Pigment Epithelium-Derived Factor (PEDF) Receptors Are Involved in Survival of Retinal Neurons.

The demise of retinal ganglion cells (RGCs) is characteristic of diseases of the retina such as glaucoma and diabetic or ischemic retinopathies. Pigment epithelium-derived factor (PEDF) is a multifunctional secreted protein that mediates neuroprotection and inhibition of angiogenesis in the retina. We have studied expression and regulation of two of several receptors for PEDF, patatin-like phospholipase 2 gene product/PEDF-R and laminin receptor (LR), in serum-starved RGC under normoxia and hypoxia and investigated their involvement in the survival of retinal neuronal cells. We show that PEDF-R and LR are co-expressed in RGC and R28 retinal precursor cells. Expression of both receptors was enhanced in the presence of complex secretions from retinal glial (Müller) cells and upregulated by VEGF and under hypoxic conditions. PEDF-R- and LR-knocked-down cells demonstrated a markedly attenuated expression of anti-apoptotic Bcl-2 family members (Bcl-2, Bcl-xL) and neuroprotective mediators (PEDF, VEGF, BDNF) suggesting that both PEDF-R and LR mediate pro-survival effects of PEDF on RGC. While this study does not provide evidence for a differential survival-promoting influence of either PEDF-R or LR, it nevertheless highlights the importance of both PEDF receptors for the viability of retinal neurons.

Müller Cell-Derived PEDF Mediates Neuroprotection via STAT3 Activation.

Background/ Aims: This study was performed to reveal signaling pathways exploited by pigment epithelium-derived factor (PEDF) derived from retinal (glial) Müller cells to protect retinal ganglion cells (RGCs) from cell death. METHODS: The survival of RGCs was determined in the presence of conditioned culture media (MCM) from or in co-cultures with Müller cells. The significance of PEDF-induced STAT3 activation was evaluated in viability assays and using Western blotting analyses and siRNA-transfected cells. RESULTS: Secreted mediators of Müller cells increased survival of RGCs under normoxia or hypoxia to a similar degree as of PEDF- or IL-6-exposed cells. PEDF and MCM induced an increased STAT3 activation in RGCs and R28 cells, and neutralization of PEDF in MCM attenuated STAT3 activation. Inhibition of STAT3 reduced PEDF-promoted survival of RGCs. Similar to IL-6, PEDF induced STAT3 activation, acting in a dose-dependent manner via the PEDF receptor (PEDF-R) encoded by the PNPLA2 gene. Ablation of PEDF-R attenuated MCM-induced STAT3 activation and compromised the viability of PEDF-exposed R28 cells. CONCLUSIONS: Müller cells are an important source of PEDF, which promotes RGC survival through STAT3 activation and, at least in part, via PEDF-R. Enhancing the secretory function of Müller cells may be useful to promote RGC survival in retinal neurodegenerative diseases.

Anesthetic efficacy of a combination of 0.5 M mannitol plus 36.8 mg of lidocaine with 18.4 µg epinephrine in maxillary infiltration: a prospective, randomized, single-blind study.

The purpose of this prospective, randomized, single-blind study was to determine the anesthetic efficacy of lidocaine with epinephrine compared to lidocaine with epinephrine plus 0.5 M mannitol in maxillary lateral incisor infiltrations. Forty-one subjects randomly received 2 maxillary lateral infiltrations consisting of a 1.84-mL solution of 36.8 mg lidocaine with 18.4 µg epinephrine (control solution) and a 2.90-mL solution of 36.8 mg lidocaine with 18.4 µg epinephrine (1.84 mL) plus 0.5 M mannitol (1.06 mL) in 2 separate appointments spaced at least 1 week apart. The maxillary lateral incisor was blindly electric pulp-tested in 2-minute cycles for 60 minutes postinjection. No response from the subject to the maximum output (a reading of 80) of the pulp tester was used as the criterion for pulpal anesthesia. Total percent pulpal anesthesia was defined as the total of all pulpal anesthesia readings (at output of 80) over the 60-minute test period. Pain during solution deposition and postoperative pain were also measured. The results demonstrated that a 2.90-mL solution of 36.8 mg lidocaine with 18.4 µg epinephrine (1.84 mL) plus 0.5 M mannitol (1.06 mL) was not statistically significantly superior to a 1.84-mL solution of 36.8 mg lidocaine with 18.4 µg epinephrine. The pain of solution deposition was lower with the lidocaine/mannitol formulation. Postoperative pain was not statistically significantly different between the lidocaine/mannitol formulation and the lidocaine formulation without mannitol. We concluded that adding 0.5 M mannitol to a lidocaine with epinephrine formulation was not significantly more effective in achieving a greater percentage of total pulpal anesthesia (as defined in this study) than a lidocaine formulation without mannitol in the maxillary lateral incisor.

