A novel approach to managing circumferential entrapment of a child's tongue within a plastic lid.

BACKGROUND: The increased popularity of reusable drinking bottles may have safety implications when used by children. This paper discusses the lessons learnt from managing two cases of children presenting to our ENT department who required surgical intervention for complications arising from their use. CASE REPORT: This paper presents a case series of two five-year-old children who attended the emergency department with circumferential entrapment of their tongue within plastic drinking bottle lids of similar design. The unique anaesthetic and surgical challenges surrounding these cases are discussed. CONCLUSION: These represent the only reported cases of circumferential entrapment of the tongue by a foreign body requiring general anaesthesia where orotracheal intubation was contraindicated. A creative general anaesthetic approach was taken using ketamine and Optiflow high-flow nasal oxygen therapy. A reproducible surgical technique using powered cutting instruments is also discussed.

Renal, Cardiac, and Autonomic Effects of Catheter-Based Renal Denervation in Ovine Heart Failure.

[Figure: see text].

Complicated Dengue Fever and Its Treatment Dilemmas: A Single-Center Experience in Sri Lanka.

Dengue is an arboviral infection that affects humanscausing significant morbidity and mortality in tropical countries. Our first patient who had diabetes presented with shock and was managed as dengue hemorrhagic fever with superadded sepsis which required noradrenalin plus broad-spectrum intravenous antibiotics. The second patient developed severe bradycardia during the ascending limb of the critical phase with hemodynamic stability, which recovered on discharge. Third patient presented with severe and rapid leaking; we used intravenous albumin as an alternative colloid with good outcome. The fourth patient was a pregnant mother at term, and she went into spontaneous labor during the latter half of the critical phase. The fifth patient developed dengue hemorrhagic fever complicated with probable haemophagocytic lymphohistiocytosis. She was treated with intravenous steroids andimmunoglobulin, yet succumbed on day 7. Conclusion. Dengue is an extremely challenging and dynamic disease, which can lead to many unusual complications.A high index of suspicion is key to diagnose and treat promptly.

Curcumin loaded zinc oxide nanoparticles for activity-enhanced antibacterial and anticancer applications.

Zinc oxide nanoparticles and curcumin have been shown to be excellent antimicrobial agents and promising anticancer agents, both on their own as well as in combination. Together, they have potential as alternatives/supplements to antibiotics and traditional anticancer drugs. In this study, different morphologies of zinc oxide-grafted curcumin nanocomposites (ZNP-Cs) were synthesized and characterized using SEM, TGA, FTIR, XRD and UV-vis spectrophotometry. Antimicrobial assays were conducted against both Gram negative and Gram-positive bacterial stains. Spherical ZnO-curcumin nanoparticles (SZNP-Cs) and rod-shaped ZnO-curcumin nanoparticles showed the most promising activity against tested bacterial strains. The inhibition zones for these curcumin-loaded ZnO nanocomposites were consistently larger than their bare counterparts or pure curcumin, revealing an additve effect between the ZnO and curcumin components. The potential anticancer activity of the synthesized nanocomposites was studied on the rhabdomyosarcoma RD cell line via MTT assay, while their cytotoxic effects were tested against human embryonic kidney cells using the resazurin assay. SZNP-Cs exhibited the best balance between the two, showing the lowest toxicity against healthy cells and good anticancer activity. The results of this investigation demonstrate that the nanomatrix synthesized can act as an effective, additively-enhanced combination delivery/therapeutic agent, holding promise for anticancer therapy and other biomedical applications.

The appropriateness of current UK training in acute internal medicine.

Doctors training in Acute Internal Medicine (AIM) need to provide evidence that they can effectively manage 20 'top' and 40 'other important' acute medical presentations. However, the presentations considered important in the AIM curriculum do not have an empirical evidence base. This study compared real-life presentations against those in the AIM curriculum. Data on all presentations to the acute medical service at The Royal Free Hospital, London, were collected retrospectively for five non-consecutive weeks and prospectively for one week. Five frequently encountered presentations viz: cough, nausea and vomiting, dizziness, hyperglycaemia and lethargy were not amongst those listed as 'top' or 'other important' in the AIM curriculum. Hence, demonstration of competency in these presentations is currently not an explicit requirement.

