Knowledge of emergency dental management among a localized sample of athletic trainers

BACKGROUND/AIMS

Athletic trainers are often the point person when sports-related traumatic dental injuries (TDIs) occur. The aim of this study was to assess knowledge levels of the management of TDIs among athletic trainers in the Midwest United States, as well as evaluate variables that may influence knowledge levels.

MATERIAL AND METHODS

A survey was sent to athletic trainers licensed in Minnesota, Nebraska, and Iowa. The survey included 28 multiple-choice and fill in the blank questions split into three sections. The three sections included background, emergency management of TDIs, and opinion questions.

RESULTS

Of the participants, 100% recalled receiving medical first aid training. However, only 71% recalled receiving formal training on emergency management of dental injuries. Although 75% were confident in managing a dental injury, over 63% of participants scored less than 70% in the knowledge score section. Majority of the participants (98.4%) reported that they believe training on the management of TDIs is important. Athletic trainers working with contact sports were more likely to have experienced managing TDIs more recently than those working in noncontact sports.

CONCLUSIONS

This study shows the gaps in knowledge among athletic trainers pertaining to management of TDIs and emphasizes the importance of sports community having adequate education on emergency management of such dental injuries.

Simultaneous Detection of Multiple Tumor-targeted Gold Nanoparticles in HER2-Positive Breast Tumors Using Optoacoustic Imaging

Purpose To develop optoacoustic, spectrally distinct, actively targeted gold nanoparticle-based near-infrared probes (trastuzumab [TRA], TRA-Aurelia-1, and TRA-Aurelia-2) that can be individually identifiable at multispectral optoacoustic tomography (MSOT) of human epidermal growth factor receptor 2 (HER2)-positive breast tumors. Materials and Methods Gold nanoparticle-based near-infrared probes (Aurelia-1 and 2) that are optoacoustically active and spectrally distinct for simultaneous MSOT imaging were synthesized and conjugated to TRA to produce TRA-Aurelia-1 and 2. Freshly resected human HER2-positive (n = 6) and HER2-negative (n = 6) triple-negative breast cancer tumors were treated with TRA-Aurelia-1 and TRA-Aurelia-2 for 2 hours and imaged with MSOT. HER2-expressing DY36T2Q cells and HER2-negative MDA-MB-231 cells were implanted orthotopically into mice (n = 5). MSOT imaging was performed 6 hours following the injection, and the Friedman test was used for analysis. Results TRA-Aurelia-1 (absorption peak, 780 nm) and TRA-Aurelia-2 (absorption peak, 720 nm) were spectrally distinct. HER2-positive human breast tumors exhibited a significant increase in optoacoustic signal following TRA-Aurelia-1 (28.8-fold) or 2 (29.5-fold) (P = .002) treatment relative to HER2-negative tumors. Treatment with TRA-Aurelia-1 and 2 increased optoacoustic signals in DY36T2Q tumors relative to those in MDA-MB-231 controls (14.8-fold, P < .001; 20.8-fold, P < .001, respectively). Conclusion The study demonstrates that TRA-Aurelia 1 and 2 nanoparticles operate as a spectrally distinct HER2 breast tumor-targeted in vivo optoacoustic agent. Keywords: Molecular Imaging, Nanoparticles, Photoacoustic Imaging, Breast Cancer Supplemental material is available for this article. © RSNA, 2023.

Abstract 2458: Comparing influences of active targeting and nanoparticle size on tumor specificity in pancreatic adenocarcinoma

Purpose: While nanoparticles are widely studied as potential theranostic treatments for cancer, weak tumor specificity has hindered clinical translation. Features that contribute to tumor specificity are historically controversial, particularly when using clinically relevant models. Aggressive cancers, such as pancreatic ductal adenocarcinoma (PDAC), stand to benefit from development of highly specific nanoparticles as a theranostic drug delivery system. This work evaluates active targeting and nanoparticle size, in a silica-based nanoparticle for specific accumulation and release of contrast agent within an orthotopically implanted tumor.

Methods: Mesoporous silica nanoparticles (MSNs) were synthesized with wormhole-like pores using a silica precursor to coat a surfactant scaffold. Chitosan was attached to MSN surface as a pH-responsive gatekeeper for encapsulated agents. A series of acidification and basification procedures resulted in loading of photoacoustic contrast agent IR780 within MSN pores. MSNs were further functionalized for attachment of V7 peptide to target aggressive and acidic pancreatic cancer. pH-sensitivity and tumor specificity/uptake was validated using an in vitro PDAC cell model (S2VP10L) prior to implantation and assessment in an animal model. Functionalized MSNs were intravenously injected into athymic mice with orthotopically implanted PDAC tumors. Near infrared fluorescence and optoacoustic imaging were used to evaluate the biodistribution of MSNs subsequent to treatment.

Results: Zeta potential, DLS, and TEM were utilized to show three differently sized MSNs of 26, 45, and 73 nm and confirm conjugation of chitosan and V7 peptide. Dye-release assays indicated significantly increased agent release from MSNs in acidic pH (~90%) compared to biological pH (~15%) (p=0.001). Treatment of PDAC cell line with MSNs showed highest uptake and specificity with actively targeted 26nm particles and that all actively targeted MSNs exhibited greater specificity than all passively targeted MSNs (p&lt;0.05). In vivo results utilizing optoacoustic imaging confirmed that active targeting produces a stronger tumor specificity, and that nanoparticle size has a secondary influence in which the smaller, 26 nm MSNs, showed optimal specificity (p&lt;0.001). Ex vivo evaluation of organs was in agreement with in vivo observations.

Conclusion: Active targeting outperforms nanoparticle size for facilitation of tumor-specific uptake in an acidic PDAC murine model. Active targeting was necessary for high accumulation of MSNs and contrast agent in the tumor. Nanoparticle size had a secondary, but notable influence on tumor uptake in which smaller sized MSNs resulted in higher tumor specificity.

Citation Format: William M. MacCuaig, Abhilash Samykutty, Molly McNally, Ajay Jain, William E. Grizzle, Lacey R. McNally. Comparing influences of active targeting and nanoparticle size on tumor specificity in pancreatic adenocarcinoma [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 2458.

Abstract 300: Matrix metalloproteinase-9 responsive active targeted silica nanoparticles for pancreatic cancer detection by multispectral optoacoustic tomography

Purpose: Pancreatic ductal adenocarcinoma (PDAC) is the most lethal disease and the leading cause of cancer death worldwide. The survival rate of patients with this form of cancer is about 8%. The physiological barrier of the tumor microenvironment composed of a dense stroma and disorganized blood vessels creates a barrier for early identification and treatment of this deadly disease. In recent years, nanoparticle-based controlled delivery systems were developed to exploit the pathophysiology of biological systems such as acidic tumor microenvironment or the altered tumor-specific enzymes to improve the diagnosis and treatment efficacy. Here, we demonstrate the collagenase IV-mediated tumor site-selective release of the IR-780 imaging probe from the M-Ge-SDC1 nanoparticles, revealing the feasibility of the collagenase IV (MMP-9) responsive target specificity for diagnosing pancreatic cancer by multispectral optoacoustic tomography (MSOT) imaging.

