Evaluation of a Curved Design Rubber Bristle Interdental Cleaner on Patients with Gingivitis.

Purpose: The purpose of this clinical study was to evaluate the effectiveness of a curved rubber bristle interdental cleaner, as compared to dental floss, in the reduction of gingivitis and plaque.Methods: Gingival Index (GI), Bleeding on Probing (BOP), Periodontal Probing Depth (PPD) and Modified QH Plaque Index (MQH-PI) parameters were evaluated in an examiner-masked, parallel group, controlled clinical study. A total of 50 participants with gingivitis (no site with PPD >4 mm, BOP ≥10% but ≤50%) met the eligibility criteria. Participants were randomly assigned to either the curved rubber bristle interdental cleaner (cRBIC) group or the ADA-accepted dental floss (Floss) group. Participants used the devices for four weeks. Parameters were obtained at 2 and 4 weeks. Participants scored their level of product familiarity, satisfaction and motivation for interdental cleaning.Results: There were no statistically significant differences between the two groups in changes from baseline to 2 or 4 weeks in GI, BOP%, and MQH-PI. However, cRBIC group showed greater reduction of PPD at 4 weeks from baseline, compared with Floss group (p<0.05). The cRBIC group showed overall better compliance level than Floss group. The mean score of "ease of use" of the cRBIC group was significantly greater than that of Floss group. However, Floss group showed higher levels of "satisfaction" than cRBIC group. Motivation for interdental cleaning was higher in cRBIC.Conclusion: The cRBIC was similar to Floss in clinical effectiveness; however, PPD reduction at 4 weeks was greater with the cRBIC. Ease of use of cRBIC may have affected the participants' motivation for interdental cleaning, resulting in better compliance.

Are Nursing Students Appropriate Partners for the Interdisciplinary Training of Surgery Residents?

BACKGROUND: Interdisciplinary team training in a simulation center recreates clinical team interactions and holds promise in improving teamwork of clinicians by breaking down educational silos. The objective of our study was to assess the appropriateness of interdisciplinary training with general surgery residents and nursing students. METHODS: Over 2 consecutive academic years (2012-2013 and 2013-2014), general surgery residents participated in interdisciplinary team-training simulation-based sessions with senior nursing students. Scenario objectives included demonstration of appropriate teamwork and communication, and clinical decision making; sessions incorporated interdisciplinary debriefing of the scenarios. Participants were asked to assess their team-training experience and the appropriateness of their team-training partner. Responses were compared. RESULTS: A total of 16 team-training sessions were conducted during the study period. Overall, 12 surgery residents (67%) and 44 nursing students (63%) who had participated in at least 1 session responded to the survey. Although both residents and nursing students indicated that the knowledge and team skills acquired during these sessions were useful to them in clinical practice (73% vs 86%, respectively; p = not significant), residents rated their educational value lower (3.3 vs 4.3 on a 5-point scale, respectively; p < 0.01) and only 18% of the residents felt that these sessions should be continued compared with 90% of nursing students (p < 0.05). Most useful components of the sessions were participation in the scenario (73%) and debriefing (54%) for residents and for the nursing students, debriefing (91%), observation of others (68%), and interaction with resident physicians (66%) ranked highest; 48% of student nurses preferred residents as team-training partners whereas 100% residents preferred practicing nurses and 0% with nursing students owing to their limited clinical experience. CONCLUSIONS: Interdisciplinary team training and debriefing of surgery residents with nursing students is feasible and highly valued by nursing students. Nevertheless, our experience indicates that residents do not prefer nursing students as team-training partners owing to their limited clinical experience and would rather train with experienced nurses.

Fluticasone Induces Epithelial Injury and Alters Barrier Function in Normal Subjects.

