Dental management considerations for the patient with an acquired coagulopathy. Part 1: Coagulopathies from systemic disease

Current teaching suggests that many patients are at risk for prolonged bleeding during and following invasive dental procedures, due to an acquired coagulopathy from systemic disease and/or from medications. However, treatment standards for these patients often are the result of long-standing dogma with little or no scientific basis. The medical history is critical for the identification of patients potentially at risk for prolonged bleeding from dental treatment. Some time-honoured laboratory tests have little or no use in community dental practice. Loss of functioning hepatic, renal, or bone marrow tissue predisposes to acquired coagulopathies through different mechanisms, but the relationship to oral haemostasis is poorly understood. Given the lack of established, science-based standards, proper dental management requires an understanding of certain principles of pathophysiology for these medical conditions and a few standard laboratory tests. Making changes in anticoagulant drug regimens are often unwarranted and/or expensive, and can put patients at far greater risk for morbidity and mortality than the unlikely outcome of postoperative bleeding. It should be recognised that prolonged bleeding is a rare event following invasive dental procedures, and therefore the vast majority of patients with suspected acquired coagulopathies are best managed in the community practice setting

Towards an optimal therapy strategy for myogenous TMD, physiotherapy compared with occlusal splint therapy in an RCT with therapy-and-patient-specific treatment durations

Appendix. Threshold of signs and symptoms. Post-hoc power analysis on measures of effectiveness. Two-way ANOVA statistical analysis for pain intensity. Rules for progressing and ending splint therapy. Rules for progressing and ending physiotherapy. A stepped-care model including two possible therapies. (PDF 86 kb

Topical Insulin Accelerates Wound Healing in Diabetes by Enhancing the AKT and ERK Pathways: A Double-Blind Placebo-Controlled Clinical Trial

Background: Wound healing is impaired in diabetes mellitus, but the mechanisms involved in this process are virtually unknown. Proteins belonging to the insulin signaling pathway respond to insulin in the skin of rats. Objective: The purpose of this study was to investigate the regulation of the insulin signaling pathway in wound healing and skin repair of normal and diabetic rats, and, in parallel, the effect of a topical insulin cream on wound healing and on the activation of this pathway. Research Design and Methods: We investigated insulin signaling by immunoblotting during wound healing of control and diabetic animals with or without topical insulin. Diabetic patients with ulcers were randomized to receive topical insulin or placebo in a prospective, double-blind and placebo-controlled, randomized clinical trial (NCT 01295177) of wound healing. Results and Conclusions: Expression of IR, IRS-1, IRS-2, SHC, ERK, and AKT are increased in the tissue of healing wounds compared to intact skin, suggesting that the insulin signaling pathway may have an important role in this process. These pathways were attenuated in the wounded skin of diabetic rats, in parallel with an increase in the time of complete wound healing. Upon topical application of insulin cream, the wound healing time of diabetic animals was normalized, followed by a reversal of defective insulin signal transduction. In addition, the treatment also increased expression of other proteins, such as eNOS (also in bone marrow), VEGF, and SDF-1 alpha in wounded skin. In diabetic patients, topical insulin cream markedly improved wound healing, representing an attractive and cost-free method for treating this devastating complication of diabetes.Sao Paulo Research Foundation (FAPESP)Sao Paulo Research Foundation (FAPESP)National Institute of Science and Technology (INCT)National Institute of Science and Technology (INCT)National Council for Scientific and Technological Development (CNPq)National Council for Scientific and Technological Development (CNPq

Is there a predictable relationship between surface physical-chemical properties and cell behaviour at the interface?

International audienceThere is much interest in predicting and controlling the outcome of interaction between artificial surfaces and living cells. However, although there is an impressive amount of information on the behaviour of many cell populations deposited on a variety of surfaces, there is presently no available theory to explain or even summarize these data. Indeed, it is not even obvious that such a theory may exist. The aim of the present review is to emphasize the problems encountered when one attempts to build such a theory. Three sequential steps of cell surface interactions are considered: 1) protein adsorption is a preliminary step liable to involve irreversible interaction between the surface and several hundreds of molecular species occurring in blood or plasma. 2) the second step is the formation of adhesive bonds. Several theoretical frameworks were suggested to account for this step, including DLVO theory, physical chemistry of surfaces, and formation of specific ligandreceptor bonds. It is concluded that present evidence supports the latter approach, although this involves serious difficulties. 3) The last step is the triggering of a specific cell program such as apoptosis, proliferation, migration, differentiation or activation. Recent evidence suggests that in addition to the nature and amount of stimulated surface receptors, additional cues such as substratum mechanical or topographical properties may significantly affect cell behaviour

Determination of the lifetime and force dependence of interactions of single bonds between surface-attached CD2 and CD48 adhesion molecules.

