Informed consent in dentistry and medicine in Spain: Practical considerations and legality.

BACKGROUND: The healthcare practice of dentistry, as well as medicine, is framed within a legal environment. Patients have the right to know all the information related to any action performed on them and dental or medical doctors are obliged to obtain their patient's prior written informed consent (IC) before undertaking any healthcare procedures. MATERIAL AND METHODS: Here we reviewed the legality and jurisprudence in Spain regarding IC. We also used INFLESZ text readability analysis software to analyse a sample of official Spanish informed consent documents (ICDs) from different surgical and interventional procedures related to dentistry and oral cavity interventions. RESULTS: It is a mistake to confound IC with ICDs. This error prevents physicians from considering the former as a care process in which the patient's authorisation signature is the last link in a chain formed, almost in its entirety, by the informative process and deliberation alongside the patient. Multiple factors can influence communication between practitioners and their patients. Importantly, treatment adherence is greater when patients feel involved and autonomous in shared decision-making and when the circumstances of their lives are adequately considered. We concluded that although the ICDs we analysed conformed to the requirements set out in international law, they were somewhat difficult to read according to the reading habits of the general Spanish population. CONCLUSIONS: Knowledge about the legality of IC helps professionals to understand the problems that may arise from their non-compliance. This is because the omission or defective fulfilment of IC obligations is the origin of legal responsibility for medical practitioners. In this sense, to date, there have been more convictions for defective ICs than for malpractice. The information provided in ICs should include the risks, benefits, and treatment alternatives and must be tailored to the needs and capabilities of the patient to enable autonomous decision-making.

False positive for ß2-transferrin in rhinorrhoea. Ocular trauma. / Un falso positivo para ß2-transferrina en rinorrea. Traumatismo ocular.

Ocular perforations require an action depending on the findings observed. Additionally, the closeness of the orbit to the nasal cavity and the anterior cranial fossa requires any collateral damage in these spaces to be ruled out. The presence of a penetrating ocular injury associated with ipsilateral rhinorrhoea in which the presence of ß2-transferrin -a highly specific and sensitive marker to identify cerebrospinal fluid- is detected, obliges to suspect and locate any possible leakage. A case is presented in which this unbound protein is detected in post-traumatic rhinorrhoea with an origin in the eyeball, making the diagnosis of a CSF leak into a false positive.

In vitro ATP-dependent F-actin sliding on myosin is not influenced by substitution or removal of bound nucleotide.

To examine possible role of F-actin-bound nucleotide in ATP-dependent actin-myosin sliding, we prepared various actin filaments with different nucleotide contents and compared their sliding velocities on heavy mero-myosin in the presence of 2'-deoxyadenosine 5'-triphosphate (dATP) to exclude possible exchange of external ATP with the actin-bound nucleotide. Neither the sliding velocity nor the length of the actin filaments was significantly influenced by substitution or removal of actin-bound nucleotide, indicating that actin-bound nucleotide may not play a significant role in the sliding between actin and myosin.

Drug combinations in the treatment of gastric adenocarcinoma: a randomized Southwest Oncology Group study.

The FAM combination with the simultaneous administration of 5-fluorouracil, doxorubicin, and mitomycin C is considered standard chemotherapy for gastric adenocarcinoma. This study was initiated to determine whether a kinetically designed sequential administration of these three drugs would be superior and whether the presence or absence of easily measurable tumor would imply differences in survival. To do so, the Southwest Oncology Group tested two schedules in a randomized study of 239 patients. Independent judgments of response were made by two authors with the same results. Equivalent response rates (23% of all eligible sequential and 30% simultaneous) and median survival durations (22 and 23 weeks, respectively) were seen. Patients with and without readily measurable tumors each lived a median of 22 weeks. Higher degrees of hematologic toxicity were associated with prolonged survival (median 27 weeks versus 20 weeks, p = 0.04). Patients treated by community oncologists were described as having higher response rates than those treated in major medical centers (64% versus 31%, p = 0.03). The meaning of this is questionable in that there were no statistical differences in survival or toxicity. Those with prior exposure to 5-fluorouracil had only a tendency, without statistical significance, for a slightly inferior response and survival.

