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A Prospective Survey Comparing Patients’ Experience of a Nurse-Led Clinic and Consultant-Led Clinic for Surveillance of Patients with Dilatation of the Intrathoracic Aorta

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World Journal of Cardiovascular Surgery 2019年第2期9卷 24-34页

作者： Bhuvaneswari Krishnamoorthy rashmi birla William R. Critchley Paul D. Waterworth Department of Cardiothoracic Surgery Manchester Foundation NHS Trust Manchester UK Division of Cardiovascular Sciences Faculty of Biology Medicine and Health The University of Manchester Manchester UK Faculty of Health and Social Care Edge Hill University Ormskirk UK The Endothelial Cell Biology Unit School of Molecular and Cellular Biology University of Leeds Leeds UK

Background: Increasing workload in consultant-led clinics often means patients to wait a long time for clinic appointments. To address this, there is an increasing trend in developing nurse-led clinics across many specialities in the National Health Service. This study aims to assess whether the implementation of a nurse-led clinic in thoracic aortic surgery will optimise the utilisation of health care services and improve overall patient satisfaction. Methods: 80 follow-up patients were asked to complete a questionnaire following their appointment in an aortic clinic, which was led either by a consultant (n = 40) or an aortic specialist nurse (n = 40). All patients seen by a nurse in the clinic were assessed by a consultant surgeon prior to the clinic for suitability. No new patients were seen by a nurse. Any patient with an aortic dimension of 5 cm or greater was seen by the consultant. If there were any complicated clinical features, the patient was seen in the consultant-led clinic. Patients were asked questions about their time spent with the respective health care professionals across 12 categories (punctuality, preparedness, understanding of concerns, clarity of speech, listening, respect, explaining, letting you talk, putting you at ease, emotional support, advice and advice for next follow-up). Patients rated each category using an ordinal scale from 0 - 10. Results: Patient scores were greater in nurse-led clinics compared to consultant-led clinics across a number of categories although only punctuality reached significance (mean 9.2 vs. 6.8, p 0.05). Conclusion: Patients were highly satisfied with the nurse-led clinic across all categories, with greater satisfaction for punctuality. These findings suggest that a nurse-led clinic can be implemented for the management of carefully selected thoracic aortic surgery patient without reduction in patient satisfaction.

关键词： Nurse-Led Clinic Consultant-Led Clinic Thoracic Aortic Surgery Surveillance Patient Satisfaction

Right Ventricular Failure Following Acute Type A Aortic Dissection: An Alternative Strategy

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World Journal of Cardiovascular Surgery 2019年第3期9卷 35-39页

作者： Ruchir P. Mashar rashmi P. birla Paul D. Waterworth General Surgery Hereford County Hospital Hereford UK Cardiothoracic Surgery Liverpool Heart and Chest Hospital Liverpool UK Cardiac Surgery Wythenshawe Hospital Manchester UK

Coronary malperfusion is a complication of aortic dissection, and can lead to ventricular failure. We report 2 cases of right ventricular (RV) failure, following aortic dissection, successfully bridged to recovery using right ventricular assist devices (RVADs). The first was a 54 year-old man, who had difficulty weaning from bypass due to a stunned RV following aortic root replacement. The second was a 34 year-old woman, who after replacement of the ascending aorta, suffered episodes of ventricular fibrillation (VF), and RV failure. Both had an RVAD implanted, allowing eventual recovery. We recommend more widespread use of VADs in such cases.

关键词： Right Ventricular Failure Assist Devices Acute Type A Aortic Dissection

Minimally invasive surgery for gastro-oesophageal junction adenocarcinoma: Current evidence and future perspectives

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World Journal of Gastrointestinal Oncology 2023年第10期15卷 1675-1690页

作者： Rodica birla Petre Hoara Florin Achim Valeriu Dinca Diana Ciuc Silviu Constantinoiu Adrian Constantin Department of General Surgery Carol Davila UniversityBucharest 011172Romania Department of General Surgery Carol Davila University of Medicine and PharmacyBucharest 020021Romania Faculty of Medicine “Titu Maiorescu”UniversityBucharest 031593Romania

Minimally invasive surgery is increasingly indicated in the management of malignant *** oesophagectomy is a difficult operation,with a long learning curve,there is actually a shift towards the laparoscopic/thoracoscopic/robotic approach,due to the advantages of visualization,surgeon comfort(robotic surgery)and the possibility of the whole team to see the operation as well as and the operating *** currently there are still many controversial topics,about the surgical treatment of patients with gastro-oesophageal junction(GOJ)adenocarcinoma,such as the type of open or minimally invasive surgical approach,the type of oesophago-gastric resection,the type of lymph node dissection and others,the minimally invasive approach has proven to be a way to reduce postoperative complications of resection,especially by decreasing pulmonary *** implementation of new technologies allowed the widening of the range of indications for this type of surgical *** short-term and long-term results,as well as the benefits for the patient-reduced surgical trauma,quick and easy recovery-offer this type of surgical treatment the premises for future *** article reviews the updates and perspectives on the minimally invasive approach for GOJ adenocarcinoma.

