Where should epistaxis education be focused? A comparative study between the public and healthcare workers on knowledge of first aid management methods of epistaxis.

BACKGROUND: Epistaxis can be life-threatening. Simple first aid management can stem bleeding. This study compared knowledge of first aid management methods of epistaxis between the general public and healthcare workers. METHOD: A cross-sectional study of 100 healthcare workers and 103 adult members of the public was conducted at a large London teaching hospital. Respondents completed a survey assessing knowledge on nasal pinching site, head tilt and appropriate adjunct treatment use for first aid management of epistaxis. RESULTS: Twenty-four per cent and 68 per cent of healthcare workers compared with 25.2 per cent and 37.9 per cent of the public answered correctly on nasal pinching position and head tilt position, respectively, with a statistical difference for head tilt position. Two per cent, 2 per cent and 24 per cent of healthcare workers mentioned ice use on the nose, ice use in the mouth or ice use but not site, respectively, compared with 0 per cent, 0 per cent and 4.9 per cent of the public, with a statistical difference for ice without site. CONCLUSION: Healthcare workers and the public lack knowledge on first aid management of epistaxis. Improved education on first aid management is required, targeting healthcare workers and the public.

Potassium titanyl phosphate laser surface tympanoplasty as a novel treatment for chronic granular myringitis in a series of 14 patients.

OBJECTIVE: Granular myringitis is a chronic and difficult-to-treat condition of the tympanic membrane. This paper presents a minimally invasive treatment technique using the potassium titanyl phosphate laser. DESIGN: A retrospective case review of patients who underwent potassium titanyl phosphate laser treatment between 2015 and 2020 was performed. All patients underwent final telephone follow up in 2020 to ascertain whether they had any ongoing myringitis symptoms, and all were offered further face-to-face follow up. RESULTS: Fourteen patients with myringitis were identified, with one patient having both ears affected. Of the 15 affected ears, 2 required a second treatment, resulting in a total of 17 laser treatment cases. At the first post-operative review, the appearance of the drum had improved in 10 out of 17 treatments (59 per cent). CONCLUSION: Potassium titanyl phosphate laser surface tympanoplasty may provide safe, quick and effective resolution of myringitis.

Sex Effects on Mirror Overflow during Finger Tapping in Children with ADHD.

OBJECTIVES: The presence of excessive mirror overflow in children with Attention Deficit/Hyperactivity Disorder (ADHD) is discussed in numerous published reports. These reports, however, include a limited age range in their samples. The objective of this study is to examine the effects of diagnosis and sex on mirror overflow and standard deviation (SD) of tap time in children with and without ADHD across a larger age range (5-12 years) of children. METHODS: One-hundred and forty-eight children with ADHD and 112 age- and sex-matched typically developing (TD) children completed a finger sequencing task. Mirror overflow, SD of tap time, and mean tap time were measured using finger twitch transducers. RESULTS: Results reveal a significant diagnostic effect on mirror overflow such that boys and girls with ADHD demonstrate increased overflow compared to same-sex TD children. Boys with ADHD demonstrated more variable tap times compared to TD boys; no diagnostic effect was observed in the girls. CONCLUSIONS: Boys with ADHD exhibit anomalous motor variability; girls with ADHD show similar levels of variability as TD girls. Boys and girls with ADHD exhibit similar levels of excessive mirror overflow. This lack of sex differences on mirror overflow is distinct from reports finding sex effects on overflow and could result from an examination of a broader age range than is included in prior reports. Adolescent data would provide a greater understanding of the trajectory of anomalous mirror overflow across development. Examination of functional and structural connectivity would expand the current understanding of the neurobiological foundation of motor overflow.

'PDSAFE' - a multi-dimensional model of falls-rehabilitation for people with Parkinson's. A mixed methods analysis of therapists' delivery and experience.

