Salivary flow rate and pH during prolonged gum chewing in humans.

Gum chewing for 20 min causes an increase in salivary flow rate and salivary pH. Most people chew gum for longer than 20 min, and our aim was to determine how whole mouth salivary flow rate and pH might adapt during prolonged gum chewing. Resting saliva was collected over 5 min; gum-stimulated saliva was collected at intervals during 90 min, chewing a single pellet (1.5 g) of mint-flavoured, sugar-free gum (n = 19). Subjects chewed at their own preferred rate and style. Both salivary flow rate and pH were increased above resting levels for the entire 90 min. The salivary flow was significantly greater (anovaP < 0.05) than resting flows up to 55-min chewing. The saliva pH remained significantly higher (P < 0.0001) than the resting pH even after 90-min chewing. When the experiment was repeated with the gum pellets replaced at 30 and 60 min (n = 9), similar increases in salivary flow rate and pH were found. In the latter experiment, there was no evidence of any cumulative effects on flow or pH. The persistent increase in salivary pH in particular could be beneficial to oral and dental health.

Advanced life support skills undertaken by nurses--UK survey.

Many nurses successfully complete the Resuscitation Council (UK), European Resuscitation Council, advanced life support (ALS) Provider Course. Acquiring ALS provider status is not necessarily a licence to practice and individual hospital policy determines which skills these nurses can then perform without direct medical supervision. This postal survey aimed to determine which ALS skills are utilised by nurse ALS providers working in a variety of clinical areas within acute hospitals in the UK. A questionnaire was sent to the Resuscitation Officer or Nursing Director of all acute hospital groups in the UK. Almost 261 (87%) of the questionnaires were completed and returned. Nurse ALS providers in 99% of coronary care units, 89% of intensive care units, and 88% of accident and emergency departments undertook manual defibrillation. The majority of hospitals ran compulsory in-house training sessions for intravenous cannulation. Laryngeal mask insertion by nurse ALS providers was permitted in 19% of coronary care units and in the wards of 16% of the responding hospitals. Tracheal intubation by nurse ALS providers working in coronary care units, intensive care units and emergency departments was permitted by 11% of the responding hospitals. This survey has demonstrated that many acute hospitals do not permit nurse ALS providers to use a number of the skills taught on the ALS provider course. General ward-based nurse ALS providers, in particular, are restricted in the ALS skills, they are permitted to use. It would be more efficient for nurses to be trained and assessed specifically in skills they are then permitted to use. Having been assessed in a given skill and achieved a nationally recognised standard, nurse ALS providers should be permitted to use it in clinical practice.

Addition of synthetic and natural antioxidants to α-tocopheryl acetate supplemented beef patties: effects of antioxidants and packaging on lipid oxidation.

Friesian steers (n=5), aged 26-27 months, were fed a diet containing 2000 (supplemented) IU α-tocopheryl acetate/head/day for approximately 50 days prior to slaughter. Muscularis semimembranosus muscles from supplemented cattle were held in frozen storage (-20°C×12 weeks) following which they were minced and divided into five batches. The batches contained: (1) control, containing only vitamin E supplemented beef (C); (2) vitamin E supplemented beef with 4% soya oil (S); (3) vitamin E supplemented beef mixed with 0.2% Duralox NMC dissolved in 4% soya oil (R1); (4) vitamin E supplemented beef mixed with 0.25% Herbalox type 25 (containing 25 natural antioxidant extracts of rosemary) dissolved in 4% soya oil (R2); and (5) vitamin E supplemented beef mixed with a 1:1 mixture of 0.01% (w/w) BHA and 0.01% (w/w) BHT dissolved in 4% soya oil (B). The meat was then aerobically packaged (A) or packaged under the following modified atmospheres (MAP); 30:70 (M(1)); 70:30 (M(2)) or 80:20 (M(3)) (O(2):CO(2)). Oxidative stability (TBARS) and Hunter 'a' values (redness) were determined in all beef patties over 8 days of refrigerated (4°C) storage. Under MAP or aerobic packaging conditions, elevated oxygen levels brought about increased (P<0.05) TBARS numbers during refrigerated storage. However, the addition of rosemary extracts or BHA/BHT significantly (P<0.05) improved the oxidative stability of dietary α-tocopheryl acetate supplemented beef. Rosemary extracts were as effective in reducing TBARS as the combination of synthetic antioxidants, BHA/BHT.

Supraventricular tachycardia complicating the use of prostaglandin vaginal gel for induction of labour.

We present a case of a 31-year-old female patient who developed a supraventricular tachycardia and haemodynamic instability secondary to the use of vaginal prostaglandin E(2)gel for induction of labour. This complication occurred despite the patient's young age, absence of pre-existing ischaemia or coronary artery spasm, and the use of vaginal, rather than intravenous or intramyometrial prostaglandin. Physicians should be aware that serious cardiovascular complications can occur with vaginal prostaglandin E(2)therapy even in the absence of pre-existing risk factors.

