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PubMed1999

Aerosol and splatter production by focused spray and standard ultrasonic inserts.

BACKGROUND: Control of contamination in the dental office has sometimes deterred practitioners from using ultrasonic scalers. Recent studies point to the aerosol and splatter produced during ultrasonic scaling as a vehicle for the possible transmission of bloodborne pathogens. A recently introduced ultrasonic insert that focuses the spray produced during scaling may reduce this aerosol contamination. An aerosol reduction device (ARD) that is attached to the ultrasonic handpiece has been shown to reduce the contamination cloud by placing suction in close proximity to the ultrasonic tip. The purpose of this study was to compare the contamination produced by a standard insert (S) and the new focused spray (F) insert with and without the use of the aerosol reduction device (ARD). METHODS: The testing was conducted in vitro within a plastic enclosure using a dye in the coolant spray. After mock scaling of a dentoform model, the number of contaminated squares on the enclosure was counted and recorded. RESULTS: Analysis of the data indicated no significant difference (P >0.05, Mann-Whitney U test) between the S or F inserts in the amount of contamination produced. When the aerosol reduction device was used, there was a significant reduction (P <0.05, Mann-Whitney U test) in the amount of contamination for both inserts with a greater reduction for the standard insert. CONCLUSIONS: The traditional style of ultrasonic insert (S) and the newer focused coolant water insert (F) produce an equal amount of aerosol contamination. The amount of aerosol contamination produced by both inserts is copious. The ARD significantly reduced contamination with both styles of inserts. These findings support the use of a large bore high-volume evacuator whenever an ultrasonic scaler is used.

Aerosols↗
PubMed2006

Effect of impact on chondrocyte viability during insertion of human osteochondral grafts.

BACKGROUND: Osteochondral grafts, used to treat chondral and osteochondral defects, require high insertional forces that may affect the viability of chondrocytes in the graft. The objectives of this study were to (1) measure the loading impact during insertion of osteochondral grafts, (2) evaluate the effect of insertional loading on chondrocyte viability, and (3) assess this effect on chondrocyte apoptosis and activation of caspase-3. METHODS: The distal parts of twelve fresh femora from six adult human cadavers were harvested within seventy-two hours after the death of the donor. From each femur, four 15-mm-diameter cylindrical osteochondral grafts were isolated; two of these grafts (a total of twenty-four grafts in the study) were transplanted with standard impact insertion into recipient sockets in the other condyle of the ipsilateral femur. The other two grafts served as unloaded controls. Loads were measured during the insertion of ten of the twenty-four transplanted grafts. Full-thickness cartilage disks were then removed from the grafts, incubated for up to forty-eight hours, and analyzed for cell viability, TUNEL (terminal deoxynucleotidyl transferase-mediated dUTP nick end labeling)-positive reactivity, and caspase-3 activation, each as a function of the depth from the articular surface. RESULTS: The insertion of an osteochondral graft was characterized, on the average (and standard deviation), by 10 +/- 4 impacts, each generating 2.4 +/- 0.9 kN of load and 13.3 +/- 4.9 MPa of stress for a duration of 0.57 +/- 0.13 ms with a 0.62 +/- 0.25 N.s impulse. Impact insertion increased cell death in the superficial 500 mum to 21% at one hour (p < 0.001) and 47% at forty-eight hours (p < 0.001) and also increased cell death in deeper layers at forty-eight hours. Some cell death was due to apoptosis, as indicated by an increase in caspase-3 activation at eight hours (p < 0.01) and TUNEL-positive cells at forty-eight hours (p < 0.05) in the superficial 500 mum of impacted cartilage. CONCLUSIONS: Impact insertion of osteochondral grafts generates damaging loads that cause chondrocyte death, particularly in the superficial zone, mainly as a result of apoptosis mediated by the activation of caspases. CLINICAL RELEVANCE: Chondrocyte death that occurs during impact insertion of osteochondral grafts may lead to compromised function. Understanding the mechanisms and consequences of such impact loading may provide insights into potential therapeutic interventions, or lead to changes in the insertion technique, to decrease the cell injury associated with impact loading.

