Circadian disruption and human health: A bidirectional relationship

Circadian rhythm disorders have been classically associated with disorders of abnormal timing of the sleep–wake cycle, however circadian dysfunction can play a role in a wide range of pathology, ranging from the increased risk for cardiometabolic disease and malignancy in shift workers, prompting the need for a new field focused on the larger concept of circadian medicine. The relationship between circadian disruption and human health is bidirectional, with changes in circadian amplitude often preceding the classical symptoms of neurodegenerative disorders. As our understanding of the importance of circadian dysfunction in disease grows, we need to develop better clinical techniques for identifying circadian rhythms and also develop circadian based strategies for disease management. Overall this review highlights the need to bring the concept of time to all aspects of medicine, emphasizing circadian medicine as a prime example of both personalized and precision medicine.     

How we managed a difficult to ventilate patient

A 40-year-old female presented with respiratory difficulty, cough and sputum with blood streaking. Her right lung was destroyed, and trachea was shifted to the same side. On mechanical ventilation, she developed hypoxia and rise in blood pressure. Ventilator was not delivering set tidal volume. After looking into the cause, it was decided to reintubate the patient with new endotracheal tube after cutting bevel. Thereafter, there was successful ventilation.     

Is neutrophilia the key to diagnosing appendicitis in pregnancy?

BackgroundThe diagnosis of acute appendicitis (AA) in pregnancy remains challenging. We investigated which preoperative clinical factors are most predictive of AA in pregnant women.Methods164 pregnant patients undergoing magnetic resonance imaging for suspected AA were retrospectively reviewed. Logistic regression was used to compare those with pathologically confirmed AA and those without.Results28 patients (17.1%) had pathologically confirmed AA. 42.9% (n = 12) were perforated at the time of operation. Factors associated with AA included history of emesis (p = 0.005), migratory abdominal pain (p = 0.006), rebound tenderness (p = 0.01), elevated white blood cell count (p = 0.003), elevated Alvarado Score (p < 0.001), elevated neutrophil count (p = 0.021), and left shift (p = 0.001). As a screening test, a left shift with neutrophils >70% provided a sensitivity and negative predictive value of 100.0%.DiscussionEvery patient in our series with AA had a left shift. Neutrophil count and percentage should be considered in the diagnostic evaluation of these patients to better guide resource utilization and treatment.     

Contextualizing the lived experience of quality of life for persons with spinal cord injury: A mixed-methods application of the response shift model

Objective: The objective of this study was to gain greater insight into individuals’ quality of life (QOL) definitions, appraisals, and adaptations following spinal cord injury (SCI).

Design: A mixed-methods design, applying the Schwartz and Sprangers response shift (RS) model. RS is a cognitive process wherein, in response to a change in health status, individuals change internal standards, values, or conceptualization of QOL

Setting: Community-dwelling participants who receive medical treatment at a major Midwestern medical system and nearby Veterans’ Affairs hospital.

Participants: A purposive sample of participants with SCI (N?=?40) completed semi-structured interviews and accompanying quantitative measures.

Interventions: Not applicable.

Outcome Measures: Qualitative data were analyzed using content analysis to identify themes. Analysis of variance were performed to detect differences based on themes and QOL, well-being, and demographic and injury characteristics.

Results: Four RS themes were identified, capturing the range of participant perceptions of QOL. The themes ranged from complete RS, indicating active engagement in maintaining QOL, to awareness and comparisons redefining QOL, to a relative lack of RS. Average QOL ratings differed as a function of response shift themes. PROMIS Global Health, Anxiety, and Depression also differed as a function of RS themes.

Conclusion: The RS model contextualizes differences in QOL definitions, appraisals, and adaptations in a way standardized QOL measures alone do not.     

Removable appliances to correct anterior crossbites in the mixed dentition: a systematic review

Abstract

Objectives: To investigate the effectiveness of an upper removable appliance in the treatment of an anterior crossbite in term of quality of life, effectiveness, treatment time, long term stability and cost minimization.

Design: Systematic review

Data source: A search strategy was implemented using both manual hand search and electronic databases, including Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, ScienceDirect, Scopus and Ebsco.

Study eligibility criteria: Randomized controlled clinical trials

Participants: Children in the early or late mixed dentition with an anterior crossbite affecting one or more incisors, and no underlying skeletal class III pattern.

Interventions: Upper removable appliance compared with other orthodontic appliances.

