A National Referral Service for Paediatric Brachytherapy: An Evolving Practice and Outcomes Over 13 Years

AIMS

Most children requiring radiotherapy receive external beam treatment and few have tumours suitable for brachytherapy. No paediatric radiotherapy centre will treat enough patients from its own normal catchment population for expertise in brachytherapy to be developed and sustained. Following discussion and agreement in the national paediatric radiotherapy group, a service for paediatric brachytherapy in the UK has been developed. We report the process that has evolved over more than 10 years, with survival and functional outcome results.

MATERIALS AND METHODS

Since 2009, potential patients have been referred to the central paediatric oncology multidisciplinary team meeting, where imaging, pathology and treatment options are discussed. Since 2013, the National Soft Tissue Sarcoma Advisory Panel has also reviewed most patients, with the principal aim of advising on the most suitable primary tumour management for complex patients. Clinical assessment and examination under anaesthetic with biopsies may be undertaken to confirm the appropriateness of brachytherapy, either alone or following conservative surgery. Fractionated high dose rate brachytherapy was delivered to a computed tomography planned volume after implantation of catheters under ultrasound imaging guidance. Since 2019, follow-up has been in a dedicated multidisciplinary clinic.

RESULTS

From 2009 to 2021 inclusive, 35 patients (16 female, 19 male, aged 8 months to 17 years 6 months) have been treated. Histology was soft-tissue sarcoma in 33 patients and carcinoma in two. The treated site was pelvic in 31 patients and head and neck in four. With a median follow-up of 5 years, the local control and overall survival rates are 100%. Complications have been few, and functional outcome is good.

CONCLUSION

Brachytherapy is effective for selected paediatric patients, resulting in excellent tumour control and good functional results. It is feasible to deliver paediatric brachytherapy at a single centre within a national referral service.

Immunotolerance of dairy heifers in response to repeated exposure to bacterial lipopolysaccharide endotoxin

Dairy cattle face a variety of stressful events on a daily basis. More specifically, climate change has resulted in more frequent heat stress events that increase the incidence of chronic bacterial infections by inducing conditions like leaky gut syndrome, whereby the integrity of the intestinal epithelium is compromised allowing for luminal bacterial lipopolysaccharide (LPS) endotoxin to infiltrate the host's bloodstream resulting in acute or chronic systemic stimulation of the innate immune system. Repeated exposure to LPS over a short period of time is reported to induce immunotolerance within the host. This LPS tolerance is an essential immunohomeostatic response that can protect against over activation of the inflammatory response during subsequent exposure to LPS. In the present study, Holstein calves (n = 20) were initially stress challenged with either saline, or 100, 200 or 400 ng/kg of LPS administered intramuscular, and again re-challenged with 200 ng/kg of LPS 2-weeks later. Serum was collected every 2 hr for 6 hr to profile changes in circulatory stress biomarkers after the repeated LPS exposures. Heifers that were initially challenged with 100, 200 and 400 ng/kg of LPS demonstrated significantly attenuated cortisol responses in the second challenge (p < 0.01, 0.01 and 0.05, respectively), whereas control animals who previously received saline demonstrated a strong cortisol response at 2 hr after receiving 200 ng/kg of LPS (p < 0.05). The cytokine/chemokine (IL-6, CCL2, CCL3 and CCL4) responses were also attenuated during the LPS rechallenge (p < 0.05). Finally, microRNA expression profiles were determined to assess the epigenetic response to repeated LPS exposure. Interestingly, miR-31 and miR-223 were downregulated in response to the second LPS challenge. The present study demonstrates the dynamic nature of the stress response in dairy cattle as it relates to the development of LPS tolerance. Understanding the roles of various stress biomarkers in the context of innate immune cell tolerance is essential for evaluating their impact on immune system homeostasis.

