Diagnostic and treatment preferences for cracked posterior teeth

BACKGROUND

Longitudinal cracks in teeth are common and often present challenges in diagnosis and management. This study investigated the preferred diagnostic process and treatment modalities for these cracked teeth.

METHODS

Dentists currently registered with Dental Board of Australia and practising within Australia were invited to complete an online Qualtrics-based survey on their perspectives on the presentations, diagnosis, and treatment preferences for cracked teeth.

RESULTS

Of respondents, 56.8% chose to place an indirect cuspal-coverage restoration on an asymptomatic cracked vital tooth. When the tooth was mildly cold sensitive, direct cuspal-coverage restoration was favoured (64.9%), while 36.8% preferred placing an orthodontic band in a tooth with biting pain. Respondents had higher odds of recommending indirect restoration when CAD-CAM milling was available on-site or magnification was routinely used, regardless of presenting symptoms. Almost half (46.8%) preferred to extract if the tooth undergoing root canal treatment had a crack with a 5 mm probing pocket depth. Most (71.4%) demonstrated a poor understanding of cracked tooth biomechanics.

CONCLUSION

Australian dentists varied in their diagnostic and treatment preferences for cracked teeth, reflecting a need for more well-controlled clinical studies in the diagnostic process, clinical biomechanics and treatment modalities for these teeth. © 2023 Australian Dental Association.

Beyond Protein Synthesis; The Multifaceted Roles of Tuberin in Cell Cycle Regulation

The ability of cells to sense diverse environmental signals, including nutrient availability and conditions of stress, is critical for both prokaryotes and eukaryotes to mount an appropriate physiological response. While there is a great deal known about the different biochemical pathways that can detect and relay information from the environment, how these signals are integrated to control progression through the cell cycle is still an expanding area of research. Over the past three decades the proteins Tuberin, Hamartin and TBC1D7 have emerged as a large protein complex called the Tuberous Sclerosis Complex. This complex can integrate a wide variety of environmental signals to control a host of cell biology events including protein synthesis, cell cycle, protein transport, cell adhesion, autophagy, and cell growth. Worldwide efforts have revealed many molecular pathways which alter Tuberin post-translationally to convey messages to these important pathways, with most of the focus being on the regulation over protein synthesis. Herein we review the literature supporting that the Tuberous Sclerosis Complex plays a critical role in integrating environmental signals with the core cell cycle machinery.

Clinical outcomes up-to 10 years of asymptomatic incidental aortic dissections and large aortic aneurysms detected on computer tomography aortography (CTA) prior to transcatheter aortic valve implantation (TAVI)

Background/Introduction

Computer tomography aortography (CTA) is performed routinely to aid planning of transcatheter aortic valve implantation (TAVI). Incidental findings are common, and may influence the decision to proceed with TAVI. The safety and long term outcomes of performing TAVI in patients with previously undiagnosed incidental CT findings of aortic dissections and large aortic aneurysms is currently unknown.

Purpose

To establish the frequency of incidental aortic dissections and large aortic aneurysms prior to TAVI, and subsequent clinical outcomes of patients. We hypothesize that transfemoral access is safe in patients with incidental finding of aortic dissection and large aortic aneurysms.

Methods

This was a retrospective study of 628 sequential TAVI patients in a large, UK tertiary centre between January 2010 and September 2020. Patients were evaluated in 3 groups as per pre-TAVI CTA: incidental aortic dissections, aortic aneurysm >4cm and all others (control group). Endpoints were procedural success, peri-procedural major bleeding and/or vascular complications and/or CVA, length of hospital stay, 30-day and 1-year mortality.

