In-vitro external fixation pin-site model proof of concept: A novel approach to studying wound healing in transcutaneous implants

External fixation is an essential surgical technique for treating trauma, limb lengthening and deformity correction, however infection is common, with infection rates ranging from 4.5 to 100% of cases. Throughout the literature researchers and clinicians have highlighted a relationship between excessive movement of the pin and skin and an increase in the patient's risk of infection, however, currently no studies have addressed this role of pin-movement on pin-site wounds. This preliminary study describes a novel in vitro pin-site model, developed using a full-thickness human skin equivalent (HSE) model in conjunction with a bespoke mechanical system which simulates pin-movement. The effect of pin-movement on the wound healing response of the skin equivalents was assessed by measuring the expression of pro-inflammatory cytokines. Six human skin equivalent models were divided into three test groups: no pin as the control, static pin-site wound and dynamic pin-site wound (n = 3). On day 3 concentrations of IL-1α and IL-8 showed a significant increase compared to the control when a static fixation pin was implanted into the skin equivalent (p < 0.05) and (p < 0.005) respectively. Levels of IL-1α and IL-8 increased further in the dynamic sample compared to the static sample (p < 0.05) and (p < 0.0005). This study demonstrates for the first time the application of HSE model to study external-fixation pin-movement in vitro. The results of this study demonstrated pin-movement has a negative effect on soft-tissue wound-healing, supporting the anecdotal evidence reported in the literature, however further analysis of wound heading would be required to verify this hypothesis.

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

BACKGROUND

Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications.

METHODS

We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC).

FINDINGS

In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]).

INTERPRETATION

In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required.

FUNDING

British Journal of Surgery Society.

Association between genetic and socioenvironmental risk for schizophrenia during upbringing in a UK longitudinal cohort

BACKGROUND

Associations of socioenvironmental features like urbanicity and neighborhood deprivation with psychosis are well-established. An enduring question, however, is whether these associations are causal. Genetic confounding could occur due to downward mobility of individuals at high genetic risk for psychiatric problems into disadvantaged environments.

METHODS

We examined correlations of five indices of genetic risk [polygenic risk scores (PRS) for schizophrenia and depression, maternal psychotic symptoms, family psychiatric history, and zygosity-based latent genetic risk] with multiple area-, neighborhood-, and family-level risks during upbringing. Data were from the Environmental Risk (E-Risk) Longitudinal Twin Study, a nationally-representative cohort of 2232 British twins born in 1994-1995 and followed to age 18 (93% retention). Socioenvironmental risks included urbanicity, air pollution, neighborhood deprivation, neighborhood crime, neighborhood disorder, social cohesion, residential mobility, family poverty, and a cumulative environmental risk scale. At age 18, participants were privately interviewed about psychotic experiences.

RESULTS

Higher genetic risk on all indices was associated with riskier environments during upbringing. For example, participants with higher schizophrenia PRS (OR = 1.19, 95% CI = 1.06-1.33), depression PRS (OR = 1.20, 95% CI = 1.08-1.34), family history (OR = 1.25, 95% CI = 1.11-1.40), and latent genetic risk (OR = 1.21, 95% CI = 1.07-1.38) had accumulated more socioenvironmental risks for schizophrenia by age 18. However, associations between socioenvironmental risks and psychotic experiences mostly remained significant after covariate adjustment for genetic risk.

CONCLUSION

Genetic risk is correlated with socioenvironmental risk for schizophrenia during upbringing, but the associations between socioenvironmental risk and adolescent psychotic experiences appear, at present, to exist above and beyond this gene-environment correlation.

High Work Demands and Depression: The Moderating Role of the Serotonin Transporter Gene (5-HTT) and Work Control

Background:

High work demands (i.e. a heavy workload, tight time pressures, conflicting work tasks) put individuals at high risk of depression. Our aim was to test whether the relationship between high work demands and depression is moderated by genetic vulnerability to depression and by work control.

Methods:

Participants are members of the Dunedin Study, a 1972-73 longitudinal birth cohort assessed most recently in 2004-2005, at age 32 (96% response rate). This analysis included all participants who were employed at age 32. Depression was measured using the Diagnostic Interview Schedule. Work demands and work control were assessed in an interview. Genetic vulnerability to stress was ascertained by the serotonin transporter gene (5-HTT).