XBP1 mitigates aminoglycoside-induced endoplasmic reticulum stress and neuronal cell death.

Here we study links between aminoglycoside-induced mistranslation, protein misfolding and neuropathy. We demonstrate that aminoglycosides induce misreading in mammalian cells and assess endoplasmic reticulum (ER) stress and unfolded protein response (UPR) pathways. Genome-wide transcriptome and proteome analyses revealed upregulation of genes related to protein folding and degradation. Quantitative PCR confirmed induction of UPR markers including C/EBP homologous protein, glucose-regulated protein 94, binding immunoglobulin protein and X-box binding protein-1 (XBP1) mRNA splicing, which is crucial for UPR activation. We studied the effect of a compromised UPR on aminoglycoside ototoxicity in haploinsufficient XBP1 (XBP1(+/-)) mice. Intra-tympanic aminoglycoside treatment caused high-frequency hearing loss in XBP1(+/-) mice but not in wild-type littermates. Densities of spiral ganglion cells and synaptic ribbons were decreased in gentamicin-treated XBP1(+/-) mice, while sensory cells were preserved. Co-injection of the chemical chaperone tauroursodeoxycholic acid attenuated hearing loss. These results suggest that aminoglycoside-induced ER stress and cell death in spiral ganglion neurons is mitigated by XBP1, masking aminoglycoside neurotoxicity at the organismal level.

Novel Dictyostelium unconventional myosin, MyoM, has a putative RhoGEF domain.

We have cloned a novel unconventional myosin gene myoM in Dictyostelium. Phylogenetic analysis of the motor domain indicated that MyoM does not belong to any known subclass of the myosin superfamily. Following the motor domain, two calmodulin-binding IQ motifs, a putative coiled-coil region, and a Pro, Ser and Thr-rich domain, lies a combination of dbl homology and pleckstrin homology domains. These are conserved in Rho GDP/GTP exchange factors (RhoGEFs). We have identified for the first time the RhoGEF domain in the myosin sequences. The growth and terminal developmental phenotype of Dictyostelium cells were not affected by the myoM(-) mutation. Green fluorescent protein-tagged MyoM, however, accumulated at crown-shaped projections and membranes of phase lucent vesicles in growing cells, suggesting its possible roles in macropinocytosis.

Suppression of oncogenic viral interferon regulatory factor (vIRF) of Kaposi's sarcoma-associated herpesvirus by ribozyme-mediated cleavage.

Kaposi's sarcoma-associated herpesvirus/human herpesvirus 8 (KSHV/HHV8) has been etiologically associated with several malignancies including Kaposi's sarcoma and primary effusion lymphoma. Oncogenic viral interferon regulatory factor (vIRF) encoded by KSHV ORF-K9 is a homologue of cellular interferon regulatory factor (IRF), and has been demonstrated to inhibit type I/II interferon signal transduction and transform NIH3T3 cells through the interactions with IRF-1, IRF-3, and CBP/p300 proteins. To counteract vIRF's pathogenic role, we have developed five ribozymes targeting ORF-K9 mRNA to suppress vIRF expression. The vIRF RNA substrates were cleaved up to 80% in a substrate-specific manner in transcript cleavage assays in vitro. In a transient transfection assay, two of the ribozymes efficiently suppressed the expression of vIRF protein measured by dual-color immunofluorescence assay that simultaneously detects the expression of both vIRF protein and ribozyme. Flow cytometry analysis showed that these ribozymes reduced vIRF expression up to 76%. A mutant ribozyme had no cleavage activity in vitro, but exhibited antisense effect in vivo. These results suggest that the ribozymes may provide a new approach for functional knockout of vIRF gene, and are potential candidates of antiviral therapy for KSHV-related malignancies.

