A Randomised Controlled Trial of Postoperative Sensitivity after Class II Restoration with Bulk-Fill vs Conventional Composites

INTRODUCTION

Bulk-fill composites may simplify posterior restorations, saving time and reducing technical complexity. Post-operative sensitivity is a risk of posterior composites; bulk-fill composites could mitigate this. This single centre, double-blinded, parallel groups randomised controlled trial compared postoperative sensitivity following restoration of class II carious lesions with bulk-fill or conventional, layered composite.

NULL HYPOTHESIS

there will be no difference in post-operative sensitivity between the two materials.

METHODS

Participants requiring class II restoration of posterior teeth were randomised to bulk-fill (FU) (Coltene Fill-UpTM) or conventional, layered (BE) (Coltene Brilliant Everglow) composite. Allocation was concealed during cavity preparation. Only the operating dentist knew allocation. The outcome was 24 h post-operative sensitivity.

RESULTS

41 patients were randomised (20/group). Two patients from FU group were excluded from analysis (factors unrelated to intervention). There was no difference in postoperative sensitivity at 24 h nor any time point. Only participant age and baseline sensitivity scores significantly impacted post-operative sensitivity. One restoration debonded in FU group at 10 days, with no other adverse effects. No difference in time taken to place restorations was seen.

CONCLUSIONS

Within the study's limitations, post-operative sensitivity after class II posterior restorations was no different in bulk-fill restorations compared with conventional, incrementally cured composite.

Follow-up arrangements in head and neck cancer clinics during the COVID-19 pandemic: results from two tertiary UK head and neck cancer centres

INTRODUCTION

The aim of this paper is to report the pattern of follow-up that occurred for a cohort of head and neck cancer (HNC) patients across two large centres in the UK (Aintree and Leeds), as a consequence of the COVID-19 pandemic.

METHODS

Patients had been treated for HNC with curative intent between April 2017 and October 2019 by 14 oral and maxillofacial (OMFS) and ear nose and throat (ENT) oncology surgeons in the Patient Concerns Inventory intervention trial. In October 2020, hospital records were reviewed, and information collected on the timing and mode (face-to-face/telephone/video) of follow-up consultations. In addition, recurrence, second primary tumours and deaths were recorded.

RESULTS

At the start of 'lockdown', 212 members of the cohort were known to be alive. During the post-lockdown period (follow-up appointment data comprised 5 months in Aintree and 7 months in Leeds) 7 died and 13 were identified as palliative/recurrence/new primary/metastases ('new event'). In Aintree, the first ENT/OMFS consultations after lockdown were 51 (67%) telephone and 25 (33%) face-to-face appointments. In Leeds, 46 (78%) consultations were by telephone and 13 (22%) were face-to-face. The second ENT/OMFS consultations post lockdown included 11 (44%) telephone and 14 (56%) face-to-face in Aintree, and 21 (75%) telephone and 7 (25%) face-to-face in Leeds.

CONCLUSIONS

These data suggest that clinicians favoured remote consultations. Variations in practice were observed but reached a point of a 'hybrid follow-up approach' that included both face-to-face and remote consultations. With the emergence of telemedicine, clinicians may consider a follow-up model tailored to risk stratification. The development of the mode of such a consultation model needs further evaluation.

1521 Oral Foregut Duplication Cyst in A Neonate: A Case Report and Review of The Literature

A four-day-old neonate was referred to the Oral and Maxillofacial Surgery department by the Paediatric medical team regarding a cystic lesion associated with the child’s lingual frenulum. The lesion appeared to be affecting feeding causing a potential failure to thrive.

An MRI showed a 22 x 14 x 17 mm thin-walled oval cystic structure within the midline of the tongue/floor of the mouth. The decision was made with the family to surgically excise the lesion under a general anaesthetic. The histopathology results demonstrated the cyst to be lined with both gastric surface mucus cells and ciliated respiratory-type epithelium.

The patient was diagnosed with having an Oral Foregut Duplication Cyst (OFDC), also known as a lingual choristoma, enteric duplication cyst or heterotopic gastrointestinal cyst of the oral cavity. OFDCs are benign developmental anomalies that contain foregut derivatives. The cyst linings can contain gastrointestinal, respiratory, squamous or mixed cell types. There are only approximately 58 cases reported in the literature, demonstrating the rarity of these lesions.

OFDCs can be asymptomatic but in some neonates, they can present with difficulties feeding, swallowing and even has been shown to cause airway obstruction. If left in situ an OFDC can potentially go on to hinder speech development.

Although rare, OFDCs should be considered in a differential diagnosis of congenital oral lesions and in particular those of the anterior floor of mouth and tongue. With the use of pre-op imaging to help planning, surgical excision is both diagnostic and therapeutic.

