Prevention of postoperative nausea and vomiting after orthognathic surgery: a scoping review.

INTRODUCTION: Postoperative nausea and vomiting (PONV) is one of the most common adverse events following orthognathic surgery. It's a distressing feeling for patients and continues to be the cause of postoperative complications such as bleeding, delayed healing, and wound infection. This scoping review aims to identify effective PONV prophylaxis strategies during orthognathic surgery that have emerged in the past 15 years. METHODS: We searched Pubmed, Cochrane Controlled Register of Trials, and Embase from 2008 to May 2023. Studies meeting the following criteria were eligible for inclusion: (1) recruited patients undergo any orthognathic surgery; (2) evaluated any pharmacologic or non-pharmacologic method to prevent PONV. Studies meeting the following criteria were excluded: (1) case series, review papers, or retrospective studies; (2) did not report our prespecified outcomes. RESULTS: Twenty-one studies were included in this review. Pharmacological methods for PONV prevention include ondansetron and dexamethasone (3 studies), peripheral nerve block technique (4 studies), dexmedetomidine (1 study), pregabalin (2 studies), nefopam (2 studies), remifentanil (1 study), propofol (2 studies), and penehyclidine (1 study). Non-pharmacologic methods include capsicum plaster (1 study), throat packs (2 studies) and gastric aspiration (2 studies). CONCLUSIONS: Based on current evidence, we conclude that prophylactic antiemetics like dexamethasone, ondansetron, and penehyclidine are the first defense against PONV. Multimodal analgesia with nerve block techniques and non-opioid analgesics should be considered due to their notable opioid-sparing and PONV preventive effect. For the non-pharmacological methods, throat packs are not recommended for routine use because of their poor effect and serious complications. More prospective RCTs are required to confirm whether gastric aspiration can prevent PONV effectively for patients undergoing orthognathic surgery.

Compressive force regulates orthodontic tooth movement via activating the NLRP3 inflammasome.

Mechanical stress regulates various cellular functions like cell inflammation, immune responses, proliferation, and differentiation to maintain tissue homeostasis. However, the impact of mechanical signals on macrophages and the underlying mechanisms by which mechanical force regulates bone remodeling during orthodontic tooth movement remain unclear. NOD-like receptor family pyrin domain-containing 3 (NLRP3) inflammasome has been reported to promote osteoclastic differentiation to regulate alveolar bone resorption. But the relationship between the compressive force and NLRP3 inflammasome in macrophages remains unknown. In this study, immunohistochemical staining results showed elevated expression of NLRP3 and interleukin-1ß, as well as an increased number of macrophages expressing NLRP3, on the compression side of the periodontal tissues, after force application for 7 days. Furthermore, the number of tartrate-resistant acid phosphatase-positive osteoclasts, and the mRNA and protein expression levels of osteoclast-related genes in the periodontal tissue decreased in the Nlrp3-/- mice compared to the WT mice group after orthodontic movement. In vitro mechanical force activates the NLRP3 inflammasome and inhibits autophagy. Intraperitoneal injection of the autophagy inhibitor 3-methyladenine in Nlrp3-/- mice promoted orthodontic tooth movement. This result indicates that the absence of NLRP3 inflammasome activation can be partially compensated for by autophagy inhibitors. Mechanistically, force-induced activation of the NLRP3 inflammasome in macrophages via the cGAS/P2X7R axis. In conclusion, compressive force regulates orthodontic tooth movement via activating the NLRP3 inflammasome.

Effect of 650-nm low-level laser irradiation on c-Jun, c-Fos, ICAM-1, and CCL2 expression in experimental periodontitis.