Apoptosis↗
PubMed1997

Peripherally inserted central catheters in general medicine.

OBJECTIVE: To report the success rate and complications associated with peripherally inserted central venous catheters (PICCs) and to compare costs between PICCs and centrally inserted central catheters. MATERIAL AND METHODS: We undertook a cohort study of the first 1,000 patients referred to the PICC service of a large tertiary-care, university-affiliated, community hospital. The data were analyzed for insertion success rate, insertion mode, complication rate, successful completion, insertion costs, and applicability of PICCs in "high-risk" groups (transplant, human immunodeficiency virus-infected, intensive-care unit, and pediatric populations). RESULTS: Of 1,000 consecutive PICC attempts, 963 (96.3%) were successful. Cutdown procedures were necessary in 141 insertions (14.6%). Complications of PICC placement occurred in 170 cases (17.7%). Among the major complications were a need for multiple attempts at insertion in 92 cases, malpositioning in 56, mechanical phlebitis in 37, clotting in 37, and bleeding in 5. The rate for completion of therapy was 68.9%. Frequent reasons for early termination were dislodgment (in 85 cases) and infection (in 72-37 confirmed and 35 potential cases). The rate of confirmed infection was 11 per 10,000 catheter days. The costs of PICC insertion were less than those associated with centrally inserted central catheters. CONCLUSIONS: PICCs can satisfy long-term vascular needs and are safe in many patient populations. The infection rate did not depend on insertion mode, lumen number, or patient's immune status. Use of total parenteral nutrition was the most important risk factor in all patient subsets. Cost and safety considerations strongly favor PICCs as alternatives to other vascular access devices.

Catheterization, Central Venous↗
PubMed2002

Removal and insertion of pollinia in flowers of Oxypetalum (Asclepiadaceae) in southeastern Brazil.

Pollinarium removal and pollinium insertion of seven Oxypetalum species (O. alpinum var. alpinum, O. appendiculatum, O. banksii subsp. banksii, O. jacobinae, O. mexiae, O. pachyglossum and O. subriparium) were recorded in Viçosa. Minas Gerais. They presented a tendency of one or two pollinarium removals and one pollinium insertion (single insertion), except O. appendiculatum. In this species, mainly, two pollinia of the same pollinarium were inserted per stigmatic chamber (double insertion), resulting exceptionally in 6-10 inserted pollinia in a flower, an unusual occurrence among the Asclepiadaceae. No association between removal and insertion was found, e.g., O. subriparium and O. banksii subsp. banksii had the highest pollinarium removal (1.78 and 1.45, respectively) and one of the lowest pollinium insertions (0.02 in both species), per flower. Oxypetalum mexiae showed the lowest pollinarium removal and pollinium insertion per flower (0.09 and 0.01, respectively) among the studied species and other Asclepiadaceae. Oxypetalum subriparium, O. banksii subsp. banksii and O. mexiae might be having reproductive limitations. Pollinarium removal and pollinium insertion per flower of the studied species varied from site to site, similarly to what was recorded for other Asclepiadaceae.

Apocynaceae↗
PubMed1992

Conveyance of partial agonism/antagonism to bombesin/gastrin-releasing peptide analogues on Swiss 3T3 cells by a carboxyl-terminal leucine insertion.

