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Some arthritis patients may be more physically sensitive to temperature changes, barometric pressure, and humidity than others. Does weather affect your osteoarthritis? Do weather changes make you feel more achey and cause more joint pain and stiffness? What do you do to head off the flare-ups caused by weather?
Warm to Cold Weather Causes Flare-Ups
- I'm 57 and have undiagnosed hip disfunction (maybe bursitis) which normally causes aches when the weather changes from summer to winter. Other normal ailments in the general area seem to be affected because of all this going on. Wish the medical community understood it better and provided better assistance to sufferers.
- —Guest Freddy M
- I agree with all of the above. My bones, muscles, joints have more pain when it is humid. I live in Las Vegas, NV, mainly it is a dry climate. When there is any humidity I feel it, and I am in more pain. I have Osteoarthritis, Fibro, and chronic back pain, with bones deteriorating in my spine. I read that in Japan they started a study of how weather changes do effect some people. Wish they would do a study here in the states, we can't all be stating the same thing. We are in more pain when the weather changes.
- —Guest Espi47
Set up tests
- I have lived in Tucson, AZ and now in Venice , Fl. I am in constant pain from arthritis in Venice. Not in AZ. Why night test numerous people for three weeks in both locations. I bet you will find I am not unique. I am 80, male, golfer. re. ost. arthritis.
- —Guest Richard Hitt
Humidity and hot weather
- When the humidity goes up my body doesn't feel like my own anymore. I feel this particularly bad in my hands which feel like they are big clubs on the ends of painful sticks. My whole body is tired and my brain goes foggy.
- —Guest Candice
Arthritis and weather
- Yes, any time there is cloudy and rainy weather, it effects me -- mood, joint and muscle pain worsen and if sunshine comes I feel happy and no pain.
- —Guest PAUL
Does cold weather make arthritis worse
- Yes I think cold weather does play a part in severity of arthritis pain. I have Osteoarthritis and I ache more, my joints get locked and stiffer. I can bearly walk right in winter because I'm in so much pain.
- —Guest CharHoloman
Barometric Arthritis
- When a front is approaching, I will literally get sick all over the day before it arrives. My body puffs up, my joints hurt, and my head feels like it's made of cotton:I can't think straight, I feel depressed, I can't focus or concentrate. I move in slow motion and get out of breath. I call it my "hurricane syndrome" because it is particularly awful as a hurricane approaches, and I literally can not pack to evacuate. I have to sit or lie down until it's passed. I don't know what to do to help myself. My doctors have no idea, either. Are there any remedies for this? Will "water pills" help? When the weather is dry, I feel normal. I live in Florida, so I fell pretty bad all summer during the rainy season. In addition, I have become heat intolerant in the last 3 years. I can't be outside for more than 15 minutes without feeling overcome by it. I have gone through extensive testing for heart and autoimmune diseases. Nothing was found except some inflammation markers. Is there a connection?
- —Guest gainor hillegass
OA and weather changes
- It feels like my joints are too big for the surrounding ligaments and muscles. I've had a 2 level C5 thru C7 fusion with plates and screws. Also a 2 level L4 thru S1 with rods and screws and a plate . They say people who have metal in their body with OA, it makes the pain worse and I agree.
- —Guest Julie m


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Another Look at the Nike Free Flyknit 2013 Launch Collection
With the Nike Free Flyknit launch collection now available, we've got a look at how the shoe appears on-foot. The Free Flyknit's sock-like upper conforms perfectly to the foot for a second-skin feel, making this a great looking option for people who like to wear their shoes sans socks. Available in a range of colorways from safe and simple all-black to a vibrant rainbow-esque number, the launch collection has something to offer for everyone. Find the collection now at Nike retail locations and select stockists like Wish.
Date: Aug 2, 2013 / Views: 186 / Author: James Shorrock

subset: commoncrawl


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Historical Map: Metro de Madrid, 1981
Having had a look at Madrid's current map (2.5 Stars), I thought we'd delve into the past and see what came before it. The first thing to notice is how much smaller the system was in 1981: only 10 Metro lines instead of 12 - and many of those are much shorter than now, and no light rail lines.
Have we been there? No.
What we like: A paragon of clean, functional transit map design. There's great flow in this map, especially compared to the staccato, rigid, 90-degree matrix of the current map. Even without a legend, everything on this map is perfectly clear.
What we don't like: Some minor station placement and labelling issues. Some route colours look similar (the 2 and 7, and the 9 and 10), but I think this is more to do with the age of the map that has been scanned than an issue with the design of the map itself.
Our rating: What can I say? I'm a sucker for simple, clean, well-designed maps. Four stars.
(Source: Mikeyashworth/Flickr)


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Unknown; Estimated Early July 2010 - age 20.
Rae was never afraid of heights like Vivian was. She was the weird kid who used to climb into trees and up the fences on the baseball field at school until several teachers would somehow manage to get her down. So, naturally, she had no problem when they ran out of money to pay rent and got kicked out, ending up on a roof of an old apartment complex that was being demolished in a few weeks time. The building itself was too hazardous on the inside - which was the argument Rae used since she was not going to sleep in a room that sounded as if it would collapse on her at any moment - but the roof seemed fine. So far.
They lived like urchins, stealing and begging where they could. It was not a preferred lifestyle, obviously, but she dealt with it. She dealt with the glares as the two of them slouched on the sidewalk, waiting for someone to divert their attention. Both of them dealt with the disgusted glances on the days where they hadn't been able to nick some new clothes or sneak into a set of showers at a local gym. They dealt with the disappointed stares because they both appeared to be fine young women who could've been doing nicely elsewhere. She and Viv still attended college - thank God for scholarships and some leftover money from Tyler and Linnette before they moved out that just barely covered it - because education was still quite important. Education could get them a job - no matter how shit the pay was - and they'd be able to work their ways back into a permanent living situation. Despite being homeless, they still had some things: a few pairs of clothes, their laptops (like hell they were going to show up to class with the reek of the city on them and an obvious appearance of a street urchin), and a few other necessities. Their phones had already gone after they were unable to pay the phone bill shortly before getting kicked out. But it wasn't as if they needed to contact anyone, anyway - all they needed was each other.
Tyler and Linnette had rushed to their aid after hearing that Rae and Viv were incredibly low on money, but - to no surprise - they refused the help from their aunt and uncle. It was like a sort of determination to prove that they could survive on their own, instead of staying in the penthouse after high school graduation like their uncle had suggested. It was a pretty stupid way of thinking, but it wasn't as if the two sisters were known for making rational decisions.
Rae's feet pounded on the sidewalk, almost stubbing her toe at a particularly sharp corner. She made a mental note to snatch some new shoes whenever they next decided was safe to shoplift again. The repetitive pattern of either her or Vivian slipping into a store and disappearing without a trace was probably very noticeable, and Rae wondered if Tyler - being a police officer - was aware of what his nieces were up to. Sometimes, when they spotted an officer patrol car, they'd quickly duck behind the nearest cover, afraid of being discovered by their uncle. He was part of the law, a loyal enforcer, and they were breaking it over and over and over. She was actually surprised that Tyler hadn't hunted them down to ground them for life in jail already - but, then again, they didn't have active phones so he had no way to contact them.
Angry shouting came behind her, and she cursed her luck to hit a drugstore where an officer was just coincidentally shopping as well. Rae had been careless; she hadn't glanced around before nicking what she need, but her mind had been elsewhere. It had been a stupid mistake.
But, still, she got away. A quick turn into an alleyway, and she fell through the dark portal she had already conjured seconds earlier with her powers. The nausea came as she landed abruptly on her back, her breath escaping with a low "Fuck!". Rae wasted no time in recovering, though, and glanced around to make sure she had gotten her location right. Once she affirmed her doubt, she clambered up the fire escape, picking up her pace as her thoughts wondered if the officer had sent out an alert or if someone would stumble into this alleyway and see her heading to the roof and follow, suspicious. Reaching the top, she braced herself for the run. That was one of the things she hated most about that stupid old building - the place was literally falling apart. The elevators inside didn't work anymore, obviously, and the staircase creaked dangerously. Even the fire escape was gone, ripped down by wear and a few storms over the decades. Given all of that, it required a jump from the nearest building to get to the roof. Rae, while not afraid of heights, did pretty mediocre with jumping and any physical activity. She never did any sports - although they were under her interests - and didn't have a body for such.
She ran.
And jumped.
Her fingers brushed the ledge, gripping tightly the moment contact was made, and lost her breath for the second time in the previous half hour as her body slammed against the brick structure. Fuck. She managed to get her other hand up on the ledge but began panicking when her left hand started slipping, the digits losing circulation. Her heart raced, and she closed her eyes preparing for what would hopefully be a miracle. Her left hand scrambled for more of the ledge to hold onto, but the little feeling she had remaining gave her a pathetic attempt that only sent her a bit closer to slipping. Her feet dangled in the air, searching for footholds, but there were none where a fire escape formerly stood.
I'm gonna di- Her left hand slipped.
But, at the same time, another hand snatched her wrist and held on. Her sister's face appeared, peering over the edge. "You fucking idiot." It was a great thing to be greeted with. Not.
"Please don't let go." she muttered in a strained tone.
"Never." Vivian's tone carried with her the same irritation it gained a few years back, but at the same time, there was an underlying hint of that sister bond that had been stretched since they left high school.
Her sister dragged her up with a grunt, and Rae plopped on the roof, her eyes fixed on the sky as she regained her breath. She refused to meet the angry gaze of her sister and yanked out a bottle of medicine, offering it to her with a huff, "You're welcome." The bottle was snatched out of Rae's hand and all she got in response were irritated words. "I thought I told you to-" Cough. "Not sneak off." Rae shrugged, "You're getting worse."
