Intravenous sedation in 200 geriatric patients undergoing office oral surgery

Two hundred geriatric patients ranging from age 65 to 92 yr (mean age 72 yr) were evaluated for office oral surgery and intravenous sedation. Surgical time ranged from 6 to 129 min. Monitored anesthesia care was utilized for the administration of fentanyl, midazolam or diazepam, and methohexital. No serious complications were seen and no patients were hospitalized.

The role of endogenous opioids in enhancing the antinociception produced by the combination of delta 9-tetrahydrocannabinol and morphine in the spinal cord

We have shown previously that intrathecal (i.t.) administration of the combination of delta 9-tetrahydrocannabinol (THC) and morphine results in a greater than additive antinociceptive effect. Similarly, pretreating mice with subthreshold doses of the kappa agonist, Dynorphin A (1-8), produced a parallel, leftward shift of the morphine dose-response curve, shifting the ED50 of morphine from 0.32 to 0.04 micrograms/mouse. A cocktail of enzyme inhibitors used to prevent the metabolism of Dynorphin A (1-8) into the delta receptor agonist, [Leu5]-enkephalin, attenuated the enhancement of morphine-induced antinociception by delta 9-THC. The enhanced antinociceptive effect observed after i.t. administration of the combination of delta 9-THC and morphine was also attenuated with antisera to Dynorphin A (1-8) (10 micrograms/ mouse) and Dynorphin A (1-13) (10 micrograms/mouse). Antisera to Dynorphin A (1-8) and Dynorphin A (1-17) blocked the antinociceptive effects of delta 9-THC (50 micrograms i.t.) without producing any significant alteration in the hypothermic and cataleptic effects or hypomotility produced by delta 9-THC. The antinociception produced by the combination of delta 9-THC and morphine was blocked by the kappa antagonist, nor-binaltorphimine (2 micrograms/ mouse), as well as the delta antagonist, naltrindole (5 micrograms/ mouse). Thus, the antinociception of morphine, which is mediated predominately by mu receptors, may be enhanced by delta 9-THC through the activation of kappa and delta receptors.

An assessment of the reliability of pulp testing deciduous teeth

The aim of this study was to assess the reliability of children's responses to pulp testing of deciduous teeth. The maxillary canine was chosen as the test tooth. One hundred children aged 7-10 years were selected who had at least one non-carious maxillary canine with an intact root showing only early radiographic signs of resorption. Using a minimization sampling technique, the children were allocated to one of two groups, for pulp testing with ethyl chloride (EC) or with an electric pulp tester (EPT). True and sham tests for both pulp testing methods were applied. The tests were repeated following an application of 5% lignocaine paste to the gingival margin around the tooth to prevent gingival detection of the stimulus. Children were asked to record their responses to each of the four tests on a visual analogue scale (VAS) of 1-10. Significantly higher mean scores were obtained with true tests than with sham tests, for both EC and EPT. The application of lignocaine to the gingival margin did not significantly affect the responses to either EC or EPT. It was concluded that pulp testing of intact maxillary deciduous canines with no or only early signs of radiographic root resorption, using EC or EPT, results in reliable responses in 7-10-year-olds, suggesting that pulp testing is valid in the deciduous dentition. The VAS was a useful tool for the evaluation of the children's responses.

Compliance with follow-up care among adolescent males with sexually transmitted diseases

The aim of the study was to investigate behavioral and sociodemographic characteristics of a sample of 45 male adolescents with sexually transmitted diseases who attended family planning clinics. Low rates of compliance with follow-up care were noted. Only 13 (28.9%) males returned to the clinic for their scheduled appointments. Neither behavioral nor sociodemographic variables were related to compliance.

Early arrested development and coronal resorption of an impacted maxillary canine: report of case

Coronal resorption of maxillary canines is a possible complication of long standing impaction. Degeneration of the enamel epithelium allows the connective tissues to come into direct contact with enamel. Irregular replacement of the pericoronal tissues and resorbed enamel by bone characterizes the histological picture. Inflammatory changes are rare. Resorption of enamel is slow and usually symptomless so that reported cases have usually been incidental radiographic findings in older patients. This report presents the early arrested development, ankylosis and resorption of the crown of a maxillary canine in a child 7.7-years-old. Arrest of crown development occurred between three and four-years-of-age. Radiographically the crown of the canine was incompletely formed and showed irregular resorption. Serial radiographs taken over a five-year period showed movement of the canine superiorly in relation to the hard palate which was taken as radiographic evidence for ankylosis of the resorbing maxillary canine in a growing child.

