Aerosol source apportionment uncertainty linked to the choice of input chemical components

For a Positive Matrix Factorization (PMF) aerosol source apportionment (SA) studies there is no standard procedure to select the most appropriate chemical components to be included in the input dataset for a given site typology, nor specific recommendations in this direction. However, these choices are crucial for the final SA outputs not only in terms of number of sources identified but also, and consequently, in the source contributions estimates. In fact, PMF tends to reproduce most of PM mass measured independently and introduced as a total variable in the input data, regardless of the percentage of PM mass which has been chemically characterized, so that the lack of some specific source tracers (e.g. levoglucosan) can potentially affect the results of the whole source apportionment study. The present study elaborates further on the same concept, evaluating quantitatively the impact of lacking specific sources' tracers on the whole source apportionment, both in terms of identified sources and source contributions. This work aims to provide first recommendations on the most suitable and critical components to be included in PMF analyses in order to reduce PMF output uncertainty as much as possible, and better represent the most commons PM sources observed in many sites in Western countries. To this aim, we performed three sensitivity analyses on three different datasets across EU, including extended sets of organic tracers, in order to cover different types of urban conditions (Mediterranean, Continental, and Alpine), source types, and PM fractions. Our findings reveal that the vehicle exhaust source resulted to be less sensitive to the choice of analytes, although source contributions estimates can deviate significantly up to 44 %. On the other hand, for the detection of the non-exhaust one is clearly necessary to analyze specific inorganic elements. The choice of not analysing non-polar organics likely causes the loss of separation of exhaust and non-exhaust factors, thus obtaining a unique road traffic source, which provokes a significant bias of total contribution. Levoglucosan was, in most cases, crucial to identify biomass burning contributions in Milan and in Barcelona, in spite of the presence of PAHs in Barcelona, while for the case of Grenoble, even discarding levoglucosan, the presence of PAHs allowed identifying the BB factor. Modifying the rest of analytes provoke a systematic underestimation of biomass burning source contributions. SIA factors resulted to be generally overestimated with respect to the base case analysis, also in the case that ions were not included in the PMF analysis. Trace elements were crucial to identify shipping emissions (V and Ni) and industrial sources (Pb, Ni, Br, Zn, Mn, Cd and As). When changing the rest of input variables, the uncertainty was narrow for shipping but large for industrial processes. Major and trace elements were also crucial to identify the mineral/soil factor at all cities. Biogenic SOA and Anthropogenic SOA factors were sensitive to the presence of their molecular tracers, since the availability of OC alone is unable to separate a SOA factor. Arabitol and sorbitol were crucial to detecting fungal spores while odd number of higher alkanes (C27 to C31) for plant debris.

Surgery and opioids: evidence-based expert consensus guidelines on the perioperative use of opioids in the United Kingdom

There are significant concerns regarding prescription and misuse of prescription opioids in the perioperative period. The Faculty of Pain Medicine at the Royal College of Anaesthetists have produced this evidence-based expert consensus guideline on surgery and opioids along with the Royal College of Surgery, Royal College of Psychiatry, Royal College of Nursing, and the British Pain Society. This expert consensus practice advisory reproduces the Faculty of Pain Medicine guidance. Perioperative stewardship of opioids starts with judicious opioid prescribing in primary and secondary care. Before surgery, it is important to assess risk factors for continued opioid use after surgery and identify those with chronic pain before surgery, some of whom may be taking opioids. A multidisciplinary perioperative care plan that includes a prehabilitation strategy and intraoperative and postoperative care needs to be formulated. This may need the input of a pain specialist. Emphasis is placed on optimum management of pain pre-, intra-, and postoperatively. The use of immediate-release opioids is preferred in the immediate postoperative period. Attention to ensuring a smooth care transition and communication from secondary to primary care for those taking opioids is highlighted. For opioid-naive patients (patients not taking opioids before surgery), no more than 7 days of opioid prescription is recommended. Persistent use of opioid needs a medical evaluation and exclusion of chronic post-surgical pain. The lack of grading of the evidence of each individual recommendation remains a major weakness of this guidance; however, evidence supporting each recommendation has been rigorously reviewed by experts in perioperative pain management.

One-year measurements of secondary organic aerosol (SOA) markers in the Paris region (France): Concentrations, gas/particle partitioning and SOA source apportionment

Twenty-five biogenic and anthropogenic secondary organic aerosol (SOA) markers have been measured over a one-year period in both gaseous and PM₁₀ phases in the Paris region (France). Seasonal and chemical patterns were similar to those previously observed in Europe, but significantly different from the ones observed in America and Asia due to dissimilarities in source precursor emissions. Nitroaromatic compounds showed higher concentrations in winter due to larger emissions of their precursors originating from biomass combustion used for residential heating purposes. Among the biogenic markers, only isoprene SOA marker concentrations increased in summer while pinene SOA markers did not display any clear seasonal trend. The measured SOA markers, usually considered as semi-volatiles, were mainly associated to the particulate phase, except for the nitrophenols and nitroguaiacols, and their gas/particle partitioning (GPP) showed a low temperature and OM concentrations dependency. An evaluation of their GPP with thermodynamic model predictions suggested that apart from equilibrium partitioning between organic phase and air, the GPP of the markers is affected by processes suppressing volatility from a mixed organic and inorganic phase, such as enhanced dissolution in aerosol aqueous phase and non-equilibrium conditions. SOA marker concentrations were used to apportion secondary organic carbon (SOC) sources applying both, an improved version of the SOA-tracer method and positive matrix factorization (PMF) Total SOC estimations agreed very well between both models, except in summer and during a highly processed Springtime PM pollution event in which systematic underestimation by the SOA tracer method was evidenced. As a first approach, the SOA-tracer method could provide a reliable estimation of the average SOC concentrations, but it is limited due to the lack of markers for aged SOA together with missing SOA/SOC conversion fractions for several sources.