"It'll pass."
"Yeah. And you'll be looking terrible and feeling terrible for the whole time. This makes it better, y'know?"
Vivian didn't respond, and Rae sat up, "So, what we were talking about before you coughed yourself to sleep this morning…"
Her sister scowled, "We're not gonna do… that-" Cough. Sniffle. "First thing. I don't care how much money it gets us. You're, you're not gonna go into that kind of… business." Vivian said 'business' like one said 'swine'. Rae shrugged, "Figured you'd say that." She was relieved, really. It had been a suggestion, but she wasn't too eager to get into bed with strange men or women just to get food and nick more bucks than paid from their wallets and purses.
"And the second thing?"
Vivian pondered and thought, "If, uh, if we can get ourselves into that, yeah. There's lots of profit."
"Lots of easy ways to fuck up."
"Well, it was your suggestion."
Rae exhaled then a thought crossed her mind, "Viv?"
"What?" She hated that sting that the irritated voice gave her.
"You got my back, right?"
"I'll take that as a yes."
More silence.
"I've got your back, too."
July 17th, 2010 - age 20.
"You said you've got my back!"
They looked like fucking weirdos, screaming at each other in the middle of the street. Rae took a step away from her sister; Vivian took a step forward.
"You've got my back, don't you?"
She ducked her head in shame, remembering her words from before, and muttered, "But this… it's different."
"No! It's not different, Rae! Goddammit."
Her fists clenched, "But-"
"Are you with me or not?" Vivian's tone was demanding. Controlling. Manipulative in ways that Rae hated but at the same time couldn't resist because her sister knew just how to get her to lose the fight.
"I… Fine." Her body sagged with defeat, and the hint of a triumphant smirk flickered across Vivian's features. A business card was shoved into her hand, and Viv gestured at the payphone a few feet away.
She approached the thing, inserted the money required, and swallowed down a bout of fear as the other side rang.
"Miss Edison." Rae recognized the voice of the man who had mysteriously approached them two days ago.
Vivian had said yes immediately; Rae said no; Vivian quickly corrected her at the man's half-angry, half-disappointed look and said, "She meant she'd think about it.
"Your sister did say you needed some… persuasion." She shuddered as she thought she heard a mocking tone in his voice. "So, do you have an answer for me, Miss Edison?"
Rae glanced at the business card in her hand.
"Um, yes."
"Do you have an answer for me or is your answer yes?"
"I-… Both."
She could almost hear the man's smile over the phone, imagine it on his features, unfaltering and triumphant.
"Excellent. Welcome aboard to Nexus Corporations, Miss Edison."


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Man turns himself in after hit-and-run
OMAHA, Neb. -
A man turned himself in to police after a hit-and-run accident on Sunday.
Manuel M. Rodriguez, 27, told police he was driving a pickup truck when it crossed the center line near 39th and L streets and hit a red Chevy Silverado.
Two children suffered injuries in the accident.
Rodriguez was booked for leaving the scene of a personal injury accident and driving under suspension.
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text: nycartscene nycartscene: thru Apr 26:"Alexander the Great: The Iolas Gallery 1955-1987" Paul Kasmin Gallery, 293 10th Ave., NYCthe exhibition showcases work by many major artists whose careers were defined through their work with influential 20th century art dealer Alexander Iolas. "Iolas played a pivotal role in twentieth century art in America. He is recognized for being among the first to introduce American audiences to Surrealism, mounting Andy Warhol's first gallery exhibition, and being an artist's advocate who championed work according to his own tastes, rather than popular trends. Iolas was known throughout his career as a passionate art lover who built deep personal relationships and facilitated intercontinental connections among artists, gallerists, and collectors via his eponymous galleries in Athens, Geneva, Madrid, Milan, New York and Paris. His influence spread to arts patrons as well. His close work with Dominique de Menil, for example, helped to define and build her collection." artists include: Victor Brauner, Giorgio de Chirico, William N. Copley, Joseph Cornell, Max Ernst, Lucio Fontana, Alain Jacquet, Ray Johnson, Marina Karella, Yves Klein, Les Lalanne, René Magritte, Roberto Matta, Jules Olitski, Man Ray, Martial Raysse, Ed Ruscha, Niki de Saint Phalle, Harold Stevenson, Takis, Dorothea Tanning, Paul Thek, Jean Tinguely, and Andy Warhol. nycartscene


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and the quality of service delivery and staffing."2 This section provides a brief history of PEPFAR's approach to HSS; this is followed by a more in-depth discussion of PEPFAR activities related to each building block of the health system.
History of PEPFAR's Approach to and Increasing Focus on HSS
In PEPFAR's first Five-Year Strategy, OGAC articulated the importance of supporting national strategies, laboratory systems, workforce training, and information systems because these components of health systems were essential for scaling up quality services (OGAC, 2005b). Recognizing that partner country health systems were not prepared to support needed services, OGAC committed to providing "targeted technical assistance, training, and funding to improve and expand the infrastructure necessary to ensure optimal delivery of HIV/AIDS treatment services" (OGAC, 2004, p. 39). Although "evidence demonstrates that scale-up of HIV services has produced stronger health systems and, conversely, that stronger health systems were critical to the success of the HIV scale-up" (Palen et al., 2012, p. S113), some have argued that the disease-specific nature of the PEPFAR program may have undermined a coordinated approach to health planning and delivery (Bärnighausen et al., 2011; Hanefeld, 2010; OGAC, 2009f).
OGAC has recognized the largely ad hoc nature of HSS interventions during the first phase of the PEPFAR program (2004–2009) and also the lack of a strategic focus on strengthening each building block of the health system (OGAC, 2009f). PEPFAR-supported HSS interventions were largely disease-specific or somewhere on the continuum between disease-specific and a broader health system response (see Table 9-1). The reauthorization legislation provided the opportunity for PEPFAR to formally identify and support strategies to "strengthen overall health systems in high-prevalence countries, including support for workforce training, retention, and effective deployment, capacity building, laboratory development, equipment maintenance and repair, and public health and related public financial management systems and operations"3 as well as for PEPFAR and partner country governments to commit to a "deeper integration" of HIV services into existing national programs and systems.4 The reauthorization legislation laid out goals for PEPFAR to strengthen health policies and systems for not only HIV/AIDS, but also tuberculosis and malaria, in support of increasing
2 Tom Lantos and Henry J. Hyde United States Global Leadership Against HIV/AIDS, Tuberculosis, and Malaria Reauthorization Act of 2008, P.L. 110-293, 110th Cong., 2nd sess. (July 30, 2008), 101(c), 22 U.S.C. 7611(c)(2)(B)(ii).
3Ibid., 301(c)(5)(D), 22 U.S.C. 2151b-2(d)(6)(G)(ii).
4Ibid., 301(c)(6), 22 U.S.C. 2151b-2(d)(8).


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- Official Sites
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Wyoming, IL
This Afternoon
Wyoming is a city located in Stark County, Illinois. As of the 2000 census, the city had a total population of 1,424. It is the headquarters of the Rock Island Trail State Park.
Wyoming is located at 41°3'49" North, 89°46'27" West (41.063576, -89.774041).
According to the United States Census Bureau, the city has a total area of 1.9 km2 (0.7 mi2). 1.9 km2 (0.7 mi2) of it is land and none of it is covered by water.
As of the census of 2000, there were 1,424 people, 629 households, and 408 families residing in the city. The population density was 743.0/km2 (1,918.1/mi2). There were 669 housing units at an average density of 349.1/km2 (901.2/mi2). The racial makeup of the city was 99.09% White, 0.00% African American, 0.00% Native American, 0.21% Asian, 0.00% Pacific Islander, 0.00% from other races, and 0.70% from two or more races. 0.07% of the population were Hispanic or Latino of any race.
There were 629 households out of which 26.1% had children under the age of 18 living with them, 53.1% were married couples living together, 8.9% had a female householder with no husband present, and 35.1% were non-families. 32.1% of all households were made up of individuals and 17.6% had someone living alone who was 65 years of age or older. The average household size was 2.26 and the average family size was 2.84.
In the city the population was spread out with 22.3% under the age of 18, 7.7% from 18 to 24, 24.4% from 25 to 44, 23.9% from 45 to 64, and 21.6% who were 65 years of age or older. The median age was 42 years. For every 100 females there were 85.7 males. For every 100 females age 18 and over, there were 84.0 males.
The median income for a household in the city was $30,463, and the median income for a family was $41,797. Males had a median income of $30,074 versus $22,115 for females. The per capita income for the city was $16,574. 10.6% of the population and 9.1% of families were below the poverty line. 13.5% of those under the age of 18 and 7.1% of those 65 and older were living below the poverty line.


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I was appalled to read your full-page feature on Henry Watkins Allens, a traitor to the United States of America.
The Confederate States were never recognized as a nation, only a band of murderous citizens who fought to maintain slavery as the basis for their collective economies. They made their money from the flesh of humans. Your glorification of this treasonous individual only serves to stoke the real fires of bigotry and separatism still burning in our state.
God save America from the hero worship of people like Henry Watkins Allen.
Terrence Verigan
technology consultant
Copyright © 2014, Capital City Press LLC • 7290 Bluebonnet Blvd., Baton Rouge, LA 70810 • All Rights Reserved
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Roger will be playing an intimate set with Jim Toscano on percussion, Matt Schneider on Bass, Cello and Vocals, and Frank Ferrara on Electric Guitar and Vocals. This is a beautiful room in a great neighborhood. We hope you can make it! Check out the "Shows" Section for tickets and details!
An interview and live performance with John Platt will be aired on Sunday 7/6 between 8:00a-11:00 on WFUV, 90.7. A big thanks to John for having us on the program!
