Opinions and practice of stress ulcer prophylaxis in Australian and New Zealand intensive care units.

BACKGROUND: Intensivists frequently prescribe proton pump inhibitors (PPIs) or histamine-2 receptor blockers (H2RBs) to intensive care unit patients for stress ulcer prophylaxis (SUP). Despite the common use of SUP medicines, there is limited high-level evidence to support the choice between them. AIM: To describe self-reported practice of SUP by Australian and New Zealand intensivists. METHOD: An online questionnaire of intensivists between 13 January and 3 February 2014. RESULTS: Seventy-two intensivists responded to the survey: 61 (85%) practised in public metropolitan ICUs and 13/48 (27%) practised in paediatric ICUs. Fifty-two (72%) respondents indicated that PPIs were their preferred SUP medicine. Respondents estimated that an average of 84% of ventilated and 53% of non-ventilated patients received SUP medicines during their ICU admission. Seven respondents (9%) were concerned or very concerned about the possible increased risk of upper gastrointestinal bleeding associated with H2RBs versus PPIs. Ten respondents (14%) were concerned or very concerned about the possible greater risk of Clostridium difficile infection, and 15 respondents (21%) were concerned or very concerned about the possible greater risk or ventilator-associated pneumonia with PPIs versus H2RBs. Most respondents (64 [89%]) agreed or strongly agreed that there was insufficient evidence to support the choice of an optimal SUP medicine, and 58 respondents (81%) agreed or strongly agreed to patient enrollment in an RCT comparing PPIs with H2RBs. CONCLUSION: Most survey respondents felt that current evidence is insufficient to justify the preferential use of PPIs or H2RBs for SUP and would enroll patients in a comparative SUP RCT.

Maxillary and mandibular base size in ancient skulls and of modern humans from Opi, Abruzzi, Italy: a cross-sectional study.

AIM: The size and shape of the jaws are related to occlusion and masticatory muscle function. Consequently, teeth and muscles are considered the functional matrix for the two jaws. Existing studies did not focus on the relationship between maxillary and mandibular base but on just their absolute dimensions. As the relationship between the two is of interest to orthodontists, the aim of this study was to calculate the maxillary-mandibular ratio (m-m ratio) in individuals from Central Italy and to compare it to that of ancient skulls from the same geographic area. METHODS: Forty individuals from Opi, a small, isolated mountain village in Central Italy, and 40 ancient skulls from the same region were the sample of this study. The lengths of the maxillary and mandibular base were assessed on lateral cephalograms, the m-m ratio was calculated, and the measurements between the groups were compared. RESULTS: Due to a significantly shorter maxillary base in the modern human sample, the m-m ratio was significantly lower in these subjects. CONCLUSION: This finding supports the hypothesis that growth of the skull is strongly modulated by the functional matrix, within which a morphologic unit develops.

Fixed orthodontic therapy in temporomandibular disorder (TMD) treatment: an alternative to intraoral splint.

This study evaluated the use of a fixed orthodontic appliance in treatment of temporomandibular disorder (TMD) compared to the use of an intra-oral splint. Fifty (50) adult patients, with confirmed anterior disk displacement with reduction in at least one temporomandibular joint (TMJ), were divided into three groups: 20 patients treated with AR splint (Group I); 20 patients treated with a fixed orthodontic appliance (Group II) and 10 patients who underwent no treatment (Control Group). Joint pain, joint noise, muscle pain, and subjective relief were evaluated monthly before the treatment began (T0) and for six months thereafter. Subjects in Group I and Group II displayed a significant decrease in joint pain (p < 0.01) from T2 and in muscle pain from T1 (p < 0.01) to T6. Subjects in Group I showed a higher decrease in the frequency of joint noise (p < 0.05) from T1 to T6, compared with Group II. At T2 and T3, the patients in Group II reported a significantly lower discomfort level associated with the devices than subjects treated with the AR splint (p < 0.05). However, at T5 and T6, this observation was inverted. The use of a fixed orthodontic appliance seems to be as efficacious as the use of an AR maxillary splint in the treatment of joint pain and muscle pain, but not in the treatment of joint noise. These results are valid, at least for the short-term clinical results (first six months of treatment). Clinical implications for long-term use are not clarified by these results.

An in vitro investigation on friction generated by ceramic brackets.

AIM: To compare friction (F) of conventional and ceramic brackets (0.022-inch slot) using a model that tests the sliding of the archwire through 10 aligned brackets. METHODS: Polycrystalline alumina brackets (PCAs), PCA brackets with a stainless steel slot (PCA-M), and monocrystalline sapphire brackets (MCS) were tested under elastic ligatures using various archwires in dry and wet (saliva) states. Conventional stainless steel brackets were used as controls. RESULTS: In both dry and wet states, PCA and MCS brackets expressed a statistically significant higher F value with respect to stainless steel and PCA-M brackets when combined with the rectangular archwires (P<.01). PCA brackets showed significantly higher friction than MCS brackets (P<.01) when coupled with 0.014 x 0.025-inch nickel-titanium (Ni-Ti) archwire. SEM analysis showed differences in the surfaces among stainless steel, MCS, PCA-M, and PCA brackets. In the wet state, the mean F values were generally higher than in the dry state. CONCLUSION: PCA brackets showed significantly higher F than MCS brackets only when combined with 0.014 x 0.025-inch Ni-Ti archwires. Thus, in this study, a 10 aligned-brackets study model showed similar results when compared to a single bracket system except for friction level with 0.014 × 0.025-inch Ni-Ti archwires.