Dental age estimation using the Kvaal method-an evaluation of length and width ratios: a systematic review

This study aimed to systematically review the correlational accuracy between width ratios and length ratios based on the Kvaal methodology with chronological age. This systematic review followed Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA). The search strategy included ProQuest, PubMed, Science Direct, and Taylor and Francis and Willey online without time or language restriction using Kvaal method of age estimation as key words for the search up to December 2021. A team of two researchers independently selected the studies and extracted the data. The Covidence platform was used to systematically organize all titles. The full texts of eligible studies were analyzed. Risk of bias (RoB) was assessed using a modified (to the specific characteristics of this systematic review) checklist based on Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement checklist for observational studies. A total of 658 articles were initially reviewed, but 22 were selected for inclusion. The risk of bias was estimated to be unclear to low overall. Among the length ratios, ratio R showed a strong association with chronological age, followed by ratio P. For the width ratios, ratio B demonstrated a close association with chronological age, followed by ratio C. The results suggest that width ratios correlate better with chronological age than length ratios. This systematic review suggests the width ratios are more strongly associated with chronological age than the length ratios. Using a width ratio could serve as a convenient and rapid way to estimate dental age. Our results apply equally to all types of ethnic groups.

Cortical spreading depolarization-induced constriction of penetrating arteries can cause watershed ischemia: A potential mechanism for white matter lesions

Periventricular white matter lesions (WMLs) are common MRI findings in migraine with aura (MA). Although hemodynamic disadvantages of vascular supply to this region create vulnerability, the pathophysiological mechanisms causing WMLs are unclear. We hypothesize that prolonged oligemia, a consequence of cortical spreading depolarization (CSD) underlying migraine aura, may lead to ischemia/hypoxia at hemodynamically vulnerable watershed zones fed by long penetrating arteries (PAs). For this, we subjected mice to KCl-triggered single or multiple CSDs. We found that post-CSD oligemia was significantly deeper at medial compared to lateral cortical areas, which induced ischemic/hypoxic changes at watershed areas between the MCA/ACA, PCA/anterior choroidal and at the tip of superficial and deep PAs, as detected by histological and MRI examination of brains 2-4 weeks after CSD. BALB-C mice, in which MCA occlusion causes large infarcts due to deficient collaterals, exhibited more profound CSD-induced oligemia and were more vulnerable compared to Swiss mice such that a single CSD was sufficient to induce ischemic lesions at the tip of PAs. In conclusion, CSD-induced prolonged oligemia has potential to cause ischemic/hypoxic injury at hemodynamically vulnerable brain areas, which may be one of the mechanisms underlying WMLs located at the tip of medullary arteries seen in MA patients.

Post-Progression Survival in Patients with Oligometastatic or Polymetastatic Pancreatic Adenocarcinoma

PURPOSE/OBJECTIVE(S)

Distant progression following surgical resection of stage I-III pancreatic ducal adenocarcinoma (PDAC) is a major cause of morbidity and mortality. Herein, we investigated the impact of tumor burden at the time of distant progression on survival. We hypothesize that patients with limited number of metastases (≤5) in a single organ will have improved survival post progression.

MATERIALS/METHODS

We queried our institutional database for patients with the following inclusion criteria: 1-Stage I-III PDAC who underwent curative resection, and 2-Metachronous single organ (liver or lung) distant failure >3 months from the date of surgery. Patients with serosal and/or multiple organ metastases were excluded. Single organ metastases other than liver or lung were also excluded. Patients were stratified into oligometastatic (≤5 tumors), and polymetastatic (>5 tumors). Primary endpoint was survival post failure, while secondary endpoints were distant failure free survival (DFFS) and overall survival. Reverse KM curve was used to calculate median follow up. KM curves were plotted for DFFS identified from date of surgery until date of distant failure, survival post failure was identified from date of distant failure until death/last follow up, and overall survival was identified from date of surgical resection until death/last follow up.

