Management of Gastrointestinal Foreign Bodies with Brief Review of the Guidelines

Foreign body (FB) ingestion is a common health problem that affects children more than adults. According to gastroenterologists' guidelines, the management of FB ingestion differs slightly between adult and children. This review aimed to compile adult and children guidelines and establish an understandable association to reveal the requirements and timing of the endoscopic procedure, which is the most effective and least complicated technique for gastrointestinal FBs. Coins, pins, and chicken and fish bones have been the most commonly ingested FBs. However, with their increasing use in recent years, large batteries with lithium-ion conversion, stronger magnets composed of rare earth metals, such as neodymium, and superabsorbent objects have become the most morbid and mortal, necessitating new management strategies. Although the approach to gastrointestinal FBs is controversial, with different treatment options available in different disciplines, many studies have demonstrated the efficacy and safety of endoscopic procedures. Many factors influence the timing of endoscopy, including the nature, size, and location of the ingested object and the patient's clinical condition.

Stability and success rate of dual-thread miniscrews

OBJECTIVES

To date, the clinical stability of dual-thread orthodontic miniscrews has not been studied. This study aimed to compare the primary stability and long-term clinical success rate of dual-thread and cylindrical orthodontic miniscrews and to examine the association between various clinical factors and the success rate of miniscrews.

MATERIALS AND METHODS

A total of 145 cylindrical and 135 dual-thread miniscrews were inserted in the maxillary and mandibular buccal alveolar areas of 142 patients. The torque and Periotest (Siemens, Bensheim, Germany) values were recorded during insertion and removal. The effect of clinical variables such as sex, age, screw design, jaw, side of placement, root proximity, and site of placement on the success rate was examined using logistic regression analysis.

RESULTS

There was no statistically significant difference (P = .595) in the overall clinical success rate between the two designs, with an overall success rate of 82.1% and 84.4% for the cylindrical and dual-thread miniscrews, respectively. Age and screw-root proximity were significantly associated with failure (P < .05).

CONCLUSIONS

The dual-thread miniscrews did not show superior long-term stability and clinical success rate as compared with the cylindrical miniscrews. The results of this study suggest that patient age and screw-root proximity influence the clinical success rate of miniscrews.

Morphologic design of sugar-based polymer nanoparticles for delivery of antidiabetic peptides

Zwitterionic polymer nanoparticles of diverse morphologies (spherical, cylindrical, and platelet-like) constructed from biocompatible sugar-based polymers are designed to extend the pharmacological activities of short- and long-acting insulin peptides, thereby providing potential for therapeutic systems capable of reducing the frequency of administration and improving patient compliance. Amphiphilic block copolymers composed of zwitterionic poly(d-glucose carbonate) and semicrystalline polylactide segments were synthesized, and the respective block length ratios were tuned to allow formation of nanoscopic assemblies having different morphologies. Insulin-loaded nanoparticles had similar sizes and morphologies to the unloaded nanoparticle counterparts. Laser scanning confocal microscopy imaging of three-dimensional spheroids of vascular smooth muscle cells and fibroblasts after treatment with LIVE/DEAD® stain and FITC-insulin-loaded nanoparticles demonstrated high biocompatibility for the nanoconstructs of the various morphologies and significant intracellular uptake of insulin in both cell lines, respectively. Binding of short-acting insulin and long-acting insulin glargine to nanoparticles resulted in extended hypoglycemic activities in rat models of diabetes. Following subcutaneous injection in diabetic rats, insulin- and insulin glargine-loaded nanoparticles of diverse morphologies had demonstrated up to 2.6-fold and 1.7-fold increase in pharmacological availability, in comparison to free insulin and insulin glargine, respectively. All together, the negligible cytotoxicity, immunotoxicity, and minimal cytokine adsorption onto nanoparticles (as have been demonstrated in our previous studies) provide exciting and promising evidence of biocompatible nanoconstructs that are poised for further development toward the management of diabetes.

Optical quality in low astigmatic eyes with or without cylindrical correction

PURPOSE

To investigate whether optical quality could be improved by cylindrical correction for low astigmatic eyes with different amounts and axis orientations in patients with myopia up to - 3.00 diopters (D).

METHODS

A cross-sectional study enrolling healthy young eyes with 0 to - 3.00 D myopia and - 0.50 to - 0.75 D myopic astigmatism was implemented. With a repeated-measures design, outcome measures were sequentially obtained for each subject under two correction modalities: spherocylindrical correction and spherical correction. Subjective refraction was used to determine the refractive prescriptions accordingly in the two correction modalities to obtain optimal subject-reported visual acuity. Primary outcomes were optical quality parameters including objective scatter index (OSI), modulation transfer function (MTF) cut-off, Strehl ratio (SR), and a simulated contrast visual acuity-optical quality analysis system (OQAS) values (OV) obtained by a double-pass system. Corrected distance visual acuity (CDVA) was measured as a secondary outcome. Outcome comparisons between the two correction modalities were performed by grouping in different amounts (- 0.50 D, - 0.75 D) and axes (with the rule, WTR; against the rule, ATR; oblique, OBL) of astigmatism.

