Mpox in the Emergency Department: A Case Series

Introduction

We sought to describe the demographic characteristics, clinical features, and outcomes of a cohort of patients who presented to our emergency departments with mpox (formerly known as monkeypox) infection between May 1-August 1, 2022.

Case Series

We identified 145 patients tested for mpox, of whom 79 were positive. All positive cases were among cisgender men, and the majority (92%) were among men who have sex with men. A large number of patients (39%) were human immunodeficiency virus (HIV) positive. There was wide variation in emergency department (ED) length of stay (range 2-16 hours, median 4 hours) and test turnaround time (range 1-11 days, median 4 days). Most patients (95%) were discharged, although a substantial proportion (22%) had a return visit within 30 days, and 28% ultimately received tecrovirimat.

Conclusion

Patients who presented to our ED with mpox had similar demographic characteristics and clinical features as those described in other clinical settings during the 2022 outbreak. While there were operational challenges to the evaluation and management of these patients, demonstrated by variable lengths of stay and frequent return visits, most were able to be discharged.

The Role of a Tertiary Level Safety Net Hospital in New York City's 2022 Mpox Outbreak

Similar to the early phases of the COVID-19 pandemic, New York City was the national epicenter of the ongoing 2022 mpox (formerly monkeypox) outbreak. Cases quickly began to rise in July 2022, primarily in gay, bisexual, or other men who have sex with men. Tools in the form of a reliable diagnostic test, an effective vaccine, and a viable treatment option have been available from the onset, although logistically complex to roll out. The special pathogens program at NYC Health + Hospitals/Bellevue, the flagship facility for the largest public hospital system in the United States, collaborated with multiple departments within Bellevue, the hospital system, and the NYC Department of Health and Mental Hygiene, to swiftly establish ambulatory testing, immunizations, patient-centered inpatient care, and outpatient therapeutics. With the ongoing mpox outbreak, hospitals and local health departments must prepare a systemwide response to identify and isolate patients and provide high-quality care. Findings from our experience can help guide institutions in developing a multipronged, comprehensive response to the ongoing mpox outbreak.

Advanced wastewater treatment with ozonation and granular activated carbon filtration: Inactivation of antibiotic resistance targets in a long-term pilot study

The inactivation of antibiotic resistant bacteria (ARB) and genes (ARGs) in an advanced plant combining ozonation and granular activated carbon (GAC) filtration applied for effluent after conventional activated sludge treatment at a full-scale urban wastewater treatment plant was investigated for over 13 consecutive months. The nitrite compensated specific ozone dose ranged between 0.4 and 0.7 g O₃/g DOC with short-time sampling campaigns (0.2-0.9 g O₃/g DOC). Samples were analysed with culture-dependent methods for bacterial targets and with qPCR for genes. The log removal values were correlated with a decrease of the matrix UV absorption at 254 nm (ΔUV₂₅₄) and indicated a range of ΔUV₂₅₄ that corresponds to a sufficient membrane damage to affect DNA. For trimethoprim/sulfamethoxazole resistant E. coli, sul1, ermB and tetW, this phase was observed at ΔUV₂₅₄ of ~30 % (~0.5 g O₃/g DOC). For ampicillin resistant E. coli and bla_TEM-1, it was observed around 35-40 % (~0.7 g O₃/g DOC), which can be linked to mechanisms related to oxidative damages in bacteria resistant to bactericidal antibiotics. GAC treatment resulted in a further abatement for trimethoprim/sulfamethoxazole E. coli, sul1 and tetW, and in increase in absolute and relative abundance of ermB and bla_TEM-1.

Predicting mortality in adults with suspected infection in a Rwandan hospital: an evaluation of the adapted MEWS, qSOFA and UVA scores

RATIONALE

Mortality prediction scores are increasingly being evaluated in low and middle income countries (LMICs) for research comparisons, quality improvement and clinical decision-making. The modified early warning score (MEWS), quick Sequential (Sepsis-Related) Organ Failure Assessment (qSOFA), and Universal Vital Assessment (UVA) score use variables that are feasible to obtain, and have demonstrated potential to predict mortality in LMIC cohorts.

OBJECTIVE

To determine the predictive capacity of adapted MEWS, qSOFA and UVA in a Rwandan hospital.