Gastrin-releasing peptide (GRP) is a neuroendocrine hormone that may be involved in the pathophysiology of small cell lung carcinoma. We describe carboxylterminal peptide analogues of GRP and bombesin, a 14-residue amphibian homologue, that were modeled after the antagonist [Leu13-psi(CH2NH)-Leu14]bombesin and retained the psi bond. Three novel peptides contained a Leu insertion amino to the psi bond, i.e. ... Leu13Leu14 psi X (residues numbered after bombesin) where X = LeuNH2 or norleucine-NH2). The Leu-insertion analogues behaved as pure partial agonists/antagonists when examined for the ability to stimulate [3H]thymidine incorporation into quiescent Swiss 3T3 cells (agonist activity) and to diminish the agonist response of GRP (antagonist activity). A time course of [3H]thymidine incorporation into quiescent cells indicated maximal incorporation at 20-h post-peptide addition for bombesin and GRP and a Leu-insertion peptide, but the extent of the incorporation for the Leu-insertion peptide was half that of GRP and bombesin. The agonist dose responses of the Leu-insertion peptides (EC50 values of 1-10 nM) paralleled GRP and bombesin, but the maximal response of the Leu-insertion peptides, even at concentrations as high as 10(-4) M, was half the maximal value of GRP or bombesin. High concentrations of the Leu-insertion peptides antagonized 10 nM GRP (a concentration that produced a near-maximal GRP response) yielding a response that was half the maximal value of GRP and equivalent to the maximal response of the Leu-insertion peptides alone. Analogues of the form ... Leu13 psi X behaved as complete antagonists. The KD values of the Leu-insertion peptides for competitive binding versus 125I-GRP (2-50 nM) were as potent as parent ... Leu14 agonists. Stability studies indicated that peptide potencies for both agonist and antagonist activities diminished upon peptide incubation in medium or on cells. The results suggested that, for the Leu-insertion peptides, degradation into distinct products with different activities was not responsible for their partial agonist/antagonist behavior. Computer-generated molecular modeling studies indicated that the novel structures could adopt energy minimized conformations for either an agonist or an antagonist as proposed earlier (Coy, D.H., Heinz-Erian, P., Jiang, N.-Y., Sasaki, Y., Taylor, J., Moreau, J.-P., Wolfrey, W.T., Gardner, J.D., and Jensen, R. T. (1988) J. Biol. Chem. 263, 5056-5060).

3T3 Cells↗
PubMed2003

Insertion of intrauterine devices: a comparison of experience with Mirena and Multiload Cu 375 during post-marketing monitoring in New Zealand.

AIM: To compare the incidence of reported insertion problems with the levonorgestrel-releasing intrauterine device (Mirena) with that of the copper device Multiload Cu 375. METHODS: Prescription Event Monitoring (PEM) methodology, as used in the Intensive Medicines Monitoring Programme, was used to identify cohorts of women and record events associated with insertion. RESULTS: Data were analysed from 16 159 women receiving Multiload Cu 375 between 1991 and 2001, and 3452 women receiving Mirena between 1998 and 2001. Difficult insertion was reported more often with Mirena (RR= 2.7, 95% CI = 2.2--3.3, p <0.0001). Stratified analyses suggested this was not explained by the presence of more nulliparous women in the Mirena cohort or the non-contraceptive indications for use of Mirena. Mechanical problems with the device were reported in about 1% of Mirena insertions compared with 0.01% of Multiload Cu 375 insertions and this difference was significant (p <0.001). About 2% of Mirena insertions were performed under general anaesthetic compared with 0.1% of Multiload Cu 375 insertions. Adverse reactions to insertion, including pain and vaso-vagal reaction, were more frequent with Mirena than with Multiload Cu 375 (p <0.001). CONCLUSIONS: During the period of study, insertion of Mirena was more difficult and was associated with more device problems and adverse reactions than insertion of Multiload Cu 375.

Adolescent↗
PubMed2003

Review of peripherally inserted central catheters in the Singapore acute-care hospital.

Peripherally inserted central catheters are frequently used whenever reliable central venous access is required for a prolonged period of time. The objective of this study was to review utilisation profile, complication rates and outcomes of patients who were treated in our hospital with the therapy that required placement of the peripherally inserted central catheter. We reviewed the medical records of all patients who had peripherally inserted central catheter placed between the beginning of July and the end of October 2002. Five patients who remained hospitalised at the time of review (six weeks after the last day of study period) were excluded. Seventy-eight patients with 94 peripherally inserted central catheters were analysed in detail. Sixty-four peripherally inserted central catheters (68.1%) were placed for prolonged antibiotic therapy, 27 (28.7%) mainly to administer total parenteral nutrition and 3 (3.2%) were inserted for other reasons. Catheters were in place before removal for a mean 17.2 days. Forty-eight catheters (51.1%) were removed after completion of therapy on average 20.2 days after insertion. Complications were frequent but minor. Thirty-three catheters (35.1%) were removed due to catheter-related complications. The most common complication were phlebitis followed by accidental removal. In summary, peripherally inserted central catheters proved to be reasonably safe and a reliable way of providing therapy requiring prolonged intravenous access. Complications were frequent but relatively minor. Complication rates in our study were similar to those reported in other studies on this subject. Peripherally inserted central catheters remain a convenient and reasonable alternative to other centrally or peripherally inserted venous devices.

