Review of Modern Insulin Pumps and the Perioperative Management of the Type 1 Diabetic Patient for Ambulatory Dental Surgery.

The use of continuous insulin pump systems for effective management of glycemic control in the patient with type 1 diabetes mellitus (T1DM) is steadily increasing. Although the types of devices and their respective manufacturers vary, insulin pumps all utilize similar underlying concepts based on the delivery of exogenous insulin to patients with T1DM in manners that more closely approximate the normal biologic function and performance of the pancreas. As insulin pumps becomes more commonplace and their use more widespread, the sedation or anesthesia provider must ensure familiarity with the basic knowledge of pump function and the various perioperative management considerations. This review provides a concise overview of the pathophysiology of T1DM, introduces foundational aspects of common insulin pump systems, and discusses several general recommendations regarding the perioperative management of insulin pumps during dental surgeries.

Vacuum microwave dehydration decreases volatile concentration and soluble protein content of pea (Pisum sativum L.) protein.

BACKGROUND: Peas are an inexpensive yet nutritious and sustainable source of protein. However, it is challenging to incorporate pea proteins into food formulations owing to their beany or green off-flavours and their limited water solubility. RESULTS: Vacuum microwave dehydration (VMD) of pea protein with an initial moisture content of 425% (dry basis, db) at 2 W g-1 specific microwave energy and 200 Torr vacuum level for 88 min led to an 83% reduction in total volatile compound concentration. VMD processing at high initial moisture contents facilitated the Maillard reaction, enhancing the extent of protein cross-linking, leading to a marked decrease in soluble protein content, to 11 g kg-1 . Reducing the initial moisture content to 56% db greatly retained protein solubility (112-113 g kg-1 ), but it only led to a minor reduction in total volatile compound concentration (2-11% reduction). A high microwave energy (20 W g-1 )-short time (2 min) treatment at 200 Torr vacuum level was found optimal, reducing both volatile levels and soluble protein content by ~50%. CONCLUSION: Evidently, it is difficult to employ VMD without reduction of pea protein solubility and corresponding changing in functionality. Yet, if optimized, VMD has the capability to decrease volatile concentrations while retaining protein solubility. Future sensory analysis should be conducted to determine whether the aforementioned reductions in total volatile compound concentration may have a notable effect on consumer palatability. © 2020 Society of Chemical Industry.

Natural Acidification with Low-pH Fruits and Incorporation of Essential Oil Constituents for Organic Preservation of Unpasteurized Juices.

Essential oil constituents (EOCs) derived from antimicrobial plant extracts can be used for organic preservation of food products. However, the characteristic flavor resulting from EOCs limit the concentration that can be used in high-pH beverages. This work provides an innovative approach of organically preserving a high-pH beverage (watermelon juice) with a natural blend of low-pH fruits (apples and lemons) and EOCs simultaneously. This low-pH fruit blend not only lowers the pH of the food to below critical pH (4.6), but also reduces the potential off-flavors of EOCs, offering a good preservation approach. This was verified using a sensory trial (n = 50) coupled with storage studies and evaluation of various quality parameters using an extreme vertices mixture design with varying proportions of the fruit-base (watermelon juice), the acidulant (apple-lemon juice blend), and the antimicrobial agent (EOC blend). EOC and acidulant containing juices received better sensory scores than those without acidulant, but lower than when EOCs were absent. Microbial load of juices with EOCs after 14 days of storage did not deviate from day 0, while those without EOCs increased 3-fold on a logarithmic scale. Juices containing EOCs also had higher total phenolic content and antioxidant capacity. However, presence of EOCs did not impact pH, total soluble solids, titratable acidity or color, while acidification had significant effects on pH and titratable acidity. Optimum composition of juice formulations were prescribed according to a multi-parameter optimization algorithm. We concluded that the process of natural acidification (with apple-lemon juice blend) coupled with antimicrobial plant extracts is successful in extending the shelf-life of fruit juices with minimal effects on quality/sensory parameters. PRACTICAL APPLICATION: This research proposes using a unique method for organic preservation of juices using very small amounts of essential oil constituents and acidification. Off-flavors that may arise can be mitigated without the use of chemical additives, but rather with a blend of tart fruit juices, such as apple and lemon juices. The EOCs and the acidulant act synergistically as a hurdle to inhibit microbial growth, so that thermal processing does not need to be employed.

