Controversies in Anesthesia for Oral and Maxillofacial Surgery

The future of office-based anesthesia for oral and maxillofacial surgery is at risk. Oral and maxillofacial surgeons have been on the forefront of providing safe and effective outpatient anesthesia for decades. Recent changes in Medicare policies have had, and will continue to have, a significant effect on the training of oral and maxillofacial surgery residents regarding anesthesia. The outcome of these changes can have a major effect on the specialty of oral and maxillofacial surgery and a cornerstone of the profession.

Shelter type and birth number influence the birth and death sites of lambs and ewe movement around lambing time

A significant number of lambs born each yr in Australia die within 72 h of birth. Periods of high wind, combined with rain and low temperatures, can lead to marked increases in the level of mortality. Under these weather conditions mortality levels may be reduced with the provision of shelter, provided it is utilized by lambs. This study used GPS collars to determine the use of shelter by ewes and lambs, to compare the movement of ewes with twin lambs across 2 types of shelter (hedgerows and shrubs), while also comparing ewes with single and twin lambs in a single shelter type (hedgerows). Additionally, the birth sites of 364 lambs and death sites of 252 lambs were recorded across the 3 shelter type and litter size combinations (Twins in shrubs, Twins in hedgerows, Singles in hedgerows) plus an unsheltered group (Singles in unsheltered). A higher (P < 0.001) than randomly expected percentage of ewes lambed in the areas closest to both shelter types; in the shrub shelter 42% of ewes lambed within 2.5 m of shrub rows compared to an expected 11% based on the proportion of the paddock this area constituted. Despite the higher than expected percentage of ewes lambing close to the shelter rows, ewes in both twin lamb shelter types avoided the areas close to the shelter before and after lambing (Hedgerows-2.5 m; Shrubs- 6.25 m) and single bearing ewes showed no preference for or against these areas. With a high proportion of twin bearing ewes lambing close to the shelter, a design that reduces the potential for ewe and offspring separation while providing good shelter will offer the greatest potential reduction in newborn twin lamb mortality arising from exposure.

Intraprostatic ethanol diffusion: comparison of two injection methods using ex vivo human prostates

BACKGROUND

Intraprostatic injection of ethanol has been previously tested in clinical trials as a potential treatment of BPH, with variable outcomes. As evident from animal studies, the inconsistency was owing to various degrees of ethanol backflow along the needle tract. In acute canine experiments, we previously documented that using convection enhanced delivery (CED) eliminates backflow and improves ethanol distribution. The goal of this study was to compare the diffusion pattern between a microporous hollow fiber catheter (MiHFC) and a standard needle in human prostates from organ donors.

METHODS

Prostates were harvested from cadaveric organ donors immediately after removal of organs for transplant. After trimming off excess fat and weighing, prostates were injected with absolute ethanol. The total injected volume was 25% of the calculated prostate volume. One lateral lobe was injected using a single lumen 21-gauge control needle. The contralateral lobe was injected with the same volume but using a MiHFC. Immediately after injection, prostates were fixed en bloc in 10% neutral-buffered formalin, and then sectioned. Three-dimensional reconstruction was performed to determine lesion volume based on hematoxylin- and eosin-stained cross-sections.

RESULTS

Three fresh human prostates were harvested and injected. The time from harvest to intraprostatic injection was 15-35 min. The lesion created by the MiHFC was 1.14±0.52 cm(3), whereas that from the control needle was 0.28±0.10 cm(3) (P=0.038). No backflow was observed along the needle tract of the MiHFC.

CONCLUSIONS

This study shows that freshly harvested human prostates can be used to evaluate new treatments using intraprostatic injection. Similar to in vivo canine experiments, the ethanol lesion sizes were significantly bigger with the use of a MiHFC when compared with a standard single lumen needle.

Rapid implementation of inpatient electronic physician documentation at an academic hospital

Electronic physician documentation is an essential element of a complete electronic medical record (EMR). At Lucile Packard Children's Hospital, a teaching hospital affiliated with Stanford University, we implemented an inpatient electronic documentation system for physicians over a 12-month period. Using an EMR-based free-text editor coupled with automated import of system data elements, we were able to achieve voluntary, widespread adoption of the electronic documentation process. When given the choice between electronic versus dictated report creation, the vast majority of users preferred the electronic method. In addition to increasing the legibility and accessibility of clinical notes, we also decreased the volume of dictated notes and scanning of handwritten notes, which provides the opportunity for cost savings to the institution.