Thoracic epidural anaesthesia and analgesia: United Kingdom practice.

BACKGROUND: Thoracic epidural analgesia has become increasingly practised in recent years. Complications are rare but potentially serious and, consequently, careful evaluation is required before undertaking this technique. The practice surrounding this procedure varies widely amongst anaesthetists. METHODS: A postal survey to examine the practice of thoracic epidural analgesia was sent to all Royal College of Anaesthetists tutors in the United Kingdom. RESULTS: Responses were received from 240 tutors, representing a return rate of 83%. When obtaining consent for thoracic epidural cannulation, 42% of respondents mentioned risk of a dural tap complication and 11% mentioned neurological damage. Fifty percent of respondents performed epidural cannulation following induction of general anaesthesia. The practice of epidural insertion in patients with abnormal coagulation varied, although over 80% of respondents did not consider concurrent treatment with either aspirin or non-steroidal anti-inflammatory drugs a contraindication. Sterile precautions for epidural insertion also varied between anaesthetists. Postoperatively, 95% of respondents used an opioid-based bupivacaine solution for epidural infusions, and these were most commonly nursed on general surgical wards (63%). Seventy-eight percent of hospitals provided an acute pain team to review epidural analgesia. CONCLUSION: In the United Kingdom, there is little consensus in the practice of thoracic epidural analgesia relating to the issues of informed consent, epidural cannulation in patients with deranged clotting and the sterile precautions taken prior to performing epidural insertion. Most respondents use an opioid-based bupivacaine solution to provide postoperative epidural analgesia. Most hospitals in the UK now provide an acute pain service for thoracic epidural follow-up.

Patient-controlled intranasal diamorphine for postoperative pain: an acceptability study.

A patient acceptability study was conducted using patient-controlled intranasal diamorphine. Patients undergoing nonemergency orthopaedic or gynaecological surgery self-administered intranasal diamorphine for 24 h postoperatively. Pain, pain relief, sedation, respiratory rate, nausea and vomiting were assessed regularly. After 24 h, patients and their attending nurses completed a questionnaire assessing satisfaction and practical aspects of the technique. Satisfaction was reported as good or complete by 69% of patients and 69% of nurses. Pain relief was assessed as better than expected by 45% of patients and better than normal by 50% of nurses. Seventy-nine per cent of patients would be pleased to use patient-controlled intranasal diamorphine again and 89% of nurses would be happy for their patients to use it again. Sedation was uncommon and mild and there were no episodes of significant respiratory depression. Fifty-three per cent of patients reported no nausea and 74% did not vomit at any stage. There were seven withdrawals, four due to problems with the device and three due to therapeutic problems. The nasal spray may need modification to improve reliability. However, we found patient-controlled intranasal analgesia an effective technique, which was well tolerated by patients and nurses and was without unpleasant side-effects. Further work to determine how it performs compared with intramuscular or intravenous analgesia is now needed.

Effects of alpha-tocopheryl acetate supplementation and salt addition on the oxidative stability (TBARS) and warmed-over flavour (WOF) of cooked turkey meat.

1. Day-old turkey poults (n = 14) were randomly divided into 2 groups (n = 7) and fed diets containing 20 (E20) and 600 (E600) mg all-rac-alpha-tocopheryl acetate/kg food for 21 weeks prior to slaughter. Following slaughter, breast and leg meat was removed and 4 batches of patties were produced from each. Two of the batches were formed from E20 meat (E20) and E20 plus 1% salt (E20S). Two similar batches were formed from E600 meat (E600) and E600 plus 1% salt (E600S). 2. Patties were fried, cooled and overwrapped with high oxygen-permeable film. Overwrapped patties were displayed in a 4 microC cabinet under fluorescent light (616 lux). Lipid oxidation (TBARS numbers) was determined on d 0, 2, 4, 6, 8 and 10, while taste panels to assess warmed-over flavour (WOF) were carried out on d 0, 2 and 4 of refrigerated (4 degrees C) display. 3. In the case of both leg and breast meat, E600 patties were the least susceptible of the 4 treatment batches to lipid oxidation. Salt had the effect of promoting lipid oxidation, with E20S and E600S patties having higher TBARS numbers than the corresponding patty batches where salt was absent. 4. Taste panel results showed that leg and breast patties formed from the meat of turkeys given alpha-tocopheryl acetate enriched diets developed significantly (P < 0.05) less WOF than those formed from control turkey meat on d 2 and 4 of refrigerated (4 degrees C) display. Patties containing 1% salt generally exhibited a greater degree of WOF than patties without salt. 5. A linear relationship was observed between TBARS numbers and WOF percentages for all batches of leg and breast patties.