Results

2.9% of patients (n=18) had incidental aortic dissection, of which 66.7% (n=12) were male, with a mean age of 86.7±4.4. 3.8% of patients (n=24) had aortic aneurysms >4 cm. 83.3% (n=20) of them were male and the mean age was 82.8±5.4. Transfemoral approach was favoured in 77.8% of patients in the dissection group and 83.3% of patients in the aneurysm group versus 93.3% in the control group. Procedural characteristics are summarised in Table 1. Vascular access complications, stroke, bleeding and length of hospital stay were comparable between all 3 groups (Table 1). Patients with dissection and large aneurysm had similar success rate of valve implantation compared to the control group (88.9% and 87.5% vs 97.1%, p=0.452). 30-day mortality in the dissection group was higher than the other 2 groups (21.1% vs 0% and 5.6%, p=0.004). Log-rank analysis revealed a higher incidence of MACE in the dissection group over 24 months compared to the other two groups (Figure 1).

Conclusion

A transfemoral approach appears to be a safe choice in patients with incidental findings of aortic dissection or aortic aneurysms >4cm, given no significant difference in terms of valve implant success, vascular injury, major bleeding or unplanned surgical repair. However, patients with stable previous aortic dissections have a significantly higher 30-day mortality and overall lower survival rate over 24 months. This important observation needs to be further investigated in a larger-scale, long-term follow up study, and may in future influence TAVI treatment planning.

Funding Acknowledgement

Type of funding sources: None. Figure 1. Survival curve

New concept: "TARN friendly trauma reporting" (what radiologists say really does matter)

AIM

To establish if detailed review of trauma reports with reference to coding manual improved accuracy of ISS and to establish if demonstrated changes in coding affected performance and tariff payment.

MATERIALS AND METHODS

A study was undertaken which gathered data from 6 months across the five trusts with information on imaging undertaken, mechanism of injury (MOI), Injury Severity Score (ISS), and injury descriptors was included. Patients with ISS near to a best practice tariff boundary of 9 and 16 (5-8 and 11-15) then had their imaging reviewed by the Radiology Department with direct reference to the ISS coding manual. Injuries were then re-coded and ISS recalculated.

RESULTS

Over the 6-month period, 1,693 patients were admitted to the database from the five hospitals. One hundred and sixty-nine (9.9%) patients met the inclusion criteria for review. Thirty-five (20.7%) had a change in abbreviated (region specific) injury code, with 30 a change in the resultant ISS. Three had a decrease in ISS and 27 increased ISS with all 27 moving across an ISS best practice tariff and three moving across two payment tariff boundaries. With re-coding, there was a potential £15,000 of lost revenue from the major trauma centre (MTC) alone.

CONCLUSION

Reporting with reference to ISS description improves the accuracy of ISS significantly. Radiologists improving the descriptions of specific injury patterns and adopting 'Trauma Audit and Research Network friendly' reporting strategies may improve data accuracy, performance, and payment of best practice tariffs to hospitals.

Dysphagia as the Predominant Symptom in Posterior Circulation Stroke: A Case Report

Patient: Male, 55-year-old

Final Diagnosis: Stroke

Symptoms: Dysphagia • headache • vertigo

Medication: —

Clinical Procedure: —

Specialty: Neurology

Variations in practice of thromboprophylaxis across general surgical subspecialties: a multicentre (PROTECTinG) study of elective major surgeries

BACKGROUND

Despite guidelines recommending perioperative thromboprophylaxis for patients undergoing general surgery, we have observed significant variations in its practice. This may compromise patient safety. Here, we quantify the heterogeneity of perioperative thromboprophylaxis across all major general surgical operations, and place them in relation to their risk of bleeding and venous thromboembolism.

METHODS

Retrospective review of all elective major general surgeries performed between 1 January 2018 and 30 June 2019 across seven Victorian hospitals was conducted.

RESULTS

A total of 5912 patients who underwent 6628 procedures were reviewed. Significant heterogeneity was found in the use of chemoprophylaxis, timing of its initiation, type of anticoagulant administered and application of extended chemoprophylaxis. These variations were observed within the same procedure, and between different surgeries and subspecialties. Contrastingly, there was minimal heterogeneity with the use of mechanical thromboprophylaxis. Oesophago-gastric, liver and colorectal cancer resections had the highest thromboembolic risk. Breast, oesophago-gastric, liver, pancreas and colon cancer resections had the highest bleeding risk.