RESULTS

Out of 128 patients who developed metachronous distant progression following surgical resection, we identified 76 patients who met the inclusion criteria with a median follow up of 50 months. Among those, at the time of distant failure, 63% (n = 48) and 37% (n = 28) patients had ≤5 vs >5 metastases respectively. Median number of metastases was one (range 1-5) and eight (range 6-33), while 12 and 11 patients developed local failure in the oligometastatic and polymetastatic cohorts respectively. Among the 48 patients who developed oligometastases, 69% (n = 33) and 31% (n = 15) had liver and lung metastases respectively. On the other hand, 68% (n = 19) and 32% (n = 9) had liver and lung polymetastases respectively. Median DFFS was 11, and 9 months (HR = 1.59, 95 % CI 0.95-2.64, p value = 0.046), survival post distant failure was 17.8 and 5.3 months (HR = 3.03, 95 % CI 1.52-6.01, p value<0.0001), and median survival was 29.8, and 16.7 months (HR = 2.52, 95 % CI 1.31-4.86, p value = 0.0007) among patients with oligometastases and polymetastases respectively.

CONCLUSION

Within the surgically resected stage I-III PDAC who developed single organ liver or lung metachronous disease, oligometastases (one-five lesions) were more prevalent, had more durable DFFS, had improved survival post failure, and a longer median survival compared to patients with polymetastatic recurrence (>five metastases). Trials on treatment of metastatic PDAC should stratify by number of metastases, and the oligometastatic subset may derive survival benefit from ablative radiation therapy.

Are non-invasive estimations of plasma volume an accurate measure of congestion in patients with chronic heart failure?

AIMS

We report associations between different formulae for estimating plasma volume status (PVS) and clinical and ultrasound markers of congestion in patients with chronic heart failure (CHF) enrolled in the Hull Lifelab registry.

METHODS AND RESULTS

Cohort 1 comprised patients with data on signs and symptoms at initial evaluation (n = 3505). Cohort 2 included patients with ultrasound assessment of congestion [lung B-line count, inferior vena cava (IVC) diameter, jugular vein distensibility (JVD) ratio] (N = 341). Two formulae for PVS were used: (a) Hakim (HPVS) and (b) Duarte (DPVS). Results were compared with clinical and ultrasound markers of congestion. Outcomes assessed were mortality and the composite of heart failure (HF) hospitalisation and all-cause mortality. In cohort 1, HPVS was associated with mortality [hazard ratio (HR) per unitary increase = 1.02 (1.01-1.03); P < 0.001]. In cohort 2, HPVS was associated with B-line count (HR) = 1.05 [95% confidence interval (CI) (1.01-1.08); P = 0.02] and DPVS with the composite outcome [HR = 1.26 (1.01-1.58); P = 0.04]. HPVS and DPVS were strongly related to haemoglobin concentration and HPVS to weight. After multivariable analysis, there were no strong or consistent associations between PVS and measures of congestion, severity of symptoms, or outcome. By contrast, log[NTproBNP] was strongly associated with all three.

CONCLUSION

Amongst patients with CHF, HPVS and DPVS are not strongly or consistently associated with clinical or ultrasound evidence of congestion, nor clinical outcomes after multivariable adjustment. They appear only to be surrogates of the variables from which they are calculated with no intrinsic clinical utility.

The relation between change in left ventricular systolic function and subsequent mortality in patients with chronic heart failure

Background

Increasing severity of impairment of left ventricular systolic dysfunction (LVSD) in patients with chronic heart failure (CHF) is associated with higher mortality. However, the relation between temporal changes in LVSD severity and long-term clinical outcome is unknown.

Purpose

We therefore investigated the effects of change of LVSD as measured by serial echocardiography on all-cause mortality in patients with CHF.

Methods

Patients with CHF defined as the presence of compatible symptoms and either at least moderate LVSD or NTproBNP &gt;125 ng/L were enrolled. LVSD was qualitatively assessed as: none, mild, moderate, and severe. Echocardiography was performed at baseline and 12 months. The primary endpoint was all-cause mortality. Cox proportional hazard models were used to assess the relation between changes in LVSD and outcome. Hazard ratios (HR) are reported with 95% confidence intervals (CI).

