Determining viability of fresh or cryopreserved homograft valves at implantation

Summary Studies of homograft valves in the past two decades have suggested that viable valves, i.e., those maintaining chemical and structural integrity of their leaflet intercellular matrix, have a better long-term function than nonviable valves. The most effective qualitative methods of assessing leaflet viability involve destruction of the valve leaflets; thus, these methods have been limited to random use in selected valves. A study was conducted in swine in an attempt to establish a control tissue which could be tested in place of the homograft leaflets, thereby determining viability levels of every valve clinically implanted and correlating the results with long-term clinical function. Thirty samples each of the aortic and pulmonary artery wall and tricuspid leaflet were compared with aortic and pulmonary leaflets. Utilizing the technique of C¹⁴-proline uptake, viability was assessed at procurement, following sterilization, and following cryopreservation and short-term storage. The tricuspid leaflet was found to retain the same level of viability as the aortic and pulmonary leaflets before and after the cryopreservation period. It was concluded that the tricuspid leaflet could be utilized as the control tissue.     

Determination of the need for tricuspid valve replacement: value of preoperative right ventricular angiocardiography

Of 530 patients undergoing tricuspid valve surgery from January 1, 1961 through December 31, 1987, those 362 patients having had preoperative right ventricular angiocardiography were studied. Mean age was 58.5 years. There were 71 males and 291 females. Tricuspid valve replacement (TVR) was performed in 126 (34.8%), and 236 underwent tricuspid valve repair (65.2%). The predominant pathology was combined tricuspid insufficiency and stenosis in 18 patients (4.9%), and isolated tricuspid insufficiency in 344 (95.1%). There were no complications related to the right ventriculogram. Preoperative angiographic severity of tricuspid valve incompetence was grade 1 in 23 patients (6.4%), grade 2 in 65 (17.9%), grade 3 in 109 (30.1%), and grade 4 in 165 (45.6%). Intraoperative assessment of the severity of tricuspid valve incompetence correlated 72% of the time with the preoperative angiographic assessment, in those patients with more severe degrees of incompetence (grade 3+ or 4+), p (X 2) less than 0.001. Increasing severity of preoperative angiographic triscuspid valve incompetence was associated with the requirement for TVR (vs. repair), p (X 2) = 0.0002. In conclusion, preoperative right ventricular angiography is a useful method for assessing tricuspid valve function and may predict the requirement for TVR in patients undergoing tricuspid valve surgery.     

Addressing Sexuality Among People Living With Chronic Disease and Disability: A Systematic Mixed Methods Review of Knowledge,Attitudes, and Practices of Health Care Professionals

ObjectiveTo systematically review health care professionals’ practices and attitudes toward addressing sexuality with people who are living with chronic disease and disability.Data SourcesScopus, PubMed, PsycINFO, Cumulative Index to Nursing and Allied Health, Allied and Complementary Medicine Database, and MEDLINE were searched to August 2020 for English language publications. Reference lists of relevant publications were also searched.Study SelectionEligible studies reported on knowledge, attitudes, and behaviors of health care professionals about addressing sexuality in the context of chronic disease and disability. The search yielded 2492 records; 187 full texts were assessed for eligibility and 114 documents were included (103 unique studies). Study quality was rated using the Mixed Methods Appraisal Tool.Data ExtractionCharacteristics of included studies were recorded independently by 2 authors. Differences were resolved through discussion or by a third author.Data SynthesisA sequential, exploratory mixed studies approach was used for synthesis. Pooled analysis showed that 14.2% (95% CI, 10.6-18.9 [I²=94.8%, P<.001]) of health professionals report routinely asking questions or providing information about sexuality. Professionals reported limited confidence, competence, and/or comfort when initiating conversations about sexuality or responding to patient questions. Sexual rehabilitation typically focused on the effect of disease, disability, and medication on sexual function. Broader dimensions of sexuality were rarely addressed.ConclusionDespite recognizing the value of sexuality to health and well-being, most health professionals regardless of clinical context fail to routinely include assessment of sexuality in their practice. Professionals have limited knowledge and confidence when addressing sexuality and experience significant discomfort when raising this topic with people living with chronic disease and disability. Multicomponent implementation programs are needed to improve health professionals’ knowledge, competence, and comfort when addressing sexuality for people living with chronic disease and disability.     