Effect of networked hybridized nanoparticle reinforcement on the thermal conductivity and mechanical properties of natural rubber composites.

Thermal conductivity of natural rubber (NR) was enhanced by incorporating novel conductive hybrid nanofillers, namely polyaniline grafted carbon black (PANI/CB) nanoparticles and carbon black nanoparticles linked with carbon microfiber (CF/CB) composites. The PANI/CB hybrid fillers were synthesized using an in situ method, where aniline monomers were initially adsorbed onto carbon black spherical domains and, afterwards, it was polymerized in the presence of an oxidizer. Final rubber composites were prepared through melt mixing, where PANI/CB and CF/CB filler loading was kept at 40 parts per hundred of rubber (phr). The thermal conductivity values of the rubber composites with CF/CB (20 : 20) and PANI/CB (20 : 20) yield were 0.45 W m-1 K-1 and 0.31 W m-1 K-1, respectively and the thermal conductivity improved significantly compared to the control (0.25 W m-1 K-1) sample. The higher thermal conductivity values of CF/CB and PANI/CB incorporated composites suggest that the generated networked structure of CF and PANI nanofibers with CB nanoparticles has immensely contributed to enhancing the heat dissipation compared to that of the neat CB rubber composite. Scanning electron micrographs (SEM) confirmed the attachment of the synthesized PANI onto the spherical CB nanoparticles and interconnected morphology of CF/CB and PANI/CB hybrid fillers. The synthesized PANI/CB hybrid filler was further characterized using Fourier-transform infrared (FTIR) spectroscopy to evaluate the chemical properties. Furthermore, thermogravimetric analysis revealed the higher thermal stability of CF/CB (20 : 20) and PANI/CB (20 : 20) composites compared to the control. Moreover, the addition of CF/CB (20 : 20) and PANI/CB (20 : 20) improved the mechanical properties such as ultimate tensile strength, modulus at break, resilience and abrasion resistance significantly and well above the minimum required standard mechanical parameters in the tyre industry. These reinforced composites show great potential to be used as heat dissipating rubber composites in the tyre industry.

Facile and low-cost synthesis of pure hematite (α-Fe2O3) nanoparticles from naturally occurring laterites and their superior adsorption capability towards acid-dyes.

Hematite nanoparticles have a broad range of outstanding applications such as in wastewater treatment, electrolytic studies, and photoelectrochemical and superparamagnetic applications. Therefore, the development of facile and novel methods to synthesize hematite nanoparticles using low-cost raw materials is an important and timely requirement. In this study, we have developed a facile economical route to synthesize hematite nanoparticles, directly from the naturally occurring material laterite. Laterite is a rock that is rich in Fe and Al with extensive distribution in large mineable quantities in many countries around the world, though not yet utilized for major industrial applications. In this method, ferric ions in the laterite were leached out using acid and the solution obtained was hydrolyzed with slow-release hydroxyl ions which were acquired by aqueous decomposition of urea. The resulted precursor was calcined to obtain hematite nanoparticles. Characterization data shows that the final product is comprised of spherical hematite nanoparticles with a narrow particle size vs. frequency distribution with an average particle diameter of 35 nm. The synthesized product has a purity of over 98%. Furthermore, the synthesized nanoparticles show an excellent adsorption percentage as high as 70%, even when the initial dye concentration in water is 5000 ppm and the amount of material is minimal, towards acid dyes which are excessively used in textile based industries. Such acid dyes are a threat to the environment when they are released into water bodies by industries in massive quantities. Therefore synthesized hematite nanoparticles are ideal to treat dye wastewater in industrial effluents because such nanoparticles are low cost and economical, and the synthesis procedure is rather facile and effective.