Results

At baseline, 170 (11%) had no, 231 (16%) mild, 633 (43%) moderate and 453 (30%) severe LVSD. Amongst patients with either moderate or severe LVSD at baseline, 40% had improvement in function at 12 months (figure 1). Amongst patients with no LVSD at baseline, only 14% had deterioration of function. During subsequent median follow up of 2773 days, 868 patients died. Worsening of LVSD was associated with increasing all-cause mortality in patients with moderate LVSD and severe LVSD at baseline, but this was not significant after adjustment for covariables (table 1). Improvement of LVSD was independently associated with better survival in patients with moderate LVSD at baseline (HR 0.72 (95% CI: 0.53–0.98, p=0.04).

Conclusion

Greater severity of LVSD at baseline is associated with increasing likelihood of improvement. Amongst patients with moderate LVSD, improvement in LVSD is independently associated with survival.

Funding Acknowledgement

Type of funding sources: Public Institution(s).

Hypochloraemia following admission to hospital with heart failure is common and associated with an increased risk of readmission or death: a report from OPERA-HF

AIMS

Hypochloraemia is common in patients hospitalized with heart failure (HF) and associated with a high risk of adverse outcomes during admission and following discharge. We assessed the significance of changes in serum chloride concentrations in relation to serum sodium and bicarbonate concentrations during admission in a cohort of 1002 consecutive patients admitted with HF and enrolled into an observational study based at a single tertiary centre in the UK.

METHODS AND RESULTS

Hypochloraemia (<96 mmol/L), hyponatraemia (<135 mmol/L), and metabolic alkalosis (bicarbonate >32 mmol/L) were defined by local laboratory reference ranges. Outcomes assessed were all-cause mortality, all-cause mortality or all-cause readmission, and all-cause mortality or HF readmission. Cox regression and Kaplan-Meier curves were used to investigate associations with outcome. During a median follow-up of 856 days (interquartile range 272-1416), discharge hypochloraemia, regardless of serum sodium, or bicarbonate levels was associated with greater all-cause mortality [hazard ratio (HR) 1.44, 95% confidence interval (CI) 1.15-1.79; P = 0.001], all-cause mortality or all-cause readmission (HR 1.26, 95% CI 1.04-1.53; P = 0.02), and all-cause mortality or HF readmission (HR 1.41, 95% CI 1.14-1.74; P = 0.002) after multivariable adjustment. Patients with concurrent hypochloraemia and natraemia had lower haemoglobin and haematocrit, suggesting congestion; those with hypochloraemia and normal sodium levels had more metabolic alkalosis, suggesting decongestion.

CONCLUSION

Hypochloraemia is common at discharge after a hospitalization for HF and is associated with worse outcome subsequently. It is an easily measured clinical variables that is associated with morbidity or mortality of any cause.

Natural history and prognostic significance of anaemia and iron deficiency in ambulatory patients with heart failure

Background

Anaemia and iron deficiency (ID) are both common and associated with adverse outcomes in patients with heart failure (HF). However, the incidence of and recovery from anaemia and ID and their impact on prognosis are not well described.

Methods

Between 2001 and 2018, patients with suspected HF referred to a clinic serving a local population of ∼500,000 were invited to be enrolled in a long-term registry. HF was defined as relevant symptoms or signs with either at least moderate systolic dysfunction on echocardiography or raised plasma concentration of amino-terminal pro-B type natriuretic peptide (NT-proBNP ≥125pg/ml). ID was defined as a transferrin saturation (TSAT) of &lt;20%, anaemia was defined as a haemoglobin (Hb) of &lt;13.0 g/dL in men and &lt;12.0 g/dL in women. At 1-year follow-up, 872 patients had repeat assessments for ID. Patients were grouped into four phenotypes according to the presence or absence of anaemia and/or ID. Those who developed or recovered from ID and anaemia were assessed separately. Survival analysis was conducted at 5 years after the one-year visit.

Results

The prevalence of ID and anaemia at baseline was 40% and 29% respectively. At baseline and at one-year, 53% of patients had either ID, anaemia or both. Compared to other groups, those with both anaemia and ID were older, had worse renal function and higher median NT-proBNP. In patients with TSAT &gt;20% without anaemia at baseline, 23% had ID at 1 year, 14% were anaemic and 6% developed both. At one year, 11% of patients with anaemia and ID at baseline had normal values for both compared to 16% of those with anaemia but not ID. In patients with ID without anaemia at baseline, 51% remained iron deficient at one year, irrespective of initial Hb.

