Treatment guidelines for primary nonretentive encopresis and stool toileting refusal

Nonretentive encopresis refers to inappropriate soiling without evidence of fecal constipation and retention. This form of encopresis accounts for up to 20 percent of all cases. Characteristics include soiling accompanied by daily bowel movements that are normal in size and consistency. An organic cause for nonretentive encopresis is rarely identified. The medical assessment is usually normal, and signs of constipation are noticeably absent. A full developmental and behavioral assessment should be made to establish that the child is ready for intervention to correct encopresis and to identify any barriers to success, particularly disruptive behavior problems. Successful interventions depend on the presence of soft, comfortable bowel movements and addressing toilet refusal behavior. Daily scheduled positive toilet sits are recommended. Incentives may be used to reinforce successful defecation during these sits. A plan for management of stool withholding should be agreed on by the parents/caretakers and the family physician before intervention.     

A Spray-Dried Combination of Capreomycin and CPZEN-45 for Inhaled Tuberculosis Therapy

Tuberculosis (TB) remains the single most serious infectious disease attributable to a single-causative organism. A variety of drugs have been evaluated for pulmonary delivery as dry powders: capreomycin sulfate has shown efficacy and was safely delivered by inhalation at high doses to human volunteers, whereas CPZEN-45 is a new drug that has also been shown to kill resistant TB. The studies here combine these drugs—acting by different mechanisms—as components of single particles by spray-drying, yielding a new combination drug therapy. The spray-dried combination powder was prepared in an aerodynamic particle size range suitable for pulmonary delivery. Physicochemical storage stability was demonstrated for a period of 6 months. The spray-dried combination powders of capreomycin and CPZEN-45 have only moderate affinity for mucin, indicating that delivered drug will not be bound by these mucins in the lung and available for microbicidal effects. The pharmacokinetics of disposition in guinea pigs demonstrated high local concentrations of drug following direct administration to the lungs and subsequent systemic bioavailability. Further studies are required to demonstrate the in vivo efficacy of the combination to confirm the therapeutic potential of this novel combination.     

Dental students' reflections on their community-based experiences: the use of critical incidents

Dental schools are challenged to develop new learning methodologies and experiences to better prepare future dental practitioners. The purpose of this study was to gain insight into the community-based experiences of dental students as documented in their critical incident essays and explore what learning outcomes and benefits students reported. Following two required community-based clinical rotations, each student wrote a reflection essay on a self-defined critical incident that occurred during the rotations. Rotations took place in settings such as a public health clinic, special needs facility, hospital, or correctional institution. Essays for two classes of students were content-analyzed for recurring themes and categories. Students were confronted in their rotations with a wide range of situations not typically encountered in dental academic settings. Their essays showed that, as a result of these rotations, students developed increased self-awareness, empathy, communications skills, and self-confidence. Critical incidents challenged assumptions and stereotypes, enhanced awareness of the complexities of dental care, and raised complex ethical dilemmas. The essays also illustrated a heightened sense of professional identity and enabled students to appreciate the role dentistry can play in impacting patients' lives. We concluded from the study that community-based dental education that includes a process for reflection holds promise as an educational strategy to facilitate the personal and professional development of future dentists.     

An ultrastructural basis for electrocardiographic alterations associated with Duchenne's progressive muscular dystrophy

Electrocardiographic abnormalities were identified in 63 (84%) of 75 patients with Duchenne's progressive muscular dystrophy. A tall R wave over V1 with an abnormal R/S ratio was seen in 64% of the patients, a deep and narrow Q wave greater than 4 mm over leads I, V5, and V6 in 44%, sinus tachycardia in 32% and right axis deviation in 16%. Other ECG abnormalities included an abnormal PV1 index in 14% of patients and a short P-R interval in 6%. Ultrastructural characteristics of the heart were determined for two patients with characteristic electrocardiographic abnormalities. Common to both hearts was a total loss of thick as well as thin myofilaments, which gave a "moth-eaten" appearance to the myofiber. This feature, combined with preservation of the transverse tubular system, formed the most characteristic ultrastructural finding and was seen most consistently in the posterobasal area of the left ventricle. Alterations of Z-band material; accumulation of mitochondria, occasionally containing electron-dense bodies and showing loss or discontinuity of cristae; dilatation of sarcoplasmic reticulum with striking ectasia of cisternae; depletion of glycogen particles; a paucity of lipoid or lipochrome granules; and the absence of virus-like particles were other consistent ultrastructural features. Comparison of skeletal and cardiac muscle disclosed identical subcellular changes. These observations support the contention that the distinctive ECG pattern associated with Duchenne's dystrophy results from multifocal degenerative changes involving myocardium, predominantly the posterobasal region of the left ventricle and the posterior papillary muscle.     