ASD and VSD Flow Dynamics and Anesthetic Management.

Atrial septal defects and ventricular septal defects are often encountered in patients presenting for treatment under anesthesia. The flow mechanisms for both defects are predominantly left to right shunting prior to long-term maladaptive changes that may occur. Close examination of the shunt dynamics demonstrates a minor right to left shunt that occurs as well. The article discusses these dynamics and the impact on an anesthetic plan.

Ovarian fibromas and fibrothecomas: sonographic correlation with computed tomography and magnetic resonance imaging: a 5-year single-institution experience.

OBJECTIVES: To evaluate imaging characteristics of ovarian fibromas and fibrothecomas and to identify select clinical markers and imaging features to help in their diagnosis. METHODS: Over a 5-year period, 18 of 29 women with histologically proven fibromas or fibrothecomas underwent sonography, computed tomography (CT), or magnetic resonance imaging (MRI). On review of the images, tumor size, solid component characteristics, and cystic components were evaluated. Age, cancer antigen 125 (CA-125), and Meig syndrome were assessed. RESULTS: Eleven fibrothecomas and 7 fibromas were evaluated. Sonography was performed for 15 tumors, CT for 9, and MRI for 6. Mean age was 52.6 (range, 13-82) years. Mean tumor size was 8.8 (range, 2-18) cm. Seventy-two percent of the tumors were solid, and 28% had cystic components. On sonography, the solid components were isoechoic or hypoechoic compared to the uterus. On CT with contrast, 2 of 8 lesions (25%) showed enhancement. On T1-weighted MRI, 5 lesions (83%) showed an isointense signal, and 1 (17%) showed a hyperintense signal compared to the myometrium. On T2-weighted MRI, 4 of 6 lesions (67%) were hypointense; 1 (16.5%) was isointense; and 1 (16.5%) was hyperintense. Elevated CA-125 was present in 5 of 29 patients (28%). One had Meig syndrome. CONCLUSIONS: For a cystic adnexal mass where the primary consideration is commonly an epithelial tumor, the possibility of a cystic stromal tumor should also be considered. Unlike previous studies reporting both T1 and T2 hypointensity, fibrothecomas and fibromas can also show T1 and T2 isointensity and, exceptionally, hyperintensity. Vascularity, shown by Doppler flow and MRI and CT enhancement, is a characteristic of some fibromas and fibrothecomas. Although CA-125 is elevated in some patients, a true correlation is difficult to assess. Meig syndrome is infrequent.

A comparison of fospropofol to midazolam for moderate sedation during outpatient dental procedures.

Moderate intravenous (IV) sedation combined with local anesthesia is common for outpatient oral surgery procedures. An ideal sedative agent must be safe and well tolerated by patients and practitioners. This study evaluated fospropofol, a relatively new sedative/hypnotic, in comparison to midazolam, a commonly used benzodiazepine, for IV moderate sedation during oral and maxillofacial surgery. Sixty patients were randomly assigned to either the fospropofol or the midazolam group. Each participant received 1 µg/kg of fentanyl prior to administration of the selected sedative. Those in the fospropofol group received an initial dose of 6.5 mg/kg, with 1.6 mg/kg supplemental doses as needed. Those in the midazolam group received initial doses of 0.05 mg/kg, followed by 0.02 mg/kg supplemental doses. The quality of sedation in each patient was evaluated with regard to (a) onset of sedation, maintenance, and recovery profile; (b) patient and surgeon satisfaction; and (c) hemodynamic stability and adverse effects. The fospropofol group demonstrated shorter physical recovery times than midazolam patients, taking a mean of 11.6 minutes versus 18.4 minutes for physical recovery (P = .007). Cognitive recovery comparison did not find any difference with a mean of 7.5 minutes versus 8.8 minutes between the 2 drug groups (P = .123). The fospropofol group had a higher rate of local anesthetic injection recall (90.5 vs 44.4%, P = .004). Other parameters of recall were comparable. Two adverse effects demonstrated significance, with more patients in the midazolam group experiencing tachycardia (48.2 vs 9.4%, P = .001), and more patients in the fospropofol group experiencing perineal discomfort (40.6 vs 0, P < .001). No significant difference was found in any other measures of sedation safety, maintenance, or satisfaction. Fospropofol, when administered intravenously by a dentist anesthesiologist at the indicated dose in this study, appears to be a safe, well-tolerated alternative to midazolam for intravenous moderate sedation during minor oral surgery procedures.