Effect of dietary α-tocopheryl acetate supplementation on α-tocopherol distribution in raw turkey muscles and its effect on the storage stability of cooked turkey meat.

Day-old turkey chicks (n = 99) were divided at random into three groups (n = 33) and fed diets containing 20 (E20), 300 (E300) and 600 (E600) mg all-rac-α-tocopheryl acetate per kg feed per day for 21 weeks prior to slaughter. After slaughter, breasts and legs were removed and examined for α-tocopherol content. Breast muscle from birds fed the three diets was oven cooked, cooled, sliced and overwrapped. The oxidative and colour stability of the slices was examined. Mean α-tocopherol levels in turkey muscle were significantly (p < 0.05) higher in the E300 and E600 groups compared to the control group fed the E20 diet. α-Tocopherol levels in the E300 and E600 groups showed that concentrations in leg muscle were significantly (p <0.05) higher than in breast muscle. α-Tocopherol levels in leg and breast muscles from birds fed E20 and E600 diets decreased significantly (p < 0.05) during 12 months of frozen (-20 °C) storage. TBARS numbers for breast slices from all three dietary groups, cooked both 24 hr after slaughter and following frozen (-20 °C × 11 months) storage, increased during refrigerated (4 °C) display for 10 days. TBARS numbers for slices produced from meat previously held in frozen storage increased more rapidly than those for meat cooked following slaughter. In both cases, E300 and E600 diets significantly (p < 0.05) suppressed lipid oxidation compared to E20 samples. In general, Hunter a values for meat slices from turkeys fed the E300 and E600 diets were higher than those for meat slices from turkeys fed the E20 diet.

Assessment of alpha-tocopheryl acetate supplementation, addition of salt and packaging on the oxidative stability of raw turkey meat.

1. One-day-old turkey poults (n = 14) were randomised into 2 groups (n = 7) and fed diets containing 20 (E20) and 600 (E600) mg all-rac-alpha-tocopheryl acetate/kg food for 21 weeks prior to slaughter. Two batches were formed from E20 meat (E20) and E20 plus 10 g salt/kg (E20S). Two similar batches were formed from E600 meat (E600) and E600 plus 10 g salt/kg (E600S). 2. The effects of alpha-tocopheryl acetate supplementation and salt addition on the oxidative stability of raw turkey patties was investigated during aerobic and vacuum-packaged refrigerated (4 degrees C) storage. 3. Dietary alpha-tocopheryl acetate supplementation reduced TBARS (thiobarbituric acid reacting substances) numbers for raw overwrapped and vacuum-packaged turkey leg and breast patties. 4. Dietary alpha-tocopheryl acetate had the greatest influence on TBARS numbers for raw overwrapped turkey leg patties. 5. The addition of 10 g salt/kg increased TBARS numbers for overwrapped and vacuum-packaged turkey leg and breast patties. 6. Vacuum-packaged patties remained more oxidatively stable than similarly treated overwrapped patties throughout the experimental period.

A neurogenic mechanism for symmetrical arthritis.

Human synovium is richly innervated by autonomic and sensory nerve fibres, many of which contain neuropeptides. The hypothesis is that, in addition to a sensory role, some of these fibres modulate the response of the synovial membrane to a variety of noxious stimuli by releasing these peptides. Synovial damage results in acute inflammation in the damaged joint and a neurogenically mediated infiltrate of inflammatory cells in the contralateral joint. These cells might protect the contralateral synovium from injury similar to that in the damaged joint. An increased response would lead to synovitis and symmetrical disease.

Regulation of the estrous cycle in ewes with progestin containing implants: Influence of dose and day of cycle at treatment.

Implants containing Norgestomet (G. D. Searle and Co., Chicago) were inserted subcutaneously in ewes on selected days of the estrous cycle. When ewes were treated for 13 days with 2 or 3 mg Norgestomet, implantation 13 days post-estrus reduced the number of ewes in estrus within 5 days of implant removal and reduced the number of estrous ewes that lambed compared with ewes implanted 4 days post-estrus. When ewes were implanted with 3 or 6 mg Norgestomet 4 or 13 days post-estrus, no difference in estrus response was found. Conception rate was not influenced by day of treatment, but was higher in those ewes treated with 6 mg than ewes treated with 3 mg. Compared to no treatment, treatment with 3 or 6 mg Norgestomet reduced the number of uterine and oviducal sperm recovered 12 or 24 hr after insemination from ewes implanted for 12 days 2 or 12 days post-estrus. However, more sperm were recovered from ewes treated 2 days than 12 days post-estrus with the principal increase occurring in ewes treated with 6 mg of Norgestomet.