[Improving the effectiveness of local anesthesia in patients with arterial hypertension in the provision of emergency dental care]. / Povyshenie effektivnosti mestnogo obezbolivaniya u patsientov s arterial'noi gipertenziei pri okazanii neotlozhnoi stomatologicheskoi pomoshchi.

THE AIM OF THE STUDY: Was to evaluate the use of Ketorol Express as a preventive analgesia to increase the effectiveness of local anesthesia in providing emergency dental care to patients with arterial hypertension. MATERIALS AND METHODS: The study was conducted on the basis of the state autonomous healthcare institution of the Moscow region «Royal Dental Clinic¼ with the participation of 83 people. The patients were divided into two groups. In group 1, Ketorol Express was prescribed as a preventive analgesia in a dosage of 20 mg before local anesthesia. Patients of group 2 underwent dental interventions without the use of preventive analgesia. A 3% solution of mepivacaine was used as a local analgesic solution. For a subjective assessment of the effectiveness of anesthesia, use a visual analog scale. All patients had their blood pressure and heart rate measured before and after the interventions and hemodynamic parameters were continuously monitored during emergency dental care. RESULTS: In group 1, the effectiveness of combined anesthesia with the infiltration method of local anesthetic administration was 93±1.17%, according to the patient, 94±1.47%, according to the doctor, with the conductive method of anesthesia at the mandibular orifice - according to the patient it was 91±1.01%, according to the doctor 92± 1.36%. In group 2, when providing emergency dental care with the infiltration method of administration of 3% mepivacaine the anesthesia was effective in 80±1.97% of cases according to the patient and in 80±1.17% of cases according to the doctor, with the conductive method of anesthesia at the mandibular orifice, the effectiveness of anesthesia according to the patient was 82±1.11%, according to the doctor 85±1.23%. CONCLUSION: The results of the study demonstrated a statistically significant increase in the effectiveness of local anesthesia performed with a 3% solution of mepivacaine in patients with arterial hypertension due to the use of preventive analgesia with Ketorol Express at a dosage of 20 mg (2 tablets of 10 mg) in emergency dental care with registration and analysis of changes in hemodynamic parameters.

[Pain syndrome correction after teeth whitening]. / Korrektsiya bolevogo sindroma pri otbelivanii zubov.

THE AIM OF THE STUDY: Was to develop an algorithm for the correction of pain syndrome using the drug Ketorol Express depending on the level of situational and personal anxiety of patients during office teeth whitening. MATERIALS AND METHODS: The study involved 60 people (mean age 25±0.85 years), who were divided into three groups depending on the level of personal and situational anxiety according to the Spielberger scale modified by Yu. L. Khanin. In the first group of patients with a high level of anxiety Ketorol Express was prescribed as a preventive analgesia before the whitening procedure, then the drug was used in case of pain. In the second group, patients with an average level of anxiety the drug was prescribed immediately after the whitening procedure, and then used in the event of a pain syndrome. The third group of patients with a low level of anxiety took the drug only in case of pain. To assess the severity of pain, the general well-being by the patient and the general well-being by the doctor, visual analogue scales were used. RESULTS: The study showed that the occurrence and correction of pain syndrome during teeth whitening depends on the patient's psycho-emotional state (both personal and situational anxiety). CONCLUSION: The developed regimen for prescribing Ketorol Express can significantly reduce pain in patients with different levels of anxiety.

[Preventive analgesia for the improvement of local anesthesia efficacy in treatment of acute pulpitis in molars]. / Ispol'zovanie preventivnoi anal'gezii dlya povysheniya effektivnosti mestnogo obezbolivaniya pri lechenii ostrykh pul'pitov molyarov.

THE AIM OF THE STUDY: Was the assessment of the efficacy of using non-steroidal anti-inflammatory drug Ketorol Express as a preventive analgesia in the treatment of acute pulpitis in molars. MATERIALS AND METHODS: The study comprised 128 individuals, 76 (59.4%) women and 52 (40.6%) men. The mean age was 37.4 years. Two different visual-analog scales were used to evaluate the effectiveness of pain relief and the general well-being of the patient and the doctor. THE RESULTS: Of the study proved that the preventive analgesia with Ketorol Express at a dosage of 20 mg 15 minutes before local anesthesia with 4% articaine with epinephrine 1:200 000 in patients diagnosed with acute pulpitis of molars was effective since local anesthesia high effectiveness, absence of necessity for alternate anesthesia were registered by patients, which coincided with the dentist's opinion. CONCLUSION: Preventive analgesia with Ketorol Express improves the efficacy of local anesthesia in the treatment of acute pulpitis in molars.