At 5-years, survival was markedly worse for those with anaemia at baseline compared to those without anaemia, irrespective of iron status. Compared to those who had normal TSATs and Hb, those with both anaemia and ID had the worst survival (HR=2.35; 1.77–3.11; p&lt;0.001), followed by those with anaemia without ID (HR=1.93; 1.40–2.67; p&lt;0.001) and those with isolated ID (HR=1.34; 1.01–1.78; p=0.046).

Compared to patients who never had anaemia or ID, patients who developed (HR 2.01; 1.41–2.88; p&lt;0.001) or recovered from (HR 2.21; 1.45–3.39; p&lt;0.001) anaemia or ID (HR 1.61; 1.14–2.28; 0.007 and HR 1.63; 1.16–2.28; 0.005 respectively) had a worse prognosis.

Conclusions

About 30% of patients with HF who have neither anaemia nor ID will develop such problems within a year and this associated with a worse prognosis. Recovery from ID and anaemia is also common, but this is not associated with a better prognosis. Factors leading to the development of anaemia and ID may be driving prognosis rather than anaemia and ID themselves

Funding Acknowledgement

Type of funding source: None

Ultraflexible nanoelectronic probes form reliable, glial scar-free neural integration

Implanted brain electrodes construct the only means to electrically interface with individual neurons in vivo, but their recording efficacy and biocompatibility pose limitations on scientific and clinical applications. We showed that nanoelectronic thread (NET) electrodes with subcellular dimensions, ultraflexibility, and cellular surgical footprints form reliable, glial scar-free neural integration. We demonstrated that NET electrodes reliably detected and tracked individual units for months; their impedance, noise level, single-unit recording yield, and the signal amplitude remained stable during long-term implantation. In vivo two-photon imaging and postmortem histological analysis revealed seamless, subcellular integration of NET probes with the local cellular and vasculature networks, featuring fully recovered capillaries with an intact blood-brain barrier and complete absence of chronic neuronal degradation and glial scar.

Beyond the 5-HT3 receptors

Accumulation of reactive oxygen species, such as hydrogen peroxide (H2O2), generated by inflammatory cells or other pathological conditions, leads to oxidative stress, which may contribute to the neuronal degeneration observed in a wide variety of neurodegenerative disorders such as Alzheimer’s disease. Recent investigations have described effective properties of tropisetron, such as antiphlogistic action or protection against β-amyloid induced-neuroinflammation in rats. Our data revealed that H2O2-induced cell death in rat pheochromocytoma cell line (PC12) can be inhibited by tropisetron, as defined by 3-[4, 5-dimethylthiazol-2-yl]-2, 5-diphenyl tetrazolium bromide assay, caspase 3 and caspase 12 levels. We further showed that tropisetron exerts its protective effects by upregulation of heme oxygenase-1, glutathione, catalase activity, and nuclear factor-erythroid 2 p45-related factor 2 level. Moreover, tropisetron was recently found to be a partial agonist of α7 nicotinic acetylcholine receptor (α7nAChR). The activation of α7nAChR could inhibit inflammatory and apoptotic signaling pathways in the oxidative stress conditions. In this study, selective α7nAChR antagonists (methyllycaconitine) reversed the effects of tropisetron on caspase 3 level. Our findings indicated that tropisetron can protect PC12 cells against H2O2-induced neurotoxicity through α7nAChR in vitro.

Salivary gland myoepithelial carcinoma

Salivary gland myoepithelial carcinoma (MC) or malignant myoepithelioma is a rare entity. MC usually presents as a slow-growing painless mass arising in the parotid gland, but may involve other salivary glands. This tumour may be particularly locally aggressive, but its clinical and biological features are not yet fully understood. MC may arise from pre-existing benign lesions, such as pleomorphic adenomas or benign myoepitheliomas, or may arise de novo. It usually affects patients over 50 years old, with no gender preference. Because it is often asymptomatic, the presentation and diagnosis can be delayed by months, even years. The current WHO classification considers MC to be an intermediate- to high-grade malignancy. Other published data suggest it is likely to be a high-grade neoplasm, consistent with its aggressive behaviour. Its epidemiology, histopathological features, immunohistochemical profile, clinical behaviour and optimal management are not well understood. Following review of the current literature we aim to address these.

