The effects of a topical gel containing chitosan, 0,2% chlorhexidine, allantoin and despanthenol on the wound healing process subsequent to impacted lower third molar extraction.

BACKGROUND: Despite efforts to prevent postoperative discomfort, there are still many immediate side effects associated with the surgical extraction of impacted lower third molars. Cicatrization is a physiological process through which the loss of integrity of oral mucosa is recovered and damaged tissues are repaired. Bexident Post (ISDIN, Spain) is a topical gel that contains chitosan, 0.2% chlorhexidine, allantoin and dexpanthenol. While this gel has many clinical indications, there are no published clinical trials evaluating its use in impacted mandibular third molar surgery. This study aims to clinically evaluate the efficacy of a gel containing chitosan, 0.2% chlorhexidine, allantoin and dexpanthenol on wound healing and reduction of postoperative side effects and complications after extraction of an impacted mandibular third molar. MATERIAL AND METHODS: A split-mouth design study was carried out on a total of 50 bilaterally and symmetrically impacted third molar extractions, which were randomly placed into either a control group (CG=25) or an experimental group (EG=25). Patients were all informed of the purpose of the study and provided written consent. All procedures were carried out by the same dental practitioner, in accordance with standard surgical protocol. A different dental practitioner, unaware of which treatment had been applied, provided follow-up care. The EG applied 10 ml of topical gel composed of chitosan, 0.2% chlorhexidine, allantoin and dexpanthenol to the surgical wound three times a day for 10 days, patients in the CG did not apply any gel. RESULTS: The groups were homogeneous insofar as potentially confounding variables. No significant findings were found regarding postoperative swelling and pain. Neither of the groups displayed poor healing or infectious complications of the wound during the postoperative period. In all the recorded follow-ups (Day 7 p=0.001, and Day 14 p=0.01), the wound's aesthetic appearance was better in the EG. Overall treatment tolerance was satisfactory and similar in both groups. CONCLUSIONS: The gel composed of chitosan, 0.2% chlorhexidine, allantoin and dexpanthenol did not aid in patients' postoperative comfort; however, improved wound healing was observed.

Assessment of online monitoring strategies for measuring N2O emissions from full-scale wastewater treatment systems.

Clark-Type nitrous oxide (N2O) sensors are routinely used to measure dissolved N2O concentrations in wastewater treatment plants (WWTPs), but have never before been applied to assess gas-phase N2O emissions in full-scale WWTPs. In this study, a full-scale N2O gas sensor was tested and validated for online gas measurements, and assessed with respect to its linearity, temperature dependence, signal saturation and drift prior to full-scale application. The sensor was linear at the concentrations tested (0-422.3, 0-50 and 0-10 ppmv N2O) and had a linear response up to 2750 ppmv N2O. An exponential correlation between temperature and sensor signal was described and predicted using a double exponential equation while the drift did not have a significant influence on the signal. The N2O gas sensor was used for online N2O monitoring in a full-scale sequencing batch reactor (SBR) treating domestic wastewater and results were compared with those obtained by a commercial online gas analyser. Emissions were successfully described by the sensor, being even more accurate than the values given by the commercial analyser at N2O concentrations above 500 ppmv. Data from this gas N2O sensor was also used to validate two models to predict N2O emissions from dissolved N2O measurements, one based on oxygen transfer rate and the other based on superficial velocity of the gas bubble. Using the first model, predictions for N2O emissions agreed by 98.7% with the measured by the gas sensor, while 87.0% similarity was obtained with the second model. This is the first study showing a reliable estimation of gas emissions based on dissolved N2O online data in a full-scale wastewater treatment facility.

Increased IL6 plasma levels in indolent systemic mastocytosis patients are associated with high risk of disease progression.

