A novel method to maintain ductus arteriosus patency

AbstractSurvival of patients with certain ductal-dependent congenital heart diseases depends on continued patency of the ductus arteriosus or the surgical creation of an aortopulmonary shunt. The latter may be difficult in the presence of hypoplastic pulmonary arteries. Long-term prostaglandin therapy may be used to maintain ductal patency but is not without limitation and side effects.This experimental study describes a novel approach to maintain ductal patency with a stainless steel stent. Six newborn lambs ≤48-h old had a ductal stent placed during right heart catheterization. Two lambs <36-h old had a stent delivered by the arterial route. The stent was delivered and released at the target with relative ease and no incidence of embolization. Continued ductal patency up to 3 months was demonstrated by repeat cardiac catheterization and angiography, two-dimensional color Doppler echocardiography and postmortem examination.The experimental model provides a left to right shunt model in which the size may be increased as the animal grows. More important, a ductal stent could be used to maintain ductal blood flow in neonates and infants with ductal-dependent cardiac malformations, thereby avoiding a thoracotomy

Simulating the Influence of Injection Timing, Premixed Ratio, and Inlet Temperature on Natural Gas / Diesel Dual-Fuel HCCI Combustion in a Diesel Engine

YesDual-fuel HCCI engines allow a relatively small quantity of diesel fuel to be used to ignite a variety of fuels such as natural gas or methane in HCCI mode. The gaseous fuel is mixed with the incoming air, and diesel fuel is sprayed into the cylinder by direct injection. Mathematical modelling is used to investigate the effects of parameters such as premixed ratio (fuel ratio) and pilot fuel injection timing on combustion of a dual-fuel HCCI engines. A CFD package is used with AVL FIRE software to simulate dual-fuel HCCI combustion in detail. The results establish a suitable range of premixed ratio and liquid fuel injection timing for low levels of NOx, CO and HC emissions along with a reliable and efficient combustion. Dual-fuel HCCI mode can increase NOx emission with lower premixed ratios in comparison to normal HCCI engines, but it is shown that the NOx emission reduces above a certain level of the premixed ratio. Due to the requirement of homogenous mixing of liquid fuel with air, the liquid fuel injection is earlier than for diesel engines. It is shown that, with careful control of parameters, dual-fuel HCCI engines have lower emissions in comparison with conventional engines

Intraligamentary local anaesthesia for posterior mandibular extractions

This article reviews research and author experience behind Intraligamentary Local Anaesthesia (ILA) and Infiltration Local Anaesthesia (IFA) with Inferior Alveolar Nerve Block (IANB). In particular, the use of ILA with 4% articaine is discussed as an effective anaesthetic technique to replace both IANB and IFA for the purpose of tooth extraction in the posterior mandible. ILA also avoids the possible complications associated with IANB. Other advantages and some shortfalls of the ILA technique are described in relation to primary dental care. The technique for achieving ILA is described. CPD/Clinical Relevance: The ILA technique with articaine is a simple, swift and effective alternative to IANB and IFA for extraction of posterior teeth in the mandible in primary dental care. ILA has fewer potential debilitating complications than IANB and is likely to be more effective than IFA

The effect of draw ratio on the mechanical properties and crystalline structure of single polymer polypropylene composites

The properties of self-reinforced single polymer composites produced by the Leeds hot compaction process are highly dependent on the compaction temperature as well as the constituent oriented elements used to produce the compacted sheets. In this paper, the variation in tensile mechanical properties of uniaxial hot compacted sheets manufactured from drawn polypropylene (PP) tapes with change in compaction temperature have been investigated, for a range of different draw ratio tapes. It is shown that there is a measureable difference between the optimum compaction temperatures required for obtaining the highest modulus and strength in the compacted sheets. The compaction temperature required to achieve the maximum tensile modulus was seen to increase with increasing draw ratio. The compaction temperature to obtain the maximum tensile strength was found to be both independent of the draw ratio and a few degrees higher than that for obtaining the maximum modulus. Peak modulus and peak tensile strength was shown to be dependent on the draw ratio of the drawn tape. Differential scanning calorimetry measurements on the compacted sheets were also performed in order to investigate the change in crystalline structure with compaction temperature and draw ratio. This has shown that the changes in structure within the oriented phase (i.e. tapes) during the compaction process itself are directly related to the final properties of the hot compacted sheets

Depression symptoms and cognitive function among individuals with advanced HIV infection initiating HAART in Uganda

