Characterization of Age-Related Injury Patterns and Surgical Treatment of Pediatric Facial Fractures: Analysis of the National Trauma Data Bank.

BACKGROUND: Presentation of pediatric facial fractures varies widely and many injuries are encountered infrequently by most practitioners. This study summarizes injury patterns in a large cohort of facial fractures and their subsequent surgical management. METHODS: Demographic and clinical characteristics of patients 18 years of age or younger admitted between 2009 and 2015 to trauma centers participating in the National Trauma Data Bank were examined. Craniofacial fractures and reconstructive procedures performed at index admission were selected based on ICD-9 and AIS codes. A multivariable analysis was used to determine independent determinants of surgical repair. RESULTS: Out of 60,094 pediatric patients evaluated in the US emergency departments, 48,821 patients were admitted and underwent open treatment (n = 8364; 17.1%) or closed treatment (n = 4244; 8.7%) of facial fractures. Falls were the most common mechanism of injury in infants and toddlers (<2-year-old, 44.4%, P <0.001), while motor vehicle collisions (32.9%, P <0.001) and assault (22.1%, P <0.001) were most commonly seen in adolescents (12-18-year-old). The frequency and odds of repair of facial fractures increased with advancing age, more so with open than closed treatment in adolescents (73.0%) as compared to infants and toddlers (50.3%). Children who sustained mandible fractures are the most likely to require surgical treatment at index-admission (odds ratio = 13.9, 95% confidence interval 13.1-14.8, P <0.001). CONCLUSIONS: Population-based data shows that pediatric fracture patterns and associated early repair vary significantly with age. Patient demographics and hospital characteristics are significant determinants of surgical treatment that should be related to clinical outcomes in future studies.

Contemporary Characterization of Injury Patterns, Initial Management, and Disparities in Treatment of Facial Fractures Using the National Trauma Data Bank.

BACKGROUND: Contemporary description of facial fracture patterns and factors associated with early operative intervention at trauma centers is lacking. The purpose of this study was to characterize injuries and initial treatment patterns of patients suffering from facial fractures. METHODS: Using the National Trauma Databank from 2007 to 2015, patients suffering from facial fractures were included. Demographics, injury characteristics, and outcomes including operative interventions were assessed. RESULTS: Over 9 years, 626,270 patients were included: 74.5% were male, 39.0% suffered traumatic brain injury (TBI), and 23.3% severe noncraniofacial injuries (chest, abdomen, and/or extremity Abbreviated Injury Score ≥3). A total of 537,594 (85.8%) patients were admitted and 184,206 (34.3%) underwent operations for their facial injuries during the index hospitalization. The frequency and patterns of fractures varied by age, sex, race, and mechanism of injury. Operative intervention rates were highest for mandible (63.2%) and lowest for orbit fractures (1.0%). Multiple regression revealed that multiple factors were independently associated with the odds of early fracture repair including: female versus male (odds ratio [95% confidence interval]: 0.96 [0.94-0.98]), age >65 versus <18 years (0.62 [0.59-0.64]), non-white race (0.95 [0.94-0.97]), uninsured versus Medicaid (0.88 [0.86-0.90]), hospital bed size (>600 vs ≤200 beds, 1.67 [1.61-1.73]), TBI (0.70 [0.69-0.71]), and C-spine injury (0.93 [0.90-0.96]). CONCLUSIONS: Facial fractures are common among many demographic cohorts, and multiple patient and injury-specific factors influenced fracture patterns and management. Early operative intervention was highest for mandible fractures and lowest for orbit fractures. Multiple factors including age, sex, insurance status, hospital characteristics, and race/ethnicity were independently associated with early operative intervention, highlighting disparities in care.

Utility of Postoperative Mandibulomaxillary Fixation After Rigid Internal Fixation of Isolated Mandibular Fractures.

PURPOSE: The utility of postoperative mandibulomaxillary fixation (MMF) after open reduction and internal fixation (ORIF) of mandible fractures is debated. The purpose of this study is to analyze if patients undergoing ORIF with postoperative MMF have improved outcome compared with those treated with ORIF alone. METHODS: A retrospective study was performed on patients who underwent ORIF of isolated mandibular fractures. Patients were divided into those placed in MMF postoperatively (ORIF with MMF) and those who were not (ORIF only). Postoperative complications and follow-up compliance were compared. RESULTS: A total of 238 patients were identified. Of these, 204 had sufficient follow-up with 94 patients in the ORIF with MMF group and 107 patients in the ORIF only group. Both groups had similar minor complication rates (13% vs 12%, P = 0.83) and major complication rates (16% vs 13%, P = 0.69). After adjusting for potential confounders, the use of postoperative MMF did not reduce the risk of minor (P = 0.34) or major complications (P = 0.57). Patients with postoperative MMF had a 5% lost to follow-up rate compared to 20% in the ORIF only group. CONCLUSION: Postoperative MMF does not improve clinical outcome after ORIF in patients with isolated mandible fractures but has the potential benefit of improving follow-up compliance.

