A comparison of Demirjian's four dental development methods for forensic age estimation in South Australian sub-adults

The aim of this study was to compare the accuracy of Demirjian's four dental development methods for forensic age assessment in a South Australian population. The sample comprised orthopantomograms (OPGs) of 408 sub-adult individuals (211 male; 197 female) with an age range of 4.9–14.5 years. The OPGs were obtained from various dental schools and clinics in urban Adelaide. The following Demirjian methods were evaluated: the original 7-tooth technique; the revised 7-tooth system; the 4-tooth method; and the alternate 4-tooth approach. The left mandibular teeth in each OPG were assessed and rated according to the eight stages (A–H) defined and illustrated in Demirjian et al.⁵ Differences between chronological and estimated ages were calculated for males and females separately; 95% confidence intervals of mean age differences were calculated and ANOVA used to assess the significance of mean differences.When comparing all four methods there were significant differences overall (and in individual age groups) between mean chronological and estimated age in both sexes. In addition, each method consistently overestimated chronological age. We also demonstrate that the accuracy of the dental age methods evaluated varies in different subsets of an Australian population, a finding that parallels previous research in other global populations. Based on our analyses we conclude that population-specific standards based on dental maturity curves, as opposed to estimated ages, would provide more accurate and statistically robust age estimations.     

Laparoscopic diagnosis and treatment of intestinal obstruction

Background: Intestinal obstruction is a common reason for general surgical referral. The traditional approach has been conservative management, followed by laparotomy if conservative measures are unsuccessful. However, with the advent of minimally invasive surgery, the need for laparotomy for this common problem is being challenged.Methods: From May 1991 to April 2001, 167 patients underwent laparoscopy for diagnosis and/or treatment of intestinal obstruction. Average patient age was 62 years (range, 21–98). The site of obstruction was the stomach in seven patients, small bowel in 116 patients, and colon in 44 patients.Results: Laparoscopy successfully diagnosed the site of obstruction in all patients. In addition, 154 patients (92.2%) were successfully treated laparoscopically without conversion to laparotomy. Both intraoperative and postoperative complication rates were low (3.5 and 18.6%, respectively) and compared favorably with those of published reports.Conclusions: Intestinal obstruction can be approached safely and effectively by laparoscopy with the intent not only to correctly diagnose the patient but also to render treatment.     

Exercise training and coronary collateral circulation

This review examines the potential for an exercise-induced increase in coronary collateral circulation, with specific reference to the role and functional significance of collateral vessels, highlighting animal and human studies in particular, and their inherent methodological limitations. Exercise training may enhance myocardial oxygen supply by promoting transient periods of myocardial ischemia, a potent trigger of collateral growth. Some human studies have shown that moderate-to-high intensity training can result in a higher double product at the onset of angina and/or ischemic ST-segment depression, suggesting that myocardial oxygen supply has increased. Attempts to use thallium-201 exercise scintigraphy to assess myocardial perfusion before and after a physical training program have produced conflicting data, whereas angiographic studies in group trials have, without exception, yielded disappointing results. Thus, direct evidence that exercise stimulates collateralization in humans is lacking.     

Postoperative apnea, respiratory strategies, and pathogenesis mechanisms: a review

Recovery from anesthesia is ideally routine and uneventful. After extubation, the recovering postoperative patient ought to breathe without supportive care or additional oxygenation. It has been demonstrated in previous studies that postoperative pulmonary complications are clinically relevant in terms of mortality, morbidity, and length of hospital stay. Compromised postoperative ventilation can be described as the condition in which the postoperative patient does not have satisfactory spontaneous ventilation support and adequate oxygenation. Causes of impaired ventilation, oxygenation, and airway maintenance can be mechanical, hemodynamic, and pharmacologic. This review describes prevalence and differential diagnosis, including co-morbidities of postoperative apnea. The physiological mechanisms of breathing and prolonged postoperative apnea are also reviewed; these mechanisms include influences from the brainstem, the cerebral cortex, and chemoreceptors in the carotid and aortic body. Causes of prolonged postoperative apnea and management are also discussed.     

The effect of treatment strategy on stone comminution efficiency in shock wave lithotripsy

