Isolated volar dislocation of the distal radioulnar joint: a case series and systematic review.

INTRODUCTION: Isolated volar dislocations of the distal radioulnar joint are reported as rare. We observed three such cases over a 12-month period. Literature to date consists of multiple case reports and case series with no structured reviews. There is debate as to incidence, mechanism, investigation, treatment and prognosis. METHODS: A case series and formal systematic review was performed. This included an analysis of the demographics, mechanism, presentation, investigation, treatment and outcome of the cases identified from the wider published series. FINDINGS: In total 99 cases of this injury were identified from 59 papers, with a further 9 cases having an associated ulna styloid fracture. CONCLUSIONS: This is a rare injury, representing up to 0.02% of all bony injuries, which is diagnosed late in 36% of cases. Inability to obtain a true lateral radiograph may contribute to the diagnosis being missed. Computed tomography scans are useful in suspected cases without radiographic confirmation. Acute cases are successfully treated with closed reduction in 78% of cases; however associated soft tissue injuries may need to be surgically addressed. Delayed presentation is more likely to require open surgery and preoperative MRI scans are indicated to aid surgical planning. Chronic instability rarely occurs and may need treatment with reconstruction or salvage. A good, subjective, result is reported in the majority of patients.

Legalisation of e-scooters in the UK: the injury rate and pattern is similar to those of bicycles in an inner city metropolitan area.

INTRODUCTION: Rental electric scooters (e-scooters) have become more available to the UK public following amendments to legislation in 2020 affecting rideshare schemes. Existing literature from outside the UK demonstrates a worrying trend of increasing injuries related to their use and non-compliance with suggested safety precautions. An e-scooter rideshare scheme trial began in Liverpool in October 2020. We intended to identify the musculoskeletal injury rate and describe the injuries sustained during this pilot. METHODS: Data were collected retrospectively from electronic patient records on all patients at a major trauma centre covering the whole of the Liverpool rideshare trial site presenting with e-scooter and bicycle musculoskeletal injuries between the trial start on 6th October 2020 and 5th May 2021 and between 6th March 2020 and 5th October 2020. Data on rental e-scooter use were obtained from the rideshare operator. RESULTS: Fifty-one patients sustained musculoskeletal injuries involving e-scooters during the trial period and six injuries before the trial. Two-thirds of injuries were on rental e-scooters. We calculate an orthopaedic injury rate of 26.1 injuries per million km on e-scooters and 24.1 injuries per million km on bicycles. Over 70% of e-scooter patients had upper limb injuries, over 50% had lower limb injuries and 15.7% of patients required surgery. CONCLUSIONS: We observed an increase in musculoskeletal injuries presenting to hospital during the e-scooter pilot. Rates of musculoskeletal injuries were comparable to rates of injuries sustained on bicycles. E-scooters should be regulated closely and further safety measures introduced to minimise the rate of injuries.

Nonlinear plasma wavelength scalings in a laser wakefield accelerator.

Laser wakefield acceleration relies on the excitation of a plasma wave due to the ponderomotive force of an intense laser pulse. However, plasma wave trains in the wake of the laser have scarcely been studied directly in experiments. Here we use few-cycle shadowgraphy in conjunction with interferometry to quantify plasma waves excited by the laser within the density range of GeV-scale accelerators, i.e., a few 10^{18}cm^{-3}. While analytical models suggest a clear dependency between the nonlinear plasma wavelength and the peak potential a_{0}, our study shows that the analytical models are only accurate for driver strength a_{0}≲1. Experimental data and systematic particle-in-cell simulations reveal that nonlinear lengthening of the plasma wave train depends not solely on the laser peak intensity but also on the waist of the focal spot.

Influence of apical preparation size and irrigation technique on root canal debridement: a histological analysis of round and oval root canals.

