Techniques and results of palate fistula repair following palatoplasty: a 234-case multicenter study. / Técnicas y resultados de reparación de fístulas palatinas pospalatoplastia: estudio multicéntrico de 234 casos.

INTRODUCTION: Palate fistula is the most frequent complication following palatoplasty. The objectives of this study were: to describe the most widely used repair techniques; to study results and recurrence rate; to analyze potentially predictive recurrence variables; and to assess whether a specific technique is superior according to fistula size and location. MATERIALS AND METHODS: Retrospective study of patients undergoing palate fistula repair in 7 healthcare facilities from 2008 to 2018. All facilities had at least 20 new cases of cleft lift and palate annually (range: 20-80), with a fistula incidence of 14% (range: 1.5-20%). Minimum follow-up was 1 year. 8 variables were collected for statistical analysis purposes. RESULTS: 234 fistula patients underwent surgery. Most fistulas occurred in complete bilateral cleft lift and palate (Veau type IV). The most frequent location was the hard palate (Pittsburgh types IV and V (63.2%)), and fistulas were mostly large (42.1%) and medium (39.5%). The most frequent repair technique was re-palatoplasty (34.2%). Recurrence rate was 22%. The multivariate analysis demonstrated more recurrences in re-palatoplasty repaired type III fistulas in patients over 3 years old. CONCLUSION: A tendency towards using flap repair in large hard palate fistulas, re-palatoplasty in medium hard palate and soft and hard palate junction fistulas, and local flaps or re-palatoplasty in small fistulas at any location was observed. However, it could not be statistically demonstrated whether a specific repair technique was superior in different clinical situations.

INTRODUCCION: La fístula palatina es la complicación más frecuente tras una palatoplastia. Los objetivos de este estudio fueron: describir las técnicas de reparación más frecuentemente empleadas; estudiar los resultados y la tasa de recidiva; analizar posibles variables predictivas de recidiva y valorar la posible superioridad de una determinada técnica según el tamaño y la localización de la fístula. MATERIAL Y METODO: Estudio retrospectivo de pacientes operados de fístulas palatinas desde 2008 hasta 2018 en 7 centros. Todos operaban al menos 20 casos nuevos de fisuras labiopalatinas al año (rango 20-80) con una incidencia de fístulas de 14% (rango: 1,5-20%). El seguimiento mínimo fue de 1 año. Se recogieron 8 variables para el análisis estadístico. RESULTADOS: Se operaron 234 pacientes con fístulas. La mayoría ocurrieron en fisuras labiopalatinas bilateral completa (tipo IV de Veau). La localización más frecuente fue el paladar duro (tipos IV y V de Pittsburgh (63,2%) y la mayoría fueron grandes (42,1%) y medianas (39,5%). La técnica de reparación más frecuente fue la repalatoplastia (34,2%). La tasa de recidiva fue del 22%. El análisis multivariante mostró más recidivas en fístulas tipo III reparadas con repalatoplastia, en mayores de 3 años. CONCLUSION: Se observó una tendencia a utilizar más reparación con colgajo en fístulas grandes del paladar duro, repalatoplastia en fístulas medianas de paladar duro y de la unión, y colgajos locales o repalatoplastia en fístulas pequeñas en cualquier localización, pero no se pudo demostrar estadísticamente la superioridad de una técnica reparadora concreta en diferentes situaciones clínicas.

Cecal bascule: a systematic review of the literature.