Predicting cardiovascular risk in a Chinese primary Sjögren's syndrome population: development and assessment of a predictive nomogram.

Background: Patients with primary Sjögren's syndrome (pSS) are at increased risk of cardiovascular morbidity as compared with the general population. Objectives: A retrospective study on 349 Chinese patients with pSS was conducted to identify potential risk factors for cardiovascular events and develop a cardiovascular risk nomogram. Design: This is a retrospective observational study. Methods: The study included 349 patients who were diagnosed with pSS at Tongji Hospital, School of Medicine, Tongji University, China from January 2010 to March 2022. The least absolute shrinkage and selection operator (LASSO) was used to select features for the cardiovascular risk model. The features selected in LASSO were used to build the cardiovascular risk model in a multivariate logistic regression analysis. C-index, receiver operating characteristic (ROC) curve, calibration plot, and decision curve analysis were used to assess the predictive model. Internal validation was performed by bootstrapping. Results: Sex, joint pain as an initial symptom, dry mouth, oral ulcers, dental caries, Raynaud's phenomenon, fatigue, diabetes, elevated thyroid-stimulating hormone (TSH) level, and elevated systolic blood pressure were included in the nomogram for the prediction of cardiovascular risk. Our model had good discrimination (C-index: 0.824, 95% confidence interval: 0.712-0.936) and good calibration (C-index in the interval validation: 0.8). Decision curve analysis indicated that our nomogram demonstrated clinical usefulness for intervention in a cardiovascular disease possibility threshold of 3%. Conclusion: The cardiovascular risk nomogram incorporating sex, initial joint pain, dry mouth, oral ulcer, dental caries, Raynaud's phenomenon, fatigue, diabetes, elevated TSH, and systolic blood pressure could be used in the prediction of cardiovascular risk in patients with pSS and the guidance of further treatment.

Semi-IPN ionogel based on poly (ionic liquids)/xanthan gum for highly sensitive pressure sensor.

In this paper, a novel ionogel with semi-interpenetrating poly (ionic liquids)/xanthan gum (PIL/XG) polymer network (semi-IPN) was prepared by using a simple one-pot method. The structure and the pressure sensing performance have been systematically investigated. It was found that introducing a low content (0.3-3.1 wt%) of XG significantly promoted the mechanical performance of ionogels with little effect on the ionic conductivity. The optimized PIL/XG containing 2.2 wt% XG exhibited high compression strength (761.0 kPa) and ionic conductivity (0.63 S/m at 25 °C). Such ionogels showed a liner response (0-100 kPa) and high sensitivity value of 6.86 kPa-1 in a capacitive mode. Meanwhile, as a resistive sensor, PIL/XG exhibited a wide response range to dynamic pressure ranges with stable repeatability. Furthermore, this ionogel exhibited excellent bactericidal properties against both gram-positive bacteria and gram-negative bacteria. This research provides a potential approach for developing ionogels based on semi-IPN with pressure-sensitive and anti-bacterial properties.

Anti-biofouling microfiltration membranes based on 1-vinyl-3-butylimidazolium chloride grafted PVDF with improved bactericidal properties and vitro biocompatibility.

Polyvinylidene fluoride (PVDF) porous membranes have been widely used as the filtration and separation industry. Herein, novel microfiltration membranes based on 1-vinyl-3-butylimidazolium chloride ([VBIm][Cl]) grafted PVDF (PVDF-g-[VBIm][Cl]) were prepared via the non-solvent induced phase separation method. The chemical composition and microstructure of PVDF-g-[VBIm][Cl] membranes were characterized by Fourier transform infrared spectroscopy, X-ray photoelectron spectroscopy, Scanning electron microscopy and Water contact angle measurements. The results showed that an increasing in [VBIm][Cl] grafting content leads to the increasing hydrophilicity and wetting capacity of the PVDF-g-[VBIm][Cl] porous membranes. The anti-biofouling properties of membranes were evaluated by measuring the water flux before and after Bovine serum albumin solution treatment. It was found that the modified membranes presented a good anti-biofouling property. The degree of irreversible flux loss caused by protein adsorption dramatically reduced from 42.1% to 2.9% compared with the pristine hydrophobic PVDF membranes. Meanwhile, these PVDF-g-[VBIm][Cl] membranes also exhibited excellent bactericidal properties against both gram-positive bacteria Staphylococcus saureus and gram-negative bacteria Escherichia coli, while PVDF membranes did not show any antibacterial activity. The vitro biocompatibility of the modified membranes was studied by hemolysis analysis, the platelet adhesion observation, thromboelastography assay and cytotoxicity assay. It was found that the incorporation of [VBIm][Cl] into PVDF membranes has less effect on the hemolysis and cytotoxicity of PVDF membranes. Furthermore, both hydrophilicity and charges of the membrane surface played important role in the adhesion and activation of platelet cells, which consequently affected the clotting process of whole blood. The membrane with appropriate [VBIm][Cl] grafting ratio (2.94 wt.%) exhibited good hemocompatibility with less blood coagulation effect. As an ultrafiltration membrane, PVDF-g-[VBIm][Cl] membranes have potential applications in the biomedical field due to the improved antibacterial property and biocompatibility.