1512 A Service Evaluation of Transoral Laser Resection Procedures for Oral Cancer and Dysplasia

Aim

The use of the diode laser is a frequently employed treatment modality in primary surgical excision, especially for early oral cancer. This is due to advantages offered in precision of excision, and potential reduced post-operative pain compared to other excision methods. Additionally, haemostasis can often be obtained simultaneous to excision. Despite frequent use of laser excision for oral cancer/dysplasia, there is limited information on the incidence of postoperative complications.

Method

Data was collected retrospectively by review of electronic healthcare records for a 5-year period (Jan 2015-Jan 2020) for patients who underwent transoral laser excision of oral dysplasia in a major UK teaching hospital. The number of short (<30 days) and longer-term complications was evaluated and categorised using the Clavien-Dindo classification.

Results

A total 260 patients received diode laser resection for oral cancer/dysplasia in this period. Approximately one third of patients had the diagnosis of SCC and 52% of patients were treated on a day case basis. Approximately one third of patients experienced postoperative complications.; including positive or close resection margins (16%), bleeding (8%), superficial infection (6%) and significant postoperative pain (2%). A total of 16% of patients required further treatment in theatre (Clavien-Dindo IIIb).

Conclusions

The use of lasers for excision of oral tumours and dysplastic lesions is a frequently employed modality, offering advantages to the operating surgeon (improved haemostasis, excellent manoeuvrability) and patients (reduced pain and scarring). Complications are largely predictable in nature, but the surgical team should be aware of potential issues to ensure safe, effective patient care.

Current practice in the management of peripheral ameloblastoma: a structured review

Ameloblastoma is the most common benign, but locally destructive, epithelial odontogenic tumour. Peripheral ameloblastoma may involve soft tissues without invasion or involvement of bone. The aim of this structured review was to evaluate the literature and guide clinical management. Three online databases were searched for relevant studies: Medline, EMBASE, and Ovid Evidence-Based Medicine, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. A total of 520 papers were initially identified, and after exclusions were applied, 45 were included. Conservative surgical excision was the treatment of choice. There was no consensus in relation to the extent of the surgical margins required. The management of peripheral ameloblastoma appears to favour conservative excision with narrow margins of normal tissue. Follow up of at least 10 years is recommended to monitor for recurrence.

Dressing disrupted: negotiating care through the materiality of dress in the context of dementia

This paper explores how the materiality of dress mediates and shapes practices of care in the context of dementia. Earlier research called for an approach to conceptualising care that recognised the role played by everyday artefacts. We extend this to a consideration of dress and dressing the body in relation to people with dementia that involves the direct manipulation of material objects, as well as the materiality of bodies. The paper draws on an ESRC funded study Dementia and Dress, which examined experiences of dress for people with dementia, families and care-workers using ethnographic and qualitative methods. Our analysis explores the process of dressing the body, the physicality of guiding and manipulating bodies into clothing, dealing with fabrics and bodies which 'act back' and are resistant to the process of dressing. We consider how the materiality of clothing can constrain or enable practices of care, exploring tensions between garments that support ease of dressing and those that sustain identity. Examining negotiations around dress also reveals tensions between competing 'logics' of care (Mol ).

Architecture and health care: a place for sociology

Sociologists of health and illness have tended to overlook the architecture and buildings used in health care. This contrasts with medical geographers who have yielded a body of work on the significance of places and spaces in the experience of health and illness. A review of sociological studies of the role of the built environment in the performance of medical practice uncovers an important vein of work, worthy of further study. Through the historically situated example of hospital architecture, this article seeks to tease out substantive and methodological issues that can inform a distinctive sociology of healthcare architecture. Contemporary healthcare buildings manifest design models developed for hotels, shopping malls and homes. These design features are congruent with neoliberal forms of subjectivity in which patients are constituted as consumers and responsibilised citizens. We conclude that an adequate sociology of healthcare architecture necessitates an appreciation of both the construction and experience of buildings, exploring the briefs and plans of their designers, and observing their everyday uses. Combining approaches and methods from the sociology of health and illness and science and technology studies offers potential for a novel research agenda that takes healthcare buildings as its substantive focus.

Consumption and the constitution of age: expenditure patterns on clothing, hair and cosmetics among post-war 'baby boomers'

The article addresses debates around the changing nature of old age, using U.K. data on spending on dress and related aspects of appearance by older women to explore the potential role of consumption in the reconstitution of aged identities. Based on pseudo-cohort analysis of Family Expenditures Survey, it compares spending patterns on clothing, cosmetics and hairdressing, 1961-2011. It concludes that there is little evidence for the 'baby boomers' as a strategic or distinctive generation. There is evidence, however, for increased engagement by older women in aspects of appearance: shopping for clothes more frequently; more involved in the purchase of cosmetics; and women over 75 are now the most frequent attenders at hairdressers. The roots of these patterns, however, lie more in period than cohort effects, and in the role of producer-led developments such as mass cheap fashion and the development of anti-ageing products.