DESIGN, SETTING, PARTICIPANTS AND OUTCOME MEASURES

We prospectively collected data on all adult patients admitted to a tertiary hospital in Rwanda with suspected infection over 7 months. We calculated an adapted MEWS, qSOFA and UVA score for each participant. The predictive capacity of each score was assessed including sensitivity, specificity, positive and negative predictive value, OR, area under the receiver operating curve (AUROC) and performance by underlying risk quartile.

RESULTS

We screened 19 178 patient days, and enrolled 647 unique patients. Median age was 35 years, and in-hospital mortality was 18.1%. The proportion of data missing for each variable ranged from 0% to 11.7%. The sensitivities and specificities of the scores were: adapted MEWS >4, 50.4% and 74.9%, respectively; qSOFA >2, 24.8% and 90.4%, respectively; and UVA >4, 28.2% and 91.1%, respectively. The scores as continuous variables demonstrated the following AUROCs: adapted MEWS 0.69 (95% CI 0.64 to 0.74), qSOFA 0.65 (95% CI 0.60 to 0.70), and UVA 0.71 (95% CI 0.66 to 0.76); there was no statistically significant difference between the discriminative capacities of the scores.

CONCLUSION

Three scores demonstrated a modest ability to predict mortality in a prospective study of inpatients with suspected infection at a Rwandan tertiary hospital. Careful consideration must be given to their adequacy before using them in research comparisons, quality improvement or clinical decision-making.

Evolving oxygenation management reasoning in COVID-19

The initial phase of the SARS-CoV-2 pandemic in the United States saw rapidly-rising patient volumes along with shortages in personnel, equipment, and intensive care unit (ICU) beds across many New York City hospitals. As our hospital wards quickly filled with unstable, hypoxemic patients, our hospitalist group was forced to fundamentally rethink the way we triaged and managed cases of hypoxemic respiratory failure. Here, we describe the oxygenation protocol we developed and implemented in response to changing norms for acuity on inpatient wards. By reflecting on lessons learned, we re-evaluate the applicability of these oxygenation strategies in the evolving pandemic. We hope to impart to other providers the insights we gained with the challenges of management reasoning in COVID-19.

Perceptions and attitudes regarding sexually transmitted infection and family planning among adolescents in Northern Madagascar

The prevalence of sexually transmitted infections (STIs) and early pregnancy are high among adolescents in Madagascar. We applied a qualitative descriptive approach to evaluate perceptions, attitudes, and misconceptions regarding STIs and contraception among female and male adolescents ages 15-19 years (n = 43) in Northern Madagascar in 2014 using focus group discussions with open-ended questions. Data were coded and analyzed for major themes. Participants were in grades 6 to 12 in school; 53% were female. Despite high levels of awareness, significant stigma against and misconceptions about STIs, condom use, and sexual practices existed. Many participants did not know how to use condoms and felt uncomfortable suggesting condoms with regular partners, despite acknowledging infidelity as a frequent problem. Male participants were more willing to use condoms as contraception for unwanted pregnancy than for prevention of STIs. Most participants held misconceptions about side effects of contraceptives, including infertility, cancer, and preventing bad blood from leaving the woman's body. Systematic and community-wide health education and formal reproductive health curricula in schools may improve attitudes and stigma regarding STIs and family planning. These strategies need to be developed and employed via collaboration among faith-based, community, and non-governmental organizations, schools, and governmental health and social service agencies.

Epidemiology of gingivitis in schoolchildren in Bucharest, Romania: a cross-sectional study

BACKGROUND AND OBJECTIVE

Gingivitis is the most prevalent oral disease in children, being strongly associated to social gradients. Many studies have reported different results concerning the extent and intra-oral distribution of gingivitis in children. The aim of this study was to investigate the epidemiologic parameters and socio-related risk factors of gingivitis in the 10-17-year-old Bucharest schoolchildren population and to analyze its intra-oral distribution.

MATERIAL AND METHODS

Cross-sectional data were obtained from 1595 schoolchildren, social condition being assigned using a simple questionnaire. Classes of students were used as clusters in a single-stage cluster sampling method. An intra-oral exam was performed for all the children included in this study. Silness and Löe scores, prevalence and the extent of gingivitis were calculated.

