Is arthrocentesis of temporomandibular joint with corticosteroids beneficial? A systematic review.

BACKGROUND: Temporomandibular disorders (TMDs) are musculoskeletal conditions that can inhibit the normal function of temporomandibular joints (TMJs) and affect the patient's quality of life, negatively. Arthrocentesis (AC) is a minimally invasive surgical procedure used for treating TMDs. The aim of present paper is to evaluate the advantages of administrating corticosteroid (CS) during AC by reviewing high quality released articles. MATERIAL AND METHODS: Searching on Cochrane Library, Web of Science, Google Scholar, PubMed, ProQuest, and Scopus databases were performed with focusing on proper key words. Related titles and abstracts, up to December 2017, were screened and selected based on inclusion criteria. The full text of all randomized controlled trials (RCTs) was extensively read and subjected to quality assessments. RESULTS: After initial search, a total of 2067 articles were included into the study. Finally, 7 studies were reliable enough in methodology and randomization to be included into the study. All of the observed studies showed improvements in jaw functions and pain relief with no statistical differences in both AC and control groups. One study reported painless maximum incisal opening in CS group than the control group. CONCLUSION: Based on available RCTs, the AC of TMJ with CS seems to result in similar findings to other therapeutic drugs, with no significant differences.

Anaesthetic efficacy of lidocaine/clonidine for inferior alveolar nerve block in patients with irreversible pulpitis.

AIMS: This prospective, randomized, double-blind study aimed to compare the efficacy of lidocaine with epinephrine versus lidocaine with clonidine for inferior alveolar nerve block (IANB) and hemodynamic stability (heart rate, systolic blood pressure, diastolic blood pressure and mean arterial pressure) in patients with irreversible pulpitis. METHODOLOGY: One hundred patients with irreversible pulpitis in mandibular molar teeth randomly received 1.8 mL of 2% lidocaine with clonidine (15 µg mL-1 ) or 1.8 mL of 2% lidocaine with epinephrine (12.5 µg mL-1 ), using a conventional IANB technique. Endodontic access cavities were prepared 15 min after solution deposition, and all patients were required to have profound lip numbness. Success was defined as no or mild pain (visual analog scale recording) upon endodontic access cavity preparation or initial canal instrumentation. The hemodynamic parameters were measured before, during and 5, 10 and 30 min after administration. Finally, the collected data were subjected to independent t-test, chi-square and Fisher's exact test using spss software ver.20 at a significant level of 0.05. RESULTS: The success rates for IANB using lidocaine with epinephrine and lidocaine with clonidine solutions were 29% and 59%, respectively. The clonidine group exhibited a significantly higher success rate (P < 0.05). Five minutes after drug administration, systolic blood pressure and heart rate significantly increased in the lidocaine with epinephrine group and insignificantly decreased in lidocaine with clonidine group. CONCLUSION: For mandibular molars with irreversible pulpitis, addition of clonidine to lidocaine improved the success rate of IANB compared to a standard lidocaine/epinephrine solution.

Effect of twist and porosity on the electrical conductivity of carbon nanofiber yarns.

This study focuses on the effect of twist and porosity on the electrical conductivity of carbon nanofiber (CNF) yarns. The process of fabrication of CNF yarns included the synthesis of aligned ribbons of polyacrylonitrile (PAN) nanofibers via electrospinning. The PAN ribbons were twisted into yarns with twist levels ranging from zero twist to high twists of 1300 turn per meter (tpm). The twist imposed on the ribbons substantially improved the interactions between nanofibers and reduced the porosity. The PAN yarns were subsequently stabilized in air, and then carbonized in nitrogen at 1100 °C for 1 h. Compressive stresses developed between the PAN nanofibers as a result of twist promoted interfusion between neighboring nanofibers, which was accelerated by heating the yarns during stabilization to temperatures above the glass transition of PAN. The electrical conductivity of the yarns was measured with a four point probe measurement technique. Although increasing the twist promotes electrical conductivity between nanofibers by forming junctions between them, our results indicate that the electrical conductivity does not continuously increase with increasing twist, but reaches a threshold value after which it starts to decrease. The causes for this behavior were studied through experimental techniques and further explored using a yarn-equivalent electrical circuit model.

Protective effects of resveratrol against osteonecrosis at the extraction site in bisphosphonate-treated rats.