The GlenCoveRecordPilot recently wrote a great piece on my experience with fatherhood and being a musician. Check it out here!


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Joe Dumars, among his other problems in the last several years, has done a terrible job of communicating his views to diehard Pistons fans.
Dumars wants to remain behind the scenes, and when he speaks publically, he doesn't want to reveal too much. I get that.
But when the Pistons are as bad as they've been lately, only diehard fans are listening anyway, and simple platitudes won't placate them.
Thankfully, Zach Lowe of Grantland has pulled incredible information from Dumars in an amazing Q&A. The discussion includes:
- How Josh Smith, Greg Monroe and Andre Drummond can learn from the Hawks and Grizzlies (a topic I expounded upon at ProBasketballTalk)
- How the Brandon Jennings sign-and-trade came to fruition
- The subtle differences between Jennings and Brandon Knight
- Dumars' research into Jennings' background
- Why Dumars expects more from Monroe defensively (a topic Lowe previously covered)
- Drummond's simple free-throw mistakes
Here's one example of the depth of their conversation:
In contrasting Knight with Jennings, one little thing stood out: They are both good 3-point shooters, and Knight has actually been a little better. But Jennings takes a ton of 3-pointers off the dribble on the pick-and-roll, and shoots very well on those shots, while Knight takes most of his from spot-up situations — when he doesn't have the ball until it is passed to him. Did you notice the same thing? It seems like that fits with what you're talking about.
You've done your homework. We like his ability to score off the bounce, if you will — to be able to pull up and make shots, and come off a pick and penetrate, and dish, and score those little floaters in the lane. We feel it's imperative to do all of that in today's game.
And now we have people for him to get the ball to. I'd also say this: We like his ability to see the floor. He shoots a lot, but it's not that he doesn't see the floor well. During the four days we were talking about the trade, we broke down hours and hours and hours of film of him, watching him, offensively, just watching his assists. Just watching to see: "Does he see the floor?" And for us, that really hammered it home.
I don't have a lot to add. Read the whole thing, and you'll be a smarter fan.
Tags: Andre Drummond Brandon Jennings Brandon Knight Greg Monroe Joe Dumars Josh Smith


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And now for some newer guns.
Last week I posted about some historical reproductions. Now let's have a quick overview of some newer guns we got to try on the same trip to the range. I'll include some *very* brief comments, and may return to do longer reviews later when I have some additional time.
First up, the USFA ZiP .22LR, shown with 25-round mag for additional grip purchase:
Comments: Ugh. I hated this gun. Seriously. It's awkward to hold, worse to shoot, all sharp angles and weirdly thick. It's the kind of ugly that isn't even interesting. The design requires you to put your hand right up close to the muzzle to cycle the action. Since it was brand new, I'll forgive it having problems cycling properly (this is fairly common with rim-fire guns which are brand new), but I sure as hell wouldn't want to have to shoot it enough to break it in.
Bottom line: if someone insisted on giving me one of these, I'd just turn around and sell it to use the money for almost any other purpose.
Next, the Excel Arms MP-22 .22mag Accelerator:
Comments: Nice gun. Shot very well, and the 8.5″ barrel is sufficiently long to get some benefit out of the .22WMR cartridge. The heavy bull barrel also does a good job of taming the recoil and muzzle-flip, as can be seen in this vid:
Next, the SIG 232 .380acp:
Comments: SIG SAUER's version of the classic PPK. Just what you'd expect: quality, accurate, easy to shoot for even someone with large hands, as can be seen in this image of my buddy who has even larger hands than I do:
Next, the Glock 42 .380acp:
Comments: I did not expect to like this gun. I was REALLY surprised when I did. Seriously, it is the best-shooting Glock I've ever handled. For such a small gun, it fit my large hands comfortably and was easy to shoot well. With Glock quality and reliability, this may be the first .380acp I would seriously consider as a CCW gun.
Next, the Kimber Solo Carry 9mm:
And here's a vid of shooting it:
Comments: Kimber quality. Lot of power in a small package, and I felt it in the web between thumb and forefinger of my dominant hand. But that was just a sting, not uncomfortable, even shooting premium SD ammo. Another good candidate for CCW.
And here's a quick look at an old classic: Winchester Model 70 XTR Featherweight in 6.5 Swedish (6.5mm x 55mm)
Comments: Like I said, a classic. And as such, a known quantity. But the first time I've shot one in 6.5 Swede, and I was pleasantly surprised by how little recoil there was.
Well, that's all that I have images of, though we also shot a Chiappa M1-22 and a KelTec PMR-30 .22 mag. Again, both are known quantities and shot as expected. Oh, and my buddy gave my Steyr S9 a go, and you can see that vid here.
As noted, I may revisit any of these with a longer review sometime later, but don't hold your breath.
Jim Downey
Perceived recoil and bullet weight.
Got a great question recently, and I thought I would share some of my thoughts about it, then invite others to weigh in. Here's the question:
I hope that you folks can help me with a question I have had for many years now. Why is the recoil so much heavier with lighter bullets in the same caliber and powder loadings than heavier bullets of the same caliber and loadings?
For example. With my S&W model 60, Gold Dot L/E 38 special 135 grain JHP +P loads recoil much harder than the Remington 125 grain JHP +P loads. The same thing happens with my Glock mod 23 .40cal when I shoot 180 grain JHP rounds vs 165 grain JHP rounds. The 165 grain rounds recoil much harder. One would think the heavier round with the same powder load would recoil harder. Can you help?
Perceived recoil is a surprisingly complex problem. It's not just a matter of total force, but the 'shape' of the recoil impulse as well. Then there are the ergonomics of how a particular gun fits a particular person/hand. Add in the mechanical action of how the gun operates (some use part of the recoil energy to cycle the action, some don't), and various psychological/physiological factors (are you tired? just had an adrenaline dump? afraid of a given gun/caliber/cartridge?), and you can see how many different factors might come into play.
A good place to start is to look at the equation for Muzzle Energy (ME). Let's use the numbers for the Steyr M40 (very similar to your Glock 23) which was one of the 'real world' guns used in the .40 S&W tests we did. Calculations are from Airhog.
The 165gr Federal Hydra-Shok JHP has a velocity of 943fps out of the 4″ barrel. That gives a Muzzle Energy of 325.88ft-lbs.
The 180gr Federal Hydra-Shok JHP has a velocity of 989fps out of the 4″ barrel. That gives a Muzzle Energy of 391.04ft-lbs.
OK, that would seem to indicate that the heavier bullet should cause more recoil. The ME is higher, and you're shooting them out of the same gun.
But I'm a little wary of that example. Usually, a lighter bullet is faster than a heavier one if they have the similar powder charge, out of barrels of the same length. Here's another example, looking at 9mm from a Beretta 92.
The Cor-Bon 90gr JHP +P has a velocity of 1522 out of the 4.875″ barrel. That gives a Muzzle Energy of 463.05ft-lbs.
The Cor-Bon 125gr JHP +P has a velocity of 1291 out of the 4.875″ barrel. That gives a Muzzle Energy of 462.72ft-lbs.
And those are very close to the same amount of ME, and should feel about the same in terms of recoil were that the only factor.
So what's going on? Why do we see one instance where the ammo is just a bit faster in the heavier bullet (resulting in higher ME), but much slower in another instance?
I suspect that it's probably due to differences in loadings between the different ammo. Even with ammo from the same manufacturer (in the examples above), there's nothing saying that they are using either the same propellant OR similar amounts of the same propellant for loadings which use different bullet weights. That means that trying to generalize the amount of recoil between different bullet weights just on the basis of brand is difficult if not impossible.
Furthermore, if you've done any reloading, or spend some time looking over reloading data, you'll know that even when you're using the same propellant in the same cases, different bullet weights usually means different bullets (in terms of manufacturer and/or shape) resulting in different seating depths and overall length. It may seem to be a trivial matter, but this results in different pressure profiles (the amount of pressure within the firing chamber of the gun). Just one example, taken from the Hodgdon Reloading site, for maximum-pressure loads using GDHPs:
The 90gr bullet with 7.0gr of Longshot powder has an overall length of 1.010″ and gives a velocity of 1,378fps, a pressure of 32,300 PSI, and would have a ME of 379.57ft-lbs.
The 115gr bullet with 6.0gr of Longshot powder has an overall length of 1.125″ and gives a velocity of 1,203fps, a pressure of 32,300 PSI and would have a ME of 369.64ft-lbs.
Note that while the heavier bullet uses a full 1.0gr less of propellant and has a longer overall length, it generates the same amount of pressure. If we drop back to the same amount of the same powder for each loading (6.0gr), then the pressure generated in the lighter bullet loading drops to 29,400 PSI, velocity drops to 1,278fps, and ME drops to 326.48ft-lbs.
But not all pressure is created equal, even if it is nominally 'the same'. The pressure impulse also matters. That's the curve of how the pressure rises and falls over time, which is largely related to how 'fast' or 'slow' the propellant burns. Propellants used for handgun loads tend to be very 'fast' (burn rapidly), so the impulse tends to be sharper. Here's a good explanation of the matter.
And if you think about it, the heavier the bullet used, the longer/slower it takes to start moving when the cartridge is fired. That should mean that the impulse is spread out over a slightly longer time than it would be with a lighter bullet. So in some sense, the lighter bullet would result with a 'snappier' feel. And that may well be what it is that you're feeling when you experience more perceived recoil (and have controlled for all the other factors) from lighter bullets.
Other thoughts on the subject?
Jim Downey
Wait … it's 2014?? How did THAT happen?
2013 was a busy year for BBTI.
We did the .22Mag tests. We did the 9mm Glock Tests. I got my .460 Rowland conversion up and running. And I found some really fun .44Mag +P+ loads, then figured out a simple hack so that they would feed reliably in my lever gun. Like I said, a busy year.