RESULTS

The gingival scores showed a mild inflammation and the prevalence of gingivitis was 91%. Boys had a higher gingival (0.19 vs. 0.18; p < 0.05) and plaque scores (0.71 vs. 0.59; p < 0.01) than girls. Children who did not live in overcrowded households, whose parents had a better education and those who had direct access to school dental services displayed better gingival conditions (p < 0.05). Gingivitis was more severe on the upper teeth, with the maximum score being reached at the right upper lateral incisor (0.63 on distal surface).

CONCLUSIONS

Gingival condition in Bucharest schoolchildren population was associated to social gradients. School dental services are also another factor that seems to be related with gingivitis.

Implementation and evaluation of a curriculum to teach reproductive health to adolescents in northern Madagascar

BACKGROUND

In Madagascar, prevalence of sexually transmitted infections (STIs) and unplanned pregnancies are high among adolescents. Limited reproductive health education is available.

METHODS

In northern Madagascar, in 2014, we assessed the baseline knowledge, attitudes and self-efficacy regarding STIs/HIV and family planning among 155 adolescents, and designed and implemented a 6-week reproductive health curriculum for adolescents using complementary teaching methods. We evaluated the curriculum through pre- and post-curriculum surveys of adolescents using paired t-tests.

RESULTS

Pre-test survey revealed a general lack of knowledge regarding different types of STIs. Post-curriculum, there was a significant improvement in the following educational domains: general knowledge of HIV/AIDS, other STIs and family planning (49%±17% to 65%±15%) (p<0.001), self-efficacy and use of contraceptives (57%±26% to 70%±26%) (p<0.01), and the overall combined scores of knowledge, attitude and self-efficacy (53%±14% to 68%±14%) (p<0.001). Open-ended questions revealed significant misconceptions and stigma regarding oral and anal sex and usage of condoms.

CONCLUSIONS

Important misconceptions and knowledge gaps regarding reproductive health exist among adolescents. The comprehensive reproductive health curriculum with complementary teaching methods was feasible, well-received and effective, and could be considered for integration into the schools' curricula.

Cumulative exposure to medical radiation for children requiring surgery for congenital heart disease

OBJECTIVE

To describe cumulative radiation exposure in a large single-center cohort of children with congenital heart disease (CHD) and identify risk factors for greater exposure.

STUDY DESIGN

A detailed medical radiation exposure history was collected retrospectively for patients aged <18 years who underwent surgery for CHD between January 1, 2001, and July 22, 2009. Cumulative per patient exposure was quantified as the effective dose in millisieverts (mSv) and annualized (mSv/year).

RESULTS

A total of 4132 patients were subjected to 134,715 radiation examinations at a median follow-up of 4.3 years (range, 0-8.6 years). Exposure clustered around the time of surgery. The median exposure was 14 radiologic tests (the majority of which were plain film radiographs) at an effective dose of 0.96 mSv (the majority of which was from cardiac catheterization), although this distribution had a very wide range. Almost three-quarters (73.7%) were exposed to <3 mSv/year, and 5.3% were exposed to >20 mSv/year. Neonates, children with genetic syndromes, and children requiring surgery for cardiomyopathy, pulmonary valve, single ventricle, or tricuspid valve diseases were more likely to have higher exposure levels, and those requiring surgery for aortic arch anomalies or atrioventricular septal defects were more likely to have lower levels.

CONCLUSION

Children with CHD requiring surgery are exposed to numerous medical forms of ionizing radiation. Although the majority of patients receive <3 mSv/year, there are identifiable risk factors for higher exposure levels. This may have important health implications as these patients age.

[Outpatient anesthesia for patients with obstructive sleep apnea: results of a national survey]

BACKGROUND

In Germany there is currently no national standard for the management of patients with obstructive sleep apnea syndrome (OSAS). The object of this survey was to obtain information on the treatment concept for patients with OSAS and to report on the current practice in Germany.

METHODS

Data collection was obtained through an online questionnaire. A total of 12,113 members of the supporting anesthesia societies from all over Germany were invited to participate via e-mail. Additionally an announcement was made in a professional journal.