AIM: To examine the debridement of round and oval root canals prepared to two apical sizes with and without ultrasonically activated irrigation. METHODOLOGY: Mandibular premolars with round (n = 48) and oval (n = 48) root canals were pair-matched after microCT scanning and randomly divided into two experimental groups (n = 20): group 1, rotary NiTi to size 20, .04 taper; group 2, rotary NiTi to size 40, .04 taper. Specimens were subdivided into two subgroups (n = 10): subgroup A, syringe and needle (SNI); subgroup B, ultrasonically activated irrigation (UAI). Untreated canals (eight oval and eight round) served as controls. Specimens were processed for histological evaluation for measurement of the remaining pulp tissue and debris (RPT), and the perimeter percentage of root canal area untouched by the instruments (PRAU). Following assessment of normality, multiple-way anova models were used to study the effects of preparation size, irrigation technique and canal cross-sectional shape, and their interactions on the RPT and PRAU (α = 0.05). RESULTS: All experimental groups had significantly less RPT than the control (P < 0.05). Both the preparation size (20 vs. 40) and the irrigation technique (SNI vs. UAI) had a significant effect on RPT (P = 0.006 and P < 0.001, respectively). Groups irrigated with SNI always had significantly greater RPT than those irrigated with UAI, irrespective of the preparation size (P < 0.001). Canals prepared to size 20 had significantly greater RPT than those with size 40 in the SNI subgroup (P < 0.001), but there was no significant difference in the UAI subgroup (P = 0.481). CONCLUSIONS: Root canals prepared to a larger size (40) were cleaner than those prepared to a smaller size (20), when irrigation was performed with a syringe and needle. When the irrigant was ultrasonically activated, smaller preparations resulted in canals that were as clean as larger preparations. This finding was common to both round and oval canals of freshly extracted premolars with vital pulp tissue.

Effect of root canal irrigation protocols on the dislocation resistance of mineral trioxide aggregate-based materials: A systematic review of laboratory studies.

The aim of this systematic review was to address the question: Do different irrigating protocols have an impact on the dislocation resistance of mineral trioxide aggregate (MTA)-based materials? The review was performed using a well-defined search strategy in three databases (PubMed, Scopus, Web of Science) to include laboratory studies performed between January 1995 and May 2017, in accordance with PRISMA guidelines. Two reviewers analysed the papers, assessed the risk of bias and extracted data on teeth used, sample size, size of root canal preparation, type of MTA-based material, irrigants, canal filling method, storage method and duration, region of roots and the parameters of push-out testing (slice thickness, plunger dimensions and plunger loading direction), the main results and dislocation resistance values (in MPa). From 255 studies, 27 were included for full-text analysis. Eight papers that met the inclusion criteria were included in this review. There was a wide variation in dislocation resistance due to differences in irrigation sequence, time and concentration of irrigants, storage method and duration, and the parameters of push-out bond strength testing. A meta-analysis was not done but qualitative synthesis of the included studies was performed. No definitive conclusion could be drawn to evaluate the effect of irrigation protocols on dislocation resistance of MTA-based materials. Recommendations have been provided for standardized testing methods and reporting of future studies, so as to obtain clinically relevant information and to understand the effects of irrigating protocols on root canal sealers and their interactions with the dentine walls of root canals.

The current treatment landscape of irritable bowel syndrome in adults in Hong Kong: consensus statements.

OBJECTIVE: The estimated prevalence of irritable bowel syndrome in Hong Kong is 6.6%. With the increasing availability of pharmacological and non-pharmacological treatments, the Hong Kong Advisory Council on Irritable Bowel Syndrome has developed a set of consensus statements intended to serve as local recommendations for clinicians about diagnosis and management of irritable bowel syndrome. PARTICIPANTS: A multidisciplinary group of clinicians constituting the Hong Kong Advisory Council on Irritable Bowel Syndrome-seven gastroenterologists, one clinical psychologist, one psychiatrist, and one nutritionist-convened on 20 April 2017 in Hong Kong. EVIDENCE: Published primary research articles, meta-analyses, and guidelines and consensus statements issued by different regional and international societies on the diagnosis and management of irritable bowel syndrome were reviewed. CONSENSUS PROCESS: An outline of consensus statements was drafted prior to the meeting. All consensus statements were finalised by the participants during the meeting, with 100% consensus. CONCLUSIONS: Twenty-four consensus statements were generated at the meeting. The statements were divided into four parts covering: (1) patient assessment; (2) patient's psychological distress; (3) dietary and alternative approaches to managing irritable bowel syndrome; and (4) evidence to support pharmacological management of irritable bowel syndrome. It is recommended that primary care physicians assume the role of principal care provider for patients with irritable bowel syndrome. The current statements are intended to guide primary care physicians in diagnosing and managing patients with irritable bowel syndrome in Hong Kong.

