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Yak butter's high unsaturated fatty acid level predisposes it to oxidation, hence must be converted into more stable forms like powder. This study aimed to spray dry yak butter using 10% yak butter and four sodium caseinate (NaCas) formulations: sample A: 100% NaCas; sample B: 50% NaCas, 50% lactose; sample C: 75% NaCas, 25% lactose; and sample D: 25% NaCas, 75% maltodextrin. The powders were vacuum and hermetically sealed, and evaluated for oxidative stability, physical and sensory properties during storage at 65 ℃ for 30 days. The results showed that samples B and D had similar and most favorable physical properties (such as, moisture, water activity, particle size, bulk density re-dispersion time, and encapsulation efficiency); though sample B, together with sample C, browned the most during storage. The majority of the sensory panelists preferred samples B and D; observed high caking in samples C and B; and the least whiteness loss and caking in samples D and A but high off-flavors in samples A and C. After storage, peroxide and thiobarbituric acid values of powder samples ranged from 34.98 to 69.54 meqO2/kg and 1.85-9.43 mg MD/kg, respectively, in the decreasing order of A, C, B, and D. Sample D, followed by B, showed the highest radical scavenging activity. Therefore, for optimum yak butter powder physical properties and oxidative stability, 50%:50%, NaCas: lactose, and 25%:75%, NaCas: maltodextrin formulations should be used. This study provides essential knowledge for butter powder processors., (© 2022. The Author(s).)

Objective: To summarize and evaluate the relevant evidence on nutrition management of post-stroke dysphagia (PSD) to provide evidence-based basis for clinical staff., Methods: We searched evidence in BMJ Best Practice, Up To Date, Cochrane Library, PubMed and so on from their inception to May 31, 2021. The quality assessment was conducted by two researchers by using AGREE II for guidelines, JBI evidence-based health care center evaluate standards for systematic review and expert consensus., Results: An initial searching of 445 literatures resulted in 26 literatures that met inclusion criteria. Finally, a total of 38 pieces of evidence were summarized from 5 aspects including nutrition risk screening and assessment, nutrition support principles, enteral nutrition, parenteral nutrition, and hydration management., Conclusions: This study summarized the evidence of the nutrition management for PSD patients. Since evidences are from different countries, it's better to assess the clinical environment and other related factors before their application., Competing Interests: None., (AJTR Copyright © 2022.)

To evaluate the effect of different inflation volume on the measurement accuracy of the modified cuff pressure measurement method in different shapes of cuffs, so as to provide reference for the correct monitoring of cuff pressure in clinic. In vitro study: The traditional cuff pressure measurement method (the cuff pressure gauge before measurement shows 0 cm H 2 O) and the modified cuff pressure measurement method (the cuff pressure before measurement shows 25 cm H 2 O, 28 cm H 2 O, 30 cm H 2 O or 32 cm H 2 O) were used to measure cylindrical and tapered cuffs, and the effect of different inflation volume on cuff pressure was analyzed statistically. Clinical study: patients with the artificial airway established by orotracheal intubation or tracheotomy in Neuro-ICU were prospectively selected as subjects, and the measurement procedure was the same as in vitro study. In vitro study showed that the pressure loss values of cylindrical cuff and tapered cuff using the traditional cuff pressure measurement method were (3.75 ± 0.31) cm H 2 O and (4.92 ± 0.44) cm H 2 O, respectively, and clinical study showed that the pressure loss values were (5.07 ± 0.83) cm H 2 O and (5.17 ± 0.93) cm H 2 O, respectively. The actual measured values measured by the traditional cuff pressure measurement method of the two cuff shapes were compared with the corrected target value of 28 cm H 2 O, and the differences were statistically significant (P < 0.000). Both in vitro and clinical study had shown that all differences between the actual measured value and the corrected target value using the modified cuff pressure measurement method (measured with 25 cm H 2 O, 30 cm H 2 O, 32 cm H 2 O) were statistically significant (P < 0.000), and the range of overall differences was (0-1.23 ± 0.25) cm H 2 O. In vitro study had shown that the pressure variation coefficient (CV) of the tapered cuff was greater than that of the cylindrical cuff, and the difference was statistically significant (3.08 ± 0.25 VS 2.41 ± 0.21, P < 0.000). The traditional cuff pressure measurement method can directly lead to the cuff pressure drop, which is easy to cause the leakage of secretions on the cuffs and the misjudgment of the cuff pressure by medical personnel. However, the modified cuff pressure measurement method can effectively reduce cuff pressure loss, and taking the actual cuff pressure value as the inflation volume is the highest measurement accuracy.The tapered cuff is more susceptible to air volume, so it is necessary to pay attention to its measurement and correction in clinical practice., (© 2021. The Author(s), under exclusive licence to Springer Nature B.V.)

