further research and clinical studies may be needed to fully validate its efficacy and safety in dental practice.

Capillary Haemangioma of Gingiva - A Rare Lesion.

Capillary Haemangioma is a benign vascular tumour characterized by proliferation of blood vessels with a very striking similarity to pyogenic granuloma with a predilection to occur on the gingiva. Though the head and neck are the most common region of occurrence, but is considered to be rare occurring on the gingiva, intra-orally. The lesion clinically mimicked pyogenic granuloma but was histopathologically diagnosed as capillary haemangioma. It was surgically excised and followed up for 6 months without any recurrence.

Sampling Methods and their Prospects in Liquid-Based Cytology of Oral Mucosa: A Comparative Study.

Examining epithelial cells in the mouth cavity is simple and non-invasive with exfoliative cytology. Liquid-based cytology is an additional diagnostic technique that can improve the specificity and sensitivity of conventional cytology. The purpose of our study was to describe the consistency of normal oral mucosa samples obtained with three different tools: the Cytobrush®, dermatological curette, and OralCDx® for liquid-based cytology. Literature review was done, and reporting of the improvements in the field of investigation and diagnosis has been reported. The present communication aims toward comparing three different sampling instruments such as Cytobrush, curette, and OralCDx for liquid-based cytology of the oral mucosa.

Dactoscopy in Human Identification: A Retrospective Study in Bhubaneswar City.

Anthropometry, fingerprints, age estimation, gender determination, blood types, DNA, and dental features are examples of traditional techniques for identifying a person. The present study aimed toward observing the patterns of fingerprints and their reliability toward human identification. A retrospective study was conducted in a tertiary care unit in Bhubaneswar city. Fingerprints were recorded, and the individual identification mark was noted for each individual. Reporting of the patterns was done. Sir Henry Galton's classification was used to study the fingerprint patterns. IBM Statistical Package for Social Sciences was used for the statistical analysis. Type A was the most common type seen for the right-hand little finger. Type A was the most common type seen for the left-hand little finger; Type C was the most common type seen for the left-hand ring finger. Statistically significant correlations between gender and dermatoglyphics were found, supporting their usage as trustworthy forensic evidence.

Assessment of Skeletal Age using Hand-Wrist Radiographs Following BJORK System Sample Size - Prospective Study.

Introduction: The planning of effective orthodontic therapy greatly benefits from an understanding of the skeletal maturation and stage of growth of the patients seeking orthodontic treatment. However, the patient's various craniofacial structures have varying levels of growth potential. The patient is exposed to additional radiation when hand-wrist radiographs are regularly used to forecast growth. As an alternative, cervical vertebrae in the lateral cephalograph have been suggested. When arranging orthodontic treatment for growing children, it is important to take into account the pubertal growth spurt, which is a crucial time in therapy. Conclusion: Finding out how much growth a patient with skeletal discrepancy would experience during adolescence is one of the key goals of conducting a hand and wrist radiograph.

Activated carbon based paste electrodes for the simultaneous and effective detection of divalent cadmium and lead ions in wastewater.

Heavy metals (HM) have gained significant attention in terms of regular monitoring and detection owing to their toxicity, non-biodegradability, and persistence. Current techniques for detecting HM are expensive, cumbersome, and require sophisticated instruments and skilled labour. Hence, developing cheap, rapid, energy-efficient, and accurate sensors is imperative and electrochemical techniques have emerged as promising tools. The current study involves the fabrication of an electrochemical sensor for the concurrent detection of lead (Pb2+) and cadmium (Cd2+) ions using modified carbon paste electrodes (mCPE). Activated carbon (AC) with a BET surface area of 1118 m2 g-1 was obtained by chemical activation and thermal treatment of the waste rubberwood sawdust. AC-Graphite, AC-Reduced Graphene Oxide (RGO), and AC-RGO-Chitosan were the types of mCPEs that were utilised. The electrochemical behaviours and effects of pH, concentration, and scan rate were studied using Cyclic voltammetry (CV). Studies on detection were conducted using CV and linear sweep voltammetry. Although all the 3 mCPEs detected Cd2+ and Pb2+ in the simulated wastewater, the CPE with RGO and AC could detect Cd2+ as low as 10.91 µg L-1 and Pb2+ as low as 14.01 µg L-1. The work explored the possibility of using AC as a potential sustainable substitute for graphite in CPE.

