Pharmacologic behavior management for pediatric dental treatment

Sedatives are an important and necessary management technique for some children during dental procedures. Sedation can be administered safely and efficiently by competent practitioners who have special training in the use of the technique in children and who adhere to sedation guidelines. Nonetheless, some children present with special needs, such as medically compromising conditions, or multiple carious teeth in a child who is fearful or whose family must travel a long distance for care. Sedation cannot always safely and adequately meet the needs of these children. In these cases, general anesthesia in a hospital, ambulatory care facility, or office is indicated and must be provided by an appropriately licensed and trained physician or dentist.

Report of the ADEA president's task force on the Surgeon General's report on oral health. American Dental Education Association

In response to the first-ever Surgeon General's report on oral health, released on May 25, 2000, ADEA President Rowland A. Hutchinson, D.D.S., M.S., appointed a task force to study the report from the perspective of dental education. The task force was charged with making recommendations to the ADEA Board of Directors as to the Association's message to members and the general public, the Association's role in addressing oral health disparities, the legislative and policy implications of the report, and areas of collaboration between ADEA and others in the dental and health professions. The task force reviewed the report and made five recommendations, including increasing public awareness of the report's messages, promoting collaborative activities with a goal of improving America's oral health, and providing leadership in the drive to promote the incorporation of new science in dental education. The task force also identified numerous ADEA initiatives that address issues related to the Surgeon General's report.

Women's experience of breast conserving treatment for breast cancer

The implementation of the National Breast Screening Programme in the UK, and subsequent increase in early detection of small cancers, has facilitated breast conserving treatment for more women with a breast cancer diagnosis than ever before. While a substantial body of literature has evolved regarding psychosocial morbidity and support needs of women at diagnosis and during treatment, there are specific gaps in the current knowledge base. The purpose of this study was to describe the experiences of women who had breast conserving treatment for early breast cancer, focusing on issues related to diagnosis, surgery, and radiotherapy. The study was designed within the context of clinical audit, with a view to informing service development. Seventy-six women who had undergone breast conserving surgery within the last 3-12 months, completed a self-report questionnaire. Findings indicated that although the majority of women expressed satisfaction with their treatment overall, a number of specific areas require attention from healthcare professionals. Further research is required to validate these findings and to explore: potential implications of different referral routes; information and support needs preceding definitive diagnosis; particular needs of those women with ductal carcinoma in situ (DCIS) vs. invasive disease; 'end of treatment' and ongoing information and support needs.

Questionnaires of accident and emergency departments: are they reproducible?

BACKGROUND

Questionnaires are commonly sent to accident and emergency (A&E) departments to determine common practice and are often extrapolated to best practice.

AIMS

To determine if questionnaire based studies have a defined population of A&E departments and whether studies are reproducible.

METHODS

All questionnaires in the Journal of Accident and Emergency Medicine were reviewed and assessed for inclusion criteria, departments studied and study design.

RESULTS

30 questionnaires were detected, 22 were postal, six telephone and two did not state method of contact. Sample sizes ranged from 15 to 740 and inclusion of A&E departments was highly variable according to geographical area, size of department or consultant status. Seventeen (54.8%) did not state the source of A&E department listings. Response rates ranged from 55-100%. Only three studies undertook subset analysis according to either size or locality.

CONCLUSIONS

Questionnaire of studies A&E departments have poor methodology descriptions, which means that many are not reproducible. Inclusion criteria are highly variable and failure to analyse important subsets may mean that individual departments cannot apply recommendations. Questionnaire studies relating to A&E do not use a consistent well defined population of A&E departments. Information in the studies is usually inadequate to allow them to be repeated.

Phacoemulsification and opaque intraocular lens implantation for the treatment of intractable diplopia

Intractable diplopia secondary to paralytic strabismus may be treated with the occlusion of the affected eye. Established treatments include occlusion with a patch, opaque spectacles or contact lenses, and performing upper lid lowering procedures or tarsorrhaphies. Two cases are presented in which intractable diplopia was resolved by performing clear lens phacoemulsification and the insertion of an opaque intraocular lens. Both patients reported a resolution of their diplopia having been dissatisfied with other forms of treatment. Although opaque intraocular lens insertion is not recommended as the initial treatment of choice in such cases, it offers a valuable treatment option for those patients in whom other forms of therapy have failed.