E-PROOF: E-intervention for protein intake and resistance training to optimize function: A study protocol.

BACKGROUND: Accounting for more than 60% of cancer survivors, older (≥65 years) cancer survivors have a 2- to 5-fold risk of physical function impairment, compared to cancer-free peers. One strategy to improve physical function is dietary and resistance training interventions, which improve muscle strength and mass by stimulating muscle protein synthesis. The E-PROOF (E-intervention for Protein Intake and Resistance Training to Optimize Function) study will examine the feasibility, acceptability, and preliminary efficacy of a 12-week randomized controlled trial of an online, tailored nutritional and resistance training education and counseling intervention to improve physical function and associated health outcomes (muscle strength, health-related quality of life (HRQoL), self-efficacy, and weight management). METHODS: In this study, 70 older cancer survivors will be randomized to one of two groups: experimental (receiving remote behavioral counseling and evidence-based education and resources), and control (general survivorship education). We will examine the intervention effects on physical function, muscle strength, HRQoL, self-efficacy, weight, and waist circumference during a 12-week period between the experimental and control groups. Three months following the end of the intervention, we will conduct a follow-up assessment to measure physical function, muscle strength, and HRQoL. SIGNIFICANCE AND IMPACT: This study is the first synchronous, online protein-focused diet and resistance training intervention among older cancer survivors. This novel study advances science by promoting independent health behaviors among older cancer survivors to improve health outcomes, and provide foundational knowledge to further address this growing problem on a wider scale through online platforms.

Anesthetic efficacy of a combination of 0.5 M mannitol plus 127.2 mg of lidocaine with 50 µg epinephrine in inferior alveolar nerve blocks: a prospective randomized, single-blind study.

The purpose of this prospective, randomized, single-blind study was to determine the anesthetic efficacy of 127.2 mg lidocaine with 50 µg epinephrine compared to 127.2 mg lidocaine with 50 µg epinephrine plus 0.5 M mannitol in inferior alveolar nerve (IAN) blocks. Forty subjects randomly received 2 IAN blocks consisting of a 3.18 mL formulation of 127.2 mg lidocaine with 50 µg epinephrine and a 5 mL formulation of 127.2 mg lidocaine with 50 µg epinephrine (3.18 mL) plus 0.5 M mannitol (1.82 mL) in 2 separate appointments spaced at least 1 week apart. Mandibular anterior and posterior teeth were blindly electric pulp tested at 4-minute cycles for 60 minutes postinjection. Pain of solution deposition and postoperative pain were also measured. No response from the subject to the maximum output (80 reading) of the pulp tester was used as the criterion for pulpal anesthesia. Total percent pulpal anesthesia was defined as the total of all the times of pulpal anesthesia (80 readings) over the 60 minutes. One hundred percent of the subjects had profound lip numbness with both inferior alveolar nerve blocks. The results demonstrated that a 5 mL formulation of 127.2 mg lidocaine with 50 µg epinephrine plus 0.5 M mannitol was significantly better than the 3.18 mL formulation of 127.2 mg lidocaine with 50 µg epinephrine for all teeth. Solution deposition pain and postoperative pain were not statistically different between the lidocaine/mannitol formulation and the lidocaine formulation without mannitol. We concluded that adding 0.5 M mannitol to a lidocaine with epinephrine formulation was significantly more effective in achieving a greater percentage of total pulpal anesthesia than a lidocaine formulation without mannitol.

