UK Transfusion Laboratory Collaborative: minimum standards for staff qualifications, training, competency and the use of information technology in hospital transfusion laboratories 2014.

The SHOT Adverse Incident Reporting Scheme has consistently reported an unacceptably high level of errors originating in the laboratory setting. In 2006 an initiative was launched in conjunction with the IBMS, SHOT, RCPath, BBTS, UK NEQAS, the NHSE NBTC and the equivalents in Scotland, Wales and Northern Ireland that led to the formation of the UK TLC. The UK TLC in considering the nature and spread of the errors documented by SHOT concluded that a significant proportion of these errors were most likely to be related to either the use of information technology or staff education, staffing levels, skill mix, training and competency issues. In the absence of any formal guidance on these matters, the UK TLC developed a series of recommendations using the results of two laboratory surveys conducted in 2007 and 2008.

Intravenous pamidronate treatment in children with moderate-to-severe osteogenesis imperfecta started under three years of age.

OBJECTIVE: Evaluate clinical outcome of early cyclic intravenous pamidronate treatment in children with moderate-to-severe osteogenesis imperfecta (OI), commenced before three years of age. METHODS: A retrospective review of 17 patients with moderate-to-severe OI. Development, anthropometry, fracture history, bone mineral density (BMD) and biochemistry were collected at baseline, 12 and 24 months. RESULTS: Four had OI type I, eleven had type III, one OI-FKBP10 type and one OI type V. Mean age at start of pamidronate was 14 ± 11 months. Pamidronate ranged from 6 to 12 mg/kg/year. No adverse reaction apart from fever and vomiting was noted. Long bone fracture decreased from a mean of 10.4/year to 1.2/year after 12 months and 1.4/year after 24 months (p = 0.02). Lumbar spine age- and height-matched BMD Z-scores increased (p < 0.005). Sixteen with vertebral compression fractures at baseline all showed improved vertebral shape (p < 0.001). Concavity index, likewise, improved (p < 0.005). Motor milestones compared to historical data show earlier attainment in rolling over, crawling, pulling to stand and walking independently but not sitting. CONCLUSION: Cyclic intravenous pamidronate, started under 3 years of age in children with moderate-to-severe OI, was well tolerated and associated with an increase in lumbar spine BMD, reduced fracture frequency, vertebral remodelling and attainment of motor milestones at an earlier age.

The successful use of pamidronate in an 11-year-old girl with complex regional pain syndrome: response to treatment demonstrated by serial peripheral quantitative computerised tomographic scans.

Complex regional pain syndrome (CRPS) is a disorder that can cause significant functional morbidity. While it usually presents in adulthood, it has also been reported in children. Multiple treatment modalities have been reported with mixed success. Bisphosphonate therapy has been shown to be effective in adult patients, but there are limited data in children. We report the successful use of intravenous pamidronate therapy in diminishing pain, improving function, and restoring bone mass in an 11-year-old girl with CRPS of her left lower limb following a tibial fracture. Previous treatment with intense physiotherapy and regional sympathetic blockade had not improved her symptoms. Pain improved within weeks of the first pamidronate infusion, with subsequent improvement in function. The benefit in pain reduction and function was sustained during the 2-year treatment regime. Improvement in bone mass and density was demonstrated by dual-energy X-ray absorptiometry (DXA) and peripheral quantitative computerised tomography (pQCT). pQCT scans showed marked improvement in bone size and geometry and muscle bulk on the affected side. No adverse affects were reported. We conclude that intravenous pamidronate was associated with reduced pain, a return of function, and recovery of bone and muscle parameters in a child with CRPS. Before definitive conclusions can be drawn, a randomised controlled trial similar to those undertaken in adults previously is required to fully validate this approach.

Effects of nicotine on the strength of attachment of gingival fibroblasts to glass and non-diseased human root surfaces.

