[Oral healthcare for frail and care-dependent older people in Germany and the Netherlands]. / Mondzorg voor kwetsbare en zorgafhankelijke ouderen in Duitsland en Nederland.

To improve oral health for frail and care-dependent older people, both intra- and extramurally, in the Euregio Rhine-Waal area in the Netherlands and Germany, we inventoried barriers to oral care for the target group according to the literature, the organisation of oral care in both countries and the implications of this organisation for daily and professional (oral) healthcare and oral care. Results show most identified barriers are common to both countries, but the organisation of oral healthcare differs in both countries. The main differences lie in the financing and organisation of oral care in the intramural situation. In the Netherlands, this is to a large degree regulated and organised on the basis of the Chronic Care Act (Wlz), using the Verenso Oral Care Directive for care-dependent clients as a base for enforcement. In Germany, on the other hand, the provision of oral care in the home situation is more effectively facilitated. In both countries, various initiatives have recently been employed to improve, among other things, information supply, education and financing of oral healthcare.

Systematic review of the influence of chemotherapy-associated liver injury on outcome after partial hepatectomy for colorectal liver metastases.

BACKGROUND: The impact of chemotherapy-associated liver injury (CALI) on postoperative outcome in patients undergoing partial hepatectomy for colorectal liver metastases (CRLM) remains controversial. The objective of this study was to clarify the effect of CALI (sinusoidal dilatation (SD), steatosis and steatohepatitis) on postoperative morbidity and mortality by investigating a large data set from multiple international centres. METHODS: PubMed and Embase were searched for studies published between 1 January 2004 and 31 December 2013 with keywords 'chemotherapy', 'liver resection', 'outcome' and 'colorectal metastases' to identify potential collaborating centres. Univariable and multivariable analyses were performed using binary logistic regression models, with results presented as odds ratios (ORs) with 95 per cent confidence intervals. RESULTS: A consolidated database comprising 788 patients who underwent hepatectomy for CRLM in eight centres was obtained. In multivariable analyses, severe SD was associated with increased major morbidity (Dindo-Clavien grade III-V; OR 1·73, 95 per cent c.i. 1·02 to 2·95; P = 0·043). Severe steatosis was associated with decreased liver surgery-specific complications (OR 0·52, 95 per cent c.i. 0·27 to 1·00; P = 0·049), whereas steatohepatitis was linked to an increase in these complications (OR 2·08, 1·18 to 3·66; P = 0·012). Subgroup analysis showed that lobular inflammation was the sole component associated with increased overall morbidity (OR 2·22, 1·48 to 3·34; P = 0·001) and liver surgery-specific complications (OR 3·35, 2·11 to 5·32; P < 0·001). Finally, oxaliplatin treatment was linked to severe SD (OR 2·74, 1·67 to 4·49; P < 0·001). CONCLUSION: An increase in postoperative major morbidity and liver surgery-specific complications was observed after partial hepatectomy in patients with severe SD and steatohepatitis. Postoperative liver failure occurred more often in patients with severe SD.

27Al MQMAS of the δ-Al13-Keggin.

One-dimensional 27Al, 23Na Magic-Angle-Spinning (MAS) NMR and 27Al Multiple-Quantum Magic-Angle-Spinning NMR (MQMAS) measurements are reported for the δ-isomer of the Al13 Keggin structure at high spinning speed and 14.1 T field. Values for the CQ and η parameters are on the same scale as those seen in other isomers of the Al13 structure. Density functional theory (DFT) calculations are performed for comparison to the experimental fits using the B3PW91/6-31+G* and PBE0/6-31+G* levels of theory, with the Polarizable Continuum Model (PCM).

Management of haemodynamically stable patients with penetrating abdominal stab injuries: review of practice at an Australian major trauma centre.

INTRODUCTION: The management of haemodynamically stable patients who present following a penetrating abdominal injury (PAI) remains variable between mandatory surgical exploration and more selective non-operative approaches. The primary aim of this study was to assess compliance with an algorithm guiding selective non-operative management of haemodynamically stable patients with PAI. The secondary aim was to examine the association between compliance and unnecessary laparotomies. METHODS: This was a retrospective cohort study involving all patients with PAI that presented to a major trauma centre from January 2007 to December 2011. Data were extracted from the trauma registry and patients' electronic medical records. RESULTS: There were 189 patients included in the study, of which 79 (41.8 %) patients complied with the algorithm. The laparotomy rate in the setting of algorithm compliance was significantly lower than algorithm non-compliance (12.7 vs. 68.2 %; p < 0.01) as were unnecessary laparotomy rates (0 vs. 33.3 %; p = 0.03). CONCLUSION: Among haemodynamically stable patients presenting with PAI, compliance with an algorithm guiding selective non-operative management was low, but associated with lower laparotomy and lower unnecessary laparotomy rates. Improved compliance with algorithms directed towards selective non-operative management of PAI should be encouraged with stringent vigilance towards patient safety.

