Dry Socket Prevalence and Risk Factors in Third Molar Extractions: A Prospective Observational Study.

Background Third molar extraction is a routine oral surgical procedure that is often complicated by the development of a dry socket (alveolar osteitis). This prospective observational study aimed to investigate the prevalence of dry sockets and identify associated risk factors and causes, contributing to a comprehensive understanding of the postoperative outcomes of oral surgery. Methods This study employed a prospective observational design with a 12-month follow-up period. Participants aged 18-40 years scheduled for third molar extraction were included, whereas those with coagulopathies, pregnant or lactating women, patients with vitamin deficiencies, and individuals on medications affecting healing were excluded. Data collection involved comprehensive assessments at baseline, intraoperative details, and postoperative evaluations at 48 hours, one week, and two weeks. Statistical analyses included descriptive statistics, chi-square tests, t-tests, or Mann-Whitney U tests, and logistic regression for the risk factor analysis. Results A total of 238 participants with diverse demographic characteristics were enrolled in this study. The prevalence of dry sockets increased progressively from 20.6% at 48 hours to 41.2% at two weeks post-extraction. Smoking, poor oral hygiene, and surgical technique emerged as significant risk factors, with corresponding odds ratios of 6.41 (95% CI: 2.86-14.36, p < 0.001), 9.53 (95% CI: 2.12-42.84, p = 0.003), and 3.27 (95% CI: 2.08-5.15, p < 0.001), respectively. Pain intensity, measured using a Visual Analog Scale, gradually decreased from 48 hours to two weeks post-extraction. Conclusion This study provides valuable insights into the prevalence and risk factors associated with dry sockets following third molar extractions. Smoking, poor oral hygiene, and poor surgical techniques were identified as significant contributors, emphasizing the importance of preoperative counseling and targeted interventions.

The impact of temporary mechanical circulatory support strategies on thrombocytopenia.

One common but not well-understood phenomenon of temporary mechanical circulatory support (MCS) use is thrombocytopenia. This clinical issue increases the risk of bleeding and the need for platelet transfusion. Additionally, heparin-induced thrombocytopenia must be considered as part of the differential diagnosis, which complicates patient management. In what follows, we analyze the degree and relative rate of platelet count drop with various temporary MCS strategies - Impella 5.5; Veno-venous Extracorporeal Membrane Oxygenation (VV ECMO); Veno-arterial ECMO (VA ECMO); Intra-aortic Balloon Pump (IABP) and Centrimag Biventricular Assist Device (BIVAD). A total of 337 cohort was investigated. 77 was included for analysis after strict exclusion criteria were utilized (platelet transfusions, bleeding complications, etc.). Repeated measure mixed effect and linear regression models were used to assess the percent platelet drop on implantation of MCS and recovery after explantation of MCS. A statistically significant mean percent drop occurred in MCS types - VA ECMO(-69.6%, p < 0.001), VV ECMO(-40.9%, p < 0.001), Impella 5.5(-20.9%, p = 0.01) and IABP(-28.3%, p = 0.01), except Centrimag BIVAD(-6.5%, p = 0.61). Platelet recovery to or above baseline occurred in VA ECMO(+107.0%, p = 0.42), Impella 5.5(+117.2%, p = 0.28), IABP(+108.3%, p = 0.37), VV-ECMO(163.3%, p = 0.01*) and Centrimag BIVAD(+100.1%, p = 0.99). These results show that the degree of thrombocytopenia depends on MCS device type and is reversible.

Thermal Disinfection Validation: The Relationship Between A0 and Microbial Reduction.

Validating a thermal disinfection process for the processing of medical devices using moist heat via direct temperature monitoring is a conservative approach and has been established as the A0 method. Traditional use of disinfection challenge microorganisms and testing techniques, although widely used and applicable for chemical disinfection studies, do not provide as robust a challenge for testing the efficacy of a thermal disinfection process. Considerable research has been established in the literature to demonstrate the relationship between the thermal resistance of microorganisms to inactivation and the A0 method formula. The A0 method, therefore, should be used as the preferred method for validating a thermal disinfection process using moist heat.

Application of Processing Guidance: Case Study of Cleaning Validations on Flexible Endoscopes.

In 2015, the Food and Drug Administration (FDA) updated its guidance on test methods for cleaning validations for reusable medical devices. The changes include the condition and contamination of devices, test samples and controls, cleaning process performed during validation, extraction methods, and endpoints. This article reviews the FDA's changes to cleaning validations. Examples are presented using flexible endoscopes in order to provide a practical guide to performing cleaning validations.

