Endoscopic and Radiologic Central Compartment Disease as Predictors of Perennial Inhalant Allergen Sensitization in Chronic Rhinosinusitis

BACKGROUND

Central compartment atopic disease (CCAD) is a recently described variant of chronic rhinosinusitis (CRS) strongly associated with atopy. The association between central compartment disease (CCD) and inhalant allergy is not well established in South-East Asia, where perennial allergic rhinitis is common.

OBJECTIVES

The primary objective was to evaluate endoscopic and radiologic CCD as predictors of perennial allergen sensitization in primary CRS. The secondary objective was to compare clinical characteristics of CCAD with other CRS subtypes (CRSwNP and CRSsNP).

METHODS

A retrospective study of consecutive patients with primary CRS who underwent endoscopic sinus surgery at our institution was performed. Allergen sensitization was confirmed by skin or serum testing. Endoscopy records and computed tomography scans of paranasal sinuses were reviewed for CCD. The diagnostic accuracy of endoscopic and radiologic CCD in predicting atopy was calculated.

RESULTS

There were 104 patients (43 CCAD, 30 CRSwNP and 31 CRSsNP). Endoscopic CCD was significantly associated with aeroallergen sensitization (odds ratio (OR) 3.99, 95% confidence interval (CI) 1.65-9.67, P = 0.002). Endoscopic CCD predicted atopy with 57% sensitivity, 72% specificity, 69% positive predictive value and positive likelihood ratio of 2.05. Radiologic CCD was not associated with aeroallergen sensitization (OR 0.728, 95%CI 0.292-1.82, P = 0.496). There were more CCAD patients who reported hyposmia (86% vs 42%, P < 0.001) and had anosmia on olfactory testing than CRSsNP (65% vs 14%, P = 0.015). The prevalence of atopy was significantly higher in CCAD than CRSwNP and CRSsNP (70% vs 37% and 42%, P = 0.015 and P = 0.05, respectively). Median serum total immunoglobulin E was higher in CCAD (283 IU/ml) and CRSwNP (127 IU/ml) than CRSsNP (27 IU/ml, P = 0.006 and P = 0.042, respectively).

CONCLUSIONS

Endoscopic CCD was a better predictor of inhalant allergy than radiologic CCD in primary CRS, in a locale of perennial allergic rhinitis.

Oral Incompetence: changes in speech intelligibility following facial nerve paralysis

BACKGROUND

Speech may be compromised following facial nerve paralysis (FNP), depending on the cause of the paralysis. This can result in lower quality of life and a reduced capacity to return to vocational roles. Despite its prevalence, it is incompletely understood and rarely described. This study prospectively evaluated the impact of FNP on speech intelligibility.

METHODS

This observational study recruited patients who were diagnosed with FNP and who reported oral incompetence from the Sydney Facial Nerve Service. Their speech was analysed using patient reported outcome measures (Speech Handicap Index) and perceived intelligibility (Speech Pathologist, community member control participants, participant self-rating, and dictation software).

RESULTS

Forty participants with FNP and 40 controls were recruited. Participants with FNP rated their intelligibility to be significantly worse than other raters (p <0.001). Consonant analysis demonstrated bilabial, fricatives and labiodental phonemes to be most commonly affected following FNP.

CONCLUSION

Oral competence is compromised after FNP which can lead to a poorer perception of their intelligibility and reduced speech related quality of life.

Epidemiology and aetiology of chronic rhinosinusitis in Asia-A narrative review

BACKGROUND

Despite having a similar prevalence to Western populations, literature on chronic rhinosinusitis (CRS) in the Asian population is sparse. There is limited data on the epidemiology and aetiology of CRS in Asia.

OBJECTIVES

To review the current literature on the epidemiology and aetiology of CRS in Asia.

METHODS

This is a narrative review of published data on the epidemiology and aetiology of CRS. Studies on CRS in Asian countries, published in English and indexed on PubMed or Google Scholar were reviewed. Where available, data extracted included epidemiology, endotype and cytokine profiles and genetic profiles.

