Clinical consensus recommendations for the non-surgical treatment of children with Perthes’ disease in the UK

Aims The aim of this study was to produce clinical consensus recommendations about the non-surgical treatment of children with Perthes’ disease. The recommendations are intended to support clinical practice in a condition for which there is no robust evidence to guide optimal care. Methods A two-round, modified Delphi study was conducted online. An advisory group of children’s orthopaedic specialists consisting of physiotherapists, surgeons, and clinical nurse specialists designed a survey. In the first round, participants also had the opportunity to suggest new statements. The survey included statements related to ‘Exercises’, ‘Physical activity’, ‘Education/information sharing’, ‘Input from other services’, and ‘Monitoring assessments’. The survey was shared with clinicians who regularly treat children with Perthes’ disease in the UK using clinically relevant specialist groups and social media. A predetermined threshold of ≥ 75% for consensus was used for recommendation, with a threshold of between 70% and 75% being considered as ‘points to consider’. Results A total of 40 participants took part in the first round, of whom 31 completed the second round. A total of 87 statements were generated by the advisory group and included in the first round, at the end of which 31 achieved consensus and were removed from the survey, and an additional four statements were generated. A total of 60 statements were included in the second round and 45 achieved the threshold for consensus from both rounds, with three achieving the threshold for ‘points to consider’. The recommendations predominantly included self-management, particularly relating to advice about exercise and education for children with Perthes’ disease and their families. Conclusion Children’s orthopaedic specialists have reached consensus on recommendations for non-surgical treatment in Perthes’ disease. These statements will support decisions made in clinical practice and act as a foundation to support clinicians in the absence of robust evidence. The dissemination of these findings and the best way of delivering this care needs careful consideration, which we will continue to explore

New insights into the genetic etiology of Alzheimer's disease and related dementias

Characterization of the genetic landscape of Alzheimer's disease (AD) and related dementias (ADD) provides a unique opportunity for a better understanding of the associated pathophysiological processes. We performed a two-stage genome-wide association study totaling 111,326 clinically diagnosed/'proxy' AD cases and 677,663 controls. We found 75 risk loci, of which 42 were new at the time of analysis. Pathway enrichment analyses confirmed the involvement of amyloid/tau pathways and highlighted microglia implication. Gene prioritization in the new loci identified 31 genes that were suggestive of new genetically associated processes, including the tumor necrosis factor alpha pathway through the linear ubiquitin chain assembly complex. We also built a new genetic risk score associated with the risk of future AD/dementia or progression from mild cognitive impairment to AD/dementia. The improvement in prediction led to a 1.6- to 1.9-fold increase in AD risk from the lowest to the highest decile, in addition to effects of age and the APOE ε4 allele

Salivary flow rates measured during radiation therapy in head and neck cancer patients: A pilot study assessing salivary sediment formation

Statement of problem: Xerostomia often occurs in patients being managed for head and neck cancer who receive radiation therapy. Although accurate salivary sampling can be therapeutically important to measure during radiation, sampling errors can occur because of salivary sediments. Determining the impact that salivary sediments have on measured salivary flow rates during radiation is important for management of patients. Purpose: The purpose of this study was to assess the magnitude of error associated with the inclusion of nonsalivary components (sediment) in the calculation of whole stimulated saliva flow rates prior to and during radiation therapy (SS and SSR) in patients with head and neck cancer. Material and methods: Whole paraffin-stimulated saliva was collected in large-mouth centrifuge tubes from 20 patients with head and neck cancer prior to and during the third week of radiation therapy. Gravimetric methods were used to calculate the flow rates at g/5 min. After centrifugation, supernatant saliva was removed and the sediment was oven-dried to remove residual moisture. Sediment weight was subtracted from the original weight of saliva specimens and flow rates were recalculated. Means and standard deviations were determined and flow rate differences before (BC) and after (AC) sediment correction were evaluated statistically with the paired t test (α=.05). A nonparametric analysis of the flow rate data with the Wilcoxon matched-pairs signed-ranks test was also used to examine the magnitude and direction of the intrapair (BC-AC) differences (α=.05). Results: On average, salivary sediment contributed less than 1% of the total uncorrected weight of saliva prior to radiation therapy. In specimens collected during radiation therapy, sediment contributed an average of 14% of the total uncorrected weight and as high as 95.4% in 1 patient. Sediment percentages were 20% and higher in 4 patients. In the Wilcoxon analysis, 19 out of 20 paired BC and AC flow rates were higher in the BC group in the SS and SSR samples. Conclusions: The error associated with the inclusion of salivary sediment in the calculation of saliva flow rates prior to radiation treatment was small, but statistically significant. The magnitude of the sediment effect was more pronounced in specimens taken during radiotherapy and was significant, as determined by the Wilcoxon test, but the mean paired differences were not significantly different according to the t test. (J Prosthet Dent 2008;100:142-146). © 2008 The Editorial Council of the Journal of Prosthetic Dentistry

Diagnostic performance of PCA3, Hepsin and microRNA biomarkers in ejaculate in combination with serum PSA for the detection and triaging of prostate cancer

Podium Presentation Abstracts no. 68M.J. Roberts, C.W.K. Chow, H.J. Schirra, R. Richards, M. Buck, L.A. Selth, S.A.R. Doi, H. Samaratunga, J. Perry-Keene, D. Payton, J. Yaxley, M.F. Lavin and R.A., (Frank) Gardine