An unusual delayed complication of inferior alveolar nerve block

Systemic and localised complications after administration of local anaesthetic for dental procedures are well recognised. We present two cases of patients with trismus and sensory deficit that arose during resolution of trismus as a delayed complication of inferior alveolar nerve block.

Steroid injection for inferior heel pain: a randomised controlled trial

BACKGROUND:

Plantar fasciitis is a common cause of heel pain. The aim of this study was twofold: to compare steroid injection with placebo injection and to compare ultrasound guided with unguided steroid injection in the management of this condition.

METHODS:

65 patients with inferior heel pain were recruited between November 2008 and June 2011. Heel pain was measured using a visual analogue scale (VAS) at baseline and follow-up 6 and 12 weeks after injection.

RESULTS:

22 patients were randomised to ultrasound guided steroid injection, 21 patients to palpation guided steroid injection and 22 to ultrasound guided placebo injection. There was a significant difference in VAS scores between the groups at 6 and 12 weeks (p=0.018 and p=0.004, respectively). There was a 19.7 (95% CI 2.5 to 37.0) difference in mean VAS scores at 6 weeks between the ultrasound guided steroid group and the placebo group and a 24.0 (95% CI 6.6 to 41.3) difference between the unguided steroid group and the placebo group at 6 weeks. At 12 weeks, the mean difference was 25.1 (95% CI 6.5 to 43.6) and 28.4 (95% CI 11.1 to 45.7) respectively between both steroid injection groups and the placebo group. There was no difference in VAS scores following steroid injection between the ultrasound guided and the unguided groups at either time point. Plantar fascia thickness was significantly reduced after injection in both active treatment groups (p=0.00).

CONCLUSIONS:

In this study, steroid injection showed a clear benefit over placebo at 6 weeks and this difference was maintained at 12 weeks.Trial Registration No ISRCTN79628180 (www.controlled-trials.com).

Morphological consequences of lateral outfracture of the inferior turbinate

Objective: We report three cases of lateral outfracture of the inferior turbinate, which demonstrate a range of changes in the size, position and shape of the inferior turbinate.

Method: During a study of the validity of computer modelling of nasal airflow, computed tomography scans of the noses of patients who had undergone lateral outfracture of the inferior turbinate were collected. The pre-operative scan was compared with the post-operative scan six weeks later.

Results: In one patient, there was only a small lateral displacement of the inferior turbinate. In the other two cases, appreciable reduction in the volume of one inferior turbinate was noted, in addition to minor changes in the shape.

Conclusion: Lateral outfracture of the inferior turbinate produces varied and inconsistent changes in morphology which may affect the shape, size and position of the turbinate.

Who Feels Inferior? A Test of the Status Anxiety Hypothesis of Social Inequalities in Health

The empirical association between income inequality, population health and other social problems is now well established and the research literature suggests that the relationship is not artefactual. Debate is still ongoing as to the cause of this association. Wilkinson, Marmot and colleagues have argued for some time that the relationship stems from the psycho-social effects of status comparisons. Here, income inequality is a marker of a wider status hierarchy that provokes an emotional stress response in individuals that is harmful to health and well-being. We label this the ‘status anxiety hypothesis’. If true, this would imply a structured relationship between income inequality at the societal level, individual income rank and anxiety relating to social status. This paper sets out strong and weak forms of the hypothesis and then presents three predictions concerning the structuring of ‘status anxiety’ at the individual level given different levels of national income inequality and varying individual income. We then test these predictions using data from a cross-national survey of over 34,000 individuals carried out in 2007 in 31 European countries. Respondents from low inequality countries reported less status anxiety than those in higher inequality countries at all points on the income rank curve. This is an important precondition of support for the status anxiety hypothesis and may be seen as providing support for the weaker version of the hypothesis. However, we do not find evidence to support the stronger version of the hypothesis which requires the negative effect of income rank on status anxiety to be exacerbated by increasing income inequality.

Presentation of a plasmablastic lymphoma in a human immunodeficiency virus-positive patient after administration of an inferior alveolar dental block

Human immunodeficiency virus (HIV) is a serious worldwide healthcare problem with implications for all healthcare workers. The reported oral manifestations of the disease are numerous and have been categorised according to the strength of their association with HIV infection. Oral non-Hodgkin's lymphoma is strongly associated with HIV infection, and an increased incidence of such neoplasms is widely reported. This case report details the presentation of a rare subcategory of plasmablastic lymphoma in an HIV-positive patient after administration of an inferior alveolar dental block to facilitate extraction of mandibular teeth. This highly aggressive neoplasm is a large B-cell lymphoma with a predilection for the oral cavity. Unfortunately, the prognosis for such a tumour is poor as detailed in this case.

What motion distributions yield global transparency and spatial segmentation?

