Yt is on video: Waching daily Feb 1 2017

Why Does Red Meat Turn Brown When Cooked?

This is thanks to a protein called myoglobin, which also is what makes the raw red meat

look red, not blood, as many people think.

Myoglobin is a protein that stores oxygen in muscle cells, very similar to its cousin,

hemoglobin, which stores oxygen in red blood cells.

This oxygen store is necessary for muscles which need immediate oxygen for energy during

continual usage.

So how does the myoglobin end up making the meat turn brown when cooked?

This darkening effect is due to the oxidation state of the iron atoms in myoglobin.

When the myoglobin is exposed to oxygen, before you cook the meat, the iron atom oxidation

level is +2 and it is bound to a dioxygen molecule (O2), which makes the meat appear

bright red.

As you cook the meat, this iron atom loses an electron and goes to a +3 oxidation level

with this process ending up turning the meat brown.

White meat, on the other hand, doesn't turn dark brown like red meat because it has significantly

less myoglobin in it.

In fact, the myoglobin levels are actually one of the main factors that officially distinguish

white meat from red meat.

Bonus Facts:

Contrary to popular belief, "searing" meat does not in any way "seal the juices

in".

Water in seared meat evaporates at either the same rate or a higher rate, in some cases,

than non-seared meat.

What searing does do is play a role in browning, which can affect the flavor.

But, in this case, the browning is caused by caramelization of sugars combined with

a chemical reaction with amino acids and

the sugars.

For more infomation >> Why Does Red Meat Turn Brown When Cooked? - Duration: 2:17.

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Peter Capaldi backing Frances de la Tour for Doctor Who - Duration: 6:31.

For more infomation >> Peter Capaldi backing Frances de la Tour for Doctor Who - Duration: 6:31.

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Forecast Focus for January 31 - Duration: 1:55.

For more infomation >> Forecast Focus for January 31 - Duration: 1:55.

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Learn Colors for Children with Garbage Trucks 3D Vehicles - Cars Colours for Kids - Learning Videos - Duration: 12:34.

Learn Colors for Children with Garbage Trucks 3D Vehicles - Cars Colours for Kids - Learning Videos

Learn Colors for Children with Garbage Trucks 3D Vehicles - Cars Colours for Kids - Learning VideosLearn Colors for Children with Garbage Trucks 3D Vehicles - Cars Colours for Kids - Learning VideosLearn Colors for Children with Garbage Trucks 3D Vehicles - Cars Colours for Kids - Learning VideosLearn Colors for Children with Garbage Trucks 3D Vehicles - Cars Colours for Kids - Learning VideosLearn Colors for Children with Garbage Trucks 3D Vehicles - Cars Colours for Kids - Learning VideosLearn Colors for Children with Garbage Trucks 3D Vehicles - Cars Colours for Kids - Learning VideosLearn Colors for Children with Garbage Trucks 3D Vehicles - Cars Colours for Kids - Learning VideosLearn Colors for Children with Garbage Trucks 3D Vehicles - Cars Colours for Kids - Learning Videos

For more infomation >> Learn Colors for Children with Garbage Trucks 3D Vehicles - Cars Colours for Kids - Learning Videos - Duration: 12:34.

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LEARN COLORS w Garbage Truck and Learn Numbers w Spiderman Cars Cartoon for Kids Learning Video - Duration: 11:27.

LEARN COLORS w Garbage Truck and Learn Numbers w Spiderman Cars Cartoon for Kids Learning Video

LEARN COLORS w Garbage Truck and Learn Numbers w Spiderman Cars Cartoon for Kids Learning VideoLEARN COLORS w Garbage Truck and Learn Numbers w Spiderman Cars Cartoon for Kids Learning VideoLEARN COLORS w Garbage Truck and Learn Numbers w Spiderman Cars Cartoon for Kids Learning VideoLEARN COLORS w Garbage Truck and Learn Numbers w Spiderman Cars Cartoon for Kids Learning VideoLEARN COLORS w Garbage Truck and Learn Numbers w Spiderman Cars Cartoon for Kids Learning VideoLEARN COLORS w Garbage Truck and Learn Numbers w Spiderman Cars Cartoon for Kids Learning VideoLEARN COLORS w Garbage Truck and Learn Numbers w Spiderman Cars Cartoon for Kids Learning Video

LEARN COLORS w Garbage Truck and Learn Numbers w Spiderman Cars Cartoon for Kids Learning Video

For more infomation >> LEARN COLORS w Garbage Truck and Learn Numbers w Spiderman Cars Cartoon for Kids Learning Video - Duration: 11:27.