Metals in urban soils of Europe: A systematic review

Metal contamination of soils is widespread across Europe and is of great concern as it may impact food production, the supply of drinking water and human health (European Environment Agency, 2014; Panagos et al., 2013). Most research to date on soil metal contamination has focussed on agricultural soils (Tóth et al., 2016a). Current knowledge of the extent of urban soil metal contamination in Europe, however, is limited, especially for soils in recreational areas, which is particularly concerning as these areas may have a high footfall. Here, we conducted a systematic analysis of metal contamination in European urban soils based on 174 peer-reviewed studies spanning 143 urban sites and 29 European countries. The results show that reporting of data on urban soil metals is highly heterogeneous across the study area. Over half of all studies are from only five countries (Italy, Spain, UK, Poland and Serbia) and no data are available for 14 other European countries. The metals that most commonly exceed national safety thresholds are Pb, Zn, Cu, Cr and Ni. Elevated levels of these metals are usually attributed to anthropogenic sources, primarily traffic and industry. Some 22 % of urban sites studied show anthropogenic enrichment; this phenomenon is most common in Italy, Serbia and Finland. In contrast, 44 % of urban sites studied show geogenic metal enrichment; this is most common in Italy, the UK and Serbia. The dataset is subject to a sample size bias, whereby soil metal enrichment is identified more frequently in regions with more data. Future studies should focus on key knowledge gaps, such as urban soils in locations with current or historical heavy industrialisation and locations in central and eastern Europe. Study methods should be standardised to facilitate comparison of soil metal data from different studies and European safety thresholds should be identified for key elements.

The diabetes community exercise programme plus usual care versus usual care in patients with type 2 diabetes: A randomised, two-arm, parallel, open-label trial

BACKGROUND

Exercise is important in type 2 diabetes (T2D) management. Focussing on Māori and Pacific people and those from deprived circumstances, the Diabetes Community Exercise Programme (DCEP) was developed to engage people with T2D in exercise. We report the evaluation of whether being offered DCEP (plus usual care) was more effective than usual care in improving glycaemic control at 1-year.

METHODS

A randomised, two-arm, parallel, open-label trial with blinding of outcome assessor and data analyst. Adults (age ≥35 years) with T2D recruited from two New Zealand (NZ) communities were randomised, using opaque sealed envelopes and stratified by centre with random block lengths, to DCEP or usual care. DCEP comprises twice-weekly, two-hour sessions of exercise and education over 12-weeks, followed by a twice-weekly maintenance exercise class. The primary outcome was between-group differences in mean changes of glycated haemoglobin (HbA1c) from baseline to 1-year follow-up with intention-to treat analysis. This trial is registered with the Australian NZ Clinical Trials Registry (ANZCTR): ACTRN12617001624370p and is closed to new participants.

FINDINGS

From 2018 - 2019, of 294 people screened, 165 (mean age 63·8, SD16·2 years, 56% female, 78·5% European, 14% Māori, 6% Pacific, 27% most deprived) were baseline evaluated, randomised, and analysed at study end (DCEP = 83, control = 82). Multimorbidity (≥2) and polypharmacy (>5 medications) were high (82%, 69%). We found no statistically significant between-groups differences in HbA1c (mmol/mol) change at 15 months (mean 3% higher in DCEP, 95% CI 2% lower to 8% higher, p = 0·23). Twelve-week intervention adherence was good (41% attended >80% available sessions). No adverse events were reported.

INTERPRETATION

DCEP was not effective in improving glycaemic control, possibly due to insufficient exercise intensity. Our attendance demonstrated DCEP's cultural accessibility. DCEP might be good to engage in exercise marginalised people with high Hb1Ac levels, multimorbidity, and high polypharmacy.

FUNDING

Health Research Council of New Zealand.