Methods: Mesoporous silica nanoparticles (MSN) with wormhole pore topology were synthesized and were characterized by dynamic light scattering (DLS) and transmission electron microscopy (TEM). The surface of MSN was conjugated with Gelatin-A to obtain M-Ge. The M-Ge particles were loaded with propidium Iodide (PI) or IR780 infrared imaging dye. The M-Ge surface was further conjugated with Syndecan-1 (SDC1) to improve the target specificity to release imaging cargo from the nanoparticles. Female athymic mice were orthotopically implanted with S2VP10 tumor cells. After a week of tumor implantation, mice were intravenously injected with M-Ge-SDC1 nanoparticles containing IR780 dye and were imaged with MSOT and AMI.

Results: In the current study, Mesoporous silica nanoparticles with 27 nm diameter were synthesized. The Gelatin-A crosslinking on the surface of MSN particles as a gatekeeper was developed that could degrade upon contact with collagenase IV in the tumor microenvironment. The conjugation of SDC1 further improved the tumor specificity. The athymic mice orthotopically implanted with S2VP10 cells closely resemble human PDAC. Our results demonstrated that intravenous delivery of M-Ge-SDC1 nanoparticles could enzymatically degrade (MMP-9) and release IR780 at the tumor site and conjugation of SDC1 further improved the tumor specificity to detect the orthotopically implanted pancreatic tumors (p&lt;0.0001,n=5).

Conclusion: Due to the lack of effective screening tools, PDAC has the lowest survival rate and limited therapeutic efficacy for current FDA-approved drugs compared to other malignancies. Innovative technologies to develop engineered nanoparticles with active targeting moiety and dynamic imaging technology can overcome these limitations. Implementing such systems can enhance PDAC detection that can be translated into the clinic to improve health care.

Citation Format: Abhilash Samykutty, Molly McNally, William M. MacCuaig, Jordan Hagood, Girish Mishra, Barish H. Edil, William E. Grizzle, Lacey R. McNally. Matrix metalloproteinase-9 responsive active targeted silica nanoparticles for pancreatic cancer detection by multispectral optoacoustic tomography [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 300.

Reopening Oral Health Services during the COVID-19 Pandemic through a Knowledge Exchange Coalition

BACKGROUND

The COVID-19 novel coronavirus closed oral health care in Nova Scotia (NS) Canada in March 2020. Preparing for a phased reopening, a knowledge exchange coalition (representing government, academia, hospitals, oral health professions, and regulators) developed return-to-work (RTW) guidelines detailing the augmentation of standard practices to ensure safety for patients, oral health care providers (OHPs), and the community. Using online surveys, this study explored the influence of the RTW guidelines and related education on registered NS OHPs during a phased return to work.

METHODS

Dissemination of R2W guidelines included website or email communiques and interdisciplinary education webinars that coincided with 2 RTW phases approved by the government. Aligned with each phase, all registered dentists, dental hygienists, and dental assistants were invited to complete an online survey to gauge the influence of the coalition-sponsored education and RTW guidelines, confidence, preparedness, and personal protective equipment use before and after the pandemic.

RESULTS

Three coalition-sponsored multidisciplinary webinars hosted 3541 attendees prior to RTW. The response to survey 1 was 41% (881/2156) and to survey 2 was 26% (571/2177) of registrants. Survey 1 (82%) and survey 2 (89%) respondents "agreed/strongly agreed" that R2W guidelines were a primary source for guiding return to practice, and most were confident with education received and had the skills needed to effectively treat patients during the COVID-19 pandemic. Confidence and preparedness improved in survey 2. Gowns/lab coat use for aerosol-generating procedures increased from 26% to 93%, and the use of full face shields rose from 6% to 93% during the pandemic.

CONCLUSIONS

A multistakeholder coalition was effective in establishing and communicating comprehensive guidelines and web-based education to ensure unified reintegration of oral health services in NS during a pandemic. This multiorganizational cooperation lay the foundation for responses to subsequent waves of COVID-19 and may serve as an example for collaboratively responding to future public health threats in other settings.

KNOWLEDGE TRANSFER STATEMENT

The return-to-work strategy that was developed, disseminated, and assessed through this COVID-19 knowledge exchange coalition will benefit oral health practitioners, professional regulators, government policy makers, and researchers in future pandemic planning.

Abstract 2790: Evaluation of S100A9 targeted nanoparticles containing rapamycin to treat pancreatic adenocarcinoma

Despite Pancreatic cancer being expected to contribute to only 3% of new cancer cases in both males and females in 2019, it is expected to cause an estimated 45,750 deaths making it the third highest contributor to cancer deaths. This is due to the low survivability associated with pancreatic cancer which has a 5-year survival rate of only 9%. In order to address the poor prognosis common with pancreatic cancer, biomarkers are being used to create therapies targeted to specific cancer cells. The S100A8/A9 complex is a heterodimer, known for modulating the inflammatory response, and it is upregulated in a variety of cancers including pancreatic cancers. For this reason, we selected it as a targeting agent to deliver Rapamycin to pancreatic cancer cells via a mesoporous silica-encased gold nanorod (MS-GNR). The use of this nanoparticle allows an anticancer molecule to be encapsulated within the mesoporous silica matrix by further encapsulation of the nanoparticle with the pH sensitive polymer chitosan. A low pH tumor microenvironment induces relaxation of the chitosan surrounding this chitosan-capped mesoporous silica gold nanorod (CMG) allowing for the anticancer molecule to be released only in cancer cells. The gold nanorod at the core of this enables these nanoparticles to be imaged in real time via Multispectral Optoacoustic Tomography (MSOT). Using these tools, we linked S100A9 to a mesoporous silica-encased gold nanorod which contained Rapamycin held in via the chitosan polymer (S100A9-Rap-CMG). MSOT imaging revealed a strong uptake in S2013Q and MiaPaca pancreatic cancer cells. Further tests showed that at a pH 6.8 S100A9-Rap-CMG treatment resulted in an increase in cell death by 69% compared to treatment at physiologic pH of 7.4 by the S100A9-Rap-CMG's which did not induce cell death. This data indicates the feasibility of S100A9 as a targeting agent for pancreatic cancer cells and the potential benefits of nano-drug delivery of Rapamycin to treat pancreatic adenocarcinoma. The ultimate benefit of the nano-drug delivery includes both increased tumor targeting and mitigating premature drug release and offsite delivery.

