Meyer L. Rhein and Mortarization - Controlling the Root Apex During Focal Infection.

Many stalwarts in the dental profession stood out during the conflagrations of the Focal Infection Era 100 years ago, in an attempt to prevent the wholesale extraction of teeth. One of these individuals, Dr. Meyer L. Rhein, both a physician and dentists often scolded the dental profession for their proclivity in disregarding the biological basis for root canal treatment. His understanding and management of the apical root anatomy challenges did not go unnoticed as he fought to retain teeth regardless of the status of the dental pulp and surrounding supportive structures.

Bilateral hydronephrosis secondary to endometriosis managed by endoscopic ureteral stent placement in a captive Guinea baboon (Papio papio).

Spontaneous endometriosis is an estrogen-dependent, progressive and painful disease that affects a variety of nonhuman primates, including several species of baboons (Papio sp.). This case documents multimodal management of severe endometriosis in a captive female baboon within a zoological institution. An 18-yr-old, intact female Guinea baboon (Papio papio) was found to have an enlarged uterus. Fifteen months post ovariohysterctomy, scarring associated with endometrial tissue resulted in ureteral strictures, bilateral hydronephrosis, and azotemia. Cystoscopic placement of bilateral ureteral stents with fluoroscopy was performed and resulted in short-term clinical improvement. The animal's condition declined and euthanasia was elected 4 mo after ureteral stent placement. Severe endometriosis with secondary inflammation resulting in bilateral hydroureter and hydronephrosis, as well as concurrent cystitis, ureteritis, and pyelonephritis were confirmed at necropsy. Despite possible complications, ureteral stents can be considered a useful therapeutic option in patients with ureteral disease.

Decreasing Pain and Increasing the Rate of Chronic Wound Closure With the Use of a Noninvasive Bioelectronic Medical Device: A Case Series.

INTRODUCTION: Chronic wounds are a source of significant morbidity. Medical and scientific efforts are ongoing to further therapeutic modalities improving pain scores and augmenting healing while decreasing complications and reducing the social and economic burden of wounds. Electrical current therapy, or electrical stimulation (ES), has been shown to decrease and modulate both acute and chronic pain; however, understanding of the role of ES in wound closure is limited. OBJECTIVE: This single-center case series reports use of a topical ultrahigh frequency ES (UHF-ES) therapy to decrease wound pain and improve the rate of closure in difficult-to-heal wounds in 9 patients. MATERIALS AND METHODS: Initially, each patient underwent individualized care of their chronic wounds for a minimum of 8 weeks, after which adjunct UHF-ES therapy was provided 3 times per week for an average of 8 additional weeks. Wound size and pain level were documented for the period before and after UHF-ES. RESULTS: Overall, pain improved across the 9 patients. One patient was insensate, and another experienced an increase in pain during treatment. Of the 8 patients with sensation, 7 (88%) experienced a decrease in wound pain, with an average 3.4-point reduction per 10-point visual analog scale. Average pain level was 4.14 before treatment and 0.71 after. The average wound size was 5.70 cm2 ± 5.23 cm2 approximately 8 weeks before the initiation of treatment, 4.34 cm2 ± 4.51 cm2 at the time of treatment, and 1.2 cm2 ± 1.75 cm2 at the conclusion of treatment. The average percentage of wound closure with individualized wound care alone was 23.77%, which increased to 64.58% with the addition of UHF-ES therapy. The weekly percentage of wound closure was statistically significant (P = .0027) between the 2 treatment methods. CONCLUSIONS: While additional research into the use of ES (namely, UHF-ES in wound healing) is warranted, the device reported herein may be an effective, safe, and low-cost adjunct treatment in the care of chronic, difficult-to-heal wounds.

Importance of gyrokinetic exact Fokker-Planck collisions in fusion plasma turbulence.

Gyrokinetic simulations of turbulence are fundamental to understanding and predicting particle and energy loss in magnetic fusion devices. Previous works have used model collision operators with approximate field-particle terms of unknown accuracy and/or have neglected collisional finite Larmor radius effects. This work moves beyond models to demonstrate important corrections using a gyrokinetic Fokker-Planck collision operator with the exact field-particle terms, in realistic simulations of turbulence in magnetically confined fusion plasmas. The exact operator shows significant corrections for temperature-gradient-driven trapped electron mode turbulence and zonal flow damping, and for microtearing modes in a Joint European Torus pedestal under ITER-like wall conditions. Analysis of the corrections using parameter scans motivates an accurate model which closely reproduces the exact results while reducing computational demands.

Where Are They Now? Evolution of a Nurse Anesthesia Training School in Ghana and a Survey of Graduates.

