Beyond Description: The Many Facets of Dental Biomechanics.

Teeth lie at the interface between an animal and its environment and, with some exceptions, act as a major component of resource procurement through food acquisition and processing. Therefore, the shape of a tooth is closely tied to the type of food being eaten. This tight relationship is of use to biologists describing the natural history of species and given the high instance of tooth preservation in the fossil record, is especially useful for paleontologists. However, correlating gross tooth morphology to diet is only part of the story, and much more can be learned through the study of dental biomechanics. We can explore the mechanics of how teeth work, how different shapes evolved, and the underlying forces that constrain tooth shape. This review aims to provide an overview of the research on dental biomechanics, in both mammalian and non-mammalian teeth, and to synthesize two main approaches to dental biomechanics to develop an integrative framework for classifying and evaluating dental functional morphology. This framework relates food material properties to the dynamics of food processing, in particular how teeth transfer energy to food items, and how these mechanical considerations may have shaped the evolution of tooth morphology. We also review advances in technology and new techniques that have allowed more in-depth studies of tooth form and function.

How do morphological sharpness measures relate to puncture performance in viperid snake fangs?

It makes intuitive sense that you need a sharp tool to puncture through a tough material. The typical approach to evaluating sharpness in biological puncturing tools is to treat morphological measurements as a proxy for puncture ability. However, there are multiple approaches to measuring sharpness, and the relative influence of morphology on function remains unclear. Our goal is to determine what aspects of tip morphology have the greatest impact on puncture ability, using ( a) viper fangs and ( b) engineered punches to isolate the effects of different sharpness measures. Our results indicate that tip included angle is the strongest predictor of puncture performance in both viper fangs and engineered punches. For puncture tools with small included angles, sharpness index (based on the radius of curvature) also affects puncture ability. Finally, we found that punches serve as good predictors of fang performance at small angles and sharpness index values.

Flexibility of Heterocercal Tails: What Can the Functional Morphology of Shark Tails Tell Us about Ichthyosaur Swimming?

The similarities between ichthyosaurs and sharks are a text-book example of convergence, and similarities in tail morphology have led many to theorize that they had similar swimming styles. The variation of ichthyosaur tail shapes is encompassed within the diversity of shark families. In particular early ichthyosaurs have asymmetrical tails like the heterocercal tails of carcharhinid sharks, while later occurring ichthyosaurs have lunate tails similar to those of lamnid sharks. Because it is not possible to measure ichthyosaur tail function, the goal of this study is to measure and compare the flexibility and stiffness of lunate and heterocercal shark tails, and to measure skeletal and connective tissue features that may affect tail flexibility. We measured flexibility in 10 species and focused on five species in particular, for dissection: one pelagic and one bottom-associated individual from each order, plus the common thresher shark (Alopias vulpinus), a tail-slapping specialist. As expected, lunate tails were overall less flexible than heterocercal tails and had greater flexural stiffness. Our results suggest that the cross-sectional profile of the skeletally supported dorsal lobe dictates flexural stiffness, but that changing tissue composition dictates flexural stiffness in the ventral lobe. We also found structural differences that may enable the tail slapping behavior of the common thresher shark. Finally, we discuss how our morphological measurements compare to ichthyosaur measurements from the literature; noting that similarities in functional morphology suggest sharks may be a good analog for understanding ichthyosaur swimming biomechanics.

The influence of cactus spine surface structure on puncture performance and anchoring ability is tuned for ecology.

Spines are common morphological features found in almost all major biological groups offering an opportunity to explore large-scale evolutionary convergence across disparate clades. As an example, opuntioid cacti have spines with barbed ornamentation that is remarkably similar in form and scale to that found on porcupine quills, suggesting specific biomechanical convergence across the animal and plant kingdoms. While the mechanics of porcupine quills as defensive mechanisms has been previously tested, the mechanics of cactus spines (which have evolved to fill a number of functions including defence, climbing and dispersal) has not been characterized. Here we study the puncturing and anchoring ability of six species of cactus, including both barbed and non-barbed spines. We found that barbed spines require less work to puncture a variety of targets than non-barbed spines. Barbed spines also require more work than non-barbed spines to withdraw from biological materials, owing to their barbs engaging with tissue fibres. These results closely match those found previously for barbed versus non-barbed porcupine quills, implying biomechanical convergence. The variation in performance of barbed versus non-barbed spines, as well as between barbed spines from different species, is probably tied to the diversity of ecological functions of cactus spines.

How to best smash a snail: the effect of tooth shape on crushing load.

