The effect of sepsis and its inflammatory response on mechanical clot characteristics: a prospective observational study

Purpose: Sepsis and its progression are known to have a major influence on the coagulation system. Current coagulation tests are of limited use when assessing coagulation in sepsis patients. This study aims to assess the potential for a new functional biomarker of clot microstructure, fractal dimension, to identify changes in the mechanical properties of clot microstructure across the sepsis spectrum (sepsis, severe sepsis and septic shock). Methods: A total of 100 patients that presented acutely to a large teaching hospital were included in this prospective observational study (50 sepsis, 20 severe sepsis and 30 septic shock) against a matched control of 44 healthy volunteers. Fractal analysis was performed, as well as standard markers of coagulation, and six plasma markers of inflammation. Results: Fractal dimension was significantly higher in the sepsis and severe sepsis groups than the healthy control (1.78 ± 0.07 and 1.80 ± 0.05 respectively vs 1.74 ± 0.03) (p < 0.001), indicating a significant increase in mechanical clot strength and elasticity consistent with a hypercoagulable state. Conversely, fractal dimension was significantly lower in septic shock (1.66 ± 0.10, p < 0.001), indicating a significant reduction in mechanical clot strength and functionality consistent with a hypocoagulable state. This corresponded with a significant increase in the inflammatory response. Conclusions: This study confirms that clot microstructure is significantly altered through the various stages of sepsis. Of particular importance was the marked change in clot development between severe sepsis and septic shock, which has not been previously reported

The Hall Technique; a randomized controlled clinical trial of a novel method of managing carious primary molars in general dental practice: acceptability of the technique and outcomes at 23 months

<p>Abstract</p> <p>Background</p> <p>Scotland has high levels of untreated dental caries in primary teeth. The Hall Technique is a simplified method of managing carious primary molars using preformed metal crowns (PMCs) cemented with no local anaesthesia, caries removal or tooth preparation. This study compared the acceptability of the Hall Technique for children, their carers, and dentists, and clinical outcomes for the technique, with conventional restorations.</p> <p>Methods</p> <p>General dental practice based, split mouth, randomized controlled trial (132 children, aged 3–10). General dental practitioners (GDPs, n = 17) in Tayside, Scotland (dmft 2.7) placed conventional (Control) restorations in carious primary molars, and Hall Technique PMCs on the contralateral molar (matched clinically and radiographically). Dentists ranked the degree of discomfort they felt the child experienced for each procedure; then children, their carers and dentists stated which technique they preferred. The teeth were followed up clinically and radiographically.</p> <p>Results</p> <p>128 conventional restorations were placed on 132 control teeth, and 128 PMCs on 132 intervention teeth. Using a 5 point scale, 118 Hall PMCs (89%) were rated as no apparent discomfort up to mild, not significant; for Control restorations the figure was 103 (78%). Significant, unacceptable discomfort was recorded for two Hall PMCs (1.5%) and six Control restorations (4.5%). 77% of children, 83% of carers and 81% of dentists who expressed a preference, preferred the Hall technique, and this was significant (Chi square, p < 0.0001). There were 124 children (94% of the initial sample) with a minimum follow-up of 23 months. The Hall PMCs outperformed the Control restorations:</p> <p>a) 'Major' failures (signs and symptoms of irreversible pulpal disease): 19 Control restorations (15%); three Hall PMCs (2%) (P < 0.000);</p> <p>b) 'Minor' failures (loss of restoration, caries progression): 57 Control restorations (46%); six Hall PMCs (5%) (P < 0.000)</p> <p>c) Pain: 13 Control restorations (11%); two Hall PMCs (2%) (P = 0.003).</p> <p>Conclusion</p> <p>The Hall Technique was preferred to conventional restorations by the majority of children, carers and GDPs. After two years, Hall PMCs showed more favourable outcomes for pulpal health and restoration longevity than conventional restorations. The Hall Technique appears to offer an effective treatment option for carious primary molar teeth.</p> <p>Trial registration number</p> <p>Current Controlled Trials ISRCTN47267892 – A randomized controlled trial in primary care of a novel method of using preformed metal crowns to manage decay in primary molar teeth: the Hall technique.</p

Giant magnons of string theory in the lambda background

The analogues of giant magnon configurations are studied on the string world sheet in the lambda background. This is a discrete deformation of the AdS(5)xS(5) background that preserves the integrability of the world sheet theory. Giant magnon solutions are generated using the dressing method and their dispersion relation is found. This reduces to the usual dyonic giant magnon dispersion relation in the appropriate limit and becomes relativistic in another limit where the lambda model becomes the generalized sine-Gordon theory of the Pohlmeyer reduction. The scattering of giant magnons is then shown in the semi-classical limit to be described by the quantum S-matrix that is a quantum group deformation of the conventional giant magnon S-matrix. It is further shown that in the small g limit, a sector of the S-matrix is related to the XXZ spin chain whose spectrum matches the spectrum of magnon bound states.Comment: 53 pages, 6 figures, final version to appear in JHE

Episodes of pain from teeth treated with Control restorations and Hall PMCs

Minimum patient follow-up 23 months; range of pain episodes 0–36 months.<p><b>Copyright information:</b></p><p>Taken from "The Hall Technique; a randomized controlled clinical trial of a novel method of managing carious primary molars in general dental practice: acceptability of the technique and outcomes at 23 months"</p><p>http://www.biomedcentral.com/1472-6831/7/18</p><p>BMC Oral Health 2007;7():18-18.</p><p>Published online 20 Dec 2007</p><p>PMCID:PMC2265270.</p><p></p

Radiograph of Hall PMC on tooth 54 (URD) recorded as unsatisfactory fit

Patient randomisation number 34.<p><b>Copyright information:</b></p><p>Taken from "The Hall Technique; a randomized controlled clinical trial of a novel method of managing carious primary molars in general dental practice: acceptability of the technique and outcomes at 23 months"</p><p>http://www.biomedcentral.com/1472-6831/7/18</p><p>BMC Oral Health 2007;7():18-18.</p><p>Published online 20 Dec 2007</p><p>PMCID:PMC2265270.</p><p></p

'Major' failures for Control restorations and Hall PMCs noted clinically, radiographically or both

Minimum patient follow-up 23 months; range of restoration failure 0–36 months.<p><b>Copyright information:</b></p><p>Taken from "The Hall Technique; a randomized controlled clinical trial of a novel method of managing carious primary molars in general dental practice: acceptability of the technique and outcomes at 23 months"</p><p>http://www.biomedcentral.com/1472-6831/7/18</p><p>BMC Oral Health 2007;7():18-18.</p><p>Published online 20 Dec 2007</p><p>PMCID:PMC2265270.</p><p></p

Clinical photograph of a patient with six PMCs fitted using the Hall Technique at separate appointments

The occlusion has adjusted to give even contact between the arches.<p><b>Copyright information:</b></p><p>Taken from "The Hall Technique; a randomized controlled clinical trial of a novel method of managing carious primary molars in general dental practice: acceptability of the technique and outcomes at 23 months"</p><p>http://www.biomedcentral.com/1472-6831/7/18</p><p>BMC Oral Health 2007;7():18-18.</p><p>Published online 20 Dec 2007</p><p>PMCID:PMC2265270.</p><p></p