This study was designed to investigate the effect of 650-nm low-level laser irradiation (LLLI) as an adjunctive treatment of experimental periodontitis. To investigate possible LLLI-mediated anti-inflammatory effects, we utilized an experimental periodontitis (EP) rat model and analyzed c-Jun, c-Fos, ICAM-1, and CCL2 gene expressions on PB leukocytes and in the gingival tissue. Total RNA was isolated from the gingivae and peripheral blood (PB) leukocytes of normal, EP, scaling, and root planing (SRP)-treated EP and LLLI + SRP-treated EP rats, and gene expressions were analyzed by real-time PCR. The productions of c-Jun, c-Fos, ICAM-1, and CCL2 in gingivae were analyzed immunohistochemically. Tartrate-resistant acid phosphatase (TRAP) staining was used to determine osteoclast activity in alveolar bone. The c-Jun and ICAM-1 messenger RNA (mRNA) levels were significantly decreased in the EP rat gingival tissue treated by SRP + LLLI than by SRP, the c-Jun, ICAM-1, and c-Fos mRNA levels on PB leukocytes reduced after LLLI treatment but did not show any significant differences in both groups. There was no significant difference in CCL2 mRNA levels on PB leukocytes and in gingivae between the SRP + LLLI and the SRP groups. The c-Fos mRNA levels in gingivae did not show significant difference in both groups. Immunohistochemistry showed that the CCL2, ICAM-1, c-Jun, and c-Fos productions were significantly reduced in rats of the SRP + LLLI group compared with the only SRP group. LLLI significantly decreased the number of osteoclasts as demonstrated by TRAP staining. The 650-nm LLLI might be a useful treatment modality for periodontitis.

Effect of multiple alcohol-based hand rub applications on the tensile properties of thirteen brands of medical exam nitrile and latex gloves.

Current CDC guidance for the disinfection of gloved hands during the doffing of personal protective equipment (PPE) following the care of a patient with Ebola recommends for multiple applications of alcohol-based hand rub (ABHR) on medical exam gloves. To evaluate possible effects of ABHR applications on glove integrity, thirteen brands of nitrile and latex medical exam gloves from five manufacturers and two different ABHRs were included in this study. A pair of gloves were worn by a test operator and the outside surfaces of the gloves were separately treated with an ABHR for 1-6 applications. Tensile strength and ultimate elongation of the gloves without any ABHR treatments (control gloves) and gloves after 1-6 ABHR applications were measured based on the ASTM D412 standard method. In general, tensile strength decreased with each ABHR application. ABHRs had more effect on the tensile strength of the tested nitrile than latex gloves, while ethanol-based ABHR (EBHR) resulted in lesser changes in tensile strength compared to isopropanol-based ABHR (IBHR). The results show that multiple EBHR applications on the latex gloves and some of the nitrile gloves tested should be safe for Ebola PPE doffing based on the CDC guidance. Appropriate hospital staff practice using ABHR treatment and doffing gloves is recommended to become more familiar with changes in glove properties.

TGF-ß promotes the proliferation and osteogenic differentiation of dental pulp stem cells a systematic review and meta-analysis.

BACKGROUND: Dental pulp stem cells (DPSCs) are adult stem cells with multi-directional differentiation potential derived from ectoderm. Vitro experiments have shown that adding cytokines can help DPSCs to be transformed from multipotent stem cells to osteoblasts. TGF-ß has been proved to have an effect on the proliferation and mineralization of bone tissue, but its effect on the osteogenesis and proliferation of dental pulp stem cells is still uncertain. We aim to determine the effect of TGF-ß on the osteogenesis and proliferation of dental pulp stem cells. METHODS: We have identified studies from the Cochrane Central Register of Controlled Trials, PubMed, Embase, and China national knowledge infrastructure (CNKI) for studies interested in TGF-ß and proliferation and differentiation of dental pulp stem cells in the following indicators: A490 (an index for evaluating cell proliferation), bone sialoprotein (BSP), Col plasmid-1 (Col-1), osteocalcin (OCN), runt-related transcription factor 2 (Runx-2); and the number of mineralized nodules. Any language restrictions were rejected. Furthermore, we drew a forest plot for each outcome. We conducted a sensitivity analysis, data analysis, heterogeneity, and publication bias test. We evaluate the quality of each study under the guidance of Cochrane's tool for quality assessment. RESULTS: The pooled data showed that TGF-ß could promote the proliferation and ossification of dental pulp stem cells. All the included results support this conclusion except for the number of mineralized nodules: TGF-ß increases the A490 index (SMD 3.11, 95% CI [0.54-5.69]), promotes the production of BSP (SMD 3.11, 95% CI [0.81-6.77]), promotes the expression of Col-1 (SMD 4.71, 95% CI [1.25-8.16]) and Runx-2 (SMD 3.37, 95% CI [- 0.63 to 7.36]), increases the content of OCN (SMD 4.32, 95% CI [1.20-7.44]) in dental pulp, and has no significant effect on the number of mineralized nodules (SMD 3.87, 95% CI [- 1.76 to 9.51]) in dental pulp stem cells. CONCLUSIONS: TGF-ß promotes the proliferation and osteogenesis of dental pulp stem cells.

