Consequences of meconium stained amniotic fluid: What does the evidence tell us?

Background

Meconium stained amniotic fluid (MSAF) is common and associated with meconium aspiration syndrome (MAS). Other consequences of meconium passage before birth are less well understood.

Methods

We reviewed the literature for original papers reporting on outcomes associated with MSAF.

Findings

Among preterm infants MSAF is more prevalent than previously believed and is associated with higher neonatal morbidity. Intrauterine exposure to meconium is associated with inflammation of tissues of the lung, chorionic plate and umbilical vessels and through various mechanisms may contribute to neonatal morbidity, independent of MAS. No compelling evidence supported an association between MSAF and increased neurological impairment, including early seizure activity.     

Skeletal and dental effects of tooth-borne versus hybrid devices for mandibular symphyseal distraction osteogenesis

Objective: To evaluate and compare, retrospectively, the skeletal and dental effects of mandibular symphyseal distraction osteogenesis (MSDO) achieved through the use of tooth-borne versus hybrid distractors.Materials and Methods:Pretreatment (T1), predistraction (T2), postdistraction (T3), and posttreatment (T4) orthodontic records were collected and analyzed for 47 patients (20 tooth-borne, 27 hybrid). At each time point, records included intraoral photographs, study models, postero-anterior cephalometric radiographs, and lateral cephalometric radiographs. Submental vertex radiographs were taken at T2, T3, and T4. Changes in a total of 18 measurements were analyzed to compare patients undergoing tooth-borne versus hybrid distraction.Results:The cumulative effects of orthodontics and MSDO produced similar gains in measured arch widths, with a decreased irregularity index in both groups (P > .05). However, there were differences in the timing during which the expansion was achieved. The hybrid distractor group gained space during the distraction phase of treatment. The tooth-borne group showed greater gains during pre- and postdistraction orthodontics. Comparisons of intercanine and interbone marker widths demonstrated a more parallel separation of bone during distraction with the hybrid distractor (P < .001). Distraction with the tooth-borne distractor was disproportionate, with greater separation of the canines in alveolar bone than of the bone markers in basal bone. During postdistraction orthodontics, the tooth-borne distractor group showed statistically greater increases in measurements.Conclusion:Both skeletal and dental expansion was achieved with both appliances. Greater skeletal expansion was achieved with a hybrid distractor. Greater dental expansion was achieved with a tooth-borne distractor.     

Investigation of different bleaching conditions on the amount of elutable substances from nano-hybrid composites

Objectives

To analyse the influence of irradiation time, aging before bleaching, and bleaching technique (home bleaching vs. in-office bleaching) on the amount of elutable substances from modern nano-hybrid resin-based composites (RBCs).

Methods

Specimens (n = 5) of three nano-hybrid RBCs (Venus^® Diamond, Tetric EvoCeram^® and Filtek™ Supreme XTE) were irradiated for 5, 10, 20 and 40 s. The degree of conversion (DC) was measured in real-time with Fourier transform infrared spectroscopy (FTIR). Specimens were bleached either directly after irradiation or after aging (1.5 or 6 month in distilled water at 37 °C) with Opalescence^® PF15% for 6 h (simulation of home bleaching) or PF35% for 0.5 h (simulation of in-office bleaching) and incubated in ethanol/water (3:1) at 37 °C for 7 d. The eluates were analyzed by gas chromatography/mass spectrometry. Unbleached specimens at the above mentioned irradiation times were used as controls.

Results

Bleaching increases the amount of elutable substances. This amount is generally stronger influenced by aging than by polymerization time or concentration of the gel. 2-Hydroxyethyl methacrylate was found in amounts up to 334.14 (106.91) μmol/l (Tetric EvoCeram^®, irradiation time 5 s; bleaching with 15% CP) as a destruction product. Diethoyxdimethylsilane was found in all eluates from bleached specimens, but not in the control groups. This substance may be formed by oxidation of 3-methacryloxy-propyltrimethoxysilane, indicating that the bond between inorganic filler and organic matrix might be weakened after bleaching.

Significance

Bleaching gels might alter the physical properties of resin-based composites, especially at low irradiation times and fresh placed restorations.     

Tackling malaria,village by village: a report on a concerted information intervention by medical students and the community in Mifumi,Eastern Uganda

Background

Can an information intervention facilitated by information technology and carried out by an interdisciplinary team comprising medical students, technical experts, and the community itself make a positive contribution in reducing the burden of malaria at the village level?In Mifumi village in Eastern Uganda, MIFUMI Project, Makerere University College of Health Sciences Community Based Education and Service program (COBES), and the U.S. National Library of Medicine carried out a series of activities between 2007 and 2010.

Methods

The team surveyed the community''s knowledge of malaria prevention and treatment; implemented a health information intervention using tutorials in a variety of media; and observed the community''s use of previously distributed insecticide treated nets (ITNs) using a digital pen application.

Results

As a result of concerted education and outreach, the village residents have a good understanding of malaria prevention and treatment seeking behaviors. Leveraging the power of information technology and interdisciplinary teamwork, medical students and the denizens of a rural community were able to engage in an interactive experience of health education and promotion.

Conclusion

Preliminary observations suggest that a health information intervention in concert with a collaborative community effort of education and prevention can build capacity within a community to take control of its own health.     

