Literature overview highlights lack of paediatric donation protocols but identifies common themes that could guide their development

Aim

Paediatric donation is a unique and extremely sensitive process that requires specific knowledge and competencies. Most countries use protocols for organ and tissue donation to ensure optimal care for the donor and family, but these mainly focus on adults. However, the donation process for children differs from adults in many ways. An overview of the literature was performed to identify protocols for the paediatric population.

Methods

PubMed, Web of Science, EMBASE and the Internet were searched up to March 2016 for papers or other sources in English related to specific organ and tissue donation protocols for children and neonates. This comprised title, abstract and then full‐text screening of relevant data.

Results

We included 12 papers and two electronic sources that were mainly from North America and Europe. Most discussed donations after cardiac death. The recurring themes included identifying potential donors, approaching parents, palliative care and collaboration with organ procurement organisations. Most papers called for paediatric donation policies to be standardised.

Conclusion

Scientific publications in English on paediatric donation protocols are very scarce. No comprehensive paediatric donation protocol was found. We identified several recurring themes in the literature that could be used to develop such protocols.     

Prevalence and correlates of musculoskeletal disorders among Australian dental hygiene students

Abstract: Introduction: Although musculoskeletal disorders (MSD) have been identified as a significant occupational health issue for dental hygienists, few studies have explored this problem among the dental hygiene student population. Aim: The aim of this study was to investigate the prevalence and correlates of MSD among a selection of undergraduate dental hygiene students in Australia. Methodology: A self‐reporting questionnaire was distributed to dental hygiene students at an Australian university during 2008, from which a response rate of approximately 72% was achieved. Results: Musculoskeletal disorders were most commonly reported by students at the neck (64.29%), lower back (57.94%) and shoulder (48.41%) regions. Logistic regression indicated various correlations with MSD. Students who did not undertake regular exercise every week experienced an increased risk of lower back pain [Odds Ratio (OR): 4.88, 95% Confidence Interval (CI): 1.75–14.9]. Students undertaking 16–20 h of desk‐based study per week were much more likely to report neck pain (OR: 19.7, 95% CI: 1.34–378.94). Working 6–10 h on a computer each week was a risk factor for shoulder (OR: 7.03, 95% CI: 1.42–39.49) and upper back pain (OR: 5.29, 95% CI: 1.21–25.56). Conclusions: Overall, this study suggests that MSD are a reasonably common problem for dental hygiene students in Australia. As such, further studies are required to establish epidemiological patterns of MSD, and our profession will need to carefully consider preventive strategies to help minimize the impact of this important occupational health issue on the next generation of dental hygienists.     

WEAR PROMOTED IN THE APICAL THIRD OF SIMULATED CANALS AFTER INSTRUMENTATION WITH PROTAPER UNIVERSAL SYSTEM

Objective:

This study evaluated the wear in the apical third of simulate canals after preparation with ProTaper Universal Rotary System.

Material and Methods:

24 sets of instruments were used in 24 simulated canals in transparent epoxy resin blocks with degree of curvature of either 20°or 40°. The canals were photographed preoperatively and after preparation of the apical stop with ProTaper F3, F4 and F5 instruments. The initial and final images were exported to Adobe Photoshop^® software and superimposed to detect the root canal wall differences (in mm) between them, in two points located 1 (A) and 5 (B) mm from the point where the working length was established. Data were subjected to analysis of variance to verify the existence of interaction among the factors: canal curvature, instrument size and curve location. Significant level was set at 5%.

Results:

Regardless of the location and the canal curvature, F4 and F5 instruments produced the greatest wear (p<0.05).

Conclusions:

There was a deviation from the original pathway towards the outside of the root curvature in both analyzed points. All instruments produced canal transportation, but the F4 and F5 instruments produced more than the other instruments, and should thus be used with care in curved canals.     

A mouse model linking viral hepatitis and salivary gland dysfunction

Objective:  Viral hepatitis is known to cause xerostomia in humans, but this has not been reported in an animal model. We report a severe, acute, highly reproducible saliva deficiency occurring in BALB/c mice as a result of experimental viral hepatitis.
Materials and Methods:  BALB/c mice, splenectomized or carrying genetic mutations to detect immunological contributions to the saliva deficiency syndrome, were infected intraperitoneally with a non-lethal dose of murine cytomegalovirus. Pilocarpine-stimulated saliva volumes were determined between 0 and 15 days after infection. Salivary gland, liver, spleen, and sera were analyzed for the presence of virus, cytokines, inflammatory infiltrates, and tissue damage.
Results:  Saliva deficiency was detectable 2 days after cytomegalovirus infection, peaked at 88% below normal by day 7, and resolved partially in all mice by 15 days postinfection as sialoadenitis increased. Neither salivary gland viral titers, sialoadenitis, splenectomy, nor systemic inflammatory markers correlated with hyposalivation severity. Elevated liver enzymes did correlate with hyposalivation, and mice genetically resistant to murine cytomegalovirus-induced hepatitis were significantly protected.
Conclusions:  Murine cytomegalovirus-induced salivary gland dysfunction is biphasic, with an acute hepatitis-associated phase and a later sialoadenitis-associated phase. Acute murine cytomegalovirus infection of BALB/c mice may provide a model for investigation of hepatitis-associated xerostomia.     

Detection of the A189G mtDNA heteroplasmic mutation in relation to age in modern and ancient bones

The aim of this study was to demonstrate the presence of the A189G age-related point mutation on DNA extracted from bone. For this, a peptide nucleic acid (PNA)/DNA sequencing method which can determine an age threshold for the appearance of the mutation was used. Initially, work was done in muscle tissue in order to evaluate the sensitivity of the technique and afterwards in bone samples from the same individuals. This method was also applied to ancient bones from six well-preserved skeletal remains. The mutation was invariably found in muscle, and at a rate of up to 20% in individuals over 60 years old. In modern bones, the mutation was detected in individuals aged 38 years old or more, at a rate of up to 1%, but its occurrence was not systematic (only four out of ten of the individuals over 50 years old carried the heteroplasmy). For ancient bones, the mutation was also found in the oldest individuals according to osteologic markers. The study of this type of age-related mutation and a more complete understanding of its manifestation has potentially useful applications. Combined with traditional age markers, it could improve identification accuracy in forensic cases or in anthropological studies of ancient populations.     

Recurrent cerebral venous thrombosis revealing paraneoplastic angiitis in Hodgkin’s lymphoma

Recurrent cerebral venous thrombosis (CVT), as a manifestation of paraneoplastic angiitis and revealing of nodular lymphocyte predominant Hodgkin's disease (NLPHD), is an extremely rare condition. We herein report a 55-year-old man who developed recurrent CVT despite efficacious anticoagulant therapy and subsequent stenting of the superior longitudinal sinus. Progressive neurological deterioration ensued and a body scan revealed axillary lymph nodes. Pathological analysis led to a diagnosis of NLPHD. Conventional angiography showed CVT and multiple arterial narrowings. A paraneoplastic primary cerebral angiitis with prominent venous structure involvement was suspected. Immunotherapy using rituximab and steroids provided a dramatic recovery. This case of CVT due to paraneoplastic cerebral angiitis is a rare condition and represents a new, very rare manifestation of nodular lymphocyte predominant Hodgkin's disease.