Spatial and temporal analysis of land cover changes and water quality in the Lake Issaqueena watershed, South Carolina.

Monitoring changes in land cover and the subsequent environmental responses are essential for water quality assessment, natural resource planning, management, and policies. Over the last 75 years, the Lake Issaqueena watershed has experienced a drastic shift in land use. This study was conducted to examine the changes in land cover and the implied changes in land use that have occurred and their environmental, water quality impacts. Aerial photography of the watershed (1951, 1956, 1968, 1977, 1989, 1999, 2005, 2006, and 2009) was analyzed and classified using the geographic information system (GIS) software. Seven land cover classes were defined: evergreen, deciduous, bare ground, pasture/grassland, cultivated, and residential/other development. Water quality data, including sampling depth, water temperature, dissolved oxygen content, fecal coliform levels, inorganic nitrogen concentrations, and turbidity, were obtained from the South Carolina (SC) Department of Health and Environmental Control (SCDHEC) for two stations and analyzed for trends as they relate to land cover change. From 1951 to 2009, the watershed experienced an increase of tree cover and bare ground (+17.4 % evergreen, +62.3 % deciduous, +9.8 % bare ground) and a decrease of pasture/grassland and cultivated land (-42.6 % pasture/grassland and -57.1 % cultivated). From 2005 to 2009, there was an increase of 21.5 % in residential/other development. Sampling depth ranged from 0.1 to 0.3 m. Water temperature fluctuated corresponding to changing air temperatures, and dissolved oxygen content fluctuated as a factor of water temperature. Inorganic nitrogen content was higher from December to April possibly due to application of fertilizers prior to the growing season. Turbidity and fecal coliform bacteria levels remained relatively the same from 1962 to 2005, but a slight decline in pH can be observed at both stations. Prior to 1938, the area consisted of single-crop cotton farms; after 1938, the farms were abandoned, leaving large bare areas with highly eroded soil. Starting in 1938, Clemson reforested almost 30 % of the watershed. Currently, three fourths of the watershed is forestland, with a limited coverage of small farms and residential developments. Monitoring water quality is essential in maintaining adequate freshwater supply. Water quality monitoring focuses mainly on the collection of field data, but current water quality conditions depend on the cumulative impacts of land cover change over time.

The effect of placental restriction on insulin signaling and lipogenic pathways in omental adipose tissue in the postnatal lamb.

Intrauterine growth restriction (IUGR) followed by accelerated growth after birth is associated with an increased risk of abdominal (visceral) obesity and insulin resistance in adult life. The aim of the present study was to determine the impact of IUGR on mRNA expression and protein abundance of insulin signaling molecules in one of the major visceral fat depots, the omental adipose depot. IUGR was induced by placental restriction, and samples of omental adipose tissue were collected from IUGR (n = 9, 5 males, 4 females) and Control (n = 14, 8 males, 6 females) neonatal lambs at 21 days of age. The mRNA expression of the insulin signaling molecules, AMP-kinase (AMPK) and adipogenic/lipogenic genes was determined by qRT-PCR, and protein abundance by Western Blotting. AMPKα2 mRNA expression was increased in male IUGR lambs (0.015 ± 0.002 v. 0.0075 ± 0.0009, P < 0.001). The proportion of the AMPK pool that was phosphorylated (%P-AMPK) was lower in IUGR lambs compared with Controls independent of sex (39 ± 9% v. 100 ± 18%, P < 0.001). The mRNA expression and protein abundance of insulin signaling proteins and adipogenic/lipogenic genes was not different between groups. Thus, IUGR is associated with sex-specific alterations in the mRNA expression of AMPKα2 and a reduction in the percentage of the total AMPK pool that is phosphorylated in the omental adipose tissue of neonatal lambs, before the onset of visceral obesity. These molecular changes would be expected to promote lipid accumulation in the omental adipose depot and may therefore contribute to the onset of visceral adiposity in IUGR animals later in life.

The transition from fetal growth restriction to accelerated postnatal growth: a potential role for insulin signalling in skeletal muscle.