Cryptosporidiosis. Report of a fatal case complicated by disseminated toxoplasmosis.

A middle-aged woman suffered from chronic diarrhea and malnutrition as a result of a small intestinal infection with a coccidial protozoan--Cryptosporidium. This parasite has been found among a wide range of reptilian, avian and mammalian hosts, but rarely in human beings. This woman ultimately died as a result of disseminated toxoplasmosis of the type usually encountered in an adult whose immune responses were compromised. There was clinical evidence of both humoral and cellular immunologic incompetence, such as depressed levels of complement and immunoglobulins, and decreased T cell reactivity, respectively. The former could be accounted for on the basis of malnutrition causing deficient protein synthesis, and the latter may have been a manifestation of altered function of transformed T cells.

Splenic histiocytosis in idiopathic thrombocytopenic purpura: a relative sphingomyelinase deficiency?

The case of a patient in whom idiopathic thrombocytopenic purpura (ITP) was associated with diffuse splenic histiocytosis is described; the patient's subsequent sphingomyelinase level was at the lower limits of the normal range. The patient's splenic lecithin:sphingomyelin ratio was not significantly different from that of 11 age-matched control subjects. It is postulated that the sporadic cases of splenic histiocytosis in patients with ITP are due to a relative, acquired sphingomyelinase deficiency.

Purification and properties of a DNA ligase from sea urchin embryos.

DNA ligase was purified about 2,000-fold from blastulae of sea urchin, Hemicentrotus pulcherrimus, by means of 1 M KCl-extraction, phosphocellulose, DEAE-cellulose, Sepharose CL-6B, and double-stranded DNA cellulose column chromatography. The purified DNA ligase had a molecular weight of 80,000 (determined by Sephadex G-150) and a sedimentation coefficient of 4.1S (by glycerol gradient centrifugation). The purified enzyme required ATP and Mg2+ (or Mn2+) as cofactors for activity, and was inhibited by N-ethylmaleimide. Apparent Km values for ATP, Mg2+, and Mn2+ were 4 microM, 2.7 mM, and 0.3 mM, respectively.

Structure and function of D-amino acid oxidase. IX. Changes in the fluorescence polarization of FAD upon complex formation.

1. The fluorescence polarization, P, of FAD increased on complex formation with the apoenzyme of D-amino acid oxidase [D-amino acid: O2 ocidoreductase (deaminating), EC 1.4.3.3]. The time course of the increase was monophasic. The values of P were extimated to be 0.04, 0.4, and 0.4 for FAD, the enzyme and the enzyme-benzoate complex, respectively. 2. The value of P of the enzyme is dependent on its concentration, indicating that the degrees of dissociation of FAD in the monomer and dimer are different. The dissociation constant was calculated to be 7 times 10-minus 7 M for the monomeric form of the enzyme. This value is far larger than the value for the dimeric form of the enzyme, 1 times 10-minus 8 M, calculated from equilibrium dialysis data. 3. Changes in fluorescence polarization of the enzyme due to changes in solution pH or temperature can be explained in terms of the monomer-dimer equilibrium.

Correlation between erythrocyte aldose reductase level and human diabetic retinopathy.

AIM: To examine the relation between aldose reductase (AR) and the development and progression of diabetic retinopathy by comparing the erythrocyte AR levels with the prevalence of diabetic retinopathy in NIDDM patients. METHODS: A clinic based cross sectional study was used. 611 NIDDM patients and 73 controls were enrolled. Erythrocyte AR levels were determined by ELISA. These AR levels were then correlated with patient age, duration of diabetes, and HbA(1c) levels. AR levels were also correlated with the prevalence of diabetic retinopathy in the entire NIDDM patient group and in three subgroups formed by separating the NIDDM patients by their duration of diabetes. The prevalence of diabetic retinopathy significantly increased with increased erythrocyte AR levels in patients with duration of diabetes of less than 10 years. A similar, but non-significant correlation between the prevalence of retinopathy and increased erythrocyte AR levels was observed in patients with diabetes duration of 10-20 and >/=20 years. RESULTS: The prevalence of diabetic retinopathy increased with increased erythrocyte AR levels in NIDDM patients with a duration of diabetes of less than 10 years. CONCLUSION: It was suggested that the inhibition of AR in patients with early NIDDM might be beneficial in reducing the development of diabetic retinopathy.

