A randomized clinical trial comparing the efficacy of mandibular implant-supported overdentures and conventional dentures in diabetic patients. Part II. Comparisons of masticatory performance

STATEMENT OF PROBLEM

Convincing evidence is lacking to demonstrate the functional superiority of mandibular implant-supported overdentures over conventional dentures.

PURPOSE

This randomized clinical trial was conducted to compare masticatory functional effectiveness of mandibular implant-supported overdentures and conventional dentures in diabetic denture wearers with clinically acceptable metabolic control.

METHODS

A total of 102 edentulous diabetic patients, treated with or without insulin, were randomized to receive a new maxillary and either a mandibular conventional denture or an implant-supported overdenture. Treatment was completed in 89 patients, 37 with conventional dentures and 52 with Hader bar-clip attachment overdentures supported by two IMZ implants. Besides data from medical and dental histories, oromaxillofacial examinations, and questionnaires, masticatory tests were performed by patients before and at 6 and 24 months after treatment completion. Although 78 patients (28 in the conventional, 50 in the overdenture group) performed tests at 6 months after treatment, 68 (25 in the conventional, 43 in the overdenture) had performance data for both entry and 6-month posttreatment intervals.

RESULTS

The two treatment groups were highly comparable in terms of general characteristics, quality of original dentures, tissue support, and past denture experience. No significant differences were found between patients treated for diabetes with or without insulin. All four masticatory performance scores with original dentures were higher in the conventional denture group than the overdenture group. The posttreatment performance scores for the two treatment groups became similar because of the higher gains in the overdenture group. Patients with low initial performance scores showed greater posttreatment gains with both conventional dentures and overdentures.

CONCLUSIONS

The implant-supported overdenture showed no significant advantage over the conventional denture for improving the ability to comminute food in this group of diabetic patients with higher than average initial functional levels observed for other groups of denture wearers in previous studies.

A randomized clinical trial comparing the efficacy of mandibular implant-supported overdentures and conventional dentures in diabetic patients. Part I: Methodology and clinical outcomes

STATEMENT OF PROBLEM

Scientific evidence is lacking to support the general application of implant-supported mandibular overdentures.

PURPOSE

This randomized clinical trial was undertaken to compare the efficacy of conventional mandibular and implant-supported overdentures in diabetic edentulous patients with clinically acceptable metabolic control.

METHOD

A total of 102 diabetic patients, treated with or without insulin, were randomized to receive a new maxillary denture and either a conventional or an implant-supported removable mandibular overdenture. Treatment was completed for 89 patients, 37 with the conventional and 52 with implant-supported dentures. Detailed examinations, tests, and questionnaires were given before and at 6- and 24-months after treatment completion. Comparisons between the two treatment groups were made for treatment failures based on prespecifed criteria and the type and amount of maintenance care provided.

RESULTS

The insulin and noninsulin treated groups were collapsed because of the lack of significant differences at entry. The conventional denture and implant-supported overdenture groups were similar in terms of general demographics, medical status, quality of their original dentures and denture support, several functional measures, and patient satisfaction. Treatment was judged to be successful in 56.9% of patients with conventional dentures and 72.1% with overdentures. This difference in success rate was not statistically significant (p > 0.05). Patients with treatment failures in both groups required excessive maintenance care. Those with conventional dentures needed frequent denture base adjustments and relines, whereas those with overdentures required frequent clip replacements and repairs. Although significant improvements were seen with both treatment modalities, a higher percentage of patients with implant-supported overdentures than those with conventional dentures reported improvements in chewing comfort and moderate-to-complete overall satisfaction.

[Polymorphism at the LDL receptor gene locus in patients with cholesterol gallstone disease]

OBJECTIVE

To investigate the association between the dinucleotide repeat polymorphism at the 3' end of the LDL receptor gene and cholesterol gallstone disease.

METHODS

Polymorphism of the (dTA)n was amplified by using polymerase chain reaction, and the alleles identification was performed with denaturing polyacrylamide gel electrophoresis and silver stain technique.

RESULTS

Analysis of allele frequencies in 131 unrelated Chinese gallstone patients and 79 controls indicated that the C allele was more frequent in the patients with cholesterol gallstones than that in the controls (0.40 vs 0.27, P < 0.01), and the frequency of the BB genotype of the LDL receptor gene was markedly lower (P < 0.005), while the CC and BC genotypes were significantly higher in the patients with cholesterol gallstones than in the controls respectively (P < 0.05, P < 0.05).

CONCLUSION

The present study suggests that the LDL receptor gene polymorphism may be associated with cholesterol gallstone disease.

