Coblation intracapsular tonsillectomy in a paediatric tertiary centre: Revision surgery rates over a nine-year period.

OBJECTIVES: Coblation intracapsular tonsillectomy (ICT) is increasingly being used in the paediatric population because of the rapid recovery and low rates of complications associated with it. There is, however, a risk of symptomatic regrowth with this technique. The objective of our study is to establish the rate of, and risks for, revision surgery over time in a major tertiary referral centre with a large cohort of paediatric Coblation ICT cases. METHODS: A retrospective review of all children (0-19 years) undergoing Coblation ICT from April 2013 to June 2022 was undertaken, using electronic databases and clinical records. Post-operative follow up was reviewed and revision cases were subsequently identified and examined. Statistical analysis was performed using a Chi-Squared test. RESULTS: 4111 patients underwent Coblation ICT during the studied period, with or without concomitant adenoidectomy. Of these, 135 (3.3 %) required revision tonsil surgery, primarily for recurrence of initial symptoms; two patients required two consecutive revision procedures (137 revision procedures in total). Eight-eight (n = 88) (64 %) of these were revised with a repeat Coblation ICT procedure and 49 (36 %) with bipolar diathermy extracapsular tonsillectomy (ECT) of remnant tonsil tissue. The revision rates after Coblation ICT declined steeply on a year-on-year basis since the commencement of this technique (from 10.6 % early on, to 0.3 % at the end of the study period P<0.001). A significantly higher revision rate was noted in children below the age of two at the time of primary surgery, compared to those older than two years of age (P<0.001). CONCLUSIONS: This study demonstrates real-world departmental revision rates over a nine-year period from the technique's commencement of use. With Coblation ICT, symptomatic re-growth occurs rarely, but may be clinically significant, with higher rates of recurrent symptoms seen in children under two years of age at the time of primary surgery. The revision rate apparently drops over time in parallel with overall experience of surgeons and formalised training.

High quantum yield carbon dots and nitrogen-doped carbon dots as fluorescent probes for spectroscopic dopamine detection in human serum.

Recent advances in fluorescent carbon dots have shown great potential for the sensing of biological molecules. In this study, one-step hydrothermally synthesised carbon dots (CD) and nitrogen doped carbon dots (NCD) with high quantum yields of 54.29% and 89.82%, respectively, were investigated and demonstrated to be a reliable, cost-effective, and naked-eye fluorescent probe for the detection of dopamine, a neurotransmitter, in human serum fluids. The current study is well supported by a comprehensive synthesis approach and has been described utilizing a variety of microscopic and spectroscopic techniques. The discovered approach is time and pH dependent, and it provides a robust platform for specifically detecting aberrant dopamine levels using a fluorescence quenching mechanism. Dopamine detection limits for CD were calculated to be 5.54 µM for CD and 5.12 µM for NCD, respectively. The fluorescence quenching shows a linear continuous trend with a range within 3.3-500 µM and 3.3-400 µM of dopamine concentration for CD and NCD respectively. To further verify the sensitivity of CD and NCD as fluorescent probes, interference studies in the presence of different biological components were also studied and validated. This work shows that carbon-based nanomaterials and their doped nanostructures, due to their high fluorescence, have significant potential as fluorescent probes in neurological disease diagnosis as they display high selectivity, sensitivity and fast responses in the real time spectroscopic detection of dopamine in human fluid samples.

Two-year evaluation indicates zirconia bridges acceptable alternative to PFMs.

OBJECTIVE: The aim of this in-vivo study was to evaluate the 2-year clinical performance of zirconia computer-aided design/computer-aided manufacturing (CAD/CAM)-generated bridges. METHODS: A total of 16 three- or four-unit Lava zirconia bridges were done on 15 subjects. The bridges were cemented using RelyX™ Unicem Self-Adhesive Universal Resin Cement. Evaluation was done at 6-month, 1-year, and 2-year recall visits. Evaluation criteria were color stability and matching, marginal integrity, marginal discoloration, incidence of caries, changes in restoration-tooth interface, changes in surface texture, postoperative sensitivity, maintenance of periodontal health, changes in proximal and opposing teeth, and maintenance of anatomic form. In each of these parameters, the bridges were rated in one of three possible categories: "A" (alpha)--ideal; "B" (bravo)--acceptable; and "C" (charlie)--unacceptable. RESULTS: After 2 years, 100% of the bridges were rated "A" for color stability and matching, marginal discoloration, incidence of caries, changes in restoration-tooth interface, changes in surface texture, postoperative sensitivity, and change in proximal or opposing teeth. In the parameter of marginal integrity, 6.25% of the bridges were rated "B;" the remaining 93.75% were rated "A." Maintenance of periodontal health was rated "B" for 6.25% of the bridges and "A" for 93.75%. At 2 years, 12.5% of the bridges rated "C" in maintenance of anatomic form and 87.5% rated "A." CONCLUSION: The overall clinical outcome was that the CAD/CAM-generated zirconia bridges were clinically acceptable.

