Frequency and reporting of complications after Dupuytren's contracture interventions: A systematic review and meta-analysis.

INTRODUCTION: Numerous complications are reported following interventions for Dupuytren's contracture; however, their incidence, management, and outcomes remain poorly reported. The aims of this review were to report the proportions of complications, compare likelihood of complications between interventions, and evaluate reporting of complications, including assessment, grading, management, and subsequent reporting of their impact on patient outcomes. METHODS: Extracted data included patient demographics, intervention details, complications, their management, and final outcomes. Analysis of descriptive data enabled review of complications reporting. Meta-analysis(MA) of non-comparative datasets enabled estimation of proportions of patients experiencing complications. Network meta-analysis(NMA) of comparative studies estimated the relative occurrence of complications between interventions. Risk of bias analysis was performed. RESULTS: 26 studies, comprising 10,831 patients, were included. Interventions included collagenase injection, percutaneous needle fasciotomy(PNF), limited fasciectomy(LF), open fasciotomy(OF), and dermofasciectomy(DF). Overall quality and consistency of outcomes reporting was poor. MA enabled estimates of probabilities for three common complications(infection, nerve injury, complex regional pain syndrome(CRPS)) across all interventions; the reported rates for LF were 4.5% for infection, 3% for nerve injury, and 3.3% for CRPS. As the commonest intervention, LF was used as the reference intervention for comparison of the commonest complications via NMA, including haematoma [OF OR 0.450(0.277, 0.695); PNF OR 0.245(0.114, 0.457)], infection [PNF OR 0.2(0.0287, 0.690); DF OR 2.02(1.02, 3.74)], and neuropraxia [PNF OR 0.0926(0.00553, 0.737)]. We noted that the complication incidence was higher the more invasive the intervention. CONCLUSIONS: There was limited reporting of complication occurrence, management, and outcomes following interventions, contributing to a gap in information for informed patient consent. MA was possible for reporting of proportions for infection, nerve injury, and CRPS across interventions. NMA enabled direct comparison of the six commonest complications between interventions. These findings can guide intervention selection. Improving consistency and quality in complications reporting is essential to aid counselling of patients regarding the true rates and consequences of the risks of interventions. TYPE OF STUDY/LEVEL OF EVIDENCE: 2.

Enamel Caries Detection and Diagnosis: An Analysis of Systematic Reviews.

Detection and diagnosis of caries-typically undertaken through a visual-tactile examination, often with supporting radiographic investigations-is commonly regarded as being broadly effective at detecting caries that has progressed into dentine and reached a threshold where restoration is necessary. With earlier detection comes an opportunity to stabilize disease or even remineralize the tooth surface, maximizing retention of tooth tissue and preventing a lifelong cycle of restoration. We undertook a formal comparative analysis of the diagnostic accuracy of different technologies to detect and inform the diagnosis of early caries using published Cochrane systematic reviews. Forming the basis of our comparative analysis were 5 Cochrane diagnostic test accuracy systematic reviews evaluating fluorescence, visual or visual-tactile classification systems, imaging, transillumination and optical coherence tomography, and electrical conductance or impedance technologies. Acceptable reference standards included histology, operative exploration, or enhanced visual assessment (with or without tooth separation) as appropriate. We conducted 2 analyses based on study design: a fully within-study, within-person analysis and a network meta-analysis based on direct and indirect comparisons. Nineteen studies provided data for the fully within-person analysis and 64 studies for the network meta-analysis. Of the 5 technologies evaluated, the greatest pairwise differences were observed in summary sensitivity points for imaging and all other technologies, but summary specificity points were broadly similar. For both analyses, the wide 95% prediction intervals indicated the uncertainty of future diagnostic accuracy across all technologies. The certainty of evidence was low, downgraded for study limitations, inconsistency, and indirectness. Summary estimates of diagnostic accuracy for most technologies indicate that the degree of certitude with which a decision is made regarding the presence or absence of disease may be enhanced with the use of such devices. However, given the broad prediction intervals, it is challenging to predict their accuracy in any future "real world" context.