OBJECTIVE: The airway epithelium has a number of roles pivotal to the pathogenesis of asthma, including provision of a physical and immune barrier to the inhaled environment. Dysregulated injury and repair responses in asthma result in loss of airway epithelial integrity. Inhaled corticosteroids are a corner stone of asthma treatment. While effective in controlling asthma symptoms, they fail to prevent airway remodeling. Direct cytopathic effects on the airway epithelium may contribute to this. METHODS: This study examined the effects of a 4-week treatment regimen of inhaled fluticasone 500 µg twice daily in healthy human subjects. Induced sputum was collected for cell counts and markers of inflammation. Barrier function was examined by diethylenetriaminepentacetic acid (DTPA) clearance measured by nuclear scintillation scan, and albumin concentration in induced sputum. RESULTS: Steroid exposure resulted in epithelial injury as measured by a significant increase in the number of airway epithelial cells in induced sputum. There was no change in airway inflammation by induced sputum inflammatory cell counts or cytokine levels. Epithelial shedding was associated with an increase in barrier function, as measured by both a decrease in DTPA clearance and decreased albumin in induced sputum. This likely reflects the normal repair response. CONCLUSION: Inhaled corticosteroids cause injury to normal airway epithelium. These effects warrant further evaluation in asthma, where the dysregulated repair response may contribute to airway remodeling.

Just Say No to NOTA: Why the Prohibition of Compensation for Human Transplant Organs in NOTA Should Be Repealed and a Regulated Market for Cadaver Organs Instituted.

The United States faces a shortage of organs for transplantation; thousands of individuals die each year while waiting for organs. The organ donation system relies on altruism because the National Organ Transplantation Act (NOTA) prohibits donors from receiving valuable consideration for organs to be used for transplantation. This paper contains a proposal for a regulated market for cadaveric organs as a mechanism to increase the number of organs available for transplantation. A regulated market for cadaveric organs is appropriate in the United States for the following reasons: (1) it is consistent with the numerous ways in which bodies. are currently treated as commodities; (2) it is unlikely to further disadvantage the poor; (3) it would not expose organ recipients to undue harm; (4) in the current organ transplantation system, everyone except the organ donor, benefits financially; (5) the prohibition in NOTA is inconsistent with laws permitting next of kin to recover for damage to the body of a deceased family member; (6) the protection of the dignitary interests of organs for donation is inconsistent with the current protections of the dignitary interests of human specimens; and (7) permitting a market for organs promotes the American values of autonomy and liberty.

A Second's Chance: Gang Violence Task Force prevention program.

We describe a gang violence intervention and define targets for prevention. At-risk youths were identified through courts, public schools, and law enforcement regarding gang-related activities. They participated in "A Second's Chance," a true-to-life mock emergency department resuscitation and death of a gang member provided over an 18-month period. A questionnaire was completed by each participant. Forty-nine youths identified as at risk for gang involvement participated (37 male and 12 female, P < 0.001). Average age was 14.5 years (range, 10 to 19 years); 32 were black, 9 Hispanic, 6 white, and 2 other (P < 0.05). Seventeen (35%) had prior arrests (P = 0.059), 13 (77%) of whom had multiple arrests (P < 0.05). Forty-one (84%) reported a family member jailed (P < 0.001). Forty-two (86%) witnessed neighborhood criminal drug activity (P < 0.001). Household leadership was predominately maternal (24 [49%], (P < 0.05). Forty-four (90%) participants provided positive meaningful responses to the intervention (P < 0.001). Gang violence prevention should be channeled through maternal family members. History of incarcerated relatives, acquaintances, and neighborhood exposure to drugs and crime may represent additional risk factors for gang-related involvement. Demonstrations of gang violence scenarios raise awareness to consequences of gang-related activities. Family and neighborhood characteristics should be included in development of intervention scenarios.

Phosphorylation status of heat shock protein 27 influences neurite growth in adult dorsal root ganglion sensory neurons in vitro.

