Thalamic feedback shapes brain responses evoked by cortical stimulation in mice and humans

Cortical stimulation with single pulses is a common technique in clinical practice and research. However, we still do not understand the extent to which it engages subcortical circuits which contribute to the associated evoked potentials (EPs). Here we find that cortical stimulation generates remarkably similar EPs in humans and mice, with a late component similarly modulated by the subject's behavioral state. We optogenetically dissect the underlying circuit in mice, demonstrating that the late component of these EPs is caused by a thalamic hyperpolarization and rebound. The magnitude of this late component correlates with the bursting frequency and synchronicity of thalamic neurons, modulated by the subject's behavioral state. A simulation of the thalamo-cortical circuit highlights that both intrinsic thalamic currents as well as cortical and thalamic GABAergic neurons contribute to this response profile. We conclude that the cortical stimulation engages cortico-thalamo-cortical circuits highly preserved across different species and stimulation modalities.

The oral health situation and treatment need of schoolchildren Afghanistan: a cross-sectional study

AIM

The present study explores the treatment need for dental caries in schoolchildren in Herat, Afghanistan.

METHODS

A convenience sample of 13 schools were selected for the study. All schools were located in the urban areas near Herat and were selected through allocation by the Ministry of Health, which also approved the study protocol. In the schools, classes were allocated by the principal of the school. All the children in the allocated classes were included in the survey. Data collection was performed in the school setting by trained Afghan dentist examiners. To measure caries experience, DMFT/dmft scores were used, counting the number of decayed (measured at both white spot (D≥1) and cavitation level (D≥3), according to WHO criteria), missing and filled teeth.

CONCLUSION

Dental caries is a considerable oral health problem in the study population. The present sample has a high proportion of untreated carious lesions and a very low level of restorative care. Moreover, significant differences were shown in relation to gender and age groups. The present survey results confirm the need for professional operative and preventive oral health care in this region.

Quality of life, walking ability and change of living situation after trochanteric femur fracture in geriatric patients-Comparison between sliding hip screw and cephalomedullary nails from the registry for geriatric trauma

BACKGROUND

There is no well-established gold standard for treating trochanteric femur fractures in the elderly. The two common treatment options are cephalomedullary nails (CMN) and sliding hip screws (SHS). In this study, treatment using CMN and SHS were compared for a cohort of patients older than 70 years of age: The main outcomes were quality of life and main residence after surgery.

METHODS

In this retrospective study we analyzed 24,919 patients from 100 hospitals, treated between 2016 and 2019 and documented in the Registry for Geriatric Trauma. The impact of CMN vs. SHS on the walking ability, quality of life (QoL), living situation, mortality, and revision rate were analyzed. To analyze the change of the living situation, the main residence 120 days after surgery for patients, who lived in their own home before fracture, was described for both groups.

FINDINGS

A total of 10,995 patients could be included of which 10,436 patients were treated with CMN and 369 patients with SHS. 120 days postoperative the QoL differed significantly (p = 0.020) in favor of treatment using CMN. 26% of the SHS group who lived at home prior to surgery had to reside in a nursing home after surgery, whereas the rate was only 18% in the CMN group (p < 0.001). No significant difference in the mortality rate nor a difference in the walking ability 120 days postoperative were found. CMN were implanted more promptly (median: 13.9 vs. 18.4 hours; p < 0,001). No differences were found concerning the revision rate between the two groups, neither during inpatient treatment (p = 0.723) nor during the 120 day follow-up period (p = 0.524).

INTERPRETATION

There might be a benefit for geriatric patients with trochanteric femur fractures to be treated with a proximal femur nail in regard to a higher QoL and a reduced institutionalization rate. Mortality or revision rate was not affected by the chosen implant.

Parents' perceptions of oral health, general health and dental health care for children with Down syndrome in Sweden

AIM

To describe parental perceptions of general health, oral health and received dental health care in Swedish children with Down syndrome (DS).

METHODS

Online questionnaire, quantitative data analysis (Chi-square test).