Citation Format: Karl Thomas, Molly McNally, Abhilash Samykutty, Lacey R. McNally. Evaluation of S100A9 targeted nanoparticles containing rapamycin to treat pancreatic adenocarcinoma [abstract]. In: Proceedings of the Annual Meeting of the American Association for Cancer Research 2020; 2020 Apr 27-28 and Jun 22-24. Philadelphia (PA): AACR; Cancer Res 2020;80(16 Suppl):Abstract nr 2790.

Abstract P1-01-04: Uptake of trastuzumab targeted mesoporous silica-coated chitosan capped gold nanorods in breast cancer cell lines and ex vivo patient samples

Background: Approximately two-thirds of operative breast cancer cases are suitable for breast conserving surgery (BCS). In order for BCS to be successful, negative surgical margins should be obtained. Despite improvement in imaging techniques, the ability to achieve negative margins for BCS remains variable with positive margin rates ranging from 21 to 50%. Due to this high re-excision rate, there is an unmet need for a reliable technology to localize the tumor and assess excision margins in real time. Multispectral Optoacoustic Tomography (MSOT) is an emerging imaging modality capable of real time imaging of numerous contrast agents with enhanced spatial resolution of 75µm at depths of 5 cm. This imaging modality has the ability to visualize tumor tissue in a standard operating room setting allowing for precise surgical excision with the potential of increasing rate of negative margins. We developed gold nanorods targeting Human epidermal growth factor receptor-2 (HER2) as a contrast agent to visualize the breast tumor tissue in cell line as well as in ex vivo patient samples using MSOT.

Methods: Gold nanorods were created using hydrogen peroxide (GNR-H2O2) as a reducing agent to create an MSOT detectable contrast agent; the nanorods were stabilized via encapsulation with mesoporous silica together with subsequent chitosan capping. HER2+ breast cancer cells were specifically targeted by conjugating the mesoporous silica-coated chitosan capped gold nanorods (CMGs) to Trastuzumab resulting in TRA-CMG particles. The TRA-CMG particles were evaluated in HER2+ and HER2- breast cancer cell lines as well as fresh HER2+ (N=6) and HER2- freshly resected patient tumor tissues (N=6). All HER2- tumor samples were triple negative breast cancer (TNBC) subtype. Tumor uptake was evaluated in tissue mimicking phantoms using MSOT. In vivo, TRA-CMG were IV injected into female mice with DY36T2Q tumors and imaged using MSOT imaging 6 hours post injection (N=5).

Results: TRA-CMG particles were 8nm wide and 98nm in length. Treatment of HER2+ breast cancer cell lines, DY36T2Q and SKBR3, with TRA-CMG resulted in 2.5x and 3.1x enhanced signal, respectively, as compared to HER2- MDA-MD468 cells (p&lt;0.01). In ex vivo patient samples treated with TRA-CMG that were placed into tissue mimicking phantoms and imaged using MSOT, TRA-CMG had 12x greater uptake in HER2+ samples than in HER2- samples (p&lt;0.004) (Table) In vivo evaluation of TRA-CMG demonstrated tumor specific uptake with 12.1 a.u, compared to liver 1.1 a.u., and kidney 0.9 a.u. in the DY36T2Q breast cancer mode (p&lt;0.007).

Conclusion: The significant uptake of TRA-CMG particles in HER2+ tumors suggests the potential of this particle to be used for diagnostic imaging as well as with intraoperative imaging using MSOT. Future clinical applications include improving the rate of negative margins for patients undergoing breast conservation.

Patient tumor chracteristics and TRC-CMG uptakePatientBreast Cancer SubtypeTumor GradePathologic StageTRA-CMG Uptake (a.u.)1TNBC3ypT3N3a1.22TNBC3ypT2N00.33TNBC3ypT4bN1a0.54ER+PR+HER2+2pT1cN213.35ER+PR-HER2+3pT1cN017.96TNBC2ypT0N00.47ER-PR-HER2+3pT2N019.48ER+PR-HER2+3pT2N015.69ER-PR-HER2+3pT1cN016.610TNBC3pT2N1a0.911ER+PR+HER2+3ypTN018.712TNBC2pT1cN00.7

Citation Format: Akiko Chiba, Alexandra Thomas, Karl N. Thomas, Abhilash Samykutty, Molly McNally, Lacey McNally. Uptake of trastuzumab targeted mesoporous silica-coated chitosan capped gold nanorods in breast cancer cell lines and ex vivo patient samples [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P1-01-04.

Abstract 1937: pH-responsive tumor-targeted mesoporous silica nanoparticle for the identification of pancreatic cancer using optoacoustic tomography

Purpose: Due to inadequate early detection and inability to operate at advanced stages, pancreatic ductal adenocarcinoma (PDAC) has remained one of the most difficult types of cancer to treat. A small range of non-specific symptoms coupled with quick metastasis rate result in a poor 5-year survival rate; 14% for those diagnosed within stage IA, and as low as 1% for those diagnosed during stage IV. Nanoparticles have recently emerged as a potential delivery agent for diagnostic and therapeutic agents, and although clinical success has not been ample due to targeting accuracy issues. This work shows a nanoparticle that has been functionalized with a pancreatic cancer-specific targeting ligand and exhibits specific particle release in pancreatic malignant environment (pH 6.6) as compared to non-malignant environments (pH 7.4). Methods: Wormhole-pored mesoporous silica nanoparticles were formed at 80°C using Tetrapropyl orthosilicate (TPOS) and a scaffold of hexadecyltrimethyl-ammonium bromide (CTAB). Acetic acid and ethanol were used in dialysis procedures to remove the CTAB scaffold and create worm-like pores. Chitosan was added to coat the silica particles and serve as a gatekeeper. IR-780 was added before the solution was acidified to load the dye into the worm-hole particles created. Shortly after, the solution pH was raised back to physiological levels (pH=7.4) to trap the dye within the particle. The particle surfaces were functionalized to attach a targeting ligand pH-low insertion peptide (V7) to conjugate the dye-loaded nanoparticles. Pancreatic adenocarcinoma cells (S2VP10 line) were plated in pH-7.4,6.8, and 6.6 PBS solutions with the loaded particles to assess uptake via near-infrared fluorescence and multispectral optoacoustic imaging. Results: Zeta potential and dynamic light scattering were used to ensure the 63nm size nanoparticle and proper coating. Near-infrared fluorescence imaging showed ~10X increased signal at pH 6.6 as compared to pH=7.4. MSOT imaging ~5X increased signal in the malignant microenvironment environment that is acidic as compared to the non-malignant environment at pH 7.4. Conclusion: The functionalized wormhole mesoporous silica nanoparticles coated with chitosan demonstrated pH-sensitivity in terms of cellular uptake via NIR fluorescence and MSOT imaging.

