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Knowledge of emergency dental management among a localized sample of athletic trainers. Dent Traumatol 2024. [PMID: 38234017 DOI: 10.1111/edt.12920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 10/31/2023] [Accepted: 01/01/2024] [Indexed: 01/19/2024]
Abstract
BACKGROUND/AIMS Athletic trainers are often the point person when sports-related traumatic dental injuries (TDIs) occur. The aim of this study was to assess knowledge levels of the management of TDIs among athletic trainers in the Midwest United States, as well as evaluate variables that may influence knowledge levels. MATERIAL AND METHODS A survey was sent to athletic trainers licensed in Minnesota, Nebraska, and Iowa. The survey included 28 multiple-choice and fill in the blank questions split into three sections. The three sections included background, emergency management of TDIs, and opinion questions. RESULTS Of the participants, 100% recalled receiving medical first aid training. However, only 71% recalled receiving formal training on emergency management of dental injuries. Although 75% were confident in managing a dental injury, over 63% of participants scored less than 70% in the knowledge score section. Majority of the participants (98.4%) reported that they believe training on the management of TDIs is important. Athletic trainers working with contact sports were more likely to have experienced managing TDIs more recently than those working in noncontact sports. CONCLUSIONS This study shows the gaps in knowledge among athletic trainers pertaining to management of TDIs and emphasizes the importance of sports community having adequate education on emergency management of such dental injuries.
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Reopening Oral Health Services during the COVID-19 Pandemic through a Knowledge Exchange Coalition. JDR Clin Trans Res 2021; 6:279-290. [PMID: 33902341 PMCID: PMC8207488 DOI: 10.1177/23800844211011985] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The COVID-19 novel coronavirus closed oral health care in Nova Scotia (NS) Canada in March 2020. Preparing for a phased reopening, a knowledge exchange coalition (representing government, academia, hospitals, oral health professions, and regulators) developed return-to-work (RTW) guidelines detailing the augmentation of standard practices to ensure safety for patients, oral health care providers (OHPs), and the community. Using online surveys, this study explored the influence of the RTW guidelines and related education on registered NS OHPs during a phased return to work. METHODS Dissemination of R2W guidelines included website or email communiques and interdisciplinary education webinars that coincided with 2 RTW phases approved by the government. Aligned with each phase, all registered dentists, dental hygienists, and dental assistants were invited to complete an online survey to gauge the influence of the coalition-sponsored education and RTW guidelines, confidence, preparedness, and personal protective equipment use before and after the pandemic. RESULTS Three coalition-sponsored multidisciplinary webinars hosted 3541 attendees prior to RTW. The response to survey 1 was 41% (881/2156) and to survey 2 was 26% (571/2177) of registrants. Survey 1 (82%) and survey 2 (89%) respondents "agreed/strongly agreed" that R2W guidelines were a primary source for guiding return to practice, and most were confident with education received and had the skills needed to effectively treat patients during the COVID-19 pandemic. Confidence and preparedness improved in survey 2. Gowns/lab coat use for aerosol-generating procedures increased from 26% to 93%, and the use of full face shields rose from 6% to 93% during the pandemic. CONCLUSIONS A multistakeholder coalition was effective in establishing and communicating comprehensive guidelines and web-based education to ensure unified reintegration of oral health services in NS during a pandemic. This multiorganizational cooperation lay the foundation for responses to subsequent waves of COVID-19 and may serve as an example for collaboratively responding to future public health threats in other settings. KNOWLEDGE TRANSFER STATEMENT The return-to-work strategy that was developed, disseminated, and assessed through this COVID-19 knowledge exchange coalition will benefit oral health practitioners, professional regulators, government policy makers, and researchers in future pandemic planning.
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Abstract
Goals of screening for frailty include (a) promoting healthy aging, (b) addressing frailty with preventive and targeted interventions, (c) better aligning social and medical responses to frailty with the needs of frail older adults and (d) preventing harms to frail older adults from excessive and inappropriate medical interventions that are insensitive to the implications of frailty. However, the medicalization of frailty and outcomes of the screening process also risk harming frail older adults and their autonomy through stereotyping and by legitimizing denial of care. This risk of harm gives rise to ethical and legal questions and considerations that this paper addresses. Frailty screening that is ethically defensible will situate and support healthcare that is consistent with people's needs, circumstances and capacity to benefit from the care provided. We also call for an informed consent process that incorporates supported or shared decision making in order to protect the autonomy of frail older adults.
