GMC revises guidelines.
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Acquired Immunodeficiency Syndrome↗
Biomedical subjects
S Clark
Publications and source records attributed to S Clark.
Complaints. Telling examples.
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Data Collection↗
Professional attitudes to specialisation and minor oral surgery in general dental practice.
A questionnaire was distributed to the general dental practitioners of Grampian Region to investigate their perception of the need, the advantages and disadvantages, qualifications and location, of a 'specialist' or 'specialist' practice in minor oral surgery. A 92% response rate was achieved. Nearly nine out of ten practitioners believed there was a need for such a 'specialist' with 85% being willing to refer to one. Up to 48% would refer more patients for minor oral surgery than they do at present. They envisaged reduced patient waiting and improved convenience as the main advantages of such a service. The patient paying for treatment and post-operative complications are perceived as the major disadvantages. The type of procedures that the practitioners expect a 'specialist' to undertake is as expected, although only 75% expect implants to be undertaken. Most practitioners, 86%, would prefer if the 'specialist' worked in a 'specialist' only practice. Other alternative venues would be viewed favourably with the 'specialist' working in another dental practice being the least favourable. Nearly nine out of ten practitioners believe that a qualification is necessary for such a 'specialist' and if a minor oral surgery qualification was introduced 73% of practitioners would regard it as the most appropriate qualification. Many practitioners in principle would attempt to gain it, 82% of practitioners would refer their private patient to a specialist with this qualification.
Attitude of Health Personnel↗
The patient's view of minor oral surgery in dental practice.
A recent audit of patients who underwent minor oral surgery within their own general dental practice confirms that treatment performed in this environment can have a high level of patient satisfaction. This article reports the results of the audit and explores the reasons why the patients chose to receive treatment in this way.
Apicoectomy↗
Current issues in management of thromboses.
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Animals↗
Minor oral surgery 'specialisation' in general dental practice.
A practitioner with 4 years' hospital oral surgery experience undertook minor oral surgery procedures within a general dental practice over a 4-year period. The variety of work completed is shown. The National Health Service fees for the procedures indicate that a practice limited to minor oral surgery is both practically and financially viable when referral fees and x-rays are included. Differences in the types of procedure undertaken by visiting 'specialist' practitioners and 'specialist' practices is highlighted. A population of 310,000 is suggested for a 'specialist' practice in minor oral surgery to be feasible.
Apicoectomy↗
Macrophage foam cells from experimental atheroma constitutively produce matrix-degrading proteinases.
Monocyte-derived foam cells figure prominently in rupture-prone regions of atherosclerotic plaques. Peripheral blood monocytes in culture can produce certain enzymes that degrade extracellular matrix, known as matrix metalloproteinases (MMPs). Lipid-laden macrophages may thus contribute to weakening of extracellular matrix of rupture-prone atherosclerotic plaques. However, the spectrum and regulation of MMP production by foam cells remain unknown. To investigate this issue, we isolated lipid-laden macrophages from rabbit aortic lesions produced by a combination of hypercholesterolemia and balloon injury. Freshly isolated aortic macrophage foam cells, identified using cell-specific antibodies, contained immunoreactive stromelysin and interstitial collagenase, whereas alveolar macrophages isolated from the lungs of same rabbits did not. Macrophages from both tissue sources released gelatinolytic activity consistent with the 92-kDa gelatinase. In vitro, lipid-laden aortic macrophages, but not alveolar macrophages, synthesized de novo and released immunoprecipitable stromelysin and collagenase, with or without stimulation by phorbol ester or bacterial lipopolysaccharide. These stimuli caused foam cells to release additional gelatinolytic activity that migrated faster than a purified preparation of 92-kDa gelatinase in substrate-containing polyacrylamide gels, indicating activation of the 92-kDa gelatinase or induction of the 72-kDa gelatinase. Our results show that lipid-laden macrophages elaborate MMPs capable of degrading the major constituents of vascular extracellular matrix even without further stimulation. Therefore, these cells may contribute to remodeling of the extracellular matrix during atherogenesis and to the disruption of plaques often responsible for acute clinical manifestations of atherosclerosis.
Animals↗
Increased phosphorylation of focal adhesion kinase in diabetic rat kidney glomeruli.
Altered extracellular matrix production by the glomerular mesangium is a feature of diabetes mellitus. Matrix proteins, including fibronectin, via interaction with cell-surface receptors (the integrins) may activate intracellular pathways such as prostaglandin production, shown previously to be stimulated by addition of fibronectin to glomerular cores. However, the signalling pathways involved are unclear. An intracellular tyrosine kinase (focal adhesion kinase), associated with focal adhesions, is known to be phosphorylated after interaction with matrix proteins. We now show for the first time, in glomeruli from diabetic rats, that focal adhesion kinase has increased phosphorylation on tyrosine, when compared with non-diabetic control rats. This phosphorylation was labile and disappeared with extended time of sample preparation or digestion of glomeruli to glomerular cores. Cultured mesangial cells, from non-diabetic rats, plated onto fibronectin also showed increased tyrosine phosphorylation of focal adhesion kinase accompanied by a twofold increase in prostaglandin production. However, it may not be possible to replicate fully the diabetic ¿state¿ in vitro merely by use of raised glucose concentrations, as these conditions (for 3 weeks) resulted in decreased focal adhesion kinase phosphorylation, despite increased fibronectin and prostaglandin levels. A role for increased focal adhesion kinase phosphorylation in kidney glomeruli isolated from diabetic rats, and any linkage to intracellular signalling pathways remains to be determined.