Systemic mastocytosis (SM) is a heterogeneous disease with altered interleukin (IL)-6 and IL13 plasma levels. However, no study has simultaneously investigated the plasma levels of IL1ß, IL6, IL13, CCL23 and clusterin in SM at diagnosis and correlated them with disease outcome. Here we investigated IL1ß, IL6, IL13, CCL23 and clusterin plasma levels in 75 SM patients--66 indolent SM (ISM) and 9 aggressive SM--and analyzed their prognostic impact among ISM cases grouped according to the extent of hematopoietic involvement of the bone marrow cells by the KIT D816V mutation. Although increased IL1ß, IL6 and CCL23 levels were detected in SM patients versus healthy controls, only IL6 and CCL23 levels gradually increased with disease severity. Moreover, increased IL6 plasma levels were associated with ISM progression to more aggressive disease, in particular among ISM patients with multilineal KIT mutation (ISM-ML), these patients also showing a higher frequency of organomegalies, versus other ISM-ML patients. Of note, all ISM patients who progressed had increased IL6 plasma levels already at diagnosis. Our results indicate that SM patients display an altered plasma cytokine profile already at diagnosis, increased IL6 plasma levels emerging as an early marker for disease progression among ISM cases, in particular among high-risk ISM patients who carry multilineage KIT mutation.

Minimizing N2O emissions and carbon footprint on a full-scale activated sludge sequencing batch reactor.

A continuous, on-line quantification of the nitrous oxide (N2O) emissions from a full-scale sequencing batch reactor (SBR) placed in a municipal wastewater treatment plant (WWTP) was performed in this study. In general, N2O emissions from the biological wastewater treatment system were 97.1 ± 6.9 g N2O-N/Kg [Formula: see text] consumed or 6.8% of the influent [Formula: see text] load. In the WWTP of this study, N2O emissions accounted for over 60% of the total carbon footprint of the facility, on average. Different cycle configurations were implemented in the SBR aiming at reaching acceptable effluent values. Each cycle configuration consisted of sequences of aerated and non-aerated phases of different time length being controlled by the ammonium set-point fixed. Cycles with long aerated phases showed the largest N2O emissions, with the consequent increase in carbon footprint. Cycle configurations with intermittent aeration (aerated phases up to 20-30 min followed by short anoxic phases) were proven to effectively reduce N2O emissions, without compromising nitrification performance or increasing electricity consumption. This is the first study in which a successful operational strategy for N2O mitigation is identified at full-scale.

Evaluation of process conditions triggering emissions of green-house gases from a biological wastewater treatment system.

In this study, methane (CH4) and nitrous oxide (N2O) emission dynamics of a plug-flow bioreactor located in a municipal full-scale wastewater treatment plant were monitored during a period of 10 weeks. In general, CH4 and N2O gas emissions from the bioreactor accounted for 0.016% of the influent chemical oxygen demand (COD) and 0.116% of the influent total Kjeldahl nitrogen (TKN) respectively. In order to identify the emission patterns in the different zones, the bioreactor was divided in six different sampling sites and the gas collection hood was placed for a period of 2-3 days in each of these sites. This sampling strategy also allowed the identification of different process perturbations leading to CH4 or N2O peak emissions. CH4 emissions mainly occurred in the first aerated site, and were mostly related with the influent and reject wastewater flows entering the bioreactor. On the other hand, N2O emissions were given along all the aerated parts of the bioreactor and were strongly dependant on the occurrence of process disturbances such as periods of no aeration or nitrification instability. Dissolved CH4 and N2O concentrations were monitored in the bioreactor and in other parts of the plant, as a contribution for the better understanding of the transport of these greenhouse gases across the different stages of the treatment system.

Nitritation versus full nitrification of ammonium-rich wastewater: comparison in terms of nitrous and nitric oxides emissions.

The processes of nitritation and full nitrification of synthetic reject wastewater were compared in terms of N2O and NO emissions. Two lab-scale sequencing batch reactors (SBR1 and SBR2) were enriched with Nitrosomonas (ammonia-oxidizing bacteria) and Nitrobacter (nitrite-oxidizing bacteria), as shown by fluorescence in situ hybridization (FISH) and high-resolution 16S rRNA tag pyrosequencing. Stable conversion of ammonium to nitrite and nitrite to nitrate was achieved in SBR1 and SBR2 respectively. Biomass from SBR2 was added in SBR1 in order to achieve full nitrification. Under nitritation, 1.22% of the converted-N was emitted as N2O, and 0.066% as NO. During the transition from nitritation to full nitrification, effluent nitrite concentrations decreased but nitrogen oxides were emitted at levels similar to the nitritation period. Gas emissions decreased sharply under full nitrification conditions (0.54% N2O-N/converted-N; 0.021% NO-N/converted-N), probably as a result of the combined effect of lower nitrite and ammonium concentrations in the bioreactor.

N2O and NO emissions from a partial nitrification sequencing batch reactor: exploring dynamics, sources and minimization mechanisms.