Mechanistic insights into the formation of polyion complex aggregates from cationic thermoresponsive diblock copolymers.

HYPOTHESIS: The formation of polyion complexes (PICs) comprising thermoresponsive polymers is intended to result in the formation of aggregates that undergo significant structural changes with temperature. Moreover the observed modifications might be critically affected by polymer structure and PICs composition. EXPERIMENTS: Different block copolymers based on cationic poly(3-acrylamidopropyltrimethylammonium chloride) and thermoresponsive poly(N-isopropylacrylamide) were synthesized by aqueous RAFT/MADIX polymerization at room temperature. Addition of poly(acrylic acid) in a controlled fashion led to the formation of PICs aggregates. The structural changes induced by temperature were characterized by differential scanning calorimetry, Nuclear Magnetic Resonance spectroscopy and scattering methods. FINDINGS: Thermoresponsive PICs undergo significant structural changes when increasing temperature above the cloud point of the thermoresponsive block. The reversibility of these phenomena depends strongly on the structural parameters of the block copolymers and on PICs composition.

Homemade infant formula recipes may contain harmful ingredients: a quantitative content analysis of blogs.

OBJECTIVE: When breast-feeding is not possible, commercially made human milk substitute is recommended. Some consumers would prefer to make their own homemade infant formula (HIF) and may seek information on this practice from internet sources. The purpose of the current study was to investigate the content of blogs posting HIF recipes. DESIGN: Blog postings were identified through a comprehensive search conducted using the Google search engine and the following search terms along with the term 'blog': 'Make Your Own Baby Formula', 'Homemade Baby Formula', 'Do It Yourself (DIY) Baby Formula', 'DIY Baby Formula', 'Baby Formula Recipe' and 'All Natural Baby Formula'. A quantitative content analysis of blogs offering recipes for HIF was completed. Blogs that met the inclusion criteria were reviewed for disclaimers, blogger's credentials, rationale for HIF use, advertisement or sale of recipe ingredients and recipe ingredients. SETTING: Worldwide Web. RESULTS: Fifty-nine blogs, featuring one hundred forty-four recipes, met inclusion criteria. Among reviewed blogs, 33·9 % did not provide a disclaimer stating breast milk is the preferred option, 25·4 % recommended consulting a healthcare professional before using, and 76·3 % and 20·3 % either advertised or sold ingredients or recipe kits, respectively. Credentials of bloggers varied and only seven bloggers identified themselves as 'nutritionists'. The three most frequently mentioned recipe ingredients were whole raw cow's milk (24·3 %), raw goat's milk (23·6 %) and liver (14·5 %). CONCLUSIONS: Clinicians should be aware of this trend, discuss source of formula with parents, advocate for appropriate infant feeding practices and monitor for side effects.

Instabilities of High Speed Dislocations.

Despite numerous theoretical models and simulation results, a clear physical picture of dislocations traveling at velocities comparable to the speed of sound in the medium remains elusive. Using two complementary atomistic methods to model uniformly moving screw dislocations, lattice dynamics and molecular dynamics, the existence of mechanical instabilities in the system is shown. These instabilities are found at material-dependent velocities far below the speed of sound. We show that these are the onset of an atomistic kinematic generation mechanism, which ultimately results in an avalanche of further dislocations. This homogeneous nucleation mechanism, observed but never fully explained before, is relevant in moderate and high strain rate phenomena including adiabatic shear banding, dynamic fracture, and shock loading. In principle, these mechanical instabilities do not prevent supersonic motion of dislocations.

Mechanisms of reinforcement in polymer nanocomposites.

