Cough-induced rib fractures: A comprehensive analysis of 90 patients in a single center.

Background: This study aims to evaluate clinical and radiological characteristics of the patients with cough-induced rib fractures. Methods: Between January 2008 and December 2022, a total of 90 patients (35 males, 55 females; mean age: 58±20 years; range, 20 to 92 years) who had cough-induced rib fractures were retrospectively analyzed. Patients' characteristics, findings of physical and radiological examination, and patients' outcomes were recorded. Results: Of the patients, 64% were postmenopausal, 37% had metabolic disease of the bone, and 21% had chronic cough. Cough etiology was acute upper respiratory tract infection (32%), followed by chronic obstructive pulmonary disease. Thoracic computed tomography documented 154 fractures. Cough-induced rib fractures were mostly on the right side (58%). Multiple fractures were more commonly seen in older patients (p=0.007), in the presence of novel coronavirus disease-2019 (COVID-19) pneumonia (p=0.03), and metabolic disease of the bone (p=0.01). Mostly the sixth rib was affected (23%). Most fractures (81.3%) affected the fourth to ninth ribs. Most fractures developed on the anterolateral aspect of the rib (51%). The mean duration of hospital stay was 5.0±1.6 days. Morbidity developed in one patient (1.1%) (hemothorax). Mortality occurred in two patients (2.2%) due to COVID-19 pneumonia and acute myocardial infarction. Conclusion: Localized pain after cough should be investigated in terms of cough-induced rib fractures. Cough-induced rib fractures are mostly seen in the presence of acute upper respiratory tract infection, chronic obstructive pulmonary disease, and pneumonia. Postmenopausal women are more risky to develop cough-induced rib fractures. Multiple cough-induced rib fractures are common in the presence of metabolic disease of the bone, older age, COVID-19 pneumonia.

Clinical survival of No-prep indirect composite laminate veneers: a 7-year prospective case series study.

BACKGROUND: The no preparation technique which is a reversible form of treatment characterized by the absence of tooth tissue preparation and preserves the soft tissue architecture while preserving all natural tooth structures is indicated in cases where the tooth structure allows material to be added. The aim of this study is to evaluate the clinical performance and survival rates of indirect composite laminate veneers with no preparation after 7 years. MATERIALS AND METHODS: A total of 80 indirect composite veneers were placed on maxillary anterior teeth in 35 patients (n = 80). Diastema (n = 64), wedge tooth anomalies (n = 9) and re-shaping (n = 7) were the main indications for veneer treatments. All laminate veneers were fabricated with an indirect microhybrid composite material (Gradia, GC Dental). No tooth preparation was performed. Light-cured resin cement (Choice 2, Bisco) was used to lute the veneers. Composite veneers were evaluated using Modified United States Public Health Service criteria. Survival rates of the veneers were calculated using Kaplan-Meier statistics. The data containing the results of the USPHS criteria at baseline, 2 years and 7 years was statistically analyzed using Wilcoxon Signed Rank test at the 0.05 level of significance. RESULTS: The overall survival rate was 91.3%. After 7 years, 7 absolute failures including 4 debonding (marginal adaptation, score 4) and 3 fractures (fracture of restoration, score 3) were noted. Color match was scored as 1 (n = 34) and 2 (n = 15). Slightly rough surfaces (41 of 73 laminates) and slight marginal discoloration (15 of 73 laminates) were noted. The overall scores after 84 months were significantly higher than the baseline scores for the marginal adaptation (p = 0.008), color match (p = 0.000), marginal discoloration (p = 0.000), surface roughness (p = 0.000), and fracture of restoration (p = 0.001) criteria. CONCLUSIONS: In this study, indirect composite veneers without any preparation on maxillary anterior teeth showed acceptable performance in terms of both survival rate and quality of restorations. This procedure offers a predictable and successful treatment that ensures maximum preservation of the intact tooth.

Evaluation of the bonding effectiveness of a universal adhesive to the plasma-activated dentin surface.

This study aimed to evaluate the effect of non-thermal atmospheric pressure plasma on the bond strength of a universal adhesive used in etch-and-rinse mode. Dentin surfaces were etched with phosphoric acid and samples were divided into groups exposed to either dry bonding, plasma-dried bonding, plasma-dried and rewetted bonding, or wet bonding (n  =  10). Dentin surfaces of the plasma-dried specimens were treated with a plasma jet before the adhesive procedure. After application, composite blocks were built, and specimens were subjected to micro-tensile bond strength testing after 24 h and after 10,000 thermal cycles. The hybrid layer formation was evaluated by micro-Raman spectral analysis; the resin-dentin interface was analyzed by scanning electron microscopy. One-way ANOVA and Tukey's post hoc multiple comparison tests were used to statistically analyze the data. The bond strength values of the plasma-dried bonding groups were statistically higher than the non-plasma-treated groups both before and after aging. After the thermal cycles, bond strength values decreased significantly only in the wet bonding group. Micro-Raman spectral analysis revealed that plasma-drying increased adhesive penetration, especially hydrophobic monomer infiltration. This may increase the mechanical properties and durability of the resin-dentin interface, provide long-term stability, and improve the polymerization rate of the adhesive layer.