And we couldn't have done it without help. Of several types. To see the list of those donors who have helped offset some of our operating costs, pop over to the BBTI site. And here's a list of the top-10 referring sites (excluding search engines and Wikipedia):
- thefiringline.com
- defensivecarry.com
- guns.com
- thefirearmblog.com
- ar15.com
- thetruthaboutguns.com
- survivalistboards.com
- glocktalk.com
- reddit.com
- rimfirecentral.com
Altogether, we had 243,230 visitors to the BBTI website, and some 12,000+ views of this blog. Since we've gone through several iterations of the site over the last five years, it's hard to say exactly how many visitors or pageviews or hits we've had in total — but it's more than we ever really expected. Thanks, everyone.
And particular thanks to my Good Lady Wife, who has done all the webwork and most of the number crunching over the years.
We don't currently have any concrete plans for new tests in 2014. But who knows? Keep an eye here and on our Facebook page for news.
Happy New Year, everyone!
Jim Downey
Some Muzzle Energy comparisons.
I got a nice note from Jason at Leaf Technologies, who had been curious about how different cartridges compared in terms of Muzzle Energy (ME). So what he did was take the data from BBTI and average the ME curves for the cartridges he was interested in, then plot them head-to-head in one Excel graph. He sent me the result, and with his permission I am sharing it here:
(Click to enlarge.)
I always love to see how others use our data, and the conclusions they draw from it. It's EXACTLY the sort of thing we hoped would happen, and why we've made the data freely available. If you would like to read some of Jason's conclusions, and the discussion they engender, pop over to the Northeast Shooters Forum.
And if you have your own interesting spin on how our data can be used in a new way, drop me a note. If I think it'd be of interest to others, I'll be happy to post it here/link to it. Just send an email to firstname.lastname@example.com
Jim Downey
Happy Thanksgivuk … er, I mean Birthday!
OK, first: Happy Thanksgiving to all my fellow Americans. And Happy Hanukkah to all who observe it!
But most of all,
Happy Birthday to BBTI!
Yeah, it's our fifth birthday. We officially launched the site on Thanksgiving in 2008. And it's been a fun romp since then. We've gone through many different iterations on the site, adding in more calibers/cartridges, doing the big cylinder gap test, tweaking this and changing that. We've shot something on the order of 22,000 – 23,000 rounds. We've had something in excess of 20 million hits to the site. We've invested more than $50,000 and untold hundreds of hours of labor. And we've become pretty much the default resource for anyone who has needed (or just wondered about) data pertaining to handgun ammunition performance over barrel length. Like I said, it's been fun! Thanks for helping to make it so!
And since it is our birthday, it's time for a gift in the form of a whole new section to the BBTI website:
From that page:
For years people have wondered about the effects of the different styles of rifling, and whether one or the other would offer specific advantages for accuracy or velocity from a given cartridge. But since many different factors can have an effect on both accuracy and velocity, these discussions have largely remained anecdotal. We decided to see whether we could generate data as to performance differences between the two styles of rifling as concerns bullet velocity, using our standard chop-test techniques. The data on this page is the result of those tests.
Check it out when you get a chance! And thanks again to all who have shared links to our site, who have sent us emails, who have contributed to help offset our costs — you folks have made our success possible, and it is very much appreciated.
Jim Downey
PS: as a personal thanks as well, I have made both my first novel and our care-giving memoir available for free download for today and tomorrow (Nov. 28th & 29th).
With charts! Graphs! Slo-mo!
John Ervin at Brass Fetcher Ballistic Testing has put together another great video presentation, showing in several ways how Jacketed Hollow Point (JHP) ammo performs in comparison to Full Metal Jacket (FMJ) ammo for 9 different handgun cartridges. It's long (22 minutes), but very nicely documents just exactly how the two different bullet styles behave at handgun velocities. Here's the video:
The cartridges covered are .22 LR, .25 ACP, .32 ACP, .380 ACP, 9mm Makarov (9×18), 9mm Police (Ultra), .38 Special, 9mm Luger (9×19), and .45 ACP. His data and presentation makes a great companion to our own data, and I really recommend that you set aside the time to watch the video at your earliest convenience.
Jim Downey
How long is too long?
We've long known that many pistol calibers/cartridges are optimized for fairly short barrels — you see real benefits in increasing barrel length out to 6″ or 8″ or so, with diminishing returns beyond that. (The exception to this is the 'magnum' rounds: .44mag, .357mag, etc.) It's not that you don't see any benefit in a longer barrel, but the gain tends to flatten out. Take a look at the muzzle energy graph for the 9mm Luger (9×19) and this is quickly apparent:
Take a look at the left side of that graph. There's some indication that the bullets are actually slowing down in the last couple of inches of an 18″ barrel. Whether or not this is just a glitch in our earlier test data, or an indication that friction is starting to win out over the remaining energy from the expanding gas of a fired cartridge is something I've always wondered about. Clearly, at some point a bullet will start to slow down, even stop; anyone who has ever fired a squib load and had to hammer the bullet out of a barrel knows that this can indeed happen. But at what point would this effect start to be clear?
Good question. And not one we really wanted to spend the money on to find out. See, the barrel blanks we've used all along came in an 18″ length standard for pistol calibers/cartridges. Longer barrels were available from different sources, but there was a big jump up in price for those, and it just didn't make much sense to get into that.
However …
When we started to set up to do the so-called "Glock Tests" we had to find a different source for our barrel blanks, since our other supplier couldn't provide a polygonal barrel (the kind of barrel Glock uses, though they are not unique in this). We sourced the barrels from Lothar Walther. And as it turned out, their barrel blanks are longer than 18″. Specifically, we received a 26″ barrel with traditional land-and-groove rifling and a 24″ barrel with polygonal rifling. Here they are:
So …
Well, we didn't want to spend the time and money doing full chop tests from 26/24 inches down to 18″. But we did decide to just go ahead and get some benchmark data at the full length, just for shits and grins. And here is the data for those lengths, along with data from 18″, 17″, and 16″ lengths for comparison:
PNW Arms STD P 115gr SCHP
Trad: 1074 fps 1161 fps 1163 fps 1171 fps
Poly: 1064 fps 1131 fps 1131 fps 1135 fps
Federal STD P 115gr Hi-Shok
Trad: 1305 fps 1330 fps 1333 fps 1330 fps
Poly: 1323 fps 1331 fps 1336 fps 1135 fps
CorBon +P 115gr DPX
Trad: 1117 fps 1232 fps 1249 fps 1236 fps
Poly: 1057 fps 1186 fps 1195 fps 1208 fps
Black Hills +P 115gr JHP
Trad: 1494 fps 1508 fps 1512 fps 1498 fps
Poly: 1496 fps 1521 fps 1515 fps 1518 fps
Federal STD P 147gr JHP
Trad: 1036 fps 1061 fps 1084 fps 1085 fps
Poly: 1046 fps 1088 fps 1098 fps 1088 fps
So, there ya go: in each and every case, there is a noticeable decrease in velocity in going from an 18″ barrel to either the 24″ or 26″ barrel. And keep in mind that the protocols for this test were 10 shots of each ammo at each barrel length over two chrono units, rather than just 3 shots as we had done for previous chop tests.
Not too surprising, but nice to see actual data.
We hope to have the full data sets, with charts & graphs, up on the website soonish (maybe next week?). Watch here and on our FaceBook page for a posting when it is available.
Jim Downey
M1 .30 carbine performance.
Got another nice email with a video link from John Ervin at Brass Fetcher Ballistic Testing, this time covering the performance of the venerable M1 Carbine .30 cal cartridge. From John:
Despite its handsome wood furniture and vaguely military-type appearance, the M1 Carbine is an effective firearm for self-defense and small game hunting. Hornady makes 'Critical Defense' ammunition for it now and Federal continues to make its excellent 110gr SP, so good ammunition choices are available for M1 Carbine owners.
The M1 Carbine is excellent for its low recoil, small mechanical sight offset and cartridge that is sufficient in lethality to repulse human attackers (when using good soft point ammunition) at distance.
And here's the video so you can see for yourself:
I'll leave it at that for now … I have a lot to do this week to get ready for our 9mm "Glock Tests" this coming weekend. Yup, those are finally happening. I'll post some preliminary thoughts/results probably this weekend or the first of next week, with full info to come after we have a chance to crunch the numbers a bit.
Jim Downey
Ammo shortage? What ammo shortage??
Oh — THAT — ammo shortage.
Yeah, the beginning of January I wrote that we were finally moving forward with the testing of polygonal vs. traditional rifling; the so-called "Glock Tests", and outlined how we were planning on conducting a bit of an experiment in asking for suggested ammo loads to include in the tests, and then seeing what kind of support there was for a slate of different choices by allowing pledges to help purchase ammo.
But, as someone who wrote me put it: where did we think we were going to *find* any such ammo?
Initially, I thought that the shortage we were seeing would be a fairly temporary problem, and that by the time spring rolled around we'd be able to locate sufficient quantities for our testing (we need about 350 rounds of each type).
Yeah, so much for that idea. Now you know why I don't play the stock market or bet on races.
The ammo shortage has just continued to deepen. It's to the point where people are having a hard time finding enough of any kind of ammo just to keep in practice with a trip to the range once or twice a month. I'm damned glad I reload my practice ammo, and have a decent store of most components.
But that doesn't do a damned thing for our testing. The whole idea is to test factory ammo, not some cobbled-together handload version of factory ammo.
So we're putting off the "Glock Tests" again, until the situation gets better. Keep an eye here and elsewhere for news about when this will change.