Coarse-grained molecular dynamics simulations are used to elucidate molecular mechanisms responsible for different mechanical behaviours of elastomers containing spherical particles with different volume fractions. We observe that different filler volume fractions result in qualitatively different responses of the polymer nanocomposite to tensile strain. At relatively low filler volume fraction a yield drop appears in the stress-strain curve. As the filler volume fraction increases there is a reduction in the rate of plastic hardening, becoming plastic softening at sufficiently high filler volume fraction. We demonstrate that these behaviours are a result of the network formed by the polymer chains and filler particles. We identify three distinct molecular structural motifs between polymer and filler particles whose relative prevalence varies with the filler volume fraction and as the system is dynamically strained. We show how this evolution in molecular structure is directly linked to the observed mechanical response.

Gridded birth and pregnancy datasets for Africa, Latin America and the Caribbean.

Understanding the fine scale spatial distribution of births and pregnancies is crucial for informing planning decisions related to public health. This is especially important in lower income countries where infectious disease is a major concern for pregnant women and new-borns, as highlighted by the recent Zika virus epidemic. Despite this, the spatial detail of basic data on the numbers and distribution of births and pregnancies is often of a coarse resolution and difficult to obtain, with no co-ordination between countries and organisations to create one consistent set of subnational estimates. To begin to address this issue, under the framework of the WorldPop program, an open access archive of high resolution gridded birth and pregnancy distribution datasets for all African, Latin America and Caribbean countries has been created. Datasets were produced using the most recent and finest level census and official population estimate data available and are at a resolution of 30 arc seconds (approximately 1 km at the equator). All products are available through WorldPop.

Aesthetic possibilities in removable prosthodontics. Part 3: Photometric tooth selection, tooth setting, try-in, fitting, reviewing and trouble-shooting.

This final article in a series of three on producing complete dentures which the patient considers attractive, describes selecting the denture teeth, setting the front teeth at the chairside, the try-in visits, processing, fitting and reviewing the dentures. The role of the patient as captain of the ship, the dental nurse as the patient's support and liaison officer, and the clinician as the first technical officer is outlined. The use of immediate replay video technology in allowing a patient to see what the trial denture really looks like is described. It is vital that the patient is completely happy with its appearance in every detail before any denture is finished. Dealing with post-fitting aesthetic problems is considered.

Aesthetic possibilities in removable prosthodontics. Part 2: start with the face not the teeth when rehearsing lip support and tooth positions.

Even dentures exhibiting superb aesthetics are of no use if they visibly move during speech and social intercourse. In this, the second paper of three on removable denture aesthetics, we describe impression making and shaping the wax occlusal record rims. Not only are the impressions important for producing dentures with maximum retention, stability and support, but their extensions and the thickness of their borders have a decisive influence on lip support and profile. This article shows how the contours of the definitive impressions and the wax rims are developed so as to prescribe the overall form of the replacement gums and teeth. Properly trimmed rims are in essence an early three-dimensional rehearsal, an opportunity for developing the patient's preferred lip support and natural positioning of the denture teeth at subsequent stages. They can also give an early indication of what speech will be like with the new dentures. Without this 3D clinical information, laboratory technicians have to guess where to put the teeth and have little option but to fall back on the stereotypes of their textbook training.

Aesthetic possibilities in removable prosthodontics. Part 1: the aesthetic spectrum from perfect to personal.

Patients requiring dentures are getting older and as a result can be difficult to treat owing to various co-morbidities. This series of papers presents an overview of the processes involved in making removable dentures which the patient considers to be functionally and aesthetically successful. We hope not only to provide technical suggestions but also to address the issue of the clinician's, technician's and dental nurse's relationships with the dentally depleted patient. It is increasingly clear from defence organisation reports that this has a decisive effect on the success of this fundamentally difficult enterprise ('The only branch of dentistry in which you are trying to attach something to nothing' [Hubert Aïche]). It seems best to conduct the planning and the treatment itself as a co-production - the patient assuming responsibility for choosing between the treatment options offered and playing the leading role in making aesthetic decisions. Distinctions are drawn between the idealised whiter-than-white, 'nobody-in-particular', attention-seeking denture at one extreme, and the highly personalised, discreet and naturalistic denture at the other. Reproducing nature in this way is time consuming and therefore expensive, but many 'denture sufferers' see it as good value. Methods for creating the latter, which through its very normality switches off the social observer's attention, are explained in detail in papers two and three of this series. These papers are designed to help clinicians and technicians involved in providing removable prosthodontics improve the appearance of their dentures and increase their patients' aesthetic satisfaction. They are not scientific articles in the Popperian sense of advancing theories which are capable of being falsified. Instead, they are an amalgamation of 72 years of combined experience in providing removable dental prostheses. We have found this branch of dentistry immensely interesting and have on many occasions had the satisfaction of seeing our patients' lives changed for the better.

