Catch Me If You Can

Nocardia is a genus of anaerobic gram-positive bacteria that most commonly infect persons with compromised immunity. Pneumonia and soft tissue infections are seen most frequently; osteomyelitis is an uncommonly reported manifestation of nocardiosis. We report a case of pelvic osteomyelitis due to Nocardia asteroides in a patient with unrecognized acquired immune deficiency syndrome (AIDS) without evidence of concomitant pulmonary or skin infection.

Delayed Onset of Nonthermal Melting in Single-Crystal Silicon Pumped with Hard X Rays

In this work, we monitor the onset of nonthermal melting in single-crystal silicon by implementing an x-ray pump-x-ray probe scheme. Using the ultrashort pulses provided by the Linac Coherent Light Source (SLAC) and a custom-built split-and-delay line for hard x rays, we achieve the temporal resolution needed to detect the onset of the transition. Our data show no loss of long-range order up to 150±40  fs from photoabsorption, which we interpret as the time needed for the electronic system to equilibrate at or above the critical nonthermal melting temperature. Once such equilibration is reached, the loss of long-range atomic order proceeds inertially and is completed within 315±40  fs from photoabsorption.

Physiological and perceptual responses in the elderly to simulated daily living activities in UK summer climatic conditions

OBJECTIVES

The elderly population is at an increasingly significant health risk to heat-related illnesses and mortality when compared with younger people in the same conditions. This is due to an increased frequency and severity of heatwaves, attributed to climate change, and reduced ability of elderly individuals to dissipate excess heat. Consequently, most excess deaths and emergency visits during heatwaves occur in people aged more than 65 years. The aim of this investigation was to assess the physiological and perceptual responses of elderly people during exercise sessions equating to activities of daily living in UK summer climatic conditions.

STUDY DESIGN

Mixed-method, randomised research design.

METHODS

Twenty-eight participants (17 males, 10 females and 1 transgender female) were randomly assigned into three experimental groups; 15°C, 25°C or 35°C, with 50% relative humidity. Participants completed one preliminary and three experimental trials within their assigned environment. The data from the preliminary incremental recumbent cycling test was used to calculate participant's individual exercise intensities equating to 2, 4 and 6 metabolic equivalents (METs) for the subsequent trials. During experimental trials, participants completed 30-min seated rest and 30-min cycling.

RESULTS

No change was observed in thermal comfort ([TC] just uncomfortable in both trials), and only modest changes in ratings of perceived exertion (14 ± 2 vs 15 ± 2) at 6 METs in 25°C compared with those in 35°C were observed. In contrast, thermal strain markers did significantly increase (P < 0.05) across the same conditions, including change in rectal temperature (ΔT_re) during exercise (0.27 ± 0.17°C vs 0.64 ± 0.18°C) and peak skin temperature ([T_skin] 32.94 ± 1.15°C vs 36.11 ± 0.44°C).

CONCLUSION

When completing exercise that equates to activities of daily living, elderly people could have a decreased perceptual awareness of the environment even though physiological markers of thermal strain are elevated. Consequently, the elderly could be less likely to implement behavioural thermoregulation interventions (i.e. seek shade and/or remove excess layers) due to a decreased awareness of an increasingly thermally challenging environment.

Fat storage-inducing transmembrane (FIT or FITM) proteins are related to lipid phosphatase/phosphotransferase enzymes

