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Biomedical subjects

R C Hall

Publications and source records attributed to R C Hall.

At least 37 records · Page 2Linked to original sources

Quantitative immunohistochemical evidence of a functional gradient of chondroitin 4-sulphate/dermatan sulphate, developmentally regulated in the predentine of rat incisor.

A quantitative examination was carried out on the early and mature stages of dentinogenesis in the rat incisor, using a post-embedding immunogold labelling with an anti-chondroitin 4 sulphate/dermatan sulphate antibody (2B6). At a very early stage of predentine formation, before polarizing odontoblasts have established junctional complexes, immunolabelling was weak. In contrast, when polarized odontoblasts established distal junctional complexes, immunolabelling in predentine was uniform and threefold denser than in initial predentine. The same gold particle density was found in the non-mineralized mantle dentine. During circumpulpal dentine formation, a gradient was seen in predentine, a larger number of gold particles being scored in the proximal zone compared with the distal region adjacent to the mineralization front. In circumpulpal dentine, some labelling was found within the lumen of the tubules and in the bordering dentine around the tubules. A few particles were also detected in intertubular matrix after demineralization. Together, these data provide evidence for a developmentally regulated gradient during the transition between mantle and circumpulpal dentine, and also in a more mature part of the tooth, a functional gradient that probably plays a role in the process of mineralization.

Animals↗

Transforming growth factor-beta1 (TGF-beta1) in dentine matrix. Ligand activation and receptor expression.

Transforming Growth Factor-beta (TGF-beta) and other members of this family of growth factors have been implicated in tooth development and dental tissue repair. This study aimed to investigate regulatory factors for TGF-beta1 in rabbit incisor dentine matrix and the expression of receptors for TGF-beta in dental tissues better to understand the control of its biological activity. Approximately half of the TGF-beta1 in dentine matrix was present in active form. TGF-beta1 was found in association with latency associated peptide (LAP), betaglycan and decorin in an isolated dentine matrix preparation. Immunohistochemistry showed strong staining for TGF-beta type I and II receptors in odontoblasts with more variable and weaker staining of other pulpal cells. Association of TGF-beta1 with betaglycan, decorin and LAP may regulate the availability and biological activity of this growth factor and influence its presentation to the TGF-beta type I and II receptors on odontoblasts. During dental tissue repair, such control processes will be important in regulating the biological effects of TGF-beta1 on cells of the dentine-pulp complex.

Animals↗

Investigation of calcium-binding sites on the surfaces of selected gram-positive oral organisms.

Dental plaque is rich in anionic groups with a high calcium-binding capacity which may affect mineral dynamics at the tooth surface. The two major calcium-binding sites on Gram-positive cell surfaces are carboxylate groups (in proteins and peptidoglycan cross-links) and phosphate groups (in lipoteichoic and teichoic acid). Equilibrium dialysis was used to measure calcium-binding capacities of whole cells and purified cell-wall material (CWM) from Streptococcus mutans R9, Strep. oralis EF186, Strep. gordonii NCTC 7865, Strep. downei NCTC 11391, Actinomyces naeslundii WVU627 and Lactobacillus casei AC413. This material was stripped of phosphate (PS-CWM) and treated to mask carboxylate groups (CM-CWM). Whole-cell calcium-binding capacities ranged from 240 (Strep. downei) to 50 (L. casei) mu mol/g (dry wt). Differences in CWM, PS-CWM and CM-CWM calcium-binding capacities demonstrated the greater importance of phosphate in comparison with carboxylate groups in cell calcium binding. These data indicate that, in streptococci, calcium binding is predominantly phosphate group-based, especially in the teichoic acid-containing Strep. oralis. In the other species tested, calcium binding is predominantly carboxylate group-based.

Actinomyces↗

Ethical and legal implications of managed care.

This article addresses several ethical, regulatory, and legal issues in managed care with attention to recent court cases that focus on physicians' responsibility, fiduciary duty, and the impact that these legal decisions have on physicians practicing in a managed care environment. Discussion of the impact of changes in the control of decision-making processes for physicians, the use of managed care protocols, restriction of resources, and gatekeeping systems are addressed as are the specific duties and obligations of physicians to their patients.

Cost Control↗

The use of immunohistochemistry in understanding the structure and function of the extracellular matrix of dental tissues.

The availability of monoclonal and polyclonal antibodies directed toward the recognition of epitopes in a variety of extracellular matrix components of the dentition represents a powerful tool in the investigation of the structure and biology of dental tissues in health and disease. The immunolocalization of both whole molecule structures and specific regions of molecules has the potential to yield information on tooth development, the effects of aging, changes in tooth structure during the initiation and progression of the caries process, together with the response of the tooth to restorative treatment. This review reports on current research to elucidate the role of extracellular matrices of enamel, dentin, cementum, and bone. Attention is directed at the use of antibodies toward the small leucine-rich proteoglycans such as decorin and biglycan, in addition to their glycosaminoglycan chains. Antibodies are also being developed toward dental tissue-specific macromolecules such as phosphophoryn and amelogenin; the use of these antibodies will increase our understanding of the role of these macromolecules in mineralized tissues.