关键词： Gastro-oesophageal adenocarcinoma Minimally invasive oesophagectomy Laparoscopic gastrectomy Abdomino-mediastinal lymph node dissection Indocyanine green fluorescence imaging

Computerized tomography based “patient specific blocks” improve postoperative mechanical alignment in primary total knee arthroplasty

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World Journal of Orthopedics 2016年第7期7卷 426-433页

作者： Raju Vaishya Vipul Vijay Vikas P birla Amit K Agarwal Department of Orthopaedics Joint Replacement and ArthroscopyIndraprastha Apollo Hospital

AIM: To compare the postoperative mechanical alignment achieved after total knee arthroplasty(TKA) using computer tomography(CT) based patient specific blocks(PSB) to conventional instruments(CI).METHODS: Total 80 knees were included in the study, with 40 knees in both the groups operated using PSB and CI. All the knees were performed by a single surgeon using the same cruciate sacrificing implants. In our study we used CT based PSB to compare with CI. Postoperative mechanical femoro-tibial angle(MFT angle) was measured on long leg x-rays using picture archiving and communication system(PACS). We compared mechanical alignment achieved using PSB and CI in TKA using statistical ***: The PSB group(group 1) included 17 females and seven males while in CI group(group 2) there were 15 females and eight males. The mean age of patients in group 1 was 60.5 years and in group 2 it was 60.2 years. The mean postoperative MFT angle measured on long-leg radiographs in group 1 was 178.23°(SD = 2.67°, range: 171.9° to 182.5°) while in group 2, the mean MFT angle was 175.73°(SD = 3.62°, range: 166.0° to 179.8°). There was significant improvement in postoperative mechanical alignment(P value = 0.001), in PSB group compared to CI. Number of outliers were also found to be less in group operated with PSB(7 Knee) compared to those operated with CI(17 Knee).CONCLUSION: PSB improve mechanical alignment after total knee arthroplasty, compared to CI. This may lead to lower rates of revision in the PSB based TKA as compared to the conventional instrumentation.

关键词： Knee Replacement Arthroplasty Patient specific jigs Conventional jigs

Long Term Excessive Zn Supplementation Induced Oxidative Stress in Wistar Rats Fed on Semi-Synthetic Diet

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Food and Nutrition Sciences 2012年第6期3卷 724-731页

作者： Kshetrimayum birla Singh Department of Zoology Pachhunga University College Mizoram University Aizawl India.

The use of Zn as micronutrient in husbandry and agriculture practices and also in baby foods and multivitamin supplements have been increased during the last two decades. However, the effect of long term increasing Zn load on the oxidative stress in the body has not been worked so far. The supplementation of pharmacological dosage of Zn in otherwise Zn adequate diet was investigated with the aim if excess Zn in the diet triggers oxidative stress and its conesquence on enzymes of antioxidant defense system. In this study, three groups of rats were fed on semi-synthetic diet containing 20 mg Zn/kg (control, group-I), 40 mg Zn/kg (group-II) and 80 mg Zn/kg (group-III) diet respectively for a period of 6 months. Blood lipid profile in the serum, lipid peroxidation status and the activities of antioxidant enzymes and trace minerals level were estimated both in the liver and kidney of three groups of rats. The study revealed that the gain in body weight increased in rats in Zn concentration dependent manner. The blood lipid profile displayed a significant rise in serum glucose, total lipids, cholesterol, triglycerides, LDL-cholesterol, VLDL-cholesterol whereas HDL-cholesterol showed a reduction in their levels in group-II and III than their control counter parts. The lipid peroxidation products were higher and the enzyme activities of superoxide dismutase, catalase, glutathione-s-transferase, glutathione reductase, glutathione (reduced) and glucose-6-phosphate dehydrogenase were significantly lowered in liver and kidney of group-II and group-III. Their mineral status revealed a higher Zn concentration and lower Cu, Mg and Mn both in liver and kidney. This data suggest that Zn in excess in diet when fed for longer periods of time induces oxidative stress by altering the status of minerals.

关键词： Zn Cu Mg Mn Lipid Peroxidation Antioxidant Enzymes Oxidative Stress Zn Supplementation

Molecular Basis of Hypertension: A Systematic Review on the Role of Metal Ions for Increase Prevalence of Hypertension in India

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Journal of Biosciences and Medicines 2016年第7期4卷 12-22页

作者： Kshetrimayum birla Singh Department of Zoology Pachhunga University College Mizoram University Aizawl India

Metal ions played critical role in regulation of hypertension (HT) or blood pressure (BP). The physiological roles of metals commonly present in the diet in the etiology of HT need to be reviewed as recent survey on the metal status in the various vegetable and meat food stuffs commonly consumed by living population in India revealed an imbalance in its level. Higher levels of zinc (Zn) in diet is observed to increase the BP by various mechanisms including oxidative stress through decreased activity of superoxide dismutase (SOD) enzyme, increasing levels of angiotensin converting enzyme (ACE) and aldosterone and by causing acidification due to change in the levels of H+, Na+, K+ and Ca2+ ions in the blood. High level of copper (Cu) and low level of magnesium (Mg) and manganese (Mn) in the blood is also associated with HT through various mechanisms like elevation of chronic inflammation, accelerating Na+ pump of cell membrane and by disturbing lipid metabolism in the body. An epidemiological study conducted in the population of Manipur, India consuming Zn rich diet reveals significant disparities in distribution of the metals in the blood of the hypertensive (HTS) patients as compared to the normotensives (NT) control and thus indicates that the change in body metal homeostasis may be a triggering factor for the development of HT in this population and corroborate the reports of published literatures. The role of the metals variations in the body and their possible involvement in HT is reviewed and discussed in this paper.

