Effect of the carbon dioxide 10,600-nm laser and topical fluoride gel application on enamel microstructure and microhardness after acid challenge: an in vitro study

Abstract

The aim of this in-vitro study was to evaluate positive effects of the carbon dioxide laser (CO₂, 10,600 nm) with acidulated phosphate fluoride (APF) gel on enamel acid resistance. Twenty extracted human third molars (40 surfaces) were randomly assigned into four groups: group C, untreated control; group L, CO₂ laser alone group; group F, APF 1.23% fluoride gel; and group FL, APF 1.23% gel and laser. Samples from group L were irradiated with a CO₂ laser for 30s. The parameter settings used were average power, 0.73 W; time on, 100 μs; time off, 40 ms; tip-to-tissue distance, 20 mm; tip diameter 700 μm; and energy density with movements, 5 J/cm². Samples from group F were treated with the APF gel for 4 min, and the gel was washed off with distilled water. The enamel samples from group FL were treated with APF gel for 4 min and then irradiated with the CO₂ laser for 30s without removing the gel. Each enamel sample was placed in 50 ml soft drink (pH = 2.75) for 10 min then rinsed with deionized water and stored in artificial saliva at 37 °C for 1 h. Samples were assessed for Vickers hardness number (VHN) before and after treatments and subjected to SEM analysis. Data were analyzed using a one-way analysis of variance (ANOVA) and Tukey's test (α < 0.05). After the acid challenge, the untreated C group was demineralized to a great extent and the enamel surface was with the lowest mean score of microhardness. The observed VHN in the control (C group) had a mean value of 176.13, the scores in the CO₂ laser group (L group) were with mean value of 238.40, the F group with a mean value of 218.45, and the fluoride-treated and laser-irradiated FL group—with a mean of 268.28 VHN. Paired t test performed to compare groups C, L, F, and FL has shown that group FL has greater resistance to decrease in microhardness of dental enamel (P ≤ 0.05) on exposure to acidic protocol. After the acid challenge, the fluoride-treated and laser-irradiated samples (group FL) showed the least diminution in enamel surface microhardness. The sub-ablative carbon dioxide laser irradiation in combination with fluoride treatment is more effective in protecting enamel surface and resisting demineralization than CO₂ laser irradiation or fluoride alone.

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Breaking paradigms in severe epistaxis: the importance of looking for the S-point

Publication date: Available online 20 January 2018
Source:Brazilian Journal of Otorhinolaryngology
Author(s): Eduardo Macoto Kosugi, Leonardo Balsalobre, João Mangussi Gomes, Miguel Soares Tepedino, Daniel Marcus San da Silva, Erika Mucciolo Cabernite, Diego Hermann, Aldo Cassol Stamm
IntroductionSince the introduction of nasal endoscopy into the field of Otorhinolaryngology, the treatment paradigm for cases of severe epistaxis has shifted toward early and precise identification of the bleeding site. Although severe epistaxis is usually considered to arise from posterior bleeding, an arterial vascular pedicle in the superior portion of the nasal septum, around the middle turbinate axilla projection, frequently has been observed. That vascular pedicle was named the S-point.ObjectiveThe aim of this study was to describe the S-point and report cases of severe epistaxis originating from it.MethodsA retrospective case series study was conducted. Nine patients with spontaneous severe epistaxis, where the S-point was identified as the source of bleeding, were treated between March 2016 and March 2017.ResultsMale predominance (77.8%) with age average of 59.3 years old were reported. Most cases presented comorbidities (88.9%) and were not taking acetylsalicylic acid (66.7%). A predominance of left sided involvement (55.6%) anteroposterior bleeding being the principal initial presentation (77.8%) was seen. Six patients (66.7%) presented with hemoglobin levels below 10g/dL, and four (44.4%) required blood transfusion. Cauterization of S-point was performed in all patients, with complete resolution of bleeding. No patient experienced recurrence of severe epistaxis.ConclusionThe S-point, a novel source of spontaneous severe epistaxis, is reported, and its cauterization was effective and safe. Otolaryngologists must actively seek this site of bleeding in cases of severe epistaxis.



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Intratidal Analysis of Intraoperative Respiratory System Mechanics: Keep it Simple

No abstract available

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The Syringe Driver: Continuous Subcutaneous Infusions in Palliative Care, 4th ed.

No abstract available

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Alkalinized Lidocaine Preloaded Endotracheal Tube Cuffs Reduce Emergence Cough After Brief Surgery: A Prospective Randomized Trial