CONCLUSION

Perioperative chemoprophylaxis across general surgery is highly variable. This study has highlighted key areas of variance. Our findings also enable surgeons to compare their practices, and provide baseline data to inform future efforts towards optimizing thromboprophylaxis for general surgical patients.

Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study

BACKGROUND

This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery.

METHODS

This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery.

RESULTS

A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498).

CONCLUSION

There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.

Comparison of sporadic and familial behavioral variant frontotemporal dementia (FTD) in a North American cohort

INTRODUCTION

Behavioral variant frontotemporal dementia (bvFTD) may present sporadically or due to an autosomal dominant mutation. Characterization of both forms will improve understanding of the generalizability of assessments and treatments.

METHODS

A total of 135 sporadic (s-bvFTD; mean age 63.3 years; 34% female) and 99 familial (f-bvFTD; mean age 59.9; 48% female) bvFTD participants were identified. f-bvFTD cases included 43 with known or presumed chromosome 9 open reading frame 72 (C9orf72) gene expansions, 28 with known or presumed microtubule-associated protein tau (MAPT) mutations, 14 with known progranulin (GRN) mutations, and 14 with a strong family history of FTD but no identified mutation.

RESULTS

Participants with f-bvFTD were younger and had earlier age at onset. s-bvFTD had higher total Neuropsychiatric Inventory Questionnaire (NPI-Q) scores due to more frequent endorsement of depression and irritability.

DISCUSSION

f-bvFTD and s-bvFTD cases are clinically similar, suggesting the generalizability of novel biomarkers, therapies, and clinical tools developed in either form to the other.

How Service-Learning promotes intergenerational harmony: Case study of a Service-Learning project in a science course

The Office of Service-Learning, Lingnan University partnered with the Discovery and Education Department, Ocean Park (a theme park in Hong Kong) to develop a Service-Learning project. Along with the traditional goals of Service-Learning (enhance undergraduate student learning, provide useful service for community partner), we added an additional goal of promoting [1]The educational services (narration services at the exhibits and interactive games) aimed to fulfil Ocean Park’s goal of providing a richer visitor experience, as well as promote the message of marine conservation. This study provides information on how including elders as service providers in a Service-Learning project can facilitate reciprocal learning between age groups and promote intergenerational harmony.   [1] CLD 9008 Life Sciences: The Way Life Works. This course is taught by Professor Jonathan Fong, Assistant Professor in Science Unit, Lingnan University.

Critical care usage after major gastrointestinal and liver surgery: a prospective, multicentre observational study

BACKGROUND

Patient selection for critical care admission must balance patient safety with optimal resource allocation. This study aimed to determine the relationship between critical care admission, and postoperative mortality after abdominal surgery.

METHODS

This prespecified secondary analysis of a multicentre, prospective, observational study included consecutive patients enrolled in the DISCOVER study from UK and Republic of Ireland undergoing major gastrointestinal and liver surgery between October and December 2014. The primary outcome was 30-day mortality. Multivariate logistic regression was used to explore associations between critical care admission (planned and unplanned) and mortality, and inter-centre variation in critical care admission after emergency laparotomy.

RESULTS

Of 4529 patients included, 37.8% (n=1713) underwent planned critical care admissions from theatre. Some 3.1% (n=86/2816) admitted to ward-level care subsequently underwent unplanned critical care admission. Overall 30-day mortality was 2.9% (n=133/4519), and the risk-adjusted association between 30-day mortality and critical care admission was higher in unplanned [odds ratio (OR): 8.65, 95% confidence interval (CI): 3.51-19.97) than planned admissions (OR: 2.32, 95% CI: 1.43-3.85). Some 26.7% of patients (n=1210/4529) underwent emergency laparotomies. After adjustment, 49.3% (95% CI: 46.8-51.9%, P<0.001) were predicted to have planned critical care admissions, with 7% (n=10/145) of centres outside the 95% CI.

