Notes

Spatial dependence along with determinants regarding efficiency easement adoptions in the United States.
Traumatic brain injury (TBI) is a leading cause of mortality and disability worldwide. Head injured patients may frequently require emergency neurosurgery. The perioperative TBI period is very important as many interventions done in this stage can have a profound effect on the long-term neurological outcome. This practical concise narrative review focused mainly on 1) the management of severe TBI patients with neurosurgical lesions admitted to a spoke center (i.e. hospital without neurosurgery) and therefore needing a transfer to the hub center (i.e. hospital with neurosurgery); 2) the management of severe TBI patients with intracranial hypertension/brain herniation awaiting for neurosurgery and 3) the neuromonitoring-oriented management in the immediate post-operative period. The proposals presented in this review mainly apply to severe TBI patients admitted to high-income countries.A considerable amount of literature has nurtured the idea that massive transfusion is an independent trauma disease and therapeutic tool. In this opinion paper, the authors expose the evolution and challenge the classic paradigm and historic definition of massive transfusion. Based on current evidence the elements of an evolving strategy in transfusion management and bleeding control are exposed such as use of tranexamic acid, combination and ratios of blood products, use of fluids and viscoelastic testing. The synergy of these elements provides the basis to develop updated strategies and perspectives for transfusion management after trauma and to consider a classic definition of massive transfusion as outdated or the need for massive transfusion as failure. An alternative concept, Time Critical Transfusion may be better placed to take into account modern transfusion management after trauma.
The aim of this study was to analyze the activity of the imipenem-relebactam combination (IMI/REL) against a collection of multidrug-resist Enterobacterales, Pseudomonas aeruginosa and Acinetobacter baumannii clinical isolates.

The study was conducted in two tertiary hospitals in Spain and included 192 clinical isolates of these 3 genera (139 resistant and 53 susceptible to IMI). The MICs for IMI with and without REL (at a fixed concentration of 4 mg/L) were determined by a standard broth microdilution method according to international recommendations.

All IMI-susceptible E. coli strains were also susceptible to IMI/REL. Enterobacterales resistant to IMI due to the production of carbapenemases, the MIC50 and MIC90 decreased from 64/256 with IMI to 8/64 mg/L with IMI/REL. This high activity was principally detected among isolates with KPC enzymes. Enterobacterales with class B carbapenemases, P. aeruginosa carrying VIM carbapenemase and A. baumannii strains showed no changes on IMI MIC50 or MIC90 after aior to IMI against A. baumannii.
The main objective of the present study is to assess the sensitivity and specificity of a retrospective diagnostic of lymphatic tuberculosis (LTB), testing frozen samples using gene amplification PCR methods. The secondary objective was to compare the results of two different commercial tuberculosis gene amplification methods for this purpose.

We retrospectively studied 38 frozen samples, previously processed for mycobacterial culture between January 2014 and August 2019. The results of the previous cultures were 21 samples positive for Mycobacterium tuberculosis complex (MTB) (5 being smear positive), 7 samples culture positive for Mycobacterium avium-intracellulare complex and 10 samples which were mycobacterial culture negative and discarded for LTB diagnosis, used as controls. The samples were processed using two gene amplification methods Xpert® MTB/RIF Ultra (Cepheid) and Abbott RealTime MTB Assay (Abbott).

Compared to initial culture results the sensitivity and specificity of Xpert® MTB/RIF Ultra were 57.1% and 100% and 52.3 % and 92.5%, respectively for the Abbott RealTime MTB assay. The differences were not statiscally significant. In addition, there were no differences according to the period of freezing.

Gene amplification of frozen samples confirmed the diagnosis of lymphatic TB in almost 60% of cases, allowing retrospective diagnosis in initially non suspected cases. Both gene amplification techniques tested were equally useful.
Gene amplification of frozen samples confirmed the diagnosis of lymphatic TB in almost 60% of cases, allowing retrospective diagnosis in initially non suspected cases. Both gene amplification techniques tested were equally useful.
The avulsion of the impacted lower third molar is one of the most common procedures in oral surgery. Even though it is characterized by possible complications due to the lesion of lingual and inferior alveolar nerves, the intra-oral surgical approach represents the first choice strategy when planning surgery. However, in case of ectopic tooth in the mandibular basal bone, it is appropriate to consider an extra-oral transcutaneous surgical approach. The ectopia of the inferior wisdom tooth represents a very rare clinical condition and sometimes it is even unknown by patients and dentists further evidence of this fact is represented by the paucity of paper related to the topic that can be found in the international scientific literature.

The experience of the Department of Maxillofacial Surgery of San Gerardo Hospital in Monza (Italy) in management and treatment of ectopic impacted lower third molar is exposed through the presentation of three cases of ectopic third molar.

Two out of three patients, aware of the risks related to the surgical procedure, refused the treatment proposed. One patient underwent surgical avulsion of the wisdom tooth through extra-oral transcervical approach. No early or late complications have been observed.