BACKGROUND: Alkalinized lidocaine in the endotracheal tube (ETT) cuff decreases the incidence of cough and throat pain on emergence after surgery lasting more than 2 hours. However, alkalinized lidocaine needs 60–120 minutes to cross the ETT cuff membrane; therefore, its usefulness in shorter duration surgery is unknown. This prospective double-blind randomized controlled trial tested the hypothesis that alkalinized lidocaine would reduce the incidence of emergence cough after surgeries lasting 90 minutes before intubation with either 2 mL of 2% lidocaine and 8 mL of 8.4% bicarbonate (group AL) or 10 mL of normal saline (group S). Cuffs were emptied immediately before intubation. After intubation, either 2 mL of 2% lidocaine (AL) or 2 mL of saline (S) were injected into the cuff. Additional 8.4% bicarbonate (AL) or saline (S) was injected into the cuff until there was no air leak. Anesthesia was maintained using desflurane, rocuronium, and either fentanyl or sufentanil to maintain vital signs within 20% of baseline values. Opioids administered in prophylaxis of extubation cough were proscribed. A standardized "no touch" emergence technique was used. A blinded assessor noted any cough above 0.2 minimum alveolar concentration (MAC) of expired desflurane. At 0.2 MAC, once every 30 seconds, the patient was instructed to open his eyes and extubation occurred once a directed response was noted. RESULTS: A total of 213 patients were randomized and 100 patients in each group completed the experimental protocol. The incidence of extubation cough in group AL was 12%, significantly lower (1-sided P = .045) than the 22% incidence in group S. The 1-tailed risk ratio for cough in group AL was 0.55 (0–0.94, P = .045). Total amount of opioids administered (P = .194), ETT cuff preloading times (P = .259), and extubation times (P = .331) were not significantly different between groups. The average duration of surgery was 59 ± 28 minutes in group AL and 52 ± 29 minutes in group S (P = .057). CONCLUSIONS: Alkalinized lidocaine in the ETT cuff significantly decreased general anesthesia emergence cough after surgeries with an average duration of slightly

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“Mirror, Mirror on the Wall”: Learning From Reflections on Quality

No abstract available

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A Novel Approach to Synthesize the Evidence on Analgesic Adjuvants for Postoperative Pain

No abstract available

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Learning From Human Factors Can Make Anesthesia Even Safer

No abstract available

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MicroRNAs as Clinical Biomarkers and Therapeutic Tools in Perioperative Medicine

Over the past decade, evolutionarily conserved, noncoding small RNAs—so-called microRNAs (miRNAs)—have emerged as important regulators of virtually all cellular processes. miRNAs influence gene expression by binding to the 3′-untranslated region of protein-coding RNA, leading to its degradation and translational repression. In medicine, miRNAs have been revealed as novel, highly promising biomarkers and as attractive tools and targets for novel therapeutic approaches. miRNAs are currently entering the field of perioperative medicine, and they may open up new perspectives in anesthesia, critical care, and pain medicine. In this review, we provide an overview of the biology of miRNAs and their potential role in human disease. We highlight current paradigms of miRNA-mediated effects in perioperative medicine and provide a survey of miRNA biomarkers in the field known so far. Finally, we provide a perspective on miRNA-based therapeutic opportunities and perspectives.

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Sugammadex and Oral Contraceptives: Is It Time for a Revision of the Anesthesia Informed Consent?

No abstract available

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Pediatric Anesthesiology Fellows’ Perception of Quality of Attending Supervision and Medical Errors

BACKGROUND: Appropriate supervision has been shown to reduce medical errors in anesthesiology residents and other trainees across various specialties. Nonetheless, supervision of pediatric anesthesiology fellows has yet to be evaluated. The main objective of this survey investigation was to evaluate supervision of pediatric anesthesiology fellows in the United States. We hypothesized that there was an indirect association between perceived quality of faculty supervision of pediatric anesthesiology fellow trainees and the frequency of medical errors reported. METHODS: A survey of pediatric fellows from 53 pediatric anesthesiology fellowship programs in the United States was performed. The primary outcome was the frequency of self-reported errors by fellows, and the primary independent variable was supervision scores. Questions also assessed barriers for effective faculty supervision. RESULTS: One hundred seventy-six pediatric anesthesiology fellows were invited to participate, and 104 (59%) responded to the survey. Nine of 103 (9%, 95% confidence interval [CI], 4%–16%) respondents reported performing procedures, on >1 occasion, for which they were not properly trained for. Thirteen of 101 (13%, 95% CI, 7%–21%) reported making >1 mistake with negative consequence to patients, and 23 of 104 (22%, 95% CI, 15%–31%) reported >1 medication error in the last year. There were no differences in median (interquartile range) supervision scores between fellows who reported >1 medication error compared to those reporting ≤1 errors (3.4 [3.0–3.7] vs 3.4 [3.1–3.7]; median difference, 0; 99% CI, −0.3 to 0.3; P = .96). Similarly, there were no differences in those who reported >1 mistake with negative patient consequences, 3.3 (3.0–3.7), compared with those who did not report mistakes with negative patient consequences (3.4 [3.3–3.7]; median difference, 0.1; 99% CI, −0.2 to 0.6; P = .35). CONCLUSIONS: We detected a high rate of self-reported medication errors in pediatric anesthesiology fellows in the United States. Interestingly, fellows' perception of quality of faculty supervision was not associated with the frequency of reported errors. The current results with a narrow CI suggest the need to evaluate other potential factors that can be associated with the high frequency of reported errors by pediatric fellows (eg, fatigue, burnout). The identification of factors that lead to medical errors by pediatric anesthesiology fellows should be a main research priority to improve both trainee education and best practices of pediatric anesthesia.

