[Transoral approach for sublingual-plunging ranula]. / Transoraler Zugang bei sublingualer Tauchranula.

The case of a 7-year-old boy suffering from progressive submental/submandibular swelling is reported. Following clinical and imaging diagnostics (MRI), the suspected diagnosis of a sublingual-plunging ranula was made. Surgery was performed with transoral excision of the sublingual gland in combination with excision of the ranula. Additional submandibular gland excision should be avoided.

Job satisfaction among immigrant nurses in Israel and the United States of America.

AIM: The aim of this study is to examine perceptions of job satisfaction among immigrant registered nurses (RNs) in Israel and the USA. BACKGROUND: Former Soviet Union (FSU) RNs in Israel and Filipino RNs in the USA make up the majority of the immigrant nursing workforce in their host countries. However, little is known about their perception of job satisfaction. METHODS: Data were gathered using the Index of Work Satisfaction Scale among 71 FSU RNs recruited from three different courses in baccalaureate and master's degree programmes at a central Israeli university, and 96 Filipino RNs attending a national convention hosted by the Philippine Nurses Association of America. The required sample size was obtained by means of the WINPEPI COMPARE2 program, used to determine power and sample size for comparisons of two groups in cross-sectional designs. FINDINGS: The findings show that FSU RNs perceived pay and professional status as important, although they were least satisfied with pay. For Filipino RNs, organizational policies and interactions were most important and they were least satisfied by task requirements. Although the average length of residence in the host country was similar in the two samples, significant differences were found between FSU and Filipino RNs in selected demographic variables and components of job satisfaction. CONCLUSIONS: Different characteristics of immigrant RNs affect their distinct perceptions of job satisfaction. As successful adjustment of international immigrant RNs to their workplace could enhance perceptions of job satisfaction, nursing managers should support professional advancement of immigrant RNs through mentorship and educational programmes. There is a need to conduct longitudinal studies among international immigrant RNs in order to better understand changes in their job satisfaction over time and contributing factors. STUDY LIMITATIONS: Generalization of the findings is limited, because a convenience sample was used to recruit FSU and Filipino immigrant RNs.

Nurses' preferred end-of-life treatment choices in five countries.

BACKGROUND: Previous research has focused on physician's perspectives of end-of-life (EOL) decision making as well as patient and family EOL decision making. There is a lack of research pertaining to the EOL treatment preferences of nurses and especially nurses working in a variety of care settings. AIM: The aim of this study was to compare nurses' EOL treatment preferences in Hong Kong, Ireland, Israel, Italy and the USA. METHODS: A comparative descriptive design was used with a convenience sample of nurses (n = 1089). A survey questionnaire using EOL hypothetical clinical case scenarios was used to collect data between June 2011 and July 2012. RESULTS: Nurses in every country consistently chose a more aggressive option for patients than for themselves or for a parent. The treatment preferences of nurses varied from country to country. Lack of knowledge of patients' wishes and duty of care were the main influencing factors on treatment preferences. STUDY LIMITATIONS: The study was limited to the hypothetical nature of the scenarios; however, the study highlights numerous future research questions. CONCLUSIONS: This study is the first to examine and compare nurses' preferred EOL treatment choices in five countries from three different continents. The findings of this study raise several important questions for healthcare researchers, for policy development, and highlight the need for further international collaboration.

[Maxillofacial fractures: midface and internal orbit. Part 2: therapeutic options]. / Maxillofaziale Frakturen: Mittelgesicht und interne Orbita. Teil 2: Therapieoptionen.

While the state of the art of clinical assessment and imaging techniques were described in Part 1, this contribution presents a systematic review of the surgical treatment principles in the management of midface and internal orbit fractures from initial care to definitive treatment, including illustrative case examples. New developments and advances are characterized by limited versus extended surgical approaches, by standardization of osteosynthesis principles with regard to three-dimensional buttress reconstruction, by newly developed individualized implants such as titanium meshes and, especially for complex fracture patterns, by critical assessment of anatomical reconstruction through intraoperative endoscopy, as well as intraoperative and postoperative imaging. Newly developed resorbable soft tissue anchors can be used both for ligament and soft tissue resuspension in order to reduce ptosis effects in the cheeks and nasolabial area to achieve facial aesthetics similar to those prior to the injury.

[Maxillofacial fractures: midface and internal orbit : Part 1: classification and diagnosis]. / Maxillofaziale Frakturen: Mittelgesicht und interne Orbita : Teil 1: Klassifikation und Diagnostik.

Fractures of the midface and internal orbit occur isolated or in combination with other injuries. Frequently, the patients are first seen in emergency rooms responsible for the coordination of initial diagnostic procedures, followed by the transfer to specialties for further treatment. It is, therefore, important for all colleagues in traumatology to understand the basic principles of injuries to the midface. Thus, the aim of this article is the description of the anatomy and the current classification systems in use, the related clinical symptoms, and the essential diagnostic measures to obtain precise information about the injury pattern. Issues for treatment will be illustrated and discussed in "Part 2" of this article.

