Long-term systemic lupus erythematosus disease control after allogeneic bone marrow transplantation

Systemic lupus erythematosus (SLE), a disorder of the immune system, is potentially curable by allogeneic bone marrow transplantation (alloBMT). Until recently, alloBMT was limited by donor availability and toxicity. Reduced intensity conditioning (RIC) combined with post-transplantation cyclophosphamide (PTCy) has improved the availability and safety of alloBMT permitting its exploration in severe-refractory autoimmune illnesses. We report the six-year follow-up of a young female whose refractory SLE-associated nephrosis resolved after RIC alloBMT with PTCy.

An overview of children's oral health-related quality of life assessment: from scale development to measuring outcomes

The objectives of this paper are to present an overview of children's oral health-related quality of life and include specific applications for using quality of life assessment in dental research. The process of developing pediatric oral health- related quality of life measures, in particular the Child Oral Health Impact Profile, is outlined. Examples of children's oral health-related quality of life measurement in caries research are also provided. Quality of life outcomes are presented and discussed in the context of caries research. Lastly, the relevance of measuring clinically meaningful difference in the context of measuring outcomes research is highlighted with recommendations for future research.

Rediscovering Sig Socransky, the Genius and His Legacy

Some individuals make contributions so vital to their field of knowledge that their names become almost synonymous with that field. This is the case of Sig Socransky and the field of periodontal microbiology. Sig Socransky, or simply Sig, was born in Toronto, Canada and received his DDS degree from the University of Toronto in 1957. He studied microbiology and periodontology at Harvard, receiving a certificate in 1961. That same year he was recruited to work as a Research Associate at the Forsyth Dental Center. In 1968, he was nominated Senior Member of the Staff and Head of the Department of Periodontology. During his 50-year career at Forsyth, Sig published over 300 manuscripts, keeping an average of 7 publications per year. His work had an indelible impact in the fields of periodontology and oral microbiology. All these accomplishments pale in comparison with the impact that Sig had on a personal level. We have collected testimonials from some of his former students, closest collaborators, and friends in an attempt to give readers an insight into Sig’s personality. We hope we can offer those who knew him through his work a glimpse of how it felt to interact with this remarkable individual.

Confinement effects on monosaccharide transport in nanochannels

Transport theories based on the continuum hypothesis may not be appropriate at the nanoscale in view of surface effects. We employed molecular dynamics simulations to study the effects of confinement and concentration on diffusive transport of glucose in silica nanochannels (10 nm or smaller). We found that glucose modifies the electrical properties of nanochannels and that, below 5 nm in channel height, glucose adsorption and diffusivity are significantly reduced. With increasing concentration, the diffusivity is reduced linearly in the bulk, while it is reduced nonlinearly at the interface. The effective diffusivity reduction is related to the interface thickness, which can be 2-4 nm depending on concentration, and has an unexpected reduction at low concentrations. Results suggest that nanochannels present a one-dimensional cage environment that affects diffusivity in a fashion similar to cage-breaking diffusion. Our simulation results, consistent with the experimental observations presented here, suggest that nanoconfinement is the essential cause of the observed altered fluid diffusive transport, not accounted for by classical theories, because of coupling of confinement and concentration effects.

Characterisation of bacteria in ascites--reporting the potential of culture-independent, molecular analysis

Spontaneous bacterial peritonitis (SBP) is a severe complication of liver disease. A significant proportion of patients have culture-negative ascites, despite having similar signs, symptoms and mortality to those with SBP. Therefore, empirical antibiotic treatment for infection is often started without knowledge of the causative organisms. Here, we investigated the potential of molecular techniques to provide rapid and accurate characterisation of the bacteria present in ascitic fluid. Ascites samples were obtained from 29 cirrhotic patients undergoing clinically indicated therapeutic paracentesis. Bacterial content was determined by terminal restriction fragment length polymorphism (T-RFLP) analysis, quantitative polymerase chain reaction (PCR) and 16S ribosomal clone sequence analysis. Bacterial signal was detected in all samples, compared to three out of ten using standard methods. Bacterial loads ranged from 5.5 x 10(2) to 5.4 x 10(7) cfu/ml, with a mean value of 1.9 x 10(6) cfu/ml (standard deviation +/- 9.6 x 10(6) cfu/ml). In all but one instance, bacterial species identified by culture were also confirmed by molecular analyses. Preliminary data presented here suggests that culture-independent, molecular analyses could provide rapid characterisation of the bacterial content of ascites fluid, providing a basis for the investigation of SBP development and allowing early and targeted antibiotic intervention.

