The effect of preventive oral care on postoperative infections after head and neck cancer surgery.

OBJECTIVE: This study aimed to investigate the incidence of postoperative pneumonia (PP) and surgical site infection (SSI) in head and neck cancer (HNC) patients and clarify the relationship between oral care and postoperative infection. METHODS: We conducted a retrospective observation survey based on the medical records of 209 HNC surgery patients managed at a University Hospital in 2016-2018. The incidence of PP and SSI were assessed in patients who underwent operations of the nose and paranasal sinuses to the larynx. Factors associated with PP and SSI in a univariate analysis were included in a multiple logistic regression analysis. A Cox proportional hazards model was used analyze the incidence of PP according to time after surgery. The present study was approved by the ethical review board of our Institute. RESULTS: The rates of PP and SSI in our study population were 20.5% and 23.0%. Operative time (P < 0.01), blood loss (P = 0.004), tracheostomy (P < 0.01), reconstruction (P < 0.01), and preoperative plaque control record (PCR) (P < 0.01) were significantly associated with PP. The PCR depicted the oral hygiene based on the percentage of plaque attached to the tooth neck. A multiple logistic regression analysis indicated that the incidence of PP was significantly higher in patients with PCR values of ≥50% after preoperative oral care (OR=10.174, 95% CI 2.14-48.32, P = 0.004). Tracheostomy (P < 0.01), reconstruction (P = 0.044), a lower preoperative albumin level (P = 0.019), and a lower preoperative hemoglobin level (P < 0.01) were significantly associated with SSI. CONCLUSIONS: The incidence of PP among patients who received oral care was high in those patients with high PCR values, indicating the importance of increasing compliance to preoperative oral care.

Functional disturbance of the stress-adaptation system in patients with scleroderma.

There have been several reports indicating the association between recent stress experiences and the onset or the exacerbation of rheumatic diseases, although few such reports exist in patients with scleroderma (SSc). The present study was performed to elucidate whether there were any functional disturbances in the neuro-endocrine-immune system as a homeostatic system upon stress in SSc patients. Various serum levels of stress-related hormones and cytokines were examined before and after a mental calculation stress test, and a basal questionnaire study of sense of coherence (SOC, which is related to the ability to cope with stress), recent stress experiences, and quality of life (QOL) was performed in 17 SSc patients and in 38 healthy volunteers. Physical QOL state was impaired in patients, but there were no differences in recent stress experiences and SOC scores between patients and controls. Basal serum cortisol levels were similar in patients and controls, but increased levels of proinflammatory cytokine and noradrenalin were seen in SSc patients. Characteristically, contrary to the control group, whose cortisol levels increased significantly following the mental calculation stress test, no significant increase was observed in the patients when post-test cortisol levels were compared to pre-test levels, suggesting a defect in the normal cortisol response upon stress in SSc patients. The present results suggest that there may be impaired function of the neuro-endocrine-immune system upon stress in SSc patients.

Correlation between femoral neck version and strain on the femur after insertion of femoral prosthesis.

Stress analysis on the femur after insertion of a femoral prosthesis with a modular interchangeable neck with adjustable neck version was performed using in vitro experimental procedures and cemented strain gauges. Although strain on the anterior and posterior aspects was less than on the medial and lateral aspects, it was more markedly affected by adjusting the interchangeable neck from straight to anteverted (or retroverted) than strain on the medial and lateral aspects, particularly around the stem tip. There was a highly significant correlation between compressive strain on the side toward which the prosthetic neck was oriented and the extent of neck version, whether anteverted or retroverted. Insertion of a femoral implant in excessive anteversion (or retroversion) may cause noticeably increased stress on the anterior and posterior aspects of the proximal femoral shaft.

Sabedoria na saúde: diálogo sobre saúde. Um novo século de saúde: o budismo e a arte da medicina / Wisdom in the health: dialogue on health. A new century of health: the buddhism and the art of the medicine

Apresenta diálogos sobre saúde com base nas perspectivas médicas e budista entre o presidente da Soka Gakkai Internacional - SGI - Daisaku Ikeda, e o coordenadors da Divisão de Médicos da SGI, Shuhei Morita e Hiroyuki Toyofuku, cujos respectivos campos de especialidade são cirurgia e medicina interna

Sabedoria na saúde: diálogo sobre saúde. Um novo século de saúde: o budismo e a arte da medicina / Wisdom in the health: dialogue on health. A new century of health: the buddhism and the art of the medicine

Apresenta diálogos sobre saúde com base nas perspectivas médicas e budista entre o presidente da Soka Gakkai Internacional - SGI - Daisaku Ikeda, e o coordenadors da Divisão de Médicos da SGI, Shuhei Morita e Hiroyuki Toyofuku, cujos respectivos campos de especialidade são cirurgia e medicina interna