Mortality from sudden unexpected death in epilepsy (SUDEP) in a cohort of adults with intellectual disability

BACKGROUND

People with intellectual disability (ID) and epilepsy are more likely to die prematurely than the general population. A significant number of deaths in people with epilepsy may be potentially preventable through better seizure control, regular monitoring and raising awareness among patients and carers. The aim of this project was to study mortality from sudden unexpected death in epilepsy (SUDEP) in adults with ID.

METHODS

All adults (≥20 years old) living in Leicester city, Leicestershire and Rutland, UK, with ID between 1993 and 2010 were identified using the Leicestershire Intellectual Disability Register database. People with and without ID who died during the same period were identified using death certificate data from the Office for National Statistics (ONS). Deaths from probable and definite SUDEP were identified. Additional information on adults with ID who had died from probable or definite SUDEP was obtained from case notes and post-mortem reports, where available. Cases of probable and definite SUDEP in adults with ID were compared with the general population using standardised mortality ratios (SMRs).

RESULTS

A total of 898 adults with ID had died over the 18-year study period. Of these, 244 deaths (27%) occurred in people with ID who had a diagnosis of epilepsy. Twenty-six people with ID died from probable or definite SUDEP, which was the second most common cause of death among adults with ID and epilepsy. All-cause specific SMRs were 2.2 [95% confidence interval (CI): 2.0-2.4] and 2.8 (95% CI: 2.5-3.1) for men and women with ID respectively. SMRs were 3.2 (95% CI: 2.7-3.8) and 5.6 (95% CI: 4.6-6.7) for men and women with epilepsy and ID respectively. During the same study period, 83 adults without ID had died of probable or definite SUDEP. The SMRs for SUDEP in patients with ID were 37.6 for men (95% CI: 21.9-60.2) and 52.0 for women (95% CI: 23.8-98.8). We found that in the majority of ID cases there was little detailed documentation on the circumstances surrounding deaths, no communication with patients/carers about risk of SUDEP and an absence of post-mortem reports or carers' referral for bereavement counselling.

CONCLUSION

The authors believe that a comprehensive risk management under a multiagency/multidisciplinary framework should be undertaken for all adults with ID and epilepsy in day-to-day clinical practice to reduce mortality in people with ID.

Dual-wavelength photothermal optical coherence tomography for imaging microvasculature blood oxygen saturation

A swept-source dual-wavelength photothermal (DWP) optical coherence tomography (OCT) system is demonstrated for quantitative imaging of microvasculature oxygen saturation. DWP-OCT is capable of recording three-dimensional images of tissue and depth-resolved phase variation in response to photothermal excitation. A 1,064-nm OCT probe and 770-nm and 800-nm photothermal excitation beams are combined in a single-mode optical fiber to measure microvasculature hemoglobin oxygen saturation (SO(2)) levels in phantom blood vessels with a range of blood flow speeds (0 to 17  mm/s). A 50-μm-diameter blood vessel phantom is imaged, and SO(2) levels are measured using DWP-OCT and compared with values provided by a commercial oximeter at various blood oxygen concentrations. The influences of blood flow speed and mechanisms of SNR phase degradation on the accuracy of SO(2) measurement are identified and investigated.

In vivo depth-resolved oxygen saturation by Dual-Wavelength Photothermal (DWP) OCT

Microvasculature hemoglobin oxygen saturation (SaO2) is important in the progression of various pathologies. Non-invasive depth-resolved measurement of SaO2 levels in tissue microvasculature has the potential to provide early biomarkers and a better understanding of the pathophysiological processes allowing improved diagnostics and prediction of disease progression. We report proof-of-concept in vivo depth-resolved measurement of SaO(2) levels in selected 30 µm diameter arterioles in the murine brain using Dual-Wavelength Photothermal (DWP) Optical Coherence Tomography (OCT) with 800 nm and 770 nm photothermal excitation wavelengths. Depth location of back-reflected light from a target arteriole was confirmed using Doppler and speckle contrast OCT images. SaO(2) measured in a murine arteriole with DWP-OCT is linearly correlated (R(2)=0.98) with systemic SaO(2) values recorded by a pulse-oximeter. DWP-OCT are steadily lower (10.1%) than systemic SaO(2) values except during pure oxygen breathing. DWP-OCT is insensitive to OCT intensity variations and is a candidate approach for in vivo depth-resolved quantitative imaging of microvascular SaO(2) levels.