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Abstract
Aims The aim of this study was to determine the diagnostic utility of histological analysis in spinal biopsies for spondylodiscitis (SD). Patients and Methods Clinical features, radiology, results of microbiology, histology, and laboratory investigations in 50 suspected SD patients were evaluated. In 29 patients, the final (i.e. treatment-based) diagnosis was pyogenic SD; in seven patients, the final diagnosis was mycobacterial SD. In pyogenic SD, the neutrophil polymorph (NP) infiltrate was scored semi-quantitatively by determining the mean number of NPs per (×400) high-power field (HPF). Results Of the 29 pyogenic SD patients, 17 had positive microbiology and 21 positive histology (i.e. one or more NPs per HPF on average). All non-SD patients showed less than one NP per HPF. The presence of one or more NPs per HPF had a diagnostic sensitivity of 72.4%, specificity 100%, accuracy 100%, positive predictive value (PPV) 81.0%, and negative predictive value (NPV) 61.9%. Sensitivity, specificity, and accuracy were greater using the criterion of positive histology and/or microbiology than positive histology or microbiology alone. Granulomas were identified histologically in seven mycobacterial SD patients, and positive microbiology was detected in four. Conclusion The diagnosis of pyogenic SD was more often confirmed by positive histology (one or more NPs per HPF on average) than by microbiology, although diagnostic sensitivity was greater when both histology and microbiology were positive. Cite this article: Bone Joint J 2019;101-B:246–252.
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Osteopontin-targeted probe detects orthotopic breast cancers using optoacoustic imaging. Biotech Histochem 2018; 93:608-614. [PMID: 30260254 DOI: 10.1080/10520295.2018.1514466] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Improved detection of breast cancer using highly sensitive, tumor-specific imaging would facilitate diagnosis, surveillance and assessment of response to treatment. We conjugated osteopontin peptide to an infrared fluorescent dye to serve as a contrast agent for detection of breast cancer by multispectral optoacoustic tomography (MSOT). Selective binding of the osteopontin-based probe was identified using flow cytometry and near infrared fluorescent imaging in triple negative and HER2 positive breast cancer cell lines in vitro. Osteopontin-750 accumulation was evaluated in vivo using MSOT with secondary confirmation of signal accumulation using near infrared fluorescent imaging. The osteopontin-based probe demonstrated binding to breast cancer cells in vitro. Similarly, after intravenous administration of the osteopontin-750 probe, it accumulated preferentially in the subcutaneous breast tumor in nude mice (557 MSOT a.u. compared to untargeted organs such as kidney (53.7 MSOT a.u.) and liver (32.1 MSOT a.u.). At 2.5 h post-injection, signal intensity within the tumor was 9.7 and 17 times greater in the tumor bed than in the kidney or liver, respectively. Fluorescence imaging ex vivo comparing tumor signal to that of nontarget organs confirmed the results in vivo. MSOT imaging demonstrated selective accumulation of the fluorescent osteopontin targeting probe to tumor sites both in vitro and in vivo, and provided high-resolution images. Further development of this tool is promising for advanced diagnostic imaging, disease surveillance and therapeutic models that limit nontarget toxicity.
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Linking Inuit Knowledge and Public Health for Improved Child and Youth Oral Health in NunatuKavut. JDR Clin Trans Res 2018; 3:256-263. [PMID: 30938603 DOI: 10.1177/2380084418767833] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The oral health of Inuit children in Canada has been identified as a public health crisis. Although efforts are being made to identify and address ways to deal with this crisis, current policy and program approaches are largely entrenched within the prevailing paradigm of dental science to the exclusion of Indigenous people's understandings of health. This article reports qualitative findings of a larger study aimed at identifying, understanding, and addressing rates of oral disease among children living in NunatuKavut, a cluster of small, coastal Inuit communities located in southern Labrador, Canada. Through 18 focus groups with youth (n = 86), caregivers (n = 22), and interviews with key informant (n = 13), this study begins to elucidate southern Inuit understandings of oral health. Theorized using Two-Eyed Seeing, an Indigenous approach to balancing both Indigenous and non-Indigenous understandings of the world, the findings reported here reveal 3 themes, each of which is crosscut by historical and contemporary dimensions: 1) (w)holistic conceptualizations of health are essential to good oral health, 2) achieving optimal oral health is prohibitive for Inuit communities, and 3) community-engaged oral health service delivery is needed. Our recommendations have implications for improved oral public health service delivery for Inuit communities, in that the inclusion of Inuit perspectives on oral health should form an instrumental element of oral public health service delivery. Knowledge Transfer Statement: The results of this study may be used by clinicians and oral health educators to inform approaches to oral health service delivery within the context of Indigenous communities. It may also be used by policymakers to recognize how historical and contemporary issues of colonization relate to the formation of oral health-related policies.