One good bit of news, however: we already had a decent selection and sufficient quantity of each ammo type to do the .22WMR (.22Magnum) tests. So we're going to go ahead and do that sequence of tests here this spring — sometime soon!
Sorry for the bad news, everyone — really. These tests have been delayed several times for one (good) reason or another, and we're just as frustrated by that as everyone else. But when ammo supplies start to become more available, we'll be sure to try and get them done as soon as we can.
Jim Downey
Now, about those "Glock" tests…
As mentioned previously, for some time we've been planning on doing a series of inch-by-inch chop tests on the Glock-style polygonal barrels (Glock was unable to supply 18″ barrels, so we'll be using 6 grove poly and 6 land traditional barrels from Lothar Walther). We've run into a number of unexpected delays, but now have the barrels we need, and are planning on doing the series of tests sometime later this year, hopefully in spring/early summer. For testing purposes, we'll be conducting traditional 'land & groove' barrels in the same calibers at the same time, so that we have direct head-to-head comparisons. Because we're expecting a fairly subtle difference in performance, we're going to do 10 (ten) shots for each inch of barrel for both style barrels. And to keep the scope of the project manageable, we're only going to test two cartridges/calibers: 9mm (9×19) and .45 ACP.
In order to do the tests this way, we'll need a minimum of 340 rounds of each ammo to test. Add in "real world guns" and allowing for errors/glitches which mean extra shots, we're planning on getting 400 rounds of each ammo to be tested. Figure an average of about $1 per round for premium self-defense ammunition, and we're looking at about $400 for each ammo selected for testing. There are some specific ammunition types/loads we've tested previously that we want to revisit for comparison purposes, but our selection is hardly comprehensive — time and money are limited.
So we'd like to try an experiment: do Kickstarter-style crowdfunding to see what ammunition types/loads people want to have us test. This will allow two things:
- To let people help support the project by offsetting our costs.
- To help us find new ammunition types/loads.
Now, Kickstarter itself isn't firearm-friendly. And that's OK — we can do this on our own, just using our own site. What we'll do is put up a list of different ammo types/loads, and solicit donations targeted for each during a specific time frame. When pledges are made, we'll keep a running tally total for each ammo, and once it crosses a certain threshold, then that specific type/load will be added to our testing list.
But first we need to create our list of ammo. So, for the next two weeks, either add a comment to this blog post or send an email to email@example.com with one specific 9mm ammunition type/load you would like to see us test. Please, just one type/load per comment or email, and just five or six such entries per person. I'm going to have to collate these myself, so help make it a little easier on me. Just sending in a selected ammo doesn't obligate you to support that ammo with $ in the second phase of this test, but it's probably a good idea to only recommend ammo you would be willing to actually support, and ones you think you can get others to support. And remember, keep your recommendations limited to factory mass-produced ammo; handloads or artisanal ammo which the average person doesn't have access to will not be selected for inclusion in the tests. Also: we're only accepting recommendations and donations from individuals, not ammo manufacturers.
You can see all the 9mm ammo we've tested previously here: 9mm Luger Results.
As I said, this is an experiment. If it works for selecting 9mm ammo to test, we may extend it to the .45 ACP tests, and then see about using a similar approach for other testing. We hope that this will be a way we can expand our research and make it more responsive to what data the firearms-enthusiast community wants to see. You can help by sending in your suggestions, but in also spreading the word on the different forums/blogs where our data may be used.
Thanks, everyone, for your ongoing interest and support!
Jim Downey
Last chance.
So, we have a new winner! Kyle won the all-leather IWB of unknown make.
The next, and final, holster in our drawing is very much a known brand: a High Noon Holsters "Skin Tite" model leather OWB. This is a right-handed almost new holster which has a $54.95 value (plus shipping).
This particular holster is marked for a Steyr M. But just about any medium-large semi will fit (though the retention snap may not be in the perfect position). Interestingly, both a full-size 1911 and my Ruger Mark I fit perfectly (with the barrel protruding out the bottom).
Rules are the same as previously:
So, here's the deal: make any kind of contribution to the Kickstarter (as little as $1.00 – I won't mind), and enter into this drawing for a holster. Please note that this is *IN ADDITION* to the other rewards there on the Kickstarter – all perfectly good and valuable rewards. Then just come here and leave a comment, or post it on the BBTI Facebook page, or send me a Tweet. I'll enter your name into a completely separate drawing. And next Wednesday after the Kickstarter is over I'll select a name and send that person this holster is up for grabs.
If you've already contributed to the Kickstarter, just let me know and your name will go in the hat for this drawing.
Last chance – get your entries in and help me out with making the Kickstarter a success! Thanks!
Jim Downey
Up next …
… in my holster give-away is a very sweet all leather IWB of unknown make. It's non-molded, and should accommodate almost any semi from medium to full size. Here are some pix of it with my Steyr M357:
But I also checked to see whether the following would fit:
- Full-sized 1911 (fits fine, barrel protrudes about 2″ out bottom)
- Steyr S9 (fits fine, much like the M357)
- Springfield EMP (rides low, but secure)
- J-frame S&W revolver (same as EMP)
Smaller semi-automatics and derringers do fit, but sit so far down inside the holster that they are difficult to retrieve.
Same rules as previously:
So, here's the deal: make any kind of contribution to the Kickstarter (as little as $1.00 – I won't mind), and enter into a drawing for a holster. Please note that this is *IN ADDITION* to the other rewards there on the Kickstarter – all perfectly good and valuable rewards. Then just come here and leave a comment, or post it on the BBTI Facebook page, or send me a Tweet. I'll enter your name into a completely separate drawing. And each week or so while the Kickstarter is going I'll select a name and send that person whichever holster is up for grabs. Each winner's name will go back into the hat for the next drawing, so you have multiple chances to win (meaning that the sooner you enter, the better for you).
If you've already contributed to the Kickstarter, just let me know and your name will go in the hat for the first drawing (and subsequent ones).
I will draw a winner next Friday, Oct 12.
And here's a heads-up: the final drawing will occur on Wednesday, Oct. 17, — the day after the Kickstarter ends. And that item will be a High Noon Skin Tite holster. Remember – you just need to "enter" once, and you will automatically be added to both drawings. So, what are you waiting for? Go register!
Jim Downey
The $1 freebie – PLUS!
So, I have another free promotional day running on my novel Communion of Dreams today. All the info about it is in this blog post: the $1 freebie.
That's all well and good. But as noted previously, I am offering BBTI fans a little something extra:
That's a pair of Versacarry holsters with a paperback copy of the book. These are both for .380/9mm/.357 Sig barrel guns, and are the "small" and "medium" sizes.
If you're not familiar with the Versacarry, here's a good review by one of the other Guns.com writers. I've tested these two holsters, and found them to be an interesting and potentially useful minimalist IWB holster.
But as I noted previously, I'm not a fan of IWB. So I'm giving both of these Versacarry holsters away. Same rules as last time:
So, here's the deal: make any kind of contribution to the Kickstarter (as little as $1.00 – I won't mind), and enter into a drawing for a holster. Please note that this is *IN ADDITION* to the other rewards there on the Kickstarter – all perfectly good and valuable rewards. Then just come here and leave a comment, or post it on the BBTI Facebook page, or send me a Tweet. I'll enter your name into a completely separate drawing. And each week or so while the Kickstarter is going I'll select a name and send that person whichever holster is up for grabs. Each winner's name will go back into the hat for the next drawing, so you have multiple chances to win (meaning that the sooner you enter, the better for you).
If you've already contributed to the Kickstarter, just let me know and your name will go in the hat for the first drawing (and subsequent ones).
So, what are you waiting for? Go register!
I'll draw a name from those submitted on Friday, Oct. 5th.
Jim Downey
Take a chance on a holster.
I haven't mentioned it here yet, but last weekend I launched a Kickstarter project to support my next novel:
St. Cybi's Well – a prequel to Communion of Dreams by Jim Downey
Prequel to the popular novel Communion of Dreams. Get an early release download or a hand-bound copy in your choice of cover material.
So, *why* am I mentioning it here now?
Well, yesterday I got an unexpected box in the mail. Sometime a few weeks back I contributed a few bucks to a firearms-related website, and was entered into a drawing for various goodies. I never win these things, but participate just to be supportive of groups I like. Anyway, as you might have guessed, I actually won something for a change. This is what the box contained:
Here's the holster with my Springfield EMP in it:
This is a perfectly nice holster, made by Woodenleather.com. It's marked as being for an "L-frame" S & W revolver with a 2.5″ barrel, but as you can see it isn't molded specifically for that, and seems suitable for IWB use with a range of medium-to-small guns. I also tried my Steyr S9 and M357 guns, which fit perfectly, and smaller guns such as a Bond Arms derringer would also work, but ride deeper in it. A full-size 1911 and my Colt Python both fit fine, but the barrel protrudes out the end.
Now, the thing is, while this is a mighty fine holster, it's made to be either used IWB or OWB left-handed. Note the position of the clip in the second image above. To me, it's useless (or almost so). As I was thinking of how to find a new home for it, I also got to thinking about several other holsters of varying quality I have which I have wound up with but which I never use and I had another idea: use them for a promotion for the Kickstarter.
So, here's the deal: make any kind of contribution to the Kickstarter (as little as $1.00 – I won't mind), and enter into a drawing for a holster. Please note that this is *IN ADDITION* to the other rewards there on the Kickstarter – all perfectly good and valuable rewards. Then just come here and leave a comment, or post it on the BBTI Facebook page, or send me a Tweet. I'll enter your name into a completely separate drawing. And each week or so while the Kickstarter is going I'll select a name and send that person whichever holster is up for grabs. Each winner's name will go back into the hat for the next drawing, so you have multiple chances to win (meaning that the sooner you enter, the better for you).