Organisms that are durophagous, hard prey consumers, have a diversity of tooth forms. To determine why we see this variation, we tested whether some tooth forms break shells better than others. We measured the force needed with three series of aluminium tooth models, which varied in concavity and the morphology of a stress concentrating cusp, to break a shell. We created functionally identical copies of two intertidal snail shells: the thicker shelled Nucella ostrina and the more ornamented Nucella lamellosa using a three-dimensional printer. In this way, we reduced variation in material properties between test shells, allowing us to test only the interaction of the experimental teeth with the two shell morphologies. We found that for all tooth shapes, thicker shells are harder to break than the thinner shells and that increased ornamentation has no discernible effect. Our results show that for both shell morphologies, domed and flat teeth break shells better than cupped teeth, and teeth with tall or skinny cusps break shells best. While our results indicate that there is an ideal tooth form for shell breaking, we do not see this shape in nature. This suggests a probable trade-off between tooth function and the structural integrity of the tooth.

Prevalence of ischaemic heart disease at admission to intensive care and its influence on red cell transfusion thresholds: multicentre Scottish Study.

BACKGROUND: Restrictive transfusion triggers are safe for most critically ill patients, but doubts exist for patients with ischaemic heart disease (IHD). We investigated the prevalence of reported IHD at admission to the intensive care unit (ICU) and investigated how this influenced red cell transfusion triggers. We also compared observed practice with the clinicians' responses to clinical scenarios. METHODS: We studied 1023 sequential ICU admissions over 100 days to 10 Scottish ICUs. Daily haemoglobin, red cell transfusion, and haemorrhage data were available for 99.4% of 5638 ICU patient days. We recorded if IHD was recorded in clinical records at ICU admission. We grouped admissions as having a non-cardiac primary ICU diagnosis and no documentary evidence of IHD (Group 1, n=697), a non-cardiac primary ICU diagnosis with evidence of IHD (Group 2, n=213), or a cardiac primary ICU admission diagnosis (Group 3, n=113). We examined pre-transfusion haemoglobin concentration (Hb) for transfusion episodes not associated with haemorrhage. Clinical transfusion scenarios were sent to intensivists in the ICUs after data collection, which were designed to explore the clinicians' attitude to transfusion triggers in patients with IHD. RESULTS: Previous myocardial infarction was documented in 159 (16%), cardiac failure in 142 (14%), and angina in 167 (16%). Overall, 28.8% of admissions had >/=1 of these documented. The adjusted mean (se) pre-transfusion Hb concentrations varied across the groups. These were 74 (2.2) g litre(-1) in Group 1, 77 (2.3) g litre(-1) in Group 2, and 79 (3.1) g litre(-1) in Group 3 (P=0.003 across the groups). There was concordance between observed practice and responses to the scenario similar to Group 1, but discordance for patients with IHD (Groups 2 and 3). In scenario responses, intensivists stated these patients should have significantly higher transfusion triggers than were actually observed (median [IQR] response for both groups: 90 [80-100] g litre(-1)). CONCLUSIONS: About 29% of patients admitted to Scottish ICUs had documented IHD, which was associated with small adjustments to Hb transfusion triggers. In response to scenarios, clinicians believe that patients with IHD require higher transfusion triggers than are observed in practice.

Dimeric W3SO3 cluster complexes: synthesis, characterization, and potential applications as X-ray contrast agents.

Our continued research on the use of heavy metal cluster complexes as a new class of X-ray contrast agents in medical diagnostic imaging is described. A series of 2:3 cluster-ligand complexes, [(W(IV)3SO3)2L3]4- (L = linear polyaminopolycarboxylate ligands), were isolated from the reaction of aqua ion [W(IV)3SO3(H2O)9]4- (prepared in large quantities through an improved literature process) with respective ligands in refluxing DMF. The salts of [(W(IV)3SO3)2L3]4- complex anions were fully characterized using routine techniques such as elemental analysis, MS, HPLC, UV-vis, IR, and NMR. The solid structures of two complex anions, [(W(IV)3SO3)2(PDTA)3]4- and [(W(IV)3SO3)2(HO-PDTA)3]4-, were determined by X-ray crystallography. They are the first examples wherein two W(IV)3SO3 clusters are complexed and linked by three ligands that contain two terminal iminodiacetate (bis-IDA) groups. Complexation of the unstable aqua ion [W(IV)3SO3(H2O)9]4- with ligands has imparted desired biological compatibility to the tungsten metal cluster. These complexes are stable and highly soluble in H2O. The potential utility of such tungsten cluster complexes as X-ray contrast agents was evaluated in both in vitro and in vivo animal studies. In addition, the syntheses of several new linear polyaminopolycarboxylate ligands used in this study are reported.

Central and peripheral adverse hemodynamic changes during laparoscopic surgery and their reversal with a novel intermittent sequential pneumatic compression device.

