Cleft Laterality Dental Arch Relationship Outcomes for Children with Unilateral Cleft Lip and Palate in New Zealand

OBJECTIVES

To investigate cleft laterality dental arch relationship outcomes of children with non-syndromic complete unilateral cleft lip and palate (UCLP) in New Zealand.

DESIGN

A retrospective nationwide study.

SETTINGS

Virtual 3D orthodontic study models collected prior to undertaking secondary alveolar bone grafting.

PARTICIPANTS

A total of 104 patients with UCLP (L = 80: R = 24).

OUTCOME MEASURES

Four calibrated assessors used the GOSLON Yardstick and 100 mm Visual Analogue Scale (VAS) to score the randomised models on 2 separate assessment sessions. Weighted Kappa were used to determine the intra/inter-rater reliability for the GOSLON and correlations for the VAS.

RESULTS

Intra-rater reliability ranged from 0.57-0.88 (GOSLON) and 0.45-0.93 (VAS). Inter-rater reliability ranged from 0.62-0.86 (GOSLON) and 0.64-0.93 (VAS).GOSLON scores for the left UCLP were 31.2% for good/very good; 26.3% for fair; 42.5% for poor/very poor while the right UCLP scored 8.3% for good/very good; 37.5% for fair; 54.2% for poor/very poor. The mean VAS for left and right UCLP were 53.4 (sd 22.5) and 44.6 (sd 17.1) respectively. Neither the GOSLON nor VAS differences reached statistical significance (both P = .08).

CONCLUSIONS

From a clinical perspective right UCLP had worse dental arch relationship outcomes, however, these differences failed to reach statistical significance. Further studies using larger sample sizes are required to determine if cleft laterality is an important consideration when investigating UCLP dental arch outcomes.

Relationship between TLR-2 level and clinical or radiological severity on patients with tuberculosis spondylitis in Dr. Wahidin Sudirohusodo hospital Makassar

Spinal tuberculosis or TB spondylitis is one of the most common types of extra pulmonary tuberculosis, which is about 15% of all cases. It causes severe morbidity, neurological deficits, and severe deformities in the patients. The growth of Mycobacterium tuberculosis in culture specimens obtained from infected tissue is the single gold standard diagnostic test for spinal TB. Toll-like receptor (TLR) is one of the important receptors in the first-line defence system against microbes. TLR-2 and TLR-4 are known to be associated with tuberculosis infection. Based on this background, the researchers were interested in examining the relationship between TLR-2 levels and the clinical and radiological severity of TB spondylitis patients. A cross-sectional study was conducted with patients diagnosed with tuberculosis spondylitis at Dr Wahidin Sudirohusodo Makassar. Patients diagnosed with TB spondylitis confirmed by blood tests, GeneExpert, and magnetic resonance imaging without prior treatment were included. Data analysis were conducted by using descriptive analysis and one-way ANOVA for bivariate analysis. The mean value of TLR2 levels in TB spondylitis patients was 9.1 g/dL. TLR2 levels in paraesthesia were significantly higher than normal (P < .05). Similar trend were analyzed on the motor neurologic status with TLR2 levels in paraparesis were significantly higher than those in normal (P < .05). There is a significant relationship between the TLR2 levels in TB spondylitis and their impaired motor and sensory function. Spinal destruction has been shown to provide significant relationship with TLR2 value in spondylitis TB.

Management of 3 month old neglected talus neck fracture: A case report and review of literature

Background

Talus fractures are extremely uncommon, accounting for approximately 1 % of foot and ankle fractures. The talar neck fracture has a high probability of damaging the anastomotic ring, which would interrupt blood circulation to talar body and cause serious issues with fracture healing and integrity. Due to insufficient radiological and clinical examination, approximately 39 % of midfoot and ankle fractures could be undiagnosed after initial evaluation. Talus fractures account for about half of these missed fractures. Anatomic reduction and advanced fixation methods can be performed in the management of neglected talus neck fracture for the purpose of improving functional outcome.

Case report

A 30-year-old male patient presented with swelling and pain on the right foot while walking for three months. He had previously fallen about two meters from stairs three months back. Instead of going to the hospital, he received conventional massage therapy. Three months later, he came to us complaining of chronic, dull aching, swelling, and continuous pain when walking and standing. After radiology evaluation, the patient was diagnosed with neglected nonunion type III Hawkins fracture of the neck talus and managed by double incision approach, Iliac crest cancellous bone graft, open reduction and internal fixation (ORIF) with cannulated screw. He was able to return to full weight bearing and his previous activity without experiencing any pain after 14 months.

Conclusion

Open reduction and internal fixation (ORIF) with Iliac crest cancellous bone graft is a reliable methods for neglected non-union type III Hawkins fracture of neck talus with great functional outcomes after 14 months of follow up.

The role of neutrophil to lymphocyte ratio in predicting lung metastasis in giant cell tumor of the extremities

OBJECTIVE

Inflammation has a vital role in tumor development and metastasis. Changes in blood count parameters have been associated with tumor prognosis. We aimed to evaluate the prognostic significance of neutrophil to lymphocyte ratio (NLR) in predicting lung metastasis of giant cell tumors of the bone (GCTB) of the extremities.

PATIENTS AND METHODS

34 GCTB patients (22 males and 12 females) were included in the study. Patients were divided into two groups. The metastasis group (n = 7) included GCTB patients with lung metastasis, while the non-metastasis group (n = 27) included those without lung metastasis. Descriptive statistics and frequency distribution were calculated [age, white blood cell (WBC), neutrophil, lymphocyte, platelets, neutrophil to lymphocyte ratio (NLR), and platelets to lymphocytes ratio (PLR)]. Continuous normal variables were expressed as mean ± standard deviation and compared using Student's t-tests. The receiver operating characteristic (ROC) curve analysis was used to evaluate the ability of NLR and PLR to predict lung metastasis. The factors were considered to be statistically significant at p < 0.05.

