Silicone nasal prosthesis retained by an intranasal stent: A clinical report

Nasal defects after tumor excision can leave a patient functionally and esthetically impaired. Loss of nasal septal cartilage support causes the soft tissue to collapse or undergo stenosis, further compounding the problem. Intranasal stents can be used to maintain the patency of such nasal defects. This clinical report describes the use of an acrylic resin nasal stent bonded to a silicone nasal prosthesis to rehabilitate a patient with a nasal defect.     

General anxiety symptoms after acute lung injury: Predictors and correlates

Objective

Acute lung injury (ALI) is common in the intensive care unit (ICU), typically requiring life support ventilation. Survivors often experience anxiety after hospital discharge. We evaluated general anxiety symptoms 3 months after ALI for: (1) associations with patient characteristics and ICU variables, and (2) cross-sectional associations with physical function and quality of life (QOL).

Methods

General anxiety was assessed as part of a prospective cohort study recruiting patients from 13 ICUs at four hospitals in Baltimore, MD using the Hospital Anxiety and Depression Scale — Anxiety Subscale (HAD-A), with associations evaluated using multivariable linear and logistic regression models.

Results

Of 152 patients, 38% had a positive screening test for general anxiety (HAD-A ≥ 8). Pre-ICU body mass index and psychiatric comorbidity were associated with general anxiety (OR, 95% confidence interval (CI): 1.06 (1.00, 1.13) and 3.59 (1.25, 10.30), respectively). No ICU-related variables were associated with general anxiety. General anxiety was associated with the number of instrumental ADL dependencies (Spearman's rho = 0.22; p = 0.004) and worse overall QOL as measured by EQ-5D visual analog scale (VAS) (rho = − 0.34; p < 0.001) and utility score (rho = − 0.30; p < 0.001), and by the SF-36 mental health domain (rho = − 0.70; p < 0.001) and Mental Component Summary score (rho = − 0.73; p < 0.001).

Conclusion

Many patients have substantial general anxiety symptoms 3 months after ALI. General anxiety was associated with patient characteristics and impaired physical function and quality of life. Early identification and treatment of general anxiety may enhance physical and emotional function in patients surviving critical illnesses.     

Comparison of two fracture toughness testing methods using a glass-infiltrated and a zirconia dental ceramic

PURPOSE

The objective of this study was to compare the fracture toughness (K_Ic) obtained from the single edge V-notched beam (SEVNB) and the fractographic analysis (FTA) of a glass-infiltrated and a zirconia ceramic.

MATERIALS AND METHODS

For each material, ten bar-shaped specimens were prepared for the SEVNB method (3 mm × 4 mm × 25 mm) and the FTA method (2 mm × 4 mm × 25 mm). The starter V-notch was prepared as the fracture initiating flaw for the SEVNB method. A Vickers indentation load of 49 N was used to create a controlled surface flaw on each FTA specimen. All specimens were loaded to fracture using a universal testing machine at a crosshead speed of 0.5-1 mm/min. The independent-samples t-test was used for the statistical analysis of the K_Ic values at α=0.05.

RESULTS

The mean K_Ic of zirconia ceramic obtained from SEVNB method (5.4 ± 1.6 MPa·m^1/2) was comparable to that obtained from FTA method (6.3 ± 1.6 MPa·m^1/2). The mean K_Ic of glass-infiltrated ceramic obtained from SEVNB method (4.1 ± 0.6 MPa·m^1/2) was significantly lower than that obtained from FTA method (5.1 ± 0.7 MPa·m^1/2).

CONCLUSION

The mean K_Ic of the glass-infiltrated and zirconia ceramics obtained from the SEVNB method were lower than those obtained from FTA method even they were not significantly different for the zirconia material. The differences in the K_Ic values could be a result of the differences in the characteristics of fracture initiating flaws of these two methods.     

In depression,bacterial translocation may drive inflammatory responses,oxidative and nitrosative stress (O&NS), and autoimmune responses directed against O&NS‐damaged neoepitopes

Maes M, Kubera M, Leunis J‐C, Berk M, Geffard M, Bosmans E. In depression, bacterial translocation may drive inflammatory responses, oxidative and nitrosative stress (O&NS), and autoimmune responses directed against O&NS‐damaged neoepitopes. Objective: Depression is accompanied by activation of immuno‐inflammatory and oxidative and nitrosative stress (IO&NS) pathways, and increased IgM/IgA responses to lipopolysaccharide (LPS) of gram‐negative commensal bacteria. The latter suggests that bacterial translocation has caused IgM/IgA responses directed against LPS. Bacterial translocation may drive IO&NS responses. Method: To examine the associations between IgM/IgA responses to LPS and IO&NS measurements, including plasma/serum interleukin‐1 (IL‐1), tumor necrosis factor (TNF)α, neopterin, lysozyme, oxidized LDL (oxLDL) antibodies, peroxides, and IgM (auto)immune responses against malondialdehyde (MDA), azelaic acid, phophatidyl inositol (Pi), NO‐tryptophan and NO‐tyrosine in depressed patients and controls. Results: We found significant positive associations between IgM/IgA responses to LPS and oxLDL antibodies, IgM responses against MDA, azelaic acid, Pi, NO‐tryptophan, and NO‐tyrosine. The IgA responses to LPS were correlated with lysozyme. There were no significant positive correlations between the IgM/IgA responses to LPS and IL‐1 and neopterin. Conclusion: The findings show that in depression there is an association between increased bacterial translocation and lysozyme production, an antibacterial compound, O&NS processes, and autoimmune responses directed against O&NS generated neoantigenic determinants. It is suggested that bacterial translocation may drive IO&NS pathways in depression and thus play a role in its pathophysiology.     