Fat storage-inducing transmembrane (FIT or FITM) proteins have been implicated in the partitioning of triacylglycerol to lipid droplets and the budding of lipid droplets from the ER. At the molecular level, the sole relevant interaction is that FITMs directly bind to triacyglycerol and diacylglycerol, but how they function at the molecular level is not known. Saccharomyces cerevisiae has two FITM homologues: Scs3p and Yft2p. Scs3p was initially identified because deletion leads to inositol auxotrophy, with an unusual sensitivity to addition of choline. This strongly suggests a role for Scs3p in phospholipid biosynthesis. Looking at the FITM family as widely as possible, we found that FITMs are widespread throughout eukaryotes, indicating presence in the last eukaryotic common ancestor. Protein alignments also showed that FITM sequences contain the active site of lipid phosphatase/phosphotransferase (LPT) enzymes. This large family transfers phosphate-containing headgroups either between lipids or in exchange for water. We confirmed the prediction that FITMs are related to LPTs by showing that single amino-acid substitutions in the presumptive catalytic site prevented their ability to rescue growth of the mutants on low inositol/high choline media when over-expressed. The substitutions also prevented rescue of other phenotypes associated with loss of FITM in yeast, including mistargeting of Opi1p, defective ER morphology, and aberrant lipid droplet budding. These results suggest that Scs3p, Yft2p and FITMs in general are LPT enzymes involved in an as yet unknown critical step in phospholipid metabolism.

The longitudinal association between weight change and health-related quality of life in adults and children: a systematic review

This systematic review examined longitudinal associations between weight change (weight gain and loss) and both physical and mental aspects of health-related quality of life (HRQOL) compared with stable weight in adults and children of the general population. MEDLINE, EMBASE, PsycINFO and PubMed databases were searched. Longitudinal observational studies measuring HRQOL with six predefined instruments were synthesized according to type of association: weight change and change in HRQOL (change-on-change association) and weight change and HRQOL at follow-up (predictive association). Twenty studies of adults (n = 15) or children (n = 5) were included. Fifteen studies used the SF-12 or SF-36. Results of nine studies in adults examining the change-on-change association were combined through a tallying of 606 analyses. Weight gain was most often associated with reduced physical, but not mental HRQOL, across all baseline body mass index categories and in both men and women. Weight loss may be associated with improved physical, but not mental HRQOL, among adults with overweight and obesity. Weight gain was more strongly associated with HRQOL than weight loss, implicating a greater need for preventative strategies to tackle obesity. Results in children and for the predictive association generally reflected these findings but require further research.

Painful Pseudotendon of the Flexor Carpi Radialis Tendon: A Literature Review and Case Report

BACKGROUND

Flexor tendon ruptures in the wrist are uncommon. Flexor carpi radialis (FCR) tendon rupture can occur in rheumatoid patients, following cortisone injection for tenosynovitis, and following trauma. Following tendon rupture, tethering of the ruptured FCR tendon, or pseudotendon, can form which may or may not be symptomatic.

METHODS

A literature review was done reviewing treatment and outcomes of FCR tendon lesions. A case report of painful FCR pseudotendon following a fall is presented. The patient presented 4 months after injury with a tender lump 6 cm proximal to the wrist joint with pain and weakness aggravated with wrist motion and gripping.

RESULTS

The literature review reveals operative excision of a symptomatic FCR pseudotendon lesion results in great patient satisfaction with no morbidity. In this case report, in spite of conservative measures including cortisone injection and activity modification, the patient had persistent symptoms. The patient proceeded with surgery for complete excision of both the painful pseudotendon and retracted FCR tendon stump. Post-operatively, his wrist motion and grip strength returned to normal, and his Disabilities of the Arm, Shoulder, and Hand (DASH) score was significantly improved from 72 to 9.

CONCLUSIONS

FCR pseudotendon is an uncommon condition and can be seen following trauma. Majority of FCR tendon ruptures resolve with non-operative treatment. Based on the excellent outcomes following complete FCR tendon harvest for thumb carpometacarpal (CMC) joint reconstruction, complete excision of a symptomatic pseudotendon results in excellent relief of symptoms with no long-term morbidity.

