The prevalence of developmental defects of enamel, a prospective cohort study of adolescents in Western Sweden: a Barn I TAnadvarden (BITA, children in dental care) study

AIM

To describe the prevalence of different types of developmental defects of the enamel (DDE) in varying age-cohorts and habitations, and to analyse if early trauma to the primary teeth and early subsequent serious health problems were related to DDE in the permanent dentition. Dental fear and anxiety, and aesthetic problems as a consequence of DDE were also investigated.

METHODS

DDE was registered over 5 years annually in three age cohorts (796 children). The DDE index (FDI Commision on Oral Health, Research and Epidemiology, Int Dent J 42:411-426, 1992) was used. Information on diseases in early childhood, trauma to the primary teeth, and dental fear and anxiety were collected.

RESULTS

The prevalence of DDE was 33.2% (boys 37.1%, girls 29.3%, p = 0.02). Demarcated opacities (DEO), solely, were the most frequent kind of defect, affecting 18%. Five percent (5%) had diffuse opacities (DIO) and 1% had hypoplasias, whereas 7% had teeth with both DEO and DIO. The most frequently affected teeth of DEO, as well as of DIO, were the first permanent molars and maxillary central incisors. Dental injuries to the primary anterior teeth raised the risk for DDE in the permanent teeth, but early serious health problems did not. Generalised DDE was common (8.4%). The paediatric dentists assessed the DDE in the maxillary anterior teeth as more serious than did the affected children and their parents.

CONCLUSIONS

Generalised DDE was more frequent than expected, as well as the occurrence of both DEO and DIO in the same individual. The first permanent molars and the upper central incisors were the most affected teeth.

An Adverse Event Analysis: Inadvertent Exsanguination Following Left Ventricular Assist Device Implantation in a Child

Neurologic deficit subsequent to cardiac surgery remains a cause of postoperative morbidity and mortality. Although myriad risk factors for postoperative cognitive decline have been identified, their individual influence remains undefined. Although less emphasis is now placed on the heart lung machine as the major source of postoperative cognitive decline, the conduct of cardiopulmonary bypass and, in particular, the management of the bypass circuit remain key to patient safety. We present a case of inadvertent intraoperative exsanguination of a patient following open heart surgery for implantation of a left ventricular assist device. The patient suffered significant neurologic damage. However, the nature of the patient's cerebral injury indicated thromboembolism as the likely cause, rather than hypoxic-ischemic injury caused by hypoperfusion. Subsequent investigation of the incident identified several possible sources and potential causes of embolization to the brain that could not rule out the exsanguination event as a contributing factor.

Atomic structure of defects and dopants in 2D layered transition metal dichalcogenides

Transmission electron microscopy can directly image the detailed atomic structure of layered transition metal dichalcogenides, revealing defects and dopants.

Chronic rhinosinusitis and mood disturbance

BACKGROUND

This study is part of the Chronic Rhinosinusitis Epidemiology Study (CRES). The overarching aim is to determine factors that influence the onset and severity of chronic rhinosinusitis (CRS). The aim of this analysis is to determine whether those with CRS are more likely to report psychiatric morbidity and in particular mood disturbance compared with healthy controls.

METHODS

CRES consists of a study-specific questionnaire regarding demographic and socioeconomic factors and past medical history as well as a nasal symptom score (SNOT-22) and SF-36 (QoL - quality of life tool). Both of these tools contain mental health or emotional well-being domains. Participants were specifically asked whether they had ever consulted with their General Practitioner for anxiety or depression. Questionnaires were distributed to patients with CRS attending ENT outpatient clinics at 30 centres across the United Kingdom from 2007-2013. Controls were also recruited at these sites. Patients were divided into subgroups of CRS according to the absence/presence of polyps (CRSsNPs/CRSwNPs) or allergic fungal rhinosinusitis (AFRS).

RESULTS

Consultations with a family physician for depression or anxiety were higher amongst those with CRS than controls, but this was only significant for those with CRSsNPs. Odds ratio (OR) for CRSsNPs vs controls: 1.89; OR for CRSwNPs: 1.40. Patients with CRS showed significantly higher mental health morbidity than controls across the mental health and emotional wellbeing domains of the SF-36 and SNOT-22. Mean difference in the mental health domain of SF-36 was 8.3 for CRSsNPs and 5.3 for CRSwNPs. For the emotional domain of SNOT-22, differences were 7.7 and 6.3 respectively.