Adriamycin combined with 10-day Ara-C, vincristine, and prednisone (10-day ADOAP) in the treatment of adult acute leukemia patients under fifty years of age. A Southwest Oncology Group Study.

In a twelve-month period, 56 consecutive patients with acute leukemia, aged 15-50, were treated by administration of a 10-day continuous infusion of Ara-C in combination with adriamycin, oncovin and prednisone (10 day ADOAP). Of 50 evaluable patients, there were 39 complete remissions (78%) with a median remission duration of 71 weeks. After adjustment for age and other known prognostic factors, the complete remission rate is still 10% higher than that found using a similar regimen without adriamycin.

Analysis of changes in corneal shape and refraction following scleral buckling surgery.

PURPOSE: A prospective study was performed to investigate changes in corneal shape and axial length following scleral buckling surgery. METHODS: We investigated the changes in corneal shape, refraction, and axial length following scleral buckling surgery in 24 patients who underwent local buckling and 14 patients who underwent encircling with additional segmental buckling. The corneal shape was determined by corneal topography and autokeratometry, refraction was measured by autorefractometry, and axial length was measured by A-mode ultrasonography before surgery, and 1, 2, and 7 days, and 1, 3, and 6 months after surgery. RESULTS: After local buckling, the axial length shortened and a hyperopic change was observed. After encircling with additional segmental buckling, the axial length elongated and a myopic shift was detected. The direction of the surgically induced corneal astigmatic vectors was almost identical to the direction of the buckle. There was a tendency for shorter distances between the limbus and the buckle to be associated with greater absolute values. Astigmatism gradually decreased following surgery and stabilized in about 3 months. CONCLUSIONS: Surgeons should select a surgical procedure to ensure favorable postoperative visual acuity while minimizing changes in the shape of the cornea.

Mineral metabolism in plasma, urine and bone of periparturient cows fed anionic diets with different calcium and phosphorous contents.

The objective of this experiment was to evaluate the influences of Ca and P contents in an anionic diet on the mineral metabolism in plasma, urine and bone in periparturient diary cows. Fifteen multiparous Holstein-Friesian cows were divided into 3 dietary groups (5 cows/group) by dietary Ca and P contents and dietary cation-anion balance [(Na + K) - (Cl + S) mEq/kg DM]; diet 1 [low Ca (0.46%), low P (0.24%), cationic (+195.8 mEq/kg DM)]; diet 2 [low Ca (0.46%), low P (0.24%), anionic (-32.4 mEq/kg DM)]; and diet 3 [high Ca (0.93%), high P (0.60%), anionic (-41.0 mEq/kg DM)]. Cows were fed one of these 3 diets from approximately 4 weeks before the expected calving date to 5 days after calving. There was no outbreak of milk fever in any cows fed these 3 diets; however, plasma Ca levels at 1 and 2 days after calving tended to be higher in the cows fed diet 3 than those in the cows fed diets 1 or 2. Fractional urinary excretion of Ca in the cows fed diet 2 or 3 was higher than that in the cows fed diet 1. Fractional urinary excretion and plasma level of Pi were higher during the periparturient period in the cows fed diet 3 than those in the cows fed diets 1 or 2. There were no significant differences in plasma parathyroid hormone levels among the 3 groups. In the spongy substance of ilium at 5 days after calving, the Ca and Mg contents bone volume and trabecular thickness were the lowest, but not significant, in the cows fed diet 2. These data suggest that sufficient Ca and P contents in an anionic diet may be effective in maintaining plasma Ca and Pi levels of periparturient cows and further in preventing of potential bone damage brought about by increased urinary mineral excretion following the feeding of an anionic diet.