Comparison of five methodologies to apportion organic aerosol sources during a PM pollution event

This study presents a comparison of five methodologies to apportion primary (POA) and secondary organic aerosol (SOA) sources from measurements performed in the Paris region (France) during a highly processed PM pollution event. POA fractions, estimated from EC-tracer method and positive matrix factorization (PMF) analyses, conducted on measurements from PM₁₀ filters, aerosol chemical speciation monitor (ACSM) and offline aerosol mass spectrometry (AMS), were all comparable (2.2-3.7 μg m^-3 as primary organic carbon (POC)). Associated relative uncertainties (measurement + model) on POC estimations ranged from 8 to 50%. The best apportionment of primary traffic OA was achieved using key markers (EC and 1-nitropyrene) in the chemical speciation-based PMF showing more pronounced rush-hour peaks and greater correlation with NO_x than other traffic related POC factors. All biomass burning-related factors were in good agreement, with a typical diel profile and a night-time increase linked to residential heating. If PMF applied to ACSM data showed good agreement with other PMF outputs corrected from dust-related factors (coarse PM), discrepancies were observed between individual POA factors (traffic, biomass burning) and directly comparable SOA factors and highly oxidized OA. Similar secondary organic carbon (SOC) concentrations (3.3 ± 0.1 μg m^-3) were obtained from all approaches, except the SOA-tracer method (1.8 μg m^-3). Associated uncertainties ranged from 14 to 52% with larger uncertainties obtained for PMF-chemical data, EC- and SOA-tracer methods. This latter significantly underestimated total SOA loadings, even including biomass burning SOA, due to missing SOA classes and precursors. None of the approaches was able to identify the formation mechanisms and/or precursors responsible for the highly oxidized SOA fraction associated with nitrate- and/or sulfate-rich aerosols (35% of OA). We recommend the use of a combination of different methodologies to apportion the POC/SOC concentrations/contributions to get the highest level of confidence in the estimates obtained.

Probiotic characterization of bacterial strains from fermented South Indian tomato pickle and country chicken intestine having antioxidative and antiproliferative activities

AIM

The present study aims to evaluate the potential antioxidant and antiproliferative properties of probiotic bacterial isolates Weissella cibaria p3B, Bacillus subtilis CS, and Bacillus tequilensis CL, isolated from South Indian fermented tomato pickle (homemade) and gut content of indigenous country chicken.

METHODS AND RESULTS

The bacterial isolates exhibited antimicrobial activity against food-borne, human pathogenic bacteria, along with better survival under different bile and acidic conditions, hydrophobicity towards several hydrocarbons, and adherence to intestinal epithelial cells (INT-407 cells). Also, the intact cell (IC) mixture of the three species showed better DPPH, ABTS, and Fe²⁺ chelating activity as compared to the individual IC or cell extract (CE) activity. Among the three bacterial species, W. cibaria p3B revealed maximum antiproliferative activity against HeLa and Caco-2 cancer cells, all of which were nontoxic to INT-407 cells. Apart from being non-hemolytic, the bacterial isolates did not display any necrotic inhibition in HeLa and Caco-2 cells. The cell free supernatant (CFS) of the three bacterial isolates were tested for the production of antimicrobial peptides or bacteriocins. It found that the CFS of bacterial isolates was stable at various temperature, pH and sensitive to proteolytic enzymes confirms protenoius in nature of the antimicrobil peptides or bacteriocins.

CONCLUSION

The bacterial isolates showed promising antimicrobial, antioxidant as well as antiproliferative activities with better survival ability at different pH and bile concentrations. The three bacterial isolates were able to produce potential antimicrobial peptides or bacteriocins.

SIGNIFICANCE AND IMPACT OF THE STUDY

These results indicate better compatibility of our bacterial isolates against synthetic drugs to avoid adverse side effects and can be processed as dietary supplements against food and human pathogens. They can also provide antioxidative and antiproliferative benefits to humans and animals.

The use of intravenous lidocaine for postoperative pain and recovery: international consensus statement on efficacy and safety

Intravenous lidocaine is used widely for its effect on postoperative pain and recovery but it can be, and has been, fatal when used inappropriately and incorrectly. The risk-benefit ratio of i.v. lidocaine varies with type of surgery and with patient factors such as comorbidity (including pre-existing chronic pain). This consensus statement aims to address three questions. First, does i.v. lidocaine effectively reduce postoperative pain and facilitate recovery? Second, is i.v. lidocaine safe? Third, does the fact that i.v. lidocaine is not licensed for this indication affect its use? We suggest that i.v. lidocaine should be regarded as a 'high-risk' medicine. Individual anaesthetists may feel that, in selected patients, i.v. lidocaine may be beneficial as part of a multimodal peri-operative pain management strategy. This approach should be approved by hospital medication governance systems, and the individual clinical decision should be made with properly informed consent from the patient concerned. If i.v. lidocaine is used, we recommend an initial dose of no more than 1.5 mg.kg^-1 , calculated using the patient's ideal body weight and given as an infusion over 10 min. Thereafter, an infusion of no more than 1.5 mg.kg^-1 .h^-1 for no longer than 24 h is recommended, subject to review and re-assessment. Intravenous lidocaine should not be used at the same time as, or within the period of action of, other local anaesthetic interventions. This includes not starting i.v. lidocaine within 4 h after any nerve block, and not performing any nerve block until 4 h after discontinuing an i.v. lidocaine infusion.