Dataset on structure and mechanical properties of electrospun polyacrylonitrile nanofibrous mesh reinforced by halloysite nanotubes.

The mechanical properties of electrospun polyacrylonitrile (PAN)-based membranes for ultrafiltration, such as oil-water separation and heavy metals from water, are often characterised in the dry state but little is known about the membrane properties in the hydrated state. This dataset comprised mechanical properties and structure-related properties of electrospun PAN-based membranes. The mechanical dataset described the yield strength and strain, stiffness, resilience energy, fracture strength, strain at fracture and fracture toughness of electrospun neat PAN and halloysite nanotube (HNT) reinforced PAN membranes in both hydrated and dry states. The data related to the hydrated state were derived from direct measurements of the mechanical properties of the PAN-based membrane using a novel environmental micromechanical tester. The structure-related dataset comprised electron micrographs and quantitative measurements (fibre diameter and pore diameter) derived from the micrographs. For further interpretation and discussion of the dataset, the reader is referred to the research data article, "Direct measurement of the elasticity and fracture properties of electrospun polyacrylonitrile/halloysite fibrous mesh in water" (Govindasamy et al., 2014).

A model to predict nodal metastasis in patients with oral squamous cell carcinoma.

Difficulty in precise decision making on necessity of surgery is a major problem when managing oral squamous cell carcinomas (OSCCs) with clinically negative neck. Therefore, use of clinical and histopathological parameters in combination would be important to improve patient management. The main objective is to develop a model that predicts the presence of nodal metastasis in patients with OSCC.623 patients faced neck dissections with buccal mucosal or tongue squamous cell carcinoma (SCC) were selected from patients' records. Demographic data, clinical information, nodal status, Depth of invasion (DOI) and pattern of invasion (POI) were recorded. The parameters which showed a significant association with nodal metastasis were used to develop a multivariable predictive model (PM). Univariate logistic regression was used to estimate the strengths of those associations in terms of odds ratios (OR). This showed statistically significant associations between status of the nodal metastasis and each of the following 4 histopathological parameters individually: size of the tumour (T), site, POI, and DOI. Specifically, OR of nodal metastasis for tongue cancers relative to buccal mucosal cancers was 1.89, P-value < 0.001. Similarly, ORs for POI type 3 and 4 relative to type 2 were 1.99 and 5.83 respectively. A similar relationship was found with tumour size; ORs for T2, T3, and T4 compared to T1 were 2.79, 8.27 and 8.75 respectively. These four histopathological parameters were then used to develop a predictive model for nodal metastasis. This model showed that probability of nodal metastasis is higher among tongue cancers with increasing POI, with increasing T, and with larger depths while other characteristics remained unchanged. The proposed model provides a way of using combinations of histopathological parameters to identify patients with higher risks of nodal metastasis for surgical management.

Quality of Life in Older Adults Attending a University Family Practice Centre in Sri Lanka.

BACKGROUND: This study aimed to assess the quality of life (QoL) and identify factors influencing it in older adults attending a University Family Practice situated in a semi-urban area in Sri Lanka, a lower middle income country. OBJECTIVES: To describe the QoL among older adults attending the Family Practice Centre, University of Sri Jayewardenepura. DESIGN: A descriptive cross sectional study. SETTING: Family Practice Centre, University of Sri Jayewardenepura, Sri Lanka. PARTICIPANTS: 140 registered older adults >60years who attended the centre over 3 months in 2012. RESULTS: The majority of participants (51.4%) were between 60-69years, females (65%), 67.9% were married, and (88.6%) lived with their families. QoL was satisfactory, with spiritual and functional aspects being the most satisfactory and physical QoL being the least satisfactory, however latter too had a mean score (>50). Better QoL was seen in males, with better education, married and living with spouse, and perceived adequacy of income. Poorer QoL was seen in participants living alone, presence of 3 or more health problems, being admitted to hospital or, and accidents and falls in the past one year. CONCLUSIONS: QoL in this group of older adults was satisfactory with spiritual and functional aspects being the most satisfactory and the physical aspect being the least. Preventing unnecessary hospital admissions and accidents could help to improve QoL in older adults.