Characteristics of wastewater originating from dental practices using predominantly mercury-free dental materials

Dental materials are currently undergoing a revolution. Mercury use, including traditional amalgam (mercury-containing) material used in dental fillings, is now being widely regulated under the Minamata convention, and dental amalgam is currently being replaced by resin formulations in dentistry. These resin-based materials can be tuned to offer varying material properties by incorporation of a range of nano- and micro-particle based 'fillers' for different dental properties and applications. However, these innovations may have a concomitant effect on the waste streams associated with common dental applications, in particular the potential for higher concentrations of novel micro- and nanomaterials within wastewater streams, and a potential route for novel nanomaterials into the wider Environment. These new materials may also mean that wastewater filtering apparatus commonly deployed at present, such as amalgam separators, may be less efficient or insufficient to capture these new filler materials in dental facility wastewater. In this work, we analyse dental wastewater streams from three dental facilities in Ireland with differing amalgam separators in place. The potential overall toxicity, particulate load and physicochemical properties are analysed. The overall risk posed by these new materials is also discussed.

Surgical caps displaying team members' names and roles improve effective communication in the operating room: a pilot study

Background

Teamwork in the operating theatre is a complex emergent phenomenon and is driven by cooperative relationships between staff. A foundational requirement for teamwork is the ability to communicate effectively, and in particular, knowing each other’s name. Many operating theatre staff do not know each other’s name, even after formal team introductions. The use of theatre caps to display a staff member’s name and role has been suggested to improve communication and teamwork.

Methods

We hypothesized that the implementation of scrub hats with individual team members' names and roles would improve the perceived quality and effectiveness of communication in the operating theatre. A pilot project was designed as a pre-/post-implementation questionnaire sent to 236 operating room staff members at a general hospital in suburban Melbourne, Victoria, Australia, between November 6 to December 18, 2018. Participants included medical practitioners (anaesthetists, surgeons, obstetricians and gynaecologists), nurses (anaesthetic, scrub/scout and paediatric nurses), midwives and theatre technicians. The primary outcome was a change in perceived teamwork score, measured using a five position Likert scale.

Results

Of 236 enrolled participants, 107 (45%) completed both the pre and post intervention surveys. The median perceived teamwork response of four did not change after the intervention, though the number of low scores was reduced (p = 0.015). In a pre-planned subgroup analysis, the median perceived teamwork score rose for midwives from three to four (p < 0.001), while for other craft groups remained similar. The median number of staff members in theatre that a participant did not know the name of reduced from three to two (p < 0.001). Participants reported knowing the names of all staff members present in the theatre more frequently after the intervention (31% vs 15%, p < 0.001). The reported rate of formal team introductions was not significantly different after the intervention (34.7% vs 47.7% p = 0.058).

Conclusions

In this study, we found that wearing caps displaying name and role appeared to improve perceived teamwork and improve communication between staff members working in the operating theatre.

Permafrost Dynamics Observatory-Part I: Postprocessing and Calibration Methods of UAVSAR L-Band InSAR Data for Seasonal Subsidence Estimation

Interferometric synthetic aperture radar (InSAR) has been used to quantify a range of surface and near surface physical properties in permafrost landscapes. Most previous InSAR studies have utilized spaceborne InSAR platforms, but InSAR datasets over permafrost landscapes collected from airborne platforms have been steadily growing in recent years. Most existing algorithms dedicated toward retrieval of permafrost physical properties were originally developed for spaceborne InSAR platforms. In this study, which is the first in a two part series, we introduce a series of calibration techniques developed to apply a novel joint retrieval algorithm for permafrost active layer thickness retrieval to an airborne InSAR dataset acquired in 2017 by NASA's Uninhabited Aerial Vehicle Synthetic Aperture Radar over Alaska and Western Canada. We demonstrate how InSAR measurement uncertainties are mitigated by these calibration methods and quantify remaining measurement uncertainties with a novel method of modeling interferometric phase uncertainty using a Gaussian mixture model. Finally, we discuss the impact of native SAR resolution on InSAR measurements, the limitation of using few interferograms per retrieval, and the implications of our findings for cross-comparison of airborne and spaceborne InSAR datasets acquired over Arctic regions underlain by permafrost.

