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Abstract Background Depression is often a chronic relapsing condition, with relapse rates of 50-80% in those who have been depressed before. This is particularly problematic for those who become suicidal when depressed since habitual recurrence of suicidal thoughts increases likelihood of further acute suicidal episodes. Therefore the question how to prevent relapse is of particular urgency in this group. Methods/Design This trial compares Mindfulness-Based Cognitive Therapy (MBCT), a novel form of treatment combining mindfulness meditation and cognitive therapy for depression, with both Cognitive Psycho-Education (CPE), an equally plausible cognitive treatment but without meditation, and treatment as usual (TAU). It will test whether MBCT reduces the risk of relapse in recurrently depressed patients and the incidence of suicidal symptoms in those with a history of suicidality who do relapse. It recruits participants, screens them by telephone for main inclusion and exclusion criteria and, if they are eligible, invites them to a pre-treatment session to assess eligibility in more detail. This trial allocates eligible participants at random between MBCT and TAU, CPE and TAU, and TAU alone in a ratio of 2:2:1, stratified by presence of suicidal ideation or behaviour and current anti-depressant use. We aim to recruit sufficient participants to allow for retention of 300 following attrition. We deliver both active treatments in groups meeting for two hours every week for eight weeks. We shall estimate effects on rates of relapse and suicidal symptoms over 12 months following treatment and assess clinical status immediately after treatment, and three, six, nine and twelve months thereafter. Discussion This will be the first trial of MBCT to investigate whether MCBT is effective in preventing relapse to depression when compared with a control psychological treatment of equal plausibility; and to explore the use of MBCT for the most severe recurrent depression - that in people who become suicidal when depressed. Trial Registration Current Controlled Trials: ISRCTN97185214.

Climate change is a major global threat to our society's urban areas, with the majority of Europe's population living in cities and their cultural heritage. Historic districts of significant cultural value and the communities connected to these places have an important role to play in fostering location-based identity and economy, social cohesion, innovation, urban regeneration, and climate change adaptation. Thus, it is important to make historic districts climate resilient, by jointly considering climate change adaptation, disaster risk management, heritage management, and sustainable urban development. However, this is often a major challenge for local and regional administrators and relevant stakeholders. This paper constitutes the first major result of the EU R&I Task Force for Climate Neutral and Resilient Historic Urban Districts. It provides an overview of the challenges faced by practitioners and researchers when jointly addressing the needs of resilient historic districts and provides an initial set of recommendations produced by the task force to address these challenges. These challenges cover different issues around five topics (i) data availability, use and its management, (ii) the common responsibility fragmentation in policy and governance, (iii) the challenge on integrating local knowledge and traditions in resilience building, (iv) the difficulties around the co-ownership and co-production in governance and (v) the importance of mainstreaming heritage management in adaptation and resilience policies., Competing Interests: No competing interests were disclosed., (Copyright: © 2023 Egusquiza A et al.)

Objective: In patients with a history of suicidal depression, recurrence of depressive symptoms can easily reactivate suicidal thinking. In this study, we investigated whether training in mindfulness, which is aimed at helping patients "decenter" from negative thinking, could help weaken the link between depressive symptoms and suicidal cognitions., Method: Analyses were based on data from a recent randomized controlled trial, in which previously suicidal patients were allocated to mindfulness-based cognitive therapy (MBCT), an active control treatment, cognitive psychoeducation (CPE), which did not include any meditation practice, or treatment as usual (TAU). After the end of the treatment phase, we compared the associations between depressive symptoms, as assessed through self-reports on the Beck Depression Inventory-II (Beck, Steer, & Brown, 1996), and suicidal thinking, as assessed through the Suicidal Cognitions Scale (Rudd et al., 2001)., Results: In patients with minimal to moderate symptoms at the time of assessment, comparisons of the correlations between depressive symptoms and suicidal cognitions showed significant differences between the groups. Although suicidal cognitions were significantly related to levels of symptoms in the 2 control groups, there was no such relation in the MBCT group., Conclusion: The findings suggest that, in patients with a history of suicidal depression, training in mindfulness can help to weaken the association between depressive symptoms and suicidal thinking, and thus reduce an important vulnerability for relapse to suicidal depression., ((c) 2015 APA, all rights reserved).)

