Evaluation of Three Block Anesthesia Methods for Pain Management During Mandibular Third Molar Extraction: A Meta-analysis.

A patient's pain during mandibular third molar extraction often creates problems for a dental surgeon and can also cause immense patient discomfort, such as decreased quality of life, serious complications, or even danger to the patients' lives. Effective pain management is therefore of great importance. Conventional block anesthesia method often fails to control such pain completely during an operation. Therefore, two available alternatives, Gow-Gates (G-G) and Vazirani-Akinosi (V-A) methods, have been developed. However, the results of current studies regarding their effectiveness and safety are somewhat ambiguous. The use of G-G and V-A techniques is therefore restricted. This study did a comprehensive review of the relevant research and finally 7 RCTs were included. The results of this meta-analysis indicate that both G-G and V-A techniques have a lower risk of positive aspiration. G-G technique also evidenced a higher success rate than the conventional method. V-A was faster while the G-G technique in contrast had a slower onset time than the conventional technique. In terms of the measurement of analgesic success, however, the V-A method was statistically indistinguishable from conventional techniques. These findings will hopefully endow clinicians with the knowledge required to make appropriate choices for effective anesthesia during lower third molar extraction.

Attitudes of midwives towards perinatal bereavement in Hong Kong.

OBJECTIVE: to explore attitudes towards perinatal bereavement care among midwives working in Hong Kong through examination of relationships between attitudes towards bereavement support, need for bereavement education and appropriate hospital policy. DESIGN: a descriptive correlational survey. SETTING: the obstetric and gynaecology units at two hospitals. INSTRUMENT: a structured self-report questionnaire on attitudes towards perinatal bereavement support; required support and education needs for midwives on bereavement care. PARTICIPANTS: 154 out of 202 midwives (76.2% response rate) working at the two units. FINDINGS: two-step cluster analysis yielded two clusters. Cluster 1 consisted of 91 (59.1%) midwives and cluster 2 consisted of 63 (40.9%) midwives. Cluster 2 midwives were younger, had less obstetric and gynaecology experience, junior ranking and less post-qualification education than cluster 1 midwives. Cluster 1 midwives had additional personal grieving experiences and experience of caring for grieving parents. Attitudes towards bereavement care were positively correlated with educational needs (r(s)=0.55, p< 0.001) and hospital policy support (r(s)=0.50, p< 0.001). CONCLUSIONS: Hong Kong midwives require increased bereavement care knowledge and experience, improved communication skills, and greater hospital and team member support. Findings may be used to improve support of midwives, to ensure sensitive bereavement care in perinatal settings and to reflect training needs in the midwifery education curricula. Study findings highlight the universality of grief for a lost baby, irrespective of cultural differences in approaching emotional topics. This study may help midwives internationally to gain a broader perspective in this area.

Daturametelins H, I, and J: three new withanolide glycosides from Datura metel L.

Three new withanolide glycosides named daturametelins H-J (1-3), together with two known ones, daturataturin A (4) and 7,27-dihydroxy-1-oxowitha-2,5,24-trienolide (5), were isolated from the MeOH extract of the aerial parts of Datura metel L. (Solanaceae). Their structures were determined mainly by spectroscopic techniques including 2D-NMR (HMBC, HMQC, (1)H,(1)H-COSY, NOESY) and MS experiments. Compounds 1-5 were tested for their antiproliferative activity towards the human colorectal carcinoma (HCT-116) cell line. The nonglycosidic compound 5 exhibited the highest activity of the tested withanolides, with an IC(50) value of 3.2+/-0.2 microM (Table 3).

Guaiane-type sesquiterpenoids from Alisma orientalis.

Two guaiane-type sesquiterpenoids named orientalol E (1) and orientalol F (3) were isolated from the rhizome of Alisma orientalis (SAM) JUZEP together with two known guaiane-type sesquiterpenoids alismol (2) and alismoxide (4). Their relative stereostructures were elucidated by spectroscopic methods, whereas absolute stereostructures were determined on the basis of chemical correlation.

[A new alkaloid from Opuntia vulgaris].

AIM: To study the chemical constituents of the stems of Opuntia vulgaris Mill(Cactaceae). METHODS: The compounds of Opuntia vulgaris were isolated by chromatography of Amberlite Dowex 50 and silica gel, and identified by means of UV, IR, MS, 1D and 2D NMR. RESULTS: Three compounds were isolated and identified as: opuntin B(I), 4-hydroxyproline(II) and tyrosine(III). CONCLUSION: Compound I is a new alkaloid.

Isolation and identification of antioxidants from Sophora japonica.

A new flavonol triglycoside, kaempferol 3-O-alpha-L-rhamnopyranosyl-(1 --> 6)-beta-D-glucopyranosyl-(1 --> 2)-beta-D-glucopyranoside (1), as well as two known kaempferol 3-O-[alpha-L-rhamnopyranosyl-(1 --> 6)]-[beta-D-glucopyranosyl-(1 --> 2)]-beta-D-glucopyranoside (2) and kaempferol 3-O-beta-D-glucopyranosyl-(1 --> 2)-beta-D-glucopyranoside-7-O-alpha-L-rhamnopyranoside (3), were isolated from the n-BuOH extract of the pericarps of Sophora japonica by bioassay-guided fractionation. The structure of compound 1 was established by UV, IR, MS, and one- and two-dimensional NMR spectroscopy, including DEPT, NOESY, DQF-COSY, TOCSY, HMQC, and HMBC experiments. Compounds 1-3 showed antioxidative activity in DPPH and cytochrome-c assay using HL-60 cell system.

A new coumaronochromone from Sophora japonica.

A new coumaronochromone derivative, sophorophenolone (1), along with 13 known compounds, l-maackiain (2), medicagol (3), 7-O-methylpseudobaptigenin (4), pseudobaptigenin (5), 7,3'-di-O-methylorobol (6), genistein (7), prunetin (8), daidzein (9), formononetin (10), Di-O-methyldaidzein (11), quercetin (12), kaempferol (13) and isorhamnetin (14) were isolated from pericarps of Sophorajaponica L. The structure of compound 1 was established by UV, IR, MS, and one-dimensional and two-dimensional NMR spectroscopy, including DEPT, NOESY, 1H-1H COSY, HMQC, and HMBC experiments.