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Muscle as an osteoinductive niche for local bone formation with the use of a biphasic calcium sulphate/hydroxyapatite biomaterial. Bone Joint Res 2016; 5:500-511. [PMID: 27784668 PMCID: PMC5108354 DOI: 10.1302/2046-3758.510.bjr-2016-0133.r1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 07/29/2016] [Indexed: 12/21/2022] Open
Abstract
Objectives We have observed clinical cases where bone is formed in the overlaying muscle covering surgically created bone defects treated with a hydroxyapatite/calcium sulphate biomaterial. Our objective was to investigate the osteoinductive potential of the biomaterial and to determine if growth factors secreted from local bone cells induce osteoblastic differentiation of muscle cells. Materials and Methods We seeded mouse skeletal muscle cells C2C12 on the hydroxyapatite/calcium sulphate biomaterial and the phenotype of the cells was analysed. To mimic surgical conditions with leakage of extra cellular matrix (ECM) proteins and growth factors, we cultured rat bone cells ROS 17/2.8 in a bioreactor and harvested the secreted proteins. The secretome was added to rat muscle cells L6. The phenotype of the muscle cells after treatment with the media was assessed using immunostaining and light microscopy. Results C2C12 cells differentiated into osteoblast-like cells expressing prominent bone markers after seeding on the biomaterial. The conditioned media of the ROS 17/2.8 contained bone morphogenetic protein-2 (BMP-2 8.4 ng/mg, standard deviation (sd) 0.8) and BMP-7 (50.6 ng/mg, sd 2.2). In vitro, this secretome induced differentiation of skeletal muscle cells L6 towards an osteogenic lineage. Conclusion Extra cellular matrix proteins and growth factors leaking from a bone cavity, along with a ceramic biomaterial, can synergistically enhance the process of ectopic ossification. The overlaying muscle acts as an osteoinductive niche, and provides the required cells for bone formation. Cite this article: D. B. Raina, A. Gupta, M. M. Petersen, W. Hettwer, M. McNally, M. Tägil, M-H. Zheng, A. Kumar, L. Lidgren. Muscle as an osteoinductive niche for local bone formation with the use of a biphasic calcium sulphate/hydroxyapatite biomaterial. Bone Joint Res 2016;5:500–511. DOI: 10.1302/2046-3758.510.BJR-2016-0133.R1.
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Comparison of ACTIVE-mini to the Vicon motion camera system in measuring infant movements. Neuromuscul Disord 2015. [DOI: 10.1016/j.nmd.2015.06.203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
Infected nonunion of a long bone continues to present difficulties in management. In addition to treating the infection, it is necessary to establish bony stability, encourage fracture union and reconstruct the soft-tissue envelope. We present a series of 67 infected nonunions of a long bone in 66 patients treated in a multidisciplinary unit. The operative treatment of patients suitable for limb salvage was performed as a single procedure. Antibiotic regimes were determined by the results of microbiological culture. At a mean follow-up of 52 months (22 to 97), 59 patients (88%) had an infection-free united fracture in a functioning limb. Seven others required amputation (three as primary treatment, three after late failure of limb salvage and one for recalcitrant pain after union). The initial operation achieved union in 54 (84%) of the salvaged limbs at a mean of nine months (three to 26), with recurrence of infection in 9%. Further surgery in those limbs that remained ununited increased the union rate to 62 (97%) of the 64 limbs treated by limb salvage at final follow-up. The use of internal fixation was associated with a higher risk of recurrent infection than external fixation.
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The rate of symptomatic venous thromboembolism in patients undergoing elective Ilizarov surgery and the cost of chemical prophylaxis. Bone Joint J 2014; 96-B:426-30. [DOI: 10.1302/0301-620x.96b3.32939] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Recent recommendations by the National Institute for Health and Care Excellence (NICE) suggest that all patients undergoing elective orthopaedic surgery should be assessed for the risk of venous thromboembolism (VTE). Little is known about the incidence of symptomatic VTE after elective external fixation. We studied a consecutive series of adult patients who had undergone elective Ilizarov surgery without routine pharmacological prophylaxis to establish the incidence of symptomatic VTE. A review of a prospectively maintained database of consecutive patients who were treated between October 1998 and February 2011 identified 457 frames in 442 adults whose mean age was 42.6 years (16.0 to 84.6). There were 425 lower limb and 32 upper limb frames. The mean duration of treatment was 25.7 weeks (1.6 to 85.3). According to NICE guidelines all the patients had at least one risk factor for VTE, 246 had two, 172 had three and 31 had four or more. One patient (0.23%) developed a pulmonary embolus after surgery and was later found to have an inherited thrombophilia. There were 27 deaths, all unrelated to VTE. The cost of providing VTE prophylaxis according to NICE guidelines in this group of patients would be £89 493.40 (£195.80 per patient) even if the cheapest recommended medication was used. The rate of symptomatic VTE after Ilizarov surgery was low despite using no pharmacological prophylaxis. This study leads us to question whether NICE guidelines are applicable to these patients. Cite this article: Bone Joint J 2014;96-B:426–30.
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Prevention of infection in external fixator pin sites. Acta Biomater 2014; 10:595-603. [PMID: 24076071 DOI: 10.1016/j.actbio.2013.09.019] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Revised: 09/15/2013] [Accepted: 09/18/2013] [Indexed: 12/19/2022]
Abstract
Infection in external fixator pins is known to be a significant problem, with incidences between 3% and 80% reported in the literature. An infection occurs when planktonic bacteria adhere to external fixator pins and subsequently produce a biofilm which protects the bacteria from host defences. The most commonly implicated organisms are Staphylococcus aureus and Staphylococcus epidermidis. Once an infection occurs, treatment is difficult. Systemic antibiotics have limited benefits and considerable side-effects. The only definitive management is removal of the pin. This review will consider the current and potential future strategies for reducing pin site infection. Techniques to prevent infection must prevent bacterial adhesion, allow good osteointegration and have a low toxicity. Current areas of interest reviewed are titanium-copper alloys, nanosilver coatings, nitric oxide coatings, chitosan coatings, chlorhexidine and iodine, hydroxyapatite and antibiotic coatings. At present there is no consensus on the prevention of pin site infection, and there is a paucity of randomized controlled trials on which to draw a conclusion. Whilst a number of these strategies have potential future use, many of the above strategies need further studies in animal models to ensure no cytotoxicity and prevention of osteointegration. Following this, well-designed randomized controlled clinical trials are required to give future ways to prevent external fixator pin site infections.