RESULTS

Parents of 101 children with DS (52 boys, 49 girls, mean age: 9.6 years) participated. Seventy percent rated their child's general health and 74% their child's oral health as good or very good. Parents, who rated their child's oral health as poor (8%), also reported that dental procedures were difficult. Children received dental care at general (55%) and specialist clinics (53%). Ninety-four percent of parents of children receiving specialist dental health care were satisfied compared to 70% of parents with children in general clinics. The parents most valued characteristics of dental professionals were patience (63%) and their ability to engage the child (68%). Parents wanted multidisciplinary collaboration.

CONCLUSION

Most parents rated their child's general and oral health as good or very good. Children with poor oral health were also reported to have difficulties coping with dental procedures. Parents wanted dental care to be tailored to meet their child's unique needs. They wanted dental professionals to have knowledge about children with a need for special care. Lastly, they requested multidisciplinary collaboration.

A tissue-mimicking prostate phantom for 980 nm laser interstitial thermal therapy

Purpose: To develop a phantom with optical and thermal properties matched to human prostate. This phantom will provide a platform for the development and characterization of 980 nm laser interstitial thermal therapy (LITT) systems. Methods: A polyacrylamide gel was doped with Naphthol Green B, Intralipid, and Bovine Serum Albumin (BSA). The necessary concentration of each ingredient was determined by measuring the optical properties via fluence measurements and light diffusion theory. LITT was then performed under the same conditions as a previous clinical trial in which temperature was monitored via a thermal probe. The thermal data and induced coagulation zone were compared to clinical data to illustrate the similarity between the phantom and patient. LITT was also performed under magnetic resonance thermometry (MRT). Results: The requisite concentrations of Naphthol Green B, Intralipid and BSA were found to be 0.144% (w/v), 8.06% (v/v) and 31.4% (v/v) respectively. In the native state, the absorption coefficient and reduced scattering coefficient ( μs' ) were found to be 0.66 ± 0.06 cm^-1 and 8.27 ± 0.50 cm^-1 respectively, with μs' increasing to 17.63 ± 1.41 cm^-1 after coagulation. The thermal response of the phantom was similar to that observed clinically with maximum thermal probe measurements of 64.2 °C and 66.9 °C respectively. The shape of the induced coagulation zone was qualitatively and quantitatively similar to the MRT zone of elevated temperature and the coagulation zone observed clinically. Conclusions: A phantom which simulates optical and thermal response to 980 nm LITT was constructed and demonstrated to be similar to human prostate.

Review of the dental treatment backlog of people with disabilities in Europe

AIM

The present research aims at reviewing the oral health conditions and treatment needs of people with disabilities in Europe.

METHODS

A comprehensive literature search was conducted using Medline and Embase with a timeframe from January 2008 until December 2017. Subsequently, a citation tracking was undertaken. Articles in English, French and Dutch were included.

RESULTS

Forty-two articles were included. A variety of oral health problems and treatment needs was reported. More untreated carious lesions, less restorations, a higher number of extractions and less prosthetic rehabilitations were seen in people with disabilities compared with other individuals without disabilities. The oral hygiene level and the periodontal conditions were poor. Moreover, a higher risk of dental trauma, orthodontic problems and tooth wear were reported.

DISCUSSION

Different determinants contribute to the oral health condition and treatment needs of people with disabilities. These determinants can be inherent in persons with a disability (biological factors), their lifestyle, the environment or the organization of oral health care. A treatment backlog was a common finding in people with disabilities. However, results need to be interpreted with caution because of the variety of people with disabilities included in this literature review. Proposed solutions can be put at the level of daily oral care, through oral health promotion programs and the creation of a supportive environment, but also at the level of dental attendance, facilitating the access to oral health care services and focusing the training of dental students and dentists.

CONCLUSION

This comprehensive review clearly shows a dental treatment backlog in people with disabilities. Solutions require efforts from the caregivers and dental professionals.

Use of the universal pain assessment tool for evaluating pain associated with temporomandibular disorders in youngsters

AIM

Determine, whether the UPAT could be used as an extra tool to collect data on functional TMJ pain and to assess orofacial pain levels related to temporomandibular disorder(s) (TMD) in youngsters.