1015 Sleep Duration and Physical and Mental Health Among Adult Survivors of Childhood Cancer: Results from the St. Jude Lifetime Cohort

Introduction

Sleep disturbances are prevalent among adult survivors of childhood cancer, though little is known about associations between sleep and health in this vulnerable population.

Methods

Survivors recruited from the St. Jude Lifetime Cohort (n=911; 52% female; mean age 34 years; 26 years post-diagnosis) completed surveys assessing habitual sleep patterns and mental health and underwent comprehensive physical examinations. A subset of survivors (n=491) completed sleep actigraphy. Short sleep duration was defined as sleeping <7 hours per night, assessed via self-report or actigraphy. Clinically-assessed health outcomes were defined as grade ≥2 using modified CTCAE criteria for cardiac, pulmonary, and renal conditions. Anxiety and depression were defined as scores ≥90th percentile on the Brief Symptom Inventory-18. Covariates included childhood cancer treatment exposures, demographics, body mass index, and physical inactivity. Separate logistic or modified Poisson (common outcomes) regression models were computed for each health category to estimate odds ratios (OR) or relative risks (RR) and 95% confidence intervals (CI).

Results

Self-report and actigraphy-assessed short sleep was identified in 44% and 42% of survivors, respectively. However, these measures were weakly correlated (r=0.23). In adjusted multivariable models, self-reported short sleep was associated with higher risk of pulmonary conditions (RR=1.3, 95% CI=1.1-1.7), depression (OR=2.6, 95% CI=1.4-5.1) and anxiety (OR=3.4, 95% CI=1.6-6.8), while associations with cardiac (RR=1.10, 95% CI=0.94-1.30) and renal conditions (OR=1.30, 95% CI=0.79-2.13) were not significant. There were no significant associations between actigraphy-assessed short sleep and any of the health outcomes.

Conclusion

Habitual self-reported short sleep was associated with clinically ascertained adverse health outcomes. Although the temporality of these associations cannot be determined in this cross-sectional study, sleep is a modifiable health behavior and improving sleep may improve health in survivors. Measures of self-reported sleep may have unique value when assessing the relationship between sleep and health.

Support

CA225590, K. Krull Principal Investigator; CA195547, M. Hudson and L. Robison Principal Investigators; CA21765, C. Roberts, Principal Investigator

TBX1 Regulates Chondrocyte Maturation in the Spheno-occipital Synchondrosis

The synchondrosis in the cranial base is an important growth center for the craniofacial region. Abnormalities in the synchondroses affect the development of adjacent regions, including the craniofacial skeleton. Here, we report that the transcription factor TBX1, the candidate gene for DiGeorge syndrome, is expressed in mesoderm-derived chondrocytes and plays an essential and specific role in spheno-occipital synchondrosis development by inhibiting the expression of genes involved in chondrocyte hypertrophy and osteogenesis. In Tbx1-deficient mice, the spheno-occipital synchondrosis was completely mineralized at birth. TBX1 interacts with RUNX2, a master molecule of osteoblastogenesis and a regulator of chondrocyte maturation, and suppresses its transcriptional activity. Indeed, deleting Tbx1 triggers accelerated mineralization due to accelerated chondrocyte differentiation, which is associated with ectopic expression of downstream targets of RUNX2 in the spheno-occipital synchondrosis. These findings reveal that TBX1 acts as a regulator of chondrocyte maturation and osteogenesis during the spheno-occipital synchondrosis development. Thus, the tight regulation of endochondral ossification by TBX1 is crucial for the normal progression of chondrocyte differentiation in the spheno-occipital synchondrosis.

Speciation of organic fractions does matter for aerosol source apportionment. Part 3: Combining off-line and on-line measurements

The present study proposes an advanced methodology to refine the source apportionment of organic aerosol (OA). This methodology is based on the combination of offline and online datasets in a single Positive Matrix Factorization (PMF) analysis using the multilinear engine (ME-2) algorithm and a customized time synchronization procedure. It has been applied to data from measurements conducted in the Paris region (France) during a PM pollution event in March 2015. Measurements included OA ACSM (Aerosol Chemical Speciation Monitor) mass spectra and specific primary and secondary organic molecular markers from PM₁₀ filters on their original time resolution (30 min for ACSM and 4 h for PM₁₀ filters). Comparison with the conventional PMF analysis of the ACSM OA dataset (PMF-ACSM) showed very good agreement for the discrimination between primary and secondary OA fractions with about 75% of the OA mass of secondary origin. Furthermore, the use of the combined datasets allowed the deconvolution of 3 primary OA (POA) factors and 7 secondary OA (SOA) factors. A clear identification of the source/origin of 54% of the total SOA mass could be achieved thanks to specific molecular markers. Specifically, 28% of that fraction was linked to combustion sources (biomass burning and traffic emissions). A clear identification of primary traffic OA was also obtained using the PMF-combined analysis while PMF-ACSM only gave a proxy for this OA source in the form of total hydrocarbon-like OA (HOA) mass concentrations. In addition, the primary biomass burning-related OA source was explained by two OA factors, BBOA and OPOA-like BBOA. This new approach has showed undeniable advantages over the conventional approaches by providing valuable insights into the processes involved in SOA formation and their sources. However, the origins of highly oxidized SOA could not be fully identified due to the lack of specific molecular markers for such aged SOA.

