Fetoscopic laser treatment of twin-to-twintransfusion syndrome (TTTS)

The aim of this study was to report the results of the first 10 cases of fetoscopic laser surgery for twin-to-twin transfusion syndrome by the Rotunda Hospital Fetal Treatment Programme. All cases of severe TTTS managed by our team from 2006 to 2007 were included. All fetoscopic laser surgeries were performed by a single specialist in fetal medicine. All pregnancies were followed up to pregnancy completion and a minimum of six weeks neonatal life. Laser surgeries were performed with ultrasound guidance and percutaneously using local anaesthesia via a 2.8mm rigid fetoscope. Selective laser ablation of placental vessels was accomplished with a neodymium:YAG laser. The first 10 cases of severe TTTS managed by our team are reported. Laser ablation of placental vessels was accomplished successfully in all cases. Two pregnancies were complicated by preterm premature rupture of membranes before 22 weeks and both pregnancies were lost. Of the remaining 16 fetuses, one was diagnosed with significant ventriculomegaly postoperatively and underwent selective termination in the United Kingdom. The overall intact neonatal survival rate was 65%. Fetoscopic laser ablation of placental vessels for severe twin-to-twin transfusion syndrome is now available in Ireland, and our programme has delivered results that are in keeping with international best practices in this regard.     

Out of Africa: traveller malaria in paediatric patients presenting to Our Lady of Lourdes Hospital Drogheda

Malaria is one of the world's most important parasitic infections and is endemic in over 100 countries. The number of cases of malaria in Ireland has increased significantly over the last 10 years. The aim of this study was to retrospectively examine cases of paediatric malaria presenting to Our Lady of Lourdes Hospital Drogheda over a one year period to identify the reason for travel to endemic areas, to establish if prophylaxis was received on travelling and to determine the clinical course and post-treatment follow up. Five children presented during the study period, all children were infected with the Plasmodium falciparum, two had evidence of cerebral involvement, all were children travelling to visit family and none of the children received adequate prophylaxis. This study highlights the importance of parental education on the risks associated with non-compliance with malaria prophylaxis and the complications associated with malaria infection in children.     

The effects of early isolation on sexual behavior and c-fos expression in naïve male Long-Evans rats

Previous findings have demonstrated that the maternal environment is important for the development of male sexual behavior. The present study examined the effects of complete early life isolation and replacement 'stroking' stimulation on male sexual behavior and neural activation as seen by Fos immunoreactivity (Fos-IR). Animals were either artificially reared (AR) with minimal (AR-MIN) or maximal (AR-MAX) body simulation, or maternally reared (MR). In adulthood, animals were either given an exposure to an estrous female (EXP) or left undisturbed (NoEXP). No significant effects of early development were found in sexual behavior; however differences in activation in response to this exposure were observed. AR-MIN animals showed lower Fos-IR in the medial preoptic area and the ventromedial hypothalamus compared to MR animals. AR-MAX animals were not significantly different from either condition. These findings demonstrate that although there are no differences in the quality of the first copulatory exposure between AR and MR animals, the brain's response to this exposure differs in sites within the brain that subserve sexual behavior.     

Effects of early deprivation and maternal separation on pup-directed behavior and HPA axis measures in the juvenile female rat

Juvenile female rats show maternal-like behavior toward pups. The purpose of the following experiment was to investigate whether the HPA axis, through the use of early separation manipulations that alter HPA functioning in rats, plays a role in the juvenile response to foster pups. Female rats were early deprived or maternally separated for 5 hours daily from PND 2 to 14 and compared to animal facility-reared rats. Deprivation or separation increased CRH-R1 IR in the juvenile PVN, but had no other effects on other HPA measures or on maternal behavior. Pup-exposure during the juvenile period blunted corticosterone levels after acute and repeated pup-exposures when compared to exposure to novelty and conspecifics respectively. Repeated exposures to pups also increased CRH-R1 IR relative to isolation during the juvenile period. Overall, the data suggest that although pup-exposure affects corticosterone levels, the HPA axis does not relate to juvenile maternal behavior in the present experiments.     