Anesthetic efficacy of a combination of 0.9 M mannitol plus 68.8 mg of lidocaine with 50 µg epinephrine in inferior alveolar nerve blocks: a prospective randomized, single blind study.

The purpose of this prospective randomized, single blind study was to determine the anesthetic efficacy of 68.8 mg of lidocaine with 50 µg epinephrine compared to 68.8 mg lidocaine with 50 µg epinephrine plus 0.9 M mannitol in inferior alveolar nerve (IAN) blocks. Forty subjects randomly received 2 IAN blocks consisting of a 1.72-mL formulation of 68.8 mg lidocaine with 50 µg epinephrine and a 5-mL formulation of 68.8 mg lidocaine with 50 µg epinephrine (1.72 mL) plus 0.9 M mannitol (3.28 mL) in 2 separate appointments spaced at least 1 week apart. Mandibular anterior and posterior teeth were blindly electric pulp tested at 4-minute cycles for 60 minutes postinjection. No response from the subject to the maximum output (80 reading) of the pulp tester was used as the criterion for pulpal anesthesia. Total percent pulpal anesthesia was defined as the total of all the times of pulpal anesthesia (80 readings), for each tooth, over the 60 minutes. One hundred percent of the subjects had profound lip numbness with both inferior alveolar nerve blocks. The results demonstrated that the 5 mL-formulation of 68.8 mg lidocaine with 50 µg epinephrine plus 0.9 M mannitol was significantly better than the 1.72-mL formulation of 68.8 mg lidocaine with 50 µg epinephrine for all teeth, except the lateral incisor. We concluded that adding 0.9 M mannitol to a lidocaine with epinephrine formulation was significantly more effective in achieving a greater percentage of total pulpal anesthesia (as defined in this study) than a lidocaine formulation without mannitol. However, the 0.9 M mannitol/lidocaine formulation would not provide 100% pulpal anesthesia for all the mandibular teeth.

Anesthetic efficacy of combinations of 0.5 m mannitol and lidocaine with epinephrine in inferior alveolar nerve blocks: a prospective randomized, single-blind study.

The purpose of this prospective, randomized, single-blind study was to determine the anesthetic efficacy of lidocaine with epinephrine compared to lidocaine with epinephrine plus 0.5 M mannitol in inferior alveolar nerve (IAN) blocks. Forty subjects randomly received an IAN block in 3 separate appointments spaced at least 1 week apart using the following formulations: a 1.8 mL solution of 36 mg lidocaine with 18 µg epinephrine (control solution); a 2.84 mL solution of 36 mg lidocaine with 18 µg epinephrine (1.80 mL) plus 0.5 M mannitol (1.04 mL); and a 5 mL solution of 63.6 mg lidocaine with 32 µg epinephrine (3.18 mL) plus 0.5 M mannitol (1.82 mL). Mandibular teeth were blindly electric pulp tested at 4-minute cycles for 60 minutes postinjection. No response from the subject to the maximum output (80 reading) of the pulp tester was used as the criterion for pulpal anesthesia. Mean percent total pulpal anesthesia was defined as the total of all the times of pulpal anesthesia (80 readings) over the 60 minutes. Pain of solution deposition and postoperative pain were also measured. The results demonstrated that 2.84 mL of lidocaine with epinephrine plus 0.5 M mannitol was significantly better than 1.8 mL of lidocaine with epinephrine for the molars and premolars. The 5 mL of lidocaine with epinephrine plus 0.5 M mannitol was statistically better than 1.8 mL of lidocaine with epinephrine and 2.84 mL of lidocaine with epinephrine plus 0.5 M mannitol for all teeth except the central incisor. Solution deposition pain and postoperative pain were not statistically different among the mannitol formulations and the lidocaine formulation without mannitol. We concluded that adding 0.5 M mannitol to lidocaine with epinephrine formulations significantly improved effectiveness in achieving a greater percentage of total pulpal anesthesia compared with a lidocaine formulation without mannitol for IAN block.

