Genome wide association studies for carcass traits measured by video image analysis in crossbred lambs

This is the first UK genome wide association study investigating potential links between Video Image Analysis (VIA) carcass traits and molecular polymorphisms in crossbred sheep. Phenotypic and genotypic data were collected from two crossbred lamb populations: Texel x Scotch Mule (TxSM, n = 2330) and Texel x Lleyn (TxL, n = 3816). Traits measured included live weights at birth, eight weeks and weaning (∼15 weeks). VIA-predicted traits included total weights and weights of fat, muscle and bone in the whole carcass and primal (hind leg, saddle, shoulder) regions. Within-breed heritabilities estimated for the VIA traits ranged from 0.01 to 0.70, indicating potential for inclusion of some traits in breeding programmes. The two crossbred populations differed in SNPs associated with different traits. Two SNPs on chromosomes two (s74618.1) and eight (s68536.1), respectively, reached genome-wise significance for TxSM, explaining <1% of trait variance, for whole carcass fat and muscle weights, hind leg and saddle fat weights and shoulder bone weights. For TxL, four SNPs reached genome-wise significance, on chromosome two for hind leg muscle weight (OAR2_117,959,202 and OAR2_11804335), on chromosome 10 for whole carcass bone weight (OAR19_8,995,957.1), and on chromosome 19 for weaning weight (s40847.1), each explaining <1% of trait genetic variation. Differences in apparent genetic control of carcass traits may be influenced by the lambs' cross-breed, but also by management decisions affecting environmental variance and trait definitions, which should be understood in order to define protocols for incorporation of carcass traits into (cross)breeding programmes. IMPLICATIONS: Combining VIA-measured carcass traits with conventional production traits in a breeding programme could potentially improve the production and product quality of meat sheep. Phenotypes for VIA traits could be collected relatively easily if VIA machines were present at all abattoir sites. The current study and future Genome Wide Association Studies may help to identify potentially informative molecular markers, that explain large proportions of the genetic variance observed in VIA-measured carcass traits. Including this information in the estimation of breeding values could increase the accuracy of prediction, increasing the potential rate of genetic improvement for product quality. This study confirms the polygenic architecture of the investigated carcass traits, with a small number of molecular markers that each explain a small amount of genetic variation. Further studies across breed types are recommended to further test and validate molecular markers for traits related to lamb carcass quality, as measured by video image analysis.

Surgical outcomes of the surgical techniques following management of iatrogenic trigeminal nerve injuries: A systematic review

Objective

To investigate the effectiveness of the microsurgical treatment in restoring full sensory recovery following trigeminal nerve injuries caused by iatrogenic oral and maxillofacial surgical interventions.

Methods

A detailed search was conducted on the Cochrane central register of controlled trials, Medline and Embase. Clinical studies with at least twelve months of follow up were included and assessment of risks of bias was made using the Robbin I assessment tool.

Results

Six studies were identified in the searches which include 227 patients. The lingual nerve was the most common injured nerve, followed by the inferior alveolar nerve. Third molar removal was the most frequent cause of nerve injury, followed by root canal treatment, pathology excision, coronectomy, orthognathic surgery, dental implants and then local anaesthetic injections. Overall, surgical interventions for nerve injuries showed neurosensory improvement postoperatively in the majority of patients.

Conclusion

Direct neurorrhaphy is still the gold-standard technique when the tension at the surgical site is minimal. Promising results have been noted on conduit applications following traditional repair or grafting. Further research is needed on the efficacy of allografting and conduit applications in nerve repair.

Genome-wide association study of health and production traits in meat sheep

Genotypes are currently widely used in animal breeding programmes to enhance the speed of genetic progress. With sufficient data, a Genome-Wide Association Study (GWAS) can be performed to identify informative markers. The aim of this study was to investigate the genetic background of health (footrot and mastitis) and production (birth weight, weaning weight, scan weight, and fat and muscle depth) traits using the available phenotypic and Single Nucleotide Polymorphism (SNP) data collected on the UK Texel sheep population. Initially, 10 193 genotypes were subject to quality control, leaving 9 505 genotypes for further analysis. Selected genotypes, recorded on four different Illumina chip types from low density (15 k SNPs) to high density (606 006 SNPs), were imputed to a subset of 45 686 markers from 50 k array, distributed on 27 chromosomes. Phenotypes collected on 32 farms across the UK for footrot and mastitis and extracted from the UK National database (iTexel) for the production traits were used along with pre-estimated variance components to obtain de-regressed breeding values and used to perform GWAS. Results showed three SNPs being significant on the genome-wise level ('OAR8_62240378.1' on chromosome 8 for birth weight, 's14444.1' on chromosome 19 for weaning weight and 's65197.1' on chromosome 23 for scan weight). Fourteen subsequent SNPs were found to be significant at the chromosome-wise level. These SNPs are located within or close to previously reported QTLs impacting on animal health (such as faecal egg count or somatic cell count) and production (such as body or carcass weight and fat amount). These results indicate that the studied traits are highly polygenic with complex genetic architecture.