Acute Disease↗
PubMed2005

The marginal quality of luted ceramic inserts in bovine teeth and ceramic inlays in extracted molars after occlusal loading.

PURPOSE: To compare the marginal adaptation of adhesively luted ceramic inserts in standardized cylindrical cavities of bovine dentin and enamel with the marginal adaptation of adhesively luted ceramic inlays in extracted molars after mechanical loading, and to calculate the minimum sample size required to differentiate between material groups based on the findings of this investigation. MATERIALS AND METHODS: Ceramic inserts of similar dimension were luted in standardized cylindrical cavities of bovine dentin and enamel (n = 6, O = 4 mm) with seven different adhesive/resin cement systems (Syntac/Variolink, Prime & Bond NT/Variolink, Excite DSC/Variolink, AdheSE/Variolink, Excite DSC/Multilink, Multilink Primer/ Multilink, RelyX Unicem). The same materials were used to lute ceramic inlays (Empress II) in three-surface cavities of extracted human molars (n = 6 per group). All specimens were submitted to 2000 cycles of thermocycling. In addition, restored teeth were submitted to cyclic loading (640,000 cycles, 50 N) in a chewing simulator. Replicas after stressing were analyzed with SEM, and the percentage of continuous margin of the inserts and the inlays was calculated, differentiating the proximal part of the inlay into cervical dentin/enamel and axio-proximal enamel. The mean percentage values per material group of the insert and inlay groups were ranked using relative ranks. Sample size estimation was done for pooled standard deviations comparing between two and seven materials and assuming 20% or 10% of the mean of continuous margin to be statistically significant. RESULTS: The Spearman correlation coefficient between the variables "insert dentin" and "inlay cervical dentin" was 0.71 (p = 0.07), between "insert enamel" and "inlay axio-proximal enamel" 0.07 (p = 0.9). The variability of the test results was large for both the insert and inlay variables, especially at the resin-dentin interface. No statistically significant difference between the materials could be found for the insert method when ANOVA and Bonferroni post-hoc tests were applied (p > 0.05), while the inlays luted with Prime & Bond NT/Variolink showed significantly less continuous margin at the cervical dentin than all other groups with the exception of RelyX Unicem. At least 16 (63) inlays and 14 (57) inserts had to be used per group for differences of 20% (10%) of the mean of continuous margin. CONCLUSION: To evaluate luting agents with regard to their ability to reduce marginal discrepancies, the inlay model is inadequate due to high sample numbers which make the test time-consuming and expensive; furthermore its clinical relevance is uncertain. Alternatively, the insert method may be a suitable screening method for dentinal margins, although its clinical relevance is also unknown.

Analysis of Variance↗
PubMed1990

Biosynthesis of enterobacterial common antigen in Escherichia coli. Biochemical characterization of Tn10 insertion mutants defective in enterobacterial common antigen synthesis.