RESULTS

There were no significant differences between the lymphocyte count (1.81 vs. 2.23 103/mm3), platelet count (436 vs. 364 103/mm3), and PLR values (247 vs. 190) of the two groups (p > 0.05). The WBC count (11.8 vs. 8.95 103/mm3), neutrophil count (8.78 vs. 5.69 103/mm3), and NLR levels (5.45 vs. 2.81) (p < 0.05) were significantly higher in the metastasis group. The presence of an NLR cut-off value of 3.7 significantly predicted the existence of lung metastasis (AUC = 0.857 [95%CI = 0.714-1], p = 0.004) with a sensitivity of 85% and specificity of 82%.

CONCLUSIONS

NLR may serve as a promising prognostic marker for predicting lung metastasis in GCTB patients.

A proposed methodology for uncertainty extraction and verification in priority setting partnerships with the James Lind Alliance: an example from the Common Conditions Affecting the Hand and Wrist Priority Setting Partnership

Background

To report our recommended methodology for extracting and then confirming research uncertainties – areas where research has failed to answer a research question – derived from previously published literature during a broad scope Priority Setting Partnership (PSP) with the James Lind Alliance (JLA).

Methods

This process was completed in the UK as part of the PSP for “Common Conditions Affecting the Hand and Wrist”, comprising of health professionals, patients and carers and reports the data (uncertainty) extraction phase of this. The PSP followed the robust methodology dictated by the JLA and sought to identify knowledge gaps, termed “uncertainties” by the JLA. Published Cochrane Systematic Reviews, Guidelines and Protocols, NICE (National Institute for Health and Care Excellence) Guidelines, and SIGN (Scottish Intercollegiate Guidelines Network) Guidelines were screened for documented “uncertainties”. A robust method of screening, internally verifying and then checking uncertainties was adopted. This included independent screening and data extraction by multiple researchers and use of a PRISMA flowchart, alongside steering group consensus processes.

Selection of research uncertainties was guided by the scope of the Common Conditions Affecting the Hand and Wrist PSP which focused on “common” hand conditions routinely treated by hand specialists, including hand surgeons and hand therapists limited to identifying questions concerning the results of intervention, and not the basic science or epidemiology behind disease.

Results

Of the 2358 records identified (after removal of duplicates) which entered the screening process, 186 records were presented to the PSP steering group for eligibility assessment; 79 were deemed within scope and included for the purpose of research uncertainty extraction (45 full Cochrane Reviews, 18 Cochrane Review protocols, 16 Guidelines). These yielded 89 research uncertainties, which were compared to the stakeholder survey, and added to the longlist where necessary; before derived uncertainties were checked against non-Cochrane published systematic reviews.

Conclusions

In carrying out this work, beyond reporting on output of the Common Conditions Affecting the Hand and Wrist PSP, we detail the methodology and processes we hope can inform and facilitate the work of future PSPs and other evidence reviews, especially those with a broader scope beyond a single disease or condition.

102 A REVIEW OF THE REFERRAL PATHWAYS & OUTCOMES TO RAPID ACCESS FRAILTY ASSESSMENT UNIT (RAFAU)IN A REGIONAL HOSPITAL

Background

The RAFAU is a Multidisciplinary Team including Medical, Physiotherapy and Occupational Therapy, incorporating a fulltime team of OT and PT based in the Emergency Department called RAFT (Rapid Access Frailty Team). It aims to prevent hospital admissions and social crises. There are three main referral pathways, via community (GP, Public Health Nurses, Allied Health Professionals), RAFT-ED, and general medical follow up.

Methods

The data used was from RAFAU attendances between May 2021 and March 2022. Inclusion criteria was age greater than 65 and attendance in person. Exclusion criteria was incomplete data. Data was manually recorded after each attendance using data entry points including age range, methods of and reason for referral, etc. This gave us the raw data to develop information on our cohort. Data analysis was completed using Excel.

Results

A total of 569 patients were seen. The most populous age brackets were 81-85 (28%), 70-75 (25%) and 75-80 (26%) respectively. The vast majority of referrals were from GPs (57%), followed by RAFT-ED (30%). The most common reasons for referral were Medical (34%), Cognitive (27%) and Falls (26%).

Conclusion

A significant number of patients were seen for the first time by the RAFAU MDT. GPs were the major source of referrals which is to be expected as GPs are in more frequent contact with patients and act as gatekeepers to specialist hospital services. The primary referral reasons were also to be expected as these are three issues that are at the core of Gerontology. 173 hospital admissions were prevented in the ED by a combination of the RAFT and Emergency Doctors. There is good rationale for keeping the RAFAU and RAFT-ED team, and where possible expanding their services. This model could easily be expanded to other hospitals.

Chronic Rupture of Achilles Tendon Caused by Haglund's Deformity: A Case Report

A chronic Achilles tendon rupture is a tendon rupture occurring more than 4-6 weeks after a traumatic injury. Haglund's deformity, caused by bony abnormalities in the ankle (mostly due to osteophyte or bone spur), can cause chronic inflammation and degeneration of the Achilles tendon, eventually leading to rupture. This presents a challenge for clinicians who provide tendon repair procedures. We present a 69-year-old woman who had difficulty moving her left leg and had a deformity on the left leg compared to her right leg after falling nine months before but with pain starting three months before the accident. There was a seven-centimeter gap in the calcaneus with a positive Thompson test. The Haglund's deformity on the left calcaneus was visible on the ankle X-ray. The patient had a chronic total rupture of the left Achilles tendon, which was treated with a flexor hallucis longus (FHL) tendon transfer and resection of the deformity. One week after surgery, the patient's ability to walk and the shape of the left leg improved. This case report describes a chronic left Achilles tendon condition that was successfully repaired through tendon repair surgery using FHL tendon transfer and removal of Haglund's deformity.

