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The potential of single date fully Polarimetric RADARSAT‐2 data in retrieving crop biophysical parameters using Machine Learning techniques was investigated. Various polarimetric parameters along with coherent and incoherent decomposition techniques were assessed for its sensitivity toward crop parameters like Wet and Dry Biomass, Crop Height, Leaf Area Index and Vegetation Water Content. A set of 39 polarimetric observables extracted from the Quad‐Pol data were used for regression analysis. In this study two Machine Learning techniques Random Forest Regression (RFR) and Multiple Linear Regression (MLR) models were assessed for the prediction of Wet Biomass (gm−2) and Height (cm). The most significant (6 out of 39) variables were applied for prediction. The results revealed that RFR algorithm performed better than MLR. The coefficient of determination (R2) and root‐mean‐square‐error of estimating wet biomass and height were 0.646, 655.65 (gm−2) and 0.71, 14.5 (cm) respectively in RFR and 0.566, 683.86 (gm−2) and 0.65, 16.14 (cm) respectively in MLR. Thus this study explored the effective application of quad‐pol data for assessing sensitivity and accurate retrieval of parameters using optimum PolSAR observables. Key Points: Important polarimetric observables and their sensitivity toward biophysical parameters were analyzedEffective retrieval of crop parameters from a single‐date polarimetric data using Random Forest and Multiple Linear Regression was explored [ABSTRACT FROM AUTHOR]

Background: The precise burden of paediatric surgical care in South Africa is unknown. In the absence of epidemiological data, hospital-based study is a first step to gauge the burden and profile of paediatric surgical disease. We aim to describe the profile of pathology, pattern of referrals, and complications of paediatric surgical care at Chris Hani Baragwanath Academic Hospital (CHBAH). Methods: A 1-year retrospective record review for the period 3/1/2019 to 1/1/2020 was conducted by evaluation of the morbidity and mortality databases of the Department of Paediatric Surgery (DPS). Number of admissions, consultations, complications, and surgeries performed were analysed and classified. Results: A total of 11,932 unique patient encounters occurred. Emergencies (79%, 1841/2329) accounted for the majority of admissions. Trauma accounted for 49% (896/1841) of emergency admissions. Elective surgery constituted 52% (1202/2316) and emergency surgery 48% (1114/2316) of all procedures performed. The emergency department (55%, 1271/2329), outpatients department (19%, 447/2329), and peripheral hospitals (16%, 378/2329) were the source of the majority of admissions. A complication rate of 9% (208/2316) was observed. Conclusion: The high-volume subspecialist environment at CHBAH presents the ideal environment for delivery of specialist paediatric surgical services and training. Injury prevention, optimal use of existing resources, and additional physical, human and financial resources are required to meet the existing and predicted future burden of paediatric surgical disease. [ABSTRACT FROM AUTHOR]

Summary: Phrenic‐sparing analgesic techniques for shoulder surgery are desirable. Intra‐articular infiltration analgesia is one promising phrenic‐sparing modality, but its role remains unclear because of conflicting evidence of analgesic efficacy and theoretical concerns regarding chondrotoxicity. This systematic review and meta‐analysis evaluated the benefits and risks of intra‐articular infiltration in arthroscopic shoulder surgery compared with systemic analgesia or interscalene brachial plexus block. We sought randomised controlled trials comparing intra‐articular infiltration with interscalene brachial plexus block or systemic analgesia (control). Cumulative 24‐h postoperative oral morphine equivalent consumption was designated as the primary outcome. Secondary outcomes included visual analogue scale pain scores during the first 24 h postoperatively; time‐to‐first analgesic request; patient satisfaction; opioid‐related side‐effects; block‐related adverse events; and any indicators of chondrotoxicity. Fifteen trials (863 patients) were included. Compared with control, intra‐articular infiltration reduced 24‐h postoperative analgesic consumption by a weighted mean difference (95%CI) of −30.9 ([−38.9 to −22.9]; p < 0.001). Intra‐articular infiltration also reduced the weighted mean difference (95%CI) pain scores up to 12 h postoperatively, with the greatest reduction at 4 h (−2.2 cm [(−4.4 to −0.04]); p < 0.05). Compared with interscalene brachial plexus block, there was no difference in opioid consumption, but patients receiving interscalene brachial plexus block had better pain scores at 2, 4 and 24 h postoperatively. There was no difference in opioid‐ or block‐related adverse events, and none of the trials reported chondrotoxic effects. Compared with systemic analgesia, intra‐articular infiltration provides superior pain control, reduces opioid consumption and enhances patient satisfaction, but it may be inferior to interscalene brachial plexus block patients having arthroscopic shoulder surgery. [ABSTRACT FROM AUTHOR]

Objectives: We aimed to compare the effectiveness of antiretroviral therapy (ART) classes for achieving HIV RNA suppression to < 50 HIV‐1 RNA copies/mL within 6 months of initiation with high viral loads (VLs). Secondary objectives were to compare viral suppression (VS) at 12 weeks and 12 months, partial HIV RNA suppression to < 200 copies/mL, time to VS, time to rebound, and change in CD4 cell count. Methods: This was a multicentre, retrospective, observational study. Adult patients were included if they initiated ART between January 2005 and December 2016 with a VL ≥ 100 000 copies/mL. Results: There were 220 patients included in the study. The median VL was 252 919 [interquartile range (IQR) 149 472–500 000] copies/mL. Nonnucleoside reverse transcriptase inhibitor (NNRTI) recipients were more likely to achieve VS by 6 months compared to those initiating ART containing protease inhibitors (PIs) [75.4% vs. 44.1%, respectively; odds ratio (OR) 3.34; 95% confidence interval (CI) 1.62–6.90] or integrase strand transfer inhibitors (INSTIs) (75.4% vs. 55.8%, respectively; OR 2.40; 95% CI 1.03–5.58). VS at 12 weeks was more frequent with INSTI‐containing regimens than with PIs (28.9% vs. 9.0%, respectively; OR 4.10; 95% CI 1.69–9.92). VS at 12 months did not significantly differ between treatment regimens. Median time to complete VS for INSTI, PI and NNRTI recipients was 22.3 (95% CI 13.4–33), 30.1 (95% CI 25–36) and 19.9 (95% CI 16–22.3) weeks, respectively. There were no significant differences in time to viral rebound or change in CD4 cell counts. Conclusions: Patients with high VLs initiated on NNRTIs were more likely to achieve VS by 6 months on ART compared to INSTI and PI recipients. [ABSTRACT FROM AUTHOR]