RESULTS

A total of 1,671 questionnaires were analyzed. The average age of the respondents was 45 years, 64% were male and 36% were female. The average work experience was 16 years and 85% of the respondents were consultants. In total 85% of anesthesiologists were predominantly working in inpatient care and 12% were predominantly active in outpatient care. Of the respondents 63% preferred regional anesthesia, 20% preferred general anesthesia for patients with OSAS and 17% did not have a preference for a specific anesthesia procedure. Outpatient surgery for patients with OSAS was performed by 72% of the respondents using regional anesthesia and by 55% of the respondents using local anesthesia with sedation. Of the anesthesiologists 49% consented to outpatient surgery using general anesthesia and 14% to interventions involving the airways. Compared to anesthesiologists working predominantly in inpatient departments, those working predominantly in outpatient departments treated patients with OSAS more frequently on an outpatient basis, used general anesthesia significantly more often, discharged those patients significantly earlier and observed less complications.

CONCLUSIONS

This survey shows that outpatient surgery for patients with sleep apnea is common practice in Germany. It is also performed when patients have moderate or severe OSAS and for respiratory tract surgery. This means that the management is not conform to the guidelines of the American Society of Anesthesiologists (ASA).

Application of pressure mapping techniques to measure push and gripping forces with precision

Gripping and push forces, also named coupling forces, have induced effects on the transmission of the vibration in the upper limb. The assessment of the vibration exposure with powered tools thus requires that these man/machine coupling parameters are controlled and monitored. To date, no reliable metrological systems enable their precise measurements. This study first investigated how much precision could be expected from the pressure mapping technique for the determination of coupling forces by means of numerical integration. Then a specific procedure was worked out and validated to instrument hand-held tools and measure the coupling forces with regard to the appropriate current standards. The proposed method was applied as a case study on an ordinary breaker and an anti-vibration breaker.

[Smoking--a proven risk factor for periodontal disease?]

While bacterial dental plaque is widely considered as the etiological risk factor for the development of periodontal diseases, numerous publications from recent years pointed out the role of environmental factors like smoking as aggravating the severity of disease expression. The present paper reviews the updated literature linking epidemiologically between the presence of smoking habit and disease prevalence in the same population, as well as studies reporting on cell toxicity of nicotine and its by-products on gingival cells, negative effect on humoral and cell-mediated immune system, enhancement of bacterial plaque pathogeneity, and disruption of the wound healing processes. Finally, a negative effect is apparent on the supportive stage of the periodontal treatment, indicating lasting effect of smoking for years to come following the termination of active periodontal treatment.

[Periodontal disease--an additional risk factor for cardiovascular diseases?]

In 1989, a case-control study was published, linking between coronary heart disease and periodontal disease in the studied population. Since then, a number of additional studies, focused the attention to the possible role of dental infections in the pathogenesis of atherosclerosis. Some of these newer cohort studies, are prospective in nature, measuring incidence of the two diseases in large patient populations. The present article reviews these studies, and the proposed mechanisms which might explain the relationships between these two systemically distinct diseases.

The relationship between periodontal diseases and diabetes: an overview

Diabetes mellitus, caused by the malfunction of insulin-dependent glucose and lipid metabolism, presents with the classical triad of symptoms: polydypsia, polyuria, and polyphagia which are often accompanied by chronic fatigue and loss of weight. Complications of diabetes mellitus include retinopathy, nephropathy, neuropathy, and cardiovascular disease. Periodontal diseases are infections affecting the periodontium and resulting in the loss of tooth support. The association between diabetes mellitus and periodontitis has long been discussed with conflicting conclusions. Both of these diseases have a relatively high incidence in the general population (diabetes 1% to 6% and periodontitis 14%) as well as a number of common pathways in their pathogenesis (both diseases are polygenic disorders with some degree of immunoregulatory dysfunction). On the one hand, numerous reports indicate a higher incidence of periodontitis in diabetics compared to healthy controls, while other reports fail to show such a relationship. Clarification of this dilemma is occurring as the diagnostic criteria for periodontitis and diabetes mellitus improve, controlled studies with increased sample sizes are carried out, and the studies take into account major confounding variables that impact on the pathogenesis of both diseases. Current studies tend to support a higher incidence and severity of periodontitis in patients with diabetes mellitus. The overview looks at the bidirectional relationship between periodontitis and diabetes. An analysis of the National Health and Nutrition Examination Survey (NHANES) III data set confirms the previously reported significantly higher prevalence of periodontitis in diabetics than in non-diabetics (17.3% versus 9%). The analysis of the data also shows that the prevalence of diabetes in patients with periodontitis is double that seen in the non-periodontitis patients (12.5% versus 6.3%) and that this difference is also statistically significant. The pathogenesis of the 2 diseases is reviewed with an emphasis on common genetic and immune mechanisms. On the basis of the overview, 2 hypotheses for testing the relationship between periodontitis and diabetes are discussed. The first proposes a direct causal or modifying relationship in which the hyperglycemia and hyperlipidemia of diabetes result in metabolic alterations that may then exacerbate bacteria-induced inflammatory periodontitis. The second hypothesis proposes that a fortuitous combination of genes (gene sets) could result in a host who, under the influence of a variety of environmental stressors, could develop either periodontitis or diabetes or both.