The effect of shape on the margination dynamics of non-neutrally buoyant particles in two-dimensional shear flows

The margination dynamics of microparticles with different shapes has been analyzed within a laminar flow mimicking the hydrodynamic conditions in the microcirculation. Silica spherical particles, quasi-hemispherical and discoidal silicon particles have been perfused in a parallel plate flow chamber. The effect of the shape and density on their margination propensity has been investigated at different physiologically relevant shear rates S. Simple scaling laws have been derived showing that the number n of marginating particles scales as S(-0.63) for the spheres; S(-0.85) for discoidal and S(-1) for quasi-hemispherical particles, regardless of their density and size. Within the range considered for the shear rate, discoidal particles marginate in a larger number compared to quasi-hemispherical and spherical particles. These results may be of interest in drug delivery and bio-imaging applications, where particles are expected to drift towards and interact with the walls of the blood vessels.

Predicting Autism Spectrum Quotient (AQ) from the Systemizing Quotient-Revised (SQ-R) and Empathy Quotient (EQ)

BACKGROUND

Empathizing is a specific component of social cognition. Empathizing is also specifically impaired in autism spectrum condition (ASC). These are two dimensions, measurable using the Empathy Quotient (EQ) and the Autism Spectrum Quotient (AQ). ASC also involves strong systemizing, a dimension measured using the Systemizing Quotient (SQ). The present study examined the relationship between the EQ, AQ and SQ. The EQ and SQ have been used previously to test for sex differences in 5 'brain types' (Types S, E, B and extremes of Type S or E). Finally, people with ASC have been conceptualized as an extreme of the male brain.

METHOD

We revised the SQ to avoid a traditionalist bias, thus producing the SQ-Revised (SQ-R). AQ and EQ were not modified. All 3 were administered online.

SAMPLE

Students (723 males, 1038 females) were compared to a group of adults with ASC group (69 males, 56 females).

AIMS

(1) To report scores from the SQ-R. (2) To test for SQ-R differences among students in the sciences vs. humanities. (3) To test if AQ can be predicted from EQ and SQ-R scores. (4) To test for sex differences on each of these in a typical sample, and for the absence of a sex difference in a sample with ASC if both males and females with ASC are hyper-masculinized. (5) To report percentages of males, females and people with an ASC who show each brain type.

RESULTS

AQ score was successfully predicted from EQ and SQ-R scores. In the typical group, males scored significantly higher than females on the AQ and SQ-R, and lower on the EQ. The ASC group scored higher than sex-matched controls on the SQ-R, and showed no sex differences on any of the 3 measures. More than twice as many typical males as females were Type S, and more than twice as many typical females as males were Type E. The majority of adults with ASC were Extreme Type S, compared to 5% of typical males and 0.9% of typical females. The EQ had a weak negative correlation with the SQ-R.

DISCUSSION

Empathizing is largely but not completely independent of systemizing. The weak but significant negative correlation may indicate a trade-off between them. ASC involves impaired empathizing alongside intact or superior systemizing. Future work should investigate the biological basis of these dimensions, and the small trade-off between them.