OBJECTIVE: To study the influence of a novel intermittent sequential pneumatic compression device (Lympha-press) on the adverse cardiac and peripheral hemodynamic changes induced by positive-pressure pneumoperitoneum (PPPn) in laparoscopic surgery. SUMMARY BACKGROUND DATA: Creation of PPPn is known to cause adverse central and peripheral hemodynamic changes. An intrasubject observational study was undertaken to quantitate these adverse changes and to assess the influence of an intermittent sequential pneumatic compression system on these adverse hemodynamic changes during laparoscopic surgery with PPPn. METHODS: The study involved 16 consecutive patients undergoing laparoscopic surgery with PPPn of 12 mmHg and 30 degrees head-up tilt position. The following peripheral hemodynamic recordings were made using Doppler ultrasound: peak systolic velocity (PSV), end diastolic velocity (EDV), and cross-sectional area of the femoral vein. Central monitoring included cardiac output and stroke volume by transesophageal Doppler, blood pressure, and pulse. The hemodynamic state based on these parameters was assessed before induction of PPPn with the anesthetized patient in the supine position, after induction of PPPn and head-up tilt position with Lympha-press off, and during PPPn and head-up tilt position with Lympha-press on, and after desufflation with the patient in the supine position under general anesthesia. RESULTS: Positive-pressure pneumoperitoneum and the head-up tilt position resulted in a 33% reduction in PSV, a 21% reduction in EDV, and a 29% increase in cross-sectional area of the femoral vein. This was associated with a 20% reduction in cardiac output and an 18% reduction in stroke volume. Activation of Lympha-press during PPPn and the head-up tilt position resulted in a 129% increase in PSV and a 55% increase in EDV by 55%. It also increased the cardiac output by 27% and stroke volume by 16%, with no effect on cross-sectional area. Compared with the pre-PPPn stage, there was no difference in cardiac output or stroke volume, but the PSV was higher by 78% and the EDV by 32%. After abdominal desufflation in the supine position, the cardiac output and stroke volume were restored to the pre-PPPn level, but persistent and significant elevations were observed during the period of study in PSV, EDV, and cross-sectional area. CONCLUSIONS: Significant and individually variable central and peripheral hemodynamic changes are encountered during laparoscopic surgery with PPPn and the head-up tilt position. These are reversed by intermittent sequential pneumatic compression using Lympha-press.

Computed tomographic analysis of airway dimensions after carotid endarterectomy.

Airway obstruction is a rare but serious postoperative complication of carotid endarterectomy. We prospectively studied airway dimensions between the hyoid bone and cricoid cartilage in patients undergoing carotid endarterectomy using preoperative and postoperative computed tomographic (CT) scans of the neck. CT scans showed soft tissue swelling in all 19 patients. Five patients with clinical evidence of airway obstruction and a hematoma present on CT scan were intubated postoperatively. The three-dimensional reconstruction of the neck from the CT scans showed a reduction in the volume of the airway in all patients. This reduction was greater in the intubated (62% +/- 9%) compared to the nonintubated (32% +/- 7%) patients (P < 0.01). The anterior-posterior and transverse diameters of the airway were reduced, while retropharyngeal edema was increased after carotid endarterectomy. This change was greater for the upper airway at the level of the hyoid compared to the arytenoids and cricoid, and was significantly greater in the intubated than the nonintubated patients. Tracheal deviation was greater in the intubated than in the nonintubated patients. These results demonstrate significant soft tissue edema of the neck after carotid endarterectomy that reduces airway volume and can result in airway obstruction.

A comparison of percutaneous and operative tracheostomies in intensive care patients.

The aim of our study was to compare the complication rate of convenional surgical and percutaneous dilational tracheostomies performed under general anaesthesia in critically ill patients. Fifty-three consecutive patients whose lungs were mechanically ventilated and who required tracheostomy were randomised to undergo either conventional surgical tracheostomy (n = 28) in the operating room or percutaneous dilational tracheostomy (n = 25) in the intensive care unit under general anaesthesia. All of the procedures were successfully completed. No deaths were related to the performance of either tracheostomy technique. Three patients in each group required a dressing change for minor bleeding at the tracheostomy site. There was no major bleeding requiring blood transfusion. One patient in each group developed atelectasis detected on chest x-ray post-operatively. In the surgical tracheostomy group, there were two patients with cuff leaks, one with a stomal infection and one with a pneumothorax. None of these complications occurred after percutaneous, dilational tracheostomy. We conclude that the low incidence of complications in both groups indicates that percutaneous dilational tracheostomy can be performed as safely in the intensive care unit with general anaesthesia as surgical tracheostomy can be performed in the operating room.

Evaluation of predictive ability of APACHE II system and hospital outcome in Canadian intensive care unit patients.