Short-term grazing of lucerne and chicory increases ovulation rate in synchronised Merino ewes

This study evaluated the ability of short-term grazing of live=green pasture to increase ovulation rate during late summer when annual pasture is generally dead and of low quality. Ovulation rates, measured by the number of corpora lutea, were compared between 4 nutritional treatments: senesced phalaris (Phalaris aquatica), phalaris plus 500g lupin grain per day, lucerne (Medicago sativa) or chicory (Chicorum intybus) pastures. The study used 100 Merino ewes per treatment, divided between 2 replicates. The experiment was repeated in 3 years; February 2006, and January 2007 and 2008. Oestrus was synchronised and the ewes grazed the pastures for 9 days prior to ovulation at times corresponding to days 8-17 of the cycle in 2006, and days 6-14 in 2007 and 2008. The proportion of ewes producing multiple ovulations was higher (P<0.05) in the lucerne and chicory (0.36, 0.38) than the phalaris (0.27), and intermediate in the lupin (0.33) treatment. Regression analysis showed that the proportion of ewes with multiple ovulations increased with the quantity of live herbage (P<0.04). Responses were achieved even at low levels of live herbage with 90% of the maximum proportion of multiples occurring at 350kg DM/ha. It is concluded that providing short-term grazing of live chicory or lucerne to ewes can increase ovulation rates relative to ewes grazing senesced phalaris and to levels similar to those achieved by lupin grain supplementation.

Solar UV reduces Cryptosporidium parvum oocyst infectivity in environmental waters

AIMS

To determine the effect of solar radiation on Cryptosporidium parvum in tap and environmental waters.

METHODS AND RESULTS

Outdoor tank experiments and a cell culture infectivity assay were used to measure solar inactivation of C. parvum oocysts in different waters. Experiments conducted on days with different levels of solar insolation identified rapid inactivation of oocysts in tap water (up to 90% inactivation within the first hour). Increased dissolved organic carbon content in environmental waters decreased solar inactivation. The role of solar ultraviolet (UV) in inactivation was confirmed by long-pass filter experiments, where UV-B was identified as the most germicidal wavelength. Reductions in oocyst infectivity following solar radiation were not related to a loss of excystation capacity.

CONCLUSIONS

Solar UV can rapidly inactivate C. parvum in environmental waters.

SIGNIFICANCE AND IMPACT OF THE STUDY

This is the first study to assess natural sunlight inactivation of C. parvum oocysts in surface waters and drinking water using an infectivity measure and determines the wavelengths of light responsible for the inactivation. The findings presented here provide valuable information for determining the relative risks associated with Cryptosporidium oocysts in aquatic environments and identify solar radiation as a critical process affecting the oocyst survival in the environment.

Critical processes affecting Cryptosporidium oocyst survival in the environment

Cryptosporidium are parasitic protozoans that cause gastrointestinal disease and represent a significant risk to public health. Cryptosporidium oocysts are prevalent in surface waters as a result of human, livestock and native animal faecal contamination. The resistance of oocysts to the concentrations of chlorine and monochloramine used to disinfect potable water increases the risk of waterborne transmission via drinking water. In addition to being resistant to commonly used disinfectants, it is thought that oocysts can persist in the environment and be readily mobilized by precipitation events. This paper will review the critical processes involved in the inactivation or removal of oocysts in the terrestrial and aquatic environments and consider how these processes will respond in the context of climate change.

Medial approach for tibial bone graft: anatomic study and clinical technique

PURPOSE

The purpose of this study is to quantify the amount of bone graft material present in the proximal tibia via a lateral versus a medial approach, as well as describe an alternative technique for obtaining this bone graft material. A quantitative anatomic and statistical analysis and comparison are presented. The goal of this study is to demonstrate the advantages and simplicity associated with utilizing the proximal tibia as a bone graft harvest site in oral and maxillofacial surgery via a medial approach.

MATERIAL AND METHODS

Forty lower extremities from 20 cadavers were studied. All specimens were dissected, and anatomic landmarks were recorded. Anatomic structures, including vessels, nerves, muscle attachments, articular surfaces, and their relationships to various anatomic landmarks were identified, measured with a linear millimeter ruler, and recorded. Bone harvest was accomplished using either a medial (20 extremities) or lateral (20 extremities) approach. The amount of bone available for harvest using both techniques was compared. Variables evaluated included volume of graft, age, gender, and relationships among anatomic structures.