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Strategy for improving and maintaining compliance with adequate hospital hand hygiene practices. J Hosp Infect 2011; 77:87-8. [DOI: 10.1016/j.jhin.2010.09.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Accepted: 09/09/2010] [Indexed: 10/18/2022]
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Abstract No. 310: CAM/Ethiodol/PVA Chemoembolization of Intrahepatic Cholangiocarcinoma. J Vasc Interv Radiol 2009. [DOI: 10.1016/j.jvir.2008.12.305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Abstract
BACKGROUND Concerns have been raised regarding the risks associated with gastroesophageal reflux (GER). We examined the association of gastroesophageal reflux with survival. METHODS Between 1988 and 1993, valid symptom surveys were mailed to population-based cohorts. Respondents were classified into 4 GER symptom categories: daily, at least weekly (not daily), infrequent (less than weekly), and none. Administrative records were used to identify deaths during the follow-up (through June 2006). Association between survival and GER subgroups was assessed using proportional hazards regression to compute hazard ratios (HRs, 95% confidence intervals), adjusting for age, gender, education level, Charlson Comorbidity Index, alcohol, and tobacco. RESULTS At baseline, 5,288 eligible subjects (mean age 53 yr, 51% female) responded (response rates over 70%); 2% reported daily heartburn, 13% weekly (not daily) heartburn, 40% infrequent heartburn, and 35% no heartburn. At 10 yr, 83% (95% CI 81-84%) of the no heartburn group was alive. An overall association between heartburn category and survival was detected (P < 0.001). Compared to no heartburn, daily heartburn was not associated with an increased risk of death (HR 1.16, 95% CI 0.82-1.65), but better survival was observed for weekly (HR 0.67, 95% CI 0.55-0.83) and infrequent (HR 0.80, 95% CI 0.70-0.92) heartburn. Increasing age, male gender, greater Charlson index, and tobacco use all predicted worse survival. CONCLUSIONS In this population-based study with over 50,000 person-years of follow-up, reflux symptoms were not associated with worse survival. The vast majority of heartburn sufferers can be reassured of the benign nature of their condition.
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Overlap of gastro-oesophageal reflux disease and irritable bowel syndrome: prevalence and risk factors in the general population. Aliment Pharmacol Ther 2007; 26:453-61. [PMID: 17635380 DOI: 10.1111/j.1365-2036.2007.03366.x] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Gastro-oesophageal reflux disease (GERD) and irritable bowel syndrome may occur more often than expected by chance, but little community data exists and risk factors are unknown. AIM To determine prevalence and risk factors for overlap of GERD and irritable bowel disease. METHODS Population-based, cross-sectional survey was conducted by mailing a valid symptom questionnaire to eligible residents of Olmsted County, MN, aged 30-95 years. Irritable bowel syndrome were defined by Rome III; GERD was defined by weekly or more frequent heartburn and/or acid regurgitation. RESULTS 2298 questionnaires returned (women 52%, 55% response). Irritable bowel syndrome and GERD occurred together more commonly than expected by chance; the prevalence of irritable bowel syndrome-GERD overlap, GERD alone and irritable bowel syndrome alone were 3%, 15% and 5% in men, and 4%, 14% and 10% in women, respectively. Predictors of irritable bowel syndrome-GERD overlap vs. irritable bowel syndrome alone, and separately, GERD alone, were insomnia (OR 1.3, 95% CI: 1.06-1.70; OR 1.5, 95% CI: 1.13-1.90, respectively) and frequent abdominal pain (OR 3.9, 2.2-6.7; OR 1.8, 1.02-3.2, respectively). An additional predictor of irritable bowel syndrome-GERD overlap vs. GERD alone was higher somatization (OR 1.7, 1.1-2.4) and for irritable bowel syndrome-GERD overlap vs. irritable bowel syndrome alone was a higher body mass index (OR 1.0, 1.003-1.07). CONCLUSIONS Irritable bowel syndrome and GERD overlap is common in the population and does not occur by chance.