A new technique for neonatal Jeune syndrome: External thoracic expansion.

Jeune syndrome is a rare form of skeletal dysplasia characterized by a narrow, bell-shaped chest (thoracic cage), and typical phalangeal and pelvic bone deformities. Chest expansion is impaired by the short, horizontally positioned ribs, resulting in alveolar hypoventilation and eventually neonatal-infantile death in most cases. External distraction with sternoplasty is a new technique for the treatment of Jeune syndrome, which was firstly used by our team on a newborn by placing a sliding finger fixator which was designed for ulnar lengthening. We believe that this approach can be life-saving in neonates with improved and widespread usage.

Does conception spontaneously or with ART affect postpartum parenting behaviors?

Pregnancy and parenting may be psychologically more complex after assisted conception than after spontaneous conception. On the other hand, the literature demonstrates that mothers who conceived with ART comply with transition to parenting easily although they experience more problems in pregnancy and postpartum. This study aimed to compare postpartum parenting behaviors of women who conceived spontaneously or with ART. This descriptive, cross-sectional and comparative study was conducted between October 2017 and June 2018 in Dokuz Eylul University postpartum clinic with 50 spontaneous mother and 50 ART mothers. After a brief explanation of the study, the personal information form was applied to women and the parenting behaviours were observed by using Postpartum Parenting Behavior Scale. The total PPBS average score in the ART group was 5.40 ± 1.41 compared with 3.62 ± 2.24 in the comparison group. The ART mother displayed significantly a more positive attitude toward their infant than spontaneous mother (p = 0.00). Also, in six components of PPBS separately it was determined higher score in ART group, respectively (p = 0.04, p = 0.00, p = 0.00, p = 0.00, p = 0.00, p = 0.00). Mothers who were conceived with ART exhibit more positive parenting behaviors.

Bronchial Artery Embolization, an Increasingly Used Method for Hemoptysis; Treatment and Avoidance.

OBJECTIVES: Hemoptysis is an alarming symptom. It may cause some severe life-threatening complications. Hypertrophic and fragile bronchial artery causes hemoptysis and occurs mostly in bronchiectasis, sarcoidosis, active or sequelae tuberculosis, aspergilloma, lung cancer or cystic fibrosis. Bronchial artery embolization is one of the angiographic methods used in diagnosis and treatment for years performed by radiologists. Hemoptysis is used mostly in patients with hemoptysis. Using this method, surgical management with high mortality and morbidity rates can be avoided or better conditions for surgery can be provided via stopping hemorrhage before surgery. We aim to share the experiences of our hospital about patients who underwent bronchial artery embolization and compare our results with the literature. METHODS: Thirty-nine patients (29 male, 10 female) underwent angiography-aiming embolization. Pathologies were hemoptysis in 37 patients, Castleman disease in two patients. Embolization was performed in 33 patients; 31 for hemoptysis, two for Castleman disease. Bilateral embolization was performed in six patients. RESULTS: Computed tomography (CT) was helpful in diagnosing the side of bleeding in 91.8% of the patients with hemoptysis. Bronchoscopy was diagnostic in 53% of patients. Polyvinyl alcohol (n=27) was mostly used for embolization. Hemoptysis recurred in six patients (19.3%). All were managed successfully, of four with re-embolization. One major complication, transient blindness, was observed. CONCLUSION: Bronchial artery embolization is minimally invasive, more tolerable compared to surgery can be managed with high success and lower complication rates, especially hemoptysis and in some other situations. It provides time for evaluating the underlying disease and delaying surgery for elective conditions. That is why this method has been used increasingly.

Computed Tomography-guided Transthoracic Core Needle Biopsy of Lung Masses: Technique, Complications and Diagnostic Yield Rate.

OBJECTIVES: Computed tomography-guided core needle biopsy has an important role in the accurate histopathological diagnosis of lung masses. The present study aims to share our results of computed tomography-guided percutaneous core needle biopsy of lung masses. METHODS: A total of 117 patients had computed tomography-guided percutaneous core needle biopsy for lung masses between January 2017-September 2019 in our institution. In this study, these patients' post-procedural complications, diagnostic-yield-rates and radiological-histopathological correlations were evaluated retrospectively. RESULTS: Complications occurred in 23 (20%) patients (20 (17%) of pneumothorax; 3 (3%) of hemorrhage). Chest-tube-drainage was needed in five (4%) of all patients. No significant difference was found between complication rates and patient gender/age, tumor volume/localization or needle-path-length (p>0.05). In 77 of the 85 (91%) primary-lung-cancer-cases radiological and pathological diagnostic results were correlated. CONCLUSION: Computed tomography-guided core needle biopsy has a high diagnostic yield rate with acceptable complication rates in the diagnosis of lung masses.

Diffusion MR: A New Diagnostic Tool for Elastofibroma Dorsi.

