Retention of Root Canal Posts: Effect of Cement Film Thickness, Luting Cement, and Post Pretreatment.

The aim of this study was to investigate the effect of the cement film thickness of a zinc phosphate or a resin cement on retention of untreated and pretreated root canal posts. Prefabricated zirconia posts (CosmoPost: 1.4 mm) and two types of luting cements (a zinc phosphate cement [DeTrey Zinc] and a self-etch adhesive resin cement [Panavia F2.0]) were used. After removal of the crowns of 360 extracted premolars, canines, or incisors, the root canals were prepared with a parallel-sided drill system to three different final diameters. Half the posts did not receive any pretreatment. The other half received tribochemical silicate coating according to the manufacturer's instructions. Posts were then luted in the prepared root canals (n=30 per group). Following water storage at 37°C for seven days, retention of the posts was determined by the pull-out method. Irrespective of the luting cement, pretreatment with tribochemical silicate coating significantly increased retention of the posts. Increased cement film thickness resulted in decreased retention of untreated posts and of pretreated posts luted with zinc phosphate cement. Increased cement film thickness had no influence on retention of pretreated posts luted with resin cement. Thus, retention of the posts was influenced by the type of luting cement, by the cement film thickness, and by the post pretreatment.

Influencing factors on the length of stay in lumbar spine surgery: analysis of the German spine registry

INTRODUCTION Spinal disc herniation, lumbar spinal stenosis and spondylolisthesis are known to be leading causes of lumbar back pain. The cost of low back pain management and related operations are continuously increasing in the healthcare sector. There are many studies regarding complications after spine surgery but little is known about the factors predicting the length of stay in hospital. The purpose of this study was to identify these factors in lumbar spine surgery in order to adapt the postoperative treatment. MATERIAL AND METHODS The current study was carried out as a post hoc analysis on the basis of the German spine registry. Patients who underwent lumbar spine surgery by posterior surgical access and with posterior fusion and/or rigid stabilization, whereby procedures with dynamic stabilization were excluded. Patient characteristics were tested for association with length of stay (LOS) using bivariate and multivariate analyses. RESULTS A total of 356 patients met the inclusion criteria. The average age of all patients was 64.6 years and the mean LOS was 11.9 ± 6.0 days with a range of 2-44 days. Independent factors that were influencing LOS were increased age at the time of surgery, higher body mass index, male gender, blood transfusion of 1-2 erythrocyte concentrates and the presence of surgical complications. CONCLUSION Identification of predictive factors for prolonged LOS may allow for estimation of patient hospitalization time and for optimization of postoperative care. In individual cases this may result of a reduction in the LOS.

German Total Ankle Replacement Register of the German Foot and Ankle Society (D. A. F.) - presentation of design and reliability of the data as well as first results