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Ischemic Preconditioning and the Role of Antifibrinolytic Drugs: Translation From Bench to Bedside

No abstract available

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Emergency General Surgery: Time for Anesthesiology and Surgery to Work Together to Drive Improvement in Outcomes

No abstract available

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Developing Reflective Practice: A Guide for Medical Students, Doctors, and Teachers

No abstract available

http://ift.tt/2roGKTI

New Diabetes Medications Raise New Perioperative Concerns for the Anesthesiologist

No abstract available

http://ift.tt/2DQiIn7

Not All Calcium Formulations Are Alike

No abstract available

http://ift.tt/2rq59sf

“That’s Not What I Said”: Seeking Fidelity in Citations

No abstract available

http://ift.tt/2Dl3C88

Disparities in Anesthesia Care

No abstract available

http://ift.tt/2DQiEDT

Informed Consent and Cognitive Dysfunction After Noncardiac Surgery in the Elderly

Cognitive dysfunction 3 months after noncardiac surgery in the elderly satisfies informed consent thresholds of foreseeability in 10%–15% of patients, and materiality with new deficits observed in memory and executive function in patients with normal test performance beforehand. At present, the only safety step to avoid cognitive dysfunction after surgery is to forego surgery, thereby precluding the benefits of surgery with removal of pain and inflammation, and resumption of normal nutrition, physical activity, and sleep. To assure that consent for surgery is properly informed, risks of both cognitive dysfunction and alternative management strategies must be discussed with patients by the surgery team before a procedure is scheduled.

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A multi-centre, open, investigator initiated phase IV clinical trial to evaluate the efficacy and safety of ingenol mebutate gel, 0.015% on the face and scalp, and 0.05% on the trunk and extremities, in Korean patients with actinic keratosis (PERFECT)

Abstract

Background

Ingenol mebutate gel is a novel, field-directed topical treatment for actinic keratosis (AK). Most pivotal studies have targeted Western populations. No clinical study has been conducted to investigate its efficacy and safety in Asian populations.

Objectives

To evaluate the efficacy and safety of ingenol mebutate gel for treating AK of face/scalp and trunk/extremities in a large Asian (Korean) population.

Methods

In this multi-centre, open-label, interventional, parallel group, prospective phase 4 study (PERFECT, NCT02716714), the eligible subjects were allocated into either the face/scalp or the trunk/extremities group, according to their selected treatment area location. After application of ingenol mebutate gel, the subjects were followed-up for 6 months. The primary efficacy endpoint was complete clearance (CC) rate of AK lesions in the selected treatment area on Day 57. The quality of life was evaluated using Skindex-29. Safety endpoints included local skin responses, scar, pigmentation, pain, and adverse events.

Results

In total, 78.1% (95% CI: 66.86–86.92%) of subjects had CC on day 57, with 76.6% (95% CI: 64.31–86.25%) in face/scalp group and 88.9% (95% CI: 51.75–99.72%) in trunk/extremities group. Among them, the CC rate was sustained in 88.9% (48/54 subjects, 95% CI: 77.37–95.81%) on Month 6. The local skin responses significantly increased 1 day after the treatment compared to baseline, and decreased afterwards. Among the total subjects, 7.8% (6/77 subjects) had hyperpigmentation on the application area. Scars were not reported.

Conclusions

Ingenol mebutate is effective for the treatment of AK in Asians, with tolerable safety profiles.

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Severe cutaneous adverse reactions due to inappropriate medication use

Summary

Backgroud

The proportion of severe cutaneous adverse reactions (SCARs) that could be avoided if medication use was consistent with good medical practice is unknown.

Objectives

To estimate the proportion of SCARs related to inappropriate medication use.

Methods

Retrospective study of all validated SCARs collected in a French registry between 2003 and 2016. For each case, all plausible drugs suspected to induce SCARs (i.e., not just the drug regarded as "the most probable") were considered regarding three causes of preventability: (1) prescription for an inappropriate indication, (2) unintentional rechallenge despite a previous allergy to the drug, or (3) self-medication with prescription medicines.

Results

602 cases were included in the analyses. Antibiotics, anticonvulsants and allopurinol were the drugs most frequently involved, accounting for more than 50% of all cases. All suspected medications were considered appropriately used for 417 of the 602 individuals included in the study population (69.3%, 95% CI [65.6-73.0]),and inappropriately used. for 144 individuals (23.9% [20.5-27.3]).. These inappropriate uses were mainly due to prescriptions for inappropriate indication (65.8% [58.4-73.2]) or unintentional rechallenge (20.9% [14.6-27.2]). Allopurinol and cotrimoxazole were the drugs most frequently involved in inappropriate indications (accounting for 51.9% [42.3-61.5] and 13.5% [6.9-20.1] of cases, respectively). Antibiotics were the largest group involved in unintentional rechallenge. Non-steroidal anti-inflammatory drugs available on prescription were most involved in inappropriate self-medication.

Conclusions

Our results underline the need for respecting the appropriate indication of drugs to reduce the incidence of SCARs. All efforts to reduce unintentional rechallenge also seem to be necessary preventive measures.

This article is protected by copyright. All rights reserved.

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