A world-wide series of epidemiological and experimental studies have demonstrated that there is an association between being small at birth, accelerated growth in early postnatal life and the emergence of insulin resistance in adult life. The aim of this study was to investigate why accelerated growth occurs in postnatal life after in utero growth restriction. Samples of quadriceps muscle were collected at approximately 140 days gestation (term approximately 150 days gestation) from normally grown fetal lambs (Control, n = 7) and from growth restricted fetal lambs (placentally restricted: PR, n = 8) and from Control (n = 14) and PR (n = 9) lambs at 21 days after birth. The abundance of the insulin and IGF1 receptor protein was higher in the quadriceps muscle of the PR fetus, but there was a lower abundance of the insulin signalling molecule PKC, and GLUT4 protein in the PR group. At 21 days of postnatal age, insulin receptor abundance remained higher in the muscle of the PR lamb, and there was also an up-regulation of the insulin signalling molecules, PI3Kinase p85, Akt1 and Akt2 and of the GLUT4 protein in the PR group. Fetal growth restriction therefore results in an increased abundance of the insulin receptor in skeletal muscle, which persists after birth when it is associated with an upregulation of insulin signalling molecules and the glucose transporter, GLUT4. These data provide evidence that the origins of the accelerated growth experienced by the small baby after birth lie in the adaptive response of the growth restricted fetus to its low placental substrate supply.

A review of the surgical strategies for the management of gallbladder carcinoma based on T stage and growth type of the tumour.

AIMS: Surgery for gallbladder carcinoma is a technically challenging exercise. The extent of resection varies based on a number of factors, and controversy exists regarding what constitutes an acceptable resection. A review of current recommendations and practice was undertaken. METHODS: A comprehensive literature review was performed, searching Medline for articles published since 2000, using the MeSH heading of 'gallbladder cancer' and 'surgery'. Abstracts were reviewed and articles retrieved if the main focus of the article centred on the surgical management of gallbladder carcinoma. OBSERVATIONS: The extent of hepatic resection and lymph node dissection required varies in particular with T stage. Growth pattern and anatomical location of the tumour within the gallbladder also influence surgical management. CONCLUSIONS: Discrepancy exists between the Eastern and Western literature in terms of what constitutes an acceptable limit of resection, and these issues are discussed.

Clustering in artificial categories: an equivalence analysis.

Category clustering is a robust finding in the free recall of familiar category members, but has rarely been studied with artificial categories. In the present study, college students learned artificial categories via stimulus-equivalence methodology. Arbitrary match-to-sample training with nonsense syllables established three interrelated conditional discriminations, and, for most subjects, unreinforced test trials revealed the emergent stimulus-control relations considered to be evidence of equivalence classes. Free-recall tests revealed evidence of significant within-class clustering both before and after equivalence testing, but was more pronounced after the equivalence tests. These findings confirm that classic phenomena like clustering in free recall can be studied with stimulus-equivalence methodology, thus allowing for experimental control over relevant variables.

Developmental profile of Sry transcripts in mouse brain.

Transient activation of the gene Sry in the gonadal ridge during a brief period of embryonic development is believed to function as a key signal for sex determination. However, a number of reports suggest that Sry expression is not as restricted in space and time as one would expect if its role was confined to directing male-specific differentiation in the early gonadal anlage. We have previously reported the occurrence of Sry/SRY transcripts in adult murine and human brain. The present communication is concerned with the study of the ontogenetic time course of Sry transcripts in mouse brain as detected by reverse transcription-polymerase chain reaction (RT-PCR). Particular emphasis was placed on the identification of two different forms of Sry mRNA, which can be linear or circular. To this aim, we used specific RT-PCR strategies to distinguish between both. Sry transcripts were found in male brain tissue of all ontogenetic stages investigated. Circular, presumably untranslatable, transcripts were found in embryonic brains of day 11 through 19. In contrast, postnatal Sry transcripts were linear, and thus translatable, and were found in diencephalon, midbrain, and cortex. The change from one transcript form to the other suggests that expression of the Sry gene in mouse brain is developmentally regulated, presumably by a switch in promoter selection. This supports the notion that Sry expression in brain is biologically significant.

Developmental regulation of glutamic acid decarboxylase mRNA expression and splicing in the rat striatum by dopamine.