CONCLUSIONS

After risk adjustment, no 30-day survival benefit was identified for either planned or unplanned postoperative admissions to critical care within this cohort. This likely represents appropriate admission of the highest-risk patients. Planned admissions in selected, intermediate-risk patients may present a strategy to mitigate the risk of unplanned admission. Substantial inter-centre variation exists in planned critical care admissions after emergency laparotomies.

Soluble expression of recombinant midgut zymogen (native propeptide) proteases from the Aedes aegypti Mosquito Utilizing E. coli as a host

Background

Studying proteins and enzymes involved in important biological processes in the Aedes aegypti mosquito is limited by the quantity that can be directly isolated from the mosquito. Adding to this difficulty, digestive enzymes (midgut proteases) involved in metabolizing blood meal proteins require a more oxidizing environment to allow proper folding of disulfide bonds. Therefore, recombinant techniques to express foreign proteins in Escherichia coli prove to be effective in producing milligram quantities of the expressed product. However, with the most commonly used strains having a reducing cytoplasm, soluble expression of recombinant proteases is hampered. Fortunately, new E. coli strains with a more oxidizing cytoplasm are now available to ensure proper folding of disulfide bonds.

Results

Utilizing an E. coli strain with a more oxidizing cytoplasm (SHuffle® T7, New England Biolabs) and changes in bacterial growth temperature has resulted in the soluble expression of the four most abundantly expressed Ae. aegypti midgut proteases (AaET, AaSPVI, AaSPVII, and AaLT). A previous attempt of solubly expressing the full-length zymogen forms of these proteases with the leader (signal) sequence and a modified pseudo propeptide with a heterologous enterokinase cleavage site led to insoluble recombinant protein expression. In combination with the more oxidizing cytoplasm, and changes in growth temperature, helped improve the solubility of the zymogen (no leader) native propeptide proteases in E. coli. Furthermore, the approach led to autocatalytic activation of the proteases during bacterial expression and observable BApNA activity. Different time-points after bacterial growth induction were tested to determine the time at which the inactive (zymogen) species is observed to transition to the active form. This helped with the purification and isolation of only the inactive zymogen forms using Nickel affinity.

Conclusions

The difficulty in solubly expressing recombinant proteases in E. coli is caused by the native reducing cytoplasm. However, with bacterial strains with a more oxidizing cytoplasm, recombinant soluble expression can be achieved, but only in concert with changes in bacterial growth temperature. The method described herein should provide a facile starting point to recombinantly expressing Ae. aegypti mosquito proteases or proteins dependent on disulfide bonds utilizing E. coli as a host.

Electronic supplementary material

The online version of this article (10.1186/s12858-018-0101-0) contains supplementary material, which is available to authorized users.

Emergency presentations of acute biliary pain: changing patterns of management in a tertiary institute

BACKGROUND

Acute biliary pain is the most common presentation of gallstone disease. Untreated patients risk recurrent pain, cholecystitis, obstructive jaundice, pancreatitis and multiple hospital presentations. We examine the outcome of implementing a policy to offer laparoscopic cholecystectomy on index presentation to patients with biliary colic in a tertiary hospital in Australia.

METHODS

This is a retrospective cohort study of adult patients presenting to the emergency department (ED) with biliary pain during three 12-month periods. Outcomes in Group A, 3 years prior to policy implementation, were compared with groups 2 and 7 years post implementation (Groups B and C). Primary outcomes were representations to ED, admission rate and time to cholecystectomy.

RESULTS

A total of 584 patients presented with biliary colic during the three study periods. Of these, 391 underwent cholecystectomy with three Strasberg Type A bile leaks and no bile duct injuries. The policy increased admission rates (A = 15.8%, B = 62.9%, C = 29.5%, P < 0.001) and surgery on index presentation (A = 12.0%, B = 60.7%, C = 27.4%, P < 0.001). There was a decline in time to cholecystectomy (days) (A = 143, B = 15, C = 31, P < 0.001), post-operative length of stay (days) (A = 3.6, B = 3.2, C = 2.0, P < 0.05) and representation rates to ED (A = 42.1%, B = 7.1%, C = 19.9%, P < 0.001). There was a decline in policy adherence in the later cohort.

