Effect of mechanical stresses on viral capsid disruption during droplet formation and drying

Identification of the mechanisms by which viruses lose activity during droplet formation and drying is of great importance to understanding the spread of infectious diseases by virus-containing respiratory droplets and to developing thermally stable spray dried live or inactivated viral vaccines. In this study, we exposed suspensions of baculovirus, an enveloped virus, to isolated mechanical stresses similar to those experienced during respiratory droplet formation and spray drying: fluid shear forces, osmotic pressure forces, and surface tension forces at interfaces. DNA released from mechanically stressed virions was measured by SYBR Gold staining to quantify viral capsid disruption. Theoretical estimates of the force exerted by fluid shear, osmotic pressures and interfacial tension forces during respiratory droplet formation and spray drying suggest that osmotic and interfacial stresses have greater potential to mechanically destabilize viral capsids than forces associated with shear stresses. Experimental results confirmed that rapid changes in osmotic pressure, such as those associated with drying of virus-containing droplets, caused significant viral capsid disruption, whereas the effect of fluid shear forces was negligible. Surface tension forces were sufficient to provoke DNA release from virions adsorbed at air-water interfaces, but the extent of this disruption was limited by the time required for virions to diffuse to interfaces. These results demonstrate the effect of isolated mechanical stresses on virus particles during droplet formation and drying.

A systematic review of the role of penicillin versus penicillin plus metronidazole in the management of peritonsillar abscess

BACKGROUND

Peritonsillar abscess is a localised infection in the peritonsillar space. Pus from the abscess can contain anaerobes. Many clinicians prescribe metronidazole in addition to penicillin, but evidence to support this is limited. This review assessed the evidence of benefit of metronidazole for the treatment of peritonsillar abscess.

METHODS

A systematic review was conducted of the literature and databases including Ovid Medline, Ovid Embase, PubMed and Cochrane library. Search terms included all variations of peritonsillar abscess, penicillin and metronidazole.

RESULTS

Three randomised, control trials were included. All studies assessed the clinical outcomes after treatment for peritonsillar abscess, including recurrence rate, length of hospital stay and symptom improvement. There was no evidence to suggest additional benefit with metronidazole, with studies suggesting increased side effects.

CONCLUSION

Evidence does not support the addition of metronidazole in first-line management of peritonsillar abscess. Further trials to establish optimum dose and duration schedules of oral phenoxymethylpenicillin would benefit clinical practice.

740 ASSESSING THE IMPACT OF A DEDICATED FRAILTY MULTIDISCIPLINARY TEAM TO DELIVER A PROACTIVE VIRTUAL COMPREHENSIVE GERIATRIC ASSESSMENT

Introduction

Surrey Downs Health and Care (SDHC) is an innovative partnership between acute and community providers, local general practitioner (GP) federations and adult social care. The NHS Long Term Plan emphasises the importance of ageing well and supporting people living with frailty by improving integrated proactive services in the community. To achieve this, SDHC collaborated with local Primary Care Networks (PCNs) to develop a frailty multidisciplinary team (MDT) to deliver proactive virtual Comprehensive Geriatric Assessments (CGA).

Method

A monthly frailty MDT meeting was introduced across two PCNs. MDT members included a geriatrician, GP, frailty nurse, community matron, district nurse, therapists, social prescriber, paramedic practitioner and social worker. A reactive-proactive model was utilised; patients over 65-years-old already referred to the community teams were proactively screened for frailty and scored using the Clinical Frailty Scale (CFS). Patients that scored 6 and above were discussed at the MDT and a virtual CGA completed.

Results

151 patients were referred for MDT discussion over eight months. Patients had a mean age of 86 years and a modal CFS score of 6. In the 8-weeks following MDT discussion compared with the 8-weeks prior, patients attended 11% fewer GP consultations, a 9% decrease in community visits and 30% fewer emergency department (ED) attendances.

Conclusion

The implementation of a dedicated PCN frailty MDT who conducted proactive CGAs reduced patient attendance to ED and resulted in fewer consultations with community services. This success has led to a system wide implementation of the model to the other local PCNs.

Planning considerations prior to laryngectomy for a patient infected with severe acute respiratory syndrome coronavirus-2 pre-operatively

BACKGROUND

Coronavirus disease 2019 was declared a pandemic on 11th March 2020. All non-urgent surgical procedures have been postponed indefinitely. The British Association of Head and Neck Oncology state that only those with treatable head and neck cancer unsuitable for alternative treatment should undergo surgery. This paper details our management of a patient who tested positive for severe acute respiratory syndrome coronavirus-2 days before curative surgery for laryngeal cancer.

CASE REPORT

By following British Association of Head and Neck Oncology guidance, a 49-year-old male scheduled for total laryngectomy and bilateral neck dissection for a T3 transglottic squamous cell cancer was pre-operatively identified as an asymptomatic carrier of severe acute respiratory syndrome coronavirus-2. Following 14-day isolation and laboratory proven viral clearance, he underwent successful major surgery. He was managed throughout the peri- and post-operative phases without complications or adverse effects on staff.

CONCLUSION

With careful planning, previous coronavirus disease 2019 positive status should not prevent an individual from undergoing successful total laryngectomy and bilateral neck dissection in a safe and timely manner during the pandemic.