Electromyographic differences of the gluteus maximus, gluteus medius, biceps femoris, and vastus lateralis between the barbell hip thrust and barbell glute bridge

Hip extensor muscles are critical to sport performance as events requiring sprinting and forceful landings are highly dependent on these muscles. Despite biomechanical differences between the barbell hip thrust (BHT) and the barbell glute bridge (BGB), both are biomechanically efficient ways to load this musculature for training purposes. Research investigating the differences in muscular activity between the BHT and BGB has yet been conducted. The aim of this study was to investigate, through surface electromyography, if one exercise is more optimal than the other in producing greater muscle activation for specific hip extensor muscles. Ten male participants completed a two-part study protocol. Results revealed the BHT elicited significantly greater muscle activity within the vastus lateralis for peak and mean outcomes; however, the BGB elicited significantly greater muscle activity in the upper and lower gluteus maximus for peak and mean outcomes and mean outcome in the gluteus medius. Current findings suggest, the BGB is, at minimum, a superior substitute for the BHT for eliciting a larger magnitude of activity in the gluteus maximus. Future studies between the two exercises are warranted to discern which produces greater hypertrophy and whether adaption of the BHT or BGB transfers more optimally to sport performance.

Supplements and refinements to current classifications and nomenclature of the fronto-ethmoidal transition region by systematic analysis with 3D CT microanatomy

Objective: The microanatomy of the fronto-ethmoidal transition region has been addressed in several classifications. CT stereoscopic imaging (3DCTSI) provides improved display and delineates three defined complex “spaces”, the Frontal Sinus/Frontal Recess Space, the Infundibular Space of the Ethmoid Uncinate Process, and the Ethmoid Bulla Space (FSRS, IS-EUP, EB), none of which were adequately described with the “cell” terminology. We present details on the 3D microanatomy, variability, and prevalence of these spaces. Methods: 3D stereoscopic imaging displays (3DCTSI) were created from 200 datasets. The images were analyzed and categorized by a radiologist (SJZ), and consultant otolaryngologists, focusing on 3D microanatomy of the fronto-ethmoidal transition, the frontal recess/frontal sinus, and drainage pathways, in comparison to established anatomical classification systems. Results: The anterior ethmoid is subdivided into seven groups with the following core properties and prevalence: 1. The horizontal roof of the IS-EUP is attached to the superior half of the frontal process of the maxilla (19%); 2. The IS-EUP extends into the frontal recess (6.5%); 3. The IS-EUP extends into the frontal recess and the frontal sinus (18.5%); 4. A bulla is seen in the medial frontal sinus (3%); 5. The ethmoid bulla and supra bullar space extend into the frontal sinus (7%); 6. Lamellae extend into the FSRS antero-superiorly (25%); 7. FSRS expansion expands below the upper half of the frontal process of the maxilla (FSRS) (21%). Conclusion: 3-D analysis of the detailed anatomy provides important new anatomic information with the increased focus on precision surgery in the region.

3D CT stereoscopic imaging: an improved anatomical understanding of the anterior ethmoid sinus and frontal sinus drainage pathway

OBJECTIVE: The objective of this presentation is to display a series of new anatomical concepts and terms regarding the frontal si- nus, its drainage pathway and cells vs. spaces of the anterior ethmoid, based on Three-Dimensional Computer X-ray Tomography Stereoscopic Imaging (3DCTSI) and contrast these concepts to those reported in the current literature. METHODS: Given the new anatomic observations provided by 3DCTSI, and the widespread anatomic variations a small sample was initially selected to describe our observations. Six exemplary cases according to the “Classification of Fronto-Ethmoidal cells” by Kuhn, Bent et al., Lee et al., expanded by Wormald et al., and adopted by Ramakrishnan et al., Huang et al., and Void et al. (1-7) were chosen to illustrate our detailed anatomic observations. Additional observations and data of prevalence identified in a larger series will follow. RESULTS and CONCLUSION: Conceptually, the anterior ethmoid “cells” are in essence “spaces” with openings that communicate with the middle meatus and/or the ethmoidal infundibulum. The frontal sinus and frontal recess are a united and continuous three-dimensional, irregularly shaped space, the Frontal Sinus/Recess Space (FSRS). The uncinate process has two segments: the Ethmoidal Uncinate Process (EUP), which encompasses the Infundibular Space of the EUP (IS-EUP), currently known as the Agger Nasi cell; and the Turbinal Uncinate Process (TUP), which borders the Turbinal Infundibulum (TI) medially. The superior attach- ment of the EUP will be detailed in each of the six cases (Table 2). The middle meatus and infundibular passages are the drainage pathways from the frontal sinus and maxillary sinus to the nasal cavity.

