Efficacy of the circulatory management of an antenatally diagnosed congenital diaphragmatic hernia: outcomes of the proposed strategy

Object

The purpose of this study is to evaluate the outcome of our therapeutic strategy for antenatally diagnosed congenital diaphragmatic hernia (ADCDH).

Methods

We treated 61 cases of ADCDH according to our strategy. Prostaglandin E1 was required to be maintained the patency of the ductus arteriosus (PDA) in 39 cases (Group I) while it was not administered in 22 cases (Group II). Left ventricular end-diastolic dimension (LVDD) and Tei index were measured with echocardiography on days 0, 2, and 7 after birth. Radical surgery was performed on all cases by day 2.

Results

On day 0, Group I showed smaller LVDD and Tei index than those in Group II. Between day 0 and day 2, these parameters increased significantly in Group I, but not in Group II. On day 7, no significant difference in these parameters was observed between the two groups. Five patients died of cardiac and respiratory failure, resulting in a survival rate of 92 %.

Conclusion

Our therapeutic strategy improves the clinical outcome of ADCDH. This can be attributed to two factors: earlier surgery resulting in improved LV function. The latter attenuates pulmonary hypertension and maintains PDA with a consequent decrease in right ventricular afterload to compensate for the low cardiac output resulting from PDA.     

Influence of finish line design on marginal adaptation of electroformed metal-ceramic crowns

STATEMENT OF PROBLEM: Gold electroformed metal-ceramic restorations have been promoted as alternatives to conventional metal-ceramic restorations. However, little is known about the relationship between tooth preparation design and marginal adaptation for this type of crown. PURPOSE: This study evaluated the influence of 3 different finish line designs on the marginal adaptation of electroformed metal copings and metal-ceramic crowns. MATERIAL AND METHODS: Three steel dies were prepared for maxillary central incisor crowns with 3 finish line designs: shoulder, rounded shoulder, and deep chamfer preparations. Eight standardized electroformed metal-ceramic crowns were fabricated for each group. Marginal discrepancies were measured at 60 points for each specimen along the circumferential margin at 4 sites (labial, mesial, lingual, and distal surfaces, with 15 points for each site) before and after firing procedures using a laser microscope. Data among the 3 different groups were statistically analyzed using the Kruskal-Wallis test and the Mann-Whitney U test with the Bonferroni correction. Marginal discrepancies between prefiring and postfiring procedures were evaluated using the Wilcoxon signed-ranks test (alpha = .05). RESULTS: Significant differences in the marginal discrepancies of electroformed metal copings without porcelain and metal-ceramic crowns were found among all groups. The lowest range of median marginal discrepancy values (P < .05) at 4 sites, both before and after firing, occurred with the deep chamfer preparation (17.64-21.78 microm and 23.96-25.72 microm, respectively). The highest range values were observed in the shoulder preparation (38.13-49.89 microm and 73.87-89.44 microm, respectively). In all situations, the marginal discrepancies of the postfiring procedures were significantly greater (P = .02 or less) than those of the prefiring procedures. CONCLUSION: Within the limitations of this study, the marginal adaptation of electroformed metal copings or metal-ceramic crowns is affected by finish line design and sequentially diminished by porcelain firing procedures.     

The roles of the N-terminal portions of various tachykinins in promoting salivation

OBJECTIVES: In order to determine the active sites for salivation of various tachykinins, the regulatory roles of the N-terminal portion of various newly-synthesized tachykinins were studied after i.p. injection of rats using the submandibular glands as model organs. METHODS: N-shortened oligopeptides from kassinin, eledoisin, neurokinins A (NKA) and NKB were synthesized by the multipin peptide synthesis method. Amino acids were eliminated one by one to form octa- to undeca-peptides adjoining the inactive or less active heptapeptides and various heptapeptides, in which an amino acid in position 8 (Xaa8), numbering as in an undecapeptide, was replaced with Tyr, Phe, Ile or Val. RESULTS: The N-terminal amino acids in positions 1 to 4 could be activators or inhibitors, depending on whether the C-terminal heptapeptide was inactive or less active. The Xaa8 residue, in combination with amino acids in positions 5 and 6, seemed to be very important in determining the sialogogic activity of a heptapeptide. The discrimination between NKA and NKB appeared due to the N-terminal amino acid sequence in positions I to 4 including Phe or Ser in position 6. CONCLUSIONS: It is concluded that the N-terminal amino acids in positions I to 4 serve as either activators or inhibitors depending upon the sialogogic activity of the C-terminal heptapeptide, in which particular amino acids in positions 5, 6 and 8 regulate its activity.     

New combined anteversion technique in hybrid THA: cup-first procedure with CT-based navigation

European Journal of Orthopaedic Surgery & Traumatology - Combined anteversion (CA) technique (stem-first procedure) is generally accepted as the optimal technique to attain an appropriate CA...     

A Comparative Immunohistochemical Study of Anal Canal Epithelium in Humans and Swine,Focusing on the Anal Transitional Zone Epithelium and the Anal Glands

To better understand the cellular origins and differentiation of anal canal epithelial neoplasms, the immunohistochemical profiles of the anal canal epithelium in humans and swine were evaluated. Formalin‐fixed tissue sections were immunostained for mucin (MUC: MUC2, MUC5AC, MUC5B), desmoglein 3 (DGS3), p63, CDX2, SOX2, and α‐smooth muscle actin (α‐SMA). The anal transitional zone (ATZ) epithelium covered the anal sinus and consisted of a stratified epithelium with mucous cells interspersed within the surface lining. Anal glands opened into the anal sinus. Ducts and acini of intraepithelial or periepithelial mucous type were the main structures of human anal glands, whereas those of swine were compound tubuloacinar mixed glands. Distal to the ATZ epithelium, non‐keratinized stratified squamous epithelium merged with the keratinized stratified squamous epithelium of the perianal skin. MUC5AC expression predominated over MUC5B expression in the ATZ epithelium, while MUC5B expression was higher in the anal glands. SOX2 was positive in the ATZ epithelium, anal glands, and squamous epithelium except in the perianal skin. In humans, DGS3 was expressed in the ATZ epithelium, anal gland ducts, and squamous epithelium. p63 was detected in the ATZ epithelium, anal glands, and squamous epithelium. Myoepithelial cells positive for α‐SMA and p63 were present in the anal glands of swine. Colorectal columnar cells were MUC5B⁺/MUC2⁺/CDX2⁺/MUC5AC^?/SOX2^?. The ATZ epithelium seems to be a distinctive epithelium, with morphological and functional features allowing smooth defecation. The MUC5AC⁺/SOX2⁺/MUC2^?/CDX2^? profile of the ATZ epithelium and anal glands is a useful feature for diagnosing adenocarcinoma arising from these regions. Anat Rec, 301:796–805, 2018. © 2017 Wiley Periodicals, Inc.