Excitation and Control of Plasma Wakefields by Multiple Laser Pulses.

We demonstrate experimentally the resonant excitation of plasma waves by trains of laser pulses. We also take an important first step to achieving an energy recovery plasma accelerator by showing that a plasma wave can be damped by an out-of-resonance trailing laser pulse. The measured laser wakefields are found to be in excellent agreement with analytical and numerical models of wakefield excitation in the linear regime. Our results indicate a promising direction for achieving highly controlled, GeV-scale laser-plasma accelerators operating at multikilohertz repetition rates.

Correction: The nanotipped hairs of gecko skin and biotemplated replicas impair and/or kill pathogenic bacteria with high efficiency.

Correction for 'The nanotipped hairs of gecko skin and biotemplated replicas impair and/or kill pathogenic bacteria with high efficiency' by X. Li, et al., Nanoscale, 2016, 8, 18860-18869.

The nanotipped hairs of gecko skin and biotemplated replicas impair and/or kill pathogenic bacteria with high efficiency.

We show that gecko microspinules (hairs) and their equivalent replicas, bearing nanoscale tips, can kill or impair surface associating oral pathogenic bacteria with high efficiency even after 7 days of repeated attacks. Scanning Electron Microscopy suggests that there is more than one mechanism contributing to cell death which appears to be related to the scaling of the bacteria type with the hair arrays and accessibility to the underlying nano-topography of the hierarchical surfaces.

Long-Term Follow-Up of a Revascularized Immature Necrotic Tooth Evaluated by CBCT.

This case study reports the successful treatment of an immature upper premolar with periapical pathosis and sinus tract using revascularization technique. Clinical and radiographic examination demonstrated the recovery of vitality, continued root development, and periapical healing at the 7-month follow-up. In addition, severe calcification of the canal was noted at the 36-month follow-up. At the 66-month follow-up, cone-beam computed tomography (CBCT) revealed complete periapical healing, apical closure, increase in root length and thickness of dentin, and severe calcification of the root canal. Even though the nature of tissue within the root canal is unknown, revascularization appears to give good clinical and radiographic success. This case report highlights that severe calcification of the canal is one of the long-term outcomes of revascularized root canals.

Litigation costs of wrong-site surgery and other non-technical errors in orthopaedic operating theatres.

INTRODUCTION: This study reviews the litigation costs of avoidable errors in orthopaedic operating theatres (OOTs) in England and Wales from 1995 to 2010 using the National Health Service Litigation Authority Database. MATERIALS AND METHODS: Litigation specifically against non-technical errors (NTEs) in OOTs and issues regarding obtaining adequate consent was identified and analysed for the year of incident, compensation fee, cost of legal defence, and likelihood of compensation. RESULTS: There were 550 claims relating to consent and NTEs in OOTs. Negligence was related to consent (n=126), wrong-site surgery (104), injuries in the OOT (54), foreign body left in situ (54), diathermy and skin-preparation burns (54), operator error (40), incorrect equipment (25), medication errors (15) and tourniquet injuries (10). Mean cost per claim was £40,322. Cumulative cost for all cases was £20 million. Wrong-site surgery was error that elicited the most successful litigation (89% of cases). Litigation relating to implantation of an incorrect prosthesis (eg right-sided prosthesis in a left knee) cost £2.9 million. Prevalence of litigation against NTEs has declined since 2007. CONCLUSIONS: Improved patient-safety strategies such as the World Health Organization Surgical Checklist may be responsible for the recent reduction in prevalence of litigation for NTEs. However, addition of a specific feature in orthopaedic surgery, an 'implant time-out' could translate into a cost benefit for National Health Service hospital trusts and improve patient safety.

Treatment of fracture subluxations of the proximal interphalangeal joint using a ligamentotaxis device: a multidisciplinary approach.

