Modified Split‐Cast Technique: A New,Timesaving Clinical Remount Technique

Interocclusal discrepancies can be eliminated by a clinical remount procedure, but most practitioners avoid it because of the time involved. This article introduces a new timesaving method, the modified split‐cast technique. It uses a semi‐adjustable articulator, tin foil as plaster separator, and an addition‐type, silicone bite‐registration material. The technician does most of the remounting procedures before the denture delivery appointment, so the dentist spends very little time chairside to complete the clinical remount procedure. Compared with the conventional and two other remounting techniques, the new technique is faster and easier to manipulate.     

Stressors in the ICU: a comparison of patients' and nurses' perceptions

Aims and objectives. The aim of the study was to compare the stressors as perceived by patients in an intensive care unit (ICU) against those of nurses on the basis of their perceptions of patients’ stressors. Background. Getting admitted to an ICU is viewed as a stressful event by patients. However, numerous studies have indicated that nurses do not always accurately perceive the stressors of their clients. Therefore, it is important for nurses to know what seems most stressful from the patients’ perspective so that appropriate nursing measures can be directed towards minimising such stressors. Design. Survey. Methods. As a convenience sample, 60 patients and 54 critical care nurses were recruited. The Intensive Care Unit Stressor Questionnaire (Chinese) (ICU‐CSQ) was used to collect the perceptions of stressors by the patients. Nurses were also asked to rate the items in the said questionnaire according to how they believe patients would rate them. Results. In every comparison, nurses evaluated the items to be significantly more stressful than patients did. Overall perceived stress levels of nurses were also significantly higher than those of their patients (z = ?8·78, p < 0·001). Conclusions. Nurses tended to rate the items as more stressful than did the patients, perhaps over‐emphasising the stressful nature of the ICU. The findings also highlight the importance of cultural beliefs on the perceived stress levels among the Chinese population. Relevance to clinical practice. Findings in this study have strong implications in clinical practice, especially in a critical care setting. Nurses must attempt to identify and endeavour to cope with the situations that patients listed as most stressful. Moreover, attention must be drawn towards measures aimed at relieving the stress of patients by taking into account their cultural values so that culture‐specific interventions for reducing their stress can be established.     

Minimally invasive spinal surgery

Minimally invasive surgery offers quicker recovery and less morbidity for our patients through smaller surgical wounds and less tissue trauma. Although minimally invasive surgery has progressed in other fields of surgery for many years, spine surgeons have not previously embraced this philosophy for the various reasons discussed. However, minimally invasive spinal surgery has gained much interest in recent years. With the advent of new instrumentation, technology, and techniques, the promise of minimally invasive surgery in the spinal arena has become a reality. With the use of the microscope, navigational tools, newly developed canula for retraction, and image-guided percutenous pedicle screw systems, we can accomplish the same surgical procedures as currently used through smaller wounds and with greater precision. Nevertheless, all new technology does offer us an initial challenge of steep learning curves. Minimally invasive should not equate to minimal and inadequate treatment for our patients. Furthermore, careful analysis of this new technique is underway to assess its true advantages as compared with our current and proven techniques.     

Identification of Candida species in the clinical laboratory: a review of conventional,commercial, and molecular techniques

In healthy individuals, Candida species are considered commensal yeasts of the oral cavity. However, these microorganisms can also act as opportunist pathogens, particularly the so‐called non‐albicans Candida species that are increasingly recognized as important agents of human infection. Several surveys have documented increased rates of C. glabrata, C. tropicalis, C. guilliermondii, C. dubliniensis, C. parapsilosis, and C. krusei in local and systemic fungal infections. Some of these species are resistant to antifungal agents. Consequently, rapid and correct identification of species can play an important role in the management of candidiasis. Conventional methods for identification of Candida species are based on morphological and physiological attributes. However, accurate identification of all isolates from clinical samples is often complex and time‐consuming. Hence, several manual and automated rapid commercial systems for identifying these organisms have been developed, some of which may have significant sensitivity issues. To overcome these limitations, newer molecular typing techniques have been developed that allow accurate and rapid identification of Candida species. This study reviewed the current state of identification methods for yeasts, particularly Candida species.     

Inhibition of platelet function by contrast media: iopamidol and ioxaglate versus iothalamate. Work in progress

The effects of an ionic contrast agent, meglumine iothalamate (Conray-60), and two newer low-osmolality radiographic contrast media, sodium meglumine ioxaglate (Hexabrix) and iopamidol (B-15,000), on platelet aggregation and secretion responses were studied. All three agents inhibited platelet responses during stimulation with adenosine diphosphate (ADP), epinephrine, and collagen. Platelet function was inhibited by iothalamate at concentrations of 11 mg iodine/ml and above, and by the newer agents at concentrations above 30 mg iodine/ml. Addition of exogenous calcium decreased the iothalamate-induced inhibition of aggregation but did not improve dense granule secretion. There was no consistent effect of exogenous calcium on platelet inhibition by iopamidol and ioxaglate. These studies indicate that the newer agents inhibit platelet function less than iothalamate does, and that chelation of Ca2+ may not be the major mechanism of platelet inhibition by contrast agents.     