Anesthetic Success Using Nitrous Oxide and a Combination of Lidocaine/Clonidine for the Inferior Alveolar Nerve Block and the Effects on Blood Pressure and Pulse in Patients with Symptomatic Irreversible Pulpitis: A Prospective, Randomized, Double-blind Study.

INTRODUCTION: The pulpal anesthetic success rates for an inferior alveolar nerve block (IANB) alone in patients presenting with symptomatic irreversible pulpitis are less than adequate. Nitrous oxide and clonidine have shown increases in IANB success when administered individually, but their success has not been evaluated when used together. The purpose of this prospective, randomized, double-blind study was to determine the effect of nitrous oxide/oxygen plus an IANB using lidocaine/clonidine on the success of the IANB in patients with symptomatic irreversible pulpitis and to evaluate the effect of clonidine on blood pressure and pulse. METHODS: Sixty-two emergency patients experiencing moderate to severe pain and a diagnosis of symptomatic irreversible pulpitis were enrolled. Subjects were randomly divided into 2 groups and received nitrous oxide/oxygen and an IANB using 2% lidocaine with either 27 µg clonidine or 18 µg epinephrine as vasoconstrictors. Blood pressure and pulse were recorded before and during the emergency endodontic treatment. Anesthetic success was defined as no or mild pain upon access and instrumentation of the canals. RESULTS: The pulpal anesthetic success rate in both treatments was 58%, with no significant difference between the groups. There was no statistically significant difference in pulse or systolic blood pressure with the use of clonidine compared with epinephrine. Diastolic blood pressure was significant. CONCLUSIONS: The use of nitrous/oxide plus the addition of lidocaine/clonidine for the IANB in teeth with symptomatic irreversible pulpitis resulted in no statistically significant difference in anesthetic success of the IANB. There were no statistically significant differences in pulse or systolic blood pressure with the use of clonidine compared with epinephrine; diastolic blood pressure was significant.

A prospective, randomized, double-blind comparison of 2% lidocaine with 1:100,000 epinephrine, 4% prilocaine with 1:200,000 epinephrine, and 4% prilocaine for maxillary infiltrations.

The purpose of this prospective, randomized, double-blind crossover study was to evaluate the anesthetic efficacy of 2% lidocaine with 1:100,000 epinephrine, 4% prilocaine with 1:200,000 epinephrine, and 4% prilocaine in maxillary lateral incisors and first molars. Sixty subjects randomly received, in a double-blind manner, maxillary lateral incisor and first molar infiltrations of 1.8 mL of 2% lidocaine with 1:100,000 epinephrine, 1.8 mL of 4% prilocaine with 1:200,000 epinephrine, and 1.8 mL of 4% prilocaine, at 3 separate appointments spaced at least 1 week apart. The teeth were pulp-tested in 3-minute cycles for a total of 60 minutes. Anesthetic success (ie, obtaining 2 consecutive 80 readings with the electric pulp tester) and onset of pulpal anesthesia were not significantly different between 2% lidocaine with 1:100,000 epinephrine, 4% prilocaine with 1:200,000 epinephrine, and 4% prilocaine for the lateral incisor and first molar. For both lateral incisor and first molar, 4% prilocaine with 1:200,000 epinephrine and 2% lidocaine with 1:100,000 epinephrine were equivalent for incidence of pulpal anesthesia. However, neither anesthetic agent provided an hour of pulpal anesthesia. For both lateral incisor and first molar, 4% prilocaine provided a significantly shorter duration of pulpal anesthesia compared with 2% lidocaine with 1:100,000 epinephrine and 4% prilocaine with 1:200,000 epinephrine.

A prospective, randomized, double-blind study of the anesthetic efficacy of sodium bicarbonate buffered 2% lidocaine with 1:100,000 epinephrine in inferior alveolar nerve blocks.