The Use of Hydroxyapatite Loaded with Doxycycline (HADOX) in Dentoalveolar Surgery as a Risk-Reduction Therapeutic Protocol in Subjects Treated with Different Bisphosphonate Dosages

Medication-related osteonecrosis of the jaw (MRONJ) is considered as a severe adverse side effect of specific drugs such as anti-resorptive and anti-angiogenic medications. Evidence suggests that MRONJ is linked to invasive dental procedures, mainly dentoalveolar surgery. Several preventive strategies to minimize the risk of developing MRONJ have been investigated. However, no investigation has been attempted to evaluate the therapeutic effect of local drug-delivery technology as a preventive strategy protocol. The aim of this study is to evaluate the efficacy of hydroxyapatite-containing doxycycline (HADOX) in rats with high-risk MRONJ development. All the rats used in this study were divided into seven groups. Six groups of rats out of seven were exposed to two different doses of antiresorptive drug therapy for four weeks before undergoing an upper incisor extraction. After 28 days, all the animals were euthanized, and the bone blocks were processed for histological and histomorphometrical evaluation. The histomorphometric analysis confirmed that newly formed bone (NFB) was present in all groups, with significant differences. NFB in the HADOX group treated with zoledronic acid at 4% showed (28.38; C.I. 22.29-34.48), which represents a significant increase compared to HA (15.69; C.I. 4.89-26.48) (p = 0.02). A similar pattern was observed in the HADOX group treated with zoledronic acid 8% ZA treatment (p = 0.001). Conclusions: HADOX did not inhibit any bone repair and reduced early inflammatory response. Hence, HADOX could promote bone healing in patients undergoing antiresorptive drug therapy.

Virtual and augmented reality in dental education: The good, the bad and the better

INTRODUCTION

Virtual reality and augmented reality (VR/AR) are becoming established technologies with a wide range of possibilities in various academic fields, including dentistry. The practice of dentistry encompasses a spectrum of skills and knowledge of anatomy, complex technical and clinical skills and sound academic understanding. This review aims to scope the current use of these technologies in dental education, explore their impact on teaching and learning and envisage their potential in this field.

MATERIALS AND METHODS

The Cochrane Library, PubMed and EMBASE were searched. Cochrane Handbook was used to conduct this systematic review. Inclusion and exclusion criteria were applied; randomised control trials published in English in the last 10 years (2010-2020) were considered and screened independently by two authors.

RESULTS

Fourteen of 524 studies were included and assessed. The majority of articles describing the use of VR/AR focused on an Undergraduate/General Dental Practitioner audience. Its use in Oral and Maxillofacial Surgery, Endodontics and Restorative dentistry was also described. There is evidence of motor skill acquisition using these systems which is comparative to that of traditional methods.

CONCLUSION

The use of VR/AR is well established in dental education; most applications relate to undergraduate education as a useful adjunct to dental training. In this article, the breadth of learning in dental education using VR/AR was exploited providing an overview to aid dental education. VR/AR is a useful adjunct to conventional learning in dentistry. However, there are limitations preventing VR/AR widespread use and applications, such as lack of trials, standardisation and accreditation of systems/content.

Evaluation of prognostic risk models for postoperative pulmonary complications in adult patients undergoing major abdominal surgery: a systematic review and international external validation cohort study

BACKGROUND

Stratifying risk of postoperative pulmonary complications after major abdominal surgery allows clinicians to modify risk through targeted interventions and enhanced monitoring. In this study, we aimed to identify and validate prognostic models against a new consensus definition of postoperative pulmonary complications.

METHODS

We did a systematic review and international external validation cohort study. The systematic review was done in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched MEDLINE and Embase on March 1, 2020, for articles published in English that reported on risk prediction models for postoperative pulmonary complications following abdominal surgery. External validation of existing models was done within a prospective international cohort study of adult patients (≥18 years) undergoing major abdominal surgery. Data were collected between Jan 1, 2019, and April 30, 2019, in the UK, Ireland, and Australia. Discriminative ability and prognostic accuracy summary statistics were compared between models for the 30-day postoperative pulmonary complication rate as defined by the Standardised Endpoints in Perioperative Medicine Core Outcome Measures in Perioperative and Anaesthetic Care (StEP-COMPAC). Model performance was compared using the area under the receiver operating characteristic curve (AUROCC).

FINDINGS

In total, we identified 2903 records from our literature search; of which, 2514 (86·6%) unique records were screened, 121 (4·8%) of 2514 full texts were assessed for eligibility, and 29 unique prognostic models were identified. Nine (31·0%) of 29 models had score development reported only, 19 (65·5%) had undergone internal validation, and only four (13·8%) had been externally validated. Data to validate six eligible models were collected in the international external validation cohort study. Data from 11 591 patients were available, with an overall postoperative pulmonary complication rate of 7·8% (n=903). None of the six models showed good discrimination (defined as AUROCC ≥0·70) for identifying postoperative pulmonary complications, with the Assess Respiratory Risk in Surgical Patients in Catalonia score showing the best discrimination (AUROCC 0·700 [95% CI 0·683-0·717]).

INTERPRETATION

In the pre-COVID-19 pandemic data, variability in the risk of pulmonary complications (StEP-COMPAC definition) following major abdominal surgery was poorly described by existing prognostication tools. To improve surgical safety during the COVID-19 pandemic recovery and beyond, novel risk stratification tools are required.

FUNDING

British Journal of Surgery Society.