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Does Opening the Peritoneum at the Time of Renal Transplanation Prevent Lymphocele Formation? Transplant Proc 2006; 38:3524-6. [PMID: 17175321 DOI: 10.1016/j.transproceed.2006.10.182] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2006] [Indexed: 11/26/2022]
Abstract
BACKGROUND The occurrence of lymphocele formation following renal transplantation is variable, and the optimal approach to treatment remains undefined. Opening the peritoneum at the time of transplantation is one method of decreasing the incidence of lymphocele formation. The purpose of this study was to determine whether creating a peritoneal window at the time of transplantation decreases the incidence of lymphocele formation. METHODS We performed a retrospective review of renal transplants conducted at our institution between 2002 and 2004. Records were reviewed to obtain details regarding opening of the peritoneum at the time of transplant and occurrence of lymphocele. Every patient underwent routine ultrasound imaging in the peri-operative period. Graft dysfunction secondary to the lymphocele was the primary indication for intervention. Data were analyzed by chi-square. RESULTS During the initial transplant the peritoneum was opened in 35% of patients. The overall incidence of fluid collections, identified by ultrasound, was 24%. Opening the peritoneum did not decrease the incidence of lymphocele. However, more patients with a closed peritoneum required an intervention for a symptomatic lymphocele. In the 11 patients with an open peritoneum and a fluid collection, only one required an intervention. In patients whose peritoneum was left intact, 24% of fluid collections required intervention. Graft survival was equivalent. CONCLUSION Creating a peritoneal window at the time of transplantation did not decrease the overall incidence of postoperative fluid collections. However, forming a peritoneal window at the time of transplantation did decrease the incidence of symptomatic lymphocele.
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Iliofemoral distraction and hip reconstruction for the sequelae of a septic dislocated hip with chronic femoral osteomyelitis. ACTA ACUST UNITED AC 2005; 87:863-6. [PMID: 15911675 DOI: 10.1302/0301-620x.87b6.16052] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We describe a technique of ‘cross-hip distraction’ to reduce a dislocated hip with subsequent reconstruction of the joint for septic arthritis with extensive femoral osteomyelitis. A 27-year-old woman presented with a dislocated, collapsed femoral head and chronic osteomyelitis of the femur. Examination revealed a leg-length discrepancy of 7 cm and an irritable hip. A staged technique was used with primary clearance of osteomyelitis and secondary reconstruction of the hip. A cross-hip monolateral external fixator was used to establish normal anatomy followed by an arthroplasty. A good functional outcome was achieved. The use of cross-hip distraction avoids soft-tissue and nerve damage and achieved improved abductor function before arthroplasty.
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Abstract
The correction of transverse maxillary deficiency can be an important component of an orthodontic treatment plan. A number of different techniques are available for the correction of such discrepancies. The aim of this article is to review the methods available to clinicians discussing their indications, advantages and disadvantages.
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Abstract
Retention is normally required after active orthodontic tooth movement to hold the teeth in their new positions. This article reviews the principles of orthodontic retention and describes common retention regimes and appliances.
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Deficiencies in foot care of diabetic patients on renal replacement therapy. ACTA ACUST UNITED AC 2003. [DOI: 10.1002/pdi.535] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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An in vivo probe based on mechanically strong but structurally small carbon electrodes with an appreciable surface area. Anal Chem 2001; 73:4793-800. [PMID: 11681453 DOI: 10.1021/ac0104532] [Citation(s) in RCA: 41] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Physically small carbon electrodes were fabricated by pyrolyzing acetylene in a nitrogen atmosphere using pulled quartz capillaries as the supporting substrate. A carbon disk geometry was obtained when a parallel flow of acetylene (50 kPa) and nitrogen (10 mL min(-1)) was introduced into the system. Further, carbon was found to deposit at the tip and on the shank of the quartz capillaries when the nitrogen flow rate was increased (80 mL min(-1)), yielding an approximately cylindrical geometry. A series of electrochemical and spectroscopic analyses was carried out to examine the type of carbon surface obtained by pyrolysis of acetylene. The results suggested that a surface consisting of an almost defect-free highly oriented pyrolytic graphite type structure was formed by the pyrolyzed acetylene. However, this contradicts the kinetically reversible electron transfer observed for dopamine oxidation at these electrodes. Meanwhile, the nonpolar and relatively oxygen-free characteristics indicate that these electrodes also behave similarly to a hydrogenated carbon surface. The formation of a hydrogenated carbon-type surface may be plausible as a result of the attack on the carbon surface by a surplus of hydrogen produced by the pyrolysis of acetylene to form graphitic carbon. These characteristics are expected to aid in reducing electrode fouling, which is often encountered in electrochemical detection of neurotransmitters in vivo. In conjunction with a miniature physical dimension, their appreciable surface area and enhanced mechanical strength make these carbon electrodes well suited to the detection of neurotransmitters in vivo.
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Home healthcare nurses--why they leave and why they stay. CARING : NATIONAL ASSOCIATION FOR HOME CARE MAGAZINE 2001; 20:62-7. [PMID: 11588885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
This is a second article in a series of two reports on the National Association for Home Care's (NAHC) study of nursing recruitment and retention. The first article presented the results of the quantitative analysis. This article presents results of the qualitative analysis.
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Phorbasin B and C: novel diterpenes from a southern Australian marine sponge, Phorbas species. JOURNAL OF NATURAL PRODUCTS 2001; 64:645-647. [PMID: 11374965 DOI: 10.1021/np0005614] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
A southern Australian Phorbas sp. has yielded the novel diterpenes phorbasin B (2) and phorbasin C (3). Phorbasins B and C possess a hitherto unknown carbon skeleton, and their structures were assigned on the basis of detailed spectroscopic analyses.