Ghana, like other countries in sub-Saharan African, has limited access to surgery. One contributing factor is the inadequate number of anesthesia providers. To address this need, Kybele, Inc., a US-based non-governmental organization, partnered with the Ghana Health Service to establish the third nurse anesthesia training school (NATS) in Ghana. The school, based at Ridge Regional Hospital (RRH) in Accra, opened in October 2009. This paper describes the evolution of the training program and presents the curriculum. Second, the results of a voluntary survey conducted among the first four classes of graduates (2011-2014) are presented to determine their perceived strengths and gaps in training and to identify employment locations and equipment availability. Seventy-five of 93 graduates (81%) responded to the survey. The graduates reported working in 39 hospitals across 7 of the 10 regions in Ghana. Six providers (8%) worked alone and 16 (21%) were one of only two providers. Fifty-three providers (71%) had no physician anesthesiologist at their facility. Most providers had access to basic anesthesia equipment; however, there was limited access to emergency airway equipment. While most graduates felt that their training had prepared them for their current positions, 21% reported experiencing a patient death during anesthesia. The NATS at RRH has been sustained and most of the graduates are working in Ghana, filling an important void. Quality improvement and continuing education must be emphasized in an effort to reduce surgical morbidity and mortality in Ghana.

Use of collagenase ointment in conjunction with negative pressure wound therapy in the care of diabetic wounds: a case series of six patients.

BACKGROUND: Diabetic wounds with additional comorbidities are costly, time intensive, and difficult to heal. Often, multiple modalities may be necessary to achieve wound resolution, relying on the synergistic advantage of each therapy to affect wound healing. The selectivity of Clostridium collagenase is physiologically effective at degrading non-viable collagen fibers while preserving living collagen tissue. Additionally, negative pressure wound therapy (NPWT) has long been used to aid wound healing while concurrently depreciating biological wound burden time. METHODS: Six patients were selected from those appearing to our university based limb salvage service. Inclusion criteria included patients with a recurrent mixed fibrotic and granular wound base, in which NPWT was indicated, without exclusion criteria. Patients enrolled were administered clostridial collagenase ointment at each regularly scheduled NPWT dressing change. Patients were followed until healing, with visual representations of wound progression and time to full healing recorded. RESULTS: Tandem application of these therapies appeared to expedite wound healing by clearing degenerative fibrous tissue and expediting wound granulation without additional complication. Unfortunately, not all patients were able to reach full healing; with two patients experiencing ulcer recurrence, likely a result of their significant comorbid nature. CONCLUSION: In our experience, we have noticed a specific subgroup of patients who benefit greatly when collagenase enzymatic debridement therapy is combined with NPWT. It is our belief that this combination therapy combines the molecular clearing of non-viable collagen with the wound granulation necessary to advance complex wounds to the next step in healing despite the current paucity in literature discussing this specific pairing.

Epidural opioid analgesia in infant rats I: mechanical and heat responses.

The aim of this study was to investigate the analgesic effects of epidural opioids in neonatal rat pups. The contribution of individual opioid receptor subtypes in the spinal cord to analgesia at different developmental stages was investigated using epidural mu (morphine sulphate), delta (DPDPE) and kappa (U69593) opioid receptor agonists in neonatal rats aged postnatal day (P) 3, 10 and 21. Thresholds for flexion withdrawal reflexes to mechanical stimuli (von Frey hairs) and to noxious heating of the hind paw were low in neonates and increased with postnatal age. The analgesic action of each opioid receptor agonist followed an individual developmental pattern. In mechanical tests, all three opioid agonists were considerably more efficacious analgesics in younger animals and ED50s at P3 were always lower than at P21. In heat tests, the pattern differed. The efficacy of the kappa opioid agonist decreased with postnatal age, morphine efficacy increased over the same period and the effects of the delta agonist remained relatively unchanged. The distribution and concentration of tritiated morphine in the spinal cord following epidural administration did not alter significantly with postnatal age, suggesting that opioid access is not a major determinant of the effects reported here. It is concluded that whereas heat pain is particularly sensitive to spinal kappa opioids in neonates, mechanical sensory thresholds are generally sensitive to all spinal opioids in the newborn. The differing epidural opioid requirements compared to older subjects is likely to be due to developmental changes in spinal cord opioid receptor distribution or pharmacology.

Epidural opioid analgesia in infant rats II: responses to carrageenan and capsaicin.