The small heat shock protein Hsp27 influences neurite growth, potentially via phosphorylation-dependent interactions of Hsp27 with actin. To investigate the contribution of Hsp27 phosphorylation to neurite growth in adult DRG neurons, we employed hamster Hsp27 cDNA constructs (in pIRES-EGFP) with mutations in the phosphorylation sites, either mimicking constitutively phosphorylated Hsp27 (with substitution of serines 15 and/or 90 by glutamate) or preventing phosphorylation at the site (serines 15/90 replaced by alanine). Five mutant constructs were employed in this study in addition to wild-type hamster Hsp27; siRNA directed against the rat Hsp27 was used to depress endogenous Hsp27. Neurite growth was assessed in EGFP-expressing cells following immunocytochemistry and tracing of neurite growth. Hsp27 staining and phalloidin labelling were used to examine Hsp27 and actin colocalization in neurons and growth cones. Overall, our results demonstrate that the role that Hsp27 plays in neurite growth can be affected by phosphorylation, oligomerization, or a combination of both. Hsp27 constructs that are able to dimerize and/or form large oligomers [WT, Hsp27-AA, Hsp27-AE, Hsp27-Δ(5-23)] rescued siRNA-depressed neurite growth, whereas Hsp27 mutants that do not form dimers or oligomers (Hsp27-EE and Hsp27-EA) were unable to rescue the effect of the siRNA. The phalloidin labelling qualitatively showed a higher level of localization of actin with the Hsp27-AA compared with the other constructs. Although phosphorylation appears to be important in growth, the ability of Hsp27 to exist in both phospho- and nonphospho- states is likely key to its role in regulating cytoskeletal elements involved in neurite growth.

Heat shock protein 27 is involved in neurite extension and branching of dorsal root ganglion neurons in vitro.

Alteration of the cytoskeleton in response to growth factors and extracellular matrix proteins is necessary for neurite growth. The cytoskeletal components, such as actin and tubulin, can be modified through interaction with other cellular proteins, including the small heat shock protein Hsp27. Our previous work suggested that Hsp27 influences neurite growth, potentially via its phosphorylation state interactions with actin. To investigate further the role of Hsp27 in neurite outgrowth of adult dorsal root ganglion (DRG) neurons, we have both down-regulated endogenous Hsp27 and expressed exogenous Hsp27. Down-regulation of Hsp27 with Hsp27 siRNA resulted in a decrease of neuritic tree length and complexity. In contrast, expression of exogenous Hsp27 in these neurons resulted in an increase in neuritic tree length and branching. Collectively, these results demonstrate that Hsp27 may play a role in neuritic growth via modulation of the actin cytoskeleton.

Hsp27 and axonal growth in adult sensory neurons in vitro.

BACKGROUND: Neurite growth can be elicited by growth factors and interactions with extracellular matrix molecules like laminin. Among the targets of the signalling pathways activated by these stimuli are cytoskeletal elements, such as actin, tubulin and neurofilaments. The cytoskeleton can also be modulated by other proteins, such as the small heat shock protein Hsp27. Hsp27 interacts with actin and tubulin in non-neuronal cells and while it has been suggested to play a role in the response of some neurons to injury, there have been no direct studies of its contribution to axonal regeneration. RESULTS: We have investigated neurite initiation and process extension using cultures of adult dorsal root ganglion (DRG) sensory neurons and a laminin stimulation paradigm. Employing confocal microscopy and biochemical analyses we have examined localization of Hsp27 at early and later stages of neurite growth. Our results show that Hsp27 is colocalized with actin and tubulin in lamellopodia, filopodia, focal contacts and mature neurites and growth cones. Disruption of the actin cytoskeleton with cytochalasin D results in aberrant neurite initiation and extension, effects which may be attributable to alterations in actin polymerization states. Inhibition of Hsp27 phosphorylation in our cultures results in an atypical growth pattern that may be attributable to an effect of pHsp27 on the stability of the actin cytoskeleton. CONCLUSION: We observed colocalization of the phosphorylated and non-phosphorylated forms of Hsp27 with actin and tubulin in both very early and later stages of neurite growth from cultured adult DRG neurons. The colocalization of Hsp27 and pHsp27 with actin in lamellopodia and focal contacts at early stages of neurite growth, and in processes, branch points and growth cones at later stages, suggests that Hsp27 may play a role in neuritogenesis and subsequent neurite extension, and potentially in the patterning of this growth. Hsp27 has been reported to play a key role in modulating actin cytoskeletal dynamics as an actin-capping protein in non-neuronal cells. Our results suggest that this may also be the case in neurons and support a role for Hsp27 in neurite outgrowth via its phosphorylation state-dependent interactions with actin.