Proposed requirements for a European Doctorate in Dentistry: a discussion document prepared by a special interest group under the auspices of the Association for Dental Education in Europe.

In the Bologna process a third cycle is distinguished at the doctoral level. In documents on the Bologna process it is advocated to harmonise the structure and requirements of the doctorate, which in Europe are characterised by a wide variety. Differences exist in all possible requirements between countries, and even between schools within one country differences can be seen. In this paper an inventory is made of these differences in the dental doctorate between European countries. Moreover, the need for necessary harmonisation of requirements for a European dental doctorate is strongly advocated and a proposal is presented.

Immediate erosive potential of cola drinks and orange juices.

Little is known about the erosive potential of soft drinks within the first minutes of exposure to teeth, and about the potentially protective role of salivary proteins. We hypothesized that the erosive potential is determined primarily by pH and decreases in the presence of salivary proteins. To investigate this, we first added uncoated hydroxyapatite crystals and, second, salivary-protein-coated hydroxyapatite crystals to 20 commercially available cola drinks and orange juices simultaneously, with pH recordings every 15 sec for 3 min. The amount of apatite lost per liter of soft drink per sec was calculated from titratable acidity values to each pH obtained by crystal addition. The erosive potential within the first minutes of exposure was determined solely by the pH of the drink, and the erosive potential was ten-fold higher in cola drinks compared with juices. However, salivary proteins reduced the erosive potential of cola drinks by up to 50%.

[The prevalence of sicca symptoms in Iceland.].

OBJECTIVES: Sjoegren' syndrome is one of the most common inflammatory systemic rheumatic disorders. The syndrome is characterised by tiredness, pain problems and mucosal dryness. The goal of this study is to elucidate the prevalence of sicca symptoms in the Icelandic population and to calculate the preliminary prevalence value for Sjoegren' syndrome in Iceland. MATERIAL AND METHODS: Random sample was retrieved from two age groups; 40-49 and 70-75 years Icelandic inhabitants of Reykjavík and Akureyri. Questionnaire with 14 questions of the most common symptoms of Sjoegren' syndrome was mailed to those sampled. A small sample was evaluated by Schirmer-I test, tear film break up time (BUT) and Rose Bengal score for keratoconjunctivitis sicca (KCS) and unstimulated salivary flow rate was performed. RESULTS: The questionnaire was sent to 621 subjects, 300 male and 321 female. The response rate was 74%. Of those 20.3% had subjective symptoms of dry eyes and 12.0% of dry mouth according to the six questions used in the European classification criteria (EEC). The prevalence of both was higher in females (p<0.05). Of the 23 subjects who reported sicca symptoms, fatigue and pain problems; 26% had abnormal Shirmer-I test, 13% had abnormal BUT and 39% had abnormal salivary flow rate, two of those individuals fulfilled the EEC criteria for Sjoegren' syndrome (0.2%; 0-0.5%, 95% CI). None in the age and sex matched control group fulfilled the EEC criteria. CONCLUSION: The subjective symptoms of dry eye and dry mouth are common in Iceland, as are the three major symptoms of Sjoegren' syndrome. Standardised objective diagnostic criteria is necessary when the diagnosis of the syndrome is made.

Recognizing the pleckstrin homology domain fold in mammalian phospholipase D using hidden Markov models.

Phospholipase D was first described in plant tissue but has recently been shown to occur in mammalian cells where it is activated by cell surface receptors. Its mode of activation by receptors in unclear. Biochemical studies suggest that it may occur downstream of other effector proteins and that small GTP-dependent regulatory proteins may be involved. The sequence in a non-designated region of mammalian phospholipase D1 and 2 shows similarity to a structural domain that is present in signalling proteins that are regulated by protein kinases or heterotrimeric G-proteins. Mammalian phospholipase D has structural similarities with other lipid signalling phospholipases and thus may be regulated by receptors in an analogous fashion.

The effect of cyclodextrins on the stability of peptides in nasal enzymic systems.

Leucine enkephalin (YGGFL) undergoes rapid degradation in sheep nasal mucosa to yield GGFL which is further degraded to FL. The activity of the nasal mucosal homogenate against YGGFL and GGFL (t1/2 12 and 7 min) was significantly greater than that observed with a nasal wash fluid (t1/2 40 and 13 min). The effect of cyclodextrins on the rate of degradation of FGG and YGGFL by leucine aminopeptidase (LAP) and of GGF by carboxypeptidase A (CPA) was monitored. Little effect was observed with FGG (with LAP) but the half-life of YGGFL (with LAP) was extended from approximately 44 min to approximately 75 min in the presence of a 25-fold excess of beta-cyclodextrin. The stability of GGF (with CPA) was also enhanced; an effect was observable with a 5-fold excess of cyclodextrin and the half-life could be extended by 40-75%. An equation is presented which allows the estimation of the concentration of free peptide in the peptide-cyclodextrin solutions.