CONCLUSION

Index hospital admission and cholecystectomy for biliary colic decrease patient representations, time to surgery, post-operative stay and complications of gallstone disease. This study demonstrates the impact of the policy with initial improvement, the dangers of policy attrition and the need for continued reinforcement.

Power-efficient III-V/silicon external cavity DBR lasers

We report the design and characterization of external-cavity DBR lasers built with a III-V-semiconductor reflective-SOA with spot-size converter edge-coupled to SOI waveguides containing Bragg grating mirrors. The un-cooled lasers have wall-plug-efficiencies of up to 9.5% at powers of 6 mW. The lasers are suitable for making power efficient, hybrid WDM transmitters in a CMOS-compatible SOI optical platform.

Outcomes of screening-detected ductal carcinoma in situ treated with wide excision alone

BACKGROUND

Ductal carcinoma in situ (DCIS) is commonly identified on screening mammography. Standard treatment for localized DCIS is wide local excision (WLE) and adjuvant radiotherapy. This approach represents overtreatment in many cases, where the DCIS would never have become clinically significant, or where less intensive treatment would have been satisfactory. We reviewed the medium-term outcome of a cohort of screen detected DCIS patients treated mainly with WLE without radiotherapy.

METHODS

All patients diagnosed with DCIS at NorthWestern BreastScreen between January 1994 and December 2005 were identified from a prospective database. Demographic, pathological, treatment, and outcome data were collected and analyzed. Survival and local recurrence (LR) rates were determined, and associations between various factors and recurrence were analyzed.

RESULTS

A total of 422 patients were diagnosed with DCIS. There were 400 patients treated with WLE, and 27 of these received adjuvant radiotherapy. The 5- and 8-year overall and breast cancer specific survival rates were 96.1 and 91.3%, and 99.6 and 99.3%, respectively. The local recurrence rate was 15.4 and 17.1% at 5 and 8 years. Of 56 local recurrences, 34 had WLE after recurrence, 16 of which had adjuvant radiotherapy. No single factor was statistically significantly associated with local recurrence, although combining factors revealed groups where the LR rate was less than 5%.

CONCLUSIONS

Breast cancer specific mortality was very low in this cohort of older patients with screen-detected DCIS. There was a moderate rate of local recurrence that could usually be salvaged with breast conservation. Decisions regarding adjuvant radiotherapy should take these findings into account.

Localized CT-guided irradiation inhibits neurogenesis in specific regions of the adult mouse brain

Radiation is used in the study of neurogenesis in the adult mouse both as a model for patients undergoing radiation therapy for CNS malignancies and as a tool to interrupt neurogenesis. We describe the use of a dedicated CT-guided precision device to irradiate specific sub-regions of the adult mouse brain. Improved CT visualization was accomplished with intrathecal injection of iodinated contrast agent, which enhances the lateral ventricles. T2-weighted MRI images were also used for target localization. Visualization of delivered beams (10 Gy) in tissue was accomplished with immunohistochemical staining for the protein γ-H2AX, a marker of DNA double-strand breaks. γ-H2AX stains showed that the lateral ventricle wall could be targeted with an accuracy of 0.19 mm (n = 10). In the hippocampus, γ-H2AX staining showed that the dentate gyrus can be irradiated unilaterally with a localized arc treatment. This resulted in a significant decrease of proliferative neural progenitor cells as measured by Ki-67 staining (P < 0.001) while leaving the contralateral side intact. Two months after localized irradiation, neurogenesis was significantly inhibited in the irradiated region as seen with EdU/NeuN double labeling (P < 0.001). Localized radiation in the rodent brain is a promising new tool for the study of neurogenesis.