Aerophagia in adolescents is associated with exposure to adverse life events and psychological maladjustment.

BACKGROUND: Aerophagia is a common childhood functional gastrointestinal disorder. We studied the association between adverse life events (ALEs), psychological maladjustment, somatization, and aerophagia (AP) in adolescents. We also assessed the impact of AP on their health-related quality of life (HRQoL). METHODS: A cross-sectional survey was conducted on 2500 subjects of 13-18 years in 8 randomly selected schools in Sri Lanka. Translated, validated, and self-administered questionnaires were used to collect data. Aerophagia was diagnosed using Rome III criteria. KEY RESULTS: A total of 2453 questionnaires were analyzed (males 1200 [48.9%], mean age 14.8 years, SD 1.6 years). Of them, 371 adolescents had AP (15.1%). Aerophagia was associated with exposure to physical abuse (20.4% vs. 12.7% in controls, P < .0001), emotional abuse (20.3% vs. 8.2% in controls, P < .0001), and other ALEs (22% vs. 10.2% in controls, P < .001). One hundred and ninety (51.2%) adolescents with AP and 775 (37.2%) controls had a personality score above the international cutoff value of 105, indicating psychological maladjustment (odds ratio 1.77, 95% confidence interval 1.42-2.21, P < .0001). Those with AP had higher somatization (16.4 vs. 8.9) and lower overall HRQoL scores (77.0 vs. 85.1, P < .0001). HRQoL scores of adolescents with AP were lower in all domains, namely, physical (80.6 vs. 86.9), emotional (69.1 vs. 80.3), social (83.8 vs. 90.5), and school (72.6 vs. 82.5) functioning (P < .0001). CONCLUSIONS AND INFERENCES: Aerophagia was associated with exposure to ALEs and psychological maladjustment. Affected teenagers suffer from more somatic symptoms and has a poor HRQoL.

A set of systematic reviews to help reduce inappropriate prescribing to older people: study protocol.

BACKGROUND: Multimorbidity and polypharmacy are common in older people. Assessment tools or lists of criteria aimed at supporting prescription decisions for older people exist, but have often been based on expert opinion with insufficient consideration of the evidence available. The present paper describes the methods we are using to systematically review the existing evidence on the efficacy and safety of the most commonly prescribed drugs for older people in the management of their chronic medical conditions and to develop recommendations to reduce inappropriate prescriptions for incorporation into the Comprehensive Medication Review (CMR) tool developed by the PRIMA-eDS European project. METHODS: We selected the 20 most relevant drugs/drug classes in terms of prescription volumes and risk of hospitalisation for older people and the most relevant indications for the most common chronic conditions among older people and a total of 35 distinct drug-indication pairs were chosen. Based on clinical considerations we collapsed some indications together, reducing the 35 pairs to a final total of 22 separate systematic reviews (SR). A common methodology will be used for each individual SR, based on the methodological manuals of the Cochrane collaboration and the PRISMA statement for reporting systematic reviews. Our search strategy will have a staged approach where we initially search for systematic reviews and meta-analyses, but if relevant reviews are not found, then search for individual studies (controlled intervention and observational studies). Our pilot work and initial scoping of the literature suggested that very few, relevant individual trials or existing systematic reviews have researched or reported exclusively on older people. Therefore, sufficient data might not be available to perform meta-analysis but we will provide a narrative synthesis describing characteristics and findings of included studies. The collected evidence will be used to construct recommendations on when not to use or to discontinue a drug, or when to reduce its dose. Recommendations will be developed in team meetings using the GRADE methodology to reflect the strength of the recommendation and the quality of the evidence. Recommendations will be built into the CMR tool. DISCUSSION: This protocol has been prepared for a series of systematic reviews which will provide research-based evidence to develop recommendations to reduce inappropriate polypharmacy in older people as part of the CMR tool of the PRIMA-eDS project.

