Strategies to reduce pulmonary complications after esophagectomy

Esophagectomy,the surgical removal of all or part of the esophagus,is a surgical procedure that is associated with high morbidity and mortality.Pulmonary complications are an especially important postoperative problem.Therefore,many perioperative strategies to prevent pulmonary complications after esophagectomy have been investigated and introduced in daily clinical practice.Here,we review these strategies,including improvement of patient performance and technical advances such as minimally invasive surgery that have been implemented in recent years.Furthermore,interventions such as methylprednisolone,neutrophil elastase inhibitor and epidural analgesia,which have been shown to reduce pulmonary complications,are discussed.Benefits of the commonly applied routine nasogastric decompression,delay of oral intake and prophylactic mechanical ventilation are unclear,and many of these strategies are also evaluated here.Finally,we will discuss recent insights and new developments aimed to improve pulmonary outcomes after esophagectomy.     

Effectiveness of a collaborative recovery training program in Australia in promoting positive views about recovery

OBJECTIVE: This study examined the impact of a two-day, recovery-based training program for mental health workers on knowledge, attitudes, and hopefulness related to the recovery prospects of people with enduring mental illness. METHODS: A self-report pre-post training repeated-measures design was used with 248 mental health workers from the community-based government health sector (N=147) and nongovernment organizations (N= 101) in eastern Australia. RESULTS: Staff attitudes and hopefulness improved after training. Trainees significantly increased their knowledge regarding principles of recovery and belief in the effectiveness of collaboration and consumer autonomy support, motivation enhancement, needs assessment, goal striving, and homework use. CONCLUSIONS: This preliminary evidence indicates that staff recovery orientation can improve with minimal training.     

Capacity of coronal dentin to increase fiberglass post retention: a pull-out test

PURPOSE: To evaluate the capacity of residual dentin in the coronal part of the root canal to increase the retention of serrated fiberglass posts (Extra-glass P-6%). METHODS: 40 freshly-extracted maxillary central incisors were randomly and evenly divided into four test groups (TGs) with no (TG0), one (TG1), two (TG2) and three (TG3) coronal walls, respectively. After shaping, the canals were filled with gutta-percha and prepared to receive fiberglass posts. Coronal wall dentin was etched with 38% phosphoric acid for 60 seconds, rinsed, and dried. Dentin bonding agent (Prime & Bond NT) was applied, and fiberglass posts were luted for 8 mm into the post space using a self-cure composite (ResiLute). All samples were then subjected to tensile forces in a universal testing machine. Data were analyzed with ANOVA and Student t-tests (P< 0.01). RESULTS: The samples with residual coronal dentin showed higher bond strength than the samples without residual crown walls (TG0=100.30N; TG1=201.83N; TG2=263.54N; TG3=278.86N). The differences between the groups were all statistically significant at P< 0.01, except for the difference in tensile strength between TG2 and TG3, which was not statistically significant. Residual crown walls significantly increased the tensile load required to displace the posts.     

Friction of conventional and self-ligating brackets using a 10 bracket model

The friction generated by various bracket-archwire combinations previously has been studied using in vitro testing models that included only one or three brackets. This study was performed using a specially designed apparatus that included 10 aligned brackets to compare the frictional resistance generated by conventional stainless steel brackets, self-ligating Damon SL II brackets and Time Plus brackets coupled with stainless steel, nickel-titanium and beta-titanium archwires. All brackets had a 0.022-inch slot, and five different sizes of orthodontic wire alloys used. Each bracket-archwire combination was tested 10 times, and each test was performed with a new bracket-wire sample. Time Plus self-ligating brackets generated significantly lower friction than both the Damon SL II self-ligating brackets and Victory brackets. However, the analysis of the various bracket-archwire combinations showed that Damon SL II brackets generated significantly lower friction than the other brackets when tested with round wires and significantly higher friction than Time Plus when tested with rectangular archwires. Beta-titanium archwires generated higher frictional resistances than the other archwires. All brackets showed higher frictional forces as the wire size increased. These findings suggest that the use of an in vitro testing model that includes 10 brackets can give additional interesting information about the frictional force of the various bracket-archwires combinations to the clinician and the research worker.     