Background Among patients with HIV infection, depression is the most frequently observed psychiatric disorder. The presence of depressive symptoms and cognitive dysfunction among HIV patients has not been well studied in Sub-Saharan Africa. Initiation of highly active antiretroviral therapy (HAART) may have an effect on the prevalence and the change over time of depression symptoms and cognitive impairment among HIV-positive individuals. Methods We recruited 102 HIV-positive individuals at risk of cognitive impairment who were initiating HAART and 25 HIV-negative individuals matched for age and education. Depression was assessed using the Centre for Epidemiologic Studies Depression Scale (CES-D). Neurocognitive assessment included the International HIV Dementia Scale (IHDS), an 8 test neuropsychological battery and the Memorial Sloan Kettering scale. Assessments were carried out at 0, 3 and 6 months. Results The HIV-positive group had more respondents with CES-D score > 16 than the HIV-negative group at all 3 clinic visits (54%Vs 28%; 36% Vs 13%; and 30% Vs 24% respectively; all p < 0.050 OR 2.86, 95% CI: 1.03, 7.95, p = 0.044). The HIV positive group had higher likelihood for cognitive impairment (OR 8.88, 95% CI 2.64, 29.89, p < 0.001). A significant decrease in the mean scores on the CES-D (p = 0.002) and IHDS (p = 0.001) occurred more in the HIV-positive group when compared to the HIV-negative group. There was no association between clinical Memorial Sloan Kettering score and depression symptoms (p = 0.310) at baseline. Conclusion Depression symptomatology is distinct and common among cognitively impaired HIV patients. Therefore individuals in HIV care should be screened and treated for depression

Diagnosis and management of Cornelia de Lange syndrome:first international consensus statement

Cornelia de Lange syndrome (CdLS) is an archetypical genetic syndrome that is characterized by intellectual disability, well-defined facial features, upper limb anomalies and atypical growth, among numerous other signs and symptoms. It is caused by variants in any one of seven genes, all of which have a structural or regulatory function in the cohesin complex. Although recent advances in next-generation sequencing have improved molecular diagnostics, marked heterogeneity exists in clinical and molecular diagnostic approaches and care practices worldwide. Here, we outline a series of recommendations that document the consensus of a group of international experts on clinical diagnostic criteria, both for classic CdLS and non-classic CdLS phenotypes, molecular investigations, long-term management and care planning

A multimodal cell census and atlas of the mammalian primary motor cortex

ABSTRACT We report the generation of a multimodal cell census and atlas of the mammalian primary motor cortex (MOp or M1) as the initial product of the BRAIN Initiative Cell Census Network (BICCN). This was achieved by coordinated large-scale analyses of single-cell transcriptomes, chromatin accessibility, DNA methylomes, spatially resolved single-cell transcriptomes, morphological and electrophysiological properties, and cellular resolution input-output mapping, integrated through cross-modal computational analysis. Together, our results advance the collective knowledge and understanding of brain cell type organization: First, our study reveals a unified molecular genetic landscape of cortical cell types that congruently integrates their transcriptome, open chromatin and DNA methylation maps. Second, cross-species analysis achieves a unified taxonomy of transcriptomic types and their hierarchical organization that are conserved from mouse to marmoset and human. Third, cross-modal analysis provides compelling evidence for the epigenomic, transcriptomic, and gene regulatory basis of neuronal phenotypes such as their physiological and anatomical properties, demonstrating the biological validity and genomic underpinning of neuron types and subtypes. Fourth, in situ single-cell transcriptomics provides a spatially-resolved cell type atlas of the motor cortex. Fifth, integrated transcriptomic, epigenomic and anatomical analyses reveal the correspondence between neural circuits and transcriptomic cell types. We further present an extensive genetic toolset for targeting and fate mapping glutamatergic projection neuron types toward linking their developmental trajectory to their circuit function. Together, our results establish a unified and mechanistic framework of neuronal cell type organization that integrates multi-layered molecular genetic and spatial information with multi-faceted phenotypic properties

Clinical and academic recommendations for primary dental care prosthodontics

Prosthodontic practice includes a large proportion of dental care provision, mostly undertaken in primary dental care (PDC) in the UK. However, there is limited research evidence in prosthodontic practice, necessary to tackle key questions to improve oral and dental health. In addition, many overarching challenges exist within the NHS system relevant to prosthodontics. For example, demands on healthcare services from increasing patient expectations, the ever-ageing and growing population, risks of litigation, availability of appropriate care, difficulties with access to care, rapidly emerging treatments and technologies, and ongoing needs for education. This article develops clinical and academic recommendations to improve oral health improvements in PDC prosthodontics, further to recommendations determined by the James Lind Alliance, a non-profit making initiative to tackle treatment 'uncertainties' (http://www.jla.nihr.ac.uk/), and the overarching challenges, which are mentioned above. Considerable clinical and academic author experiences from primary, secondary and tertiary care as well as education and research in prosthodontics are employed. We consider management of networks involving patients, carers, healthcare professionals, industry and academics, in order to increase access to improve oral and general health and help drive dental research, education and communication. We investigate how to manage dental disease and intervene to improve the longevity of restorations and the dentition. Finally, we review how rapidly developing digital technologies can best be utilised, in conjunction with industry, in order to improve oral health