Is segmental enhancement inversion on enhanced biphasic MDCT a reliable sign for the noninvasive diagnosis of renal oncocytomas?

OBJECTIVE: The objective of our study was to retrospectively determine whether segmental enhancement inversion or other CT patterns seen at enhanced biphasic MDCT are predictive for the diagnosis of renal oncocytoma. MATERIALS AND METHODS: Twenty-nine patients with 32 oncocytomas diagnosed by either biopsy or resection who had undergone enhanced biphasic CT between January 2004 and March 2010 were included in this study. Biphasic CT scans were analyzed for the presence of segmental enhancement inversion. Segmental enhancement inversion was defined as a renal mass with two distinctive segments in which the attenuation of the segments changed between the two phases of CT. The masses were further characterized on imaging to determine if any imaging feature is predictive of renal oncocytoma. RESULTS: Of the 32 renal oncocytomas, 16 oncocytomas were eliminated from analysis. These masses were eliminated because they were larger than 4 cm (n = 4), the CT examinations were inadequate (n = 10), or the pathology results were questionable (n = 2). The remaining 16 tumors (mean size, 2.6 cm; range, 1.8-3.9 cm) were included in our study. Only two tumors showed distinct segments of variable degrees of enhancement, with one of those tumors having segmental enhancement inversion. Three masses had a central region of low density. The most common feature, identified in eight of the 16 oncocytomas, was a slightly heterogeneous mass that became homogeneous on the later phase of CT. Three oncocytomas had a homogeneous appearance on both phases. CONCLUSION: Contrary to a prior report, we did not find segmental enhancement inversion to be a characteristic enhancement pattern of small renal oncocytomas on biphasic MDCT. We found no specific features on biphasic CT that could be considered reliable and could strongly suggest the diagnosis of renal oncocytoma.

Rib head protrusion into the central canal in type 1 neurofibromatosis.

BACKGROUND: Intraspinal rib head dislocation is an important but under-recognized consequence of dystrophic scoliosis in patients with neurofibromatosis 1 (NF1). OBJECTIVE: To present clinical and imaging findings of intraspinal rib head dislocation in NF1. MATERIALS AND METHODS: We retrospectively reviewed clinical presentation, imaging, operative reports and post-operative courses in four NF1 patients with intraspinal rib head dislocation and dystrophic scoliosis. We also reviewed 17 cases from the English literature. RESULTS: In each of our four cases of intraspinal rib head dislocation, a single rib head was dislocated on the convex apex of the curve, most often in the mid- to lower thoracic region. Cord compression occurred in half of these patients. Analysis of the literature yielded similar findings. Only three cases in the literature demonstrates the MRI appearance of this entity; most employ CT. All of our cases include both MRI and CT; we review the subtle findings on MRI. CONCLUSION: Although intraspinal rib head dislocation is readily apparent on CT, sometimes MRI is the only cross-sectional imaging performed. It is essential that radiologists become familiar with this entity, as subtle findings have significant implications for surgical management.

Meniscal Ossicle in the Lateral Meniscus: An Unusual Variant of a Rare Entity.

Meniscal ossicles are rare entities of the knee usually involving the medial meniscus. Lateral meniscal ossicles are exceedingly rare. We present a case of a lateral meniscal ossicle found incidentally after trauma. The etiology and characteristic findings on imaging are discussed.

Dynamic intracellular distribution of Eaf2 and its potential involvement in UV-Induced DNA damage response.

Eaf2 encodes a tumor suppressor that plays multiple functions in transcriptional activation, apoptosis, and embryonic development. In this study, we utilized GFP-EAF2 fusion protein to describe the dynamic subcellular movement of Eaf2. GFP-EAF2 is preferentially localized to the nucleus, and in the presence of ELL, it accumulates in nuclear speckles. However, Eaf2 is an unstable nuclear protein whose stability is affected by serum. Further, we provided first evidence that nuclear distribution of Eaf2 is responsive to DNA damage. Following UV irradiation, Eaf2 is relocalized to the nucleolus, suggesting a possible functional involvement of Eaf2 in DNA damage response.