RESULTS AND CONCLUSION

The prevalence of CRS in Asia ranges widely from 2.1% to 28.4%. Type 2 inflammation has been reported in 5%-55% of Asian patients, with lower levels of Type 2 cytokines reported in head to head comparisons of Western versus Asian patients. Notably, there exists marked heterogeneity in criterion of the tissue eosinophilic infiltration for diagnosis of type 2 CRS. Our review suggests that differences in prevalence of CRS and proportion of eosinophilic CRS between Asia and Europe and the Americas requires further study. Large-scale Asian studies utilising standardised definitions are needed to bridge this gap. Head to head genetic and microbiomal analysis may also be useful in understanding differences in CRS between the Asian and Western populations.

Chiral Response of Twisted Bilayer Graphene

We present an effective (minimal) theory for chiral two-dimensional materials. These materials possess an electromagnetic coupling without exhibiting a topological gap. As an example, we study the response of doped twisted bilayers, unveiling unusual phenomena in the zero frequency limit. An in-plane magnetic field induces a huge paramagnetic response at the neutrality point and, upon doping, also gives rise to a substantial longitudinal Hall response. The system also accommodates nontrivial longitudinal plasmonic modes that are associated with a longitudinal magnetic moment, thus endowing them with a chiral character. Finally, we note that the optical activity can be considerably enhanced upon doping and our general approach would enable systematic exploration of 2D material heterostructures with optical activity.

Deformation and scattering in graphene over substrate steps

The electrical properties of graphene depend sensitively on the substrate. For example, recent measurements of epitaxial graphene on SiC show resistance arising from steps on the substrate. Here we calculate the deformation of graphene at substrate steps, and the resulting electrical resistance, over a wide range of step heights. The elastic deformations contribute only a very small resistance at the step. However, for graphene on SiC(0001) there is strong substrate-induced doping, and this is substantially reduced on the lower side of the step where graphene pulls away from the substrate. The resulting resistance explains the experimental measurements.

Co-stimulation and counter-stimulation: lipid raft clustering controls TCR signaling and functional outcomes

T cell receptor (TCR) antigen recognition induces the formation of a specialized 'immunological synapse' at the T cell : antigen presenting cell (APC) junction. This junction is generated by the recruitment and exclusion of particular proteins from the contact area and is required for T cell activation. We and others have hypothesized that lipid raft/non-raft partitioning provides a molecular basis for protein sorting which organizes the TCR, co-stimulators, signal transducers and the actin cytoskeleton at the T cell : APC interface. Here we discuss the emerging paradigm that co-stimulators induce the directional transport and clustering of lipid rafts at the T cell : APC interface, thus generating platform(s) specialized for processive and sustained TCR signal transduction and T cell activation. We also discuss recent data implicating the involvement of 'counter-stimulators' and other negative regulators which prevent optimal raft clustering at the TCR contact site and, thus, facilitate T cell inactivation and tolerance induction.

Assessment of patient sociodemographic variables in clinical trials--can patient characteristics make a difference?

INTRODUCTION

The recruitment of patients into clinical trials is often thought to be a selective process whereby non-biological variables such as education, occupation, family/social support, and socioeconomic status are often found to be predictive of patient volunteers. This paper considers whether the susceptibility of trials to recruit non-representative patient populations may impair the extrapolation of results to diverse sociodemographic patient groups and/or hinder operational trial efficiency.

METHOD

A review of the Embase and Medline databases was conducted using Subject Headings (clinical trial or randomised-controlled trial) combined with Keywords (sociodemographic, education, occupation or socioeconomic). References presenting patient sociodemographic characteristics in relation to trial recruitment or impact on measured trial data points were reviewed.

RESULTS

Both quantitative and qualitative reports suggest clinical trials are prone to recruit biased sociodemographic cohorts. This review suggests three trial cohort analyses that may enhance the interpretation of trial results and provide insight into the operational efficiency of clinical trials. Assessments include: (1) comparing recruited trial cohort with source population; (2) assessing trial data points across sociodemographic groupings irrespective of treatment; (3) assessment of patient dropouts based on sociodemographic characteristics.