Dress, dementia and the embodiment of identity

The article explores the significance of dress in the embodied experience of dementia, exploring questions of identity, memory and relationship. It suggests that clothing and dress are important in the analysis of the day-to-day experiences of people with dementia, giving access to dimensions of selfhood often ignored in over-cognitive accounts of being. As a result clothing and dress can be significant to the provision of person-centred dementia care. These arguments are explored through ideas of embodied identity, the materialisation of memories, and the maintenance, or otherwise, of appearance in care. The article forms part of the background to an ESRC-funded empirical study exploring the role of clothing and dress in the everyday lives of people with dementia, living at home or in care homes, and of their relatives.

Conceptualising body work in health and social care

Body work is a central activity in the practice of many workers in the field of health and social care. This article provides an introduction to the concept of body work--paid work on the bodies of others--and demonstrates its importance for understanding the activities of health and social care workers. Providing an overview of existing research on body work, it shows the manifold ways in which this can inform the sociology of health and illness--whether through a micro-social focus on the inter-corporeal aspects of work in health and social care, or through elucidating our understanding of the times and spaces of work, or through highlighting the relationship between mundane body work and the increasingly global movements of bodies, workers and those worked-upon. The article shows how understanding work undertaken on the bodies of others as 'body work' provides a mechanism for relating work in the sphere of health and social care to that in other sectors, opening up new avenues for research.

NGO initiatives in risk reduction: an overview

NGOs appear to be well placed to play a significant role in natural disaster mitigation and preparedness (DMP), working, as they do, with poorer and marginalised groups in society. However, there is little information on the scale or nature of NGO DMP activities. This paper reports the findings of a study seeking to address that gap. It confirms that NGOs are involved in a diverse range of DMP activities but that a number of them are not labelled as such. Moreover, evidence of the demonstrable quality and benefits of DMP involvement is poor. The paper concludes that a number of problems need to be overcome before DMP can be satisfactorily mainstreamed into NGO development and post-disaster rehabilitation programmes. However, there are some early indications of momentum for change.

Spontaneous tubal re-canalisation: a late complication of Falope ring sterilisation

The case presented demonstrates the possibility of late failure of laparoscopic female sterilisation due to migration of a Falope ring with tubal recanalisation as a possible mechanism.

Analysis of the impact of intracellular reactive oxygen species generation on the structural and functional integrity of human spermatozoa: lipid peroxidation, DNA fragmentation and effectiveness of antioxidants

Exposure of human spermatozoa to nicotinamide adenine dinucleotide phosphate (NADPH) resulted in the dose dependent generation of reactive oxygen species (ROS) which, at a critical level of intensity, induced lipid peroxidation, DNA damage and a dramatic decline of sperm motility. This system was then used as a model for screening the ability of different antioxidants to combat oxidative stress created through the excessive intracellular generation of toxic oxygen products of metabolism. A variety of antioxidants that has previously been shown to be protective against extracellularly derived oxidants (e.g. superoxide dismutase, catalase, vitamin E, hypotaurine) were ineffective in this system. Albumin, however, could provide complete protection against NADPH induced oxidative stress via mechanisms that did not involve the suppression of the lipid peroxidation cascade but rather the inactivation of lipid peroxides generated during this process. Albumin did not protect against DNA damage induced by NADPH but was extremely effective at preventing DNA fragmentation arising from the suppression of glutathione peroxidase activity with mercaptosuccinate. These studies emphasize that the design of clinically effective antioxidant treatments will depend, critically, upon the source of the oxidative stress. For cases involving excessive intracellular ROS generation, albumin appears to be an important means of neutralizing lipid peroxide-mediated damage to the sperm plasma membrane and DNA.