A bone regenerative approach to alveolar ridge maintenance following tooth extraction. Report of 10 cases

TEN PATIENTS WHO REQUIRED two or more anterior teeth extractions were utilized in this study. Extraction procedures were carried out with a full thickness surgical flap approach. After flap reflection, teeth were removed with a minimum of trauma to the surrounding bone. Following extraction silicone-based impression techniques were used to produce a model of the alveolar process and small metal pins were placed in the alveolus to be used as fixed points to make measurements of ridge dimensions. One socket was covered with an expanded polytetrafluoroethylene (ePTFE) barrier membrane (experimental site); the other socket was a conventional control. The soft tissue flaps were then mobilized using periosteal releasing incision and the wound closed with ePTFE mattress sutures. Six months following extraction, patients were treated with flap surgery to expose both extractions sites to remove the ePTFE membranes and to measure ridge dimensions using the pins as fixed points. Clinical and model measurements have shown statistically significant better ridge dimensions at experimental sites than at control (P < or = 0.05). Three patients with exposed membranes had similar dimensional changes as controls. Results from this study suggested that this improved technique offers a predictable alveolar ridge maintenance enhancing the bone quality for dental implant procedures and esthetic restorative dentistry.

[Pancreatic ischemia: a continuous injury factor in acute necrotic pancreatitis]

ANP model in rats was used to determine the concentration of TXB2, PGF1 alpha in plasma and the ACE activity in serum in five groups. The concentration of TXB2, PGF1 alpha in all experimental groups was significantly different from that of control group (P < 0.05). The comparison of ACE activity was just the same as the above except that of 6 h. The factors leading to pancreatic ischemia functioned continously. We conclude that pancreatic ischemia is a continuous injury factor in ANP, and there is no reperfusion-injury in the course of the disease.

Fatty acid unsaturation increases expression and capping of murine lymphocyte CD44 and CD45

We studied the effect of incubating murine lymphocytes with cis-unsaturated fatty acids on expression and capping of CD44 and CD45. Lymphocytes were incubated with stearic (18:0) or oleic (18:1 omega-9) acid bound to bovine serum albumin (BSA). After incubation with rat anti-CD44 or anti-CD45 monoclonal antibodies and then with fluorescent-labeled anti-rat antibody, mean fluorescence intensity (FI) was measured by using flow cytometry. Capping was measured after warning and fixation in paraformaldehyde. Steady-state fluorescence anisotropy (rs) was measured after the cells had been incubated with trimethylammoniumdiphenylhexatriene. Incubation with oleic acid, but not stearic acid or BSA alone, was associated with an increase in FI of CD44. Expression of CD45, however, was increased by both stearic and oleic acids to the same degree over BSA controls. CD44 and CD45 capping were both increased by incubation with oleic acid. Rs was decreased in cells incubated with oleic acid, suggesting an increase in membrane fluidity. We conclude that incubation with oleic acid increases expression of CD44 and increases capping of both CD44 and CD45. These findings were confirmed in feeding experiments, in which rs was reduced and CD44 capping increased by polyunsaturated fatty acid diets.

Involvement of CD44 and the cytoskeletal linker protein ankyrin in human neutrophil bacterial phagocytosis

The leukocyte CD44 and CD45 cell surface receptors are associated via the linker proteins ankyrin and fodrin with the cytoskeleton, which itself is important in immune cell functions such as adherence, chemotaxis, and phagocytosis. The effects of rat antihuman CD44 and CD45 monoclonal antibodies on phagocytosis of fluoresceinated heat-killed Staphylococcus aureus 502A by normal human neutrophils (PMNs) during 2 hr incubation in RPMI-1640 was studied via flow cytometry and confocal microscopy. Flow cytometry was performed using an excitation wavelength of 488 nm, fluorescence being measured at 515-560 nm on 50,000 PMNs per sample. Confocal microscopy was performed on samples after further incubation with rhodamine-conjugated antiankyrin. Anti-CD44 resulted in an increase of 27-31% compared to control (P = 0.004) in the proportion of PMNs fluorescing, an increase of 17-24% (P = 0.001) in mean intracellular fluorescence per PMN, and an increase in total PMN fluorescence of 50-58% compared to control (P < 0.001). In contrast, anti-CD45 had little effect on phagocytosis. Colchicine (a microtubule-disrupting agent) enhanced, whereas cytochalasin-D (a microfilament inhibitor) inhibited bacterial phagocytosis; cytochalasin-D completely abrogated the effect of anti-CD44 on this PMN function. Hyaluronic acid augmented phagocytosis by an increment similar to that observed with anti-CD44. Two-color flow cytometry and confocal microscopy demonstrated that ankyrin always colocalized with ingested fluorescein isothiocyanate (FITC)-labeled bacteria. These data strongly suggest that CD44 is involved in bacterial phagocytosis, provide further evidence of CD44 receptor linkage to cytoskeletal elements in human leukocytes, and suggest that ankyrin has a significant role in the transport of phagosomes.