Disadvantaged, Outnumbered, and Discouraged: Women's Experiences as Healthy Volunteers in U.S. Phase I Trials.

While enormous strides have been made in the representation of women in clinical trials, the percentage of women enrolling in Phase I trials still remains low, which both raises public health concerns about the safety of new drugs and social justice concerns regarding their inclusion in research. As part of a longitudinal study of healthy volunteers in the United States, our inquiry aimed to examine impediments to women enrolling in Phase I trials as well as their experiences participating in these studies at residential research clinics. We analyzed 111 semi-structured interviews conducted with 47 women who had enrolled in at least one Phase I trial. Our study indicates that women face discrimination during all stages of their participation in Phase I trials from their ability to qualify for studies, the treatment they receive in the clinic facilities, and a lack of social support. Specifically, we found that (1) study designs disadvantage participants of childbearing potential, (2) women feel vulnerable in the clinic space when outnumbered by men, and (3) heterosexual women are often discouraged from participation by their husbands or significant others. Placing these findings within the scholarly literature on barriers to women's clinical trial participation, we argue that diverse strategies attending both to physiological and social factors are needed to combat inequalities in U.S. Phase I trial participation.

Flexible Endoscopes: Terminal Sterilization and Impact to Patient Safety.

Flexible endoscopes are implicated in deaths from healthcare-associated infections (HAIs), in particular antibiotic-resistant infections. This article analyzes whether terminal sterilization should be required as part of endoscope reprocessing to reduce or eliminate HAIs and thus improve patient safety. Reusable flexible endoscopes are processed to make them ready for clinical use by the processing department of the healthcare facility. Unlike most critical and semicritical medical devices, the final step of processing an endoscope is high-level disinfection and not terminal sterilization. This is because most flexible endoscopes come in contact with mucosal membranes (versus contact with direct blood stream) and cannot withstand sterilization. However, sterilization currently is performed by a small number of U.S. healthcare facilities on reusable flexible endoscopes with the belief that they are safer for use compared to flexible endoscopes that are high-level disinfected. Based on the analysis in this article, terminal sterilization is not a required or necessary step to eliminate HAIs.

A Feedback Loop between Hypoxia and Matrix Stress Relaxation Increases Oxygen-Axis Migration and Metastasis in Sarcoma.

Upregulation of collagen matrix crosslinking directly increases its ability to relieve stress under the constant strain imposed by solid tumor, a matrix property termed stress relaxation. However, it is unknown how rapid stress relaxation in response to increased strain impacts disease progression in a hypoxic environment. Previously, it has been demonstrated that hypoxia-induced expression of the crosslinker procollagen-lysine, 2-oxoglutarate 5-dioxygenase 2 (PLOD2), in sarcomas has resulted in increased lung metastasis. Here, we show that short stress relaxation times led to increased cell migration along a hypoxic gradient in 3D collagen matrices, and rapid stress relaxation upregulated PLOD2 expression via TGFß-SMAD2 signaling, forming a feedback loop between hypoxia and the matrix. Inhibition of this pathway led to a decrease in migration along the hypoxic gradients. In vivo, sarcoma primed in a hypoxic matrix with short stress relaxation time enhanced collagen fiber size and tumor density and increased lung metastasis. High expression of PLOD2 correlated with decreased overall survival in patients with sarcoma. Using a patient-derived sarcoma cell line, we developed a predictive platform for future personalized studies and therapeutics. Overall, these data show that the interplay between hypoxia and matrix stress relaxation amplifies PLOD2, which in turn accelerates sarcoma cell motility and metastasis. SIGNIFICANCE: These findings demonstrate that mechanical (stress relaxation) and chemical (hypoxia) properties of the tumor microenvironment jointly accelerate sarcoma motility and metastasis via increased expression of collagen matrix crosslinker PLOD2.

Collagen Fiber Architecture Regulates Hypoxic Sarcoma Cell Migration.