The experience-based design (ebd) approach is a method of measuring patient experience, which deliberately draws out subjective, emotional and personal feelings of the patients using a service. We describe how the experience-based design approach has been used to measure the experiences of teenage patients at orthodontic consultation appointments in a district general hospital. This has allowed us to identify the points in the patient's journey where they experience most anxiety and nervousness and to target service improvements in these areas. We found the ebd approach effective in measuring patient experience in a teenage patient population. We demonstrate how the service improvements implemented have reduced negative feelings during new patient consultations., (© 2014 British Orthodontic Society.)

Few empirical studies have explored the associations between formal and informal mindfulness home practice and outcome in Mindfulness-based Cognitive Therapy (MBCT). In this study ninety-nine participants randomised to MBCT in a multi-centre randomised controlled trial completed self-reported ratings of home practice over 7 treatment weeks. Recurrence of Major Depression was assessed immediately after treatment, and at 3, 6, 9, and 12-months post-treatment. Results identified a significant association between mean daily duration of formal home practice and outcome and additionally indicated that participants who reported that they engaged in formal home practice on at least 3 days a week during the treatment phase were almost half as likely to relapse as those who reported fewer days of formal practice. These associations were independent of the potentially confounding variable of participant-rated treatment plausibility. The current study identified no significant association between informal home practice and outcome, although this may relate to the inherent difficulties in quantifying informal home mindfulness practice. These findings have important implications for clinicians discussing mindfulness-based interventions with their participants, in particular in relation to MBCT, where the amount of participant engagement in home practice appears to have a significant positive impact on outcome., (Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: We compared mindfulness-based cognitive therapy (MBCT) with both cognitive psychological education (CPE) and treatment as usual (TAU) in preventing relapse to major depressive disorder (MDD) in people currently in remission following at least 3 previous episodes., Method: A randomized controlled trial in which 274 participants were allocated in the ratio 2:2:1 to MBCT plus TAU, CPE plus TAU, and TAU alone, and data were analyzed for the 255 (93%; MBCT = 99, CPE = 103, TAU = 53) retained to follow-up. MBCT was delivered in accordance with its published manual, modified to address suicidal cognitions; CPE was modeled on MBCT, but without training in meditation. Both treatments were delivered through 8 weekly classes., Results: Allocated treatment had no significant effect on risk of relapse to MDD over 12 months follow-up, hazard ratio for MBCT vs. CPE = 0.88, 95% CI [0.58, 1.35]; for MBCT vs. TAU = 0.69, 95% CI [0.42, 1.12]. However, severity of childhood trauma affected relapse, hazard ratio for increase of 1 standard deviation = 1.26 (95% CI [1.05, 1.50]), and significantly interacted with allocated treatment. Among participants above median severity, the hazard ratio was 0.61, 95% CI [0.34, 1.09], for MBCT vs. CPE, and 0.43, 95% CI [0.22, 0.87], for MBCT vs. TAU. For those below median severity, there were no such differences between treatment groups., Conclusion: MBCT provided significant protection against relapse for participants with increased vulnerability due to history of childhood trauma, but showed no significant advantage in comparison to an active control treatment and usual care over the whole group of patients with recurrent depression.

Background: The assessment of intervention integrity is essential in psychotherapeutic intervention outcome research and psychotherapist training. There has been little attention given to it in mindfulness-based interventions research, training programs, and practice., Aims: To address this, the Mindfulness-Based Interventions: Teaching Assessment Criteria (MBI:TAC) was developed. This article describes the MBI:TAC and its development and presents initial data on reliability and validity., Method: Sixteen assessors from three centers evaluated teaching integrity of 43 teachers using the MBI:TAC., Results: Internal consistency (α = .94) and interrater reliability (overall intraclass correlation coefficient = .81; range = .60-.81) were high. Face and content validity were established through the MBI:TAC development process. Data on construct validity were acceptable., Conclusions: Initial data indicate that the MBI:TAC is a reliable and valid tool. It can be used in Mindfulness-Based Stress Reduction/Mindfulness-Based Cognitive Therapy outcome evaluation research, training and pragmatic practice settings, and in research to assess the impact of teaching integrity on participant outcome.

