The current crisis in orthodontic education : the residents\u27 perspective.

The purpose of this study is to identify orthodontic residents\u27 demographic trends, goals for the future, and perspectives on training. A 26-item survey, conducted at the Graduate Orthodontic Residency Program, in August 2003, was distributed to residents representing 51 of the 58 orthodontic programs in the U.S. Questionnaires were sent to 5 programs not attending GORP. Of the 380 questionnaires distributed at the meeting, 295 were returned, while 35 of 50 mailed questionnaires were returned. Total response rate was 77%. Clinical education was the most important factor when choosing a residency. Residents\u27 future plans were to publish their research, earn American Board of Orthodontics (ABO) certification, and work four days a week. Several trends were identified since last surveyed in 1992. Interest in full time academic orthodontic careers continues to decline. The number of females in orthodontic training is increasing. Residents planning to earn ABO certification increased significantly

Noninvasive estimation of peak pulmonary artery pressure by M-mode echocardiography

In an attempt to predict peak pulmonary artery pressure from routine M-mode echocardiographic tracings, 95 infants and children with congenital heart disease were examined. Following the Burstin method for prediction of peak pulmonary artery pressure, which was originally based on the phonocardiogram and jugular phlebogram, M-mode echocardiography was used to measure the interval from pulmonary valve closure to tricuspid valve opening, namely, the period of isovolumic diastole. The measured interval was plotted on a modified table relating the interval, heart rate and predicted peak pulmonary artery pressure.The peak pulmonary artery pressure predicted by echocardiography was compared with that measured at cardiac catheterization. The correlation between predieted and actual peak pulmonary artery pressure was good (r = 0.86) for routine studies with the patient in the nonsedated state. All patients with a predicted peak pressure less than 40 mm Hg were found at catheterization to have a pressure less than 40 mm Hg. The correlation was better (r = 0.96) when comparing predictions made from the echocardiogram obtained while the patient was sedated for catheterization. Prediction of the magnitude of elevation of peak pressure was especially good when prediction and measurement were nearly simultaneous. Predictions were less accurate in the presence of tachycardia at rates of more than 155 beats/min. The method for estimating peak pulmonary artery pressure from M-mode echocardiographic tracings is reliable, relatively simple and clinically useful

A Rare Case of Appendiceal Mucocele with Myxoglobulosis

A 63-year-old man was admitted with an abdominal mass in the right lower quadrant. The tumor was diagnosed as mucocele of the appendix after admission and surgically removed. The appendix containing gelatinous mucus with numerous round bodies was distended to the size of an egg. Therefore, a diagnosis of myxoglobulosis was postoperatively made. This is a rare disease and the diagnosis has been preoperatively made in none of patients in Japan. The present case could present an echographic pattern characteristic of this cyst. Studies on all available echograms from previous patients could provide information necessary for preoperative diagnosis of myxoglobulosis

Mesenteric Bleeding due to a Ruptured Aneurysm of the Middle Colic Artery

An outpatient with repeated colic attacks of unknown cause was hospitalized and was subjected to CT scan, ultrasound inspection, cytodiagnosis via abdominocentesis, resulting in the diagnosis of epigastrial hematoma. Further angiographical investigation evidenced the presence of middle colic artery. Aneurysm was also detected in the right colic artery. Other celiac arteries, however, were normal. The aneurysms detected were surgically removed with a portion of the intestinal tract. The pathological investigation of the resected aneurysm in the present cast could not prove the association with several other diseases which have been mentioned as possible causes for aneurysm. While only 10 cases of aneurysm at the superior mesenteric arterial branch have been reported, the authors believe that angiographical inspection should indispensably be attempted for diagnosis in cases of abdominal pain or abdominal tumors of unknown causes

Differencial Diagnosis of an Abdominal Tumors of Uncertain Origin Using Fine Needle Aspiration Biopsy (FNAB)

FNAB under ultrasonic guidance was performed on 14 cases with abdomical tumors of uncertain origin. All of them could not be clarified their relationship with the liver, the biliary tract, the pancreas or the alimentary tract by routine clinical exams including diagnostic imaging such as CT and Ultrasonography. Preoperating histological diagnosis has been obtained for 12 of these by FNAB, thus diagnostic rate being 85.7%. The details of tumors identified by autopsy and operations were: 3 cases of lymphoma; 3 cases of leiomyosarcoma; 4 cases of adenocarcinoma; 2 cases of hematoma; and 1 case of inflammatory mass. Non-epithelial tumor was most frequently observed. FNAB is a simple diagnostic method with high cost-effectiveness for determining the therapeutical plan for an abdominal tumor of uncertain origin which is encounted in the daily treatment

Inhibition of the potassium channel Kv1.3 reduces infarction and inflammation in ischemic stroke.

