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

The WOCE–era 3–D Pacific Ocean circulation and heat budget

Author Posting. © The Author(s), 2009. This is the author's version of the work. It is posted here by permission of Elsevier B.V. for personal use, not for redistribution. The definitive version was published in Progress In Oceanography 82 (2009): 281-325, doi:10.1016/j.pocean.2009.08.002.To address questions concerning the intensity and spatial structure of the 3–dimensional circulation within the Pacific Ocean and the associated advective and diffusive property flux divergences, data from approximately 3000 high–quality hydrographic stations collected on 40 zonal and meridional cruises have been merged into a physically consistent model. The majority of the stations were occupied as part of the World Ocean Circulation Experiment (WOCE), which took place in the 1990s. These data are supplemented by a few pre–WOCE surveys of similar quality, and time–averaged direct–velocity and historical hydrographic measurements about the equator. An inverse box model formalism is employed to estimate the absolute along–isopycnal velocity field, the magnitude and spatial distribution of the associated diapycnal flow and the corresponding diapycnal advective and diffusive property flux divergences. The resulting large–scale WOCE Pacific circulation can be described as two shallow overturning cells at mid– to low latitudes, one in each hemisphere, and a single deep cell which brings abyssal waters from the Southern Ocean into the Pacific where they upwell across isopycnals and are returned south as deep waters. Upwelling is seen to occur throughout most of the basin with generally larger dianeutral transport and greater mixing occurring at depth. The derived pattern of ocean heat transport divergence is compared to published results based on air–sea flux estimates. The synthesis suggests a strongly east/west oriented pattern of air–sea heat flux with heat loss to the atmosphere throughout most of the western basins, and a gain of heat throughout the tropics extending poleward through the eastern basins. The calculated meridional heat transport agrees well with previous hydrographic estimates. Consistent with many of the climatologies at a variety of latitudes as well, our meridional heat transport estimates tend toward lower values in both hemispheres.This work was funded by National Science Foundation grants OCE–9710102, OCE– 9712209 and OCE–0079383, and also benefited from work on closely related projects funded by NSF grants OCE–0223421 and OCE–0623261, and NOAA grant NA17RJ1223 funded through CICOR. For G.C.J. NASA funding came under Order W–19,314

SARS-CoV-2 Spike triggers barrier dysfunction and vascular leak via integrins and TGF-β signaling

Severe COVID-19 is associated with epithelial and endothelial barrier dysfunction within the lung as well as in distal organs. While it is appreciated that an exaggerated inflammatory response is associated with barrier dysfunction, the triggers of vascular leak are unclear. Here, we report that cell-intrinsic interactions between the Spike (S) glycoprotein of SARS-CoV-2 and epithelial/endothelial cells are sufficient to induce barrier dysfunction in vitro and vascular leak in vivo, independently of viral replication and the ACE2 receptor. We identify an S-triggered transcriptional response associated with extracellular matrix reorganization and TGF-β signaling. Using genetic knockouts and specific inhibitors, we demonstrate that glycosaminoglycans, integrins, and the TGF-β signaling axis are required for S-mediated barrier dysfunction. Notably, we show that SARS-CoV-2 infection caused leak in vivo, which was reduced by inhibiting integrins. Our findings offer mechanistic insight into SARS-CoV-2-triggered vascular leak, providing a starting point for development of therapies targeting COVID-19

Guidelines for the management of pregnancy in women with cystic fibrosis

Women with cystic fibrosis (CF) now regularly survive into their reproductive years in good health and wish to have a baby. Many pregnancies have been reported in the literature and it is clear that whilst the outcome for the baby is generally good and some mothers do very well, others find either their CF complicates the pregnancy or is adversely affected by the pregnancy. For some, pregnancy may only become possible after transplantation. Optimal treatment of all aspects of CF needs to be maintained from the preconceptual period until after the baby is born. Clinicians must be prepared to modify their treatment to accommodate the changing physiology during pregnancy and to be aware of changing prescribing before conception, during pregnancy, after birth and during breast feeding. This supplement offers consensus guidelines based on review of the literature and experience of paediatricians, adult and transplant physicians, and nurses, physiotherapists, dietitians, pharmacists and psychologists experienced in CF and anaesthetist and obstetricians with experience of CF pregnancy. It is hoped they will provide practical guidelines helpful to the multidisciplinary CF teams caring for pregnant women with CF

Efficiency of a dual density studded fish pass designed to mitigate for impeded upstream passage of juvenile European eels (Anguilla anguilla) at a model Crump weir

This study demonstrated that juvenile (glass) eels utilised a specific substrate (eel tiles) to circumvent a model Crump weir under an experimental setting. Upstream passage efficiency was 0% and 67% for the unmodified (no studded eel tiles on the downstream face; control) and modified (with studded eel tiles on the downstream face; treatment) setups, respectively, and greater for a small (59%) compared to large (41%) stud configuration. Eels were active and motivated to ascend the weir during both control and treatment setups. Approach and attempt rates were elevated during the first few minutes of the treatment compared to control trials. Eels were edge oriented under both setups, and ascended the weir through the tiles during single burst swimming events (reaching estimated speeds of 68.5 cm s-1). Eel tiles may provide a cost effective solution for mitigating impacts of anthropogenic barriers to juvenile eel migration. Further research is required to determine passage efficiencies under higher flows, for a greater size range of eel, and for other migratory anguilliform fish (e.g. lamprey, Lampretra spp. and Petromyzon marinus L.). The performance of eel tiles should be validated through robust field studies