CONCLUSION

In view of the known sociodemographic disparities found in trial recruitment, a methodology is suggested which may provide valuable information regarding the external validity of trial results and/or assessing operational trial efficiency. The challenge to those undertaking clinical trials should be to firstly determine whether recruitment biases may exist, and secondly whether trial integrity may be compromised by the presence of such biases.

Assessment of nutrition education needs among a sample of elderly Chinese in an urban area

As Malaysia is moving towards a rapidly developing economy, its elderly population is also expected to increase not only in numbers and proportion but also in their life expectancies. This demographic shift from a relatively young population to one that includes an increasing number of old and very old age group presents a real challenge to nutritionists and health professionals. The challenge is to maintain a healthy and vigorous elderly population who can lead fulfilling and independent lives. Health promotion and disease prevention efforts, including nutrition education, targeted towards this group can contribute important elements in meeting the challenge. The objective of the study was to assess the nutrition education needs of a sample of elderly Chinese in an urban area. The sample consisted of 34 males and 36 females, whose age ranged from 55 to 86 years. They were generally affluent and well-educated with a mean income of RM101 1.86 and 8.0 years of formal education. A self-administered questionnaire which requires 20 to 30 minutes to complete was used to collect the information. The results of the nutrition knowledge assessment indicated that the typical respondent correctly identified 16 of the 22 nutrition knowledge statements. A majority (91.4%) of the respondents recognized the fact that tomato, dark green leafy vegetables, and orange juice are good sources of vitamin C, while the statement on vitamin supplementation was correctly answered by only 15.7% of the respondents. The mean nutrition knowledge score was 26.14 with a range of between 18 and 36. The t-test indicated a significant difference (t=3.63, p_0.05) between males and females in their nutrition knowledge scores, with the males having higher mean scores. Although only 8.6% of the respondents reported they had participated before in a nutrition education programme, a majority of them believed that nutrition education can improve the nutritional and health status of the elderly. A majority (80%) of the respondents mentioned newspaper articles as their source of nutrition information, while only 8.6% indicated the dietitian as their source of information. However, the doctor was identified as a more creditable and reliable source of information by a majority.

The surface finish of the new microfill restorative materials. A scanning electron microscope study

Surface smoothness is an important requirement for restorative materials. Recently, restorative materials claimed to be inherently smooth in surface characteristics have been developed. Matrix-formed and finished surfaces of five new microfill restorative materials were compared with two composite resins, an acrylic resin and a silicate cement by means of scanning electron microscopy. The results of this investigation indicated that the matrix-formed surfaces of all the restorative materials studied were not altogether perfect. Polishing using sandpaper and cuttlefish discs produced a very smooth surface finish in the new microfill restorative materials, Estic microfill, Estilux microfill, Isopast, Isolux and Silar which was comparable to that of the acrylic resin, Sevriton. The composite resins, Adaptic and Estilux exhibited the worst surface finish and the silicate cement, Bio-trey was intermediate. Finishing, using other finer polishing devices on four of the materials produced a further improvement in the surface finish.

The combined application of topical fluoride and fissure sealant--results after 2 years

The effectiveness of combining the application of topical stannous fluoride and fissure sealing using Nuva Seal was tested in a group of school children over a 2-year period. The retention rate of the applied sealant was 71.1%. The caries reduction after 2 years was 76.8% which appears to be slightly better than comparable studies using the sealant alone. Staining of the fissures, which may indicate an uptake of the applied fluoride by the tooth was also observed. Whilst the combined approach theoretically should provide additional protection from dental caries following the loss of the applied sealant, further observations are necessary to substantiate the hypothesis.

The treatment of hypersensitive cervical abrasion cavities using ASPA cement

This study evaluated the usefulness of the alumino-silicate polyacrylate (ASPA) or glass ionomer cement in the treatment of hypersensitive cervical abrasion cavities. Various methods of treatment of hypersensitive cervical abrasion cavities have been described, and all these methods have their disadvantages. The ASPA cement was used to treat non-carious hypersensitive cervical abrasion cavities in 189 teeth from fifty-eight adult patients. The patients were followed-up for periods ranging from 6-15 months. Of the 189 treated teeth, the ASPA restoration was intact in 163 or 86.2%. Seventeen teeth or 9.0% had partial loss of the restorations and nine or 4.8% had complete loss of restorations. With regard to symptoms, 176 or 93.1% of the treated teeth were no longer sensitive to stimuli from the oral cavity following placement of the ASPA restoration. Of the fifty-eight patients, fifty-two or 89.7% were completely relieved of all symptoms. Of the remaining teeth eleven or 5.8% reported a reduction in the severity of the symptoms. Only one patient, with both restorations lost, reported no improvement. No case of pulpal death was recorded, and there was no evidence of caries at the margin of any of the restorations. The results indicate that the method is effective, and it has some distinct advantages over existing methods of treatment of these cavities.