Purpose: Inguinoscrotal testicular descent has been proposed to occur via sensory fibers of the sexually dimorphic genitofemoral nerve, which release a neurotransmitter, calcitonin gene related peptide, to guide the migrating gubernaculum into the scrotum. We hypothesize that androgen mediated regression of the genitofemoral nerve mammary branch is necessary for inguinoscrotal descent in rats. We compared the spatiotemporal development of the genitofemoral nerve in control and antiandrogen treated rats., Materials and Methods: A total of 29 Sprague-Dawley® rats were collected (animal ethics committee approval A644) in control and antiandrogen treated groups (flutamide, embryonic days 16 to 19, 75 mg/kg body weight/5% ethanol + oil) on embryonic days 17 and 19, and on postnatal day 2. Sagittal sections of the gubernaculum and its surrounding structures were processed for standard histology and immunohistochemistry for androgen receptor, nerves (Tuj1), calcitonin gene related peptide (marker for genitofemoral nerve) and cell nuclei (DAPI)., Results: The inguinal mammary bud, its adjacent androgen receptor and genitofemoral nerve mammary branch (containing calcitonin gene related peptide) persisted from embryonic day 17 to postnatal day 2 in all antiandrogen treated males, yet regressed in all control males by postnatal day 2., Conclusions: Antiandrogens resulted in the persistence of the mammary branch and inguinal mammary bud. Persistent genitofemoral nerve mammary branches may arrest or slow down gubernacular migration by releasing calcitonin gene related peptide in the mammary inguinal fat pad, thus reducing the chemotactic gradient to calcitonin gene related peptide from genitofemoral nerve branches in the distal scrotum. We hypothesize that this process may be related to antiandrogen induced cryptorchidism in the rodent., (Copyright © 2012 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)

The Productive Mental Health Ward programme has been developed to improve efficiency and safety in the NHS. Patients in a medium-secure mental health unit used patient safety crosses as a tool for self-reflection as part of their recovery journey. This article describes how the project was set up as well as initial findings.