Complex fracture subluxations of the proximal interphalangeal joint are often difficult to treat and their outcome variable. A number of methods for treatment of these injuries have been described. We have used a ligamentotaxis device (Ligamentotaxor, Arex, Palaiseau Cedex, France) since 2008. We performed 28 operations in 28 patients with complex proximal interphalangeal joint injuries over a 3-year period. Patients followed a standardized postoperative rehabilitation regime, including fixator adjustment as necessary. The mean age was 33 years (range 18-67). The mean time to surgery was 7 days. At final follow-up (mean 22 months, range 6-52) the mean proximal interphalangeal joint range of motion was 85° (range 60°-110°). The mean QuickDASH functional outcome score was 4.8 (range 0-36.4). Our results compare favourably with other devices reported in the literature.

Performance of three cognitive screening tools in a sample of older New Zealanders.

BACKGROUND: With the ubiquitous Mini-Mental State Exam now under copyright, attention is turning to alternative cognitive screening tests. The aim of the present study was to investigate three common cognitive screening tools: the Montreal Cognitive Assessment (MoCA), the Rowland Universal Dementia Assessment Scale (RUDAS), and the recently revised Addenbrooke's Cognitive Assessment Version III (ACE-III). METHODS: The ACE-III, MoCA and RUDAS were administered in random order to a sample of 37 participants with diagnosed mild dementia and 47 comparison participants without dementia. The diagnostic accuracy of the three tests was assessed. RESULTS: All the tests showed good overall accuracy as assessed by area under the ROC Curve, 0.89 (95% CI = 0.80-0.95) for the ACE-III, 0.84 (0.75-0.91) for the MoCA, and 0.86 (0.77-0.93) for RUDAS. The three tests were strongly correlated: r(84) = 0.85 (0.78-0.90) between the ACE-III and MoCA, 0.70 (0.57-0.80) between the ACE-III and RUDAS; and 0.65 (0.50-0.76) between the MoCA and RUDAS. The data derived optimal cut-off points for were lower than the published recommendations for the ACE-III (optimal cut-point ≤76, sensitivity = 81.1%, specificity = 85.1%) and the MoCA (≤20, sensitivity = 78.4%, specificity = 83.0%), but similar for the RUDAS (≤22, sensitivity = 78.4%, specificity = 85.1%). CONCLUSIONS: All three tools discriminated well overall between cases of mild dementia and controls. To inform interpretation of these tests in clinical settings, it would be useful for future research to address more inclusive and potentially age-stratified local norms.

'Screw-in' tendency of rotary nickel-titanium files due to design geometry.

AIM: To examine the effect of several standard geometric characteristics of rotary instruments on the 'screw-in' forces and stresses generated on root dentine using 3D finite element analysis (FEA). METHODOLOGY: Four cross-sectional designs (triangular, slender-rectangular, rectangular and square) were evaluated. The area of the triangular cross-section and of the slender-rectangular model were the same. Another rectangular model had the same centre-core diameter as the triangular one. Each design was twisted into a file model with 5, 10 or 15 threads over its 16-mm-long working section. Three curved root canals were simulated as rigid surface models: θ = 15 degrees/R = 36 mm radius; θ = 30/R = 18; and θ = 45/R = 12. A commercial FEA package was used to simulate the file rotating in the canal to determine the 'screw-in' force and reaction torque on the instrument. RESULTS: Instruments of a square cross-section had the highest 'screw-in' force and reaction torsional stresses followed by the rectangle, the triangle design and the slender-rectangle design, respectively. The file with closer pitch generated lower stresses, compared with that with longer pitch. The greater the root canal curvature, the higher the 'screw-in' force and reaction torque generated. CONCLUSION: This study demonstrated that the 'screw-in' tendency depends on both the instrument geometry and canal curvature. Clinicians should be aware that certain instrument designs are prone to develop high 'screw-in' forces, requiring the operator to maintain control of the handpiece or to use a brushing action to prevent instruments being pulled into the canal.

Predictors of restenosis after carotid endarterectomy: 17-year experience in a tertiary referral vascular center.