INTRODUCTION Even though arthroplasty of the ankle joint is considered to be an established procedure, only about 1,300 endoprostheses are implanted in Germany annually. Arthrodeses of the ankle joint are performed almost three times more often. This may be due to the availability of the procedure - more than twice as many providers perform arthrodesis - as well as the postulated high frequency of revision procedures of arthroplasties in the literature. In those publications, however, there is often no clear differentiation between revision surgery with exchange of components, subsequent interventions due to complications and subsequent surgery not associated with complications. The German Orthopaedic Foot and Ankle Association's (D. A. F.) registry for total ankle replacement collects data pertaining to perioperative complications as well as cause, nature and extent of the subsequent interventions, and postoperative patient satisfaction. MATERIAL AND METHODS The D. A. F.'s total ankle replacement register is a nation-wide, voluntary registry. After giving written informed consent, the patients can be added to the database by participating providers. Data are collected during hospital stay for surgical treatment, during routine follow-up inspections and in the context of revision surgery. The information can be submitted in paper-based or online formats. The survey instruments are available as minimum data sets or scientific questionnaires which include patient-reported outcome measures (PROMs). The pseudonymous clinical data are collected and evaluated at the Institute for Evaluative Research in Medicine, University of Bern/Switzerland (IEFM). The patient-related data remain on the register's module server in North Rhine-Westphalia, Germany. The registry's methodology as well as the results of the revisions and patient satisfaction for 115 patients with a two year follow-up period are presented. Statistical analyses are performed with SAS™ (Version 9.4, SAS Institute, Inc., Cary, NC, USA). RESULTS About 2½ years after the register was launched there are 621 datasets on primary implantations, 1,427 on follow-ups and 121 records on re-operation available. 49 % of the patients received their implants due to post-traumatic osteoarthritis, 27 % because of a primary osteoarthritis and 15 % of patients suffered from a rheumatic disease. More than 90 % of the primary interventions proceeded without complications. Subsequent interventions were recorded for 84 patients, which corresponds to a rate of 13.5 % with respect to the primary implantations. It should be noted that these secondary procedures also include two-stage procedures not due to a complication. "True revisions" are interventions with exchange of components due to mechanical complications and/or infection and were present in 7.6 % of patients. 415 of the patients commented on their satisfaction with the operative result during the last follow-up: 89.9 % of patients evaluate their outcome as excellent or good, 9.4 % as moderate and only 0.7 % (3 patients) as poor. In these three cases a component loosening or symptomatic USG osteoarthritis was present. Two-year follow-up data using the American Orthopedic Foot and Ankle Society Ankle and Hindfoot Scale (AOFAS-AHS) are already available for 115 patients. The median AOFAS-AHS score increased from 33 points preoperatively to more than 80 points three to six months postoperatively. This increase remained nearly constant over the entire two-year follow-up period. CONCLUSION Covering less than 10 % of the approximately 240 providers in Germany and approximately 12 % of the annually implanted total ankle-replacements, the D. A. F.-register is still far from being seen as a national registry. Nevertheless, geographical coverage and inclusion of "high-" (more than 100 total ankle replacements a year) and "low-volume surgeons" (less than 5 total ankle replacements a year) make the register representative for Germany. The registry data show that the number of subsequent interventions and in particular the "true revision" procedures are markedly lower than the 20 % often postulated in the literature. In addition, a high level of patient satisfaction over the short and medium term is recorded. From the perspective of the authors, these results indicate that total ankle arthroplasty - given a correct indication and appropriate selection of patients - is not inferior to an ankle arthrodesis concerning patients' satisfaction and function. First valid survival rates can be expected about 10 years after the register's start.

Development of post-pump syndrome in a sheep after mitral valve stenting

A one-year-old healthy sheep received an implant stenting the mural ('posterior') leaflet of the mitral valve. The experiment was authorized by the Cantonal Ethical Committee. The surgery was performed on the open, beating heart during cardiopulmonary bypass (CPB). Management of anaesthesia was based on isoflurane with mechanical intermittent positive pressure ventilation (IPPV) of the lungs, combined with intercostal nerve blocks and intravenous fentanyl and lidocaine. Marked cardiovascular depression occurred towards the end of CPB time and required high doses of dopamine, dobutamine, lidocaine and ephedrine to allow for weaning off the CPB pump. Moreover, severe pulmonary dysfunction developed when IPPV was re-initiated after CPB. Hypoxaemia persisted throughout the recovery from general anaesthesia. Multiple organ failure developed gradually during the three postoperative days, leading to euthanasia of the animal. As described in this case, marked lung injury associated with some degree of failure of other vital organs may occur in sheep after CPB. Intraoperative cardiorespiratory complications when weaning-off may indicate the development of 'post-pump syndrome'.

European experience with the second-generation Edwards SAPIEN XT transcatheter heart valve in patients with severe aortic stenosis: 1-year outcomes from the SOURCE XT Registry