Extra-oral surgical approach for ectopic lower third molar should be considered for selected cases. Given the rarity of the clinical condition and the procedure-related risks, accurate pre-operative information has to be provided to the patient by physician and the procedure should only be performed by expert and competent surgeons.
Extra-oral surgical approach for ectopic lower third molar should be considered for selected cases. Given the rarity of the clinical condition and the procedure-related risks, accurate pre-operative information has to be provided to the patient by physician and the procedure should only be performed by expert and competent surgeons.
Second Hand smoke (SHS) exposure to children causes several systemic problems like asthma, dental problems like caries and effects overall well being. This study was conducted to study impact of SHS on primary school children by associating it with dental caries, cotinine level, asthma severity and overall well being.

Case control study was conducted amongst 200 children 9-15 years old that came to dental college in Muradnagar. Children who lived in smoking households were identified as SHS subjects-100 children and those who lived in non smoking households were identified as control group- 100 children. Parents completed questionnaire regarding their smoking status. In children's questionnaire severity of asthma was determined by using expert panel report (EPR3), dental caries was recorded by dmft index and psychological assessment of children was done using WHO- 5 well being index. Collection of unstimulated saliva of children was done in sterile plastic tubes and cotinine level was measured using enzyme-linked-immunosorbent assay (ELISA). Proteasome purification Students t test and one way analysis of variance (ANOVA) was used for analysing data.

Mean number of children suffering from asthma was higher in SHS subjects in comparison to control group i.e. 348.9 ±166.509 and 247.3±15.86 respectively. dmft and WHO- well being scores increased as level of cotinine increased. Mean cotinine level was higher in SHS subjects than control group i.e. 348.9 ±166.509 and 247.3±15.86 respectively.

SHS has an adverse impact on young children reflected by poor dmft scores and psychological well being, increased cotinine levels and asthma severity in comparison to control group.
SHS has an adverse impact on young children reflected by poor dmft scores and psychological well being, increased cotinine levels and asthma severity in comparison to control group.
To evaluate the voids percentage and the retreatability by different supplementary irrigation techniques of a matched-taper single cone and epoxy resin-based sealer.

A total of 72 single-rooted premolars were prepared and filled with gutta-percha and MM-Seal. The percentage of voids in the whole root canal and each anatomical part were evaluated by Micro-CT scans. After root filling removal, the teeth were randomly allocated (n=24) to group A, syringe irrigation; group B, Tornado Brush and group C, ultrasonically activated irrigation and rescanned to establish the volume of remnant root filling material. The data relative to voids and retreatment techniques were established by Kruskal-Wallis test. Differences in retreatment time were examined using one-way ANOVA and Tukey's test (P< .05).

No significant difference was found in the voids percentage between the different root-thirds and between the supplementary irrigation groups in the MM-Seal remnants for the whole root canal and each section. In all groups, the coronal region exhibited more remaining material than other sections.

MM-Seal showed low voids percentage and its removal was not significantly improved by supplementary irrigation techniques.
MM-Seal showed low voids percentage and its removal was not significantly improved by supplementary irrigation techniques.
The aim of the present article was to review and depict the main radiological features of odontogenic keratocysts, thus helping the differential diagnoses from other odontogenic cysts and neoplasms.

A review of articles published between January 2000 and October 2020 using Medline and the MeSH Term "odontogenic keratocyst" in combination with the following terms 'imaging,' 'radiology,' 'panoramic radiograph,' and 'computed tomography,' was performed.

Radiographically, OKCs are well-defined unilocular or multilocular radiolucencies bounded by corticated margins. Most lesions are unilocular; instead, multilocular OKCs represent about the 30% of cases, mainly involving the posterior mandible. When, particularly in large lesions, OKCs display a multilocular presentation with adjacent satellite cysts (daughter cysts) a "soap-bubble appearance" can be recognized.

Panoramic radiograph and CT still play an important role in the diagnosis and treatment planning of OKCs. Unfortunately, it may not be easy to differentiate OKCs from other odontogenic lesions, especially when they are small and unilocular. Histopathological findings are still necessary to obtain a definitive diagnosis.
Panoramic radiograph and CT still play an important role in the diagnosis and treatment planning of OKCs. Unfortunately, it may not be easy to differentiate OKCs from other odontogenic lesions, especially when they are small and unilocular. Histopathological findings are still necessary to obtain a definitive diagnosis.
Classification of oral lichen planus (OLP) as a condition with malignant potential is still controversial. One of the major properties of malignancy is invasion. Ln332-γ2 chain plays a critical role in invasive activity of cancer cells. This study aims to compare Ln332-γ2 chain expression in OLP, oral epithelial dysplasia (OED) and oral squamous cell carcinoma (OSCC).

Ln332-γ2 expression was evaluated in 16 epithelial hyperplasia with no dysplasia (group A), 16 OLP (group B), 18 OED (group C) and 18 OSCC (group D) by immunohistochemistry.

Except in A group, Ln332-γ2 expression was detected in other groups. There was a significant difference in Ln332-γ2 expression among B, C and D groups as well as between B and D, C and D groups (P< 0.001). However, there was no significant difference between B and C groups (P= 0.999).

According to the findings of this study, the likelihood of similarity of OLP with premalignant dysplastic lesion can be suggested. This is not corroborating OLP definitive transformation to an OSCC.
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