Regulation of localized corrosion of 316L stainless steel on osteogenic differentiation of bone morrow derived mesenchymal stem cells.

Localized corrosion has become a concerning issue in orthopedic implants as it is associated with peri-implant adverse tissue reactions and implant failure. Here, the pitting corrosion of 316 L stainless steels (316 L SSs) was initiated by electrochemical polarization to simulate the in vivo localized corrosion of orthopedic implants. The effect of localized corrosion on osteogenic differentiation of bone marrow derived mesenchymal stem cells (BMSCs) was systematically studied. The results suggest that pitting corrosion of 316 L SS reduced the viability, adhesion, proliferation, and osteogenic differentiation abilities of BMSCs, especially for the cells around the corrosion pits. The relatively high concentrations of metallic ions such as Cr3+ and Ni2+ released by pitting corrosion could cause cytotoxicity to the BMSCs. The inhomogeneous electrochemical environment resulted from localized corrosion could promote reactive oxygen species (ROS) generation around the corrosion pits and cause oxidative stress of BMSCs. In addition, localized corrosion could also electrochemically interact with the cells and lead to cell membrane depolarization. The depolarized cell membranes and relatively high levels of ROS mediated the degradation of the osteogenic capacity of BMSCs. This work provides new insights into corrosion-mediated cell function degeneration as well as the material-cell interactions.

Multi-Catcher Polymers Regulate the Nucleolin Cluster on the Cell Surface for Cancer Therapy.

Cell signal transduction mediated by cell surface ligand-receptor is crucial for regulating cell behavior. The oligomerization or hetero-aggregation of the membrane receptor driven by the ligand realizes the rearrangement of apoptotic signals, providing a new ideal tool for tumor therapy. However, the construction of a stable model of cytomembrane receptor aggregation and the development of a universal anti-tumor therapy model on the cellular surface remain challenging. This work describes the construction of a "multi-catcher" flexible structure GC-chol-apt-cDNA with a suitable integration of the oligonucleotide aptamer (apt) and cholesterol (chol) on a polymer skeleton glycol chitosan (GC), for the regulation of the nucleolin cluster through strong polyvalent binding and hydrophobic membrane anchoring on the cell surface. This oligonucleotide aptamer shows nearly 100-fold higher affinity than that of the monovalent aptamer and achieves stable anchoring to the plasma membrane for up to 6 h. Moreover, it exerts a high tumor inhibition both in vitro and in vivo by activating endogenous mitochondrial apoptosis pathway through the cluster of nucleolins on the cell membrane. This multi-catcher nano-platform combines the spatial location regulation of cytomembrane receptors with the intracellular apoptotic signaling cascade and represents a promising strategy for antitumor therapy.

Promoting osseointegration by in situ biosynthesis of metal ion-loaded bacterial cellulose coating on titanium surface.

The biologically inert and excessive elastic modulus of Ti implant surface, as well as the excessive gap between implant and host, will lead to poor bone integration even implant failure. To solve the above problems, in this study, a method for functional Ti implant is reported, in which metal ions-containing bacterial cellulose (BC) coating is introduced in situ on the surface of Ti with complex shapes. Magnesium and strontium ions can be loaded into BC by in situ biosynthesis, which have great effects on the growth of bacteria and the structure of cellulose. In addition, both in vitro and in vivo experiments confirmed that the in situ preparation of functional BC coating on the Ti surface can integrate the operative crevices and promote osteogenesis. This simple and novel method for functional Ti implants has potential application value in clinical bone tissue repair and regeneration.

