Modelling clinical decision-making in triage of referrals for extraction.

Introduction: Oral surgery services are progressively moving out of traditional hospital departments and into primary care. This necessitates accurate methods of triaging referrals, so patients of varying complexity are managed in the most suitable environment. The latest NHS commissioning proposal identifies 'level 1' procedures as simple extractions which do not require referral. We developed a model for quantifying how accurately these simple extractions can be predicted from information in standard referral letters. Methods: Experienced clinicians (N = 10) were independently asked to predict whether extractions (N = 25) were likely to be simple-forceps or surgical procedures, from information provided in specially developed standardised referral letters. One oral surgeon had previously completed all extractions. The triaging clinicians were asked to comment on reasons for each decision and state their level of confidence in their predictions. Results: Only 67% (range 52­76%) of extractions were correctly predicted as either simple or surgical with a significant propensity to underestimate the complexity of surgical extractions rather than overestimating simple procedures (p <0.05). High levels of confidence reported by the clinicians in their decisions correlated with more accurate predictions (p <0.05). Conclusions: This is the first attempt to develop a model for clinical decision-making in oral surgery triage services. Our findings suggest there is significant scope for improvement and highlight areas for development.

Synthesis and 1H NMR studies of 3-(D-erythro-glycerol-1-yl)-1H-pyrazolo[3,4-b]quinoxaline and its 7-chloro and 7-methyl analogues.

3-(D-erythro-Glycerol-1-yl)-1H-pyrazolo[3,4-b]quinoxaline and its 7-chloro and 7-methyl analogues (11 and 12) were prepared from the corresponding quinoxalines. The 7-substituted analogues 11 and 12 were obtained as the preponderant isomers, and the 6-substituted analogues as the minor isomers. The structure and position of the substituent were determined by 1H NMR studies. The effect of substitution on the chemical shift of other protons is discussed.

Synthesis of structured lipids and etherlipids with antioxidants: combination of a selena fatty acid and a selena fatty alcohol with a carotenoic acid in glyceride molecules.

Selenium and carotenoids show similar and complementary properties and protect against a variety of pathological processes. Mixtures of both compounds are found in nutritional supplements and are used to prevent several diseases. The synthetic connection of carotenoids with selenium in glycerols may increase the chemopreventive activity of the individual compounds. Beta-apo-8'-carotenoic acid and 7-selenacapryloic acid were esterified with glycerol to highly unsaturated stable di- and triglycerides. Intramolecular selenium:carotenoid ratios of 1:1, 2:1 and 1:2 were obtained for 1-(7-selenaoctanoyl)-3-(3beta-apo-8 -carotenoyl)-glycerol, 1,3-di-(beta-apo-8'-carotenoyl)-2-(7-selenaoctanoyl)-glycero l and 1,2-di-(7-selenaoctanoyl)-3-(beta-apo-8'-carotenoyl)-glycero l, respectively. The carotenoic acid was likewise connected to the pharmacologically interesting 11-selenalaurylglycerolether forming an alkyl-acylglyceride: 1-(11-selenadodecyl)-3-(beta-apo-8'-carotenoyl)-glycerol.

Expression of TNF and the 55-kDa TNF receptor in epidermis, oral mucosa, lichen planus and squamous cell carcinoma.

UNLABELLED: TNF has diverse biological effects including a role in the immune response and growth regulatory effects. OBJECTIVES: The aim of this study was to determine the nature and location of cells able to synthesise and respond to TNF in oral mucosa in health and disease. MATERIALS AND METHODS: The location of immunoreactive TNF and 55-kDa and 75-kDa TNF receptors was demonstrated using immunohistology. We also used RT-PCR to help determine the sites of synthesis of this cytokine in oral mucosa. RESULTS: Only occasional TNF-positive cells were detected in normal epidermis and oral mucosa. However, this cytokine was found throughout the epithelia in oral lichen planus, leukoplakia and squamous cell carcinoma (SCC). The possible cellular sources and biological effects of TNF in these disease processes is discussed. The 55-kDa TNFR was expressed at the cell membrane throughout the epidermis, but confined to the lower cell layers on oral mucosa. Ten of 22 SCC did not express this receptor. A significant correlation was observed between the velocity of tumour growth and absence of TNF receptors. CONCLUSIONS: The growth inhibitory and immunoregulatory effects of TNF may be modulated by changes in receptor expression and alterations in synthesis of this cytokine in a subgroup of oral SCC.