FISSURE SEALANT IN A NUTSHELL. EVIDENCE-BASED META-EVALUATION OF SEALANTS’ EFFECTIVENESS IN CARIES PREVENTION AND ARREST

ObjectiveThis meta-evaluation aimed to summarize all available evidence regarding different fissure sealants on occlusal caries prevention, arrest, retention rate, adverse effect, and cost-effectiveness; when compared with no intervention, other preventive or minimally-invasive procedures.Materials and MethodsThe systematic reviews and meta-analyses were identified via four electronic databases and manual searching. Two independent reviewers performed study selection, data extraction, quality assessment with AMSTAR-2.ResultsAmong the 366 records yielded, 38 systematic reviews were identified as eligible 24 of them included meta-analyses. Moderate evidence has supported the efficacies of resin-based sealants (RBS) in occlusal caries prevention, arrest and cost-effectiveness compared to no interventions. Low to very low certainty of evidence suggested similar effectiveness of glass-ionomer cements in caries prevention with RBS and more superior performance of resin infiltration in arresting non-cavitated occlusal lesions.ConclusionThis meta-evaluation supports the use of RBS on permanent molars to reduce occlusal caries occurrence, arrest lesion progression and alleviate oral health inequalities between individuals of different socioeconomic status. This meta-evaluation also advocates further research on glass-ionomer cements and resin infiltration with respect to their efficacies in caries prevention and arrest.     

Pilot study of Sandostatin (octreotide) therapy of refractory HIV-associated diarrhea

Seventeen AIDS patients were enrolled in a prospective open-label dose-finding study of octreotide (Sandostatin) therapy for refractory diarrhea. Five were nonevaluable due to progression of AIDS symptomatology, and one was excluded because of lack of confirmation of HIV infection. Five of 11 evaluable patients responded to therapy (45%); two each at 50 g and 100 g, and one at 250 g thrice daily doses. A sixth patient demonstrated a moderate reduction in stool volume at 250 g thrice daily, which, although deemed clinically relevant, did not meet the criteria for response. On discontinuation of therapy, diarrhea recurred in all patients within 1–12 days, and responded to reinitiation of octreotide in those five patients who resumed treatment. Only one of the three patients with concurrent cryptosporidial infection responded to treatment. The drug was well tolerated, with mild symptomatology in three patients. Long-term treatment at a stable dose was effective in three of five treated patients for periods for seven months in one (moderate responder) and one year in two. One patient required dose increases to control symptoms, but after one year of treatment developed severe nausea following injections, which required dose cessation. One patient had partial control of his diarrhea for only three months despite two dose increases. These data suggest that octreotide may be of useful therapeutic value in HIV-associated diarrhea and that further studies are indicated.This study was supported by Sandoz Canada Inc.     

Autism spectrum disorder severity reflects the average contribution of de novo and familial influences

