Analysis of hospital-based emergency department visits for dental caries in the United States in 2008.

OBJECTIVES: Using nationally representative data, we examined differences in dental care utilization in emergency departments (EDs) among working age adults associated with rural residence and lack of health insurance. METHODS: We used data from the 2008 Nationwide Emergency Department Sample, restricted to working age adults (ages 19-64; 16,928,424 observations). The dependent variable was a principal diagnosis of dental caries. The primary independent variable was patient's area of residence, rural versus urban. The control variables were payer, age, gender, median income, region, and admission timing. Logistic regression analysis was performed to determine the association with residence, payer, and other covariates. Multivariate logistic regression models were estimated. RESULTS: In 2008, there were an estimated 74 million ED visits among working adults ages 19-64 in the United States. Dental caries accounted for between 0.2 percent and 1.0 percent of all visits, depending on patient characteristics. Rural patients were significantly more likely than urban patients to have dental visits. Dental visits were more prevalent among patient with government insurance or self -pay relative to the privately insured. CONCLUSIONS: The Affordable Care Act may reduce the proportion of self-pay visits for dental care. Medicaid expansion may not result in improved dental use among Medicaid patients unless dental services are covered and dental practitioners appropriately engaged.

Effect of high-frequency alternating current on spinal afferent nociceptive transmission.

OBJECTIVE: The study was performed to test the hypothesis that high-frequency alternating current (HFAC) ranging from 2 to 100 kHz delivered to the spinal dorsal roots reduces activity of spinal wide dynamic range (WDR) dorsal horn neurons (DHNs) during noxious peripheral stimulation. MATERIALS AND METHODS: This hypothesis was tested in both small and large animal in vivo preparations. Single-unit extracellular spinal DHN recordings were performed in seven adult rats and four adult goats while testing various parameters of HFAC delivered to the nerve roots or dorsal root entry zone using various electrode types. Frequencies tested ranged from 2 to 100 kHz but focused on the 3 to 50 kHz range. This study investigated the ability of HFAC to inhibit WDR neuronal activity evoked by noxious mechanical (pinch), and electrical stimuli was tested but was primarily focused on electrical stimulation. RESULTS: Rat Study: Effects of HFAC were successfully tested on 11 WDR neurons. Suppression or complete blockade of evoked activity was observed in all 11 of these neurons. Complete data sets for neurons systematically tested with 15 baseline and post-HFAC stimulus sweeps were obtained in five neurons, the nociceptive activity of which was suppressed by an average of 69 ± 9.7% (p < 0.0001). Goat Study: HFAC was successfully tested on 15 WDR neurons. Conclusive suppression or complete nociceptive blockade was observed for 12/15 and complete data sets with at least 20 baseline and post-HFAC stimulus sweeps were obtained from eight DHNs. For these neurons the mean activity suppression was 70 ± 10% (p < 0.005). CONCLUSIONS: Delivery of HFAC to the region of epidural nerve root or nerve root entry inhibited afferent nociceptive input and therefore may have potential to serve as an alternative to traditional spinal cord stimulation without sensory paresthesia as neuronal activation cannot occur at frequencies in this range.

Optimization of a glycoengineered Pichia pastoris cultivation process for commercial antibody production.

Glycoengineering enabled the production of proteins with human N-linked glycans by Pichia pastoris. This study used a glycoengineered P. pastoris strain which is capable of producing humanized glycoprotein with terminal galactose for monoclonal antibody production. A design of experiments approach was used to optimize the process parameters. Followed by further optimization of the specific methanol feed rate, induction duration, and the initial induction biomass, the resulting process yielded up to 1.6 g/L of monoclonal antibody. This process was also scaled-up to 1,200-L scale, and the process profiles, productivity, and product quality were comparable with 30-L scale. The successful scale-up demonstrated that this glycoengineered P. pastoris fermentation process is a robust and commercially viable process.

Morphological analyisis of the fabella in Brazilians / Análisis morfológico de la fabela en brasileños

Among the present`s sesamoids in the human body, the fabella can be found in the posterior part of the knee in low incidence. This report is quite controverted in the classic anatomical literature as well as its constitution. Its fixation is on the tendon of the gastrocnemius lateralis, close to its origin, in the posterior part of condilus femuralis lateralis. However, when its occurs, generally induces in the knee the absence of arcuate ligament with the presence of fabellofibular ligament. The prevalence is larger in male individuals. Few studies discuss the histology of the fabella. Some authors suggest that the fabella basically formed by bone tissue and others describe it as a fibrocartilaginous. The aim of this study is to analyze the incidence of the fabella, its histological structure and its association with presence or absence of fabellofibular ligaments through macro and microscopic study. Sixty-two Brazilian´s knees were dissected and the fabella was found in two diferent specimens. The tissue had been removed and fixed in 4 percent formaldehyde for microscopic evaluation. The fabella is a sesamoid bone that appears on knee in a small frequency in Brazilians. Its presence provokes absence of the arcuate ligament and the presence of the fabellofibular ligament. The histological study demonstrated bone tissues on its constitution without osteoclasts.