Genetic effects of long-term captive breeding on the endangered pygmy hog.

Long-term captive populations often accumulate genetic changes that are detrimental to their survival in the wild. Periodic genetic evaluation of captive populations is thus necessary to identify deleterious changes and minimize their impact through planned breeding. Pygmy hog (Porcula salvania) is an endangered species with a small population inhabiting the tall sub-Himalayan grasslands of Assam, India. A conservation breeding program of pygmy hog from six founders has produced a multi-generational captive population destined for reintroduction into the wild. However, the impact of conservation breeding on its genetic diversity remained undocumented. Here, we evaluate temporal genetic changes in 39 pygmy hogs from eight consecutive generations of a captive population using genome-wide SNPs, mitochondrial genomes, and MHC sequences, and explore the relationship between genetic diversity and reproductive success. We find that pygmy hog harbors a very low genome-wide heterozygosity (H) compared to other members of the Suidae family. However, within the captive population we find excess heterozygosity and a significant increase in H from the wild-caught founders to the individuals in subsequent generations due to the selective pairing strategy. The MHC and mitochondrial nucleotide diversities were lower in captive generations compared to the founders with a high prevalence of low-frequency MHC haplotypes and more unique mitochondrial genomes. Further, even though no signs of genetic inbreeding were observed from the estimates of individual inbreeding coefficient F and between individuals (FIS) in each generation, the kinship coefficient showed a slightly increasing trend in the recent generations, due to a relatively smaller non-random sample size compared to the entire captive population. Surprisingly, male pygmy hogs that had higher heterozygosity also showed lower breeding success. We briefly discuss the implications of our findings in the context of breeding management and recommend steps to minimize the genetic effects of long-term captive breeding.

Telemedicine in paediatric otorhinolaryngology: Lessons learnt from remote encounters during the Covid19 pandemic and implications for future practice.

INTRODUCTION: Covid19 has necessitated new methods of conducting outpatient consultations. At our institute, patient-facing paediatric ENT appointments were replaced with telemedical consultations. METHOD: We performed a prospective analysis of the outcomes following telephone consultations with parents and describe our experience of remote consulting during a pandemic, and the possibilities for future applications of telemedicine in paediatric ENT. RESULTS: 215 patients were appropriately referred to the paediatric ENT clinic, 65% of these patients were deemed suitable for remote telephone consultation. Following a telephone call, 50% did not need further ENT clinic management, most commonly due to being listed for surgery (20%) or discharged (18%). The treating consultant assessed 81% of phone consultations as being effective. When given the choice, patients reported that 29% would choose a telephone consultation whilst 43% preferred a face to face consultation. CONCLUSION: Our experience has shown that there are areas of paediatric ENT that can be streamlined effectively by substituting face to face consultations with telephone consultations. However, prospective evaluation of these remote contacts suggest that telephone consultations are not a panacea and cannot be indiscriminately applied to all. Instead, the strategies to take forwards into a post Covid19 practice are vetting of referrals, individualised treatment plans, and giving patients a choice.

Clinical trial assessing light enhancement of in-office tooth whitening.

OBJECTIVE: Evaluate a light-enhanced in-office tooth whitening system in order to assess tooth color and safety. METHODS: Thirty-three adults were randomly assigned to one of three treatment groups. Professional treatment involved application of a 25% H(2)O(2) gel (Discus Dental ZOOM!) with light enhancement, H(2)O(2) gel alone, or the light alone with no peroxide. The 12 anterior teeth were treated three times for 20 minutes each. Efficacy was measured objectively as L*a*b* color change using digital images, tooth shade was measured, and safety was evaluated immediately after treatment and at posttreatment days 7 and 30. RESULTS: After adjusting for baseline and age, immediate (end-of-treatment) means (SE) for Deltab* (yellowness) were -3.1 (0.25) for the gel + light, -2.0 (0.25) for the gel-only group, and -2.4 (0.25) for the light-only group. Significant (p < 0.05) color rebound was evident at posttreatment day 7. By day 30, adjusted means (SE)for Deltab* were -1.7 (0.20) for the gel + light group, -1.1 (0.20) for the gel-only group, and -0.5 (0.20) for the light-only group. Both peroxide groups differed significantly (p < 0.05) from light alone on Deltab* and DeltaL*. In the gel + light group, 91% of subjects experienced tooth sensitivity, the majority of which was moderate or severe. Adverse events were low in the light-only group. CONCLUSION: Use of light enhancement for in-office whitening leads to immediate color change, after which there was significant color and shade rebound within 7 days as well as moderate-to-severe tooth sensitivity during and after treatment. CLINICAL SIGNIFICANCE Increased tooth sensitivity during treatment and appreciable short-term color rebound after treatment may impact the utility of in-office tooth whitening with peroxide and light as a stand-alone esthetic procedure. (J Esthet Restor Dent 21:336-347, 2009).