CONCLUSIONS

Depression and anxiety are significantly more common in patients with CRS compared to healthy controls, especially in those with CRSsNPs. This added mental health morbidity needs consideration when managing these patients in primary and secondary care settings.

A novel method for ABO-incompatible heart transplantation

BACKGROUND

Since 1996, ABO-incompatible heart transplantation has been undertaken by performing whole-body plasma exchange to remove isohemagglutinins using the cardiopulmonary bypass (CPB) circuit at the time of transplantation. This requires large volumes of donated blood and blood products, causes hemodynamic instability during the exchange transfusion, and limits practical use to small children. We sought to determine the efficacy of anti-A/B immunoadsorption within the CPB circuit on removal of isohemagglutinins in an ex vivo setting before its use clinically.

METHODS

An anti-A/B immunoadsorption column was placed into a CPB circuit mimicking a typical ABO-incompatible transplant patient, which had been primed with type O whole human blood. Samples were taken for determination of isohemagglutinin titers following each plasma volume pass through the anti-A/B immunoadsorption column.

RESULTS

There was a linear decrease of at least 1 dilution seen in both anti-A and anti-B IgG and IgM antibodies with each plasma volume pass through the column. This predictable removal allowed the formulation of selection criteria for ABO-incompatible heart transplantation given the reciprocal of titer and patient weight. This degree of predictability allowed us to use it successfully in the clinical setting, reducing antibodies to an undetectable level during ABO-incompatible heart transplantation.

CONCLUSIONS

The incorporation of an anti-A/B immunoadsorption column into the extracorporeal circuit reduces allogeneic blood product requirement for ABO-incompatible heart transplantation, while providing efficacious removal of anti-A and anti-B isohemagglutinins. This can be undertaken within the time period of CPB before graft reperfusion and expands the potential recipient pool to larger patients with higher isohemagglutinin titers.

A cross sectional analysis of a case-control study about quality of life in CRS in the UK; a comparison between CRS subtypes

BACKGROUND

The Sinonasal Outcome Test (SNOT-22) has been used as a patient reported outcome measure to grade symptom severity before and after treatment for chronic rhinosinusitis (CRS).

METHODOLOGY

This analysis uses data from the CRS Epidemiology Study (CRES). The overarching aim of CRES was to determine factors that influence the onset and severity of CRS. A study-specific questionnaire including SNOT-22 was distributed to patients with CRS attending ENT clinics across 30 centres in the United Kingdom. The aim of this analysis was to compare SNOT-22 scores between those with different types of CRS to determine any differences present in the total score or the subdomains and to assess whether any differences varied according to gender.

RESULTS

There were a total of 1249 CRS participants in the following subgroups: CRS without nasal polyps (CRSsNPs) (n=553), CRS with nasal polyps (CRSwNPs) (n=651), allergic fungal rhinosinusitis (AFRS) (n=45). Since there were differing gender ratios in each subgroup, males and females were analysed separately. The mean and standard deviation for SNOT-22 was: males CRSsNP 41.1 (21.0), CRSwNP 41.7 (20.5); females CRSsNP 49.6 (19.7), CRSwNP 49.5 (22.9). In the nasal domain, those with CRSwNP scored more highly than those with CRSsNP; for males 18.1 (8.1) vs. 15.9 (7.9); for females 19.6 (8.0) vs 16.7 (7.5).

CONCLUSIONS

Patients with CRSwNPs report higher symptom scores in the nasal domain of SNOT-22 than those with CRSsNPs with women in both subgroups reporting higher total scores than men.

A pilot randomised controlled trial investigating a Mediterranean diet intervention in pregnant women for the primary prevention of allergic diseases in infants

BACKGROUND

Observational studies suggest a potentially protective role of the Mediterranean diet (MD) in allergic diseases, including asthma. Large scale randomised controlled trials (RCTs) are needed to test the hypothesised allergy-prevention benefits of a MD during pregnancy. The present two-arm pilot RCT in pregnant women at high-risk of having a child who would develop allergic disease investigated maternal recruitment, retention and acceptability of an MD dietary intervention in the UK. The trial also assessed the effect of the intervention on MD adherence scores at 12 and at 24 weeks post-randomisation.