Effect of Different Solutions on the Colour Stability of Nanoparticles or Fibre Reinforced PMMA

This study aimed to evaluate the colour stability of polymethyl methacrylate (PMMA) denture base reinforced with ZrO2 nanoparticles, E-glass fibres, and TiO2 nanoparticles at various concentrations over 180-day storage in Steradent™ (STD) denture cleaner or coffee (CF). A total of 130 disc-shaped specimens were fabricated at various filler concentrations and divided into four main groups to measure the colour changes. Groups Z, T, and E consisted of PMMA reinforced with ZrO2 nanoparticles, TiO2 nanoparticles, or E-glass fibre, respectively, while Group C consisted of PMMA specimens without filler served as the control group (n = 10). The three reinforced groups were further subdivided according to the filler content (n = 10) added to the PMMA (1.5%, 3.0%, 5.0%, and 7.0% wt.%). Half of the specimens were stored in STD, while the other half was stored in CF for 180 days. A Minolta Chroma Meter was used to measure the colour changes (ΔE) at 7, 30, 90 and then 180 days. The results were assessed using two-way repeated-measures analysis of variance (RM-ANOVA) along with Bonferroni post hoc tests at a p ≤ 0.05 significance level. Significant different colour changes (ΔΕ) were observed between all tested groups and across different time points. TiO2-reinforced PMMA in coffee showed the lowest colour stability, while the E-glass fibre-reinforced PMMA in STD/CF showed the highest colour stability. Furthermore, coffee appeared to have the greatest impact on the CF change in comparison to the STD/CF. The results indicated that the filler type and concentration, type of solution, and length of storage all affected the colour stability of the tested specimens.

Discovery of hidden pedigree errors combining genomic information with the genomic relationship matrix in Texel sheep

Genomic variants such as Single Nucleotide Polymorphisms and animal pedigree are now used widely in routine genetic evaluations of livestock in many countries. The use of genomic information not only can be used to enhance the accuracy of prediction but also to verify pedigrees for animals that are extensively managed using natural mating and enabling multiple-sire mating groups to be used. By so doing, the rate of genetic gain is enhanced, and any bias associated with incorrect pedigrees is removed. This study used a set of 8 764 sheep genotypes to verify the pedigree based on both the conventional opposing homozygote method as well as a novel method when combined with the inclusion of the genomic relationship matrix (GRM). The genomic relationship coefficients between verified pairs of animals showed on average a relationship of 0.50 with parent, 0.25 with grandparent, 0.13 with great grandparent, 0.50 with full-sibling and 0.27 with half-sibling. Minimum obtained values from these verified pairs were then used as thresholds to determine the pedigree for unverified pairs of animals, to detect potential errors in the pedigree. Using a case study from a population partially genotyped UK sheep, the results from this study illustrate a powerful way to resolve parentage inconsistencies, when combining the conventional 'opposing homozygote' method using genomic information together with GRM for pedigree checking. In this way, previously undetected pedigree errors can be resolved.

Systematic review of medication related osteonecrosis of the jaw (MRONJ) in patients undergoing only antiangiogenic drug therapy: surgery or conservative therapy?

Osteonecrosis of the jaw is a severe adverse condition affecting patients exposed to specific types of medications. Previous studies have highlighted that osteonecrosis of the jaw is triggered by invasive dental procedures and can be very challenging to manage, especially in patients with cancer. The primary aim of this review was to analyse all available evidence on the management (surgical and/or conservative) of medication related osteonecrosis of the jaws (MRONJ) in patients with a history of antiangiogenic drugs therapy and who had not been previously exposed to any antiresorptive drug treatments. A multi-database search (PubMed, MEDLINE, EMBASE and CINAHL) was performed to identify related multi-language papers published from January 2003 until November 2020. Data were extracted from relevant papers and analysed according to the outcomes selected in this review. The search generated 28 studies eligible for the analysis. The total number of patients included in the analysis was 36. Sixteen patients were treated with anti-vascular endothelial growth factor drugs (anti-VEGF) while the remaining patients were administered a combination of antiangiogenic drugs. The most common MRONJ site was the mandible in 29 patients. MRONJ recurrence after treatment was only reported in six patients, the majority of which were treated conservatively. The data reviewed confirmed that an invasive procedure was the most common trigger of MRONJ with relatively high frequency of postoperative recurrence following treatment. However, due to the low quality of available research in the literature, it is difficult to draw a definitive conclusion on the validity of the presented treatment to manage patients affected by MRONJ associated with angiogenic therapy.

Assessment of dental anxiety using modified dental anxiety scale among adults with cleft lip and/or palate

Objectives

This study aimed to investigate dental anxiety levels among adults with cleft lip and/or palate (CL/P) and compare to adults with no orofacial cleft. The study also intended to find out the impact of cleft severity, gender and age on the perceived dental anxiety.

Methods

The study was composed of a sample of 70 adult participants who received and completed dental treatments. After sending self-addressed envelopes with consent forms and Modified Dental Anxiety Scale (MDAS) to 192 potential participants, 35 participants with CL/P (CL/P group) and 35 participants with no CL/P (control group), agreed to participate. Data were analysed using Mann-Whitney U test. A two-tailed P-value < 0.05 was considered as statistically significant.

Results

54.3% of adults with CL/P (23 females and 12 males, age range from 16 to 72 years) reported normal dental anxiety, while the remaining 45.7% reported moderate dental anxiety. No extreme dental anxiety were recorded in the CL/P group. These results were similar to the control group and there were no significant differences between groups (p > 0.05). Female participants recorded higher median anxiety scores than male participants in the CL/P group, and participants with cleft lip had higher median scores than participants with cleft lip and palate. However, these were not statistically significant.

Conclusion

The results suggest that CL/P did not affect dental anxiety levels for participants with the CL/P as there were no extreme cases and their results were comparable to a general non-cleft sample.

