Epidermal cells differentiated from stem cells from human exfoliated deciduous teeth and seeded onto polyvinyl alcohol/silk fibroin nanofiber dressings accelerate wound repair.

Mesenchymal stem cells (MSCs) or epidermal stem cells (ESCs) may be used as a source of cells for skin wound repair in order to preserve the patient's remaining autologous skin and reduce the wound area and pain. Many studies use MSCs as therapeutic cells for wound healing, but treatment with ESCs instead can speed up wound repair. In additional to therapeutic cells, the biomechanical properties and surface topography of the dressing also affect the speed of wound healing. Silk fibroin (SF) has the property of promoting collagen regeneration to accelerate wound healing. It has made into nanofibers as a wound healing dressing with hydrophilic polyvinyl alcohol (PVA). Methanol-treated PVA-SF dressing (PFSM) is a beadless nanofiber that can mimic the structure of endogenous extracellular matrix. In this study, SHED was first differentiated into ESCs and then effects of SHED and ESCs on wound closure were compared. Differentiation of SHED into ESCs was shown to induce growth factors that reached a maximum on the third day. In vivo, PFSM/ESC showed regeneration of granulation tissue on the third day, and the wound closure percent was 53.49%, which was 1.18-fold higher than PFSM/SHED. Therefore, the differentiation of stem cells into ESCs in advance combined with PFSM dressing can effectively accelerate wound healing in vivo. These findings can be applied to clinical treatment in the future.

Impacts of disease severity on postoperative complications in children with sleep-disordered breathing.

OBJECTIVES/HYPOTHESIS: To investigate the effects of diseases severity on postoperative complications following adenotonsillectomy (T&A) in children with sleep-disordered breathing (SDB). STUDY DESIGN: Retrospective study. METHODS: Children aged <18 years were enrolled and underwent T&A for treating SDB. Polysomnography was used to classify the disease severity: primary snoring (apnea-hypopnea index [AHI] <1), mild (AHI = 1-5), moderate (AHI = 5-10), and severe obstructive sleep apnea [OSA] (AHI ≥10). Postoperative bleeding was graded using a severity scale (level I, self-reported bleeding; level II, requiring inpatient admission; level III, requiring reoperation). Primary bleeding is defined as hemorrhage occurring within the initial 24 postoperative hours. Perioperative respiratory complications are defined as oxygen saturation of less than 90%, 92%, or 95% in the recovery room. Major respiratory complications include laryngospasm, pulmonary edema, pneumonia, and intubation at recovery stage. RESULTS: A total of 610 children were included, of whom 42 (6.9%), eight (1.3%), and six (1.0%) children showed levels I, II, and III postoperative bleeding, respectively. Only one child had primary bleeding. The incidence and timing of postoperative bleeding did not differ significantly for children with different OSA severities. The rate of perioperative respiratory complications ranged from 1.6% to 14.3% on the basis of their definitions. The Cochran-Armitage test supported the trend that perioperative respiratory complications increase with the AHI. Six children developed major respiratory complications, which were not significantly associated with OSA severity. CONCLUSIONS: Children with severe OSA have increased risks of perioperative respiratory complications. However, OSA severity does not influence major respiratory complications or postoperative bleeding in children. LEVEL OF EVIDENCE: 4. Laryngoscope, 127:2646-2652, 2017.

Eliciting Cervical Vestibular-Evoked Myogenic Potentials by Bone-Conducted Vibration via Various Tapping Sites.