Citation Format: William MacCuaig, Abhilash Samykutty, Molly McNally, Kylie Nairon, Surya Banks, William Grizzle, Lacey R. McNally. pH-responsive tumor-targeted mesoporous silica nanoparticle for the identification of pancreatic cancer using optoacoustic tomography [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 1937.

Abstract 1952: Tumor microenvironment targeted Rosella nanoparticle for the detection of triple negative breast cancer by multispectral optoacoustic tomography

Purpose: Recent advances in the nanotechnology and molecular imaging provides an excellent opportunity for development of delivery vehicles and imaging probes to improve real-time assessment and early detection of breast cancer progression.The absence of estrogen receptor (ER), progesterone receptor (PR), or HER-2 genes, represents a major clinical challenge for triple negative breast cancer (TNBC). Because of the absence of reliable markers, there is an unmet clinical need for developing efficient methods to identify TNBC. We have developed an acidic pH targeted Rosella nanoparticles that can actively release IR780 dye into orthotopically implanted TNBC tumors to improve tumor detection using multispectral optoacoustic imaging technology (MSOT).

Methods: The Rosella nanoparticles are a mesoporous silica base with wormhole pore architecture containing a chitosan gatekeeper and V3 pHLIP targeting peptide. The particles were synthesized using the sol-gel method and characterized by transmission electron microscopy (TEM) and dynamic light scattering (DLS). The Rosella particles were loaded with propidium Iodide (PI) or IR780 infrared imaging dye to evaluate pH-sensitive cargo release. Female athymic mice were implanted with MDA-MB-468 breast cancer cells by the mammary fat pad injection. Once the tumor reaches 3mm in size, athymic mice were intravenously injected with ROSELLA nanoparticles carrying IR780 dye and were imaged with MSOT.

Results: We have synthesized the Rosella nanoparticle with wormhole pores that is 27 nm diameter and can encapsulate the IR780 imaging probes for the detection of the TNBC. The Rosella particle contains a chitosan gatekeeper which can degrade upon contact with acidic pH tumor to prevent off-target release and is further sensitized to pH using V3 peptide. The Rosella nanoparticles can detect acidic tumor microenvironment and can penetrate inside the tumor cells. As a model of TNBC, we have injected MDA-MB-468 cells into the mammary fat pad of the female athymic mice to develop breast tumors. Once the tumor reached 3mm in size, we have intravenously delivered ROSELLA nanoparticles to the athymic mice with TNBC tumors. Our results were demonstrated that the intravenous injection of the ROSELLA particles could detect the orthotopically implanted TNBC tumors (p&lt;0.0001,n=5).

Conclusion: most aggressive subtypes of breast cancer, TNBC has a poor response for majority of the FDA-approved breast cancer drugs. To overcome these limitations, the distinct nanoformulations with potent imaging technology will enable to develop tumor-penetrating nanoparticles to more effectively deliver chemotherapeutics or imaging agents with least off-target effects. Future translation of these technologies has a high clinical impact concerning our current treatment options for TNBC patients.

Citation Format: Abhilash Samykutty, Molly McNally, Alexandra Thomas, William Grizzle, Lacey R. McNally. Tumor microenvironment targeted Rosella nanoparticle for the detection of triple negative breast cancer by multispectral optoacoustic tomography [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 1952.

Abstract 1934: Development of spectrally distinct silica coated gold nanorods for detection of cancer using MSOT

Traditional cancer imaging devices are limited in their ability to screen for multiple contrast agents simultaneously in real time. Multispectral Optoacoustic Tomography (MSOT) is an emerging imaging modality capable of real-time imaging of numerous contrast agents with enhanced spatial resolution of 75µm at depths of 5 cm. The use of exogenous contrast agents in MSOT remains largely unexplored, so we developed two species of spectrally distinct gold nanorod as contrast agents for use in MSOT. Our goal was to evaluate the potential of MSOT to spectrally differentiate two exogenous contrast agents simultaneously. Two gold nanorod species were created using hydrogen peroxide (GNR-H2O2) or ascorbic (GNR-ASC) acid as reducing agents to modify the length of each species to create nanorods with individual light absorbance spectra in the IR range (680-900 nm). These gold nanorods were highly stabilized via encapsulation with mesoporous silica along with a subsequent chitosan capping. Human epidermal growth factor receptor 2 positive (HER2+) cells were specifically targeted by conjugating these mesoporous silica-coated chitosan capped gold nanorods (CMGs) to Trastuzumab resulting in TRA-CMG particles. Both TRA-CMG-ASC and TRA-CMG-H2O2 resulted in optoacoustic spectrally distinct signals when imaged in tissue phantoms both individually as well as mixed within the same well after multispectral processing using linear regression. Treatment of HER2+ breast cancer cell lines, DY36T2Q and SKBR3, with TRA-CMG-H2O2 resulted in 2.5x and 3.1x enhanced signal, respectively, as compared to HER2- MDA-MD468 cells. Treatment of DY36T2Q and SKBR3 cells with TRA-CMG-ASC demonstrated 3.7x and 6.9x, respectively, compared to MDA-MD468. In all three cell lines treated with a combination of TRA-CMG-H2O2’s and TRA-CMG-ASC’s clear and distinct signals were observed for each particle, demonstrating that each TRA-CMG possessed and maintained a detectibly distinct optoacoustic spectrum, in the IR range, allowing them to be detectable as separate contrast agents in MSOT while proximate to other targeted contrast agents. Both particles have demonstrated that they can be simultaneously administered and targeted at HER2+ cell while also maintaining distinct photoacoustic signals in MSOT upon consolidation. Each particle species, targeted to the same cells, were capable of being monitored individually in the presence of the other gold nanorod contrast agent.

Citation Format: Karl N. Thomas, Abhilash Samykutty, Molly McNally, Lacey R. McNally. Development of spectrally distinct silica coated gold nanorods for detection of cancer using MSOT [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 1934.

Ethical and Legal Implications of Frailty Screening

Goals of screening for frailty include (a) promoting healthy aging, (b) addressing frailty with preventive and targeted interventions, (c) better aligning social and medical responses to frailty with the needs of frail older adults and (d) preventing harms to frail older adults from excessive and inappropriate medical interventions that are insensitive to the implications of frailty. However, the medicalization of frailty and outcomes of the screening process also risk harming frail older adults and their autonomy through stereotyping and by legitimizing denial of care. This risk of harm gives rise to ethical and legal questions and considerations that this paper addresses. Frailty screening that is ethically defensible will situate and support healthcare that is consistent with people's needs, circumstances and capacity to benefit from the care provided. We also call for an informed consent process that incorporates supported or shared decision making in order to protect the autonomy of frail older adults.

The role of histology in the diagnosis of spondylodiscitis

Aims

The aim of this study was to determine the diagnostic utility of histological analysis in spinal biopsies for spondylodiscitis (SD).