OBJECTIVE: To explore the clinical reasoning of physiotherapists using PDSAFE; according to disease severity and their experiences of treatment delivery in a large fall-prevention trial for people with Parkinson's (PwP). DESIGN: A descriptive study of delivering PDSAFE. Semi-structured interviews explored therapists' experiences. SETTING: A two-group, home-based, multi-centred, single-blinded, randomised controlled trial showed no overall effect on fall reduction between groups but demonstrated a significant secondary effect relating to disease severity with benefits to balance, falls efficacy and near-falls for all. PARTICIPANTS: Physiotherapists with a background in neurology and older-person rehabilitation were trained in the delivery of PDSAFE INTERVENTION: A multi-dimensional, individually tailored and progressive, home-based programme. RESULTS: Fifteen physiotherapists contributed to the 2587 intervention sessions from the PDSAFE trial and six of those physiotherapists took part in the interviews. The personalised intervention was reflected in the range of strategies and exercises prescribed. Most commonly prescribed fall-avoidance strategies were 'Avoiding tripping', 'Turning' and 'Freezing Cues' and all possible combinations of balance and strength training within the programme were selected. PwP with greater disease severity were more likely to have received less challenging strategies, balance and strengthening exercises than those with lower disease severity. Therapists considered the focus on fall events and fall avoidance strategies an improvement on 'impairment only' treatment. The presence of cognitive deficits, co-morbidities and dyskinesia were the most challenging aspects of delivering the intervention. CONCLUSION: Falls management for PwP is complex and compounded by the progressive nature of the condition. Physiotherapists both delivered and positively received PDSAFE. (248 words) The trial registration number is ISRCTN 48152791.

A large case series of temporal bone fractures at a UK major trauma centre with an evidence-based management protocol.

OBJECTIVE: To review the management of temporal bone fractures at a major trauma centre and introduce an evidence-based protocol. METHODS: A review of reports of head computed tomography performed for trauma from January 2012 to July 2018 was conducted. Recorded data fields included: mode of trauma, patient age, associated intracranial injury, mortality, temporal bone fracture pattern, symptoms and intervention. RESULTS: Of 815 temporal bone fracture cases, records for 165 patients met the inclusion criteria; detailed analysis was performed on the records of these patients. CONCLUSION: Temporal bone fractures represent high-energy trauma. Initial management focuses on stabilisation of the patient and treatment of associated intracranial injury. Acute ENT intervention is directed towards the management of facial palsy and cerebrospinal fluid leak, and often requires multidisciplinary team input. The role of nerve conduction assessment for immediate facial palsy is variable across the UK. The administration of high-dose steroids in patients with temporal bone fracture and intracranial injury is not advised. A robust evidence-based approach is introduced for the management of significant ENT complications associated with temporal bone fractures.

Development of an Introductory Neuroscience Teaching Experience for Undergraduates with a Low-Cost Neuroscience Summer Academy.

Undergraduate students studying neuroscience have limited opportunities to develop and apply teaching skills before joining a graduate program. Once in a graduate program, students in neuroscience programs are often hired as teaching assistants, adjuncts, or instructors of record. We propose that a low-cost, mentored, short-term summer neuroscience brain academy with high school student participants provides undergraduate students with critical introductory neuroscience teaching experience. Additionally, the experience serves as a service-learning opportunity for faculty and student personnel in a neuroscience laboratory. In this specific program, undergraduate students generate and deliver neuroscience lessons to high school students under the mentorship of a faculty member. This article contains an overview of the purpose of the summer academy, budgetary considerations, materials required, and the roles of faculty and students, with the goal that this model can be replicated at other universities. We propose that this experience addresses a critical gap in early neuroscience professional training.

The Representation of Color across the Human Visual Cortex: Distinguishing Chromatic Signals Contributing to Object Form Versus Surface Color.

Many theories of visual object perception assume the visual system initially extracts borders between objects and their background and then "fills in" color to the resulting object surfaces. We investigated the transformation of chromatic signals across the human ventral visual stream, with particular interest in distinguishing representations of object surface color from representations of chromatic signals reflecting the retinal input. We used fMRI to measure brain activity while participants viewed figure-ground stimuli that differed either in the position or in the color contrast polarity of the foreground object (the figure). Multivariate pattern analysis revealed that classifiers were able to decode information about which color was presented at a particular retinal location from early visual areas, whereas regions further along the ventral stream exhibited biases for representing color as part of an object's surface, irrespective of its position on the retina. Additional analyses showed that although activity in V2 contained strong chromatic contrast information to support the early parsing of objects within a visual scene, activity in this area also signaled information about object surface color. These findings are consistent with the view that mechanisms underlying scene segmentation and the binding of color to object surfaces converge in V2.