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The ethics of water fluoridation. JOURNAL (CANADIAN DENTAL ASSOCIATION) 2000; 66:592-3. [PMID: 11253350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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Ethics in an aging society: challenges for oral health care. JOURNAL (CANADIAN DENTAL ASSOCIATION) 1999; 65:623-6. [PMID: 10658394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/15/2023]
Abstract
Health and aging are deeply meaningful and complex realities. The demographic reality of the Canadian population in the 21st century requires an in-depth understanding of the health care goals of older people, an analysis of the attitudes toward older people that affect societal decision making and the educational and policy changes required to effect positive change. Viewing these issues through the lens of oral health care allows an analysis of health care goals for the older population. A look at representative cases where oral health needs were not met uncovers some of the attitudes and values about oral health, the goals of health care and the unique circumstances of older people that present barriers to appropriate care.
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Neonatal abstinence syndrome. IRISH MEDICAL JOURNAL 1999; 92:232-3, 236. [PMID: 10360095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
A 12 month review of infants admitted with neonatal abstinence syndrome to a neonatal intensive care unit was undertaken. The relationship of maternal drug abuse to symptoms, the effectiveness of pharmacologic agents in controlling symptoms and the length of inpatient stay were investigated. A retrospective review of maternal and infant records was performed. Those infants with a serial Finnegan score greater than 8 were treated. Pharmacologic treatment was oral morphine sulphate (0.2 mg 4-6 hourly), phenobarbitone (3-7 mgs/kg/day), or combination of the above. 43 infants were admitted to the hospital during the year. The average maternal age was 24.6 years, (18-34 years). Drug use volunteered by the mothers was methadone alone in 6 cases, methadone and benzodiazepines in 14, methadone and heroin and benzodiazepines in 7, methadone and heroin in 10, heroin alone in 2, and other multiple drug use including oral morphine sulphate, dothiepin and cannabis in 4. Average gestational age was 40.3 (35-42 weeks). The average birthweight was 2.81 kgs (1.89-3.91 kgs). Time to onset of withdrawal symptoms was 2.8 (1-13) days. The duration of pharmacologic treatment (oral morphine sulphate and/or phenobarbitone) was 21.8 (1-62) days. The total hospital stay for the 43 infants was 1,011 days. This study confirms that polydrug abuse is the commonest type of drug abuse in Dublin. The duration of withdrawal symptoms is loosely related to drug type, but increasing duration of symptoms is noted for infants exposed to benzodiazepines. Our experience would favour the use of morphine sulphate to treat pure opiate withdrawal symptoms. Over the 12-month period, there was an average occupancy of 3 beds per day in the paediatric department.
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Should the drinking water of Truro, Nova Scotia, be fluoridated? Water fluoridation in the 1990s. Community Dent Oral Epidemiol 1993; 21:118-25. [PMID: 8348782 DOI: 10.1111/j.1600-0528.1993.tb00734.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
An epidemiological assessment of differences in caries and fluorosis prevalences between children in Truro (< 0.1 ppm) and Kentville (fluoridated at 1.1 ppm in 1991), Nova Scotia, Canada, was completed in 1991. Out of a total of 429 children, in grades 5 and 6, in the two towns in 1991, 219 (51%) were examined. Parents answered a self-administered questionnaire investigating the sources of drinking water used by the children since birth, residence history, use of fluoride supplements, dentifrices, and other fluoride products during the first 6 yr of the life. The examination criteria differentiated between non-cavitated and cavitated carious lesions. Dental fluorosis was measured using the TSIF index. Examiner agreement was excellent. Of the children examined, 80 (36.5%) drank water (fluoridated or non-fluoridated) from municipal water systems during the first 6 yr of life. The children were assigned into five groups based upon residence history and exposure to fluoridated water during the first 6 yr of life. The percentage difference in mean DMFS scores between children in the fluoridated and non-fluoridated groups is 17% (delta DMFS1 = 0.7) when non-cavitated carious lesions are included and 39% (delta DMFS2 = 1.1) when they are excluded. The differences are not statistically significant. The significant risk factors associated with the DMFS1 and DMFS2 scores identified by a stepwise multiple regression analysis are: education level of the father, gender, and number of years of reported use of toothpaste during the first 6 yr of life. Dental fluorosis (mainly TSIF score of 1) was present in 41.5% and 69.2% of the children in the non-fluoridated and fluoridated groups, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
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Strain gauge plethysmography for the detection of deep venous thrombosis. JOURNAL OF BIOMEDICAL ENGINEERING 1993; 15:135-9. [PMID: 8459692 DOI: 10.1016/0141-5425(93)90043-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Deep venous thrombosis is a widely recognized medical problem which results in significant morbidity and mortality. Venography is the current 'gold standard' diagnostic test for deep venous thrombosis; however it is costly, invasive and is unnecessarily performed in 50% of cases. This paper describes a self-contained, non-invasive system for automatic venous occlusion plethysmographic measurement and analysis. An examination of 274 symptomatic limbs was conducted using strain gauge plethysmography and a subsequent venographic examination was then performed. The plethysmographic results were then compared with venography so as to develop a means of discrimination for thrombotic and non-thrombotic limbs. Strain gauge plethysmography using the Belfast DVT Screener yielded a sensitivity of 100% and a sensitivity of 66.3% for proximal segment DVT. The efficacy of the discriminatory algorithm was then tested for the diagnosis of DVT in a further 101 symptomatic patients. A sensitivity of 94.7% and a specificity of 81.7% were observed for strain gauge plethysmography for proximal segment thrombosis in this patient group. The Belfast DVT Screener is highly sensitive for deep venous thrombosis and may be used to reduce the need for venography, which is of benefit to both the patient and clinician.