Patients and Methods

Clinical features, radiology, results of microbiology, histology, and laboratory investigations in 50 suspected SD patients were evaluated. In 29 patients, the final (i.e. treatment-based) diagnosis was pyogenic SD; in seven patients, the final diagnosis was mycobacterial SD. In pyogenic SD, the neutrophil polymorph (NP) infiltrate was scored semi-quantitatively by determining the mean number of NPs per (×400) high-power field (HPF).

Results

Of the 29 pyogenic SD patients, 17 had positive microbiology and 21 positive histology (i.e. one or more NPs per HPF on average). All non-SD patients showed less than one NP per HPF. The presence of one or more NPs per HPF had a diagnostic sensitivity of 72.4%, specificity 100%, accuracy 100%, positive predictive value (PPV) 81.0%, and negative predictive value (NPV) 61.9%. Sensitivity, specificity, and accuracy were greater using the criterion of positive histology and/or microbiology than positive histology or microbiology alone. Granulomas were identified histologically in seven mycobacterial SD patients, and positive microbiology was detected in four.

Conclusion

The diagnosis of pyogenic SD was more often confirmed by positive histology (one or more NPs per HPF on average) than by microbiology, although diagnostic sensitivity was greater when both histology and microbiology were positive. Cite this article: Bone Joint J 2019;101-B:246–252.

Osteopontin-targeted probe detects orthotopic breast cancers using optoacoustic imaging

Improved detection of breast cancer using highly sensitive, tumor-specific imaging would facilitate diagnosis, surveillance and assessment of response to treatment. We conjugated osteopontin peptide to an infrared fluorescent dye to serve as a contrast agent for detection of breast cancer by multispectral optoacoustic tomography (MSOT). Selective binding of the osteopontin-based probe was identified using flow cytometry and near infrared fluorescent imaging in triple negative and HER2 positive breast cancer cell lines in vitro. Osteopontin-750 accumulation was evaluated in vivo using MSOT with secondary confirmation of signal accumulation using near infrared fluorescent imaging. The osteopontin-based probe demonstrated binding to breast cancer cells in vitro. Similarly, after intravenous administration of the osteopontin-750 probe, it accumulated preferentially in the subcutaneous breast tumor in nude mice (557 MSOT a.u. compared to untargeted organs such as kidney (53.7 MSOT a.u.) and liver (32.1 MSOT a.u.). At 2.5 h post-injection, signal intensity within the tumor was 9.7 and 17 times greater in the tumor bed than in the kidney or liver, respectively. Fluorescence imaging ex vivo comparing tumor signal to that of nontarget organs confirmed the results in vivo. MSOT imaging demonstrated selective accumulation of the fluorescent osteopontin targeting probe to tumor sites both in vitro and in vivo, and provided high-resolution images. Further development of this tool is promising for advanced diagnostic imaging, disease surveillance and therapeutic models that limit nontarget toxicity.

Abstract 3727: Dual acidic pH targeted mesoporous silica nanoparticles for noninvasive detection of triple negative breast cancer

Purpose: Current screening methods for triple negative breast cancer suggest the presence and size of tumor, but do not identify the tumor microenvironment. The inability to determine precise tumor location and position following diagnosis impedes medical confidence in surgical resection and radiation therapy. Theranostic nanoparticles can be targeted for dye and drug delivery to facilitate non-invasive characterization and treatment of malignancies. Combinational use of nanomedicine and Multispectral Optoacoustic Tomography (MSOT) renders high resolution images through ultrasonic detection of thermoelastic dye expansion (the optoacoustic effect). Approaches in nanomedicine are steadily growing, but clinical evaluation relies on minimizing off-target accumulation and controlling cargo release. We evaluated a mesoporous silica nanoparticles with pH-sensitive chitosan gatekeeper and tumor targeting V3 pH low-insertion peptide (V3 pHLIP) conjugation (V3-CMSN-780) for dual acidic pH targeted delivery to triple negative breast cancer. Methods: Mesoporous silica nanoparticles were synthesized around a structural skeleton of hexadecyltrimethylammonium bromide (CTAB). CTAB was removed from the particles through repeated dialysis. Subsequent particles were characterized with digital light scattering (DLS) and zetasizer to confirm particle size and zeta potential. Mesoporous nanoparticles were then coated with chitosan for extracellular acidic pH selectivity and functionalized with variant 3 pH low-insertion peptide (V3 pHLIP) to promote anchoring of the particle to tumor cells. Functionalized nanoparticles (V3-CMSN) were loaded with NIR 780 (5 mg/mL) and delivered to MDA-MB-231 and MDA-MB-468 malignant cell lines at pH 7.4, 6.8, and 6.6 to confirm pH-sensitive dye release into the cells with Near Infrared fluorescent imaging. V3-CMSN treated cells were inserted into tissue mimicking phantoms which were evaluated using MSOT. Results: The size of V3-CMSN-780 was 35 d. nm with a zeta potential of 25 mV. V3-CMSN were loaded with 780 dye with a dye loading efficiency of 77%. Cellular uptake of V3-CMSN-780 within MDA-MB-231 cells was 2152 a.u., 5242 a.u., and 3639 a.u. at pHs 7.4, 6.8, and 6.6, respectively, based NIR fluorescent imaging. Treatment of MDA-MB-231 cells with V3-CMSN-780 within tissue mimicking phantoms also confirmed acidic pH selectivity of the particles with a 6X and 4X accumulation of particles at pH 6.8 and 6.6 as compared to pH 7.4. While similar results were observed in MDA-MB-468 cells with NIR fluorescent imaging, MSOT imaging indicated that MDA-MB-468 cells treated at pH 6.8 and 6.6 had increased 780 signal, 110X and 16X, incomparison to pH 7.4. Conclusion: Successful dual targeting of breast tumor cells provides a foundation for later in vivo and ex vivo studies using V3-780-CMSNs to deliver diagnostic and therapeutic cargo to malignant breast tissue.

Citation Format: Joshua T. Hayes, Abhilash Samykutty, Molly McNally, Alexandra Thomas, Akiko Chiba, William Grizzle, Karen M. Winkfield, Lacey R. McNally. Dual acidic pH targeted mesoporous silica nanoparticles for noninvasive detection of triple negative breast cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 3727.