The authors, using a crossover design, randomly administered, in a double-blind manner, inferior alveolar nerve (IAN) blocks using a buffered 2% lidocaine with 1:100,000 epinephrine/sodium bicarbonate formulation and an unbuffered 2% lidocaine with 1:100,000 epinephrine formulation at 2 separate appointments spaced at least 1 week apart. An electric pulp tester was used in 4-minute cycles for 60 minutes to test for anesthesia of the first and second molars, premolars, and lateral and central incisors. Anesthesia was considered successful when 2 consecutive 80 readings were obtained within 15 minutes, and the 80 reading was continuously sustained for 60 minutes. For the buffered 2% lidocaine with 1:100,000 epinephrine/sodium bicarbonate formulation, successful pulpal anesthesia ranged from 10-71%. For the unbuffered 2% lidocaine with 1:100,000 epinephrine formulation, successful pulpal anesthesia ranged from 10-72%. No significant differences between the 2 anesthetic formulations were noted. The buffered lidocaine formulation did not statistically result in faster onset of pulpal anesthesia or less pain during injection than did the unbuffered lidocaine formulation. We concluded that buffering a 2% lidocaine with 1:100,000 epinephrine with sodium bicarbonate, as was formulated in the current study, did not statistically increase anesthetic success, provide faster onset, or result in less pain of injection when compared with unbuffered 2% lidocaine with 1:100,000 epinephrine for an IAN block.

The efficacy of a repeated buccal infiltration of articaine in prolonging duration of pulpal anesthesia in the mandibular first molar.

Previous studies have shown declining rates of pulpal anesthesia over 60 minutes when a cartridge of 4% articaine is used with 1:100,000 epinephrine for buccal infiltration in the mandibular first molar. The authors conducted a prospective, randomized, single-blind, crossover study comparing the degree of pulpal anesthesia obtained with 2 sets of mandibular first molar buccal infiltrations, given in 2 separate appointments, to 86 adult subjects: an initial infiltration of a cartridge of 4% articaine with 1:100,000 epinephrine plus a repeated infiltration of the same anesthetic and dose given 25 minutes following the initial infiltration versus an initial infiltration of a cartridge of 4% articaine with 1:100,000 epinephrine plus a mock repeated infiltration given 25 minutes following the initial infiltration. The authors used an electric pulp tester to test the first molar for anesthesia in 3-minute cycles for 112 minutes after the injections. The repeated infiltration significantly improved pulpal anesthesia from 28 minutes through 109 minutes in the mandibular first molar. A repeated infiltration of a cartridge of 4% articaine with 1:100,000 epinephrine given 25 minutes after an initial infiltration of the same type and dose of anesthetic significantly improved the duration of pulpal anesthesia, when compared with only an initial buccal infiltration, in the mandibular first molar.

Pulpal Anesthesia of Adjacent Teeth Following Infiltration of 2% Lidocaine With 1:100,000 Epinephrine in the Maxillary Lateral Incisor and First Molar.

The purpose of this study was to determine anesthetic success in adjacent teeth following a primary infiltration of the maxillary lateral incisor and first molar using 1.8 mL of 2% lidocaine with 1:100,000 epinephrine. Three hundred eight asymptomatic subjects received an infiltration of a cartridge of 2% lidocaine with 1:100,000 epinephrine over the maxillary lateral incisor (163 subjects) or first molar (145 subjects). Pulpal anesthesia of the injected tooth and adjacent mesial and distal teeth was monitored with the electric pulp tester in 2-minute cycles for a total of 60 minutes. No response from the subject at the maximum output (80 reading) of the pulp tester was used as the criterion for pulpal anesthesia. Comparisons of the odds of pulpal anesthesia (defined as an 80/80 response to electric pulp testing over 60 minutes) between the experimentally injected tooth and adjacent teeth were analyzed using mixed-models, repeated-measures logistic regression. When compared with the lateral incisor infiltration, the adjacent mesial tooth (central incisor) and distal tooth (canine) achieved statistically lower anesthetic success. When compared with the first molar, the mesial tooth (second premolar) did not differ statistically. However, significant differences were shown between the first molar and the second molar, with the distal tooth (second molar) achieving a statistically higher rate of pulpal anesthesia, which was related to a better duration of anesthesia. For asymptomatic patients, local anesthesia of the adjacent mesial (central incisor) and distal (canine) teeth to the infiltrated lateral incisor had lower pulpal anesthetic success. Because standard infiltration anesthesia of the lateral incisor is of short duration, repeating the infiltration at 30 minutes will result in a high incidence of pulpal anesthesia for 60 minutes. Local anesthesia of the adjacent distal tooth to the first molar (second molar) had a statistically higher rate of total pulpal anesthesia than the infiltrated first molar due to the longer duration of pulpal anesthesia. However, if pulpal anesthesia is required for 60 minutes in the first and second molars, the clinician may need to add an additional infiltration to ensure anesthesia.