Permanent vision loss in one eye following administration of local anesthesia for a dental extraction

Prilocaine Plain, an amide local anesthetic (LA), is somewhat less potent than lidocaine and considerably less toxic after injection into peripheral tissues. Clinically, it produces less vasodilation and is similar to other amide LA in relative freedom from allergic reactions. It is reliably used in a plain solution for cardiac patients receiving short procedures. In this report a patient with a known diagnosis of bacterial endocarditis suffered permanent visual loss in the left eye immediately following dental extraction surgery prior to mitral valve surgery. The clinical implications indicate that the delivery of LA must be done with aspiration before and during the injection. This will possibly prevent intravascular injection, which can lead to fluid emboli occluding the ophthalmic artery with the devastating result of vision loss.

Factors impacting injury documentation after sexual assault: role of examiner experience and gender

OBJECTIVE

This study was undertaken to determine whether physician gender or level of experience is associated with the prevalence of trauma documented in victims after sexual assault.

STUDY DESIGN

All female patients 15 years or older reporting to an urban hospital with a complaint of sexual assault between January 1997 and September 1999 underwent a standardized history and physical examination by a second- or third-year resident in obstetrics and gynecology. Data were abstracted and verified. A chi(2) or Fisher exact test was used for categoric analysis.

RESULTS

The overall prevalence of genital trauma was 21% in the 662 patients available for analysis. The prevalence of genital trauma documented by second- and third-year residents was 50 of 191 patients (26.2%) and 90 of 471 patients (19.1%), respectively (P=.04), despite similar assault characteristics between the 2 groups. The prevalence of genital trauma documented by male examiners (105/499 [21.0%]) and female examiners (35/160 [21.9%]) did not differ (P=.8). All examiners documented a similar prevalence of body trauma (52%).

CONCLUSION

This study supports the hypothesis that the examiner's experience level may influence the prevalence of genital trauma documented after a sexual assault. Genital trauma documented was not associated with examiner gender in this study.

High levels of monoaromatic compounds limit the use of solid-phase microextraction of methyl tert-butyl ether and tert-butyl alcohol

Recently, two papers reported the use of solid-phase microextraction (SPME) with poly(dimethylsiloxane)(PDMS)/Carboxen fibers to determine trace levels of methyl tert-butyl ether (MTBE) and tert-butyl alcohol (tBA) in water. Attempts were made to apply this technique to the analysis of water samples containing high levels of benzene, toluene, ethylbenzene, xylenes, and trimethylbenzenes (BTEXsTMBs) as would be expected at leaking underground storage tank sites. It was found that when the sample contained total aromatic compounds above 1 ppm, the response of the internal standards, deuterated MTBE and tBA, dropped by more than 65%. As this decrease in internal standard peak area was unacceptable, a static headspace method was used instead. This headspace method was used successfully to analyze groundwater from 670 monitoring wells at 74 service stations located in the northeast United States. In these monitoring wells, 30% of the samples contained total BTEXsTMBs above 1 ppm. If the SPME method was used to analyze these samples, dilution of more than 200 samples would be required to minimize the adverse matrix effect that high aromatic content had on the internal standard peak area.

Prevalence of oral soft tissue lesions in HIV-infected minority children treated with highly active antiretroviral therapies

PURPOSE

This project studied the prevalence of oral soft tissue disease in HIV-infected children treated with highly active antiretroviral therapy (HAART).

METHODS

Thirty-eight HIV-infected children participated in the study. Twenty-three of these patients were treated with HAART while 14 received exclusively reverse transcriptase inhibitors (RTI) and served as controls. The children were examined three times at approximately one-month intervals while their health history and laboratory data were abstracted from medical charts. Analyses were performed to determine differences in lesion prevalence between treatment groups as well as between lesion and no lesion groups with regard to immune differences.

RESULTS

Thirty patients (79%) had oral lesions detected in at least one visit. There were no differences in specific lesion prevalence between HAART compared with RTI-treated children. However, a trend for more oral candidiasis in the latter group was observed. Subjects with oral soft tissue lesions had lower CD4 counts (P = 0.04) and percentage (P = 0.01) but similar viral loads when compared to patients without oral soft tissue disease.