Identifying and modelling prognostic factors with censored data

A major issue in the analysis of diseases is the identification and assessment of prognostic factors relevant to the development of the illness. Statistical analyses within the proportional hazards framework suffer from a lack of flexibility due to stringent model assumptions such as additivity and time-constancy of effects. In this paper we use tree-based models and varying coefficient models to allow for detectability of prognostic factors with possibly non-additive, non-linear and time-varying impact on disease development. Questions concerning model and smoothing parameter selection are addressed. An analysis of a data set of breast cancer patients demonstrates the ability of these methods to reveal additional insight into the disease influencing mechanisms.

Adherence of periodontopathic bacteria to bioabsorbable and non-absorbable barrier membranes in vitro

Guided tissue regeneration (GTR) techniques are increasingly used for the treatment of periodontal defects, or in conjunction with dental implant procedures. As adhesion of bacteria to barrier membranes used in these techniques may lead to failure, a prerequisite for treatment success is an infection-free healing process. The present study examined the adhesion of 3 periodontal pathogenic bacteria: Actinobacillus actinomycetemcomitans, Treponema denticola and Porphyromonas gingivalis, to 3 barrier membranes: Collagen, (Biomend) PTFE, (TefGen-FD) and e-PTFE, (Gore-Tex). The membranes were incubated with 3[H]-thymidine labeled bacteria, and the number of adherent bacteria was calculated using a scintillation counter. The effect of albumin coating on bacterial adherence to the membranes was also studied. Bacterial adherence to the membranes was further examined by scanning electron microscopy (SEM). The results show that the adherence of all bacterial strains to collagen membranes was significantly higher than to the other membranes tested. Precoating of the membranes with albumin did not change the bacterial adherence significantly. These findings are of importance in evaluating the ability of periodontal bacteria to colonize and infect different types of barrier membranes.

Modelling and exploring human sleep with event history analysis

In this paper we propose the use of statistical models of event history analysis for investigating human sleep. These models provide appropriate tools for statistical evaluation when sleep data are recorded continuously over time or on a fine time grid, and are classified into sleep stages such as REM and nonREM as defined by Rechtschaffen and Kales (1968). In contrast to conventional statistical procedures, event history analysis makes full use of the information contained in sleep data, and can therefore provide new insights into non-stationary properties of sleep. Probabilities of or intensities for transitions between sleep stages are the basic quantities for characterising sleep processes. The statistical methods of event history analysis aim at modelling and estimating these intensities as functions of time, taking into account individual sleep history and assessing the influence of factors of interest, such as hormonal secretion. In this study we suggest the use of non-parametric approaches to reveal unknown functional forms of transition intensities and to explore time-varying and non-stationary effects. We then apply these techniques in a study of 30 healthy male volunteers to assess the mean population intensity and the effects of plasma cortisol concentration on the transition between selected sleep stages as well as the influence of elapsed time in a current REM period on the intensity for a transition to nonREM. The most interesting findings are that (a) the intensity of the nonREM-to-REM transitions after sleep onset in young men shows a periodicity which is similar to that of nonREM/REM cycles; (b) 30-45 min after sleep onset, young men reveal a great propensity to pass from light sleep (stages 1 or 2) into slow-wave sleep (SWS) (stages 3 or 4); (c) high cortisol levels imposed additional impulses on the transition intensity of (i) wake to sleep around 2 h after sleep onset, (ii) nonREM to REM around 6 h later, (iii) stage 1 or stage 2 sleep to SWS around 2, 4 and 6 h later and (iv) SWS to stage 1 or stage 2 sleep about 2 h later. Moreover, high cortisol concentrations at the beginning of REM periods favoured the change to nonREM sleep, whereas later their influence on a nonREM change became weak and weaker. As sleep data are also available as event-oriented data in many studies in sleep research, event history analysis applied additionally to conventional statistical procedures, such as regression analysis or analysis of variance, could help to acquire more information and knowledge about the mechanisms behind the sleep process.