Morphometric Examination of the Equine Adult and Foal Lung

To understand the mechanisms of airway inflammation associated with equine diseases such as Rhodococcus equi infection, we must identify baseline “normal” structural characteristics of the horse lung. To develop a detailed understanding of the morphology of the horse lung, we adapted and applied stereological methods to the lungs from healthy adult horses (N = 4) and 1‐day (N = 5) and 30‐day (N = 5) old foals. The left lung was fixed in situ by intrabronchial instillation of glutaraldehyde/paraformaldehyde fixative at 25 cm H₂O column and sampled using a fractionator design followed by embedding in glycol methacrylate. The lung was characterized into parenchyma and non‐parenchyma, where median parenchymal density was 81.0% in 1‐day‐old foals, 84.4% in 30‐day‐old foals and 93.7% in adult lungs. The median volume density of alveolar airspace per lung was 45.9% in 1‐day‐old, 55.5% in 30‐day and 66.9% in adult horse lungs. The median alveolar surface area increased with age, from 205.3 m², 258.2 m², and 629.9 m² in 1‐day‐old foals, 30‐day‐old foals, and adults, respectively. While the median alveolar surface density decreased with age, the mean linear intercept (mean free distance within acinar airspaces) increased with age. Alveolar surface area was greater than endothelial surface area within each lung. The ratio between alveolar and endothelial surface density remains unchanged with age. The median endothelium surface area was 106.2 m² in 1‐day, 147.5 m² in 30‐day, and 430 m² in adult lungs. The data suggest the foal lung is functionally developed and postnatal lung development and remodelling is driven by alveolar expansion paralleled with angiogenesis. Anat Rec, 297:1950–1962, 2014. © 2014 Wiley Periodicals, Inc.     

Diagnostic accuracy and clinical utility of biopsy in musculoskeletal lesions: A comparison of fine‐needle aspiration,core, and open biopsy techniques

Selection of biopsy technique for musculoskeletal lesions is complex. Fine‐needle aspiration (FNA) is uncommonly used due to concerns regarding accuracy. We compared diagnostic accuracy of FNA, core, and open biopsy in a series of musculoskeletal lesions. Records of the University of Utah were searched for biopsy and resection specimens of musculoskeletal lesions. Results of corresponding imaging studies were obtained. Biopsy and FNA diagnoses were correlated with resection diagnoses. For each technique, diagnostic accuracy, utility, and frequency of subsequent biopsy were calculated. Open biopsy had the highest diagnostic accuracy (89%) followed by FNA (82%) and core biopsy (78%). Clinically significant errors occurred with all methods. The likelihood of an open biopsy being performed was affected by prior performance of an FNA or core biopsy and by diagnostic imaging and FNA results. Diagn. Cytopathol. 2014;42:476–486. © 2014 Wiley Periodicals, Inc.     

Efficacy of various side-to-side toothbrushes for noncontact biofilm removal

Objectives

The aim of this study was to evaluate the efficacy of four different powered toothbrushes with side-to-side action for noncontact biofilm removal in vitro.

Materials and methods

A three-species biofilm was formed in vitro on protein-coated titanium disks using a flow chamber combined with a static biofilm growth model. Subsequently, the biofilm-coated substrates were exposed to four different side-to-side toothbrushes (A, B, C, and D) with various brushing times (2, 4, and 6 s) and brushing (bristle-to-disk) distances (0, 2, and 4 mm). The biofilm volumes were measured using volumetric analyses with confocal laser scanning microscope images and Imaris version 7.5.2 software.

Results

The median percentages of biofilm reduction by the analyzed toothbrushes ranged from 9 % to 80 %. The abilities of the tested toothbrushes to remove the in vitro biofilm differed significantly (p?<?0.05). Two of the tested toothbrushes (C and D) were capable of significant biofilm reduction by noncontact brushing.

Conclusions

It was possible to reduce a three-species in vitro biofilm by noncontact brushing with two out of four side-to-side toothbrushes.

Clinical relevance

Toothbrushes C and D show in vitro a high efficacy in biofilm removal without bristle contact.     

The outcome after surgical therapy of bisphosphonate-associated osteonecrosis of the jaw—results of a clinical case series with an average follow-up of 20 months

Objectives

The present case series evaluates the success rate of osteotomy and primary wound closure in patients with bisphosphonate-associated osteonecrosis of the jaw (BRONJ).

Materials and methods

Eighty patients suffering from BRONJ were included in the study. All patients received intravenous bisphosphonate therapy and underwent osteotomy and primary wound closure according to a standardised protocol. After discharge, the patients were reviewed on a regular basis over an average time period of 20 months.

Results

During follow-up in 11 patients, a recurrence of BRONJ occurred in the former operation field. Seventeen patients died due to their underlying disease. The success rate of osteotomy and primary wound closure in the treatment of BRONJ was calculated at 84.2 % 20 months after surgery. The results showed non-significant difference concerning the outcome of surgery in the different clinical stages of BRONJ.

Conclusions

In accordance with previous studies, stage-independent osteotomy and primary wound closure combined with antibiotics shall be deemed a viable treatment option in patients suffering from BRONJ.

Clinical relevance

With a high success rate, osteotomy in combination with primary wound closure seems to be a viable alternative to more conservative protocols in the treatment of BRONJ.