An Evaluation of Ibuprofen Versus Ibuprofen/Acetaminophen for Postoperative Endodontic Pain in Patients With Symptomatic Irreversible Pulpitis and Symptomatic Apical Periodontitis.

The purpose of this investigation was to compare ibuprofen versus an ibuprofen/acetaminophen combination for postoperative pain control in a patient model specific to teeth diagnosed with symptomatic irreversible pulpitis and symptomatic apical periodontitis. One hundred and two patients presenting with moderate to severe pain from a maxillary or mandibular posterior tooth diagnosed with symptomatic irreversible pulpitis and symptomatic apical periodontitis were included. Following local anesthetic administration, complete endodontic cleaning and shaping was performed. Patients were randomly assigned to receive identically appearing tablets of ibuprofen 200 mg or a combination of ibuprofen 200 mg/acetaminophen 216.7 mg with instructions to take 3 tablets every 6 hours as needed for pain. Patients were also given a prescription for an escape medication to take if the study medications did not adequately control their pain. A 4-day diary was used to record pain ratings and medication use. Moderate to severe pain was experienced by 59-61% of the patients on postoperative day 1 and 50-57% of the patients on day 2, with the pain ratings decreasing over the next 2 days. There were no statistically significant differences between the 2 groups in postoperative pain, percussion pain, or medication use. There was no difference between ibuprofen and the combination of ibuprofen/acetaminophen in the reduction of postoperative pain following endodontic debridement in patients with symptomatic irreversible pulpitis and symptomatic apical periodontitis.

Anesthetic Efficacy of Intranasal 3% Tetracaine plus 0.05% Oxymetazoline (Kovanaze) in Maxillary Teeth.

INTRODUCTION: Needle-free anesthetic delivery is a promising alternative to traditional anesthetic routes of administration. The purpose of this study was to determine the patient preference for and pulpal anesthetic efficacy of a 3% tetracaine plus 0.05% oxymetazoline (Kovanaze) nasal spray in maxillary lateral incisors and first premolars. METHODS: Fifty adult subjects randomly received a 3% tetracaine plus 0.05% oxymetazoline (Kovanaze) nasal spray and mock infiltration or a mock nasal spray and 2% lidocaine with 1:100,000 epinephrine infiltration at the maxillary lateral incisor or first premolar in 2 appointments spaced at least 1 week apart in a single-blind cross-over design. Pulpal anesthesia was evaluated with an electric pulp tester. Side effects and subject preferences were also recorded. RESULTS: Anesthetic success was significantly lower for the Kovanaze nasal spray and mock infiltration (22%-37%) than for the mock nasal spray and lidocaine infiltration (89%-91%). Subjects reported more unwanted effects (nasal drainage and congestion, burning, pressure, and sinus congestion) after the Kovanaze nasal spray and mock infiltration than the mock spray and maxillary infiltration. Before participating in the study, more subjects (56%) preferred the nasal spray route versus a standard infiltration (44%). After experiencing both routes of administration, 100% of subjects preferred the standard infiltration. CONCLUSIONS: The 3% tetracaine plus 0.05% oxymetazoline (Kovanaze) nasal spray provided significantly less successful pulpal anesthesia than the lidocaine infiltration, was less preferable, and caused more unwanted effects.