3D CT stereoscopic imaging: an improved anatomical understanding of the anterior ethmoid sinus and frontal sinus drainage pathway

Objective: The objective of this presentation is to display a series of new anatomical concepts and terms regarding the frontal sinus, its drainage pathway and cells vs. spaces of the anterior ethmoid, based on Three-Dimensional Computer X-ray Tomography Stereoscopic Imaging (3DCTSI) and contrast these concepts to those reported in the current literature. Methods: Given the new anatomic observations provided by 3DCTSI, and the widespread anatomic variations a small sample was initially selected to describe our observations. Six exemplary cases according to the “Classification of Fronto-Ethmoidal cells” by Kuhn, Bent et al., Lee et al., expanded by Wormald et al., and adopted by Ramakrishnan et al., Huang et al., and Void et al. (1-7) were chosen to illustrate our detailed anatomic observations. Additional observations and data of prevalence identified in a larger series will follow. Results and Conclusion: Conceptually, the anterior ethmoid “cells” are in essence “spaces” with openings that communicate with the middle meatus and/or the ethmoidal infundibulum. The frontal sinus and frontal recess are a united and continuous three-dimensional, irregularly shaped space, the Frontal Sinus/Recess Space (FSRS). The uncinate process has two segments: the Ethmoidal Uncinate Process (EUP), which encompasses the Infundibular Space of the EUP (IS-EUP), currently known as the Agger Nasi cell; and the Turbinal Uncinate Process (TUP), which borders the Turbinal Infundibulum (TI) medially. The superior attachment of the EUP will be detailed in each of the six cases (Table 2). The middle meatus and infundibular passages are the drainage pathways from the frontal sinus and maxillary sinus to the nasal cavity.

Bayesian Optimization of a Free-Electron Laser

The Linac coherent light source x-ray free-electron laser is a complex scientific apparatus which changes configurations multiple times per day, necessitating fast tuning strategies to reduce setup time for successive experiments. To this end, we employ a Bayesian approach to maximizing x-ray laser pulse energy by controlling groups of quadrupole magnets. A Gaussian process model provides probabilistic predictions for the machine response with respect to control parameters, enabling a balance of exploration and exploitation in the search for the global optimum. We show that the model parameters can be learned from archived scans, and correlations between devices can be extracted from the beam transport. The result is a sample-efficient optimization routine, combining both historical data and knowledge of accelerator physics to significantly outperform existing optimizers.

Simultaneous Determination of Chlorothalonil and Hexachlorobenzene in Technical and Formulated Materials by Capillary Gas Chromatography: Collaborative Study

A collaborative study was conducted for the capillary gas chromatographic (GC) method for the simultaneous determination of the fungicide chlorothalonil (CTL) and the accompanying impurity, hexachlorobenzene (HCB), in technical and formulated materials. The method calls for the dissolution of technical and dry formulations of CTL and HCB from the aqueous flowable formulation. The 10 participating laboratories were asked to analyze the samples by adhering to the method as closely as their instrumentation and data systems allowed, and to note any deviations from the method. Collaborators were asked to prepare the standards and samples, set up the capillary GC systems, analyze the samples, and calculate the results. CTL produced reproducibility relative standard deviations (RSDR) of 0.4–2.5 (active ingredient concentrations ranged from approximately 52 to 98% by weight). HCB produced RSDR values of 5.2–22% (HCB concentrations were 0.02–0.04% by weight). The method was adopted First Action by AOAC INTERNATIONAL.

134 The effect of follicle-stimulating hormone and equine chorionic gonadotropin injection protocols on laparoscopic ovum pickup in prepubertal Kiko goats

In vitro fertilization has served as a great tool in the human and bovine field in its ability to treat infertility in females. The purpose of this study was to compare hormone injection treatments in goats using the laparoscopic ovum pickup technique. A crossover trial was conducted to evaluate 2 superovulation injection protocols [a multiple-injection FSH (F) and a one-injection FSH-eCG (F+E)] for their ability to increase recovery of oocytes using laparoscopic ovum pickup (LOPU) technique in 10 prepubertal Kiko does. Does were randomly assigned to 2 sequence groups (n=5). Period 1 initiated on 28 July 2017 and Period 2 on 12 August 2017. A CIDR device was inserted on Day 0 and removed after LOPU. On Day 6 of each period, 3mL of prostaglandin F2α was given IM to each doe. F-treated does received (IM) twice daily injections of 15, 12.5, 10, and 7.5mg of FSH, whereas F+E-treated does received (IM) 80mg of FSH and 300 international units (IU) of eCG. Thirty-six hours after injection, follicles were aspirated using LOPU. Treatment response measurements included total follicles observed, oocyte recovery rate, and blastocyst rate. Total follicles observed were higher (P=0.004) in F+E-treated does (305 follicles) than F-treated does (236 follicles). Neither oocyte recovery rates (F+E=41.5% and F=38.1%) nor blastocysts rates (F+E=18% and F=32%) were affected (P&gt;0.05) by injection protocol. In conclusion, we summarise that multiple injections of FSH can results in a higher number of follicles produced; however, this does not have a subsequent effect on IVF and development rates.

Prenatal omega-3 LCPUFA and symptoms of allergic disease and sensitization throughout early childhood - a longitudinal analysis of long-term follow-up of a randomized controlled trial

Background

Randomized controlled trials of prenatal omega (ω-3) long chain polyunsaturated fatty acid (LCPUFA) supplementation are suggestive of some protective effects on allergic sensitization and symptoms of allergic disease in childhood. Due to the nature of the atopic march, investigation of any effects of this prenatal intervention may be most informative when consistently assessed longitudinally during childhood.

Methods

Follow-up of children (n = 706) with familial risk of allergy from the Docosahexaenoic Acid to Optimize Mother Infant Outcome (DOMInO) trial. The intervention group received fish oil capsules (900 mg of ω-3 LCPUFA) daily from <21 weeks' gestation until birth; the control group received vegetable oil capsules without ω-3 LCPUFA. This new longitudinal analysis reports previously unpublished data collected at 1 and 3 years of age. The allergic disease symptom data at 1, 3 and 6 years of age were consistently reported by parents using the "International Study of Asthma and Allergies in Childhood" (ISAAC) questionnaire. Sensitization was determined by skin prick test to age specific, common allergen extracts.