Application of care bundles in bowel preparation for colonoscopy in children.

BACKGROUND: To explore the value of care bundles (CBs) in bowel preparation for colonoscopy in children. METHODS: Children who underwent electronic fiberoptic colonoscopy or enteroscopic surgery in our hospital from September 2016 to October 2017 were enrolled as the conventional nursing (CN) group and children who received such procedures from November 2017 to December 2018 were enrolled as the care bundle group. Polyethylene glycol electrolyte lavage solution (PEG-ELS) was used for bowel preparation in all children. The CBs included nurse education, risk evaluation of inadequate bowel preparation, education of children and families, and observation and assessment during preparation. The quality of bowel preparation, tolerance and safety, families' anxiety score, and degree of satisfaction with hospitalization were compared between these two groups. RESULTS: Eighty-two children were enrolled in this study, with 42 cases in the CB group and 40 cases in the CN group. Symptoms of distension, abdominal pain, vomiting, and fatigue, along with intragastric feeding, were compared between the two groups. An additional enema was performed in 2 cases in the CB group and in 12 cases in the CN group, demonstrating a significant difference between the groups. The Aronchick score and anxiety score of families were 1.24±0.85 vs. 2.35±1.76 (t=-3.477, P=0.001) and 3.28±0.85 vs. 5.45±1.78 (t=-3.473, P=0.001) in the CN group and CB group, respectively. The satisfaction rate was 97.62% vs. 85.00% (χ2=6.764, P<0.001). CONCLUSIONS: Implementation of the care bundles in the bowel preparation of children planning to receive colonoscopy can improve the quality of preparation and the satisfaction with hospitalization while alleviating the anxiety of patients and their families.

Hyperbranched polyglycerol-modified graphene oxide as an efficient drug carrier with good biocompatibility.

As a promising drug carrier, graphene oxide (GO) has been studied widely in drug delivery due to its excellent loading ability to aromatic drugs. However, its biocompatibility, such as stability and blood compatibility, is now the biggest obstacle for its further application. Herein, the hyperbranched polyglycerol (HPG)-modified GO was prepared through the anionic ring-opening polymerization using GO as the initiator directly, and then the doxorubicin hydrochloride was loaded and showed obvious cytotoxicity to tumor cells. The obtained HPG-GO displayed good stability in the aqueous solution, as well showed low toxicity in vitro and in vivo. As an injectable drug carrier, HPG-GO showed good blood compatibility with negligible effect on the hemolysis and blood coagulation. Such a stable and blood-compatible GO derivative may be applied widely in drug delivery in the future.

MWNT-hybrided supramolecular hydrogel for hydrophobic camptothecin delivery.

To encapsulate the hydrophobic camptothecin (CPT) into hydrogel matrix with a high loading amount, a supramolecular hydrogel hybrided with multi-walled carbon nanotubes (MWNTs) was developed by the host-guest interactions and used for loading and delivering CPT. Firstly, carboxylated MWNTs were modified by polyethylene glycol monomethyl ether (MPEG), which resulted in the water-dispersed MPEG-MWNTs. Then α-cyclodextrin (α-CD) was mixed with MPEG-MWNTs and the hybrid supramolecular hydrogel was fabricated by the inclusion interactions between α-CD and MPEG. The used MPEG not only dispersed MWNTs in aqueous solution, but also functioned as hydrogel matrix by interacting with α-CD. The gelation time for the sol-gel transition and rheological properties of the resultant hydrogels were studied. Due to the excellent application of MWNTs in drug delivery, hydrophobic CPT could be loaded into the hydrogel matrix by a higher amount compared with micelles. By in vitro release and cell viability tests, it was found that the encapsulated CPT could exhibit a controlled and sustained release behavior as well as sustained antitumor efficacy.

A star-shaped porphyrin-arginine functionalized poly(L-lysine) copolymer for photo-enhanced drug and gene co-delivery.