CONCLUSIONS

HAART does not appear to significantly affect oral soft tissue disease prevalence in HIV-infected children. Presence of lesions was associated with decreased immunity and may signal advancing disease.

Sporadic acute hepatitis E in the united kingdom: an underdiagnosed phenomenon?

BACKGROUND

Hepatitis E (HEV) is the primary cause of enterically transmitted non-A non-B hepatitis worldwide. Case reports of HEV in individuals in the United Kingdom relate to travel to endemic areas or contact with individuals who have visited these areas.

CASE REPORTS

Four individuals presented with acute hepatitis to a hepatology clinic in a teaching hospital. Serology confirmed acute hepatitis E in all four. Investigation by the Communicable Disease Control Department established no links between the cases, no travel to an endemic area, and no contacts.

CONCLUSION

Contrary to current belief, community acquired hepatitis E virus infection occurs sporadically in the United Kingdom and should be considered as a cause of seronegative hepatitis.

Hepatic stellate cells express the low affinity nerve growth factor receptor p75 and undergo apoptosis in response to nerve growth factor stimulation

We have examined the expression of p75, a member of the TNF receptor superfamily in hepatic stellate cells (HSC) and pancreatic stellate cells (PSC). Activated HSC and PSC were demonstrated by Western blot analysis to express p75. p75 was immunolocalized to cells with a myofibroblast-like morphology in the fibrotic bands of six fibrotic and cirrhotic liver biopsies and three biopsies of fibrotic human pancreas. Immunostaining of parallel sections indicated that these cells were alpha-smooth muscle actin-positive, identifying them as activated HSC and PSC, respectively. HSC apoptosis in tissue culture in the presence of serum was quantified after addition of 0.1 to 100 ng/ml of nerve growth factor (NGF) a ligand for p75, by in situ counting of apoptotic bodies after addition of acridine orange. HSC demonstrated a significant increase in apoptosis in response to 100 ng/ml NGF (0.05 > P by Wilcoxon's rank; n = 7) after 24 hours. NGF 100 ng/ml had no effect on HSC proliferation, but reduced total HSC DNA by 19% relative to control after 24 hours (n = 3). These data demonstrate that activated HSC express p75 and respond to NGF stimulation by undergoing apoptosis. We therefore report p75 as a novel marker of activated HSC and suggest that signaling via ligand binding to p75 may provide a mechanism for selective apoptosis of HSC.

Head-to-head evaluation of five chlamydia tests relative to a quality-assured culture standard

Nucleic acid amplification tests offer superior sensitivity for the detection of Chlamydia trachomatis infection, but many laboratories still use nonamplification methods because of the lower cost and ease of use. In spite of their availability for more than a decade, few studies have directly compared the nonamplification tests. Such comparisons are still needed in addition to studies that directly compare individual nonamplification and amplification tests. The purpose of this study was to evaluate and compare the performance characteristics relative to culture of five different tests for the detection of C. trachomatis with and without confirmation of positive results. The tests were applied to endocervical specimens from 4,980 women attending family planning clinics in the northwestern United States. The five nonculture tests included Chlamydiazyme (Abbott), MicroTrak direct fluorescent antibody (DFA) (Syva), MicroTrak enzyme immunoassay (EIA) (Syva), Pace 2 (Gen-Probe), and Pathfinder EIA (Sanofi/Kallestad). All positive results obtained with a nonculture test (except MicroTrak DFA) were confirmed by testing the original specimens with a blocking antibody test (Chlamydiazyme), a cytospin DFA (MicroTrak EIA and Pathfinder EIA), and a probe competition assay (Pace 2). The prevalence of culture-proven chlamydia was 3.9%. The sensitivities of the nonculture tests were in a range from 62 to 75%, and significant differences between tests in terms of sensitivity were observed. The positive predictive value for each test was 0.85 or higher. The specificities of the nonculture tests without performance of confirmations were greater than 99%. Performing confirmatory tests eliminated nearly all of the false positives.