Results

Changes over time in symptoms of allergic disease with sensitization (IgE-mediated) and sensitization did not differ between the groups; interaction p = 0.49, p = 0.10, respectively. Averaged across the 1, 3 and 6-year assessments, there were no significant effects of prenatal ω-3 LCPUFA supplementation on IgE-mediated allergic disease symptoms (adjusted relative risk 0.88 (95% CI 0.69, 1.12), p = 0.29) or sensitization (adjusted relative risk 0.97 (95% CI 0.82, 1.15), p = 0.76). Sensitization patterns to common allergens were consistent with the atopic march, with egg sensitization at 1 year strongly associated with house dust mite sensitization at 6 years, (p < 0.0001).

Discussion

Although there is some evidence to suggest that maternal supplementation with 900mg ω-3 LCPUFA has a protective effect on early symptoms of allergic disease and sensitization in the offspring, we did not observe any differences in the progression of disease over time in this longitudinal analysis. Further investigation into the dose and timing of ω-3 LCPUFA supplementation, including long-term follow up of children using consistent outcome reporting, is essential to determine whether this intervention may be of benefit as a primary prevention strategy for allergic disease.

Conclusion

Maternal supplementation with 900 mg of ω-3 LCPUFA did not change the progression of IgE-mediated allergic disease symptoms or sensitization throughout childhood from 1 to 6 years.

Trial registration

Australian New Zealand Clinical Trials Registry (ACTRN); DOMInO trial ACTRN12605000569606, early childhood allergy follow up ACTRN12610000735055 and 6-year allergy follow up ACTRN12615000498594.

Cross-cultural adaptation and implementation of Good Life with osteoarthritis in Denmark (GLA:D™): group education and exercise for hip and knee osteoarthritis is feasible in Canada

OBJECTIVE

Adapt and evaluate the feasibility of implementing Good Life with osteoArthritis in Denmark (GLA:D^TM) in Canada for people with mild to severe hip/knee osteoarthritis.

METHODS

Patients triaged to non-surgical management participated in two education sessions and 12 supervised, neuromuscular exercise classes. We used the RE-AIM implementation framework evaluating outcomes of Reach, Effectiveness/Efficacy, Adoption, Implementation and Maintenance. Patients completed surveys pre-program and at 3 months follow-up. Program fidelity was evaluated at four observations against a priori criteria. We conducted semi-structured interviews with therapists post-program.

RESULTS

72 patients consented to participate, 59 started the program and one withdrew on physician advice. The remaining 58 provided follow-up data. Mean age was 67 years; 78% were female and 52% had body mass index (BMI) >25. The effect of the program was demonstrated: 40% improvement in pain with 59% achieving a clinically important improvement of ≥2 points on the Numeric Pain Rating scale. Statistically significant improvement also occurred in the Hip disability/Knee injury and Osteoarthritis Outcome Score subscales. 24% reported increased physical activity. Program fidelity was demonstrated with all criteria met. Therapists emphasized that rolling recruitment allowed appropriate supervision and resulted in participants encouraging each other. 99% of participants indicated they benefitted from and were satisfied with the program and 90% reported using the knowledge daily. 52% were willing to pay >$250 Cdn for the program.

CONCLUSION

GLA:D^TM implementation was feasible in the Canadian context with results similar to those of >7,000 participants in Denmark. Implementation and evaluation of GLA:D^TM Canada is now occurring nationally.

Population-based cohort study of variation in the use of emergency cholecystectomy for benign gallbladder diseases

Background

The aims of this prospective population-based cohort study were to identify the patient and hospital characteristics associated with emergency cholecystectomy, and the influences of these in determining variations between hospitals.

Methods

Data were collected for consecutive patients undergoing cholecystectomy in acute UK and Irish hospitals between 1 March and 1 May 2014. Potential explanatory variables influencing the performance of emergency cholecystectomy were analysed by means of multilevel, multivariable logistic regression modelling using a two-level hierarchical structure with patients (level 1) nested within hospitals (level 2).

Results

Data were collected on 4744 cholecystectomies from 165 hospitals. Increasing age, lower ASA fitness grade, biliary colic, the need for further imaging (magnetic retrograde cholangiopancreatography), endoscopic interventions (endoscopic retrograde cholangiopancreatography) and admission to a non-biliary centre significantly reduced the likelihood of an emergency cholecystectomy being performed. The multilevel model was used to calculate the probability of receiving an emergency cholecystectomy for a woman aged 40 years or over with an ASA grade of I or II and a BMI of at least 25·0 kg/m2, who presented with acute cholecystitis with an ultrasound scan showing a thick-walled gallbladder and a normal common bile duct. The mean predicted probability of receiving an emergency cholecystectomy was 0·52 (95 per cent c.i. 0·45 to 0·57). The predicted probabilities ranged from 0·02 to 0·95 across the 165 hospitals, demonstrating significant variation between hospitals.

Conclusion

Patients with similar characteristics presenting to different hospitals with acute gallbladder pathology do not receive comparable care.

DNA Methylation and microRNA patterns are in association with the expression of BRCA1 in ovarian cancer

Ovarian cancer is the sixth most prevalent cancer in women and is considered the most lethal gynecological malignancy. It can be inherited as a familial disease but also has a strong spontaneous occurrence. Although the disease is associated with genome instability brought on by genetics and environmental factors there is evidence that mutations in the gene encoding for the breast cancer type 1 susceptibility protein (BRCA1) or its down-regulation are involved in its development. Down-regulation of BRCA1 expression by hypermethylation of its promoter may account for some cases of ovarian cancer but this does not explain the cause of the majority of the disease. This review explores the role of BRCA1 promoter hypermethylation and micro-RNAs (miRNA) involved in the regulation of BRCA1 and their role in ovarian cancer development as well as some of the exciting discoveries which could lead to targeting miRNA with a view to restoring BRCA1 expression in diseased tissues.