ObjectiveInhibitors of the voltage-gated K+ channel Kv1.3 are currently in development as immunomodulators for the treatment of autoimmune diseases. As Kv1.3 is also expressed on microglia and has been shown to be specifically up-regulated on "M1-like" microglia, we here tested the therapeutic hypothesis that the brain-penetrant small-molecule Kv1.3-inhibitor PAP-1 reduces secondary inflammatory damage after ischemia/reperfusion.MethodsWe studied microglial Kv1.3 expression using electrophysiology and immunohistochemistry, and evaluated PAP-1 in hypoxia-exposed organotypic hippocampal slices and in middle cerebral artery occlusion (MCAO) with 8 days of reperfusion in both adult male C57BL/6J mice (60 min MCAO) and adult male Wistar rats (90 min MCAO). In both models, PAP-1 administration was started 12 h after reperfusion.ResultsWe observed Kv1.3 staining on activated microglia in ischemic infarcts in mice, rats, and humans and found higher Kv1.3 current densities in acutely isolated microglia from the infarcted hemisphere than in microglia isolated from the contralateral hemisphere of MCAO mice. PAP-1 reduced microglia activation and increased neuronal survival in hypoxia-exposed hippocampal slices as effectively as minocycline. In mouse MCAO, PAP-1 dose-dependently reduced infarct area, improved neurological deficit score, and reduced brain levels of IL-1β and IFN-γ without affecting IL-10 and brain-derived nerve growth factor (BDNF) levels or inhibiting ongoing phagocytosis. The beneficial effects on infarct area and neurological deficit score were reproduced in rats providing confirmation in a second species.InterpretationOur findings suggest that Kv1.3 constitutes a promising therapeutic target for preferentially inhibiting "M1-like" inflammatory microglia/macrophage functions in ischemic stroke

Variance in Management of Extracorporeal Membrane Oxygenation-Associated Fibrin Sheaths at a Single Institution

Objective: Extracorporeal membrane oxygenation (ECMO) support for patients with cardiac or respiratory failure has been increasingly used by advanced critical care practitioners. The thromboembolic complications of ECMO have been extensively discussed and researched; however, research and discussion on the development, risks, and management of cannulae-associated fibrin sheaths are lacking. Methods: Institutional review board approval was not required. We have presented three cases detailing the identifi- cation and individualized management of ECMO-associated fibrin sheaths at our institution. The three patients provided written informed consent for the report of their case details and imaging studies. Results: Of our three patients with ECMO-associated fibrin sheaths, two were managed successfully with anticoagulation alone. One could not receive anticoagulation therapy and underwent inferior vena cava filter placement. Conclusions: Fibrin sheath formation around indwelling ECMO cannulae is an unresearched complication of ECMO cannulation. We would recommend an individualized approach to the management of these fibrin sheaths and have provided three examples of successful management

Extracorporeal Membrane Oxygenation for Graft Dysfunction Early After Heart Transplantation: A Systematic Review and Meta-analysis

Introduction: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is a prevailing option for the management of severe early graft dysfunction. This systematic review and individual patient data (IPD) meta-analysis aims to evaluate (1) mortality, (2) rates of major complications, (3) prognostic factors, and (4) the effect of different VA-ECMO strategies on outcomes in adult heart transplant (HT) recipients supported with VA-ECMO. Methods and Results: We conducted a systematic search and included studies of adults (≥18 years) who received VA-ECMO during their index hospitalization after HT and reported on mortality at any timepoint. We pooled data using random effects models. To identify prognostic factors, we analysed IPD using mixed effects logistic regression. We assessed the certainty in the evidence using the GRADE framework. We included 49 observational studies of 1477 patients who received VA-ECMO after HT, of which 15 studies provided IPD for 448 patients. There were no differences in mortality estimates between IPD and non-IPD studies. The short-term (30-day/in-hospital) mortality estimate was 33% (moderate certainty, 95% confidence interval [CI] 28%–39%) and 1-year mortality estimate 50% (moderate certainty, 95% CI 43%–57%). Recipient age (odds ratio 1.02, 95% CI 1.01–1.04) and prior sternotomy (OR 1.57, 95% CI 0.99–2.49) are associated with increased short-term mortality. There is low certainty evidence that early intraoperative cannulation and peripheral cannulation reduce the risk of short-term death. Conclusions: One-third of patients who receive VA-ECMO for early graft dysfunction do not survive 30 days or to hospital discharge, and one-half do not survive to 1 year after HT. Improving outcomes will require ongoing research focused on optimizing VA-ECMO strategies and care in the first year after HT

Rapid clearance of cellular debris by microglia limits secondary neuronal cell death after brain injury in vivo

Moderate or severe traumatic brain injury (TBI) causes widespread neuronal cell death. Microglia, the resident macrophages of the brain, react to injury by migrating to the lesion site, where they phagocytose cellular debris. Microglial phagocytosis can have both beneficial (e.g. debris clearance) and detrimental (e.g. respiratory burst, phagoptosis) consequences. Hence, whether the overall effect of microglial phagocytosis after brain injury in vivo is neuroprotective or neurotoxic is not known. Here, we establish a system with which to carry out dynamic real-time analyses of the mechanisms regulating cell death after brain injury in vivo. We show that mechanical injury to the larval zebrafish brain induces distinct phases of primary and secondary cell death. Excitotoxicity contributes to secondary cell death in zebrafish, reflecting findings from mammals. Microglia arrive at the lesion site within minutes of injury, where they rapidly engulf dead cells. Importantly, the rate of secondary cell death is increased when the rapid removal of cellular debris by microglia is reduced pharmacologically or genetically. In summary, our results provide evidence that microglial debris clearance is neuroprotective after brain injury in vivo