Behaviour of PMMA Resin Composites Incorporated with Nanoparticles or Fibre following Prolonged Water Storage

When PMMA denture base acrylics are exposed to oral environments for prolonged periods, the denture base absorbs water, which has a negative influence on the denture material and the degree to which the denture base will be clinically effective. This study assessed the water sorption, desorption, and hygroscopic expansion processes within PMMA denture-base resins reinforced with nanoparticles or fibre in comparison to the non-reinforced PMMA. The surfaces of the fillers were modified using a silane coupling agent (y-MPS) before mixing with PMMA. Group C consisted of specimens of pure PMMA whereas groups Z, T, and E consisted of PMMA specimens reinforced with ZrO₂, TiO₂ nanoparticles, or E-glass fibre, respectively. The reinforced groups were subdivided into four subgroups according to the percentage filler added to the PMMA resin by weight (1.5%, 3.0%, 5.0%, or 7.0%). Five specimens in disc shape (25 ± 1 mm × 2.0 ± 0.2 mm) were tested for each group. To assess water sorption and hygroscopic expansion, specimens from each group were individually immersed in water at 37 ± 1 °C for 180 days. The samples were then desorbed for 28 days at 37 ± 1 °C, to measure solubility. Water sorption and solubility were calculated using an electronic balance in accordance with ISO Standard 20795-1, and hygroscopic expansion was measured using a laser micrometre. Statistical analysis was undertaken at a p ≤ 0.05 significance level using a one-way ANOVA followed by Tukey post-hoc tests. The results demonstrated that the values of sorption (W_sp), mass sorption (M_s%), and % expansion within the tested groups reached equilibrium within 180 days. A noticeable difference was observed in groups Z and E for (W_sp)/(M_s%) compared to the Group C, but this was not significant. However, the difference between Group C and Group T for these measurements was significant. Non-significant differences also existed between each respective reinforced group and the control group in terms of hygroscopic expansion % values. During the 28-day desorption period, there were no differences in the values of solubility (W_sl)/mass desorption (M_d%) between Group C and each of the reinforced tested groups. The findings indicate that the inclusion of ZrO₂ nanoparticles or E-glass fibres does not increase the water solubility/sorption of the PMMA. However, modifying the PMMA with TiO₂ did significantly increase the water sorption level.

Dental extractions in primary care for patients at risk of MRONJ

Aims This study aims to understand the experiences of general dental practitioners (GDPs) performing dental extractions for patients at risk of developing medication-related osteonecrosis of the jaw (MRONJ) and to identify the key features of the patients who are referred to secondary care for their extractions.Materials and methods A mixed-method study consisting of quantitative analysis of anonymised electronic referrals and thematic analysis of in-depth telephone interviews with GDPs.Results In total, 122 electronic referrals for patients at risk of MRONJ were identified. The majority of the referrals contained insufficient information to categorise the patient's risk of developing MRONJ. In-depth telephone interviews with six GDPs were analysed and the themes identified were consequences, difficult decisions, patient awareness and bridging the gap.Conclusion Our results show that fewer than half of the referrals to secondary care investigated in this study showed a clear indication for secondary care involvement and the quality of the patient information provided was often insufficient to determine the patients' risk of developing MRONJ. Improved local guidance for the management of these patients and a dedicated pathway for their post-operative complications may encourage GDPs to perform more of these dental extractions in practice.

Evaluation of Oral Health-related Quality of Life for Adult Individuals with Cleft Lip and/or Palate Using OHIP-49 and Compared with a Control Group: A Cross-Sectional Study

Objectives:

This study aimed at evaluating oral health-related quality of life (OHRQoL) among adults with cleft lip and/or palate (CL/P) and compared it with adults with no orofacial cleft. The study also intended to find out the impact of cleft severity, gender, and age on the perceived OHRQoL.

Materials and Methods:

The study was composed of a sample of 70 adult participants who received and completed dental treatments: 35 participants with CL/P (CL/P group) and 35 participants with no orofacial cleft (control group) agreed to participate. Each participant completed the Oral Health Impact Profile (OHIP-49) with no missing data. The OHIP-49 data were analyzed using the Mann–Whitney U test, and a P-value <0.05 was considered as statistically significant.

Results:

Adults with CL/P reported higher scores in all the seven subscales of the OHIP-49. These results were statistically significant in physical disability (mean scores of 1.22, p = 0.017) and social disability (mean scores of 0.93, p = 0.046). Females with CL/P recorded better OHRQoL in the handicap domain (p = 0.026). Participants with cleft lip only recorded better OHRQoL compared with those with cleft lip and palate, and that was statistically significant at both the functional limitation (p = 0.003) and the physical pain (p = 0.046). There was a significant positive correlation between increasing age and functional limitation (p = 0.025).

Conclusion:

CL/P negatively affected OHRQoL for adults with CL/P mainly on physical and social disabilities of OHIP-49 when compared with a general non-cleft sample.

A Systematic Review and Meta-Analysis of Complications Associated With Autogenous Diced Cartilage Wrapped in Fascia Used in Nasal Dorsum Augmentation

BACKGROUND

Nasal dorsum augmentation is a highly challenging rhinoplastic procedure. Problems encountered in this surgery, such as residual humps, irregularities, and asymmetry, account for a significant number of revision rhinoplasties.

OBJECTIVES

The aim of this meta-analysis was to assess complication rates and graft harvesting site morbidity and revision rates.

METHODS

We carried out a systematic review of the literature for pertinent materials in PubMed/Medline and Google Scholar up to and including August 2020. In addition, the reference list of included studies was searched manually. The criteria used were those described in the PRISMA Declaration for performing systematic reviews.

RESULTS

The initial search yielded 236 results. After 3 stages of screening, 16 papers (18 groups) were included in the systematic review and meta-analysis. Our results indicated that the total rates for the complications studied were as follows: graft resorption, 2.52%; insufficient augmentation, 3.93%; deviation (graft displacement), 1.77%; infection, 2.30%; irregularity, 1.36%; supra-tip depression, 1.13%; overcorrection, 3.06%; hematoma at recipient site, 1.36%; and visible bulging of the graft, 2.64%. The total rates for donor site hypertrophic scar and donor site hematoma were 2.64% and 3.58%, respectively. The rate of the revision surgery was 3.03%.