Supplemental L-arginine HCl augments bacterial phagocytosis in human polymorphonuclear leukocytes

That L-arginine (L-Arg) augments the host response to acute bacterial sepsis suggests that this amino acid intervenes early in the immune response, perhaps via the nitric oxide synthetase (NOS) pathway. The effect of L-Arg supplementation on in vitro phagocytosis of fluorescein-labeled, heat-killed Staphylococcus aureus by peripheral blood neutrophils (PMNs) from 12 normal human volunteers was studied. Separated PMNs were incubated for 2 h with labeled bacteria, with and without supplemental L-Arg, D-arginine, glycine, and/or the NOS inhibitors L-canavanine, aminoguanidine, or L-NG-nitroarginine methyl ester. PMNs were fixed and extracellular fluorescence quenched with crystal violet. By flow cytometry and confocal microscopy, L-Arg supplementation was shown to result in a highly significant increase in PMN bacterial phagocytosis, the maximal effect being seen with L-Arg 380 microM and falling off with higher concentrations. This augmentation was completely abrogated by NOS inhibitors in molar excess, but inhibitors alone did not suppress phagocytosis below that of unsupplemented controls. Neither D-arginine nor glycine affected phagocytosis; the L-Arg effect was stereospecific and not related to utilization of L-Arg as an energy source. L-Arg supplementation significantly enhances bacterial phagocytosis in human neutrophils, perhaps by effects on cytoskeletal phenomena, and this appears to be mediated through NOS activity. Phagocytosis by nonspecific immune cells which intervene early in the response to sepsis is critically important, and beneficial effects of L-Arg on the clinical course of sepsis may be due at least in part to augmentation of phagocyte function.

[Experimental studies on effects of zinc and germanium on immune function and anti-oxidation in mice]

Zinc and germanium concentrations in serum, liver and muscle of mice, T-lymphocyte subgroup proportion, serum superoxide dismutase (SOD) activity and malonodialdehyde (MDA) were determined to study whether there exist synergism or antagonism between zinc and germanium. Results showed there existed, to certain extent, competitive effects of serum zinc and germanium in mice. When concentration of serum zinc increased, that of germanium decreased, or vise versa. There existed certain relationship between zinc and germanium concentrations in serum and those in muscle and liver of mice, and between those and CD3 count and SOD activity. Immune function in mice was influenced and their T-lymphocyte subgroup proportion changed with changes in serum zinc and germanium concentrations. With increased germanium and decreased zinc serum concentrations, CD3 and CD1 counts decreased, CD8 count unchanged, and the ratio of CD1 to CD3 decreased, which showed certain antagonist effects of them as they operated together. But, no antagonism was observed in their anti-oxidant effects, SOD activity increased to varied extent, and the level of MDA decreased.

Diets high in polyunsaturated oils decrease lymphocyte membrane anisotropy and B-cell mitogenesis

Balb/c mice were fed semipurified diets containing 40% of total calories as lipids: olive, safflower, or fish oil. After 2 weeks of feeding, splenic mononuclear cells were isolated and assayed for steady-state fluorescence anisotropy by means of the probe diphenylhexatriene. Splenocytes were also incubated with the mitogens concanavalin A, phytohemagglutinin, or lipopolysaccharide; subsequent uptake of tritiated thymidine was measured as an index of proliferation. No differences were observed in the membrane anisotropy and mitogenesis of mice fed the olive oil diet (high in monounsaturated fatty acids) and the control group. However, membrane anisotropy was significantly lowered in mice fed the safflower or fish oil diets (high in polyunsaturated fatty acids), and the mitogenic response to lipopolysaccharide was suppressed. Mitogenic responses to concanavalin A and phytohemagglutinin were not significantly affected by the type of lipid in the diet.