Assessment of the functional properties of protein extracted from the brown seaweed Himanthalia elongata (Linnaeus) S. F. Gray

A protein extract from the brown seaweed Himanthalia elongata (Linnaeus) S. F. Gray was prepared and its functional properties, colour and amino acid composition were assessed for its potential future use by the food industry. The total content of amino acids was determined as 54.02±0.46gaminoacids/kg dry weight, with high levels of the essential amino acids lysine and methionine. SDS-PAGE showed 5 protein bands with molecular weights of 71.6, 53.7, 43.3, 36.4 and 27.1kDa. The water holding capacity and oil holding capacity were determined as 10.27±0.09gH2O/g and 8.1±0.07goil/g respectively. Foaming activity and stability were higher at alkaline pH values. The emulsifying capacity and stability of the extract varied depending on the pH and oil used. These results demonstrate the potential use of Himanthalia elongata protein extract in the food industry.

Evaluation of the Cariogram for root caries prediction

OBJECTIVES

The aim of this study was to evaluate complete and reduced Cariogram models in predicting root caries risk in independently living older adults by comparing the caries risk assessment of the programme to observed root caries increment over a two-year period.

METHODS

A prospective study recording root caries incidence was conducted on 334 dentate older adults. Data were collected on participant's medical history, fluoride exposure, and diet. Saliva samples were collected to measure salivary flow rate, buffer capacity and bacterial counts. Clinical examination was completed to record decayed, missing and filled teeth (DMFT) and also exposed, filled and decayed root surfaces (RDFS). This was repeated after 12 and 24 months. Scores were entered into the Cariogram and baseline risk category was recorded. Reduced Cariogram models were generated by omitting individual salivary variables and all salivary variables. The performance of the complete and reduced Cariogram models in predicting root caries incidence were evaluated by receiver operating characteristic (ROC) analysis.

RESULTS

280 participants were examined at two year follow up. 55.6% of those in the highest risk group developed new caries compared to 3.8% in the lowest risk group. The mean root caries increment in the highest risk group was 2.00 (SD 3.20) compared to 0.04 (SD 0.20) in the lowest risk group. The area under the ROC curve for the complete Cariogram model was 0.77 (95% CI 0.70-0.83) indicating a fair performance in predicting root caries. Omitting individual or all salivary variables did not significantly alter the predictive ability of the Cariogram.

CONCLUSION

Within the limitations of this study, the Cariogram was clinically useful in identifying individuals with a high risk of developing root caries.

CLINICAL SIGNIFICANCE

Identification of a caries risk assessment tool which could reliably select high-risk individuals for root caries prevention strategies would maximise the cost effectiveness of professionally delivered prevention measures.

Pragmatic treatment planning for the older dentate patient

INTRODUCTION

Population ageing is a progressive trend in most developed nations, including Ireland. Alongside this trend, there has been a concomitant decrease in tooth loss among Irish adults (Whelton, 2007). As a result, there will be more dentate older patients presenting for care. Future treatment strategies will be based on patient demand, clinician skill set, pragmatism, future planning and cost-effectiveness.

CASE REPORTS

This article presents the use of minimally invasive concepts in the management of older patients. As well as describing these principles, two cases treated by the staff and students of Cork University Dental School and Hospital are presented as examples.

DISCUSSION

Older patients can be provided with good aesthetic, functional outcomes using the principles of minimally invasive dentistry. Futhermore, these treatment options are less likely to fail catastrophically in future years, resulting in tooth loss and edentulousness in advanced years when adaptation may be challenging.

CONCLUSION

Treatment choices for older adults should be as evidence based an pragmatic as possible, with a view to impact of future failure.

Tooth replacement for partially dentate elders: A willingness-to-pay analysis

OBJECTIVES

The primary aim of this study was to investigate partially dentate elders' willingness-to-pay (WTP) for two different tooth replacement strategies: Removable Partial Dentures (RPDs) and, functionally orientated treatment according to the principles of the Shortened Dental Arch (SDA). The secondary aim was to measure the same patient groups' WTP for dental implant treatment.