BACKGROUND: Cecal volvulus is a rare clinical entity with an average incidence of 2.8-7.1 per million people per year, accounting for 1-2% of all large bowel obstructions. Cecal bascule is the rarest type of cecal volvulus, accounting for 5-20% of all cases. Although several case reports have been published, there is no consensus regarding its diagnosis and treatment. The aim of this study was to review the literature on cecal bascule in order to summarize the etiopathogenesis, clinical features, diagnosis, and treatment options. METHODS: The PubMed, MEDLINE, and Scopus databases were systematically searched by two independent authors. Cecal bascule was defined as anterior displacement of the distended cecum on the ascending colon without any torsion. The etiopathogenesis, clinical features, diagnosis, and treatment options were analyzed. RESULTS: Nineteen previously published papers reporting on 26 patients were included. The mean age of patients from previously reported cases was 55.1 ± 19.2 years, and 54% of all patients were males. Presenting symptoms included abdominal pain in 16 (61%), distension in 22 (84%), and vomiting in eight patients (30%). The mean time to diagnosis was 3.6 ± 2.6 days. The extent of surgery varied from cecopexy to right colectomy. There was no postoperative mortality. Cecal bascule recurred one 1 year after index surgery in one patient. CONCLUSIONS: Cecal bascule is a rare clinical entity, which is mostly encountered in patients with peritoneal adhesions, mobile cecum, bowel dysfunction, and cecal displacement. In patients with recurrent or persistent abdominal pain and distension, cecal bascule should be considered. The majority of these patients require surgical management.

The Nucleosome Remodeling and Deacetylase Complex NuRD Is Built from Preformed Catalytically Active Sub-modules.

The nucleosome remodeling deacetylase (NuRD) complex is a highly conserved regulator of chromatin structure and transcription. Structural studies have shed light on this and other chromatin modifying machines, but much less is known about how they assemble and whether stable and functional sub-modules exist that retain enzymatic activity. Purification of the endogenous Drosophila NuRD complex shows that it consists of a stable core of subunits, while others, in particular the chromatin remodeler CHD4, associate transiently. To dissect the assembly and activity of NuRD, we systematically produced all possible combinations of different components using the MultiBac system, and determined their activity and biophysical properties. We carried out single-molecule imaging of CHD4 in live mouse embryonic stem cells, in the presence and absence of one of core components (MBD3), to show how the core deacetylase and chromatin-remodeling sub-modules associate in vivo. Our experiments suggest a pathway for the assembly of NuRD via preformed and active sub-modules. These retain enzymatic activity and are present in both the nucleus and the cytosol, an outcome with important implications for understanding NuRD function.

Obesity and contraception: metabolic changes, risk of thromboembolism, use of emergency contraceptives, and role of bariatric surgery.

Rates of obesity are increasing worldwide. Due to the medical consequences of obesity, routine health care like family planning becomes complicated. Conflicting data exists regarding efficacy of hormonal contraceptives in obese women, while little data on efficacy of emergency contraception in obese women exists. Much of what is available suggests lower serum hormonal levels in obese women with little effect on ovulation inhibition. Contraceptive steroids can cause a number of deteriorating metabolic changes, particularly in obese women; whether these changes are clinically significant is unknown. Venous thromboembolic risk is increased with both obesity and use of hormonal contraceptives; however the question remains if the risk is additive or multiplicative. Bariatric surgery can lead to digestive changes which may affect absorption of contraceptive hormones. While long acting reversible contraceptives may be the best option in the post operative obese patient, little data, beyond a simple recommendation to avoid pregnancy for at least one year, exists to help guide appropriate contraceptive choice.

Decreasing incidence of renal cortical necrosis in patients with acute renal failure in developing countries: a single-centre experience of 22 years from Eastern India.