Electrochemical sensor based on CuSe for determination of dopamine

A simple binary copper selenide, CuSe nanostructure, has been investigated as electrochemical sensor for dopamine detection. The hydrothermally synthesized and electrodeposited CuSe nanostructures showed high sensitivity for dopamine detection with low limit of detection (LOD). A sensitivity of 26 μA/μM.cm² was obtained with this electrochemical sensor which is ideal to detect even small fluctuations in the transient dopamine concentration. Apart from high sensitivity and low LOD, the dopamine oxidation on the catalyst surface also occurred at a low applied potential (< 0.18 V vs Ag|AgCl), thereby significantly increasing selectivity of the process specifically with respect to ascorbic and uric acids, which are considered to be the most prominent interferents for dopamine detection. Electrochemical redox tunability of the catalytic Cu center along with low coordination geometry is believed to enhance the rate of dopamine attachment and oxidation on the catalyst surface thereby reducing the applied potential. The presence of Cu also increases conductivity of the catalyst composite which further improves the charge transfer thus increasing the sensitivity of the device. This is the first report of electrochemical dopamine sensing with a simple binary selenide comprising earth-abundant elements and can have large significance in designing efficient sensors that can be transformative for understanding neurodegenerative diseases further. Graphical abstract.

Non-invasive acoustic fabrication methods to enhance collagen hydrogel bioactivity

Much attention has focused recently on utilizing components of the extracellular matrix (ECM) as natural building blocks for a variety of tissue engineering applications and regenerative medicine therapies. Consequently, new fabrication methods are being sought to enable molecular control over the structural characteristics of ECM molecules in order to improve their biological function. Exposing soluble collagen to acoustic forces associated with ultrasound propagation produces localized variations in collagen microfiber organization that in turn, promote cell behaviors essential for tissue regeneration, including cell migration and matrix remodeling. In the present study, mechanisms by which ultrasound interacts with polymerizing collagen to produce functional changes in collagen microstructure were investigated. The rate of collagen polymerization was manipulated by adjusting the pH of collagen solutions and the temperature at which gels were polymerized. Results demonstrate that the phase transition of type I collagen from fluid to gel triggered a simultaneous increase in acoustic absorption. This phase transition of collagen involves the lateral growth of early-stage collagen microfibrils and importantly, corresponded to a defined period of time during which exposure to ultrasound introduced both structural and functional changes to the resultant collagen hydrogels. Together, these experiments isolated a critical window in the collagen fiber assembly process during which mechanical forces associated with ultrasound propagation are effective in producing structural changes that underlie the ability of acoustically-modified collagen hydrogels to stimulate cell migration. These results demonstrate that changes in material properties associated with collagen polymerization are a fundamental component of the mechanism by which acoustic forces modify collagen biomaterials to enhance biological function.

Wound protectors for improved exposure in open hernia repair

INTRODUCTION

Achieving adequate surgical exposure is fundamental to good surgical practice. Traditionally, in the repair of ventral and open inguinal hernias, this has been accomplished with the aid of self-retaining retractors or by extending the incision length. We propose that using disposable wound protectors, surgical exposure will be improved for a given incision length in the repair of ventral and open inguinal hernias, compared to traditional methods.

METHOD

Through the use of an animal tissue model, we compared incisions of varying lengths and measured the dimensions of the exposure achieved with disposable wound protectors (Alexis™) and a Mollison self-retainer. We calculated the surface area and, therefore, exposure gained using the specified wound retraction devices and compared the results.

RESULTS

The average superficial surface area of wound with a self-retainer compared to the small and extra-small disposable wound protector was 2.65 cm² vs 2.27 cm² (small) and 2.2 cm² (extra-small) for 2 cm incision length, 3.6 cm² vs 4.93 cm² and 4.2 cm² for 3 cm incision length, 5.19 cm² vs 8.25 cm² and 6.27 cm² for 4 cm incision length, 6.17 cm² vs 12.25 cm² and 9.07 cm² for 5 cm incision length, and 8.75 cm² vs 16.73 cm² and 10.78 cm² for 6 cm incision length [p = 0.038 (small) and p = 0.049 (extra-small)]. Our results show a statistically significant increase in surface area of a wound for each incision length when a disposable wound protector was used for exposure, compared to a self-retainer.

CONCLUSION

Our results demonstrate that the use of disposable wound protectors provides superior surgical exposure for a given incision length compared to traditional techniques in the repair of ventral and open inguinal hernia repairs.

Abstract OT3-04-02: Neoadjuvant Her2-targeted therapy +/- immunotherapy with pembrolizumab (neoHIP): An open label randomized phase II trial

Background: In preclinical models HER2-directed therapy administered with checkpoint blockade is synergistic. Clinically, trastuzumab administered with pembrolizumab-mediated checkpoint blockade in trastuzumab-resistant HER2-positive metastatic breast cancer was safe and demonstrated modest activity. However, because checkpoint blockade can confer improved responses when administered earlier in the course of disease, trastuzumab with pembrolizumab administered in the curative-intent, treatment-naive setting may confer life-long, tumor-specific immunity and ultimately, improve cure rates. Moreover, the potential synergy of trastuzumab and pembrolizumab with paclitaxel may overcome the need for dual HER2-blockade. The neo-HIP study is a randomized, multicenter, phase II, open-label trial to evaluate the efficacy and safety of weekly paclitaxel, trastuzumab plus pertuzumab (THP) vs weekly THP plus pembrolizumab (THP-K) vs a HER2 monotherapy regimen (TH-K) as neoadjuvant treatment in patients with HER2-positive early stage invasive breast cancer.

