Assessment of volume preservation performed before or after partial nephrectomy accurately predicts postoperative renal function: Results from a prospective multicenter study

Purpose

Partial nephrectomy (PN) is standard for small renal masses, improving renal function by preserving renal parenchyma compared with radical nephrectomy. Recent work demonstrated that postoperative surgeon assessment of volume preservation (SAVP) and 3D imaging measurements agree and correlate with postoperative function. We hypothesize preoperative assessment of volume preservation (PAVP) with PN based on preoperative imaging will reliably indicate postoperative renal function.

Management of orthopedic oncology patients during coronavirus pandemic

The new measures implemented in hospitals also altered the operation of orthopedics and traumatology departments. The main purpose of this article is to discuss how orthopedic oncology clinics should be organized during the pandemic and to present the process management scheme for patients requiring orthopedic surgery, including trauma surgery, from diagnosis to treatment, together with our experiences. Instead of thinking about the global emergence of the epidemic, it is time to act decisively. At first glance, the coronavirus disease 2019 (COVID-19) pandemic and orthopedics may seem to be unrelated disciplines, but the provision of healthcare services to patients who require them proves that these two fields are parts of the same whole. Our experiences in treating neutropenic, lymphocytopenic, and chemotherapy patients seem to have proven beneficial during this process. We operated on 10 biopsy patients, 15 primary bone sarcomas, 9 soft tissue sarcomas, and 82 trauma patients within this time frame. Only three patients were suspected to have COVID-19 before admission. The early identification, strict isolation, and effective treatment of these patients prevented any nosocomial infections and disease-related comorbidities. This success is the result of the multidisciplinary cooperation of the Ministry of Health, our hospital, and our clinic.     

Clermont-Ferrand versus Vectec uterine manipulator for total laparoscopic hysterectomy

Objective: To compare the operation time and performance of two uterine manipulators used for total laparoscopic hysterectomy (TLH).

Material and methods: Design: Retrospective cohort analysis. Design classification: Canadian Task Force Classification II-2. Setting: Tertiary-care university-based teaching hospital and academic affiliated private hospital. Patients: All consecutive patients who underwent for TLH between January 2014 and June 2017. All operations were performed by two expert endoscopic surgeons using one of the following uterine manipulators depending on surgeon preferences: Clermont-Ferrand (CF) or Vectec (VT) MAUT60. Patients were excluded if additional surgeries such as urogynecological procedures were performed, TLH was converted to laparotomy prior to colpotomy, and when their operation records could not be obtained. A total of 169 patients were added to final analysis. Operation time, colpotomy time and the subjective performance of manipulators such as movement of the uterus, visualization of the vaginal fornices, and maintenance of pneumoperitoneum were evaluated by watching un-edited operation videos.

Results: A total of 169 patients (83 patients in CF group; 86 patients in VT group) were included in the final analysis. Patients’ baseline characteristics were comparable between groups. Operation time and time required for colpotomy were significantly shorter in the VT group. Lateral movements of the manipulators and elevation of the uterus were better with VT compared to CF (p?=?.001 for both). Compared to the CF, VT was superior for visualization of the vaginal fornices (p?=?.004) and maintenance of pneumoperitoneum (p?<?.001). Both surgeons had perfect agreement on the performance grading of manipulators (p?<?.001, Kappa values were between 0.86–0.92). There was no difference between groups in estimated blood loss and duration of hospital stay. Reinsertion or the need to change the manipulator was not required in either group. No pelvic or vaginal abscess, cuff cellulitis, dehiscence, or hematoma formations were noted.

Conclusion: Laparoscopic hysterectomy assisted with the VT uterine manipulator is associated with shorter operation and colpotomy time. Furthermore, the movements of uterus, visualization of the vaginal fornices, and maintenance of pneumoperitoneum were significantly better with VT compared to the CF manipulator.     

How primary care reforms influenced health indicators in Manisa district in Turkey: Lessons for general practitioners

Background: Turkish health reforms began in 2003 and brought some significant changes in primary care services. Few studies in Turkey compare the shift from health centres (HC) to family physicians (FP) approach, which was initiated by reforms.