BACKGROUND: Renal cortical necrosis (RCN) accounts for 2% of all cases of acute renal failure (ARF) in adults and 15-20% of ARF during the third trimester of pregnancy in developed nations. However, RCN incidence is higher in developing countries ranging from 6-7% of all cases of acute renal failure. The present study describes changing trends in the clinical spectrum of RCN in patients with ARF in Eastern India. METHODS: Patients with ARF suspected to have RCN on clinical grounds underwent percutaneous renal biopsy. Patients showing cortical necrosis on histology were included in the present study. Diffuse and patchy cortical necrosis was classified based on standard histological criteria. The patients with cortical necrosis were studied over a period of 22 years; from July 1984 to December 2005. The results of our observation were compared with respect to etiology, incidence, prognosis and outcome of renal cortical necrosis in two study periods; namely, 1984-1994 and 1995-2005. RESULTS: The incidence of RCN was 3.12% of all cases of ARF of diverse etiology. RCN was observed in 57 patients; obstetric 32 (56.2%); non-obstetric 25 (43.8%). Diffuse cortical necrosis was the dominant lesion in 41 (71.9%) patients and the remaining 16 (28%) patients had patchy cortical necrosis. The overall incidence of RCN in obstetric ARF was 15.2%; the incidence being higher (11.9%) in the post-abortal group in comparison to 3.3% in late pregnancy. RCN had occurred complicating abruptio placentae, puerperal sepsis and postpartum haemorrhage (PPH) in late pregnancy, while septic abortion was the sole cause of RCN in early pregnancy. Haemolytic uraemic syndrome (HUS) was the major (31.5%) cause of RCN in the non-obstetric group and miscellaneous factors were responsible in seven (12.3%) patients. Partial recovery of renal function was observed in 11 (19.2%), and 16 (28%) patients had progressed to ESRD. The incidence of RCN decreased from 6.7% in 1984-1994 to 1.6% in 1995-2005 of total ARF cases. RCN following obstetrical complication decreased significantly; 4.7% in the 1990s to 0.5% of the total ARF cases, in the 2000s. The mortality decreased to 19% in 1995-2005 from the initial high mortality of 72% in 1984-1994. The renal prognosis improved as a result of the decreased mortality of patients. CONCLUSION: We observed a decreasing trend in the incidence of RCN in patients with ARF in recent years, which is associated with increased patient survival and better renal prognosis. This improvement was mainly due to declining incidence and severity of RCN in obstetrical ARF.

Acute renal failure in the intensive care unit.

BACKGROUND: Acute renal failure (ARF) in the intensive care unit (ICU) is associated with high mortality. A thorough understanding of the clinical spectrum of the disease is needed in order to devise methods to improve the final outcome due to this problem. AIMS AND OBJECTIVES: The aim of the present study was to analyze the clinical spectrum, causes, risk and prognostic factors and final outcome of ARF in the setting of ICU. METHOD: This prospective study involved patients admitted to ICU during the period between September 2003 to January 2005 (17 months). Patients who developed ARF during the ICU stay were included in the study. The clinical and laboratory data were collected at admission and then on daily basis. Data recorded included; patient characteristics, underlying medical conditions responsible for ICU admission, dialytic status, need for ventilation, total duration of ICU stay, APACHE-III score and final outcome, and these data were analyzed for predicting survival using univariate and multivariate analysis. RESULTS: Twelve hundred and fifteen (1215) patients were admitted to ICU from September 2003 to January, 2005 and 46 (3.79%) patients developed ARF after admission to ICU. Mean age of patients was 44.9 +/- 17 years and 56.5% were males. Comorbidity was seen in 24 (52%) patients; hypertension (34.7%), diabetes mellitus (28.3%), coronary artery disease (30.4%) and chronic kidney disease (13%). ARF had developed complicating medical and surgical conditions in 33 (71.7%) and 11 (23.7%) patients respectively. The etiology of ARF was multifactorial and included; hypotension (71.74%), volume depletion (17.4%), nephrotoxic drugs (67.39%), and sepsis (69.5%). Multiple organ system failure (MOSF) was noted in 63% of cases and dialysis was required in 25 (54.3%) patients. Mortality occurred in 63% of patients. MOSF and sepsis were found to be significant adverse prognostic factors when multiple logistic regression analysis was done. CONCLUSIONS: ARF was seen in 3.79% of cases in our ICU and associated with poor prognosis. Presence of sepsis, MOSF, higher APACHE--III scores and ventilation need were correlated with higher mortality in ARF patients in the intensive care unit.

Identification and characterization of major degradation products of risperidone in bulk drug and pharmaceutical dosage forms.