Post rtPA CT brain may not be mandatory in all stroke patients when resources are limited

Background: Routine neuroimaging of the brain is performed after recombinant-tissue-plasminogen activator (rtPA) treatment in patients with acute ischemic stroke. However, in situation where resources are limited, it is not known if a follow-up computed tomography (CT) is beneficial for guiding the treatment plan or not. The purpose of this study is to investigate the need for a follow-up CT in patients with acute stroke after rtPA treatment. Methods: Patients who were treated with intravenous rtPA were included. Clinical symptoms/signs of the patients were evaluated at 24 h after rtPA treatment compared with baseline NIHSS. The need for a follow-up CT after rtPA treatment was assessed by comparison of the early clinical changes with the CT brain results that would affect the management plan: presence of hemorrhagic transformation, malignant MCA infarction, or large cerebellar infarction. Results: 200 patients were included. 19 patients (9.5%) had complete recovery. CT post rtPA revealed no change in these patients. In 105 patients who had early improvement with NIHSS of 1–10 at 24 h, follow-up CT findings did not change the plan of management in 85%. Follow-up CTs may help in planning further management in 65% and 67% of the patients who had NIHSS > 10 at 24 h and early worsening, respectively. Conclusions: CT post rtPA may not be required in patients with early clinical recovery (NIHSS = 0). However, in patients with residual severe deficit post rtPA or patients with early worsening or suspected posterior circulation stroke, CT post rtPA is still needed.     

Effectively addressing the mid- and long-term needs of young people affected by the tsunami in Aceh: An on-site assessment

Within two months of the Asian tsunami, a team of four individuals conducted an assessment on the post-disaster needs of young people in Aceh Province. In addition to assessing current needs, the team examined the extent to which young people (aged 14–24) were involved in the planning and implementation of ongoing rebuilding and relief efforts. Finally, the team assessed the degree to which young people could be involved in such efforts as the recovery process moves forward. The team: reviewed all existing documents developed and/or compiled by the UN Office for Coordination of Humanitarian Assistance (UNOCHA) from the inception of the disaster relief response to the present; met with approximately 20 organizations including UN agencies as well as international and local programs presently working in Banda Aceh and Maulaboh; and conducted direct discussions with young people in a variety of settings.     

The platelet amyloid precursor protein ratio as a diagnostic marker for Alzheimer’s disease in Thai patients

The platelet amyloid precursor protein (APP) ratio has recently been shown to be a promising diagnostic marker for Alzheimer’s disease (AD). To evaluate its usefulness in Thai patients, platelet APP was analyzed by immunoblotting. The APP ratio was calculated as the ratio of the combined band density of the 120-kD and 130-kD isoforms compared to that of the 110-kD isoform. The mean ages (and ranges) of 27 normal and 13 AD-affected subjects were 68.3 (60–84) and 79.3 (70–97) years, respectively. The Thai Mental State Examination (TMSE) scores demonstrated that the AD patients had significantly poorer cognitive functions than the normal subjects, with mean TMSE scores of 20.3 and 27.6 (maximum score of 30 points), respectively (p < 0.05). The platelet APP ratios of the AD patients were significantly lower than those of normal subjects: values (mean ± standard deviation) were 7.32 ± 1.29 and 9.13 ± 3.00, respectively (p < 0.05) for AD patients and normal subjects. However, the ranges of the APP ratios from both groups markedly overlapped, which precluded the establishment of a cutoff level to differentiate between the AD and normal subjects. In addition, no significant correlations were observed between the platelet APP ratio and the TMSE score or between the APP ratio and the serum cholesterol in this study, in contrast to previous reports.     

Prevalence and predictors of carotid stenosis in Thai patients with ocular disorders

There are limited data on prevalence and predictors of carotid stenosis (CS) in Thai and Asian patients with ocular disorders. A total of 135 of 2849 patients enrolled in the Neurosonology Registry had an ocular indication (OI). Demographics, the nature of the OI, risk factors (RF), presence of CS >50% and non-stenotic carotid plaque (NSCP) were analyzed. The mean age of patients was 60.40 ± 14.02 years. The RF included hypertension (47.4%), hypercholesterolemia (34.07%), diabetes mellitus (DM) (31.11%) and current smoking (41.48%). NSCP was found in 20% of Thai patients with OD. CS was found in 11.11% (ipsilateral 10.37%). Predictors of CS were ocular ischemic syndrome (odds ratio [OR] 19.63, p = 0.000), retinal artery occlusion (OR 14.13, p = 0.000), anterior ischemic optic neuropathy (OR 9.75, p = 0.002), neovascularized glaucoma (OR 8.15, p = 0.018), and DM (OR 2.53, p = 0.037). The presence of CS (11.11%), and CS or NSCP (31%) are markers of atherosclerotic risk. The nature of the OI predicted carotid findings. Carotid ultrasound helps to identify the risk for cardiovascular events and should be considered in patients with OI.