Animals↗

Modification of the proteoglycans of rat incisor dentin-predentin during in vivo fluorosis.

Proteoglycans (PGs) were isolated from the dentin-predentin of fluorotic and control rat incisor teeth using demineralization in EDTA, followed by extraction with 4 M guanidinium chloride in the presence of protease inhibitors. Differences in the behaviour of fluorotic and control PG were evident during purification by anion exchange chromatography on Q-Sepharose and MONO-Q interfaced with fast protein liquid chromatography. The PG from fluorotic teeth exhibited a more anionic profile, due to changes in glycosaminoglycan characteristics, since no apparent differences were evident between the respective core proteins, both of which were 45 kDa. The constituent glycosaminoglycan chains of fluorotic dentin were of lower molecular size and showed the additional presence of dermatan sulfate and heparan sulfate by comparison to nonfluorotic controls, where only chondroitin-4-sulfate was detected.

Animals↗

The value of consultation-liaison interventions to the general hospital.

Changes in health care funding have greatly enhanced the value of consultation-liaison services to their parent hospitals. This paper reviews representative studies showing that consultation-liaison interventions improve patient care, enhance patients' satisfaction with treatment, and reduce polypharmacy, adverse drug reactions, and subsequent hospitalizations. Reductions in costs of hospitalization realized by consultation-liaison interventions are also described, including average reductions in hospital stays of one to one and a half days, upgrades in diagnosis-related group (DRG) codes, and timely patient transfers to inpatient medical-psychiatric units or inpatient psychiatric facilities. These data suggest that consultation-liaison services will become increasingly important over the next few years.

Combined Modality Therapy↗

Adsorption of bovine serum albumin onto hydroxyapatite.

The adsorption of bovine serum albumin (BSA) onto hydroxyapatite (HA) has been studied as a function of protein concentration, pH and ionic strength. Isotherm data (adsorption being a reversible process) have been analysed using the Langmuir model, the adsorption parameters AT (maximum amount of protein adsorbed, mg m-2) and K (affinity constant, L g-1) being calculated for each solution condition (except NaF). For the pH dependence of adsorption, both AT and K increase with decreasing pH, indicating that both electrostatic and hydration effects are important. For the ionic strength dependence, increasing NaCI concentrations result in a slight increase in AT, but K decreases. With increasing CaCI2 concentrations the AT and K values increase, the opposite being true for increasing concentrations of Na2HPO4. NaF both enhances and inhibits adsorption depending on the concentration. Possible reasons for these results are discussed.

Adsorption↗

Thyroid disease and abnormal thyroid function tests in women with eating disorders and depression.

Forty-two female patients with an eating disorder and major depression were compared with 48 female patients with major depression in a retrospective chart study for the prevalence of thyroid disease and laboratory thyroid function abnormalities in the absence of thyroid disease. Eating disorder patients, aged 30-80 years, had a significantly higher incidence in thyroid diseases (53%) then those with major depression alone (17%). The incidence of thyroid disease did not differ between the two groups among patients aged 11-29 years. Abnormal thyroid screening values occurred in 40% of euthyroid eating disorder patients and 34% of those with major depression. While the overall prevalence of thyroid disease in depressed females (15%) was similar to that in the general population (10.5%), thyroid disease in the eating disordered/depressed patients was twice the rate expected (24%) in the general population. Female patients who require psychiatric hospitalization should be routinely evaluated for thyroid function, especially those diagnosed with an eating disorder and depression.

Adolescent↗

Outcome assessment in depressed hospitalized patient.

Psychiatric symptoms as well as work, social, and physical functioning were compared in two groups of psychiatric patients (36 depressed only and 34 depressed in conjunction with an eating disorder) and 77 controls. In both groups, Global Assessment of Functioning (GAF) scores significantly improved from hospital admission to discharge and remained improved at 1.5 years postdischarge. As outpatients, the GAF, Zung Depression, and anxiety scores of both groups were significantly lower than for controls. Ratings of social functioning for depressed only outpatients did not differ from controls on five out of six measures. Predictors of posthospital improvement included high satisfaction with hospital treatment, high GAF scores on admission to hospital, perceived effectiveness of outpatient therapy, younger age, and an historical absence of sexual abuse or prior psychiatric hospitalization.

Activities of Daily Living↗

A modified GAF scale.

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Activities of Daily Living↗

The influence of fluoride on proteoglycan structure using a rat odontoblast in vitro system.