A survey on the use of intravenous lidocaine infusion for acute pain in Scottish Hospitals

Introduction

Intravenous (IV) lidocaine infusions are increasingly used in the management of acute pain. They are particularly used in patients undergoing colorectal surgery, where they are also found to decrease rates of postoperative ileus. IV lidocaine has significant toxicity in overdose. There are no current national guidelines or standards on the provision of IV lidocaine infusions. We aimed to get a snapshot of current usage and usage practices in Scottish NHS Hospitals, to identify common themes and variations in practice.

Methods

A survey designed by the authors was emailed to 20 Scottish NHS Hospitals with an acute pain team. These were then followed up by telephone, if necessary.

Results

Of the 20 hospitals, 16 (80%) responded; 12 out of 16 (75%) of the responding hospitals either used IV lidocaine infusions for acute pain or were planning to use them in the near future. There was variability in practices regarding delivery device, prescriber grade, bolus dosing, length of infusion, location of infusion and use with other local anaesthetic (LA) infusions.

Conclusions

A majority of Scottish NHS Hospitals use IV lidocaine infusions in the management of acute pain. There are some variations in current practice; standardising practices may decrease the risk of LA toxicity. A national guideline is recommended.

Microdeletion in a FAAH pseudogene identified in a patient with high anandamide concentrations and pain insensitivity

The study of rare families with inherited pain insensitivity can identify new human-validated analgesic drug targets. Here, a 66-yr-old female presented with nil requirement for postoperative analgesia after a normally painful orthopaedic hand surgery (trapeziectomy). Further investigations revealed a lifelong history of painless injuries, such as frequent cuts and burns, which were observed to heal quickly. We report the causative mutations for this new pain insensitivity disorder: the co-inheritance of (i) a microdeletion in dorsal root ganglia and brain-expressed pseudogene, FAAH-OUT, which we cloned from the fatty-acid amide hydrolase (FAAH) chromosomal region; and (ii) a common functional single-nucleotide polymorphism in FAAH conferring reduced expression and activity. Circulating concentrations of anandamide and related fatty-acid amides (palmitoylethanolamide and oleoylethanolamine) that are all normally degraded by FAAH were significantly elevated in peripheral blood compared with normal control carriers of the hypomorphic single-nucleotide polymorphism. The genetic findings and elevated circulating fatty-acid amides are consistent with a phenotype resulting from enhanced endocannabinoid signalling and a loss of function of FAAH. Our results highlight previously unknown complexity at the FAAH genomic locus involving the expression of FAAH-OUT, a novel pseudogene and long non-coding RNA. These data suggest new routes to develop FAAH-based analgesia by targeting of FAAH-OUT, which could significantly improve the treatment of postoperative pain and potentially chronic pain and anxiety disorders.

Using the Model for Improvement to implement the Critical-Care Pain Observation Tool in an adult intensive care unit

Managing pain is challenging in the intensive care unit (ICU) as often patients are unable to self-report due to the effects of sedation required for mechanical ventilation. Minimal sedative use and the utilisation of analgesia-first approaches are advocated as best practice to reduce unwanted effects of oversedation and poorly managed pain. Despite evidence-based recommendations, behavioural pain assessment tools are not readily implemented in many critical care units. A local telephone audit conducted in April 2017 found that only 30% of Scottish ICUs are using these validated pain instruments. The intensive care unit (ICU) at Raigmore Hospital, NHS Highland, initiated a quality improvement (QI) project using the Model for Improvement (MFI) to implement an analgesia-first approach utilising a validated and reliable behavioural pain assessment tool, namely the Critical-Care Pain Observation Tool (CPOT). Over a six-month period, the project deployed QI tools and techniques to test and implement the CPOT. The process measures related to (i) the nursing staff's reliability to assess and document pain scores at least every four hours and (ii) to treat behavioural signs of pain or CPOT scores ≥ 3 with a rescue bolus of opioid analgesia. The findings from this project confirm that the observed trends in both process measures had reduced over time. Four hourly assessments of pain had increased to 89% and the treatment of CPOT scores ≥3 had increased to 100%.

The Impact of Persistent Leukoencephalopathy on Brain White Matter Microstructure in Long-Term Survivors of Acute Lymphoblastic Leukemia Treated with Chemotherapy Only

BACKGROUND AND PURPOSE

Survivors of acute lymphoblastic leukemia are at risk for neurocognitive deficits and leukoencephalopathy. We performed a longitudinal assessment of leukoencephalopathy and its associations with long-term brain microstructural white matter integrity and neurocognitive outcomes in survivors of childhood acute lymphoblastic leukemia treated on a modern chemotherapy-only protocol.

MATERIALS AND METHODS

One hundred seventy-three survivors of acute lymphoblastic leukemia (49% female), treated on a chemotherapy-only protocol, underwent brain MR imaging during active therapy and repeat imaging and neurocognitive testing at follow-up (median, 13.5 years of age; interquartile range, 10.7-17.6 years; median time since diagnosis, 7.5 years; interquartile range, 6.3-9.1 years). Persistence of leukoencephalopathy was examined in relation to demographic and treatment data and to brain DTI in major fiber tracts and neurocognitive testing at follow-up.

RESULTS

Leukoencephalopathy was found in 52 of 173 long-term survivors (30.0%) and persisted in 41 of 52 (78.8%) who developed it during therapy. DTI parameters were associated with leukoencephalopathy in multiple brain regions, including the corona radiata (fractional anisotropy, P = .001; mean diffusivity, P < .001), superior longitudinal fasciculi (fractional anisotropy, P = .02; mean diffusivity, P < .001), and superior fronto-occipital fasciculi (fractional anisotropy, P = .006; mean diffusivity, P < .001). Mean diffusivity was associated with neurocognitive impairment including in the genu of the corpus callosum (P = .04), corona radiata (P = .02), and superior fronto-occipital fasciculi (P = .02).