Results:

Among individuals exposed to high work demands, symptoms of depression were significantly higher among those who carried two short alleles of the 5-HTT gene (‘s/s’ group) than among ‘l’ carriers (interaction between 5-HTT gene and work demands: β=4.22, se=1.86, p=0.02). However, this gene-environment interaction was only present among those individuals who had low control over their work (interaction between 5-HTT gene and high work demands: β: 7.21, se: 2.73, p=0.009), not among those who had high work control (interaction between 5-HTT gene and high work demands: β: 1.32, se: 2.53, p=0.60).

Conclusion:

Pending replication, the serotonin transporter gene appears to moderate the effects of high work demands on symptoms of depression. This gene-environment interaction is attenuated by high work control.

Spatially distributed delay line interferometer based on transmission Bragg scattering

A novel approach for a delay line interferometer (DLI) based on transmission Bragg scattering is proposed. We have numerically and experimentally demonstrated for the first time, to the best of our knowledge, that a Bragg grating (BG) can deliver the functionality of a DLI in its transmission mode along a single common interfering optical path, instead of the conventional DLI implementation with two interfering optical paths. As a proof of concept, phase-modulated fiber BGs have been designed and fabricated, showing the desired functionality in the transmission mode of the BG. The proposed approach is applicable to any kind of BG technology, such as volume BGs, dielectric mirrors, silicon photonics, and other optical waveguide-based Bragg structures.

Genetics and Crime: Integrating New Genomic Discoveries Into Psychological Research About Antisocial Behavior

Drawing on psychological and sociological theories of crime causation, we tested the hypothesis that genetic risk for low educational attainment (assessed via a genome-wide polygenic score) is associated with criminal offending. We further tested hypotheses of how polygenic risk relates to the development of antisocial behavior from childhood through adulthood. Across the Dunedin and Environmental Risk (E-Risk) birth cohorts of individuals growing up 20 years and 20,000 kilometers apart, education polygenic scores predicted risk of a criminal record with modest effects. Polygenic risk manifested during primary schooling in lower cognitive abilities, lower self-control, academic difficulties, and truancy, and it was associated with a life-course-persistent pattern of antisocial behavior that onsets in childhood and persists into adulthood. Crime is central in the nature-nurture debate, and findings reported here demonstrate how molecular-genetic discoveries can be incorporated into established theories of antisocial behavior. They also suggest that improving school experiences might prevent genetic influences on crime from unfolding.

Compact assembly-free vector bend sensor based on all-in-fiber-core Mach-Zehnder interferometer

A novel low-cost, compact, assembly-free and sensitive optical fiber curvature sensor is presented. This device consists of an off-axis positive refractive index modified zone (PRIMZ), induced by a direct femtosecond laser, written in a single-mode fiber (SMF) core. The PRIMZ transforms the original SMF section into a few-mode fiber (FMF). As a result, the whole fiber forms an assembly-free "SMF-FMF-SMF" sandwich Mach-Zehnder interferometer. When the device is bent, a direction-dependent spectral shift of the interference pattern is produced. The sensitivity of the sensor is up to 2.53 and 2.24  nm/m^-1 for the 0° and 180° orientations in a wide bend range (from 0 to 4  m^-1). In addition, the device is immune to the surrounding refractive index and has a low-temperature crosstalk, which makes it very attractive for practical structural monitoring applications.

Ultra-compact all-in-fiber-core Mach-Zehnder interferometer

Optical Mach-Zehnder interferometers (MZIs) are useful components in a variety of optical applications, including optical modulation; signal processing; and physical, chemical, and biological sensing. We introduce here a novel, assembly-free all-in-fiber-core MZI, which is directly written with a femtosecond laser. By introducing a positive refractive index-modified zone in half of the fiber core, the original single-mode fiber section is converted into a few-mode fiber section, where a strong coupling between the two lowest-order guided modes is generated, resulting in a well-defined interference spectrum in transmission. This device promises many significant advantages over existing approaches such as ease of fabrication, stability, small insertion loss, robustness extremely broad operating bandwidth, and precise and controllable cavity lengths. These advantages make this device strikingly attractive with the potential for extensive adoption in fiber communications, signal processing, sensors, and laser wavelength control.