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Fertility Outcomes Post Uterine Sparing Surgeries for Post Partum Hemorrhage - Duration: 11:08.

Today we're going to talk

about fertility outcomes

in post uterine-sparing

surgeries for postpartum

hemorrhage, or PPH.

Our discussion will focus

on the literature review

and discussion.

And the group members are Eric,

Daniel, Alfred, myself.

We are supervised by Dr. T. C.

Tan as well as Dr. Sonali.

Today, for our presentation,

we are going to give

a brief introduction

of the topic

as well as provide

the patient case scenario,

followed by the actual critique

of the article

based on the systematic review.

We are also going talk

about the KK experience

as well as the study conducted

in KKH on postpartum hemorrhage,

followed by conclusion.

Now, introduction.

Why is the topic of fertility

outcomes

in post-uterine intervention

important?

Because health is not just

a concept but a state

of complete physical, mental,

and social well-being.

And not just simply

about the absence of disease.

The case we are presenting

is the case of Mrs. P, who

is a 29-year-old G2P1 female

at 29 weeks gestation.

She basically present

PV bleeding associated

with abdominal pain.

The bleeding was noted to be

fresh, without clots.

She had

no prior provisional bleeding

during her pregnancy.

Routine antenatal blots were

normal.

Currently she has no fever,

headache, or hematemesis.

She also has no history of falls

or trauma.

Obstetric history-wise, includes

intra-uterine fetal demise

at 24 weeks gestation

previously, delivered by lower

segment Cesarean section

for preeclampsia three years

ago, complicated by PPH.

Code Green was activated three

hours after admission based

non-reassuring fetal status.

The baby was 1.3 kilograms,

delivered by LSCS, complicated

by a tear in the bladder serosa,

with significant PPH and a blood

loss of 2.5 liters.

Following which are uterine

compressions and B-lynch suture

was done.

Post-op-wise, her recovery

was uncomplicated.

The patient was discharged well

post-op day 5.

Now, based on the case,

what are the considerations

that a patient might have?

Of course, the patient might

definitely think about

whether she can get pregnant

again, the risk

to her pregnancies, especially

subsequent pregnancies

after this episode of postpartum

hemorrhage, which

is a complication of pregnancy.

And if possible,

when is the best time to get

pregnant again?

So the article we're talking

about is actually this article

on "Menstrual and Fertility

Outcomes Following the Surgical

Management of Postpartum

Hemorrhage-- a Systematic

Review."

For the article, they used study

selection and literature search

involving the following

databases.

Data extraction-wise, they've

studied the characteristics

of trial participants, the types

of intervention, the time

of follow up,

outcomes, complications,

as well as a quality assessment

of the procedures done.

Now, basically, this slide

is the most important slide

of the whole article.

Mainly the focus on three

procedures,

which is pelvic and uterine

artery embolization,

uterine devascularization, and

uterine compression sutures.

If you note, normal resumption

of menstruation

was 460 of 503 patients, which

was 91%.

Out of which 168 women desired

future pregnancies.

And the number of patients who

actually got pregnant

was 126, which is 25%.

Patiently

with recurrent postpartum

hemorrhage is 18.

For the next procedure,

uterine devascularization,

28 out of 32, which

is close to 88%,

had normal resumption

of menstruation

within six months,

out of which 39 desired

pregnancies, but only 33

actually achieved pregnancies.

For the uterine compression

sutures, 65 out of 71, which

is 90.27%, had normal resumption

of menstruation

within six months.

Out of which 28 desired

pregnancies and 24 actually

achieved pregnancies.

If you look at this slide,

it seems that the number

of patients who have

post-procedure complications

is the lowest

in the uterine compression

sutures, where there are

actually no complications

in terms of preterm

labor, early pregnancy loss,

as well as recurrent postpartum

hemorrhage.

However, the data does suggest

that pelvic uterine embolization

is the most studied procedure

in this paper.

But we actually noted

that patients who actually

undergo this procedure

are patients who actually need

to be stable,

because such procedures are

interventional radiological

techniques,

and require the expertise

of an interventional radiologist

on standby.