METHODS

Thirty women were recruited at around 12 weeks of gestation. Retention was high (28 out of 30; 93%). The intervention was acceptable to participants. Mean (SD) adherence to the MD at baseline was 12.4 (2.9) in the intervention arm (n = 14) and 13.0 (1.9) in the control arm (n = 16), where 24 represents maximal adherence. There was a favourable short-term change in MD score: the adjusted mean difference (intervention - control) in the change in MD score from baseline to 12 weeks post-randomisation was 2.4 (95% confidence interval = 0.6-4.2, P = 0.012).

CONCLUSIONS

The trial provides important insights into recruitment, retention and sustaining the dietary intervention, which will be used in the design of a large RCT.

How well do farmers know their badgers? Relating farmer knowledge to ecological survey data

Knowledge of badger distribution is important for the management of bovine tuberculosis. At the farm level, typically the only information on badger activity available is from the farmers themselves. This study compares how well farmer perceptions of badger activity match data obtained from ecological surveys. Farmer estimates of numbers of badger setts (burrows) surrounding their farms were generally correlated with field survey results, but tended to be underestimates. Farmers correctly recorded 50 per cent of setts recorded in surveys, with larger setts and active setts more likely to be correctly recorded. Badger visits to farm buildings and yards were also monitored using surveillance cameras. The majority of farmers were aware of badger visits to their farm buildings, but in 22 per cent of cases farmers were not aware of badger visits. At the farm level, knowledge of badger activity will be useful in informing vets and animal health professionals of the potential risks of disease transmission, and hence directing management interventions. However, the tendency to underestimate activity, combined with a lack of detailed knowledge of sett locations, means that farmer estimates of badger activity should be interpreted with caution and in isolation may not be sufficient to inform management interventions.

Flow Conditions in the Intracranial Aneurysm Lumen Are Associated with Inflammation and Degenerative Changes of the Aneurysm Wall

BACKGROUND AND PURPOSE

Saccular intracranial aneurysm is a common disease that may cause devastating intracranial hemorrhage. Hemodynamics, wall remodeling, and wall inflammation have been associated with saccular intracranial aneurysm rupture. We investigated how saccular intracranial aneurysm hemodynamics is associated with wall remodeling and inflammation of the saccular intracranial aneurysm wall.

MATERIALS AND METHODS

Tissue samples resected during a saccular intracranial aneurysm operation (11 unruptured, 9 ruptured) were studied with histology and immunohistochemistry. Patient-specific computational models of hemodynamics were created from preoperative CT angiographies.

RESULTS

More stable and less complex flows were associated with thick, hyperplastic saccular intracranial aneurysm walls, while slower flows with more diffuse inflow were associated with degenerated and decellularized saccular intracranial aneurysm walls. Wall degeneration (P = .041) and rupture were associated with increased inflammation (CD45+, P = .031). High wall shear stress (P = .018), higher vorticity (P = .046), higher viscous dissipation (P = .046), and high shear rate (P = .046) were associated with increased inflammation. Inflammation was also associated with lack of an intact endothelium (P = .034) and the presence of organized luminal thrombosis (P = .018), though overall organized thrombosis was associated with low minimum wall shear stress (P = .034) and not with the flow conditions associated with inflammation.

CONCLUSIONS

Flow conditions in the saccular intracranial aneurysm are associated with wall remodeling. Inflammation, which is associated with degenerative wall remodeling and rupture, is related to high flow activity, including elevated wall shear stress. Endothelial injury may be a mechanism by which flow induces inflammation in the saccular intracranial aneurysm wall. Hemodynamic simulations might prove useful in identifying saccular intracranial aneurysms at risk of developing inflammation, a potential biomarker for rupture.

Hepatotoxicity in acute iron poisoning

Although liver injury is a recognized consequence of acute iron poisoning, its description is limited to several case reports. It appears to be dose-related, however, there are published reports of severe iron poisoning without liver injury. The purpose of this study is to examine the hypothesis that this is a dose-related phenomenon and to identify the serum iron concentration of risk for this outcome. The design of this study is a retrospective review of our hospital's experience over 20 years. Extracted data included demographics, time of ingestion, highest serum iron concentration and highest hepatic transaminase activity. Iron poisoning was defined as a serum iron concentration / 300 mg/dL (55 mmol/L) within 12 hours of ingestion. Hepatotoxicity was defined as a serum transaminase (either ALT or AST) / 150 U/L. Severe hepatotoxicity was defined as / 1000 U/L. Seventy-three patients (1 / 704 mg/dL (55 / 48 years old) participated in the study and of these patients 60 (47 female) did not have hepatotoxicity. Their serum iron concentrations were 300 / 128 mmol/L). Thirteen patients had hepatotoxicity and of these patients, nine had severe liver injury. Severe injury was associated with serum iron concentrations well in excess of 1000 mg/dL (182 mmol/L). Our data support hepatotoxicity due to iron poisoning as a doserelated phenomenon with clinically important cases unlikely with a serum iron concentration of B / 700 mg/dL (128 mmol/L) within the first 12 hours. Clinically important hepatotoxicity occurs with values in excess of 1000 mg/dL (182 mmol/L).