If you've already contributed to the Kickstarter, just let me know and your name will go in the hat for the first drawing (and subsequent ones).
So, what are you waiting for? Go – get entered!
Jim Downey
And once again…
…I am reminded of how happy I am to not have to deal with the public day in and day out.
As I said two months ago:
People really will always find something to bitch about, won't they? Even if it is free & unencumbered research data that they can't get elsewhere.
This time I got a complaint from someone about our having excluded a particular make of handgun. No "Hey, thanks for the data, I wonder why you haven't tested This Brand?" Or "I love the site, but is there a reason why you've not included This Brand?" Just an email with the header "WHY NO GLOCKS TESTED?" Yeah, all caps. Nothing else other than the question repeated in the body.
I actually get some variation of this question just about every week. Let me rephrase that: at least every week. Which is why that question is at the top of the FAQ on the BBTI site.
I responded, as I usually do, with that link and some variation of: "we didn't include them because we hate them" (which is joking off of what the FAQ says). Usually this takes care of the issue.
But sometimes people either don't go look at the FAQ, or are too dense/sarcasm-impaired to "get" my response. That was the case with the current querent. After a couple more exchanged emails I finally convinced him that we don't actually hate Glocks.
But the truth is, we *have* intentionally excluded Glocks so far. As I told my querent in my final email:
There are a lot of different factors which go into the selection of the guns we include in our tests. Glocks have a different barrel structure, so comparing them with the 'standard' rifling tends to skew results. For this reason we've so far avoided including them.
I say "so far" because we're presently in the process of finalizing a test sequence where we do the formal inch-by-inch chop tests on Glock polygonal barrels. It's taken us two years to be able to get the necessary 18″ blanks to do this properly. Having that data will allow us to do head-to-head comparisons with the 'standard' rifling results, and so give everyone data which actually is useful rather than just anecdotal. And yes, as part of that sequence we will be testing actual Glocks in different calibers and with different barrel lengths. We hope to be able to conduct these tests yet this fall, but are waiting on the gunsmithing work to be done.
This isn't actually "news" – I hinted at it in June on the BBTI Facebook page (which you should "Like" if you're on FB, so you see these things sooner), but it is the first I've mentioned it here or on any forums.
Anyway, yeah, I'm glad I don't have to deal with the public on a daily basis any longer. My blood pressure problems would be a lot worse than they actually are.
Jim Downey
…bring May flowers.
Well – I see that I didn't post stats last month for March. Sorry about that – a combination of being busy promoting my novel as well as getting together with some of the other BBTI guys to do some fun shooting (and to try out a .460 Rowland conversion kit for a Glock 21!).
So, first things first: March had a total of 21,499 visitors, and April had 19,918 visitors. Just a bit of a slow period there.
Next, remember that we're now linking from the BBTI page on Real World Guns to reviews of said guns I've written for Guns.com. There are usually a couple new each week, so check back often!
And here is the first of some additional reviews from my shooting expedition the beginning of April: Wise Lite Arms Sterling 9mm. Coming weeks should see more than a dozen other reviews of handguns and PCCs (pistol caliber carbines).
A quick note that things with my novel have been going great, and so far some 14,000 people have downloaded the Kindle edition. If you enjoy my reviews and articles, then you may want to check out the book – it's been getting a lot of really good discussion and reviews.
It's Up!
The new Ballistics By The Inch site is now up and running! Bigger, Faster, And with More DATA! Take a look, spread the word, let us know if there are any glitches or problems.
Jim Downey
Interesting development.
Interesting – for the first time, I've seen someone use the BBTI data as a baseline for whether or not to trust claims by an ammo manufacturer about the performance of other ammo which we haven't tested. Here's the quote from a discussion on THR:
As Mayo has already said, it's from Corbon. If you will check Corbons velocity claim for other loads with the ballistic by the inch's real gun tests of the same loads, you will see they are very close. Therefore I'm comfortable with using the Corbon site data for this load.
Perhaps a subtle distinction, but to a certain extent it moves our data into the category of being the trusted independent research by which other things are measured. Very interesting, indeed.
Jim Downey
(Oh, something else: my latest article is up on Guns.com, and now my byline also has links to all my other articles, if you're interested.)
New round of .380 ACP tests.
Well, it was a fun couple of days this week out at Camp BBTI – doing a new round of testing, primarily focused on the .380 ACP cartridge (9x17mm). This has become an increasingly popular cartridge used for small self-defense guns, so we decided to expand the different ammos we tested using the BBTI 'chop tests' as well as a dozen real world guns. You can see the guns here:
And here's a great pic of Jim K and Keith at the shooting table, getting ready to shoot the 4″ barrel:
We also did the full chop tests (as well as a real world gun) on 9mm Makarov and 9mm Ultra – two cartridges which are between a .380 and the 9mm Parabellum in terms of power/performance. We'll post the full data on the BBTI site as soon as everything is crunched and ready – but for now let me just say that heretofore I haven't been a big fan of the .380, but with the right ammunition I'd consider carrying a gun in that caliber. We were all surprised at how well the Buffalo Bore rounds performed at even the 2″ barrel length.
Jim Downey
Cross posted to my personal blog.
Wiki, oh Wiki, where do you roam?
Just spent a chunk of the afternoon and early evening doing something I had been meaning to do for at least a year: adding info about BBTI to various and sundry Wikipedia pages about ballistics and cartridges. I still need to create an actual 'page' about BBTI, but haven't ever done that, so . . .
Anyway, now for all the cartridges/calibers we tested there are links on Wikipedia, plus any related entries that I could think of. But if you find yourself poking around there, and come across an entry which would appropriately link/mention BBTI, please edit it to do so (or drop me a note and I'll take care of it.) This isn't an effort to get more hits to the BBTI site (we're rapidly approaching 2.5 million), but just to help more people get the information that they need.
Jim Downey
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The size of the vessel and on board services vary between operators, but all offer a fantastic way to experience the magnificent scenery. Commentary about the flora and fauna are provided, along with information about the history and geology of the area.
Your Te Anau Glowworm Caves adventure begins with a scenic cruise across Lake Te Anau to the western side of the lake. Upon arrival at Cavern House our friendly guides invite you to accompany them underground in small groups.As you explore by path and small boat, your senses will be overwhelmed. Observe how the rushing water sculpts the rock formations, before gliding through silent darkness to the glowworm grotto. The delicate incandescence of hundreds of tiny glowworms is a magical sight.Duration: 2hrs 15mins.Departures: all year
With a friendly crew to welcome you and a glass of bubbly in hand, the mood is set and youre on your way.
Doubtful Sound offers world class scenery with mountains rising high above the sea and amazing wildlife; you can see dolphins, penguins and seals. We will take you fishing to catch your dinner and retrieve lobster from the depths
the freshest seafood ever is what we dine on at night. And whilst the crew prepare your dinner you can go for a kayak if you wish, or perhaps laze about on the top deck and read a book or talk with new friends. The words paradise is never far from our customers lips.
When you choose a Doubtful Sound overnight cruise with Fiordland Expeditions you will not want to leave but we guarantee when you do
you will take away memories that last a lifetime.
Come join us for an overnight cruise in the tranquillity and beauty that Doubtful Sound has to offer on our new vessel "Seafinn". Cruise with us as you view the wildlife, dolphins, seals, penguins. Have a go at fishing for your supper, go swimming and in the evening sit on the deck and watch the sunset as Doubtful puts on a spectacular night display, stargazing is a must. Kayaks are now available - come enjoy a paddle.Succulent crayfish, freshly caught fish, venison and fresh vegetables every day, what more could you ask for 12 passengers only in 4x double cabins, 2x twin cabins. Private, friendly and kiwi operated. All food, bedding and fishing gear supplied. B.Y.O. refreshments.Charters also available for longer duration, give us a call.
Join us aboard the Maiden of Milford for your Milford Sound boat cruise and marvel at one of the most stunning places on earth. Relax in our uncrowded, modern catamaran while we spoil you with unlimited, close-up viewing of waterfalls, wildlife and rainforest from our three viewing decks (both inside and out). Our vessel can take up to 200 passengers but we always limit our numbers to 150 to ensure an enhanced viewing experience.
We provide 4 cruises daily (3 in Winter), all offering complimentary coffee & tea. Our Pita Pit franchise aboard the boat offers healthy but very filling breakfast, lunch and snack options.
Don`t know how to get there? Give us a call for more information on our different coach tours and flight options.
So come and join us for an experience you will never forget.
Milford Sound is a world-renowned natural wonder. Experience Milford Sound's grandeur with Real Journeys - we offer a range of daytime and overnight cruises to suit all travellers: Nature Cruises: Leisurely and relaxed, extended daytime cruise with specialist nature guides on board. Scenic Cruises: Cruise the full length of the fiord on one of our modern, spacious vessels. Overnight Cruises: An overnight bed & breakfast experience, on-board nature guide and explore the fiord by kayak or small boat.Coach connections available from Queenstown and Te Anau, plus scenic flights from Queenstown.
PLEASE NOTE: * Manapouri Underground Power Station is CLOSED for maintenance for at least 9 months from 1 Nov 2014 - 31 Jul 2015. Trips will NOT operate next season and only recommence the following year on 1 Nov 2015.
New in 2010 the Discovery Centre & Underwater Observatory is a highly recommended addition to a cruise in Milford Sound.
With more than 40 years of working and living in the Fiordland area, we at Cruise Milford can guarantee you a truly memorable and informative visit.
