Endoloop versus endostapler closure of the appendiceal stump in pediatric laparoscopic appendectomy

Background

There is little information available to inform choice of technique for appendiceal stump control in pediatric laparoscopic appendectomy (LA). We compared complications (stump leak, intra-abdominal abscess formation [IAA], surgical site infection [SSI]) in children undergoing LA for perforated (PA) and nonperforated appendicitis (NPA) by technique of appendiceal stump control.

Methods

All children who underwent LA for confirmed acute appendicitis between 2006 and 2009 were reviewed. Choice of stump control (endoloop [EL] or endostapler [ES]) was determined by surgeon preference. Interactions between stump closure techniques and other potential confounders (intra-abdominal drain, irrigation, different antibiotic regimens) were explored using a logistic regression model.

Results

Of 242 patients undergoing LA, 57 (23.6%) had PA. In the PA group the appendiceal stump was closed with EL in 47 (82.5%) patients, while in the NPA group EL was used in 161 (87%) patients. Among PA patients, IAA was more common in the ES than the EL group (5 of 10 [50%] v. 6 of 47 [12.7%]). There was no significant difference in rates of SSI. Among NPA patients, there were no differences in rates of IAA or SSI. There were no stump leaks in either group. Logistic regression analysis confirmed the predictive effect of ES use on IAA formation in PA (adjusted odds ratio 7.09; 95% confidence interval 1.08–46.13; p = 0.042).

Conclusion

Our data suggest that in most cases of PA, the appendiceal stump can be safely controlled with EL. Within the PA group, the higher rates of IAA seen in ES patients may be attributable to the quality of the appendiceal stump rather than the technique of closure.     

Prediction of prolonged laryngoscopy.

Duration of laryngoscopy must be kept as short as possible to prevent disturbances of oxygenation and ventilation. Because the factors associated with prolonged laryngoscopy are not well known, we studied 1000 patients undergoing tracheal intubation under general anaesthesia to determine the possible effects of their characteristics on the incidence of prolonged laryngoscopy (defined as lasting longer than 15 s). Multiple logistic regression analysis was performed to determine the odds ratio for significant factors. Prolonged laryngoscopy occurred in 158 patients (15.8%). Six characteristics were determined as risk factors for a prolonged laryngoscopy: weight > 80 kg [OR 3.7 (95% CI 1.9-7.1)]; tongue protrusion < 3.2 cm [OR 2.0 (1.0-4.2)]; mouth opening < 5 cm [OR 4.3 (2.1-8.9)]; upper incisor length > 1.5 cm [OR 4.2 (2.0-8.6)]; Mallampati class > 1 [OR 10.0 (7.1-14.6)]; and head extension < 70 degrees [OR 7.1 (3.8-13.6)]. The presence of three of these factors predicted prolonged laryngoscopy with a sensitivity of 0.72 and a specificity of 0.91     

Photobiomodulation therapy reduces apoptotic factors and increases glutathione levels in a neuropathic pain model

Neuropathic pain (NP) is caused by damage to the nervous system due to reactive oxygen spices (ROS) increase, antioxidants reduction, ATP production imbalance, and induction of apoptosis. In this investigation, we applied low-level laser 660 nm (photobiomodulation therapy) as a new strategy to modulate pain. In order to study the effects of photobiomodulation therapy (660 nm) on NP, chronic constriction injury (CCI) model was selected. Low-level laser of 660 nm was used for 2 weeks. Thermal and mechanical hyperalgesia were measured before and after surgery on days 7 and 14, respectively. Paw withdrawal thresholds were also evaluated. Expression of p2x3, Bax, and bcl2 protein was measured by western blotting. The amount of glutathione (GSH) was measured in the spinal cord by continuous spectrophotometric rate determination method. The results are presented as mean?±?SD. Statistical analysis of data was carried out using SPSS 21. CCI decreased the pain threshold, 2-week photobiomodulation therapy significantly increased mechanical and thermal threshold, decreased P2X3 expression (p?<?0.001), and increased bcl2 expression (p?<?0.01), but it was not effective on the Bax expression. We speculated that although photobiomodulation therapy increased ROS generation, it increased antioxidants such as GSH. Increase in bcl2 is another mitochondrial protection mechanism for cell survival and that pain relief and decrease in P2X3 expression confirm it.     

Antifungal effects of sodium hypochlorite and chlorhexidine in root canals.

The purpose of this study was to evaluate the antifungal properties of 0.12% chlorhexidine, 1% NaOCl, and 5% NaOCl. Root sections were enlarged and the smear layer was removed in half of the specimens. The specimens were fixed in the wells of tissue culture plates. Each root canal was dispensed with an inoculum of Candida albicans. After 10 days, the root sections were treated with 3 ml of either disinfectant solution for 1 min, 5 min, 30 min, and 1 h. Then, root sections were incubated in test tubes having Sabouraud's Dextrose Broth at 37 degrees C for 24 h. In the presence of the smear layer, antifungal activity was observed only in 1-h treatment groups for all solutions. However, in the absence of the smear layer, 5% NaOCl alone started to show antifungal activity after 30 min. The antimicrobial effectiveness of irrigating solutions should be re-evaluated, particularly in patients predisposed to oral candidiasis.     

