Spontaneous degradation via diketopiperazine formation of peptides containing a tetrahydroisoquinoline-3-carboxylic acid residue in the 2-position of the peptide sequence

The δ-opioid antagonists H-Tyr-Tic-Phe-OH (Tic = tetrahydroisoquinoline-3-carboxylic acid) and H-Tyr-Tic-Phe-Phe-NH₂ were shown to undergo spontaneous Tyr-Tic diketopiperazine formation with concomitant cleavage of the Tic-Phe peptide bond in DMSO but not in aqueous solution at pH 7.7.     

Nasal Lymphoid Tissue (NALT) as a Mucosal Immune Inductive Site

Intranasal (i.n.) immunization is a very effective route for inducing mucosal immunity, but the cellular mechanism responsible for regulating and disseminating these responses is not fully understood. The authors studied the role of nasal lymphoid tissue (NALT) as a mucosal inductive site by using highly purified NALT cells obtained by a new method of mechanical isolation. The NALT cells, like Peyer's patch (PP) cells, were smaller in size and less granular than lymphocytes from salivary glands (SG) and small intestinal lamina propria (LP). The NALT cells isolated from i.n. immunized mice contained antigen-specific antibody-secreting cells (ASC) predominantly of immunoglobulin (Ig)A isotype, similar to those also recovered from salivary glands in a time course study. However, the higher proportion of smaller sized spots formed by NALT cells in ELISPOT assays suggested that these cells were less differentiated precursors of those found in salivary glands. This was supported by the fact that after i.n. immunization, IgA ASC appeared in NALT, as well as in mucosal effector sites SG and LP, but none or very few in another mucosal inductive site, PP. In contrast, after intragastric (i.g.) immunization, IgA ASC were detected in PP, along with the SG and LP, but none or very few in NALT. Furthermore, after i.n. immunization, lymphocytes from NALT but not PP proliferated in response to the specific antigen in culture. These findings imply that NALT served as an inductive site for IgA antibody responses at mucosal effector sites.     

Pharmacists' and pre-registration pharmacy graduates' views of proxy consultations

Proxy consultations, when a customer seeks advice or requests a medicine on behalf of someone else, account for up to one-third of all visits to a community pharmacy. A combined qualitative and quantitative approach was taken to explore pharmacy staff perceptions, and management of, proxy consultations and the use of protocols. Based upon the results of 12 qualitative interviews, a postal questionnaire was designed and sent to 100 randomly selected community pharmacists and 100 pre-registration pharmacy graduates. Fifty-five pharmacists and 44 pre-registration pharmacy graduates (49.5 per cent overall) completed the questionnaire. Respondents cited lack of information about the patient concerning their clinical condition, symptoms or medication as particular difficulties when managing proxy consultations. Respondents offered nine strategies for coping with proxy consultations, including checking the patient medication record, obtaining additional information from the proxy customer and ringing the patient directly. Eighty-six respondents (88 per cent) thought they were more cautious when selling medicines to proxy customers. Most respondents (N=69) felt that their protocols took account of proxy customers although the majority (N=91) also thought they had to be flexible when using protocols in proxy consultations. Proxy consultations are an area of practice which merit future pharmacy practice research.     

Hepatitis C and B virus infections in populations at low or high risk in Ho Chi Minh and Hanoi, Vietnam

Abstract Inhabitants and patients of two cities in Vietnam were tested for antibodies to hepatitis C virus (anti-HCV), hepatitis B surface antigen (HBsAg) and antibody to HBsAg (anti-HBs). Anti-HCV was detected in 43 (9%) of 491 individuals without liver disease in Ho Chi Minh, more frequently ( P < 0.001) than in 18 (4%) of 511 in Hanoi. There was no apparent age-specific distribution of anti-HCV. Among inhabitants of both cities, HBsAg and anti-HBs were frequent, detected in 10-14% and 35-37%, respectively; the prevalence of anti-HBs increased in parallel with age. Among individuals at high risk, the prevalence of anti-HCV was particularly high in drug users (58/67 or 87%) and patients on maintenance haemodialysis (15/28 or 54%) or with haemophilia (7/24 or 29%) in Ho Chi Minh, and in drug users in Hanoi (61/200 or 31%). Prevalence of HBsAg and anti-HBs in high-risk groups was not different from those in the general population. Screening of anti-HCV in blood donors in Vietnam is of urgent necessity because blood supply is dependent on commercial blood donors, many of whom are drug users at high risk.     