METHODS

Patients were screened at the N1 Dental Clinic of Tbilisi State Medical University. The clinical scores of possible functional jaw pain were collected using the UPAT, to indicate pain severity on a visual scale during different jaw movements (opening, closing and lateral).

STATISTICS

Comparisons of categorised data have been performed by chi-square test and Fisher's Exact test (where expected values were less than 5). The P value less than 0.05 was considered as statistically significant.

RESULTS

Two hundred and ninety-one youngsters were screened by calibrated dentists. The majority (59%) of participants were male; age distribution ranged from 8 to 15 years (mean 11.46 ± 2.11). The results of the UPAT demonstrated the existence of functional TMJ pain in 15.46% (n=45) of the patients without significant prevalence (P > 0.05) in this survey group.

CONCLUSION

According to the results of the present study, the UPAT demonstrated that it could be an additional tool to detect the existence of functional jaw pain possibly associated with TMD and also a valid instrument to score pain intensity associated with TMD in youngster patients.

Are Down syndrome children more vulnerable to tooth wear?

BACKGROUND

An oral condition that has largely been ignored in the Down syndrome population is pathological tooth wear. This study is aimed to create more awareness of the reasons underlying the tooth wear observed in patients with Down syndrome and to suggest different methods to prevent this condition. This research also potentially serves as a platform for future researchers to perform an in-depth analysis of the factors we identified. The aim of this study was to determine if children with Down syndrome are more prone to tooth wear than children who do not have Down syndrome.

METHODS

Our sample consisted of 120 children with Down syndrome who were compared with 120 children with no disabilities. The parents or guardians were asked to complete a questionnaire and a 3-day diet chart, while the wear on each tooth was recorded using the standardised Simplified Smith and Knight Tooth Wear Index.

RESULTS

Children with Down syndrome experience tooth wear more frequently than non-Down syndrome children. A history of asthma, mouth breathing and gastro-oesophageal reflux disease as well as the intake of acidic diet and drinks has exerted significant effects on the prevalence of tooth wear.

CONCLUSIONS

The early diagnosis and analysis of the underlying aetiology are important for the management of tooth wear in children with Down syndrome who have shown a greater tendency to develop erosive lesions.

Dental care in children with Down syndrome: A questionnaire for Belgian dentists

Background

To date, research on the opinions of dentists on the oral health care of children with DS (Down Syndrome) is scarce.

Material and Methods

Evaluate the views and knowledge of Belgium dentists regarding dental care of children with DS. An adequate sample of dentists were invited to fill in a validated questionnaire. Results were assessed in 95% confidence interval with p< 0.05 level.

Results

A total of 356 questionnaires were returned (177 men, 179 women). Mean age of the dentists was 50.3 years (SD: 11.9) and 75% obtained their degree more than 20 years ago. 72.5% of all dentists replied that they had not been instructed in how to treat children with DS during their dental educational training, whereas this is only the case for 39% of the dentists who obtained their degree less than 10 years ago. Half of the group indicated that additional training and education would be (very) desirable (52.8%).

Conclusions

Dentists don’t seem to feel comfortable in treating children with DS and refer them to a special care dentistry centre in a hospital. It is positive that dentists are in favour of obtaining additional training and education to help them feel more confident in treating children with DS in daily practice. However we must not conclude that because students or qualified dentists received such training that they will automatically treat more patients with special needs.

Key words:Oral health care, Down syndrome, children, dentists, Belgium.

Erosive tooth Wear in special Olympic athletes with intellectual disabilities

Background

Special Olympics (SO) events represent an opportunity to obtain considerable information regarding intellectual disable (ID) patients. Studies done with SO data have shown an overview of the oral health status of these athletes; however, no information exists regarding the erosive tooth wear (ETW). Therefore, the aim of this study is to determine the presence and severity of ETW in athletes with ID who participated in the SO Belgium 2016.