METHODS

55 patients who had completed a previous RCT comparing two tooth replacement strategies (RPDs (n=27) and SDA (n=28)) were recruited (Trial Registration no. ISRCTN26302774). Patients were asked to indicate their WTP for treatment to replace missing teeth in a number of hypothetical scenarios using the payment card method of contingency evaluation coupled to different costs. Data were collected on patients' social class, income levels and other social circumstances. A Mann-Whitney U Test was used to compare differences in WTP between the two treatment groups. To investigate predictive factors for WTP, multiple linear regression analyses were conducted.

RESULTS

The median age for the patient sample was 72.0 years (IQR: 71-75 years). Patients who had been provided with RPDs indicated that their WTP for this treatment strategy was significantly higher (€550; IQR: 500-650) than those patients who had received SDA treatment (€500; IQR: 450-550) (p=0.003). However patients provided with RPDs indicated that their WTP for SDA treatment (€650; IQR: 600-650) was also significantly higher than those patients who had actually received functionally orientated treatment (€550; IQR: 500-600) (p<0.001). The results indicated that both current income levels and previous treatment allocation were significantly correlated to WTP for both the RPD and the SDA groups. Patients in both treatment groups exhibited little WTP for dental implant treatment with a median value recorded which was half the market value for this treatment (€1000; IQR: 500-1000).

CONCLUSIONS

Amongst this patient cohort previous treatment experience had a strong influence on WTP as did current income levels. Both treatment groups indicated a very strong WTP for simpler, functionally orientated care using adhesive fixed prostheses (SDA) over conventional RPDs.

CLINICAL SIGNIFICANCE

Partially dentate older patients expressed a strong preference for functionally orientated tooth replacement as an alternative to conventional RPDs.

Changing trends in antibiotic resistance for urinary E. coli infections over five years in a university hospital

Objective

We wanted to look at the antibiotic resistance patterns in our university teaching hospital for E. coli cultured from urine to assess the resistance profiles to common antibiotics used in the hospital.

Patients and methods

Results were obtained of all positive urine cultures between January 2007 and December 2011 both from the hospital and urology department. Trends in susceptibility and resistance data for E. coli to trimethoprim, amoxicillin, ciprofloxacin, gentamicin and nitrofurantoin were examined.

Results

A total of 40,722 hospital urine specimens were culture positive in the five-year period, of which 15,311 (37.6%) grew E. coli. Across the hospital there was no evidence of change in resistance to trimethoprim over the five-year period (38.1% in 2007 compared to 36.6% in 2011; p = 0.313). The percentage resistance to amoxicillin rose slightly (52.6% to 54.4%), and this was statistically significant (p = 0.011). Overall there was a statistically significant fall in resistance to ciprofloxacin but resistance has remained stable for the last three years (15.5% to 13.5%, p = 0.013). A trend of increasing resistance to gentamicin (p = 0.002) resulted from the 2007 baseline of 3.4% to 4.9% in 2008, but resistance remained stably low thereafter. Resistance to nitrofurantoin fell significantly (from 10.4% to 1.6%; p ≤ 0.0005).

Conclusions

The number of E. coli-positive urine cultures from hospital in-patients remained broadly stable over this five-year period. Resistance to trimethoprim and amoxicillin remains high. Gentamicin resistance remains low, but the statistically significant rise over the five-year period suggests resistance rates should continue to be carefully monitored. Nitrofurantoin resistance is very low and has significantly decreased. This narrow-spectrum antibiotic should be considered the mainstay for treating uncomplicated urinary tract infections in females.