Asian earthquake: report from the first volunteer British hospital team in Pakistan

At 8:52 am on 8 October 2005 a massive earthquake wracked northern Pakistan and Kashmir. Various teams were sent to Islamabad and the disaster region from the UK. We discuss the types of injury patterns seen and recommend that a central register of volunteers should be created to deal with similar situations in the future.

Calcium mobilisation and CCK secretion induced by modified fatty acids and latex microspheres reveal dual receptor mechanisms for lipid stimulation of STC-1 cells

How fatty acids stimulate enteroendocrine cells to release cholecystokinin (CCK) is largely unknown. Recently, we proposed that the murine enteroendocrine cell line, STC-1, responds to insoluble fatty acid aggregates rather than fatty acid monomers in solution. This hypothesis led to two testable predictions. First, other insoluble particles of similar size but unrelated to fatty acid may be able to stimulate STC-1 cells in a similar fashion to dodecanoic acid and second, fatty acid sensing in STC-1 cells should be fairly insensitive to chemical modifications of the fatty acid as long as these modifications do not greatly alter the ability of the molecule to form insoluble aggregates. We used several analogues of dodecanoic acid and several varieties of latex microsphere (varying in size and surface charge) to see whether the predictions of our model hold. We found that while there was at least one latex microsphere that could induce CCK secretion and calcium mobilisation in STC-1 cells, there was a very poor correlation between the presence of insoluble aggregates and a cellular response. Instead the most important property, determining the potency of fatty acid analogues as stimulants of CCK secretion, was their amphipathicity. Removal of either the polar head or lipophilic tail completely abolished the ability of a given fatty acid analogue to stimulate STC-1 cells. These data suggested that while fatty acids can stimulate cells as aggregates, they may also be acting in monomeric form with the oil:water partitioning coefficient playing a crucial role. We finally resolved this issue with the observation that the sulfate ion greatly altered the response of STC-1 cells to monomeric dodecanoic acid. In the presence of sulfate, STC-1 cells will only respond to dodecanoic acid aggregates whereas when sulfate is replaced with chloride the cells clearly respond to dodecanoic acid monomers which are completely in solution. In summary, we propose that dodecanoic acid can stimulate STC-1 cells via two separate pathways one involving fatty acid monomers in solution and one involving fatty acid aggregates. Which pathway dominates depends on the presence of sulfate in the extracellular medium.

Model for avulsion injury in the rat brachial plexus using passive acceleration

We have developed an experimental model for brachial plexus injuries in the rat that closely simulates the characteristics of human injury. This model produces avulsion injuries in a noninvasive manner. A prototype apparatus was designed that allowed a force to be transmitted to a restrained limb by passive acceleration. Reproducible results were obtained in 32 rats. A significant correlation was found between the test weight and the number of roots avulsed (r = 0.92; P < 0.05). The amount of force also correlated to the pattern of avulsion injury: a 230-g weight produced either C6 (54%), C7 (15%), or C6 and C7 (31%) avulsions; a 330-g weight produced C6 (18%), C7 (9%), or C6 and C7 (73%) avulsions; a 530-g weight produced C5 through C8 (75%) or C6 through T1 (25%) avulsions. This model of brachial plexus injury may be useful to further our understanding of the cellular response to this incapacitating injury and to develop therapeutic strategies with behavioral correlates.

High-pressure liquid chromatographic determination of ibuprofen in plasma

A sensitive, simple, and rapid method for the quantitation of ibuprofen in plasma, using 1-(p-fluorobenzoyl)-5-methoxy-2-methylindole acetic acid as the internal standard, was developed. The method is based on reversed-phase high-pressure liquid chromatography with a mobile phase containing acetonitrile--0.1 M acetic acid (55:45 v/v). The chromatographic elution time was 8.5 min, and ibuprofen quantities as low as 0.1 microgram/ml can be assayed. The suitability of the method is demonstrated.