Respiratory tract infection after oral and maxillofacial surgery under general anesthesia and related factors.

INTRODUCTION: We aimed to explore the respiratory tract infection after oral and maxillofacial surgery under general anesthesia and related factors. METHODOLOGY: A total of 494 patients receiving oral and maxillofacial surgery under general anesthesia with tracheal intubation were assigned to a non-infection group (n=469) and an infection group (n=25). Another 494 healthy people undergoing physical examination in the same period were enrolled to establish a classification tree model. The distribution of pathogens, drug resistance of main pathogens, and related influencing factors of postoperative respiratory tract infection were analyzed. The influencing factors of respiratory tract infection were screened by logistic regression analysis. After construction of the classification and regression tree (CART) model based on the influencing factors, the accuracy was evaluated by plotting receiver operating characteristic (ROC) curve. RESULTS: Pseudomonas aeruginosa was highly resistant to cefazolin and more sensitive to cefoperazone, ciprofloxacin, norfloxacin and imipenem. Staphylococcus aureus was highly resistant to gentamicin and more sensitive to vancomycin. Age ≥ 60 years old, history of lung diseases, operation time ≥ 4 h, anesthesia ventilation time ≥ 120 min, and orotracheal intubation were independent influencing factors of respiratory tract infection (p< 0.05). The results of the gain chart, index map, and Risk value indicated a high predictive value of the CART model for the risk of postoperative respiratory tract infection. The area under the ROC curve was 0.869 [95% confidence interval: 0.795-0.947]. CONCLUSIONS: The CART model has a high predictive value and may reduce the risk of postoperative infection.

The Dental Health of Orphan and Non-orphan Children in Fuyang City, China.

PURPOSE: To assess the dental health of orphan and non-orphan children in Fuyang City, China. MATERIALS AND METHODS: A total of 332 orphan children were selected from social child welfare institutes and 590 non-orphan children were selected from the Experimental Primary and Middle Schools through random sampling in Fuyang City, China. The indices for Decayed, Missing, Filling (DMF) in orphan and non-orphan children were determined by dental inspections to assess their dental health. The periodontal status of orphan and non-orphan children aged 12-15 years was determined using the percentages of bleeding gingiva and dental calculus. RESULTS: In the age range of 3 to 5 years, the percentage of caries (81%) and the mean DMF (4.41; SD: 2.06; 95% CI: 3.82 to 5.00) of orphan children were statistically significantly higher than the percentage of caries (64%) and the mean DMF of the non-orphan control cohort (3.29; SD: 2.05; 95% CI: 2.87 to 3.71; p < 0.05). In the age range of 12 to 15 years, the percentage of caries (50.8%) and the mean DMF (1.28; SD: 1.26; 95% CI: 1.12 to 1.43) of orphan children were statistically significantly higher than the percentage of caries (34.5%) and the mean DMF (1.11; SD: 1.24; 95% CI: 1.01 to 1.23; p < 0.05) of non-orphan children. For orphan children ages 3 to 5 years, the percentage of restorations was statistically significantly lower (p < 0.05) than that of non-orphan children (30%). For orphan children ages 12 to 15 years, the percentage of restorations was 3.9%, statistically significantly lower (p < 0.05) than that of non-orphan children (19.4%). In orphan children ages 12 to 15 years, the percentages of bleeding gingiva (76.0%) and dental calculus (69.3%) were statistically significantly higher (p < 0.05) than those of the non-orphan children (46.2% and 39.1%, respectively). There was no statistically significant difference in the evaluation indicators above between different genders within the groups studied, except the percentage of restorations. CONCLUSION: The dental health of orphan children in Fuyang City is worse than that of non-orphan children of the same age ranges. The values determined in this study can be used as a starting metric to measure the effectiveness of dental health care programs in improving the dental health of both orphan and non-orphan children.

A randomized, double-blind, celecoxib- and placebo-controlled study of the effectiveness of CS-706 in acute postoperative dental pain.

BACKGROUND: CS-706 is a cyclooxygenase-2 (COX-2)-selective inhibitor with an in vitro selectivity ratio (COX-1:COX-2) similar to that of celecoxib. It has exhibited analgesic, anti-inflammatory, and antitumor properties in animal models. OBJECTIVES: This study evaluated the tolerability of single doses of CS-706 and compared the analgesic efficacy of CS-706 with that of celecoxib and placebo in the dental pain model. METHODS: This was a randomized, double-blind, double-dummy, active- and placebo-controlled study. Healthy male and female subjects with moderate to severe pain intensity (PI) after dental surgery were randomized ( approximately 50 per group) to receive a single oral dose of CS-706 10, 50, 100, or 200 mg; celecoxib 400 mg; or placebo. PI and pain relief (PR) were measured on categorical and visual analog scales through 24 hours after the dose. The primary efficacy variable was the time-weighted sum of PR scores at 4 hours after the dose (TOPAR4). The onset of analgesia was assessed by calculating the pain intensity difference (PID). Perceptible and meaningful pain relief were assessed using a 2-stopwatch method. RESULTS: The majority of subjects were female (62.0%) and white (59.5%). Subjects' mean (SD) age was 22.6 (3.9) years, and their mean body mass index was 25.3 (5.1) kg/m(2). All doses of CS-706 were associated with significant analgesic efficacy compared with placebo based on the primary end point, TOPAR4 (P<0.001), and on all secondary end points (P<0.05, comparisons of all CS-706 doses vs placebo) with the exception of time to 100% PR for CS-706 10 mg. Single 50-, 100-, and 200-mg doses of CS-706 also were significantly more effective than celecoxib for TOPAR4 (P=0.036, P=0.004, and P=0.006, respectively). The onset of analgesia (PID >or= 1) for all CS-706 doses occurred within 1 hour after dosing (P<0.001 vs placebo). The median duration of analgesia, measured as the time to administration of rescue medication, was significantly greater for all doses of CS-706 compared with placebo (5.7 hours for CS-706 10 mg, >24 hours for CS-706 50, 100, and 200 mg, and 1.7 hours for placebo; P<0.001 for CS-706 50, 100, and 200 mg). These data suggest that once-daily administration of CS-706 may be effective in providing relief of acute pain. The incidence of adverse events was similar among all treatment groups. Adverse events occurring in >or= 5 % of subjects in any treatment group were nausea, vomiting, dry socket, dizziness, headache, and paresthesia. CONCLUSION: Single doses of CS-706 had significant analgesic efficacy compared with celecoxib and placebo in the relief of postoperative dental pain in the healthy subjects enrolled in this study.