Methods:Patients ≥18 years old with previously untreated, non-metastatic, stage II-III, HER2-positive (by ASCO/CAP guidelines) breast cancer are eligible. Patients with inflammatory breast cancer or bilateral primary tumors are excluded. Adequate organ function and ECOG PS 0-1 are required. Approximately 174 patients will be randomly assigned to 1 of 3 arms with stratification by clinical nodal status (positive vs. negative) and hormone receptor status (positive vs. negative). In arm A, patients will receive T at 80mg/m2 weekly for 12 weeks, H at 8mg/Kg (1 loading dose) and then 6mg/Kg IV every 3 weeks x 3 doses, P at 840mg (1 loading dose) and then 420mg/Kg IV every 3 weeks x 3 doses (THP). In arm B, patients will receive the same regimen as arm A with the addition of pembrolizumab 200mg IV every 3 weeks x 4 doses (THP-K). In arm C, patients will receive the same regimen as arm B, but without pertuzumab (TH-K). Definitive surgery will be 3-6 weeks after the last treatment dose. After surgery, patients in all arms willbe treated per the treating physician's discretion. After completion of post-operative chemotherapy, patients will receive radiotherapy per local clinical standard and those patients whose tumors are hormone-receptor positive will receive hormone therapy as per local standard-of-care. The purpose of this phase II study is to identify whether Arm B (THP-K) and/or Arm C (TH-K) demonstrate a clinically significant improvement in pCR rate when compared with Arm A (THP). The primary end point is pCR rate in the breast and axilla (ypT0/Tis ypN0). Secondary end points include pCR rate by ypT0ypN0 and ypT0/Tis, residual cancer burden index, event free survival, breast conserving surgery rate, safety and overall survival. Exploratory correlative studies will characterize the immunologic responses to the interventions and explore potential predictors of efficacy and toxicity.

Citation Format: McArthur HL, Leal JHS, DiLauro Abaya C, Basho R, Coleman H, Shiao S, Knott S, Tighiouart M, Dadmanesh F, Giuliano A, Verma S. Neoadjuvant Her2-targeted therapy +/- immunotherapy with pembrolizumab (neoHIP): An open label randomized phase II trial [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr OT3-04-02.

Transcriptional subtyping and CD8 immunohistochemistry identifies poor prognosis stage II/III colorectal cancer patients who benefit from adjuvant chemotherapy

Purpose

Transcriptomic profiling of colorectal cancer (CRC) has led to the identification of four consensus molecular subtypes (CMS1 to 4) that have prognostic value in stage II and III disease. More recently, the Colorectal Cancer Intrinsic Subtypes (CRIS) classification system has helped to define the biology specific to the epithelial component of colorectal tumors; however, the clinical value of these classification systems in the prediction of response to standard-of-care adjuvant chemotherapy remains unknown.

Patients and Methods

Using samples from four European sites, we assembled a novel cohort of patients with stage II and III CRC (n = 156 samples) and performed transcriptomic profiling and targeted sequencing and generated a tissue microarray to enable integrated multiomics analyses. We also accessed data from two published cohorts of patients with stage II and III CRC: GSE39582 and GSE14333 (n = 479 and n = 185 samples, respectively).

Results

The epithelial-rich CMS2 subtype of CRC benefitted significantly from treatment with adjuvant chemotherapy in both stage II and III disease (P = .02 and P < .001, respectively), whereas the CMS3 subtype significantly benefitted in stage III only (P = .001). After CRIS substratification of CMS2, we observed that only the CRIS-C subtype significantly benefitted from treatment with adjuvant chemotherapy in stage II and III disease (P = .0081 and P < .001, respectively), whereas the CRIS-D subtype significantly benefitted in stage III only (P = .0034). We also observed that CRIS-C patients with low levels of CD8⁺ tumor-infiltrating lymphocytes were most at risk for relapse in both stage II and III disease (log-rank P = .0031; hazard ratio, 12.18 [95% CI, 1.51 to 98.58]).

Conclusion

Patient stratification using a combination of transcriptional subtyping and CD8 immunohistochemistry analyses is capable of identifying patients with poor prognostic stage II and III disease who benefit from adjuvant standard-of-care chemotherapy. These findings are particularly relevant for patients with stage II disease, where the overall benefit of adjuvant chemotherapy is marginal.

Polymer coated gold-ferric oxide superparamagnetic nanoparticles for theranostic applications

BACKGROUND

Engineered inorganic nanoparticles (NPs) are essential components in the development of nanotechnologies. For applications in nanomedicine, particles need to be functionalized to ensure a good dispersibility in biological fluids. In many cases however, functionalization is not sufficient: the particles become either coated by a corona of serum proteins or precipitate out of the solvent. We show that by changing the coating of magnetic iron oxide NPs using poly-L-lysine (PLL) polymer the colloidal stability of the dispersion is improved in aqueous solutions including water, phosphate buffered saline (PBS), PBS with 10% fetal bovine serum (FBS) and cell culture medium, and the internalization of the NPs toward living mammalian cells is profoundly affected.