The effect of a mock trial on nursing students' ability to make clinically sound legal judgments.

In an attempt to enhance nursing students' abilities to make legally sound clinical judgments, a mock trial experience was developed and evaluated. Using a quasi-experimental design, students' learning was assessed using scenarios derived from actual cases involving nurses. Satisfaction with a traditional learning approach was compared to learning through attendance at a mock trial. A significant difference was found in learning before and after the trial (t = 2.26, P < 0.05), and students preferred the mock trial experience to traditional classroom presentations.

Caries experience in Icelandic 12-year-old urban children between 1984 and 1991.

In order to evaluate trends in caries experience, a 20% random sample of 12-yr-old residents of Reykjavik, Iceland (252 children) was examined clinically and radiographically in 1991 under conditions consistent with those of the survey conducted in 1984. In addition to caries data, frequency of toothbrushing and use of fluoride dentifrice were recorded. The mean DFT and DFS were 3.0 and 4.1, respectively. The decrease in caries experience reached 60% with an annual fall in DFS of nearly 10%. During the 7-yr period between examinations the decline in DFT and DFS scores averaged 5.2 and 8, respectively, the annual reduction amounting to 0.7 DF teeth or 1.1 DF surfaces per child. The ratio of approximal/occlusal caries and the proportion of approximal caries were similar in both surveys. Fourteen percent of the children were free from manifest caries in 1991, but only 2% in 1984. Polarization between low and high prevalence individuals had intensified. Ninety-five percent of the children brushed their teeth regularly and 97% reported using a fluoride dentifrice.

Molecular species analysis of a product of phospholipase D activation. Phosphatidylethanol is formed from phosphatidylcholine in phorbol ester- and bradykinin-stimulated PC12 cells.

Tumor-promoting phorbol esters or calcium-mobilizing receptor ligands stimulate phosphatidylcholine breakdown and in many cells this is accompanied by phospholipase D (PLD) activation. We tested whether or not a direct relationship exists between these two phenomena. Pheochromocytoma (PC12) cells were stimulated with the phorbol ester 12-O-tetradecanoyl-phorbol-13-acetate or with the calcium-mobilizing receptor ligand bradykinin in media containing 1% ethanol. The fatty acid composition of the molecular species of phosphatidylethanol (PEt), a product of PLD activation, formed in stimulated cells was compared with the molecular species of endogenous phospholipids isolated from unstimulated PC12 cells. PEt was isolated and analyzed by fast atom bombardment-mass spectrometry (FAB-MS) in the negative ion mode. Fatty acid composition and headgroup structure of the major PEt molecular ions were confirmed by linked scan analysis. Phosphatidylcholine, phosphatidylethanolamine, phosphatidylserine, and phosphatidylinositol were isolated from unstimulated cells and converted into phosphatidic acids using PLD. Mass spectra of the respective phosphatidic acids were obtained by fast atom bombardment-mass spectrometry as described above. The molecular species of PEt formed in 12-O-tetradecanoylphorbol-13-acetate- and bradykinin-stimulated PC12 cell were identical to those of phosphatidylcholine isolated from untreated cells.

Bis(monoacylglycero)phosphate from PC12 cells, a phospholipid that can comigrate with phosphatidic acid: molecular species analysis by fast atom bombardment mass spectrometry.

Phospholipids from pheochromocytoma (PC12) cells were purified by one-dimensional thin-layer chromatography (TLC). Material corresponding in RF to phosphatidic acid (PA) was analyzed by fast atom bombardment mass spectrometry (FAB). The molecular ions of the major constituents corresponded in mass to phosphatidylglycerols (PG), which, however, have a lower RF value. Analysis of the mass spectra demonstrated that this material consists of bis(monoacylglycero)phosphates (BMP, lysobisphosphatidic acid), a structural isomers of PG. Linked scans of individual molecular ions indicate that BMP from PC12 cells is esterified almost exclusively with monounsaturated (16:1 and 18:1) and polyunsaturated (20:4 and 22:6) fatty acids. One of the two major molecular species contains two monounsaturated (18:1/18:1), while the other contains both a monounsaturated (18:1) and a polyunsaturated (22:6) fatty acid ester. FAB in combination with TLC is ideally suited for analysis of molecular species of phospholipids.