Purpose: Cryptorchidism is the most common male congenital abnormality. The rodent gubernaculum steers the testis from abdomen to scrotum postnatally by eversion and migration through the developing inguinal fat pad (IFP). We hypothesize that extracellular matrix remodeling in/around the gubernaculum is necessary for eversion and migration and is permitted by timed IFP maturation and aimed to examine regional development and matrix metalloproteinase (MMP) content., Methods: Embryonic day 19 (E19) and postnatal days 0 and 2 (P0, P2) wild-type Sprague-Dawley rats (n = 10) were prepared for histologic examination (trichrome) and immunohistochemistry (membrane-type MMP-1 [MT1-MMP], MMP2) and analyzed using light/confocal microscopy., Results: At E19, IFP contained fibroblasts and immature cells in an extensive collagenous extracellular matrix. Cells in the gubernaculum base were cytoplasmic-MT1-MMP-positive (inactive). At P0, the gubernaculum had everted, and adjacent cells were membranous-MT1-MMP-positive (active). At P2, the gubernaculum was migrating through the IFP, and adjacent cells were membranous-MT1-MMP-positive. Adipocyte maturation began cranially in the IFP and proceeded in a craniocaudal gradient until more uniformly mature at P2., Conclusion: The MT1-MMP-positive cells may remodel the gubernaculum for eversion and provide the collagenolysis necessary for migration, like an icebreaking ship, through the IFP, which matures to permit migration through collagen-rich tissue. Disruption of these processes may cause cryptorchidism., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Background/purpose: Inguinoscrotal testicular descent is controlled by androgens between embryonic days E16-19, but androgen receptor (AR) and estrogen receptor (ER) locations are unknown. We aimed to find AR, ERα, and ERβ in the gubernaculum and inguinal fat pad (IFP) in normal rats and after flutamide treatment., Methods: Sprague-Dawley timed-mated rats were injected with flutamide (75 mg/kg body weight/5% ethanol + oil) on E16-19 or vehicle alone. Male fetuses or pups (5-10/group) were collected at E16; E19; and postnatal (P) days 0, 2, 4, 8. Sections were prepared for hematoxylin and eosin or immunohistochemistry for AR, ERα, and ERβ. Receptor labeling was quantitated as distinct nuclear labeling/100 μm(2) in gubernaculum and IFP., Results: There was minimal gubernacular AR-labeling until E19, dramatically increasing postnatally. By contrast, at E16-E19 there was significant IFP AR immunoreactivity suppressed by flutamide (P < .05). No ERα expression was observed, but ERβ was expressed in both gubernaculum and IFP, maximally at E16, but unchanged by flutamide., Conclusions: During the androgen sensitivity window (E16-19), the gubernaculum contains ERβ but minimal ERα or AR, while the IFP, which is supplied by the genitofemoral nerve, contains abundant AR that are flutamide-sensitive. These results suggest that the IFP could be the site of androgenic action controlling gubernacular development., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Background/aims: How androgens control inguinoscrotal descent remains controversial but may include canonical Wnt signaling via the transcriptional co-activator β-catenin. The canonical Wnt pathway transcribes genes regulating mesenchymal cell migration, fate, extracellular matrix remodeling, and in addition Axin2, a feedback product that reliably identifies Wnt activation. The relationship between β-catenin and androgen receptor warranted investigation into the involvement of the canonical Wnt pathway in testicular descent., Methods: Gubernacula from male Sprague-Dawley control (n = 22) and flutamide-treated (n = 18) rats at E17, E19, and D0 time-points were processed for immunohistochemistry. Sagittal sections stained for presence of androgen receptor, Axin2, and β-catenin were analyzed by fluorescent confocal microscopy., Results: At E19, β-catenin was strongly expressed in the membrane of developing cremaster muscle cells and the cytoplasm of gubernacular core cells. Axin2 expression was ubiquitous in nuclei of gubernacular mesenchymal cells, representing canonical Wnt signaling. After androgen blockade, Axin2 was conspicuously absent in the fibroblasts of the gubernacular core while remaining unaffected elsewhere. Reduced staining of Axin2 in E17 and D0 gubernacula suggests that Wnt signaling coincides with androgen programming., Conclusion: Axin2 expression in the E19 gubernaculum confirms canonical Wnt pathway activation. Its absence in the core of flutamide-treated gubernacula indicates Wnt down-regulation. As androgen is required for inguinoscrotal descent, downstream Wnt signaling may control initial gubernacular remodeling. Defects in this complex molecular process may play a role in cryptorchidism., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Purpose: Cryptorchidism is a common abnormality and normal testicular descent is controlled by the gubernaculum. The cremaster may originate from abdominal muscles during gubernacular eversion or alternatively it may develop inside the gubernaculum. We studied cremaster myogenesis to determine how it develops., Materials and Methods: Coronal sections of the pelvis were prepared from male Sprague-Dawley® rats and from males treated prenatally with the antiandrogen flutamide at embryonic day 19, and postnatal days 10, 19 and 35 after receiving ethical approval. Immunohistochemical stains were prepared for Ki67, Pax-7, myogenin, myosin heavy chain 7, Myh1, Myh2, Myh4, embryonic myosin, and slow and cardiac troponin T. Cell counts of the 1) gubernacular tip, 2) proximal gubernaculum/cremaster muscle and 3) adjacent abdominal wall are shown as a percent of positive fibers or positive cells per area., Results: Throughout embryonic day 19, and postnatal days 10 and 19 proliferation (Ki67) was maximal at the gubernacular tip (p <0.001), as were muscle stem cells markers (Pax-7 p <0.05), early myogenesis (myogenin p <0.001) and immature muscle (Myh7, and slow and cardiac troponin T p <0.0001). In contrast, secondary (fast twitch, Myh1, 2 and 4) fibers were more common in abdominal muscles (p <0.0001). Differences in muscle maturity and composition decreased with time. Flutamide treated rats showed more cellular proliferation than controls postnatally on postnatal day 10 (p <0.001) as well as persistent immature embryonic myosin at the tip from postnatal day 19 (p <0.05)., Conclusions: Results show that the rat cremaster muscle is more immature at the gubernacular tip, consistent with myogenesis occurring in the gubernaculum during migration to the scrotum, as proposed in humans., (Copyright © 2011 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.)