Objectives: This study compares health status indicators during the HC period before reforms (2003–2007) and the FP period after reforms (2008–2012) in Turkey.

Methods: This study encompasses time series data consisting of the results of a 10-year assessment (2003–2012) in Manisa district. All the data were obtained electronically and by month. The intersection points of the regression curves of these two periods and the beta coefficients were compared using segmented linear regression analysis.

Results: The mean number of follow-up per person/year during the HC period in infants (10.5), pregnant women (6.6) and women (1.8) was significantly higher than the mean number of follow-up during the FP period in infants (6.7), pregnant women (5.6) and women (0.9). Rates of BCG and measles vaccinations were significantly higher during the FP period; however, rates of HBV and DPT were same. The mean number of outpatient services per person/year during the FP period (3.3) was significantly higher than HC period (2.8). Within non-communicable diseases, no difference was detected for hypertension prevalence. Within communicable diseases, there was no difference for rabies suspected bites but acute haemorrhagic gastroenteritis significantly decreased. The infant mortality rate and under five-year child mortality rate significantly increased during the FP period.

Conclusion: Primary care services should be reorganized and integrated with public health services.     

Effect of high-powered LED polymerization on the shear bond strength of a light-polymerized resin luting agent to ceramic and dentin

STATEMENT OF PROBLEM: A newly introduced high-powered light-emitting diode (LED) light-polymerization unit with various polymerization modes is purported to polymerize dental resins more quickly than standard units. However, there is insufficient information about the effects of this type of light source and its polymerization modes on resin luting agents (RLAs). PURPOSE: This in vitro study evaluated the effects of different modes of a high-powered LED polymerization unit on the shear bond strength of a light-polymerized RLA to ceramic and dentin. MATERIAL AND METHODS: Sixty ceramic cylinders (3 x 3 mm) were fabricated from a heat-pressed ceramic (IPS Empress 2). Specimen surfaces were abraded using 600-grit silicon carbide paper and airborne-particle abraded with 50-mum desiccant alumina particles, cleaned ultrasonically, etched using hydrofluoric acid, and treated with a silane coupling agent (Ceramic primer). Sixty noncarious, freshly extracted, permanent human molar teeth were embedded in autopolymerizing acrylic resin, and their dentin surfaces were wet-ground using a grinding and polishing machine fitted with 180-grit abrasive disks. The ground dentin surfaces were then etched with 37% phosphoric acid gel, and an adhesive agent (Single Bond) was applied. Ceramic specimens (n = 15) were bonded to dentin surfaces with a dual-initiated RLA (Rely-X ARC) and individually polymerized by 1 of 4 different modes, as follows: Halogen standard mode (Control) (600 mW/cm2 for 40 seconds); high-powered LED fast mode (1100 mW/cm2 for 10 seconds); high-powered LED pulse mode (1100 mW/cm2 for 10 seconds); and high-powered LED exponential mode (1100 mW/cm2 for 20 seconds). Cemented specimens were subjected to shear loading until fracture using a universal testing machine. A stereomicroscope (x25) was used to identify the mode of fracture. Bond strength (MPa) data were analyzed using 1-way analysis of variance and the Tukey HSD test (alpha = .05). RESULTS: Specimens polymerized using halogen standard mode (23.9 +/- 1.3 MPa) and LED exponential mode (23.0 +/- 1.1 MPa) had significantly higher ( P < .001) mean shear bond strengths compared with both LED fast (15.1 +/- 1.3 MPa) and pulse (14.6 +/- 1.3 MPa) modes. The Tukey HSD tests showed no significant differences in shear bond strength between specimens polymerized using high-powered LED exponential mode and halogen standard mode. Most failures were adhesive failures at the dentin-RLA interface or the RLA-ceramic interface in specimens polymerized using high-powered LED fast or pulse modes. CONCLUSION: Within the limitations of this study, the shear bond strength of an RLA to ceramic and dentin was found to be similar when polymerized using halogen light in standard mode and high-powered LED light in exponential mode, whereas shear bond strength was significantly lower when polymerized using LED in fast or pulse mode.     

