Laparoendoscopic single‐site (LESS) vs laparoscopic living‐donor nephrectomy: a systematic review and meta‐analysis

The aim of this study was to provide a systematic review and meta‐analysis of reports comparing laparoendoscopic single‐site (LESS) living‐donor nephrectomy (LDN) vs standard laparoscopic LDN (LLDN). A systematic review of the literature was performed in September 2013 using PubMed, Scopus, Ovid and The Cochrane library databases. Article selection proceeded according to the search strategy based on Preferred Reporting Items for Systematic Reviews and Meta‐analyses criteria. Weighted mean differences (WMDs) were used to measure continuous variables and odds ratios (ORs) to measure categorical ones. Nine publications meeting eligibility criteria were identified, including 461 LESS LDN and 1006 LLDN cases. There were more left‐side cases in the LESS LDN group (96.5% vs 88.6%, P < 0.001). Meta‐analysis of extractable data showed that LLDN had a shorter operative time (WMD 15.06 min, 95% confidence interval [CI] 4.9–25.1; P = 0.003), without a significant difference in warm ischaemia time (WMD 0.41 min, 95% CI –0.02 to 0.84; P = 0.06). Estimated blood loss was lower for LESS LDN (WMD ?22.09 mL, 95% CI –29.5 to –14.6; P < 0.001); however, this difference was not clinically significant. There was a greater likelihood of conversion for LESS LDN (OR 13.21, 95% CI 4.65–37.53; P < 0.001). Hospital stay was similar (WMD –0.11 days, 95% CI –0.33 to 0.12; P = 0.35), as well as the visual analogue pain score at discharge (WMD –0.31, 95% CI –0.96 to 0.35; P = 0.36), but the analgesic requirement was lower for LESS LDN (WMD –2.58 mg, 95% CI –5.01 to –0.15; P = 0.04). Moreover, there was no difference in the postoperative complication rate (OR 1.00, 95% CI 0.65–1.54; P = 0.99). Renal function of the recipient, as based on creatinine levels at 1 month, showed similar outcomes between groups (WMD 0.10 mg/dL, –0.09 to 0.29; P = 0.29). In conclusion, LESS LDN represents an emerging option for living kidney donation. This procedure offers comparable surgical and early functional outcomes to the conventional LLDN, with a lower analgesic requirement. However, it is more technically challenging than LLDN, as shown by a greater likelihood of conversion. The role of LESS LDN remains to be defined.     

Implant site development: clinical realities of today and the prospects of tissue engineering

The success of dental implants depends on their placement in bone of adequate density and volume in order to achieve primary stability. Optimal esthetics of implants requires their placement in a position approximating that of the natural teeth they replace. However, there is generally at least some degree of atrophy in the sites where implants are to be placed. This atrophy may occur either before or after tooth extraction. Following extraction of teeth, there is commonly alveolar ridge resorption in horizontal and vertical dimensions. Alternatively, some of the oral hard and soft tissues may be destroyed by pathologic conditions such as periodontitis, endodontic infections, or trauma. All of these conditions may potentially compromise the final esthetics and function of implant-supported restorations. During the initial years of the development of the osseointegration protocol, implants were placed with little or no modification of implant sites. Though osseointegration was successfully achieved, esthetic outcome was not a primary objective of therapy at that time. A gradual paradigm shift has occurred in implant dentistry from merely achieving successful osseointegration to achieving final restorative outcomes that mimic natural dentition and their surrounding oral tissues. These objectives have been materialized by advancements in surgical techniques, as well as availability of biomaterials to enable predictable regeneration of oral hard and soft tissues. The objective of the present review is to briefly discuss some of the techniques that are currently available for implant site development.     

Review of policies,data, and interventions to improve maternal nutrition in Afghanistan

Malnutrition contributes to direct and indirect causes of maternal mortality, which is particularly high in Afghanistan. Women's nutritional status before, during, and after pregnancy affects their own well‐being and mortality risk and their children's health outcomes. Though maternal nutrition interventions have documented positive impact on select child health outcomes, there are limited data regarding the effects of maternal nutrition interventions on maternal health outcomes globally. This scoping review maps policies, data, and interventions aiming to address poor maternal nutrition outcomes in Afghanistan. We used broad search categories and approaches including database and website searches, hand searches of reference lists from relevant articles, policy and programme document requests, and key informant interviews. Inclusion and exclusion criteria were developed by type of source document, such as studies with measures related to maternal nutrition, relevant policies and strategies, and programmatic research or evaluation by a third party with explicit interventions targeting maternal nutrition. We abstracted documents systematically, summarized content, and synthesized data. We included 20 policies and strategies, 29 data reports, and nine intervention evaluations. The availability of maternal nutrition intervention data and the inclusion of nutrition indicators, such as minimum dietary diversity, have increased substantially since 2013, yet few nutrition evaluations and population surveys include maternal outcomes as primary or even secondary outcomes. There is little evidence on the effectiveness of interventions that target maternal nutrition in Afghanistan. Policies and strategies more recently have shifted towards multisectoral efforts and specifically target nutrition needs of adolescent girls and women of reproductive age. This scoping review presents evidence from more than 10 years of efforts to improve the maternal nutrition status of Afghan women. We recommend a combination of investments in measuring maternal nutrition indicators and improving maternal nutrition knowledge and behaviours.     