OBJECTIVES: This study compared bone-conducted vibration (BCV) cervical vestibular-evoked myogenic potentials (cVEMPs) via tapping at various skull sites in healthy subjects and patients with vestibular migraine (VM) to optimize stimulation conditions. DESIGN: Twenty healthy subjects underwent a series of cVEMP tests by BCV tapping via a minishaker at the Fz (forehead), Cz (vertex), and inion (occiput) sites in a randomized order of tapping sites. Another 20 VM patients were also enrolled in this study for comparison. RESULTS: All 20 healthy subjects had clear BCV cVEMPs when tapping at the inion (100%) or Cz (100%), but not at the Fz (75%). Mean p13 and n23 latencies from the Cz tapping were significantly longer than those from the Fz tapping, but not longer than those from the inion tapping. Unlike healthy subjects, tapping at the Cz (95%) elicited a significantly higher response rate of present cVEMPs than tapping at the inion (78%) in 20 VM patients (40 ears), because seven of nine VM ears with absent cVEMPs by inion tapping turned out to be present cVEMPs by Cz tapping. CONCLUSIONS: While both inion and Cz tapping elicited 100% response rate of cVEMPs for healthy individuals, Cz tapping had a higher response rate of cVEMPs than inion tapping for the VM group. In cases of total loss of saccular function, cVEMPs could not be activated by either inion or Cz tapping. However, if residual saccular function remains, Cz tapping may activate saccular afferents more efficiently than inion tapping.

Comparison of rigid and flexible endoscopy for removing esophageal foreign bodies in an emergency.

BACKGROUND/PURPOSE: Despite the effectiveness of endoscopies in removing ingested foreign bodies (FBs) impacted in the esophagus, the merits and limitations of flexible endoscopy (FE) and rigid endoscopy (RE) remain unclear. Therefore, this study compares the advantages and disadvantages of both endoscopic procedures from a clinical perspective. METHODS: A retrospective review was made of 273 patients suspected of esophageal FBs in emergency consultations of a tertiary medical referral center from March 2010 to March 2014. All patients received routine physical examinations, otolaryngological examinations, and X-rays of the neck and chest. The door-to-endoscopy time, procedure time, postendoscopic hospital stay, successful removal rates, and complications were analyzed as well. RESULTS: In this study, the most common esophageal FBs were fish and animal bones (76%) in adults and coins (74%) in children. The patients with existing esophageal FBs had significantly more frequent symptoms of dysphagia and signs of linear opacity as detected with lateral neck radiography than those without FB. Additionally, the door-to-endoscopy time, procedure time, and postendoscopic hospital stay was significantly shorter in FE patients than in RE patients. However, both RE and FE patients had high rates of successful FB removal (95%) and low complication rates (2%). CONCLUSION: Both FE and RE remove esophageal FBs successfully, as evidenced by their high success rates, low complication rates, and high detection rates. Although FE under local anesthesia is a less time-consuming procedure for adults, RE under general anesthesia may be preferable for children and can serve as an alternative to FE.

The effect of different patient education methods on quality of bowel cleanliness in outpatients receiving colonoscopy examination.

AIMS: To investigate the effectiveness of an educational film intervention on the quality of bowel cleanliness of outpatients receiving colonoscopy examinations and also to understand the related factors affecting bowel cleanliness. METHOD: This is a quasi-experimental design. One hundred four patients in the experimental group and 114 patients in the control group are the participants in this study. An 8-minute "Preparation for Bowel Cleanliness" educational film was made based on clinical experience and references to related literature. We adopted a valid Aronchick scale evaluate bowel cleanliness. RESULTS: The patients in the experimental group had significantly better bowel cleanliness compared to the control group (80.8% vs. 48.2%, p<.001). Logistic regression showed that the experimental group, gender, and experience with colonoscopy were potentially important factors that may affect bowel cleanliness. CONCLUSIONS: The "Preparation for Bowel Cleanliness" educational film provides simple and easy-to-follow methods for the preparation of cleaning the colon and related information.

Selective effects of head posture on ocular vestibular-evoked myogenic potential (oVEMP) by bone-conducted vibration.

