Referrals to a facial pain service

AIM: To assess the quality of referral letters to a facial pain service and highlight the key requirements of such letters. METHOD: The source of all referral letters to the service for five years was established. For one year the information provided in 94 referrals was assessed. Using a predetermined checklist of essential information the referral letters were compared to these set criteria. RESULTS: The service received 7,001 referrals and, on average, general dental practitioners (GDPs) referred 303 more patients per year than general medical practitioners (GMPs). Seventy-one percent of all referrals were from primary care practitioners, the rest were from specialists. Over 70% of GMP and 52% of GDP letters included a past medical history, with GMPs more likely to suggest a possible diagnosis and include previous secondary care referrals. The mean score for GMP referrals compared to the standard proforma (maximum of 12) was 5.6 and for GDP referrals 5.0. A relevant drug history was included by 75.6% GMP compared to 38.7% of GDPs. GMPs were more likely to include any relevant mental health history. CONCLUSIONS: The overall quality of referral letters is low which makes it difficult for the specialists to provide robust treatment plans

A Notch updated

Cell–cell signaling mediated by the Notch receptor is iteratively involved in numerous developmental contexts, and its dysregulation has been associated with inherited genetic disorders and cancers. The core components of the signaling pathway have been identified for some time, but the study of the modulation of the pathway in different cellular contexts has revealed many layers of regulation. These include complex sugar modifications in the extracellular domain as well as transit of Notch through defined cellular compartments, including specific endosomes

Herbage nutritive value of binary- and multi-species swards relative to single-species swards in intensive silage systems

peer-reviewedThe nutritive value of sown binary- and multi-species grassland mixtures may differ from the values expected based on single-species swards of their constituent species. Field plots were established in a split-plot design to assess the nutritive value of binary- and multi-species mixtures compared to single-species swards of three grass species and red clover (RC) (Trifolium pratense L.) managed for intensive silage production. The nutritive value of grass–legume binary mixtures reflected the values of the constituent species grown on their own, and thus may be predicted from monoculture values. The relatively low digestibility (dry matter digestibility [DMD]) and crude protein (CP) content of the Italian ryegrass (Lolium multiflorum L.) sward compared to perennial ryegrass (Lolium perenne L.) and timothy (Phleum pratense L.) suggests that it may have a limited role in binary- or multi-species swards. Herbage nutritive value in the multi-species swards (Mix 1: perennial ryegrass, timothy, RC and white clover [Trifolium repens L.]; Mix 2: perennial ryegrass, timothy, RC, ribwort plantain [Plantago lanceolata L.] and chicory [Cichorium intybus L.] ) appeared to be influenced more by the presence of legumes than herbs. Compared to perennial ryegrass, the multi-species swards had a slower rate of DMD decline prior to Cut 1, but subsequently had lower DMD values at the mid-season harvests. Both multi-species mixtures exhibited DMD, water-soluble carbohydrate (WSC) and CP values that would not have been predicted from their constituent species and thus need to be measured on herbage from field plots growing these mixtures

Protein O-fucosyltransferase 1 (Pofut1) regulates lymphoid and myeloid homeostasis through modulation of Notch receptor ligand interactions

Notch signaling is essential for lymphocyte development and is also implicated in myelopoiesis. Notch receptors are modified by O-fucosylation catalyzed by protein O-fucosyltransferase 1 (Pofut1). Fringe enzymes add N-acetylglucosamine to O-fucose and modify Notch signaling by altering the sensitivity of Notch receptors to Notch ligands. To address physiologic functions in hematopoiesis of Notch modified by O-fucose glycans, we examined mice with inducible inactivation of Pofut1 using Mx-Cre. These mice exhibited a reduction in T lymphopoiesis and in the production of marginal-zone B cells, in addition to myeloid hyperplasia. Restoration of Notch1 signaling rescued T lymphopoiesis and the marrow myeloid hyperplasia. After marrow transfer, both cell-autonomous and environmental cues were found to contribute to lymphoid developmental defects and myeloid hyperplasia in Pofut1-deleted mice. Although Pofut1 deficiency slightly decreased cell surface expression of Notch1 and Notch2, it completely abrogated the binding of Notch receptors with Delta-like Notch ligands and suppressed downstream Notch target activation, indicating that O-fucose glycans are critical for efficient Notch-ligand binding that transduce Notch signals. The combined data support a key role for the O-fucose glycans generated by Pofut1 in Notch regulation of hematopoietic homeostasis through modulation of Notch-ligand interactions