Acid, base and oxygen stability of risperidone, a novel anti-psychotic drug, has been evaluated storing the sample in solution phase. One of the major degradation products has been identified and characterized by using techniques namely IR, MS and NMR after isolation by preparative LC. The other major degradation product has been identified with help of MS/MS data and by co-eluting in analytical LC with the available standard. The effect of acid and base resulted in the formation of hydroxy risperidone and the effect of oxygen lead to the formation of N-oxide of risperidone. The two major degradation products in the dosage forms were also characterized as 9-hydroxy risperidone and N-oxide of risperidone, after enrichment through preparative LC, by LC-MS/MS and HPLC. Structural elucidation of degradation product leading to the formation of N-oxide of risperidone is discussed in detail.

Determinants of efficacy of immunotherapy with tumor-derived heat shock protein gp96.

Immunotherapy with gp96 was highly effective in mice bearing methylcholanthrene-induced fibrosarcomas (Meth A tumors) when treatment began 7 days or less after tumor challenge, but significantly less effective if the treatment began 9 days after challenge. Immunotherapy of pre-existing tumors showed all the hallmarks of specificity of gp96 and dose-restriction observed previously with prophylactic studies. When mice with large primary Meth A tumors were treated with surgery alone, or with surgery followed by therapy with Meth A-derived gp96, the mice that received surgery and immunotherapy did significantly better than those receiving surgery alone. The relationship between the time of initiation of immunotherapy with gp96 and its efficacy was also tested in a metastatic model of the Lewis lung carcinoma. In this model, immunotherapy with gp96 was very effective if treatment began up to 31 days after tumor challenge, but significantly less so if therapy was initiated day 33 post-tumor challenge. These observations suggest that the regulatory phenomena that interfere with immunotherapy gather momentum with surprising speed.

Racial differences in access to high-quality cardiac surgeons.

OBJECTIVES: Racial differences in access to cardiac artery bypass graft (CABG) surgery are well documented. This study extends the literature by examining racial differences in access to high-quality cardiac surgeons. METHODS: The analyses included 11,296 CABG surgeries in New York State in 1996. Regression techniques were used to identify significant associations between a patient's race, health maintenance organization (HMO) enrollment, and the quality of the surgeon performing the surgery, measured by the surgeon's risk-adjusted mortality rate (RAMR). RESULTS: Non-Whites were more likely than Whites to have access to surgeons of higher RAMR, by 11.7% among HMO enrollees (1-tailed P < .1) and by 5.4% among fee-for-service enrollees (1-tailed P < .05). CONCLUSIONS: Even when racial minorities do gain access to CABG services, they are more likely that non-Whites to receive care from lower-quality providers.

Benzoquinone modified electrode for sensing NADH and ascorbic acid.

A benzoquinone modified basal plane pyrolytic graphite electrode shows electrocatalytic activity for the oxidation of NADH and ascorbic acid in phosphate buffer (pH 7.3). The modified electrode shows a linear variation of catalytic current with concentration in the range 1-10 mM for both NADH and ascorbic acid. The rate constants have been estimated from the surface coverage data.

Force Parameters for On-line Tool Wear Estimation: A Neural Network Approach.

Reliable on-line tool conditioning monitoring is an essential feature of modern sophisticated and automated machine tools. Appropriate and timely decision for tool-change is urgently required in the machining systems. Ample researches have been carried out in this direction.Recently artificial neural networks (NN) are applied for this purpose in conjunction with suitable sensory systems. Its fast processing capability is well-suited for quick estimation of tool condition and corrective measure to be taken.The present work uses back-propagation type training and feed-forward testing procedures for the neural networks. Three models using different force parameters are tried to monitor tool wear on-line. The close estimation of the modeled output to the actual wear value demonstrates the possibility of successful tool wear monitoring. Copyright 1996 Elsevier Science Ltd.