CONCLUSIONS

Leukoencephalopathy during active therapy and neurocognitive impairment at long-term follow-up are associated with microstructural white matter integrity. DTI may be more sensitive than standard MR imaging for detection of clinically consequential white matter abnormalities in childhood acute lymphoblastic leukemia survivors treated with chemotherapy and in children undergoing treatment.

Speciation of organic fractions does matter for aerosol source apportionment. Part 2: Intensive short-term campaign in the Paris area (France)

The present study aimed at performing PM₁₀ source apportionment, using positive matrix factorization (PMF), based on filter samples collected every 4h at a sub-urban station in the Paris region (France) during a PM pollution event in March 2015 (PM₁₀>50μgm^-3 for several consecutive days). The PMF model allowed to deconvolve 11 source factors. The use of specific primary and secondary organic molecular markers favoured the determination of common sources such as biomass burning and primary traffic emissions, as well as 2 specific biogenic SOA (marine+isoprene) and 3 anthropogenic SOA (nitro-PAHs+oxy-PAHs+phenolic compounds oxidation) factors. This study is probably the first one to report the use of methylnitrocatechol isomers as well as 1-nitropyrene to apportion secondary OA linked to biomass burning emissions and primary traffic emissions, respectively. Secondary organic carbon (SOC) fractions were found to account for 47% of the total OC. The use of organic molecular markers allowed the identification of 41% of the total SOC composed of anthropogenic SOA (namely, oxy-PAHs, nitro-PAHs and phenolic compounds oxidation, representing 15%, 9%, 11% of the total OC, respectively) and biogenic SOA (marine+isoprene) (6% in total). Results obtained also showed that 35% of the total SOC originated from anthropogenic sources and especially PAH SOA (oxy-PAHs+nitro-PAHs), accounting for 24% of the total SOC, highlighting its significant contribution in urban influenced environments. Anthropogenic SOA related to nitro-PAHs and phenolic compounds exhibited a clear diurnal pattern with high concentrations during the night indicating the prominent role of night-time chemistry but with different chemical processes involved.

Chronic post-amputation pain: peri-operative management - Review

Study design

Narrative review.

Method

Eight bibliographic databases were searched for studies published in the (last five years up until Feb 2017). For the two database searches (Cochrane and DARE), the time frame was unlimited. The review involved keyword searches of the term 'Amputation' AND 'chronic pain'. Studies selected were interrogated for any association between peri-operative factors and the occurrence of chronic post amputation pain (CPAP).

Results

Heterogeneity of study populations and outcome measures prevented a systematic review and hence a narrative synthesis of results was undertaken. The presence of variation in two gene alleles (GCH1 and KCNS1) may be relevant for development of CPAP. There was little evidence to draw conclusions on the association between age, gender and CPAP. Pre-operative anxiety and depression influenced pain intensity post operatively and long-term post amputation pain (CPAP). The presence of pre-amputation pain is correlated to the development of acute and chronic post amputation pain while evidence for the association of post-operative pain with CPAP is modest. Regional anaesthesia and peri-neural catheters improve acute postoperative pain relief but evidence on their efficacy to prevent CPAP is limited. A suggested whole system pathway based on current evidence to optimize peri-operative amputation pain is described.

Conclusion

The current evidence suggests that optimized peri-operative analgesia reduces the incidence of acute peri-operative pain but no firm conclusion can be drawn on reducing risk for CPAP.

Subjective and objective evaluation of frontal smile esthetics in patients with facial asymmetry-a comparative cross-sectional study

AIM AND OBJECTIVES

To analyze the relationship between subjective and objective evaluations of pre-treatment posed smiles in patients with facial asymmetry and to assess the influence of dentofacial structures involved in asymmetry on the perception of smile attractiveness.

SAMPLE

Thirty-five patients (25 males and 10 females) between 18 and 25 years of age with facial asymmetry were selected.

MATERIALS AND METHODS

Pre-treatment clinical photographs of posed smiles were subjectively evaluated by a panel of 20 orthodontists, 20 oral surgeons, and 20 laypersons. A customized Smile Mesh program was used for objective evaluation of the same smiles. Direct comparison among three smile groups (unattractive, slightly attractive, and attractive) for different Smile Mesh measurements was carried out using two-way anova test. Additionally, linear regression was performed to evaluate whether these measurements could predict the attractiveness of captured smiles.

RESULTS

Patients with 'slightly attractive' smiles had a significantly greater distance between the incisal margin of the maxillary central incisor and the lower lip during smiling. The Smile Index was significantly greater in attractive smiles. However, based on the coefficients of linear regression, no objectively gathered measurement could predict smile attractiveness.

CONCLUSIONS

Attractiveness or unattractiveness of smiles in patients with facial asymmetry could not be predicted by any measurement of Smile Mesh. The presence of facial asymmetry did not significantly influence the perception of smile esthetics.