The fnr gene of Bacillus licheniformis and the cysteine ligands of the C-terminal FeS cluster

In the facultatively anaerobic bacterium Bacillus licheniformis a gene encoding a protein of the fumarate nitrate reductase family of transcriptional regulators (Fnr) was isolated. Unlike Fnr proteins from gram-negative bacteria, but like Fnr from Bacillus subtilis, the protein contained a C-terminal cluster of cysteine residues. Unlike in Fnr from B. subtilis, this cluster (Cys226-X2-Cys229-X4-Cys234) is composed of only three Cys residues, which are supposed to serve together with an internal residue (Cys71) as the ligands for an FeS center. Transfer of the B. licheniformis gene to an fnr mutant of B. subtilis complemented the ability for synthesis of nitrate reductase during anaerobic growth.

Adhesion of periodontal bacteria to titanium, and titanium alloy powders

In this study, the adhesion of radioactively labeled Actinomyces viscosus (A. viscosus), Actinobacillus actinomicetemcomitans (Aa) and Porphyromonas gingivalis (P. gingivalis) to titanium (Ti) and Ti-6-Al-4V alloy (Ti-alloy) coated with albumin or human saliva was investigated. All the tested bacteria displayed greater attachment to Ti-alloy than to Ti. P. gingivalis exhibited less adhesion to Ti and Ti-alloy than did the other bacterial strains. Adhesion of A. viscosus and Aa was greatly reduced when Ti or Ti-alloy were coated with albumin or saliva. P. gingivalis demonstrated a lesser reduction in adhesion to albumin or saliva-coated surfaces. The results show that oral bacteria have different adhesion affinities for Ti and Ti-alloy and that both albumin and human saliva reduce bacterial adhesion.

Resources for lesbian ethnographic research in the lavender archives

The problematics of undertaking lesbian ethnography and cultural history are related in part to the dearth of printed records lesbians kept or preserved for posterity. Technological, financial, and security considerations typically made it necessary for them to operate more informally and inconspicuously, hand-to-hand and by word-of-mouth. Lavender archives, nonetheless, are the repositories of lesbian cultural history. This paper preoccupies itself with the pragmatic issues of developing and maintaining accessible research venues from which to cultivate the study of multiracial and multiethnic lesbian lives. I provide a survey of available resources for doing lesbian scholarship, addressing some of the ethical issues involved with lesbian ethnographic research.

Mechanism of adsorption of human albumin to titanium in vitro

Our previous studies have shown that human albumin is one of the main salivary proteins that adsorb to titanium (Ti). The goal of the present study was to investigate the role of electrostatic interactions in the adsorption of human albumin to Ti-oxide (TiO2) in vitro. The binding profile of human albumin to Ti was analyzed according to an adsorption isotherm. Purified human serum albumin (HSA) was suspended with native, calcium-, magnesium-, or potassium-treated commercially pure Ti powders, at pH 3.0 and 7.0. The amount of unadsorbed protein in the supernatant fluid was measured. The maximum amount of adsorbed albumin was 0.13 mg/1.0 g Ti. The albumin-Ti association constant was 2.77 mL/mg. Pretreatment of Ti with calcium, or magnesium alone, or combined with increasing pH values (3.0-7.0) resulted in augmented adsorption of HSA to Ti. No increase in adsorption was observed following pretreatment of Ti with potassium. These results point to the involvement of electrostatic interactions in the adsorption of HSA to TiO2.

alpha-Amylase and salivary albumin adsorption onto titanium, enamel and dentin: an in vivo study

In vivo adsorption of salivary albumin and alpha-amylase onto titanium, enamel and dentin was analysed following their exposure to the oral cavity for 2h. Oral appliances in six adults served as a platform for carrying 4-mm discs of the three materials. Adherent proteins were eluted from the discs and the amounts of salivary albumin and alpha-amylase were measured by an enzyme-linked immunosorbent assay. While significant difference between the adsorption of albumin and alpha-amylase onto enamel as compared with dentin was observed, adsorption onto titanium was significantly lower. A sample of whole saliva was also collected from each participant. The mean total amounts of albumin and alpha-amylase in the participants' whole saliva were 0.03 and 0.54 mg ml-1, respectively. Titanium adsorbed significantly less (4.43%) of the total albumin than did enamel (14.30%) or dentin (18.80%). No significant difference was found in the relative amounts of alpha-amylase adsorbed by the three materials. This significantly selective adsorption of proteins may enable the attachment of specific bacteria and thus alter the composition of the dental plaque and its potential pathogenicity.