Influence of dielectric constant on sedimentation rate of concentrated suspensions of aluminum and magnesium hydroxides.

Sedimentation of dilute pharmaceutical suspensions obeys Stokes's law, which assumes that there is no interaction between particles. The behavior of concentrated pharmaceutical suspensions is generally interpreted by use of modifications of Stokes's law that do not consider chemical interaction between particles. Properties of the medium itself, such as dielectric constant and surface tension, have not been included in the established equations. The present work shows that the dielectric constant of the medium has a distinct effect on the rate of sedimentation of the systems investigated.

Evaluation of three manually operated weeding devices.

Performance of three manually operated weeders was evaluated from ergonomics and mechanical considerations. Three operators were selected for laboratory and field trials; they represented the 5th, 50th and 95th percentiles of the operator population. Laboratory tests were conducted in a psychometric chamber to study physiological response under varying load and environmental conditions. From the data, relationships between energy expenditure rate and oxygen consumption rate vs heart rate were established. Field tests were carried out with the three weeders in a farm with Arhar crop (Cajannus Cajan L.) during August-September, when the average ambient temperature and relative humidity were 36 degrees C and 82% respectively. The results of this investigation indicated that weeding with the indigenous tools of a 'khurpi' and a spade and with the improved tool (3-tine hoe) could be rated as 'moderately heavy' work. However, a 'khurpi' demanded less energy expenditure than a 3-tine hoe followed by a spade. The squatting posture with a 'khurpi' appeared to be more comfortable than the standing posture with about 145 degrees erect position for the 3-tine hoe, followed by the standing posture with about 108 degrees erect position with the spade. For consideration of higher output, the order was spade, 3-tine hoe and 'khurpi', For weeding efficiency the trend was, however, just the reverse.

Comparative toxicity of ethylene dichloride in F344/N, Sprague-Dawley and Osborne-Mendel rats.

Studies were conducted to compare the toxicity of ethylene dichloride (EDC) in F344/N rats, Sprague-Dawley rats, and Osborne-Mendel rats. Ten rats/sex/group were exposed to EDC in drinking-water at 0, 500, 1000, 2000, 4000 and 8000 ppm for 13 wk. The highest concentration was limited by the maximum solubility of EDC in water (about 9000 ppm). In addition, F344/N rats (10/sex/group) were administered EDC in corn oil by gavage to compare toxicity resulting from bolus administration with that of continuous exposure in drinking-water. Gavage doses of EDC were within the range of total daily doses (in mg/kg body weight/day) resulting from exposure in drinking-water. EDC administered by gavage resulted in greater toxicity to F344/N rats than did administration of similar doses in drinking-water. All males receiving 240 and 480 mg/kg body weight and 9/10 females receiving 300 mg/kg body weight by gavage died before the end of the study. Necrosis of the cerebellum was observed in the brains of 3 males receiving 240 mg/kg body weight and 3 females receiving 300 mg/kg body weight. Hyperplasia and inflammation of the forestomach mucosa were observed in 8 male and 3 female rats that died or were killed in moribund condition. EDC caused minimal toxicity to F344/N, Sprague-Dawley and Osborne-Mendel rats at the drinking-water concentrations used in these studies; only female F344/N rats had EDC-related renal lesions. Based on mortality and EDC-related lesions, the no-effect levels for EDC administered by gavage to F344/N rats were 120 mg/kg body weight for males and 150 mg/kg body weight for females.

No evidence of toxicity or carcinogenicity of pentaerythritol tetranitrate given in the diet to F344 rats and B6C3F1 mice for up to two years.