We have examined the ability of observers to parse bimodal local-motion distributions into two global motion surfaces, either overlapping (yielding transparent motion) or spatially segregated (yielding a motion boundary). The stimuli were random dot kinematograms in which the direction of motion of each dot was drawn from one of two rectangular probability distributions. A wide range of direction distribution widths and separations was tested. The ability to discriminate the direction of motion of one of the two motion surfaces from the direction of a comparison stimulus was used as an objective test of the perception of two discrete surfaces. Performance for both transparent and spatially segregated motion was remarkably good, being only slightly inferior to that achieved with a single global motion surface. Performance was consistently better for segregated motion than for transparency. Whereas transparent motion was only perceived with direction distributions which were separated by a significant gap, segregated motion could be seen with abutting or even partially overlapping direction distributions. For transparency, the critical gap increased with the range of directions in the distribution. This result does not support models in which transparency depends on detection of a minimum size of gap defining a bimodal direction distribution. We suggest, instead, that the operations which detect bimodality are scaled (in the direction domain) with the overall range of distributions. This yields a flexible, adaptive system that determines whether a gap in the direction distribution serves as a segmentation cue or is smoothed as part of a unitary computation of global motion.

Exploring grain size as a cause for dead-layer effects in thin film capacitors

Pulsed laser deposition was used to make a series of Au/Ba0.5Sr0.5TiO3 (BST)/SrRuO3/MgO thin film capacitors with dielectric thickness ranging from similar to15 nm to similar to1 mum. Surface grain size of the dielectric was monitored as a function of thickness using both atomic force microscopy and transmission electron microscopy. Grain size data were considered in conjunction with low field dielectric constant measurements. It was observed that the grain size decreased with decreasing thickness in a manner similar to the dielectric constant. Simple models were developed in which a functionally inferior layer at the grain boundary was considered as responsible for the observed dielectric behavior. If a purely columnar microstructure was assumed, then constant thickness grain-boundary dead layers could indeed reproduce the series capacitor dielectric response observed, even though such layers would contribute electrically in parallel with unaffected bulk- like BST. Best fits indicated that the dead layers would have a relative dielectric constant similar to40, and thickness of the order of tens of nanometers. For microstructures that were not purely columnar, models did not reproduce the observed dielectric behavior well. However, cross-sectional transmission electron microscopy indicated columnar microstructure, suggesting that grain boundary dead layers should be considered seriously in the overall dead-layer debate. (C) 2002 American Institute of Physics.

Distribution-based adaptive bounding genetic algorithm for continuous optimisation problems

A new search-space-updating technique for genetic algorithms is proposed for continuous optimisation problems. Other than gradually reducing the search space during the evolution process with a fixed reduction rate set ‘a priori’, the upper and the lower boundaries for each variable in the objective function are dynamically adjusted based on its distribution statistics. To test the effectiveness, the technique is applied to a number of benchmark optimisation problems in comparison with three other techniques, namely the genetic algorithms with parameter space size adjustment (GAPSSA) technique [A.B. Djurišic, Elite genetic algorithms with adaptive mutations for solving continuous optimization problems – application to modeling of the optical constants of solids, Optics Communications 151 (1998) 147–159], successive zooming genetic algorithm (SZGA) [Y. Kwon, S. Kwon, S. Jin, J. Kim, Convergence enhanced genetic algorithm with successive zooming method for solving continuous optimization problems, Computers and Structures 81 (2003) 1715–1725] and a simple GA. The tests show that for well-posed problems, existing search space updating techniques perform well in terms of convergence speed and solution precision however, for some ill-posed problems these techniques are statistically inferior to a simple GA. All the tests show that the proposed new search space update technique is statistically superior to its counterparts.

Toward Self-Assembled Ferroelectric Random Access Memories: Hard-Wired Switching Capacitor Arrays with Almost Tb/in.2 Densities

We report on the successful fabrication of arrays of switchable nanocapacitors made by harnessing the self-assembly of materials. The structures are composed of arrays of 20-40 nm diameter Pt nanowires, spaced 50-100 nm apart, electrodeposited through nanoporous alumina onto a thin film lower electrode on a silicon wafer. A thin film ferroelectric (both barium titanate (BTO) and lead zirconium titanate (PZT)) has been deposited on top of the nanowire array, followed by the deposition of thin film upper electrodes. The PZT nanocapacitors exhibit hysteresis loops with substantial remnant polarizations, while although the switching performance was inferior, the low-field characteristics of the BTO nanocapacitors show dielectric behavior comparable to conventional thin film heterostructures. While registration is not sufficient for commercial RAM production, this is nevertheless an embryonic form of the highest density hard-wired FRAM capacitor array reported to date and compares favorably with atomic force microscopy read-write densities.

Applying a QSPR correlation to the prediction of surface tensions of ionic liquids

Ionic liquids (ILs) have attracted large amount of interest due to their unique properties. Although large effort has been focused on the investigation of their potential application, characterization of ILs properties and structure–property relationships of ILs are poorly understood. Computer aided molecular design (CAMD) of ionic liquids (ILs) can only be carried if predictive computational methods for the ILs properties are available. The limited availability of experimental data and their quality have been preventing the development of such tools. Based on experimental surface tension data collected from the literature and measured at our laboratory, it is here shown how a quantitative structure–property relationship (QSPR) correlation for parachors can be used along with an estimation method for the densities to predict the surface tensions of ILs. It is shown that a good agreement with literature data is obtained. For circa 40 ionic liquids studied a mean percent deviation (MPD) of 5.75% with a maximum deviation inferior to 16% was observed. A correlation of the surface tensions with the molecular volumes of the ILs was developed for estimation of the surface tensions at room temperature. It is shown that it can describe the experimental data available within a 4.5% deviation. The correlations here developed can thus be used to evaluate the surface tension of ILs for use in process design or in the CAMD of new ionic liquids.