Medical journal (Fort Sam Houston, Tex.)最新文献

Objective: The aim of this study was to compare area under the curve (AUC), frequency, and odds of return of spontaneous circulation (ROSC) when epinephrine was administered in hypovolemic and normovolemic cardiac arrest models.

Methods: Twenty-eight adult swine were randomly assigned to 4 groups: HIO Normovolemia Group (HIONG); HIO Hypovolemia Group (HIOHG); IV Normovolemia (IVNG); and IV Hypovolemia Group (IVHG). Swine were anesthetized. The HIOH and IVH subjects were exsanguinated 35% of their blood volume. Each was placed into arrest. After 2 minutes, cardiopulmonary resuscitation was initiated. After another 2 minutes, 1 mg of epinephrine was given by IV or HIO routes; blood samples were collected over 5 minutes and analyzed by high-performance liquid chromatography. Subjects were defibrillated every 2 minutes.

Results: The AUC in the HIOHG was significantly less than both the HIONG (p = 0.047) and IVHG (p = 0.021). There were no other significant differences in the groups relative to AUC (p > 0.05). HIONG had a significantly higher occurrence of ROSC compared to HIOHG (p = 0.018) and IVH (p =0.018) but no other significant differences (p > 0.05). The odds of ROSC were 19.2 times greater for HIONG compared to the HIOHG.

Conclusion: The study strongly supports the effectiveness of HIO administration of epinephrine and should be considered as a first-line intervention for patients in cardiac arrest related to normovolemic causes. However, our findings do not support using HIO access for epinephrine administration for patients in cardiac arrest related to hypovolemic reasons.

Purpose: Proximal femoral bone stress injuries (BSI), especially those involving the femoral neck (FNBSI), pose a risk to military medical readiness. There is currently no optimal physical examination technique or test item cluster that substantially influences the clinical diagnosis of FNBSI. Consequently, a lower threshold to order diagnostic imaging is employed by clinicians who manage military populations at risk for FNBSI. A viable physical examination technique or cluster of techniques is needed to better inform this clinical decision process and reduce the associated diagnostic imaging burden. This project assessed the perceived clinical utility of several novel physical examination techniques intended to identify proximal femoral bone stress injuries.

Methods: Thirteen FNBSI-specific physical examination techniques were evaluated using standardized grading criteria, evaluating safety, reliability, and credibility. Based on group consensus, two weight-bearing techniques- forward lunge and tap (FLT), rear lunge reach and tap (RLRT)-and three non-weight-bearing techniques- proximal femoral shear test, 45-degree compress and percuss, and the side-lying scissor test-were each determined to possess a parsimonious cluster of desirable examination properties. A one-hour, multimedia presentation accompanied by live demonstrations was presented to 13 clinicians. Each clinician rated the physical examination techniques based on the following five criteria: patient safety, likely to identify only bone pathology, accuracy regardless of symptom duration or acuity, performed in the mid-range of available motion, and reliability. These criteria were individually weighted from 1 (strongly disagree) to 5 (strongly agree), yielding a possible maximum score of 25. Each physical examination technique was also given a yes or no rating for overall credibility. The minimum acceptable value was set a priori at 80% yes votes.

Results: All clinicians in attendance were physical therapists with an average of 5.9 (SD: 4.4) years of experience managing patients with FNBSI. All attendees either agreed or strongly agreed all techniques would be safe to use with patients suspected of having a FNBSI. The highest overall scoring test based on the five criteria was the FLT with a score of 21. The only two tests to exceed the 80% benchmark for overall credibility were the FLT (92.3%) and the RLRT (83.3%). There were no overall statistically significant differences within each individual criterion except for the safety criterion. However, post hoc pairwise comparisons revealed no statistically significant differences.

Conclusions: A minimum of two of the novel physical examination techniques (FLT, RLRT) appear to have sufficient credibility to warrant further evaluation based on voting results from an experienced group of clinicians. A concurrent criterion validity study to assess the dia

Objective: The purpose of this report was to document clinical responses to Nd:YAG laser energy in patients with surgical injury to terminal branches of the trigeminal nerve.

Background: Limited evidence from in vitro, animal, and human studies suggests infrared laser energy may positively influence recovery after peripheral or cranial nerve injury, although clinical effects of neodymiumdoped yttrium aluminum garnet (Nd:YAG) lasers remain unstudied in this context.

Methods: We applied Nd:YAG laser energy in the treatment of three consecutive patients presenting with altered neurosensory function following various oral and maxillofacial procedures. The time interval between surgical injury and laser photobiomodulation ranged from one week to two years.

Results: All patients exhibited reduction in the area of diminished sensation and partial recovery of normal neurosensory function. The two patients with long-standing neurosensory deficiency experienced near complete recovery of intraoral sensation, with residual zones of diminished sensation from the perioral skin.