Crystal structure and thermoelectric properties of Sr-Mo substituted CaMnO3: a combined experimental and computational study

A combination of experimental and computational techniques has been employed to study doping effects in perovskite CaMnO₃. High quality Sr-Mo co-substituted CaMnO₃ ceramics were prepared by the conventional mixed oxide route. Crystallographic data from X-ray and electron diffraction showed an orthorhombic to tetragonal symmetry change on increasing the Sr content, suggesting that Sr widens the transition temperature in CaMnO₃ preventing phase transformation-cracking on cooling after sintering, enabling the fabrication of high density ceramics. Atomically resolved imaging and analysis showed a random distribution of Sr in the A-site of the perovskite structure and revealed a boundary structure of 90° rotational twin boundaries across {101}_orthorhombic; the latter are predominant phonon scattering sources to lower the thermal conductivity as suggested by molecular dynamics calculations. The effect of doping on the thermoelectric properties was evaluated. Increasing Sr substitution reduces the Seebeck coefficient but the power factor remains high due to improved densification by Sr substitution. Mo doping generates additional charge carriers due to the presence of Mn³⁺ in the Mn⁴⁺ matrix, reducing electrical resistivity. The major impact of Sr on thermoelectric behaviour is the reduction of the thermal conductivity as shown experimentally and by modelling. Strontium containing ceramics showed thermoelectric figure of merit (ZT) values higher than 0.1 at temperatures above 850 K. Ca_0.7Sr_0.3Mn_0.96Mo_0.04O₃ ceramics exhibit enhanced properties with S_1000K = -180 μV K^-1, ρ_1000K = 5 × 10^-5 Ωm, k_1000K = 1.8 W m^-1 K^-1 and ZT ≈ 0.11 at 1000 K.

Associations between IL-1RA polymorphisms and small intestinal bacterial overgrowth among patients with irritable bowel syndrome from India

BACKGROUND

Low-grade inflammation (controlled by pro and anti-inflammatory molecules), induced by gut microbes in patients with small intestinal bacterial overgrowth (SIBO), may be associated with irritable bowel syndrome (IBS). Polymorphisms of IL-RA gene (anti-inflammatory) was evaluated in IBS and healthy subjects (HS); small intestinal mucosal IL-1α and β levels (pro-inflammatory) in relation to the presence of SIBO were evaluated in a subset of patients.

METHODS

Two hundred and twenty-one IBS patients and 273 age- and gender-matched HS were included. Exactly 209 of 221 patients (Rome III) and 273 HS were genotyped (PCR) for IL-1RA polymorphism. Mucosal IL-1α and β levels (pg/mg of biopsy) were estimated (ELISA) in 82/221 patients with and without SIBO (≥10(5)  CFU/mL upper gut aspirate bacteria).

KEY RESULTS

Genotype 1/1 (IL-1RA over-producer) was less frequent among patients than controls (p = 0.007); genotypes 1/3 (p = 0.012, OR = 3.301, 95% CI = 1.31-8.35) and 2/3 (both under-producers; p = 0.009, OR = 7.703, 95% CI = 1.66-35.82) were commoner among IBS. Fifteen of 82 (18.3%) patients had SIBO. Levels of IL-1α and β were higher among patients with SIBO than without (IL-1α: 35.4 [20.1-66.8] vs 25.5 [4.2-65.3], p < 0.001; IL-1β: 206.8 [133.5-365.9] vs 93.1 [25.5-197.7], p < 0.001) and those with bloating than without (p = 0.012; p = 0.015). IL-1β was higher among patients with Bristol stool type 6 than those with type 1-2 (p = 0.002) and type 3-5 (p = 0.007).

CONCLUSIONS & INFERENCES

Polymorphisms 1/1 (IL-1RA over-producer) was infrequent and 1/3 and 2/3 (under-producers) frequent among IBS. Increased IL-1α and β levels were associated with SIBO. Increased IL-1β level was predominantly associated with bloating and loose stools (Bristol type 6).

Comparison of foetomaternal circulation in normal pregnancies and pregnancy induced hypertension using color Doppler studies

The aim of present study was to assess fetomaternal blood flows in normal and abnormal pregnancies using color Doppler indices. Subjects were divided into two groups as: Group A of 25 subjects of normal pregnancy as controls and group B of 25 subjects of pregnancy induced hypertension. All the subjects were lying in the age-group of 25-35 years and having 28 to 34 weeks of gestation; the patients were evaluated by detailed history and were subjected to complete general examination. Blood pressure was taken on two occasions at least 6 hours apart. Systemic examination and obstetrical examination was done in all subjects. All cases were subjected to pathological tests- Haemogram, Test for proteins in urine. Ultrasound assessment of fetal growth was done by measuring BPD (Biparietal diameter), HC (Head circumference), FL (Femur length) and AC (Abdominal circumference): Average gestational age and effective fetal weight was then calculated by ultrasound machine. Color Doppler was used to assess the various Doppler indices indices: Pulsatility index (PI), Resistive index (RI) and Systolic diastolic ratio (S/D ratio) in bilateral uterine, umbilical and middle cerebral arteries and compared to the standard normograms. Percentage of subjects having abnormal Doppler indices were calculated. Assessment of percentage of SGA (small for gestational age) fetuses was done in all the three groups. Decline in mean values of all Doppler indices was found with advancing gestational age in normal pregnancy suggesting decreased vascular resistance and increased blood flow in fetomaternal circulation. In pregnancy induced hypertensives, the mean values of Doppler indices showed a decline as in normal pregnancy but showed an increase (more than 2 S.D. of the mean) for that gestational age in comparison to the control group suggesting increased impedance to blood flow in uteroplacental and fetomaternal circulation. Umbilical artery Doppler indices were found to be the most sensitive indicator of uteroplacental and fetoplacental insufficiency in pregnancy induced hypertensives (P = 0.001). Thus we concluded that color Doppler can detect changes in fetomaternal circulation which correlate strongly with the fetal growth and therefore associated with pregnancy outcome.