Indigent adolescents' concerns about health care reform

This study assessed the knowledge and concerns of 348 indigent adolescent girls on health care reform. Most knew little about current health care reform and most of the information they received came from the media. They listed family planning, treatment for sexually transmitted diseases, and maternity care as their most important health needs.

CROSS-CULTURAL SOCIAL AND ORGANIZATIONAL PSYCHOLOGY

This review considers recent theoretical and empirical developments in cross-cultural studies within social and organizational psychology. It begins with a description of the importance and the difficulties of universalizing psychological science. It then continues with an examination of theoretical work on both the internal-proximal and the external-distal constraints that mediate culture's influence on behavior. Influences on social cognition are documented by describing research on self-concept, self-esteem, emotions, attribution processes, person perception, interpersonal attraction, and justice. Group processes are addressed in the areas of leadership, decision-making, and negotiation, and research in organizational psychology is examined with respect to work motivation and work behavior. The review concludes that considerable improvement is evident in recent cross-cultural research. However, future research must include a broader range of cultures and attend more closely to the levels at which cultural effects should be analyzed, and cultural samples must be unpackaged in more psychologically useful ways.

4-Ipomeanol and 2-aminoanthracene cytotoxicity in C3H/10T1/2 cells expressing rabbit cytochrome P450 4B1

In the present study, retroviral vectors were used to stably transfer and express the cDNA encoding rabbit CYP4B1 in mouse C3H/10T1/2 cells. The replication defective retroviral vector was packaged in the ecotropic packaging cell line, GP+E-86, with infectious titer of approximately 1 x 10(6) cfu/mL. Infection, followed by selection with G418, showed an infection efficiency of approximately 70% for the recipient C3H/10T1/2 cells. Analysis of ten G418 resistant clones showed that the number of vector inserts ranged from 4 to 13 copies per cell genome. Each clone was positive for microsomal CYP4B1 protein as determined by immunoblotting. Cytochrome P450 4B1 activity was assessed by the cytotoxicity of 4-ipomeanol, a known substrate for P450 4B1 and a model compound for chemical-induced injury to the lung. The initial clonigenic assays showed that 100% toxicity occurred in all the clones after a 96-hr exposure to 250 microM 4-ipomeanol. Parental C3H/10T1/2 cells were resistant to 4-ipomeanol at concentrations as high as 1 mM. Two clones, designated No. 2 and No. 19, differing in levels of P450 4B1 protein, were characterized further for 4-ipomeanol and other chemical toxicities. A concentration-response study indicated 50% cytotoxicity at 4-ipomeanol concentrations of 1.5 micrograms/mL for clone No. 2 and 2.5 micrograms/mL for clone No. 19. A panel of agents representing the aromatic amines, some of which are known or suspected P450 4B1 substrates, were tested for cytotoxicity in clone No. 2. These agents included 2-aminoanthracene, 2-aminonaphthalene, 2-aminofluorene, 2-acetylaminofluorene and 4-aminobiphenyl. Only 2-aminoanthracene gave a clear cytotoxic response reducing the survival fraction of clone No. 2 to 50% at 0.2 micrograms/mL while affecting parental cells minimally. In vitro expression of CYP4B1 provides a new experimental system for further elucidating the cytotoxic and mutagenic effects of P450 4B1 substrates.

Characterization of bacterial phospholipids by electrospray ionization tandem mass spectrometry

A negative ion electrospray ionization tandem mass spectrometric technique was developed for the analysis of glycerophospholipids. Examination of the product ion mass spectrum of the deprotonated molecular ion provided sufficient information to identify both the class of glycerophospholipid and the molecular weights of the two fatty acid moieties. This technique was applied to the profiling of glycerophospholipids present in the chloroform/methanol extracts of four different bacterial species. The principal bacterial phospholipids detected by this technique were phosphatidylglycerols and diphosphatidylglycerols, accompanied by small amounts of phosphatidylethanolamines for two of the bacterial species examined. The fatty acid composition of the phosphatidylglycerols for each bacteria was determined by tandem mass spectrometry and presented graphically. Differences in the fatty acid composition for each bacterial species were readily apparent from a visual examination of the data sets.