Influence of El Niño on atmospheric CO2 over the tropical Pacific Ocean: Findings from NASA's OCO-2 mission.

Spaceborne observations of carbon dioxide (CO2) from the Orbiting Carbon Observatory-2 are used to characterize the response of tropical atmospheric CO2 concentrations to the strong El Niño event of 2015-2016. Although correlations between the growth rate of atmospheric CO2 concentrations and the El Niño-Southern Oscillation are well known, the magnitude of the correlation and the timing of the responses of oceanic and terrestrial carbon cycle remain poorly constrained in space and time. We used space-based CO2 observations to confirm that the tropical Pacific Ocean does play an early and important role in modulating the changes in atmospheric CO2 concentrations during El Niño events-a phenomenon inferred but not previously observed because of insufficient high-density, broad-scale CO2 observations over the tropics.

Pro-angiogenic effect of RANTES-loaded polysaccharide-based microparticles for a mouse ischemia therapy.

Peripheral arterial disease results from the chronic obstruction of arteries leading to critical hindlimb ischemia. The aim was to develop a new therapeutic strategy of revascularization by using biodegradable and biocompatible polysaccharides-based microparticles (MP) to treat the mouse hindlimb ischemia. For this purpose, we deliver the pro-angiogenic chemokine Regulated upon Activation, Normal T-cell Expressed and Secreted (RANTES)/CCL5 in the mouse ischemic hindlimb, in solution or incorporated into polysaccharide-based microparticles. We demonstrate that RANTES-loaded microparticles improve the clinical score, induce the revascularization and the muscle regeneration in injured mice limb. To decipher the mechanisms underlying RANTES effects in vivo, we demonstrate that RANTES increases the spreading, the migration of human endothelial progenitor cells (EPC) and the formation of vascular network. The main receptors of RANTES i.e. CCR5, syndecan-4 and CD44 expressed at endothelial progenitor cell surface are involved in RANTES-induced in vitro biological effects on EPC. By using two RANTES mutants, [E66A]-RANTES with impaired ability to oligomerize, and [44AANA47]-RANTES mutated in the main RANTES-glycosaminoglycan binding site, we demonstrate that both chemokine oligomerization and binding site to glycosaminoglycans are essential for RANTES-induced angiogenesis in vitro. Herein we improved the muscle regeneration and revascularization after RANTES-loaded MP local injection in mice hindlimb ischemia.

The challenges of hydrogen and metals.

The Royal Society Scientific Discussion Meeting 'The challenges of hydrogen and metals' was held in Carlton House Terrace, London, UK, on 16-18 January 2017. This is the introductory article to the discussion meeting issue which includes contributed papers and seven discussion papers. Here, we introduce the motivation to hold the Meeting and give a brief overview of the contents. We conclude with acknowledgements.This article is part of the themed issue 'The challenges of hydrogen and metals'.

Molecular Simulation of Gas Solubility in Nitrile Butadiene Rubber.

