Implementing National Guidelines in Real Life: The Peterborough Neurodevelopmental Service (NDS)

National documents over the last few years have highlighted the mental health needs of children with neurodevelopmental disabilities. Results showed the poor levels of provision for this vulnerable high-risk group. The National Service Framework (NSF) for children, ( DoH, 2004 ), set out 9 standards for care and service development. Here we describe how standards, principles and concepts from the NSF and the National Autism Plan for Children were applied in the development of an integrated multi-agency, multi-disciplinary neurodevelopmental service (NDS) for school-aged children in Peterborough, UK.     

Influence of ultrasonic excitation and heat application on the microleakage of glass ionomer cements

Background: The aim of this study was to assess the influence of externally applied ‘command set’ methods on the microleakage of several glass ionomer cements (GICs). Methods: Four different restorative GICs were cured using three different methods: standard curing (SC), ultrasonic excitation (UC) and by an external heat source (HC). Different conditioning agents (10% polyacrylic and 10% citric acid) were used. The sample comprised 180 teeth with 360 Class V restorations placed on the lingual and vestibular tooth surface. After thermocycling, the teeth were immersed in a dye solution for 24 hours, embedded in acrylic resin, sectioned and evaluated. Oberholtzer criteria were used for margin evaluation. Data were analysed using three‐way ANOVA. Results: The heat cured GIC showed statistically significant better marginal adaptation compared to the other tested groups (SC, UC) (p < 0.001). GICs in groups with HC and conditioned cavities had lower microleakage scores. The highly viscous material Fuji IX GP Fast in the HC and conditioned cavities group demonstrated the best marginal adaptation. The other three products reacted similarly to heating treatment. Leakage at the enamel margins was significantly lower than the cementum/dentine margins (p < 0.001). Conclusions: Heating the GIC during setting decreased microleakage, improved marginal adaptation of the GIC restoration and is suitable for clinical practice.     

Axon length maintenance and synapse integrity are regulated by c-AMP-dependent protein kinase A (PKA) during larval growth of the drosophila sensory neurons

Axonal extension and synaptic targeting are usually completed during early development, but the axonal length and synaptic integrity need to be actively maintained during later developmental stages and the adult life. Failure in the axonal length maintenance and the subsequent axonal degeneration have been associated with neurological disorders, but currently little is known about the genetic factors controlling this process. Here, we show that regulated intracellular levels of cAMP-dependent protein kinase A (PKA) are critical for the axon maintenance during the transition from the early to the later larval stages in the Drosophila class IV dendritic arborization (da) sensory neurons. Our data indicate that when the intracellular levels of PKA are increased via genetic manipulations, these peripheral neurons initially form synapses with wild-type appearance, at their predicted ventral nerve cord (VNC) target sites (in the first and second instar larval stages), but that their synapses disintegrate, and the axons retract and become fragmented in the subsequent larval stages (third larval stage). The affected axonal endings at the disintegrated synaptic sites still express the characteristic presynaptic and cytoskeletal markers such as Bruchpilot and Fascin, indicating that the synapse had been initially properly formed, but that it later lost its integrity. Finally, the phenotype is significantly more prominent in the axons of the neurons whose cell bodies are located in the posterior body segments. We propose that the reason for this is the fact that during the larval development the posterior neurons face a much greater challenge while trying to keep up with the fast-paced growth of the larval body, and that PKA is critical for this process. Our data reveal PKA as a novel factor in the axonal length and synapse integrity maintenance in sensory neurons. These results could be of help in understanding neurological disorders characterized by destabilized synapses.     

Endocrine cells in human fetal corpus of stomach: appearance, distribution, and density

Background

Since reports on endocrine cells and their kinetics in the corpus of the human stomach are limited, the aim of this study was to examine the appearance, localization, density, and the relationship among the endocrine cell types in the corpus of the human stomach during prenatal and early postnatal development.

Methods

We examined chromogranin A, somatostatin, ghrelin, glucagon, and serotonin expression by immunohistochemistry in 2 embryos, 38 fetuses, and 3 infants in the corpus of human stomach.