Abstract P6-07-01: CCN3 Impairs Osteoblasts and Stimulates Osteoclast Differentiation To Favor Breast Cancer Metastasis to Bone

Background: The mechanisms underlying the osteotropism of breast cancer are not fully understood. Breast cancer cell lines that aggressively metastasize to bone appear to have increased expression of CCN3 (Nov) compared to those that weakly metastasize to bone. This study aimed to functionally implicate CCN3 in the process of breast cancer metastasis to bone.

Methods: Primary cultures of mouse bone marrow cells were used to assess the effect of recombinant CCN3 protein on RANKL, OPG and on osteoblasts and osteoclasts. To extend data obtained from cell and animal-based models, we have examined CCN3 expression a panel of human breast cancer bone metastases.

Results: CCN3 protein impaired osteoblast differentiation in a dose dependant manner, resulting in an increase in the RANKL/OPG ratio that indirectly favors osteoclast formation. CCN3 also directly induced osteoclast differentiation of RANKL-primer RAW 264.7 monocytes. CCN3 enhanced osteoclast differentiation through its ability to induce calcium mobilization and the subsequent nuclear translocation of NFATc1, a transcription factor essential for osteoclast differentiation. Immunohistochemical staining indicated that CCN3 is readily detectable, both in the breast tumor/stroma and in the majority of breast cancer bone metastasis samples.

Conclusion: Our data support a clinically relevant and important role for CCN3 in modulating the differentiation capacity of bone resident cells to support osteoclast formation and the formation of osteolytic bone metastases.

Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P6-07-01.

THE RELATIONSHIP BETWEEN BACTERIAL GROWTH AND PHAGE PRODUCTION

1. The effects of temperature and H-ion concentration on the reaction between antistaphylococcus phage and a susceptible staphylococcus have been studied. 2. The temperature optimum for phage production is in the neighborhood of 35°C. and that for bacterial growth is approximately 40°C. 3. With increasing H-ion concentrations there occur: (a) an increase in the lag phase of bacterial growth without any corresponding increase in the lag phase of phage production; (b) a diminution in the total bacterial population accumulating in the medium without any corresponding drop in the total amount of phage formed. 4. With increasing alkalinity there is no pronounced change in the curves of bacterial growth and phage formation. At pH 8.5 the lytic threshold is increased to about 1000 phage units per bacterium instead of 100–140 as is usually the case and the time of lysis is delayed. 5. By adjusting the medium to pH 6 and 28°C. bacterial growth can be completely inhibited while phage production continues at a rapid rate. 6. Apparently, the previously stressed importance of bacterial growth as the prime conditioning factor for phage formation does not hold, for under certain experimental conditions the two mechanisms can be dissociated.

Management of post-infectious olfactory dysfunction: a nationwide survey of UK ENT consultants

OBJECTIVE

To determine the current practice of UK ENT consultants in investigating cases of suspected post-infectious olfactory dysfunction.

METHOD

We prepared questionnaires and posted these to every consultant ENT surgeon registered with the British Association of Otolaryngologists Head and Neck Surgeons (BAO-HNS). Questions included preferred radiological investigation, smelling test and follow up.

RESULTS

A total of 510 questionnaires were sent, with a response rate of 51%. Most UK consultant ENT surgeons investigated suspected post-infectious olfactory dysfunction by performing either a CT (44%) or an MRI (29%) scan, but only 37% performed formal smell tests. Most consultant ENT surgeons (76%) decide not to follow up post-infectious olfactory dysfunction.

CONCLUSION

This study gives an indication that suspected post-infectious olfactory dysfunction is not investigated thoroughly in the United Kingdom, with only a minority of clinicians performing formal smell tests and a lack of consensus as to radiological investigation. Standardisation of investigations is key to adequately managing suspected post-infectious olfactory dysfunction.