OBJECTIVES The SOURCE XT Registry (Edwards SAPIEN XT Aortic Bioprosthesis Multi-Region Outcome Registry) assessed the use and clinical outcomes with the SAPIEN XT (Edwards Lifesciences, Irvine, California) valve in the real-world setting. BACKGROUND Transcatheter aortic valve replacement is an established treatment for high-risk/inoperable patients with severe aortic stenosis. The SAPIEN XT is a balloon-expandable valve with enhanced features allowing delivery via a lower profile sheath. METHODS The SOURCE XT Registry is a prospective, multicenter, post-approval study. Data from 2,688 patients at 99 sites were analyzed. The main outcome measures were all-cause mortality, stroke, major vascular complications, bleeding, and pacemaker implantations at 30-days and 1 year post-procedure. RESULTS The mean age was 81.4 ± 6.6 years, 42.3% were male, and the mean logistic EuroSCORE (European System for Cardiac Operative Risk Evaluation) was 20.4 ± 12.4%. Patients had a high burden of coronary disease (44.2%), diabetes (29.4%), renal insufficiency (28.9%), atrial fibrillation (25.6%), and peripheral vascular disease (21.2%). Survival was 93.7% at 30 days and 80.6% at 1 year. At 30-day follow-up, the stroke rate was 3.6%, the rate of major vascular complications was 6.5%, the rate of life-threatening bleeding was 5.5%, the rate of new pacemakers was 9.5%, and the rate of moderate/severe paravalvular leak was 5.5%. Multivariable analysis identified nontransfemoral approach (hazard ratio [HR]: 1.84; p < 0.0001), renal insufficiency (HR: 1.53; p < 0.0001), liver disease (HR: 1.67; p = 0.0453), moderate/severe tricuspid regurgitation (HR: 1.47; p = 0.0019), porcelain aorta (HR: 1.47; p = 0.0352), and atrial fibrillation (HR: 1.41; p = 0.0014), with the highest HRs for 1-year mortality. Major vascular complications and major/life-threatening bleeding were the most frequently seen complications associated with a significant increase in 1-year mortality. CONCLUSIONS The SOURCE XT Registry demonstrated appropriate use of the SAPIEN XT THV in the first year post-commercialization in Europe. The safety profile is sustained, and clinical benefits have been established in the real-world setting. (SOURCE XT Registry; NCT01238497).

Bariatric surgery in women of child-bearing age, timing between an operation and birth, and associated perinatal complications

Thesis (Master's)--University of Washington, 2016-06

Psychological risk factors for chronic post-surgical pain after inguinal hernia repair surgery:a prospective cohort study.

A significant proportion of patients experience chronic post-surgical pain (CPSP) following inguinal hernia surgery. Psychological models are useful in predicting acute pain after surgery, and in predicting the transition from acute to chronic pain in non-surgical contexts. This is a prospective cohort study to investigate psychological (cognitive and emotional) risk factors for CPSP after inguinal hernia surgery. Participants were asked to complete questionnaires before surgery and 1 week and 4 months after surgery. Data collected before surgery and 1 week after surgery were used to predict pain at 4 months. Psychological risk factors assessed included anxiety, depression, fear-avoidance, activity avoidance, catastrophizing, worry about the operation, activity expectations, perceived pain control and optimism. The study included 135 participants; follow-up questionnaires were returned by 119 (88.1%) and 115 (85.2%) participants at 1 week and 4 months after surgery respectively. The incidence of CPSP (pain at 4 months) was 39.5%. After controlling for age, body mass index and surgical variables (e.g. anaesthetic, type of surgery and mesh type used), lower pre-operative optimism was an independent risk factor for CPSP at 4 months; lower pre-operative optimism and lower perceived control over pain at 1 week after surgery predicted higher pain intensity at 4 months. No emotional variables were independently predictive of CPSP. Further research should target these cognitive variables in pre-operative psychological preparation for surgery. © 2011 European Federation of International Association for the Study of Pain Chapters.

A Bayesian neural network algorithm identifies patients in whom post-EVAR surveillance may be unnecessary

Lifelong surveillance is not cost-effective after endovascular aneurysm repair (EVAR), but is required to detect aortic complications which are fatal if untreated (type 1/3 endoleak, sac expansion, device migration). Aneurysm morphology determines the probability of aortic complications and therefore the need for surveillance, but existing analyses have proven incapable of identifying patients at sufficiently low risk to justify abandoning surveillance. This study aimed to improve the prediction of aortic complications, through the application of machine-learning techniques. Patients undergoing EVAR at 2 centres were studied from 2004–2010. Aneurysm morphology had previously been studied to derive the SGVI Score for predicting aortic complications. Bayesian Neural Networks were designed using the same data, to dichotomise patients into groups at low- or high-risk of aortic complications. Network training was performed only on patients treated at centre 1. External validation was performed by assessing network performance independently of network training, on patients treated at centre 2. Discrimination was assessed by Kaplan-Meier analysis to compare aortic complications in predicted low-risk versus predicted high-risk patients. 761 patients aged 75 +/− 7 years underwent EVAR in 2 centres. Mean follow-up was 36+/− 20 months. Neural networks were created incorporating neck angu- lation/length/diameter/volume; AAA diameter/area/volume/length/tortuosity; and common iliac tortuosity/diameter. A 19-feature network predicted aor- tic complications with excellent discrimination and external validation (5-year freedom from aortic complications in predicted low-risk vs predicted high-risk patients: 97.9% vs. 63%; p < 0.0001). A Bayesian Neural-Network algorithm can identify patients in whom it may be safe to abandon surveillance after EVAR. This proposal requires prospective study.

