Κυριακή 18 Σεπτεμβρίου 2022

Prevention of the Occupational Silicosis Epidemic

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Abstract
An Australian National Dust Disease Taskforce was established to address the re-emergence of occupational lung disease, in particular silicosis. Exposure to respirable crystalline silica (RCS) occurs in various industries in Australia. We asked occupational hygienists about their practical experiences and perspectives on RCS exposure and regulatory action. A total of 105 members of the Australian Institute of Occupational Hygienists completed an anonymous questionnaire, which addressed individual characteristics, experience, perceived level of employer awareness, effectiveness of current regulation, and recommendations for improvement, across three main industrial sectors. Based on professional experience, 71% were concerned about the potential for RCS over-exposure. Barriers to adequate exposure control included lack of management commitment and financial resources. The employment of specialist occupational hygiene inspectors was considered to b e the most effective regulatory strategy. Given the large number of exposed workers in the construction industry, with only a moderate awareness, there is the potential for significant cost shifting of the burden of occupational lung disease from employers on to individuals and the public health system. A nationally consistent approach to RCS exposure control across all industrial sectors is now recommended, with an increased focus on measuring and controlling exposure.
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The T‐shaped FST pharyngoplasty step‐by‐step closure technique

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Abstract

Pharyngocutaneous fistula is one of the most common and serious complications associated with total laryngectomy. Numerous studies tried to evaluate causative and predisposing factors associated with this complication, but data are considerably variable and there is still no international consensus. Incidence rate varies considerably between studies, with reported rates from 3% to 65%. This 4K video presents our T-shaped four-step technique (FST) for closing the pharyngeal mucosa after total laryngectomy in a step-by-step manner. All sutures were performed by braided absorbable 3/0 26 mm 1/2c (Vicryl plus 3.0; Ethicon, Somerville, NJ, USA). Recordings were performed using a Karl Storz 4K 3D VITOM® exoscope (Karl Storz SE & Co. KG, Tuttlingen, Germany). We have been described this technique through a high-definition video, showing each step, and tips from the authors. Our T-shaped pharyngoplasty closure technique can be divided into four steps: 1. "Key Stitches"; 2. "A rea Refinement Stitches"; 3. "Modified Connell Suture"; 4. "Modified Purse String Suture." Our T-shaped FST closure technique proved to be an effective and reproducible method, which we feel could be the preferred choice for primary pharyngoplasty closure.

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Immunomodulatory fibrous hyaluronic acid‐Fmoc‐diphenylalanine‐based hydrogel induces bone regeneration

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Abstract

Aim

To investigate the potential of an ultra-short aromatic peptide hydrogelator integrated with hyaluronic acid (HA) to serve as a scaffold for bone regeneration.

Materials and methods

Fluorenylmethyloxycarbonyl-diphenylalanine (FmocFF)/HA hydrogel was prepared and characterized using microscopy and rheology. Osteogenic differentiation of MC3T3-E1 preosteoblasts was investigated using Alizarin red, alkaline phosphatase and calcium deposition assays. In vivo, 5-mm diameter calvarial critical-sized defects were prepared in 20 Sprague-Dawley rats and filled with either FmocFF/HA hydrogel, deproteinized bovine bone mineral, FmocFF/Alginate (Alg) hydrogel or left unfilled. 8 weeks following implantation, histology and micro-CT analyses were performed. Immunohistochemistry was performed in 6 rats to assess the hydrogel's immunomodulatory effect.

Results

A nanofibrous FmocFF/HA hydrogel with a high storage modulus of 46KPa was prepared. It supported osteogenic differentiation of MC3T3-E1 preosteoblasts and facilitated calcium deposition. In vivo, the hydrogel implantation resulted in approximately 93% bone restoration. It induced bone deposition not only around the margins, but also generated bony islets along the defect. Elongated M2 macrophages lining at the periosteum-hydrogel interface were observed 1 week after implantation. After 3 weeks, these macrophages were dispersed through the regenerating tissue surrounding the newly formed bone.

Conclusion

FmocFF/HA hydrogel can serve as a cell-free, biomimetic, immunomodulatory scaffold for bone regeneration.

This article is protected by copyright. All rights reserved.

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Effectiveness of root canal treatment for vital pulps compared with necrotic pulps in the presence or absence of signs of periradicular pathosis: a systematic review and meta‐analysis

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Abstract

Background

Pre-operative pulpal status may influence the outcomes of root canal treatment (RCTx) according to various measures used.

Objectives

To compare effectiveness of RCTx of teeth with a vital pulp versus a necrotic pulp using a range of clinical and patient-related outcomes, for the development of S3-Level clinical practice guidelines.

Methods

A search was conducted in the PubMed-MEDLINE, Scopus, EMBASE, Google scholar databases and available repositories, followed by hand searches, until 29 March 2022. Clinical studies published in English language comparing the stipulated outcomes of RCTx of teeth with vital versus necrotic pulp were included. The Newcastle-Ottawa Scale was adapted to assess study quality. Effects of pulpal status were estimated and expressed as risk ratio (RR) using fixed- and random-effect meta-analyses. The quality of evidence was assessed through the Grading of Recommendations Assessment, Development, and Evaluation tool.