Twelve independent Tn10 insertion mutants of Escherichia coli K12 were isolated that were defective in the synthesis of enterobacterial common antigen (ECA). The mutants were identified by screening a random pool of Tn10 insertion mutants for their ECA phenotype using a colony-immunoblot assay. All 12 of the Tn10 insertion mutants were found to be located in the chromosomal region of the rff-rfe genes. Four of the Tn10 insertions were in rfe genes while the remaining eight Tn10 insertions were in rff genes. All of the rfe::Tn10 insertion mutants were defective in the synthesis of GlcNAc-pyrophosphorylundecaprenol (C55-PP-GlcNAc, lipid I), the first lipid-linked intermediate involved in ECA synthesis. Biochemical characterization of the rff::Tn10 insertion mutants revealed that they were defective in various steps of ECA synthesis subsequent to the synthesis of lipid I. These defects included: (i) the inability to synthesize UDP-ManNAcA due to Tn10 insertions in the structural genes for UDP-GlcNAc-2-epimerase (rffE) and UDP-ManNAcA (N-acetyl-D-mannosaminuronic acid) dehydrogenase (rffD), (ii) defects in the synthesis of C55-GlcNAc-ManNAcA (lipid II) due to insertion of transposon Tn10 in the structural gene for the UDP-ManNAcA transferase (rffM), (iii) the inability to synthesize TDP-Fuc4NAc (4-acetamido-4,6-dideoxy-D-galactose) due to Tn10 insertions in the structural gene for the transaminase that catalyzes the conversion of TDP-4-keto-6-deoxy-D-glucose to TDP-4-amino-4,6-dideoxy-D-galactose (rffA), and (iv) defects in steps subsequent to the synthesis of C55-GlcNAc-ManNAcA-Fuc4NAc (lipid III). In addition, a re-examination of a mutant possessing the rff-726 lesion revealed that it was defective in the synthesis of lipid III due to a defect in the structural gene for the Fuc4NAc transferase (rffT).

Acetylglucosamine↗
PubMed1988

Influence of DNA sequence on the formation of non-B right-handed helices in oligopurine.oligopyrimidine inserts in plasmids.

A systematic study was conducted on seven recombinant plasmids harboring synthetic inserts which had all purines on one strand and all pyrimidines on the complementary strand (Pur.Pyr). The inserts ranged in G+C content from 100% [G19.C19] to 0% [A20.T20] with intermediate contents at 66% [(TCC)8.(GGA)8], 50% [(CT)12.(AG)12 and (TTCC)6.(GGAA)6], 33% [(TTC)8.(GAA)8], and 25% [(GAAA)6.(TTTC)6]. The specific reactions at the base pair level of these inserts with enzymatic (S1 and P1 nucleases) and chemical (bromoacetaldehyde, OsO4, diethyl pyrocarbonate, and dimethyl sulfate) probes were evaluated as influenced by pH, negative supercoiling, and ionic strength (NaCl). Supercoil-induced relaxation studies using two-dimensional gels also provided important conformational information. We conclude that the five inserts with 66-25% G+C adopt a non-B right-handed conformation which is stabilized by negative supercoiling. Low pH (pH values 4.5-5.0) tends to stabilize this structure but is not essential for its formation. Surprisingly, an end bias of reactivity from the center toward the 5'-end of the purine strand of these inserts was generally found for the enzymatic and chemical probes which was irrespective of the orientation of the insert in the pRW790 vector. An intramolecular triple-stranded model for the unusual structure of the insert accounts most favorably for these observations. Unexpectedly, the A20.T20 insert seems to remain in an orthodox right-handed B-conformation under all conditions tested. The G19.C19 insert does adopt a non-B right-handed structure as for the five inserts with 66-25% G+C, but the pattern of reactivities and hence its conformation is different.

Base Sequence↗
PubMedDate not supplied

[Advantages and disadvantages of IUD insertion immediately after abortion].