METHODS

A multifunctional magnetic NP is designed to perform a near-infrared (NIR)-responsive remote control photothermal ablation for the treatment of breast cancer. In contrast to the previously reported studies of gold (Au) magnetic (Fe3O4) core-shell NPs, a Janus-like nanostructure is synthesized with Fe3O4 NPs decorated with Au resulting in an approximate size of 60 nm mean diameter. The surface of trisoctahedral Au-Fe3O4 NPs was coated with a positively charged polymer, PLL to deliver the NPs inside cells. The PLL-Au-Fe3O4 NPs were characterized by transmission electron microscopy (TEM), XRD, FT-IR and dynamic light scattering (DLS). The unique properties of both Au surface plasmon resonance and superparamagnetic moment result in a multimodal platform for use as a nanothermal ablator and also as a magnetic resonance imaging (MRI) contrast agent, respectively. Taking advantage of the photothermal therapy, PLL-Au-Fe3O4 NPs were incubated with BT-474 and MDA-MB-231 breast cancer cells, investigated for the cytotoxicity and intracellular uptake, and remotely triggered by a NIR laser of ~ 808 nm (1 W/cm2 for 10 min).

RESULTS

The PLL coating increased the colloidal stability and robustness of Au-Fe3O4 NPs (PLL-Au-Fe3O4) in biological media including cell culture medium, PBS and PBS with 10% fetal bovine serum. It is revealed that no significant (< 10%) cytotoxicity was induced by PLL-Au-Fe3O4 NPs itself in BT-474 and MDA-MB-231 cells at concentrations up to 100 μg/ml. Brightfield microscopy, fluorescence microscopy and TEM showed significant uptake of PLL-Au-Fe3O4 NPs by BT-474 and MDA-MB-231 cells. The cells exhibited 40 and 60% inhibition in BT-474 and MDA-MB-231 cell growth, respectively following the internalized NPs were triggered by a photothermal laser using 100 μg/ml PLL-Au-Fe3O4 NPs. The control cells treated with NPs but without laser showed < 10% cell death compared to no laser treatment control CONCLUSION: Combined together, the results demonstrate a new polymer gold superparamagnetic nanostructure that integrates both diagnostics function and photothermal ablation of tumors into a single multimodal nanoplatform exhibiting a significant cancer cell death.

Plasmid Dynamics in KPC-Positive Klebsiella pneumoniae during Long-Term Patient Colonization

Carbapenem-resistant Klebsiella pneumoniae strains are formidable hospital pathogens that pose a serious threat to patients around the globe due to a rising incidence in health care facilities, high mortality rates associated with infection, and potential to spread antibiotic resistance to other bacterial species, such as Escherichia coli Over 6 months in 2011, 17 patients at the National Institutes of Health (NIH) Clinical Center became colonized with a highly virulent, transmissible carbapenem-resistant strain of K. pneumoniae Our real-time genomic sequencing tracked patient-to-patient routes of transmission and informed epidemiologists' actions to monitor and control this outbreak. Two of these patients remained colonized with carbapenemase-producing organisms for at least 2 to 4 years, providing the opportunity to undertake a focused genomic study of long-term colonization with antibiotic-resistant bacteria. Whole-genome sequencing studies shed light on the underlying complex microbial colonization, including mixed or evolving bacterial populations and gain or loss of plasmids. Isolates from NIH patient 15 showed complex plasmid rearrangements, leaving the chromosome and the blaKPC-carrying plasmid intact but rearranging the two other plasmids of this outbreak strain. NIH patient 16 has shown continuous colonization with blaKPC-positive organisms across multiple time points spanning 2011 to 2015. Genomic studies defined a complex pattern of succession and plasmid transmission across two different K. pneumoniae sequence types and an E. coli isolate. These findings demonstrate the utility of genomic methods for understanding strain succession, genome plasticity, and long-term carriage of antibiotic-resistant organisms.

IMPORTANCE

In 2011, the NIH Clinical Center had a nosocomial outbreak involving 19 patients who became colonized or infected with blaKPC-positive Klebsiella pneumoniae Patients who have intestinal colonization with blaKPC-positive K. pneumoniae are at risk for developing infections that are difficult or nearly impossible to treat with existing antibiotic options. Two of those patients remained colonized with blaKPC-positive Klebsiella pneumoniae for over a year, leading to the initiation of a detailed genomic analysis exploring mixed colonization, plasmid recombination, and plasmid diversification. Whole-genome sequence analysis identified a variety of changes, both subtle and large, in the blaKPC-positive organisms. Long-term colonization of patients with blaKPC-positive Klebsiella pneumoniae creates new opportunities for horizontal gene transfer of plasmids encoding antibiotic resistance genes and poses complications for the delivery of health care.

Malignant tumours of the jaws

Almost all variants of malignant primary and secondary tumours of bone have been described as occurring within the jaws. Odontogenic carcinomas and sarcomas are peculiar to the jawbones and are distinctly uncommon. Non-odontogenic tumours in comparison arise with more frequency, yet the maxilla and mandible remain unusual sites for most primary and secondary non-odontogenic tumours of bone. The most commonly occurring primary bone tumours affecting the jaws include osteosarcoma, Burkitt's lymphoma and multiple myeloma, while secondary or metastatic tumours to the jaws are rare in contrast to the remainder of the skeleton.