Acculturation among immigrant nurses in Israel and the United States of America.

BACKGROUND: Former Soviet Union (FSU) nurses in Israel and Filipino registered nurses (RNs) in the United States of America (USA) play significant roles in the delivery of health-care services in their host countries. However, little is known about how they acculturate in a different culture. OBJECTIVES: The purposes of this study were to determine the levels of and the difference in acculturation of FSU nurses in Israel and Filipino RNs in the USA. METHODS: Acculturation was assessed using A Short Acculturation Scale for Filipino Americans and t-test was conducted to determine the difference in acculturation between these two groups of immigrant nurses. FINDINGS: Results revealed that Filipino RNs have an acculturation level that leaned towards their host culture while FSU nurses have an acculturation level that was closer to their original culture than the Israeli culture and that there was a significant difference in acculturation between these two groups of immigrant nurses. CONCLUSIONS: Differences in acculturation between two predominant groups of immigrant nurses in Israel and the USA exist. Understanding the differences and the factors that affect their integration into their host cultures could be used to develop strategies to assist Filipino and FSU immigrant nurses achieve positive personal and work-related outcomes.

[Severe bacterial soft tissue infections in the head and neck region : Overview of the causes, pathogenesis, diagnostics, treatment and possible sequelae]. / Schwere bakterielle Weichgewebeinfektionen im Kopf- und Halsbereich : Ein Überblick über die Ursachen, Pathogenese, Diagnostik, Therapie und mögliche Folgen.

BACKGROUND: This article gives an overview of severe and fulminant infections of the head and neck region. The focus is on the treatment, diagnostics and causes of abscesses, phlegmon and necrotizing fasciitis. OBJECTIVE: Despite guideline-conform treatment soft tissue infections of the head and neck can spread rapidly and be life-threatening. MATERIAL AND METHODS: Analysis and discussion of basic research and expert recommendations, case reports. RESULTS: While purulent tonsillitis is the primary cause of severe bacterial soft tissue infections in children, dental infections are the leading cause in adults. The infections often spread along anatomic spaces and can extend into the brain or mediastinum and a hematogenic dissemination is also possible. Multiple operations and combined antibiotic treatment are often required as well as additional treatment, such as intubation, tracheotomy and dialysis. Late or early onset complications can occur and reconstructive measures might be necessary in addition to rehabilitation. CONCLUSION: Severe bacterial soft tissue infections can be still life-threatening despite guideline-conform treatment and are associated with a high mortality especially in high-risk patients even with intensive medical care. They can lead to disfiguration and loss of function resulting in a greatly reduced quality of life. Rapid diagnostics and therapy are essential for successful treatment.

Bifunctional effect of Zoledronic Acid (ZA) on human mesenchymal stem cells (hMSCs) based on the concentration level.

BACKGROUND: Treatment of massive bone defects is a great challenge. Mesenchymal stem cells (MSCs) enhance bone regeneration by differentiating into osteoblasts. Bisphosphonates (BPs) are antiresorptives reducing bone resorption. Despite Medication-related osteonecrosis of the jaw (MRONJ) is a known side effect of antiresorptives, evidences suggest that BPs have positive effect on bone formation. The aims of this study were to investigate the effect of zoledronic acid (ZA) and geranylgeraniol (GGOH) on human mesenchymal stem cells (hMSCs) being a part of the bone microenvironment and evaluate whether low dose of bisphosphonate has enhanced osteogenic differentiation of hMSCs. MATERIALS AND METHODS: The effect of ZA and GGOH on MSCs was investigated in addition to the effect of low doses of ZA on osteogenic differentiation of MSCs and analysed by WST-1, Live/Dead staining and coefficient of drug index (CDI). The osteogenic differentiation of the cells was confirmed by ALP activity, xylenol orange and alizarin red staining, microarray and PCR with levels of statistical significance indicated at *P<0.05, **P<0.01 and ***P<0.0001. MAIN FINDINGS: Although, high concentration of ZA had significantly decreased the cell viability in MSCs, GGOH reversed the action of ZA on the cells while at very high concentration; it caused severe reduction in the cell viability. CDI showed antagonism or synergism depending on the concentrations of ZA and GGOH. CONCLUSION: The treatment of cells with ZA has increased the mineralization and osteogenic differentiation of MSCs. Our study supported the hypothesis that zoledronic acid plays a bifunctional role depending on the concentration.

Silicone breast implantation-induced scleroderma: description of four patients and a critical review of the literature.