Toll-like receptor 4 plays significant roles during allergic rhinitis

Allergic rhinitis is a nasal hypersensitivity and allergic disease which leads to inflammation of nasal mucosa. Previous investigations revealed that innate immune receptors play a key role in the pathogenesis of inflammatory diseases including allergic diseases. Toll-like receptors (TLRs), which are important innate immune receptors, play crucial roles in the recognition of foreign antigens, including allergens, and subsequently for the induction of immune responses such as inflammation. There are several controversial reports regarding the roles of TLR4 in the pathogenesis of allergic rhinitis. This review presents current information regarding the roles of TLR4 in the pathogenesis of allergic rhinitis and the plausible mechanisms which lead to the expression and function of TLR4 in this disease.

TLR3 and its roles in the pathogenesis of type 2 diabetes

Type 2 diabetes (T2D) is the most prevalent non&mdash;infectious disease and leads to several complications including nephropathy and retinopathy. The mechanisms and signaling molecules responsible for the development and progression of T2D, as well as its associated complications are yet to be identified. It would appear that genetic backgrounds and immunological parameters of people susceptible to T2D may play important roles in induction of T2D. TLRs participate in several cellular pathways which can induce activation of proliferation. However, in contradiction, these pathways can also be associated with apoptosis. The multiple roles of TLRs and their signaling molecules associated with T2D pathways makes them candidates for the induction of immune&mdash;regulated diseases like T2D. TLR3 has been identified as an intracellular ligand and subsequently activates signaling molecules via the TRIF pathway. Therefore, the alteration of expression of TLR3 and their functions may lead to inappropriate induction of immune system functions that are related to T2D disease. The aim of this review was to collect recent data regarding the roles of TLR3 in the progression and pathogenesis of T2D.

Clinical recommendations for management of mesiodens and unerupted permanent maxillary central incisors

BACKGROUND

Un-erupted maxillary incisors may result secondary to supernumerary teeth. Despite the removal of such mesiodentes, orthodontic traction of a permanent un-erupted maxillary incisor may be required.

REVIEW

The literature regarding the impacted maxillary central incisor(s) was reviewed and all pertinent publications on the subject assessed. The review specifically relative to mesiodentes, surgical exposure and orthodontic management was interpreted together with the clinical experience of a number of the authors' cases. From this analysis a set of recommendations was developed.

RECOMMENDATIONS

(1) A sufficient arch space has to be ensured or orthodontically created for permanent maxillary central incisor(s). (2) Early surgical extraction of a mesiodens or mesiodentes (ideally before 7 years of age), with simultaneous closed surgical exposure of the permanent impacted maxillary incisor with bonding of an attachment with gold chain. (3) Re-evaluation after 2-3 months to assess for any natural eruption of the maxillary central incisor. (4) Application of orthodontic traction in the event of non-eruption.

CONCLUSION

Early diagnosis of the presence of mesiodentes is imperative. Appropriate surgical and/or orthodontic traction is often indicated with regular post-surgical follow-up assessments.

Medication use in pregnancy: a cross-sectional, multinational web-based study

OBJECTIVES

Intercountry comparability between studies on medication use in pregnancy is difficult due to dissimilarities in study design and methodology. This study aimed to examine patterns and factors associated with medications use in pregnancy from a multinational perspective, with emphasis on type of medication utilised and indication for use.

DESIGN

Cross-sectional, web-based study performed within the period from 1 October 2011 to 29 February 2012. Uniform collection of drug utilisation data was performed via an anonymous online questionnaire.

SETTING

Multinational study in Europe (Western, Northern and Eastern), North and South America and Australia.

PARTICIPANTS

Pregnant women and new mothers with children less than 1 year of age.

PRIMARY AND SECONDARY OUTCOME MEASURES

Prevalence of and factors associated with medication use for acute/short-term illnesses, chronic/long-term disorders and over-the-counter (OTC) medication use.

RESULTS

The study population included 9459 women, of which 81.2% reported use of at least one medication (prescribed or OTC) during pregnancy. Overall, OTC medication use occurred in 66.9% of the pregnancies, whereas 68.4% and 17% of women reported use of at least one medication for treatment of acute/short-term illnesses and chronic/long-term disorders, respectively. The extent of self-reported medicated illnesses and types of medication used by indication varied across regions, especially in relation to urinary tract infections, depression or OTC nasal sprays. Women with higher age or lower educational level, housewives or women with an unplanned pregnancy were those most often reporting use of medication for chronic/long-term disorders. Immigrant women in Western (adjusted OR (aOR): 0.55, 95% CI 0.34 to 0.87) and Northern Europe (aOR: 0.50, 95% CI 0.31 to 0.83) were less likely to report use of medication for chronic/long-term disorders during pregnancy than non-immigrants.

CONCLUSIONS

In this study, the majority of women in Europe, North America, South America and Australia used at least one medication during pregnancy. There was a substantial inter-region variability in the types of medication used.

The response to testosterone undecanoate in men with type 2 diabetes is dependent on achieving threshold serum levels (the BLAST study)

BACKGROUND

The association between testosterone deficiency and insulin resistance in men with type 2 diabetes is well established. Current Endocrine Society and European Association of Urology guidelines recommend the measurement of testosterone levels in all men with type 2 diabetes and in men suffering from erectile dysfunction. It is recognised that a range of physical symptoms appear as the testosterone level falls but few studies have addressed the threshold at which symptoms improve with physiological replacement. We report the first double-blind placebo-controlled study conducted exclusively in a male type 2 diabetes population to assess the metabolic changes with testosterone replacement.