OBJECTIVES: To evaluate the ability of the acute Physiology and Chronic Health Evaluation II (APACHE II) scoring system to predict patient outcome in two Canadian intensive care units (ICUs). To compare the severity of illness and outcome of Canadian ICU patients with existing United States data. DESIGN: Prospective data collection on 1,724 Canadian ICU patients for validation of the APACHE II system. Comparison of the outcome of Canadian ICU patients to retrospective United States data on 4,087 patients from the 1985 APACHE II multicenter study. SETTING: Canadian data from two university teaching hospital ICUs. United States data from 13 ICUs, ten of which were in university teaching hospitals. PATIENTS: Consecutive patients admitted to adult medical/surgical ICUs. Coronary care unit, neurosurgical and cardiac surgery patients were excluded. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: For each patient, demographic data, diagnosis, APACHE II score and hospital survival data were collected. The predicted risk of death was calculated for each patient using the APACHE II risk of death equation. The accuracy in outcome prediction of the APACHE II system was assessed by means of the receiver operating characteristic curve, 2 x 2 decision matrices and linear regression analysis. The severity of illness and hospital mortality for the Canadian patients was compared with that of United States patients from the 1985 APACHE II multicenter study. In 1,724 Canadian ICU patients, the mean +/- SEM APACHE II score was 16.5 +/- 0.2. The predicted death rate was 24.7% and the observed death rate was 24.8%. Using receiver operating curve analysis, good correlation was found between predicted outcome and observed outcome. The area under the curve was 0.86. From the 2 x 2 decision matrix constructed for a predicted risk of death of 0.5, 83% of patients were correctly classified. The sensitivity was 50.9% and the specificity was 93.6%. When observed death rate was plotted against predicted death rate, linear regression analysis gave an r2 of .99. Canadian patients had a higher death rate and APACHE II score than the United States patients. After controlling for severity of illness using the APACHE II score, the Canadian and United States death rates were similar. CONCLUSIONS: The ability of the APACHE II system in predicting group outcome is validated in this Canadian ICU population by receiver operating characteristic curve, 2 x 2 decision matrices and linear regression analysis. The Canadian patients had a higher overall hospital death rate than the United States patients. After controlling for severity of illness using APACHE II scores, the hospital death rate was comparable between the Canadian and United States patients.

Developing a quality management strategy.

A collaborative strategy between a college of nursing and a specialist nursing service was devised using outcomes driven by the ENB Higher Award. The successful implementation of this strategy has shown that the expectations of increased clinical-based innovation, resulting from this new approach to practitioner development, are achievable.

The synthesis and evaluation of macrocyclic gadolinium-DTPA-bis(amide) complexes as magnetic resonance imaging contrast agents.

The authors found that DTPA bis(amide) macrocycles can be prepared in reasonable yields using simple methods and readily available starting materials. Gadolinium complexation is facile and gives rise to monomeric and dimeric species. The "pocket size" influences the solid state structure of the final complex, with Gd-DTPA-EAM existing as a dimer wherein the macrocycle bridges between two metal centers. Increasing the size of the bridging diamide moiety yields a macrocycle with a sufficiently large pocket to allow for the formation of nine-coordinant monomeric complexes. The solution behavior of all the complexes studied is consistent with the complex being present as monomers. All complexes display kinetic lability comparable to Gd-DTPA-BMA. The measured KTherm and KSel values of the complexes vary with the size of the pocket. Values similar to those observed for Gd-DTPA-BMA have been obtained with Gd-DTPA-OAM. There appears to be a good correlation between log K(Gd/Zn) and the acute toxicity for the complexes studied, with Gd-DTPA-OAM showing a toxicity value similar to that of Gd-DTPA-BMA. Although many of these complexes are chemically interesting, they do not offer any unique advantages as new magnetic resonance imaging contrast agents compared with the DOTA- and DTPA-based products currently used clinically.

Clinical monitoring of neuromuscular function.

With the advent of shorter-acting non-depolarizing neuromuscular blocking drugs, the use of nerve stimulation as a means of monitoring the neuromuscular junction has become more widespread. This article describes the patterns of nerve stimulation and modes of monitoring muscular response in current clinical use. These patterns and modes are compared and their clinical relevance is discussed.

The minimum effective dose of lignocaine to prevent injection pain due to propofol in children.

In a single-blind study of 100 children aged 1 to 10 years, the minimum effective dose of lignocaine required to prevent injection pain due to propofol was 0.2 mg.kg-1 when veins on the dorsum of the hand were used. This is more than twice the adult value. We concluded that injection pain should not limit the use of propofol in children if an adequate amount of lignocaine is mixed immediately prior to injection.