Resveratrol (RSV) is a phytoestrogen with a wide range of therapeutic effects, including antioxidant and anti-inflammatory effects. This study was performed to evaluate the protective role of RSV against osteonecrosis after tooth extraction in rats treated with bisphosphonates. Thirty-nine male Wistar rats, weighing 300-350 g, were divided into three groups (n = 13) according to the planned drug regimen: alendronate + dexamethasone (AL/DEX), alendronate + dexamethasone + RSV (AL/DEX/RSV), and no drugs (control group). The first and second molars of each rat were extracted and the extraction sites were analysed histologically 14 days later. The data collected were subjected to statistical analysis by means of Kruskal-Wallis, Mann-Whitney, χ2, and Fisher's exact tests using IBM SPSS software at a significance level of 0.05. The incidence of osteonecrosis was significantly lower in the AL/DEX/RSV group (P = 0.001) and control group (P = 0.041) than in the AL/DEX group, while the amount of new bone formation did not differ significantly between the AL/DEX/RSV and AL/DEX groups (P > 0.05). RSV showed a protective effect by significantly reducing osteonecrosis, which could be due to its antioxidant effects.

Cardiovascular death and progression to end-stage renal disease after major surgery in elderly patients.

BACKGROUND: Reliable estimates for risk of cardiovascular-specific mortality and progression to end-stage renal disease (ESRD) among elderly patients undergoing major surgery are not available. This study aimed to develop simple risk scores to predict these events. METHODS: In a single-centre cohort of elderly patients undergoing major surgery requiring hospital stay longer than 24 h, progression to ESRD and long-term cardiovascular-specific mortality were modelled using multivariable subdistribution hazard models, adjusting for co-morbidity, frailty and type of surgery. RESULTS: Before surgery, 2·9 and 11·9 per cent of 16 655 patients had ESRD and chronic kidney disease (CKD) respectively. During the hospital stay, 46·9 per cent of patients developed acute kidney injury (AKI). Patients with kidney disease had a significantly higher risk of cardiovascular-specific (CV) mortality compared with patients without kidney disease (adjusted hazard ratio (HR) for CKD without AKI 1·60, 95 per cent c.i. 1·25 to 2·01; AKI without CKD 1·70, 1·52 to 1·87; AKI with CKD 2·80, 2·50 to 3·20; ESRD 5·21, 4·32 to 6·27), as well as increased progression to ESRD (AKI without CKD 5·40, 3·44 to 8·35; CKD without AKI 8·80, 4·60 to 17·00; AKI with CKD 31·60, 19·90 to 49·90). CV Death and ESRD Risk scores were developed to predict CV mortality and progression to ESRD. Calculated CV Death and ESRD Risk scores performed well with c-statistics: 0·77 (95 per cent c.i. 0·76 to 0·78) and 0·82 (0·78 to 0·86) respectively at 1 year. CONCLUSION: Kidney disease in elderly patients undergoing major surgery is associated with a high risk of CV mortality and progression to ESRD. Risk scores can augment the shared decision-making process of informed consent and identify patients requiring postoperative renal-protective strategies.

ANTECEDENTES: No se dispone de estimaciones fiables acerca del riesgo de mortalidad cardiovascular y de progresión a insuficiencia renal terminal (end-stage renal disease, ESRD) en pacientes longevos a los que se realiza cirugía mayor. Este estudio tiene como objetivo desarrollar un sistema de puntuación simple de riesgos para predecir estos eventos. MÉTODOS: En una cohorte de un solo centro de 16.655 pacientes longevos a los que se realizó cirugía mayor con hospitalización de más de 24 horas, se estimó la progresión a ESRD y la mortalidad cardiovascular a largo plazo utilizando modelos multivariables de subdistribucion de riesgos ajustados por comorbilidades, fragilidad y tipo de cirugía. RESULTADOS: Antes de la cirugía, presentaron ESRD y enfermedad renal crónica (chronic kidney Disease, CKD) un 2,9% y un 12,3% de los pacientes, respectivamente. Durante la hospitalización, el 46,9% de los pacientes desarrollaron insuficiencia renal aguda (acute kidney injury, AKI). Los pacientes con enfermedad renal tenían un riesgo significativamente mayor de mortalidad cardiovascular (CV) en comparación con los pacientes sin enfermedad renal para presentar AKI (cociente de riesgos instantáneos, hazard ratio, HR ajustado) 1,6 (i.c. del 95% 1,3-2,0), AKI sin CKD 1,7 (1,5-1,9), AKI en presencia de CKD 2,8 (2,5-3,2) y ESRD 5,2 (4,3-6,3), así como una mayor progresión a ESRD (AKI sin CKD 5,4 (3,4-8,4), CKD sin AKI 8,8 (4,6-17), y AKI en presencia de CKD 31,6 (19,9-49,9)). Se desarrollaron las escalas CV Death y ESRD Risk para predecir la mortalidad cardiovascular y la progresión a ESRD. Ambas escalas funcionaron bien a 1 año con un coeficiente de concordancia de 0,77 (i.c. del 95% 0,76-0,78) y 0,82 (0,78-0,86) respectivamente. CONCLUSIÓN: La enfermedad renal en pacientes longevos tras cirugía mayor se asocia con un elevado riesgo de mortalidad cardiovascular y de progresión a ESRD. Las escalas de riesgo pueden facilitar la toma de decisiones en el momento del consentimiento informado e identificar los pacientes que requieren estrategias de protección renal postoperatorias.