The validity of the optimum model

The paper discussed the value of the ‘Optimum Model” in describing the inter-relationship between metric characters and natural fitness. This model represents one extreme of a whole spectrum of models. It can be used to predict changes in the mean of the character under natural selection, but the basic premises underlying such use are not well understood.

Four-Year Prospective Audit of Tonsillectomy Practice in Argyll and Clyde

Abstract Objective: To assess the practice of tonsillectomy in Inverclyde and Renfrewshire area of Argyll and Clyde Health Board. Design: an audit Setting: Royal Alexandra Hospital, Paisley Subjects: all patients undergoing tonsillectomy were prospectively audited over a four year period. Information audited included: age, sex, length of stay, operator grade, complications, readmissions and prophylactic antibiotic use. Results: 1582 cases were audited. 64% were women. The mean age of the patients was 16.76% of patients were discharged on the first post operative day. The majority of operations were carried out by staff grades and associate specialists. The primary complication rate was very low (1.33%). 3% of patients were readmitted, mostly because of secondary haemorrhage. Prophylactic post operative antibiotics were used in 39% of cases. Conclusions: it is safe to discharge patients on the first day post tonsillectomy, even if they live some distance from the hospital. Prophylactic post operative antibiotic use does not decrease the rate of readmission. Tonsillectomy is carried out safely in Argyll and Clyde.

Importance of the structural integrity of a carbon conjugated mediator for photocatalytic hydrogen generation from water over a CdS–carbon nanotube–MoS2 composite

CdS quantum dots is shown to promote photocatalytic hydrogen production from water significantly over single-layer MoS₂ on double-walled carbon nanotube.

Idiopathic resorption of impacted mesiodentes: a radiographic study

BACKGROUND

Although a large number of mesiodentes are left in situ, only a few are found in radiographs from epidemiological studies of adult populations. This leads to the development of a hypothesis that mesiodentes may be resorbed and disappear over time. The aim of this study was to radiographically investigate the frequency of resorptions and pathologies in relation to mesiodentes left in situ.

METHODS

The study population consisted of 44 individuals, with 49 mesiodentes left in situ at an early age. The individuals were 18-38 years old when re-examined. The inclusion criteria were that the mesiodentes had been diagnosed in childhood and left in situ, and that each individual was over 18 years of age at the time of re-examination. Either digital or analogue intraoral radiographs were used at the re-examination and compared with earlier analogue radiographs.

RESULTS

Forty-one per cent of the impacted mesiodentes showed resorptions-from limited to nearly complete resorption. No pathologies in connection to the mesiodentes were found.

CONCLUSION

About half of the mesiodentes examined displayed resorption. No pathologies caused by the mesiodentes were recorded.

The atomic structure of defects in graphene

Defects in graphene influence its electronic, magnetic, chemical and mechanical properties. It is therefore important to have a detailed understanding of their exact atomic structure in order to accurately predict their behaviour. In this talk I will present a summary of research on resolving the atomic structure of vacancy defects in graphene, single atom dopants covalently bonded in the lattice, and their transition dynamics. By using aberration-corrected transmission electron microscopy, combined with monochromation of the electron source to reduce chromatic aberration effects, sub-Angstrom spatial resolution at a low accelerating voltage of 80 kV is achieved. Methods have been developed to introduce defects into the lattice of graphene with 10 nm spatial accuracy within the electron microscope using a controlled focussed beam. This enables the study of defect structures with unprecedented clarity and accuracy whilst in a low-pressure vacuum environment. Atomic models determined from TEM imaging are compared with DFT calculated atomic models to gain deeper insights into the C-C bond lengths and the relationship between electronic charge density distribution and bond lengths.