Conclusions: Although all patients in this case series demonstrated clinical improvements compared with baseline, controlled studies are needed to determine whether Nd:YAG laser energy accelerates or enhances recovery of neurosensory function after surgical nerve injury. Studies establishing the relative efficacies of Nd:YAG and diode lasers appear warranted.

Background: Purpose: The purpose of this Observational Retrospective Cohort is to compare opioid prescription pattern trends from 1 January 2010 to 31 December 2017 amongst the Dental Health Activity (DENTAC), Obstetrics/Gynecology (OBGYN), Emergency Room (ER), and Family Medicine departments assigned to the Carl R. Darnall Army Medical Center, Fort Hood, TX. In addition, as a secondary outcome, the type of opioids prescribed will be explored during the same time frame.

Methods: An Observational Retrospective Cohort Longitudinal Archival Medical Chart Review was executed by a report collection from the Pharmacy Data Transaction Service (PDTS). Data analysis was developed with a Repeated Measures Analysis of Variance (ANOVA) in order to compare means across multiple variables based on repeated observations. By utilizing a mix of factors model, variables within each department (Test of Within-Subjects Effects) and between departments (Test of Between-Subjects Effects) were analyzed.

Results: The statistical analysis demonstrated no significant differences within the number of pills dispensed from the DENTAC and OBGYN departments. A moderate decrease in prescription patterns at the Emergency Department and extreme decrease at the Family Medicine Department was reported. No significant differences between the number of patients and number of prescriptions dispensed were found within each department over the 8-year period. The statistical analysis showed significant differences between the Family Medicine and Emergency departments in comparison with the DENTAC and OBGYN departments. From 2010-2016, Family Medicine and Emergency Departments demonstrated a substantial decrease in opioid prescribing. The DENTAC and OBGYN departments showed a constant linear factor from 2010 to 2016 indicating minimal changes in number of pills dispensed and revealing a small decrease of pills dispensed during 2017. The most common types of opioid medication prescribed in the four departments from 1 JAN 2010 to 31 DEC 2017 were Morphine Sulfate and Hydromorphone HCL.

Conclusions: In this study, the DENTAC AND OBGYN departments did not show a significant decrease in number of opioid pills and number of prescriptions dispensed compared to the Family Medicine and ER departments. Overall, the Family Medicine department showed the most drastic change in opioid prescription patterns from 1 JAN 2010 to 31 DEC 2017 at the Carl R. Darnall Army Medical Center, Fort Hood, TX. The most common types of opioid medication prescribed in the same period of time within the four departments were characterized by morphine and hydromorphone components.

Introduction: Polymerization for modern dental resin-based composites (RBCs) not only occurs immediately upon light exposure but also continues for another 24 hours, well beyond after light is terminated. However, many questions still remain about the role of polymerization kinetics in optimizing the physical properties of a new RBC type-the bulk-fill.

Objective: The aim is to study the post-cure polymerization kinetics of bulk-fill RBCs and to compare their degree of polymeric conversion (DC) and depth-of-cure (DoC) with an incremental-fill, conventional RBC.

Methods: Five representative bulk-fill RBCs [Surefil SDR+Stress Decreasing Resin Flow Plus (SDRFP), Tetric EvoCeram Bulk Fill (TECB), Filtek 1 Bulk Fill (F1B), Venus Bulk Fill (VB), and Sonicfill (SF3)] and one conventional RBC [Filtek Supreme Ultra (FSU)] were investigated. The upper surface per RBC specimen was exposed to a light curing unit (Paradigm, 3M-ESPE, irradiance=1221 ± 5 mW/cm2) for 20 seconds. The DC per RBC brand were measured at the bottom surface (specimen Ø=4 mm, thickness=3 mm and 5 mm) as a function of post-curing times using a Fourier transform infrared attenuated total reflection spectrometer. Real-time data recording for post-cure DC began immediately upon light exposure and continued at steady intervals, up to15 min, then again after 24 hours. The DoC of all six RBC brands (n=6 / group) were measured according to ISO-4049. Data were analyzed with nonlinear regression and analysis of variances (ANOVA)/Tukey (α=0.05).

Results: Mean DC for the six RBCs with 5 mm curing height after 24 hours were: TECB=79.5%, VB=75.7%, SDRFP=69.2%, SF3=65.8%, F1B=51.8%, and FSU=44.0%. Bulk-fill RBCs showed higher DC efficiency than the conventional RBC for both the 3 mm and 5 mm curing heights. Significant differences in DoC were found amongst the six RBC brands: VB=5.1 mm, SDRFP=4.6 mm, F1B=3.8 mm, TECB=3.5 mm, FSU=3.0 mm, and SF3=2.7 mm.

