Patent nasopalatine ducts: an update of the literature and a series of new cases.

PURPOSE: The objective of this review is to present an update and summary of clinical findings of cases with a patent nasopalatine duct (NPD) reported in the literature from 1881 to 2016. METHODS: Previous articles and reviews about patent NPDs were studied and copies of all original publications were obtained for data verification. Furthermore, a literature search was conducted. In addition, the study sample was complemented with four cases recently seen in our institution. RESULTS: Ten out of 67 published cases were to be excluded for this analysis due to misinterpretation or misreporting in previous articles. Overall, 57 cases with NPD patency could be analyzed. Males outnumbered females in a ratio of 2:1. The mean age (when this information was available) was 34.1 ± 17.6 years (range 6-69 years). NPDs were located bilaterally (60%), unilaterally (20%) or centrally (20%). Complete or partial patency was reported in 73.9 and 26.1%, respectively. 74.1% of patients presented a variety of clinical signs and symptoms. The ability of the patient to produce a squeaky or whistling sound was the most frequent clinical finding (23.8%). CONCLUSIONS: Caution must be exercised when reading review articles about NPD patency since wrong data have been copied in several subsequent publications. Since epidemiological data are missing with regard to patent NPDs, age and gender predilections are not warranted. Bilateral occurrence and full patency were prevailing features in the evaluated case reports of patent NPDs.

Environmental Factors Variably Impact Tea Secondary Metabolites in the Context of Climate Change.

Climate change is impacting food and beverage crops around the world with implications for environmental and human well-being. While numerous studies have examined climate change effects on crop yields, relatively few studies have examined effects on crop quality (concentrations of nutrients, minerals, and secondary metabolites). This review article employs a culturally relevant beverage crop, tea (Camelia sinensis), as a lens to examine environmental effects linked to climate change on the directionality of crop quality. Our systematic review identified 86 articles as relevant to the review question. Findings provide evidence that shifts in seasonality, water stress, geography, light factors, altitude, herbivory and microbes, temperature, and soil factors that are linked to climate change can result in both increases and decreases up to 50% in secondary metabolites. A gap was found regarding evidence on the direct effects of carbon dioxide on tea quality, highlighting a critical research area for future study. While this systematic review provides evidence that multiple environmental parameters are impacting tea quality, the directionality and magnitude of these impacts is not clear with contradictory evidence between studies likely due to confounding factors including variation in tea variety, cultivar, specific environmental and agricultural management conditions, and differences in research methods. The environmental factors with the most consistent evidence in this systematic review were seasonality and water stress with 14 out of 18 studies (78%) demonstrating a decrease in concentrations of phenolic compounds or their bioactivity with a seasonal shift from the spring and /or first tea harvest to other seasons and seven out of 10 studies (70%) showing an increase in levels of phenolic compounds or their bioactivity with drought stress. Herbivory and soil fertility were two of the variables that showed the greatest contradictory evidence on tea quality. Both herbivory and soil fertility are variables which farmers have the greatest control over, pointing to the importance of agricultural management for climate mitigation and adaptation. The development of evidence-based management strategies and crop breeding programs for resilient cultivars are called for to mitigate climate impacts on crop quality and overall risk in agricultural and food systems.

Chimeric interleukin 2 receptor alpha chain antibody derivatives with fused mu and gamma chains permit improved recruitment of effector functions.

In order to investigate the feasibility of shuffling effector functions of monoclonal antibodies, we constructed chimeric antibodies with fused heavy chains. The derivatives studied are based on a monoclonal antibody directed against the alpha chain of the human Il2-R. Derivatives studied were the IgG1 and IgM isotypes; IgM delta, lacking the ability of multimerization due to a deletion; IgMc gamma 1 and IgGlc mu, with fused mu and gamma 1 chains and vice versa. IgG1, IgM delta and IgMc gamma 1 were secreted as monomers, IgM and IgG1c mu as polymers. The Ki values for competition with radio-iodinated Il2 with respect to binding to the Il2-R were markedly lower for polymeric than for monomeric derivatives (300-400 pM versus 2500-6500 pM). Recruitment of complement mediated by the deposition of C3 fragments, either of heterologous (rabbit) or homologous (human) origin, was mediated only by the polymeric derivatives IgM and IgG1c mu. ADCC was mediated by monomeric IgG1 and polymeric IgG1c mu, the latter derivative being active at concentrations 100-fold lower than the former. Together, the results demonstrate that both CDC and ADCC effector functions can be combined on a polymeric antibody derivative with fused gamma 1 and mu chains. In addition, such a derivative, due to its polymeric nature, has a high binding affinity. These properties may be important for the elimination of target cells in vivo.