Clathrin-mediated endocytosis of high density lipoprotein3 in human intestinal Caco-2 cells. A post-embedding immunocytochemical study

The mechanism by which high density lipoprotein (HDL) removes excess cholesterol from intracellular sites has been the subject of much controversy. There is some evidence that HDL binds to specific cell surface receptors without internalization. Other evidence suggests that HDL is taken up by endocytosis, enters a pathway of endosomal trafficking and is resecreted from the cells (retroendocytsosis). In the present study, we investigated the distribution of apolipoprotein AI, the major protein constituent of HDL, in cultured intestinal Caco-2 cells employing post-embedding immunocytochemistry on LR White-embedded material. Cells grown under control conditions showed label for apolipoprotein AI in the endoplasmic reticulum. After incubation with native apolipoprotein E-free high density lipoprotein3 (HDL3) additional label for apolipoprotein AI was found in endosomes. These endosomes were observed near lipid droplets and in the basolateral cytoplasm. Further, it was demonstrated that label for apolipoprotein AI was colocalized with label for clathrin on the basolateral membrane. Our results support the concept that HDL3 is internalized and subsequently processed in an endosomal pathway in Caco-2 cells besides de novo synthesis of apolipoprotein AI.

Is there a dysplasia-carcinoma sequence in rat gastric remnant?

Epithelial dysplasia in the gastric remnant is generally considered to have a positive predictive value for malignancy. Whether dysplasia progresses to carcinoma or whether both just have a common origin, is still a matter of controversy. The aim of the present study in rats was to investigate the natural history of epithelial lesions in the gastric remnant. A gastric resection was carried out in 50 male Wistar rats. Postoperatively the animals received N-methyl-N'-nitro-N-nitrosoguanidine orally. Gastroscopy was carried out monthly and biopsies were taken for histologic evaluation. The rats were killed after 12 months or if gastric cancer was found on gastroscopy. Twenty-four rats died postoperatively and were excluded from the study. A total of 228 gastroscopies was performed in the remaining 26 animals; 24 animals developed dysplastic lesions during the follow-up period. The rate of development of gastric cancer within one month increased with the stage of dysplasia at the previous examination (3% for mild, 48% for moderate, 100% for severe dysplasia). There was a strong correlation between the time period following gastric resection and grade of dysplasia and between the grade of dysplasia and development of cancer. Our study demonstrates that gastric stump cancer in rats develops from dysplastic lesions. A dysplasia-carcinoma sequence can therefore be assumed.

Adsorption of salivary proteins onto prosthetic titanium components

In vivo adsorption of salivary proteins onto prosthetic titanium components was analyzed after exposure of titanium abutments to the oral environment for a period of 2 to 6 weeks. Gel electrophoresis and Western immunoblotting were used to separate and identify the proteins, which were mainly alpha-amylase and serum albumin. Selective adsorption of proteins enables attachment of specific oral bacteria and thus may alter the composition of the dental plaque formed on titanium surfaces.

Adsorption of human salivary proteins to titanium powder. I. Adsorption of human salivary albumin

Titanium (Ti) is among the most widely used implant materials in dentistry today. The success of Ti implants is associated with their interactions with the surrounding tissues and biological fluids. In the present study, the adsorption of salivary proteins to Ti and the effect of calcium (Ca) on this process were investigated. Untreated and Ca-treated Ti powders were suspended in human clarified whole saliva. After incubation, the supernatant fluid was collected for protein analysis. The powders were then washed and resuspended in EDTA to desorb proteins from Ti surfaces. Sodium dodecylsulphate polyacrylamide gel electrophoresis and Bradford protein assay were conducted to determine the concentration and type of proteins that adsorbed onto Ti surfaces. The presence of Ca ions enhanced the adsorption of salivary proteins to Ti. A 66 kDa protein, identified by immunoblotting as albumin, was found as the main adsorbed salivary protein. Adsorption of albumin to Ti pretreated with Ca was significantly greater than to native Ti. The Ca-dependent adsorption process was reversed by EDTA. The data suggest that salivary albumin is one of the main constituents of a salivary biofilm formed on Ti dental implants and its adsorption to Ti surfaces is Ca-dependent. The presence of albumin on Ti dental implants may affect plaque accumulation on the implants and the biocompatibility of Ti implants.