As for the reported

complications and associations,

we are going to look

at embolization

and devascularization

techniques,

as well as uterine compression

suture, or the B-lynch suture.

For uterine artery embolization

or pelvic devascularization,

complications included

endometritis as well as

endometrial ischemia,

uterine synechiae

and amenorrhea, otherwise known

as Asherman's syndrome,

increased risk

of abnormal presentation

in subsequent pregnancies.

For uterine compression sutures,

which is the B-lynch suture,

complications

such as uterine synechiae

and amenorrhea,

or Asherman's syndrome,

have been reported.

The article basically reported

that most women do not have

adverse menstrual and fertility

outcomes following

surgical intervention

of severe postpartum hemorrhage,

as shown in the slides.

The strengths of this paper,

generally, was that a wide range

of studies

were reviewed because it was

a literature review.

The studies were prospective as

well as retrospective.

They were drawn from all

around the world, and did not

focus only

on the British journals,

but also to a majority

of articles from Europe as well.

The use of common endpoints

to compare each study

was also a strength

of this paper.

The authors provided

a good discussion on limitations

of studies done,

as well as some conclusions.

However the weaknesses

for these people

are that the quality assessment

of selection was subjective,

because the endpoints were not

really very clear.

No randomized controlled trials

were done in the papers

reviewed, but only prospective

as well as retrospective studies

based on the complications.

There was

insufficient representation

of compression procedures

in the meta analysis,

such as the compression sutures.

We are now going to talk

about the experience and study

in KKH.

Complications and pregnancy

outcomes following

uterine compression

suture for postpartum

hemorrhage, a single center

experience.

Basically, the KK people studied

59,655 deliveries over a four

year period,

starting from first January,

2008 to 31st December, 2012.

Out of which 23 deliveries

required B-lynch sutures to be

performed as a result

of postpartum hemorrhage,

and out of which only three

pregnancies were achieved

following B-lynch compression

sutures.

As mentioned, there were only

three pregnancies in two

patients

reported from this study.

For Patient 1,

she had a miscarriage

in the first trimester.

The second successful pregnancy

was a 39-week pregnancy, which

was delivered

by elective Cesarean section

due to a placenta previa as well

as a transverse lie.

For Patient 2, it was also

an elective Cesarean section

for a term baby at 39 weeks.

If you look at the picture

in this slide, it shows that

for Patient 2,

following B-lynch compression

sutures.

This picture was basically taken

at the Cesarean delivery

of the second baby,

following

the B-lynch compression suture

of the first pregnancy

as a result of postpartum

hemorrhage.

This picture basically shows

fundal distortion, which

is a complication noted

for B-lynch compression sutures.

So basically,

uterine compression sutures

have been shown to be

effective at preserving

the uterus as compared

to procedures

such as hysterectomy.

The risk of loss of fertility

and subsequent pregnancy

outcomes remains.

And the total risk remains

unknown.

So while adverse pregnancy

outcomes have been reported,

there have still been

successful conceptions

and deliveries following

compression sutures,

such as the two

successful pregnancies reported

in this paper.

The low rate of successful term

pregnancies following

compression sutures

may be related to factors which

are non-medical,

such as psychological stress

from traumatic delivery causing

mothers to choose not to have

subsequent pregnancies.

Most women do not have

adverse menstrual or fertility

outcomes in the long term

after uterine-sparing surgical

procedures due to postpartum

hemorrhages, basically from all

the papers we have seen.

Data from the 2014 paper

from KK, which studied fertility

outcomes after B-lynch suture,

are

consistent

with the other studies.

Adverse outcomes

in subsequent pregnancies

remain restricted to isolated

case reports.

And the study and follow-up

for this cohort of women

remains very important.

So now, going back

to the Conclusions slide.

The questions frequently asked

by women.

Can they get pregnant again?

The answer is definitely yes.

Because such procedures aim

to preserve the uterus,

and that more women actually

resume menstruation as chosen

to be an endpoint or parameter

to measure fertility.

In terms of risk

to the pregnancy,

it seems to be

comparable with patients

with past abdominal pelvic

surgery,

basically because all procedures

done have complications,

and they are no different or no

higher than patients undergoing

normal pelvic surgery.