A Comparative Study of Mid-Crestal Incision and Diode Laser Shaped Incision to Assess Papilla Level in Second Stage Dental Implant Surgery.

Objectives: To assess papilla level using different techniques in a second stage dental implant surgery. Materials and Methods: Thirty patients who received 45 dental implants were equally divided into 3 groups of 10 each. Group I patients were operated with a scalpel with mid-crestal incision. In group II, dental implants were exposed with a gallium-aluminum-arsenide diode laser. In group III, dental implants were exposed with I shaped incision using a scalpel. Assessment of modified gingival index (mGI), modified plaque index (mPI), and Jemt index were performed at baseline, 3 months, and 6 months. The measurement of FAJI, FAJAdj, ST height, and CP Bone crest was performed. Results: A significant difference in crestal bone level of FAJ- I, FAJ- adj, ST height, and CP Bone crest was recorded at baseline, 3 months, and 6 months among groups I, II, and III (P < 0.05). At 6 months, both groups II and III exhibited >60% of papilla fill as compared to group I. Conclusion: Diode laser offers maximum papillary fill and resulted in less crestal bone loss as compared to mid-crestal and I shaped incision during a second stage surgery.

General aspects and novel PEMss in microbial fuel cell technology: A review.

The current scenario of energy production is mostly shifted towards sustainable renewable energy sources. Other than the energy production from natural resources such as sun, wind and water, microbial fuel cell system (MFC) has earned attraction in recent times. These microbial fuel cell systems are bioelectrochemical cell that possesses a unique ability to generate power as well as treats wastewater simultaneously. In this paper, an overview of the microbial fuel cell system and the effect of significant components on the performance of microbial fuel cell systems are reviewed. Firstly, the importance of the MFC system in power generation, its components, the working principle and various configurations of the MFC were briefly introduced. Biofilm plays a major role in the MFC system. Thus the importance of bio film, bio film formation and characterization techniques are summarised. Further, the review mainly addresses the mechanism of conventional and novel membrane materials on the performance of the MFC system. In addition, special emphasis on ceramic-based materials in the MFC system is presented. Finally, recent applications of the MFC systems are discussed.

Enhanced performance of novel carbon nanotubes - sulfonated poly ether ether ketone (speek) composite proton exchange membrane in mfc application.

Sulfonated poly ether ether ketone (SPEEK) nanocomposite proton exchange membrane (PEM) was prepared by incorporating multi-walled carbon nanotubes (CNT) at different weight percentages for microbial fuel cell (MFC) applications. Physico-chemical, thermal, mechanical and morphological characteristics of the prepared CNT-SPEEK composite membranes were analyzed using various techniques. Further, the water uptake capacity, Ion exchange capacity (IEC) and MFC performance of the CNT-SPEEK composite membranes were evaluated and compared with the pristine SPEEK membrane. Results show that incorporation of CNTs in SPEEK membranes exhibited a better water uptake capacity (34.18%-36.02%) and IEC (1.94-2.15 meq/g) compared to the SPEEK membrane. Improvement in membrane properties resulted in 2-fold higher power density compared to SPEEK membrane. Composite membrane with 0.75% CNT-SPEEK produced the higher power density (1.77 W/m2) in comparison with all the membranes evaluated. Chemical oxygen demand (COD) removal efficiency values of the MFC with SPEEK composite membranes were also found to be around 90%. Overall, the results reveal that CNT-SPEEK composite membrane as a potential PEM for MFC applications.