High-sensitivity and large-dynamic-range refractive index sensors employing weak composite Fabry-Perot cavities

Most sensors face a common trade-off between high sensitivity and a large dynamic range. We demonstrate here an all-fiber refractometer based on a dual-cavity Fabry-Perot interferometer (FPI) that possesses the advantage of both high sensitivity and a large dynamic range. Since the two composite cavities have a large cavity length difference, one can observe both fine and coarse fringes, which correspond to the long cavity and the short cavity, respectively. The short-cavity FPI and the use of an intensity demodulation method mean that the individual fine fringe dips correspond to a series of quasi-continuous highly sensitive zones for refractive index measurement. By calculating the parameters of the composite FPI, we find that the range of the ultra-sensitive zones can be considerably adjusted to suit the end requirements. The experimental trends are in good agreement with the theoretical predictions. The co-existence of high sensitivity and a large dynamic range in a composite FPI is of great significance to practical RI measurements.

Ultra-sensitive refractive index sensor based on an extremely simple femtosecond-laser-induced structure

We demonstrate here an extremely simple, compact, and robust refractive index (RI) probe sensor based on a femtosecond-laser induced refractive index-modified dot (RIMD) fabricated near the end face of a single-mode fiber. The RIMD and the fiber end face form a Fabry-Perot interferometer, which is highly sensitive to surrounding RI. The fabrication process of the RIMD involves only one step and takes ∼0.1  s, which is extremely short, compared with other techniques. The proposed sensor exhibits an ultra-high sensitivity of ∼2523.2  dB/RIU at an RI of 1.435, which is one to two orders of magnitude higher than that of the existing intensity-modulated RI sensors. Moreover, the proposed sensor has the distinct advantages of compact size (∼50  μm), easy fabrication, and no temperature cross-sensitivity. The advantages of the device make it a promising candidate for applications in designing highly sensitive sensors in a biochemical and environmental measurement field.

Developments in contact lens measurement: A comparative study of industry standard geometric inspection and optical coherence tomography

PURPOSE

The aim of this study was to compare a developmental optical coherence tomography (OCT) based contact lens inspection instrument to a widely used geometric inspection instrument (Optimec JCF), to establish the capability of a market focused OCT system.

METHODS

Measurements of 27 soft spherical contact lenses were made using the Optimec JCF and a new OCT based instrument, the Optimec is830. Twelve of the lenses analysed were specially commissioned from a traditional hydrogel (Contamac GM Advance 49%) and 12 from a silicone hydrogel (Contamac Definitive 65), each set with a range of back optic zone radius (BOZR) and centre thickness (CT) values. Three commercial lenses were also measured; CooperVision MyDay (Stenfilcon A) in -10D, -3D and +6D powers. Two measurements of BOZR, CT and total diameter were made for each lens in temperature controlled saline on both instruments.

RESULTS

The results showed that the is830 and JCF measurements were comparable, but that the is830 had a better repeatability coefficient for BOZR (0.065mm compared to 0.151mm) and CT (0.008mm compared to 0.027mm). Both instruments had similar results for total diameter (0.041mm compared to 0.044mm).

CONCLUSIONS

The OCT based instrument assessed in this study is able to match and improve on the JCF instrument for the measurement of total diameter, back optic zone radius and centre thickness for soft contact lenses in temperature controlled saline.

Convergent translational evidence of a role for anandamide in amygdala-mediated fear extinction, threat processing and stress-reactivity

Endocannabinoids are released 'on-demand' on the basis of physiological need, and can be pharmacologically augmented by inhibiting their catabolic degradation. The endocannabinoid anandamide is degraded by the catabolic enzyme fatty acid amide hydrolase (FAAH). Anandamide is implicated in the mediation of fear behaviors, including fear extinction, suggesting that selectively elevating brain anandamide could modulate plastic changes in fear. Here we first tested this hypothesis with preclinical experiments employing a novel, potent and selective FAAH inhibitor, AM3506 (5-(4-hydroxyphenyl)pentanesulfonyl fluoride). Systemic AM3506 administration before extinction decreased fear during a retrieval test in a mouse model of impaired extinction. AM3506 had no effects on fear in the absence of extinction training, or on various non-fear-related measures. Anandamide levels in the basolateral amygdala were increased by extinction training and augmented by systemic AM3506, whereas application of AM3506 to amygdala slices promoted long-term depression of inhibitory transmission, a form of synaptic plasticity linked to extinction. Further supporting the amygdala as effect-locus, the fear-reducing effects of systemic AM3506 were blocked by intra-amygdala infusion of a CB1 receptor antagonist and were fully recapitulated by intra-amygdala infusion of AM3506. On the basis of these preclinical findings, we hypothesized that variation in the human FAAH gene would predict individual differences in amygdala threat-processing and stress-coping traits. Consistent with this, carriers of a low-expressing FAAH variant (385A allele; rs324420) exhibited quicker habituation of amygdala reactivity to threat, and had lower scores on the personality trait of stress-reactivity. Our findings show that augmenting amygdala anandamide enables extinction-driven reductions in fear in mouse and may promote stress-coping in humans.