RESULTS

A total of 194 eyes of 194 subjects were evaluated. Significantly better CDVA were shown by spherocylindrical correction for all types of astigmatism except for - 0.50 D WTR astigmatism (P = 0.831). For eyes with - 0.50 D WTR astigmatism, better outcome was only shown in OSI with spherocylindrical correction (P = 0.019). For eyes with - 0.50 D ATR and OBL astigmatism, spherocylindrical correction demonstrated better outcomes in all parameters except for SR (P > 0.05). For eyes with - 0.75 D astigmatism, significantly better outcomes in all optical quality parameters were shown with spherocylindrical correction regardless of the axis (P < 0.05).

CONCLUSIONS

Eyes with ATR or OBL myopic astigmatism may benefit in optical quality and visual acuity by combining a cylindrical correction even with a low amount down to - 0.50 D. However, optical quality and visual acuity improvement are limited for WTR astigmatic eyes when the amount of astigmatism is less than - 0.75 D.

Distribution and amount of stresses caused by insertion or removal of orthodontic miniscrews into the maxillary bone: A finite element analysis

OBJECTIVE

Initial stability of miniscrews is an important factor in their success as orthodontic anchorages. One of the factors affecting this stability is the stresses exerted to the bone by the screw. Since the distribution and extent of stresses and strains produced during insertion or removal of miniscrews had not been measured before, this study used finite element analysis (FEA) to measure these parameters in tapered versus cylindrical screws with or without pilot sockets.

MATERIALS AND METHODS

An FEA model of maxilla, pilot hole, and tapered/cylindrical miniscrews were created from 875 CT scan data. The bone cortex was considered 2mm thick. The cancellous bone was reconstructed below the cortical bone. Miniscrews were modelled on the basis of commercial titanium tapered and cylindrical miniscrews (1.6mm wide, 8mm long). The diameter and length of the guiding hole were considered to be 1.1 and 1.5mm, respectively. The miniscrews were inserted (and removed) between the maxillary second premolar and first molar. Stress/strain produced in the bones or screws were measured.

RESULTS

During screw insertion, in all setups, the highest stress existed within both the bone and screw, when the screw was in the cortical bone; after insertion into the cancellous bone, the stress suddenly dropped. In cylindrical screws, the highest amount of stress was distributed around the neck which was used for screw driving. In tapered screws, the stress was mostly distributed around the front one-third of the screw. During screw removal, the results of four setups were rather similar with stresses concentrated around screw necks, in the depth of the screw hole, and around the bone surface. The greatest bone stress during insertion was caused by the pilot-less tapered screw (10.18MPa) and the lowest stress was exerted by a pilot-less cylindrical screw (0.74MPa).

CONCLUSION

Most of the stress and strain is tolerated by the cortical bone and not the cancellous one. Using cylindrical miniscrews might be more bone-friendly. However, all cases had stresses below tolerable thresholds, and hence are safe.

Microdamage generation by tapered and cylindrical mini-screw implants after pilot drilling

OBJECTIVE

To investigate the relationship between mini-screw implant (MSI) diameter (1.6 vs 2.0 mm) and shape (tapered vs cylindrical) and the amount of microdamage generated during insertion.

MATERIALS AND METHODS

Thirty-six cylindrical and 36 tapered MSIs, 6 mm long, were used in this study. Half of each shape was 1.6 mm in diameter, while the other half was 2.0 mm. After pilot drilling, four and five MSIs were inserted, respectively, into fresh cadaveric maxillae and mandibles of dogs. Bone blocks containing the MSIs were sectioned and ground parallel to the MSI axis. Epifluorescent microscopy was used to measure overall cortical thickness, crack length, and crack number adjacent to the MSI. Crack density and total microdamage burden per surface length were calculated. Three-way analysis of variance (ANOVA) was used to test the effects of jaw, and MSI shape and diameter. Pairwise comparisons were made to control the overall significance level at 5%.

RESULTS

The larger (2.0 vs 1.6 mm) cylindrical MSIs increased the numbers, lengths, and densities of microcracks, and the total microdamage burden. The same diameter cylindrical and tapered MSIs generated a similar number of cracks and crack lengths. More total microdamage burden was created by the 2.0-mm cylindrical than the 2.0-mm tapered MSIs. Although higher crack densities were produced by the insertion of 1.6-mm tapered MSIs, there was no difference in total microdamage burden induced by 1.6-mm tapered and 1.6-mm cylindrical MSIs.

CONCLUSIONS

Pilot drilling is effective in reducing microdamage during insertion of tapered MSIs. To prevent excessive microdamage, large diameter and cylindrical MSIs should be avoided.