Preservation of human heart valves for replacement in children with heart valve disease: past, present and future.

Valvular heart disease affects 30% of the new-borns with congenital heart disease. Valve replacement of semilunar valves by mechanical, bioprosthetic or donor allograft valves is the main treatment approach. However, none of the replacements provides a viable valve that can grow and/or adapt with the growth of the child leading to re-operation throughout life. In this study, we review the impact of donor valve preservation on moving towards a more viable valve alternative for valve replacements in children or young adults.

Becoming a congenital heart surgeon: the long and challenging road.

Training in congenital cardiac surgery is potentially lengthier and more demanding than training in any other surgical field. The duration of training is proportional to the complexity of the specialization. The expertise of a wide range of procedures is required. There is no doubt that some individuals may acquire the requisite abilities with greater ease than others, but fundamentally, these are capabilities that can be taught and learnt. Moreover, congenital cardiac surgeons are required to have a detailed understanding of pathophysiology and morphology, in addition to the stamina and empathy required to manage these complex patients. A fellowship is just the start of such training and is followed by a long road eventually leading to a lifelong journey to become a qualified congenital cardiac surgeon. Effective mentorship is a prerequisite throughout training to guide surgeons on this journey.

RECOMMENDATIONS FOR USE AND SCORING OF ORAL HEALTH IMPACT PROFILE VERSIONS.

BACKGROUND: OHIP's original seven-domain structure does not fit empirical data, but a psychometrically sound and clinically more plausible structure with the four OHRQoL dimensions Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact has emerged. Consequently, use and scoring of available OHIP versions need to be revisited. AIM: We assessed how well the overall construct OHRQoL and its four dimensions were measured with several OHIP versions (20, 19, 14, and 5 items) to derive recommendations which instruments should be used and how to score them. METHODS: Data came from the "Dimensions of OHRQoL Project" and used the project's learning sample (5,173 prosthodontic patients and general population subjects with 49-item OHIP data). We computed correlations among OHIP versions' summary scores. Correlations between OHRQoL dimensions, on one hand, and OHIP versions' domain scores or OHIP-5's items, on the other hand, were also computed. OHIP use and scoring recommendations were derived for psychometrically solid but also practical OHRQoL assessment. RESULTS: Summary scores of 5-, 14-, 19- and 49-item versions correlated highly (r = 0.91-0.98), suggesting similar OHRQoL construct measurement across versions. The OHRQoL dimensions Oral Function, Orofacial Pain, Orofacial Appearance, and Psychosocial Impact were best measured by the OHIP domain scores for Physical Disability, Physical Pain, Psychological Discomfort, and Handicap, respectively. CONCLUSION: Recommendations were derived which OHIP should be preferably used and how OHIP versions should be scored to capture the overall construct and the dimensions of OHRQoL. Psychometrically solid and practical OHRQoL assessment in all settings across all oral health conditions can be achieved with the 5-item OHIP.

Cervicofacial non-tuberculous mycobacterial lymphadenitis: clinical determinants of incomplete surgical removal.

In patients with non-tuberculous mycobacterial cervicofacial lymphadenitis, incomplete surgical removal of infected lymph nodes leads to delayed healing and a higher recurrence rate, with eventual spontaneous drainage through the skin. However, complete surgical removal is not always achievable due to the extent of the infected tissue and proximity to vulnerable structures, such as the facial or accessory nerve. The aim of this study was to identify the clinical determinants of the (in)ability to perform complete surgical removal. The electronic health records of patients aged 0-15 years with bacteriologically proven non-tuberculous mycobacterial cervicofacial lymphadenitis, who underwent surgical treatment and preoperative sonographic imaging, were analysed. This was a case-control study. A total of 103 patients met the inclusion criteria. Most of the infections were unilateral, submandibular, and caused by Mycobacterium avium. Multiple logistic regression analysis revealed that higher age (odds ratio 1.24, 95% confidence interval 1.04-1.47) and fistulization (odds ratio 3.15, 95% confidence interval 1.13-8.75) were significantly associated with a limited ability to surgically remove all infected tissue. However, a larger sonographic lymph node size was not significantly associated. These findings could aid clinicians when informing the parent(s)/guardian(s) of the patient preoperatively and in properly estimating the intraoperative and postoperative course.