Evaluation of Biodentine in the Restoration of Root Caries

There is no “gold-standard” material for the operative management of root caries. The aim of this study was to determine if the clinical performance of Biodentine would be acceptable for the restoration of root caries in older adults. A randomized controlled clinical trial was conducted comparing a calcium silicate cement (Biodentine), a high-viscosity glass ionomer cement (Fuji IX GP Extra), and a resin-modified glass ionomer cement (Fuji II LC). Of the 334 volunteers assessed for eligibility, 249 were excluded. A total of 303 lesions in 85 participants were randomized, with 151 lesions allocated to receive Biodentine, 77 to Fuji IX GP Extra, and 77 to Fuji II LC. Patients were reviewed by a calibrated dentist who was not involved in restoration placement and who was blinded to material allocation. Restorations were assessed according to a modified US Public Health Service criteria. The cumulative survival percentages after 6 mo and 1 y were 58.6% and 47.2% in the Biodentine group, 89.6% and 83.8% in the Fuji IX GP Extra group, and 89.5% and 84.9% in the Fuji II LC group, respectively. There were statistically significant differences ( χ2 test, P < 0.001) in restoration failure rates between restoration groups. There was no difference between Fuji IX GP Extra and Fuji II LC, but differences ( P < 0.001) were shown between the Fuji II GP Extra group and the Biodentine group and also between the Fuji II LC group and the Biodentine group at both time points. Based on the results of this study, Biodentine cannot be recommended for the operative management of root caries. Fuji IX GP Extra and Fuji II LC displayed similar success rates, and high-viscosity glass ionomer cement and resin-modified glass ionomer cement continue to be the best available option for the restoration of root caries ( ClinicalTrials.gov NCT01866059).

Knowledge Transfer Statement: The results of this study can assist dental practitioners when selecting a restorative material for the operative management of root caries. This randomized controlled trial compared the 1-y clinical performance of a calcium silicate–based material to that of a high-viscosity glass ionomer cement and a resin-modified glass ionomer cement in the operative management of root caries. The study concluded that high-viscosity glass ionomer cement and resin-modified glass ionomer cement continue to be the best available option to dental practitioners when restoring the root surface.

The effects of single versus twice daily short term heat acclimation on heat strain and 3000m running performance in hot, humid conditions

Endurance performances are impaired under conditions of elevated heat stress. Short term heat acclimation (STHA) over 4-6 days can evoke rapid adaptation, which mitigate decrements in performance and alleviate heat strain. This study investigated the efficacy of twice daily heat acclimation (TDHA) compared to single session per day heat acclimation (SDHA) and normothermic training, at inducing heat acclimation phenotype and its impact upon running performance in hot, humid conditions. Twenty one, moderately trained males were matched and assigned to three groups; SDHA (mean±SD) (peak oxygen consumption [V̇O2peak] 45.8±6.1mLkg(-1)min(-1), body mass 81.3±16.0kg, stature 182±3cm), TDHA (46.1±7.0mLkg(-1)min(-1), 80.1±11.9kg, 178±4cm) or control (CON) (47.1±3.5mLkg(-1)min(-1), 78.6±16.7kg, 178±4cm). Interventions consisted of 45min cycling at 50% V̇O2peak, once daily for 4d (SDHA) and twice daily for 2d (TDHA), in 35°C, 60% relative humidity (RH), and once daily for 4 days (CON) in 21°C, 40% RH. Participants completed a pre- and post-intervention 5km treadmill run trial in 30°C, 60% RH, where the first 2km were fixed at 40% V̇O2peak and the final 3km was self-paced. No statistically significant interaction effects occurred within- or between-groups over the 2-4 days intervention. While within-group differences were found in physiological and perceptual measures during the fixed intensity trial post-intervention, they did not statistically differ between-groups. Similarly, TDHA (-36±34s [+3.5%]) and SDHA (-26±28s [+2.8%]) groups improved 3km performances (p=0.35), but did not differ from CON (-6±44s [+0.6%]). This is the first study to investigate the effects of HA twice daily and compare it with traditional single session per day STHA. These STHA protocols may have the ability to induce partial adaptive responses to heat stress and possibly enhance performance in environmentally challenging conditions, however, future development is warranted to optimise the administration to provide a potent stimuli for heat adaptation in athletic and military personnel within a rapid regime.