Intensive care unit course of infants and children after cranial vault reconstruction for craniosynostosis

<p>Abstract</p> <p>Background</p> <p>Craniosynostosis (CSS) results from the premature closure of one or more cranial sutures, leading to deformed calvaria at birth. It is a common finding in children with an incidence of one in 2000 births. Surgery is required in order to release the synostotic constraint and promote normal calvaria growth. Cranial vault remodeling is the surgical approach to CSS repair at our institution and it involves excision of the frontal, parietal, and occipital bones. The purpose of this article is to describe the post-operative course of infants and children admitted to our PICU after undergoing cranial vault remodeling for primary CSS.</p> <p>Findings</p> <p>Complete data was available for analyses in only 82 patients, 44 males (M) and 38 females (F); M: F ratio was 1:1.2. Patients (pts) age in months (mo) ranged from 2 mo to 132 mo, mean 18.2 ±-24.9 mo and weights (wt) ranged from 4.7 kg to 31.4 kg, mean 10.24 ± 5.5 Kg.. Duration of surgery (DOS) ranged from 70 minutes to 573 minutes mean 331.6 ± 89.0 minutes. No significant correlation exist between duration of surgery, suture category, patient's age or use of blood products (P > 0.05). IOP blood loss was higher in older pts (P < 0.05) and it correlates with body temperature in the PICU (P < .0001). Post-op use of FFP correlated with intra-operative PRBC transfusion (P < 0.0001). More PRBC was transfused within 12 hrs-24 hrs in PICU compared to other time periods (P < 0.05). LOS in PICU was < 3 days in 68% and > 3 days in 32%. Pts with fever had prolonged LOS (P < 0. 05); re-intubation rate was 2.4% and MVD were 1.83 days. Repeat operation for poor cosmetic results occurred in 9.7% of pts.</p> <p>Conclusions</p> <p>Post-op morbidities from increased use of blood products can be minimized if cranial vault remodeling is done at a younger age in patients with primary CSS. PICU length of stay is determined in part by post-op pyrexia and it can be reduced if extensive evaluations of post-op fever are avoided.</p

The effect of experimental diabetes and glycaemic control on guided bone regeneration:histology and gene expression analyses

OBJECTIVES: To investigate the effect of experimental diabetes and metabolic control on intramembranous bone healing following guided bone regeneration (GBR). MATERIAL AND METHODS: Ninety-three Wistar rats were allocated to three experimental groups, healthy (H), uncontrolled diabetes (D) and controlled diabetes (CD). Twenty one days following diabetes induction, a standardised 5-mm defect was created at the mid-portion of each parietal bone. In 75 animals (25H, 25D, 25CD), one defect was treated with an intracranial and extracranial membrane according to the GBR principle, and one defect was left empty (control); five animals per group were then randomly sacrificed at 3, 7, 15, 30 and 60 days and processed for decalcified histology. In 18 animals (6H, 6D, 6CD), both defects were treated according to the GBR principle; three animals from each group were then randomly sacrificed at 7 and 15 days of healing and employed for gene expression analysis. RESULTS: Application of the GBR therapeutic principle led to significant bone regeneration even in the D group. However, at 15 and 30 days, the osteogenesis process was impaired by uncontrolled diabetes, as shown by the significant reduction in terms of defect closure (38-42%) and newly formed bone (54-61%) compared to the healthy group. The comparison of the D vs. H group at 15 days of healing yielded the largest number of genes with significantly differential expression, among which various genes associated with the ossification process (bmp4, ltbp4, thra and cd276) were identified. CONCLUSIONS: Uncontrolled diabetes seems to affect early phases of the bone regeneration following GBR. A misregulation of genes and pathways related to cell division, energy production, inflammation and osteogenesis may account for the impaired regeneration process in D rats. Further studies are warranted to optimise the GBR process in this medically compromised patient population

The Fate of Porous Hydroxyapatite Granules Used in Facial Skeletal Augmentation

Facial appearance is largely determined by the morphology of the underlying skeleton. Hydroxyapatite is one of several materials available to enhance projection of the facial skeleton. This study evaluated the long-term maintenance of augmented bony projection when porous hydroxyapatite granules are used on the facial skeleton. Ten female patients aged 28–58 years were studied following aesthetic augmentation of the facial skeleton at 24 sites using porous hydroxyapatite granules. Postoperative CT scans at 3 months served as the baseline measurement and compared with scans taken at 1 and 2 years, with the thickness of the hydroxyapatite measured in axial and coronal planes. Thickness of original bone plus overlay of hydroxyapatite, thickness of the overlying soft tissue, and the overall projection (bone plus soft tissue) were recorded. It was found that 99.7% of the hydroxyapatite was maintained at 2 years, with no statistical difference (t test) from the baseline measurement. The overall projection (bony and soft tissue) was maintained as there was no evidence of native bone resorption or soft tissue atrophy. Radiographic results confirmed that the use of porous hydroxyapatite granules for enhancement of the facial skeleton is not only a predictable procedure, but maintains full bony projection at 2 years