Receptor for the pain modulatory neuropeptides FF and AF is an orphan G protein-coupled receptor

Opiate tolerance and dependence are major clinical and social problems. The anti-opiate neuropeptides FF and AF (NPFF and NPAF) have been implicated in pain modulation as well as in opioid tolerance and may play a critical role in this process, although their mechanism of action has remained unknown. Here we describe a cDNA encoding a novel neuropeptide Y-like human orphan G protein-coupled receptor (GPCR), referred to as HLWAR77 for which NPAF and NPFF have high affinity. Cells transiently or stably expressing HLWAR77 bind and respond in a concentration-dependent manner to NPAF and NPFF and are also weakly activated by FMRF-amide (Phe-Met-Arg-Phe-amide) and a variety of related peptides. The high affinity and potency of human NPFF and human NPAF for HLWAR77 strongly suggest that these are the cognate ligands for this receptor. Expression of HLWAR77 was demonstrated in brain regions associated with opiate activity, consistent with the pain-modulating activity of these peptides, whereas the expression in adipose tissue suggests other physiological and pathophysiological activities for FMRF-amide neuropeptides. The discovery that the anti-opiate neuropeptides are the endogenous ligands for HLWAR77 will aid in defining the physiological role(s) of these ligands and facilitate the identification of receptor agonists and antagonists.

IgA nephropathy in psoriasis

IgA nephropathy (IGAN) was first described by Berger and Hinglais in 1968. It is now the most common glomerular disease worldwide. IGAN has been associated with several diseases. Its association with psoriasis has been rarely described. We report a case of IGAN with crescentic changes, associated with psoriasis vulgaris. We review the literature on the association of IGAN with psoriasis and discuss the likely pathogenetic linkage.

N-acylated alpha-(3-pyridylmethyl)-beta-aminotetralin antagoinists of the human neuropeptide Y Y5 receptor

Alpha-(3-Pyridylmethyl)-beta-aminotetralins were acylated with amino-piperidinyl and-pyrrolidinyl acetic acids, and with (aminomethyl)cyclohexanecarboxylic acid. Reaction with acyl chlorides, chloroformates, and isocyanates gave amides 8e, carbamates 9, and ureas 10, which bound to the Y5 receptor with nanomolar affinity. Congeners 11a and 11d containing a terminal benzimidazolone group were shown to be functional Y5 antagonists.

Evaluation of low-pressure arterial and venous clamps: electron microscopic study and possible clinical applications

These authors report on validating their choice of disposable clamps in arterial and venous microsurgery in a comparative and experimental study using the scanning electron microscope. This appears to be the first evaluation of venous endothelial clamping lesions. Early intimal clamping lesions were studied using three different clamps and two protocols in 18 femoral arteries and veins in rabbits. Results were evaluated using a new classification that can be applied to both arterial and venous lesions: Grade I: cellular disorientation and disorganization; endothelial lamination; and absent or very few platelet deposits; Grade II: alterations of the cytoplasmic membranes in fusiform cells; presence of at least one breach of endothelial continuity; and moderate number of platelet deposits; Grade III: presence of endothelial detachment; and large numbers of platelet deposits. They showed that in arteries, all the clamps tested caused only low-grade lesions. In contrast, in veins, they demonstrated both the very fragile nature of the endothelium, and also the comparative safety of the low-pressure venous clamp. Their choice of specific clamps for venous anastomoses was validated.