Results

Twenty-eight studies published between 1961 and 2021 were included. Five studies have investigated the 'tooth survival' outcome, four reported pulpal status was not a significant predictor, consistent with meta-analysis finding (RR: 1.00; 95% CI: 1.00, 1.00; n=3). Seven studies reported pulpal status had no significant influence on post-operative pain, regardless of duration after treatment. Sixteen studies have analysed 'periapical health', eleven revealed pulpal status had no significant influence. Meta-analyses revealed the influence was not significant if pre-operative periapical radiolucency was absent (RR: 0.95; 95% CI: 0.90, 1.00; n=9) but significant if it was present (RR: 1.12; 95% CI: 1.05, 1.19; n=11). Most studies were classified as 'some concerns' (n=16) to 'low' (n=10) risk of bias (RoB).

Discussion

Evidence is limited and only available for three outcomes when comparing the effectiveness of RCTx in permanent teeth with vital pulp versus pulp necrosis. Nevertheless, the quality of available evidence was moderate to high. The 'periapical health' data heterogeneity could be explained by pre-operative radiolucency, thus RCTx was found more effective for prevention than resolution of apical periodontitis.

Conclusions

There was no significant difference in the 'tooth survival', 'post-operative pain' and 'evidence of apical radiolucency' outcomes of RCTx in teeth with vital or necrotic pulps.

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Response assessment in pediatric craniopharyngioma: recommendations from the Response Assessment in Pediatric Neuro-Oncology (RAPNO) working group

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Abstract
Craniopharyngioma is a histologically benign tumor of the suprasellar region for which survival is excellent but quality of life often poor secondary to functional deficits from tumor and treatment. Standard therapy consists of maximal safe resection with or without radiation therapy. Few prospective trials have been performed, and response assessment has not been standardized. The Response Assessment in Pediatric Neuro-Oncology (RAPNO) committee devised consensus guidelines to assess craniopharyngioma response prospectively. Magnetic resonance imaging (MRI) is the recommended radiologic modality for baseline and follow-up assessments. Radiologic response is defined by two-dimensional measurements of both solid and cystic tumor components. In certain clinical contexts, response of solid and cystic disease may be differentially considered based on their unique natural histories and responses to treatment. Importantly, the committee incorporated fu nctional endpoints related to neuro-endocrine and visual assessments into craniopharyngioma response definitions. In most circumstances, cystic disease should be considered progressive only if growth is associated with acute, new-onset or progressive functional impairment. Craniopharyngioma is a common pediatric CNS tumor for which standardized response parameters have not been defined. A RAPNO committee devised guidelines for craniopharyngioma assessment to uniformly define response in future prospective trials.
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Extracapsular dissection with a transparotid facial nerve dissection approach versus partial superficial parotidectomy for benign tumours in the tail of the parotid gland: a single-centre retrospective study of 89 patients

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The aims of this study were (1) to evaluate the transparotid facial nerve dissection approach (TFND), in which the intraparotid cervicofacial or temporofacial division is identified first through a superficial lobe incision; and (2) to compare extracapsular dissection with a TFND (ECD-TFND) with partial superficial parotidectomy with a retrograde approach (PSP) for benign tumours in the tail of the parotid gland with respect to surgical outcomes. Eighty-nine patients underwent PSP or ECD-TFND for benign tumours in the tail of the parotid gland: 49 were treated surgically with PSP and 40 with ECD-TFND. (Source: International Journal of Oral and Maxillofacial Surgery)
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Comparative effectiveness of BNT162b2 and mRNA-1273 booster dose after BNT162b2 primary vaccination against the Omicron variants: A retrospective cohort study using large-scale population-based registries in Japan

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Abstract
Background
Direct comparative effectiveness of booster doses of BNT162b2 and mRNA-1273 after BNT162b2 primary vaccination is unknown.
Methods
We investigated comparative effectiveness of BNT162b2 and mRNA-1273 booster dose using data from registry systems for vaccination and COVID-19 infection in a local city in Japan. We followed participants aged ≥16 years who completed the BNT162b2 primary vaccination between November 22, 2021, and April 15, 2022. We collected information on age, sex, vaccination status, vaccine type, and infection status. Age was categorized as 16–44, 45–64, 65–84, and ≥85 years. Vaccine effectiveness for mRNA-1273 and no booster vaccination against BNT162b2 was estimated using age-stratified Cox regression adjusted for age, sex, and days since the second vaccination. The estimated hazard ratios for mRNA-1273 and no booster vaccinations were integrated separately using random effects meta-analyses .
Results
During the study period, we identified 62,586 (40.4%), 51,490 (33.2%), and 40,849 (26.4%) participants who received BNT162b2, mRNA-1273, and no booster dose, respectively. The median age was 69, 71, and 47 years for BNT162b2, mRNA-1273, and no booster dose, respectively. The integrated hazard ratio with reference to BNT162b2 was 1.72 for no booster vaccination and 0.62 for mRNA-1273. The comparative effectiveness of mRNA-1273 was similar across age categories.
Conclusions
Both homologous and heterologous vaccinations are effective against Omicron variants. In the head-to-head comparison, the effect was stronger in people who received heterologous vaccination than in those who received homologous vaccination. These findings may help improve logistics and decision making in future vaccination programs.
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