Oral mucosal diseases: the inflammatory dermatoses

The oral inflammatory dermatoses is a term used to describe a number of predominantly immune-mediated disorders: lichen planus (LP), erythema multiforme (EM), the vesiculobullous diseases pemphigoid (MMP), pemphigus (PV) and epidermolysis bullosa acquisita (EBA). These conditions are characterized by frequent involvement of the oral mucosa and often associated with extraoral manifestations, particularly of the skin, but can involve the eyes, both the conjunctiva and sclera, the nasal and pharyngeal mucosa, as well as the genitals. Given their frequent, and sometimes initial involvement of the oral mucosa, oral health professionals need to be both familiar with the clinical features and presentations of these conditions, and appreciate their critical role in management. This paper reviews the clinical features and presentation of the oral dermatoses, provides guidance as to the appropriate investigations needed to differentiate and correctly diagnose these conditions, details the aetio-pathology of these diseases and discusses their management.

Effort required to finish shotgun-generated genome sequences differs significantly among vertebrates

BACKGROUND

The approaches for shotgun-based sequencing of vertebrate genomes are now well-established, and have resulted in the generation of numerous draft whole-genome sequence assemblies. In contrast, the process of refining those assemblies to improve contiguity and increase accuracy (known as 'sequence finishing') remains tedious, labor-intensive, and expensive. As a result, the vast majority of vertebrate genome sequences generated to date remain at a draft stage.

RESULTS

To date, our genome sequencing efforts have focused on comparative studies of targeted genomic regions, requiring sequence finishing of large blocks of orthologous sequence (average size 0.5-2 Mb) from various subsets of 75 vertebrates. This experience has provided a unique opportunity to compare the relative effort required to finish shotgun-generated genome sequence assemblies from different species, which we report here. Importantly, we found that the sequence assemblies generated for the same orthologous regions from various vertebrates show substantial variation with respect to misassemblies and, in particular, the frequency and characteristics of sequence gaps. As a consequence, the work required to finish different species' sequences varied greatly. Application of the same standardized methods for finishing provided a novel opportunity to "assay" characteristics of genome sequences among many vertebrate species. It is important to note that many of the problems we have encountered during sequence finishing reflect unique architectural features of a particular vertebrate's genome, which in some cases may have important functional and/or evolutionary implications. Finally, based on our analyses, we have been able to improve our procedures to overcome some of these problems and to increase the overall efficiency of the sequence-finishing process, although significant challenges still remain.

CONCLUSION

Our findings have important implications for the eventual finishing of the draft whole-genome sequences that have now been generated for a large number of vertebrates.

Partnered care in the Bahamas: A model of advanced healthcare delivery for developing countries

OBJECTIVE

To assess the delivery of advanced specialized medical care using The Partnered Care Model as a means of providing affordable access to all, irrespective of ability to pay.

DESIGN AND METHODS

A retrospective analysis of all persons presenting to a specialized, private, cardiac unit, The Bahamas Interventional Cardiology Center (BICC), over an 8.5-year period from March 1996 to September 2004 was conducted. The Bahamas Heart Center's Discounted Service System had been applied since inception to all patients in three groups including insured patients billed at 100% of the fee schedule of The Medical Association of the Bahamas for the procedures performed, private self-pay and government patients billed at 75% and 50% respectively. Their respective distribution and contributions to total revenue was analyzed. A series of financial models were constructed taking into consideration variables that could influence the percentages of revenues collected from each sector and the number of individuals served

RESULTS

One thousand five-hundred and forty-two patients received services in BICC over the 8.5 year period (56% males and 44% females age range: 0.25 - 96 years, with mean age of 55.7 years). One thousand eight-hundred and eighty-eight patient-procedures were performed, with 51% insured generating 69% total revenue, 18% Private producing 16% Revenue, and 31% Government patients generating 15%. Financial models were created to predict revenue behaviour in various scenarios.

CONCLUSION

Partnered Care is a viable alternative for Governments (Ministries of Health) of developing countries to provide costly specialized healthcare to their populations at minimal expense and capital outlay. Partnered Care reduces the otherwise overwhelming burden of healthcare cost to governments, particularly in developing countries, by sharing the burden of care between the private, user and government sectors.

A controlled trial of a school-based intervention to improve asthma management

The present study investigated schools as an appropriate context for an intervention designed to produce clinical and psychological benefits for children with asthma. A total of 193 out of 219 (88.1%) children with asthma (aged 7-9 yrs) from 23 out of 24 (95.8%) schools completed the study. Intervention schools received a staff asthma-training session, advice on asthma policy, an emergency beta2-agonist inhaler with spacer and whole-class asthma workshops. Nonintervention schools received no asthma-related input. Intervention children required less general practitioner-prescribed preventer medication despite no differences in symptom control compared with the nonintervention asthmatic group. Increased peer knowledge of asthma may have mediated improved active quality of life in the intervention group, together with increased self-esteem in young females. Those females not receiving the intervention, but identified as being asthmatic within the classroom, and thus possibly stigmatised, reported decreased self-esteem. Lower self-esteem in young males was associated with pet ownership. No change was found in staff knowledge, the establishment of asthma policies or school absences which were low even before intervention. In conclusion, a whole-school intervention can improve the health of children with asthma when followed with support for all children but effects are likely to be modified by sex and the home environment.

Intraoral perineurioma: report of a case with a review of the literature

Perineurioma is a rare benign peripheral nerve sheath tumour that occurs as an intraneural or extraneural form. To the best of our knowledge, this is the second reported case of an intraoral submucosal extraneural perineurioma. The tumour was symptomless, measured 2 cm in diameter and occurred in the nasolabial fold of a 46-year-old black female. Awareness of the occurrence of this neoplasm in the oral cavity is important to promote detection and differentiation from other benign spindle tumours, which occur intraorally. All reported cases of perineurioma have been benign and cure is effected by localized surgical excision.

