Efficacy of adjuvant ozone therapy in reducing postsurgical complications following impacted mandibular third-molar surgery: A systematic review and meta-analysis

BackgroundResults from several randomized controlled trials have shown a beneficial effect of ozone in reducing postsurgical complications after impacted mandibular third-molar surgery, but the literature is lacking a systematic review and meta-analysis.MethodsThe authors conducted this systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines after exclusion and inclusion criteria were applied and the following outcome parameters were evaluated: pain, swelling, trismus, quality of life, number of analgesics consumed, and adverse events. RevMan Cochrane Collaboration software, Version 5.3, was used to perform meta-analysis and the Grading of Recommendation Assessment, Development and Evaluation approach was used to rate the certainty of evidence.ResultsPatients who underwent adjuvant ozone application reported lower pain scores than patients in the control group at 24 hours after surgery (95% CI, –3.94 to –1.56) and at 7 days (95% CI, –1.67 to –0.78). Pooled analysis of all 4 included trials revealed a standardized mean difference (SMD) in swelling of –0.44 at 24 hours, 0.63 at 72 hours, and –0.87 at 7 days after surgery in the experimental group. Higher mean estimates in mouth opening were experienced by patients who received ozone at 24 hours (SMD, 2.74; 95% CI, –1.93 to 7.41; 4 studies, 133 patients), 72 hours (SMD, 2.77; 95% CI, –0.63 to 6.17; 4 studies, 133 patients), and 7 days after surgery (SMD, 1.42 SMD; 95% CI, –1.34 to 4.18; 4 studies, 133 patients).Practical ImplicationsEvidence suggests that adjuvant ozone application can offer some benefit for reducing pain, improving quality of life, and decreasing mean intake of analgesics after impacted mandibular third-molar surgery, but it is not effective in reducing facial swelling and trismus, which paves the way for future research.     

Piezoelectric bone surgery for impacted lower third molar extraction compared with conventional rotary instruments: a systematic review,meta-analysis,and trial sequential analysis

The aim of this study was to evaluate whether piezoelectric bone surgery (PBS) for impacted lower third molar extraction reduces the surgical time and risk of intra- and postoperative complications in comparison with conventional rotary instruments. This meta-analysis followed the PRISMA guidelines and was registered in the PROSPERO database. The PubMed, Embase, Scopus, and OpenGrey databases were screened for articles published from January 1, 1990 to December 31, 2018. Selection criteria included randomized controlled trials (RCTs) comparing PBS with conventional rotary instruments for impacted lower third molar extraction and reporting any of the clinical outcomes (intra- and postoperative complications and duration of surgery) for both groups. A risk of bias assessment was performed using the Cochrane Collaboration tool. A meta-analysis was performed, and the power of the meta-analytic findings was assessed by trial sequential analysis (TSA). Strong evidence suggests that PBS prolongs the duration of surgery and low evidence suggests that PBS reduces postoperative morbidity (pain and trismus) in comparison with rotary instruments. Data were insufficient to determine whether PBS reduces neurological complications and postoperative swelling in comparison with burs.     

The Role of Culture in Eating Disorders

A comprehensive understanding of eating disorders should include engagement with the role of contemporary cultural trends. Feminists and critical social theorists have made significant contributions in this regard. Using two clinical cases, this paper contemplates the relationship between culture and psyche in eating disorder, proposing a psychoanalytic conceptualization underpinned by John Steiner's (1982, 1987, 1993, 2011) theory of pathological organizations and psychic retreats. Two conceptual terms will be introduced, namely ‘the normalized body order’ and ‘the abject body object’ to develop the argument. One of the clinical cases will be used to explore a particular kind of therapeutic impasse that can occur when therapist and patient are both female. In this particular case, the normalized body order emerged temporarily obstructing therapeutic progress; the impasse was understood to be an example of the so‐called anti‐analytic third (Straker, 2006 ).     