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Abstract
We have developed a computer controlled system of strain gauge plethysmography for use as a screening tool for proximal segment venous thrombi which is simple to use, well tolerated by patients and extremely accurate. The computerised test was evaluated in 171 limbs of 163 symptomatic patients by comparison with subsequent ascending venography. Each of twenty occlusive proximal segment thrombi were identified, one non occlusive thrombus screened normal giving an overall sensitivity of 95.2%. The specificity of the test was 80% with a negative predictive value of 99.0%. The computerised system allows accurate screening for proximal segment venous thrombosis, and may permit more selective use of venography in the symptomatic post-operative limb.
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Northern Ireland focus. The same, but different. Nurs Stand 1991; 5:20-1. [PMID: 1911252 DOI: 10.7748/ns.5.50.20.s32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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GP contracts: scare in the community. Nurs Stand 1990; 4:17-9. [PMID: 2109248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Ten years of turbulence. Nurs Stand 1990; 4:16-9. [PMID: 2108336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Enrolled nurses: first service. Nurs Stand 1989; 3:42-3. [PMID: 2509962] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Inside politics. Nurs Stand 1989; 44:24. [PMID: 2505119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Cultivating a greener health service. Nurs Stand 1989; 3:44-5. [PMID: 2503734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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One year on. Nurs Stand 1989; 3:50-1. [PMID: 2503737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Inside politics. Nurs Stand 1989; 3:17. [PMID: 2521150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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NHS review: healthy competition? Nurs Stand 1989; 3:8-9. [PMID: 2494536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Midwifery in crisis? Nurs Stand 1988; 3:17. [PMID: 3062408 DOI: 10.7748/ns.3.12.17.s49] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Evidence paints a bleak picture. Nurs Stand 1987; 2:16. [PMID: 27319473 DOI: 10.7748/ns.2.12.16.s42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This year's supplementary evidence from nursing unions to the Pay Review Body paints a bleak picture of severe staff shortages, critically low morale, and a workforce that is struggling to make ends meet.
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Education in the 21st century. NURSING STANDARD : OFFICIAL NEWSPAPER OF THE ROYAL COLLEGE OF NURSING 1987:7. [PMID: 3647270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Annual report highlights recruitment difficulties. NURSING STANDARD : OFFICIAL NEWSPAPER OF THE ROYAL COLLEGE OF NURSING 1987:12. [PMID: 3642320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Abstract
The nuclear localization of unoccupied oestrogen receptors has been demonstrated in MCF 7 (human breast tumour) cells by immunocytochemistry, and in GH3 (rat pituitary tumour) cells by enucleation techniques. The present study shows, by similar enucleation techniques, that high affinity (Type 1) aldosterone binding sites are similarly located in the nucleus of steroid-unexposed pituitary GH3 cells. It is, therefore, suggested that such high-affinity Type 1 sites, which are mineralocorticoid receptors in the kidney and glucocorticoid receptors in the hippocampus, are nuclear-associated proteins in the absence of steroid and are found in the cytosol compartment only upon cell disruption.
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Abstract
Using a rat pancreatic kallikrein cDNA probe (pcXP39), previously shown to hybridize to kallikrein mRNA in a variety of tissues, we have explored the control of kallikrein gene expression in rat anterior pituitary. Intact female rats have substantially higher levels of AP kallikrein mRNA than intact males; male levels are unaffected by castration, whereas female levels fall markedly postovariectomy. Administration of estradiol benzoate to intact male or ovariectomized female rats causes an increase in anterior pituitary levels of kallikrein mRNA. Since the pattern of responsiveness parallels that of PRL, we have studied GH3 cells grown in the presence and absence of estradiol; in neither instance was kallikrein mRNA above detection limits. Parallel changes were seen on Northern blots and by hybridization histochemistry; on emulsion autoradiography of pituitary sections, scattered positive cells were seen, but precise definition was not possible. We conclude that whereas in the submaxillary gland kallikrein gene expression appears androgen dependent and in the kidney is postulated to be mineralocorticoid regulated, in the anterior pituitary expression of the gene is under estrogen control; and that the local role(s) of pituitary kallikrein, whether precursor processing, control of blood flow, or other effects, would, in turn, appear to be modulated by estrogen in vivo.