Use of calretinin in the differential diagnosis of unicystic ameloblastomas

AIMS

Calretinin, a 29-kDa calcium-binding protein is expressed widely in normal human tissues and tumours including both unicystic and solid and multicystic ameloblastomas. The histological distinction between unicystic ameloblastomas and certain non-neoplastic odontogenic cysts can be problematic. The objective of this study was to determine whether calretinin was expressed in the lining epithelium of odontogenic keratocysts, residual and dentigerous cysts and to determine whether this calcium-binding protein could be used to distinguish these cysts from the unicystic ameloblastoma.

METHODS AND RESULTS

The lining epithelium in 22 cases of odontogenic keratocyst, 26 cases of residual cyst and 20 cases of dentigerous cyst were examined for the expression of calretinin. No positive epithelial staining was observed in any of these cystic lesions. In comparison, however, 81.5% of cases of unicystic ameloblastoma showed a coarse dark brown staining of the more superficial epithelial cell layers. Scattered positive stromal and epithelial cells were present; these were interpreted as mast cells.

CONCLUSIONS

Calretinin appears to be a specific immunohistochemical marker for neoplastic ameloblastic epithelium and we suggest that it may be an important diagnostic aid in the differential diagnosis of cystic odontogenic lesions and ameloblastic tumours.

The effects of thyroid and reproductive hormones on the viability of human buccal epithelium

Recent findings have shown that estrogen receptors were localized in stromal cells in the oral cavity. The role of physiological doses of growth promoting hormones such as thyroid stimulating hormone (TSH) and estrogen have not exclusively studied. This investigation identifies the cytology and biochemical response of buccal epithelial in the presence of estrogen and TSH at 24, 48, and 72 hr of incubation. The cells were obtained from pre, postmenopausal women and men. The cells were seeded at a density of 10,000 cells per well and aseptic techniques, morphological evaluation, biochemical analysis (MDA), and data analysis were performed following standard lab protocols. Results of this investigation revealed that: (i) there was an initial increase in total protein observed in cells treated with TSH in comparison to the control and estrogen treated cells. This trend continued for 48 hours, and no statistical differences were observed at the 72 hour phase, (ii) there was an initial decrease in MDA levels in cells treated with TSH, however, cellular damage was evident at 48 and 72 hours phases in comparison to estrogen and control groups, (iii) morphological evaluation demonstrated that there were structural changes associated with TSH treatment. These include aggregates, nuclear shriveling and lack of cellular boundaries. Estrogen treatment showed no structural alteration throughout the experiment.

Evaluating skill acquisition in motivational interviewing: the development of an instrument to measure practice skills

Social work education has long emphasized the need to provide competence-based education. However, little work has been done to identify, validate and evaluate competencies in specific fields such as addictions. The purpose of this study was to isolate a set of substance abuse intervention competencies using Motivational Interviewing that could be used to teach and evaluate students. The research proceeded in three stages. First, a modified Delphi approach involving social work practitioners was used to discern a set of positive and dysfunctional skills related to Motivational Interviewing. The primary researcher taught a graduate social work class aimed at teaching students theory and skills related to this model. Students demonstrated these skills with simulated clients through videotaped interviews. Finally, three observers rated the student interviews using this developed instrument. While inter-observer agreement was lower than anticipated, this study does provide early support for the development of competencies related to specific theoretical frameworks.

Calretinin expression in ameloblastomas

AIMS

Calretinin is a 29-kDa calcium-binding protein which is expressed in the central and peripheral nervous systems as well as in many other normal and pathological human tissues. The objective of this study was to determine whether calretinin was expressed in the epithelium of ameloblastomas.

METHODS AND RESULTS

Twenty-seven cases of unicystic ameloblastoma and 31 cases of solid and multicystic ameloblastoma were studied. Five-micron sections were immunohistochemically stained using either antiserum 7696 from Swant, or antiserum 18-0211 from Zymed with a standard ABC method. The results were identical with the two antisera. Positive staining was seen in 22 cases (81.5%) of unicystic ameloblastomas. This generally consisted of diffuse, intense nuclear and cytoplasmic staining of several cell layers of the more superficial cells both in the characteristic and nondescript areas of the cyst linings. In the solid and multicystic ameloblastomas, staining occurred in 29 (93. 5%) of the cases. The staining was almost always restricted to the stellate reticulum-like epithelium, was generally intense and diffuse in distribution. Areas of squamous metaplasia stained particularly intensely as did the cells surrounding micro- and macro-cysts. In both groups of lesions, most of the cases that did not stain were intensely inflamed.

CONCLUSIONS

The biological significance of calretinin expression in ameloblastomas is not known and its use as a distinctive, specific immunohistochemical marker for ameloblastic tissues remains to be confirmed. However, the results of this study raise the possibility that calretinin may be an important diagnostic aid in the differential diagnosis of cystic and solid ameloblastic tumours.