Phospholipase D-catalyzed hydrolysis of phosphatidylcholine occurs with P-O bond cleavage.

Mammalian phospholipase D has been implicated in signal-transduction mechanisms, most recently in association with stimuli that enhance phosphatidylcholine (PC) turnover. It was previously unknown whether hydrolysis of PC by phospholipase D proceeds via P-O or C-O bond cleavage. Commercially available phospholipase D isolated from Streptomyces chromofuscus was used to hydrolyse distearoyl phosphatidylcholine (PC) in a detergent-containing buffer consisting of 90% 18O-water. The product of hydrolysis, phosphatidic acid (PA), was purified by thin-layer chromatography and analyzed using californium-252 plasma desorption mass spectrometry. An increase of two mass units was observed, compared to a distearoyl PA control, consistent with a reaction mechanism involving cleavage of the P-O bond.

Immune dysfunction in children after corrective surgery for congenital heart disease.

OBJECTIVE: To study the effect of open- and closed-heart surgery on the immune status of infants and children. DESIGN: Prospective study. Data collected before anesthesia and surgery and 2 and 24 hrs after surgery. SETTING: Operating room and pediatric ICU in a children's hospital. PATIENTS: Children undergoing surgery for correction of congenital heart disease (age 3 months to 12 yrs). A total of 31 patients were studied (open-heart surgery, n = 25; closed-heart surgery, n = 6). MEASUREMENTS AND MAIN RESULTS: Increased neutrophil counts and lymphopenia were observed after both open- and closed-heart surgery. Serum levels of the complement components C3 and C4 were depressed after open-heart surgery, but not after closed procedures. The percentage of T3+ and T4+ lymphocytes, proliferative responses of the lymphocytes and serum immunoglobulin (Ig)G and IgM were decreased from preoperative levels after open-heart surgery. The percentage of T8+ lymphocytes and serum IgA levels did not change. Intraoperative variables and postoperative severity of illness (Pediatric Risk of Mortality score) did not correlate with immune suppression. CONCLUSIONS: The immune system is affected after pediatric cardiac surgery, particularly after open-heart surgery.

Pediatric disaster medicine.

Disaster situations often involve children. The specific injuries that may be expected and the implications of these injuries for both acute caregivers and disaster planners are discussed in this article.

Calcium-dependent incorporation of choline into phosphatidylcholine (PC) by base-exchange in rat brain membranes occurs preferentially with phospholipid substrates containing docosahexaenoic acid (22:6(n-3)).

The fatty acid composition of phosphatidylcholine (PC) formed by base-exchange was examined in rat brain membranes in vitro. The free choline incorporated into subspecies of PC by this phospholipase-D type activity can be distinguished from that which might enter indirectly via the last enzyme of the de novo pathway for phospholipid biosynthesis, cholinephosphotransferase, by its ionic requirements. Choline base-exchange in lysed synaptosomes is optimal when assayed at extracellular (mM) calcium concentrations and is blocked by magnesium. As much as 40% of the choline incorporated by base-exchange into rat brain membranes was recovered in subspecies of PC, representing no more than 10% of the total PC pool, which contained docosahexaenoic acid (22:6(n-3)). Docosahexaenoic acid is enriched in electrically-excitable membranes and its content in phospholipids of rat and human brain change during early development and increase with age.

Prospective evaluation of a nonradiographic device for determination of endotracheal tube position in children.

A new noninvasive, nonradiographic endotracheal tube (ETT) position detection system (ETT-PDS) for guidance of ETT positioning was evaluated in pediatric ICU patients. The system includes an ETT with a metallic element embedded at a defined distance from the ETT tip, and a portable locator instrument which detects transcutaneously the position of the metallic element. The contribution of ETT-PDS to accuracy of ETT positioning after intubation and before chest radiographs was evaluated in 92 critically ill children. The ETT malposition rates observed on the postintubation chest radiographs were 39.1% after positioning guided by clinical assessment alone, and 19.6% after positioning guided by clinical assessment plus the ETT-PDS (p less than 0.5). This reduction in malnutrition rate could not be demonstrated when the ETT-PDS was used to guide routine ETT positioning performed before morning chest radiographs.

Meeting increased demands for medical record information.

Increased volume, additional requests for the entire record, and skyrocketing costs are prompting hospital administrators to take a critical look at correspondence management. A consensus is emerging that correspondence management can and should be organized to enrich the hospital. This article reviews the reasons for the shift in attitude by administrators, explores many exciting challenges that lie ahead for medical record managers, and points to trends that will shape what we do in the 1990s.