Motivational Interviewing to Improve Pediatric Dental Recall Attendance after General Anesthesia.

Purpose: To determine the effect of motivational interviewing (MI) to improve recall attendance after dental treatment under general anesthesia (GA).
Methods: The sample consisted of parents of randomly selected pediatric patients who had oral rehabilitation under GA at a children's hospital. An 18-item questionnaire that included demographics, education, language, country of birth and age was administered prior to the GA appointment. A five-minute MI phone call three months after the procedure and a second MI phone call after the first recall was conducted by a standardized interviewer. The primary outcomes were attendance at the six- and 12-month recall visits. Data were compared to a historical control group of participants who did not receive the MI phone call during the same date range.
Results: Of 100 patients, 72 participated in the first phone call and 51 participated in the second phone call. All children had public insurance. The estimated odds of a six-month recall visit for parents receiving a single motivational interview was 2.52 times (95 percent confidence interval [95% CI]=1.43 to 4.44, P =0.001) higher compared to the control. The estimated odds of a 12-month recall visit for parents receiving two motivational interviews was 2.40 times greater (95% CI=1.27 to 4.54, P =0.006) compared to the historical control.
Conclusion: A brief intervention using MI led to an improvement in attendance at both the six- and 12-month recall visits.

Advancing peptide siRNA-carrier designs through L/D-amino acid stereochemical modifications to enhance gene silencing.

The 599 peptide has been previously shown to effectively deliver small interfering RNAs (siRNAs) to cancer cells, inducing targeted-oncogene silencing, with a consequent inhibition of tumor growth. Although effective, this study was undertaken to advance the 599 peptide siRNA-carrier design through L/D-amino acid stereochemical modifications. Consequently, 599 was modified to generate eight different peptide variants, incorporating either different stereochemical patterns of L/D-amino acids or a specific D-amino acid substitution. Upon analysis of the variants, it was observed that these modifications could, in some instances, increase/decrease the binding, nuclease/serum stability, and complex release of siRNAs, as well as influence the gene-silencing efficiencies of the complex. These modifications were also found to affect cellular uptake and intracellular localization patterns of siRNA cargo, with one particular variant capable of mediating binding of siRNAs to specific cellular projections, identified as filopodia. Interestingly, this variant also exhibited the most enhanced gene silencing in comparison to the parent 599 peptide, thus suggesting a possible connection between filopodia binding and enhanced gene silencing. Together, these data demonstrate the utility of peptide stereochemistry, as well as the importance of a key D-amino acid modification, in advancing the 599 carrier design for the enhancement of gene silencing in cancer cells.

Aortic Dissection in a Pregnant Patient without Other Risk Factors.

Background. An aortic dissection is a life-threatening condition in which the intima of the artery tears causing separation of the intima and media. Pregnancy places women at a significantly increased risk of common vascular events including venous thromboembolism, myocardial infarction, and stroke, while also increasing the risk of rarer vascular events such as aortic dissection and aortic rupture. Case. A 30-year-old previously healthy multiparous woman presenting at 36 weeks of pregnancy with a Type A aortic dissection. She underwent a combined emergent cesarean delivery followed by repair of her aortic root. Conclusions. Aortic dissection should be high on the differential for pregnant patients presenting with the characteristic complaints and physical exam findings given the high mortality rate associated with this vascular event. Teaching Points. (1) This report reviews the characteristic presentation, risk factors, and physical exam findings in a patient with an aortic dissection. (2) The report includes treatment options for pregnant patients based on the classification of the dissection.

Cervical Ectopic Pregnancy: A Rare Site of Implantation.

BACKGROUND: Cervical ectopic pregnancies are rare, comprising < 1% of ectopic pregnancies, and life threatening if there is a delay in treatment or a misdiagnosis. CASE REPORT: This case report describes a presentation of cervical ectopic pregnancy. WHY SHOULD AN EMERGENCY PHYSICIAN BE AWARE OF THIS?: This case report reviews nonsurgical and surgical treatment options for patients with cervical ectopic pregnancies.

Thoracoabdominal injuries in the elderly: 25 years of experience.

BACKGROUND: The present study was conducted to determine the clinical characteristics and outcome of hospitalized elderly patients with thoracic and thoracoabdominal injuries. METHOD: This is a longitudinal, nonblinded study using established standard of care of patients with penetrating and blunt chest trauma. From April 1972 to August 1997, 5,702 patients were hospitalized for chest injuries. Out of these patients, 171 (3%) were aged 65 or above. Of these patients, 96 (56%) had blunt trauma (group 1)--motor vehicle accident in 83 (86%) and falls in 13 (14%). The remaining 75 (44%) patients had penetrating injuries (group 2)--gunshot wounds in 47 (63%) and stab wounds in 28 (37%). RESULTS: Of the blunt trauma patients, 45% (43/96), and 15% (11/75) of the penetrating trauma patients were managed by observation alone; the remainder required surgical procedures. The overall mortality was 10% (17/171), of which mortality among penetrating and blunt trauma to the chest were 12% (9/75) and 8% (8/96), respectively. Of eight deaths due to blunt trauma, six had multiple (four or more) rib fractures. There were no deaths among the 54 patients who were simply observed, and none of them required surgery at a later date. Complication rate among the survivors was 12.3%, with only 0.4% being infectious. CONCLUSIONS: Mortality was highest among the elderly with penetrating chest trauma. Mortality was high because of cardiac and great vessel injuries in group 2, whereas multiple rib fractures and brain injuries were the higher cause of mortality in group-1 patients. Infectious complications were low among the survivors.