Entre los huesos sesamoideos que están presentes en el cuerpo humano, la fabela puede encontrarse en la cara posterior de la rodilla. Los reportes de su incidencia son bastante controvertidos en la literatura anatómica clásica, como también su constitución. Hay autores que mencionan a la fabela como tejido óseo, mientras otros la describen como una estructura fibrocartilaginosa. El sitio anatómico de ubicación es el tendón del gastrocnemio lateral, próximo de su origen, en la cara posterior del condilo femoral lateral. La prevalencia es más grande en individuos del sexo masculino. En presencia de este, se observa en rodilla la ausencia del ligamento poplíteo arqueado y la aparición del ligamento fabelo-fibular. Hay pocos trabajos que discuten la anatomía del compartimiento póstero-lateral de la rodilla con la Fabela, así como su constitución. Este trabajo tiene el propósito de analizar la incidencia de la fabela, su estructura histológica, asociándola con la presencia u ausencia de los ligamientos popliteo arqueado y fabelo-fibular a través del estudio macro y microscópico. Fueron disecados sesenta y cuatro cadáveres, sin causa mortis definida. Después fueron disecados. La fabela cuando estuvo presente fue retirada y fijada en formaldehido al 4 por ciento para su evaluación microscópica. De las sesenta y dos rodillas estudiadas dos presentaron fabela. La primera tuvo 1,6 cm de diámetro, ligeramente cóncava en su cara en contacto con cóndilo femoral lateral, bordes poco irregulares. La segunda tuvo 1,3 cm de diámetro con las mismas características estructurales. La fabela és un hueso sesamoideo que surge en la rodilla con baja frecuencia. Su aparición se acompañó de la ausencia del ligamento poplíteo-oblicuo y la presencia del ligamento fabelo-fibular. El estudio histológico determinó tejido óseo en su constitución sin osteoclastos.

Actinomycetes scale-up for the production of the antibacterial, nocathiacin.

An Amycolatopsis fastidiosa culture, which produces the nocathiacin class of antibacterial compounds, was scaled up to the 15,000 L working volume. Lower volume pilot fermentations (600, 900, and 1,500 L scale) were conducted to determine process feasibility at the 15,000 L scale. The effects of inoculum volume, impeller tip speed, volumetric gas flow rate, superficial gas velocity, backpressure, and sterilization heat stress were examined to determine optimal scale-up operating conditions. Inoculum volume (6 vs. 2 vol %) and medium sterilization (R(o) of 68 vs. 92 min(-1)) had no effect on productivity or titer, and higher impeller tip speeds (2.1 vs. 2.9 m/s) had a slight effect (20% decrease). In contrast, higher backpressure, incorporating increased head pressure at the 15,000 L scale (1.2 vs. 0.7 kg/cm(2)) and low gas flow rates (0.25 vs. 0.8 vvm), appeared to be problematic (40-50% decrease). High off-gas CO2 levels were likely reasons for observed lower productivity. Consequently, air flow rate for this 25-fold scale-up (600-15,000 L) was controlled to match off-gas CO2 profiles of acceptable smaller scale batches to maintain levels below 0.5%. The 15,000 L-scale fermentation achieved an expected nocathiacin I titer of 310 mg/L after 7 days. Other on-line data (i.e., pH, oxygen uptake rate, and CO2 evolution rate) and off-line data (i.e., analog production, glucose utilization, ammonium production, and dry cell weight) at the 15,000 L scale also tracked similarly to the smaller scale, demonstrating successful fermentation scale-up.

Pilot-scale process development and scale up for antifungal production.

A pilot-scale fermentation was developed for an antifungal compound produced by a filamentous fungus. Replacement of galactose with lactose (20-fold cost savings) and a threefold phosphate reduction (15 to 5 g/L) improved productivity 2.5-fold. Addition of supplements--glycine, cobalt chloride, and trace elements--resulted in a further twofold productivity increase, greater process robustness, and less foaming which reduced antifoam addition tenfold (30 to <3 mL/L). Mid-cycle lactose limitations were addressed by raising initial lactose levels (40 to 120 g/L) resulting in another twofold productivity increase. Overall, peak titers increased tenfold from 45 +/- 9 to 448 +/- 39 mg/L, and productivities improved from 3 to 25 mg/L day. Despite its high productivity, process scale up was challenged by high broth viscosity (5,000-6,000 cP at 16.8 s(-1)). Gassed power requirements at the 600 L scale (4.7 kW/1,000 L) exceeded available power at the 15,000 L scale (3.0 kW/1,000 L), and broth transfer to the downstream isolation facility was hindered. Mid-cycle broth dilution with up to five 10 vol% additions of 12 wt% lactose solution or whole medium-reduced viscosity three- to fivefold (1,000-1,500 cP at 16.8 s(-1)), gassed power within scale-up limits (2.5 kW/1,000 L), and peak titer by up to 45%. The process was scaled up to the 15,000 L working volume based on constant aeration rate (vvm) and peak impeller tip speed, raising superficial velocities at similar shear. This strategy maximized mass transfer rates at target gassed power per unit volume levels, and along with controlled broth viscosity, precluded multiple dilution additions. A final titer of 333 mg/L with one dilution addition was achieved, somewhat lower than expected, likely owing to inhibition from some unmeasured volatile compound (not believed to be carbon dioxide) during an extended period of high back-pressure in the early production phase.