Epilepsy education in schools

The objective of this study was to assess the effect of an epilepsy education initiative on the management of epilepsy in Southampton schools. A self-completion questionnaire survey was undertaken of staff in 19 Southampton primary schools and ten secondary schools. Changes in knowledge and management of seizures in children with epilepsy were measured following an education session and a recommended implementation of an individual seizure protocol for children with epilepsy. There were significant changes in some areas of seizure management and knowledge. Only a small number (three) of primary schools had a protocol in place. Two primary and four secondary schools were in the process of putting the protocol in place. An improvement in knowledge and seizure management has been demonstrated. Further work is needed to implement an individual seizure protocol for all children with epilepsy.

Intravascular tumour in intra-oral pleomorphic adenomas: a diagnostic and therapeutic dilemma

AIMS

Intravascular tumour has been described very rarely in pleomorphic adenomas. The aim of this study was to establish the frequency of intravascular tumour in pleomorphic adenomas arising in minor salivary glands and to determine the biological significance of this phenomenon.

METHODS AND RESULTS

Representative sections of 67 widely excised pleomorphic adenomas were examined for the presence of intravascular tumour. Sixty-two cases were derived from the palate while the remaining five were from the cheeks and lips. In instances where intravascular tumour was identified, multiple serial sections were assessed and immunohistochemical stains were performed. None of these cases showed cytological evidence of malignancy. Solid cords of intravascular tumour were present in six palatal tumours (8.9%) and consisted of plasmacytoid myoepithelial cells permeating muscular walled blood vessels and capillaries both within the tumour and capsule. Immunoperoxidase staining confirmed that the intravascular cells were phenotypically identical to those of the tumour being S100- and smooth muscle actin (SMA) positive. There is some evidence that this phenomenon represents true vascular invasion although artefactual spillage cannot be excluded.

CONCLUSIONS

Although the biological significance of intravascular tumour in pleomorphic adenomas of minor salivary glands remains unknown, the occurrence of metastatic disease has not been demonstrated nor have aggressive behaviour or recurrences.

Cystic degeneration in fibrous dysplasia of the jaws: a case report

A case of nonspecific cystic degeneration complicating fibrous dysplasia of the mandible is presented. This condition is extremely rare in the jaw bones. The patient had a painless swelling of the right face measuring 10 cm in diameter, and there was no history of trauma. Radiographs showed a poorly defined, "ground glass" radiopaque lesion; a central well-defined cyst was confirmed by means of computed tomography. During surgery, a large cystic cavity with surrounding, soft fibrous bone that merged with the cortex was observed. Histologic examination showed a large non-epithelial-lined cystic cavity with a surrounding fibro-osseous lesion, which was consistent with a diagnosis of fibrous dysplasia.

Long-term histologic changes in the dental pulp after posterior segmental osteotomies

OBJECTIVE

The purpose of this study was to examine pulp tissue for 18 months after segmental osteotomy in nonhuman primates.

STUDY DESIGN

In this long-term experimental study, subapical, posterior, maxillary, and mandibular osteotomies were done in 26 baboons (Papio ursinus). Baboons were killed humanely immediately after operation and at 3, 6, 12, and 18 months, when tissues were perfusion-fixed. Longitudinal step-serial sections of dental pulps were examined.

RESULTS

There was a loss of the odontoblast layer as early as 3 months after surgery. Inflammatory cell infiltrate was most marked in the early postoperative stages, and the formation of osteodentin and secondary dentin was evident after 6 months. Foci of necrosis were present in the 3-month and 6-month groups but were replaced by pulp fibrosis in the 12-month and 18-month groups. All these changes were more frequent in experimental than control teeth.

CONCLUSIONS

The histologic changes seen should not affect the prognosis of teeth in subapical osteotomy segments if clinicians are careful not to damage root apices and do regular, careful, clinical, and radiographic follow-up examinations. Because many pulps healed spontaneously in the study teeth, endodontic treatment should be delayed until it is clearly needed.

Sialadenosis: a presenting sign in bulimia

BACKGROUND

Sialadenosis refers to noninflammatory, often recurrent, enlargement of the salivary glands, most frequently the parotids, which is almost always associated with an underlying systemic disorder. These include diabetes, alcoholism, malnutrition, anorexia nervosa, and bulimia. It is thought that the various causes of sialadenosis all result in a common pathogenetic effect in that they produce a peripheral autonomic neuropathy which is responsible for disordered metabolism and secretion, resulting in acinar enlargement.

METHODS

This paper reports a case of sialadenosis as a presenting sign in bulimia and studies the histologic and electron microscopic features of this disease.

RESULTS

Light microscopy showed acini which appeared to be larger than normal and which were composed of plump pyramidal cells containing prominent zymogen granules. There was less interstitial fat, and the ducts were widely dispersed. Electron microscopy showed the acinar cells to be packed with membrane-limited, dark secretory granules some of which showed moulding of their outlines. Cellular organelles and nuclei were inconspicuous.

CONCLUSIONS

Management of sialadenosis depends upon identification of the underlying cause, which must then be corrected. In bulimia, the swellings may be refractory to standard treatment modalities, and parotidectomy may be considered as a last resort to improve the unacceptable aesthetics.

An audit of paediatric epilepsy care

Basic standards for the process of paediatric epilepsy care were identified and applied in a clinical audit; findings were presented and the audit repeated. Standards agreed related to quality of correspondence, prescribing practice, appropriateness of drug monitoring, use of neuroimaging, and quality of requests for electroencephalography (EEG). Parent satisfaction with staff courtesy, doctor communication, and clinic visits were also assessed. In the second audit prescribing practice and appropriateness of drug monitoring had improved, but quality of patient correspondence and requests for EEG were unchanged. In both periods of care many parents were dissatisfied with the quality and amount of information provided about epilepsy. Standards of care for the medical management of children with epilepsy can be agreed and used to identify achievable improvements in that care.