Effective analgesic alternatives to interscalene brachial plexus block are sought for shoulder surgery. Peri-articular infiltration analgesia is a novel, less invasive technique, but evidence surrounding its use is unclear. This systematic review and meta-analysis aims to evaluate the utility of peri-articular infiltration analgesia in shoulder surgery. We searched literature for trials comparing peri-articular infiltration analgesia with control or with interscalene brachial plexus block. Control groups received no intervention, placebo or systemic opioids. The primary outcome was cumulative oral morphine equivalent consumption during the first 24 h postoperatively. Secondary outcomes included: rest pain scores up to 48 h; risk of side-effects; and durations of post-anaesthetic care unit and hospital stay. Data were pooled with random-effects modelling. Seven trials (383 patients) were included. Compared with control, peri-articular infiltration analgesia reduced 24-h oral morphine consumption by a mean difference (95%CI) of -38.0 mg (-65.5 to -10.5; p = 0.007). It also improved pain scores up to 6 h, 36 h and 48 h, with the greatest improvement observed at 0 h (-2.4 (-2.7 to -1.6); p < 0.001). Peri-articular infiltration analgesia decreased postoperative nausea and vomiting by an odds ratio (95%CI) of 0.3 (0.1-0.7; p = 0.006). In contrast, peri-articular infiltration analgesia was not different from interscalene brachial plexus block for analgesic consumption, pain scores or side-effects. This review provides moderate evidence supporting peri-articular infiltration for postoperative analgesia following shoulder surgery. The absence of difference between peri-articular infiltration analgesia and interscalene brachial plexus block for analgesic outcomes suggests that these interventions are comparable, but further trials are needed to support this conclusion and identify the optimal peri-articular infiltration technique. [ABSTRACT FROM AUTHOR]

Summary: Background: Early results from the use of neuromodulation by percutaneous electrical nerve stimulation for the management of trigeminal‐mediated headshaking in horses were promising but lacked sufficient case numbers and long‐term follow‐up. The neuromodulatory procedure has since been established as EquiPENS™. Objectives: The aim of this study was to report long‐term results from a larger number of cases and to investigate for predictors of outcome. Study design: Prospective case series using international, multi‐centre data. Methods: Eligible cases were horses with a veterinary diagnosis of trigeminal‐mediated headshaking, which received EquiPENS™ neuromodulation at trained centres between August 2013 and November 2017. The standard protocol was an initial three‐procedure course, with additional procedures should a horse go into remission but then relapse. Data collected included signalment, history, diagnostic tests performed, details of any complications, whether horses had gone into remission and the length of remission. Results: Results were obtained from 168 horses, with 530 procedures. The complication rate was 8.8% of procedures. In all but one case, complications were mild and transient, without self‐trauma. Remission of headshaking following the initial course occurred in 53% (72/136) of horses. Median length of time recorded in remission was 9.5 weeks (range 2 days to 156 weeks ongoing). Where signs recurred, most horses went back into remission following additional procedures, usually for longer than from the previous procedure. No predictors for outcome were determined. Main limitations: No placebo or control group, owner‐assessed results. Conclusions: EquiPENS™ neuromodulation can be an effective and safe treatment for the management of trigeminal‐mediated headshaking in some horses. An increased understanding of neuromodulation could help optimise the technique. Advances in treatment for trigeminal‐mediated headshaking will remain limited until there is a greater understanding of the aetiopathogenesis of the condition. [ABSTRACT FROM AUTHOR]

Aim: Coronectomy is an elective surgical technique designed to reduce the risk of morbidity to the inferior dental nerve for those mandibular third molars (M3M) deemed to pose such risk. Successful coronectomy relies on the retention of a vital root with non‐inflamed pulpal tissue and healthy surrounding bone. For this reason coronectomy in teeth with disease affecting the pulp has been widely contraindicated based on theoretical presumption rather than evidence. The current case series challenges this common supposition and highlights evidence in other dental specialties to support the use of coronectomy in selected cases of teeth with pulpal involvement. Methods: Over a 5‐year period, 22 M3M teeth closely related to the IDN canal with either caries or internal resorption were treated with coronectomy. Preoperative assessment included both 2D and 3D imaging which helped determine risk assessment. Results: All patients had a minimum of 1 year post‐coronectomy review. No patients reported persistent symptoms or required root retrieval. Radiographically, there were no suggestions of apical radiolucency to indicate associated apical disease. Conclusion: This small case series provides an early insight and potential scope for considering coronectomy in selective carious or internally resorbing M3M deemed at having an elevated risk of IDN injury. [ABSTRACT FROM AUTHOR]

Introduction: Non‐steroidal anti‐inflammatory drugs (NSAIDs) are commonly used over the counter analgesics for the management of post‐operative pain following dental surgery, including dental implant placement. NSAIDs work through inhibition of the cyclo‐oxygenase (COX) enzyme, in particular the isoform COX‐2. COX‐2 has been shown to induce new bone formation with upregulation of COX‐2 demonstrated following bony fractures. The aim of this systematic review was to determine if NSAID use affects bone healing and osseointegration following dental implant placement. Methods: Electronic databases (Medline and Embase) were searched in addition to hand searches from reference lists of selected papers. Only randomised control trials were included in this review. Results: Three studies were included and data provided on bone healing and osseointegration following dental implant surgery (with and without NSAID use) were analysed. The Cochrane risk of bias tool (2.0) were used to assess risk of bias. Two randomised control trials were conducted on animal subjects and one on human participants. One animal study reported significantly reduced bone healing around dental implants following the use of prolonged subcutaneous NSAIDs. No other studies reported any significant findings. There was considerable heterogeneity between included studies. Conclusion: There is limited evidence exploring the relationship of NSAIDs and dental implant osseointegration and bone healing to draw definitive conclusions. Further research is required in this area. [ABSTRACT FROM AUTHOR]