Evaluation of power generation and treatment efficiency of dairy wastewater in microbial fuel cell using TiO2 - SPEEK as proton exchange membrane.

The aim of this study is to synthesise SPEEK composite proton exchange membrane with the addition of TiO2 nanofillers for microbial fuel cell application. SPEEK composite membrane with varying weight percentage of TiO2 (2.5, 5, 7.5 and 10%) was prepared to study the effect of TiO2 concentration on membrane performance. Synthesized composite membranes were subjected to various characterization studies such as FT-IR, XRD, Raman spectroscopy, TGA, UTM and SEM. Physico-chemical properties of membrane such as water uptake capacity, ion exchange capacity and thickness were also analyzed. 5% TiO2 - SPEEK composite membrane exhibited the higher water uptake capacity value and Ion exchange capacity value of 31% and 1.71 meq/g respectively. Performance of the MFC system with TiO2 - SPEEK membranes were evaluated and compared with the pristine SPEEK and Nafion membrane. 5% TiO2 - SPEEK membrane produced the higher power density (1.22 W/m2) and voltage (0.635 V) than the other membranes investigated. Efficacy of MFC in wastewater treatment was evaluated based on the chemical oxygen demand (COD), total organic carbon content and turbidity. Biofilm growth over the surface of the electrodes was also analyzed using scanning electron microscopy.

Dental Negligence: Accidental Administration of Formalin Instead of Local Anesthetic.

A solution like formalin used as a fixative has to be handled with lot of care and needs to be stored with utmost care. Negligence on part of the dental professional by accidentally injecting formalin instead of the local anesthetic can lead to permanent tissue damage and also may induce a life threatening situation. The operating dentist injected formalin accidentally instead of the local anesthetic and the patient experienced severe pain and burning sensation. The general practice of formalin being stored in the local anesthetic bottles and being assisted by untrained assistant is the most common reason for mishaps to happen. The dentist operating should be careful and aware of the drugs and chemicals being available in the operatory and re-check the solution being injected in the patient as to not land up in complications because of the negligence.

The extraction and process optimization of Cu (II) and Cd (II) using Pickering emulsion liquid membrane.

In the present study, the extraction of divalent heavy metals like copper [Cu (II)] and cadmium [Cd (II)] using a Pickering Emulsion Liquid Membrane (PELM) has been investigated by using three different surfactants such as Amphiphilic silica nanowires (ASNWs), Aluminum oxide nanoparticles (Alumina) and Sorbitan monooleate (SPAN 80). The influence of the process parameters such as pH, the stripping phase concentration, the agitation speed, and the carrier concentration on the extraction efficiency have been examined to find the optimum conditions at which the maximum recovery of Cu (II) and Cd (II) could take place. At optimum conditions, the extraction efficiency of 89.77% and 91.19% for Cu (II) and Cd (II) ions were achieved. Non-edible oils were used as diluent in this present study to reduce the need for toxic organic solvents in preparing PELM. The impact of each process factor on the extraction efficiency of Cu (II) and Cd (II) ions has been verified using analysis of variance (ANOVA). The higher values of F and lower values of P (less than 0.05) indicate pH is the most significant parameter on the percentage extraction of Cu (II) and Cd (II) using the Taguchi design approach.

Evaluation of Frictional Forces Generated between Three Different Ligation Methods with Four Different Sizes of Orthodontic Archwires: An In vitro Study.