Electrospray tandem mass spectrometry for analysis of native muramic acid in whole bacterial cell hydrolysates

Muramic acid is an amino sugar found in eubacterial cell walls and not elsewhere in nature. This study explored the use of electrospray tandem mass spectrometry (ESI MS/MS) in analysis of underivatized muramic acid in bacterial hydrolysates. Fungal hydrolysates were used as negative controls. The only processing used was hydrolysis in sulfuric acid followed by extraction with an organic base (N,N-dioctylmethylamine) to remove the acid prior to ESI MS/MS analysis. Compared with pure muramic acid, bacterial hydrolysates produced more complex ESI mass spectra, such that the protonated molecular ion at m/z 252 was barely detectable. In contrast, product ion spectra of m/z 252 were identical among pure muramic acid, Gram positive bacteria, and Gram negative bacteria. However, no characteristic product ion spectrum was manifested from m/z 252 in fungal samples. This allowed ready, visual differentiation of bacteria and fungi. Multiple reaction monitoring (MRM) following muramic acid fragmentations (m/z 252-->144 and m/z 252-->126) increased sensitivity and allowed quantitative differentiation when compared with the MRM of the internal standard N-methyl-D-glucamine (m/z 196-->44). ESI MS/MS required minimal sample preparation and allowed rapid sample throughput for analysis of muramic acid in whole bacterial cell hydrolysates.

Prevalence of HIV seropositivity among inner-city adolescents in 1988 and 1992

The purpose of this study was to document the change in prevalence of human immunodeficiency virus (HIV) infection among sexually active minority teens at a primary and reproductive teen health clinic. Both new and current patients were sampled in a seroprevalence study in 1988 and again in 1992. None of the 1200 adolescents sampled were seropositive for HIV in 1988. Nine of the 1085 adolescents sampled were seropositive in 1992. Five of these 9 teens reported heterosexual contact only as a potential risk factor. Six of these 9 teens were not in school. These results suggest that HIV infection is increasing among Texas urban teens. Because current education programs do not appear to be preventing viral spread, new, focused intervention must be initiated for teenagers. In particular, an effective acquired immunodeficiency syndrome prevention program for out-of-school youth is needed urgently.

Risk and protective factors for alcohol use among pregnant African-American, Hispanic, and white adolescents: the influence of peers, sexual partners, family members, and mentors

Factors affecting the drinking patterns of 183 pregnant, African-American, Hispanic, and White adolescents were investigated, including the influence of peers, sexual partners, family members, and mentors. Among participants who drank alcohol prior to their pregnancies, 87% quit or cut back on their drinking behaviors. Those adolescents who lived in environments where their partners, peers, and relatives were drinking and using drugs were more likely to have consumed alcohol in the previous month, while adolescents who identified mentors and/or parents who provided high levels of support were less likely to have consumed alcohol. Finally, distinct patterns of both drinking and life circumstances among the African-American, Hispanic, White adolescents were revealed. The implications of these findings for future research and intervention with pregnant adolescents are discussed.

The pharmacological activity of anandamide, a putative endogenous cannabinoid, in mice

The arachidonic acid derivative anandamide (arachidonylethanolamide) has been isolated from porcine brain and has been shown to bind competitively to the cannabinoid receptor. Although the pharmacological activity of this compound has not yet been fully determined, preliminary data suggest that it produces several effects similar ot the cannabinoids. In the present experiments anandamide produced effects similar to those of delta 9-tetrahydrocannabinol, including antinociception (as determined in a latency to tail-flick evaluation), hypothermia, hypomotility and catalepsy in mice after i.v., i.t. and i.p. administration. In general, the effects of anandamide occurred with a rapid onset, but with a rather short duration of action. Prominent antinociceptive effects (> 80% maximal possible effect) were measured immediately after i.v. and i.t. administration. Anandamide produced significant decreases in rectal temperature (2-4 degrees C) after either i.v. or i.t. injection. Maximal effects on motor activity (approximately 85% inhibition) were observed immediately after i.v. and i.p. administration and 10 min after i.t. administration. Maximum immobility observed after i.v. administration was over 80%, yet that produced after i.p. and i.t. administration was too small (< or = 20%) to be considered pharmacologically relevant. Anandamide was less potent (1.3 to 18 times) than delta 9-tetrahydrocannabinol in all behavioral assays. Pretreatment with nor-binaltorphimine, a kappa opioid antagonist which blocks i.t. delta 9-tetrahydrocannabinol-induced antinociception, failed to alter antinociception after i.t. anandamide administration. Binding studies demonstrating that anandamide displaces [3H]CP-55,940 from rat whole brain P2 membrane preparations with a KD of 101 +/- 15 nM. These findings demonstrate that anandamide produces effects in a tetrad of tests used to predict cannabimimetic activity and supports the contention of its role as an endogenous cannabinoid ligand. However, there appear to be distinct differences between anandamide and the cannabinoids with regard to their antinociceptive properties, and other properties vary as a function of route of administration.