Mahogunin-mediated α-tubulin ubiquitination via noncanonical K6 linkage regulates microtubule stability and mitotic spindle orientation

Mahogunin ring finger-1 (MGRN1) is a cytosolic ubiquitin ligase whose disruption or interaction with some isoforms of cytosolically exposed prion protein leads to spongiform neurodegeneration and also lack of which results in reduced embryonic viability due to mispatterning of the left–right (LR) axis during development. Here we demonstrate an interaction between the cytoskeletal protein α-tubulin and MGRN1. In cultured cell systems, loss of the ubiquitin E3 ligase activity of MGRN1 results in spindle misorientation and decreased α-tubulin polymerization, an effect also seen in primary cells. α-Tubulin was post-translationally modified by MGRN1 via noncanonical K6-linked polyubiquitination. This was significant because expression of catalytically inactive MGRN1 and/or ubiquitin mutant capable of only monoubiquitination resulted in similar mitotic spindle misorientation. The modulatory effect of MGRN1 was specific for α-tubulin and similar changes could not be detected in β- or γ-tubulin. However, catalytic inactivation of MGRN1 did not abrogate monoubiquitination of α-tubulin, thus unraveling a unique dual mode of ubiquitination by an unknown E3 ligase and MGRN1. MGRN1-mediated α-tubulin modification, and hence its stability, may highlight a key event in the LR patterning during embryogenesis.

Efficacy of sacral neuromodulation in treating chronic pain related to painful bladder syndrome/interstitial cystitis in adults

OBJECTIVE

The objective of this review is to evaluate the efficacy and safety of sacral neuromodulation in treating chronic pelvic pain related to Painful bladder syndrome/Interstitial-cystitis.

DESIGN

The databases searched were MEDLINE and EMBASE [1950- Nov 2011]. Additional searches were performed on the Cochrane Database of Systematic reviews (CDSR), Scopus, CINAHL, BIOSIS, The Cochrane controlled trials register, the science citation index, TRIP DATABASE.

RESULTS

Overall 70.8% or 170/244 patients were successful at the trial stage. The only randomized controlled trial reported a decrease in Visual analogue pain scores of 49% (7.9 to 4.0) for sacral nerve stimulation [SNS] and 29%(4.5 to 3.2) for pudendal nerve stimulation [PNS] at 6 months follow up. Nine observational studies reported a decrease in pain scores/decrease in pain medications at long term follow up following permanent sacral neuromodulation. One study showed an 80% improvement in Global response assessment score.

CONCLUSION

The results from the randomised controlled trial and case series/case reports demonstrate a reduction of pain symptoms of Painful bladder syndrome following sacral neuromodulation.

Combining Molecular Dynamics and Monte Carlo Simulations to Model Chemical Vapor Deposition: Application to Diamond

Gas-surface reactions of the type that contribute to growth during the chemical vapor deposition (CVD) of diamond films are generally completed in picoseconds, well within timescales accessible by molecular dynamics (MD) simulations. For low-pressure deposition, however, the time between collisions for a surface site can be microseconds, which makes direct modeling of CVD crystal growth impossible using standard MD methods. To effectively bridge this discrepancy in timescales, the gas-surface reactions can be modeled using MD trajectories, and then this data can be used to define probabilities in a Monte Carlo algorithm where each step represents a gas-surface collision. We illustrate this approach using the reaction of atomic hydrogen with a diamond (111) surface as an example, where we use abstraction and sticking probabilities generated using classical trajectories in a simple Monte Carlo algorithm to determine the number of open sites as a function of temperature. We also include models for the thermal desorption of hydrogen that predict that growth temperatures are not restricted by the thermal loss of chemisorbed hydrogen.

Concentration effect on tuning of block copolymer-mediated synthesis of gold nanoparticles

Synthesis of gold nanoparticles has been examined using triblock copolymer Pluronic P85 (EO26PO39EO26) at different concentrations as a function of hydrogen tetrachloroaureate (III) hydrate (HAuCl4 x 3H2O) in aqueous solution. The concentration of P85 block copolymer was varied from 0.5 to 2 wt% at fixed temperature (30 degrees C) in presence of HAuCl4 x 3H2O in the range of 0.002 to 0.2 wt% for each P85 concentration. The surface plasmon resonance in the time-dependent UV-visible spectra reveals that increase in the block copolymer concentration increases the yield of the gold nanoparticles but decreases their stability. Both small-angle neutron scattering (SANS) and dynamic light scattering (DLS) show that the number density of block copolymer micelles increase almost linearly with the concentration, which is related to result in higher numbers of nucleation centers and therefore increase in the yield of gold nanoparticles. The fact that increase in the number density of nanoparticles also increases the chances of aggregation and this tends to decrease the stability at higher block copolymer concentration. Transmission electron microscopy (TEM) images confirm the larger sizes of the nanoparticles formed in these systems at higher concentrations.