Caregivers' perceptions towards communication with mechanically ventilated patients: The results of a multicenter survey.

PURPOSE: The purpose of this study was to investigate ICU health care providers' perception towards communication and associated problems with mechanically ventilated (MV) patients. The primary aim was to quantify the extent of the problem and to determine its effect on patient care and job satisfaction. METHODS: A multicenter survey study was conducted among nurses, residents and intensivists of 15 ICUs in the Netherlands using an online questionnaire. RESULTS: Out of 1740 caregivers, 457 responses were received. Communication difficulties were experienced in half of the interactions with MV patients. Over 75% of participants indicated that patient care was negatively affected. Job satisfaction was negatively affected in 43% of the participants, primarily with feelings of unfulfillment (76%) and frustration (72%). Patient factors considered relevant to communication difficulties were delirium, disease severity and anxiety, among others. To facilitate communication, the use of basic gestures remained the most preferred method. CONCLUSIONS: In half of the interactions with MV patients, health care professionals experience significant communication difficulties. The respondents indicated that these difficulties frequently lead to negative effects on patient care and job satisfaction. These results emphasize the need for improvements such as the development of communication protocols, skills training and continued research into new communication methods.

Thermostable phycocyanin from the red microalga Cyanidioschyzon merolae, a new natural blue food colorant.

The demand for natural food colorants is growing as consumers question the use of artificial colorants more and more. The phycobiliprotein C-phycocyanin of Arthospira platensis is used as a natural blue colorant in certain food products. The thermoacidophilic red microalga Cyanidioschyzon merolae might provide an alternative source of phycocyanin. Cyanidioschyzon merolae belongs to the order Cyanidiophyceae of the phylum Rhodophyta. Its natural habitat are sulfuric hot springs and geysers found near volcanic areas in, e.g., Yellowstone National Park in the USA and in Java, Indonesia. It grows optimally at a pH between 0.5 and 3.0 and at temperatures up to 56 °C. The low pH at which C. merolae grows minimizes the risk of microbial contamination and could limit production loss. As C. merolae lacks a cell wall, phycocyanin with a high purity number of 9.9 could be extracted by an osmotic shock using a simple ultrapure water extraction followed by centrifugation. The denaturation midpoint at pH 5 was 83 °C, being considerably higher than the A. platensis phycocyanin (65 °C). The C. merolae phycocyanin was relatively stable at pH 4 and 5 up to 80 °C. The high thermostability at slightly acidic pH makes the C. merolae phycocyanin an interesting alternative to A. platensis phycocyanin as a natural blue food colorant.

In vitro detection of cholangiocarcinoma cells using a fluorescent protein-expressing oncolytic herpes virus.

Pathological confirmation is desired prior to high-risk surgery for suspected perihilar cholangiocarcinoma (PHC), but preoperative tissue diagnosis is limited by poor sensitivity of available techniques. This study aimed to validate whether a tumor-specific enhanced green fluorescent protein (eGFP)-expressing oncolytic virus could be used for cholangiocarcinoma (CC) cell detection. Extrahepatic CC cell lines SK-ChA-1, EGI-1, TFK-1 and control cells (primary human liver cells) were exposed to the oncolytic herpes simplex type 1 virus NV1066 for up to 24 h in adherent culture. The technique was validated for cells in suspension and cultured cells that had been exposed to crude patient bile. Optimal incubation time of the CC cells with NV1066 at a multiplicity of infection of 0.1 was determined at 6-8 h, yielding 15% eGFP-expressing cells, as measured by flow cytometry. Cells were able to survive 2-h crude bile exposure and remained capable of producing eGFP following NV1066 infection. Detection of malignant cells was possible at the highest dilution tested (10 CC cells among 2 × 105 control cells), though hampered by non-target cell autofluorescence. The technique was not applicable to cells in suspension due to insufficient eGFP production. Accordingly, as yet the technique is not suitable for standardized clinical diagnostics in PHC.

Dental caries, fluorosis, oral health determinants, and quality of life in adolescents.