A New Approach Model in Post Graduate Training of Local Government Officers

In 2013-15 there was a new type of post graduate training elaborated and piloted in Hungary at the Institute of Executive Training and Continuing Education (VTKI) within the National University of Public Service (NKE). Although the pilot financed by the State Administration Reform Operative Program (ÁROP) had not lacked the previously established attempts to include interactivity in the training, it was the first to observe and apply the actual principles of the European Union 2020 expressed in the threefold criteria of economic growth: smartness, sustainability and inclusiveness. All of them are represented by a pillar of the program like e-learning, class training and field training with the inclusion of local society. According to the objectives of the program there were at least 10 thousand attendees from the civil service sphere set as project indicators, so it has been a large scale training program that took place in 2014 in Hungary. The following article shows the innovations included in this new approach model of post graduate training civil servants.

Displaced Comminuted Patellar Fracture Associated with Post Anterior Cruciate Ligament Reconstruction in a Male Collegiate Basketball Player

We present a unique case of a collegiate athlete who suffered an anterior cruciate ligament (ACL) injury leading to a displaced patellar stress fracture. We identified an unusual potential association between ACL reconstruction and patellar fractures in order to avoid potential complications in the rehabilitation and return to activity process.

Factors surgical team members perceive influence choices of wearing or not wearing personal protective equipment during operative /invasive procedures

Exposure to certain bloodborne pathogens can prematurely end a person’s life. Healthcare workers (HCWs), especially those who are members of surgical teams, are at increased risk of exposure to these pathogens. The proper use of personal protective equipment (PPE) during operative/invasive procedures reduces that risk. Despite this, some HCWs fail to consistently use PPE as required by federal regulation, accrediting agencies, hospital policy, and professional association standards. The purpose of this mixed methods survey study was to (a) examine factors surgical team members perceive influence choices of wearing or not wearing PPE during operative/invasive procedures and (b) determine what would influence consistent use of PPE by surgical team members. Using an ex post facto, non-experimental design, the memberships of five professional associations whose members comprise surgical teams were invited to complete a mixed methods survey study. The primary research question for the study was: What differences (perceptual and demographic) exist between surgical team members that influence their choices of wearing or not wearing PPE during operative/invasive procedures? Four principal differences were found between surgical team members. Functional (i.e., profession or role based) differences exist between the groups. Age and experience (i.e., time in profession) differences exist among members of the groups. Finally, being a nurse anesthetist influences the use of risk assessment to determine the level of PPE to use. Four common themes emerged across all groups informing the two study purposes. Those themes were: availability, education, leadership, and performance. Subsidiary research questions examined the influence of previous accidental exposure to blood or body fluids, federal regulations, hospital policy and procedure, leaders’ attitudes, and patients’ needs on the use of PPE. Each of these was found to strongly influence surgical team members and their use of PPE during operative/invasive procedures. Implications based on the findings affect organizational policy, purchasing and distribution decisions, curriculum design and instruction, leader behavior, and finally partnership with PPE manufacturers. Surgical team members must balance their innate need to care for patients with their need to protect themselves. Results of this study will help team members, leaders, and educators achieve this balance.