Atrioventricular Block in Pregnancy: 15.8 Seconds of Asystole

Atrioventricular (AV) block in pregnancy is infrequently encountered and there is little management guidance available. We present a case of a 24-year-old G3P1011 at 24 weeks' gestation who presented to the obstetrics and gynecology clinic complaining of palpitations, fatigue, and dyspnea on exertion. Cardiology workup including an electrocardiogram (ECG) and Holter monitor detected second-degree type II (Mobitz) AV block with the longest asystole event lasting 15.8 seconds. 

A St. Jude's dual-chamber pacemaker (Abbott Laboratories, Abbott Park, IL) was implanted immediately. Standard radiation precautions were taken with additional shielding for the fetus. The patient experienced significant improvement in her symptoms. The patient went into labor at 37 3/7 weeks. Due to non-reassuring fetal heart tones, a cesarean section was performed, and a healthy baby girl was born. 

The management of heart block in pregnancy can be divided into involving those who are symptomatic and those who are asymptomatic. Symptoms of heart block can include palpitations, fatigue, dyspnea, and/or syncope; the presence of these symptoms warrants the placement of a pacemaker, preferably during pre-pregnancy or during the first two trimesters, as high-grade heart block is associated with significant mortality. Those who are in their last trimester or postpartum should consider the use of a temporary pacemaker as heart block could be due to pregnancy-related cardiovascular changes. 

For women with heart block, labor and delivery could result in worsening of bradycardia due to uterine contractions displacing blood into the central circulation. Most women with heart block do well in labor and delivery and having a pacemaker is not necessarily an indication for a cesarean section.

Short communication: Characterizing ovine serum stress biomarkers during endotoxemia

Breeding stress-resilient livestock is a potential strategy to help mitigate the negative effect of environmental and pathogenic stressors. The hypothalamic-pituitary-adrenal axis and immune system are activated during stress events and release mediators into the circulation that help restore physiological homeostasis. The purpose of this study was to assess a comprehensive set of circulatory mediators released in response to an acute immune stress challenge to identify candidate biomarkers that can be used for the selection of stress-resilient animals. Fifteen female lambs were stress challenged with an intravenous bolus of lipopolysaccharide (LPS; 400 ng/kg), and blood was collected from the jugular vein at 0, 2, 4, and 6 h after LPS challenge to identify and monitor candidate stress biomarkers; temperature was also recorded over time. Biomarker responses were evaluated with a repeated-measures model to compare time points with baseline values. As expected, all sheep had a monophasic febrile response to LPS challenge, and cortisol increased and returned to baseline by 6 h. The cytokines tumor necrosis factor-α, IL-6, IFN-γ (proinflammatory), and IL-10 (anti-inflammatory) increased, but only tumor necrosis factor-α returned to baseline during the monitoring period. The cytokines IL-1α, IL-1β, IL-17α (proinflammatory), and IL-4 (anti-inflammatory) did not respond to LPS challenge. All chemokines (CCL2, CCL3, CCL4, CXCL10, and IL-8) responded to LPS challenge; however, only CCL2, CCL3, CCL4, and CXCL10 increased over time, and only CCL3, CCL4, and CXCL10 returned to baseline during the monitoring period. MicroRNA (miR-145, miR-233, and miR-1246) also increased and remained elevated during the study. In summary, the LPS challenge induced a strong stress response in Rideau-Dorset sheep that could be monitored with a distinct profile of circulatory biomarkers.