BACKGROUND: The aim of this study was to evaluate the effect of nicotine on the strength of attachment of human gingival fibroblast cells to glass and non-diseased human root surfaces. METHODS: Human gingival fibroblast cells (HGF) were trypsinized, suspended in RPMI 1640 medium, and incubated with autoclaved human root and glass sections and nicotine (NIC) concentrations of 0 (control), 25, 50, and 100 ng/ml for 1 week. HGF attached and grew on glass and root surfaces for 4 weeks at all NIC concentrations. HGF cultures were subjected to a rotary shaker machine for 30 minutes to test the strength of attachment of these cells at 100, 150, and 200 rpm. The root and glass sections were examined at 48 hours by light microscopy. RESULTS: Control groups exhibited a monolayer of long, spindle-shaped fibroblasts with a parallel alignment and minimal overlapping. With a concentration of NIC of 50 or 100 ng/ml as well as with increasing "speeds," the number of cells attached to these surfaces decreased dramatically. When 200 rpm was used for both groups at all NIC concentrations, very few HGF remained attached to these surfaces. CONCLUSIONS: This study showed that the nature of cell attachment to either glass or root surfaces is altered by nicotine, and marked detachment was noted when nicotine exposure was coupled with vigorous agitation at different rpm. Marked detachment noted in all specimens at 200 rpm indicates that this speed is excessive for use in subsequent experimentation.

In vitro attachment of human gingival fibroblasts to endosseous implant materials.

In recent years, the focus of dental implant research has been the nature of the bone-implant interface associated with osseointegration, yet the transgingival portion of endosseous dental implants has received little attention. The purpose of this study was to determine the attachment of human gingival fibroblasts to three different implant materials: commercially pure titanium, non-porous hydroxyapatite, and porous hydroxyapatite. Cell attachment was quantified by radiolabeling gingival fibroblasts with tritiated thymidine and counting attached cells by liquid scintillation following incubation for periods of 20, 40, and 60 minutes. Additional studies coating implant surfaces with fibronectin were also performed. The nature of the implant material itself appeared to affect the number of attached cells. Determined on a surface area basis, fibroblast attachment was greatest to titanium followed by non-porous hydroxyapatite. Porous hydroxyapatite demonstrated the least amount of fibroblast attachment. When incubated with fibronectin at a concentration of 50 micrograms/ml, no increase in the number of cells attached to the various implant materials was observed. A small but statistically significant increase in the number of fibroblasts attached to porous hydroxyapatite at 40 minutes was observed when implant materials were pre-treated with fibronectin.

Toxic effect of ethylene-oxide-sterilized freeze-dried bone allograft on human gingival fibroblasts.

Freeze-dried bone allograft (FDBA) which either had or had not been sterilized by exposure to ethylene oxide (EtO) prior to lyophilization was obtained from two commercial sources. EtO-sterilized FDBA was reexposed to EtO as a positive control. Gas chromatograph assays revealed that three out of four commercially obtained EtO sterilized FDBA had no detectable EtO, with one sample having 0.21 parts per million (PPM). Surprisingly, 0.24 PPM was detected in one sample which had not been sterilized with EtO gas. This was presumed due to contamination from a gas-sterilized rubber stopper. In the cell toxicity study, FDBA and human gingival fibroblasts (HGF) were added simultaneously, incubated for 72 h, and fixed and stained. Samples of FDBA sterilized with EtO which were free of EtO did not alter HGF growth. However, the positive control FDBA which contained 0.72 PPM EtO had a deleterious effect on HGF. FDBA with EtO residuals caused morphologic change in HGF.

Retardation of epithelial migration in monkeys using a carbon dioxide laser: an animal study.