Ibuprofen and Acetaminophen Versus Intranasal Ketorolac (Sprix) in an Untreated Endodontic Pain Model: A Randomized, Double-blind Investigation.

INTRODUCTION: Previously, ketorolac was available for primary use only via intravenous and intramuscular routes. Its availability in intranasal form offers an alternative route of administration that patients can self-administer. The purpose of this study was to compare the efficacy of intranasal ketorolac (Sprix; Egalet US Inc, Wayne, PA) with a combination of ibuprofen/acetaminophen in an acute pain model of untreated endodontic patients experiencing moderate to severe pain and symptomatic apical periodontitis. METHODS: Seventy patients experiencing moderate to severe pain, a pulpal diagnosis of symptomatic irreversible pulpitis or necrosis, and a periapical diagnosis of symptomatic apical periodontitis participated. Patients were randomly divided into 2 groups and received either 31.5 mg intranasal ketorolac and placebo capsules or 1000 mg acetaminophen/600 mg ibuprofen capsules and a mock nasal spray. Patients recorded perceived pain scores on a visual analog scale every 15 minutes from drug administration up to 240 minutes. The time to 50% pain relief, the first sign of pain relief, and meaningful pain relief were recorded, and the data were analyzed. RESULTS: A decline in reported pain was observed until 120 minutes after dosing, after which reported pain remained relatively constant. There was no significant difference between the 2 groups for the time to 50% pain relief, the first sign of pain relief, or meaningful pain relief. CONCLUSIONS: The effectiveness of intranasal ketorolac was not significantly different from that of a 1000 mg acetaminophen/600 mg ibuprofen combination. Intranasal ketorolac provides a nonnarcotic alternative and an additional route of medication administration to practicing clinicians.

Exploited species impacts on trophic linkages along reef-seagrass interfaces in the Florida Keys.

The removal of fish biomass by extensive commercial and recreational fishing has been hypothesized to drastically alter the strength of trophic linkages among adjacent habitats. We evaluated the effects of removing predatory fishes on trophic transfers between coral reefs and adjacent seagrass meadows by comparing fish community structure, grazing intensity, and invertebrate predation potential in predator-rich no-take sites and nearby predator-poor fished sites in the Florida Keys (USA). Exploited fishes were more abundant at the no-take sites than at the fished sites. Most of the exploited fishes were either omnivores or invertivores. More piscivores were recorded at no-take sites, but most (approximately 95%) were moderately fished and unexploited species (barracuda and bar jacks, respectively). Impacts of these consumers on lower trophic levels were modest. Herbivorous and smaller prey fish (< 10 cm total length) densities and seagrass grazing diminished with distance from reefs and were not negatively impacted by the elevated densities of exploited fishes at no-take sites. Predation by reef fishes on most tethered invertebrates was high, but exploited species impacts varied with prey type. The results of the study show that, even though abundances of reef-associated fishes have been reduced at fished sites, there is little evidence that this has produced cascading trophic effects or interrupted cross-habitat energy exchanges between coral reefs and seagrasses.

Anesthetic efficacy of 1.8 mL and 3.6 mL of 2% lidocaine with 1:100,000 epinephrine for maxillary infiltrations.

The purpose of this prospective, randomized, single-blinded study was to measure the degree of anesthesia obtained with 1.8 mL and 3.6 mL of 2% lidocaine with 1:100,000 epinephrine in maxillary infiltrations. Ninety-six adult subjects randomly received infiltrations of 1.8 mL and 3.6 mL of the lidocaine solution at two separate appointments, in a crossover design. Thirty-two lateral incisors, 32 first premolars and 32 first molars were studied in this investigation. Anesthetic success (obtaining two consecutive 80 readings with the electric pulp tester) for the two volumes ranged from 97% to 100%. The onset of pulpal anesthesia was not statistically different between the two volumes. For both volumes, the lateral incisors had a higher percentage of anesthesia of short duration than the first premolar and first molar. The 3.6 mL volume provided a statistically longer duration of pulpal anesthesia for the lateral incisor, first premolar, and first molar.