Iranian model of renal allograft transplantation in 3028 recipients: survival and risk factors.

BACKGROUND: Considering the organ shortage crisis for renal transplantation worldwide, assessing the risk factors to establish better allocation strategies to improve graft survival seems to be crucial. OBJECTIVES: We aimed to evaluate the risk factors influencing graft and patient survival after renal transplantation to construct a model of prognostic factors for living renal transplantation (LRT), namely living unrelated renal transplantation (LURT). METHODS: We designed a retrospective multicenter survey including medical record review of 3028 patients who received renal transplants at 2 hospitals between July 1984 and December 2005. We assessed the impact on graft survival of recipient/donor relationship, recipient age and gender, donor age and gender, and viral hepatitis B and C infections. RESULTS: Among 3028 recipients, including 94.8% primary grafts, 63.4% were men, mean +/- SE of age 36.4 +/- 0.3 years, with mostly end-stage renal disease due to diabetes mellitus, hypertension, or glomerulonephritis. One-, 5-, 10- and 15-year graft survival rates were 85.4%, 68.3%, 46.4%, and 23.8%, respectively. Patient survival rates were 93.4%, 87.5%, 79.4%, and 66.4% at the above intervals, respectively. Donor age (relative hazard [RH], 1.024; P<.001), unrelated donors (RH, 1.7; P<.001), and hepatitis C virus (HCV) infection (RH, 2.65; P<.001) were the only significant factors affecting graft survival. CONCLUSION: Increased donor age, unrelated donor, and HCV infection were significant factors negatively impacting graft survival; thus, proper management of these factors may lead to better graft and patient survival.

Application of peripheral blood Mycobacterium tuberculosis PCR for diagnosis of tuberculosis patients.

BACKGROUND: Mycobacterium tuberculosis (MTB) infection is a global health problem. Failure to accurately identify cases of active MTB has serious effects on both patients and the community. Acid-fast bacilli (AFB) smear has poor sensitivity and culture methods have a delay ranging from 1 to 8 weeks for diagnosis. Nucleic acid amplification assays may be suitable candidates for this purpose. PATIENTS AND METHODS: In a prospective study, we evaluated Mycobacterium tuberculosis DNA in peripheral blood samples with PCR technique in 190 patients with pulmonary and extra pulmonary tuberculosis whom were admitted to Tehran Imam Khomeini hospitals during 2006-2010. Three ml citrated blood samples were obtained from cases. DNA extraction was performed by QIAGEN commercial kit and PCR performed with IS1081 Primer. RESULTS: Fifty six cases had extra-pulmonary tuberculosis and 134 were pulmonary. Overall sensitivity and specificity of the PCR assay was 41.1% and 95.5%, respectively. CONCLUSIONS: MTB-PCR assay on PBMC using IS1081 primer has a low sensitivity and now can not use as a single or alternative diagnostic test for tuberculosis. However, with regard to its high specificity can use for help diagnosing of TB in cases have no enough sputum (or other specimens) to examination for acid-fast bacilli (AFB) smear and culture.

Comparison of success rate and onset time of two different anesthesia techniques

BACKGROUND: Using local anesthetic is common to control the pain through blocking the nerve reversibly in dental procedures. Gow-Gates (GG) technique has a high success rate but less common. This study aimed to compare the onset time and success rate in GG and standard technique of inferior alveolar nerve block (IANB). MATERIAL AND METHODS: This descriptive, single blind study was consisted of 136 patients (59 males and 77 females) who were randomly received GG or IANB for extraction of mandibular molar teeth. Comparisons between the successes of two anesthetic injection techniques were analyzed with Chi-square test. Incidence of pulpal anesthesia and soft tissue anesthesia were analyzed with Kaplan-Meier method. Mean onset times of pulpal anesthesia, soft tissue and lip numbness were analyzed with Log-Rank test. Comparisons were considered significant at P≤0.05 by using SPSS software ver.15. RESULTS: The incidence of pulpal anesthesia in the IANB group (canine 49.3%, premolar 60.3%) were not significantly different from the GG group (canine 41.3%, premolar 74.6%) (P=0.200 and P=0.723). The success rate in the IANB group (80.82%) was not significantly different from the GG group (92.02%) (P=0.123). Furthermore, onset time of lip and buccal soft tissue numbness in GG group (3.25, 4.96 minutes) was quite similar to IANB group (3.22, 4.89 minutes) (all Pvalues >0.05). CONCLUSIONS: Although this study demonstrated higher clinical success rate for GG than IANB technique, no significant differences in success rates and onset time were observed between two techniques