PURPOSE: The comminution of kidney stones in shock wave lithotripsy (SWL) is a dose dependent process caused primarily by the combination of 2 fundamental mechanisms, namely stress waves and cavitation. The effect of treatment strategy with emphasis on enhancing the effect of stress waves or cavitation on stone comminution in SWL was investigated. Because vascular injury in SWL is also dose dependent, optimization of the treatment strategy may produce improved stone comminution with decreased tissue injury in SWL. MATERIALS AND METHODS: Using an in vitro experiment system that mimics stone fragmentation in the renal pelvis spherical BegoStone (Bego USA, Smithfield, Rhode Island) phantoms (diameter 10 mm) were exposed to 1,500 shocks at a pulse repetition rate of 1 Hz in an unmodified HM-3 lithotripter (Dornier Medical Systems, Kennesaw, Georgia). The 3 treatment strategies used were increasing output voltage from 18 to 20 and then to 22 kV every 500 shocks with emphasis on enhancing the effect of cavitation on medium fragments (2 to 4 mm) at the final treatment stage, decreasing output voltage from 22 to 20 and then to 18 kV every 500 shocks with emphasis on enhancing the effect of stress waves on large fragments (greater than 4 mm) at the initial treatment stage and maintaining a constant output voltage at 20 kV, as typically used in SWL procedures. Following shock wave exposure the size distribution of fragments was determined by the sequential sieving method. In addition, pressure waveforms at lithotripter focus (F2) produced at different output settings were measured using a fiber optic probe hydrophone. RESULTS: The rate of stone comminution in SWL varied significantly in a dose dependent manner depending on the treatment strategies used. Specifically the comminution efficiencies produced by the 3 strategies after the initial 500 shocks were 30.7%, 59% and 41.9%, respectively. After 1,000 shocks the corresponding comminution efficiencies became similar (60.2%, 68.1% and 66.4%, respectively) with no statistically significant differences (p = 0.08). After 1,500 shocks the final comminution efficiency produced by the first strategy was 88.7%, which was better than the corresponding values of 81.2% and 83.5%, respectively, for the other 2 strategies. The difference between the final comminution efficiency of the first and second strategies was statistically significant (p = 0.005). CONCLUSIONS: Progressive increase in lithotripter output voltage can produce the best overall stone comminution in vitro.     

Suppression of Experimental Aortic Aneurysms: Comparison of Inducible Nitric Oxide Synthase and Cyclooxygenase Inhibitors

The rat model of abdominal aortic aneurysm (AAA) is associated with inflammation, destruction of extracellular matrix, and production of both inducible nitric oxide synthase (iNOS) and matrix metalloproteinase-9 (MMP-9). Indomethacin, a nonselective cyclooxygenase inhibitor, may prevent AAA formation by inhibiting cyclooxygenase-2 (COX-2) activity. We hypothesized that indomethacin, rofecoxib (selective COX-2 inhibitor), and 1400W (selective iNOS activity inhibitor) would decrease aneurysm formation in the rat model. Forty-six male Wistar rats underwent intraaortic elastase infusion in two parallel studies based on medication delivery route. Sixteen rats were randomized to rofecoxib or water by gastric lavage. Thirty rats were randomized to subcutaneous saline, indomethacin, or 1400W. Heart rate, blood pressure and aortic diameters were measured. Western Blot and mRNA analysis for MMP-9 and iNOS was performed on postoperative day 7 aortic segments. Elastin degradation and inflammation were evaluated by immunohistochemistry. Elastase infusion produced AAA in all rats. 1400W significantly limited aneurysm expansion (p=0.01) whereas treatment with indomethacin and rofecoxib did not. Only 1400W significantly increased blood pressure (p < 0.001). Indomethacin alone statistically decreased MMP-9 (p < 0.011). 1400W resulted in greater conservation of aortic elastin than indomethacin (p=0.025). All groups demonstrated statistically similar expression of iNOS. In conclusion, selective iNOS activity inhibitor, 1400W, significantly decreased aneurysm size and preserved aortic elastin without altering MMP-9 levels. Indomethacin significantly decreased MMP-9 expression without decreasing aneurysm size. Rofecoxib did not significantly decrease MMP-9 expression or aneurysm size. Inhibition of iNOS limits aneurysmal expansion by mechanisms other than MMP-9 inhibition. MMP-9 inhibition by indomethacin is not sufficient to limit aneurysm expansion in our model.Presented at the 2002 Lifeline Foundation Research Initiatives in Vascular Disease Conference,Bethesda, MD, April 18-19, 2002.     

经导管支气管动脉栓塞术治疗肺部基础病变合并新型冠状病毒肺炎诱发咯血

目的 观察经导管支气管动脉栓塞术(BAE)治疗肺部基础病变合并新型冠状病毒肺炎(COVID-19)诱发咯血的价值。方法 纳入18例接受经导管BAE的肺部基础病变合并COVID-19咯血患者,观察其临床特征,根据临床转归分为治愈、显效、有效、无效及复发,评估BAE疗效。结果 首次BAE后治愈6例(6/18,33.33%)、显效3例(3/18,16.67%)、有效3例(3/18,16.67%),无效1例(1/18,5.56%)、复发5例(5/18,27.78%);5例复发者经二次BAE后均治愈。未见脊髓损伤及异位栓塞等严重并发症。结论 BAE治疗肺部基础病变合并COVID-19诱发咯血疗效确切,但短期内复发率较高。     