In 672 women the interval insertion of intrauterine contraception devices (IUD) was applied: Lippes loop D in 138 women. In 530 women the insertion was applied immediately after artificial abortion: Lippes loop C in 390 and Lippes loop D in 140 cases. Data on the effectiveness of intrauterine contraception were biostatistically treated. One- and two-year gross cumulative rates of pregnancy were 4.4 and 6.4, respectively 3.7 and 6.3 for the interval insertion of Lippes loop C and D, and 2.1 and 4.5, respectively 4.2 and 11.2 for the postabortion insertion of the same devices. Two-year cumulative rates of spontaneous expulsions of 18.5 and 8.1 for interval insertions were significantly higher than in the group of women in whom the insertion of the same devices was performed immediately after abortion and in whom these rates were 11.1 and 5.9. The removal of intrauterine contraception devices because of bleeding and pain, or because of both, with the rates of 6.4 and 3.2 in 100 women after a two-year use, was less frequent in the group of women in whom interval insertion was performed than in the group of postabortion insertions with the corresponding rates of 7.3 and 9.9, respectively. To prevent repeated abortions, a frequent use of postabortion IUD insertion is recommended. Only when an intensified bleeding is expected, it is advisable to postpone insertion at least until the first menstruation.

Abortion, Induced↗
PubMed1980

Intrauterine device termination rates and the menstrual cycle day of insertion.

World-wide clinicians apparently prefer to insert the intrauterine device (IUD) during the bleeding phase of the menstrual cycle. To examine the benefits and risks of inserting IUDs at various times during the menstrual cycle, data on over 9000 women having copper T-200 IUD insertions were analyzed. During the first 2 months after IUD insertion: 1) rates of IUD expulsion are lower the later in the menstrual cycle ;he IUD is inserted; 2) rates of IUD removal for pain and bleeding and rates of accidental pregnancy, are higher the later in the menstrual cycle IUD is inserted, particularly after day 17. The present analysis suggests that the above are probably causal associations. It is estimated that 1000 insertions before day 11 will result in 9 more terminations of IUD use for expulsion, pain and bleeding, and accidental pregnancy than if the insertions are done after day 11. Furthermore, the copper T-200 IUD can be inserted with relative safety on the day it is requested if the woman's history indicates that she is unlikely to be pregnant. There is no justification for a blanket policy of inserting IUDs only during the menses.

Adult↗
PubMed1996

[Intraoperative and postoperative insertion control of anterior cruciate ligament-plasty. A radiologic measuring method (quadrant method)].

The best proximal insertion for an ACL graft is an anatomic insertion. The anatomic landmarks of this insertion area are well known, but it is sometimes difficult to find these anatomic landmarks during the operation. Thus, it is desirable to have an objective method to control the insertion. This study was undertaken because no description is available how you can localize the projection of the anatomic ALC insertion exactly in an X-ray picture. We dissected ten human cadaveric knees with intact ACLs. The most ventral, dorsal, distal and proximal borders of the insertion area were marked with 4 K-wires. The K-wires were shortened exactly on the bone border of the intercondylar space. Then the knees were X-rayed in a strictly lateral position. Thus, the shortened ends of the K-wires determined the projection of the ACL insertion in the X-ray picture. The center of this marked area was called point K. Then we determined 4 distances in the X-ray picture: distance t: the sagittal diameter of the lateral condyle, measured along the Blumensaat line distance h: the maximal height of the notch distance a: the distance between K and the dorsal border of the condyle, measured along t distance b: the distance between t and K, measured on a perpendicular line on t Distance a is a partial distance of t and distance b is a partial distance of h. Because of varying projection factors and varying knee sizes, absolute values of these distances are not helpful. This is the reason why we expressed a and b as a proportion of t and h. Distance a was measured 24.8% of distance t. Distance b was measured 28.5% of distance h. The maximal deviation of a and b was 2.2% and 2.5%. Therefore, you can say: In a strictly lateral X-ray picture the distance of K (midpoint of proximal ACL insertion) from the dorsal border of the condyle is 24.8% of the whole diameter of the condyle, and the distance of K from the roof of the notch is 28.5% of the notch-height. This method does not depend on the size of the knee and the distance between the X-ray unit and the knee. The only condition is that the X-ray of the knee must be strictly lateral. This method is easy to handle and is reproducible. It can be used intraoperatively if the surgeon is not sure about the right insertion or if the anatomic landmarks cannot be seen exactly. It can be used postoperatively for documentation of the right position of the substitute. It can be used to find out the possible reason for rupture of a transplant (insertion too ventral) before the revision operation.