The impact of beta‐blocker therapy on anemia after traumatic brain injury

BACKGROUND: An increase in endogenous catecholamine levels after traumatic brain injury (TBI) is well described. Animal studies suggest that postinjury anemia is exacerbated by a persistent hyperadrenergic state. This study aims to determine if beta‐blocker (BB) exposure affects anemia after TBI. STUDY DESIGN AND METHODS: We reviewed a Level I trauma registry for patients with TBI, examining markers of anemia between patients who received BB with those who did not. RESULTS: A total of 174 patients were exposed to BB (BB+) and 245 were not exposed (BB?). The mean age in the BB+ group was 50 years (vs. 36 years in BB? group, p < 0.001). The mean injury severity score was 33.6 for the BB+ group (vs. 30.8 for BB? group, p = 0.01). While BB+ patients were more likely to receive a transfusion (60.9% vs. 35.1%, p < 0.001), BB+ patients reached their nadir hemoglobin (Hb) at a later day of hospitalization and their rate of decrease in Hb was significantly slower (both p < 0.001). Choosing Hb cutoffs for anemia of both 7 and 10 g/dL, Kaplan‐Meier demonstrated a significant delay in time to anemia. CONCLUSION: This study suggests beta‐blockade delays anemia after TBI. Elaboration of this effect may demonstrate an additional benefit of beta‐blockade after head injury.     

Randomized Controlled Trial of Daily Total End Range Time (TERT) for Capener Splinting of the Stiff Proximal Interphalangeal Joint

OBJECTIVE. Capener splinting is a common treatment for extension deficit of the proximal interphalangeal (PIP) joint. This study compared the effect of daily splint total end range time (TERT) of 6-12 hr versus 12-16 hr. METHOD. Twenty-two participants with extension deficits of the PIP joint were randomly allocated to a daily TERT of 6-12 hr or 12-16 hr. Progress after 8 wk of splinting was evaluated. RESULTS. No significant difference was found in change in extension range of motion (ROM) between groups (active ROM, F[4, 17] = 2.19, p = .13; passive ROM, F[4, 17] = 0.95, p = .46; torque ROM, F[4, 17] = 1.49, p = .26). Considerable crossover between groups resulted in a similar average daily TERT (9.5 hr for the 6-12 hr group vs. 11.5 hr for the 12-16 hr group). CONCLUSION. Further research with a larger sample is needed to determine whether longer daily TERT is beneficial. Our results suggest, however, that most patients find it difficult to wear splints >12 hr/day.     

Base-metal dental casting alloy biocompatibility assessment using a human-derived three-dimensional oral mucosal model

Nickel-chromium (Ni-Cr) alloys used in fixed prosthodontics have been associated with type IV Ni-induced hypersensitivity. We hypothesised that the full-thickness human-derived oral mucosa model employed for biocompatibility testing of base-metal dental alloys would provide insights into the mechanisms of Ni-induced toxicity. Primary oral keratinocytes and gingival fibroblasts were seeded onto Alloderm™ and maintained until full thickness was achieved prior to Ni-Cr and cobalt-chromium (Co-Cr) alloy disc exposure (2-72 h). Biocompatibility assessment involved histological analyses with cell viability measurements, oxidative stress responses, inflammatory cytokine expression and cellular toxicity analyses. Inductively coupled plasma mass spectrometry analysis determined elemental ion release levels. We detected adverse morphology with significant reductions in cell viability, significant increases in oxidative stress, inflammatory cytokine expression and cellular toxicity for the Ni-Cr alloy-treated oral mucosal models compared with untreated oral mucosal models, and adverse effects were increased for the Ni-Cr alloy that leached the most Ni. Co-Cr demonstrated significantly enhanced biocompatibility compared with Ni-Cr alloy-treated oral mucosal models. The human-derived full-thickness oral mucosal model discriminated between dental alloys and provided insights into the mechanisms of Ni-induced toxicity, highlighting potential clinical relevance.