Background: Operative morbidity is a common yet modifiable feature of complex surgical procedures. With increasing case volume, improvement in morbidity has been reported through designated procedural processes and greater repetition. Defined as a volume-outcome association, improvement in breast reconstruction morbidity with increasing free flap volume requires further characterization., Methods: A retrospective analysis was conducted among consecutive free flap patients using a two-microsurgeon model between January of 2002 and December of 2017. Patient demographics and operative characteristics were obtained from medical records. Complications including unplanned surgical intervention (take-back) and flap loss were obtained from prospectively kept databases. Individual surgeon operative volume was estimated by considering overall practice volume and correcting for the number of surgeons at any given time., Results: During the study period, 3949 patients met inclusion criteria. A total of 6607 breasts underwent reconstruction with 6675 free flaps. Mean patient age was 50 ± 9.4 years and mean body mass index was 28.8 ± 5.0 kg/m2. Bilateral reconstruction was performed on 2633 patients (66.5 percent), with 4626 breasts (70.5 percent) reconstructed in the immediate setting. Overall, breast and donor-site complications were reported in 507 breasts (7.7 percent) and 607 cases (15.4 percent), respectively. Take-back was required in 375 cases (9.5 percent), with complete flap loss occurring in 57 cases (0.9 percent). Based on annual flaps per surgeon, the incidence of complications decreased with increasing volume (slope = -0.12; p = 0.056)., Conclusion: Through procedural efficiency and execution of defined clinical processes using a two-microsurgeon model, increases in microsurgical breast reconstruction case volume result in decreased morbidity., Clinical Question/level of Evidence: Therapeutic, IV., (Copyright © 2021 by the American Society of Plastic Surgeons.)

The availability of social support is associated with health outcomes after acute myocardial infarction (AMI), yet previous studies have largely considered social support as a single entity, rather than examining its discrete domains. Furthermore, few studies have investigated the impact of social support in older AMI patients, in whom it may be especially important. We aimed to determine the associations between 5 discrete domains of social support - emotional support, informational support, tangible support, positive social interaction, and affectionate support - with 6-month readmission and mortality in older patients hospitalized for AMI, adjusting for known predictors of post-AMI outcomes. Three thousand six participants 75 years and older were recruited from a network of 94 hospitals across the United States. A 5-item version of the Medical Outcomes Study Social Support Survey was used to measure perceived social support, and readmission and mortality were ascertained 6 months after initial hospitalization. Independent associations were determined using multivariable regression. Among 3,006 participants, mean age was 82 years, 44% were female, and 11% non-white. Participants who were female, non-white, less educated, and lived alone tended to report lower social support. In multivariable analyses, low informational support was associated with readmission (odds ratio 1.22; 95% confidence interval 1.01 to 1.47), and low emotional support with mortality (odds ratio 1.43; 95% confidence interval 1.04 to 1.97). In conclusion, individual domains of social support had distinct, independent associations with post-AMI outcomes, lending a more nuanced and precise understanding of this important social determinant of health. Understanding these distinct associations can inform the development of interventions and policies to improve post-AMI outcomes., (Copyright © 2019 Elsevier Inc. All rights reserved.)