Breaking barriers: implementing evidence-based practice It is equally important to understand what factors will influence a clinician's ability to change their practice to incorporate current evidence; without this element evidence-based practice will achieve very little[[2]]. Cognitive theorists argue that poor clinician knowledge about current evidence-base leads to poor compliance and clinicians need to experience a clinical problem themselves before they are motivated to utilize evidence to change practice. Factors which must be considered to implement evidence-based practice with resultant changes in clinician behaviour suggest that addressing all levels in clinical practice from patients, practitioners, healthcare team members and the organization itself is needed for lasting change. [Extracted from the article]

Retinal dystrophies (RDs) are hereditary blinding eye conditions that are highly variable in their clinical presentation. The remarkable genetic heterogeneity that characterizes RD was a major challenge in establishing the molecular diagnosis in these patients until the recent advent of next‐generation sequencing. It remains unclear, however, what percentage of autosomal recessive RD remain undiagnosed when all established RD genes are sequenced. We enrolled 75 families in which RD segregates in an apparently autosomal recessive manner. We show that the yield of a multigene panel that contains known RD genes is 67.5%. The higher yield (82.3%) when whole exome sequencing was implemented instead was often due to hits in genes that were not included in the original design of the panel. We also show the value of homozygosity mapping even during the era of exome sequencing in uncovering cryptic mutations. In total, we describe 45 unique likely deleterious variants (of which 18 are novel including one deep intronic and one genomic deletion mutation). Our study suggests that the genetic heterogeneity of autosomal recessive RD is approaching saturation and that any new RD genes will probably account for only a minor role in the mutation burden. [ABSTRACT FROM AUTHOR]

Aims: The aim is to introduce a novel transalveolar technique for retrieval of tooth roots from the maxillary antrum using a modified flexible suction catheter. Method: The displaced root is confirmed using plain radiographs and the patient is placed on a preoperative antral regime of broad‐spectrum antibiotics, analgesics and nasal decongestants for one week. On the day of the operation, the precise location of the root is identified using a small volume pre‐operative cone beam computed tomogram (CBCT). A buccal mucoperiosteal flap is raised to allow visualisation and exploration of the existing extraction socket. The dentoalveolar socket is expanded using a fissure bur in a surgical handpiece to allow access to the sinus. A modified flexible fine bore suction catheter is inserted into the sinus and directed to the location of the root to enable retrieval. The socket is then flushed with saline until the root is dislodged and captured at the tip of the catheter. The socket is closed in a tension free manner with a buccal advancement flap. The antral regime prescribed pre‐operatively is continued for one week post‐operatively. Results: This technique is currently practised at Guy's Hospital under local anaesthetic, intravenous sedation and general anaesthetic. This minimally invasive technique preserves alveolar bone and offers fewer complications than the Caldwell‐Luc. It allows immediate retrieval of displaced tooth roots from the maxillary sinus and is best applied when healing has not yet taken place. Conclusion: The combination of CBCT and this transalveolar approach using a modified flexible suction catheter should be considered in all cases where roots are to be retrieved from the maxillary sinus to reduce surgical morbidity. [ABSTRACT FROM AUTHOR]

Microphthalmia is a developmental eye defect that is highly variable in severity and in its potential for systemic association. Despite the discovery of many disease genes in microphthalmia, at least 50% of patients remain undiagnosed genetically. Here, we describe a cohort of 147 patients (93 families) from our highly consanguineous population with various forms of microphthalmia (including the distinct entity of posterior microphthalmos) that were investigated using a next‐generation sequencing multi‐gene panel (i‐panel) as well as whole exome sequencing and molecular karyotyping. A potentially causal mutation was identified in the majority of the cohort with microphthalmia (61%) and posterior microphthalmos (82%). The identified mutations (55 point mutations, 15 of which are novel) spanned 24 known disease genes, some of which have not or only very rarely been linked to microphthalmia (PAX6, SLC18A2, DSC3 and CNKSR1). Our study has also identified interesting candidate variants in 2 genes that have not been linked to human diseases (MYO10 and ZNF219), which we present here as novel candidates for microphthalmia. In addition to revealing novel phenotypic aspects of microphthalmia, this study expands its allelic and locus heterogeneity and highlights the need for expanded testing of patients with this condition. [ABSTRACT FROM AUTHOR]

Summary: We have identified a non‐steroidal selective androgen receptor modulator (SARM), termed LY305, that is bioavailable through a transdermal route of administration while highly cleared via hepatic metabolism to limit parent compound exposure in the liver. Selection of this compound and its transdermal formulation was based on the optimization of skin absorption properties using both in vitro and in vivo skin models that supported PBPK modeling for human PK predictions. This molecule is an agonist in perineal muscle while being a weak partial agonist in the androgenic tissues such as prostate. When LY305 was tested in animal models of skeletal atrophy it restored the skeletal muscle mass through accelerated repair. In a bone fracture model, LY305 remained osteoprotective in the regenerating tissue and void of deleterious effects. Finally, in a small cohort of healthy volunteers, we assessed the safety and tolerability of LY305 when administered transdermally. LY305 showed a dose‐dependent increase in serum exposure and was well tolerated with minimal adverse effects. Notably, there were no statistically significant changes to hematocrit or HDL after 4‐week treatment period. Collectively, LY305 represents a first of its kind de novo development of a non‐steroidal transdermal SARM with unique properties which could find clinical utility in hypogonadal men. [ABSTRACT FROM AUTHOR]

The carbohydrate‐binding molecule galectin‐3 has garnered significant attention recently as a biomarker for various conditions ranging from cardiac disease to obesity. Although there have been several recent studies investigating its role in stroke and other cerebrovascular diseases, awareness of this emerging biomarker in the wider neurology community is limited. We performed a systematic search in PubMed, Embase, Scopus, CINAHL, Clinicaltrials.gov and the Cochrane library in November and December 2016 for articles related to galectin‐3 and cerebrovascular disease. We included both human and pre‐clinical studies in order to provide a comprehensive view of the state of the literature on this topic. The majority of the relevant literature focuses on stroke, cerebral ischemia and atherosclerosis, but some recent attention has also been devoted to intracranial and subarachnoid hemorrhage. Higher blood levels of galectin‐3 correlate with worse outcomes in atherosclerotic disease as well as in intracranial and subarachnoid hemorrhage in human studies. However, experimental evidence supporting the role of galectin‐3 in these phenotypes is not as robust. It is likely that the role of galectin‐3 in the inflammatory cascade within the central nervous system following injury is responsible for many of its effects, but its varied physiological functions and multiple sites of expression mean that it may have different effects depending on the nature of the disease condition and the time since injury. In summary, experimental and human research raises the possibility that galectin‐3, which is closely linked to the inflammatory cascade, could be of value as a prognostic marker and therapeutic target in cerebrovascular disease. [ABSTRACT FROM AUTHOR]