The adaptation of composite materials to etched enamel surfaces

The adaptation of three composite materials and one unfilled bis-GMA resin to etched enamel surfaces was investigated by examining under optical and scanning electron microscopy the adhesive-enamel junction of replicas. The length of the tags and the density of tagging observed on the replicas showed that the three composite materials, Adaptic, Concise and Delphic, adapted to the etched enamel surface equally as well as the unfilled resin Nuva Seal. The results of this study together with available results of mechanical testing and clinical studies allow the conclusion that the successful retention of the composite filling materials to an etched enamel surface is not dependent on the use of an intermediate unfilled resin or bonding agent.

Hypodontia and supernumerary tooth: report of a case and its management

A case of the occurrence of both hypodontia or congenital absence of teeth and supernumerary tooth in the mandibular labial segment is reported. The supernumerary to simulate the lower central incisor, both for aesthetic purpose and for the maintenance of space. The orthodontic management of the patient was discussed.

Influence of the topical application of fluoride on the in vitro adhesion of fissure sealants

The adhesion of four polymeric sealant materials to enamel treated with a topical application of fluoride has been assessed by tensile bond strength tests. The ultraviolet light-activated resin, Nuva Seal, was found to bond adequately to stannous fluoride-treated teeth. The tensile bond strength of Espe 71730, Alpha Seal, and Epoxylite 9075 to enamel was reduced by treatment of the enamel with stannous fluoride. Treatment of the etched enamel with acidulated phosphate fluoride reduced the bond strength of all four fissure sealants.

The long term bonding of a polymeric fissure sealant to stannous fluoride treated enamel

A report is presented of extended studies of tensile bond strength of Nuva Seal to fluoride-treated enamel 1 week, 3 months and 9 months after application. The differences in strength were not statistically significant. The use of stannous fluoride as the topical agent did not lead to any marked evidence of enamel staining.

Caries prevalence in different racial groups of schoolchildren in West Malaysia

A dental health survey of 15,197 schoolchildren age 6-18 years was conducted in West Malaysia. The caries experience in the permanent teeth of the three racial groups, namely Malay, Chinese and Indian/Pakistani, showed a distinct variation. The prevalence was highest among the Chinese children, being about twice that of the Malay and Indian/Pakistani children. In the primary dentition, however, the caries experience in the three racial groups was comparable. An analysis of the factors contributing to the racial variation showed that dietary influence was not the only factor responsible. The possibility of a racial variation in caries susceptibility has been postulated. In the primary dentition the similar caries experience observed in the three groups of children was most probably due to the widespread occurrence of rampant caries which would heavily weight the dift score of the children in all three groups. The need to fluoridate the public water supply as an effective preventive measure is emphasized.

The bonding of a polymeric fissure sealant to topical fluoride-treated teeth

The tensile bond strength of a polymeric fissure sealant to enamel treated with a variety of topical fluorides was determined. Application of acidulated phosphate fluoride solutions (APF) prior to and after acid etching reduces the tensile bond strength of Nuva Seal from 36-6+/-9-0 kg/cm2 to 4-9+/-3-3 kg/cm2 and 23-8+/-6-3 kg/cm2 respectively. The treatment of the etched enamel with freshly prepared 8% stannous fluoride solution prior to Nuva Seal application significantly increases the tensile bond strength to 55-7+/-17-1 kg/cm2. It is recommended that clinical procedures such as the application of fissure sealants, acid etch composite restorations and the direct attachment of orthodontic brackets, all of which involve etching of the enamel, should not be precedded by the topical application of APF solutions.