A Three-Dimensional Developmental Measurement of the Temporomandibular Joint

This article presents an anthropologic study of the growth and developmental changes that occur within the bony components of the temporomandibular joint. The material used was provided by the Department of Physical Anthropology of the Smithsonian Institution Museum of Natural History, Washington, D.C.

Based on a Class I normal occlusion, the authors selected a total of 100 skulls with mandibles from the Aleutian Islands collection. These skulls, which were from 2-to 20-year-old subjects, were divided into four age groups. The approximate age of each skull was determined by charts based on eruption sequence, the number of permanent teeth present, and suture closure.

Anatomic landmarks and anthropologic techniques were used to make direct linear measurements on the bony components of the 200 temporomandibular joints. Three-dimensional measurements were made on the condyles, fossae, and articular eminences of each skull.

Several variables were chosen for statistical analysis: (1) The size of the individual components of the TMJ within each age group. (2) The changes with age in the anteroposterior, medial-lateral, and vertical dimensions of the individual TMJ components. (3) Asymmetries in size between the right and the left TMJ components. (4) The interrelationship of the individual TMJ components as seen in their growth changes.

The results obtained from the various measurements used in this study were compared to the findings of a number of earlier studies.     

Sensitivity of Crosswise Model to Simplistic Selection of Nonsensitive Questions: An Application to Estimate Substance Use,Alcohol Consumption and Extramarital Sex Among Iranian College Students

Background: Nonrandomized response (NRR) models are a new generation of surveys for sensitive issues. This study aims to evaluate the validity of estimates from the crosswise model (as one of the efficient models) through employing different response probabilities of nonsensitive questions. Methods: This cross-sectional study was conducted during October and November 2015 among 1777 students of Tabriz University of Medical Sciences. Estimates of monthly alcohol consumption, and at least one instance of illicit drug use and extramarital sex over the last year were determined using direct questioning (DQ) and the Crosswise model (CM). In the last model, the probability of positive response to the nonsensitive questions was determined by using five different methods: uniform distribution (I), Benford’s law (II), and estimations based on data from three other studies (III, IV, V). Results: Crosswise estimates of sensitive behaviors with different probabilities of a positive response to nonsensitive questions differed significantly. For example, estimates of history of using illegal opioids at least once in the last year among men varied significantly from 5.0% to 16.1% with different crosswise models based on the probability of being born in Spring using method I (0.250), III (0.287), IV (0.248), and V (0.310). The model based on Benford’s law (II) was applied to estimate alcohol and cannabis consumption, and its estimates showed significant discrepancy with results of crosswise models I and V. Conclusion: Estimates from crosswise model is highly sensitive to the response probability of nonsensitive questions. It seems that if this question is not selected carefully, the mentioned models will provide overestimates or underestimates, and the more-is-better hypothesis is not always valid. To achieve valid estimates, the exact probability of a positive response to the nonsensitive question must be known for the studied population.     

Atomic layout of an orthodontic titanium mini-implant in human tissue: Insights into the possible mechanisms during osseointegration

Objectives:To evaluate nanoscale molecular interactions in the interface between human bone and orthodontic titanium implants.Materials and Methods:An orthodontic implant (sandblasted with large grit and with an acid-etched surface treated with Ti6A14V alloy) retrieved from the mandible of human after 2 months of healing was used to analyze the molecular interactive mechanism between the implant and the surrounding bone tissue. To preserve the natural state of the sample as much as possible, cryofixation and scanning electron microscope/focused ion beam milling without any chemical treatment were used during sample preparation. Atom probe tomography was used to investigate the chemical composition and structure at the interface between the implant and human bone tissue.Results:Three-dimensional (3D) reconstruction of the whole sample revealed a 20 × 50-nm² plate-like bony element diffusion layer in the sample. The iso concentration analysis of the diffusion layer indicated that the bony element, calcium, and the implant element, titanium oxide, were interspersed with each other. Detailed ionic distribution was illustrated by 3D reconstruction with partial region of interest and one-dimensional concentration profiles of the implant-bone interface.Conclusions:The study results advance nanoscale understanding of osseointegration and suggest a potential nanostructure for increasing bond strength of biomaterials to bone.