Linking Inuit Knowledge and Public Health for Improved Child and Youth Oral Health in NunatuKavut

The oral health of Inuit children in Canada has been identified as a public health crisis. Although efforts are being made to identify and address ways to deal with this crisis, current policy and program approaches are largely entrenched within the prevailing paradigm of dental science to the exclusion of Indigenous people's understandings of health. This article reports qualitative findings of a larger study aimed at identifying, understanding, and addressing rates of oral disease among children living in NunatuKavut, a cluster of small, coastal Inuit communities located in southern Labrador, Canada. Through 18 focus groups with youth (n = 86), caregivers (n = 22), and interviews with key informant (n = 13), this study begins to elucidate southern Inuit understandings of oral health. Theorized using Two-Eyed Seeing, an Indigenous approach to balancing both Indigenous and non-Indigenous understandings of the world, the findings reported here reveal 3 themes, each of which is crosscut by historical and contemporary dimensions: 1) (w)holistic conceptualizations of health are essential to good oral health, 2) achieving optimal oral health is prohibitive for Inuit communities, and 3) community-engaged oral health service delivery is needed. Our recommendations have implications for improved oral public health service delivery for Inuit communities, in that the inclusion of Inuit perspectives on oral health should form an instrumental element of oral public health service delivery. Knowledge Transfer Statement: The results of this study may be used by clinicians and oral health educators to inform approaches to oral health service delivery within the context of Indigenous communities. It may also be used by policymakers to recognize how historical and contemporary issues of colonization relate to the formation of oral health-related policies.

Muscle as an osteoinductive niche for local bone formation with the use of a biphasic calcium sulphate/hydroxyapatite biomaterial

Objectives

We have observed clinical cases where bone is formed in the overlaying muscle covering surgically created bone defects treated with a hydroxyapatite/calcium sulphate biomaterial. Our objective was to investigate the osteoinductive potential of the biomaterial and to determine if growth factors secreted from local bone cells induce osteoblastic differentiation of muscle cells.

Materials and Methods

We seeded mouse skeletal muscle cells C2C12 on the hydroxyapatite/calcium sulphate biomaterial and the phenotype of the cells was analysed. To mimic surgical conditions with leakage of extra cellular matrix (ECM) proteins and growth factors, we cultured rat bone cells ROS 17/2.8 in a bioreactor and harvested the secreted proteins. The secretome was added to rat muscle cells L6. The phenotype of the muscle cells after treatment with the media was assessed using immunostaining and light microscopy.

Results

C2C12 cells differentiated into osteoblast-like cells expressing prominent bone markers after seeding on the biomaterial. The conditioned media of the ROS 17/2.8 contained bone morphogenetic protein-2 (BMP-2 8.4 ng/mg, standard deviation (sd) 0.8) and BMP-7 (50.6 ng/mg, sd 2.2). In vitro, this secretome induced differentiation of skeletal muscle cells L6 towards an osteogenic lineage.

Conclusion

Extra cellular matrix proteins and growth factors leaking from a bone cavity, along with a ceramic biomaterial, can synergistically enhance the process of ectopic ossification. The overlaying muscle acts as an osteoinductive niche, and provides the required cells for bone formation.

Cite this article: D. B. Raina, A. Gupta, M. M. Petersen, W. Hettwer, M. McNally, M. Tägil, M-H. Zheng, A. Kumar, L. Lidgren. Muscle as an osteoinductive niche for local bone formation with the use of a biphasic calcium sulphate/hydroxyapatite biomaterial. Bone Joint Res 2016;5:500–511. DOI: 10.1302/2046-3758.510.BJR-2016-0133.R1.

Management of infected nonunion of the long bones by a multidisciplinary team

Infected nonunion of a long bone continues to present difficulties in management. In addition to treating the infection, it is necessary to establish bony stability, encourage fracture union and reconstruct the soft-tissue envelope. We present a series of 67 infected nonunions of a long bone in 66 patients treated in a multidisciplinary unit. The operative treatment of patients suitable for limb salvage was performed as a single procedure. Antibiotic regimes were determined by the results of microbiological culture. At a mean follow-up of 52 months (22 to 97), 59 patients (88%) had an infection-free united fracture in a functioning limb. Seven others required amputation (three as primary treatment, three after late failure of limb salvage and one for recalcitrant pain after union). The initial operation achieved union in 54 (84%) of the salvaged limbs at a mean of nine months (three to 26), with recurrence of infection in 9%. Further surgery in those limbs that remained ununited increased the union rate to 62 (97%) of the 64 limbs treated by limb salvage at final follow-up. The use of internal fixation was associated with a higher risk of recurrent infection than external fixation.

The rate of symptomatic venous thromboembolism in patients undergoing elective Ilizarov surgery and the cost of chemical prophylaxis

Recent recommendations by the National Institute for Health and Care Excellence (NICE) suggest that all patients undergoing elective orthopaedic surgery should be assessed for the risk of venous thromboembolism (VTE).

Little is known about the incidence of symptomatic VTE after elective external fixation. We studied a consecutive series of adult patients who had undergone elective Ilizarov surgery without routine pharmacological prophylaxis to establish the incidence of symptomatic VTE.

A review of a prospectively maintained database of consecutive patients who were treated between October 1998 and February 2011 identified 457 frames in 442 adults whose mean age was 42.6 years (16.0 to 84.6). There were 425 lower limb and 32 upper limb frames. The mean duration of treatment was 25.7 weeks (1.6 to 85.3).

According to NICE guidelines all the patients had at least one risk factor for VTE, 246 had two, 172 had three and 31 had four or more.

One patient (0.23%) developed a pulmonary embolus after surgery and was later found to have an inherited thrombophilia. There were 27 deaths, all unrelated to VTE.

The cost of providing VTE prophylaxis according to NICE guidelines in this group of patients would be £89 493.40 (£195.80 per patient) even if the cheapest recommended medication was used.

The rate of symptomatic VTE after Ilizarov surgery was low despite using no pharmacological prophylaxis. This study leads us to question whether NICE guidelines are applicable to these patients.

Cite this article: Bone Joint J 2014;96-B:426–30.

Prevention of infection in external fixator pin sites

Infection in external fixator pins is known to be a significant problem, with incidences between 3% and 80% reported in the literature. An infection occurs when planktonic bacteria adhere to external fixator pins and subsequently produce a biofilm which protects the bacteria from host defences. The most commonly implicated organisms are Staphylococcus aureus and Staphylococcus epidermidis. Once an infection occurs, treatment is difficult. Systemic antibiotics have limited benefits and considerable side-effects. The only definitive management is removal of the pin. This review will consider the current and potential future strategies for reducing pin site infection. Techniques to prevent infection must prevent bacterial adhesion, allow good osteointegration and have a low toxicity. Current areas of interest reviewed are titanium-copper alloys, nanosilver coatings, nitric oxide coatings, chitosan coatings, chlorhexidine and iodine, hydroxyapatite and antibiotic coatings. At present there is no consensus on the prevention of pin site infection, and there is a paucity of randomized controlled trials on which to draw a conclusion. Whilst a number of these strategies have potential future use, many of the above strategies need further studies in animal models to ensure no cytotoxicity and prevention of osteointegration. Following this, well-designed randomized controlled clinical trials are required to give future ways to prevent external fixator pin site infections.

Impact of gastroesophageal reflux on survival in the community

BACKGROUND

Concerns have been raised regarding the risks associated with gastroesophageal reflux (GER). We examined the association of gastroesophageal reflux with survival.