We studied single molecular interactions between surface-attached rat CD2, a T-lymphocyte adhesion receptor, and CD48, a CD2 ligand found on antigen-presenting cells. Spherical particles were coated with decreasing densities of CD48-CD4 chimeric molecules then driven along CD2-derivatized glass surfaces under a low hydrodynamic shear rate. Particles exhibited multiple arrests of varying duration. By analyzing the dependence of arrest frequency and duration on the surface density of CD48 sites, it was concluded that (i) arrests were generated by single molecular bonds and (ii) the initial bond dissociation rate was about 7.8 s-1. The force exerted on bonds was increased from about 11 to 22 pN; the detachment rate exhibited a twofold increase. These results agree with and extend studies on the CD2-CD48 interaction by surface plasmon resonance technology, which yielded an affinity constant of approximately 10(4) M-1 and a dissociation rate of > or = 6 s-1. It is concluded that the flow chamber technology can be an useful complement to atomic force microscopy for studying interactions between isolated biomolecules, with a resolution of about 20 ms and sensitivity of a few piconewtons. Further, this technology might be extended to actual cells

The dependence of the association rate of surface-attached adhesion molecules CD2 and CD48 on separation distance.

The kinetics of bond formation between spherical beads coated with CD48 and CD2-derivatized surfaces was studied with a flow chamber. For a given shear rate, the binding frequency was exquisitively sensitive to the particle velocity. Flow equations were used to derive the particle-to-surface distance from the velocity, thus yielding a relationship between this distance and the binding rate. Numerical values of the binding site densities allowed absolute determination of the rate of association between two individual molecules as a function of the distance between attachment points. In our model, this rate was about 0.03 s-1 at 10 nm separation, and it was inversely proportional to the cube of the distance

A normal lifestyle: parental stress and coping in childhood diabetes

This article forms part of an extensive literature review informing a study exploring the parental experience of home management of children with newly diagnosed diabetes. As a diagnosis of childhood diabetes may represent a major stressor event for parents, selected theories and models of stress and coping are discussed. These suggest that, Influenced by a variety of interpersonal and environmental factors, parents may approach the process of coping in different ways. Coping strategies employed by parents of children with diabetes elicited from the literature are categorized according to a psychological theory of stress and coping. Normalization, a coping strategy used by parents of chronically ill children, is discussed in relation to childhood diabetes. To conclude, implications for nursing practice are outlined and suggestions made about how parents may be assisted to cope with the demands of having a child with diabetes

O cuidado do paciente oncológico com dor crônica na ótica do enfermeiro El cuidado del paciente oncológico con dolor crónico en la visión del enfermero The care to cancer patients with chronic pain in the view of nurses

O objetivo deste estudo foi identificar como o enfermeiro interpreta o cuidado com o paciente oncológico com dor crônica. O estudo foi desenvolvido com oito enfermeiros de uma instituição hospitalar. Os dados foram coletados por entrevistas semi-estruturadas e na análise identificamos três categorias analíticas: a avaliação da dor crônica do paciente oncológico, a importância do cuidado multidisciplinar e as dificuldades para o cuidado do paciente. Os resultados mostram que os enfermeiros têm dificuldades em desenvolver o cuidado com o paciente devido à falta de conhecimentos específicos sobre o câncer, dor crônica e sua terapêutica, como também, nas habilidades expressivas para promoverem o apoio psicológico adequado.<br>El objetivo de este estudio fue identificar como el enfermero interpreta el cuidado para el paciente oncológico con dolor crónico. El estudio fue desarrollado con ocho enfermeros de una institución hospitalaria. Los datos fueron recolectados por entrevistas semi-estructuradas y en el análisis identificamos tres categorías analíticas: la evaluación del dolor crónico del paciente oncológico, la importancia del cuidado multidisciplinario y las dificultades para el cuidado del paciente. Los resultados muestran que los enfermeros tienen dificultades para desarrollar el cuidado con el paciente debido a la falta de conocimientos específicos con respecto al cáncer, dolor crónico y su tratamiento, como también, en las habilidades expresivas para la promoción del apoyo psicológico adecuado.<br>This study aims to understand how nurses interpret the care given to cancer patients with chronic pain. The informers were eight nurses from a public hospital. Data were collected on the basis of semi-structured interviews and the analysis identified three analytical categories: the evaluation of patients' pain, the importance of multidisciplinary care and nurses' difficulties to care for these patients. The results show that nurses have difficulties to care for such patients and need to update their specific knowledge related to cancer, chronic pain and its treatment as well as their skills to deal with emotions in order to promote adequate psychological support