Abstract: Objective: Trigeminal nerve injury is one of the most problematic complications of dental/oral surgical procedures with significant consequences for patients, including neuropathy and facial pain. This presentation demonstrates the results of a cross‐sectional survey studying the impact of nerve injury on patients’ quality of life. Method: Thirty patients attending a specialist nerve injury clinic at Manchester Dental Hospital were asked to complete an Oral Impact on Daily Performance (ODIP) questionnaire. Five further patients took part in semi‐structured interviews. Each interview was recorded and responses were thematically analysed. Results: Eighteen patients had an inferior alveolar nerve injury and 12 had lingual nerve injuries. There was no significant difference in mean ODIP score – and therefore effect on quality of life, for gender or type of nerve injured (P < 0.05). Nerve injury most affected patients who enjoyed social contact with other people, their ability to eat and enjoy food. It also affected their capacity to maintain an emotional state without becoming irritable. The majority (70%) of nerve injuries were caused by dental extractions. There was also some evidence to show that patients who had sustained a nerve injury following the surgical removal of a wisdom tooth had a worse quality of life when compared to the other injury groups (P < 0.05, 95% CI). Results of the interviews further demonstrated a universal dissatisfaction of how the patient was initially managed following injury. Conclusion: Iatrogentic trigeminal nerve injury still remains a significant complication in dentistry with significant impact on patients’ quality of life. Managing patients appropriately after nerve injury may help to improve the overall care given to this patient group. [ABSTRACT FROM AUTHOR]

Abstract: Background: Atopic dermatitis (AD) is associated with a heterogeneous presentation and clinical course. There is a lack of simple and validated severity assessments that are feasible for clinical practice and epidemiological research. Objectives: We sought to validate patient‐reported global AD severity in adults. Methods: We performed a prospective dermatology practice‐based study using questionnaires and evaluation by a dermatologist (n = 265). Results: At baseline and follow‐up, patient‐reported global AD severity significantly correlated with oSCORAD (Spearman ρ = 0.56 and 0.49), SCORAD (0.64 and 0.56), EASI (0.56 and 0.50), BSA (0.52 and 0.45), NRS‐itch (0.60 and 0.53), POEM (0.50 and 0.48), and DLQI (0.50 and 0.49) (P < .0001 for all). Patient‐reported moderate and severe AD vs mild AD were associated with significantly higher oSCORAD, SCORAD, EASI, BSA, NRS‐itch, POEM, and DLQI (P < .0001 for all). There was moderate concordance between patient‐reported AD severity (mild, moderate, and severe) and previously developed severity strata for oSCORAD (κ = 0.39), SCORAD (κ = 0.47), EASI (κ = 0.37), NRS‐itch (κ = 0.49), POEM (κ = 0.37), and DLQI (κ = 0.40). Among patients with severe disease at baseline, those who reported mild or moderate disease on follow‐up had significantly greater absolute reductions of oSCORAD (−23.4/−9.7/−1.8), SCORAD (−33.0/−13.2/−2.3), EASI (−17.1/−9.8/−3.2), BSA (−46%/−15%/−4%), NRS‐itch (−5/−2/0), POEM (−5/−2/0), and DLQI (−8/−6/−1) than those who continued to report severe disease (Kruskal‐Wallis, P ≤ .0003 for all). Conclusions: Patient‐reported AD severity appears to be sufficiently valid for assessing AD severity in the clinical and epidemiological setting. [ABSTRACT FROM AUTHOR]

Climate change has become a serious concern worldwide owing to its multifaceted impact upon the physical as well as socio‐economic environment (IPCC, 2013). Vulnerability to climate change is much higher in the developing countries like India, where the economy is mainly agro‐based and productivity from the agricultural sector is dependent upon summer monsoon rainfall. Hence, assessing the quantitative relationship between vegetation patterns and climatic influence has become an increasingly important study conducted on regional and global scales. As vegetation cover plays a key role in conserving the natural environment, studying the spatio‐temporal trend of vegetation is crucial in identifying changes in the natural environment. We analysed the spatial responses of SPOT‐VGT NDVI to TRMM based rainfall during a sixteen year period (1998–2013) in the Bundelkhand region of Central India. The Normalized Difference Vegetation Index (NDVI) has proven to be a strong indicator of global vegetation productivity. Among climatic factors, rainfall robustly influences both spatial and temporal outline of NDVI. In this study, we used linear regression for analysing the statistical relationship among NDVI and rainfall and their trends. The study reveals a varying pattern of vegetation dynamics in response to rainfall over the area. [ABSTRACT FROM AUTHOR]

We present a case of an intrapartum splenic artery aneurysm (SAA) rupture in a nulliparous woman. EP16.18: Intrapartum splenic artery aneurysm rupture with maternal and fetal survival: a case promptly diagnosed with the aid of hand-held ultrasound There are only 6 cases of intrapartum rupture and 31(of 115) cases of antenatal SAA rupture where both mother and baby survived within the literature. [Extracted from the article]

Dominant SCN1B mutations are known to cause several epilepsy syndromes in humans. Only 2 epilepsy patients to date have been reported to have recessive mutations in SCN1B as the likely cause of their phenotype. Here, we confirm the recessive inheritance of 2 novel SCN1B mutations in 5 children from 3 families with developmental epileptic encephalopathy. The recessive inheritance and early death in these patients is consistent with the Dravet-like phenotype observed in Scn1b−/− mice. The 'negative' clinical exome in one of these families highlights the need to consider recessive mutations in the interpretation of variants in typically dominant genes. [ABSTRACT FROM AUTHOR]

The article presents research on the sensorineural hearing effect and effectiveness of Sofradex-soaked autologous for bone pâté epitympanic and mastoid reconstruction after cholesteatoma mastoidectomy. Research shows the significant morbidity caused by modified radical mastoidectomy, the recreation of normal ear canal anatomy using epitympanic and mastoid bony obliteration, and the absence of adverse sensorineural hearing effects from Sofradex.