关键词： Zn Cu Mg Mn Hypertension India

birla(博拉)关于实验室鉴定复合磷酸盐质量的方法

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肉类工业 2016年第1期 39-40页

作者： birla(博拉)化工集团 birla(博拉)化工集团青岛特斯特食品配料有限公司山东青岛266107

磷酸盐是唯一有效激活肉蛋白的肉制品水分保持剂，添加量小但作用显著。作用于肉制品保水，提高产品出品率，赋予肉制品良好的结构，增加肉制品的弹性和脆度，并延长货架期。

关键词：复合磷酸盐实验室鉴定质量水分保持剂延长货架期肉制品肉蛋白添加量

The Open Packing of the Lesser Sac Technique in Infected Severe Acute Pancreatitis

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Surgical Science 2010年第1期1卷 7-14页

作者： DCochiorSConstantinoiu DPeta Mariana Cochior Rodica birla LPripisi Clinical Hospital CF 2 Bucharest Department of SurgeryResearch DepartmentFaculty of Medicine of theUniversity Titu MaiorescuBucharestRumania Clinical Hospital “Santa Maria”BucharestDepartment of General and Esophageal Surgery University ofMedicine and Pharmacy Carol DavilaBucharestRumania Emergency Clinic Hospital Intensive Care UnitUniversity of Medicine and PharmacyCarol DavilaBucharestRumania

Aim: The goal of this study is to evaluate the open packing of the lesser sac (OPLS) in treatment of infected severe acute pancreatitis Methodology: The study was based on 98 cases in which this technique was applied during the period between 19942007, in two departments of surgery (Clinical Hospital CF 2 and Clinical Hospital ?Sf. Maria” Bucharest). The technique was applied based on the therapeutically protocol previously established beginning with 2000. The OPLS technique was analyzed relatively to: timing of surgery, the localization of the infected necrosis or abscesses, growing germs on the cultures, antibiotics received, executed primarily or at reintervention, the number of debridement, hospitalization, morbidity and mortality. The information was statistically processed using SPSS test version 17 for Windows. Results: The OPLS technique improved the control of the local sepsis, in the retrospective/prospective study in 83.7%. Mortality was 16.3% (16/98), with a global mortality of 26.3% (75/285) and a postoperative mortality of 29.5% (66/224). Conclusions: Considering the fact that the intensive care techniques are approximately the same in the last 15 years, we thought that this improvement in the survival rate may be due to the application of OPLS in cases with indication and optimal timing for surgery.

关键词： Open Packing of the Lesser Sac (OPLS) Severe Acute Pancreatitis (SAP) Infected Necrosis Pancreatic Abscess and Necrosectomy

Effect of Temperature &Supply Voltage Variation on Stability of 9T SRAM Cell at 45 nm Technology for Various Process Corners

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Circuits and Systems 2012年第2期3卷 200-204页

作者： Manisha Pattanaik Shilpi birla Rakesh Kumar Singh Department of Electronics & Communications Bipin Chandra Tripathi kumaon Engineering College Dwarahat India Department of Electronics & Communications Sir Padampat Singhania University Udaipur India VLSI Group Atal Bihari Vajpayee Indian Institute of Information Technology and Management Gwalior India

Due to the continuous rising demand of handheld devices like iPods, mobile, tablets;specific applications like biomedical applications like pacemakers, hearing aid machines and space applications which require stable digital systems with low power consumptions are required. As a main part in digital system the SRAM (Static Random Access Memory) should have low power consumption and stability. As we are continuously moving towards scaling for the last two decades the effect of this is process variations which have severe effect on stability, performance. Reducing the supply voltage to sub-threshold region, which helps in reducing the power consumption to an extent but side by side it raises the issue of the stability of the memory. Static Noise Margin of SRAM cell enforces great challenges to the sub threshold SRAM design. In this paper we have analyzed the cell stability of 9T SRAM Cell at various processes. The cell stability is checked at deep submicron (DSM) technology. In this paper we have analyzed the effect of temperature and supply voltage (Vdd) on the stability parameters of SRAM which is Static Noise Margin (SNM), Write Margin (WM) and Read Current. The effect has been observed at various process corners at 45 nm technology. The temperature has a significant effect on stability along with the Vdd. The Cell has been working efficiently at all process corners and has 50% more SNM from conventional 6T SRAM and 30% more WM from conventional 6T SRAM cell.

关键词： DSM Technology Process Corners Write Margin Read Current Static Noise Margin