The co-delivery of drug and gene has become the primary strategy in cancer and other disease therapy. To co-deliver hydrophobic drug and functional gene efficiently into tumor cells, a star-shaped copolymer (PP-PLLD-Arg) with a photochemical internalization effect consisting of a porphyrin (PP) core and arginine-functionalized poly(L-lysine) dendron (PLLD-Arg) arms has been designed, and used to co-deliver docetaxel (DOC) and MMP-9 shRNA plasmid for nasopharyngeal cancer therapy. It was found that PP-PLLD-Arg/MMP-9 nanocomplex showed the photo-enhanced gene transfection efficiency in vitro, and could mediate a significant reduce of MMP-9 protein expression in HNE-1 cells. For co-delivery analysis, the obtained PP-PLLD-Arg/DOC/MMP-9 complexes could induce a more significant apoptosis than DOC or MMP-9 used only, and decreased invasive capacity of HNE-1 cells. Moreover, the star-shaped copolymer exhibited better blood compatibility and lower cytotoxicity compared to PEI-25k in the hemolysis and MTT assays, and also showed a good biocompatibility in vivo. Therefore, PP-PLLD-Arg with suited irradiation is a promising non-toxic and photo-inducible effective drug and gene delivery strategy, which should be encouraged in tumor therapy.

The use of poly(methacrylic acid) nanogel to control the release of amoxycillin with lower cytotoxicity.

In order to control the release of amoxycillin (AM) with lower cytotoxicity and higher activity, ethylene glycol dimethacrylate was used as the cross-linker, and a series of poly(methacrylic acid) (PMAA) nanogels were prepared to load the AM. Then, the morphology, size, in vitro release property, long-term antibacterial performance, cytotoxicity, stability and activity of this novel AM/PMAA nanogel were investigated. The results showed that the AM/PMAA nanogel sustainably released AM with long-term antibacterial activity. Moreover, the AM/PMAA nanogel could improve the stability of AM. More importantly, this AM/PMAA nanogel showed slighter cytotoxicity than AM alone, suggesting that the AM/PMAA nanogel was a more useful dosage form than AM for infectious diseases.

Preliminary studies on pH-sensitive hydrogels and in vitro release profiles of two model drugs.

The main aim of the present study was to develop a series of pH-sensitive hydrogels for targeted releasing drugs under simulated intestinal environment instead of stomach condition. These hydrogels were prepared via free radical polymerization with polyethylene glycol methacrylate 475 (PEGMA475), PEGMA950 and methacrylic acid as monomers, triethylene glycol dimethacrylate (TRGDMA), and ethylene glycol dimethacrylate as cross-link agents. The surface morphology and internal structures of hydrogels were detected by scanning electron microscope. The swelling experiments were also performed and the results revealed that the smart hydrogels were pH sensitive and their sensitiveness was reversible. Diclofenac sodium and bull serum albumin used as model drugs were loaded in the hydrogels to target releasing them in simulative intestinal tract. In vitro releasing studies showed that medicated hydrogels released model drugs slowly in acid conditions (pH 1.2), while the cumulated release amounts of drugs increased greatly when ambient pH value increased to 7.4. These phenomena indicated that these hydrogels tended to target release stimulating and destructible drugs in intestinal canal instead of gastric environment.

Music for pain and anxiety in children undergoing medical procedures: a systematic review of randomized controlled trials.

OBJECTIVE: The aim of this study was to conduct a systematic review of the efficacy of music therapy (MT) on pain and anxiety in children undergoing clinical procedures. METHODS: We searched 16 electronic databases of published and unpublished studies, subject bibliographies, reference lists of relevant articles, and trials registries. Two reviewers independently screened 4559 citations and reviewed the full manuscript of 393 studies. Nineteen studies met the inclusion criteria: randomized controlled trial, children aged 1 month to 18 years were examined, music was used as an intervention, and the study measured pain or anxiety. Music therapy was considered active if a music therapist was involved and music was used as a medium for interactive communication. Passive music therapy was defined as listening to music without the involvement of a music therapist. RESULTS: The 19 included trials involved 1513 subjects. The methodological quality of the studies was generally poor. Overall, MT showed a significant reduction in pain and anxiety (standardized mean difference [SMD] -0.35; 95% confidence interval [CI], -0.55 to -0.14; 9 studies; N = 704; I(2) = 42%). When analyzed by outcome, MT significantly reduced anxiety (SMD -0.39; 95% CI, -0.76 to -0.03; 5 studies; n = 284; I(2) = 52.4%) and pain (SMD -0.39; 95% CI, -0.66 to -0.11; 5 studies; N = 465; I(2) = 49.7%). There was no evidence of publication bias. CONCLUSIONS: Music is effective in reducing anxiety and pain in children undergoing medical and dental procedures. Music can be considered an adjunctive therapy in clinical situations that produce pain or anxiety.