[Comparative effectiveness of periodontal methods of anesthesia in the treatment of dental caries]. / Kliniko-funktsional'noe issledovanie effektivnosti i bezopasnosti primeneniya parodontal'nykh sposobov obezbolivaniya pri lechenii kariesa zubov.

AIM: The analysis of the criteria for predicting the effectiveness and safety of the use of periodontal anesthesia methods in the treatment of dental caries was carried out. MATERIALS AND METHODS: The study involved 78 patients: 41 women and 37 men aged from 25 to 56 years without severe somatic pathology, who needed treatment for dental caries. Intraligamental and modified periodontal anesthesia using a 4% articaine solution with different concentrations of vasoconstrictor were used as methods of anesthesia. The «method of the local injection anesthesia of the tooth pulp evaluating¼ was used during the modified periodontal and intraligmental anesthesia which determines the criteria for predicting the effectiveness and safety of the planned anesthesia and which is based on determining the functional parameters of the tooth pulp such as electrical excitability and microcirculation. RESULTS: The obtained results demonstrated the high efficiency and safety of the modified periodontal anesthesia with 4% articaine with epinephrine 1:200 000, which is easier to use and does not require specialized equipment. CONCLUSION: Modified periodontal anesthesia is safe and effective for the treatment of dental caries.

[Pain relief by Ketorol Express after oral surgery procedures]. / Kupirovanie bolevogo sindroma preparatom Ketorol Ekspress posle stomatologicheskikh vmeshatel'stv, soprovozhdayushchikhsya travmoi tkanei.

The aim of the study was providing rationale for using a new form of Ketorol Express for pain relief in outpatient dental practice. The study comprised 85 patients with an average age of 43.2 years, who were prescribed a three-day course of Ketorol Express therapy after a complex traumatic tooth extraction. Three different visual-analog scales were used to assess the severity of pain, the patient's General well-being, and the doctor's General well-being. After treatment with dispersed Ketorol Express tablets, the severity of the pain syndrome decreased from 4 to 1.8 points within three days. Anesthesia occurred on average in 10 minutes. This therapy was safe and well tolerated. There were no one serious adverse events, and no one patient stopped therapy due to side effects.

[Out-patient dental care in patients with arterial hypertension]. / Osobennosti okazaniia ambulatornoi stomatologicheskoi pomoshchi patsientam s arterial'noi gipertenziei.

The aim of the study was to improve dental treatment quality in patients with arterial hypertension. The study included 256 patients with arterial hypertension (153 females, 103 males) aged 35 to 60 years. Anesthesia efficacy was assessed by visual analog scale after treatment. Oral adverse effects caused by regular intake of antihypertensive drugs and interrelation with articaine and mepivacaine were described. The study proved high efficacy of 4% articaine 1:200 000. The efficacy of 3% mepivacaine with no vasoconstriction agents was 86.4±2.3% but may be enhanced to 93.3±2.3% by preventive non-steroid anti-inflammatory agents taken 25-30 minutes before treatment in maximal daily dosage.

[Local anesthesia selection algorithm in patients with concomitant disease. Part 2.] / Algoritm okazaniya stomatologicheskoi pomoshchi patsientam s soputstvuyushchei patologiei. Chast' 2.

A group of authors presents the rationale for local anesthesia selection in patients with concomitant disease based on case history; interaction analysis of drugs with local anesthetic and sedation agents; estimation of patient functional status; patient anxiety correction; dental care with hemodynamics monitoring. It was found that adhering to this algorithm promotes the prevention of urgent conditions in outpatient settings.

Local anesthesia selection algorithm in patients with concomitant somatic diseases. / Algoritm okazaniya stomatologicheskoi pomoshchi patsientam s soputstvuyushchei patologiei. Chast' 1.

The paper presents basic principles of local anesthesia selection in patients with concomitant somatic diseases. These principles are history taking; analysis of drugs interaction with local anesthetic and sedation agents; determination of the functional status of the patient; patient anxiety correction; dental care with monitoring of hemodynamics parameters. It was found that adhering to this algorithm promotes prevention of urgent conditions in patients in outpatient dentistry.

[The choice of local anesthesia for patients with hypertension in dental practice].

The study involved 153 patients (92 females, 61 males aged 30-75 years) with arterial pressure from 120/80 to 180/100 mm Hg. The role of dentist in primary diagnosis of hypertension was identified. The study highlights the need for functional status assessment before dental treatment and the importance of safe and effective local anesthesia for the patients with arterial hypertension. The paper presents rationale for the choice of local anesthetic agent for these patients.