Schistosoma japonicum: interactions of successive infections in pigs and mice using polymerase chain reaction-based identification of individual worms

The study reported here investigated acquired resistance of mice and pigs to challenge-infections with Schistosoma japonicum. Two morphologically indistinguishable isolates of the parasite (from the Anhui and Zhejiang provinces of China), which could be typed by polymerase chain reaction-linked restriction fragment length polymorphism analysis (PCR-RFLP), were used for the infections. In two parallel infection studies, 60 female outbred NMRI mice and 29 Danish Landrace/Yorkshire/Duroc crossbred pigs were used. Two of the groups received a primary infection with either the Anhui or the Zhejiang isolate, respectively. The remaining groups received a primary infection with the Zhejiang isolate and challenge-infections with the Anhui isolate at either week 2, 3, 4 or 6 post primary infection. The results of the study indicated that both mice and pigs are partially resistant to challenge-infection from week 4 post primary infection. Resistance appeared to decrease in pigs 6 weeks after primary infection, while it remained effective in mice. These results suggest that the mechanism responsible for acquired resistance in mice and pigs may not be the same and support the theory that worm burdens in pigs receiving repeated infection are in a balance between acquisition and loss of worms.

Prospects for reducing and refining the use of dogs in the regulatory toxicity testing of pharmaceuticals

A workshop was held to critically discuss the need for a nonrodent species and the role of the dog in regulatory toxicity testing of pharmaceuticals; to discuss opportunities to reduce and refine the use of dogs in preclinical toxicology; and to identify a number of specific recommendations which could be feasibly achieved to move the process forward. To facilitate a preliminary evaluation of the contribution of dog studies to the risk assessment process, anonymised, unpublished data were provided from fully evaluated, repeat-dose toxicity studies in the rat and dog. Results of the International Life Sciences Institute (ILSI) Human Toxicity Project were also presented and discussed. Analysis of the data demonstrated that the dog can provide additional toxicity information, which, in some cases, was shown to be predictive for humans. Discussions indicated that there is potential for achieving a reduction in dog use and several possible approaches were identified. To further the progress of this initiative, there is a need to collate the results of pharmacology, toxicology, and clinical studies to address some of the proposed approaches. One of the outcomes of the workshop will be the establishment of a steering group to co-ordinate data collation for further analysis.

Identification of an EDG7 variant, HOFNH30, a G-protein-coupled receptor for lysophosphatidic acid

We have identified a cDNA, designated HOFNH30, which encodes a 354 amino acid G-protein-coupled receptor (GPCR). This receptor has 96% amino acid identity to the Jurkat-T cell-derived EDG7 and could be a splice variant. RT-PCR analysis demonstrated that HOFNH30 mRNA is expressed in placenta whereas EDG7 mRNA shows highest expression in prostate. The HOFNH30 gene is localized to human chromosome 1p22. 3-1p31.1. When HOFNH30 was expressed in RBL-2H3 cells, LPA and phosphatidic acid (PA) induced a calcium mobilization response with EC(50) values of 13 nM and 3 microM, respectively. LPA also induced phosphorylation of mitogen-activated protein kinase (p42(MAPK) and p44(MAPK)) in HOFNH30-transfected but not vector-transfected RBL-2H3 cells. In the present study, we have identified a novel variant from the EDG receptor family, a GPCR for which LPA is a high-affinity endogenous ligand.

Neuromedin U is a potent agonist at the orphan G protein-coupled receptor FM3

Neuromedins are a family of peptides best known for their contractile activity on smooth muscle preparations. The biological mechanism of action of neuromedin U remains unknown, despite the fact that the peptide was first isolated in 1985. Here we show that neuromedin U potently activates the orphan G protein-coupled receptor FM3, with subnanomolar potency, when FM3 is transiently expressed in human HEK-293 cells. Neuromedins B, C, K, and N are all inactive at this receptor. Quantitative reverse transcriptase-polymerase chain reaction analysis of neuromedin U expression in a range of human tissues showed that the peptide is highly expressed in the intestine, pituitary, and bone marrow, with lower levels of expression seen in stomach, adipose tissue, lymphocytes, spleen, and the cortex. Similar analysis of FM3 expression showed that the receptor is widely expressed in human tissue with highest levels seen in adipose tissue, intestine, spleen, and lymphocytes, suggesting that neuromedin U may have a wide range of presently undetermined physiological effects. The discovery that neuromedin U is an endogenous agonist for FM3 will significantly aid the study of the full physiological role of this peptide.