Obtaining a connective tissue attachment to the root surface following a mucoperiosteal flap surgery has been a goal of periodontal therapy for a long time. The objective of this study was to examine whether controlled de-epithelialization with the CO2 laser would retard the apical migration of the epithelium and thereby increase the amount of connective tissue attachment. Elastics were placed on the maxillary premolars and incisors of 7 cynomolgus monkeys to create periodontal defects. Open flap debridement was performed on each side. On the experimental side, the oral epithelium was removed by CO2 laser irradiation. This report describes the 3 specimens at 7, 14, and 28 days respectively. On the control side sulcular epithelium was seen at 14 days. Sulcular epithelium was first seen on the test side at 28 days. For all specimens over 7 days, there was a trend to less epithelium and more connective tissue attachment on the experimental side than on the control side. However, no statistical analysis was possible on this histologic study. The CO2 laser may be a useful tool to retard epithelium and thereby enhance new connective tissue attachment.

A comparison of T4:T8 lymphocyte ratio in the periodontal lesion of healthy and HIV-positive patients.

Previous reports describe a characteristic, rapidly progressive, periodontitis that is unique to patients who are seropositive for HIV antibody (Western blot +). The purpose of this study was to compare the T4 and T8 lymphocyte subpopulations in the peripheral blood and periodontal lesions of these HIV patients with those of healthy controls. T-cell subsets in peripheral blood were quantified by flow cytometry. The values from this analysis were used to calculate the peripheral T4:T8 lymphocyte ratio for each patient. Gingival tissue (papilla) was obtained from 8 HIV+ patients and from 6 healthy HIV- control patients during routine gingival surgery. The T-cell subpopulations in the gingival tissue were determined using serial cryostat sections that were labeled with monoclonal antibodies for T4 and T8 cells and developed using an avidin-biotin-peroxidase system. Six sections were taken from each of the 14 tissue specimens (one per patient). The sections were examined at 450 x and the mean number of T4 and T8 cells calculated for each section. These mean values were then used to determine the T4:T8 lymphocyte ratio for each tissue specimen. The peripheral blood analysis revealed a mean serum T4:T8 ratio of (2.07 +/- 0.455) for the controls and (0.58 +/- 0.26) for the HIV patients. The significantly lower T4:T8 ratio in HIV patients is consistent with their diagnosis. Although the results indicated that the mean T4:T8 lymphocyte ratio in the gingiva of controls was highly variable (2.70 +/- 1.344), the gingiva of HIV patients consistently exhibited a complete absence of T-cells.(ABSTRACT TRUNCATED AT 250 WORDS)

Correlation of subclinical candidal colonization of the dorsal tongue surface with the Walter Reed staging scheme for patients infected with HIV-1.

The correlation between subclinical candidal colonization of the dorsal tongue surface and the Walter Reed staging scheme for patients positive for human immunodeficiency virus (HIV-1) antibody is reported. Of 76 cytologic smears of the dorsal tongue surface, 12 (16.2%) demonstrated subclinical colonization. The mean peripheral helper T-lymphocyte count for patients with subclinical colonization was 304 +/- 226 cells/mm3 and was not significantly different from seropositive patients without colonization (411 +/- 209 cells/mm3). The Walter Reed scheme for assessing progressive immunodysregulation did not significantly correlate with the presence of subclinical colonization. This study suggests a more complex pathogenesis for oral candidiasis in HIV-1-infected patients rather than a direct link to peripheral helper T-lymphocyte depletion below a count of 400 cells/mm3.

Evaluation of titanium dental implant osseointegration in posterior edentulous areas of micro swine.

This study investigated the micro swine (Sus scrofa) as an animal model for research in osseointegrated implant systems. As the first in a series of investigations based on this model, the study focused on the histological evaluation of the bone-implant interface of Brånemark implants. Ten titanium implants were placed in posterior edentulous areas of the swine for longitudinal evaluation of healing and osseointegration. Six-week and 18-week post-operative specimens were removed en bloc at the time of death. The samples were fixed in glutaraldehyde, embedded in acrylic, and sectioned with a diamond wafering saw. The specimens were viewed under SEM and photographed. The percentage of bone that was in direct contact with the coronal, middle, and apical segments of the implant, referred to as the contact length fraction (CLF), was determined by use of a digitizing analyzer. All implant fixtures became exposed through the soft tissue within one week of placement. Of the ten titanium fixtures placed, three failed--one by post-surgical day 14 due to food impaction into the surgical site, and the other two because of failure to osseo-integrate. Bone contact with the successfully integrated implant surfaces ranged from 19.2 to 58.5%, with a mean of approximately 34%. Osseointegration did not appear to increase over the experimental time period, since there was no difference in the percentage of bone contact between the 18-week and the six-week specimens. The lack of soft-tissue coverage over the implants caused bone loss, but did not significantly affect osseointegration in the coronal third. The micro swine appears to be a suitable animal model for use in implant research in posterior edentulous regions.