Background: Gubernacular development and testicular descent have been studied most extensively in rat models, but new transgenic mouse models require a deep understanding of normal mouse development so that results can be extrapolated to the human. We aimed to compare gubernacular anatomy during development in the mouse with that of the rat., Methods: Time-mated mice (C57BL/6) and Sprague-Dawley rats were used to collect male fetuses at embryonic (E) days E13, E14, E15, E17, E18, and E19 and neonates at postnatal (P) days P0 and P2. Fetuses and newborn were processed for serial sections (sagittal, transverse, and coronal) and stained with hematoxylin and eosin, muscle markers (embryonic myosin, desmin), a neuronal marker (Tuj1), a mitotic marker (Ki67), and keratin marker to label epithelium., Results: Early development of cremaster in the mouse was related to transversus abdominis muscle, but not internal oblique muscle (as in rats), and forms a monolaminar cremaster layer. There is close association between the regressing inguinal mammary bud and the gubernaculum in the mouse at E13. The peritoneal surface of the processus vaginalis (PV) covering the gubernaculum and epididymis was morphologically distinct from the remaining parietal peritoneum throughout development., Conclusions: Gubernacular development in mouse is similar to that in the rat except for certain structures, such as cremaster muscle. The PV seems to be derived from the surface of the urogenital ridge, separate from the remaining parietal peritoneum. This study suggests that the PV has evolved to aid testicular descent in this species, rather than a nondescript diverticulum of parietal peritoneum., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Aim: During testicular descent (TD), the genitofemoral nerve (GFN) is masculinized by androgen. This study aimed to test whether androgen receptor (AR), estrogen receptor α (ERA), or estrogen receptor β (ERB) are expressed during TD in the GFN spinal segments and dorsal root ganglia (DRG) in normal and flutamide-treated rats., Methods: Time-mated Sprague-Dawley dams were injected with flutamide (75 mg/kg, subcutaneously (S/C) in sunflower oil) on embryonic (E) days 16 to 19. Embryonic and postnatal (P) male L1-2 spinal cord segments were collected (E16, E17, E19, P0, P2, and P4) in control and flutamide-treated groups (n = 5-10). Samples were fixed in 4% paraformaldehyde. Five-micrometer-thick sections were prepared immunohistochemically for AR, ERA, and ERB., Results: During TD, ERB was expressed in L1-2 DRG. Surprisingly, AR was not expressed in prenatal DRG, only after P2. There was no ERA expression. Flutamide had no effect on AR, ERB, or ERA expression in the L1-2 DRG during TD., Conclusion: During the E window of androgen sensitivity, the GFN is not directly masculinized, with little AR expression and no change with flutamide over this period. Estrogen receptor β is expressed in the DRG during TD. However, its relevance is yet to be determined., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Background/aims: Recent work both from our laboratory and in marsupial models of testicular descent suggests a strong connection between the mammary line and gubernacular migration. This study investigated the relationship between the mammary fat pad (MFP) that underlies the mammary line and the developing gubernaculum by fluorescent immunohistochemistry., Methods: Rats at E17 and E19 were fixed and processed for immunohistochemistry. Sagittal sections of male fetuses were stained with antibodies against androgen receptor (AR), prolyl-4 hydroxylase β, Desmin, activated Notch-1, Jagged-1, and Ki-67. These were analyzed by fluorescent confocal microscopy., Results: At E17 and E19, the MFP anlage forms a continuous distribution of fibroblasts passing immediately adjacent the gubernaculum to the future scrotum. Within this exists a distinct subpopulation of fibroblasts expressing AR distributed over the path of inguinoscrotal descent of the gubernaculum. Proliferation and Notch-1 signaling were similar throughout the MFP with differential Notch-1 signaling in the E19 gubernaculum., Conclusion: This investigation has identified the presence of a distinct AR-expressing subpopulation of MFP fibroblasts over the path of inguinoscrotal descent during the key androgenic programming window of this phase. This unique developmental pattern is consistent with a prime role for the MFP in testicular descent., (Copyright © 2011 Elsevier Inc. All rights reserved.)