Results

Chromogranin?A secreting endocrine cells were identified in the corpus at week 10 of gestation. Somatostatin cells were present from the 10th week, ghrelin and serotonin cells from the 11th week, and glucagon cells from the 12th week of gestation. Endocrine cells were present individually or clustered within the glandular base and body during the first trimester, and were present separately within the basal and central parts of glands during the second and third trimesters. Somatostatin cells were the most common type of cells (~46?%) during the first trimester, while ghrelin cells were the most numerous during the second trimester (~34?%), and in infants (~28?%). The percentage of glucagon cells was significant only during the first trimester of pregnancy (5.5?%), and the percentage of serotonin cells was only significant just before birth (4.8?%).

Conclusions

These results show, for the first time, that the largest number of endocrine cells are present in the corpus during the first trimester of prenatal development. Also, these results suggest that secretory products of endocrine cells play a role in the regulation of homeostasis, growth, and differentiation, and in human stomach function.     

Evaluation of survivin expression and its prognostic value in papillary thyroid carcinoma

Overexpression of survivin, an inhibitor of apoptosis protein, has been found in a variety of human cancers, and is associated with tumor aggressiveness. In this study, we analyzed the expression of survivin in papillary thyroid carcinoma (PTC) and evaluated its clinical significance for predicting an aggressive course of disease at the time of diagnosis. Survivin expression was determined by immunohistochemistry in 104 tissue specimens of PTC, confirmed by Western blot and correlated with clinicopathological parameters. Of the tumors examined, 74 (71.15%) showed high cytoplasmic survivin expression. There was no association between high survivin expression and age, gender or tumor size. On the other hand, it was closely correlated with the presence of lymph node metastasis (P = 0.009), and there was a tendency for correlation with extrathyroidal invasion (P = 0.062). The high risk PTC group (TNM stage III–IV) was associated with high levels of survivin (P = 0.027). These results indicate that survivin is an unfavorable molecule for PTC prognosis, and that its high expression may indicate a subset of PTC patients with a more aggressive disease course. Evaluation of its expression in fine needle aspiration samples could be a useful tool for the identification of those PTC patients who require more extensive surgery, careful follow-up and therapeutic strategy.     

Computed tomography of the spine as an important diagnostic tool in the management of war missile spinal trauma

Twenty-two patients with spinal injury were evaluated by plain radiography immediately after hospital admission. In 14 patients whose condition was stable, we performed computed tomography (CT) scanning through the involved segments. To provide better planning before neurosurgical management, we divided the vertebral column in thirds. According to this division, we concluded that these injuries are mostly extensive, severely damaging all three thirds of the vertebral column and accompanying neural structures in the majority of cases. The information acquired by CT concerning bony fragments, bone destruction, dural tear, spinal cord and nerve root compression, and neural damage directly influenced the surgical management. All patients except one underwent surgery while associated injuries of other organs were given priority in management. Injuries of the thoracic and the lumbar spine were the most common ones, frequently found in association with lesions of nearby organs. Penetrating injuries with a dural lesion were present in the majority of cases, while spinal cord injury was obvious in some. They were all well visualized using spinal CT scanning. Our view is that the role of CT is essential in guiding surgical management of war missile injuries to the spine. Received: 18 February 1997     

Frequency of chromosomal aneuploidies and deletions of the RB and TP53 genes in MALT lymphomas harboring the t(14;18)(q32;q21)

The t(14;18)(q32;q21) involving the MALT1/MLT and IGH genes has been identified recently as a recurrent abnormality in mucosa-associated lymphoid tissue (MALT) lymphomas. The frequency of secondary chromosomal aberrations in MALT lymphomas harboring the t(14;18) is largely unknown. We therefore analyzed six t(14;18)-positive MALT lymphomas (five parotid, one conjunctiva) by interphase fluorescence in situ hybridization for aneuploidies of chromosomes 3, 7, 12, 18, and X, gains or disruption of the CMYC/8q24 and BCL6/3q27 genes, as well as deletions of the retinoblastoma and TP53 tumor suppressor genes. Except for one MALT lymphoma of the parotid with trisomy 3, neither aneuploidies nor deletions were detected in any of our cases.