METHODS

Between 1988 and 1993, valid symptom surveys were mailed to population-based cohorts. Respondents were classified into 4 GER symptom categories: daily, at least weekly (not daily), infrequent (less than weekly), and none. Administrative records were used to identify deaths during the follow-up (through June 2006). Association between survival and GER subgroups was assessed using proportional hazards regression to compute hazard ratios (HRs, 95% confidence intervals), adjusting for age, gender, education level, Charlson Comorbidity Index, alcohol, and tobacco.

RESULTS

At baseline, 5,288 eligible subjects (mean age 53 yr, 51% female) responded (response rates over 70%); 2% reported daily heartburn, 13% weekly (not daily) heartburn, 40% infrequent heartburn, and 35% no heartburn. At 10 yr, 83% (95% CI 81-84%) of the no heartburn group was alive. An overall association between heartburn category and survival was detected (P < 0.001). Compared to no heartburn, daily heartburn was not associated with an increased risk of death (HR 1.16, 95% CI 0.82-1.65), but better survival was observed for weekly (HR 0.67, 95% CI 0.55-0.83) and infrequent (HR 0.80, 95% CI 0.70-0.92) heartburn. Increasing age, male gender, greater Charlson index, and tobacco use all predicted worse survival.

CONCLUSIONS

In this population-based study with over 50,000 person-years of follow-up, reflux symptoms were not associated with worse survival. The vast majority of heartburn sufferers can be reassured of the benign nature of their condition.

Overlap of gastro-oesophageal reflux disease and irritable bowel syndrome: prevalence and risk factors in the general population

BACKGROUND

Gastro-oesophageal reflux disease (GERD) and irritable bowel syndrome may occur more often than expected by chance, but little community data exists and risk factors are unknown.

AIM

To determine prevalence and risk factors for overlap of GERD and irritable bowel disease.

METHODS

Population-based, cross-sectional survey was conducted by mailing a valid symptom questionnaire to eligible residents of Olmsted County, MN, aged 30-95 years. Irritable bowel syndrome were defined by Rome III; GERD was defined by weekly or more frequent heartburn and/or acid regurgitation.

RESULTS

2298 questionnaires returned (women 52%, 55% response). Irritable bowel syndrome and GERD occurred together more commonly than expected by chance; the prevalence of irritable bowel syndrome-GERD overlap, GERD alone and irritable bowel syndrome alone were 3%, 15% and 5% in men, and 4%, 14% and 10% in women, respectively. Predictors of irritable bowel syndrome-GERD overlap vs. irritable bowel syndrome alone, and separately, GERD alone, were insomnia (OR 1.3, 95% CI: 1.06-1.70; OR 1.5, 95% CI: 1.13-1.90, respectively) and frequent abdominal pain (OR 3.9, 2.2-6.7; OR 1.8, 1.02-3.2, respectively). An additional predictor of irritable bowel syndrome-GERD overlap vs. GERD alone was higher somatization (OR 1.7, 1.1-2.4) and for irritable bowel syndrome-GERD overlap vs. irritable bowel syndrome alone was a higher body mass index (OR 1.0, 1.003-1.07).

CONCLUSIONS

Irritable bowel syndrome and GERD overlap is common in the population and does not occur by chance.

Does Opening the Peritoneum at the Time of Renal Transplanation Prevent Lymphocele Formation?

BACKGROUND

The occurrence of lymphocele formation following renal transplantation is variable, and the optimal approach to treatment remains undefined. Opening the peritoneum at the time of transplantation is one method of decreasing the incidence of lymphocele formation. The purpose of this study was to determine whether creating a peritoneal window at the time of transplantation decreases the incidence of lymphocele formation.

METHODS

We performed a retrospective review of renal transplants conducted at our institution between 2002 and 2004. Records were reviewed to obtain details regarding opening of the peritoneum at the time of transplant and occurrence of lymphocele. Every patient underwent routine ultrasound imaging in the peri-operative period. Graft dysfunction secondary to the lymphocele was the primary indication for intervention. Data were analyzed by chi-square.

RESULTS

During the initial transplant the peritoneum was opened in 35% of patients. The overall incidence of fluid collections, identified by ultrasound, was 24%. Opening the peritoneum did not decrease the incidence of lymphocele. However, more patients with a closed peritoneum required an intervention for a symptomatic lymphocele. In the 11 patients with an open peritoneum and a fluid collection, only one required an intervention. In patients whose peritoneum was left intact, 24% of fluid collections required intervention. Graft survival was equivalent.

CONCLUSION

Creating a peritoneal window at the time of transplantation did not decrease the overall incidence of postoperative fluid collections. However, forming a peritoneal window at the time of transplantation did decrease the incidence of symptomatic lymphocele.

Iliofemoral distraction and hip reconstruction for the sequelae of a septic dislocated hip with chronic femoral osteomyelitis

We describe a technique of ‘cross-hip distraction’ to reduce a dislocated hip with subsequent reconstruction of the joint for septic arthritis with extensive femoral osteomyelitis. A 27-year-old woman presented with a dislocated, collapsed femoral head and chronic osteomyelitis of the femur. Examination revealed a leg-length discrepancy of 7 cm and an irritable hip. A staged technique was used with primary clearance of osteomyelitis and secondary reconstruction of the hip. A cross-hip monolateral external fixator was used to establish normal anatomy followed by an arthroplasty. A good functional outcome was achieved. The use of cross-hip distraction avoids soft-tissue and nerve damage and achieved improved abductor function before arthroplasty.

The management of transverse maxillary deficiency

The correction of transverse maxillary deficiency can be an important component of an orthodontic treatment plan. A number of different techniques are available for the correction of such discrepancies. The aim of this article is to review the methods available to clinicians discussing their indications, advantages and disadvantages.

Orthodontic Retention : Why When and How?

Retention is normally required after active orthodontic tooth movement to hold the teeth in their new positions. This article reviews the principles of orthodontic retention and describes common retention regimes and appliances.

An in vivo probe based on mechanically strong but structurally small carbon electrodes with an appreciable surface area

Physically small carbon electrodes were fabricated by pyrolyzing acetylene in a nitrogen atmosphere using pulled quartz capillaries as the supporting substrate. A carbon disk geometry was obtained when a parallel flow of acetylene (50 kPa) and nitrogen (10 mL min(-1)) was introduced into the system. Further, carbon was found to deposit at the tip and on the shank of the quartz capillaries when the nitrogen flow rate was increased (80 mL min(-1)), yielding an approximately cylindrical geometry. A series of electrochemical and spectroscopic analyses was carried out to examine the type of carbon surface obtained by pyrolysis of acetylene. The results suggested that a surface consisting of an almost defect-free highly oriented pyrolytic graphite type structure was formed by the pyrolyzed acetylene. However, this contradicts the kinetically reversible electron transfer observed for dopamine oxidation at these electrodes. Meanwhile, the nonpolar and relatively oxygen-free characteristics indicate that these electrodes also behave similarly to a hydrogenated carbon surface. The formation of a hydrogenated carbon-type surface may be plausible as a result of the attack on the carbon surface by a surplus of hydrogen produced by the pyrolysis of acetylene to form graphitic carbon. These characteristics are expected to aid in reducing electrode fouling, which is often encountered in electrochemical detection of neurotransmitters in vivo. In conjunction with a miniature physical dimension, their appreciable surface area and enhanced mechanical strength make these carbon electrodes well suited to the detection of neurotransmitters in vivo.