Spatial control of oxygen delivery to three-dimensional cultures alters cancer cell growth and gene expression

Commonly used monolayer cancer cell cultures fail to provide a physiologically relevant environment in terms of oxygen delivery. Here, we describe a three-dimensional (3D) bioreactor system where cancer cells are grown in Matrigel in modified six-well plates. Oxygen is delivered to the cultures through a polydimethylsiloxane (PDMS) membrane at the bottom of the wells, with microfabricated PDMS pillars to control oxygen delivery. The plates receive 3% oxygen from below and 0% oxygen at the top surface of the media, providing a gradient of 3-0% oxygen. We compared growth and transcriptional profiles for cancer cells grown in Matrigel in the bioreactor, 3D cultures grown in 21% oxygen, and cells grown in a standard hypoxia chamber at 3% oxygen. Additionally, we compared gene expression of conventional two-dimensional monolayer culture and 3D Matrigel culture in 21% oxygen. We conclude that controlled oxygen delivery may provide a more physiologically relevant 3D system.

Cancerpedia: A Framework for Implementing Comprehensive Cancer Centres

Background and context: Comprehensive cancer centers or programs form a nucleus of cancer care delivery. Although there are frameworks for population cancer control, no similar published framework exists for cancer centers. Aim: We sought to develop a framework for designing and implementing a comprehensive cancer center or program within the context of a population-based model of cancer control that spans diagnosis, treatment, supportive care, and palliative care as well as integration with primary care and the community. Strategy/Tactics: The framework was constructed with the patient at the center and provides a system-level perspective as well as a granular view of the fundamental resources and structures needed to build and maintain individual cancer centers and programs. Due to its breadth, we focused the framework on essential information while linking to a wide range of vetted publications that detail additional standards, guidelines and best practices. Program/Policy process: “Cancerpedia” emerged as a cohesive framework for the delivery of high-quality cancer care within and beyond the cancer center. It provides an overview of the cancer control and care delivery framework, describes cancer care services (e.g., radiotherapy, chemotherapy, palliative care) and details infrastructure and core services (e.g., physical facilities, human resources). In addition to these services, the framework presents guidelines for governance that ensure oversight and quality, describes the critical need for integrating education and research and presents the best practices for engaging in philanthropy. Cancerpedia also outlines the role of the comprehensive cancer center in integration with the community and influencing policy and regulation. Over 30 chapters provide a detailed description of each element and include a description of the service or function, resources requirements such as people, equipment and facilities, management structures, quality performance guidelines and future trends in innovation. Outcomes: To our knowledge, no comparable published framework exists as a reference for developing comprehensive cancer centers. Cancerpedia was designed to serve as a global public good and is adaptable and applicable to diverse contexts and healthcare environments. It is relevant to high-, middle- and low-income countries alike and provides a reference point from which to structure a plan for growth. What was learned: While it is important to describe the various elements required for cancer care delivery, it is critical to consider and address the integration and interdependencies of these various elements. Future opportunities for learning include seeking input from a global audience to gauge the utility and applicability of Cancerperdia to local contexts.

Comparison of Compressive Myofascial Release and the Graston Technique for Improving Ankle-Dorsiflexion Range of Motion

CONTEXT

  Restricted dorsiflexion (DF) at the ankle joint can cause acute and chronic injuries at the ankle and knee. Myofascial release and instrument-assisted soft tissue mobilization (IASTM) techniques have been used to increase range of motion (ROM); however, evidence directly comparing their effectiveness is limited.

OBJECTIVE

  To compare the effects of a single session of compressive myofascial release (CMR) or IASTM using the Graston Technique (GT) on closed chain ankle-DF ROM.

DESIGN

  Randomized controlled trial.

SETTING

  Laboratory.

PATIENTS OR OTHER PARTICIPANTS

  Participants were 44 physically active people (53 limbs) with less than 30° of DF.

INTERVENTION(S)

  Limbs were randomly assigned to 1 of 3 groups: control, CMR, or GT. Both treatment groups received one 5-minute treatment that included scanning the area and treating specific restrictions. The control group sat for 5 minutes before measurements were retaken.