Background Brain change can occur in primary biliary cholangitis ( PBC), potentially as a result of cholestatic and/or inflammatory processes. This change is linked to systemic symptoms of fatigue and cognitive impairment. Aim To identify whether brain change occurs early in PBC. If the change develops early and is progressive, it may explain the difficulty in treating these symptoms. Methods Early disease brain change was explored in 13 patients with newly diagnosed biopsy-proven precirrhotic PBC using magnetisation transfer, diffusion-weighted imaging and 1H magnetic resonance spectroscopy. Results were compared to 17 healthy volunteers. Results Cerebral magnetisation transfer ratios were reduced in early PBC, compared to healthy volunteers, in the thalamus, putamen and head of caudate with no greater reduction in patients with greater symptom severity. Mean apparent diffusion coefficients were increased in the thalamus only. No 1H magnetic resonance spectroscopy abnormalities were seen. Serum manganese levels were elevated in all PBC patients, but no relationship was seen with imaging or symptom parameters. There were no correlations between neuroimaging data, laboratory data, symptom severity scores or age. Conclusions This is the first study to be performed in this precirrhotic patient population, and we have highlighted that neuroimaging changes are present at a much earlier stage than previously demonstrated. The neuroimaging abnormalities suggest that the brain changes seen in PBC occur early in the pathological process, even before significant liver damage has occurred. If such changes are linked to symptom pathogenesis, this could have important implications for the timing of second-line-therapy use. [ABSTRACT FROM AUTHOR]

To conduct surveillance and determine the safety profile of new hepatitis C virus treatments in real-world clinical practice. Hepatic decompensation and other serious adverse events were investigated in an observational cohort study of 511 patients treated with regimens containing sofosbuvir, December 2013-June 2014. Among 499 previously stable patients (no history of hepatic decompensation during the previous 12 months), a nested case-control study was performed to identify predictors of decompensation/serious adverse event. Cases and controls were matched 1:5 based on treatment regimen and duration. Matched conditional logistic regression was used for analysis. Providers scored the likelihood that events were treatment-related (scale = 0-4). The cumulative incidence of decompensation/events was 6.4% for the total cohort. Among 499 previously stable patients, the incidence of decompensation/events was 4.5%; the mortality rate was 0.6%. Sixteen of the 499 experienced one or more serious complications considered to be at least potentially treatment-related, and the sustained virological response rate was 7/16 (44%). Two cases, both on sofosbuvir/simeprevir (without interferon or ribavirin), had complications consistent with autoimmune events (score 3, 'likely treatment-related'), and one experienced a flare of autoimmune hepatitis. Compared to controls, cases had higher baseline median model for end-stage liver disease scores (14 vs 8, P < 0.01). Decompensation/events was independently associated with lower baseline albumin ( OR = 0.12/g/dL, P = 0.01) and higher total bilirubin ( OR = 4.31/mg/dL, P = 0.01). Reduced hepatic function at baseline increased the risk of liver decompensation/events. [ABSTRACT FROM AUTHOR]

Objectives: Sodium bicarbonate has been shown clinically to be efficacious at removing dental plaque; however, its effect of mechanism against biofilms has not been evaluated in vitro. Here, we used a well-established in vitro plaque biofilm model to investigate the disruption of dental plaque biofilms. Methods: Biofilms were grown in a constant depth film fermentor for up to 14 days. The fermentor was inoculated with pooled human saliva and growth maintained with artificial saliva. After various time points, replicate biofilms were removed and subjected to treatment at varying concentrations of sodium bicarbonate. Disruption of the plaque was assessed by viable counts and microscopy. Results: The viable count results showed that younger biofilms were less susceptible to the action of sodium bicarbonate; however, biofilms of 7 days and older were increasingly susceptible to the material with the oldest biofilms being the most susceptible. Sixty-seven percentage of sodium bicarbonate slurry was able to reduce the number of organisms present by approx. 3 log10. These quantitative data were corroborated qualitatively with both confocal and electron microscopy, which both showed substantial qualitative removal of mature biofilms. Conclusions: The results from this study have shown that sodium bicarbonate is able to disrupt mature dental plaque grown in vitro and that its reported efficacy in maintaining oral hygiene may be related to this key factor. [ABSTRACT FROM AUTHOR]

Plasmablastic lymphoma ( PBL) is a rare and aggressive variant of diffuse large B-cell lymphoma ( DLBCL). It is a recently described variant of non-Hodgkin's lymphoma that occurs almost exclusively in human immunodeficiency virus ( HIV) infection, in the post-transplant setting and in other immunosuppressive states. Only a handful of cases have been reported in the literature affecting immunocompetent patients. We present a rare case of PBL arising in the maxillary sinus in an immunocompetent, HIV-negative patient. The malignancy first presented in general dental practice as painless tooth mobility. [ABSTRACT FROM AUTHOR]

Reasons for performing study There are no consistently safe and effective methods for the treatment of trigeminal-mediated headshaking in horses. In affected horses, the trigeminal nerve is sensitised, appearing to result in neuropathic pain. Percutaneous electrical nerve stimulation ( PENS) therapy is a minimally invasive neuromodulatory treatment used in people to manage neuropathic pain. Objectives To determine whether PENS therapy is safe, tolerated and effective for the management of trigeminal-mediated headshaking in horses. Study design Descriptive case series. Methods Seven horses diagnosed with trigeminal-mediated headshaking and currently showing clinical signs were studied. All procedures were carried out in sedated horses with a needle-prick sized area of skin desensitised with local anaesthetic to facilitate probe insertion. A disposable PENS probe was advanced subcutaneously adjacent to the nerve, rostral to the infraorbital foramen under ultrasonographic guidance. The nerve was stimulated for 25 min following a protocol of alternating frequencies and a perception threshold based on human clinical data. The probe was removed and the procedure repeated on the contralateral side. The protocol used comprised a series of 3 or 4 treatments, with treatments being repeated when signs of headshaking recurred. Results All horses tolerated the procedure well. Three horses developed a haematoma at the site on one occasion and 2 had increased clinical signs for up to 3 days following first treatment. Six horses demonstrated a positive response to their first treatment, returning to ridden work at the same level as prior to onset of headshaking, with 5 continuing to respond. Median remission time for first treatment was 3.8 days (range 0-8 days, n = 7), second treatment 2.5 weeks (0-8 weeks, n = 7), third treatment 15.5 weeks (0-24 weeks, n = 5) and fourth treatment 20 weeks (12-28 weeks ongoing, n = 2). Conclusions Percutaneous electrical nerve stimulation therapy is a safe, well tolerated, minimally invasive, repeatable management option for trigeminal-mediated headshaking, with encouraging efficacy for amelioration of clinical signs in the short- to medium term. [ABSTRACT FROM AUTHOR]