Elastofibroma dorsi is a benign lesion commonly presents as a palpable enlarging mass at the inferior pole of the scapula. Clinical presentation and radiological characteristics are often enough to suggest an accurate diagnosis. Increased awareness of the characteristic appearance and location of these benign lesions will increase radiologic diagnosis and decrease the need for biopsy. Ten patients were admitted with a complaint of asymptomatic or painful subcutaneous masses localized at subscapulary region. Thorax computed tomography, magnetic resonance imaging (MRI) and a new feasible technique in differential diagnosis with malignancy and probable diagnosis of elastofibroma dorsi and diffusion-weighted MRI were used for diagnosis. Surgery was applied to all patients, frozen-section biopsies of the lesions at the preoperative period, and final pathologies were all benign. Totally resection of whole lesions as en-bloc excision without any rest was performed at all patients. Postoperative and follow-up periods were uneventful. Diffusion MRI can play an important role in the future and save the patients, especially medically poor ones, from the potential risks of surgery. Necessary further examinations for probable bilaterally lesions will save the patient from the risk of a second operation.

Effect of nitric oxide synthase inhibitors in acute lung injury due to blunt lung trauma in rats.

BACKGROUND: This study aims to investigate the effects of blunt lung trauma performed in experimental rat model on lung tissue and blood as well as proinflammatory cytokines, oxidant-antioxidant enzymes and histopathological parameters after Ngamma-nitro-L-arginine methyl ester and N-iminoethyl-L-ornithine administration. METHODS: The study included 50 adult male Wistar albino rats (weighing 350 to 400 g). Rats were randomly allocated into four groups. Except in the control, moderate-level pulmonary contusion was created in all other groups. Intraperitoneal saline solution was performed in groups 1 and 2, 25 mg.kg-1 Ngamma-nitro-L-arginine methyl ester in group 3, and 20 mg.kg-1 N-iminoethyl-L-ornithine in group 4. Blood and lung tissues were studied biochemically and histopathologically. RESULTS: Best outcomes were recorded statistically significantly in groups with administration of Ngamma-nitro-L-arginine methyl ester and N-iminoethyl-L-ornithine when malondialdehyde response, mucous and histopathological values were examined. Significant improvement was detected in superoxide dismutase values in the group with administration of competitive nitric oxide synthase inhibitor Ngamma-nitro-L-arginine methyl ester. Nitric oxide values were substantially decreased in N-iminoethyl-L-ornithine group, while no significance was detected. CONCLUSION: Free oxygen radicals and lipid peroxidation played a role in pulmonary contusion after blunt lung trauma. According to biochemical and histopathological outcomes, effects of inflammation were decreased and protective effects were formed with administration of both Ngammanitro- L-arginine methyl ester and N-iminoethyl-L-ornithine.

A rare malformation of urinary system: Right ectopic thoracic kidney.

An ectopic kidney is a common developmental anomaly of the urinary system. However, the thoracic kidney (TK) is the rarest state form of an aberrant kidney. The aim of this case report is defining the symptoms in TK diagnosis and constructing a treatment model will promote the best outcomes. These patients come to the physician with the various symptoms, and they could be diagnosed incidentally. In our case, we describe 40 years female patient with severe respiratory problems and upper back pain. In the pulmonary clinic, suspected mass was diagnosed with chest X-ray, and computerized tomography detected nontraumatic nonhernia associated, a truly ectopic TK. Moreover, the thoracic surgeon and urologist team decided to exploration and reconstructed the right ectopic kidney. The 1st month of the control of patient symptoms was disappeared. Overall, TK should be kept in mind in the differential diagnosis of thoracic tumors. Surgical exploration and reconstruction should be thought in patients who have severe respiratory symptoms.

The effect of surface sealants with different filler content on microleakage of Class V resin composite restorations.

OBJECTIVE: Microleakage is still one of the most cited reasons for failure of resin composite restorations. Alternative methods to prevent microleakage have been investigated increasingly. The aim of this study is to evaluate the microleakage in Class V resin composite restorations with or without application of surface sealants with different filler content. MATERIALS AND METHODS: Ninety-six cavities were prepared on the buccal and lingual surfaces with the coronal margins located in enamel and the cervical margins located in dentin. The cavities restored with an adhesive system (Clearfil SE Bond, Kuraray, Tokyo, Japan) and resin composite (Clearfil Majesty ES-2, Kuraray, Tokyo, Japan). Teeth were stored in distilled water for 24 h and separated into four groups according to the surface sealants (Control, Fortify, Fortify Plus, and G-Coat Plus). The teeth were thermocycled (500 cycles, 5-55° C), immersed in basic fuchsine, sectioned, and analyzed for dye penetration using stereomicroscope. The data were submitted to statistical analysis by Kruskal-Wallis and Bonferroni-Dunn test. RESULTS: The results of the study indicated that there was minimum leakage at the enamel margins of all groups. Bonferroni-Dunn tests revealed that Fortify and GC-Coat groups showed significantly less leakage than the Control group and the Fortify Plus group at dentin margins in lingual surfaces (P < 0.05). CONCLUSION: The all surface sealants used in this study eliminated microleakage at enamel margins. Moreover, unfilled or nanofilled surface sealants were the most effective in decreasing the degree of marginal microleakage at dentin margins. However, viscosity and penetrability of the sealants could be considered for sealing ability besides composition.