Background: Depression is often a chronic relapsing condition, with relapse rates of 50-80% in those who have been depressed before. This is particularly problematic for those who become suicidal when depressed since habitual recurrence of suicidal thoughts increases likelihood of further acute suicidal episodes. Therefore the question how to prevent relapse is of particular urgency in this group., Methods/design: This trial compares Mindfulness-Based Cognitive Therapy (MBCT), a novel form of treatment combining mindfulness meditation and cognitive therapy for depression, with both Cognitive Psycho-Education (CPE), an equally plausible cognitive treatment but without meditation, and treatment as usual (TAU). It will test whether MBCT reduces the risk of relapse in recurrently depressed patients and the incidence of suicidal symptoms in those with a history of suicidality who do relapse. It recruits participants, screens them by telephone for main inclusion and exclusion criteria and, if they are eligible, invites them to a pre-treatment session to assess eligibility in more detail. This trial allocates eligible participants at random between MBCT and TAU, CPE and TAU, and TAU alone in a ratio of 2:2:1, stratified by presence of suicidal ideation or behaviour and current anti-depressant use. We aim to recruit sufficient participants to allow for retention of 300 following attrition. We deliver both active treatments in groups meeting for two hours every week for eight weeks. We shall estimate effects on rates of relapse and suicidal symptoms over 12 months following treatment and assess clinical status immediately after treatment, and three, six, nine and twelve months thereafter., Discussion: This will be the first trial of MBCT to investigate whether MCBT is effective in preventing relapse to depression when compared with a control psychological treatment of equal plausibility; and to explore the use of MBCT for the most severe recurrent depression--that in people who become suicidal when depressed.

Background/purpose: Inguinoscrotal testicular descent is controlled by androgens and the genitofemoral nerve, but the trigger for what makes the gubernaculum become a migratory organ like a limb bud remains unknown. Recent observations in the flutamide-treated rat suggested a link with the mammary line. We aimed, therefore, to reassess histologic anatomy in 2 different rodent models of androgen blockade, the testicular feminisation mouse (TFM) and the flutamide-treated rat., Methods: Neonatal TFM mice and fetal and neonatal rats after pretreatment of dams with an antiandrogen, flutamide (75 mg/kg; sunflower oil; days 16-19), were prepared for histologic analysis of the inguinal region and compared with fetal and neonatal controls., Results: Fetal control rats (E15.5 days) showed a mammary bud just outside the future inguinal canal adjacent to the gubernaculum. Neonatal TFM mice showed persistence of the inguinal breast bud supplied by the genitofemoral nerve. Flutamide-treated rats (D2) showed the gubernaculum surrounded by a persisting breast bud., Conclusions: The inguinal mammary line is adjacent to the gubernaculum in fetal rodents, and after androgen blockade, the gubernaculum becomes connected to the breast. The male mammary line, which is hidden in plain sight outside the inguinal canal, is made visible by androgen blockade. It may be the missing link in testicular descent, regulating gubernacular migration., (Copyright 2010 Elsevier Inc. All rights reserved.)

Aim: Inadequate androgen activity is a likely cause of cryptorchidism in humans, affecting inguinoscrotal testicular descent. Flutamide, a nonsteroidal antiandrogen, produces cryptorchidism in rats. We aimed to determine the anatomical and histologic effects of flutamide., Methods: Time-mated Sprague-Dawley female rats were injected subcutaneously with flutamide (75 mg/kg in sunflower oil) on days 16 to 19 of pregnancy. Embryonic (E) and postnatal (P) male offspring were collected (E16, E19, P0, P2, P4, P8) in control and flutamide-treated groups (n = 5-10). Samples were fixed in 4% paraformaldehyde. Five-micrometer-thick sections were prepared for hematoxylin and eosin, trichrome and immunohistochemical stains (Desmin, TuJ1, Ki67). This identified muscle and neural cells and areas of cell proliferation., Results: Postnatally, the gubernaculum in flutamide-treated rats had more mesenchyme and muscle than controls. Gubernacular eversion failed, and mammary tissue persisted around the gubernaculum in flutamide-treated rats. Flutamide had no effect on embryonic gubernacular anatomy and histology., Conclusions: Prenatal androgens altered postnatal gubernacular anatomy and histology in the postnatal period. Our findings indicate that the failure of gubernacular differentiation and migration may be because of the ongoing presence of mammary tissue in the region of the external inguinal ring.