Adherence to guideline-based antibiotic treatment for acute exacerbations of chronic obstructive pulmonary disease in an Australian tertiary hospital.

BACKGROUND: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) are an important cause of acute hospital admissions and incur significant costs, which include antibiotic costs. AIMS: This study aimed to (i) define antibiotic prescribing practice in patients admitted to a tertiary hospital with AECOPD and compare this with current locally and nationally recognised antibiotic prescribing guidelines and (ii) correlate variations in guideline-concordant antibiotic prescribing with mean length of stay (LOS) and rates of unplanned readmission to hospital. METHODS: Retrospective case series of 84 consecutive patients with uncomplicated AECOPD who met pre-specified selection criteria. RESULTS: Seventy-two of 84 participants (85.7%) received guideline-discordant antibiotics, of whom the majority (76%) received intravenous antibiotics. Mean LOS was significantly lower among patients receiving guideline-concordant therapy compared with those receiving guideline-discordant therapy (mean 1.6 days vs 3.7 days; P = 0.002). There was no significant difference between groups in rates of readmission. Estimated excess costs per patient associated with guideline-discordant therapy equalled $2642 which, if eliminated, would save approximately $300 000 per annum. CONCLUSION: In a tertiary hospital, Australian guidelines for treating patients with an AECOPD were rarely followed. The use of guideline-discordant therapy resulted in longer hospital stays and incurred greater costs. Studies are required to determine the reasons behind such discordant practice and to develop initiatives to improve antibiotic prescribing.

[Genetic effects of bystander factors from the blood sera of people irradiated as the result of the Chernobyl accident].

The purpose of this work was the analysis of the effects of bystander factors from blood sera of people affected by the Chernobyl accident on human keratinocyte cell culture (HPV-G cells). A new method was developed for evaluation of the bystander factor presence in vivo in blood of the people irradiated by the Chernobyl accident. Affected population groups included liquidators of the Chernobyl accident and people living and working in areas of the Gomel region contaminated by radionuclides. The analysis has shown that bystander factors persist in Chernobyl liquidator blood samples for more than 20 years since irradiation. The data suggest that blood sera contain bystander factors, which are able to induce micronuclei and decrease the metabolic activity of HPV-G cells.

Outcome of patients in laparoscopic training courses compared to standard patients.

BACKGROUND & AIM: Current Laparoscopic simulators have limited usefulness and patients have been used for training since the dawn of surgery. NUGITS (Northumbrian Upper Gastro Intestinal Team of Surgeons) Laparoscopic Skills courses utilise hands-on experience with simulators moving to live operating on volunteer patients. It is vital to know that the volunteer patient is not disadvantaged by greater surgical risk. METHODS: This was a case-controlled prospective comparison of patients undergoing both Laparoscopic Cholecystectomy (LC) [n=51] and Laparoscopic Inguinal Hernia (LIH) [n=62] during NUGITS training courses. They are compared with a matched (age, sex and ASA grade) control group LC (n=51) and LIH (n=62) operated on by consultants. The outcome measures were surgical peri-and post-operative complications, post-operative hospital stay, readmission and early recurrence of inguinal hernia (<6 months). RESULTS: In the LC cohort, there was no significant difference in the length of hospital stay (p=0.07) or readmission (p=0.16) in both the groups. The mean operating time was higher in the trainee compared to the control group (p=0.001). There was no difference in the post-operative morbidity or mortality in either group. In LIH cohort, the mean operating time was higher in the trainee compared with the control group. There was no significant difference in post-operative complications (p>0.05) and early post-operative recurrence of hernia (p>0.05). CONCLUSION: The post-operative outcomes of patients undergoing laparoscopic surgery during laparoscopic training courses are similar to consultant-operated patients. Thus, it is acceptable and safe to encourage patients to volunteer for laparoscopic training courses.

Rhinosinusitis, symptomatology & absence of polyposis in children with primary ciliary dyskinesia.