U.S.- and Mexico-born Hispanic teen mothers: a descriptive study of factors that relate to postpartum compliance

This study examinedfactors that related to postpartum compliance in a group of U.S.-and Mexico-born Hispanic teens who delivered at a county hospital in Houston, Texas. Only 50 (17.3%) of the combined group returnedfor their scheduled postpartum visit. Returning teens across groups were more likely to have no prenatal care, have a preterm or expired infant, report no educational plan, but have a support system. When controlling for marital status, Mexico-born married teens were the most likely to return for postpartum visits. Medical services need to focus on cultural norms andfamily support systems to increase use of health services. These factors appear to be consistent across both groups of Hispanic teens although married teens from Mexico appear to be more compliant to health care.

Interactions between delta 9-tetrahydrocannabinol and kappa opioids in mice

The selective kappa opioid receptor antagonist nor-binaltorphimine (nor-BNI) has been shown to modulate cannabinoid-induced antinociception by delta 9-tetrahydrocannabinol (delta 9-THC). However, it is not known whether nor-BNI blocks other pharmacological effects of delta 9-THC or if this is a specific action of nor-BNI. Studies were conducted in which pretreatment with nor-BNI (2, 10 and 20 micrograms i.t.) selectively blocked delta 9-THC-induced antinociception while not significantly affecting other commonly observed cannabinoid actions, which included hypothermia, hypoactivity and catalepsy. Chronic administration studies were performed to determine if cross tolerance could be established between delta 9-THC and the highly specific kappa opioid receptor agonists, U-50,488H and CI-977. The chronic delta 9-THC-treated groups were significantly tolerant, not only to i.t. delta 9-THC-induced antinociception in the tail-flick test, but also to i.t. U-50,488 and CI-977 compared with those treated chronically with vehicle. They were not cross tolerant to either DAMGO or DPDPE. Dose-response curves were generated for both delta 9-THC (i.t.) and CI-977 (i.t.) in mice tolerant to delta 9-THC and CI-977. Parallel shifts to the right of the delta 9-THC dose-response curves were observed in animals tolerant to delta 9-THC and also in animals tolerant to CI-977. Animals tolerant to CI-977 also demonstrated parallel shifts of the dose-response curves of both delta 9-THC and CI-977. This study demonstrated that cannabinoid actions can be distinguished from each other. The pharmacological separation of antinociception from the other cannabinoid-induced actions implies that it may have a mechanism distinct from other effects. In addition, this study indicates that delta 9-THC and the kappa opioid agonists may share a common mechanism of action in the production of antinociception and that a possible interaction exists between i.t. administered cannabinoid compounds and the kappa opioid receptor.

Retroviral mediated expression of human cytochrome P450 2A6 in C3H/10T1/2 cells confers transformability by 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK)