Liver transplantation improves cirrhosis-associated impaired oral glucose tolerance

BACKGROUND

Thirty-five percent to 80% of cirrhotic patients have impaired glucose tolerance (IGT) or diabetes mellitus (DM). Diabetic cirrhotics have higher morbidity and mortality than nondiabetics. Therefore, it would be worthwhile to determine whether liver transplantation improves glucose homeostasis in these patients.

METHOD

A total of 26 patients awaiting liver transplantation were evaluated for impaired glucose homeostasis by fasting blood glucose and/or oral glucose tolerance tests (OGTT). Five patients underwent transplant surgery within 1 year of OGTT and had a repeat OGTT 3-6 months after transplantation.

RESULTS

Sixty-five percent (17/26) of the patients had abnormal glucose homeostasis. Twenty-three percent (6/26) met American Diabetes Association criteria for DM, and another 42.3% (11/26) had IGT. All patients had normal HbA1C levels. After transplantation, the 2-hr blood glucose improved in four patients and the mean 2-hr glucose level was reduced (204 +/- 94 vs. 132 +/- 53 mg/dl [mean +/- SD, P=0.051]).

CONCLUSION

Liver transplantation can reverse cirrhosis-associated impaired glucose tolerance.

Bronchial angiogenesis in severe glucocorticoid-dependent asthma

To examine the role of the bronchial microvasculature and adhesion molecule expression in severe asthma, the authors have performed an immunohistochemical study on bronchial biopsies comparing 15 glucocorticoid-dependent asthmatics, 15 mild asthmatics and eight control subjects. Serially cut glycol methacrylate-embedded sections were stained with monoclonal antibodies identifying the vessel marker EN-4, intercellular adhesion molecule (ICAM)-1, vascular cell adhesion molecule (VCAM)-1, E- and P-selectin. Sections were also stained for lymphocyte function associated antigen (LFA)-1 and very late antigen (VLA)-4. By comparison with mild asthma and nonasthma, severe asthma was characterized by increased numbers of submucosal vessels (p=0.009) which was associated with increased numbers of vessels expressing ICAM-1 (p=0.005). A highly significant correlation was found between the total number of EN-4+ vessels and the vessels expressing ICAM-1 (r=0.85, p=0.01). In contrast, E-selectin expression was lower in severe as compared with mild asthma (p=0.01) but not different from normal. No differences were found between the three groups in the expression of VCAM-1 and P-selectin nor in numbers of LFA-1+ and VLA-4+ cells. The results of this study support the notion that mucosal neovascularization is an important feature of airways remodelling in severe asthma. This is associated with a relatively higher density of vessels expressing intercellular adhesion molecule-1, although the expression of this adhesion molecule per vessel was not raised.

Research in primary care: extent of involvement and perceived determinants among practitioners from one English region

The lack of research evidence relevant to and generated by general practitioners (GPs) has been a concern in the context of a putative primary care-led National Health Service (NHS). However, very little has been published on the current extent or determinants of research activity among United Kingdom primary care doctors. We surveyed all (n = 2770) service GPs in the West Midlands Region in order to quantify their research involvement and to explore determinants of this. The response rate was 49% (n = 1351). A total of 84% of responders reported participating in research or audit, with 16% having initiated their own research; 9% of GPs had been published in a peer-reviewed journal; 6% had generated research funding; and 3% had held a research training fellowship. The characteristics positively associated with initiating research included an involvement in teaching, having research-active partners, the availability of protected time, and working in a larger practice. The most commonly perceived barriers to undertaking research were lack of time (92%), lack of staff to collect data (73%), and a lack of funding (71%). In all, 41% of responders reported no interest in research. Overall, the extent of research activity among responding GPs appears to be greater than is often assumed. Recent NHS research and development proposals to strengthen and develop research in primary care are, therefore, relevant in highlighting changes to address these issues.