Dopamine (DA) promotes the morphological differentiation of striatal GABAergic neurons through D(1) receptor activation and cAMP/PKA signaling. In this study, we investigated the developmental role of DA on the expression of the two GAD(65/67) genes and the alternative splicing of GAD(67) transcripts in the rat striatum. In vivo, embryonic and adult GAD(67) splice variants and GAD(65) transcripts increased until E17 and E19, respectively. Thereafter, the embryonic GAD(67) isoform disappeared, whereas GAD(65) mRNA levels remained unchanged postnatally. The hypothesis that the prenatal ingrowth and functional maturation of nigrostriatal afferents may be responsible for these developmental events through DA-dependent signaling pathways was tested in E17 rat striatal cultures. Treatment with DA and D(1) but not D(2) agonists decreased the ratio of embryonic to adult GAD(67) mRNAs and increased GAD(65) mRNA levels as well as GABA synthesis rates. Our findings demonstrate a distinct developmental switch in the regulation of GAD(65) expression and GAD(67) splicing in the rat striatum which clearly depends upon D(1) receptor but not D(2) signaling. The dopaminergic input thus appears to control the functional differentiation of GABAergic neurons not only by upregulation of expression of the two GAD genes but also by regulating GAD(67) splicing.

Evaluation of a family-based substance abuse prevention program targeted for the middle school years.

A family-based substance abuse prevention program was evaluated which emphasizes family cohesion, school and peer attachment, self-esteem, and attitudes about adolescent use of alcohol and tobacco. The program was implemented in rural communities and targeted families with students entering middle or junior high school. Baseline surveys were conducted with students and parents in four schools and were readministered one year later. Because the program was voluntary, a quasi-experimental design was used to compare participants (29 students and 28 parents) and nonparticipants (268 students and 134 parents). Analyses of covariance indicated that student participants, as compared to nonparticipants, had higher family cohesion, less family fighting, greater school attachment, higher self-esteem, and believed that alcohol should be consumed at an older age at the one year follow-up. There were fewer significant results for parent participants. Strategies for involving parents in prevention programs are discussed.

Acquisition of arbitrary conditional discriminations by young normally developing children.

Three experiments investigated conditions designed to facilitate acquisition of arbitrary conditional discriminations in 3- to 6-year-old normally developing children. In Experiment 1, 6 subjects failed to master the arbitrary match-to-sample task under conditions of differential reinforcement alone, but 7 subjects did so when instructions or instructions and sample naming were added. In Experiment 2, sample naming introduced in a blocked-trial arrangement resulted in acquisition, but only when the sample name was a nonsense syllable provided by the experimenter (5 of 7 subjects) and not when the sample name was generated by the subject (0 of 5 subjects). Experiment 3 demonstrated the effectiveness of a training sequence involving thematically related stimuli as an intermediate step facilitating the transition from identity to novel arbitrary relations. The difficulties in mastering arbitrary conditional discriminations shown here imply that further analyses with young children will be particularly important in efforts to investigate the development of theoretically important stimulus relations.

Differentiative effects of dopamine on striatal neurons involve stimulation of the cAMP/PKA pathway.

The neurotransmitter dopamine (DA) stimulates neurite outgrowth and growth cone formation in cultures of embryonic rat striatum through activation of D1 but not D2 receptors. We show here that neurite outgrowth could be stimulated to a similar extent by elevating cellular cAMP levels. Second, the neuritotrophic effect of DA was completely abolished by inhibiting adenylate cyclase or protein kinase A (PKA) but not protein kinase C (PKC). Third, double staining of cultures with antibodies against growth-associated protein-43 (GAP-43) and the phosphorylated form of the cAMP response element binding protein (pCREB) showed that pCREB was nearly exclusively associated with GAP-43-positive, i.e., actively growing, neurons. Again, this effect depended on D1 receptor and PKA activation. Although cross-talk with other signaling pathways needs to be studied further, we conclude that DA promotes the differentiation of striatal neurons via stimulation of D1 receptors and the cAMP/PKA signal transduction pathway.

Mapping of D1 dopamine receptor mRNA by non-radioactive in situ hybridization.

In order to improve the identification and characterization of dopaminoceptive neurons, the rat brain was mapped for D1 dopamine receptor mRNA by non-radioactive in situ hybridization (ISH) with a 45mer digoxigenin-labeled oligonucleotide probe. The specificity of the results was controlled with the help of a 396-bp D1 receptor riboprobe. Labeled hybrids were visualized with an alkaline phosphatase-coupled anti-digoxigenin antibody. The high resolution obtained permitted individual labeled cells to be identified and to distinction between cell bodies and processes. D1 mRNA was largely confined to neurons. With the exception of ependymal cells, glial cells were not distinctly labeled. Subcellularly, D1 mRNA was localized to perikarya but not to dendrites or axons. D1 receptor-expressing neurons were present in all of the known terminal fields of mesencephalic or diencephalic dopaminergic neurons. However, D1 message was also detected in brain areas which are not known to contain D1 ligand binding sites or in which the presence or the cellular source of this receptor subtype had previously not been unequivocally established, such as the hippocampus or cerebellar cortex. Moreover, labeled neurons were present in regions not known to receive dopaminergic projections, such as the thalamic and some brainstem nuclei. We conclude that this ISH technique provides a considerable gain in sensitivity and resolution with regard to neurotransmitter receptor mapping.