Background Symptoms suggestive of gastroparesis are non-specific and conflicting reports exist regarding the ability of symptoms to predict the presence of gastroparesis. Our aim, therefore, was to evaluate the relationships between gastroparetic symptoms and their impact on quality of life and determine their relationship with clinical factors and gastric emptying. Methods Gastric emptying scintigraphy, sociodemographic features, health care resource utilization, gastroparetic symptoms, and quality of life using validated questionnaires were obtained from consecutive patients referred for gastric emptying testing ( GET). Descriptive analyses were conducted and logistic regression was performed to evaluate associations with abnormal gastric emptying after controlling for other covariates. Key Results Two hundred and sixty-six patients participated (195 females; mean age, 49.1 ± 17.6 years); 75% met Rome III criteria for functional dyspepsia. Gastric emptying was delayed in 28.2% at 4 h; the delay was mild in 48%, moderate in 20% and severe in 32%. Nausea/emesis and postprandial fullness, but not bloating, were significantly greater in those with delayed emptying. Postprandial fullness was most severe. Weak correlations were identified between symptom severity and the severity of gastric emptying delay. Quality of life was also lower in the delayed emptying group. Logistic regression analysis demonstrated associations between delayed gastric emptying and lower quality of life and increased symptom severity. Conclusions & Inferences In patients referred for GET, gastroparetic symptoms were more severe in those with delayed emptying. A decrease in quality of life in those with delayed gastric emptying was also present; this was not related to the severity of the delay in gastric emptying. [ABSTRACT FROM AUTHOR]

Aim The aim of this study was to assess the frequency of patients contacting the Oral Surgery Department at Manchester Dental Hospital with post-operative concerns. This will facilitate local improvements within the department for the effective management of patients re-presenting with complications. Materials and methods Between August 2013 and October 2013, the records for 31 patients re-attending the Oral Surgery Department at Manchester Dental Hospital after a surgical procedure were analysed retrospectively. All data collected were stored on a secure university hard drive and analysed using M icrosoft E xcel Spreadsheet. Results Ninety-three per cent of patients who re-attended the department required only one unplanned episode for treatment. Surgical procedures that resulted in re-attendance included removal of third molars (57%), extraction of non-third molar teeth (25%), implant placement (10%), apical root end surgery (3.5%) and excision of a ranula (3.5%). It was noted 36% of patients included in the audit were diagnosed with post-operative pain or normal healing. Conclusion The management of patients attending with unplanned episodes of treatment places an additional strain on the service delivery of clinics and inconvenience to patients. The study highlights the range of post-operative complications that patients present with. Service delivery research and review enable improvements within the department to improve the efficiency and effectiveness of patient management. This study will allow specific training to facilitate improvements in delivery of care within the dental team. [ABSTRACT FROM AUTHOR]

Liver transplantation is an accepted treatment modality in the management of MSUD. To our knowledge, ours is only the second successful case to date of a patient with MSUD receiving an allograft from an RLD who is a heterozygous carrier for the disease. In view of the worldwide shortage of available organs for transplantation, heterozygote to homozygote transplantation in the setting of MSUD may provide a viable alternative for those awaiting transplantation. We report on the case of a two-yr-old infant with MSUD, who received a left lateral segment (segments II and III) liver transplant from his mother, a heterozygote carrier of one of the three abnormal genes implicated in MSUD. Post-operative BCAA levels normalized in our patient and remained so on an unrestricted protein diet and during times of physiological stress. To date, this is only the second case of a successful RLD liver transplant in a child with MSUD. Preliminary results indicate that RLD liver transplants are at least equivalent to deceased donor liver transplants in the treatment of MSUD, although longer term follow-up is required. Heterozygote to homozygote RLD transplant in patients with MSUD presents a new pool of potential liver donors. [ABSTRACT FROM AUTHOR]

Aim To explore attitudes towards insulin acceptance an ethnically diverse population of people with Type 2 diabetes. Methods We conducted semi-structured interviews using a topic guide based on a literature review and findings from our previous study, which explored the perspectives of healthcare professionals about insulin initiation and management. Analysis of data involved undertaking an abductive reasoning approach in response to emerging themes. Results Participants discussed not only their concerns about insulin therapy, but also their views and beliefs about the necessity of insulin. Their attitudes to insulin treatment could be mapped into four main typologies. These fitted with an attitudinal scale based on the Necessity-Concerns Framework described in the medication adherence literature, comprising four attitudes: accepting, sceptical, ambivalent and indifferent. Decisions about accepting insulin involved balancing concerns (such as needle size) against the perceived necessity of insulin (generally, inadequacy of oral medication). The South Asian and white participants had similar concerns, but these were sometimes greater in South Asian participants, because of the influence of negative views and experiences of other insulin users. Conclusions When discussing insulin with people with Type 2 diabetes, healthcare providers need to ensure that they explore and contribute to patients' understanding and interpretation of the necessity of insulin as well as discussing their concerns. Furthermore, they should be aware of how an individual's social context can influence his/her perceptions about the necessity of insulin as well as their concerns, and that this influence may be greater in some South Asian populations. [ABSTRACT FROM AUTHOR]

