Spatiotemporal expression of Zic genes during vertebrate inner ear development.

BACKGROUND: Inner ear development involves signaling from surrounding tissues, including the adjacent hindbrain, periotic mesenchyme, and notochord. These signals include SHH, FGFs, BMPs, and WNTs from the hindbrain and SHH from the notochord. Zic genes, which are expressed in the dorsal neural tube and act during neural development, have been implicated as effectors of these pathways. This report examines whether Zic genes' involvement in inner ear development is a tenable hypothesis based on their expression patterns. RESULTS: In the developing inner ear of both the chick and mouse, all of the Zic genes were expressed in the dorsal neural tube and variably in the periotic mesenchyme, but expression of the Zic genes in the otic epithelium was not found. The onset of expression differed among the Zic genes; within any given region surrounding the otic epithelium, multiple Zic genes were expressed in the same place at the same time. CONCLUSIONS: Zic gene expression in the region of the developing inner ear is similar between mouse and chick. Zic expression domains overlap with sites of WNT and SHH signaling during otocyst patterning, suggesting a role for Zic genes in modulating signaling from these pathways.

Nationwide Assessment of Factors Associated with Nonoperative Management of Pediatric Splenic Injury.

To evaluate variation in care nationwide for children with splenic injuries at pediatric trauma, adult trauma, and nontrauma centers. We used the National Inpatient Sample from 2001 to 2010 to identify pediatric patients with splenic injury. We analyzed demographic, clinical, and hospital status characteristics. The primary objective was comparison of splenectomy rates at pediatric, adult, and nontrauma centers. We identified 34,599 patients with splenic injury. Throughout the study, 3,979 (11.5%) patients underwent splenectomy: 8.2 per cent of patients at pediatric trauma, 17.6 per cent at adult trauma, and 14.5 per cent at nontrauma centers. Multivariate regression analysis demonstrated patients had decreased odds of splenectomy at pediatric trauma centers compared with adult and nontrauma centers (OR = 0.42, P < 0.001). In addition, children aged 14 to 17 years (OR = 2.5) with injury severity score > 14 (OR = 5.8) had increased odds of undergoing splenectomy. In this nationwide sample, children with splenic injury treated at adult trauma and nontrauma centers had significantly higher rates of splenectomy compared with children treated at pediatric trauma centers. We highlight the need for interventions that ensure all injured children receive appropriate and high quality trauma care.

Electronic health records and the frequency of diagnostic test orders.

OBJECTIVES: To determine whether electronic health record (EHR) access influences the number of laboratory and imaging tests ordered, which is a frequently cited mechanism for EHR-enabled cost savings. STUDY DESIGN: We analyzed data on non-federally employed office-based physicians from the 2008 to 2012 Electronic Health Medical Records Survey, a supplement to the National Ambulatory Medical Care Survey. METHODS: We estimated logistic regressions to determine the relationship between EHR utilization and the volume of laboratory and imaging tests ordered in our study population, controlling for age, sex, race, clinic type, payer type, health status, comorbidities, and new patients. RESULTS: Physicians who actively used an EHR system ordered more complete blood count (CBC) tests than physicians who did not (odds ratio [OR], 1.34; P <.001), even after adjusting for patient demographics, health status, and case mix. EHR-using physicians also ordered more computerized tomography scans (OR, 1.41; P <.001) and x-rays (OR, 1.39; P <.001); the difference for magnetic resonance imaging scans was not significant (OR, 1.08; P = .449). Subgroup analysis highlighted differences in ordering among various patient cohorts. CONCLUSIONS: Using the most recent available nationally representative data, excluding federal and Veterans Affairs' hospitals, we found that physicians with EHR access ordered more tests than their non-EHR counterparts, thus contradicting a common rationale for EHR implementation. We argue that EHR use may actually increase healthcare expenditures by facilitating the ease of ordering tests. Whether these extra tests carry clinical utility requires further analysis.

Attenuation of C-reactive protein increases after exodontia by tramadol and ibuprofen.

The anti-inflammatory effects of ibuprofen and tramadol were investigated by measuring C-reactive protein concentrations after removal of an impacted lower third molar. Forty-five American Society of Anesthesiologists Class I patients were randomly categorized into 3 equal groups according to postoperative analgesic medication. The first group received tramadol (100 mg every 8 hours), the second group received ibuprofen (400 mg every 8 hours), and the last group received half doses of both drugs in combination (50 mg tramadol every 8 hours and 200 mg ibuprofen every 8 hours). C-reactive protein was measured before surgery to exclude the presence of any preexisting inflammatory condition that might interfere with the study. C-reactive protein was also determined immediately after surgery and 72 hours postoperatively. At 72 hours, C-reactive protein had increased over postsurgery baseline by 123% in the tramadol group (P < .001), 84% in the ibuprofen group (P < .001), and only 37% in the combined analgesic group (P = .078). These results suggest that tramadol may produce supra-additive anti-inflammatory effects with ibuprofen after third-molar extractions.