Long-term neurological implications of somnolence syndrome in children with acute lymphocytic leukemia

A longitudinal study of 49 children with acute lymphocytic leukemia (ALL) assessed the long-term effects of central nervous system (CNS) prophylaxis on brain function. From 10 to 12 electroencephalograms (EEGs) were done before and at intervals during and after 30 months of treatment that included 2,400 rads of CNS irradiation plus intrathecal methotrexate therapy. None of the children had CNS leukemia, and all remained in first complete remissions. All 49 had abnormally slow EEG background frequencies during the four-year study, and 29 (60%) developed somnolence syndrome six to eight weeks after CNS prophylaxis. During this syndrome, EEG background frequencies decreased more than 3 standard deviations below the expected mean values for normal children. Thereafter, 7 of the 29 began to show signs of learning disabilities and 7 developed recurrent seizures. Of the 20 children who did not have the syndrome, none showed later evidence of CNS dysfunction. Somnolence may be an early indicator of long-term neurological sequelae after cranial irradiation.     

Untersuchungen über die Korrosion von abnehmbaren kieferorthopädischen Apparaturen durch selbsttätige Reinigungsmittel

Zusammenfassung Werkstoffe für abnehmbare kieferorthopädische Apparate (Legierungen von Dehnelementen, heiß- und kaltpolymerisierte Akrylate) wurden hinsichtlich möglicher korrosiver Beeinflussung durch ein neues kieferorthopädisches selbsttätiges chemisches Reinigungsmittel untersucht.Elektronenmikroskopische Aufnahmen weisen auf keine mikromorphologischen Veränderungen der Kunststoffoberflächen im Sinne von Erosion bzw. Korrosion hin. Bei Verwendung passivierbarer Legierungen, wie sie für kieferorthopädische Schrauben zu fordern sind, kann angenommen werden, daß die Legierungen von Kukis^® Reinigungsbädern unter den üblichen Bedingungen nicht angegriffen werden.

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Summary Materials used in the construction of orthodontic appliances such as the alloys in expansion screws, heat curing acrylics, and self-curing acrylics were investigated regarding any possible corrosion resulting from the use of a new chemical immersion cleanser for removable orthodontic appliances.Electronmicroscopic findings did not indicate micromorphological alterations of resin surfaces which could be interpreted as the effect of corrosion. When passivated alloys are used as requested for orthodontic screws, it can be assumed that Kukis^®-cleansing solutions will not corrode such alloys under the cleansing conditions recommended by the producer.

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Résumé Des matériaux, utilisés pour des appareils d'orthodontie amovibles (alliages pour les vis d'expansion, résines acryliques polymérisant à chaud ou à, froid) ont été étudiés en fonction de l'influence corrosive éventuelle qu'une nouvelle substance chimique d'autonettoyage pourrait produire.Des examens électromicroscopiques ne révèlent aucune modification micromorphologique des surfaces de résine qu'on pourrait interpréter comme une érosion ou une corrosion. Quand des alliages de type passif sont employés ou indiqués pour des vis d'orthodontie, on a pu démontrer que les solutions de nettoyage de Kukis^® utilisées selon le mode d'emploi, n'attaquaient pas les alliages.

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Mit 9 Abbildungen     

MELK: a potential novel therapeutic target for TNBC and other aggressive malignancies

Introduction: There is an unmet need in triple-negative breast cancer (TNBC) patients for targeted therapies. Maternal embryonic leucine zipper kinase (MELK) is a promising target for inhibition based on the abundance of correlative and functional data supporting its role in various cancer types.

Areas covered: This review endeavors to outline the role of MELK in cancer. Studies covering a range of biological functions including proliferation, apoptosis, cancer stem cell phenotypes, epithelial-to-mesenchymal transition, metastasis, and therapy resistance are discussed here in order to understand the potential of MELK as a clinically significant target for TNBC patients.

Expert opinion: Targeting MELK may offer a novel therapeutic opportunity in TNBC and other cancers. Despite the abundance of correlative data, there is still much we do not know. There are a lack of potent, specific inhibitors against MELK, as well as an insufficient understanding of MELK’s downstream substrates. Addressing these issues is the first step toward identifying a patient population that could benefit from MELK inhibition in combination with other therapies.     

Infection after rotator cuff repair

Sixteen patients (15 men and 1 woman) were treated for infection complicating rotator cuff repair during the period 1975 through 1994. Eight of the 16 patients had their initial procedure performed elsewhere. The remaining 8 procedures were performed at our institution with the known incidence of this complication being 0.27%. In addition to intravenous antibiotic therapy, an average of 3.5 (range 2 to 8) operative procedures were required to eradicate the infections. Micro-organisms cultured were Propionibacter in 6, coagulase negative Staphylococcus in 4, Staphylococcus aureus in 4, Peptostreptococcus magnus in 1, and both Propionibacter and coagulase-negative Staphylococcus in 1. The deltoid was restored in all patients; the rotator cuff was reparable in 11. In the 12 shoulders with greater than 1 year of follow-up (average 51 months, range 14 to 165 months), active elevation averaged 110 degrees and external rotation 50 degrees. Four patients had no pain, 4 had minimal pain, and the remaining 4 had moderate pain. Satisfactory final results, which were determined by the patients' opinion or with the use of either the University of California, Los Angeles score or the modified Neer system, were obtained in 5 (42%) of the shoulders.