Objective The objective of this study was to investigate changes in volatile organic compounds ( VOCs) in exhaled breath in overweight/obese children compared with their lean counterparts. Study design Single exhaled breath was collected and analyzed per protocol using selective ion flow tube mass spectrometry ( SIFT-MS). Results Sixty overweight/obese children and 55 lean controls were included. Compared with the lean group, the obese group was significantly older (14.1 ± 2.8 vs. 12.1 ± 3.0 years), taller (164.8 ± 10.9 vs. 153.3 ± 17.1 cm) and more likely to be Caucasian (60% vs. 35.2%); P < 0.05 for all. A comparison of the SIFT-MS results of the obese group with the lean group revealed differences in concentration of more than 50 compounds. A panel of four VOCs can identify the presence of overweight/obesity with excellent accuracy. Further analysis revealed that breath isoprene, 1-decene, 1-octene, ammonia and hydrogen sulfide were significantly higher in the obese group compared with the lean group ( P value < 0.01 for all). Conclusion Obese children have a unique pattern of exhaled VOCs. Changes in VOCs observed in this study may help to gain insight into pathophysiological processes and pathways leading to the development of childhood obesity. [ABSTRACT FROM AUTHOR]

Aim Histopathological assessment of labial salivary glands has long been a core part of the diagnostic criteria for Sjogren's Syndrome. Biopsy of labial salivary glands is technique sensitive and has post-operative complications which can affect the patient's quality of life. Varying techniques for labial gland biopsy and associated complications are described in the literature. This article gives a step-by-step account of an effective technique for labial gland biopsy as described by Daniels in 1984 and provides a retrospective analysis of the post-operative complications in a series of 108 labial gland biopsies. Materials and methods A retrospective, post-operative telephone survey was carried out to study the post-operative complications of labial gland biopsies performed by a single operator. All consecutive patients (180) who had labial gland biopsies between October 2010 and August 2012 at the Department of Oral Medicine at Guy's Hospital were called, and 108 surveys were successfully completed. The telephone questionnaires aimed to find out medium and long-term complications of labial gland biopsies to include subjective measures of post-operative pain, swelling and paraesthesia. Results One patient out of 108 patients (0.9%) reported pain that lasted ≥ 6 months, and six patients (5.5%) reported swelling that lasted > 2 weeks. Three patients (2.8%) reported paraesthesia lasting ≥ 6 months with a median bother score of 0. All biopsies provided sufficient glands to allow for histopathological diagnosis. Conclusions This article describes a safe and effective technique for labial gland biopsy. Despite a low complication rate, informed consent is essential. [ABSTRACT FROM AUTHOR]

Aim Oral health changes, such as tooth loss can have a profound effect on a patient's quality of life. The partial and fully edentulous condition has negative impacts on ability to chew, speech and appearance. Dental implants support either a fixed or removable prosthesis and can provide a significant benefit to partially or fully edentulous patients. This study evaluates changes in oral health quality of life in patients receiving dental implant treatment. Materials and methods One hundred fifty patients attending a primary care dental practice specialising in dental implant treatment were given an Oral Health Impact Profile ( OHIP) questionnaire to complete before their implant treatment and 6 months post-operatively. Results One hundred seven patients successfully completed the study. Results of the analysis demonstrate statistically significant decreases in frequency of oral health problems post treatment. For every OHIP statement, the t-test revealed a statistically significant improvement in oral health quality of life ( P < 0.001). Conclusion Dental implant therapy has a positive effect on oral health quality of life as determined by the OHIP. Long term follow up is required to provide an understanding of continuing benefits from dental implant therapy. [ABSTRACT FROM AUTHOR]

Aim To describe the measurement of pain after oral surgery. Materials and methods A review of the literature describing the scales used to rate pain intensity, pain assessment by questionnaire, assessment of pain in children and older adults, the third molar pain model and factors affecting the pain experience in the context of managing pain after oral surgery. Results The most frequently used single-rating scales are the Numerical Rating Scale ( NRS), the Verbal Rating Scale ( VRS), the Visual Analogue Scale ( VAS) and the Faces Pain Scale. The surgical removal of a lower third molar with bone removal is associated with severe post-operative pain and the procedure is used as a model for investigation of analgesic efficacy. Conclusions If pain is not assessed, then it is unlikely that it will be properly treated. The scales to measure pain intensity such as the NRS that can be used readily in the hospital, clinic or over the phone when the patient has been discharged home. [ABSTRACT FROM AUTHOR]

Aim To describe the role of opioids in the management of pain after oral surgery. Materials and methods A review of the literature describing the pharmacokinetics, benefits and harms of opioids in terms of systematic review evidence, interactions, use in children, pregnancy and breastfeeding. Results A 10-mg intramuscular dose of morphine is recognised as a very effective analgesic for post-operative pain with a number needed to treat ( NNT) of 2.9. Codeine 60 mg has an NNT of 16.7 suggesting poor analgesic effectiveness, but in combination with 1 g paracetamol is an effective analgesic for the management of post-operative pain with an NNT of 2.2. Conclusions Morphine is effective for severe pain experienced by inpatients undergoing oral surgery, ideally administered intravenously or alternatively by intramuscular injection. Codeine is very effective when combined with paracetamol and is suitable for day-case and outpatient oral surgery experiencing moderate to severe pain. [ABSTRACT FROM AUTHOR]

Background Breath testing is becoming an important diagnostic method to evaluate many disease states. In the light of rising healthcare costs, is important to develop a simple non-invasive tool to potentially identify paediatric patients who need endoscopy for suspected inflammatory bowel disease (IBD). Aim To analyse exhaled volatile organic compounds (VOCs) and investigate the presence of a unique breath patterns to differentiate paediatric patients with (IBD) from healthy controls. Methods A cross-sectional, single-centre study included paediatric IBD patients and healthy controls (age range, 5-21 years). The diagnosis of IBD was confirmed by endoscopic, histological and radiographic data. Exhaled breath was collected and analysed using a selective ion flow tube mass spectroscopy (SIFT-MS) to identify new markers or patterns of IBD. Results One hundred and seventeen patients (62 with IBD and 55 healthy controls) were included in the study. Linear discriminant analysis and principle component analysis of mass scanning ion peak data demonstrated 21 pre-selected VOCs correctly classify patients with IBD or as healthy controls; P < 0.0001. Multivariable logistic regression analysis further showed three specific VOCs (1-octene, 1-decene, (E)-2-nonene) had excellent accuracy for predicting the presence of IBD with an area under the curve (AUC) of 0.96 (95% CI: 0.93-0.99). No significant difference in VOCs was found between patients with Crohn's disease or ulcerative colitis, and no significant correlation was seen with disease activity. Conclusion These pilot data support the hypothesis that a unique breathprint potentially exists for paediatric IBD in the exhaled metabolome. [ABSTRACT FROM AUTHOR]