Short-term effects of large-dose vitamin A supplementation on viral load and immune response in HIV-infected women

Vitamin A supplementation has been suggested for treatment and prevention of HIV infection. However, some in vitro data indicate that vitamin A may activate HIV. Randomly, 40 HIV-seropositive women of reproductive age were allocated to receive a single oral dose of 9900 micromol (300,000 IU) vitamin A or placebo. Plasma HIV-1 RNA concentration, total lymphocytes, selected lymphocyte subsets and activation markers, and in vitro lymphocyte proliferation to phytohemagglutinin (PHA) and Candida were measured before dosing and at various time points over an 8-week follow-up period. No differences were found between treatment groups in the frequency of signs or symptoms of acute vitamin A toxicity, nor were differences evident in any lymphocyte subset or activation marker at any time during follow-up. Mean and median viral load concentration at each time point and change in viral load from baseline to each follow-up point did not differ between treatment groups. No difference was measured between treatment groups in the proportion of women who responded to PHA or Candida. This study provides no evidence that high dose vitamin A supplementation of HIV-infected women is associated with significant clinical or immunologic adverse effects.

Protocol-guided diuretic management: comparison of furosemide by continuous infusion and intermittent bolus

OBJECTIVE

To evaluate the safety and relative effectiveness of two diuretic protocols in the intensive care unit (ICU).

DESIGN

Prospective, randomized comparative study.

PATIENTS

Thirty-three cardiac and medical ICU patients with pulmonary edema or fluid overload for which aggressive diuresis was intended.

INTERVENTIONS

Enrolled patients were randomized to fluid management strategies combining fluid restriction and individually adjusted diuretic therapy by either continuous or bolus infusions of furosemide, titrated to achieve negative hourly fluid balance.

MEASUREMENTS AND MAIN RESULTS

Cumulative intake minus output (primary endpoint); change in serum creatinine, and length of ICU and hospital stay (secondary endpoints). Diuresis by either protocol was feasible, safe, and effective. The main outcome measures were not significantly different for either group managed with a standardized protocol.

CONCLUSIONS

Protocol-guided diuretic management, with individualized titration of dosage to defined physiologic endpoints can be readily and safely implemented in the ICU. Both continuous and bolus diuretic regimens appear equally effective in achieving negative fluid balance. Larger studies with a randomized control arm are needed before these protocols can be recommended as routine practice.

Growth in infancy, infant feeding, childhood living conditions, and Helicobacter pylori infection at age 70

AIM

To examine childhood correlates of Helicobacter pylori infection in adults.

DESIGN

Follow up study of men and women whose birth weight, weight at age 1 year, and feeding in infancy were recorded by health visitors. Data on childhood housing conditions were obtained by recall.

SUBJECTS

631 men and 389 women born in Hertfordshire during 1920-30 and still living in the east or northwest districts of the county.

MAIN OUTCOME MEASURES

Serum H pylori IgG antibodies measured by enzyme linked immunosorbent assay.

RESULTS

Independent of their current social class, subjects were more likely to be H pylori seropositive if they had large numbers of siblings (p < 0.0001), and if they had lived in a crowded house (p = 0.001), or shared a bedroom or bed in childhood (p = 0.02). Low weight at 1 year was associated with increased seropositivity rates in men (p = 0.0002), but not women (p = 0.8). Men and women who were breast fed in infancy were less likely to be seropositive than those who were bottle fed (p = 0.08).

CONCLUSIONS

The findings support the current view that H pylori infection is often acquired in childhood by close person to person contact, and persists into adult life. H pylori infection may be a cause of failure to thrive in infancy, especially in boys. Alternatively, small infants may be more susceptible to infection. Breast feeding may prevent early infection.