As to the question of,

when is the best possible time

to get pregnant again?

There are basically

no guidelines as of yet.

But anecdotal advice is to wait

one year or more to allow

for healing of the uterus

to prevent

possible complications.

Thank you.

For more infomation >> Fertility Outcomes Post Uterine Sparing Surgeries for Post Partum Hemorrhage - Duration: 11:08.

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Learn Colors with Vehicles for Children | Dump Truck Excavator Cars | Learning Video for Toddlers - Duration: 14:15.

Learn Colors with Vehicles for Children | Dump Truck Excavator Cars | Learning Video for Toddlers

For more infomation >> Learn Colors with Vehicles for Children | Dump Truck Excavator Cars | Learning Video for Toddlers - Duration: 14:15.

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Top Plays of the Week Nominees (Jan. 30) - Duration: 1:33.

JACK: I ALWAYS READ THINGS

JACK: I ALWAYS READ THINGS ONLINE ABOUT HAVING A CASE OF

ONLINE ABOUT HAVING A CASE OF THE MONDAYS.

THE MONDAYS. PEOPLE COMPLAINING ABOUT MONDAY

PEOPLE COMPLAINING ABOUT MONDAY BECAUSE OF THE START OF THE WORK

BECAUSE OF THE START OF THE WORK WEEK, STUFF LIKE THAT.

WEEK, STUFF LIKE THAT. WELL HERE AT NBC 5, MONDAYS

WELL HERE AT NBC 5, MONDAYS MEANS TOP PLAYS OF THE WEEK.

MEANS TOP PLAYS OF THE WEEK. IT'S NOT A NEGATIVE, IT'S A

IT'S NOT A NEGATIVE, IT'S A POSITIVE.

POSITIVE. A CELEBRATION OF WHAT OUR LOCAL

A CELEBRATION OF WHAT OUR LOCAL ATHLETES HAVE DONE OVER THE PAST

ATHLETES HAVE DONE OVER THE PAST SEVEN DAYS.

SEVEN DAYS. HERE'S WHAT OUR CAMERAS CAUGHT

HERE'S WHAT OUR CAMERAS CAUGHT LAST WEE

LAST WEE WE START OUT AT PATRICK GYM.

WE START OUT AT PATRICK GYM. CLOCK WINDING DOWN IN THE FIRST

CLOCK WINDING DOWN IN THE FIRST QUARTER.

QUARTER. NO MATTER, THE BANK IS OPEN FOR

NO MATTER, THE BANK IS OPEN FOR HANNAH CRYMBLE, A BUZZER BEATE

HANNAH CRYMBLE, A BUZZER BEATE VERMONT WON THE GAME BY 10.

VERMONT WON THE GAME BY 10. JUMP ACROSS THE LAKE

JUMP ACROSS THE LAKE ELI BRYANT, CHRIS MIDDLETO

ELI BRYANT, CHRIS MIDDLETO THE VIOLENT THROWDOWN IN A

THE VIOLENT THROWDOWN IN A P-STATE VICTORY.

P-STATE VICTORY. CARDINALS HAD IT GOING ON THIS

CARDINALS HAD IT GOING ON THIS WEEK ON THE ICE AS WELL.

WEEK ON THE ICE AS WELL. BRADY ROULEAU DOING HIS PART TO

BRADY ROULEAU DOING HIS PART TO PREVENT SCORING.

PREVENT SCORING. POINT BLANK RANGE, GLOVE SAV

POINT BLANK RANGE, GLOVE SAV CARDS TOOK DOWN 10TH RANKED BUFF

CARDS TOOK DOWN 10TH RANKED BUFF STATE.

STATE. BACK TO THE HARDWOOD

BACK TO THE HARDWOOD VERMONT DOWN ON LONG ISLAN

VERMONT DOWN ON LONG ISLAN ANTHONY LAMB TOUCHDOWN PASS TO

ANTHONY LAMB TOUCHDOWN PASS TO TRAE BELL-HAYNES ICES THE GAME

TRAE BELL-HAYNES ICES THE GAME AND NOTCHES HIS 1,000TH CAREER

AND NOTCHES HIS 1,000TH CAREER POINT ALL ON ONE BUCKET.

POINT ALL ON ONE BUCKET. AND FINALLY, HIGH SCHOOL HOOPS.

