End-to-Side Portacaval Shunt: A Simplified Technique

A simplified technique of end-to-side portacaval shunt in the rat is described, consisting in using a microsuture with a looped end. By using this technique, combined with two-step portal vein venotomy, the portal vein and caval vein can be brought closer together in a single movement, with no need for a knot at the start of the shunt. As a result, this modified technique makes it easier and reduces the time required to perform the shunt, without any rise in associated mortality.     

Impact of platelet transfusions in children with post-diarrheal hemolytic uremic syndrome

Background

Platelet transfusions should be avoided in children with post-diarrheal hemolytic uremic syndrome (D + HUS) because they might increase microthrombi formation, thereby aggravating the disease. As this possibility has not yet been explored, we investigated whether platelet transfusion in patients with D + HUS would lead to a worse disease course compared to that in patients who did not receive platelet transfusion.

Methods

This was a case–control study in which data from D + HUS children who received platelet transfusions (cases, n? = ?23) and those who did not (controls, n? = ?54) were retrospectively reviewed and compared.

Results

Both patient groups were similar in age (p?=?0.3), gender (p? =? 0.53), weight (p? = ?0.86), height (p? = ?0.45), prior use of non-steroidal anti-inflammatory drugs (p? = ?0.59) or antibiotics (p ?= ?0.45) and presence of dehydration at admission (p? = ?0.79). The two groups also did not differ in initial leukocyte count (p? = ?0.98), hematocrit (p? = ?0.44) and sodium (p? = ?0.11) and alanine aminotransferase levels (p? = ?0.11). During hospitalization, dialysis duration (p? = ?0.08), number of erythrocyte transfusions (p? =? 0.2), serum creatinine peak (p? = ?0.22), presence of severe bowel (p? = ?0.43) or neurologic (p? = ?0.97) injury, arterial hypertension (p? = ?0.71), need for intensive care (p? = ?0.33) and death (p? = ?1.00) were also comparable.

Conclusion

Our findings suggest that platelet transfusion does not aggravate the course of the disease. Conversely, no hemorrhagic complications were observed in the group of patients who did not receive a platelet transfusion. Until these observations are confirmed by further studies, the benefits and risk of platelet transfusion should be thoughtfully balanced on an individual case basis.     

Wound healing potential of topical bacteriophage therapy on diabetic cutaneous wounds

Chronic wounds that fail to heal are a common complication of diabetes mellitus and the most common precipitating reason for nontraumatic lower limb amputation. Unfortunately, the bacterial species that cause these infections are becoming more resistant to antibiotics, making them increasingly difficult to treat. We assessed the feasibility of combating chronic bacterial infections with a topically delivered bacteriophage cocktail in two animal models of diabetes mellitus. Microbiological, planimetric, and histological parameters were compared in debrided infected wounds with or without topical bacteriophage treatment. We determined that bacteriophage treatment effectively decreased bacterial colony counts and improved wound healing, as indicated by smaller epithelial and dermal gaps, in Staphylococcus aureus and Pseudomonas aeruginosa infections but was not as effective against Acinetobacter baumannii. Although the improvements were more significant in the rodent model than in the porcine model, our results suggest that topically administered bacteriophage treatment may be effective in resolving chronic infections, especially when applied in conjunction with wound debridement. These findings have important implications for the feasibility of using topical antimicrobial therapies to safely treat chronic infections in diabetes mellitus patients.     

Endoscopically assisted tunnel approach for minimally invasive corticotomies: a preliminary report

Background: The dental community has expressed low acceptance of traditional corticotomy techniques for corticotomy‐facilitated orthodontics. These procedures are time consuming, entail substantial postoperative morbidity and periodontal risks, and are often perceived as highly invasive. Methods: A total of 114 interdental sites were treated in nine consecutive patients. Under local anesthesia, a tunnel approach requiring one to three vertical incisions per arch (depending on the targeted teeth) was used. Piezosurgical corticotomies and elective bone augmentation procedures were performed under endoscopic assistance. Postoperative cone‐beam computerized tomography evaluation was used to confirm adequate corticotomy depth. Results: Procedures were completed in a mean time of 26 minutes. Follow‐up evaluations revealed no loss of tooth vitality, no changes in periodontal probing depth, good preservation of the papillae, and no gingival recession. No evidence of crestal bone height reduction or apical root resorption was detected. Conclusions: The tunnel approach minimizes soft‐tissue debridement and permits effective cortical cuts. The combination of piezosurgery technique with endoscopic assistance provides a quick, reliable means to design and perform these corticotomies while maximizing root integrity preservation. Moreover, the sites needing bone augmentation are selected under direct vision. Compared to traditional corticotomies, this procedure has manifest advantages in surgical time, technical complexity, patient morbidity, and periodontium preservation.     