Methods

The study population consisted in 232 athletes with ID who participated in the SO special smiles program, Belgium 2016. For analysis, the sample was divided in three groups: a) athletes with ID under the age of 25 not diagnosed with Down Syndrome (DS) (n = 174), b) athletes with DS under the age of 25 (n = 39) and c) athletes with DS from 25 and older ages (n = 58). Two calibrated dentists performed dental examinations using the Basic Erosive Wear Examination Index (BEWE). The BEWE sum > 0 was used to determine prevalence of ETW. Severity was determined by two- indicators: 1) By risk levels (low, medium and high risk) proposed by the BEWE index, and 2) by the highest score reached per subject in at least one tooth (BEWE1, 2 or 3). Chi-square test and Mann-Whitney U test were used to detect significant differences among different groups (p < 0.05).

Results

The prevalence of ETW for young athletes with ID was 51.14%. Within these athletes, the DS group presented a significant higher mean BEWE sum (4.67, SD 5.64) and prevalence of ETW (69.2%BEWE> 0) when compared to athletes without DS (mean BEWE sum: 1.96, SD 3.47 and 46.3% BEWE> 0; p < 0.05). Furthermore, a significantly higher percentage of athletes with DS were considered at high risk of ETW (p < 0.05).

Conclusions

As a conclusion, half of the young athletes with ID presented at least one affected surface with ETW. The recorded prevalence and severity of ETW for the younger group of athletes with DS was distinctly higher than the athletes with ID not having DS. This shows the need to generate knowledge in order to provide correct management and prevention of erosive tooth wear in populations with ID.

Use of the universal pain assessment tool for evaluating pain associated with TMD in youngsters with an intellectual disability

Background

The Universal Pain Assessment Tool (UPAT) was used to assess the level of pain in people with limited communication skills. The UPAT enables clinicians to consult a specialized pain management team more often and lead to earlier interventions. The purpose of this study was to determine, whether the UPAT could be used as an extra tool to collect data on functional TMJ pain and to assess orofacial pain levels related to temporomandibular disorder(s) (TMD) in people with intellectual disabilities (ID).

Material and Methods

Non-down syndrome ID Athletes were screened during the Special Olympics European games in 2014. The clinical scores of possible functional jaw pain were collected using the UPAT, to indicate pain severity on a visual scale during different jaw movements (opening, closing and lateral).

Results

Two hundred and four youngsters were screened by calibrated dentists. The majority (65%) of participants were male (133 male and 71 female athletes); age distribution ranged from 15 to 23 years (mean 19.25 ± 2.53). The results of the UPAT have shown the existence of functional TMJ pain in 32% (n=65) of the athletes without significant prevalence (P > 0.05) in this survey group.

Conclusions

According to the results of the present study, the UPAT demonstrated that it could be a useful tool to detect the existence of functional jaw pain possibly associated with TMD and also a valid instrument to score pain intensity associated with TMD in people with ID.

Key words:Universal pain assessment tool - TMD in ID - TMD in youngsters.

Treatment needs and predictive capacity of explanatory variables of oral disease in young athletes with an intellectual disability in Europe and Eurasia

AIM

To evaluate the oral condition and treatment needs of young athletes with intellectual disability (ID) from 53 countries of Europe and Eurasia who participated in the Special Olympics European Games held in Antwerp, October 2014.

METHODS

A cross- sectional study was undertaken with data collected through standardised procedures from consenting athletes under 21 years of age. Oral hygiene habits, reports of oral pain and presence of gingival signs, sealants, untreated caries and missing teeth were recorded.

STATISTICS

Data analysis was performed in SPSS to produce descriptive statistics and explanatory variables for untreated decay, and gingival signs of disease were tested with Multilevel Generalized Linear Mixed Models.

RESULTS

Five hundred three athletes participated in this study (mean age 17 yrs). Untreated decay was recorded in 33.4% of the participants and 38.7% of them had signs of gingival disease. Absence of untreated decay was associated with lower chances of gingival signs, while absence of sealants was related with higher chances of untreated decay.