The aim of this study was to investigate the analgesic effects of epidural opioids upon persistent pain sensitivity in neonatal rat pups. Two models of persistent pain were used, subcutaneous injection of carrageenan, and topical application of capsaicin cream, both to the hind paw. The contribution of individual opioid receptor subtypes in the spinal cord to analgesia were tested at different developmental stages using epidural mu (morphine sulphate), delta (DPDPE) and kappa (U69593) opioid receptor agonists in neonatal rats aged P (postnatal day) 3, 10 and 21. Rat pups at all three ages displayed a reduction in mechanical (von Frey hair) threshold following carrageenan-induced inflammation of the hind paw that was evident at 3 h and was still present 5 h after application. This effect was greatest in magnitude at P21. This response was blocked by low doses of all three agonists at all ages, relative effectiveness varying with age. Comparison with potencies in acute tests (Marsh, D., Dickenson, A., Hatch, D. and Fitzgerald, M., Epidural opioid analgesia in infant rats I: mechanical and heat responses, Pain 82 (1999) 23-32) show that opioid potency is significantly greater in the presence of carrageenan inflammation at all ages. Topical capsaicin application to the hind paw produced a significant fall in withdrawal latencies to noxious heat. Generally, epidural opioid agonists did not block this C-fibre induced sensitization except at P3, when morphine and DPDPE did prevent the fall in threshold in a dose dependent manner. The results show that newborn rat pups are capable of displaying both allodynia and hyperalgesia following experimental inflammation that is blocked by epidural mu, delta and kappa opioids. The opioid potency is enhanced compared with antinociception in acute tests. This is not observed following capsaicin hyperalgesia and is therefore not a general consequence of C fibre induced increases in central excitability but relies upon mechanisms special to inflammatory pain.

Carbon mineralization and distribution of nutrients within different particle-size fractions of commercially produced olive mill pomace.

Composting is a realistic option for disposal of olive mill pomace (OMP) by making it suitable as a soil amendment for organic farming. The chemical and physical characteristics and contribution of particle-size fractions to total nutrients and carbon mineralization of seven commercial composts of OMP (COMP) were investigated. Higher proportions of manure, co-composted with OMP, reduced the organic matter (OM), total carbon and C:N ratio of the product, but increased the content of nutrients and fine particles. The fine particles had higher nutrient contents, but less OM and carbon and, unlike larger particles, did not exhibit any phytotoxicity. Less than 1.5% of added carbon was mineralized in whole compost, but a lower rate was found with larger particles. Separation of COMP by particle size fractionation and application as a soil conditioner is recommended for better optimization of COMP with the <1mm fraction providing the higher quality compost.

Penile myofibroma occurring in a dorsal hood prepuce.

Dorsal hood prepuce is a common congenital anomaly of the penis. Neoplasms of the prepuce are very rarely seen in children. We present an interesting case of a penile myofibroma encountered during circumcision of a dorsal hood foreskin in an 8-month-old infant.

Use of labelled nitrogen to measure gross and net rates of mineralization and microbial activity in permanent pastures following fertilizer applications at different time intervals.

Measurements of some of the main internal N-cycling processes in soil were obtained by labelling the inorganic N pool with the stable isotope of nitrogen ((15)N). The (15)N mean pool dilution technique, combined with other field measurements, enabled gross and net N-mineralization rates to be resolved in grassland soils, which had previously either received fertilizer N (F), or had remained unfertilized (U) for many years. The two soils were subdivided into plots that received N at different time intervals (over 3 weeks), prior to (15)N measurements being made. By this novel approach, possible 'priming' effects over time were investigated to try to overcome some of the temporal problems of isotopic labelling of soil N (native plus fertilizer) and to identify possible changes in a range of primary N-transformation processes. The results suggested that an overall stimulation of microbially mediated processes occurred with all N treatments, but there were inconsistencies associated with the release of N, both in the timing and the degree to which different processes responded to the application of fertilizer N. The rates of these processes were, however, within the range of previously reported data and the (15)N measurements were not adversely affected by the differences in N pools created by the treatments. Thus, the mean pool dilution technique was shown to be applicable to agricultural soils, under conditions relevant to grass swards receiving fertilizer. For example, between the U and F treatments, the size of inorganic N pools increased by five-fold and gross rates of mineralization reached 3.5 and 4.8 microg N g(-1) (dry soil) d(-1), respectively, but did not vary greatly with the timing of N applications. A correlation (r(2) = 0.57) was found between soil respiration (which is relatively simple to measure) and net mineralization (which is more time consuming), suggesting that the former might be used as an indicator of the latter. Although this relationship was stronger in previously unfertilized soils, the similarities found with fertilized soils suggest that this approach could be used to obtain information of wider agronomic value and would, therefore, warrant further work under a range of soil conditions.