Toxicology and carcinogenesis studies of pentaerythritol tetranitrate (PETN), an organic nitrate used in explosives and as a therapeutic agent for angina pectoris, were conducted by administering diets containing PETN,NF (National Formulary Grade, a 1:4 mixture of PETN and lactose) to both sexes of F344 rats and B6C3F1 mice in 14-day, 13-week and 2-year studies. PETN was found to be essentially non-toxic in 14-day and 13-week studies at dietary concentrations as high as 10,000 ppm; the weight gain of female rats was lower than that of controls at 5000 and 10,000 ppm in the 13-week study. In the 13-week studies, one in ten high-dose female rats had an adenoma of the Zymbal gland and one in ten high-dose female mice had a hepatocellular adenoma. Dietary concentrations chosen for the 2-year studies were 5000 and 10,000 ppm for male rats and male and female mice, and 1240 and 2500 ppm for female rats. In the 2-year studies, there were no adverse effects on survival or body weight gains in either sex of rats or mice. No neoplastic or non-neoplastic lesions were considered to be related clearly to PETN administration. Neoplasms of the Zymbal gland occurred at low incidences in PETN-exposed groups of both sexes of rats in the 2-year study.

Forestomach neoplasms in Fischer F344/N rats and B6C3F1 mice exposed to diglycidyl resorcinol ether--an epoxy resin.

Repeated dose (14 days), subchronic (13 wk) and chronic (2 yr) studies were carried out in succession to evaluate the toxic and carcinogenic effects of diglycidyl resorcinol ether (DGRE), a liquid spray epoxy resin, in F344/N rats and B6C3F1 mice. DGRE in corn oil was administered by gavage for 14 consecutive days in the repeated dose study and 5 days/wk in the subchronic and chronic studies. The mortality rate was increased in rats and mice in the repeated dose and subchronic studies. Hyperkeratosis, basal cell hyperplasia and squamous cell papillomas of the forestomach were observed in a few treated rats and mice in the subchronic study. Based on the results of the subchronic study, F344/N rats and B6CF1 mice (50 males and 50 females/species/dose) were administered DGRE (rats--0, 12, 25 and 50 mg/kg body weight, mice--0, 50 and 100 mg/kg body weight) in corn oil by gavage 5 days/wk for 103 wk. The incidence of neoplastic and non-neoplastic changes of the forestomach was increased in rats and mice in the chronic study. Under the conditions of the study, DGRE is considered to be carcinogenic to F344/N rats and B6C3F1 mice.

Oxidation of thiols by sodium N-haloarylsulphonamides.

The methods for direct titration of thiols with N-haloarylsulphonamides have been evaluated by studying the oxidation of 2-mercaptobenzoic acid, 2-mercaptopropionic acid, 3-mercaptopropionic acid, 2-naphthyl mercaptan, 2-mercaptoethanol, mercaptosuccinic acid, thiophenol, p-chlorothiophenol, butyl mercaptan and monothioglycerol, with chloramine-T (CAT), bromamine-T (BAT) and bromamine-B (BAB). The optimum conditions have been established. The precision was found to be poorer for titrations with CAT. BAB was found to give better precision and accuracy for the determination of all ten thiols studied, and is recommended for use.

Documenting foci of hepatocellular alteration in two-year carcinogenicity studies: current practices of the National Toxicology Program.

Altered hepatocellular foci (AHF) can be reliably identified in hematoxylin and eosin (H&E)-stained sections of liver from interim and final sacrifice intervals in 2-yr carcinogenicity studies in rats. While most AHF can be categorized on the basis of a defined set of descriptive terms, viz., basophilic, eosinophilic, clear vacuolated, and mixed foci, exposure to hepatocarcinogenic agents may induce unique types of AHF which should be distinguished from those that occur more commonly. It is proposed that unique treatment-associated AHF be classified as atypical AHF and that they be completely described in the pathology narrative accompanying the study. Since profound changes in the number and size of AHF have been documented in Fischer 344 rats with mononuclear cell leukemia, it is recommended that liver focus data from leukemic animals be censored in assessing potential effects of treatment on AHF. At the present time, there are insufficient data to allow routine use of AHF in regulatory decision-making in the absence of a liver tumor response. However, such data may form part of weight-of-evidence considerations used by regulatory bodies when accompanied by a concomitant liver tumor response.