CONCLUSIONS

There is consistent evidence of persistent need for increased promotion of oral health, as well as preventive and restorative treatment in young athletes with ID in Europe and Eurasia. Due to the limited predictive capacity of the studied variables for oral disease, further studies including other related factors are needed.

The return of public health to local government in England: changing the parameters of the public health prioritization debate?

OBJECTIVES

To explore the influence of values and context in public health priority-setting in local government in England.

STUDY DESIGN

Qualitative interview study.

METHODS

Decision-makers' views were identified through semi-structured interviews and prioritization tools relevant for public health were reviewed. Interviews (29) were carried out with Health and Wellbeing Board members and other key stakeholders across three local authorities in England, following an introductory workshop.

RESULTS

There were four main influences on priorities for public health investment in our case study sites: an organizational context where health was less likely to be associated with health care and where accountability was to a local electorate; a commissioning and priority-setting context (plan, do, study, act) located within broader local authority priority-setting processes; different views of what counts as evidence and, in particular, the role of local knowledge; and debates over what constitutes a public health intervention, triggered by the transfer of a public health budget from the NHS to local authorities in England.

CONCLUSIONS

The relocation of public health into local authorities exposes questions over prioritizing public health investment, including the balance across lifestyle interventions and broader action on social determinants of health and the extent to which the public health evidence base influences local democratic decision-making. Action on wider social determinants reinforces not only the art and science but also the values and politics of public health.

Prioritizing investment in public health and health equity: what can commissioners do?

OBJECTIVES

To explore commissioners' views on prioritizing for investment in health. This study reviewed: methods for decision support; their relevance for prioritizing health and health equity in principle; and their adoption by decision makers in practice.

METHODS

Decision makers' views were sought through semi-structured interviews and an online survey, and prioritization tools were reviewed. Interviews were held in 2008-2009 with a subsample followed up in 2009-2010. In late 2009, a national online survey was sent to 508 individuals across 146 primary care trusts (PCTs). The two phases of the interviews comprised 52 and 17 participants, respectively. Responses to the national survey were received from 138 decision makers in 95 (65%) PCTs. Prioritization tools were identified through interviews and the survey as above, a rapid review of literature and in consultation with health economists. A grounded theory approach was adopted for the qualitative interview analysis.

RESULTS

Although most PCTs used a prioritization framework, few of the tools identified in this review were used by public health commissioners. This was partly a consequence of limitations of priority-setting tools in the context of public health investment, and partly a lack of relevant skills and data. Tensions in relation to developing strategies for disinvestment and in prioritizing a long-term public health agenda in a context of economic austerity were evident.

CONCLUSIONS

The context for decision making appears to be more important than the deployment of specific tools and techniques. Commissioners need to recognize the limitations of priority-setting tools, but also know how to apply them to help maximize health gain and health equity over the longer term. Decision-support tools should be developed in collaboration with public health commissioners to ensure relevance and practicality of use.

PP060. Matrix metalloproteinases-2 and -9 and their inhibitors: A role in the development of pre-eclampsia?

INTRODUCTION

Pre-eclampsia (PE) is a common and potentially life-threatening condition, affecting 3-10% pregnancies[1]. Placentation has been shown to be deficient in PE and this may be a result of impaired trophoblast invasion [1]. Matrix metalloproteinases (MMPs) are zinc-dependent enzymes which may be important in trophoblast invasion. The activity of MMPs is regulated by tissue inhibitors (TIMPs) and it has been proposed that alterations in MMP/TIMP levels may alter net MMP activity and play a part in both the early and late pathophysiology of pre-eclampsia [2]. Previous studies have largely looked at both active and latent MMP-9 and there is a need for more studies looking specifically at the active forms of these enzymes.

OBJECTIVES

The aims of this study were to characterise active MMP-9 expression throughout normal gestation by immunohistochemical localisation, and to compare the levels of MMP-2, -9 (both pro and active) and TIMP-2 in normal and pre-eclamptic term placentae.