MAIN OUTCOME MEASURE(S)

  Standing and kneeling ankle DF were measured before and immediately after treatment. Change scores were calculated for both positions, and two 1-way analyses of variance were conducted.

RESULTS

  A difference between groups was found in the standing ( F_2,52 = 13.78, P = .001) and kneeling ( F_2,52 = 5.85, P = .01) positions. Post hoc testing showed DF improvements in the standing position after CMR compared with the GT and control groups (both P = .001). In the kneeling position, DF improved after CMR compared with the control group ( P = .005).

CONCLUSIONS

  Compressive myofascial release increased ankle DF after a single treatment in participants with DF ROM deficits. Clinicians should consider adding CMR as a treatment intervention for patients with DF deficits.

Hepatitis C Seroprevalence Among HIV-Infected Childbearing Women in New York State in 2006

OBJECTIVE

To identify factors associated with maternal hepatitis C virus (HCV) seroprevalence and transmission of HCV as identified by qualitative HCV ribonucleic acid (RNA) in the infants of human immunodeficiency virus (HIV) infected women delivering in New York State (NYS) in 2006.

STUDY DESIGN

In this retrospective cohort study of HIV-exposed infants born in NYS, leftover infant plasma from HIV diagnostic testing was de-identified and tested for HCV. If HCV antibodies were detected, a second specimen collected when the infant was >2 months old was tested for HCV qualitative RNA. Multivariate logistic regression was used to identify factors associated with HCV seropositivity.

RESULTS

In a final sample of 553 live birth events with perinatal HIV exposure, 21 (3.8 %) of tested infant specimens had HCV antibodies indicative of maternal HCV seropositivity. Maternal age at delivery of >35 years, Hispanic ethnicity, white race and injection drug use (IDU) were significantly associated with HCV seropositivity in multivariate analysis. No cases of HCV vertical transmission were identified among HCV exposed infant specimens.

CONCLUSIONS

This statewide population-based study of HIV-infected childbearing women shows HCV seroprevalence of 3.8 %. Maternal age of >35 years and IDU are the strongest predictors of HCV seropositivity. Although no viral transmission was documented, more comprehensive longitudinal testing would be required to conclude that HCV transmission did not occur.

Efficacy of low concentrations of sodium hypochlorite and low-powered Er,Cr:YSGG laser activated irrigation against an Enterococcus faecalis biofilm

AIM

To establish the antibacterial efficacy of low concentrations of sodium hypochlorite with and without Er,Cr:YSGG laser activation on Enterococcus faecalis biofilms in extracted teeth.

METHODOLOGY

The root canals of 96 decoronated single-rooted extracted human teeth were prepared to a size 40, 0.06 taper 1 mm beyond the apex. They were mounted within a flow cell, which was sterilized before pumping a nutrient media through the root canals. The flow cell was inoculated with E. faecalis (ATCC 700802) and cultivated for 4 weeks. The root-ends were sealed, and the roots were then subjected to one of six treatment groups: group 1: syringe irrigation (SI) with saline (control) using a 27 -gauge Monoject needle 1 mm from the apex for 2 min; group 2: as for group 1 but with 1% NaOCl; group 3: as for group 1 but with 4% NaOCl; group 4: 0.5% NaOCl irrigation for 15 s followed by laser-activated irrigation (LAI) with four 15-s cycles replenishing the irrigant between cycles; group 5: as for group 4 but with 1% NaOCl as the irrigant; group 6: as for group 4 but with 4% NaOCl as the irrigant. Following treatment, teeth were crushed and viable bacteria were quantitated by serial dilution and plating. The colony-forming unit values were compared between groups using one-way anova and Tukey-adjusted post hoc tests. A two-tailed P value of <0.05 was considered statistically significant.

RESULTS

The mean number of cells recovered from the 1% NaOCl SI group was significantly higher than that from the 4% NaOCl LAI group (P = 0.02).