Maintenance of whitening with a power toothbrush after bleaching treatment.

A randomized, parallel, examiner-blind clinical study was conducted to examine the ability of 2 toothbrushes to maintain teeth whitening after at-home bleaching. Forty subjects used a 15% carbamide peroxide tray bleaching system at home for 2 weeks per the manufacturer's instructions and then were randomly assigned to use either the Sonicare Advance power toothbrush or a manual toothbrush as part of their home oral hygiene routine for 6 months. The color of the labial surfaces of the subjects' maxillary anterior dentition was assessed before bleaching and immediately, 2 months, 3 months, and 6 months after bleaching. Color was assessed by comparison with Vita Classical shade tabs and by digital image analysis in the CIE L*a*b* color space. Both groups demonstrated a rebound effect at the 2-month visit and beyond, with mean Vita shade scores significantly higher than immediately after bleaching. At the 6-month evaluation, a significant difference in the amount of rebound in each group was observed. Specifically, the rebound of the Sonicare brush group was on average 1.12 Vita shades less than that of the manual brush group. The 6-month difference was confirmed through digital image analysis, with the Sonicare brush group 4.8 L* units lighter, corresponding to 2 Vita shades, and 2.1 b* units less yellow than the manual brush group. This clinical trial demonstrates that the Sonicare Advance toothbrush better maintains whitening after bleaching treatment than a manual toothbrush.

Investigation of a new approach to measuring contact angles for hydrophilic impression materials.

PURPOSE: The purpose of this investigation was to examine the initial water contact angles of seven unset impression materials using commercially available equipment, in an effort to determine whether polyether impression materials (Impregum) have lower contact angles and are, therefore, more hydrophilic than VPS impression materials. MATERIALS AND METHODS: The hydrophilic properties of unset polyether and VPS impression materials were analyzed with respect to their water contact angle measurements using the commercially available Drop Shape Analysis System DSA 10. Twenty-five data points per second were collected via video analysis. There was no delay from start of measurement and data collection. Data was collected for approximately 12 s. Droplet size was determined on the thickness of canula. If the droplets became too small in volume, the water that evaporated during the measurement was large in comparison to the volume of the droplet. Therefore, 5 microl was chosen as the lowest volume. Five trials were conducted per series for each featured material. Contact angles were calculated using the circle fitting method. Three tests using this technique were designed to control the variables of contact angle measurement with regard to time, the varying amount of fluid in contact with impression material during clinical use, and material thickness. Sample thickness of impression material was controlled by stripping the paste flat on a glass plate using a marking template to ensure a constant film thickness. Tests were conducted in a climatized room at 24 degrees C +/- 1 degree C. Deionized water was used as the fluid. The device was calibrated according to manufacturer's instruction for Young-Laplace fitting prior to the measurements. Results were analyzed using One-Way ANOVA, Tukey test, and t-test, as appropriate. RESULTS: Comparing the fast setting impression materials by One-Way ANOVA and Tukey tests (p < .05) revealed the initial contact angles to range from 66.2 +/- 1.5 degrees to 127.5 +/- 4.4 degrees , of which the polyether material was the lowest after 45 s (66.2 +/- 1.5 degrees ), 120 s (70.3 +/- 2.8 degrees ), and 24 h (80.3 +/- 1.0 degrees ) after start of the mix. The selected times represent the different stages of unset material, ranging from 45 s as the earliest practical data collection time to 24 h, at which a stone model would be poured. The polyether materials tested exhibited lower contact angles and, thus, significantly higher initial hydrophilicity than all measured VPS materials. Additionally, Impregum impression materials are more hydrophilic in the unset stage than in the set stage. VPS may show a stepwise development of hydrophilicity in the set stage that was not observed in the unset stage. CONCLUSIONS: The polyether impression materials tested were significantly more hydrophilic before, during, and after setting than that of VPS impression materials. Regardless of the amount of water in contact with the impression material, the polyether impression materials showed a significantly higher hydrophilicity in the unset stage than the VPS materials. The initial contact angle was not dependent on the thickness of the material. All parameters, including variation of time, volume of water droplet, and thickness of material, resulted in different absolute contact angles, but did not lead to a dramatic change in the ranking of the materials with regard to their hydrophilic behavior.