An analysis of courtship behaviour in the four-eyed spotted turtle, Sacalia quadriocellata (Reptilia: Testudines: Geoemydidae)

Abstract

A total of 168 courtship sequences from 12 male and 18 female adult captive Sacalia quadriocellata were recorded on video. Thirty male and four female discrete motor patterns were defined and described. The behavioural sequences were summarized in an intra-individual dyadic transition matrix and analyzed using chi-square and kappa analyses. Courtship behaviour models and a flow diagram were constructed for this species. The male display patterns involved tactical and visual signals to induce female receptivity to mating. In response, females may emit olfactory signals for gender recognition. Female rejection of male suitors resulted in a male success rate of 4.17%. Only seven copulations were observed. Copulation only occurred when a female became quiescent and relaxed her tail for coition.

The emerging role of pituitary tumour transforming gene (PTTG) in endocrine tumourigenesis

It is now 10 years since PTTG was first cloned and isolated. Perhaps the major story of the intervening decade of work performed by numerous groups around the world is the sheer multifunctionality ascribed to this gene. PTTG has been implicated in mechanisms of gene transactivation, cell transformation, angiogenesis, metabolism, apoptosis, DNA repair, genetic instability and mitotic control, both in endocrine and non-endocrine settings. In the current review, we cast a critical eye over a decade of PTTG research within the field of endocrine neoplasia.

Infection in acute burn wounds following the Bali bombings: a comparative prospective audit

INTRODUCTION

Bacterial colonisation and invasive bacterial infection remain the major causes of mortality and morbidity following severe burn thus ongoing surveillance of patients and monitoring of infection facilitates early intervention to minimise the risk of sepsis. The circumstances of the Bali bombings in October 2002, provided an opportunity to analyse the ramifications of lengthy transfer times, delayed resuscitation and topical treatment, on the primary incidence of burn wound infection (BWI).

METHOD

This prospective clinical audit investigated the primary incidence of BWI between the usual burn patients admitted to the Burn Unit at Royal Perth Hospital, Western Australia, and a number of survivors from the Bali bombings during a 3-month audit period in 2002. BWI was identified using the Peck et al. proposed definitions for the surveillance of burn wound infections. These include impetigo, surgical wound related infection, cellulitis and invasive infection of unexcised wounds.

RESULTS

The incidence of primary BWI in the Bali-tourist group (68.2%) compared with the standard WA group (18.2%) was significant (p=0.001).

CONCLUSION

Sensitive assessment criteria allowed for early identification of wound infection. A clinically significant difference in the Bali-tourist group is probably related to the circumstances of their injury.

A silver coated dressing reduces the incidence of early burn wound cellulitis and associated costs of inpatient treatment: Comparative patient care audits

In 2000 and 2002, the Royal Perth Hospital (RPH) Burn Unit, Western Australia, conducted two 'before and after' patient care audits comparing the effectiveness and cost of Silvazine (silver sulphadiazine and chlorhexidine digluconate cream) and Acticoat, a new dressing product for in-patient treatment of early burn wounds. The main outcome variables were: burn wound cellulitis, antibiotic use and cost of treatment. Two patient care audits and a comparative sample were used. The two regimes audited were, 'standard treatment' of twice daily showers or washes with 4% chlorhexidine soap and Silvazine cream as a topical dressing (2000, n=51), compared with the 'new treatment' of daily showers of the burn wound with 4% chlorhexidine soap and the application of an Acticoat dressing (2002, n=19). In 2002, costs were also examined using a sample of matched pairs (n=8) of current and previous patients. The main findings were: when using Acticoat the incidence of infection and antibiotic use fell from 55% (28/51) and 57% (29/51) in 2000 to 10.5% (2/19) and 5.2% (1/19) in 2002. The total costs (excluding antibiotics, staffing and surgery) for those treated with Silvazine were US$ 109,357 and those treated with Acticoat were US$ 78,907, demonstrating a saving of US$ 30,450 with the new treatment. The average length of stay (LOS) in hospital was 17.25 days for the Silvazine group and 12.5 days for the Acticoat group-a difference of 4.75 days. These audits demonstrate that Acticoat results in a reduced incidence of burn wound cellulitis, antibiotic use and overall cost compared to Silvazine in the treatment of early burn wounds.