The presence of nicotine on root surfaces of periodontally diseased teeth in smokers.

There is a growing body of scientific evidence to support the concept that the use of tobacco products significantly contributes to the progression of periodontal disease or is detrimental to healing following periodontal therapy. Several studies have shown toxic effects of nicotine on peripheral circulation and the immune response. The purpose of the present study was to identify and compare the quantity of nicotine present on root planed and nonroot planed surfaces of teeth from smokers. Twenty-nine single-rooted teeth from 11 smokers were extracted, brushed clean, and the roots sectioned longitudinally. The respective halves were either left untreated (Group A) or thoroughly root planed (Group B). Pulpal tissue was removed and the individual root sections weighed. Each half was extracted for nicotine using a methylene chloride technique. Quantification was performed using high pressure liquid chromatography (HPLC) and the sections compared on a nicotine per root weight basis. Results showed a greater amount of nicotine present on non-root planed sections than on treated sections, although some treated specimens revealed small amounts of the substance. These findings suggest that nicotine is present on the root surface but is largely removed by thorough root planing. Its presence is not surprising in light of the recent finding that nicotine and cotinine, the major metabolite of nicotine, are found in gingival crevicular fluid. Recent studies have shown a particularly harmful effect of nicotine on fibroblasts. Its presence on root surfaces may, therefore, impair wound healing and alter the host response in periodontal disease. The use of tobacco products in conjunction with periodontal therapy may interfere with optimal healing and/or lead to further periodontal breakdown.

Effectiveness of sodium fluoride on tooth hypersensitivity with and without iontophoresis.

The purpose of this study was to assess the short and long term reduction of dentinal hypersensitivity by a single application of sodium fluoride with and without iontophoresis. Two teeth in each of 16 patients were blindly evaluated before and after treatment, and at 1, 3, and 6 months. A blast of air and tactile pressure were used to assess pain. Results indicate that there is significant, immediate reduction in dentinal hypersensitivity with the use of iontophoresis that is lost with time. The use of sodium fluoride alone had no effect. Sodium fluoride with iontophoresis was demonstrated to have an immediate post treatment effect (P less than .001) that lasted through the 3-month observation period. The data suggest that iontophoresis may be a useful adjunct to sensitivity therapy and that an immediate therapeutic effect may be achieved. The efficacy of the use of sodium fluoride alone is obscured by the natural reduction of root sensitivity observed with time.

Cotinine in saliva and gingival crevicular fluid of smokers with periodontal disease.

A study was undertaken to determine the presence of cotinine, a metabolite of nicotine, in the saliva and gingival crevicular fluid of smokers with periodontal disease. Saliva and crevicular fluid samples were obtained from 16 habitual cigarette smokers and analyzed by High Performance Liquid Chromatography (HPLC) for the presence of cotinine. Thirteen non-smokers with periodontal disease served as controls. There was no evidence of cotinine (within our detection levels) in either the saliva or crevicular fluid of any of the nonsmokers. Cotinine, in a wide range of concentrations, was detected in the saliva and crevicular fluid in all of the 16 cigarette smokers. The presence of a nicotine metabolite in the saliva and gingival crevicular fluid reflects the extent of the systemic distribution of nicotine in smokers. The vasoactive properties of nicotine are well known and may possibly affect the pathogenesis of periodontal disease.