CONCLUSIONS

Current findings suggest the overall complications and revision rates with the use of diced cartilage wrapped in fascia for dorsum augmentation were relatively low and this technique is a reliable treatment choice for patients with primary/secondary dorsum deficiencies. Further studies with larger sample sizes and long-term follow-ups, clearer definitions of complications, and objective measurements are warranted to draw reliable practical conclusions.

LEVEL OF EVIDENCE: 4

Assessing Fracture Toughness and Impact Strength of PMMA Reinforced with Nano-Particles and Fibre as Advanced Denture Base Materials

Statement of Problem: Polymethyl methacrylate (PMMA) denture resins commonly fracture as a result of the denture being dropped or when in use due to heavy occlusal forces. Purpose: To investigate the effects of E-glass fibre, ZrO₂ and TiO₂ nanoparticles at different concentrations on the fracture toughness and impact strength of PMMA denture base. Materials and Methods: To evaluate fracture toughness (dimensions: 40 × 8 × 4 mm³; n = 10/group) and impact strength (dimensions: 80 × 10 × 4 mm³; n = 12/group), 286 rectangular tested specimens were prepared and divided into four groups. Group C consisted of the PMMA specimens without any filler (control group), while the specimens in the remaining three groups varied according to the concentration of three filler materials by weight of PMMA resin: 1.5%, 3%, 5%, and 7%. Three-point bending and Charpy impact tests were conducted to measure the fracture toughness and impact strength respectively. Scanning Electron Microscope (SEM) was utilised to examine the fractured surfaces of the specimens after the fracture toughness test. One-way analysis of variance (ANOVA) followed by Tukey post-hoc tests were employed to analyse the results at a p ≤ 0.05 significance level. Results: Fracture toughness of groups with 1.5 and 3 wt.% ZrO₂, 1.5 wt.% TiO₂, and all E-glass fibre concentrations were significantly higher (p < 0.05) than the control group. The samples reinforced with 3 wt.% ZrO₂ exhibited the highest fracture toughness. Those reinforced with a 3 wt.%, 5 wt.%, and 7 wt.% of E-glass fibres had a significantly (p < 0.05) higher impact strength than the specimens in the control group. The heat-cured PMMA modified with either ZrO₂ or TiO₂ nanoparticles did not exhibit a statistically significant difference in impact strength (p > 0.05) in comparison to the control group. Conclusions: 1.5 wt.%, 3 wt.% of ZrO₂; 1.5 wt.% ratios of TiO₂; and 1.5 wt.%, 3 wt.%, 5 wt.%, and 7 wt.% of E-glass fibre can effectively enhance the fracture toughness of PMMA. The inclusion of E-glass fibres does significantly improve impact strength, while ZrO₂ or TiO₂ nanoparticles did not.

Chemical Characterisation of Silanised Zirconia Nanoparticles and Their Effects on the Properties of PMMA-Zirconia Nanocomposites

Objectives: The objective of this study was to investigate the mechanical properties of high-impact (HI) heat-cured acrylic resin (PMMA) reinforced with silane-treated zirconia nanoparticles. Methods: Forty-five PMMA specimens reinforced with zirconia were fabricated and divided into three groups: Pure HI PMMA (control group), PMMA reinforced with 3 wt.% of non-silanised zirconia nanoparticles and PMMA reinforced with 3 wt.% of silanised zirconia nanoparticles. Silanised and non-silanised zirconia nanoparticles were analysed with Fourier Transform Infrared (FTIR) Spectroscopy. For measuring the flexural modulus and strength, a Zwick universal tester was used, and for surface hardness, a Vickers hardness tester were used. Furthermore, raw materials and fractured surfaces were analysed using Scanning Electron Microscopy (SEM). A one-way ANOVA test followed by a post-hoc Bonferroni test was employed to analyse the data. Results: The results showed that the mean values for flexural strength (83.5 ± 6.2 MPa) and surface hardness (20.1 ± 2.3 kg/mm²) of the group containing 3 wt.% treated zirconia increased significantly (p < 0.05) in comparison to the specimens in the group containing non-treated zirconia (59.9 ± 7.1 MPa; 15.0 ± 0.2 kg/mm²) and the control group (72.4 ± 8.6 MPa; 17.1 ± 0.9 kg/mm²). However, the group with silanised zirconia showed an increase in flexural modulus (2313 ± 161 MPa) but was not significantly different (p > 0.05) from the non-silanised group (2207 ± 252 MPa) and the control group (1971 ± 235 MPa). Conclusion: Silane-treated zirconia nano-filler improves the surface hardness and flexural strength of HI PMMA-zirconia nanocomposites, giving a potentially longer service life of the denture base.

116 Patient Long Stay in the Manchester Centre for Clinical Neurosciences Complex Spines Department: Numbers, Reasons, and Recommendations

Patient long-stay is one of the main causes of inefficient resource management in the National Health Service. Similarly, delays in treatment and access to social care contributes to the trust’s economic burden but also causes a significant delay in care for society's most vulnerable.

A single-centre evaluation of patient long stay was performed in a tertiary spinal unit in Greater Manchester. The top 50 patients who stayed the longest in an acute spinal bed between 2018 and 2019 were selected for analysis. Demographics, indication for transfer from another trust, overall length of stay, and the main reasons for such were evaluated.