Background Esophageal multiple intraluminal impedance ( MII) measurement has been used to detect gastro-esophageal reflux and bolus transport. It is not clear if MII can detect changes in luminal cross sectional area ( CSA) during bolus transport. Intraluminal ultrasound ( US) images, MII, and high resolution manometry ( HRM) were recorded simultaneously to determine temporal relationship between CSA and impedance during esophageal bolus transport and to define the relationship between peak distension and nadir impedance. Methods Studies were conducted in five healthy subjects. MII, HRM, and US images were recorded 6 cm above LES. Esophageal distensions were studied during swallows and injections of 0.5 N saline bolus into the esophagus. Key Results Temporal change in esophageal CSA correlates with changes in impedance ( r-value: mean ± SD = −0.80 ± 0.08, range: −0.94 to −0.66). Drop in impedance during distension occurs as a two-step process; initial large drop associated with onset of CSA increase, followed by a small drop during which majority of the CSA increase occurs. Peak CSA and nadir impedance occur within 1 s of each other. Increase in swallow and injection volumes increased the CSA, had no effect on large drop but increased the small drop amplitude. We observed a significant correlation between peak CSA and nadir impedance ( r = −0.90, p < 0.001) and a better correlation between peak CSA and inverse impedance ( r = 0.94, p < 0.001). Conclusions & Inferences Further studies are needed to confirm that intraluminal impedance recordings may be used to measure luminal CSA during esophageal bolus transport. [ABSTRACT FROM AUTHOR]

Aim To describe the role of non-steroidal anti-inflammatory drugs ( NSAIDs) in the management of pain after oral surgery. Materials and methods A review of the literature describing the pharmacokinetics, benefits and harms of NSAIDs in terms of systematic review evidence, interactions, use in children, pregnancy and breastfeeding. Results Twelve Cochrane reviews were identified describing the efficacy of NSAIDs for pain after oral surgery. Ibuprofen 400 mg is an effective analgesic [number needed to treat ( NNT) = 2.3 in tablet form and 1.8 in soluble form]. Cyclooxygenase-2 ( COX-2)-selective NSAIDs also demonstrate low NNTs, based on smaller studies of post-operative pain. There is association with gastrointestinal, cardiovascular and renal adverse effects. Conclusions NSAIDs are effective analgesics for moderate pain after oral surgery. The routine use of COX-2-selective NSAIDs is not recommended. Careful patient selection is important. [ABSTRACT FROM AUTHOR]

We have compared fetal heart rate patterns, Apgar scores and umbilical cord gas values following initiation of labour analgesia using either combined spinal-epidural or epidural. One hundred and fifteen healthy women requesting neuraxial analgesia in the first stage of labour were randomly assigned to receive either combined spinal-epidural (n = 62) or epidural analgesia (n = 53). Fetal heart rate traces, recorded for 30 min before and 60 min after neuraxial block, were categorised as normal, suspicious or pathological according to national guidelines. Sixty-one fetal heart rate tracings were analysed in the combined spinal-epidural group and 52 in the epidural group. No significant differences were found in fetal heart rate patterns, Apgar scores or umbilical artery and vein acid-base status between groups. However, in both combined spinal-epidural and epidural groups, there was a significant increase in the incidence of abnormal fetal heart rate patterns following neuraxial analgesia (p < 0.0001); two before compared with eight after analgesia in the combined spinal-epidural group and zero before compared with 11 after in the epidural group. These changes comprised increased decelerations (p = 0.0045) (combined spinal-epidural group nine before and 14 after analgesia, epidural group four before and 16 after), increased late decelerations (p < 0.0001) (combined spinal-epidural group zero before and seven after analgesia, epidural group zero before and eight after), and a reduction in acceleration rate (p = 0.034) (combined spinal-epidural group mean (SD) 12.2 (6.7) h−1 before and 9.9 (6.1) h−1 after analgesia, epidural group 11.0 (7.3) h−1 before and 8.4 (5.9) h−1 after). These fetal heart rate changes did not affect neonatal outcome in this healthy population. [ABSTRACT FROM AUTHOR]

Aim To describe the scientific basis of the contemporary management of pain after oral surgery. Materials and methods A review of the literature describing the concepts of pre-emptive and protective analgesia and evidence-based practice in the context of managing pain after oral surgery. Results Pain is the consequence of the interplay of numerous chemical mediators and a dynamic and plastic neuronal system, and so pain prevention and management requires the use of different classes of analgesic that act by different mechanisms and at different sites of action, ideally resulting in synergistic analgesia with few side effects. Conclusions Management can be challenging, particularly as much oral surgery is undertaken on an outpatient and day-case basis, but significant improvement can be made to the patient's experience by considering the underlying mechanisms. [ABSTRACT FROM AUTHOR]

Aim To describe the role of paracetamol (acetaminophen) in the management of pain after oral surgery. Materials and methods A review of the literature describing the pharmacokinetics, benefits and harms of paracetamol in terms of systematic review evidence, interactions, use in children, pregnancy and breastfeeding. Results Paracetamol inhibits cyclooxygenase ( COX)-3 isoenzyme and reduces prostanoid release in the central nervous system. The analgesic effectiveness of paracetamol in the control of pain after oral surgery has been shown in a number of clinical trials with a number needed to treat for 1 g paracetamol of 1.87. There are few adverse events, but at toxic doses, harm to the liver may arise and paracetamol poisoning remains the commonest cause of acute liver injury in Europe and North America. Conclusions Paracetamol is an effective analgesic for mild to moderate pain and has an excellent safety record in adults and children. It is also one of the safest analgesics to use if needed during pregnancy and breastfeeding. [ABSTRACT FROM AUTHOR]

There has been a significant increase in the number of adult patients requesting orthodontic treatment. Demands of these patients have also changed; patients are often only requesting aesthetic correction in the shortest possible time. The development of corticotomy-assisted orthodontics ( CAO) has offered potential solutions to many limitations in the management of these patients. A corticotomy is defined as a surgical procedure where only the cortical plate is cut, perforated or modified. CAO claims to have several advantages including reduced treatment time, increased traction of impacted teeth and added post-orthodontic stability. This article highlights the potential of corticotomy procedures in improving orthodontic outcomes and includes a case report. [ABSTRACT FROM AUTHOR]