Animals↗
Glucose-induced phosphorylation and activation of a high molecular weight cytosolic phospholipase A2 in neonatal rat pancreatic islets.
Previous studies have shown that stimulus-secretion coupling for the release of insulin from the pancreatic islet is potentiated by phospholipase A2 activity. Several biochemically distinct phospholipase A2 activities have been described in the islet. A recently identified cytosolic high molecular weight phospholipase A2, which requires Ca2+ for association with cellular membranes but not for catalytic activity can be activated in a protein kinase C-dependent manner in other cell-types. We determined its phosphorylation and activation in response to phorbol ester and glucose in cultured islet cells from neonatal rats. Islet cell monolayers were labelled to equilibrium with [32P]orthophosphate. Following stimulation cytosolic phospholipase A2 was immunoprecipitated and, after electrophoretic separation and transfer to nitrocellulose membrane, 32P-labelled protein was detected by autoradiography. Phospholipase A2 activity of islet cell cytosol was determined by hydrolysis of exogenous I-stearyl- 2[14C]arachidonyl phosphatidylcholine substrate. It could be shown that phosphorylation of immunoprecipitated phospholipase A2 was augmented by prolonged glucose exposure (> 1 hr) in a protein kinase C-dependent manner. Phosphorylation occurred concomitant with a glucose-induced increase in total cellular phospholipase A2 activity (177 +/- 3 nmol substrate hydrolysed/mg protein at glucose 5.6 mM vs 267 +/- 32 (SEM, n = 4) at glucose 25 mM, P < 0.05). Both acute protein kinase C (459 +/- 71) and glucose-activated phospholipase A2 activities were reduced in the presence of a specific arachidonic acid analogue inhibitor of cytosolic phospholipase A2 (to 231 +/- 10 and 161 +/- 17, respectively).(ABSTRACT TRUNCATED AT 250 WORDS)
Animals↗
Treatment of major aortic graft infection: preliminary experience with total graft excision and in situ replacement with a rifampicin bonded prosthesis.
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Aged↗
Factors affecting microbiological colony count accuracy for bioaerosol sampling and analysis.
The effects of the following variables on the occurrence of colony masking (the indistinguishable merging or overlap of sufficiently close colonies) were evaluated experimentally using the bacterium Bacillus subtilis: spore density on a collection surface, concentration of nutrients in the culture medium, sample incubation time, and ability of an observation system to distinguish overlapped colonies. Increasing spore surface density and incubation time increased colony masking, whereas lowering nutrient concentration decreased colony diameter and, therefore, masking but also limited spore germination and growth. Overall, full-strength medium was best for accurate counting of early microcolonies examined with the aid of a microscope, whereas half- or quarter-strength medium was better for counting older readily observable macrocolonies. Masking bias was determined for varying spore surface densities and colony diameters and was applied to two widely used slit-to-agar bioaerosol impactors. Appropriate collection times have been determined for these samplers to minimize colony masking for expected bioaerosol concentrations. It was found, for example, that 6-min samples collected from an environment with an air concentration of 10(3) CFU m-3 would result in colony surface densities, for 3-mm colonies, of 1.5 and 3.9 microorganisms cm-2 for the two samplers with respective masking biases of < 10% and < 20%.
Aerosols↗
Influence of the physical form of barley grain on the digestion of its starch in the human small intestine and implications for health.
It has been suggested that incomplete digestion of cereal starch explains the low energy values of certain cereals of large particle size. We used human subjects with ileostomies to investigate the digestion of barley and to determine whether the physical form of barley affects stomal excretion of starch, glucooligosaccharides, nitrogen, fat, and calculated energy. Only 2 +/- 1% of starch remained undigested after finely milled barley was eaten, but after flaked barley was eaten 17 +/- 1% resisted digestion, partly as oligosaccharides (G1-G10) but largely as intact unpitted starch granules bound by intact cell walls. The calculated energy excretion from the stoma was three times higher after flaked than after milled barley [51.5 decreasing to 15.3 kJ/g nonstarch polysaccharide (NSP, P < 0.001]. NSP, starch, and fat made almost equal contributions to the higher energy excretion. It is concluded that possibly the botanical source of cereals and certainly processing, other than retrogradation of the starch, are important determinants of starch digestibility and energy value. Possible clinical implications are introduced.
Adult↗
The potential effect on Neisseria gonorrhoeae of the use of clindamycin vaginal cream in the empirical treatment of vaginal discharge.