Exposure to violence during childhood is associated with telomere erosion from 5 to 10 years of age: a longitudinal study

There is increasing interest in discovering mechanisms that mediate the effects of childhood stress on late-life disease morbidity and mortality. Previous studies have suggested one potential mechanism linking stress to cellular aging, disease and mortality in humans: telomere erosion. We examined telomere erosion in relation to children's exposure to violence, a salient early-life stressor, which has known long-term consequences for well-being and is a major public-health and social-welfare problem. In the first prospective-longitudinal study with repeated telomere measurements in children while they experienced stress, we tested the hypothesis that childhood violence exposure would accelerate telomere erosion from age 5 to age 10 years. Violence was assessed as exposure to maternal domestic violence, frequent bullying victimization and physical maltreatment by an adult. Participants were 236 children (49% females; 42% with one or more violence exposures) recruited from the Environmental-Risk Longitudinal Twin Study, a nationally representative 1994-1995 birth cohort. Each child's mean relative telomere length was measured simultaneously in baseline and follow-up DNA samples, using the quantitative PCR method for T/S ratio (the ratio of telomere repeat copy numbers to single-copy gene numbers). Compared with their counterparts, the children who experienced two or more kinds of violence exposure showed significantly more telomere erosion between age-5 baseline and age-10 follow-up measurements, even after adjusting for sex, socioeconomic status and body mass index (B=-0.052, s.e.=0.021, P=0.015). This finding provides support for a mechanism linking cumulative childhood stress to telomere maintenance, observed already at a young age, with potential impact for life-long health.

Experimental demonstration of an optical differentiator based on a fiber Bragg grating in transmission

We report the first experimental demonstration of single transmissive fiber Bragg grating implementation of a first-order optical differentiation. The device has been designed and fabricated, and the experimental results show a good performance over an operational bandwidth of ~2 nm.

Proposal and design of phase-modulated fiber gratings in transmission for pulse shaping

An approach to pulse shaping using a phase-modulated fiber Bragg grating (FBG) in transmission is proposed and designed. We show that phase-modulated FBGs can provide transmission responses suitable for pulse shaping applications, offering important technological feasibility benefits, since the coupling strength remains basically uniform in the grating. Moreover, this approach retains the substantial advantages of FBGs in transmission, such as optimum energy efficiency, no requirement for an optical circulator, and robustness against fabrication errors.

Ultra Small Integrated Optical Fiber Sensing System

This paper introduces a revolutionary way to interrogate optical fiber sensors based on fiber Bragg gratings (FBGs) and to integrate the necessary driving optoelectronic components with the sensor elements. Low-cost optoelectronic chips are used to interrogate the optical fibers, creating a portable dynamic sensing system as an alternative for the traditionally bulky and expensive fiber sensor interrogation units. The possibility to embed these laser and detector chips is demonstrated resulting in an ultra thin flexible optoelectronic package of only 40 μm, provided with an integrated planar fiber pigtail. The result is a fully embedded flexible sensing system with a thickness of only 1 mm, based on a single Vertical-Cavity Surface-Emitting Laser (VCSEL), fiber sensor and photodetector chip. Temperature, strain and electrodynamic shaking tests have been performed on our system, not limited to static read-out measurements but dynamically reconstructing full spectral information datasets.

Complications following interventional laser surgery for oral cancer and precancerous lesions

Interventional carbon dioxide laser surgery is the preferred method to treat oral precancerous lesions and early invasive squamous cell carcinomas (SCCs). Little is known, however, about the complications that patients experience after such treatment. We retrospectively reviewed the hospital records of 82 patients with new dysplastic oral lesions or early invasive oral SCCs treated by laser surgery in the maxillofacial unit at Newcastle General Hospital. The most common postoperative complications were pain for more than two weeks after operation (n=28), bleeding (n=4), difficulties with speech (n=5), paraesthesia of the lingual nerve (n=17), difficulty swallowing (n=2), obstructive swelling of the submandibular gland (n=22), and tethering of the tongue (n=10). Overall, 78% of patients had one or more complication. In the absence of randomised controlled trials, this study provides the best available evidence for complication rates following interventional surgery. In addition to aiding in the preoperative counselling of patients, the data will help to inform and advise patients particularly during the immediate postoperative period.