Prosthetic solution for unfavorably inclined maxillary implants: a case report

Misaligned implants may affect the esthetic, phonetic, and functional results and challenge the restorative dentist. Proper attachment selection is important considering the patient-related circumstances. This article presents a case where a change in prosthetic attachments was required because implant inclination diminished overdenture retention and stability. The treatment involved an alternative implant and soft-tissue impression technique.     

Fabrication of implant-assisted restorations utilizing functional impression techniques: case reports

This article describes the fabrication of implant-supported overdentures and removable partial dentures attached to anterior fixed partial dentures utilizing impression techniques to transfer the position of implants and record soft tissue areas in a functional state.     

Effect of thermocycling on tensile strength and tear resistance of four soft denture liners

This study evaluated the effect of thermocycling on the tensile strength and tear resistance of four long-term soft denture liners. One light-activated (Astron Light, AL), two chemically activated (GC Reline Soft, GC; Silagum Comfort, SC), and one heat-cured (Molloplast-B, MLP) soft liner materials were tested. Dumbbell and trouser-leg specimen geometries were used for tensile strength and tear resistance tests, respectively. A total of 120 specimens were prepared. Test specimens for each material (n=5) were subjected to thermal cycling for 1000 and 3000 cycles between 5 degrees C and 55 degrees C in a thermocycler. Before thermocycling, AL gave the lowest tensile strength, while SC exhibited the highest tear resistance value among the materials tested (p < 0.05). Thermal cycling significantly affected the tensile strength of AL as well as the tear resistance values of AL, MLP, and GC materials. This in vitro study revealed that the tensile strength and tear resistance values of the soft liner materials tested varied according to their chemical compositions.     

Comparison of the proliferative activity in gingival epithelium after surgical treatments of intrabony defects with bioactive glass and bioabsorbable membrane

Guided tissue regeneration is based on preventing the more rapidly proliferating epithelium from growing into the periodontal defect after surgical procedures incorporating barrier membranes. The aim of this study was to compare the proliferative activity of gingival epithelium using proliferating cell nuclear antigen (PCNA) as a marker of cell proliferation after surgical treatments with bioactive glass graft material and bioabsorbable membrane. Using split mouth design, 20 intrabony defects were randomly assigned treatments with bioactive glass (BG group) or bioabsorbable membrane (BM group). Gingival biopsies were taken at preoperative and postoperative 12 weeks. After histological processing, the number of the inflammatory cells was measured in hematoxylin and eosin-stained sections; PCNA expression was determined in immunohistochemically-stained sections. At postoperative 12 weeks, the number of the inflammatory cells was significantly decreased (p < 0.01), PCNA expression was significantly increased (p < 0.001) in both treatment groups compared to baseline data. There was no significant difference in PCNA expression between baseline values of two groups (p > 0.05), while at postoperative 12 weeks, increase in BG group was significantly greater than that in BM group (p < 0.001). These results suggest that epithelial cell proliferation is more prominent after treatment of intrabony defects with bioactive glass compared to the treatment with bioabsorbable membrane.     

Levels of gingival tissue platelet activating factor after conventional and regenerative periodontal surgery

The hypothesis, a relationship between gingival tissue platelet activating factor (PAF) levels and healing after periodontal surgery, was tested by measuring PAF levels in gingival tissues collected from sites that had undergone flap surgery and guided tissue regeneration (GTR) or flap surgery alone. Using a split-mouth design, 20 intrabony defects were randomly assigned to treatment with flap surgery and GTR (group 1) or with flap surgery alone (group 2). Gingival tissue samples were obtained at surgery (baseline) and at 6-month follow-up evaluation visit. One half of each sample was used for analysis of PAF levels by high-performance liquid chromatography, and the other half of the sample was used for histomorphometric analysis that included measurements of number and diameter of blood vessels. PAF levels and diameter of blood vessels were significantly decreased (p < 0.01), and the number of blood vessels was significantly increased (p < 0.05) in both groups after 6 months compared to the baseline values. Postoperative number of blood vessels were significantly higher in group 1 (p < 0.05), whereas there was no significant difference in postoperative PAF levels between the two groups (p > 0.05). Based on the reported results, it is suggested that a decrease in gingival PAF levels might be found after conventional and regenerative periodontal surgery.