DNA错配修复基因甲基化在肝细胞癌发生发展中的作用

目的探讨DNA错配修复基因(MMR)hMLH1,hMSH2和hMSH3甲基化在肝细胞癌(HCC)发生发展中的作用。方法采用甲基化特异性聚合酶链反应(MSP)法对38例新鲜HCC组织,相应非肿瘤肝组织,2例正常的捐肝组织及6种肝癌细胞系的hMLH1,hMSH2和hMSH3基因启动子CpG岛甲基化进行检测;培养6种肝癌细胞系,MSP法检测加入5-aza-2‘-deoxycytidine前后hMSH2基因在HCC中的甲基化状态改变;逆转录．聚合酶链反应(RT-PCR)方法检测加入5-aza-2’-deoxycytidine前后hMSH2在肝癌细胞株中的mRNA表达改变。结果HCC标本中13．2％(5／38)发生了hMLH1启动子甲基化,68．4％(26／38)发生了hMSH2启动子甲基化;相应的非肿瘤肝组织中hMLH1,hMSH2启动子甲基化阳性率分别为2．6％(1／38),55．3％(21／38);2例正常肝组织中未发现甲基化;6株肝癌细胞系中有5株发生了hMSH2启动子甲基化,而未发现有MLH1启动子甲基化。所有标本中均未发现有hMSH3启动子甲基化。5-aza-2‘-deoxycytidine处理细胞株后,可部分或完全逆转hMSH2启动子甲基化,各细胞株的mRNA均有不同程度的表达增加。结论hMSH3基因启动子CpG岛甲基化与HCC的发生发展关系不大。hMSH2基因甲基化与mRNA表达密切相关,是基因表达调节的一种重要方式。hMLH1和hMSH2基因启动子CpG岛的高甲基化在HCC中是一个常见的基因改变,DNA错配修复基因尤其是hMSH2基因启动子甲基化在HCC的发生中起了重要作用,是早期事件,其可能为临床诊断HCC提供新的检测指标。     

MR imaging of facial nerve enhancement in Bell palsy or after temporal bone surgery

The authors evaluated magnetic resonance (MR) images obtained with intravenously administered gadolinium in ten patients who had facial paralysis and no facial nerve tumor. In patients with either Bell palsy (four patients) or facial paralysis after temporal bone surgery (six patients), intratemporal facial nerve enhancement was seen. Facial nerve enhancement on MR images proved to be a nonspecific finding.     

Clinical experience with HLA-B7 plasmid DNA/lipid complex in advanced squamous cell carcinoma of the head and neck.

OBJECTIVE: To investigate the safety and efficacy of alloantigen plasmid DNA therapy in patients with advanced head and neck squamous cell carcinoma using Allovectin-7 (Vical Inc, San Diego, Calif), a DNA/lipid complex designed to express the class I major histocompatibility complex antigen HLA-B7. DESIGN: Multi-institutional prospective trial. SETTING: Academic medical setting. PATIENTS: A total of 69 patients were enrolled in 3 sequential clinical trials: a single-center phase 1 trial and 2 multicenter phase 2 trials. Eligibility criteria included unresectable squamous cell carcinoma that failed conventional therapy, Karnofsky performance status score of 70 or greater, and no concurrent anticancer or immunosuppressive therapies. INTERVENTION: Patients received 2 biweekly intratumoral injections of 10 microg (phase 1 and first phase 2 trials) or 100 microg (second phase 2 trial) of Allovectin-7 followed by 4 weeks of observation. Patients with stable or responding disease after the observation period were given a second treatment cycle identical to the first. MAIN OUTCOME MEASURES: Patients were assessed for toxic effects, and tumor size was measured after cycles 1 (at 6 weeks) and 2 (at 16 weeks). RESULTS: Allovectin-7 treatment was well tolerated, with no grade 3 or 4 drug-related toxic effects. Of 69 patients treated, 23 (33%) had stable disease or a partial response after the first cycle of treatment and proceeded to the second cycle. After the second cycle, 6 patients had stable disease, 4 had a partial response, and 1 had a complete response. Responses persisted for 21 to 106 weeks. CONCLUSIONS: Intratumoral plasmid DNA immunotherapy for head and neck cancer with Allovectin-7 is safe, and further investigations are planned in patients with less advanced disease, where it could potentially improve patient survival and reduce the need for radical high-morbidity treatments.