AIM: This in vitro study was done to evaluate and compare the frictional forces produced by a passive self-ligating bracket (SLB) and two types of elastomeric ligatures (unconventional elastomeric ligatures [UELs] and conventional elastomeric ligatures [CELs]) on a conventional bracket used with four types of wires. MATERIALS: In this in vitro study, 8 numbers of conventional preadjusted edgewise appliance stainless steel brackets and 4 numbers of passive SLBs were tested. Four types of archwires and two types of ligatures were tested. Brackets were divided into three groups - Group I, Group II, and Group III. All the three groups were further divided into four subgroups based on different archwires. METHODS: Custom-made mounting jig was specially constructed for this study - upper member and lower member. After the samples were mounted, traction test was conducted using universal testing machine and readings were tabulated for all specimens. The variables in each group were subjected to one-way analysis of variance. RESULTS: All the three groups were tested for its total friction, static friction, and kinetic friction. SLBs showed a static mean little lower and had kinetic mean little greater than conventional bracket with unconventional module. CONCLUSION: UELs on conventional brackets and SLBs are able to produce lower frictional force when compared with CELs on conventional brackets.

Adenomatoid odontogenic tumor mimicking a lateral periodontal cyst - A rare case report in the mandible.

Adenomatoid odontogenic tumor (AOT) is benign tumor of the oral cavity characterized by its slow growth accounting to 3%-7% of the odontogenic tumors. AOTs mostly occur in the maxillary anterior region and most often than not associated with impacted anterior teeth. It affects the younger age group, especially below 20 years and is commonly seen in females. It occurs as two main variants - (a) central/intraosseous which is more common and (b) peripheral which is rare. The location of the lesion, its association with the impacted tooth, is the basis for the classification of AOT. The intraosseous type may be related to unerupted tooth (follicular variant) or may not be related to unerupted tooth (extra-follicular variant). Radiologically, AOT presents predominantly as a unilocular cystic lesion enclosing the unerupted tooth. The lesion presents rarely with a cystic component. Radiopacities on the intraoral periapical radiograph are seen as discrete foci having a flocculent pattern within radiolucency even with the presence of minimal calcified deposits. AOT being benign in nature is enucleated with least chances of recurrence. Here, we present a rare case of extra-follicular variant of adenomatoid odontogenic tumor in a 19-year-old female patient.

Removal of cadmium heavy metal ions from wastewater by electrosorption using modified activated carbon felt electrodes.

Cadmium contamination in industrial wastewater is an environmental issue posing a great threat to human and animal life. However, the available methods for the removal of cadmium at lower concentrations are limited. Such processes are often accompanied by sludge formation and lead to heavy metal wastage. This paper focuses on the application of an electrosorption process using modified activated carbon felt (MACF) electrodes for the removal and recovery of lower concentration of cadmium from a simulated wastewater sample without sludge formation. Activated carbon felt (ACF) electrodes were treated with 20% HNO3 for removing surface impurities and improving the surface area. The effect of the electrode modification was analyzed by performing various characterizations including scanning electron microscopy (SEM), Fourier transform infrared spectroscopy (FTIR), X-ray diffraction (XRD) and cyclic voltammetry. The adsorption isotherm and kinetic models have also been studied. The effect of operating parameters including pH, voltage, initial concentration and time were analyzed and optimized using Box-Behnken design and were obtained as 6.42, 1.44 V, 0.50 mg/L and 131.51 min respectively. During the regeneration of electrodes, a concentrated cadmium solution of 18.55 mg/L was obtained, which showed the possibility of cadmium recovery. The maximum cadmium removal was 60.60% at the optimized conditions, revealing the significance of electrosorption for heavy metal treatment.

Crop Residue Burning in India: Policy Challenges and Potential Solutions.