A sequencing batch reactor (SBR) was enriched with ammonia oxidizing bacteria (AOB) in order to treat synthetic reject wastewater (1 g NH4+ N/L). Partial nitrification was successfully achieved at a NH4+ -N to NO2- -N conversion rate of 98%. The emission dynamics of nitrous oxide (N2O) and nitric oxide (NO) were monitored during normal operation and under 3 different cycle configurations. An N2O peak was detected during the first 5 min of the cycle in all cases which corresponded to 60-80% of the total N2O emitted. When anoxic phases were introduced, N2O emissions were minimized but NO increased. Factors affecting the initial N2O peak were studied in a set of individual experiments. It was concluded that most of this N2O originated during settling due to biological reactions. Complete oxidation of NH4+ (or most likely hydroxylamine) as a result of sufficient aeration time can be a minimization strategy for N2O emissions in partial nitrification systems.

Treatment of high ethanol concentration wastewater by biological sand filters: enhanced COD removal and bacterial community dynamics.

Winery wastewater is characterized by its high chemical oxygen demand (COD), seasonal occurrence and variable composition, including periodic high ethanol concentrations. In addition, winery wastewater may contain insufficient inorganic nutrients for optimal biodegradation of organic constituents. Two pilot-scale biological sand filters (BSFs) were used to treat artificial wastewater: the first was amended with ethanol and the second with ethanol, inorganic nitrogen (N) and phosphorus (P). A number of biochemical parameters involved in the removal of pollutants through BSF systems were monitored, including effluent chemistry and bacterial community structures. The nutrient supplemented BSF showed efficient COD, N and P removal. Comparison of the COD removal efficiencies of the two BSFs showed that N and P addition enhanced COD removal efficiency by up to 16%. Molecular fingerprinting of BSF sediment samples using denaturing gradient gel electrophoresis (DGGE) showed that amendment with high concentrations of ethanol destabilized the microbial community structure, but that nutrient supplementation countered this effect.

Ammonia oxidizing bacterial community composition and process performance in wastewater treatment plants under low temperature conditions.

Nitrification can be difficult to maintain at wastewater treatment plants (WWTPs) during cold periods resulting in disrupted nitrogen removal. The aim of this study was to relate nitrification process performance to abundance and composition of the ammonia oxidizer communities in two closely located municipal WWTPs in Sweden during an eight month period covering seasonal changes and low temperature conditions. Both facilities showed lower NH(4)(+)-N removal efficiency and nitrification rates as temperature decreased. However, one of the plants had a more stable nitrification rate and higher ammonia removal efficiency throughout the entire period. The differences in performance was related to a shift in the composition of the bacterial ammonia oxidizing community from a Nitrosomonas oligotropha-dominated community to a mixed community including also Nitrosomonas ureae-like ammonia oxidizers. This was likely a response to differences in NH(4)(+)-N and organic loading.

Assessment of orofacial characteristics and oral pathology associated with cri-du-chat syndrome.

OBJECTIVE: To obtain a deeper insight into the difficulties individuals with cri-du-chat syndrome experience by means of the analysis of the most common features and oral pathology observed in the subjects enrolled in the study. SUBJECTS AND METHODS: Intra-oral and extra-oral features of a total of 33 patients with cri-du-chat syndrome (the larger sample so far analyzed) through their clinical and photographic examination. Models, orthopantomographies, and teleradiographies have been collected to establish a pattern as accurate as possible of the oral pathology associated with these patients. RESULTS: The present descriptive study shows that patients with cri-du-chat syndrome present with a series of orofacial features such as mandibular retrognathism, high palate, and variable malocclusion, more commonly anterior open-bite. Most patients also present with perioral muscle relaxation with labial incompetence and short philtrum. As regards oral pathology, these patients suffer dental erosions provoked by gastroesophageal reflux and attritions because of intense day-and-night bruxism. CONCLUSION: The odontologists' familiarity with the orofacial pathology associated with cri-du-chat syndrome and with the specific needs such disorder conveys should improve the quality of the buccodental treatment these professionals may offer to these patients.

Cancer treatment-induced oral mucositis: a critical review.