Reconstruction of tracheal wall defect with a mesh patch of nickel-titanium shape-memory alloy.

OBJECTIVES: We explored the feasibility of reconstructing tracheal wall defects with a mesh patch fashioned from a nickel-titanium shape-memory alloy. METHODS: A tracheal wall defect was first constructed surgically by resecting the anterior half of the tracheal wall between the second and sixth tracheal rings. The defect was reconstructed in 8 experimental animals by replacing the resected tracheal mucosa and tracheal cartilage with a pedicle skin flap, which was then enclosed in the mesh patch. In 4 control animals, only a pedicle skin flap with strap muscles was used in the reconstruction procedure. The performance of the animals was observed after surgery. At the end of the experiments, the reconstructed segment was harvested for anatomic evaluation. RESULTS: In the experimental group, 1 animal died 5 days after the operation. Endoscopic and anatomic examination of the 7 animals that survived the observation period showed that the reconstructed trachea was stable, with sufficient airway space for breathing. All 4 control animals died after the operation. After observing successful completion of this operation in animals, we successfully used this method to repair a tracheal wall defect in a human victim of a traffic accident. CONCLUSIONS: Tracheal defects can be successfully reconstructed by use of a mesh patch of nickel-titanium shape-memory alloy as an extraluminal stent--a method that avoids complications associated with intraluminal stents.

Sustained co-delivery of ibuprofen and basic fibroblast growth factor by thermosensitive nanoparticle hydrogel as early local treatment of peri-implantitis.

OBJECTIVE: The aims of this study were to 1) encapsulate ibuprofen (IBU) and basic fibroblast growth factor (bFGF) in a thermosensitive micellar hydrogel, 2) test the biological properties of this in situ drug delivery system, and 3) study the effect of hydrogel in promoting soft tissue healing after implant surgery and its anti-inflammatory function as an early local treatment of peri-implantitis. MATERIALS AND METHODS: A thermosensitive micellar hydrogel was prepared from amphiphilic copolymer poly(ε-caprolactone-co-1,4,8-trioxa [4.6]spiro-9-undecanone)-poly(ethylene glycol)-poly(ε-caprolactone-co-1,4,8-trioxa [4.6]spiro-9-undecanone) (PECT) nanoparticles and tested in vitro using a scanning electron microscope, rheometer, UV spectrophotometer, HPLC, and transmission electron microscope. RESULTS: The bFGF + IBU/PECT hydrogel formed a stable, water-dispersible nanoparticle core shell that was injectable at room temperature, hydrogel in situ at body temperature, and provided sustained release of both hydrophilic and hydrophobic drugs. The hydrogel promoted the proliferation and adhesion of human gingival fibroblasts, upregulated the expression of adhesion factors such as vinculin proteins, and showed anti-inflammatory properties. CONCLUSION: In situ preparation of IBU-and bFGF-loaded PECT hydrogel represents a promising drug delivery system with the potential to provide early local treatment for peri-implantitis.

Change in tensile properties of neoprene and nitrile gloves after repeated exposures to acetone and thermal decontamination.

This study investigated the change in tensile properties of neoprene and nitrile gloves after repeated cycles of exposure to acetone, followed by thermal decontamination. The glove was exposed to acetone (outer surface in contact with chemical), subjected to thermal decontamination, and tested for the tensile strength and the ultimate elongation. Thermal decontamination was carried out inside an oven for 16 hours at 100 degrees C. The exposure/decontamination procedure was repeated for a maximum of 10 cycles. For neoprene versus acetone, the mean tensile strength consistently decreased after each exposure/decontamination cycle. Multiple comparisons indicated that the mean tensile strengths between the new swatches and each exposure/decontamination group were significantly different (p < 0.05). The loss of either tensile strength or ultimate elongation was less than 23% compared with new swatches after four exposure/decontamination cycles. Swatches with out acetone exposure were then cycled through the oven in the same manner. It was found that both the heat used for thermal decontamination and acetone exposure significantly affected the tensile strength and ultimate elongation. For nitrile gloves exposed to acetone, the mean tensile strength remained virtually unchanged (p > 0.05). The mean tensile strength for the new swatches was 37.1 MPa and the mean tensile strength after nine exposure/decontamination cycles was 36.0 MPa, with a loss less than 3%. The largest single cycle loss for ultimate elongation occurred during the first exposure/decontamination cycle for both glove materials. In our previous study, decisions regarding the effectiveness of the decontamination process were based on having no discernible change in the breakthrough time and steady-state permeation rate. The results of this study indicate that the effectiveness of the decontamination process cannot be based on permeation parameters alone but must also take into account the change in physical properties.