Peer review of third trimester abdominal circumference measurements

BackgroundThird trimester growth scans represent a significant proportion of the workload in obstetric ultrasound departments. The objective of these serial growth scans is to improve the antenatal detection of babies with fetal growth restriction. The aim of this paper is to describe a method of peer review for third trimester abdominal circumference measurements which is realistic within busy obstetric ultrasound departments in the UK.MethodTwenty-two, third trimester, measured abdominal circumference images were randomly selected. Images were assessed subjectively by 12 sonographers using the image Criteria Achieved Score. For quantitative assessment, termed the Inter-operator Variability Score, three of the abdominal circumference (AC) images were blindly remeasured. Following this, a questionnaire was used to ascertain which image criteria sonographers considered most important and to reach an agreement on correct caliper placement.ResultsThe least frequently met image criteria with the lowest Criteria Achieved Score related to an oblique abdominal circumference section. These included fetal kidney present (Criteria Achieved Score 24.6%), multiple oblique ribs (Criteria Achieved Score 39.4%) and oblique spine (Criteria Achieved Score 37.5%). Caliper placement was also identified as inconsistent.DiscussionThis study demonstrates that the perfect AC section is not always possible and sonographers use their professional judgement to determine whether an image is acceptable. Seventy-three percent of the images reviewed were of an acceptable standard. There can be inconsistencies in sonographer opinion regarding what is an acceptable third trimester abdominal circumference image. These differences need to be addressed to maximise the effectiveness of the third trimester ultrasound examination.ConclusionPeer review can be used to monitor scan quality and identify areas of inconsistency.     

Isolated Pupil-Involving Third Nerve Palsy as the First Presentation of Sarcoidosis

Neurosarcoidosis is seen in 5–15% of patients with systemic sarcoidosis. The most common cranial nerve presentations are optic neuropathy and facial nerve palsy. The authors present a case of sarcoidosis presenting with a pupil-involving third nerve palsy. The patient responded to corticosteroid therapy with resolution of investigations her cranial nerve palsy but progressed to develop cerebellar signs. This is the first documented case of a pupil-involving third nerve palsy occurring as the first presentation of neurosarcoidosis. Although typically a pupil-involving third nerve palsy necessitates urgent neuroimaging to rule out a posterior communicating artery aneurysm, it is important to recognise inflammatory causes in the differential diagnosis.     

医院信息化建设中引入第三方的模式探讨

探讨医院信息化建设过程中引入第三方咨询的内容和模式。我国许多医院已开始将第三方的咨询力量引入到信息化建设中,笔者从第三方参与信息化建设概况,到如何参与规划、调研、实施和验收等环节,再到咨询服务的不同模式进行了总结和探讨,为医院确定咨询服务的内容和选择模式提供参考。     

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??Objective    To evaluate the efficacy of ropivacaine in extraction of mandibular impacted third molar. Methods    In this study 150 healthy patients who need to extract one mandibular impacted third molar were randomly divided into two groups. The experimental group was given 0.75% ropivacaine to get anesthesia??while the control group received 2% lidocaine. The time to onset and duration of action were noted. The visual analogue score??VAS??was recorded 30 min and 4 h after extraction. The rate of taking pain relieving drugs was noted. Blood pressure and pulse were monitored during the operation. Monitor the anesthetic complications and compare the anesthetic effect of the two drugs. Results               Ropivacaine had a significantly shorter onset and longer duration of oral anesthesia than lidocaine??P??0.05??. The experimental group had lower VAS 30 min and 4 h after operation??P??0.05??and fewer patients needed pain relieving drugs than the control group??P??0.05??. There was a slight decrease of the pulse in the experimental group 30 min postoperatively??P??0.05??. The pulse and blood pressure in the control group and the blood pressure in the experimental group had no obvious change. There was no complications in both groups. Conclusion    Ropivacaine may be suitable for time-consuming oral procedures because of its short onset??long duation??prolonged postoperative analgesia and minimal cardiovascular risk.