Factors Surgical Team Members Perceive Influence Choices of Wearing or not Wearing Personal Protective Equipment During Operative/Invasive Procedures

Exposure to certain bloodborne pathogens can prematurely end a person’s life. Healthcare workers (HCWs), especially those who are members of surgical teams, are at increased risk of exposure to these pathogens. The proper use of personal protective equipment (PPE) during operative/invasive procedures reduces that risk. Despite this, some HCWs fail to consistently use PPE as required by federal regulation, accrediting agencies, hospital policy, and professional association standards. The purpose of this mixed methods survey study was to (a) examine factors surgical team members perceive influence choices of wearing or not wearing PPE during operative/invasive procedures and (b) determine what would influence consistent use of PPE by surgical team members. Using an ex post facto, non-experimental design, the memberships of five professional associations whose members comprise surgical teams were invited to complete a mixed methods survey study. The primary research question for the study was: What differences (perceptual and demographic) exist between surgical team members that influence their choices of wearing or not wearing PPE during operative/invasive procedures? Four principal differences were found between surgical team members. Functional (i.e., profession or role based) differences exist between the groups. Age and experience (i.e., time in profession) differences exist among members of the groups. Finally, being a nurse anesthetist influences the use of risk assessment to determine the level of PPE to use. Four common themes emerged across all groups informing the two study purposes. Those themes were: availability, education, leadership, and performance. Subsidiary research questions examined the influence of previous accidental exposure to blood or body fluids, federal regulations, hospital policy and procedure, leaders’ attitudes, and patients’ needs on the use of PPE. Each of these was found to strongly influence surgical team members and their use of PPE during operative/invasive procedures. Implications based on the findings affect organizational policy, purchasing and distribution decisions, curriculum design and instruction, leader behavior, and finally partnership with PPE manufacturers. Surgical team members must balance their innate need to care for patients with their need to protect themselves. Results of this study will help team members, leaders, and educators achieve this balance.

Post tenebras spero lucem : Alquimia y ritos en el Quijote y otras obras cervantinas

This study focuses on two areas: alchemy (Part I) and rituals of initiation (Part II) in the works of Miguel de Cervantes, focusing on Don Quijote de la Mancha as my main case study. The first part analyses the function of alchemy and how it can be interpreted throughout the works and various literary genres of Cervantes. It will demonstrate that the texts of Cervantes contain both explicit and implicit allusions to, as well as different aspects of alchemy, such as operative and spiritual alchemy and how these are ultimately used by Cervantes as a means of expression. The author draws from this rich source and modifies these means of expression in order to achieve various results: sometimes with wit or in relation to fraud; at other times it focuses on inner alchemy relating to chivalry in what I have called spiritual chivalry, which has the aim of self-improvement and ultimately, gnosis. Regarding the chivalric rituals of initiation, according to this investigation chivalry serves as both satire and representation of the alchemical process in the case of Don Quijote, which finds its key moments during the rituals. In this sense alchemy and chivalry are studied as two sides of the same coin, in which the search for something higher, an object (the philosopher stone, the beloved), subjects the protagonist to continuous transmutations and puts him in contact with the transitory, that is, liminal states, people and spaces. From this perspective Don Quixote de la Mancha is built upon liminal poetics. My approach, which follows the tenets of analogical hermeneutics, is included within the framework of the Western Esotericism Studies. The 16th and 17th centuries were a fertile age for alchemy throughout Europe. In Spain, alchemy and other esoteric disciplines co-existed with the Spanish Inquisition and its body for the control of ideas and texts: censorship. By being ambiguous and putting into dialogue different ideas of alchemy, Cervantes not only allowed readers to reach their own conclusions, he also protected his work from censorship.

Laparoscopic adjustable gastric banding in adolescents: Results at two years including psychosocial aspects

International audience

Complications associated with malnutrition in elective surgical patients in a Malaysian setting

Purpose: To identify the level of malnutrition and complications observed in Malaysia. Methods: A prospective, observational study was conducted with the objectives of identifying the degree of malnutrition, complications and the need for nutritional support in elective surgical patients. Collection of data was performed in local tertiary hospitals using a Patient Generated Subjective Global Assessment (PG - SGA) nutritional screening tool and medical records. Results: A total of 50 patients electively admitted for surgery were included. The results demonstrated that there was a significant increase in malnourished patients post-surgery compared to pre-surgery (p = 0.0001). Most interesting was the significant number of complications observed post-surgery compared to pre-surgery (p = 0.035) which was associated to the poor level of nutrition. The most common type of complications noted post-surgery were nosocomial infection, wound infection and readmission. Conclusion: Malnutrition is prevalent pre- and post-operatively in Malaysia. Therefore, focus on the outcome of these malnourished patients should be performed to reduce complications associated with poor nutrition.