RESULTS

The mean volume of bone harvested was 25.0 mL for the lateral approach and 24.9 mL for the medial approach (range, 14 to 34 mL). The Mann-Whitney U test revealed no significant difference in mean volume of graft obtained when comparing the medial and lateral approaches (P =.9250). Pearson's correlation test revealed no correlation between age (P =.089 medial and P =.174 lateral) or gender (P =.3120 medial and P =.4440 lateral). The lateral anatomic structures evaluated included the anterior tibial vessels that emerged from the interosseous hiatus 14.3 mm inferior to tibial perpendicular and 42.6 mm lateral to the tibial parallel line. The distance from the tibial perpendicular to the articular surface did not significantly differ when comparing the medial (33.65 mm) and lateral (33.25 mm) anterior tibial surfaces. The mean length of the oblique line was 17.9 mm, and the superior portion of this line was 14.65 mm above the tibial perpendicular line.

CONCLUSIONS

Equal amounts of bone graft material are available for harvest from the medial and lateral aspects of the proximal tibia. Knowledge of important anatomic landmarks can be used preoperatively to allow for safe dissection and harvest of autogenous bone from the proximal tibia. The dissection of medial proximal tibia and harvest of bone graft material may be accomplished efficiently with minimal chances of damage or morbidity to vital adjacent structures.

Extraction of R = sigma(L)/sigma(T) from CCFR nu(mu)-Fe and nu(mu)-Fe differential cross sections

We report on the extraction of R = sigma(L)/sigma(T) from CCFR nu(mu)-Fe and nu(mu)-Fe differential cross sections. The CCFR differential cross sections do not show the deviations from the QCD expectations that are seen in the CDHSW data at very low and very high x. R as measured in nu(mu) scattering is in agreement with R as measured in muon and electron scattering. All data on R for Q(2)>1 GeV(2) are in agreement with a NNLO QCD calculation which uses NNLO parton distribution functions and includes target mass effects. We report on the first measurements of R in the low x and Q(2)<1 GeV(2) region (where an anomalous large rise in R for nuclear targets has been observed by the HERMES Collaboration).

First measurement of the low- x, low- Q(2) structure function F(2) in neutrino scattering

A new structure function analysis of CCFR deep inelastic nu-N and nu-N scattering data is presented for previously unexplored kinematic regions down to Bjorken x = 0.0045 and Q(2) = 0.3 GeV(2). Comparisons to charged lepton scattering data from NMC and E665 experiments are made and the behavior of the structure function F(2)(nu)2 is studied in the limit Q(2)-->0.

Measurements of F2 and xF(nu)(3) - xF(nu;)(3) from CCFR nu(mu)-Fe and nu;(mu)-Fe Data in a Physics Model-Independent Way

We report on the extraction of the structure functions F2 and DeltaxF(3) = xF(nu)(3)-xF(nu;)(3) from CCFR nu(mu)-Fe and nu;(mu)-Fe differential cross sections. The extraction is performed in a physics model-independent (PMI) way. This first measurement of DeltaxF(3), which is useful in testing models of heavy charm production, is higher than current theoretical predictions. The ratio of the F2 (PMI) values measured in nu(mu) and mu scattering is in agreement (within 5%) with the predictions of next-to-leading-order parton distribution functions using massive charm production schemes, thus resolving the long-standing discrepancy between the two sets of data.

Is a capacity for negative priming correlated with hypnotizability?: a preliminary study

Hypnotic responsiveness may depend upon the ability to inhibit the irrelevant stimuli that evoke responses that are incompatible with current goals (or the mapping between an irrelevant/disruptive stimulus and its response) in order to actively maintain task-relevant information. In a simple correlation design, the authors investigated the relationship between cognitive inhibition (negative priming) and hypnotic responsiveness. A statistically significant correlation was obtained between the extent of negative priming (measured in time latency) and hypnotic responsiveness (r = .491). Limitations of this preliminary study and implications for future work are discussed.

One-year results from the phase III investigation of the KeraVision Intacs

BACKGROUND

Limitations of the surgical correction for myopia include inaccuracy, instability, treatment of the central optical zone, and lack of reversibility. KeraVision Intacs offer an alternative that addresses these shortcomings.

METHODS

We present 1 year of follow-up information on 95 subjects enrolled in the United States Food and Drug Administration Phase III clinical trials.

RESULTS

At 1 year, 99% of patients (89 of 90) had 20/40 uncorrected vision or better. Ninety-two percent of eyes (83 of 90) were within 1.00 D of intended correction and 76% of eyes (68 of 90) were within 0.50 D of intended correction. Stability was achieved at 3 months, with 96% of subjects (86 of 90) having less than 1.00 D of change from their previous examination. In a substudy, 89% eyes (58 of 65) varied within +/- 0.50 D over the course of a day. Corneal curvature changed as predicted, resulting in a prolate aspheric shape within the central optical zone. Most complications or adverse events experienced were managed with additional medication or surgical intervention, resulting in a favorable outcome for subjects.