METHODS

The type 2 diabetes registers of seven general practices were screened to establish the prevalence of low testosterone and the associations with diabetes control. Of 550 eligible patients approached, 488 men (mean age 62.6) consented to take part in screening with a morning testosterone level, assessed between 8 and 11 am. This identified 211 patients for a double-blind placebo-controlled study of long acting testosterone undecanoate (TU) 1000 mg lasting 30 weeks followed by 52 weeks of open label use. The population was divided into a SEVERE group with either total testosterone (TT) of 8 nmol/l or less or free testosterone (FT) 180 pmol/l or less or a MILD group with TT 8.1-12 nmol/l or FT 181-250 pmol/l.

RESULTS

Men in the SEVERE group increased mean through TT from 7.73 nmol/l at baseline to 9.93 at 30 weeks and the MILD group from 10.47 to 11.94. The SEVERE group showed marked improvement in sexual function, but no significant improvement in metabolic parameters. The MILD group showed no improvement in sexual function, but significant improvement in weight, body mass index, waist circumference and Hospital Anxiety and Depression Scale. Improvement was seen in all parameters during 52 weeks open label treatment where trough TT levels approached 15 nmol/l. Baseline prostate-specific antigen (PSA) was lower in the SEVERE group and increased with TU for 30 weeks and then stabilised. There was no increase in PSA with treatment in the MILD group.

CONCLUSIONS

Testosterone undecanoate significantly improves sexual parameters and Ageing Male Symptom Score, but not metabolic factors at 30 weeks in men with SEVERE testosterone deficiency syndrome (TDS). In men with MILD TDS, significant improvements in metabolic but not sexual parameters were seen, suggesting that there are threshold levels for response to testosterone replacement therapy and that trials of therapy need to achieve sustained therapeutic levels to be effective. PSA showed minor rises, but only for 30 weeks in the SEVERE group.

Abstract P3-09-17: One year of adjuvant hormone therapy does not increase patient fatigue: Results of a prospective early stage breast cancer trial

INTRODUCTION: The diagnosis and treatment of breast cancer may alter a patient's mental and physical quality of life. Estrogen effects on the brain may be neuroprotective or detrimental, and adjuvant endocrine therapy may influence cognitive functions including fatigue. We previously reported that three months of adjuvant hormone therapy was not associated with change in fatigue. The purpose of this study was to prospectively determine the incidence of fatigue in early stage breast cancer patients during one year of adjuvant hormone therapy. METHODS: Seventy-four consecutive patients of a single medical oncologist with newly diagnosed hormone dependent breast cancer prescribed adjuvant hormone therapy enrolled in this prospective study. Data collected included age, race, menopausal status, breast cancer stage, body mass index, Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT)-F, Fatigue Assessment Scale (FAS), short form 36 (SF-36), and cognitive failure questionnaire (CFQ). All tests were administered by one nurse prior to hormone initiation (0 mo) and after 3, 6, 9, and 12 months (mo) of therapy. Statistical analysis was performed using Student t test for paired data with a p value of &lt;0.05 considered significant. RESULTS: Prior to starting therapy, a third of patients had a FAS score of &gt;22, consistent with moderate to severe fatigue. After 12 months of therapy, 52 patients (13 premenopausal, 39 postmenopausal) were still receiving adjuvant hormone therapy and had completed serial testing. Twenty patients received chemotherapy prior to institution of hormone treatment. There were no significant changes in FACIT-F, FAS, SF-36, or CFQs scores during the first 12 months of treatment.

 0 mo3 mo6 mo9 mo12 moFACIT-F44 (7-52)*42 (3-52)43 (3-52)43 (2-52)44 (6-52)FAS17 (10-43)18 (10-48)17 (10-48)20 (10-48)19 (10-50)Weight, lb.159 (102-256)162 (102-258)161 (102-258)163 (102-263)164 (101-258)SF-36 Total72 (12-100)68 (15-99)83 (15-99)76 (15-99)82 (7-100)CFQ70 (39-94)69 (34-92)68 (34-94)67 (28-96)70 (20-96)* Median (Range)

Although during the first six months, a small but significant increase in body weight occurred, there was no significant difference between the initial and 12 month body weight. CONCLUSION: Prior to adjuvant hormone therapy institution, breast cancer patients often have significant problems with fatigue. However, the first 12 months of adjuvant hormone therapy does not appear to affect fatigue or cognitive failure.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-09-17.

Genome-wide association study of shared components of reading disability and language impairment

Written and verbal languages are neurobehavioral traits vital to the development of communication skills. Unfortunately, disorders involving these traits-specifically reading disability (RD) and language impairment (LI)-are common and prevent affected individuals from developing adequate communication skills, leaving them at risk for adverse academic, socioeconomic and psychiatric outcomes. Both RD and LI are complex traits that frequently co-occur, leading us to hypothesize that these disorders share genetic etiologies. To test this, we performed a genome-wide association study on individuals affected with both RD and LI in the Avon Longitudinal Study of Parents and Children. The strongest associations were seen with markers in ZNF385D (OR = 1.81, P = 5.45 × 10(-7) ) and COL4A2 (OR = 1.71, P = 7.59 × 10(-7) ). Markers within NDST4 showed the strongest associations with LI individually (OR = 1.827, P = 1.40 × 10(-7) ). We replicated association of ZNF385D using receptive vocabulary measures in the Pediatric Imaging Neurocognitive Genetics study (P = 0.00245). We then used diffusion tensor imaging fiber tract volume data on 16 fiber tracts to examine the implications of replicated markers. ZNF385D was a predictor of overall fiber tract volumes in both hemispheres, as well as global brain volume. Here, we present evidence for ZNF385D as a candidate gene for RD and LI. The implication of transcription factor ZNF385D in RD and LI underscores the importance of transcriptional regulation in the development of higher order neurocognitive traits. Further study is necessary to discern target genes of ZNF385D and how it functions within neural development of fluent language.