Autism spectrum disorders (ASDs) are a highly heterogeneous group of conditions—phenotypically and genetically—although the link between phenotypic variation and differences in genetic architecture is unclear. This study aimed to determine whether differences in cognitive impairment and symptom severity reflect variation in the degree to which ASD cases reflect de novo or familial influences. Using data from more than 2,000 simplex cases of ASD, we examined the relationship between intelligence quotient (IQ), behavior and language assessments, and rate of de novo loss of function (LOF) mutations and family history of broadly defined psychiatric disease (depressive disorders, bipolar disorder, and schizophrenia; history of psychiatric hospitalization). Proband IQ was negatively associated with de novo LOF rate (P = 0.03) and positively associated with family history of psychiatric disease (P = 0.003). Female cases had a higher frequency of sporadic genetic events across the severity distribution (P = 0.01). High rates of LOF mutation and low frequencies of family history of psychiatric illness were seen in individuals who were unable to complete a traditional IQ test, a group with the greatest degree of language and behavioral impairment. These analyses provide strong evidence that familial risk for neuropsychiatric disease becomes more relevant to ASD etiology as cases become higher functioning. The findings of this study reinforce that there are many routes to the diagnostic category of autism and could lead to genetic studies with more specific insights into individual cases.The set of conditions diagnosed as autism spectrum disorders (ASDs) vary enormously in their presentation (1). The most severely impaired individuals—often those with intellectual disabilities, limited speech, and severe behavioral problems—can require lifelong care. At the other end of the functional spectrum, people diagnosed with ASDs can be verbally fluent and academically gifted and can achieve independence in adulthood (2, 3). The broad range of cognitive and behavioral profiles seen in diagnosed ASDs has been long viewed as a challenge by the research community (4). Although it is well established that (i) the cognitive/behavioral profile of people diagnosed with ASDs varies widely and (ii) the set of genetic factors related to ASDs varies widely (5, 6), the degree to which phenotype can be used to predict patterns in disease architecture remains unclear.Recent insights into the genetic influences on ASDs offer an opportunity to investigate this question through the lens of de novo vs. familial effects. On average, ASDs run in families. The siblings of children with ASDs are 10–20 times more likely to receive a diagnosis of ASD themselves (7, 8); the parents of children with ASDs are more likely to manifest autistic features, as well as a variety of other neuropsychiatric conditions, such as schizophrenia and bipolar disorder (9, 10). These epidemiologic observations are consistent with analyses suggesting that ASDs are influenced by thousands of common genetic variants transmitted between generations. It has been estimated that common, genotyped SNPs account for 20–60% of variation in ASD risk, although the effect of any individual SNP is likely very small (11–13). Many of these influences are shared with other psychiatric disorders (12, 14), which at least in part explains the familial clustering of different types of behavior problems.However, statistics about ASD heritability reflect an average. For example, there are likely many affected families for whom sibling recurrence risk is less than 10–20%. The strongest evidence toward this claim comes from studies of rare, severely deleterious genetic events that are associated with ASDs (15–20). Events of this type, for example copy number variants and loss of function (LOF) mutations, are often de novo (not seen in an affected individual’s parents). Although cases of ASDs involving a de novo mutation could reflect a concert of spontaneous and inherited genetic events, de novo events of large effect may reduce the likelihood of seeing psychiatric problems in an affected individual’s family members.     

Self‐perceived preparedness for dental practice amongst graduates of The University of Hong Kong’s integrated PBL dental curriculum

Objectives: To determine how prepared for dental practice graduates from the integrated problem‐based learning (PBL) dental undergraduate curriculum at The University of Hong Kong (HKU) perceive themselves to be and to identify factors associated with self‐perceived preparedness. Materials and methods: A postal questionnaire was sent to five cohorts of dentists who had graduated from HKU’s integrated PBL curriculum between 2004 and 2008. Using a 4‐point Likert scale, the questionnaire assessed the self‐perceived level of preparedness in 59 competencies grouped in nine domains. Responses were dichotomised into ‘poorly prepared’ and ‘well prepared’. Results: The response rate was 66% (159/241). The mean proportion (± standard deviation) of respondents indicating well‐preparedness was 72.0 ± 15.1% overall, and for each domain was as follows: general patient management, 93.1 ± 12.1%; practice management, 81.0 ± 22.2%; periodontology and dental public health, 73.5 ± 19.3%; conservative dentistry, 92.5 ± 13.1%; oral rehabilitation, 62.8 ± 24.0%; orthodontics, 23.0 ± 32.9%; managing children and special‐needs patients, 64.8 ± 28.9%; oral and maxillofacial surgery, 52.2 ± 25.2%; and drug and emergency management, 84.7 ± 22.6%. The odds of self‐perceived well‐preparedness were increased for cohorts graduating in 2004 and 2005 and graduates working in a non‐solo dental practice. Conclusions: Dental graduates of HKU’s integrated PBL curriculum felt well prepared for the most fundamental aspects of dental practice. However, apparent deficiencies of training in orthodontics and oral and maxillofacial surgery will need to be addressed by continuing education, postgraduate training and planning for the new 6‐year undergraduate curriculum in 2012.