India, the second largest agro-based economy with year-round crop cultivation, generates a large amount of agricultural waste, including crop residues. In the absence of adequate sustainable management practices, approximately 92 seems a very small number of metric tons of crop waste is burned every year in India, causing excessive particulate matter emissions and air pollution. Crop residue burning has become a major environmental problem causing health issues as well as contributing to global warming. Composting, biochar production and mechanization are a few effective sustainable techniques that can help to curtail the issue while retaining the nutrients present in the crop residue in the soil. The government of India has attempted to curtail this problem, through numerous measures and campaigns designed to promote sustainable management methods such as converting crop residue into energy. However, the alarming rise of air pollution levels caused by crop residue burning in the city of Delhi and other northern areas in India observed in recent years, especially in and after the year of 2015, suggest that the issues is not yet under control. The solution to crop residue burning lies in the effective implementation of sustainable management practices with Government interventions and policies. This manuscript addresses the underlying technical as well as policy issues that has prevented India from achieving a long-lasting solution and also potential solutions that have been overlooked. However, effective implementation of these techniques also requires us to look at other socioeconomic aspects that had not been considered. This manuscript also discusses some of the policy considerations and functionality based on the analyses and current practices. The agricultural waste sector can benefit immensely from some of the examples from other waste sectors such as the municipal solid waste (MSW) and wastewater management where collection, segregation, recycling and disposal are institutionalized to secure an operational system. Active stakeholder involvement including education and empowerment of farmers along with technical solutions and product manufacturing can also assist tremendously. Even though the issue of crop residue burning touches many sectors, such as environment, agriculture, economy, social aspects, education, and energy, the past governmental efforts mainly revolved around agriculture and energy. This sectorial thinking is another barrier that needs to be broken. The government of India as well as governments of other developing countries can benefit from the emerging concept of nexus thinking in managing environmental resources. Nexus thinking promotes a higher-level integration and higher level of stakeholder involvement that goes beyond the disciplinary boundaries, providing a supporting platform to solve issues such as crop residue burning.

Identification of potential CRAC channel inhibitors: Pharmacophore mapping, 3D-QSAR modelling, and molecular docking approach.

Upregulation of store-operated Ca2+ influx via ORAI1, an integral component of the CRAC channel, is responsible for abnormal cytokine release in active rheumatoid arthritis, and therefore ORAI1 has been proposed as an attractive molecular target. In this study, we attempted to predict the mechanical insights of ORAI1 inhibitors through pharmacophore modelling, 3D-QSAR, molecular docking and free energy analysis. Various hypotheses of pharmacophores were generated and from that, a pharmacophore hypothesis with two hydrogen bond acceptors, one hydrogen bond donor and two aromatic rings (AADRR) resulted in a statistically significant 3D-QSAR model (r2 = 0.84 and q2 = 0.74). We believe that the obtained statistical model is a reliable QSAR model for the diverse dataset of inhibitors against the IL-2 production assay. The visualization of contours in active and inactive compounds generated from the 3D-QSAR models and molecular docking studies revealed major interaction with GLN108, HIS113 and ASP114, and interestingly, these residues are located near the Ca2+ selectivity filter region. Free energy binding analysis revealed that Coulomb energy, van der Waals energy and non-polar solvation terms are more favourable for ligand binding. Thus, the present study provides the physical and chemical requirements for the development of novel ORAI1 inhibitors with improved biological activity.

Bio-modified carbon paste electrode for the detection of Pb(II) ions in wastewater.

Heavy metal pollution in water is a serious environmental concern. Lead is one of the highly toxic heavy metals, and its toxicity is due to its non-degradation characteristic in living organisms. The monitoring of Pb(II) ions concentrations in drinking water is essential for human health and a safe environment. In this work, bio-modified carbon paste electrodes were constructed with live cells and thermally dried biomass (extracted protein) from Pseudomonas aeruginosa cells and employed for the detection of Pb(II) ions from wastewater. The biomass and biosensor preparation and optimization, and the performance of modified biosensors in the detection of Pb(II) ions are discussed here. The effect of various parameters, like pH, biomass composition, scan rate, and metal ion concentration, were studied to obtain the best electrochemical response. Further, the active surface of the electrode and solution characteristics were studies using chronocoulometry and electrochemical impedance spectroscopy. Fourier transform infrared spectroscopy (FTIR) analysis was done to find the functional groups present in the thermally dried biomass. From the present study, it is clear that the thermally dried protein biomass electrode has more sensitivity than the bare carbon paste electrode.

Customized nutrition intervention and personalized counseling helps achieve nutrition targets in perioperative liver transplant patients.