The minimum inhibitory concentrations (MIC) of clindamycin for 62 consecutive isolates of Neisseria gonorrhoeae were found to be 0.03-4 mg/L; the MIC50 and MIC90 were 0.125 and 2.0 mg/L respectively. Seven women treated with clindamycin vaginal cream had cervical mucus samples taken after seven days treatment. The concentrations of clindamycin achieved in the cervical mucus were 30-150 times higher (141-337 mg/L) than the highest MIC of the 62 N. gonorrhoeae isolates. Clindamycin vaginal cream is being used increasingly in Genitourinary Medicine clinics and General Practice for the treatment of bacterial vaginosis. This study shows that clindamycin vaginal cream achieves intra cervical concentrations that are high enough to inhibit N. gonorrhoeae. Empirical use of this therapy should be preceded by urethral and cervical swabs for N. gonorrhoeae in any woman at risk of gonorrhoeae.
Anti-Bacterial Agents↗
Salmonella typhimurium displays normal invasion of mice with defective epidermal growth factor receptors.
The role of the epidermal growth factor (EGF) receptor in cell invasion by Salmonella typhimurium was examined in vitro and in vivo by using waved-2 mice which express an EGF receptor with reduced kinase activity. S. typhimurium invaded fibroblasts from waved-2 mice as efficiently as fibroblasts from wild-type control animals. In vivo, S. typhimurium both invaded the gastrointestinal tract and penetrated through to the spleen of waved-2 mice. Our studies suggest that the EGF receptor has only a limited role, if any, in cell invasion by S. typhimurium.
Animals↗
Chronic diarrhoea associated with Septata intestinalis.
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AIDS-Related Opportunistic Infections↗
A case cluster of possible tissue invasive gonorrhoea.
OBJECTIVE: To describe a cluster of patients presenting with severe symptoms and infected with an unusual strain of Neisseria gonorrhoeae. SETTING: A north London Department of Sexual Health. PATIENTS: Five patients were linked by reported sexual contact or other epidemiological evidence as part of a cluster of gonococcal infection. Cultured N gonorrhoea were subtyped by serological (serovar) and cultural (auxotype) methods and antibiotic sensitivities measured by minimum inhibitory concentration (MIC). RESULTS: Four of the patients had severe gonorrhoea-related systemic or extragenital symptoms: disseminated gonococcal infection with oligoarthritis (1 patient), acute pelvic inflammatory disease (1 patient, who was also chlamydia positive) and tender inguinal adenopathy (2 patients). The fifth patient was asymptomatic. N gonorrhoeae was isolated in four of the patients. All four organisms had identical MICs. Three of the organisms were subtyped and found to be the same rare strain (serovar 1A1, auxotype NR). CONCLUSION: This case cluster provides evidence for strain-related virulence in an uncommon gonococcal subtype.
Adult↗
Neuromuscular dysfunction following eccentric exercise.
This study examined the effects of exercise-induced muscle damage on tremor and proprioception components of neuromuscular function. Six male and six female volunteers (aged 18-30 yr) performed 50 maximal eccentric muscle actions using the forearm flexors of the nondominant arm. Forearm flexor tremor and perception of voluntary force and joint position were monitored to assess changes in neuromuscular function. Data were analyzed using REANOVA. Serum creatine kinase activity increased from a baseline value of 68 +/- 13 IU.l-1 to 2849 +/- 852 IU.l-1 5 d after exercise (P < 0.05). This was accompanied by prolonged impaired joint range of motion (P < 0.01) and reduced maximum strength (P < 0.01). Muscle soreness peaked 3 d postexercise (P < 0.01; Wilcoxon test). Tremor amplitude was increased (P < 0.01) until 48 h after exercise, whereas the power frequency spectrum was unaffected. Perception of joint position at elbow angles of 1.57 rad (P < 0.01) and 2.09 rad (P < 0.05) and perception of force (P < 0.01) were significantly impaired when the control arm acted as the reference. Joint positions were more accurately reproduced when the experimental arm acted as its own reference. The increase in tremor amplitude and loss of proprioceptive function in the days after damage-inducing eccentric exercise suggest significant impairment of neuromuscular function.
Adolescent↗
Recognition, assessment, and treatment of anxiety in the critical care patient.
A multidisciplinary group of experts involved in the treatment of critically ill patients participated in a workshop conference designed to develop practice recommendations for the recognition, assessment, and treatment of anxiety in the critical care environment. Anxiety was identified as a ubiquitous problem in critical care that may interfere with healing and recovery. The faculty agreed that clinicians should be familiar with the signs and symptoms of anxiety and should be able to determine when interventions are necessary. Whenever possible, nonpharmacologic methods for anxiolysis should be incorporated into intensive care protocols. Intensive care personnel should be trained in those interventions that require specialized expertise, and they should become familiar with the drugs available for the treatment of anxiety. Protocols for determining the best agents to be used in a given setting and their most appropriate method of administration should be established. Pharmacologic and nonpharmacologic treatments are not mutually exclusive but should be complementary. Finally, procedures for obtaining psychiatric consultation, when necessary, should be in place.
Adaptation, Psychological↗