A prospective, randomized, double-blind comparison of articaine and lidocaine for maxillary infiltrations.

The purpose of this prospective, randomized, double-blind crossover study was to evaluate the anesthetic efficacy of 4% articaine with 1:100,000 epinephrine and 2% lidocaine with 1:100,000 epinephrine in maxillary lateral incisors and first molars. Eighty subjects randomly received, in a double-blind manner, maxillary lateral incisor and first molar infiltrations of one cartridge of 4% articaine with 1:100,000 epinephrine or 2% lidocaine with 1:100,000 epinephrine at two separate appointments spaced at least 1 week apart. In maxillary lateral incisors, articaine exhibited a significantly higher anesthetic success rate of 88% when compared with a 62% success rate with lidocaine. In maxillary first molars, articaine had a similar success rate to lidocaine (78% vs 73%), and there was no significant difference between the two solutions. In conclusion, a maxillary infiltration of 4% articaine with 1:100,000 epinephrine statistically improved anesthetic success when compared with 2% lidocaine with 1:100,000 epinephrine in the lateral incisor but not in the first molar.

Anesthetic efficacy of a repeated intraosseous injection following a primary intraosseous injection.

The purpose of this prospective, randomized, single-blinded study was to determine the anesthetic efficacy of a repeated intraosseous injection given 30 minutes after a primary intraosseous injection. Using a crossover design, 55 subjects randomly received a primary X-tip intraosseous injection (Dentsply Inc, York, PA) of 1.4 mL of 2% lidocaine with epinephrine (using the Wand; Milestone Scientific, Deerfield, IL) and a repeated intraosseous or mock injection at 30 minutes in two appointments. The first molar and adjacent teeth were pulp tested every 2 minutes for a total of 120 minutes. Success was defined as obtaining two consecutive 80 readings with the electric pulp tester. Success of the initial intraosseous injection was 100% for the first molar. The repeated intraosseous injection mimicked the initial intraosseous injection in terms of pulpal anesthesia and statistically provided another 15 minutes of pulpal anesthesia. In conclusion, using the methodology presented, repeating the intraosseous injection 30 minutes after an initial intraosseous injection will provide an additional 15 minutes of pulpal anesthesia.

Comparing anesthetic efficacy of articaine versus lidocaine as a supplemental buccal infiltration of the mandibular first molar after an inferior alveolar nerve block.

BACKGROUND: The authors conducted a prospective, randomized, double-blind, crossover study comparing the degree of pulpal anesthesia achieved by means of mandibular first molar buccal infiltrations of two anesthetic solutions: 4 percent articaine with 1:100,000 epinephrine and 2 percent lidocaine with 1:100,000 epinephrine after an inferior alveolar nerve (IAN) block with the use of 4 percent articaine with 1:100,000 epinephrine. METHODS: Seventy-three blinded adult subjects randomly received buccal infiltrations at the first molar site with a cartridge of 4 percent articaine with 1:100,000 epinephrine at one appointment and a cartridge of 2 percent lidocaine with 1:100,000 epinephrine at another appointment after receiving a standard IAN block with the use of 4 percent articaine with 1:100,000 epinephrine in a crossover design. After the injections, the authors used an electric pulp tester to test the first molar for anesthesia in three-minute cycles for 60 minutes. They considered anesthesia to be successful when two consecutive 80 readings were obtained within 10 minutes of the IAN block and infiltration injection, and the 80 reading was sustained continuously through the 60th minute. RESULTS: The authors found that with the use of the 4 percent articaine formulation, successful pulpal anesthesia occurred 88 percent of the time for the first molar. With the 2 percent lidocaine formulation, successful pulpal anesthesia occurred 71 percent of the time. The results show a significant difference (P < .05) between the articaine and lidocaine formulations. CONCLUSION AND CLINICAL IMPLICATIONS: For a mandibular buccal infiltration of the first molar after a standard IAN block, 4 percent articaine with 1:100,000 epinephrine resulted in a higher success rate (88 percent) than did 2 percent lidocaine with 1:100,000 epinephrine (71 percent success rate).