Anterior Cruciate Ligament↗
PubMed1997

Insertional editing in isolated Physarum mitochondria is linked to RNA synthesis.

The mitochondrial RNAs of Physarum polycephalum are edited efficiently by nucleotide insertion both in vivo and in isolated mitochondria. Our recent studies have demonstrated that nucleotide addition can occur within 14-22 nt of the 3' end of a nascent RNA, suggesting that insertional editing may be linked to transcription. To investigate the relationship between these processes, we have examined the effects of nucleotide concentration on templated and nontemplated nucleotide addition in isolated mitochondria. At very low CTP concentrations, transcription and editing proceed with high fidelity, but the efficiency of cytidine insertional editing decreases. Insertion of single uridine and dinucleotides is not diminished under conditions that yield unedited or partially edited C insertion sites, indicating that editing events occur independently of one another. Moreover, analysis of partially edited RNA demonstrates that single nucleotides can be added at dinucleotide insertion sites. Importantly, pulse-chase experiments indicate that nontemplated nucleotides are not inserted into previously synthesized RNA once editing conditions are restored, although RNA downstream of the unedited region is edited efficiently. This result indicates that insertional editing cannot occur posttranscriptionally under these conditions, and suggests that there is only a small "window of opportunity" in which nucleotide insertion can occur. Our data are consistent with an editing activity that functions in a strictly 5' to 3' direction and adds nucleotides at, or close to, the 3' end of nascent RNA in association with the transcription complex. Several possible models for the mechanism of insertional editing in Physarum are discussed.

Animals↗
PubMed1998

Inducing labor with a sustained-release PGE2 vaginal insert. Experience at a community hospital.

OBJECTIVE: To determine the safety of initiating labor using a sustained-release prostaglandin E2 (PGE2) vaginal insert at a nonuniversity-based community hospital. STUDY DESIGN: Data were compiled from a chart review of all cases in which the insert (Cervidil) was used during a 16-month period. Continuous uterine activity and fetal heart rate (FHR) tracings were evaluated for 12 hours after dosing. The onset of regular uterine contractions or of active labor and the reason for any premature removal of the insert were sought. RESULTS: Regular contractions ensued in 62 (35.8%) of 173 pregnancies. Primary reasons for removal of the insert in 59 (34.1%) cases were active labor (38), ruptured membranes (11), uterine hyperstimulation (7) and a nonreassuring FHR tracing. The average time from insertion until premature removal was 5.7 +/- 1.3 (SD) hours (95% confidence interval, 3.3-8.2). The insert fell out in nine (5.2%) cases. Cesarean delivery for failed labor induction was necessary in five (2.9%) cases. All immediate neonatal outcomes were reassuring. Following inservice training, nurses were capable of inserting and removing the insert. CONCLUSION: This PGE2 vaginal insert, administered and removed by attending nurses, is associated with very low rates of uterine hyperstimulation and failed induction. Premature removal of the insert occurred in 34.1% of cases.

Administration, Intravaginal↗
PubMed1998

The incidence of blood contamination of lead unit dose containers with and without single-use protective inserts used with commercially prepared radiopharmaceutical unit doses.

OBJECTIVE: This investigation evaluated the effectiveness of disposable plastic inserts in radiopharmaceutical unit dose lead containers (pigs) in preventing the distribution of doses in blood-contaminated containers. Technologists commonly dispose of the syringes by placing them into the lead pigs, leaving the needles uncapped. This process raises the question of unsuspected blood contamination of these pigs. Consequently, the distribution of commercially prepared radiopharmaceutical doses in reusable lead pigs may result in radiopharmaceutical doses being distributed in containers that are contaminated with blood. METHODS: Using a simple chemical wipe test designed to determine the presence or absence of blood contamination, 618 pigs from commercial radiopharmacies throughout the U.S. were tested for contamination. The inside of the pigs and inserts, if present, were wiped before and after dose administration. Of the pigs tested, 292 came from radiopharmacies that used a protective, disposable plastic insert inside the pig, and 326 came from radiopharmacies that did not use an insert. RESULTS: Of those pigs without the protective disposable inserts, 39.3% arrived in the nuclear medicine department in pigs contaminated with blood. Of those pigs with inserts, 1% arrived with blood-contaminated inserts. After dose administration, 46.3% of the pigs without inserts were contaminated with blood and 3% of the protective inserts were contaminated. CONCLUSION: The proper use of disposable plastic inserts reduces the possibility of distributing radiopharmaceutical unit doses in containers contaminated with blood.

