Dental treatment in the cardiothoracic intensive care unit for patients with ventricular assist devices awaiting heart transplant: a case series.

OBJECTIVE: This report aims to describe the dental protocol for treating in the intensive care unit patients with end-stage heart failure who have had ventricular assist devices (VADs) emergently implanted as a bridge to heart transplant. This protocol permitted the rendering of safe and effective dental care in this setting and did not result in near-term (1-30 days) excessive hemorrhage, local and systemic infection, or contamination of the VAD. STUDY DESIGN: This descriptive cross-sectional study by the University of California, Los Angeles, Hospital Dental Service examined the dental care of 9 patients (mean age, 50 ± 12.9 years) with class IV stage D heart failure. RESULTS: Nine patients, 22 days (mean) after VAD placement, received dental treatment after intravenous prophylactic antibiotics and maintenance of prior anticoagulation, antiplatelet, or antithrombin regimen. Eight patients had extractions (mean, 4; range, 1-12), and one of them also required scaling and root planing (SRP) of the remaining teeth. A ninth individual only required SRP of 4 quadrants. No adverse outcomes developed. CONCLUSIONS: Emergent removal of active dental disease in patients with VAD awaiting heart transplant can be safely accomplished using established protocols with extended vigilance.

Langmuir monolayer as a tool toward visualization of a specific DNA-protein complex.

Immobilization and imaging of protein molecules and protein-DNA complexes on a Langmuir-Blodgett (LB) substrate have been explored here. We have prepared a nickel-arachidate (NiA) monolayer and characterized it through pressure-area isotherm on a LB trough. Recombinant RNA polymerase from Escherichia coli, where the largest subunit was replaced with the same gene having a series of histidine amino acids at the C-terminus end of the protein, was immobilized over the Ni-arachidate monolayer through a Ni(II)-histidine interaction. A single molecule of RNA polymerase could be seen through intermittent-contact atomic force microscopy (AFM). Under the condition of the formation of the LB monolayer, the enzyme molecules were arrayed and transcriptionally active. Interestingly, they could pick up sequence specific DNA molecules from the subphase in an oriented fashion. On the other hand, preformed RNA polymerase Ni(II)-arachidate monolayers bound DNA haphazardly when no surface pressure was employed.