[Free fatty acids in gallbladder bile]

Using gas chromatography and high performance liquid chromatography (HILC), we examined free fatty acid and lecithin molecular species in gallbladder biles from patients with cholesterol gallstones. Effect of free fatty acids on cholesterol nucleation in model bile was studied by a sensitive cholesterol crystal growth assay. Compared to bile of controls, biles from patients with gallstones had higher total free fatty acid level, more palmitic acid, more stearic acid, more linoleic acid and arachidonic acid. The lecithin pattern was similar in all. After free fatty acids were added to model bile, palmitic acid, oleic, acid, linoleic acid and arachidonic acid had significant effect of pro-nucleating, free fatty acids on non-protein pro-nucleating factor. These data suggest that variations in quantitation and composition of free fatty acids are importanct in the pathogenesis of cholesterol gallstone formation.

RFLP mapping of the sugary enhancer1 gene in maize

RFLP marker data from an F2∶3 population derived from a cross between a sugary1 (su1) and a sugary enhancer1 (su1, sel) inbred were used to construct a genetic linkage map of maize. This map includes 93 segregating marker loci distributed throughout the maize genome, providing a saturated linkage map that is suitable for linkage analysis with quantitative trait loci (QTL). This population, which has been immortalized in the form of sibbed F2∶3 families, was derived from each of the 214 F2 plants and along with probe data are available to the scientific community. QTL analysis for kernel sucrose (the primary form of sugar) concentration at 20 days after pollination (DAP) uncovered the segregation of seven major QTL influencing sucrose concentration; a locus linked to umc36a described the greatest proportion of the variation (24.7%). Since maltose concentration has previously been reported to be associated with the se1 phenotype, an analysis of probe associations with maltose concentration at 40 DAP was also conducted. The highly significant association of umc36a with maltose and sucrose concentrations provided evidence that this probe is linked to se1. Phenotypic evaluation for the se1 genotype in each F2∶3 family enabled us to map the gene 12.1 cM distal to umc36a. In contrast to previous work where se1 was reported to be located on chromosome four, our data strongly suggest that the sugary enhancer1 locus maps on the the distal portion of the long arm of chromosome 2 in the maize genome.

[Effect of free fatty acid on cholesterol nucleation in model bile]

We studied the effect of free fatty acids on cholesterol nucleation in model bile with a sensitive cholesterol crystal growth assay. Palmitic acid, oleic acid, linoleic acid and arachidonic acid were added to model biles in increasing concentrations from 0.5 to 20 umol/ml. The nucleation time of model bile with free fatty acids decreased to 30%-50% of control bile. The final crystal concentration increased with higher concentrations of palmitic acid. However, we found a decrease in the final crystal concentration with the unsaturated fatty acid-soleic acid, linoleic acid and arachidonic acid. The increase in the maximum crystal growth rate was marked in the model biles as linoleic acid was added. These findings show the effect of non-protein fraction in biles on gallstone formation and support the view that free fatty acids are pro-nucleating factors.

[Autonomic nervous activity at episodes of myocardial ischemia in patients with coronary artery disease by heart rate power spectral analysis]

Heart rate power spectral analysis in 44 patients with coronary artery disease was obtained from 24-hour dynamic electrocardiogram. 195 episodes of transient myocardial ischemia that was defined as horizontal or down sloping depression of the ST segment of > or = 0.1 mV and lasted for > or = 2 minutes were studied. The area of low frequency components (LF, 0.02-0.10 Hz) representing predominontly sympathetic tone with some contribution from the parasympathetic tone and that of high frequency components (HF, 0.15-0.40 Hz) representing mainly parasympathetic tone and the value of LF/HF on 4 minute heart rate power spectral graph at the deepest depression of ST segment were compared with that before the episode of myocardial ischemia. The area of HF of fast rate myocardial ischemia occurring in night reduces significantly (P < 0.001), the value of LF/HF increases markedly (P < 0.05) and the area of LF increases slightly. The results suggest that there is a change of autonomic nervous activity during the episode of fast rate myocardial ischemia in night, parasympathetic nervous tone decreases markedly, there may be secondary increase of sympathetic nervous activity.

[Gallbladder contraction and microscopi observation of the gallbladder wall in gallstone patients]

On the basis of oral cholecystography (OCG), we selected gallstone patients for nontoperative intervention. Their gallbladder function was considered as normal when gallbladder contracted over 50%-75% after a fat meal at 1 hour. We collected 99 gallstone patients and 19 normal controls; gallbladder function was normal in 77 patients and poor in 22. After a fat meal gallbladder volumes were calculated by B ultrasonography. The results showed that both fasting and residual volume in patients with so-called normal contraction were significantly greater than that in the controls (P < 0.001), though the contraction rate was not different. The combination of gallbladder contraction rate measurement and residual volume calculation by ultrasonography was superior over traditional OCG.