A clinical evaluation of the Endocater--an electronic apex locator

The purpose of this study was to evaluate the accuracy of an electronic apex locator, the Endocater, in determining the location of the apical constriction or cementodentinal junction (CDJ). Measurements made by the Endocater were also compared with the adjustments recommended by an experienced endodontist. A total of 69 teeth with 99 canals from nine patients were evaluated. The results indicated that the evaluator was 95.8% and the Endocater 67.7% accurate in positioning the probe within +/- 1.000 mm from the CDJ. Thirty-three canals or 34.4% appeared to be clinically acceptable radiographically and no adjustments were deemed necessary by the evaluator. There was a significant difference (p less than 0.003) between the evaluator's ability to adjust the electronically generated file length radiograph to acceptable clinical standards and the Endocater's ability to determine the location of the CDJ. A total of 59 canals (59.6%) of the electronically determined working lengths were beyond the CDJ (n = 99). In 27 canals, the tip of the probe was greater than 1 mm beyond the constriction. Without radiographs to confirm working lengths, many canals in this study would have been overinstrumented. Future research with electronic apex locators is needed before accepting the technique as a substitution for radiographic working length determination.     

N of 1 randomized trials for investigating new drugs

Presently, in the process of new drug development, large sample parallel group randomized trials are often begun without the detailed knowledge of optimal dose, most responsive patient group, and optimal outcomes which would be desirable. We propose that randomized trials in individual subjects (N of 1 RCTs) could be used to elucidate these issues at an early stage of drug development. In appropriate conditions N of 1 RCTs can be used to define the rapidity with which a drug begins and ceases its clinical action, the likely range of the optimal drug dose, and the optimal outcomes on which subsequent trials should focus. N of 1 RCTs can also generate initial estimates of the proportion of patients who respond to a new agent and for determining sample size, inclusion criteria, and dosage regimen(s) for subsequent parallel group trials. We provide an example of 14 N of 1 RCTs of amitriptyline in fibrositis that illustrate the ways in which N of 1 RCTs can elucidate these issues. The multiple uses of N of 1 RCTs suggest that the method has immense potential for use in the early phases of drug development programs.     

Studies on the biosynthesis of the alpha-glucosidase inhibitor acarbose: valienamine, a m-C7N unit not derived from the shikimate pathway

Feeding experiments with Actinoplanes sp. SN223/29 showed that 3-amino-5-hydroxy-[7-13C]benzoic acid is not incorporated into acarbose (I). The valienamine moiety of I is thus not derived in the same way, from the shikimate pathway, as the m-C7N units in the ansamycin, mitomycin and ansamitocin antibiotics. Feeding experiments with [U-13C3]-glycerol followed by analysis of I by multiple quantum NMR spectroscopy support this conclusion and point to formation of the valienamine moiety by cyclization of a heptulose phosphate which arises from a triose phosphate via successive transfer of two 2-carbon fragments by transketolase, as proposed by Pape and co-workers.     

Cardiovascular nursing research review. 1969 to 1988

In a review of 243 cardiovascular nursing research articles, eight themes of cardiovascular nursing research have emerged: health related behaviors, activity, cardiac output, family, adherence, patient education, stress-anxiety coping, and perception of care and treatment. Several conclusions are drawn from this review. First, the quantity of cardiovascular nursing research in the literature during 1985-1988 has more than doubled from the number of articles published during 1981-1984. Second, cardiovascular nursing researchers are following earlier recommendations to engage in theory-then-research to build a scientific basis for nursing practice. Third, the topical trends identified in this review are congruent with priorities in nursing research established by the American Nurses' Association Cabinet on Nursing Research and the National Center for Nursing Research. Further suggestions for cardiovascular nursing research in the areas of technological dependency (such as implantable defibrillators) and individual and family responses (such as risk factor modification strategies in children, and behavioral responses to cardiovascular disease in the elderly and chronically ill) are proposed.     

Successful pharyngeal pulse oximetry in low perfusion states

PURPOSE: We describe pharyngeal oximetry with the laryngeal mask airway in two patients with low perfusion states where finger oximetry failed. CLINICAL FEATURES: One patient was a 47-yr-old man with septic shock and the other a 64-yr-old man with multiorgan failure. In both patients, a # 4 laryngeal mask airway with a pediatric pulse oximeter probe was inserted behind the tracheal tube. A good waveform was obtained and oxygen saturation was 0-2% lower than arterial samples. CONCLUSION: Pharyngeal oximetry with the laryngeal mask airway is feasible in low perfusion states when finger oximetry fails.     

Biodisk: A new device for closure of patent foramen ovale: A feasibility study in swine

Purpose: To evaluate the feasibility, effectiveness, and safety of a porcine small intestinal submucosa (SIS)‐covered Biodisk (BD) for the closure of patent foramen ovale (PFO) in swine. Methods: Twelve piglets (9–30 kg) with PFO ranging in size from 6 to 12 mm were used for the in vivo testing. The BD device consisted of two basic nitinol wire components covered with platinum coil, a flexible SIS‐covered ring, and an anchor. The BD was advanced through an 8‐Fr sheath from the femoral vein. Nine acute animals were used to test the BD for deployment, stability, immediate shunt closure, and device repositioning before or after its detachment. To assess retrievability, four devices were deployed and intentionally embolized into the RA (n = 2) and LA (n = 2). The effectiveness of the device was evaluated by angiocardiography. EKG was recorded before and after PFO closure for 3 hr. From the 12 animals, nine were acute and three were followed; one for 6 weeks, one for 12 weeks, and one for 16 weeks. Results: Successful device implantation was achieved in all animals with no shunting of contrast media observed during follow‐up in. One animal needed to have device repositioned for complete PFO occlusion because of suboptimal placement at the first attempt. The device was easily placed and retrieved before detachment in all nine animals in the acute study. None of the BDs spontaneously embolized during release or on follow‐up. EKG did not demonstrate arrhythmias during or after treatment. Four intentionally embolized BDs were easily retrieved with an Amplatz goose neck snare. Macroscopic and histologic evaluation of the three long‐term animals showed that devices were well incorporated in the atrial septum with complete shunt closure. The SIS showed progressive remodeling with the host cells. There was also progressive endothelization of the BD device. Conclusion: The BD device deployment is feasible, safe, and effective. Long‐term studies are needed to evaluate its long‐term effectiveness. © 2010 Wiley‐Liss, Inc.     

IMPROVED BLOOD PRESSURE CONTROL BY MONITORING COMPLIANCE WITH ANTIHYPERTENSIVE THERAPY

Compliance with antihypertensive therapy was monitored for three months using an electronic medication dispenser in 35 patients remaining hypertensive despite the once-daily administration of a blood pressure lowering drug (either as monotherapy or as fixed-dose combination therapy). During the monitoring of compliance, the treatment was unchanged but blood pressure decreased significantly (p<0.001) from 167.9/100.4 ± 16.3/7.2 mmHg (mean ± SD) to 152.5/90.9 ± 20.9/11.5 mmHg. The percentage of days with one opening per day was 80.8 ± 20.5. Thus, discussing with the patient about compliance with the prescribed drug regimen and monitoring compliance for a few months allows better control of blood pressure. This most likely reflects increased compliance with antihypertensive drug therapy.