Since the early 1980s, case reports and case series describe an association between silicon breast implants and the appearance of autoimmune diseases, particularly scleroderma. The publication of those cases led to a large number of studies to investigate this association. The conclusion of those studies is that most probably there has not been an increased incidence of autoimmune diseases in women with silicon breast implants. Nevertheless, the US Food and Drug Administration determined that silicone gel breast implants are not completely safe, only that they are 'reasonably safe.' The debate continues regarding this association. In this article we present new cases of silicon breast implant-induced scleroderma and review the literature on this subject.

Childhood obesity: current literature, policy and implications for practice.

THE PROBLEM: In most of the industrialized world, a childhood obesity epidemic is evident, with the numbers rising each year. PURPOSE: To discuss the current literature in relation to childhood obesity and to provide health practitioners, especially nurses, with the fundamental knowledge that is imperative in the recognition of children who are at risk and thereby tailor appropriate interventions. METHOD: Databases that were accessed for current literature included CINAHL, Science Direct and ProQuest. Keywords used in the search included obesity, childhood, health, relevant national statistics, policy and health risks. The literature was confined to the past 10 years with emphasis on the past 5 years. The 50 most pertinent papers from a variety of countries were chosen, and 35 papers that represented key areas of relevance were selected as the basis of this article. This selection of papers dictated the key areas of discussion such as the acknowledged factors in childhood obesity. FINDINGS: Although childhood obesity may be related to specific cultural and national circumstances, universal themes emerged from the literature review. These include social factors, exercise, advertising, public policy and the importance of partnerships in policy. CONCLUSION: Any country that has a high rate or increasing rate of childhood obesity must acknowledge core factors that contribute to this serious health problem. Furthermore, public policy and community partnerships that include all health professionals have a responsibility in the prevention of childhood obesity. This can be implemented through education, research and advocacy of all nurses involved with children and families.

Methotrexate selectively modulates TH1/TH2 balance in active rheumatoid arthritis patients.

OBJECTIVE: The mechanism by which low dose methotrexate (MTX, the gold standard treatment for rheumatoid arthritis) exerts its anti-inflammatory effect in rheumatoid arthritis (RA) patients is still debated. Lately, the MTX immunosuppressive effect has been related to apoptosis, especially in active RA patients, with ROS involvement. METHODS: In the present research we investigated MTX oxidative effect and its ability to modulate immune balance in active versus non-active RA patients. RESULTS: Our results show that MTX induces IL-10 secretion (a TH2 cytokine) and significantly reduces TH1 profile in Peripheral Mononuclear Cells (PMNC) derived from active RA patients (n=28). Additionally, we found that MTX modulates the immune status towards TH2 dominance by decreasing the IL-12R and the CXCR3 receptors typical for the TH1 population. Moreover, MTX was found to inhibit the production of nitric oxide (NO) in these patients, a phenomenon that might contribute to MTX action toward cytokine homeostasis. A significant correlation was found between MTX IL-10 induction and NO inhibition in active RA patients. CONCLUSION: Our data suggest that, in active RA patients, apoptosis induction by MTX may be primarily due to IL-10 production via modulation of oxidative stress, which may restore the critically important immune balance. These findings may contribute to determining which group of RA patients may better respond to MTX therapy.

A comprehensive classification of mandibular fractures: a preliminary agreement validation study.

This study evaluates a comprehensive classification system for mandibular fractures based on imaging analysis. The AO/ASIF scheme, defining three fracture types (A, B, C), three groups within each type (e.g. A1, A2, A3) and three subgroups within each group (e.g. A1.1, A1.2, A1.3) with increasing severity from A1.1 (lowest) to C3.3 (highest) was used. The mandible is divided into two vertical units (I and V), two lateral horizontal units (II and IV) and one central unit (III) comprising the symphyseal and parasymphyseal region. Type A fractures are non-displaced, type B are displaced and type C are multifragmentary/defect injuries. Groups and subgroups are further defined in the classification system. Two classification sessions using semi-automatic software with 7 and 9 surgeons were performed to evaluate 100 fracture cases in the first session and 50 in the second. Inter-observer reliability and individual rater's accuracy were evaluated by kappa coefficient and latent class analysis, respectively. The analysis of inter-observer agreement for the detailed coding showed kappa coefficients around 0.50 with higher agreement among raters in the vertical units. This system allows standardization of documentation of mandibular fractures, although improvement in the definition of categories and their application is required.

Comparison of the bactericidal effect of cold atmospheric pressure plasma (CAPP), antimicrobial photodynamic therapy (aPDT), and polihexanide (PHX) in a novel wet surface model to mimic oral cavity application.