Laparoscopic common bile duct exploration by choledochotomy

Background: Management of cholelithiasis and choledocholithiasis usually requires two separate teams—the gastroenterologist/surgical endoscopist and the laparoscopic surgical team. This requires two separate procedures that potentially increase the overall morbidity and cost. Laparoscopic common bile duct exploration by choledochotomy (LCBDE-C) averts this problem with a single approach. Methods: In 1990–1991, unsuspected stones found at laparoscopy with intraoperative cholangiogram done routinely underwent postoperative ERCP. Residual stones had been found after ERCP in 16 of 22 preoperative ERCP patients and we began to seek an alternative technique. Laparoscopic common bile duct exploration by choledochotomy has achieved a high rate of success. Results: Technically successful LCBDE-C has been accomplished in 143 of 148 patients (96.6%). Retained bile duct stones have been found on postoperative cholangiogram in three patients (2.0%), all of which have been successfully removed by postoperative ERCP. Thus 140 or 148 patients had their bile duct successfully cleaned by the one-step technique alone (94.6%). Conclusions: We believe that most laparoscopic surgeons who have acquired the skills of intracorporeal suturing can be successful at laparoscopic common bile duct exploration by choledochotomy. The disadvantage of T-tube presence will likely be eliminated by future developments with intraoperative antegrade sphincterotomy-like procedures, but the ability to see both proximal and distal biliary tree with the choledochotomy in all cases seems to offer more than adequate results at this point in the evolution of the laparoscopic approach to calculus biliary tract disease. Received: 3 April 1997/Accepted: 18 September 1997     

Impact of the U.S. Food and Drug Administration's Safety‐Related Announcements on the Use of Bisphosphonates After Hip Fracture

The U.S. Food and Drug Administration (FDA) issued several announcements related to potential risk of bisphosphonates including osteonecrosis of the jaw (2005), atrial fibrillation (2007), and atypical femur fracture (2010). We aimed to evaluate the impact of three FDA drug safety announcements on the use of bisphosphonates in patients with hip fracture using claims data from a U.S. commercial health plan (2004‐2013). We calculated the proportion of patients in each quarter who received a bisphosphonate or other osteoporosis medication in the 6 months following hospitalization for hip fracture. Segmented logistic regression models examined the time trends. Among 22,598 patients with hip fracture, use of bisphosphonate decreased from 15% in 2004 to 3% in the last quarter of 2013. Prior to the 2007 announcement, there was a 4% increase in the odds of bisphosphonate use every quarter (OR 1.04; 95% CI, 1.02 to 1.07). After the 2007 announcement, there was a 4% decrease in the odds of bisphosphonate use (OR 0.96; 95% CI, 0.93 to 0.99) every quarter. The announcement in 2007 was associated with a significant decline in the rate of change of bisphosphonate uses over time (p < 0.001), but no impact on other osteoporosis medication use (p = 0.2). After the 2010 announcement, the odds of bisphosphonate use continued to decrease by 4% (OR 0.96; 95% CI, 0.94 to 0.98) each quarter and the odds of other osteoporosis medication use remained stable over time (OR 0.99; 95% CI, 0.96 to 1.02). The FDA safety announcement related to atrial fibrillation in 2007 was significantly associated with a decrease in bisphosphonate use among patients with hip fracture. © 2016 American Society for Bone and Mineral Research.     

Treatment of lower urinary tract symptoms suggestive of benign prostatic hyperplasia: sexual function

Lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH), and sexual dysfunction, are common, highly bothersome conditions in older men, and the prevalence of both disorders increases with age. Sexual dysfunction manifests mainly as erectile dysfunction (ED), ejaculatory disorders, or decreased libido/hypoactive sexual desire (HSD). Whereas both reduced rigidity and reduced ejaculate volume are highly prevalent in ageing men, reduced rigidity and pain on ejaculation are considered to be most bothersome. Sexual dysfunction is much more prevalent in patients with LUTS/BPH than in men with no LUTS/BPH, even after controlling for confounding variables such as age or comorbidities. Hence LUTS/BPH is considered an independent risk factor for sexual dysfunction. Whether this is because of a common underlying pathology, or whether the considerable bother associated with LUTS/BPH leads to reduced sexual functioning, remains to be elucidated. Despite a decline in the frequency of sexual intercourse, as well as in overall sexual functioning, most ageing men report regular sexual activity and consider their sex life as an important dimension of their quality of life (QoL). However, most patients with LUTS/BPH experience a negative effect of their LUTS on their sex life. Hence, treatment of LUTS/BPH should aim to at least maintain or, if possible, improve sexual function. Current medical treatment of LUTS/BPH consists of monotherapy with alpha1-adrenoceptor (AR) antagonists, 5alpha-reductase inhibitors (RIs) or a combination of these. Whereas 5alpha-RIs increase the risk of ED, ejaculatory disorders and HSD, alpha1-AR antagonists can induce ejaculatory disorders, but do not provoke HSD or ED. Combined therapy carries the cumulative risk for sexual dysfunction associated with either type of drug. As already indicated, ED is generally perceived as more bothersome than ejaculatory disorders. In addition, alpha1-AR antagonists slightly improve overall sexual function, possibly by increasing blood flow in the penis through alpha1-AR blockade and/or to an increased overall QoL from the relief of LUTS. It can be concluded that alpha1-AR antagonists constitute a first-line therapy for LUTS/BPH because they combine good treatment efficacy with very few adverse effects on sexual function.