A Structured Review and Classification of Demolding Issues and Proven Solutions

The demolding of replicated parts can result in damage to both the replication tooling and finished parts and is a particular problem for the replication of smaller parts which can be quite fragile. Various techniques have been proposed in the literature to solve such problems by reducing the overall demolding force. This paper presents the challenge of demolding replicated parts and reviews the proven solutions from the literature which have been developed. A summary chart of these solutions is presented which may be used to implement plans to solve demolding problems with replicated parts. Such a rationalization of existing knowledge will enable replication tool developers to systematically select and apply proven solutions to solve, and ultimately prevent, demolding problems.

Abstract P6-08-08: Three months of adjuvant hormone therapy does not increase fatigue or cognitive failure: results of a prospective early stage breast cancer trial

INTRODUCTION: The diagnosis and treatment of breast cancer may alter a patient's mental and physical quality of life. Fatigue and impaired cognition have been reported after chemotherapy and hormone therapy. The purpose of this study was to prospectively determine the incidence of fatigue and cognitive changes in early stage breast cancer patients during adjuvant hormone therapy and to evaluate the relationship of dysfunction with other risk factors.

METHODS: Fifty-four consecutive patients of a single medical oncologist with newly diagnosed hormone dependent breast cancer prescribed adjuvant hormone therapy enrolled in this prospective study. Data collected included age, race, menopausal status, breast cancer stage, body mass index, Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT)-F, Fatigue Assessment Scale (FAS), short form 36 (SF-36), cognitive failure questionnaire (CFQ), Beck depression inventory (BDI-2), Epworth sleepiness scale, and facial recognition (FR) and sheep dash time (SDT) to assess executive functioning. All tests were administered by one nurse prior to hormone initiation (0 mo) and after 3 months (3 mo) of therapy. Statistical analysis was performed using Student t test for paired data with a p value of &lt;0.05 considered significant.

RESULTS: After 3 months of therapy, 52 of 54 patients were reevaluated (1 patient dropped out and 1 excluded for metastatic disease). Of the remaining 52 patients, the mean age was 54 years (range 30–76) with self-reported race of white 38, black 13 and Indian 1 patient and 39 (75%) patients were postmenopausal. Initial tumor stage was 0 in 8 patients, 1 in 23, 2 in 20, and 3 in 1. Although the baseline mental health of patients assessed by SF-36 mental health (MH) domain was low (70 ±22.0 [mean ±SD]) after 3 months it improved to 55 ±8.1, P &lt; 0.0001. No change was found in the SF-36 domains of physical health or vitality. At baseline, 15 of 52 patients (36%) reported significant fatigue (FAS score ≥22). After 3 months of therapy fatigue as measured by either the FACIT-F (0 mo:30 ±11.2; 3 mo:31 ±9.5, p = 0.37) or FAS (0 mo:20 ±8.5; 3 mo: 20 ±7.6, p = 0.53) remained unchanged. No change was noted in depression as determined by the BDI-2 score (0 mo: 9 ±8.1 versus 3 mo:9 ± 9, p = NS) or Epworth sleepiness scores (0 mo:7 ±4.5 versus 3 mo:8 ±4.7, p = NS). The initial CFQ was considered positive (&gt;43) in 48 (92%) of patients. There was no significant change in the CFQ, SDT, or FR (CFQ 0 mo:67±12.9, 3 mo:67±13.0, p = 0.453; SDT: 0 mo:0.56±0.292 secs, 3 mo:0.52±0.223 secs, p = 0.144). BMI rose minimally after hormone therapy (0 mos:28.8 ±6.41; 3 mo:29.1 ±6.43, p = 0.0498).

CONCLUSION: Prior to adjuvant hormone therapy institution, breast cancer patients often have significant problems with fatigue, cognitive failure, and overall mental health. Overall mental health improved during the first three months of hormone therapy. However, there was no significant change in fatigue, cognitive failure, depression score, reaction time, or facial recognition. Longer follow–up will be performed to assess the possible cumulative effects of hormone therapy on fatigue or cognitive function. Supported by Ride Cincinnati

Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P6-08-08.

Validation of a one-stop carpal tunnel clinic including nerve conduction studies and hand therapy

INTRODUCTION

Carpal tunnel syndrome is the most common hand disorder. We describe a pathway that includes clinical assessment, neurophysiological testing, surgery and physical therapy all at the same visit.

METHODS

All referrals for carpal tunnel syndrome were screened for inclusion in a 'one-stop' surgeon-led clinic. Prospective clinical data collected included patient reported outcome measures and satisfaction scores, touch threshold, pinch and grip strength. Patients were assessed clinically, underwent nerve conduction studies and surgery as indicated, all on the same day. Baseline and one-year follow-up data were analysed for 57 patients (62 hands).

RESULTS

There was significant improvement in all domains of the Boston Carpal Tunnel and Michigan hand Outcomes questionnaires, grip strength and touch threshold. There were no adverse events. The total mean operating time was 12.8 minutes (range: 5-15 minutes) and the mean tourniquet time was 2.5 minutes (range: 1-11 minutes). Using a dual theatre model produced a short mean turnaround time of 14.8 minutes (range: 2-37 minutes). Patient satisfaction as judged using a Picker questionnaire was very high.

CONCLUSIONS

A highly efficient clinical service involving both diagnostics and treatment can be delivered at a single hospital visit while maintaining optimal outcomes and high patient satisfaction.