Blood replacement practices for complex orthognathic surgery: a single surgeon's experience.

PURPOSE: The purpose of this study is to review the blood replacement practices in a consecutive series of a single surgeon's experience whose patients all underwent, at a minimum, simultaneous Le Fort I maxillary osteotomy, bilateral sagittal split osteotomies of the mandible, septoplasty, and inferior turbinate reduction procedures. PATIENTS AND METHODS: A consecutive series of a single surgeon's patients who met inclusion criteria of (n = 34) during a 5-month time frame were included. Records included office charts, hospital records, and data stored at the Red Cross (hospital) blood bank. RESULTS: A total of 76% (26/34) of the study patients chose to auto donate [corrected].. Only 2 of the study patients underwent blood transfusion (6%). One of the transfused patients received 1 unit of auto-donated blood, whereas the other transfused patient received a unit of homologous packed red blood cells. Based on the total units of blood predonated, 97% (28/29) of stored units were discarded. CONCLUSION: Only a small percentage (6%) of individuals undergoing complex orthognathic and intranasal surgery received blood replacement. We believe that close collaboration between the surgical and anesthesia teams and the recovery of patients in a safely monitored environment will continue to reduce the need for transfusion in the orthognathic patient.

Phytobiomes are compositionally nested from the ground up.

Plant-associated microbes are critical players in host health, fitness and productivity. Despite microbes' importance in plants, seeds are mostly sterile, and most plant microbes are recruited from an environmental pool. Surprisingly little is known about the processes that govern how environmental microbes assemble on plants in nature. In this study we examine how bacteria are distributed across plant parts, and how these distributions interact with spatial gradients. We sequenced amplicons of bacteria from the surfaces of six plant parts and adjacent soil of Scaevola taccada, a common beach shrub, along a 60 km transect spanning O'ahu island's windward coast, as well as within a single intensively-sampled site. Bacteria are more strongly partitioned by plant part as compared with location. Within S. taccada plants, microbial communities are highly nested: soil and rhizosphere communities contain much of the diversity found elsewhere, whereas reproductive parts fall at the bottom of the nestedness hierarchy. Nestedness patterns suggest either that microbes follow a source/sink gradient from the ground up, or else that assembly processes correlate with other traits, such as tissue persistence, that are vertically stratified. Our work shines light on the origins and determinants of plant-associated microbes across plant and landscape scales.

Risk of periodontal defects after third molar surgery: an exercise in evidence-based clinical decision-making.

This article's purpose is to apply evidence-based principles to answer the question: What is the risk of having persistent or new periodontal defects on the distal aspect of the mandibular second molar after third molar removal? Commonly, the second molar periodontal health either remains unchanged or improves after third molar removal. Eighteen weeks or more after third molar removal, 52% to 100% of subjects had no change or improvement in attachment levels or probing depths. For subjects with healthy second molar periodontium preoperatively, the indication for third molar removal should be evaluated carefully because these patients have an increased risk for worsening of probing depths or attachment levels after third molar removal.

Risk of periodontal defects after third molar surgery: An exercise in evidence-based clinical decision-making.

OBJECTIVE: The object of this study was to apply evidence-based principles to answer the question, What is the risk of having periodontal defects on the distal aspect of the mandibular second molar (M2) following third molar (M3) removal? STUDY DESIGN: To identify relevant articles for review, we completed a computerized literature search of Medline. The inclusion criteria for articles included prospective cohort studies or randomized clinical trials with follow-up periods of 6 months or more, and preoperative and postoperative measurements of periodontal probing depths (PDs) or attachment levels (ALs). RESULTS: Eight articles met the inclusion criteria. Overall, the reported mean changes in ALs or PDs on the distal of M2 6 months after M3 removal were clinically insignificant, ie, less than 2 mm. Six months after M3 removal, 52% to 100% of subjects had no change or improvement in ALs or PDs. Given periodontal disease present preoperatively, the number needed to treat (NNT) ranged from 3 to 10. Given healthy periodontal status preoperatively, 48% had worsening of their periodontal measures after M3 removal and the number needed to harm (NNH) was 2. CONCLUSION: Commonly, the second molar periodontal probing depth or attachment levels either remain unchanged or improve after third molar removal. For subjects with healthy second molar periodontium preoperatively, the indication for third molar removal needs to be evaluated carefully as these subjects have an increased risk for worsening of probing depths or attachment levels after third molar removal.