Change in permeation parameters and the decontamination efficacy of three chemical protective gloves after repeated exposures to solvents and thermal decontaminations.

BACKGROUND: Chemical protective clothing (CPC) and gloves, which provide adequate protection, are usually too expensive to be considered disposable. Repeated use of CPC without effective decontamination may result in secondary exposure and injury. However, decontamination may change the physical and/or chemical properties of the barrier material, causing variations in breakthrough time (BT) and steady-state permeation rate (SSPR). METHODS: Glove materials including neoprene, Guardian butyl rubber, and nitrile synthetic rubber were selected for this study. Toluene and acetone were chosen as the challenge chemicals. Permeation was measured in a closed loop system using a 2.5 cm permeation cell and a MIRAN infrared analyzer (Foxboro, MA). Following the permeation test, the samples were thermally decontaminated. After each exposure/decontamination cycle, BT and SSPR were measured. A total of 260 permeation tests were conducted. Permeation test results were collected on each material/chemical combination for up to 10 exposure/decontamination cycles. RESULTS: On average, changes in BT and SSPR in comparison with respect to new swatches were 11.5% and 13.7% after seven exposure/decontamination cycles. The percentages increased to 26.6% and 15.9% after 10 exposure/decontamination cycles, respectively. For at least seven cycles, the BT mean for four out of five material/chemical combinations tested (neoprene/acetone, neoprene/toluene, nitrile/acetone, and nitrile/toluene) was not significantly different from the original value of the BT for each corresponding swatch. Similarly, the SSPR mean for each of the five material/chemical combinations after at least five cycles was not significantly different from those for new swatches. The BT mean for the butyl/toluene combination, however, was significantly different from the new swatches even after the first exposure/decontamination. The SSPR mean was significantly different after five cycles compared to the new swatches. CONCLUSIONS: Except for the butyl/toluene combination, thermal decontamination was an effective method in removing the solvents from the matrix of selected glove materials. Multiple reuses of some chemical protective gloves could be safe if effective decontamination methods are used and the glove materials do not have significant degradation.

Volatile metabolites produced by three strains of Stachybotrys chartarum cultivated on rice and gypsum board.

Stachybotrys chartarum (atra) is a toxigenic fungus frequently found in water-damaged buildings. Although microbial volatile organic compounds (MVOCs) produced by Aspergillus, Penicillium, and other fungi have been investigated extensively, little information exists on what MVOCs can be produced by S. chartarum. In this study, three strains of S. chartarum isolated from water-damaged residential homes in Cleveland, Ohio, were cultivated on rice and gypsum board. Air samples were collected after one, two, three, four, and six weeks of cultivation using Tenax TA tubes. Unique MVOCs were determined and other alcohols, ketones, and terpenes were also investigated using gas chromatography/mass spectrometry after thermal desorption from the sampling tube. Four unique MVOCs, 1-butanol, 3-methyl-1-butanol, 3-methyl-2-butanol, and thujopsene, were detected on rice cultures, and only one of them (1-butanol) was detected on gypsum board cultures. For a given strain, volatiles were considerably different with different cultivation media. Concentration profiles of the volatile compounds varied among compounds; however, each compound exhibited corresponding concentration trends between the strains. In comparison with our previous studies of five Aspergillus species on gypsum board under the same experimental conditions, fewer unique MVOCs were produced by S. chartarum, and they were quite different. It thus may be possible to use marker-unique MVOCs as a fingerprint to distinguish fungi in indoor environments once enough information becomes available. Our findings also indicate that volatiles produced by S. chartarum may represent a relatively small fraction of the total volatiles present in problem buildings where Aspergillus spp., Penicillium spp., and other fungi usually coexist.