Real Journeys has two exciting options for experiencing the wilderness and wildlife of Doubtful Sound.Wilderness Daytime Cruises (year round):
Your Doubtful Sound adventure begins with a cruise across the crystal clear waters of Lake Manapouri and then it is over Wilmot Pass by coach. On reaching Deep Cove, you will board our spacious catamaran, for a three hour cruise that takes in the most dramatic scenery of Doubtful Sound.Overnight Cruises (Sep - mid May):
Onboard the Fiordland Navigator there is plenty of time to enjoy the stunning views and to discover the hidden arms of Doubtful Sound. Activities include wildlife viewing, kayaking and exploring in the tender craft with the nature guide. Three course buffet dinner & cooked breakfast included.
Milford Sound has been described as the eighth wonder of the world but at Southern Discoveries, we simply call it home. We offer the widest range of daytime cruises in Milford, convenient departures, fresh hot food options and over 50 years of experience in showing people our backyard. Try an Encounter Nature small boat cruise, Discover More (including BBQ lunch & Milford Discovery Centre visit) or Scenic cruises all on modern spacious boats! All cruises have comprehensive commentary; travel the full length of the fiord, include time to stop and view dolphins, seals and penguins, and friendly hosts and skippers.
Explore Lake Manapouri aboard Pomona and enjoy stunning boat cruises, kayaking, guided walks on secluded boat-accessed tracks, swimming, fishing and even live piano music...
Join Cruise Te Anau for a boutique 3 hour Discovery Cruise to the beautiful & tranquil South Fiord of Lake Te Anau where you will view spectacular mountains & breath taking scenery.Experience the Fiordland rain forest when we disembark for a gentle guided nature walk to discover the Hidden Lakes.On your return to the boat relax and enjoy a complimentary tea/coffee, along with a homemade muffin, while taking in the ever-changing scenery before we make our way back to Te Anau.Our boutique cruises have a maximum of 12 people so you can enjoy a personal cruise into the remoteness of the Fiordland National Park, a World Heritage area, where unspoilt scenery will amaze you.Cruise Te Anau are also the only company offering Overnight Cruises on beautiful Lake Te Anau.Private charters and fishing charters are also available.Cruises depart daily at 10am, 1pm & 5pm. Bookings essential.
Embark on a multi-day voyage of discovery through some of the most isolated and beautiful regions in New Zealand.
We operate 4 , 5 or 7 day Discovery Cruise trips in Fiordland (or 6-day around Stewart Island) on-board the purpose built Milford Wanderer. The various itineraries cover the southern Dusky and Breaksea Sounds, Preservation and Chalky Inlets and the old whaling station at Prices Inlet on Stewart Island.
By following part of Captain Cooks historic 1773 voyage, Discovery Cruises offer insights into inaccessible and stunning landscapes of the world as it once was.
Maximum of 32 passengers
Hearty meals included (prepared by the on board chef)
Activities (walks plus kayaks and tender craft available)
Specialist nature guide on board
Departures: Apr mid Dec
See our website www.discoverycruise.co.nz for departures dates and itineraries.
Iconic NZ at a sweet price. Cruise Milford Sound or Doubtful Sound, or both!Our 2-hour cruise in Milford Sound offers the longest, least crowded experience plus free food on every cruise. With capacity set at half enjoy a spacious relaxed cruise with awesome crew. Choose to enjoy a BLT & OJ on our early bird 9am cruise, or join us at 12:30pm for a portion of FishnChips - its kiwi as! Or cruise with us at 3pm & receive a delicious piece of carrot cake. Coach connections from Queenstown & Te Anau available.
Experience NZs must-see destination, Doubtful Sound for our full day tour. We offer the only small-boat day cruise in this remote wilderness area so escape the crowds & visit places that few visitors get to experience, quite simply the journey of a lifetime. Free transfers from Te Anau/Manapouri available.
Visit our website for further information. Prefer to paddle? Check out our kayaking options on the website too.
Daily departures: 1 October30 April
Experience the raw beauty of Doubtful Sound Overnight onboard the Southern Secret; see piercing mountain peaks, deep valleys, rivers that turn into waterfalls and ancient glacier carved fiords. Cruises are fully catered excluding alcohol. Activities onboard can include fishing, mammal watching and star gazing on clear evenings. Wildlife often sighted in Doubtful Sound may include dolphins, penguins, seals and sea birds. Book your double or twin ensuite cabin today. Includes: transport to/from Te Anau, lunch, evening meal and snacks, private cabin onboard MV Southern Secret, breakfast and all equipment for activities whilst on board. Queenstown transfers available.
Small operator since 1994. Personalised full day and two day kayaking tours to magical Doubtful Sound. Join us on the water...
Discover the beauty of Milford Sound with Mitre Peak Cruises. Leading the way in personalised and uncrowded cruising, we offer a cruise with a difference - time to explore and understand the nature and power of Milford Sound - relaxed, unhurried.
Operating daily cruises, each two hour cruise, with commentary, ventures up the fiord out to the Tasman Sea, stopping frequently exploring cascading waterfalls, towering cliffs, rugged peaks, lush rainforest, seals and penguins. Should dolphins be at play, we make time to follow their exuberance.
Our smaller vessels mean close-up and personal viewing. Go further, see more!


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Nutrients 2013, 5(9), 3461-3469; doi:10.3390/nu5093461
Published: 3 September 2013
Abstract: We retrospectively examined esophageal cancer patients who received enteral nutrition (EN) to clarify the validity of early EN compared with delayed EN. A total of 103 patients who underwent transthoracic esophagectomy with three-field lymphadenectomy for esophageal cancer were entered. Patients were divided into two groups; Group E received EN within postoperative day 3, and Group L received EN after postoperative day 3. The clinical factors such as days for first fecal passage, the dose of postoperative albumin infusion, differences of serum albumin value between pre- and postoperation, duration of systematic inflammatory response syndrome (SIRS), incidence of postoperative infectious complication, and use of total parenteral nutrition (TPN) were compared between the groups. The statistical analyses were performed using Mann-Whitney U test and Chi square test. The statistical significance was defined as p < 0.05. Group E showed fewer days for the first fecal passage (p < 0.01), lesser dose of postoperative albumin infusion (p < 0.01), less use of TPN (p < 0.01), and shorter duration of SIRS (p < 0.01). However, there was no significant difference in postoperative complications between the two groups. Early EN started within 3 days after esophagectomy. It is safe and valid for reduction of albumin infusion and TPN, for promoting early recovery of intestinal movement, and for early recovery from systemic inflammation.
1. Introduction
Several studies have elucidated the validity of early enteral nutrition (EN) in various patient groups including critically ill patients [1,2,3], head-injury patients [4,5], burns patients [6,7], trauma patients [8,9] and septic patients [10,11]. The efficacy of early enteral nutririon after surgery for patients who have undergone major surgery has been also proven [12,13,14,15,16,17]. These studies have proven the advantages of postoperative early EN as follows: lower incidence of septic complication [11], reduction of length of hospital stay, diminishing the degree of weight loss [15]. The term "early" was classically defined as EN started within 3 days after admission or surgery [18]; however, more recently, "early" has been defined as EN started within 48 or 24 h after admission or surgery [1].
On the other hand, transthoracic esophagectomy with 3-field lymphadenectomy (TTE-3FL) for esophageal cancer is one of the most radical and invasive surgeries among gastrointestinal surgical procedures. Past reports on early EN for surgery, described above [12,13,14,15,16,17], referred mainly to colorectal or gastrointestinal surgery. Therefore, the population of TTE-3FL was very small. In general, the patients who received TTE-3FL are not able to eat via mouth for a few days to one week after surgery. Therefore, postoperative enteral nutrition and/or parenteral nutrition after esophageal surgery is routine management. Recent reports have proven the advantages of early enteral nutrition, started within 24–48 h after esophagectomy for reduction of the length of hospital stay [19], reducing postoperative morbidity [20] and also reducing the rate of life-threatening complications [21]. However, because some studies have not shown any clinical benefits with routine postoperative EN after esophagectomy [22,23], the validity of early EN after esophagectomy has remained controversial [24].
The aim of the present retrospective study was to clarify the validity of early EN for postoperative course compared with delayed EN.
2. Patients and Methods
2.1. Patient Selection
The patients who underwent transthoracic esophagectomy with three-field lymphadenectomy for esophageal cancer at Niigata University Medical and Dental Hospital during 1996–2010 were entered into the present study. This study was a retrospective chart review, and a total of 103 patients were enrolled into the analysis. The data of patients were analyzed following approval from the Institutional Review Board for Clinical Research. There was no precise protocol for starting EN in our department; therefore, the date of EN initiation was decided individually according to the clinical experience of the doctors in charge of each patient, and also according to the condition of each patient. In the present study, we used the classical criteria of early EN as starting within 3 days after surgery in this study, according to the classical definition [18]. The patients were divided into two groups by the date they started EN; Group E contained the patients who received EN within postoperative day 3, and Group L contained the patients who received EN after postoperative day 3. EN was started with an initial dose of 200–250 mL of oligomeric or polymeric formula under 20–25 mL/h from jejunostomy. EN dose was gradually increased every 12–24 h if there were no problems related to EN, and reached a maximum dose 5–6 days after starting EN in both groups. Peripheral intravenous infusion of 4.3% glucose with electrolyte solutions were also performed to supply water and electrolyte in both groups. TPN was introduced if EN could not be started at postoperative day 5.
2.2. Clinical Assessment
Clinical factors such as: age, sex, tumor stage according to the tumor-node-metastasis classification of the International Union Against cancer (6th edition) [25], bowel movement recovery expressed as days for first fecal passage, the dose of postoperative albumin infusion used, difference of serum albumin value between day 7 and pre-operation (Δalb), duration of systematic inflammatory response syndrome (SIRS), incidence of postoperative complications, and use of total parenteral nutrition (TPN) were compared between group E and group L. SIRS was diagnosed according to the criteria of the ACCP-SCCM Consensus Conference Committee [26]. For the diagnosis, at least two of the following criteria had to be fulfilled: systolic blood pressure <90 mmHg, tachycardia >90/min, respiratory rate >20/min or peripheral arterial CO2 tension (PaCO2) <32 mmHg, temperature >38.0 °C or <36.0 °C, leukocytosis >12,000/μL or leukopenia <4000/μL or 10% immature (band) forms.