CURRENT KNOWLEDGE OF DIET REGIMEN AND DEVELOPMENT OF DILATATIVE CARDIOMYOPATHY (DCM) IN DOGS

Nastanak dilatativne kardiomiopatije (DCM) se posljednjih 5 godina sve više povezuje s režimom prehrane koji u sebi sadrži mahunarke i krumpir. Glavnim čimbenikom te poveznice smatra se deficit taurina, nesencijalne aminokiseline koja sadrži sumpor i koju psi mogu endogeno sintetizirati. U namirnicama poput graška, leće, slanutka, količina prekursora taurina, aminokiselina metionina i cisteina, nije dovoljna, te posljedično tome može doći do deficita taurina i moguće pojave dilatativne kardiomiopatije. U velikih i gigantskih pasmina pasa, zbog smanjene sinteze taurina preporučuje se njegova suplementacija. Također deficiti nutrijenata poput karnitina, vitamina E, selena bakra, tiamina, ali i konzumacija hrane s visokim udjelom vlakana se povezuju s mogućim nastankom nutritivnog oblika DCM-a. Prema analizi Američke agencije za hranu i lijekove (FDA) velika većina pasa oboljelih od DCM-a konzumirala je suhu hranu koja u sebi nije sadržavala žitarice, a sadržavala je grašak i leću, što nam ukazuje na moguću poveznicu između pojedinih prehrana i nastanka DCM-a. Brojnim istraživanjima, u kojima se promjenom režima hranidbe u životinja oboljelih od DCM-a s netradicionalnog u tradicionalni, utvrdila su se poboljšanja u ehokardiografskom prikazu srca i sistoličkoj funkciji srca, smanjenju koncentracije srčanih biomarkera u krvi, te produženom srednjem vremenu preživljavanja. Zbog aktualnosti ove teme potrebna su daljnja istražvanja kako bi sa sigurnošću mogli povezati ove režime prehrane s nastankom DCM-a.Development of dilatative cardimyopathy (DCM) in the last 5 years has been more and more connected with the diet regimen that contains pulse ingredients and potatoes. Main factor of that connection was taurine deficiency, dispensable sulfur-containing amino acid that can be endogenously synthesized in the dogs liver. Ingredients like peas, lentils, chickpeas do not contain sufficient amount of amino acids methionine and cysteine, precursors of taurine Consequence of that could be taurine deficiency and development of dilatative cardiomyopathy In big and giant dog breeds supplementation of taurine should be recommended as the taurine synthesis in these dogs is much lower. Deficiency in nutrients such as carnitine, vitamin E selenium, tiamine or consumation of high fibre diet could also be connected with diet induced DCM. According to the FDA analysis most of the dogs with DCM were fed with dry food tha was grain free and contained peas and lentils, which could indicate the connection between different diets and development of DCM. Numerous studies were made in which the positive effects of diet change from nontraditional to traditional on echocardiographic assesment and systolic function of the heart, alongside improvement of concentration of cardiac biomarkers in blood and median survival rate were observed. Because this is currently a new topic, more studies are necessary if we want to get more understading of connection between diet regimen and development of DCM