Dental erosion in a population of Swiss adults.

The purpose of this study was to determine the prevalence of dental erosion in an adult population in Switzerland. 391 randomly selected persons from two age groups (26-30 and 46-50 yr) were examined for frequency and severity of erosion on all tooth surfaces. Information was gathered by interview about lifestyle, dietary and oral health habits. For facial surfaces 7.7% of the younger age group and 13.2% of the older age group showed at least one tooth affected with erosion with involvement of dentin (grade 2). 3.5 teeth per person in the younger and 2.8 teeth per person in the older age group were affected. Occlusally, at least one severe erosion was observed in 29.9% of the younger and 42.6% of the older sample with 3.2 and 3.9 erosion-affected teeth per person, respectively. 3.6% of the younger age group and 6.1% of the older age group showed slight lingual erosion on the maxillary anterior teeth. Severe lingual erosions were scarce. Data from interviews and multiple regression analyses revealed that acids from beverages are significantly associated with presence of erosion.

Epidemiology and risk factors of wedge-shaped defects in a Swiss population.

The purpose of this study was to determine the prevalence of wedge-shaped abrasion defects in the teeth of an adult Swiss population. 980 letters explaining the study were sent to randomly selected subjects. 391 persons (40%) belonging to two age groups (26-30 and 46-50 years) were checked for frequency and severity of wedge-shaped lesions on all buccal tooth surfaces. Furthermore patients were asked about dietary and prophylactic habits as well as other factors possibly relevant to this study. The frequency of severe wedge-shaped defects was 19.1% in the younger, and 47.2% in the older age group, with a mean of 3 affected teeth per person (pooled age group). On average, 34.8% of all patients suffered from tooth hypersensitivity. 84.6% of the examinees with wedge-shaped defects complained of hypersensitivity at these sites. It is concluded that wedge-shaped defects cause considerable problems to more than one third of the population, and that such lesions are often combined with hypersensitivity of affected teeth.

Interviewing, orientation and evaluation.

Interviewing, orientation and evaluation of staff are probably three of the most important and challenging tasks of any manager. This paper will discuss these processes and how they can be of value in the GI Unit.

Infection control issues in the gastrointestinal endoscopy unit.

The gastroenterology nurse is an integral member of the patient care team with a wide range of responsibilities combining the role of patient care manager with technical responsibilities for the use of complex equipment. With the increase in diagnostic and therapeutic endoscopy has come a keener awareness of what constitutes proper cleaning and disinfecting of endoscopes and endoscopic accessories as well as general aspects of infection control.

Writing job descriptions.

The skill of writing job descriptions begins with an understanding of the advantages, as well as the basic elements, of a well written description. The end result should be approved and updated as needed. Having a better understanding of this process makes writing the job description a challenge rather than a chore.

Developing an abstract and plan for presenting at education programs.

Presenters at the Society of Gastroenterology Nurses and Associates education programs are now being asked to submit abstracts on the proposed topic for presentation. In this article the author discusses the steps in planning and developing a presentation as well as submitting an abstract for consideration.

Patient teaching methods and materials.

As a result of the current healthcare politics, nurses are taking a closer look at methods to support self-care and wellness. In this article, the author discusses methods, materials, cost, and problems of patient education. There are barriers to effective patient education. Nurses need to overcome these barriers and choose the most effective method and materials for teaching patients.

Recruitment and retention of GI nurses: hiring, firing, and surviving.

Nursing turnover is costly for GI units, both financially and emotionally. The emphasis at Duke University Medical Center is changing from recruitment of GI nurses to searching for methods of retaining staff and building team morale. Recruitment and retention survey results are discussed in this article and retention strategies presented.

Healthcare reform: impact on gastrointestinal endoscopy units.

Healthcare costs, which now comprise 13.4% of the United States gross national product, continue to increase. President Clinton has placed healthcare reform on the national agenda, sparking nationwide debate. The President's plan will have an impact on all healthcare providers. As a result of this proposal, changes in the health care delivery system are occurring. The endoscopy setting will not be immune to these changes. In this article, the authors explore the possible impact of healthcare reform on nurses in general and, in particular, nurses in the endoscopy setting.