Of the 50 assessed, there was an average length of stay of 46.9 days and the majority were comprised of patients with metastatic spinal cord compression. 74% had delays to surgery due to poor medical optimisation pre-transfer.

41% remained as an inpatient longer than necessary due to non-medical concerns. The main reasons included awaiting placement in a rehabilitation facility, social care issues and delays in repatriation back to their referring trust for ongoing care.

Delays in treatment and length of stay were found to be increased in patients who were poorly optimised pre-operatively and who required complex social and medical care post-operatively.

The role of antiresorptive drugs and medication-related osteonecrosis of the jaw in nononcologic immunosuppressed patients: A systematic review

Medication related osteonecrosis of the jaw (MRONJ) is a severe condition affecting the jaws of patients exposed to specific drugs, and is primarily described in patients receiving bisphosphonate (BP) therapy. However, more recently it has been observed in patients taking other medications, such as the RANK ligand inhibitor (denosumab) and antiangiogenic drugs. It has been proposed that the existence of other concomitant medical conditions may increase the incidence of MRONJ. The primary aim of this research was to analyze all available evidence and evaluate the reported outcomes of osteonecrosis of the jaws (ONJ) due to antiresorptive drugs in immunosuppressed patients. A multi-database (PubMed, MEDLINE, EMBASE and CINAHL) systematic search was performed. The search generated twenty-seven studies eligible for the analysis. The total number of patients included in the analysis was two hundred and six. All patients were deemed to have some form of immunosuppression, with some patients having more than one disorder contributing to their immunosuppression. Within this cohort the commonest trigger for MRONJ was a dental extraction (n=197). MRONJ complications and recurrence after treatment was sparsely reported in the literature, however a total of fourteen cases were observed. The data reviewed have confirmed that an invasive procedure is the commonest trigger of MRONJ with relatively high frequency of post-operative complications or recurrence following management. However, due to low-quality research available in the literature it is difficult to draw a definitive conclusion on the outcomes analysed in this systematic review.

Association Between Periodontal Disease and Atherosclerotic Cardiovascular Diseases: Revisited

Atherosclerotic cardiovascular disease (ACVD) is an inflammatory disease of the coronary arteries associated with atheroma formation, which can cause disability and often death. Periodontitis is ranked as the sixth most prevalent disease affecting humans affecting 740 million people worldwide. In the last few decades, researchers have focused on the effect of periodontal disease (PD) on cardiovascular disease. The aim of this review was to investigate the association between these two diseases. PD is a potential risk factor that may initiate the development, maturation, and instability of atheroma in the arteries. Two mechanisms were proposed to explain such association, either periodontal pathogens directly invade bloodstream or indirectly by increasing systemic level of inflammatory mediators. Interestingly, it has been suggested that improvement in the condition of one disease positively impact the condition of the other one. Highlighting the association between these two diseases, the importance of early diagnosis and treatment of PD and its impact on cardiovascular status may be of great value in reducing the complications associated with ACVDs. Further in vitro and in vivo studies with longer follow up are necessary to confirm the causal relationship between PD and ACVDs.

A systematic review of metastatic cancer presenting in osteonecrosis of the jaws (MC-ONJ) in patients undergoing antiresorptive and/or antiangiogenic therapy for skeletal-related adverse events

INTRODUCTION

Osteonecrosis of the jaw (ONJ) is reported to be primarily associated with patients receiving bisphosphonate therapies but has been found in patients taking a number of other medications. A number of recent reports have noted the presence of metastatic cancers in the histologic analysis of osteonecrotic lesions from the jaw. The aim of the present review is to estimate the frequency and the type of metastatic cancer most commonly found in ONJ specimens in patients undergoing antiresorptive and/or antiangiogenic drug therapy.

MATERIAL AND METHODS

A multidatabase (PubMed, MEDLINE, EMBASE, and CINAHL) systematic search was performed. Any studies involving human participants treated with antiresorptive and antiangiogenic drugs were considered. Where study patients presented with malignant cells within osteonecrotic specimens, further data were collected. Data are presented using descriptive statistics.

RESULTS

A total of 13 studies met the inclusion criteria for this systematic review. Thirty-seven study patients had histologic evidence of malignant cells within medication-related osteonecrosis of the jaw (MRONJ) specimens. The most frequent phenotype of malignant cells found within MRONJ specimens were breast cancer variants (n = 15). The frequency of malignant tumor cells found within the MRONJ specimens was calculated using 4 studies. Out of 604 patients, the frequency was 4.64% (n = 28).

CONCLUSIONS

Based on the limited data available in the literature, it is plausible that not histologically analyzing all ONJ specimens could result in a small number of undiagnosed and untreated malignant diseases. Additional data based on a larger cohort of study patients is necessary to understand the role of MRONJ in metastatic spread and the influence of surgical treatment and reoccurrence.

Zygomatic implants placed in atrophic maxilla: an overview of current systematic reviews and meta-analysis

BACKGROUND

Zygomatic implants are a treatment option for severely atrophic maxilla.

MAIN TEXT

This study aimed to summarize and evaluate systematic reviews assessing the clinical outcomes of zygomatic implants including survival/failure rate and complications. PubMed-MEDLINE, Google Scholar, LILACS, and the Cochrane Database were searched up to April 2020. Risk of bias assessment was conducted by the AMSTAR tool. Initial searches yielded 175 studies. These were assessed, and following title abstract and full-text evaluation, 7 studies (2 meta-analyses) were included in the final review. According to the AMSTAR tool, 1 was deemed high quality, 4 were classified as medium, and 2 as low quality. The mean AMSTAR score (±SD) was 5.28 of 9 (±2.36) ranging from 2/9 to 9/9. The reported survival rates ranged from 95.2 to 100% except for resected maxillas, which established higher failure rates up to 21.43%. Concerning the complications with the zygomatic implants, various surgical and prosthetic complications were reported with sinusitis being the most frequently observed complication. Zygomatic implants appears to offer a promising alternative to formal bone grafting techniques with lower costs, less complications, less morbidity, shorter treatment times, and comparably high survival rates.