[Behaviors of crystalline waters of (RS)-7-(2-aminomethylmorpholino)-1- cyclopropyl-6,8-difluoro-1,4-dihydro-4-oxo-3-quinolinecarboxylic acid].

Physicochemical characteristics of crystalline water of (RS)-7-(2-aminomethylmorpholino)-1-cyclopropyl-6,8-difluoro-1,4-di hydro-4-oxo-3-quinoline-carboxylic acid were studied by thermal analyses and powder X-ray diffractometry. The dihydrate of the compound was stable under ambient or humidified conditions. The dihydrate converted to a monohydrate on drying under mild conditions. The mono- and dihydrates transformed into alpha-type anhydrate at 110 degrees C. These three kinds of crystals were convertible each other under appropriate conditions. At 165 degrees C, the hydrates and the alpha-anhydrate converted to beta-type anhydrate. The compressed effects on the crystalline waters were also discussed for the dihydrate by kinetic analyses.

Is international economic migration spreading?

"Are the numbers of migrants growing? Proof is hard to come by--many countries' statistics do not provide reliable data for legal migration; most countries do not have good estimates for illegal migration; quite a few have no useable data at all, especially migrant-sending countries. We make use of an alternative yardstick, which over a period of time compares the number of countries that receive foreigners who are economically active or that are these persons' countries of origin.... Our yardstick includes only countries of a minimum population size fixed in terms of a comparable population base in the years 1970 and 1990."

[A clinical experience of DNA probe method for identifying Mycobacterium avium and Mycobacterium intracellulare].

In Japan the number of patient infected with M. avium complex (MAC) has been increasing in contrast to a decrease of pulmonary tuberculosis. DNA probe method enabled us be able to differentiate an isolated MAC into M. avium and M. intracellulare. From 1991 to 1992, we performed an investigation to apply this new technique of the DNA probe method on 52 patients of atypical mycobacteriosis diagnosed as infected with MAC by the ordinary method at the Higashi Nagoya National Hospital. The group consisted of 27 males and 25 females. M. avium infection was found in 39 patients (M. avium group) and M. intracellulare in 16 patients (M. intracellulare group). No significant gender difference was found between two groups. The M. avium group showed more complications in contrast to the M. intracellulare group. As complications in the M. avium group, pulmonary aspergillus infection, bacterial pneumonia and bronchiectasis were found in 4, 3 and 2 cases, respectively. The rate of drug resistance to antituberculosis drugs was high in the both groups. Chemotherapy with isoniazid (INH) rifampin (RFP) and streptomycin (SM) in five patients, that with INH, RFP and ethambutol (EB) in three were found to be effective after 4 months treatment. Three patients in M. avium group died of respiratory failure, aspergillus infection and renal failure. In contrast the prognosis of patients in the M. intracellulare group seemed to be better as there was no fatal case. We conclude that DNA probe method is useful to differentiate between M. avium and M. intracellulare, and enable us to select more appropriate selection of the chemotherapy and to assess of the prognosis.

Training or employment? Japanese immigration policy in dilemma.

"This article examines the Japanese training system for foreign workers from developing countries. While providing foreign trainees with the opportunities to acquire skills and knowledge at enterprises, the system concurrently serves as an adjustment function in the labor market....The fundamental problem derives from the gap between a strict immigration policy and the Japanese economy's structural dependence on foreigners. A clear national consensus must be established on whether or not Japan should accept semi- and unskilled foreign labor. The immigration policy should reflect this in formulating its long-term vision. The training system needs reformation to fulfil its functions appropriately and to protect trainees from abuse."