CONCLUSIONS

KeraVision Intacs are effective, predictable, stable, and safe. This additive technique may also offer reversibility.

Intentionality during hypnosis: an ironic process analysis

Two studies were completed to test whether responding to hypnotic suggestions requires intentional effort. Hypnotic suggestions for amnesia were used as an analog of thought suppression, and Wegner's model of ironic processing was applied to hypnotic responding. In the first study, participants were required to maintain suggested amnesia while performing a cancellation task with and without a cognitive load. The second study required suppression of thoughts of a favorite car, once with "blank-mind" instructions and then with a suggestion for amnesia. The results of these studies indicate that dissociated control theory provides the best explanation for hypnotic responding in one subset of highly hypnotizable participants, whereas more intentional responding provides the best explanation for others.

Electrophoretic conditions for high resolution citrus isozymes in polyacrylamide gel electrophoresis

Electrophoretic conditions including electrode and gel buffers, acrylamide concentration, use of stacking gels, voltage, current, and run time were investigated in order to produce isozyme bands of high resolution which would facilitate densitometric quantification of enzyme activity following polyacrylamide gel electrophoresis (PAGE). Electrode buffers which provided optimal conditions for gels stained for the isozymes of malate dehydrogenase (MDH), 6-phosphogluconate dehydrogenase (6-PGD), phosphoglucose isomerase (PGI), and shikimate dehydrogenase (SkDH) were 0.02 M Tris-glycine, pH 8.5, 0.1 M sodium borate, pH 6.0, 0.1 M sodium borate, pH 8.7, and 0.07 M sodium borate, pH 7.0, respectively. A 0.5 M Tris-HCl, pH 7.5, gel buffer was optimal for gels stained for the isozymes of 6-PGD, PGI and SkDH. A 0.5 M Tris-HCl, pH 8.5, gel buffer was best for gels stained for MDH. Stacking gels were found to be detrimental to enzyme activity and showed no improvement in resolution for any of the enzymes. Acrylamide concentration for gels stained for MDH were 8.7%, gels stained for 6-PGD and PGI were 7.5%, while gels stained for SkDH had an acrylamide concentration of 5.0%. Higher concentrations above these levels caused a reduction and in some cases loss of band activity, while below this concentration there was a decrease in band resolution.(ABSTRACT TRUNCATED AT 250 WORDS)

Preparation of extracts for electrophoresis from citrus leaves

Extracting proteins from vegetative tissues while maintaining good enzyme activity and electrophoretic resolution presents numerous problems due to the presence of phenols, quinones, proteases and other components released during cell disruption. To overcome this problem in Citrus leaves, an extraction buffer was developed which contained EDTA, potassium chloride, magnesium chloride hexahydrate, PVP-40, 2-mercaptoethanol and bovine serum albumin in a Tris-HCl buffer, pH 7.5. This extraction buffer was used in association with liquid nitrogen for sample preparation. Buffers used in previous studies for Citrus isozyme extraction for PAGE were found to provide unsatisfactory resolution and activity for the three enzyme systems investigated (malate dehydrogenase, 6-phosphogluconate dehydrogenase and shikimate dehydrogenase). This extraction buffer maintains high enzyme activity and provides good resolution in PAGE gels suitable for densitometric analysis.

Effects of nitrite, chlorate, and chlorite on nitrate uptake and nitrate reductase activity

Effects of NO(2) (-), ClO(3) (-), and ClO(2) (-) on the induction of nitrate transport and nitrate reductase activity (NRA) as well as their effects on NO(3) (-) influx into roots of intact barley (Hordeum vulgare cv Klondike) seedlings were investigated. A 24-h pretreatment with 0.1 mol m(-3) NO(2) (-) fully induced NO(3) (-) transport but failed to induce NRA. Similar pretreatments with ClO(3) (-) and ClO(2) (-) induced neither NO(3) (-) transport nor NRA. Net ClO(3) (-) uptake was induced by NO(3) (-) but not by ClO(3) (-) itself, indicating that NO(3) (-) and ClO(3) (-) transport occur via the NO(3) (-) carrier. At the uptake step, NO(2) (-) and ClO(2) (-) strongly inhibited NO(3) (-) influx; the former exhibited classical competitive kinetics, whereas the latter exhibited complex mixed-type kinetics. ClO(3) (-) proved to be a weak inhibitor of NO(3) (-) influx (K(i) = 16 mol m(-3)) in a noncompetitive manner. The implications of these findings are discussed in the context of the suitability of these NO(3) (-) analogs as screening agents for the isolation of mutants defective in NO(3) (-) transport.