Effectiveness and safety of dipeptidyl peptidase 4 inhibitors in the management of type 2 diabetes in older adults: a systematic review and development of recommendations to reduce inappropriate prescribing.

BACKGROUND: Preventable drug-related hospital admissions can be associated with drugs used in diabetes and the benefits of strict diabetes control may not outweigh the risks, especially in older populations. The aim of this study was to look for evidence on risks and benefits of DPP-4 inhibitors in older adults and to use this evidence to develop recommendations for the electronic decision support tool of the PRIMA-eDS project. METHODS: Systematic review using a staged approach which searches for systematic reviews and meta-analyses first, then individual studies only if prior searches were inconclusive. The target population were older people (≥65 years old) with type 2 diabetes. We included studies reporting on the efficacy and/or safety of DPP-4 inhibitors for the management of type 2 diabetes. Studies were included irrespective of DPP-4 inhibitors prescribed as monotherapy or in combination with any other drug for the treatment of type 2 diabetes. The target intervention was DPP-4 inhibitors compared to placebo, no treatment, other drugs to treat type 2 diabetes or a non-pharmacological intervention. RESULTS: Thirty studies (reported in 33 publications) were included: 1 meta-analysis, 17 intervention studies and 12 observational studies. Sixteen studies were focused on older adults and 14 studies reported subgroup analyses in participants ≥65, ≥70, or ≥75 years. Comorbidities were reported by 26 studies and frailty or functional status by one study. There were conflicting findings regarding the effectiveness of DPP-4 inhibitors in older adults. In general, DPP-4 inhibitors showed similar or better safety than placebo and other antidiabetic drugs. However, these safety data are mainly based on short-term outcomes like hypoglycaemia in studies with HbA1c control levels recommended for younger people. One recommendation was developed advising clinicians to reconsider the use of DPP-4 inhibitors for the management of type 2 diabetes in older adults with HbA1c <8.5% because of scarce data on clinically relevant benefits of their use. Twenty-two of the included studies were funded by pharmaceutical companies and authored or co-authored by employees of the sponsor. CONCLUSIONS: Other than the surrogate endpoint of improved glycaemic control, data on clinically relevant benefits of DPP-4 inhibitors in the treatment of type 2 diabetes mellitus in older adults is scarce. DPP-4 inhibitors might have a lower risk of hypoglycaemia compared to other antidiabetic drugs but data show conflicting findings for long-term benefits. Further studies are needed that evaluate the risks and benefits of DPP-4 inhibitors for the management of type 2 diabetes mellitus in older adults, using clinically relevant outcomes and including representative samples of older adults with information on their frailty status and comorbidities. Studies are also needed that are independent of pharmaceutical company involvement.

Magnesium Oxide Nanoparticles Reinforced Electrospun Alginate-Based Nanofibrous Scaffolds with Improved Physical Properties.

Mechanically robust alginate-based nanofibrous scaffolds were successfully fabricated by electrospinning method to mimic the natural extracellular matrix structure which benefits development and regeneration of tissues. Alginate-based nanofibres were electrospun from an alginate/poly(vinyl alcohol) (PVA) polyelectrolyte complex. SEM images revealed the spinnability of the complex composite nanofibrous scaffolds, showing randomly oriented, ultrafine, and virtually defects-free alginate-based/MgO nanofibrous scaffolds. Here, it is shown that an alginate/PVA complex scaffold, blended with near-spherical MgO nanoparticles (⌀ 45 nm) at a predetermined concentration (10% (w/w)), is electrospinnable to produce a complex composite nanofibrous scaffold with enhanced mechanical stability. For the comparison purpose, chemically cross-linked electrospun alginate-based scaffolds were also fabricated. Tensile test to rupture revealed the significant differences in the tensile strength and elastic modulus among the alginate scaffolds, alginate/MgO scaffolds, and cross-linked alginate scaffolds (P < 0.05). In contrast to cross-linked alginate scaffolds, alginate/MgO scaffolds yielded the highest tensile strength and elastic modulus while preserving the interfibre porosity of the scaffolds. According to the thermogravimetric analysis, MgO reinforced alginate nanofibrous scaffolds exhibited improved thermal stability. These novel alginate-based/MgO scaffolds are economical and versatile and may be further optimised for use as extracellular matrix substitutes for repair and regeneration of tissues.