Temporal trends in cause-specific late mortality among five-year survivors of childhood cancer

10004

Background: Five-year survival rates for childhood cancer have increased over the past 4 decades, increasing the number of long-term survivors. Among 5-yr survivors, the impact of changes in therapy on cause-specific late mortality has not been thoroughly assessed. Methods: Late mortality was evaluated over 3 eras (1974–81, 1982–90, 1991–2000) in 26,643 5-year survivors diagnosed <21 years of age from the SEER population-based registry. Cause-specific mortality was categorized as death from recurrence/progression of primary disease, external causes, and non-recurrence/non-external causes (Non-Recur/Ext) (i.e., deaths from health conditions including sequelae of cancer therapy). Results: All-cause and Recurrence mortality was significantly lower in more recent eras ( Table ). No significant improvement in late mortality attributable to Non-Recur/Ext causes was seen. Additionally, all-cause mortality was significantly lower in more recent eras for 5-year survivors of ALL, AML, Hodgkin, NHL, and CNS tumors, but not neuroblastoma and Ewing's Sarcoma where an increase in cumulative incidence of late mortality was seen in more recent eras. Significant improvement in late mortality from Recurrence by era was seen in most diagnostic groups. Conclusions: All-cause late mortality has improved with more recent eras, attributable to reduced rates of mortality from progression of primary disease (i.e., durable remission). Importantly, however, efforts to reduce the toxicity of more recent therapies have not produced detectable reduction in mortality attributable to other health conditions including sequelae of cancer therapy (non-Recur/Ext causes of death), which would include death from second malignancy, cardiac and pulmonary conditions. Worsening late mortality for 5-year survivors of neuroblastoma and Ewing's sarcoma may be due to improved use of salvage therapies that delay, but do not ultimately prevent death. [Table: see text]

No significant financial relationships to disclose.

Preoperative evaluation of epithelial ovarian cancer with multidetector computed tomography and its correlation with surgical outcome

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Background: In the management of epithelial ovarian cancer (EOC), optimum debulking surgery (residual tumour of 1 cm or less) is the most important prognostic factor and is associated with higher survival We conducted a prospective study to evaluate the role of Multidetector (MD) CT scan to predict optimal debulking in advanced EOC. Methods: Between December, 2004 and October, 2006, 38 previously untreated patients (median age-50 years, range 26 to 70) were evaluated with contrast- enhanced MD CT scan of abdomen and pelvis. All CT scans were performed on four-slice MD CT scanner with thin slice image acquisition. Multiplanar coronal, sagital or oblique images were constructed and all images were reviewed by at least 2 radiologists. The extent of disease was determined and mapped for all areas of abdomen and pelvis. Patients underwent primary debulking surgery in which total abdominal hysterectomy, bilateral salphingo-oophorectomy, omentectomy and optimal cytoreduction was done. CT scan films were reviewed and compared with surgical findings. A CT scan scoring system was developed to predict the optimum debulking using 10 parameters: ascites, pelvic, peritoneal deposits, large bowel, small bowel, omentum, diaphragm, liver, lymphadenopathy and lesser sac. Each factor was assigned a score of 0 to 2. The statistical analysis was done using SPSS version 11 and EpiInfo 6 software. Results: The mean interval between CT scan and surgery was 11 days. 18 of 38 patients had a CT score = 7; all 18 had sub-optimal debulking. Of remaining 20 patients with CT score <7, 17(44.7%) had optimum and 3 had sub-optimal cytoreduction. The sensitivity and specificity was 85.7% (95% CI 62.6–96.2) and 100% (95% CI 77.1–100), respectively. It had positive predictive value of 100% and negative predictive value of 85% with accuracy of 92% in identification of patients who would not benefit from surgery. Presence of tumor at gall bladder fossa, porta hepatis, ligament teres, spleen , stomach, pancreas, lesser sack and pelvic side walls was associated with sub-optimal debulking. Conclusions: Pre-operative CT scan scoring helps to identify patients who are likely to have sub-optimal debulking and may be candidates for neoadjuvant chemotherapy

No significant financial relationships to disclose.

Skeletal stability after correction of maxillary hypoplasia by the Glasgow extra-oral distraction (GED) device

Maxillary distraction osteogenesis delivers excellent results, particularly in patients with clefts. In the past, devices such as the conventional facemask and the rigid external distraction device have been used to correct maxillary hypoplasia after a Le Fort I osteotomy. We describe a new device, the Glasgow extra-oral distraction device. The extent of skeletal and dental stability of corrections achieved in 10 patients with maxillary hypoplasia associated with clefts was satisfactory. This device costs little, can be produced in developing countries, and provides effective treatment for severe secondary deformity associated with clefts.

Irradiation-induced magnetism in carbon nanostructures

Nitrogen (15N) and carbon (12C) ion implantations with implant energy of 100 keV for different doses were performed on nanosized diamond (ND) particles. Magnetic measurements on the doped ND show ferromagnetic hysteresis behavior at room temperature. The saturation magnetization (M(s)) in the case of 15N implanted samples was found to be higher compared to the 12C implanted samples for dose sizes greater than 10(14) cm(-2). The role of structural modification or defects along with the carbon-nitrogen (C-N) bonding states for the observed enhanced ferromagnetic ordering in 15N doped samples is explained on the basis of x-ray photoelectron spectroscopy measurements.

Vibrational characteristics of carbon nanotubes as nanomechanical resonators

Using eigenvalue analysis of mass and stiffness matrices directly computed from atomistic simulations, natural frequencies and mode shapes of various carbon nanotubes are studied. The stiffness matrix was developed from the Tersoff-Brenner potential for carbon-carbon interactions. The computed frequencies of the radial breathing modes of a variety of armchair (n, n) nanotubes agree well with results obtained by others using different techniques. In addition, the study reveals diverse mode shapes such as accordion-like axial modes, lateral bending modes, torsional modes, axial shear modes, and radial breathing modes for a variety of single-wall, multi-wall, and bamboo-type carbon nanotubes. The effects of different constraints on the carbon nanotube ends on the computed frequencies and mode shapes have been investigated for possible applications in vibration sensors or electromechanical resonators.