OBJECTIVE: By altering head postures from sitting, supine to head hanging, this study investigated the effects of gravitational force on ocular vestibular-evoked myogenic potential (oVEMP) via either air-conducted sound (ACS) or bone-conducted vibration (BCV) stimuli. METHODS: Twenty healthy volunteers underwent the oVEMP test via ACS or BCV stimuli with the sitting, supine, and head hanging positions on the same day in a randomized order. RESULTS: All subjects had clear BCV oVEMPs in the three head postures. No significant differences existed in terms of mean nI and pI latencies, the nI-pI interval, and asymmetry ratio regardless of various positions. However, the mean nI-pI amplitude with the head hanging position (15.9 ± 6.4 µV) was significantly larger than that with the sitting position (13.8 ± 6.0 µV), but not significantly larger than that with the supine position (14.7 ± 6.1 µV). Nevertheless, such a difference in reflex amplitude does not exist in oVEMPs elicited by ACS stimuli. With the sitting position, mean linear acceleration at the mastoids in response to BCV stimuli was -0.06 ± 0.02, 0.20 ± 0.04 and -0.04 ± 0.02 g along the x-, y-, and z-axis, respectively, which did not differ significantly from those with the head hanging position. CONCLUSION: By altering head postures from sitting to head hanging, gravitational force can exert a selective effect on the reflex amplitude of oVEMPs elicited by BCV stimuli, but not by ACS stimuli. SIGNIFICANCE: Compared to ACS mode, BCV mode can provoke higher response rate, generate earlier and larger waveforms, and be influenced by both dynamic shearing force and static gravitational force to enlarge the reflex amplitude of oVEMPs.

Comparison of head elevation versus rotation methods for eliciting cervical vestibular-evoked myogenic potentials via bone-conducted vibration.

OBJECTIVES: This study investigated the feasibility of the cervical vestibular-evoked myogenic potential (cVEMP) test using bone-conducted vibration (BCV) tapping. DESIGN: Prospective study. STUDY SAMPLE: Initially, 20 healthy volunteers aged 23-38 years underwent cVEMP tests in supine position using head elevation method by BCV tapping at the Fz and inion. On another day, the same subjects underwent cVEMP tests in seated position with head rotation method by BCV tapping at the Fz and inion. Another 20 healthy subjects aged 41-60 years undergoing cVEMP tests by BCV tapping at the inion were also included for comparison. RESULTS: Tapping at the inion (100%) had significantly higher response rate of cVEMPs than tapping at Fz (65-70%), regardless of whether the head was elevated or rotated. Except for mean latencies of p13 and n23, the mean p13-n23 amplitude, corrected amplitude, and asymmetry ratio did not differ significantly between the elevation and rotation methods when cVEMPs were elicited by inion tapping; both methods showed excellent test-retest reliability. CONCLUSIONS: The BCV at the inion is the optimal method for eliciting BCV cVEMPs. These responses can be recorded using either the seated/head rotation method or supine/head elevation method.

Sequence of vestibular deficits in patients with noise-induced hearing loss.

This study utilized audiometry, and cervical vestibular-evoked myogenic potential (cVEMP), ocular VEMP (oVEMP) and caloric tests to investigate the sequence of vestibular deficits in patients with noise-induced hearing loss (NIHL). Thirty patients with NIHL underwent an inner ear test battery. Another 30 normal controls with age- and sex-matched were included for comparison. The abnormal percentages of the audiometry, and cVEMP, oVEMP and caloric tests were 100, 70, 57 and 33 % in NIHL patients, which showed significant differences from 13, 13, 7 and 3 % in normal controls, respectively. A significantly decreasing trend among the four tests, with the sequence of damage from the cochlea, followed by the saccule, utricle, and semicircular canals was noted in NIHL patients, but not in normal controls. In conclusion, the decreasing order of abnormal percentages in the function of the cochlea, saccule, utricle and semicircular canals after chronic noise exposure further supports that the pars inferior (cochlea and saccule) is more vulnerable to noise exposure than the pars superior (utricle and semicircular canals).

Comparison of bone-conducted vibration for eliciting ocular vestibular-evoked myogenic potentials: forehead versus mastoid tapping.

OBJECTIVE: This study compared bone-conducted vibration (BCV) stimuli at forehead (Fz) and mastoid sites for eliciting ocular vestibular-evoked myogenic potentials (oVEMPs). STUDY DESIGN: Prospective study. SETTING: University hospital. METHODS: Twenty healthy subjects underwent oVEMP testing via BCV stimuli at Fz and mastoid sites. Another 50 patients with unilateral Meniere's disease also underwent oVEMP testing. RESULTS: All healthy subjects showed clear oVEMPs via BCV stimulation regardless of the tapping sites. The right oVEMPs stimulated by tapping at the right mastoid had earlier nI and pI latencies and a larger nI-pI amplitude compared with those stimulated by tapping at the Fz and left mastoid. Similar trends were also observed in left oVEMPs. However, the asymmetry ratio did not differ significantly between the ipsilateral mastoid and Fz sites. Clinically, tapping at the Fz revealed absent oVEMPs in 28% of Meniere's ears, which decreased to 16% when tapping at the ipsilesional (hydropic) mastoid site, exhibiting a significant difference. CONCLUSION: Tapping at the ipsilateral mastoid site elicits earlier oVEMP latencies and larger oVEMP amplitudes when compared with tapping at the Fz site. Thus, tapping at the Fz site is suggested to screen for the otolithic function, whereas tapping at the ipsilesional mastoid site is suitable for evaluating residual otolithic function.