AND FINALLY, HIGH SCHOOL HOOPS. BFA ST. ALBANS' ELENA CLARK

BFA ST. ALBANS' ELENA CLARK THE HESITATION GETS THE DEFENDER

THE HESITATION GETS THE DEFENDER TO BITE.

TO BITE. DRIBBLE DRIVE FOR THE BUCKET

DRIBBLE DRIVE FOR THE BUCKET CHECK IT OUT AGAIN.

For more infomation >> Top Plays of the Week Nominees (Jan. 30) - Duration: 1:33.

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Clackamas family searching for missing Army reservist - Duration: 2:22.

MISSING TONIGHT.

HIS FAMILY SAYS HE WAS ON HIS

WAY TO A TRAINING PROGRAM WHEN

HE JUST UP AND DISAPPEARED.

JEFF: OUR EILEEN PARK WAS WITH

THE FAMILY ALL DAY DURING THE

SEARCH.

SHE JOINS US LIVE WITH WHAT'S

DEVELOPING NOW.

EILEEN: IT IS A COMPLETE MYSTERY

AT THIS POINT.

FAMILY MEMBERS SAY IT'S NOT LIKE

26-YEAR-OLD WILL NAUGLE TO JUST

GO MISSING.

BUT NOW THEY'RE WORRIED SICK.

THIS WHITE CIVIC IS ONE OF THE

FEW CLUES THEY HAVE TO GO ON AS

THEY CONTINUE TO SEARCH FOR WILL

NAUGLE.

THEY SAY THIS IS HIS CAR.

JUST UP AND DISAPPEARED.

EILEEN: JAMES NAUGLE IS WILL'S

BROTHER.

HE TELLS US WILL WAS RAISED IN

PORTLAND BUT RECENTLY MOVED TO

CLACKAMAS TO LIVE WITH HIS

FRIEND AT OVERLOOK POINTE

APARTMENTS.

THIS IS NOT LIKE WILL.

HE'S BEEN LOOKING FORWARD TO

DRILL.

THE RESERVES.

HE WAS REAL EXCITED TO BE WITH

HIS UNIT.

SOMETHING HE'S REALLY INTERESTED

IN.

LOOKING FORWARD TO ALL THE

TRAINING AND OPPORTUNITY

PROVIDED FOR HIM.

EILEEN: ALL DAY, FAMILY MEMBERS

HAVE BEEN HANDING OUT MISSING

FLYERS, HOPING FOR SOMEONE

AROUND THE APARTMENT COMPLEX TO

RECOGNIZE THEM.

I AM REALLY WORRIED, SCARED,

AND VERY PUZZLED.

JUST BAFFLED ON HOW SOMEBODY CAN

BE DRESSED, READY TO GO TO

TRAINING AND WALK OUT THEIR

FRONT DOOR AND DISAPPEAR.

EILEEN: JULIE SAYS

SHE IS WILL'S

SISTER AND HER BROTHER IS THE

YOUNGEST IN THE FAMILY.

HE WAS IN THE NATIONAL GUARD,

HE WAS VERY EXCITED ABOUT THIS

NEW RESERVE UNIT HE WAS IN.

HE WAS ENTHUSIASTIC ABOUT THE

CIVIL AFFAIRS UNIT.

VERY POSITIVE.

SO I DON'T SEE WHY HE WOULDN'T

BE THERE.

HE GOT READY, LEFT, IN

UNIFORM, WALKED OUT HIS FRONT

DOOR, TOLD HIS FRIEND, I'M LATE

I GOT TO GO.

AND NO ONE'S SEEN HIM SINCE.

EILEEN: I CONFIRMED WITH THE

MILITARY THAT WILL SURGE WITH

THE NATIONAL GUARD FOR SIX YEARS

AND WAS HONORABLY DISCHARGED.

HE EVEN TOURED IN AFGHANISTAN

FOR A YEAR.

THE CLACKAMAS COUNTY SHERIFF'S

OFFICE SAYS THEY HAVE NO LEADS

AS TO HIS WHEREABOUTS.

IF YOU KNOW ANYTHING ABOUT

WHERE

HE IS YOU'RE ASKED TO CALL THE

SHERIFF'S OFFICE.

BACK TO YOU.

Yt is on video

Thứ Ba, 31 tháng 1, 2017

Waching daily Feb 1 2017

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