Chronic bullous disease of childhood--another cause for potential misdiagnosis of sexual abuse?

There have been several reports of unusual skin conditions producing genital lesions that can be mistaken for sexual abuse. We report on another unusual skin condition, well known to dermatologists, that can again lead to potential misdiagnosis of sexual abuse.

Intra-vascular tumour in pleomorphic adenomas--a report of four cases

AIMS

The aim of this study was to report four cases of pleomorphic adenoma which were characterized by intra-vascular tumour.

METHODS AND RESULTS

The patients ranged in age from 13-43 years, one was male while three were female. The tumours were situated in the parotid gland, submandibular gland and palate (two cases). The intra-vascular tumour consisted of single, clustered and solid cords of cells within multiple muscular walled blood vessels and capillaries both in the capsule and in the tumour. Immunoperoxidase staining confirmed that the intra-vascular cells were phenotypically identical to those of the tumour. The possibility that the intra-vascular tumour represents artefactual 'spillage' has been considered, however there is some histological evidence suggesting that this phenomenon represents true vascular invasion.

CONCLUSIONS

The biological significance of intra-vascular tumour in pleomorphic adenomas is unknown. Thus far there has been no correlation with either recurrence or metastases.

The rapid access paediatric clinic: a way to reduce inappropriate admissions to hospital

With documented evidence of increased numbers of paediatric admissions to a reduced number of beds, it is important that children are admitted to hospital for appropriate reasons. Some hospitals have set up rapid access or emergency consultation clinics to try to avoid unnecessary paediatric admissions. This study examined the presenting problem of 451 patients referred by general practitioners (GPs) to the paediatric emergency clinic at Southampton General Hospital over a five month period, and the outcome for the children in terms of investigation, admission or follow-up. The most common presenting problems were gastrointestinal (26.8%), respiratory (22.8%) or infectious (19.1%). Cough or "chestiness" was the single most common presenting symptom. A total of 328 investigations was performed. After the clinic visit, 35.3% of children were discharged, 18.8% were asked to return to the clinic for a follow-up visit and 19.1% were admitted to the ward. 16.4% were given a future paediatric outpatient appointment, 7.3% were referred for specialist opinion in a different speciality, and 6.7% were advised to return to the GP for follow-up. The authors consider that the emergency paediatric clinic is appropriately used by GPs referring acute and sub-acute problems and believe that local satellite clinics run along similar lines would be welcomed by GPs, health visitors and parents. Although there is little documented evidence that rapid access paediatric clinics reduce admission, the authors consider that unnecessary admission was avoided for many of the children seen in the emergency clinic. Prospective studies are needed to confirm this.

Familial florid cemento-osseous dysplasia--a case report and review of the literature

Cemento-osseous dysplasia is a fairly common lesion of the jaws originating from the elements of the periodontal ligament. Most lesions do not have a hereditary basis, however a few familial cases have been documented. This is the first report of the florid form of cemento-osseous dysplasia in an African family. The mother, son and one daughter exhibited multiple sclerotic cemental masses of the jaws with large tumour-like swellings in the symphyseal area of the mandible. In the case of the mother the lesions had become infected. The familial form of cemento-osseous dysplasia differs from the non-hereditary type in that the lesions present in children, all cases are florid in nature, there is no predilection for black females, the rate of growth appears to be more rapid and the symphyseal area of the mandible is most severely affected. The mode of transmission appears to be autosomal dominant with variable phenotypic expression.

Three-dimensional computed tomography reconstruction in treatment planning for large ameloblastoma

A case of an unusually large mandibular ameloblastoma is reported in which standard radiologic examination failed to provide adequate visualization of the tumor's limits because of overlapping structures and the presence of compound shadows. Computed tomography imaging and three-dimensional reconstruction proved invaluable in the treatment planning of this large lesion, because it allowed the surgeon to visualize and comprehend the geography of the tumor and its relationship to surrounding structures and soft tissues and to formulate a surgical plan. Use of this technique helped ensure complete excision of the tumor without excessive removal of uninvolved tissue.

Neuroendocrine (carcinoid) tumor of the mandible: a case report and review of the literature

The aim of this article is to present a case of primary neuroendocrine tumor (typical carcinoid) of the mandible that occurred in a 46-year-old black woman who was seropositive for the human immunodeficiency virus. Radiologically the lesion presented as a poorly circumscribed honeycomb radiolucency that extended from tooth 21 to the ascending ramus. Histologically the tumor cells were variously arranged in small islands, trabeculae, follicles, and slitlike spaces lined by a single layer of palisaded low-columnar cells. The follicles contained an eosinophilic colloid-like substance. Immunocytochemical staining showed diffuse, intense positivity for MAK 6, pancytokeratin, S-100, and neuron-specific enolase and focal, intense, positive staining for chromogranin A. Electron microscopy showed the presence of interdigitating cell membranes, rudimentary cell attachments, and varying numbers of membrane-bound dense core granules. Special investigations failed to reveal a primary tumor, and no metastases were found. Urine and hematologic assessment did not show any evidence of functional activity. The tumor was resected, and no recurrence or spread has been seen for 2 years. Origin from foregut-derived, immature, and functionally uncommitted endocrine cells is presumed.