Temporomandibular disorders (TMDs) and fibromyalgia (FM) are two clinical conditions prevalent in today's society. Many individuals suffer from chronic pain in various muscle groups, including the muscles of mastication. Previously, TMDs and FM were thought to be separate, unrelated clinical entities. New research has shown a possible link between the two conditions; this article sheds light on possible correlations between them.

This article discusses the effect of medical school and dental school curriculum surveys, which allowed interdisciplinary analysis of the status of women's issues in the health profession. With this documentation of the status of women's health and oral issues, changes in the curriculum can now occur to close the gaps in education and training exposed in the surveys. Changes in the curriculum are aimed at improving clinical practice by practitioners and lowering barriers to care experienced by women. These changes must be incorporated into not only the medical school and dental school curriculums, but also into the practices of the current health care practitioners to be effective.

Nitric oxide (NO) triggers marked osteoclast retraction which closely resembles that due to Ca2+. The effect of Ca2+ has been attributed to a stimulated release of NO. Here, we show for the first time, by direct measurement with a microsensor, that osteoclasts do indeed produce NO and that this production is enhanced by a high Ca2+. We also show that the Ca2+ ionophore, A23187, mimics the latter. Furthermore, osteoclasts on dentine produce more NO than osteoclasts on glass and NO release from dentine-plated osteoclasts is much less sensitive to stimulation by Ca2+. Finally, the microsomal Ca2+ store-depleting agent, thapsigargin, attenuates NO release only from osteoclasts on glass, suggesting that stored Ca2+ has the dominant effect in modulating NO release from non-resorbing cells. NO is a powerful inhibitor of bone resorption: a direct demonstration of its production is therefore strong evidence for a role in modulating osteoclast function., (Copyright 1999 Academic Press.)

The relationship between somatic growth and orthodontic treatment has been limited to the evaluation of body height and skeletal age relative to craniofacial development. The aim of this study was to evaluate the correlation of anthropometric and biochemical measures of general growth with facial and occlusal changes during the early treatment of Class II Division 1 malocclusion. Findings are reported from 46 children, ages 7.20 to 12.85 years (skeletal ages, 5.75 to 12.75 years), who are enrolled in a prospective clinical trial. Body and knee heights were measured monthly, with a Holtain stadiometer and a Knee Height Measuring Device, respectively. Every three months, serum levels were measured of the hormone dehydroepiandrosterone sulfate (DHEAS), an androgen associated with growth in midchildhood, and osteocalcin, an indicator of bone turnover. Significant correlations existed between knee height and various occlusal measurements, but mandibular length was not significantly correlated with knee height and DHEAS levels. Knee height correlated significantly (P < .05) with DHEAS and osteocalcin only in 46% and 37% of the children, respectively. The results indicate that the evaluated biochemical measures, at the time intervals considered, may not increase the accuracy of growth depiction by physical measures alone (height and skeletal maturation).

In biological research, new ideas arise and quickly spread to encompass the entire field. Thus, the evolution of molecular biology has significantly changed our methods of approaching our research. A similar far-reaching finding has been the advent of radical reactions into biology. Although radical chemistry has been utilized for many technological advances that affect our daily lives, the appreciation of this same process within our cells has opened an unexplored arena for research enquiry. As cellular messengers, radical molecules seem whimsically designed: they are evanescent, rapidly and apparently indiscriminately reactive, and barely detectable by most biological methods. Yet, our initial probing of these reactive agents in cells and organisms has led us to postulate a virtually undescribed system of communication within and among cells which may have significant effects in multiple organs. In bone, radical reactants have been attributed with an important role in the control of bone resorption.