BACKGROUND AND AIM: Nutritional therapy is an integral part of care in all phases of liver transplantation (LTx). However, there are several factors that make it a challenge to manage malnutrition in these patients including, but not limited to, loss of appetite, dietary restrictions and dietary habits. Dietary habits are guided by personal choice, social, cultural and regional background with diversity ranging from veganism to vegetarianism with the latter predominant in Indian population. Therefore, it is difficult to improve nutritional intake of patients with standard dietary recommendations. We evaluated the effects of implementing personalized dietary counseling and a customized nutrition plan on its ability to enhance oral intake and, thereby improve nutritional status of patients with end stage liver disease (ESLD) being evaluated for LTx. We compared the outcomes with a matched group of patients who were prescribed standard dietary recommendations from a historic database. Primary outcome was measured by number of patients achieving ≥75% of recommended energy and protein requirements during hospitalization for LTx. Secondary outcomes included mean energy and protein intake, hours of ventilation, length of stay in Intensive Care Unit (ICU) and hospital, mortality and readmission rate in the acute phase (3months) after LTx. METHODS: This was a prospective observational study, performed at a single LTx centre. All patients >18years who enrolled for LTx and consented for the study were included. The study was conducted after obtaining institutional ethics committee approval. A protocol based nutrition planning was implemented from April'14. According to this protocol, all patients being evaluated for LTx underwent a detailed nutritional assessment by a qualified Clinical Dietitian (CD) and regularly followed up with until LTx. Nutritional intervention, including a customized nutrition care plan and personalized dietary counseling, was provided based on the severity of malnutrition. To evaluate the efficacy of this protocol, we compared the nutritional adequacy (calorie and protein intake) of 65 consecutive patients who underwent LTx between August'14-October'15 (group 1) with a historic database of 65 patients who underwent LTx between January'13 and April'14 (group 2). Patients' demographics, disease severity score, baseline markers of nutritional status (subjective global assessment (SGA), and body mass index (BMI)), were recorded. First, assessment of individual patient's oral energy and protein intake was determined by the daily calorie count during hospitalization. Then the nutritional intervention (oral nutrition supplement (ONS)/enteral nutrition (EN)/parenteral nutrition (PN)) plan was customized according to their spontaneous oral intake. As part of the protocol, health related quality of life was also assessed using short form 8 (SF-8) in group 1. Statistical analyses using Pearson's correlation, Chi-Square test were applied with SPSS version 20.0. RESULTS: The mean age of group 1 and 2 were 52.6 ± 9.8, 51.9 ± 10.5 (range 25-70years) with BMI of 26.8 ± 6.0, 26.5 ± 5.4 respectively. According to SGA, there was significant improvement in the nutritional status of group 1 patients compared to group 2 on admission for LTx. It was indicated that 88% of group 1 individuals in comparison to 98% in group 2 were malnourished. The calorie intake of group 1 (1740.2 ± 254.8) was significantly higher than group 2 (1568.5 ± 321.6) (p = 0.005). The marked improvement in protein intake in group 1 (63.1 ± 12.1) when compared with group 2 (53.1 ± 13.4) was statistically significant (p = 0.008). A subset analysis showed that non-vegetarians (consuming meat and dairy products) between the groups showed that group 1 had a significantly higher calorie (p = 0.004) and protein (p = 0.0001) intake compared to individuals in group 2. Following implementation of study's protocol, the goal of achieving ≥75% of the prescribed calories (p = 0.013) and protein (p = 0.0001) was significantly higher in group 1. CONCLUSION: When compared to the standard prescription, an individualized protocol to diagnose, stratify the severity of malnutrition early, and follow up by customized nutrition planning for patients helped to achieve nutritional targets more effectively. Inspite of patients' diversity in nutritional habits and reluctance to accept change, it is clear that a qualified and dedicated transplant nutrition team can successfully implement perioperative nutrition protocol to achieve better nutritional targets.