Conclusion: DCs were more affected by specimen thickness, through which the curing light was attenuated, than RBC types. Clinician should be aware not all bulk-fill RBCs have a DoC greater than or equal to 4 mm. Also, a bulk-fill RBC that has a high DC after a post-cure time of 24 hours may not have a high DoC, which is typically measured relatively soon after light exposure.

Military Working Dogs (MWD) are highly trained in substance detection and various phases of controlled aggression to protect military assets and personnel. Dental health is essential to maintain their performance and mission readiness. MWD's dentition is often fractured or worn due to the physically demanding nature of their job. When non-surgical endodontic therapy or full coverage crowns are deemed necessary, good communication between veterinary and dental teams is necessary to provide quality and timely treatment. These two case reports describe important prosthodontic and endodontic procedural steps and treatment considerations for providing care to MWDs.

The free fibula flap has become a relatively common reconstruction modality for composite defects of the maxillo-mandibular skeleton. After establishment of vascular and osseous integration, the next functional goal would include prosthetic rehabilitation. There are specific biological and bio-mechanical parameters required to optimize the success of prosthodontic rehabilitation. These requirements translate to a specific set of surgical modifications to the composite free flap. These case illustrations will outline the sequence of events from a well-established free fibula flap to implant supported hybrid denture. This case review will emphasize anatomical variation of the fibular bone, soft tissue profile, and spatial orientation in light of prosthodontic goals.

Orthognathic surgery has been used to enhance the function of the maxillomandibular complex with numerous positive effects on facial esthetics, as it can profoundly alter the skeletal architecture of the face. Numerous adjunctive surgical techniques are used to enhance the overall cosmetic results of orthognathic surgery to include the following: genioplasty, midface augmentation, rhinoplasty, fillers, and liposuction. Mandibular advancement, submental liposuction and genioplasty are all techniques that help to define the neck throat point (NTP), minimize submental sagging, and enhance throat length (TL) in order to establish a more harmonious facial profile. However, these procedures may still be insufficient to define the NTP in the low hyoid, retrognathic patient. This report presents the case of an adult male, with a non-existent NTP and retrognathia, who underwent corrective orthognathic surgery with the novel enhanced submentoplasty and a suture assisted resuspension of the platysma in order to establish the NTP, increase TL, minimize submental sagging, and enhance mandibular border definition.

Introduction: Retained cement following delivery of an implant-supported crown is strongly associated with peri-implant mucositis and peri-implantitis, and screw retention is a strategy for avoiding this problem entirely. In the esthetic zone, screw retention compromises esthetics unless the screw access in the crown is concealed to the palatal of the incisal edge. To avoid positioning the implant platform excessively toward the palate, practitioners can design an angled screw access channel in the crown.

Case presentation: A healthy 22-year-old patient with nonrestorable tooth #9 received extraction and immediate implant placement with immediate provisionalization. The screw access channel for the provisional restoration involved the incisal edge. Rather than placing a custom abutment and cementing the definitive restoration, an angled screw access channel was employed. The implant-supported restoration exhibited favorable esthetics, and the possibility of retained cement was avoided.

Conclusion: Up to a point, positioning maxillary anterior implants toward the palate is favorable. When the long axis of the implant is directed between the incisal edge and the cingulum of adjacent teeth, the implantsupported crown can be screw retained without compromising esthetics. In immediate implant situations, such positioning also increases the distance between the implant and the facial alveolar bone and encourages a favorable position of the marginal peri-implant mucosa. However, an excessively palatal platform position compels a restoration with irregular contours, which can frustrate proper oral hygiene and professional maintenance. Angled screw access channels allow screw retention without excessive palatal positioning of the platform, avoiding the possibility of cement-related peri-implant disease.

A considerable percentage of dental implant patients experience biofilm-mediated peri-implant disease following transmucosal abutment application. Bacterial adhesion is an early step in biofilm development. Our purpose was to assess adhesion of specific bacterial species to titanium over short exposure periods. Eight bacterial species were selected for this analysis: Streptococcus oralis, Streptococcus mitis, Gemella haemolysans, Streptococcus gordonii, Streptococcus sanguinis, Neisseria flavescens, Streptococcus salivarius, and Pseudomonas aeruginosa. We cultured each species with appropriate media and exposed titanium foil discs to the bacteria for 60, 15, 5, 1, or 0.25 minutes. Optical density at 600-nm wavelength (OD600) was assessed for the baseline inoculum and each species/exposure combination. The proportion of bacteria adherent to titanium was determined for each experimental condition. Striking titanium adhesion was noted for all evaluated species even when exposure time was limited to 15 seconds. Strategies to limit bacterial adhesion at dental implant surfaces may offer potential for improved treatment outcomes and preservation of peri-implant health.