Sodium hypochlorite accident resulting in life-threatening airway obstruction during root canal treatment: a case report.

AIM: This case report describes a serious and life-threatening complication of the use of sodium hypochlorite as an irrigation solution in root canal therapy. SUMMARY: This case report describes a hypochlorite accident that occurred in a healthy 42-year-old female who was undergoing routine root canal therapy for the lower right central incisor (tooth #41). After approximately 1 hour of irrigation with 3% sodium hypochlorite (for a total of 12 cc), the patient complained of severe pain and burning in the lip. The swelling progressed over the next 8 hours to involve the sublingual and submental fascial spaces with elevation of the tongue and resultant upper airway obstruction. The patient was intubated and remained on mechanical ventilation for 3 days. She recovered without any skin necrosis or nerve deficits. KEY LEARNING POINTS: This case report highlights the importance of carefully performing root canal irrigation with sodium hypochlorite to avoid complications. Careful injection without pressure, the use of proper rubber dam isolation, and the use of the endodontic needle are necessary to avoid this type of complication. Although it is a safe root canal irrigation solution, its use may lead to life-threatening complications. Early recognition and management of the untoward effects of sodium hypochlorite are vital for the patient's safety.

Management of palatal vascular malformation using absolute ethanol sclerotherapy.

Arteriovenous malformation is treated by variety of techniques over the years. Sclerotherapy is considered an effective and conservative technique for the treatment of benign vascular lesions and replaced the traditional role of surgical therapy, especially for the venous lesions that are surgically difficult or at inaccessible areas. Absolute ethanol was adopted as a new sclerosant agent for this complex form of venous defects to improve overall treatment results with acceptable morbidity and recurrence rates. Sclerotherapy has the advantage of no external scaring, low cost, and few complications in comparison to the surgical treatment.

Preliminary evaluation of histological changes found in a mechanical arthropatic temporomandibular joint (TMJ) exposed to an intra-articular Hyaluronic acid (HA) injection, in a rat model.

OBJECTIVE: This study investigates the histological effects of Hyaluronic acid injections in the treatment of induced temporomandibular joint (TMJ) osteoarthritis in rats. STUDY DESIGN: Twenty-four male Wister rats were subjected to induced mechanical osteoarthritis by manual hypermobility for 10 successive days. Animals were then divided into two groups; group I (control) and group II (experimental). Ten days after the induction of hypermobility, the right TMJ of the experimental animals was injected with a dose of 0.12 mg HA intra-articularly and 0.12 mg saline was injected into the left joint; while animals in the control group were left without any treatment. Two rats from group I were killed at one, two and six weeks; while 6 animals from group II were killed at one, two and four weeks post injection. RESULTS: The disk of the right joints in the experimental animals was of normal thickness and there was an increase in the thickness of the fibrocartilagenous layer. In the left joint; ulcerative changes in the disk were evident where the fibres were not well oriented and scalloped areas in the temporal bone area were present denoting osteoclastic activity. CONCLUSIONS: Repeated intra-articular TMJ injection of Hyaluronic acid appears to be a safe and effective way of inhibiting the progression of osteoarthritic changes in the joint through development of articular cartilage and reducing fibrous tissue proliferation.

Imaging of temporomandibular joint ankylosis. A new radiographic classification.

OBJECTIVES: To compare the pre-operative clinical and radiographic findings of temporomandibular joint (TMJ) ankylosis with those found at operation and propose new classification. METHODS: Thirty-three patients were treated for TMJ ankylosis. There were 18 unilateral and 12 bilateral cases. All patients underwent pre-operative clinical and radiographic examination, (consisting of a panoramic radiograph, axial and coronal CT. The surgical findings were compared with the imaging features. RESULTS: Post-contrast coronal CT was the best imaging modality for planning surgery as it displayed the anatomical relationship between the ankylosed segment and the surrounding vital structures, particularly where the sphenoid and temporal bones were involved. CONCLUSIONS: Surgical planning should be based on coronal and axial CT. A new classification of TMJ ankylosis based on the CT findings is proposed.