Preoperative assessment for children requiring dental treatment under general anesthesia.

OBJECTIVE: This study aimed to describe children <6 years requiring general anesthesia for dental treatment and factors associated with a change in medical management prior to surgery. STUDY DESIGN: This case series reviewed the past medical history and preoperative assessment of patients referred for dental preoperative evaluations at a single institution (2005-2008). A "deflection" was defined as a recommendation to change preoperative or operative care based on the preoperative assessment. The sample was analyzed using descriptive, bivariate, and multivariate analyses. RESULTS: Of 648 subjects (aged 9 months to 6 years, mean 3.9 years), 63% had a past medical history abnormality and 38% had previous surgery. In total, 14% were deflected, most commonly because of the addition of infective endocarditis prophylaxis (29%). A history of coagulation disorder had the strongest association with deflection (P < .0001, odds ratio = 10.0, 95% confidence interval = 4.6-22.1), followed by cardiac anomalies. CONCLUSION: Preoperative assessments for pediatric dental treatment frequently identify medical problems resulting in treatment plan alterations.

GDNF and GFRalpha-1 are components of the axolotl pronephric duct guidance system.

In mammals, secretion of GDNF by the metanephrogenic mesenchyme is essential for branching morphogenesis of the ureteric bud and, thus, metanephric development. However, the expression pattern of GDNF and its receptor complex-the GPI-linked ligand-binding protein, GFRalpha-1, and the Ret tyrosine kinase signaling protein-indicates that it could operate at early steps in kidney development as well. Furthermore, the developing nephric systems of fish and amphibian embryos express components of the GDNF signaling system even though they do not make a metanephros. We provide evidence that GDNF signaling through GFRalpha-1 is sufficient to direct pathfinding of migrating pronephric duct cells in axolotl embryos by: (1) demonstrating that application of soluble GFRalpha-1 to an embryo lacking all GPI-linked proteins rescues PND migration in a dose-dependent fashion, (2) showing that application of excess soluble GFRalpha-1 to a normal embryo inhibits migration and that inhibition is dependent upon GDNF-binding activity, and (3) showing that the PND will migrate toward a GDNF-soaked bead in vivo, but will fail to migrate when GDNF is applied uniformly to the flank. These data suggest that PND pathfinding is accomplished by migration up a gradient of GDNF.

Elongation of axolotl tailbud embryos requires GPI-linked proteins and organizer-induced, active, ventral trunk endoderm cell rearrangements.

Application of phosphatidylinositol-specific phospholipase C to early tailbud stage axolotl embryos reveals that a specific subset of morphogenetic movements requires glycosylphosphatidylinositol (GPI)-linked cell-surface proteins. These include pronephric duct extension, "gill bulge" formation, and embryonic elongation along the anteroposterior axis. The work of Kitchin (1949, J. Exp. Zool. 112, 393-416) led to the conclusion that extension of the notochord provided the motive force driving anteroposterior stretching in axolotl embryos, elongation of other tissues being a passive response. We therefore conjectured that axial mesoderm cells might display the GPI-linked proteins required for elongation of the embryo. However, we show here that removal of most of the neural plate and axial and paraxial mesoderm prior to neural tube closure does not prevent elongation of ventrolateral tissues. Tissue-extirpation and tissue-marking experiments indicate that elongation of the ventral trunk occurs via active, directed tissue rearrangements within the endoderm, directed by signals emanating from the blastopore region. Extension of both dorsal and ventral tissues requires GPI-linked proteins. We conclude that elongation of axolotl embryos requires active cell rearrangements within ventral as well as axial tissues. The fact that both types of elongation are prevented by removal of GPI-linked proteins implies that they share a common molecular mechanism.

Morphogenesis of the axolotl pronephric duct: a model system for the study of cell migration in vivo.

Pronephric duct (PND) morphogenesis is a critical early event in the development of the vertebrate excretory system. This structure is the exit channel for both pronephric and mesonephric filtrate, forms the ureteric bud of the metanephros and gives rise to the ductus deferens of the testis. In addition, the PND and ureteric bud epithelia induce terminal differentiation of the mesonephric and metanephric mesenchyme, respectively. Elongation of the PND in all vertebrates involves active cell migration of the primordium. In urodele embryos--unlike in some anuran, avian and mammalian embryos--elongation of the PND occurs solely by cell migration. In the axolotl embryo, the PND primordium segregates as an ovoid tissue mass from the anterodorsal flank mesoderm directly beneath somites 3-7. The primordium then extends caudally along the ventral border of the developing somites until it reaches the cloaca. The ease with which these embryos can be manipulated microsurgically makes the PND system ideal for the study of the mechanisms controlling cell migration in vivo. This review summarizes the progress that has been made in characterizing the environmental cues and the cell surface recognition systems that drive this tightly regulated migration event.