Study appraisal and synthesis: All potential articles were checked against the inclusion criteria independently, and in duplicate by two investigators. Risk of bias of eligible studies to be included in the final analysis was assessed independently by two authors using Cochrane risk of bias tool.

Results: A total of 524 articles were identified in both manual and electronic searches as well as by checking the reference lists of the final articles to be included in the study. Only 7 reports of 3 RCTs met the inclusion criteria and thus were included in the final analysis. All but one of the 3 RCTs were judged to be of very low quality. No statistical methods were employed to combine the studies due to the heterogeneity of the studies.

Conclusion: A fixed appliance was more cost-effective than a removable appliance in the correction of an anterior crossbite with a functional shift. There was no significant difference in terms of quality of life, pain intensity or long-term stability between the two appliances. On the other hand, both a removable appliance and cemented bite-pads were equally effective in the correction of an anterior dental crossbite without having any side effect.     

超声在颞下颌关节功能评价中的应用

颞下颌关节的功能状态关系到口腔颌面外科、正畸科和修复科等的治疗成败,超声作为颞下颌关节功能评价的一种新兴手段,以其无损伤性、经济、有效等特点得到了越来越广泛的应用。下面就超声在颞下颌关节盘位置检查、髁突运动轨迹和颞下颌关节音检测等方面的作用作一综述。     

Usefulness of fat-suppression magnetic resonance imaging for oral and maxillofacial lesions

In magnetic resonance imaging (MRI) of the oral and maxillofacial region, where large amounts of fat are normally present, the high signal intensity of fat on T1-weighted images (T1WI) and the chemical-shift artifact have limited the utility of paramagnetic contrast agents. Eliminating fat signal by fat-suppression techniques can increase the value of contrast-enhanced MRI. The present study was designed to evaluate the utility and role of chemical-shift imaging for fat suppression in the detection of oral and maxillofacial lesions in 22 patients (17 with malignant tumors, two with benign tumors, and three with inflammation). The depiction of lesions on the postcontrast fat-suppression T1WI was compared with that of conventional pre-and postcontrast T1 and T2WI on a four-grade scale (grades 0–3). The postcontrast fat-suppression T1WI (average grade, 2.86) were significantly superior to the precontrast T1WI (0.82) and postcontrast T1WI (1.86) and T2WI (1.68). Postcontrast fat-suppression T1WI were particularly beneficial in the detection of central necrosis or extracapsular invasion of metastatic neck lymph nodes as well as in defining the lesion extent at fat-containing areas such as the bone marrow or cheek. These findings demonstrated that the fat-suppression technique is extremely useful in the delineation of oral and maxillofacial lesions without increase of the scan time or image postprocessing procedures.     

广西西江经济带人源性沙门菌数据的动态偏离-份额分析

目的 通过动态分析2015—2019年的广西西江经济带人源性沙门菌的增长情况,为预防和控制沙门菌引起的疾病提供科学参考。方法 以西江经济带为研究区域,通过构建动态偏离-份额分析法模型,获取人源性沙门菌的区域增长份额、构成偏离份额和区位偏离份额。结果 从2015—2019年的合计数看,西江经济带的肠炎沙门菌的总偏离量（+6.943株）、伦敦沙门菌的总偏离量（+0.725株）、火鸡沙门菌的总偏离量（+0.575）均为正值,总偏离量符号为“+”表明该沙门菌属血清型的增长速度快于广西沙门菌总体的增长速度;西江经济带的鼠伤寒沙门菌的总偏离量（-42.794株）、斯坦利沙门菌的总偏离量（-3.401株）、德尔卑沙门菌的总偏离量（-7.552株）、阿贡纳沙门菌的总偏离量（-6.127株）、韦太夫雷登沙门菌的总偏离量（-0.425株）、科特布斯沙门菌的总偏离量（-6.275株）均为负值,总偏离量符号为“-”表明该沙门菌属血清型的增长速度慢于广西沙门菌总体的增长速度。从时间序列看,西江经济带的鼠伤寒沙门菌、斯坦利沙门菌、德尔卑沙门菌、阿贡纳沙门菌的总偏离量经历先下降然后上升最后再下降的过程,西江经济带的肠炎沙门菌、韦太夫雷登沙门菌、科特布斯沙门菌的总偏离量经历先上升然后下降最后再上升的过程,西江经济带的伦敦沙门菌、火鸡沙门菌的总偏离量经历先连续上升最后下降的过程。结论 西江经济带的肠炎沙门菌、伦敦沙门菌、火鸡沙门菌是具有增长优势的沙门菌属血清型。