Optically controlled tunable dispersion compensators based on pumped fiber gratings

We demonstrate optically tunable dispersion compensators based on pumping fiber Bragg gratings made in Er/Yb codoped fiber. The tunable dispersion for a chirped grating and also a uniform-period grating was successfully demonstrated in the experiment. The dispersion of the chirped grating was tuned from 900 to 1990 ps/nm and also from -600 to -950 ps/nm in the experiment.

Femtosecond laser micro-inscription of optical coherence tomography resolution test artifacts

Optical coherence tomography (OCT) systems are becoming more commonly used in biomedical imaging and, to enable continued uptake, a reliable method of characterizing their performance and validating their operation is required. This paper outlines the use of femtosecond laser subsurface micro-inscription techniques to fabricate an OCT test artifact for validating the resolution performance of a commercial OCT system. The key advantage of this approach is that by utilizing the nonlinear absorption a three dimensional grid of highly localized point and line defects can be written in clear fused silica substrates.

Processing and rendering of Fourier domain optical coherence tomography images at a line rate over 524 kHz using a graphics processing unit

In Fourier domain optical coherence tomography (FD-OCT), a large amount of interference data needs to be resampled from the wavelength domain to the wavenumber domain prior to Fourier transformation. We present an approach to optimize this data processing, using a graphics processing unit (GPU) and parallel processing algorithms. We demonstrate an increased processing and rendering rate over that previously reported by using GPU paged memory to render data in the GPU rather than copying back to the CPU. This avoids unnecessary and slow data transfer, enabling a processing and display rate of well over 524,000 A-scan∕s for a single frame. To the best of our knowledge this is the fastest processing demonstrated to date and the first time that FD-OCT processing and rendering has been demonstrated entirely on a GPU.

Characterisation and performance of a Terfenol-D coated femtosecond laser inscribed optical fibre Bragg sensor with a laser ablated microslot for the detection of static magnetic fields

We present a novel device for the characterisation of static magnetic fields through monitoring wavelength shifts of femtosecond inscribed fibre Bragg grating and micromachined slot, coated with Terfenol-D. The device was sensitive to static magnetic fields and can be used as a vectoral sensor for the detection of magnetic fields as low as 0.046 mT with a resolution of ± 0.3mT in transmission and ± 0.7mT in reflection. The use of a femtosecond laser to both inscribe the FBGs and micromachine the slot in a single stage prior to coating the device significantly simplifies the fabrication.

Housekeeping gene expression is affected by antidepressant treatment in a mouse fibroblast cell line

Quantitative real-time polymerase chain reaction (PCR) is an effective approach in investigating the effects of exogenous compounds on gene expression. This is often achieved by exploiting so-called 'housekeeping' genes as baseline controls to normalise expression levels, which have historically been assumed to have a relatively stable expression pattern. Recent non-in-vitro studies have questioned the validity of this, but previous in-vitro data were lacking following antidepressant treatment. We here investigated the stability of 12 housekeeping genes during treatment of the mouse L929 fibroblast cell line with escitalopram and nortriptyline. Cells were cultured in the presence of antidepressant at 1 microM or 10 microM for 30 min, 24 h or 48 h, and RNA subjected to quantitative PCR (qPCR). Stability of relative transcript expression values was assessed via gene-gene expression ratios and intra- and inter-group variation (using geNorm and NormFinder programs). The three most stable transcripts were adenosine triphosphate (ATP) synthase, H+ transporting mitochondrial F1 complex, beta subunit, beta-2 microglobulin and cytochrome c-1. The least stable were Gapdh, eukaryotic translation initiation factor 4A2 and Calnexin (Canx). In conclusion, care must be taken when choosing reference transcripts for analysis in qPCR. For in-vitro pharmacological studies, it should not be assumed that 'housekeeping' genes are stable.

Novel complex gratings with third-order group-delay variations for tunable pure dispersion slope compensation

We present a novel tunable dispersion compensator that can provide pure slope compensation. The approach uses two specially designed complex fiber Bragg gratings (FBGs) with reversely varied third-order group delay curves to generate the dispersion slope. The slope can be changed by adjusting the relative wavelength positions of the two FBGs. Several design examples of such complex gratings are presented and discussed. Experimentally, we achieve a dispersion slope tuning range of +/- 650 ps/nm(2) with > 0.9 nm usable bandwidth.