Efficacy and complications of polyethylene glycols for treatment of constipation in children: a meta-analysis.

Constipation is a common childhood complaint. In 90% to 95% of children, constipation is functional, which means that there is no objective evidence of an underlying pathological condition. Polyethylene glycol (PEG or macrogol) solution is an osmotic laxative agent that is absorbed in only trace amounts from the gastrointestinal tract and routinely used to treat chronic constipation in adults. Here, we report the results of a meta-analysis of PEG-based laxatives compared with lactulose, milk of magnesia (magnesium hydroxide), oral liquid paraffin (mineral oil), or acacia fiber, psyllium fiber, and fructose in children. This meta-analysis was conducted in accordance with PRISMA guidelines and involved searches of MEDLINE, Cochrane, EMBASE, and Google Scholar databases up to February 10, 2014, using the keywords (Constipation OR Functional Constipation OR Fecal Impaction) AND (Children) AND (Polyethylene Glycol OR Laxative). Primary efficacy outcomes included a number of stool passages/wk and percentage of patients who reported satisfactory stool consistency. Secondary safety outcomes included diarrhea, abdominal pain, nausea or vomiting, pain or straining at defecation, bloating or flatulence, hard stool consistency, poor palatability, and rectal bleeding. We identified 231 articles, 27 of which were suitable for full-text review and 10 of which were used in the meta-analysis. Patients who were treated with PEG experienced more successful disimpaction compared with those treated with non-PEG laxatives. Treatment-related adverse events were acceptable and generally well tolerated. PEG-based laxatives are effective and safe for chronic constipation and for resolving fecal impaction in children. Children's acceptance of PEG-based laxatives appears to be better than non-PEG laxatives. Optimal dosages, routes of administration, and PEG regimens should be determined in future randomized controlled studies and meta-analyses.

Use of absorbable hemostatic gauze with medical adhesive is effective for achieving hemostasis in presacral hemorrhage.

BACKGROUND: Management of presacral hemorrhage is always challenging. Herein we describe the use of an absorbable hemostatic gauze with α-cyanoacrylate medical adhesive to achieve hemostasis. METHODS: In this study, we conducted total mesorectal excision for the treatment of rectal cancer in 258 patients from March 2006 to May 2009. Intraoperative presacral hemorrhage developed in 5 (2%) patients during rectal mobilization. RESULTS: In these 5 patients, massive bleeding could not be controlled by pressure and pelvic packing with gauze. An absorbable hemostatic gauze spread with medical adhesive was compressed onto the bleeding vessel for at least 20 minutes. Hemostasis was achieved successfully and was maintained during the surgery. Patients recovered uneventfully and no postoperative events were noted. CONCLUSIONS: The use of an absorbable hemostatic gauze with medical adhesive is a simple and effective method for achieving hemostasis when massive presacral hemorrhage occurs. However, its effectiveness needs to be confirmed in a controlled study in a properly selected patient population.

[Treating metastatic vertebral tumor with percutaneous vertebroplasty: a report of 28 cases].

BACKGROUND & OBJECTIVE: Treating metastatic vertebral tumor is a common difficulty. Conservative treatment can't efficiently release the pain, and establish the spinal column; while operation may destroy normal tissue, and cause many complications, which would prolong the time of in-hospital, and delay the treatment of primary disease, at the same time, operation is not suitable for multiple metastatic spinal tumors. This study was designed to investigate the efficacy of percutaneous vertebroplasty (PVP) on metastatic spinal tumor under the guidance of digital subtraction angiography (DSA). METHODS: A total of 58 patients with metastatic spinal tumor were divided into 2 groups according to their intention, 28 (group A) were treated with PVP combined radiochemotherapy, 30 (group B) were treated with routine radiochemotherapy. Baselines of the 2 groups have no significant difference. Two months after treatment, the life quality, therapeutic response, stabilization of the vertebral column, and toxic effect were compared between group A and group B. RESULTS: After treatment, both groups showed significant changes in life quality, and therapeutic response (P < 0.05, t(1)=2.74, t(2)=11.74). Group A showed no complication. Group B showed 5 cases of pathologic constrictive fracture in spinal body. CONCLUSION: PVP is a simple and minimally invasive treatment with few complications, which can release pain, decrease incidence of pathologic constrictive fracture in spinal body, and improve life quality of patients with metastatic spinal tumor.