CONCLUSION

Complications were rare and usually easy to manage. However, the treatment should be directed by appropriately trained clinicians with noticeable surgical experience.

Assessing Tensile Bond Strength Between Denture Teeth and Nano-Zirconia Impregnated PMMA Denture Base

Purpose

This study evaluated tensile bond strength (TBS) between anterior acrylic teeth and denture bases made of high-impact heat-cured acrylic resin (HI PMMA) impregnated with zirconia nanoparticles.

Materials and Methods

A total of 30 specimens (each specimen containing a set of six upper anterior teeth) were fabricated from HI PMMA denture base acrylic resin reinforced with different weight concentrations of zirconia nanoparticles: 0% (control), 1.5%, 3%, 5%, 7% and 10%. TBS was tested according to a British standard (BS EN ISO 22112: 2017). A one-way analysis of variance (ANOVA) was employed with a Tukey post-hoc test.

Results

TBS values between the anterior teeth (central and lateral incisors and canine) and HI-PMMA denture base groups containing 7 wt.% (261.5 ± 66.0 N, 172.5 ± 57.4 N and 271.9 ± 86.3 N) and 10 wt.% (332.1 ± 122.9 N, 165.4 ± 48.7 N and 301.6 ± 73.2 N) zirconia were significantly lower compared to the control group (645.4 ± 84.8 N, 306.1 ± 81.6 N and 496.7 ± 179.1 N) and the other nanocomposite groups. However, TBS values for HI PMMA with 1.5 wt.% (534.4 ± 115.3 N, 304.7 ± 86.4 N, 514.0 ± 143.2 N), 3 wt.% (685.7 ± 159.6 N, 281.1 ± 78.3 N, 462.6 ± 122.1 N) and 5 wt.% (514.5 ± 134.3 N, 229.8 ± 67.3 N, 387.2 ± 99.4 N) zirconia showed slightly lower values than that of the control group but these were not significant. Failure modes between the teeth and denture base nanocomposites were predominantly cohesive fractures, which were clinically acceptable according to the Standard.

Conclusion

The addition of zirconia nanoparticles to HI PMMA denture base at high concentration (7 wt.% and 10 wt. %) significantly (p<0.05) reduced the bonding strength for all types of anterior teeth compared to the control group.

(Sub)stellar companions shape the winds of evolved stars

Binary interactions dominate the evolution of massive stars, but their role is less clear for low- and intermediate-mass stars. The evolution of a spherical wind from an asymptotic giant branch (AGB) star into a nonspherical planetary nebula (PN) could be due to binary interactions. We observed a sample of AGB stars with the Atacama Large Millimeter/submillimeter Array (ALMA) and found that their winds exhibit distinct nonspherical geometries with morphological similarities to planetary nebulae (PNe). We infer that the same physics shapes both AGB winds and PNe; additionally, the morphology and AGB mass-loss rate are correlated. These characteristics can be explained by binary interaction. We propose an evolutionary scenario for AGB morphologies that is consistent with observed phenomena in AGB stars and PNe.

Long-Term Sorption and Solubility of Zirconia-Impregnated PMMA Nanocomposite in Water and Artificial Saliva

Exposure of denture base acrylic resins to the oral environment and storage media for extended periods of time results in sorption of saliva or water, leading to a reduction in physical properties and thus clinical service life. The purpose of this in vitro study was to assess the sorption and solubility of high-impact heat-polymerised denture base acrylic resin (HI PMMA) impregnated with zirconia nanoparticles after being stored for 180 days in distilled water (DW) and artificial saliva (AS). The specimens were divided into six groups for each storage medium, according to the concentration of zirconia nanoparticles (0, 1.5, 3.0, 5.0, 7.0, and 10.0 wt.%). Data were statistically analysed for sorption and solubility using one-way and two-way ANOVA statistical tests. Sorption in DW and AS for all groups containing zirconia showed sorption values lower than the control group at 90 days, though not significantly different (p > 0.05) compared to the control group. For both the DW and AS groups, the lowest solubility value was measured in the group containing 3 wt.% zirconia, however, there was no significant difference compared to the control group except when observing 10 wt.% zirconia in AS, which showed a significantly higher solubility (p < 0.05). High-impact PMMA, impregnated with low concentrations of ZrO₂, showed the lowest sorption and solubility in both media, but was not significantly different compared to pure HI PMMA.

Prediction of intramuscular fat in lamb by visible and near-infrared spectroscopy in an abattoir environment

The study used visible and near-infrared spectroscopy (Vis-NIR) in a large commercial processing plant, to test a system for meat quality (intramuscular fat; IMF) data collection within a supply chain for UK lamb meat. Crossbred Texel x Scotch Mule lambs (n = 220), finished on grass on 4 farms and slaughtered across 2 months, were processed through the abattoir and cutting plant and recorded using electronic identification. Vis-NIR scanning of the cut surface of the M. longissimus lumborum produced spectral data that predicted laboratory-measured IMF% with moderate accuracy (R² 0.38-0.48). Validation of the Vis-NIR prediction equations on an independent sample of 30 lambs slaughtered later in the season, provided similar accuracy of IMF prediction (R² 0.54). Values of IMF from four different laboratory tests were highly correlated with each other (r 0.82-0.95) and with Vis-NIR predicted IMF (r 0.66-0.75). Results suggest scope to collect lamb loin IMF data from a commercial UK abattoir, to sort cuts for different customers or to feed back to breeding programmes to improve meat quality.