Head and neck cancer represents one of the main oncological problems. Its treatment, radiotherapy and chemotherapy leads to mucositis, and other side effects. The authors reviewed high-quality evidence published over the last 25 years on the treatment of cancer treatment-induced oral mucositis. A Medline search for double blind randomized controlled clinical trials between 1985 and 2010 was carried out. The keywords were oral mucositis, radiotherapy, chemotherapy, and head and neck. The different therapeutic approaches found for cancer treatment-induced oral mucositis included: intensive oral hygiene care; use of topical antiseptics and antimicrobial agents; use of anti-inflammatory agents; cytokines and growth factors; locally applied non-pharmacological methods; antioxidants; immune modulators; and homoeopathic agents. To date, no intervention has been able to prevent and treat oral mucositis on its own. It is necessary to combine interventions that act on the different phases of mucositis. It is still unclear which strategies reduce oral mucositis, as there is not enough evidence that describes a treatment with a proven efficiency and is superior to the other treatments for this condition.

Síndrome del ovario poliquístico: nuevas perspectivas / Polycystic ovary syndrome: new approaches

El síndrome del ovario poliquístico (SOP) es un trastorno muy prevalente, en mujeres jóvenes, que se presume como la causa más frecuente de infertilidad por anovulación. Un nuevo consenso en 2003 ha establecido como diagnóstico la presencia de 2 de los 3 criterios que caracterizan este síndrome: oligo/anovulación, hiperandrogenismo clínico y/o bioquímico, y ovario poliquístico. Pero este síndrome también está asociado con un aumento en el riesgo de presentar diabetes mellitus tipo 2 y, posiblemente, enfermedad cardiovascular. En un gran porcentaje de mujeres con SOP se identifican una serie de alteraciones metabólicas o síndrome metabólico en cuya base se encuentra la resistencia a insulina. Este síndrome metabólico asociado a SOP modifica profundamente nuestro enfoque clínico y terapéutico. En primer lugar, un cribado de síndrome metabólico (glucemia basal, perfil lipídico, presión arterial y obesidad abdominal) y prueba de tolerancia a la glucosa, se recomienda en todas las mujeres con SOP y obesidad, si bien la utilidad de estos estudios no está bien determinada en el normopeso. En segundo lugar, aparte del tratamiento del hirsutismo y de la alteración menstrual, los objetivos de tratamiento se deben centrar en la prevención de la diabetes mellitus tipo 2 y posiblemente la enfermedad cardiovascular. Finalmente, en el objetivo de la prevención de diabetes mellitus tipo 2, la modificación de hábitos dietéticos y ejercicio físico son el pilar del tratamiento, y actualmente los fármacos hipoglucemiantes que aumentan la sensibilidad a insulina tienen un papel adyuvante (AU)

Valoración de la leucocituria para el diagnóstico de infección urinaria / Assessment of leukocyturia in the diagnosis of urinary tract infections

Objetivo: Determinar la sensibilidad de la leucocituria en el sedimento urinario para el diagnostico de ITU en la infancia. Métodos: Estudio retrospectivo de los niños menores de seis años a los que en urgencias se les realizó sedimento urinario y urocultivos. Se ha estudiado la sensibilidad, especificidad, cocientes de probabilidad positivos (CPP) y negativos (CPN), valor predictivo positivo, valor predictivo negativo y curva ROC para la presencia de leucocitos en orina. Resultados: Se han estudiado 511 casos (211 niños y 300 niñas). En 87 casos (17,02 por ciento) se diagnosticó ITU. El diagnóstico de ITU fue más frecuente en los casos que tenían leucocitos en el sedimento urinario respecto a aquellos en que estaban ausentes, 29,93 por ciento versus 3,27 por ciento, p 18 leucocitos en orina, punto de corte en la curva ROC, la sensibilidad fue de 0,83 (0,77-0,88), especificidad de 0,84 (0,81-0,87), CPP de 5,25 (3,97-7,21) y CPN de 0,2 (0,12-0,28). Se calculó la probabilidad postest de no diagnosticar una ITU en ausencia de leucocitos en el sedimento, con lo que para una prevalencia del 2 por ciento, uno de cada 333 sedimentos produce un resultado falso negativo. Conclusiones: El sedimento urinario tiene una elevada sensibilidad para la detección de ITU en la infancia, por lo que parece un método adecuado de screening (AU)

Tratamiento anestésico de un paciente diagnosticado de anafilaxia inducida por el ejercicio y urticaria colinérgica / Anesthetic management of a patient diagnosed of anaphylaxis due to exercise and cholinergic urticaria

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