The Y-chromosomal genes SRY and ZFY are transcribed in adult human brain.

Sexual differentiation of the brain is thought to be regulated by hormonal signals from the developing male gonad. However, more-recent experimental and clinical data throw some doubt on the general validity of the "classical" steroid hypothesis and suggest that additional intervening factors or mechanisms need to be considered. In particular, it is now envisaged that neurons are capable of acquiring sex-specific properties independently of their hormonal environment. Here we show that two Y-chromosomal genes involved in sex determination of the gonad, SRY and ZFY, are transcribed in hypothalamus, and frontal and temporal cortex of the adult male human brain. These genes are candidates for male-specific transcriptional regulators that could confer upon human brain cells the potential for hormone-independent realization and maintenance of genetic sex.

Localization of D1 and D2 dopamine receptors in the rat mesencephalic trigeminal nucleus by immunocytochemistry and in situ hybridization.

The rat mesencephalic trigeminal nucleus (MTN) receives a dopaminergic innervation. In order to identify and localize dopaminoceptive cells within this nucleus, expression of D1 and D2 dopamine (DA) receptors was examined by immunocytochemistry with subtype-specific antibodies and in situ hybridization with digoxigenin-labeled cRNA probes. Immunocytochemical labeling was restricted to neuronal perikarya and proximal processes whereas the hybridization signal was confined to MTN cell bodies. Cells immunopositive for D1 were located throughout the entire MTN whereas cells labeled with D2 antibodies were concentrated in its caudal portion. D1 receptor message was found in relatively low levels. In contrast, high levels of mRNA for D2 were seen in MTN neurons. The distribution of DA receptor mRNA-containing cells were very similar to those of DA receptor immunoreactivity. Neurons expressing the D1 receptor gene were localized in both rostral and caudal portions, which receive inputs from masticatory muscle spindles and from spindles and periodontal ligament receptors, respectively. D2 receptors were limited to ventrocaudally located cells. These results suggest that processing of proprioceptive information in the MTN is controlled by the DAergic input through different postsynaptic mechanisms.

Close friend and group influence on adolescent cigarette smoking and alcohol use.

The relative influence of adolescents closest friends and their friendship group on their cigarette smoking and alcohol use was investigated in a short-term, longitudinal study of 1,028 students in the 6th, 8th, and 10th grades in 2 school systems. The amount of influence over the school year was modest in magnitude and came from the closest friend for initiation of cigarette and alcohol use. Only the friendship group use predicted transition into current cigarette use, whereas only the close friend use predicted transition into current alcohol use. Both group and close friends independently contributed to the prediction of adolescents' drinking to intoxication. No difference in the amount of influence, was found between stable and unstable close friendships or friendship groups; neither grade nor gender of the adolescents related to the amount of influence.

Birthdates of the tyrosine hydroxylase immunoreactive neurons in the hypothalamus of male and female rats.

This study determined the birthdates of the tyrosine hydroxylase-(TH) immunoreactive (IR) neurons in the zona incerta (ZI), periventricular nucleus (PeVN) and arcuate nucleus (AN) of male and female rats. 'Long-survival' [3H]thymidine autoradiography combined with TH immunocytochemistry, the first enzyme of catecholamine synthesis, was used. In males, TH-IR neurons originate in the ZI between embryonic days (E) 12 and 13, while in the PeVN and AN this process is prolonged until E16. The majority of TH-IR neurons became postmitotic at E12 in the ZI, between E12 and E14 in the PeVN and at E15 in the AN. The birthdate of TH-IR neurons was sexually dimorphic with (a) generation of the majority of TH-IR neurons in the ZI in males proceeding that in females, (b) generation of TH-IR neurons in the AN of males delayed as compared to females, and (c) average daily fractions of the newborn TH-IR neurons in each hypothalamic region of females exceeding that seen in males. This sexual dimorphism was observed prior to E16, i.e. before the onset of sex difference in androgen levels, implying a hormone-independent mechanism, determined at the genetic level.