CONCLUSION

Within the limitations of this laboratory study, low-powered (0.5 W) Er,Cr:YSGG laser activation did not improve the antibacterial effect of low concentrations of sodium hypochlorite.

Tunable surface topography in fluoropolymers using photo-embossing

We describe and characterise a novel method of producing tuneable surface topography in fluorinated elastomers using a modified photo-embossing process.

Are trajectories of self-regulation abilities from ages 2-3 to 6-7 associated with academic achievement in the early school years?

BACKGROUND

The aim of this study was to estimate the association between two key aspects of self-regulation, 'task attentiveness' and 'emotional regulation' assessed from ages 2-3 to 6-7 years, and academic achievement when children were aged 6-7 years.

METHODS

Participants (n = 3410) were children in the Longitudinal Study of Australian Children. Parents rated children's task attentiveness and emotional regulation abilities when children were aged 2-3, 4-5 and 6-7. Academic achievement was assessed using the Academic Rating Scale completed by teachers. Linear regression models were used to estimate the association between developmental trajectories (i.e. rate of change per year) of task attentiveness and emotional regulation, and academic achievement at 6-7 years.

RESULTS

Improvements in task attentiveness between 2-3 and 6-7 years, adjusted for baseline levels of task attentiveness, child and family confounders, and children's receptive vocabulary and non-verbal reasoning skills at age 6-7 were associated with greater teacher-rated literacy [B = 0.05, 95% confidence interval (CI) = 0.04-0.06] and maths achievement (B = 0.04, 95% CI = 0.03-0.06) at 6-7 years. Improvements in emotional regulation, adjusting for baseline levels and covariates, were also associated with better teacher-rated literacy (B = 0.02, 95% CI = 0.01-0.04) but not with maths achievement (B = 0.01, 95% CI = -0.01-0.02) at 6-7 years. For literacy, improvements in task attentiveness had a stronger association with achievement at 6-7 years than improvements in emotional regulation.

CONCLUSIONS

Our study shows that improved trajectories of task attentiveness from ages 2-3 to 6-7 years are associated with improved literacy and maths achievement during the early school years. Trajectories of improving emotional regulation showed smaller effects on academic outcomes. Results suggest that interventions that improve task attentiveness when children are aged 2-3 to 6-7 years have the potential to improve literacy and maths achievement during the early school years.

Improved Measurement of the π→eν Branching Ratio

A new measurement of the branching ratio R_{e/μ}=Γ(π^{+}→e^{+}ν+π^{+}→e^{+}νγ)/Γ(π^{+}→μ^{+}ν+π^{+}→μ^{+}νγ) resulted in R_{e/μ}^{exp}=[1.2344±0.0023(stat)±0.0019(syst)]×10^{-4}. This is in agreement with the standard model prediction and improves the test of electron-muon universality to the level of 0.1%.

Characterization and anti-settlement aspects of surface micro-structures from Cancer pagurus

Tuning surface and material properties to inhibit or prevent settlement and attachment of microorganisms is of interest for applications such as antifouling technologies. Here, optimization of nano- and microscale structures on immersed surfaces can be utilized to improve cell removal while reducing adhesion strength and the likelihood of initial cellular attachment. Engineered surfaces capable of controlling cellular behaviour under natural conditions are challenging to design due to the diversity of attaching cell types in environments such as marine waters, where many variations in cell shape, size and adhesion strategy exist. Nevertheless, understanding interactions between a cell and a potential substrate for adhesion, including topographically driven settlement cues, offers a route to designing surfaces capable of controlling cell settlement. Biomimetic design of artificial surfaces, based upon microscale features from natural surfaces, can be utilized as model surfaces to understand cell-surface interactions. The microscale surface features of the carapace from the crustacean Cancer pagurus has been previously found to influence the rate of attachment of particular organisms when compared to smooth controls. However, the nature of microscale topographic features from C. pagurus have not been examined in sufficient detail to allow design of biomimetic surfaces. In this work, the spatial distribution, chemical composition, size and shape descriptors of microscale surface features from C. pagurus are characterized in detail for the first time. Additionally, the influence of topography from C. pagurus on the settlement of marine diatoms is examined under field conditions.