Sonometric measurements of motor-neuron-evoked movements of an internal feeding structure (the radula) in Aplysia.

In many systems used to study rhythmic motor programs, the structures that generate behavior are at least partially internal. In these systems, it is often difficult to directly monitor neurally evoked movements. As a consequence, although motor programs are relatively well characterized, it is generally less clear how neural activity is translated into functional movements. This is the case for the feeding system of the mollusk Aplysia. Here we used sonomicrometry to monitor neurally evoked movements of the food-grasping organ in Aplysia, the radula. Movements were evoked by intracellular stimulation of motor neurons that innervate radula muscles that have been extensively studied in reduced preparations. Nevertheless our results indicate that the movements and neural control of the radula are more complex than has been assumed. We demonstrate that motor neurons previously characterized as radula openers (B48) and closers (B8, B15, B16) additionally produce other movements. Moreover, we show that the size of the movement evoked by a motor neuron can depend on the preexisting state of the radula. Specifically, the motor neurons B15 and B16 produce large closing movements when the radula is partially open but produce relatively weak closing movements in a preparation at rest. Thus the efficacy of B15 and B16 as radula closers is context dependent.

The neuromuscular transform: the dynamic, nonlinear link between motor neuron firing patterns and muscle contraction in rhythmic behaviors.

The nervous system issues motor commands to muscles to generate behavior. All such commands must, however, pass through a filter that we call here the neuromuscular transform (NMT). The NMT transforms patterns of motor neuron firing to muscle contractions. This work is motivated by the fact that the NMT is far from being a straightforward, transparent link between motor neuron and muscle. The NMT is a dynamic, nonlinear, and modifiable filter. Consequently motor neuron firing translates to muscle contraction in a complex way. This complexity must be taken into account by the nervous system when issuing its motor commands, as well as by us when assessing their significance. This is the first of three papers in which we consider the properties and the functional role of the NMT. Physiologically, the motor neuron-muscle link comprises multiple steps of presynaptic and postsynaptic Ca(2+) elevation, transmitter release, and activation of the contractile machinery. The NMT formalizes all these into an overall input-output relation between patterns of motor neuron firing and shapes of muscle contractions. We develop here an analytic framework, essentially an elementary dynamical systems approach, with which we can study the global properties of the transformation. We analyze the principles that determine how different firing patterns are transformed to contractions, and different parameters of the former to parameters of the latter. The key properties of the NMT are its nonlinearity and its time dependence, relative to the time scale of the firing pattern. We then discuss issues of neuromuscular prediction, control, and coding. Does the firing pattern contain a code by means of which particular parameters of motor neuron firing control particular parameters of muscle contraction? What information must the motor neuron, and the nervous system generally, have about the periphery to be able to control it effectively? We focus here particularly on cyclical, rhythmic contractions which reveal the principles particularly clearly. Where possible, we illustrate the principles in an experimentally advantageous model system, the accessory radula closer (ARC)-opener neuromuscular system of Aplysia. In the following papers, we use the framework developed here to examine how the properties of the NMT govern functional performance in different rhythmic behaviors that the nervous system may command.

Optimization of rhythmic behaviors by modulation of the neuromuscular transform.

We conclude our study of the properties and the functional role of the neuromuscular transform (NMT). The NMT is an input-output relation that formalizes the processes by which patterns of motor neuron firing are transformed to muscle contractions. Because the NMT acts as a dynamic, nonlinear, and modifiable filter, the transformation is complex. In the two preceding papers we developed a framework for analysis of the NMT and identified with it principles by which the NMT transforms different firing patterns to contractions. We then saw that, with fixed properties, the NMT significantly constrains the production of functional behavior. Many desirable behaviors are not possible with any firing pattern. Here we examine, theoretically as well as experimentally in the accessory radula closer (ARC) neuromuscular system of Aplysia, how this constraint is alleviated by making the properties of the NMT variable by neuromuscular plasticity and modulation. These processes dynamically tune the properties of the NMT to match the desired behavior, expanding the range of behaviors that can be produced. For specific illustration, we continue to focus on the relation between the speed of the NMT and the speed of cyclical, rhythmic behavior. Our analytic framework emphasizes the functional distinction between intrinsic plasticity or modulation of the NMT, dependent, like the contraction itself, on the motor neuron firing pattern, and extrinsic modulation, independent of it. The former is well suited to automatically optimizing the performance of a single behavior; the latter, to multiplying contraction shapes for multiple behaviors. In any case, to alleviate the constraint of the NMT, the plasticity and modulation must be peripheral. Such processes are likely to play a critical role wherever the nervous system must command, through the constraint of the NMT, a broad range of functional behaviors.