Isolation and structure elucidation of thiazomycin- a potent thiazolyl peptide antibiotic from Amycolatopsis fastidiosa.

Thiazolyl peptides are a class of rigid macrocyclic compounds richly populated with thiazole rings. They are highly potent antibiotics but none have been advanced to clinic due to poor aqueous solubility. Recent progress in this field prompted a reinvestigation leading to the isolation of a new thiazolyl peptide, thiazomycin, a congener of nocathiacins. Thiazomycin possesses an oxazolidine ring as part of the amino-sugar moiety in contrast to the dimethyl amino group present in nocathiacin I. The presence of the oxazolidine ring provides additional opportunities for chemical modifications that are not possible with other nocathiacins. Thiazomycin is extremely potent against Gram-positive bacteria both in vitro and in vivo. The titer of thiazomycin in the fermentation broth was very low compared to the nocathiacins I and III. The lower titer together with its sandwiched order of elution presented significant challenges in large scale purification of thiazomycin. This problem was resolved by the development of an innovative preferential protonation based one- and/or two-step chromatographic method, which was used for pilot plant scale purifications of thiazomycin. The isolation and structure elucidation of thiazomycin is herein described.

Análise qualitativa histo-diferenciada do processo de reparo da pele de Rattus Norvégicus tratados por ultra-som terapêutico pulsado de 3.0 Mhz / Histo-differentiated qualitative analysis of healing process of skin in Rattus Norvegicus treated with 3.0 MHz pulsed therapeutic ultrasound

A aceleração do reparo tecidual pode propiciar a prevenção de inúmeras complicações associadas à perda de sua continuidade. Estudos utilizando o ultra-som (US) terapêutico têm demonstrado seu efeito benéfico sobre a regeneração de tecidos e, para a análise de seus efeitos sobre a concentração dos diferentes tipos celulares e componentes da matriz extracelular, durante o processo de reparo cutâneo, foi realizado um estudo histo-diferenciado, utilizando-se técnicas de coloração especiais na pele de 20 Rattus Norvégicus 5 dias após terem sido submetidos à incisão cutânea experimental. Os animais foram divididos em 5 grupos, sendo um grupo controle e quatro grupos sonados com diferentes intensidades, tendo como resultados menor quantidade de PMN (polimorfonuclerares) e ausência de mastócitos granulosos no local da incisão nos animais sonados, quantidades de colágeno similares em todos os grupos embora mantendo, no grupo sonado, um padrão de organização cicatricial mais próximo do normal. O sistema elástico não apresentou recuperação levando-se a concluir que o US acelera o processo de reparo da pele de ratos, influencia no padrão de organização das fibras colágenas, sem, contudo parecer atuar na recuperação do sistema elástico na fase do reparo analisada.

The acceleration of the tissue repair can prevent a lot of complications associated to the loss of its continuity. Studies using therapeutic ultrasound (US) have demonstrated beneficial effect in the tissue regeneration. With the objective of analyzing its effects on the concentration of different cellular types and the extracellular matrix component during cutaneous repair process, a histo-differentiated study was carried out, using special stain techniques in the skin of 20 Rattus Norvegicus, 5 days after cutaneous incision. The animals were divided in 5 groups, a group control and four groups treated with different intensities of US. Were observed a decreasing of polymorphonuclear cells and absence of granular mast cell at the place of incision in animals treated with US, similar quantities of collagen in all the groups although maintaining, in the group treated with US, a closer to normal organization pattern. The elastic system did not present recovery. Was concluded that US accelerates the repair process in mice’s skin, influences the pattern organization of collagen fibers, without acting in the recuperation of elastic system in the analyzed phase repair.

The extended loops of ribosomal proteins L4 and L22 are not required for ribosome assembly or L4-mediated autogenous control.

Ribosomal proteins L4 and L22 both have a globular domain that sits on the surface of the large ribosomal subunit and an extended loop that penetrates its core. The tips of both loops contribute to the lining of the peptide exit tunnel and have been implicated in a gating mechanism that might regulate the exit of nascent peptides. Also, the extensions of L4 and L22 contact multiple domains of 23S rRNA, suggesting they might facilitate rRNA folding during ribosome assembly. To learn more about the roles of these extensions, we constructed derivatives of both proteins that lack most of their extended loops. Our analysis of ribosomes carrying L4 or L22 deletion proteins did not detect any significant difference in their sedimentation property or polysome distribution. Also, the role of L4 in autogenous control was not affected. We conclude that these extensions are not required for ribosome assembly or for L4-mediated autogenous control of the S10 operon.