Iatrogenic DNA damage induced in human spermatozoa during sperm preparation: protective significance of seminal plasma

Before the advent of intracytoplasmic sperm injection (ICSI) semen preparation techniques focused on the need to sustain the fertilizing potential of the spermatozoa particularly by reducing oxidative stress. However, for severely oligozoospermic patients treated by ICSI, sperm preparation protocols are used which aim to maximize sperm recovery rather than sperm function. In this study we have examined the impact of different sperm preparation techniques on oxidative stress, sperm motion and DNA integrity. Reactive oxygen species (ROS) generation was monitored using luminol-dependent chemiluminescence, seminal antioxidant activity was assessed using a total reactive antioxidant potential (TRAP) assay while sperm motility and DNA damage were evaluated using computer assisted semen analysis and in-situ nick translation respectively. The results demonstrate a significant increase in the levels of ROS generated by samples prepared by swim-up from a washed pellet compared with spermatozoa isolated directly from seminal plasma. This oxidative stress was associated with a highly significant increase in the level of DNA damage sustained by the spermatozoa while the quality of sperm motility remained largely unchanged. These results suggest that if repeated centifugation protocols are to be used to prepare spermatozoa, strategies should be developed for minimizing collateral DNA damage.

Community nursing: nurses' effectiveness in supporting carers

This article outlines the results of a research project to evaluate the effectiveness of service support to informal carers. There are many ways in which community nurses can support carers, and carers frequently report the benefits of the service. The potential significance of the community nursing service in this role, however, is yet to be realised as nursing is still highly task-orientated, with priority given to specific medical interventions. As a result, some carers face difficulties in obtaining nursing support.

Notes: a suitable case for audit

The increasing emphasis on management responsibilities and audit led us to investigate the state of surgical notes in our hospital. Twelve criteria were evaluated regarding information that should be contained in the notes and the absence of this important information was documented. Deficiencies were revealed in all criteria selected. Until hospital patients files are well kept and maintained, retrospective audit whether financial or medical will not be valid. A significant injection of resources is required to redress the situation. Hospitals which have not carried out detailed studies into the contents of their notes need to do so as a matter of urgency.

Calcium-induced chromatin condensation and cyclin phosphorylation during chromatin condensation cycles in ammonia-activated sea urchin eggs

Ammonia-activated sea urchin eggs undergo repeated cycles of DNA synthesis, nuclear envelope breakdown (NEB) and chromatin condensation. No mitotic spindle forms, nor do the eggs undergo cytokinesis. Ammonia-activated eggs exhibit a form of the cell cycle in which the nuclear cycle proceeds without segregation of the chromatin into daughter cells. We discuss here experiments that demonstrate that intracellular free calcium concentration controls the S phase-M phase transition in ammonia-activated eggs, as it does in fertilized embryos. Cyclins are proteins that are synthesized throughout the cell cycle and destroyed abruptly during each round of chromatin condensation. We find that cycles of cyclin phosphorylation and destruction occur coincident with chromatin condensation in ammonia-activated eggs. Cyclin phosphorylation also occurs in eggs treated with the tumour promoter, phorbol myristate acetate (PMA). There is no accompanying NEB or chromatin condensation, however, and the nucleus is insensitive to exogenously-generated calcium transients. These latter data indicate that cyclin synthesis and phosphorylation is not a sufficient condition for calcium-induced NEB in sea urchin embryos. PMA must fail to induce one of the necessary cell cycle initiation signals. We suggest that the missing signal is the activation of the cell cycle control protein p34cdc2, which we have shown to be phosphorylated at fertilization and which is phosphorylated in ammonia-activated eggs.

Models of carers: how do social care agencies conceptualise their relationship with informal carers?

Carers occupy an ambiguous position within the social care system. Services are predominantly structured around the dependent rather than the carer, and this has important consequences for their delivery and evaluation. Many of the problems that arise in thinking about carer issues relate to confusion over the way the relationship between social care agencies and informal carers should be perceived. The paper outlines three models that provide frames of reference for this relationship: carers as resources; carers as co-workers; and carers as co-clients. The tensions between these are then used to explore the contradictions of policy in this field.

Translational control of InsP3-induced chromatin condensation during the early cell cycles of sea urchin embryos

The cycles of DNA synthesis and chromatin condensation in dividing cells are controlled by signals from the cytoplasm. Changes in the concentration of free calcium (Cai) in the cytoplasm control a variety of cellular functions and it has thus been suggested that observed variations in Cai during the cell cycle may be the cytoplasmic signal that co-ordinates nuclear and cytoplasmic division. We show here that increases in Cai induced by the calcium-releasing second messenger inositol 1,4,5-triphosphate (Ins(1,4,5)P3), or by calcium buffers, cause premature chromatin condensation and breakdown of the nuclear envelope in sea urchin (Lytechinus pictus) early embryos. Both natural and induced chromatin condensation are prevented by calcium chelators. The nucleus becomes sensitive to the Cai signal 45 min after fertilization, but remains insensitive if protein synthesis is prevented. Our experiments demonstrate that Cai regulates the behaviour of the nucleus during the cell cycle, suggest that Ins(1,4,5)P3 is a cell cycle messenger and indicate that there is an interaction between the protein and ionic signals that control the state of chromatin during the cell cycle.