Seven Essential Strategies for Promoting and Sustaining Systemic Cultural Competence

Racial and ethnic disparities are disturbing facets of the American healthcare system that document the reality of unequal treatment. Research consistently shows that patients of color experience poorer quality of care and health outcomes contributing to increased risks and accelerated mortality rates relative to their white counterparts. While initially conceptualized as an approach for increasing the responsiveness of children’s behavioral health care, cultural competence has been adopted as a key strategy for eliminating racial and ethnic health disparities across the healthcare system. However, cultural competence research and practices largely focus on improving provider competencies, while agency and system level approaches for meeting the service needs of diverse populations are given less attention. In this article we offer seven essential strategies for promoting and sustaining organizational and systemic cultural competence. These strategies are to: (1) Provide executive level support and accountability, (2) Foster patient, community and stakeholder participation and partnerships, (3) Conduct organizational cultural competence assessments, (4) Develop incremental and realistic cultural competence action plans, (5) Ensure linguistic competence, (6) Diversify, develop, and retain a culturally competent workforce, and (7) Develop an agency or system strategy for managing staff and patient grievances. For each strategy we offer several recommendations for implementation.     

Comparison of different ultrasonic vibration modes for post removal

This in vitro study compared different ultrasonic vibration modes for intraradicular cast post removal. The crowns of 24 maxillary canines were removed, the roots were embedded in acrylic resin blocks, and the canals were treated endodontically. The post holes were prepared and root canal impressions were taken with self-cured resin acrylic. After casting, the posts were cemented with zinc phosphate cement. The samples were randomly distributed into 3 groups (n=8): G1: no ultrasonic vibration (control); G2: tip of the ultrasonic device positioned perpendicularly to core surface and close to the incisal edge; and G3: tip of the ultrasonic device positioned perpendicularly to core surface at cervical region, close to the line of cementation. An Enac OE-5 ultrasound unit with an ST-09 tip was used. All samples were submitted to the tensile test using an universal testing machine at a crosshead speed of 1 mm/min. Data were subjected to one-way ANOVA and Tukey's post-hoc tests (α=0.05). Mean values of the load to dislodge the posts (MPa) were: G1 = 4.6 (± 1.4) A; G2 = 2.8 (± 0.9) B, and G3= 0.9 (± 0.3) C. Therefore, the ultrasonic vibration applied with the tip of device close to the core's cervical area showed higher ability to reduce the retention of cast post to root canal.     

Mandibular reconstruction with tissue engineering in multiple recurrent ameloblastoma

The aim of this paper is to present a new approach to bone regeneration in a patient with multiple recurrent ameloblastoma of the left mandibular angle. Through an extraoral approach, complete resection of the tumor was achieved. Bone marrow aspirate from the iliac crest was centrifuged to concentrate the mesenchymal cellular fraction. Based on a stereolithographic cast, titanium mesh was bent preoperatively to accurately reconstruct the mandibular angle. The mesh was filled with two blocks of xenogenic material mixed with recombinant bone morphogenetic protein 7 (BMP-7) and stem cells. Nine months later, three endosseous implants were placed in the regenerated bone to restore the patient's masticatory function. At this time, bone samples were obtained for histomorphometric analysis. New bone formation was confirmed around the particles of xenograft material. The results indicate that adequate esthetics and function may be achieved with bone marrow aspirate seeded on a scaffold obtained from bovine xenograft blocks and BMP-7. This technique attains new bone formation with sufficient quantity and quality to allow for implant placement, with decreased patient morbidity and surgical time compared to conventional reconstructive methods.     

Vertical discrepancy and microleakage of laser-sintered and vacuum-cast implant-supported structures luted with different cement types

Objectives

This study aimed to evaluate the vertical misfit and microleakage of laser-sintered and vacuum-cast cement-retained implant-supported frameworks.

Methods

Three-unit implant-fixed structures were constructed with: (1) laser-sintered Co–Cr (LS); (2) vacuum-cast Co–Cr (CC); and (3) vacuum-cast Pd–Au (CP). Every framework was luted onto 2 prefabricated abutments under constant seating pressure. Each alloy group was randomly divided into three subgroups (n = 10) according to the cement used: (1) Ketac Cem Plus (KC); (2) Panavia F 2.0 (PF); and (3) RelyX Unicem 2 Automix (RXU). After 30 days of water ageing, vertical discrepancy was measured by SEM, and marginal microleakage was scored using a digital microscope. Three-way ANOVA and Student–Newman–Keuls tests were run to investigate the effect of alloy/fabrication technique, FDP retainer, and cement type on vertical misfit. Data for marginal microleakage were analysed with Kruskal–Wallis and Dunn's tests (α = 0.05).

Results

Vertical discrepancy was affected by alloy/manufacturing technique and cement type (p < 0.001). Despite the luting agent, LS structures showed the best marginal adaptation, followed by CP, and CC. Within each alloy group, KC provided the best fit, whilst the use of PF or RXU resulted in no significant differences. Regardless of the framework alloy, KC exhibited the highest microleakage scores, whilst PF and RXU showed values that were comparable to each other.

Conclusions

Laser-sintered Co–Cr structures achieved the best fit in the study. Notwithstanding the framework alloy, resin-modified glass-ionomer demonstrated better marginal fit but greater microleakage than did MDP-based and self-adhesive dual-cure resin cements. All groups were within the clinically acceptable misfit range.

Clinical significance

Laser-sintered Co–Cr may be an alternative to cast base metal and noble alloys to obtain passive-fitting structures. Despite showing higher discrepancies, resin cements displayed lower microleakage than resin-modified glass-ionomer. Further research is necessary to determine whether low microleakage scores may guarantee a suitable seal that could compensate for misfit.