Perspectives on next steps in classification of oro-facial pain - part 2: role of psychosocial factors

This study was initiated by a symposium, in which the present authors contributed, organised by the International RDC/TMD Consortium Network in March 2013. The purpose of the study was to review the status of biobehavioural research - both quantitative and qualitative - related to oro-facial pain (OFP) with respect to the aetiology, pathophysiology, diagnosis and management of OFP conditions, and how this information can optimally be used for developing a structured OFP classification system for research. In particular, we address representation of psychosocial entities in classification systems, use of qualitative research to identify and understand the full scope of psychosocial entities and their interaction, and the usage of classification system for guiding treatment. We then provide recommendations for addressing these problems, including how ontological principles can inform this process

The attitudes and experiences of families with death determination in the home

The purpose of this study is to describe the attitudes and experiences of family members with respect to death determination practices for the terminally iii clients of home care agencies. A sample of family 53 members in Southeast Michigan returned survey questionnaires. The findings indicate that police and emergency medical technicians most frequently respond to the call when a person with a terminal illness has died. Fifty percent of the family members reported feeling sad, 35 percent reported feeling relieved and 18 percent of the respondents felt angry about the arrival of multiple personnel. Feelings of anger were signficantly associated with the absence of a nurse at the time of death, the use of lights and sirens, disrespectful personnel and the arrival of multiple personnel. Feelings of anger were also significantly associated with continuing thoughts of the day of death by family members. Results suggest the need to rethink state and local laws in regard to death determination and to educate those most likely to respond to families sensitively. Home care agencies and hospices should also encourage attendance by nurses at the time of death.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/67059/2/10.1177_104990918900600504.pd

Primary antibiotic resistance of helicobacter pylori strains isolated from Portuguese children: a prospective multicentre study over a 10 year period.

OBJECTIVES: The aim of this study was to prospectively assess the pattern of evolution of primary resistance to antibiotics in Helicobacter pylori strains isolated from Portuguese children over a 10 year period (2000-09). METHODS: A total of 1115 H. pylori strains were tested for antibiotic susceptibility to clarithromycin, metronidazole, amoxicillin, ciprofloxacin and tetracycline. RESULTS: H. pylori strains were isolated from children and adolescents [ages 4 months-18 years (mean age 10.17 ± 4.03 years)], comprising 562 (50.4%) boys and 553 (49.6%) girls. Overall, the primary resistance rate was 34.7% to clarithromycin, 13.9% to metronidazole and 4.6% to ciprofloxacin, while 6.9% were resistant to two of these antibiotics simultaneously. Resistance to amoxicillin and to tetracycline was not detected. In general, the resistance rate was not associated with gender or the children's age. European ethnicity, when compared with an African background, was associated with clarithromycin resistance [P = 0.002; odds ratio (OR) = 0.30; 95% confidence interval (CI) 0.14-0.66], while the inverse situation was observed for metronidazole (P < 0.001; OR = 3.50; 95% CI 1.90-6.45). No significant temporal trend was noticed for resistance to clarithromycin and metronidazole, whereas ciprofloxacin and double-resistance rates have significantly increased over time (P = 0.004 and P = 0.05, respectively). CONCLUSIONS: The primary resistance rate of H. pylori strains isolated from Portuguese children to the commonly used anti-H. pylori antibiotics used is high. Additionally, the increasing trend of ciprofloxacin-resistant and double-resistant strains may compromise H. pylori eradication in a high-prevalence population

Influência do sistema de alojamento na concentração de gases de efeito estufa e amônia, em unidades de gestação de suínos.

O estudo teve por objetivo a determinação das concentrações médias de gases em granjas de gestação de suínos sujeitas a ventilação natural. Estudou-se os sistemas de alojamento em baias coletivas e gaiolas individuais, em edificações única ou separada, nos diferentes turnos de coleta (manhã ou tarde), durante a fase fisiológica de gestação. O ambiente das edificações de gestação, em Unidades de Produção de Leitões localizadas em Concórdia, Santa Catarina. foi analisado por um período de cinco semanas, em quatro unidades. As amostras de gás foram coletadas semanalmente no interior e exterior das unidades de produção, seguindo as recomendação da Metodologia Simplificada desenvolvida por ROBIN et al. (2006). Conclui-se que as concentrações gasosas no interior dos edifícios tendem a ser maiores no turno matutino, com maiores emissões gasosas verificadas. A explicação provavelmente está relacionada com o manejo das cortinas ao longo do dia, com alteração da dispersão de ar entre o interior e o exterior da edificação. Não existe influência da separação física de salas nas concentrações e emissões dos gases, comparando-se as salas analisadas

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

A classification of chronic pain for ICD-11.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4450869

Nrf2-dependent persistent oxidative stress results in stress-induced vulnerability to depression.