RNA Bind-n-Seq: quantitative assessment of the sequence and structural binding specificity of RNA binding proteins

Specific protein-RNA interactions guide posttranscriptional gene regulation. Here, we describe RNA Bind-n-Seq (RBNS), a method that comprehensively characterizes sequence and structural specificity of RNA binding proteins (RBPs), and its application to the developmental alternative splicing factors RBFOX2, CELF1/CUGBP1, and MBNL1. For each factor, we recovered both canonical motifs and additional near-optimal binding motifs. RNA secondary structure inhibits binding of RBFOX2 and CELF1, while MBNL1 favors unpaired Us but tolerates C/G pairing in motifs containing UGC and/or GCU. Dissociation constants calculated from RBNS data using a novel algorithm correlated highly with values measured by surface plasmon resonance. Motifs identified by RBNS were conserved, were bound and active in vivo, and distinguished the subset of motifs enriched by CLIP-Seq that had regulatory activity. Together, our data demonstrate that RBNS complements crosslinking-based methods and show that in vivo binding and activity of these splicing factors is driven largely by intrinsic RNA affinity.

Psychological therapies for people with intellectual disabilities: comments on a matrix of evidence for interventions in challenging behaviour

BACKGROUND

Psychological therapies with a proven efficacy in the general population are being adapted for use with people who have intellectual disabilities in community settings.

METHODS

A systematic review of peer-reviewed literature published between 1980 and 2010 was carried out, to identify the evidence base for effective psychological interventions in challenging behaviour. Relevant databases were searched using applied key terms. Evidence was graded, according to the quality of the research. A best-evidence Matrix was produced to improve guidance for service providers and practitioners in the range, volume and quality of psychological interventions.

RESULTS

There is a limited amount of efficacy research that meets the most stringent standards of empirical evidence.

CONCLUSIONS

It is important to broaden the evidence base and consider the context of psychological interventions, alongside the values underpinning care and treatment.

Clinical experience with Affinity Pixie oxygenation system in paediatric and infant patients

INTRODUCTION

Great Ormond Street Children's Hospital undertakes over 500 open heart cardiothoracic procedures requiring cardiopulmonary bypass per year. Data from our centre show that many of our neonatal/paediatric patients require higher cardiac indexes than previously thought. We evaluated the new Pixie oxygenation system, rated from 0.1 L/min to 2 L/min, to determine if it could be used for these patients.

METHODS

Between 2010 and 2012, 250 Pixie oxygenators were used on consecutive patients requiring correction of congenital cardiac defects. Data were collected on FiO2 requirements, oxygenator pressure drop and gaseous microemboli handling. Retrospective analysis was also undertaken on the procedures and demographics of all patients during 2011-2012 to determine the percentage of patients on whom the Pixie could be used.

RESULTS

Analysis of the procedures undertaken at Great Ormond Street Hospital (GOSH) showed that 89% were in patients under 20 kg, requiring a flow rate of <2 L/min (at a base cardiac index of 2.8 L/min/m2). The maximum FiO2 required at 2.5 L/min was 85%. Gaseous microemboli were reduced by 82.5±9.9% and bubble volume was decreased by 94.3±8.4% from the 'venous' pre-oxygenator to the 'arterial' post-oxygenator.

DISCUSSION

The Pixie oxygenator proved effective at flows up to 2.5 L/min, with air-handling capabilities comparable with other oxygenators. This represents a single oxygenator that could potentially be used to cover 89% of our surgical procedures. However, we believe that, for the smallest patients (i.e., < 2 kg), a smaller priming oxygenator should be used in order to limit unnecessary haemodilution in this vulnerable group.

Deletion variant in the ADRA2B gene increases coupling between emotional responses at encoding and later retrieval of emotional memories

A deletion variant of the ADRA2B gene that codes for the α2b adrenoceptor has been linked to greater susceptibility to traumatic memory as well as attentional biases in perceptual encoding of negatively valenced stimuli. The goal of the present study was to examine whether emotional enhancements of memory associated with the ADRA2B deletion variant were predicted by encoding, as indexed by the subjectively perceived emotional salience (i.e., arousal) of events at the time of encoding. Genotyping was performed on 186 healthy young adults who rated positive, negative, and neutral scenes for level of emotional arousal and subsequently performed a surprise recognition memory task 1 week later. Experience of childhood trauma was also measured, as well as additional genetic variations associated with emotional biases and episodic memory. Results showed that subjective arousal was linked to memory accuracy and confidence for ADRA2B deletion carriers but not for non-carriers. Our results suggest that carrying the ADRA2B deletion variant enhances the relationship between arousal at encoding and subsequent memory for moderately arousing events.