OBJECTIVE: This study aimed to assess the extent to which dental caries and fluorosis, in addition to sociodemographic and oral health behavior determinants, impact the oral health-related quality of life (OHRQoL) of adolescents. METHODS: All adolescents attending from sixth to eighth grades in the Region of Itapoã, Federal District of Brazil (n = 1122), were screened, and 618 10-15-year-olds were selected. Parents answered a questionnaire about their family's socioeconomic status. Adolescents answered a questionnaire about demographic and oral health behavior determinants in addition to the Child Perception Questionnaire. RESULTS: Cavitated dentine lesions and fluorosis were observed in 39.5 and 48.5 %, respectively. The outcome was a high score on OHRQoL (median split >9). The prevalence of adolescents with at least one domain being impacted "often" or "every day/almost every day" was 34.8 %. Adolescents with tooth brushing frequency ≤once per day and with moderate or severe cavitated dentine lesions reported a significant impact on their OHRQoL (p = 0.002; p = 0.001). Fluorosis did not impact daily life performances (p = 0.545). CONCLUSION: Increased impact on OHRQoL was related to the severity of cavitated dentine lesions, but fluorosis resulting from combined fluoride exposure from early ages was not of concern for the adolescents. CLINICAL RELEVANCE: Combined fluoride exposure from fluoridated drinking water, consumption of food prepared with fluoridated water, and daily twice brushing with conventional fluoride toothpaste from early ages may be recommended to control caries progression at population level without impact on OHRQoL. This information is particularly relevant for supporting oral health police for disadvantaged populations.

Associations of pain intensity and pain-related disability with psychological and socio-demographic factors in patients with temporomandibular disorders: a cross-sectional study at a specialised dental clinic.

The study assessed whether psychological and socio-demographic factors, including somatisation, depression, stress, anxiety, daytime sleepiness, optimism, gender and age, are associated with pain intensity and pain-related disability in patients with temporomandibular disorders (TMDs). In total, 320 TMD patients were involved in the study. The psychological status of each patient was assessed with questionnaires, including the Symptom Checklist-90 (SCL-90), Epworth Sleeping Scale (ESS), stress questionnaire and Life Orientation Test-Revised (LOT-R). TMD pain, including pain intensity and pain-related disability, was assessed with characteristic pain intensity (CPI) and disability points scales. The associations of psychological and socio-demographic factors with pain intensity and pain-related disability were assessed through logistic regression analyses. Higher pain intensity was significantly associated with more severe anxiety (P = 0·004), more severe somatisation (P < 0·001), more severe depression (P < 0·001), more severe stress (P = 0·001) and lower optimism (P = 0·025) in univariate regression analyses. However, multiple regression analysis showed that only somatisation was significantly associated with pain intensity (P < 0·001). Higher pain-related disability was significantly associated with more severe anxiety (P < 0·001), more severe somatisation (P < 0·001), more severe depression (P < 0·001), more severe stress (P < 0·001) and lower optimism (P = 0·003) in univariate regression analyses. However, multiple regression analysis showed that only depression was significantly associated with pain-related disability (P = 0·003). Among the psychological and socio-demographic factors in this study, somatisation was the best predictor of pain intensity, while depression was the best predictor of pain-related disability.

OHRQoL in a Sample of Alcohol and Drug Abusers.

AIMS: To determine oral health related quality of life (OHRQoL) in a large sample of substance abusers and to evaluate the effect of dental treatment on OHRQoL. DESIGN: A longitudinal observational study. SETTINGS: A dental care clinic specialized in treating severely addicted patients. PARTICIPANTS: A sample of severely addicted substance abusers. MEASUREMENTS: OHRQoL was measured using the OHIP-14, which was filled out at baseline (T0), prior to the first treatment session (T1), after about 6 treatment sessions (T2) and on the last day of treatment (T3). FINDINGS: Mean OHIP scores did not change from T0 to T1. At T1, a mean OHIP-14 total score = 37.1 (sd=12.4, N = 392) was found. The highest mean scores were observed for the subscales physical pain and psychological discomfort. Data from 129 patients was available on both T1 and T2. The mean OHIP-14 total score reduced significantly (mean difference = 5.63, 95% CI 3.76 - 7.51), t(128)=5.94, p <0.001. The highest reduction in mean score was found for the subscale physical pain (mean difference = 1.24, 95%CI 0.81 - 1.66). Also between T2 and T3 a significant reduction in OHIP-14 total score (mean difference = 2.41, 95%CI 0.06-4.76) took place. CONCLUSION: The oral health status of substance abusers does have a substantial effect on their quality of life, which can be improved to a great extent by dental treatment based on a model tailored to addicted patients.