Inheritance and linkage data for an unusual combination of genes (at the LKE, PI and C6 loci) in a single large sibship.

Analysis of the groups of a large sibship showed that the locus for the blood group LKE is not closely linked to the loci for MNS, Rh, HLA, Pi, Gm and C6 and is genetically independent of the loci for P1, K, Xg, Au, secretor, and C3. The locus for the Auberger (Au) blood group was shown to be genetically independent of the locus for the blood group Kell and of the loci for C3, C6, Gc, HLA, Pi and Gm groups.

The effect of nicotine on the attachment of human fibroblasts to glass and human root surfaces in vitro.

This study examined the effect of nicotine on fibroblast attachment to glass and nondiseased human root surfaces. Human foreskin fibroblasts (HFF) were trypsinized, suspended in RPMI 1640 medium, and incubated with autoclaved human root sections and nicotine concentrations of zero (control), 25, 50, 100, 200, or 400 ng/ml. The root sections were examined for fibroblast attachment at 24, 48, and 72 hours by light microscopy and scanning electron microscopy (SEM). Additional trypsinized HFF were incubated on glass surfaces with the same concentrations of nicotine and examined at one week by light microscopy. HFF attached and grew on glass and root surfaces at all concentrations of nicotine. Controls on glass surfaces exhibited a normal monolayer of long spindle-shaped fibroblasts with a parallel alignment and minimal overlapping. Nicotine-treated HFF exhibited a haphazard arrangement with cell overlapping and vacuolization of the cytoplasm. Under SEM, the controls had smooth surfaces and appeared firmly attached to the root surface via (1) microvilli and filopodia on the cell boundaries and (2) short, branched, thin-to-medium width cytoplasmic processes with microvilli and filopodia on their boundaries. Few microvilli were noted on the control cell surfaces. HFF exposed to nicotine had microvilli and filopodia on the cell surfaces and long thin and long broad cytoplasmic processes with many microvilli and filopodia that projected away from the root surface. These findings suggest that the nature of fibroblast attachment to glass and root surfaces is altered by nicotine. A similar disturbance in fibroblast attachment may occur in humans who use nicotine-containing products, making them more susceptible to destruction of the periodontium and less responsive to new attachment after periodontal therapy.

Effects of CO2 laser irradiation on gingiva.

A CO2 laser (Coherent Medical Model 400) was used to irradiate the gingival tissue of a cynomolgous monkey to determine laser effects on the epithelium and underlying connective tissue. A focal length of 400 mm and a 10-watt power setting at 0.2- and 0.5-second exposure was used. Biopsy results indicated that a 0.2-second duration of CO2 laser irradiation was inadequate to completely de-epithelialize the gingival tissue. A 0.5-second exposure exhibited complete epithelial destruction with little or no disturbance of the underlying connective tissue layer and viable connective tissue 1.0 mm below the impact site.

The use of ultrasound for the determination of periodontal bone morphology.

The purpose of this study was to assess the value of ultrasound in the measurement of periodontal bone morphology. Four patients scheduled for periodontal surgery were selected for the study. The Ocu-Scan 400 machine was used and adjusted according to the manufacturer's instructions. Teeth involved in the study were measured on the facial aspect at three different points: mesial, midfacial and distal (except one tooth measured only at the mesial point). Two different presurgical measurements were made with the use of ultrasound. The distance between the gingival margin and the crest of alveolar bone was measured during the surgical procedure. No correlation could be made between the different measurements obtained. From the results the following was concluded: measurement of alveolar bone topography with the presently available ultrasound probe is not accurate, and ultrasound measurement is a fast and painless procedure.

Bilateral palatal myoclonus. Pathophysiology and report of a case.

A case of palatal myoclonus in a 52-year-old woman is described. This is a rare condition in which the rhythmic contraction of the palatal musculature gives rise to otologic symptoms. The clinical symptoms, pathophysiologic characteristics, and recommended treatment modalities are discussed.