Stressful life events produce a state of vulnerability to depression in some individuals. The mechanisms that contribute to vulnerability to depression remain poorly understood. A rat model of intense stress (social defeat (SD), first hit) produced vulnerability to depression in 40% of animals. Only vulnerable animals developed a depression-like phenotype after a second stressful hit (chronic mild stress). We found that this vulnerability to depression resulted from a persistent state of oxidative stress, which was reversed by treatment with antioxidants. This persistent state of oxidative stress was due to low brain-derived neurotrophic factor (BDNF) levels, which characterized the vulnerable animals. We found that BDNF constitutively controlled the nuclear translocation of the master redox-sensitive transcription factor Nrf2, which activates antioxidant defenses. Low BDNF levels in vulnerable animals prevented Nrf2 translocation and consequently prevented the activation of detoxifying/antioxidant enzymes, ultimately resulting in the generation of sustained oxidative stress. Activating Nrf2 translocation restored redox homeostasis and reversed vulnerability to depression. This mechanism was confirmed in Nrf2-null mice. The mice displayed high levels of oxidative stress and were inherently vulnerable to depression, but this phenotype was reversed by treatment with antioxidants. Our data reveal a novel role for BDNF in controlling redox homeostasis and provide a mechanistic explanation for post-stress vulnerability to depression while suggesting ways to reverse it. Because numerous enzymatic reactions produce reactive oxygen species that must then be cleared, the finding that BDNF controls endogenous redox homeostasis opens new avenues for investigation

Production of drinking water using a multi-barrier approach integrating nanofiltration: a pilot scale study

A multi-barrier system was studied for the production of drinking water with high chemical and microbiological quality. The integration of nanofiltration (NF) and ultraviolet (UV) photolysis was tested at pilot scale in a surface water treatment plant. The NF membranes tested, Desal DK and NF270, allow for the production of permeates with high quality standards, although the membrane with higher molecular weight cut-off (NF270) revealed to be the best option for surface water treatment due to its higher permeability. The NF270 membrane was also efficient to deliver high quality water, even under high pollutant concentrations, making possible to operate with water recovery rates as high as 98%. Extensive studies were performed in the water treatment plant where the proposed system was tested at three locations of the drinking water production line. Seeking to achieve the best compromise between high recovery rate, high retention of chemicals and microorganisms as well as preventing operational problems (flux decline and fouling), it was found that the integrated system should be placed after the conventional sand filtration, operating at a 91% recovery rate. Under the selected conditions – TMP of 8 bar and recovery rate of 91% – it is possible to operate at constant permeability without flux decline for a period of 15 days, after which a gentle CIP procedure is recommended. Membrane fouling was also investigated and the major foulant classes identified were proteins, polysaccharides and humic acids. A cleaning protocol was also tested and the impact of each cleaning step on the recovery of permeability evaluated

Sensitization of spinal cord nociceptive neurons with a conjugate of substance P and cholera toxin

<p>Abstract</p> <p>Background</p> <p>Several investigators have coupled toxins to neuropeptides for the purpose of lesioning specific neurons in the central nervous system. By producing deficits in function these toxin conjugates have yielded valuable information about the role of these cells. In an effort to specifically stimulate cells rather than kill them we have conjugated the neuropeptide substance P to the catalytic subunit of cholera toxin (SP-CTA). This conjugate should be taken up selectively by neurokinin receptor expressing neurons resulting in enhanced adenylate cyclase activity and neuronal firing.</p> <p>Results</p> <p>The conjugate SP-CTA stimulates adenylate cyclase in cultured cells that are transfected with either the NK1 or NK2 receptor, but not the NK3 receptor. We further demonstrate that intrathecal injection of SP-CTA in rats induces the phosphorylation of the transcription factor cyclic AMP response element binding protein (CREB) and also enhances the expression of the immediate early gene c-Fos. Behaviorally, low doses of SP-CTA (1 μg) injected intrathecally produce thermal hyperalgesia. At higher doses (10 μg) peripheral sensitivity is suppressed suggesting that descending inhibitory pathways may be activated by the SP-CTA induced sensitization of spinal cord neurons.</p> <p>Conclusion</p> <p>The finding that stimulation of adenylate cyclase in neurokinin receptor expressing neurons in the spinal cord produces thermal hyperalgesia is consistent with the known actions of these neurons. These data demonstrate that cholera toxin can be targeted to specific cell types by coupling the catalytic subunit to a peptide agonist for a g-protein coupled receptor. Furthermore, these results demonstrate that SP-CTA can be used as a tool to study sensitization of central neurons in vivo in the absence of an injury.</p