[Extended family, immediate family and caregiver contacts of 100-year-old patients in Hungary]

In the year 1987, 218 centenarians lived in Hungary. First the main demographic data were reported by the surveyors of the Central Statistics Office. The basis of the experience was gained on a limited population (123 subjects). The physicians' team was organized by the Gerontology Center of the Semmelweis University of Medicine. They carried out the detailed medical and environmental check-up. The medical and environmental experiences of the gerontologists were published (1). In our present paper we would like to show the different familial and other relationships of the oldest people. The 123 centenarians were scattered over the whole country, altogether in 67 larger or smaller settlements. More of them lived with a daughter (42%), with a son (14%), with a grandchild (7%), with other relatives (5%) and 3 persons lived together with their wives. We found that the subjects who lived with relatives had a better chance to live an active and meaningful life. The co-existence of several generations, the multilateral contacts of centenarians have a beneficial effect on the quality of life.

Health and living conditions of centenarians in Hungary

Demographic data of 218 centenarians in Hungary were collected, and 123 were examined by a medical team. This data showed that the centenarians are from families with a history of longevity. A larger proportion of the centenarians live in the capital, Budapest, than in the rural areas. The centenarians are mostly manual workers (rural) and nonmanual workers. Most of them live with their families. The centenarians are healthier than the general population, drug consumption is low, and they have good adaptative abilities. We compared the clinical laboratory findings of the centenarians with that of 60-80 year olds. Though age-related changes were present in the centenarians, these age-related biological changes did not hinder them from reaching very old age. Finally, we found a few differences in the immunological, clinical laboratory, and morphological profiles of this population. We anticipate more extensive elaboration on this data in future publications.

Elevated cerebellar glucose metabolism in microvascular white matter disease: normal aging and Alzheimer's disease

Young normal, elderly, and clinically diagnosed Alzheimer disease subjects who had undergone positron emission tomography (PET) and computed tomography (CT) examinations were studied to determine the effect of periventricular white matter lesions on cerebellar glucose metabolic rates. PET-determined cerebellar metabolic rates were elevated in subjects with periventricular white matter lesions. These results suggest the cautious use of cortical-to-cerebellar ratios in future PET or single-photon-emission CT (SPECT) studies.

Partners in life: unmarried couples in Hungary

"Non-marital cohabitation in Hungary is documented using data from the 1970 and 1980 censuses and the 1984 microcensus. Observed patterns contrast with those in several other countries, particularly those of western and northwestern Europe. Firstly, in Hungary unmarried couples or 'partners in life' are more common, and their proportion is increasing more rapidly, among the previously married than among the single. Secondly, both among the single and the previously married, mothers are more likely than childless women to be cohabiting. Thirdly, although proportions cohabiting are higher in urban than in rural areas, partners in life are concentrated among those with the lowest educational level." (SUMMARY IN FRE)

[Hungary's retirement life table, 1984]

"Multivariate tables [for Hungary] present mortality and retirement of [the economically] active male and female subpopulations as well as the mortality order of [the] retired population postulating the probabilities valid for 1984. The author points out large differences in mortality order by sexes at the age of retirement and among pensioners. The computation not only shows the present situation but also provides a basis for the reform of the pension system...." (SUMMARY IN ENG AND RUS)

[Assessment of the efficiency of population policy measures]

This article is concerned with the relative effectiveness of various population policy measures. "The data sources [for] analysing efficiency (vital statistics, census data, longitudinal and retrospective analysis of fertility, data of public opinion research) and the possible methods (standardization, trend analysis, experimental samples, number of years spent for contraception by co-habitants, component forecasting approach, the analysis of the reproduction process, regression analysis, simulation models) are reviewed." (summary in ENG, RUS)