INTRODUCTION: Primary Ciliary Dyskinesia (PCD) describes a group of inherited disorders which result in functional ciliary defects leading to mucous stasis. Clinical manifestations include otitis media with effusion and chronic rhinosinusitis. Nasal polyposis has previously been thought to be linked to PCD, and current theories of 'polypogenesis' suggest that early and severe polyp formation could be expected among sufferers of this condition. METHODS: Cross-sectional observational review of all children attending the multi-disciplinary clinic at a national tertiary-referral centre for PCD across a 3-month period. Careful examination was undertaken, and the SNOT-20 questionnaire administered. RESULTS: Thirty patients were included. No nasal polyps were found, despite children clearly suffering rhinosinusitis and being debilitated by their symptoms. The rhinologically orientated questions of the SNOT-20 produced the most positive responses; however some other questions were found not to be useful in a paediatric population. CONCLUSIONS: Nasal polyps do not occur in children with PCD, despite the presence of rhinosinusitis. Given that many current theories of polyp pathogenesis hinge on prolongation of proinflammatory stimuli, further investigations are needed into why this should not occur in the situation of chronic mucous stasis which is the hallmark of PCD.

A comparison of dimensional accuracy between three different addition cured silicone impression materials.

Ten impressions of a metal implant abutment were made with each of three addition-cured silicone impression materials. Using the technique of co-ordinate metrology, the shoulder region of the abutment and corresponding regions of both impressions and dies made from these impressions were scanned and measured. Comparison of these measurements indicated that the mean dimension measured from the shoulder region for each group of impression materials was significantly different from those taken from the original metal implant abutment. However, when these impressions were cast in a gypsum based die material, none of the measured dimensions taken from the casts were significantly different from those taken from the original metal implant abutment. Thus, any change in measured dimensions occurring during impression making, was compensated for in some way by the casting process.

Emotional intelligence and stress coping in dental undergraduates--a qualitative study.

OBJECTIVE: To explore how dental undergraduates with different levels of emotional intelligence (EI) cope with stress. DESIGN: Qualitative unstructured depth interviews. SETTING: A dental teaching hospital in the UK, 2002. SUBJECTS AND METHODS: Subjects selected from the undergraduate population of a 5-year dental degree course. A questionnaire survey was carried out to determine the EI scores of the subjects. In each year of study, subjects were divided into low and high EI groups at the median score. From each EI group in each year, one male and one female subject were recruited. DATA COLLECTION: Unstructured face-to-face interviews. DATA ANALYSIS: Transcribing, sifting, indexing and charting data according to key themes. RESULTS: 10 males and 10 females with low and high EI, representing all 5 years of study were interviewed. The experience of stress, expressed in emotional terms, ranged from anger and frustration to hatred. Four sets of coping strategies, adopted at varying degrees according to EI, were identified. High EI students were more likely to adopt reflection and appraisal, social and interpersonal, and organisation and time-management skills. Low EI students were more likely to engage in health-damaging behaviours. CONCLUSIONS: Future research needs to establish whether the enhancement of EI in dental students would lead to improved stress-coping, and better physical and psychological health.

Membrane phospholipids and high-energy metabolites in childhood ataxia with CNS hypomyelination.

BACKGROUND: Childhood ataxia with CNS hypomyelination (CACH) is a leukodystrophy with extreme rarefaction of white matter caused by mutations in one of the five subunits of the translation initiation factor 2B (eIF2B). METHODS: Seven children with this disease and nine age-matched control subjects were studied with proton-decoupled phosphorus magnetic resonance (MR) spectroscopy. RESULTS: In patients with CACH, cerebral concentrations of high-energy phosphate metabolites were abnormal. Of the metabolites involved in biosynthesis and catabolism of membrane phospholipids, glycerophosphorylethanolamine was reduced (0.24 +/- 0.18 mmol/kg brain vs 0.44 +/- 0.14; p < 0.02), and phosphorylethanolamine was increased (2.32 +/- 0.53 vs 1.53 +/- 0.22; p < 0.01), whereas the choline-containing phosphorylated metabolites were unchanged. Nucleoside triphosphate (NTP) was reduced (2.44 +/- 0.34 mmol/kg brain tissue vs 3.09 +/- 0.58; p < 0.01), phosphocreatine was elevated (4.11 +/- 0.63 vs 3.27 +/- 0.33; p < 0.01), and inorganic phosphate was reduced (0.77 +/- 0.32 vs 1.06 +/- 0.26; p < 0.05). Intracellular pH was elevated in patients (7.03 +/- 0.04 vs 6.99 +/- 0.02; p < 0.02). CONCLUSIONS: The authors found an altered energy state of the residual cell population investigated. Together with previously identified replacement of white matter by CSF, the present findings raise the possibility that the genetic defect in eIF2B may result in impairment of myelin membrane synthesis or myelin membrane transport in the in vivo CACH brain. Ethanolamine metabolites constitute the plasmalogens, and the present findings may include a defect in plasmalogen metabolism.