Bad splits in bilateral sagittal split osteotomy: systematic review and meta-analysis of reported risk factors.

An unfavourable and unanticipated pattern of the bilateral sagittal split osteotomy (BSSO) is generally referred to as a 'bad split'. Patient factors predictive of a bad split reported in the literature are controversial. Suggested risk factors are reviewed in this article. A systematic review was undertaken, yielding a total of 30 studies published between 1971 and 2015 reporting the incidence of bad split and patient age, and/or surgical technique employed, and/or the presence of third molars. These included 22 retrospective cohort studies, six prospective cohort studies, one matched-pair analysis, and one case series. Spearman's rank correlation showed a statistically significant but weak correlation between increasing average age and increasing occurrence of bad splits in 18 studies (ρ=0.229; P<0.01). No comparative studies were found that assessed the incidence of bad split among the different splitting techniques. A meta-analysis pooling the effect sizes of seven cohort studies showed no significant difference in the incidence of bad split between cohorts of patients with third molars present and concomitantly removed during surgery, and patients in whom third molars were removed at least 6 months preoperatively (odds ratio 1.16, 95% confidence interval 0.73-1.85, Z=0.64, P=0.52). In summary, there is no robust evidence to date to show that any risk factor influences the incidence of bad split.

Efficacy of virtual reality exposure therapy for treatment of dental phobia: a randomized control trial.

BACKGROUND: Virtual Reality Exposure Therapy (VRET) is found to be a promising and a viable alternative for in vivo exposure in the treatment of specific phobias. However, its usefulness for treating dental phobia is unexplored. The aims of the present study are to determine: (a) the efficacy of VRET versus informational pamphlet (IP) control group in terms of dental trait and state anxiety reductions at 1 week, 3 months and 6 months follow-up (b) the real-time physiological arousal [heart rate (HR)] of VRET group participants during and following therapy (c) the relation between subjective (presence) and objective (HR) measures during VRET. METHODS: This study is a single blind, randomized controlled trial with two parallel arms in which participants will be allocated to VRET or IP with a ratio of 1:1. Thirty participants (18-50 years) meeting the Phobia Checklist criteria of dental phobia will undergo block randomization with allocation concealment. The primary outcome measures include participants' dental trait anxiety (Modified Dental Anxiety Scale and Dental Fear Survey) and state anxiety (Visual Analogue Scale) measured at baseline (T0), at intervention (T1), 1-week (T2), 3 months (T3) and 6 months (T4) follow-up. A behavior test will be conducted before and after the intervention. The secondary outcome measures are real-time evaluation of HR and VR (Virtual Reality) experience (presence, realism, nausea) during and following the VRET intervention respectively. The data will be analyzed using intention-to-treat and per-protocol analysis. DISCUSSION: This study uses novel non-invasive VRET, which may provide a possible alternative treatment for dental anxiety and phobia. TRIAL REGISTRATION NUMBER: ISRCTN25824611 , Date of registration: 26 October 2015.

Sensitive CE-MS analysis of potentially genotoxic alkylation compounds using derivatization and electrokinetic injection.

A CE-MS method has been developed to detect trace levels of potentially genotoxic alkyl halides. After derivatization of the target components with 4-dimethylaminopyridine (DMAP) or butyl 1-(pyridinyl-4yl) piperidine 4-carboxylate (BPPC), the natively positively charged derivatives are pre-concentrated by applying electrokinetic injection and separated by a highly efficient CZE method using a background electrolyte (BGE) consisting of 100mM of TRIS adjusted to pH 2.5 with phosphoric acid. Using a sheath liquid interface, subsequent MS detection allows highly specific and sensitive analysis of alkyl halides. Conditions for electrokinetic injection were optimized to allow selective and effective injection. Injection of samples with low water content at 10 kV for 150 s using a high concentration of buffer in the BGE resulted in optimum sample stacking during injection and a highly efficient CE separation. At the sample pH applied, neutral and negatively charged components are shown to be selectively discarded, resulting in injection of positively charged ions only. The sample matrix influences the efficiency of the injection, but when using an internal standard, reproducibilities better than 10% RSD are obtained. Relative recoveries of the derivatives spiked to different types of model API between 85 and 115% demonstrate that the method can be applied for quantitative analysis. Detection limits of lower than 1 mg kg(-1) for the tested alkyl halides obtained in CE-MS at least equal the sensitivity obtained in LC-MS. The CE-MS method is a valuable alternative for the LC-MS method used for analysis of alkylation compounds.