Using an in vitro rat incisor odontoblast system, the effect of fluoride on proteoglycans was investigated at both the metabolic and structural level. Incisors were removed from 4-week-old rats, split longitudinally, and the pulps removed. Teeth were incubated at 37 degrees C, 5% CO2 in Eagle's Minimum Essential Medium containing 35S-sulfate for 7 hours in the presence of 0 mM, 3 mM, or 6 mM sodium fluoride. Teeth were demineralized in EDTA, proteoglycan was extracted from the residue with 4 M guanidinium chloride, and further purified by anion exchange chromatography. Uptake of radiolabel was monitored by liquid scintillation counting. The resultant products were examined by cellulose acetate electrophoresis, SDS-PAGE, chondroitinase digestion, and amino acid analysis. Differential effects of fluoride were observed in both metabolism and biochemical characterization of proteoglycans following incubation at the two concentrations. Fluoride decreased uptake of the radiolabel but led to an accumulation of glycosaminoglycan within the proteoglycan of the matrix. Chondroitin sulfate was the predominant glycosaminoglycan identified, with the additional presence of dermatan sulfate and heparan sulfate identified. Dermatan sulfate levels increased in 3 mM-treated teeth. Fluoride-treated proteoglycans had a reduced molecular weight (200-90K to 180-79K); this reduction is primarily a result of smaller glycosaminoglycan chains, with limited reduction in the size of the core protein of 6 mM-treated teeth occurring. Such alterations in the biochemical metabolism and hence structure and function of proteoglycan may be implicated in the hypomineralization seen in fluorosis.

Amino Acids↗

Developing a level III/IV medical/psychiatry unit. Establishing a basis, design of the unit, and physician responsibility.

This article is part of a series defining the administrative, logistical, and funding issues necessary for the establishment of a medical/psychiatry unit. It emphasizes the experience of individuals who have developed such units and is offered in an attempt to prevent duplication of costly mistakes. Administrative issues, factors affecting the physical design of the unit, requirements for medical coverage and medical and psychiatric programmatic support, and the ethical issues encountered in managing such a unit are discussed.

Delivery of Health Care↗

Categorization of types of medical/psychiatry units based on level of acuity.

Medical/psychiatry units can be categorized by the level of acuity of medical and psychiatric illness. Type I units are categorized as those that primarily provide psychiatric care with a low level of medical acuity. Type II units include general medicine or medical subspecialty units that are associated with a psychiatric liaison service and provide low levels of psychiatric care to those admitted to the general medical setting. Type III and Type IV units are characterized by a true departure from the current ward settings and care for patients who have concurrent and more severe medical and psychiatric problems in a unified setting. Both of these units require special physical changes in the ward structure, additional nurse training, and coordinated physician coverage to function effectively.

Acute Disease↗

Quality assurance in a setting designed to care for patients with combined medical and psychiatric disease.

In an attempt to address the needs of patients with combined medical and psychiatric illness, a variety of clinical centers are now creating medical/psychiatry units. These units differ widely in their clinical capabilities, yet no adequate delineation of safeguards regarding quality of care currently exists. This article discusses minimum quality guidelines for four types of medical/psychiatry units that are based on the level of acuity of patients' medical and psychiatric disease.

Acute Disease↗

Bulimia nervosa. Four uncommon subtypes.

The histories and psychological profiles of more than 500 patients meeting DSM-III-R criteria for bulimia nervosa were reviewed. A total of 310 patients demonstrated the most characteristic pattern of bulimia, with finger-induced purging and occasional diet pill, diuretic, or laxative abuse. Seventeen patients reported binge eating with no self-induced vomiting but with severe laxative abuse (i.e., greater than or equal to 50 laxatives daily). A total of 126 patients reported bulimia with finger-induced purging and regular mild (i.e., 2-3 daily) laxative abuse. Eight patients reported bulimia without finger-induced purging, diuretic, or laxative abuse but with the regular abuse of ipecac as a means of inducing vomiting. Four clinical subtypes of bulimia were seen. These were overt bulimia, which occurred in 8.9% of the sample; obsessive-ritualistic bulimia, which occurred in 2% of the sample; sexually evocative bulimia (Fatal Attraction Syndrome), which occurred in 2.9% of the sample; and masochistic bulimia, which occurred in 4.9% of the sample. Each of these subtypes of bulimia are described and defined. The characteristic psychologic profile, clinical features, and implications for treatment and research are discussed.

Acting Out↗

Dual-purpose tube for enteroclysis and nasogastric-nasoenteric decompression.

A catheter designed for the dual purpose of nasogastric-nasoenteric decompression and enteroclysis is described. The catheter facilitates direct decompression of the obstructed small bowel and, if necessary, subsequent performance of enteroclysis. The use of this tube obviates dual intubation and its accompanying discomfort.

Catheterization↗

Rectal indomethacin.

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Administration, Oral↗