CURRENT KNOWLEDGE OF DIET REGIMEN AND DEVELOPMENT OF DILATATIVE CARDIOMYOPATHY (DCM) IN DOGS

Nastanak dilatativne kardiomiopatije (DCM) se posljednjih 5 godina sve više povezuje s režimom prehrane koji u sebi sadrži mahunarke i krumpir. Glavnim čimbenikom te poveznice smatra se deficit taurina, nesencijalne aminokiseline koja sadrži sumpor i koju psi mogu endogeno sintetizirati. U namirnicama poput graška, leće, slanutka, količina prekursora taurina, aminokiselina metionina i cisteina, nije dovoljna, te posljedično tome može doći do deficita taurina i moguće pojave dilatativne kardiomiopatije. U velikih i gigantskih pasmina pasa, zbog smanjene sinteze taurina preporučuje se njegova suplementacija. Također deficiti nutrijenata poput karnitina, vitamina E, selena bakra, tiamina, ali i konzumacija hrane s visokim udjelom vlakana se povezuju s mogućim nastankom nutritivnog oblika DCM-a. Prema analizi Američke agencije za hranu i lijekove (FDA) velika većina pasa oboljelih od DCM-a konzumirala je suhu hranu koja u sebi nije sadržavala žitarice, a sadržavala je grašak i leću, što nam ukazuje na moguću poveznicu između pojedinih prehrana i nastanka DCM-a. Brojnim istraživanjima, u kojima se promjenom režima hranidbe u životinja oboljelih od DCM-a s netradicionalnog u tradicionalni, utvrdila su se poboljšanja u ehokardiografskom prikazu srca i sistoličkoj funkciji srca, smanjenju koncentracije srčanih biomarkera u krvi, te produženom srednjem vremenu preživljavanja. Zbog aktualnosti ove teme potrebna su daljnja istražvanja kako bi sa sigurnošću mogli povezati ove režime prehrane s nastankom DCM-a.Development of dilatative cardimyopathy (DCM) in the last 5 years has been more and more connected with the diet regimen that contains pulse ingredients and potatoes. Main factor of that connection was taurine deficiency, dispensable sulfur-containing amino acid that can be endogenously synthesized in the dogs liver. Ingredients like peas, lentils, chickpeas do not contain sufficient amount of amino acids methionine and cysteine, precursors of taurine Consequence of that could be taurine deficiency and development of dilatative cardiomyopathy In big and giant dog breeds supplementation of taurine should be recommended as the taurine synthesis in these dogs is much lower. Deficiency in nutrients such as carnitine, vitamin E selenium, tiamine or consumation of high fibre diet could also be connected with diet induced DCM. According to the FDA analysis most of the dogs with DCM were fed with dry food tha was grain free and contained peas and lentils, which could indicate the connection between different diets and development of DCM. Numerous studies were made in which the positive effects of diet change from nontraditional to traditional on echocardiographic assesment and systolic function of the heart, alongside improvement of concentration of cardiac biomarkers in blood and median survival rate were observed. Because this is currently a new topic, more studies are necessary if we want to get more understading of connection between diet regimen and development of DCM

Design of steel cold-formed elements according to EN 1993-1-3

U ovom radu obrađen je postupak i tijek proračuna hladno oblikovanih čeličnih elemenata prema normi Eurocode 3, točnije EN 1993-1-3. Hladno oblikovani čelični elementi su prepoznatljivi po svojim tankim stijenkama i više zaobljenih kutova. Stoga se u proračunu karakteristika zahtjeva velika preciznost. Problem se javlja i zbog monosimetričnosti te zbog oblika poprečnog presjeka kada se pojave torzijski utjecaji. Slijedi otežana provedba pojednostavljenja izraza i unifikacije, razlike u mehaničkim svojstvima zbog načina izrade, a i vlastita naprezanja su drugačije raspoređena nego u slučaju standardnih elemenata. Nesavršenosti mogu biti jednake debljini stijenki, pa i veće, dok su materijalne nesavršenosti uvjetovane načinom izrade. Često dolazi i do pojave prekokritične nosivosti. Zbog navedenih specifičnosti moguća je potreba za eksperimentalno istraživanje pojedinih parametara koji su potrebni za proračun. Kao temelj za izradu europskih normi proračuna hladno oblikovanih elemenata poslužile su teorijske osnove zasnivane na ranim radovima Georga Wintera (Cornell University) još iz 1938.g

Design of steel cold-formed elements according to EN 1993-1-3

U ovom radu obrađen je postupak i tijek proračuna hladno oblikovanih čeličnih elemenata prema normi Eurocode 3, točnije EN 1993-1-3. Hladno oblikovani čelični elementi su prepoznatljivi po svojim tankim stijenkama i više zaobljenih kutova. Stoga se u proračunu karakteristika zahtjeva velika preciznost. Problem se javlja i zbog monosimetričnosti te zbog oblika poprečnog presjeka kada se pojave torzijski utjecaji. Slijedi otežana provedba pojednostavljenja izraza i unifikacije, razlike u mehaničkim svojstvima zbog načina izrade, a i vlastita naprezanja su drugačije raspoređena nego u slučaju standardnih elemenata. Nesavršenosti mogu biti jednake debljini stijenki, pa i veće, dok su materijalne nesavršenosti uvjetovane načinom izrade. Često dolazi i do pojave prekokritične nosivosti. Zbog navedenih specifičnosti moguća je potreba za eksperimentalno istraživanje pojedinih parametara koji su potrebni za proračun. Kao temelj za izradu europskih normi proračuna hladno oblikovanih elemenata poslužile su teorijske osnove zasnivane na ranim radovima Georga Wintera (Cornell University) još iz 1938.g