Molecular simulation is used to compute the solubility of small gases in nitrile butadiene rubber (NBR) with a Widom particle-insertion technique biased by local free volume. The convergence of the method is examined as a function of the number of snapshots upon which the insertions are performed and the number of insertions per snapshot and is compared to the convergence of the unbiased Widom insertion technique. The effect of varying the definition of local free volume is also investigated. The acrylonitrile content of the polymer is altered to examine its influence on the solubility of helium, CO2, and H2O, and the solubilities of polar gases are found to be enhanced relative to those of nonpolar gases, in qualitative agreement with experiment. To probe this phenomenon further, the solubilities are decomposed into contributions from the neighborhoods of different atoms, using a Voronoi cell construction, and a strong bias is found for CO2 and H2O in particular to be situated near nitrogen sites in the elastomer. Temperature is shown to suppress the solubility of CO2 and H2O but to increase that of helium. Increasing pressure is found to suppress the solubility of all gases but at different rates, according to a balance between their molecular sizes and electrostatic interactions with the polymer. These results are relevant to the use of NBR seals at elevated temperatures and pressures, such as in oil and gas wells.

Cost-effectiveness of emergency versus delayed laparoscopic cholecystectomy for acute gallbladder pathology.

BACKGROUND: The optimal timing of cholecystectomy for patients admitted with acute gallbladder pathology is unclear. Some studies have shown that emergency cholecystectomy during the index admission can reduce length of hospital stay with similar rates of conversion to open surgery, complications and mortality compared with a 'delayed' operation following discharge. Others have reported that cholecystectomy during the index acute admission results in higher morbidity, extended length of stay and increased costs. This study examined the cost-effectiveness of emergency versus delayed cholecystectomy for acute benign gallbladder disease. METHODS: Using data from a prospective population-based cohort study examining the outcomes of cholecystectomy in the UK and Ireland, a model-based cost-utility analysis was conducted from the perspective of the UK National Health Service, with a 1-year time horizon for costs and outcomes. Probabilistic sensitivity analysis was used to investigate the impact of parameter uncertainty on the results obtained from the model. RESULTS: Emergency cholecystectomy was found to be less costly (£4570 versus £4720; €5484 versus €5664) and more effective (0·8868 versus 0·8662 QALYs) than delayed cholecystectomy. Probabilistic sensitivity analysis showed that the emergency strategy is more than 60 per cent likely to be cost-effective across willingness-to-pay values for the QALY from £0 to £100 000 (€0-120 000). CONCLUSION: Emergency cholecystectomy is less costly and more effective than delayed cholecystectomy. This approach is likely to be beneficial to patients in terms of improved health outcomes and to the healthcare provider owing to the reduced costs.

Molecular Model for HNBR with Tunable Cross-Link Density.

We introduce a chemically inspired, all-atom model of hydrogenated nitrile butadiene rubber (HNBR) and assess its performance by computing the mass density and glass-transition temperature as a function of cross-link density in the structure. Our HNBR structures are created by a procedure that mimics the real process used to produce HNBR, that is, saturation of the carbon-carbon double bonds in NBR, either by hydrogenation or by cross-linking. The atomic interactions are described by the all-atom "Optimized Potentials for Liquid Simulations" (OPLS-AA). In this paper, first, we assess the use of OPLS-AA in our models, especially using NBR bulk properties, and second, we evaluate the validity of the proposed model for HNBR by investigating mass density and glass transition as a function of the tunable cross-link density. Experimental densities are reproduced within 3% for both elastomers, and qualitatively correct trends in the glass-transition temperature as a function of monomer composition and cross-link density are obtained.

Volcanic air pollution over the Island of Hawai'i: Emissions, dispersal, and composition. Association with respiratory symptoms and lung function in Hawai'i Island school children.