Adherence of investment to Au–Pd–Ag alloy using a vacuum–argon pressure casting machine

OBJECTIVE: The removal of adhered investment material from marginal metal surfaces represents a possible risk of poor marginal adaptation.The aim of this work was to evaluate the effects of argon on investment adherence to the casting surface and on the alloy surface microstructure. METHODS: A die of stainless steel was used. 10 wax copings were cast by vacuum-argon pressure, while 10 copings by vacuum-air pressure using a Combilabor CLG-77 A in a graphite crucible; supply was direct with curved sprues of slashed circle 3.5 mm. The alloy used was Herabond. After coarse investment, removal of all specimens were investigated with scanning electron microscopy and semi-quantitative digital densitometry. RESULTS: The specimens cast under vacuum-argon pressure showed less amount of investment adhered (unpaired t test of grouped specimens, difference 2.896x10(5)pixel; p=0.002) while the grain size on the casting surface increased significantly p=0.000 (difference 5.968(microm). SIGNIFICANCE: Vacuum-argon pressure supply during casting reduces the investment adherence to the metal surface, and increases the packing density and size of the grains, especially on the casting surface. These minimize the risk of marginal distortions due to casting cleaning procedures and facilitate the finishing and polishing procedures.     

Evaluation of cervical posture of children in skeletal class I, II, and III

Previous studies on the relationship between morphological structure of the face and cervical posture have predominantly focused on vertical dimensions of the face. The aim of this study was to investigate whether there are significant differences in cervical posture in subjects with a different sagittal morphology of the face, i.e., a different skeletal class. One hundred twenty (120) children (60 males and 60 females, average age 9.5 yrs., SD+/-0.5) were admitted for orthodontic treatment. Selection criteria was: European ethnic origin, date of birth, considerable skeletal growth potential remaining and an absence of temporomandibular joint dysfunction (TMD). Lateral skull radiographs were taken in mirror position. Subjects were divided into three groups based on their skeletal class. The cephalometric tracings included postural variables. The most interesting findings were: 1. children in skeletal class III showed a significantly lower cervical lordosis angle (p<0.001) than the children in skeletal class I and skeletal class II; 2. children in skeletal class II showed a significantly higher extension of the head upon the spinal column compared to children in skeletal class I and skeletal class III (p<0.001 and p<0.01, respectively). This is probably because the lower part of their spinal column was straighter than those of subjects in skeletal class I and II (p<0.01 and p<0.001, respectively). Significant differences among the three groups were also observed in the inclination of maxillary and mandibular bases to the spinal column. The posture of the neck seems to be strongly associated with the sagittal as well as the vertical structure of the face.     

Cerebrovascular reactivity by quantitative magnetic resonance angiography with a co2 challenge. Validation as a new imaging biomarker

Assessment of cerebrovascular reactivity (CVR) is essential in cerebrovascular diseases, as exhausted CVR may enhance the risk of cerebral ischemic events. Transcranial Doppler (TCD) with a vasodilatory stimulus is currently used for CVR evaluation. Scanty data are available for Quantitative Magnetic Resonance Angiography (QMRA), which supplies higher spatial resolution and quantitative cerebral blood flow values. Aims of our pilot study were: (a) to assess safety and feasibility of CO₂ administration during QMRA, (b) evaluation of CVR under QMRA compared to TCD, and (c) quantitative evaluation of blood flow from the major intracranial arterial vessels both at rest and after CO₂.     

Cutaneous manifestations of HIV—a detailed study of morphological variants,markers of advanced disease,and the changing spectrum

Background

Cutaneous manifestations are early and easily identifiable markers of human immunodeficiency virus (HIV) infection. They can help in predicting severity and progress of the disease and can be correlated well with CD4 counts. This study was undertaken to study the cutaneous manifestations of HIV infection and to correlate them with CD4 counts. It also aimed to study the changing spectrum of these manifestations and describe cutaneous manifestations seen in advanced disease.

Method

A total of 234 HIV-positive patients not on anti-retroviral therapy, who attended the outpatient department or were admitted as inpatients at Military Hospital, Shillong during the period between May 2008 and October 2009 were included. Cutaneous, mucosal, and genitourinary manifestations in these patients were studied in detail and were correlated with CD4 counts.

Results

Infections were the most common group of mucocutaneous manifestations, while onychomycosis was the commonly observed individual manifestation. A different set of cutaneous markers for advanced HIV disease was observed and new parameters for therapy were also arrived at.

Conclusion

Specific morphological variants of cutaneous markers may provide a better clue to early diagnosis of HIV and can help in diagnosing advanced stages of the disease. Fresh cutaneous markers are required for indicating cut-off levels of CD4 count at 350/μL for starting therapy.