Geographic distribution of porcelain veneer preparation depth with various clinical techniques.

STATEMENT OF PROBLEM: Various clinical techniques have been advocated for uniform reduction of the tooth surface before a porcelain veneer restoration. Often these techniques do not produce a consistently uniform labial reduction. PURPOSE: The purpose of this study was to identify the degree of inconsistency on a geographic scale in the depth of labial reduction for porcelain veneers, resulting from the use of 3 clinical techniques. The technique of co-ordinate metrology was used to map the variations in the depth of the preparation. MATERIAL AND METHODS: A single operator using 3 techniques (dimples as depth guides, freehand, or depth grooves as depth guides) prepared 90 noncarious, unrestored extracted teeth to receive porcelain veneers (n=30). Impressions of the prepared and unprepared teeth were scanned with a co-ordinate measuring machine. In-house software was used to color-code the plotted images on the basis of the depth of preparation. Profile measurements were also made along the mid-labial sagital plane at the mid-labial, incisal, and cervical regions, as well as along the mesial proximal and distal proximal areas along the mid-labial horizontal plane. The ideal depth range for the labial reduction was chosen to be 0.4 to 0.6 mm. One-way analysis of variance and the Bonferroni test were performed to determine the significance (P<.05) in the difference between the means of reductions achieved with the 3 techniques. RESULTS: There was no statistically significant difference in the mean percentage area prepared to the ideal depth range (0.4 mm-0.6 mm), between dimple (44.59%), freehand (36.35%), and depth groove (38.43%) techniques. The difference in the mean percentage area of reduction greater than 0.6 mm between dimple (12.98%), freehand (29.66%), and dimple and depth groove (37.32%) techniques were statistically significant (P=.0000), but not between freehand and depth groove techniques. With the profile measurements it was seen that there were statistically significant differences in the mean depth between dimple (0.45 mm) and depth groove (0.63 mm), and freehand (0.51 mm) and depth groove in the mid-buccal (P<.0004) and cervical (dimple = 0.48 mm, freehand = 0.52 mm, depth groove = 0.63 mm) (P<.0005) regions. There was statistically significant difference (P<.0000) in the mean depth between the dimple (0.39 mm) and freehand (0.30 mm), dimple and depth groove (0.50 mm), and freehand and depth groove techniques in the incisal area. In the mesial proximal region statistically significant difference (P<.0034) in the mean depth was found between the dimple (0.52 mm) and freehand (0.68 mm), and dimple and depth groove (0.64 mm) techniques only. In the distal proximal region, there was no statistically significant difference in the mean depth between dimple (0.55 mm), freehand (0.66 mm), and depth groove (0.64 mm) techniques. CONCLUSION: The use of dimple technique showed a trend to greater consistency and fidelity in labial reduction to a depth of 0.4 to 0.6 mm. The 3 techniques for veneer preparations studied were associated with varying degrees of inconsistency in the distribution of depth of preparation within a tooth and between teeth in the same technique group.

T cell adhesion and cytolysis of pancreatic cancer cells: a role for E-cadherin in immunotherapy?