METHODS

Immunohistochemical localisation of active MMP-9 was carried out on a gestational series of normal placentae from 6-41 weeks' gestation. Quantification of MMP and TIMP levels in term healthy (n=12), pre-eclamptic (n=16) and IUGR (n=12) placental homogenates was done by gelatin-substrate zymography and ELISA. Placentae from IUGR and healthy pregnancies were used as controls to allow us to identify and PE-specific alterations.

RESULTS

Using immunohistochemical localisation, we demonstrated a negative relationship between gestational age and active MMP-9 expression throughout normal gestation (p=0.012). The zymographic and ELISA results showed no significant difference in MMP-2, MMP-9 or TIMP-2 levels in placenta from the healthy, pre-eclamptic and IUGR groups (p>0.05).

CONCLUSION

To our knowledge, this is the first report using immunohistochemistry to specifically localise the active form of MMP-9 in a gestational series of this size. Our findings demonstrate that there may be high MMP-9 activity during early gestation, which is consistent with a key role for this enzyme in the process of placentation. Thus, it is important to determine if MMP-9 activity is abnormal in PE. In term placentae no difference was found in protein levels of MMPs and TIMPs between control and PE samples; further studies are ongoing to study the MMP and TIMP mRNA expression in these samples.

The oral health status of special olympics athletes in Belgium

OBJECTIVES

To describe and evaluate the oral condition and oral treatment needs of the participants of the Special Olympics Special Smiles program organised in Belgium in 2008.

DESIGN

A cross-sectional study where the data were collected through interviews and clinical examinations.

PARTICIPANTS

687 Belgian Special Smiles athletes participated, mean age 33 years.

RESULTS

More than 70% had at least one missing tooth. Distinct signs of gingivitis and visible caries experience were observed in 44% and 22% of dentate athletes respectively. Dutch-speaking athletes were less likely to present with untreated caries (OR: 0.46; 95% CI: 0.31-0.68) or with gingivitis (OR: 0.51; 95% CI: 0.37-0.71) compared to their French-speaking colleagues. Signs of past injury were identified in 12% of athletes. Of those athletes with an edentulous mandible, only 53% presented with a removable denture; 73% of athletes missing some maxillary anterior teeth and 30% of those missing all anterior teeth had no prosthetic replacement in the maxilla. Nearly two fifths of athletes were referred for treatment: in 12% of athletes dental treatment was considered urgent.

CONCLUSION

The results suggest that there is a tremendous unmet need for dental treatment in the Belgian Special Smiles population, with French-speaking athletes in greatest need. Improvements in data collection should be encouraged for example. more detailed screening methods (e.g. caries screening including enamel lesions, full periodontal examination) and questionnaires (e.g. inclusion of questions related to dietary habits, dental attendance). In this way barriers to optimal oral health (care) in this population could be further explored, attempts made to reduce them and so reduce health inequalities.

Is hip muscle strength the key to walking as a bilateral amputee, whatever the level of the amputations?

BACKGROUND

Little data have been reported on the factors that are important in bilateral amputee walking ability especially the role of hip strength.

STUDY DESIGN

Observational, case-control study where participants were evaluated at a single point in time.

OBJECTIVES

The aim of this study was to investigate the factors involved in bilateral amputee walking ability by assessment of walking speed, perceived exertion, exercise intensity, physiological cost index (PCI) and hip muscle strength.

METHODS

For a group of 10 bilateral amputees, with different levels of amputation, and a non-pathological reference group, walking ability was assessed using the two-minute walk test. Hip muscle strength was assessed using isokinetic strength tests.

RESULTS

Bilateral amputees were found to have slower walking speeds and increased PCI of walking which were correlated to higher levels of amputation. Peak hip torques were reduced in the amputees, which was only significant for concentric extension torque (p = 0.029), and approaching significance for concentric flexion (p = 0.061) and abduction (p = 0.057). Bilateral amputee peak hip strength suggested a positive trend with increasing walking ability.

CONCLUSIONS

Bilateral amputee walking ability was reduced and mainly related to level of amputation. The role of hip strength in bilateral amputee walking ability requires further investigation.