Collagen is prevalent in the microenvironment of many cancer types and has been demonstrated to play an important role during disease progression. We previously showed the importance of hypoxic gradients in sarcoma cell migration. Here, we utilized an oxygen gradient collagen gel platform to determine the impact of collagen fiber density and hypoxic gradient on sarcoma cell migration. The oxygen gradient was created by regulating the oxygen diffusion coefficient along with the cellular oxygen consumption rate. Collagen fiber density in the hydrogels is modified by changing the preincubation period of the collagen gel solution at 4 °C, controlling fiber density independently of collagen concentration and oxygen tension. High fiber density gels have wider and longer fibers but a similar microscale pore size with a larger nanoscale pore size and quicker stress relaxation time, compared to the low fiber density gel. Both gels have the same Young's modulus. We analyzed responses of sarcoma cells encapsulated in the different hydrogels for 3 days. In the nonhypoxic low fiber density constructs, sarcoma cells exhibit a larger aspect ratio, and the matrix has less fiber alignment compared to the nonhypoxic high fiber density constructs. Interestingly, we found a minimal effect of fiber density on cell migration and the ability of the cells to degrade the matrix in nonhypoxic constructs. When compared with hypoxic constructs, we observed the opposite trend, where cells in low fiber density constructs exhibit a lower aspect ratio and the matrix has more aligned fibers compared to hypoxic high fiber density constructs. Sarcoma cells encapsulated in high fiber density hypoxic gels migrated faster and degraded the matrix more rapidly compared to the low fiber density hypoxic constructs. Overall, we show that hypoxic cell migration and matrix degradation are enhanced in high fiber density gels, while hypoxic matrix alignment is prominent in low fiber density gels. Our results suggest that the differences in cellular responses under hypoxic gradients are due to the hydrogel architecture including fiber density, size (length and width), and stress relaxation.

Scholarly development for primary care residents.

BACKGROUND: Development, evaluation and dissemination of primary care innovations are essential for the future of health care; however, primary care physicians including family physician, lag behind hospital-based physicians in research productivity. Family medicine residencies struggle to implement scholarly skills training programmes for busy family physicians. The Primary Care Scholarly Development Program (PC-SDP) aimed to empower residents to incorporate innovation with scholarship into future practice, by facilitating successful resident scholarly projects and reducing perceived barriers. METHODS: Educational intervention. The required PC-SDP was piloted through a family medicine residency programme in the USA. Key elements included: rigorous but achievable requirements; emphasis on Boyer's scholarship of application, teaching and discovery; resident engagement, through the support of their 'professional passions'; basic research training; multilevel mentoring; and modest curriculum time. EVALUATION: A mixed-methods longitudinal evaluation included: (1) a qualitative study of intervention class; (2) assessing the scholarly output of the intervention class versus the comparison class; and (3) a follow-up survey of both groups after 3 or 4 years. RESULTS: Data were analysed from all 25 residents in the classes of 2008 and 2009 (12 intervention; 13 comparison). Qualitative interviews of residents from the intervention group revealed that their initial feelings of trepidation about scholarly work gave way to feelings of accomplishment and confidence in their ability to integrate scholarship into busy careers. Residents in the intervention group had a greater volume of scholarly output at graduation, and follow-up surveys suggest that they value incorporating scholarship into their careers more so than physicians from the comparison group. DISCUSSION: The PC-SDP seems to foster enthusiasm for scholarship by supporting residents' professional passions and facilitating successful projects. This may foster improved participation in scholarship in future clinical practice. Primary care physicians, including family physicians, lag behind hospital-based physicians in research productivity.

Smart-Phone Based Magnetic Levitation for Measuring Densities.

Magnetic levitation, which uses a magnetic field to suspend objects in a fluid, is a powerful and versatile technology. We develop a compact magnetic levitation platform compatible with a smart-phone to separate micro-objects and estimate the density of the sample based on its levitation height. A 3D printed attachment is mechanically installed over the existing camera unit of a smart-phone. Micro-objects, which may be either spherical or irregular in shape, are suspended in a paramagnetic medium and loaded in a microcapillary tube which is then inserted between two permanent magnets. The micro-objects are levitated and confined in the microcapillary at an equilibrium height dependent on their volumetric mass densities (causing a buoyancy force toward the edge of the microcapillary) and magnetic susceptibilities (causing a magnetic force toward the center of the microcapillary) relative to the suspending medium. The smart-phone camera captures magnified images of the levitating micro-objects through an additional lens positioned between the sample and the camera lens cover. A custom-developed Android application then analyzes these images to determine the levitation height and estimate the density. Using this platform, we were able to separate microspheres with varying densities and calibrate their levitation heights to known densities to develop a technique for precise and accurate density estimation. We have also characterized the magnetic field, the optical imaging capabilities, and the thermal state over time of this platform.