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.

Investigating the Mechanical Properties of ZrO2-Impregnated PMMA Nanocomposite for Denture-Based Applications

Acrylic resin PMMA (poly-methyl methacrylate) is used in the manufacture of denture bases but its mechanical properties can be deficient in this role. This study investigated the mechanical properties (flexural strength, fracture toughness, impact strength, and hardness) and fracture behavior of a commercial, high impact (HI), heat-cured denture base acrylic resin impregnated with different concentrations of yttria-stabilized zirconia (ZrO₂) nanoparticles. Six groups were prepared having different wt% concentrations of ZrO₂ nanoparticles: 0% (control), 1.5%, 3%, 5%, 7%, and 10%, respectively. Flexural strength and flexural modulus were measured using a three-point bending test and surface hardness was evaluated using the Vickers hardness test. Fracture toughness and impact strength were evaluated using a single edge bending test and Charpy impact instrument. The fractured surfaces of impact test specimens were also observed using a scanning electron microscope (SEM). Statistical analyses were conducted on the data obtained from the experiments. The mean flexural strength of ZrO₂/PMMA nanocomposites (84 ± 6 MPa) at 3 wt% zirconia was significantly greater than that of the control group (72 ± 9 MPa) (p < 0.05). The mean flexural modulus was also significantly improved with different concentrations of zirconia when compared to the control group, with 5 wt% zirconia demonstrating the largest (23%) improvement. The mean fracture toughness increased in the group containing 5 wt% zirconia compared to the control group, but it was not significant. However, the median impact strength for all groups containing zirconia generally decreased when compared to the control group. Vickers hardness (HV) values significantly increased with an increase in ZrO₂ content, with the highest values obtained at 10 wt%, at 0 day (22.9 HV_0.05) in dry conditions when compared to the values obtained after immersing the specimens for seven days (18.4 HV_0.05) and 45 days (16.3 HV_0.05) in distilled water. Incorporation of ZrO₂ nanoparticles into high impact PMMA resin significantly improved flexural strength, flexural modulus, fracture toughness and surface hardness, with an optimum concentration of 3–5 wt% zirconia. However, the impact strength of the nanocomposites decreased, apart from the 5 wt% zirconia group.

Effect of mouthguard design on retention and potential issues arising with usability in sport

BACKGROUND/AIMS

Mouthguard retention could potentially increase an athlete's motivation to wear the device, due to potential improvements in physical comfort. The aim of this study was to examine the retentive properties of selected customised mouthguard designs, during normal conditions (dry) and within the presence of artificial saliva (wet). Additionally, the correlation between thickness and retention was investigated.

MATERIAL AND METHODS

Six different custom mouthguard designs (MG1-MG6) reported in previous studies, were pressure-formed with 2 and 4 mm blanks accordingly. Thickness was measured 10 times at seven anatomical points and the mean (±SD) was recorded. A novel rig was fabricated to connect the mouthguards to a Hounsfield H10KS Tensometer, which was used to fully displace each device from the model at a constant rate of 50 mm/min. The test was repeated under both dry and wet conditions.

RESULTS

Retention forces recorded at the anterior region demonstrated higher measurements under wet conditions than dry (P < 0.001). The total retention of the mouthguards was influenced by alterations in their design. Trend analysis indicated that 64% of MG retention could be explained by their thickness under dry conditions and 55% when wet.

CONCLUSIONS

Design and thickness of mouthguards are key factors in retention. Mouthguard fabrication techniques should be considered in order to minimize dislodgment of the devices as well as potentially increasing the wearability of mouthguards during sport.

Validation Of The HAS-BLED Tool In Atrial Fibrillation Patients Receiving Rivaroxaban

Background: Atrial fibrillation (Afib) patients are at an increased risk of stroke. Patients at moderate to high risk of stroke typically receive antithrombotics, placing them at an increased risk of bleeding. The HAS-BLED tool has been validated in Afib patients receiving warfarin for prediction of major bleeding events. Although HAS-BLED has been researched in patients receiving warfarin, this tool has not been validated with the novel anticoagulant rivaroxaban. Methods: The trial design was retrospective case-control approved by the Institutional Review Board at University of Tennessee Medical Center. Patients who were identified as having a bleeding event were cross-referenced with a list of patients receiving rivaroxaban. Inclusion criteria were adult patients with atrial fibrillation who were taking rivaroxaban for at least six months, with a CHA₂DS₂-VASc score greater than or equal to 2 OR CHADS₂ score greater than or equal to 1. The primary endpoint is the predictive ability of HAS-BLED as measured through the c-statistic. Secondary endpoints include correlation of HAS-BLED and bleeding risk. Results: After reviewing 9621 medical records, 15 patients met the inclusion criteria for major bleeding. Ninety patients were randomly selected for inclusion as the matched control group. The predictive ability of HAS-BLED was not statistically significant (c statistic = 0.68; p = 0.07), but did show some diagnostic ability to predict major bleeding events. Patients with major bleeding were more likely to have a history of bleeding and use concomitant antiplatelet agents. There were significantly more patients with a HAS-BLED score greater than or equal to 3 in the patients that experienced a major bleeding event. Conclusion: HAS-BLED demonstrated some diagnostic ability to predict major bleeding events in patients receiving rivaroxaban but this was not statistically significant due to limited sample size.