The epidermis is a source of directional information for the migrating pronephric duct in Ambystoma mexicanum embryos.

In the urodele Ambystoma mexicanum, the pronephric duct (PND) is formed from a coherent group of cells that migrate from the pronephros to the cloaca along a pathway immediately ventral to the developing somites. The guidance cues used by the migrating PND primordium to find the cloaca are a local property of the migration substratum, are temporally regulated, and are both polarized and oriented. Since the pronephric duct migrates between two tissues--the underlying lateral mesoderm and the overlying epidermis--we performed a study to identify the tissue(s) in which PND guidance cues originate. Through direct manipulation of the epidermis overlying the duct pathway, we show that the migrating PND reads epidermally derived cues (1) along the anterior-posterior axis that direct migration from anterior to posterior and (2) along the dorsal-ventral axis that constrain migration to the duct pathway. Heterochronic grafting experiments reveal that the ability to direct PND migration is a stable property of flank epidermis throughout the period of PND migration. Epidermal cues are, therefore, not responsible for the observed temporal restrictions on PND migration. Thus, the region of the embryo within which the advancing PND tip can migrate actually represents an area where two distinct but required sets of PND migration cues overlap. The epidermis overlying the duct pathway provides directional information; temporal restriction of duct migration is hypothesized to be a property of the flank mesoderm.

Polyribosome targeting to microtubules: enrichment of specific mRNAs in a reconstituted microtubule preparation from sea urchin embryos.

A subset of mRNAs, polyribosomes, and poly(A)-binding proteins copurify with microtubules from sea urchin embryos. Several lines of evidence indicate that the interaction of microtubules with ribosomes is specific: a distinct stalk-like structure appears to mediate their association; ribosomes bind to microtubules with a constant stoichiometry through several purification cycles; and the presence of ribosomes in these preparations depends on the presence of intact microtubules. Five specific mRNAs are enriched with the microtubule-bound ribosomes, indicating that translation of specific proteins may occur on the microtubule scaffolding in vivo.

Three populations of migrating amphibian embryonic cells utilize different guidance cues.

Previous investigations designed to identify the molecule(s) governing the directed migration of the amphibian pronephric duct (PND) revealed a requirement for a glycosyl phosphatidylinositol (GPI)-linked cell surface molecule, possibly the ectoenzyme alkaline phosphatase (AP). Cranial neural crest cells (CNC) grafted to the flank migrate along the same pathways as the PND, suggesting that PND and CNC guidance systems might have a common molecular basis. Both PND and CNC migration pathways display AP. The present experiments demonstrate, however, that GPI-linked molecules on these pathways are not required for migration of either cell type. Because PND cells themselves express AP prominently but CNC cells do not, we asked whether the GPI-linked molecule required for PND migration resides on the PND cells themselves. Treatment of PND cells with phosphatidylinositol-specific phospholipase C, an enzyme that removes GPI-linked proteins, prevents their migration. Transplantation experiments show that although CNC cells are capable of following PND migration pathways, the converse is not the case. Extension of the transplantation experiments to include trunk neural crest (TNC) cells indicates that although CNC cells can follow PND guidance information on the flank, PND, CNC, and TNC cells all normally utilize different molecular cues to guide their migrations in situ.

Identification and characterization of the poly(A)-binding proteins from the sea urchin: a quantitative analysis.

Poly(A)-binding proteins (PABPs) are the best characterized messenger RNA-binding proteins of eucaryotic cells and have been identified in diverse organisms such as mammals and yeasts. The in vitro poly(A)-binding properties of these proteins have been studied intensively; however, little is known about their function in cells. In this report, we show that sea urchin eggs have two molecular weight forms of PABP (molecular weights of 66,000 and 80,000). Each of these has at least five posttranslationally modified forms. Both sea urchin PABPs are found in approximately 1:1 ratios in both cytoplasmic and nuclear fractions of embryonic cells. Quantification in eggs and embryos revealed that sea urchin PABPs are surprisingly abundant, composing about 0.6% of total cellular protein. This is 50 times more than required to bind all the poly(A) in the egg based on the binding stoichiometry of 1 PABP per 27 adenosine residues. We found that density gradient centrifugation strips PABP from poly(A) and therefore underestimates the amount of PABP complexed to poly(A)+ RNA in cell homogenates. However, large-pore gel filtration chromatography could be used to separate intact poly(A)-PABP complexes from free PABP. Using the gel filtration method, we found that the threefold increase in poly(A) content of the egg after fertilization is paralleled by an approximate fivefold increase in the amount of bound PABP. Furthermore, both translated and nontranslated poly(A)+ RNAs appear to be complexed to PABP. As expected from the observation that PABPs are so abundant, greater than 95% of the PABP of the cell is uncomplexed protein.