Postoperative complications were also retrospectively searched from patient records, and complications were divided into two categories: mechanical and infectious. Mechanical complication was defined as the complication directly due to failure of surgical procedure, and infectious complication was defined as the complication accompanying infection such as pneumonia, wound infection, enteritis and/or sepsis in this study. Recurrent nerve palsy indicated as vocal cord function was assessed by laryngofiberscopy in all patients, regardless of the presence or absence of hoarseness, as previously described in [27].
2.3. Statistical Analysis
The statistical analyses were performed using the Mann-Whitney U test and adjusted Chi-square test. The Exact Chi-square test was also used if individual cell size was less than 5 counts. The statistical significance was defined as p < 0.05.
3. Results
3.1. Pre- and Perioperative Clinical Features
Among a total of 103 patients, 42 patients categorized in Group E, and 61 patients categorized in Group L (Table 1). Both Group E and Group L were comparable in mean age, sex, preoperative nutritional conditions expressed by body mass index (BMI), body weight and serum albumin value, However, our results in this study were analyzed under a mixed, male and female population; therefore, gender might have some effects on our results. The distribution of the clinical stage of cancer was not similar between Group E and Group L (Group E versus Group L, stage 0: 2 vs. 0; stage I: 15 vs. 10; stage IIA: 7 vs. 5; stage IIB: 2 vs. 11; stage III: 8 vs. 19; stage IVA: 3 vs. 4; stage IVB: 5 vs. 12). However, if an earlier stage (stage 0–IIB) is compared with a more advanced stage (stage III–IVB), there was no significant difference in distribution of the stages between Group E and Group L, as shown in Table 1. The status of preoperative chemotherapy was significantly different: Group E patients received preoperative chemotherapy more frequently than Group L patients (p < 0.01). Postoperative TPN was more frequently used in Group L compared with Group E (p < 0.01).
|Table 1. Pre- and Perioperative Clinical Features: Early versus Late Enteral Nutrition (EN) (n = 103).
|Group E (n = 43)
|Group L (n = 61)
|p value (Mann-Whitney test)
|Age (years) a
|61.5 ± 6.6
|62.7 ± 6.7
|BMI (kg/m2) a
|21.8 ± 3.1
|21.2 ± 2.6
|Body weight (kg) a
|57.7 ± 9.8
|55.3 ± 9.4
|Albumin (mg/dL) a
|4.0 ± 0.4
|4.0 ± 0.4
|Surgery time (min) a
|470.1 ± 83.2
|481.1 ± 80.1
|p value (Chi square test)
|Preoperative chemotherapy
|Postopertive TPN use
a Data are mean ± standard deviation; TPN: total parenteral nutrition.
3.2. Postoperative Complications and Mortality
Postoperative complications were observed in 87 patients (84.4%) and there was no significant difference in whole complications between Group E and Group L. Furthermore, complications were categorized into two groups: mechanical and infectious. These two groups were comparable in whole mechanical complication. However, there was significant difference in the frequency of anastomotic dehiscence: anastomotic dehiscence was observed more frequently in Group E compared with Group L (p < 0.01). The frequency of recurrent nerve palsy, observed in our series, was quite high in both groups; however, almost recurrent nerve palsy was subclinical and transient. On the other hand, there was no significant difference in infectious complication, including pneumonia, wound infection, enteritis and sepsis. Perioperative death was observed in only one patient in Group E: aortic rupture occurred at postopretative day 8. The mortality of the two groups was comparable (Table 2).
|Table 2. Postoperative complication and Mortality: Early versus Late EN (n = 103).
|Group E (n = 42)
|Group L (n = 61)
|p value
|Postoperative complications
|Recurrent nerve palsy
|Anastomotic dehiscence
|Tracheal damage
|Aortic rupture
|Wound infection
|Enteritis/intestinal ischemia
3.3. Postoperative Outcomes Comparing Early EN with Late EN
Postoperative EN calorie (kcal/kg) supplied at maximum was significantly higher in group E compared with group L (28.5 versus 16.1; p < 0.01). Bowel movement recovery was observed significantly earlier in Group E (p < 0.01) and also the duration of SIRS and respirator management were significantly shorter in Group E (p < 0.01). The volume of albumin infusion was significantly smaller in Group E (p < 0.01). However, the decreased value of serum albumin (Δalb) was more prominent in Group E compared with Group L (p < 0.01) (Table 3). The length of hospital stay was, however, slightly shorter in Group E compared with Group L (p < 0.05).
|Table 3. Postoperative outcomes: Early versus Late EN (n = 103).
|Group E (n = 42)
|Group L (n = 61)
|p value
|EN Calorie (kcal/kg) a
|28.5 ± 8.5
|16.1 ± 5.4
|Bowel movement recovery (day) a
|5.2 ± 1.6
|7.4 ± 2.3
|Albumin infusion (mL) a
|83 ± 62
|169 ± 101
|∆albumin (mg/dL) a
|−1.2 ± 0.5
|−0.8 ± 0.5
|SIRS duration (day) a
|4.0 ± 5.1
|6.2 ± 5.8
|Respirator duration (day) a
|3.7 ± 7.3
|7.0 ± 5.1
|LOH (day) a
|54.2 ± 52.0
|66.3 ± 54.1
a Data are mean ± standard deviation; ∆albumin: difference of serum albumin value between day 7 and pre-operation; SIRS: systematic inflammatory response syndrome; LOH: length of hospital stay.
4. Discussion
Esophageal cancer patients are frequently malnourished due to esophageal stenosis, because of: their habits, preoperative systemic chemotherapy or the systemic effect of their neoplasm [28]. However, preoperative nutritional status, expressed by BMI, body weight and serum albumin value, showed quite good nutritional preference, and the preoperative nutritional condition of each group was comparable in this study. Surgical procedure also seemed to be comparable between the two groups because there was no significant difference in operation time between the two groups. Therefore, we think the level of surgical stress will be comparable between Group E and Group L in the present study.
In the present study, there was historical bias in the start date of enteral feeding and the rate of preoperative chemotherapy; the average start date of EN was later in the patients during 1996–2000 (average start day of EN during 1996–2000 versus 2001–2010: 7.1 days versus 3.3 days, p < 0.01), in contrast with the rate of preoperative chemotherapy, which was higher in the patients during 2001–2010.
Although there were some reports that early EN, started within 24 h after esophagectomy, has shown an advantage in reducing postoperative morbidity or life-threatening complications [20,21], we could not find an advantage in reducing complications by using "early" EN in the present study. The discrepancy of the result on morbidity between past studies and ours might be due to the difference in definition of "early" EN. We used the criteria at within 3 days, and this might be why we could not find an advantage in reducing morbidity in Group E. However, "early" EN was safely and effectively performed in our series, because the patients of Group E showed significantly earlier recovery from SIRS, and also showed shorter respirator use compared with the patients of Group L, while there seemed to be a similar level of surgical stress. Moreover, our study revealed the advantage of early EN in the recovery of intestinal movement, indicated by significantly earlier first fecal passage in Group E. These results revealed that "early" EN, even if started within 3 days after surgery, was enough to take advantage of earlier recovery from systemic inflammation and respiratory disorder.
Our study has shown that the frequency of recurrent nerve palsy was quite high in both groups; however, recurrent nerve palsy was strictly assessed by endoscopically in our department, and this seemed to be the reason for the high frequency of recurrent nerve palsy. Indeed, cases of recurrent nerve palsy in this study were not prominent.
The frequency of anastomotic dehiscence was significantly higher in Group E in this study. A possible explanation for this is that the patients in Group E received damage by preoperative chemotherapy, which was more frequently observed in Group E compared with Group L. The damage to cell recycling, vascularization, and tissue regeneration may affect the anastomotic failure, which was more frequent in Group E.
Several factors may potentially impact on the frequency of postoperative complication in our study because some factors of patient background, such as preoperative stage or preoperative therapy, were quite different. Therefore, it may be desirable to perform mulitvariate analysis to search major factors which have an impact on postoperative complication. However, the aim of this study was to clarify the validity of early EN for postoperative course compared with delayed EN; it seemed to be unnecessary to search for the factors which have an impact on postoperative complication other than EN.
The decrease of serum albumin at postoperative day 7 was significantly prominent in Group E. On the other hand, albumin infusion was significantly less in Group E. Moreover, there was no significantly difference in morbidity and mortality between group E and group L, as described above. These results showed that early EN could have the advantage of reducing albumin infusion, which means less expensive treatment. In addition, postoperative TPN was less frequently used in Group E compared with Group L.
Finally, most patients in this study were male. Females constituted a small, but, however, not negligible part of the study. Gender may affect our results in terms of: clinical factors, postoperative complications and outcomes of patients. Therefore, we have re-analyzed by using the data from only the male population. The results from 89 males in this study still showed significantly fewer days for the first fecal passage, a lesser dose of postoperative albumin infusion, less use of TPN, shorter duration of SIRS, shorter duration under respirator, and shorter length of hospital stay in Group E compared with Group L (data not shown). Again, gender may affect our results, however, we think that our results in this study will be reliable enough, if analyzed under a mixed male and female population.
5. Conclusions
Early EN started within 3 days is safe and valid for postoperative esophageal cancer patients and has advantages in reducing the use of albumin infusion and TPN, for promoting early recovery of intestinal movement, and for early recovery from systemic inflammation.
Conflicts of Interest
The authors declare no conflicts of interest.
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