Home healthcare nurses--why they leave and why they stay

This is a second article in a series of two reports on the National Association for Home Care's (NAHC) study of nursing recruitment and retention. The first article presented the results of the quantitative analysis. This article presents results of the qualitative analysis.

Phorbasin B and C: novel diterpenes from a southern Australian marine sponge, Phorbas species

A southern Australian Phorbas sp. has yielded the novel diterpenes phorbasin B (2) and phorbasin C (3). Phorbasins B and C possess a hitherto unknown carbon skeleton, and their structures were assigned on the basis of detailed spectroscopic analyses.

Ethics in an aging society: challenges for oral health care

Health and aging are deeply meaningful and complex realities. The demographic reality of the Canadian population in the 21st century requires an in-depth understanding of the health care goals of older people, an analysis of the attitudes toward older people that affect societal decision making and the educational and policy changes required to effect positive change. Viewing these issues through the lens of oral health care allows an analysis of health care goals for the older population. A look at representative cases where oral health needs were not met uncovers some of the attitudes and values about oral health, the goals of health care and the unique circumstances of older people that present barriers to appropriate care.

Neonatal abstinence syndrome

A 12 month review of infants admitted with neonatal abstinence syndrome to a neonatal intensive care unit was undertaken. The relationship of maternal drug abuse to symptoms, the effectiveness of pharmacologic agents in controlling symptoms and the length of inpatient stay were investigated. A retrospective review of maternal and infant records was performed. Those infants with a serial Finnegan score greater than 8 were treated. Pharmacologic treatment was oral morphine sulphate (0.2 mg 4-6 hourly), phenobarbitone (3-7 mgs/kg/day), or combination of the above. 43 infants were admitted to the hospital during the year. The average maternal age was 24.6 years, (18-34 years). Drug use volunteered by the mothers was methadone alone in 6 cases, methadone and benzodiazepines in 14, methadone and heroin and benzodiazepines in 7, methadone and heroin in 10, heroin alone in 2, and other multiple drug use including oral morphine sulphate, dothiepin and cannabis in 4. Average gestational age was 40.3 (35-42 weeks). The average birthweight was 2.81 kgs (1.89-3.91 kgs). Time to onset of withdrawal symptoms was 2.8 (1-13) days. The duration of pharmacologic treatment (oral morphine sulphate and/or phenobarbitone) was 21.8 (1-62) days. The total hospital stay for the 43 infants was 1,011 days. This study confirms that polydrug abuse is the commonest type of drug abuse in Dublin. The duration of withdrawal symptoms is loosely related to drug type, but increasing duration of symptoms is noted for infants exposed to benzodiazepines. Our experience would favour the use of morphine sulphate to treat pure opiate withdrawal symptoms. Over the 12-month period, there was an average occupancy of 3 beds per day in the paediatric department.

Should the drinking water of Truro, Nova Scotia, be fluoridated? Water fluoridation in the 1990s

An epidemiological assessment of differences in caries and fluorosis prevalences between children in Truro (< 0.1 ppm) and Kentville (fluoridated at 1.1 ppm in 1991), Nova Scotia, Canada, was completed in 1991. Out of a total of 429 children, in grades 5 and 6, in the two towns in 1991, 219 (51%) were examined. Parents answered a self-administered questionnaire investigating the sources of drinking water used by the children since birth, residence history, use of fluoride supplements, dentifrices, and other fluoride products during the first 6 yr of the life. The examination criteria differentiated between non-cavitated and cavitated carious lesions. Dental fluorosis was measured using the TSIF index. Examiner agreement was excellent. Of the children examined, 80 (36.5%) drank water (fluoridated or non-fluoridated) from municipal water systems during the first 6 yr of life. The children were assigned into five groups based upon residence history and exposure to fluoridated water during the first 6 yr of life. The percentage difference in mean DMFS scores between children in the fluoridated and non-fluoridated groups is 17% (delta DMFS1 = 0.7) when non-cavitated carious lesions are included and 39% (delta DMFS2 = 1.1) when they are excluded. The differences are not statistically significant. The significant risk factors associated with the DMFS1 and DMFS2 scores identified by a stepwise multiple regression analysis are: education level of the father, gender, and number of years of reported use of toothpaste during the first 6 yr of life. Dental fluorosis (mainly TSIF score of 1) was present in 41.5% and 69.2% of the children in the non-fluoridated and fluoridated groups, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Strain gauge plethysmography for the detection of deep venous thrombosis

Deep venous thrombosis is a widely recognized medical problem which results in significant morbidity and mortality. Venography is the current 'gold standard' diagnostic test for deep venous thrombosis; however it is costly, invasive and is unnecessarily performed in 50% of cases. This paper describes a self-contained, non-invasive system for automatic venous occlusion plethysmographic measurement and analysis. An examination of 274 symptomatic limbs was conducted using strain gauge plethysmography and a subsequent venographic examination was then performed. The plethysmographic results were then compared with venography so as to develop a means of discrimination for thrombotic and non-thrombotic limbs. Strain gauge plethysmography using the Belfast DVT Screener yielded a sensitivity of 100% and a sensitivity of 66.3% for proximal segment DVT. The efficacy of the discriminatory algorithm was then tested for the diagnosis of DVT in a further 101 symptomatic patients. A sensitivity of 94.7% and a specificity of 81.7% were observed for strain gauge plethysmography for proximal segment thrombosis in this patient group. The Belfast DVT Screener is highly sensitive for deep venous thrombosis and may be used to reduce the need for venography, which is of benefit to both the patient and clinician.

A computerised system of screening for deep venous thrombosis

We have developed a computer controlled system of strain gauge plethysmography for use as a screening tool for proximal segment venous thrombi which is simple to use, well tolerated by patients and extremely accurate. The computerised test was evaluated in 171 limbs of 163 symptomatic patients by comparison with subsequent ascending venography. Each of twenty occlusive proximal segment thrombi were identified, one non occlusive thrombus screened normal giving an overall sensitivity of 95.2%. The specificity of the test was 80% with a negative predictive value of 99.0%. The computerised system allows accurate screening for proximal segment venous thrombosis, and may permit more selective use of venography in the symptomatic post-operative limb.