Do High Frequency Ultrasound Images Support Clinical Skin Assessment?

High frequency ultrasound imaging has been reported as a potential method of identifying the suspected tissue damage in patients “at risk” of pressure ulceration. The aim of this study was to explore whether ultrasound images supported the clinical skin assessment in an inpatient population through identification of subcutaneous tissue damage. Skin on the heels and/or sacral coccygeal area of fifty vascular surgery inpatients was assessed clinically by tissue viability nurses and with ultrasound pre operatively and at least every other day until discharge. Images were compared to routine clinical skin assessment outcomes. Qualitative classification of ultrasound images did not match outcomes yielded through the clinical skin assessment. Images corresponding to 16 participants were classified as subgroup 3 damage at the heels (equivalent to grade 2 pressure ulceration); clinical skin assessment rated no heels as greater than grade 1a (blanching erythema). Conversely, all images captured of the sacral coccygeal area were classified as normal; the clinical skin assessment rated two participants as grade 1b (non-blanching erythema). Ultrasound imaging is a potentially useful adjunct to the clinical skin assessment in providing information about the underlying tissue. However, further longitudinal clinical assessment is required to characterise images against actual and “staged” pressure ulceration

Exploring the application of ultrasound technology in pressure ulcer prevention – an international multidisciplinary team study

Introduction: High frequency ultrasound (HFUS) can create real-time two-dimensional images of internal structures to examine the first few centimetres depth of sub-dermal soft tissue, thus may have the potential to detect tissue changes in pressure ulcer prevention. However, there is no evidence on the repeatability of HFUS. This study aimed to investigate the inter- and intra-rater repeatability of HFUS scanning.Methods: In a laboratory based study, 24 healthy subjects (21 females, 3 males;32.0812.25 years; BMI 24.945.57) participated on two occasions, one day apart. Consenting subjects had points marked (day 1 only) on both heels (lateral,posterior and medial aspects) and seating interface (coccyx, and left and right ischial tuberosities) and scanned by a researcher, then repeated by a second researcher using a HFUS scanner. Both researchers were blinded to each other’s scanning. HFUS images were quantitatively and qualitatively analysed blindly by two assessors.Results: Qualitative visual analysis showed almost perfect agreement between two assessors (0.88 kappa co-efficient). Intraclass correlation coefficients (ICCs) conducted on pixel intensity summation quantitative results showed low inter and intra-rater repeatability (25% moderate or high ICCs; ICC Z0.6). Conclusions: Although quantitative analysis showed low inter- and intra-rater repeatability, qualitative analysis showed better agreement. In practice, clinicians qualitatively read the images, and visual analysis appears to be the gold standard in HFUS interpretation. Quantitative methods of analysing HFUS images require further exploration by industry, scientists and clinicians

A Pan-Canadian narrative review on the protocols for reopening dental services during the COVID-19 pandemic

The current coronavirus disease 2019 (COVID-19) pandemic is impacting the way in which dental services are provided. The aim of this narrative review was twofold: to summarize key areas from the Canadian protocols available for the reopening and restructuring of dental services across the country and to critically review these protocols based on existing evidence. A narrative review of the existing Canadian protocols, written in English and French, was undertaken between April 15 and July 13, 2020. The protocols were obtained by searching through regulatory bodies and websites from professional organizations, and from personal contacts through academic institutions and policy leaders. The data extraction form focused only on protocols related to dentistry, and the information was compiled by a hired assistant. Content was categorized via group discussions with the research team on eight areas: office management and procedures, patient and staff screening, treatment procedures, office layout, risk reduction, personal protective equipment, supporting information, and length and readability. Thirteen protocols were identified and offered substantial variation in the level of details provided. All but two protocols specified proper donning/doffing of personal protective equipment, while all protocols recommended daily monitoring of COVID-19 related signs and symptoms in staff and patients. They varied in terms of recommended mask types, eye and face shield protection, and head coverings. While all protocols aimed at restructuring emergency dental services, their recommendations were often not based on the published evidence. This narrative review summarized key areas from 13 provincial and territorial protocols in Canada to help oral health care providers plan the reopening of their services. The information conveyed across all documents was clear, but variance highlights the need for a coordinated effort to develop an evidence-based document for dental practitioners.Arts, Faculty ofDentistry, Faculty ofNon UBCOral Biological and Medical Sciences (OBMS), Department ofOral Health Sciences (OHS), Department ofPsychology, Department ofReviewedFacult

C9ORF72 poly(GA) aggregates sequester and impair HR23 and nucleocytoplasmic transport proteins

Neuronal inclusions of poly(GA), a protein unconventionally translated from G(4)C(2) repeat expansions in C9ORF72, are abundant in patients with frontotemporal dementia (FTD) and amyotrophic lateral sclerosis (ALS) caused by this mutation. To investigate poly(GA) toxicity, we generated mice that exhibit poly(GA) pathology, neurodegeneration and behavioral abnormalities reminiscent of FTD and ALS. These phenotypes occurred in the absence of TDP-43 pathology and required poly(GA) aggregation. HR23 proteins involved in proteasomal degradation and proteins involved in nucleocytoplasmic transport were sequestered by poly(GA) in these mice. HR23A and HR23B similarly colocalized to poly(GA) inclusions in C9ORF72 expansion carriers. Sequestration was accompanied by an accumulation of ubiquitinated proteins and decreased xeroderma pigmentosum C (XPC) levels in mice, indicative of HR23A and HR23B dysfunction. Restoring HR23B levels attenuated poly(GA) aggregation and rescued poly(GA)-induced toxicity in neuronal cultures. These data demonstrate that sequestration and impairment of nuclear HR23 and nucleocytoplasmic transport proteins is an outcome of, and a contributor to, poly(GA) pathology