BACKGROUND: Kilauea Volcano on the Island of Hawai'i has erupted continuously since 1983, releasing approximately 300-12000metrictons per day of sulfur dioxide (SO2). SO2 interacts with water vapor to produce an acidic haze known locally as "vog". The combination of wind speed and direction, inversion layer height, and local terrain lead to heterogeneous and variable distribution of vog over the island, allowing study of respiratory effects associated with chronic vog exposure. OBJECTIVES: We characterized the distribution and composition of vog over the Island of Hawai'i, and tested the hypotheses that chronic vog exposure (SO2 and acid) is associated with increased asthma prevalence, respiratory symptoms, and reduced pulmonary function in Hawai'i Island schoolchildren. METHODS: We compiled data of volcanic emissions, wind speed, and wind direction over Hawai'i Island since 1992. Community-based researchers then measured 2- to 4-week integrated concentrations of SO2 and fine particulate mass and acidity in 4 exposure zones, from 2002 to 2005, when volcanic SO2 emissions averaged 1600metrictons per day. Concurrently, community researchers recruited schoolchildren in the 4th and 5th grades of 25 schools in the 4 vog exposure zones, to assess determinants of lung health, respiratory symptoms, and asthma prevalence. RESULTS: Environmental data suggested 4 different vog exposure zones with SO2, PM2.5, and particulate acid concentrations (mean±s.d.) as follows: 1) Low (0.3±0.2ppb, 2.5±1.2µg/m(3), 0.6±1.1nmolH+/m(3)), 2) Intermittent (1.6±1.8ppb, 2.8±1.5µg/m(3), 4.0±6.6nmolH+/m(3)), 3) Frequent (10.1±5.2ppb, 4.8±1.9µg/m(3), 4.3±6.7nmolH+/m(3)), and 4) Acid (1.2±0.4ppb, 7.2±2.3µg/m(3), 25.3±17.9nmolH+/m(3)). Participants (1957) in the 4 zones differed in race, prematurity, maternal smoking during pregnancy, environmental tobacco smoke exposure, presence of mold in the home, and physician-diagnosed asthma. Multivariable analysis showed an association between Acid vog exposure and cough and strongly suggested an association with FEV1/FVC <0.8, but not with diagnosis of asthma, or chronic persistent wheeze or bronchitis in the last 12months. CONCLUSIONS: Hawai'i Island's volcanic air pollution can be very acidic, but contains few co-contaminants originating from anthropogenic sources of air pollution. Chronic exposure to acid vog is associated with increased cough and possibly with reduced FEV1/FVC, but not with asthma or bronchitis. Further study is needed to better understand how volcanic air pollution interacts with host and environmental factors to affect respiratory symptoms, lung function, and lung growth, and to determine acute effects of episodes of increased emissions.

The SSTARS (STeroids and Stents Against Re-Stenosis) Trial: Different stent alloys and the use of peri-procedural oral corticosteroids to prevent in-segment restenosis after percutaneous coronary intervention.

BACKGROUND: Stent design and technological modifications to allow for anti-proliferative drug elution influence restenosis rates following percutaneous coronary intervention (PCI). We aimed to investigate whether peri-procedural administration of corticosteroids or the use of thinner strut cobalt alloy stents would reduce rates of binary angiographic restenosis (BAR) after PCI. METHODS: This was a two centre, mixed single and double blinded, randomised controlled trial using a factorial design. We compared (a) the use of prednisolone to placebo, starting at least six hours pre-PCI and continued for 28days post-PCI, and (b) cobalt chromium (CoCr) to stainless steel (SS) alloy stents, in patients admitted for PCI. The primary end-point was BAR at six months. RESULTS: 315 patients (359 lesions) were randomly assigned to either placebo (n=145) or prednisolone (n=170) and SS (n=160) or CoCr (n=160). The majority (58%) presented with an ACS, 11% had diabetes and 287 (91%) completed angiographic follow up. BAR occurred in 26 cases in the placebo group (19.7%) versus 31 cases in the prednisolone group (20.0%) respectively, p=1.00. For the comparison between SS and CoCr stents, BAR occurred in 32 patients (21.6%) versus 25 patients (18.0%) respectively, p=0.46. CONCLUSION: Our study showed that treating patients with a moderately high dose of prednisolone for 28days following PCI with BMS did not reduce the incidence of BAR. In addition, we showed no significant reduction in 6month restenosis rates with stents composed of CoCr alloy compared to SS (http://www.isrctn.com/ISRCTN05886349).