Efficacy of Codeine When Added to Paracetamol (Acetaminophen) and Ibuprofen for Relief of Postoperative Pain After Surgical Removal of Impacted Third Molars: A Double-Blinded Randomized Control Trial.

PURPOSE: The use of opioids in combination with nonopioids is common practice for acute pain management after third molar surgery. One such combination is paracetamol, ibuprofen, and codeine. The authors assessed the efficacy of codeine when added to a regimen of paracetamol and ibuprofen for pain relief after third molar surgery. MATERIALS AND METHODS: This study was a randomized, double-blinded, placebo-controlled trial conducted in patients undergoing the surgical removal of at least 1 impacted mandibular third molar requiring bone removal. Participants were randomly allocated to a control group (paracetamol 1,000 mg and ibuprofen 400 mg) or an intervention group (paracetamol 1,000 mg, ibuprofen 400 mg, and codeine 60 mg). All participants were treated under intravenous sedation and using identical surgical conditions and technique. Postoperative pain was assessed using the visual analog scale (VAS) every 3 hours (while awake) for the first 48 hours after surgery. Pain was globally assessed using a questionnaire on day 3 after surgery. RESULTS: There were 131 participants (36% men; control group, n = 67; intervention group, n = 64). Baseline characteristics were similar for the 2 groups. Data were analyzed using a modified intention-to-treat analysis and, for this, a linear mixed model was used. The model showed that the baseline VAS score was associated with subsequent VAS scores and that, with each 3-hour period, the VAS score increased by an average of 0.08. The treatment effect was not statistically meaningful, indicating there was no difference in recorded pain levels between the 2 groups during the first 48 hours after mandibular third molar surgery. Similarly, the 2 groups did not differ in their global ratings of postoperative pain. CONCLUSION: Codeine 60 mg added to a regimen of paracetamol 1,000 mg and ibuprofen 400 mg does not improve analgesia after third molar surgery.

Nano-MgO reinforced chitosan nanocomposites for high performance packaging applications with improved mechanical, thermal and barrier properties.

Chitosan nanocomposite thin films were fabricated by incorporating MgO nanoparticles to significantly improve its physical properties for potential packaging applications. A novel in-situ method was developed to synthesise spherical shaped MgO nanoparticles by heat-treating magnesium carbonate/poly(methyl methacrylate) (PMMA) composite precursor. Optimum mechanical properties of chitosan composites were yielded at 5 (w/w%) of MgO concentration, where tensile stress and elastic modulus significantly improved by 86% and 38%, respectively, compared to those of pure chitosan films. These improvements are due to the interaction of hydroxyl and amine groups of chitosan with MgO as confirmed by FTIR spectroscopy. Fracture surface morphology indicated the interplay between MgO dispersion and aggregation on the mechanical properties at different MgO concentrations. Furthermore, the chitosan/MgO nanocomposites displayed remarkable thermal stability, flame retardant properties (satisfied V0 rating according to the UL-94 standards), UV shielding and moisture barrier properties, which could certainly add value to the packaging material.

Pregnancy outcomes of antiphospholipid syndrome: In a low resource South Asian setting.