The future use of lasers in endodontics is dependent upon predictable and consistent ablation of dentin. In this pilot study we used an Ho:YAG laser fiberoptic delivery system to apply laser energy to prepared tooth sections in vitro. Longitudinally sectioned single-rooted human teeth were subjected to single-energy pulses varying from 25 to 1750 mJ at a focal length of 1 mm. At different energy levels we observed changes in the dentin surface ranging from minute surface pitting to the formation of large craters. Scanning electron microscopy and stereophotogrammetry were used to determine the relationship between the amount of energy applied to dentin and the extent of dentin ablation. Dentin crater formation was quantified by determining surface area, depth, and volume of craters produced. Increases in laser energy were compared with increases in surface area, depth, and volume of craters produced within the range of 150 to 1200 mJ. The Ho:YAG laser fiberoptic delivery system used in this study provides an effective means of ablating dentin. Three-dimensional stereophotogrammetry may prove to be a useful method for further studies on the effects of laser energy on mineralized tissues.

Matrix vesicles were isolated from the epiphyseal growth plates of normal weanling rats, and the presence of carbonic anhydrase II was demonstrated by Western blotting and ultrastructural immunolocalization using the immunogold technique. Total carbonic anhydrase activity was assayed and showed a statistically significant increase in matrix vesicles as compared to normal rat chondrocytes derived from the same growth plates. These results are the first to establish the presence of carbonic anhydrase in matrix vesicles.

Superoxide dismutase (SOD) and catalase are enzymes that protect cells from radical attack. Catalase disproportionates hydrogen peroxide, and SOD is an oxidoreductase that serves to dismutate the superoxide anion. The objective of this communication was to measure the activity of these disproportionating enzymes in the chick tibial growth cartilage and to relate enzyme activity to chondrocyte maturation and tissue calcification. Analytic techniques were optimized for the measurement of both enzymes; particular care was taken to ensure that the values obtained were due to SOD and catalase, not to the presence of other oxidases or contaminants. Catalase and SOD had similar profiles of activity in cartilage. For both enzymes, the highest levels of activity were observed in premineralized cartilage; as chondrocytes matured there was a progressive decrease in the activity of SOD and catalase. Comparison of chondrocyte SOD activity with nonmineralizing tissues indicated that the activity of cultured cartilage cells was low. We also measured the SOD activity of avascular chondrodystrophic cartilage and found it to be less than that of proliferating cartilage. When cartilage was electrofocused, three SOD isozymes were detected. The pI of the major isozyme corresponded to the copper-zinc isoform. We suggest that the observed changes in enzymatic activity are dependent on a number of cartilage-specific factors that include the vascular supply, the local production of oxygen radicals by chondrocytes, and the oxidative state of the tissue.

Vitamin D deficiency may depress bone formation but its effect on bone resorption is not well defined. As an index of bone resorption, the activity of acid phosphatase, a lysosomal enzyme found in osteoclasts, was quantitated in situ from a bone tissue smear preparation. Activity of the enzyme, measured by integrative microdensitometry increased linearly from 25 to 60 min. The distribution of activity in osteoclasts quantitated appeared to follow a normal distribution with a median value of 0.19 integrated optical density units. Animals treated with vitamin D or 1,25 dihydroxycholecalciferol had significantly increased activity of acid phosphatase in osteoclasts compared to animals which were vitamin D deficient. The increase of acid phosphatase activity averaged 63%. Vitamin D or its metabolites may have a permissive effect on the action of parathyroid hormone or act directly to increase bone resorption.

Hypophosphatemic osteomalacia may present as severe disability from bone disease. This report describes a patient with long-standing disease and multiple fractures. Medical management of the phosphate loss may be successful in promoting bone healing when it is not possible to establish the cause of the phosphaturia. Judicious increases in calcium, 1,25-dihydroxyvitamin D, and phosphorus supplements were carefully monitored to avoid failure of therapy or hypercalcemic complications from pharmacologic amounts of these supplements.