Self-reported gagging in dentistry: prevalence, psycho-social correlates and oral health.

Although gagging has a profound effect on the delivery of dental care, it is a relatively under-investigated phenomenon. This study aimed to derive a prevalence estimate of gagging during dental treatment based on patient-reported information, to determine some socio-demographic and psychological correlates and to assess the relationship of gagging with self-reported oral health and avoidance of dental care. Data were collected with a survey among Dutch twin families (n = 11 771). Estimated overall prevalence of gagging during dental treatment was 8·2% (95% CI 7·7-8·7). Patients' self-report of gagging was found to be significantly associated with female sex, a lower level of education and higher levels of dental trait anxiety, gagging-related fears (e.g. fear of objects in the mouth), anxious depression and neuroticism. Gagging also appeared to be significantly associated with untreated cavities, gingival bleeding and wearing full dentures, but not with avoidance of dental care. It can be concluded that individuals who report to gag during dental treatment are moderately dentally anxious, fear-specific situations that can trigger a gagging response and, albeit visiting the dentist equally frequently, report to have a poorer oral health compared to those who do not gag.

Predictors for the development of temporomandibular disorders in scuba divers.

The aim was to determine predictors for the development of complaints of temporomandibular disorders (TMD) in a large sample of Dutch scuba divers who were free of any TMD complaints before they started diving actively. Five-hundred and thirty-six scuba divers (mean ± SD age = 40.4 ± 11.9 years; 34.1% women) completed a specifically developed questionnaire, either online or on paper. Stepwise forward logistic regression analysis was performed to predict the presence of TMD pain, with several potential risk factors as predictors. Four hundred and eighty-five of the 536 respondents were free of any TMD pain before they started diving actively. In this sample, TMD pain was present in 214 persons (44.1%). Four predictors contributed significantly to the presence of TMD pain, viz., clenching (OR = 2.466), warm water (OR = 1.685), biting on the mouthpiece (OR = 1.598), and the quality rating of the mouthpiece (OR = 0.887, that is, a higher rating means a smaller odds of having TMD pain). TMD pain is a common complaint among scuba divers who were free of such complaints before they started diving actively. Clenching, biting on the mouthpiece, and a low rating of the mouthpiece are predictors for the presence of TMD pain in scuba divers, while diving in cold water serves as a protective factor for TMD pain.

Incidence of T790M mutation in (sequential) rebiopsies in EGFR-mutated NSCLC-patients.

AIM: Non-small cell lung cancer (NSCLC)-patients with an epidermal growth factor receptor (EGFR)-mutation have median progression-free survival (PFS) of 12 months on tyrosine kinase inhibitors (TKIs). Resistance is mediated by the EGFR T790M-mutation in the majority of patients. Longitudinal follow-up data are lacking. We retrospectively evaluated EGFR-mutated NSCLC-patients who were rebiopsied after TKI-treatment. A subgroup was sequentially rebiopsied along the course of the disease. PATIENTS AND METHODS: Advanced EGFR-mutated NSCLC-patients who had both a pre-TKI biopsy and post-TKI biopsy available were included. Information on treatments and (re)biopsies was collected chronologically. Primary endpoint was the incidence of the T790M-mutation. RESULTS: Sixty-six patients fulfilled the inclusion criteria. In first post-TKI biopsies, T790M-mutation was detected in 34 patients (52%) of patients. Twenty-seven patients had subsequent post-TKI rebiopsies with mutation analysis available; in 10 patients (37%) the T790M-status in subsequent post-TKI rebiopsies was not consistent with the T790M-status of the first post-TKI biopsy. Progression free survival (PFS) on TKI-treatment was 12.0 months. Objective response rate on TKI-treatment was 81%. Patients developing T790M-mutation at post-TKI biopsy had longer median PFS compared to T790M-negative patients (14.2 versus 11.1 months respectively (P=0.034)) and longer overall survival (45.9 months versus 29.8 months respectively (P=0.213)). Transformation to SCLC was detected in 1 patient (2%). CONCLUSION: Incidence of T790M-mutation at first post-TKI biopsy in this cohort of EGFR-mutated NSCLC-patients was 52%. Detection of T790M-mutation was not consistent over time; some patients who were T790M-positive at first post-TKI biopsy became T790M-negative in later post-TKI rebiopsies and vice versa. T790M-positive patients showed longer PFS than T790M-negative patients. Whether the low incidence of transformation to SCLC is justifying post-TKI rebiopsy in EGFR-mutated NSCLC-patients with acquired TKI-resistance in regular clinical practice is debatable.