Intraoperative hypothermia is associated with an increased intensive care unit length-of-stay in patients undergoing elective open abdominal aortic aneurysm surgery: a retrospective cohort study

Intraoperative hypothermia in open elective abdominal aortic aneurysm repair may be associated with increased hospital morbidity. This retrospective, single centre study investigated whether there was an association between intraoperative hypothermia in open elective abdominal aortic aneurysm repair and postoperative in-hospital morbidity. The data of 119 patients who underwent open infrarenal abdominal aortic aneurysm repair between January 2006 and January 2011 were collected. The electronic databases from the hospital, intensive care unit, transfusion medicine and operating theatres were linked by the patient's unique identifiers including date of birth and unit record number. Intraoperative nasopharyngeal temperature measurements were collected manually from paper-based anaesthetic records. The study group included 102 out of the 119 patients. Sixty-six patients (64.6%) had intraoperative hypothermia as defined by temperature <36°C. Intraoperative temperature was not predictive of hospital length-of-stay or any of the other perioperative complications such as acute renal failure, acute respiratory complications, acute myocardial infarction, transfusion requirements or postoperative infection. In the normothermic group, the number of hours in the intensive care unit was 35% lower (ratio of means=0.65; 95% confidence interval 0.51 to 0.84; P=0.0008), even after adjusting for possible confounders such as age, duration of anaesthesia, size of aneurysm, comorbidities and transfusion. Intraoperative hypothermia is a persisting problem and more aggressive warming strategies may need to be identified and employed to achieve normothermia.

Randomized controlled trial of fish oil supplementation in pregnancy on childhood allergies

BACKGROUND

Diets high in n-3 long chain polyunsaturated fatty acids (LCPUFA) may modulate the development of IgE-mediated allergic disease and have been proposed as a possible allergy prevention strategy. The aim of this study was to determine whether n-3 LCPUFA supplementation of pregnant women reduces IgE-mediated allergic disease in their children.

METHODS

Follow-up of children (n = 706) at hereditary risk of allergic disease in the Docosahexaenoic Acid to Optimise Mother Infant Outcome randomized controlled trial. The intervention group (n = 368) was randomly allocated to receive fish oil capsules (providing 900 mg of n-3 LCPUFA daily) from 21 weeks' gestation until birth; the control group (n = 338) received matched vegetable oil capsules without n-3 LCPUFA. The diagnosis of allergic disease was made during medical assessments at 1 and 3 years of age.

RESULTS

No differences were seen in the overall percentage of children with IgE-mediated allergic disease in the first 3 years of life between the n-3 LCPUFA and control groups (64/368 (17.3%) vs 76/338 (22.6%); adjusted relative risk 0.78; 95% CI 0.58-1.06; P = 0.11). Eczema was the most common allergic disease; 13.8% of children in the n-3 LCPUFA group had eczema with sensitization compared with 19.0% in the control group (adjusted relative risk 0.75; 95% CI 0.53-1.05; P = 0.10).

CONCLUSIONS

Overall, n-3 LCPUFA supplementation during pregnancy did not significantly reduce IgE-associated allergic disease in the first 3 years of life. Further studies should examine whether the nonsignificant reductions in IgE-associated allergies are of clinical and public health significance.

Pulmonary cryptosporidiosis and immune reconstitution inflammatory syndrome: a case report and review

Cryptosporidium rarely affects the lungs, and is not typically associated with the immune reconstitution inflammatory syndrome (IRIS). We describe the first published case of pulmonary IRIS following the initiation of antiretroviral therapy in a patient with AIDS and pulmonary cryptosporidiosis, and discuss its implications for HIV patient care.