Control of time-dependent biological processes by temporally patterned input.

Temporal patterning of biological variables, in the form of oscillations and rhythms on many time scales, is ubiquitous. Altering the temporal pattern of an input variable greatly affects the output of many biological processes. We develop here a conceptual framework for a quantitative understanding of such pattern dependence, focusing particularly on nonlinear, saturable, time-dependent processes that abound in biophysics, biochemistry, and physiology. We show theoretically that pattern dependence is governed by the nonlinearity of the input-output transformation as well as its time constant. As a result, only patterns on certain time scales permit the expression of pattern dependence, and processes with different time constants can respond preferentially to different patterns. This has implications for temporal coding and decoding, and allows differential control of processes through pattern. We show how pattern dependence can be quantitatively predicted using only information from steady, unpatterned input. To apply our ideas, we analyze, in an experimental example, how muscle contraction depends on the pattern of motorneuron firing.

Functional uncoupling of linked neurotransmitter effects by combinatorial convergence.

Physiological signaling pathways both diverge and converge-a single neurotransmitter can have multiple effects and multiple transmitters can have the same effects-in the same target cell. Divergence couples the effects of a transmitter together in a relatively fixed ratio. Different physiological circumstances may require a different ratio, however; the coupling must be made modifiable. This can be achieved through convergence. If two transmitters couple the effects in different ratios, then combinations of the transmitters can yield all intermediate ratios of the effects, thus functionally uncoupling them. This mechanism is analyzed in a well-understood, simple invertebrate neuromuscular circuit.

Myocardial adaptation to long-term action of substances associated with decreased intensity of cardiac function.

The effect of prolonged treatment of rats with 6-n-propyl-2-thiouracil (PTU), verapamil, or propranolol on cardiac pump function and the properties of myofibrils and mitochondria was studied. After 6-8 weeks of treatment, the heart rate and maximal cardiac output of the isolated heart of rats treated with verapamil or propranolol were higher than those in the control group. The PTU treatment was followed by lower heart rate and maximal work. Calcium sensitivity (pCa50 value) of skinned ventricular fibers was higher in all experimental groups compared to the control by 0.07-0.15 units. Myofibrillar Mg2+, Ca(2+)-ATPase activity measured in isolated Triton-skinned cardiomyocytes was considerably lower after PTU treatment than that in respective controls (0.128 +/- 0.013 vs 0.178 +/- 0.010 mumol Pi/min/mg protein). In contrast, long-term treatment with verapamil or propranolol was accompanied by increased activity to 0.223 +/- 0.018 and 0.254 +/- 0.015 mumol Pi/min/mg protein, respectively. Neither the basal mitochondrial respiration rate of saponin-skinned cardiac fibers nor its enhancement after addition of low ADP concentration or creatine was significantly altered in any experimental group. Also no difference between control and experimental groups was observed in the total activity of creatine kinase or relative percentage of its isoenzymes extracted from cardiac tissue. Thus the changes in cardiac pump function after prolonged treatment with agents decreasing cardiac function may be attributed to concomitant alterations of myofibrils while mitochondria remain relatively intact.

[The effect of alpha 1-stimulation and lithium on the calcium sensitivity of hyperpermeable myocardial fibers in the rat]. / Vliianie al'fa 1-stimuliatsii i litiia na kal'tsievuiu chuvstvitel'nost' giperpronitsaemykh volokon miokarda krysy.

Effects of alpha 1-adrenoagonist phenylephrine (PhE) and lithium, an inhibitor of inositolmonophosphatase, on calcium sensitivity of hyperpermeable rat myocardial fibers were studied. In the presence of propranolol, PhE reduced calcium sensitivity, and this effect was enhanced as calcium concentration was being increased during stimulation with PhE. This appears to relate to an activation of protein kinase C by calcium. LiCl also decreased calcium sensitivity of fibers. This result partially can be explained by a direct effect of Li+ on myofibrils. A combination of PhE and LiCl decreased calcium sensitivity even more, but the effect of PhE in this case was less expressed than in the absence of LiCl. Prasozin, an alpha 1-adrenoblocker, prevented from the effect of PhE both in the presence and in the absence of lithium, thus indicating that stimulation of alpha 1-adrenoceptors was involved in the effects of PhE and lithium observed in this study.