Attitudes towards individuals with halitosis: an online cross sectional survey of the Dutch general population.

OBJECTIVE: To derive an estimate of encounters with halitosis and to assess the impact of halitosis on their psychosocial interactions with halitosis patients. METHODS: Participants were 1,006 members of an online panel, being representative of the population of the Netherlands with regard to gender, age, family situation, education level and labour participation. They were invited to participate in a survey using an online questionnaire with four questions on becoming faced with people having halitosis. RESULTS: Almost 90% of the participants indicated being faced with a person having halitosis regularly, 40% at least once a week, and men significantly more frequently than women. Halitosis was reported to be a strong 'downer' when meeting a person for the first time. Whether one would draw a person's attention to his breath malodour proved to be related to the kind of person involved and appeared to decrease with the increase of the social distance to the person. Drawing a person's attention to his breath malodour would virtually always be performed personally. CONCLUSION: Halitosis is considered to be one of the most unattractive aspects of social interactions and has potentially damaging effects on psychosocial interactions and relationships.

An improved, disposable indwelling intrauterine tube ("smit sleeve") not requiring retaining stitches for brachy-radiotherapy for carcinoma of the cervix.

OBJECTIVE: The objective was to improve the design of the indwelling-intrauterine tube (IIUT) for brachy-radiotherapy of cervical cancer or sleeve, specifically one that would not require stitching to retain it properly in the uterus for periods of one to two weeks and to ensure hygiene by making them disposable, thinner, lighter, more economical, as well as more user-friendly for doctor and patient alike, and to satisfy new developments in terms of computed tomography (CT) and magnetic resonance imaging (MRI) compatibility. MATERIALS AND METHODS: Injection moulding of carefully-selected medical grade polymers enabled ten improvements to the original sleeve; some were impossible to achieve with lathe turned items. The most important innovation was the addition of two delicate and very soft "wings" to the sleeves near the tips The sleeves were used in 50 consecutive patients with advanced carcinoma of the cervix. Metal markers could be eliminated by adding barium to the polymers. RESULTS: Not a single sleeve fell out in any of the 50 patients. No complications related to the use of the sleeves were observed. These sleeves are now used exclusively in this clinic. CONCLUSIONS: The improvements were very successful; none fell out and no suturing was required, which made them still more cost-effective and more comfortable to patients.

A comparative study of the Osstell™ versus the Osstell Mentor™ to evaluate implant stability in human cadaver mandibles.

The aim of this study was to assess the primary stability of dental implants by resonance frequency analysis (RFA) using the Osstell™ and Osstell Mentor™ devices and to investigate the reproducibility and comparability of the results obtained with these devices. Twenty-four Straumann implants (Straumann AG, Basel, Switzerland) were placed in the anterior mandible of 12 fresh edentulous human cadaver mandibles. The implant stability quotients (ISQs) were measured with the Osstell™ and Osstell Mentor™ when implants were inserted at 50% of their length and following their complete insertion. The Osstell™ device measured lower scores compared with the Osstell Mentor™. This was significant for the full position (mean difference = 9·9), t (11) = 7·4, P < 0·001 and for the halfway position (mean difference = 5·9), t (11) = 2·41, P = 0·03. In conclusion, the Osstell™ produced relatively lower ISQ scores than the Osstell Mentor™.