Safety and Long‐Term Outcome of Modified Intracardiac Echocardiography‐Assisted “No‐Balloon” Sizing Technique for Transcatheter Closure of Ostium Secundum Atrial Septal Defect

Background: The need for sizing the secundum atrial septal defect (ASD) with the balloon sizing technique is still debated at least in adult patients. We sought to prospectively evaluate the effectiveness of intracardiac echocardiography (ICE)‐aided sizing technique for transcatheter closure of secundum ASD, without using a balloon sizing. Methods: In a prospective 5‐year registry, we enrolled 81 patients (mean age 48 ± 13.7 years, 54 females) who had been referred to three different centers for catheter‐based closure of secundum ASD. Eligible patients underwent ICE study and closure attempt. In a preliminary group of 21 patients, sizing balloon was performed under ICE guidance to assess the value of rim thickness necessary for device anchorage. In the remaining 60 patients, the retrieved value of the rim thickness was measured on ICE and used as key points to measure the defect and select the device. Results: In the preliminary group of patients, the value of thickness at point of initial deflection by the balloon was 1.23 ± 0.1 mm. ASD diameter in the study group was measured at the point of rim with at least 1.2 mm and the mean ASD diameter was 26.2 ± 10.1 mm. Rates of procedural success, predischarge occlusion, and major complications rate were 100%, 93.3%, and 0%, respectively. On mean follow‐up of 5.4 ± 1.8 years, the occlusion rate was 98.7% with no long‐term complications. Conclusions: Our novel ICE‐sizing technique appears to be safe and effective in adult patients, thus eventually minimizing overestimation, costs, and potential complications of balloon sizing. (J Interven Cardiol 2012;25:628–634)     

Electronic length measurement using small and large files in enlarged canals

Electronic apex locators are frequently used attached to a small size endodontic file; however, the effect on the measurement of the relative diameters of the file and the root canal has not been clarified. In this study, the length of enlarged canals was measured using small size files and files matching the canal diameter to observe a possible discrepancy. The accuracy of electronic length control during canal preparation with rotary files was also assessed. The root canals in 21 extracted, single rooted teeth were accessed, and their actual length (AL) established by passing a size 10 file just through the minor apical foramen. The teeth were then embedded in an alginate mold. The initial canal length (IL) was measured with the Root ZX apex locator by negotiating a size 10 file to the apical constriction. The canal was enlarged to size 60 with rotary files while the length was continuously controlled with the apex locator. Then, the final length measurements were obtained with a size 10 file and a size 60 file (FL-10 and FL-60, respectively). The average values of IL, FL-10 and FL-60 were calculated and compared using Repeated Measures Analysis of Variance followed by Tukey's Studentized Range test (P < 0.05). Using composite resin, the size 60 files were secured at the FL-60 length, the teeth were removed from the alginate mold, stained with Picroformal DI Buoin stain and the position of the file tip was observed histomorphometrically after the apical 4 mm of the canal was exposed by grinding the buccal aspect of the root. The IL was 0.45 mm shorter than AL (P < 0.05). The differences between FL-10, FL-60 and IL were not statistically significant. Histomorphometrically, the apical constriction was absent in all the teeth, but the file tips were confined within the root. This study concluded that the Root ZX indicated the location of an apical constriction even when the anatomic constriction was eliminated. In the enlarged canals, length measurements obtained with small and large size files were comparable.     

The Water Surrounding the Iceberg: Cultural Racism and Health Inequities

Policy Points

• Cultural racism—or the widespread values that privilege and protect Whiteness and White social and economic power—permeates all levels of society, uplifts other dimensions of racism, and contributes to health inequities.
• Overt forms of racism, such as racial hate crimes, represent only the “tip of the iceberg,” whereas structural and institutional racism represent its base. This paper advances cultural racism as the “water surrounding the iceberg,” allowing it to float while obscuring its base.
• Considering the fundamental role of cultural racism is needed to advance health equity.