Apelin-13 Protects the Brain Against Ischemic Reperfusion Injury and Cerebral Edema in a Transient Model of Focal Cerebral Ischemia

The adipocytokine apelin is a peptide that was isolated from a bovine stomach for the first time. This peptide and its receptor are abundantly expressed in the nervous and cardiovascular systems. According to previous studies, apelin-13 protects cardiomyocytes from ischemic injury as well as apoptosis. In addition, this peptide has a neuroprotective effect on hippocampal and cultured mouse cortical neurons against NMDA receptor-mediated excitotoxicity. The present study was conducted to determine whether apelin-13 provides protection in transient focal cerebral ischemia. Focal ischemia was induced by 60-min middle cerebral artery occlusion (MCAO), followed by 23-h reperfusion. Saline as a vehicle and apelin-13 at doses of 25, 50, and 100 μg were injected intracerebroventriculary (ICV) at the beginning of ischemia. Infarct volume ,brain edema, motor dysfunction, and apoptosis were assessed 24 h after MCAO. Treatment with apelin-13 at doses of 50 and 100 μg ICV markedly reduced total infarct volumes by 45 and 55 %, respectively (P?P?>?0.05). In addition, apelin-13 at doses of 50 and 100 μg reduced brain edema (P?P?P?>?0.05).     

Incidentally Visualization of the Thymus on Whole-Body Iodine Scintigraphy: Report of 2 Cases and Review of the Latest Insights

Radioiodine uptake is not commonly seen by the thymus gland. On the contrary, the gland is slowly replaced by fat after puberty. Herein, we present 2 patients with papillary thyroid carcinoma, follicular variant, and cervical lymph node involvement. After total/near-total thyroidectomy, the patients received ¹³¹I for ablation therapy. On posttreatment radioiodine scintigraphy, mediastinal ¹³¹I uptake was noted that finally was histologically/anatomically diagnosed as thymus gland uptake. It should be borne in mind as a potential cause of false-positive whole-body ¹³¹I scintigraphy.     

The encephalitogenicity of T(H)17 cells is dependent on IL-1- and IL-23-induced production of the cytokine GM-CSF

Interleukin 17 (IL-17)-producing helper T cells (T(H)17 cells) require exposure to IL-23 to become encephalitogenic, but the mechanism by which IL-23 promotes their pathogenicity is not known. Here we found that IL-23 induced production of the cytokine granulocyte-macrophage colony-stimulating factor (GM-CSF) in T(H)17 cells and that GM-CSF had an essential role in their encephalitogenicity. Our findings identify a chief mechanism that underlies the important role of IL-23 in autoimmune diseases. IL-23 induced a positive feedback loop whereby GM-CSF secreted by T(H)17 cells stimulated the production of IL-23 by antigen-presenting cells. Such cross-regulation of IL-23 and GM-CSF explains the similar pattern of resistance to autoimmunity when either of the two cytokines is absent and identifies T(H)17 cells as a crucial source of GM-CSF in autoimmune inflammation.     

Integrin expression in human dental pulp cells and their role in cell attachment on extracellular matrix proteins

Integrins are a family of heterodimeric glycoproteins consisting of alpha and beta subunits that noncovalently interact to form cell surface adhesion receptors. The objective of this study was to identify integrins in human dental pulp cells and determine their role in human dental pulp cell attachment to the biological active molecules, laminin and fibronectin. Integrin expression was studied by immunoblot and immunoprecipitation using monoclonal integrin antibodies. The role of integrin in human dental pulp cell adhesion on laminin and fibronectin was determined by inhibition of cell adhesion with those antibodies. This study found human dental pulp cells expressed alpha 1, alpha 3, alpha 5, alpha 6, alpha v, and beta 1 integrin subunits. The adhesion of human dental pulp cells to laminin and fibronectin was not inhibited by monoclonal antibody to any subunit, except that anti-beta 1 antibody inhibited pulp cells adhesion on laminin. These data provide information for further studying the role of integrins in dental pulp cell biological function.     

Biologic Activity of Porphyromonas endodontalis Complex Lipids

Introduction

Periapical infections secondary to pulpal necrosis are associated with bacterial contamination of the pulp. Porphyromonas endodontalis, a gram-negative organism, is considered to be a pulpal pathogen. P. gingivalis is phylogenetically related to P. endodontalis and synthesizes several classes of novel complex lipids that possess biological activity, including the capacity to promote osteoclastogenesis and osteoclast activation. The purpose of this study was to extract and characterize constituent lipids of P. endodontalis and evaluate their capacity to promote proinflammatory secretory responses in the macrophage cell line, RAW 264.7, as well as their capacity to promote osteoclastogenesis and inhibit osteoblast activity.

Methods

Constituent lipids of both organisms were fractionated by high-performance liquid chromatography and were structurally characterized using electrospray mass spectrometry or electrospray-mass spectrometry/mass spectrometry. The virulence potential of P. endodontalis lipids was then compared with known biologically active lipids isolated from P. gingivalis.

Results

P. endodontalis total lipids were shown to promote tumor necrosis factor alpha secretion from RAW 264.7 cells, and the serine lipid fraction appeared to account for the majority of this effect. P. endodontalis lipid preparations also increased osteoclast formation from RAW 264.7 cells, but osteoblast differentiation in culture was inhibited and appeared to be dependent on Toll-like receptor 2 expression.

Conclusions

These effects underscore the importance of P. endodontalis lipids in promoting inflammatory and bone cell activation processes that could lead to periapical pathology.     

Anoxia,calcium and contracture as mediators of myocardial enzyme release

The effects of anoxia and calcium-free perfusion on enzyme release, were studied in perfused rat hearts, at 37°C. In oxygenated hearts, calcium-free medium caused detachment of cells at intercalated discs, but no cell separation or enzyme release. Sixty minutes of anoxia with calcium-free medium caused striking cell separations, contracture of sarcomeres and enzyme release. Anoxia, followed by calcium-free medium, produced a sudden, energy-independent enzyme release with contracture and cell separations. Contraction bands as well as cell separations, were present in anoxic hearts reoxygenated in the absence of calcium. It is proposed that calcium-free media causes loss of integrity of intercalated disc junctions and contraction, and anoxic contracture pulls cells apart at weakened cell junctions, mediating membrane damage and enzyme release.