INTRODUCTION: Carotid endarterectomy (CEA) is a well-established surgical technique in stroke prophylaxis. Long-term follow-up data on restenosis or recurrent neurological symptoms in Oriental patients are unclear. METHODS: Patients' notes from 1994 to 2011 were retrospectively reviewed and analyzed. A total of 301 cases of CEA were identified. RESULTS: A lower restenosis rate was associated with the use of patch and never smokers in both univariate and multivariate analysis. Use of patch and never smokers were also found to be significantly associated with longer restenosis-free survival. Use of patch and postoperative use of statin were associated with better overall survival in both univariate and multivariate analysis. CONCLUSION: Use of patch and lack of smoking history are associated with less restenosis and longer restenosis-free survival. Use of patch and use of postoperative statin improves overall survival. Although restenosis after CEA is relatively common, reintervention was rarely necessary.

Comparison of spectral domain and swept-source optical coherence tomography in pathological myopia.

PURPOSE: To compare optical coherence tomography (OCT) images obtained with swept-source OCT (SS-OCT) and spectral domain OCT (SD-OCT) in pathological myopia. METHODS: This is a comparative observational cases series. Five patients with pathological myopia underwent SD-OCT and SS-OCT imaging. SS-OCT was performed using a prototype system (Topcon Medical Systems). SD-OCT was performed using enhanced depth imaging on the Heidelberg Spectralis OCT. The closest corresponding scans from the central subfield were compared. RESULTS: Eight eyes of five patients with pathological myopia were included (mean spherical equivalent: -16.00 ± 4.70 D). Overall, SS-OCT better visualized retino-choroidal structures. The choroid, inner segment (IS)/outer segment (OS) line, and external limiting membrane (ELM) were clearly seen in a higher proportion of SS-OCT than SD-OCT scans, (P<0.01 for all) whereas visualization of the sclera and retinal pigment epithelium (RPE) were similar. SS-OCT demonstrated foveoschisis in four eyes, with one of these not visible on SD-OCT. The wider SS-OCT scan revealed additional pathology not visible using SD-OCT along the staphyloma walls in 4/8 images. These included incomplete posterior vitreous detachment in one eye and peripheral retinoschisis in 3/8 eyes. Vitreoschisis was visible in 3/8 SS-OCT images but not in the SD-OCT images. CONCLUSION: SS-OCT is useful for imaging the posterior staphyloma of pathological myopia, providing greater detail than SD-OCT.

What are the key endodontic factors associated with oral health-related quality of life?

AIM: To determine the associations between endodontic factors and oral health-related quality of life (OHQoL), controlling for socio-demographics, pain and other oral health clinical factors. METHODOLOGY: OHQoL assessments were conducted amongst a consecutive sample of 412 Chinese patients requiring endodontic treatment employing the short-form Oral Heath Impact Profile (OHIP-14). Information on (i) number of teeth requiring endodontic treatment, (ii) tooth type, (iii) retreatment requirements, (iv) periapical radiolucency assessment and (v) diagnostic classification was obtained. In addition, socio-demographic information (age, gender, educational attainment and family income), pain ratings on a visual analogue scale (VAS) and other clinical oral health status information were collected. RESULTS: Bivariate analyses identified association between number of teeth requiring endodontic treatment and summary OHIP-14 score (P < 0.01) and four of its seven domain scores (P < 0.05). Need for endodontic retreatment was associated with summary OHIP-14 score (P < 0.05) and two of its seven domain scores (P < 0.05). In regression analyses having controlled for socio-demographics, other clinical factors and pain rating amongst 15 confounding variables, patients requiring endodontic treatment for multiple teeth were more than twice as likely to have poor OHQoL (upper quintile OHIP-14 scores) compared with those requiring endodontic treatment for a single tooth (OR = 2.16, 95% CI 1.17, 3.98, P < 0.05). Pain VAS rating and age also emerged as significant factors associated with poor OHQoL in the regression analysis. CONCLUSION: OHQoL is compromised amongst patients requiring endodontic treatment. Number of teeth requiring endodontic treatment is associated with poor OHQoL, controlling for socio-demographic and other oral health clinical and pain factors.