In order to develop more efficient in vitro systems for the study of pro-mutagenic or pro-carcinogenic chemicals, we have produced transgenic C3H/10T1/2 cell lines expressing human cytochrome P450 (CYP) 2A6. A retroviral vector containing the cDNA was packaged in psi-2 cells, and used to infect C3H/10T1/2 cells. From 100 G418-resistant clones initially isolated, three cell lines were chosen for further study based upon their morphologies, growth rates and CYP2A6-dependent coumarin 7-hydroxylase activities. Infected clone 10T1/2-04, like the 10T1/2 cells, had no detectable CYP2A6 enzyme activity, while clones 10T1/2-10 and 10T1/2-29 had microsomal CYP2A6 enzyme activities within the range found in human liver microsomes. CYP2A6 protein levels were in agreement with the observed enzyme activities. Southern blots revealed that cells from clone 10T1/2-04 contained a vector lacking the CYP2A6 cDNA, while cells from clones 10T1/2-10 and 10T1/2-29 contained multiple full-length inserts. Southern analysis also indicated the presence of an endogenous CYP2A6 ortholog in the four cell lines. All cell lines exhibited about equal sensitivity to induction of cytotoxicity and conversion to ouabain resistance by the direct acting mutagen N-methyl-N'-nitro-N-nitrosoguanidine. The four lines were also about equally sensitive to transformation by benzo[a]pyrene, a chemical requiring metabolic activation. However, only clones 10T1/2-10 and 10T1/2-29, which express CYP2A6 activity, were mutated and morphologically transformed by the tobacco specific nitrosamine 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone.

Educational efforts in preventing preterm delivery among inner city adolescents

The present study described the effectiveness of using an educational program for self-detection of premature labor in a group of forty-one indigent pregnant adolescents. Twenty-one of these teens self-detected premature labor and received appropriate medical intervention; only four had low birthweight infants and three delivered before 37 weeks. The overall results showed a significant use of the program and a high success to failure rate for those who received medical intervention. The cost-effectiveness and usefulness of this protocol in improving medical outcome for indigent teens are discussed.

Pain reported by children after dental extractions under general anaesthesia: a pilot study

A prospective study has been performed of factors influencing postoperative pain in a cohort of children undergoing dental extractions under general anaesthesia. Postoperative pain was assessed immediately after recovery from anaesthesia and also by using a visual linear analogue scale which was completed by the parent hourly for the first 10 hours and then at 24 hours. Analgesic use was also recorded. The most significant factor influencing postoperative pain was the relationship of the accompanying adult to the child; children attending with their mothers were more likely to complain of postoperative pain (P < 0.05). The results also suggested that the age of the patient and the extraction of primary rather than permanent teeth were influencing factors, although they did not reach statistical significance. Pain was reported by 57.5% of the children immediately after treatment. It would seem that the greatest need for postoperative analgesia is immediately after the dental procedure, especially in young children undergoing multiple extractions.

High-performance tandem mass spectrometry in metabolism studies

1. High-performance tandem mass spectrometry provides unit resolution in both selection of precursor ions and analysis of fragment ions, and extensive and reproducible fragmentation through collisional activation at high energy. 2. Metabolites can be analysed that occur as minor components in h.p.l.c. peaks or other mixtures. Homogeneous isotopic species can be selected for unambiguous analysis of distributions of isotope labels. Fragmentation may be significantly enhanced to provide structural information. Overall, the signal to noise ratio is greatly improved and the spectrum is simplified. 3. These points are illustrated by isotope-labelling studies of the mechanisms of glutathione conjugation of the anti-tumour agent cyclophosphamide, the cytotoxic agent phosphoramide mustard and dimethylbilirubin, an analogue of bilirubin designed to be distinguishable from endogenous bilirubin. Analysis of isomeric mixed disulphides formed between glutathione and a peptide with an internal disulphide bond is discussed. 4. Reaction-induced decomposition is presented as an alternative to collisionally induced decomposition with more efficient energy transfer.

Recombinant DNA approaches for the development of metabolic systems used in in vitro toxicology

In the past few years there has been considerable progress in the development of mammalian cell systems for use in genetic toxicology by the stable transfer of genes/cDNAs coding for drug metabolizing enzymes directly into the target cell. Alternative approaches have also been developed in which mammalian cells are transiently transfected with cDNAs coding for drug-metabolizing enzymes and S9 preparations expressing a single metabolizing enzyme isolated and used for metabolic activation. Progress in these areas is reviewed here and the relative merits of the different approaches are discussed. Work to date has focused primarily on the cytochrome P450 family of enzymes, although other enzyme systems involved in xenobiotic metabolism have been used. The central theme of this review is the transfer of genetic information to improve the metabolic capability of cell systems used in genetic toxicology. However, a basic philosophy of the review is that genetic manipulation of cultured mammalian cells has the potential for developing systems to be used to better understand chemically induced toxicological effects.