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Pro-opiomelanocortin messenger ribonucleic acid and posttranslational processing of beta endorphin in spleen macrophages. J Clin Invest 1986; 77:1776-9. [PMID: 2423557 PMCID: PMC370533 DOI: 10.1172/jci112501] [Citation(s) in RCA: 176] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
We have previously demonstrated low levels of immunoreactive (ir)-beta-endorphin (beta-EP) and ir-ACTH in a subpopulation of mouse spleen macrophages, which is consistent with an involvement of opioid peptides in modulation of immune responses. Gel chromatography studies suggested the presence of an approximately 3.5,000-molecular weight (mol wt) species, putatively beta-EP, an approximately 11.5,000-mol-wt species, putatively beta-lipotropin, and a higher molecular weight species (putative beta-EP precursor, pro-opiomelanocortin (POMC). In this study we have extended our original findings by demonstrating the presence of messenger RNA for POMC by the use of a complementary DNA probe and Northern blot analysis of extracts of mouse and rat spleen. In addition, using high performance liquid chromatography (HPLC), we have shown that the major endorphin species in mouse spleen macrophages is beta-EP1-31, and that there are smaller amounts of each of the acetylated forms, N-acetyl-beta-EP1-16 (alpha-endorphin), N-acetyl-beta-EP1-17 (gamma-endorphin), N-acetyl-beta-EP1-27, and N-acetyl-beta-EP1-31. We interpret these studies as showing that (a) the spleen is an organ of POMC synthesis and that (b) the predominant COOH-terminal product of macrophage POMC is the opiate-receptor active species beta-EP1-31.
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Anterior pituitary cells from Brattleboro (di/di), Long-Evans and Sprague-Dawley rats contain immunoreactive arginine vasopressin. Neuroendocrinology 1986; 43:577-83. [PMID: 3528899 DOI: 10.1159/000124584] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
A radioimmunoassay specific for arginine-vasopressin (AVP) was used to establish the presence of immunoreactive (ir)-AVP in extracts of anterior pituitary glands from Sprague-Dawley (SD) and Long-Evans (LE) rats (3.05 +/- 1.0 and 1.66 +/- 0.9 ng/gland, respectively). Lower levels of ir-AVP (0.56 +/- 0.26 ng/gland) were detected in anterior pituitary gland extracts from rats with hereditary diabetes insipidus (Brattleboro; di/di). The anterior pituitary gland ir-AVP from each rat strain was further characterized by reverse-phase high-performance liquid chromatography (RP-HPLC). In each case the major peak of immunoreactivity co-migrated with synthetic AVP. By peroxidase-antiperoxidase immunocytochemistry, sparsely distributed cells containing ir-AVP were localized in anterior pituitary sections. Levels of ir-AVP in primary cultures of anterior pituitary cells (from SD rats) increased from 52 +/- 5 pg/10(6) cells at 2 days in vitro to 152 +/- 17 pg/10(6) cells at 3 days; during this period 56 +/- 6 pg/ml ir-AVP was secreted into the culture medium. Fewer than 1% of the cells in these cultures were immunostainable for AVP. These data indicate that the anterior pituitary gland of the Brattleboro, Long-Evans and Sprague-Dawley rat contains ir-AVP, and that there is synthesis and secretion of this peptide in primary cultures of anterior pituitary cells in vitro.
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Bar codes set new standard for materiel managers. HEALTH CARE 1985; 27:21-2. [PMID: 10271860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Overlapping but not identical protein synthetic domains in cardiovascular cells in response to glucocorticoid hormones. J Hypertens 1984; 2:663-9. [PMID: 6527006 DOI: 10.1097/00004872-198412000-00012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
We have compared, by two-dimensional gel electrophoresis, the effects of glucocorticoids on newly synthesized proteins of cultured cardiovascular cells (rat synthetic- and contractile-state vascular smooth muscle, rat cardiac muscle and non-muscle, and bovine endothelium) and rat hepatoma (H4) cells, as a non-cardiovascular target. In each cell type, glucocorticoids consistently affected a particular set of proteins termed the glucocorticoid domain for that target tissue. Cardiovascular cells exhibited overlapping but non-identical glucocorticoid domains; these domains varied in number of proteins, proportion of induced and repressed proteins, and overlap (extent of shared protein responses) between the various cardiovascular cell types studied. On physico-chemical and co-electrophoresis data the glucocorticoid domain of cardiovascular cells also overlapped with that of hepatoma cells, but to a lesser extent. The glucocorticoid domain in cardiac muscle cells included five proteins not found in cardiac non-muscle cells. Contractile-state vascular smooth muscle cells showed some, but not all, of the proteins affected by glucocorticoids in synthetic-state cells; the only response seen in the contractile but not vascular smooth muscle cells was a protein of Mr-52K and pI-5.3, which was also induced in spontaneously contractile cardiac muscle. Further characterization of contractile and synthetic vascular smooth muscle and cardiac muscle proteins affected by glucocorticoids is necessary to ascertain their role(s) in specialized cardiovascular functions.
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