Pancreatic cancer is an aggressive and potent disease, which is largely resistant to conventional forms of treatment. However, the discovery of antigens associated with pancreatic cancer cells has recently suggested the possibility that immunotherapy might become a specific and effective therapeutic option. T cells within many epithelia, including those of the pancreas, are known to express the alphaEbeta7-integrin adhesion molecule, CD103. The only characterised ligand for CD103 is E-cadherin, an epithelial adhesion molecule which exhibits reduced expression in pancreatic cancer. In our study, CD103 was found to be expressed only by activated T cells following exposure to tumour necrosis factor beta 1, a factor produced by many cancer cells. Significantly, the expression of this integrin was restricted mainly to class I major histocompatibility complex-restricted CD8+ T cells. The human pancreatic cancer cell line Panc-1 was transfected with human E-cadherin in order to generate E-cadherin negative (wild type) and positive (transfected) sub-lines. Using a sensitive flow cytometric adhesion assay it was found that the expression of both CD103 (on T cells) and E-cadherin (on cancer cells) was essential for efficient adhesion of activated T cells to pancreatic cancer cells. This adhesion process was inhibited by the addition of antibodies specific for CD103, thereby demonstrating the importance of the CD103-->E-cadherin interaction for T-cell adhesion. Using a 51Cr-release cytotoxicity assay it was found that CD103 expressing T cells lysed E-cadherin expressing Panc-1 target cells following T cell receptor stimulation; addition of antibodies specific for CD103 significantly reduced this lysis. Furthermore, absence of either CD103 from the T cells or E-cadherin expression from the cancer cells resulted in a significant reduction in cancer cell lysis. Therefore, potentially antigenic pancreatic cancer cells could evade a local anti-cancer immune response in vivo as a consequence of their loss of E-cadherin expression; this phenotypic change may also favour metastasis by reducing homotypic adhesion between adjacent cancer cells. We conclude that effective immunotherapy is likely to require upregulation of E-cadherin expression by pancreatic cancer cells or the development of cytotoxic immune cells that are less dependent on this adhesion molecule for efficient effecter function.

A study into the variations in the labial reduction of teeth prepared to receive porcelain veneers--a comparison of three clinical techniques.

OBJECTIVES: Various techniques have been suggested to enable the operator to produce an even reduction of 0.5 mm of labial tooth enamel during preparation for a porcelain veneer. For example, in addition to the traditional free hand method, longitudinal or horizontal depth orientation grooves and the use of small round burs to produce dimples as depth guides have been suggested. However, there is no published data that compares how effective these techniques are at producing the 'ideal' veneer preparation. In this study three techniques were compared using the technique of co-ordinate metrology. METHOD: A single operator using the above three techniques prepared 84 extracted teeth. Impressions of the prepared and unprepared teeth were scanned using a co-ordinate measuring machine (CMM). Measurements of maximum labial reduction along the mid-labial plane were taken and analysed. RESULTS: The study showed that among the three techniques studied the use of small round burs (D001-012), when used side on at an angle of 45 degrees to the tooth surface to produce dimples as depth guides, resulted in the greatest frequency of tooth reductions closer to the 'ideal' depth chosen for this study, ie within the 0.4 mm-0.6 mm range. CONCLUSION: The study concluded that even after using techniques designed to produce consistent preparations, a single operator still produced preparations with considerable variation from the ideal. The study showed that among the three techniques compared the use of small round burs, when used side on at an angle of 45 degrees to the tooth surface to produce dimples as depth guides, resulted in the greatest frequency of tooth reduction closer to the 'ideal' depth chosen for this study only, ie within the 0.4 mm-0.6 mm range. It is stressed that this range may not be the ideal in all clinical situations.

Preoperative portal vein embolisation for primary and metastatic liver tumours: volume effects, efficacy, complications and short-term outcome.

BACKGROUND: The aim of portal vein embolisation is to induce hyperplasia of normal tissue when resection of a cancerous portion of the liver is contraindicated only by the volume of liver that would remain following operation. METHODS: Eight patients with inoperable liver tumours (3 women and 5 men, median age 69.5 years, 3 colorectal hepatic metastasts, 2 choloangiocarcinomas and 3 hepatocellular cancers) were selected for portal vein embolisation. Selected portal branches were occluded with microparticles and coils. Liver volumes were determined by magnetic resonance imaging (MRI) before embolisation and again before operation. RESULTS: Embolisation was successfully performed in all 8 patients, 7 by the percutaneous-transhepatic route, while one patient required open cannulation of a mesenteric vein. Management was altered in 6 patients who proceded to 'curative' resection; projected remaining liver volumes increased (Wilcoxon's matched pairs test p=0.02) from a median of 361 cc to a median of 550 cc; two patients had disease progression such that operation was no longer indicated. In one patient a misplaced coil unintentionally occluded a portal branch to normal liver. CONCLUSIONS: Portal vein embolisation produced appreciable hyperplasia of the normal liver and extended the option of 'curative' operation to 6 out of the 8 cases attempted. Complications can occur. The long-term results following operation are unknown.