PROBLEM: Antiphospholipid syndrome is associated with recurrent pregnancy loss, and specific treatment improves pregnancy outcome. Laboratory diagnosis is limited in South Asia. We assessed management outcomes of definite/probable antiphospholipid syndrome treated at a tertiary centre in Sri Lanka. METHOD: Descriptive cross-sectional study of pregnancy outcomes with heparin and aspirin therapy. OUTCOME MEASURES: miscarriage, intrauterine death and live birth when compared to previous untreated pregnancies. RESULTS: Of 646 gestations in 145 women, 146 (22.6%) received specific treatment. In the preceding pregnancies without specific treatment, the rates of miscarriage, late fetal loss, stillbirth and live birth were 60%, 26%, 8% and 7%, respectively. Following specific treatment with low-dose aspirin ± low-molecular weight heparin in 146 pregnancies (145 women), the rates of miscarriage, late fetal loss, stillbirth and live birth were 14%, 10%, 3% and 74%, respectively. Mean birth weight was 2.54 ± 0.62 kg, preterm births complicated 32 (29.6%) with a mean gestational age at delivery 33.7 ± 2.6 weeks, with three neonatal deaths. Maternal complications were: pre-eclampsia 16 (10.9%), gestational diabetes 28 (19.2%), antepartum haemorrhage in 1 patient. Only 73/145 (50.3%) women had laboratory confirmation of antiphospholipid syndrome, while others were treated empirically. Live births in diagnosed vs. empiric treatment - 80.8% vs. 67.1%. CONCLUSION: Pregnant women with clinical antiphospholipid syndrome when treated with low-dose aspirin and heparin, the live birth rate of 7% in the previous pregnancy resulted in live births of 74% in a resource limited South Asian setting.

Relationship between cardiac diffusion tensor imaging parameters and anthropometrics in healthy volunteers.

BACKGROUND: In vivo cardiac diffusion tensor imaging (cDTI) is uniquely capable of interrogating laminar myocardial dynamics non-invasively. A comprehensive dataset of quantative parameters and comparison with subject anthropometrics is required. METHODS: cDTI was performed at 3T with a diffusion weighted STEAM sequence. Data was acquired from the mid left ventricle in 43 subjects during the systolic and diastolic pauses. Global and regional values were determined for fractional anisotropy (FA), mean diffusivity (MD), helix angle gradient (HAg, degrees/%depth) and the secondary eigenvector angulation (E2A). Regression analysis was performed between global values and subject anthropometrics. RESULTS: All cDTI parameters displayed regional heterogeneity. The RR interval had a significant, but clinically small effect on systolic values for FA, HAg and E2A. Male sex and increasing left ventricular end diastolic volume were associated with increased systolic HAg. Diastolic HAg and systolic E2A were both directly related to left ventricular mass and body surface area. There was an inverse relationship between E2A mobility and both age and ejection fraction. CONCLUSIONS: Future interpretations of quantitative cDTI data should take into account anthropometric variations observed with patient age, body surface area and left ventricular measurements. Further work determining the impact of technical factors such as strain and SNR is required.

One-Piece Zirconia Ceramic versus Titanium Implants in the Jaw and Femur of a Sheep Model: A Pilot Study.

Reports have documented titanium (Ti) hypersensitivity after dental implant treatment. Alternative materials have been suggested including zirconia (Zr) ceramics, which have shown predictable osseointegration in animal studies and appear free of immune responses. The aim of the research was to investigate the bone-to-implant contact (BIC) of one-piece Zr, compared with one-piece Ti implants, placed in the jaws and femurs of domestic sheep. Ten New Zealand mixed breed sheep were used. A One-piece prototype Ti (control) and one Zr (test) implant were placed in the mandible, and one of each implant (Ti and Zr) was placed into the femoral epicondyle of each animal. The femur implants were submerged and unloaded; the mandibular implants were placed using a one-stage transgingival protocol and were nonsubmerged. After a healing period of 12 weeks, %BIC was measured. The overall survival rate for mandibular and femur implants combined was 87.5%. %BIC was higher for Zr implants versus Ti implants in the femur (85.5%, versus 78.9%) (p = 0.002). Zirconia implants in the mandible showed comparable %BIC to titanium implants (72.2%, versus 60.3%) (p = 0.087). High failure rate of both Zr and Ti one-piece implants in the jaw could be attributed to the one-piece design and surface characteristics of the implant that could have influenced osseointegration. Further clinical trials are recommended to evaluate the performance of zirconia implants under loading conditions.