Blood↗
PubMed2026

Systematic mapping of insertion-tolerant regions enables capsid engineering of an infectious RNA phage.

RNA phages are attractive platforms for the design of programmable bioparticles, but their development has been constrained by limited knowledge of genomic sites that can tolerate sequence insertion. Here, we combined MuA transposase-mediated in vitro insertion mutagenesis with our established reverse genetics systems to systematically identify insertion-tolerant regions (ITRs) in the RNA phages MS2 and PP7. Screening of 4,555 MS2 and 2,228 PP7 random insertion clones identified 29 and 26 non-redundant ITRs, respectively. We further analyzed and compared these ITRs in the context of RNA genome organization and virion architecture. Both phages contained ITRs within the maturation protein, whereas only PP7 tolerated insertions within the coat protein (CP). On the basis of structural location and plaque-forming capacity, an ITR situated between Gly74 and Glu75 (GGC^GAG) in the PP7 CP was selected for further study. Infectious phage particles generated from complementary DNA clones retained the 15-bp insertion at both the RNA and protein levels. Engineered PP7 phages carrying an Arg-Gly-Asp motif inserted into the CP at this ITR displayed enhanced in vivo clearance in a Drosophila model, despite having in vitro stability comparable to that of the wild type. These findings provide the first example of CP engineering in an infectious RNA phage and establish a framework for engineering RNA phages for biological and biotechnological applications.IMPORTANCEA major obstacle to developing RNA phages as synthetic biology platforms is the lack of design principles for genomic insertion. Here, we address this limitation by establishing a mutagenesis-and-recovery workflow that systematically identifies insertion-tolerant regions (ITRs) in the RNA phages MS2 and PP7. The resulting maps reveal distinct structural constraints in the two phages and enable rational engineering of a peptide-display site in the PP7 capsid. Using this approach, we generated an engineered infectious phage with a modified capsid, thereby providing the first demonstration of capsid engineering in an infectious RNA phage, to our knowledge. This study lays the groundwork for the rational design of live RNA phage virions as tractable and engineerable scaffolds for future biological and biotechnological applications.

Animals↗
PubMed1996

Clinical outcomes of two early postpartum IUD insertion programs in Africa.

Postpartum IUD insertion programs are new to Africa and few have been carefully evaluated. Also, data on the clinical outcomes of postpartum IUD insertions using the Copper T 380A IUD are sparse. Therefore, we conducted a study to evaluate introductory postpartum IUD programs using the Copper T 380A IUD in Kenya and Mali. Postpartum IUD acceptors in Kenya (n = 224) and Mali (n = 110) were interviewed at baseline and at 1, 3, amd 6 months after delivery. We compared expulsion, medical removal, and discontinuation rates by insertion characteristics in each country. Six-month cumulative expulsion rates were lower for immediate insertions (those within 10 minutes of placental delivery) than for late insertions (generally between 10 minutes and 72 hours after placental delivery) in both Kenya (0.01 vs 0.05) and Mali (0.15 vs 0.27). Medical removals occurred in 1% and 7% of Kenyan and Malian acceptors, respectively, while pelvic infections were rare in both countries (< or = 2%). Differences in 6-month cumulative discontinuation rates between immediate and late insertions were not significant in either Kenya (0.05 vs 0.07) or in Mali (0.24 vs 0.32). This study suggests that postpartum IUD insertions can be performed safely with acceptable expulsion rates in African settings. Previous studies of other IUDs showed that expulsion rates are lower for immediate insertions compared with late postpartum insertions. This study suggests that these findings can be extended to the Copper T 380A IUD.

Adult↗