PURPOSE: Cold atmospheric pressure plasma (CAPP) is increasingly used for medical applications. The first devices are available from commercial manufactures, promising to improve wound healing and disinfection. The underlying antimicrobial mechanisms of CAPP are discussed, while the first results on its bactericidal efficiency against common bacterial species have already been published, with promising results. Most of the plasma sources used in these studies were built by the investigators themselves, and are not commercially available or licensed for clinical use. To evaluate the postulated bactericidal effects in clinical practice, we studied a commercially available, ready-to-use CAPP-device, which is also designed to be used in the field of dental, oral, and maxillofacial treatment. MATERIALS AND METHODS: Standardized bacterial cultures of two different pathogens (Acinetobacter baumannii and Staphylococcus aureus) were produced with defined colony-forming unit concentrations. Dilutions of these cultures were treated with a commercially available CAPP product according to the manufacturer's instructions in order to evaluate the antimicrobial activity of the technique. This in vitro study compared the CAPP treatment with established clinical therapies like polihexanide (PHX) and antimicrobial photodynamic therapy (aPDT). RESULTS: The bactericidal effect was evaluated in terms of reduction in colony-forming units after treatment of the bacterial samples with a defined dose of plasma, aPDT, or PHX. For CAPP, the bactericidal effect was found to be stronger in the Gram-negative isolate (A. baumannii) than in the Gram-positive S. aureus. A strong depth dependency was observed, especially with the Gram-negative isolate. Good bactericidal effects, with a reduction in bacterial load of more than 2 × log10, could only be observed in conditions of 0.3 mm of water-film thickness or less. Such a significant reduction in bactericidal effect depending on depth was not observed using aPDT or PHX in the studied depth range of 0.3-1.8 mm. CONCLUSION: CAPP treatment performed by the device (Plasma ONE) and configuration we used in this study seems to be ill suited for sufficiently killing Acinetobacter baumannii or Staphylococcus aureus in a moist infection site, as would be expected in the oral cavity. Established local antimicrobial therapies using PHX or aPDT showed better disinfectant properties. The clinical effect of improved wound healing, described by the manufacturer and some scientists, could not be investigated using this model. Given the results, however, it seems unlikely to be a direct consequence of bactericidal effects of CAPP in a wet environment. Further development of CAPP devices, or a different configuration (e.g. with a higher output, resulting in reactive nitrogen species-dominated, gas-phase chemistry), may enhance antibacterial effects in future, while tissue compatibility of such techniques remains to be elucidated further.

Histological examination of drill sites in bovine rib bone after grinding in vitro with eight different devices.

The way in which bone is processed may affect the quality of the specimen and how much information may be gleaned on histological examination. We investigated eight widely used rasps and drills and compared the results. All large chip cutters damaged the bed and marrow of the bone. The tool that caused the least damage was the wet grinding diamond tool.

Outcome of patients with scleroderma admitted to intensive care unit. A report of nine cases.

OBJECTIVE: Patients with systemic rheumatic disease constitute a small percentage of admissions to the medical intensive care units (ICUs). Systemic sclerosis (SSc) is one of the rheumatic diseases that together with secondary complications may lead to a critical illness requiring hospitalization in the ICU. We present the features, clinical course and outcome of critically ill patients with scleroderma that were admitted to the ICU. METHODS: The medical records of nine patients with diagnosis of scleroderma (8 female, 1 male), admitted to the intensive care unit of Sheba Medical Center during the 11-year interval between 1991 and 2002, were reviewed. RESULTS: The mean age of the patients at the time of admission to the ICU was 48 +/- 13 [SD] years. The mean duration of SSc from diagnosis to the ICU admission was 8 +/- 8 years. Six patients had diffuse SSc, two patients had limited SSc and one patient had juvenile diffuse morphea. The main reasons for admission to the ICU were: infection/ septic syndrome (n = 4), scleroderma renal crisis (SRC) with pulmonary congestion (n = 2), acute renal failure associated with diffuse alveolar hemorrhage namely scleroderma- pulmonary - renal syndrome (SPRS) (n = 1), iatrogenic pericardial tamponade (n = 1), mesenteric ischemia (n = 1). The patients had high severity illness score (mean APACHE II 25 +/- 3). Eight out of nine patients (89%) that were admitted to the ICU died during the hospitalization, six (66.6%) of them died in the ICU. Septic complications as the main cause of death were determined in five patients (62.5%), while four of them had pneumonia and acute respiratory failure along with underlying severe pulmonary fibrosis. Lungs and kidneys were the most common severely affected organs by SSc in our patients. CONCLUSION: The outcome of scleroderma patients admitted to the ICU was extremely poor. Infectious complication was the most common cause of death in our patients. Although infections are treatable, the high mortality rate for this group of patients was dependent on the severity of the underlying visceral organ involvement, particularly severe pulmonary fibrosis. The severity of this involvement is a poor outcome predictor. An early diagnosis and an appropriate treatment of such complications may help to reduce the mortality in scleroderma patients.