Mortality risk factors in patients with Acinetobacter baumannii ventilator: associated pneumonia.

BACKGROUND/PURPOSE: Ventilator-associated pneumonia (VAP) caused by Acinetobacter baumannii has contributed to high mortality rate, prolonged stays in the intensive care unit, and the rapid development of antimicrobial resistance to commonly used antimicrobials. This study sought to determine predictors of mortality and carbapenem resistance for patients with A baumannii VAP. METHODS: We retrospectively reviewed 541 adult patients with A baumannii pneumonia, who were admitted to a medical center between 2005 and 2007; of which 180 (33.3%) had been treated with mechanical ventilation. Of the 180 patients, 98 (54.4%) who survived were categorized as the survivor group, and 82 (45.6%) who died as the mortality group. Eighty-seven (48.3%) with imipenem-sensitive A baumannii VAP were categorized as the IS-AB group, and the remaining 93 (51.7%) with imipenem-resistant VAP as the IR-AB group. RESULTS: Compared with the survivor group, the mortality group had significantly higher Charlson comorbidity index scores, and more neoplastic disease, other sites of infection, bloodstream infections, altered mental status, confusion, urea >7 mmol/L, respiratory rate >30/min, low blood pressure (systolic <90 mmHg or diastolic <60 mmHg), age >65 years (CURB-65) ≥ 3, creatinine > 1.6 mg/dL, C-reactive protein ≥ 100 mg/L, and imipenem resistance. The survivor group had more cases of tracheostomy and diabetes mellitus than the mortality group had. Compared with the IS-AB group, the IR-AB group had higher Charlson comorbidity index scores, longer stays before VAP onset, an increase in other sites of infection, white blood cell count <4/µL or >1.1 × 10(4)/µL, and higher hospital mortality rates. CONCLUSION: Inadequate initial empiric antimicrobial therapy and higher disease severity scores, including CURB ≥ 3 and C-reactive protein ≥ 120 mg/L, were independent risk factors associated with higher mortality rates for A baumannii pneumonia. Length of stay before VAP and white blood cell count <4/µL or >1.1 × 10(4)/µL were independent risk factors for carbapenem resistance.

Predictors of oxygen desaturation in patients undergoing diagnostic bronchoscopy.

BACKGROUND: Oxygen desaturation is not uncommon during bronchoscopy. We sought to identify factors predictive of desaturation during flexible bronchoscopy. METHODS: Over eight months, we enrolled 137 randomly selected patients who were undergoing fiberoptic bronchoscopy at our medical center. The patients' oxygen saturation was monitored on their arrival and during the procedure by finger pulse oximetry. Desaturation was defined as an overall saturation nadir of < 90% or an episode of decreased saturation of 5% from the baseline regardless of whether the patient was receiving supplemental oxygen. RESULTS: The need for oxygen supplementation before the procedure was predictive of a higher rate of desaturation episodes (73.9% vs. 50%, p = 0.036). Although all interventional procedures or their complications can cause desaturation, the specific type of procedure was the most important predictor of desaturation (lavage, 88.9%; washing, 43.8%; brushing, 15.2%; biopsy, 10%). A low peak expiratory flow rate before the procedure seemed to be predictive of a high desaturation rate in patients undergoing lavage or washing during bronchoscopy. CONCLUSION: Our study suggested that age, sex and baseline oxygen saturation were not predictors of desaturation. We should be reminded of the possibility of desaturation during every procedure, especially in patients who need supplemental oxygen before bronchoscopy.