Selective screening for chlamydial infection in women: a comparison of three sets of criteria

Selective screening has been associated with marked declines in the prevalence of chlamydial infection, the most common bacterial sexually transmitted disease (STD) in the United States. A comparison of the performance of different selective screening criteria in three groups of family planning and STD clinic clients shows that criteria recommended by the Centers for Disease Control and Prevention performed well overall, detecting 88-89% of infections by screening 58-74% of women. Criteria based on age alone performed best among low-risk clients with a low prevalence of chlamydial infection, particularly when all women younger than age 25 were screened (sensitivity, 84-92%); the age-based criteria still required screening only 59-71% of all women. Selective screening criteria should be based on age, risk profile and chlamydia prevalence in specific clinical settings, and should be reevaluated as chlamydia prevalence declines.

Absence of a relationship between malnutrition and trachoma in preschool children

PURPOSE

To determine if there is an association between malnutrition and clinical trachoma among children in a trachoma endemic region of Tanzania.

METHODS

189 children age one to five were examined by a trained eye nurse for the presence of active trachoma, using the WHO simplified grading scheme. One examiner also measured the arm circumference of the mid-aspect of the upper left arm on the same children. Trachoma was defined as the presence of follicular trachoma (TF) and/or severe trachoma (TI). Malnutrition was defined two ways: a mid-arm circumference of less than 12.5 cm, and a value one standard deviation below the age-specific mean.

RESULTS

Overall, 57% of children had trachoma, and 9% had severe trachoma. The percentage of children with arm circumference below 12.5 cm varied with age from 96% in the one-year-olds to 35% in the six-year-olds. Using either method of classifying malnutrition, there was no association with trachoma, nor with severe trachoma.

CONCLUSION

Trachoma and malnutrition are both common in this sample of children, although no relationship between the two was observed. Further work on the nutritional status in those with subclinical infection may be warranted.

Performance and cost-effectiveness of selective screening criteria for Chlamydia trachomatis infection in women. Implications for a national Chlamydia control strategy

BACKGROUND AND OBJECTIVES

Detection of subclinical Chlamydia trachomatis infection in women is a high but costly public health priority.

GOALS

To develop and test simple selective screening criteria for chlamydia in women, to assess the contribution of cervicitis to screening criteria, and to evaluate cost-effectiveness of selective versus universal screening.

STUDY DESIGN

Cross-sectional study and cost-effectiveness analysis of 11,141 family planning (FP) and 19,884 sexually transmitted diseases (STD) female clients in Washington, Oregon, Alaska, and Idaho who were universally tested for chlamydia using cell culture, direct fluorescent antibody, enzyme immunoassay, or DNA probe.

RESULTS

Prevalence of cervical chlamydial infection was 6.6%. Age younger than 20 years, signs of cervicitis, and report of new sex partner, two or more partners, or symptomatic partner were independent predictors of infection. Selective screening criteria consisting of age 20 years or younger or any partner-related risk detected 74% of infections in FP clients and 94% in STD clients, and required testing 53% of FP and 77% of STD clients. Including cervicitis in the screening criteria did not substantially improve their performance. Universal screening was more cost-effective than selective screening at chlamydia prevalences greater than 3.1% in FP clients and greater than 7% in STD clients.

CONCLUSIONS

Age and behavioral history are as sensitive in predicting chlamydial infection as criteria that include cervicitis. Cost-effectiveness of selective screening is strongly influenced by the criteria's sensitivity in predicting infection, which was significantly higher in STD clients. At the chlamydia prevalences in the populations studied, it would be cost saving to screen universally in FP clinics and selectively in STD clinics, the reverse of current practice in many locales.

Genital Chlamydia infections in sexually active female adolescents: do we really need to screen everyone?

PURPOSE

To evaluate current Chlamydia trachomatis screening guidelines, which recommend that all sexually active female adolescents undergoing a pelvic examination be tested for chlamydial infection, and determine if instead providers should target particular subpopulations of these adolescents.

METHODS

Data were collected from 148,650 sexually active females, ages 15-19 years, tested by direct immunofluorescent antibody in 160 family planning clinics from 1988-92. Trends in chlamydia prevalence by demographic, behavioral, and clinical risk factors were analyzed. Logistic regression modeling was used to identify selective screening criteria. Predictive models were developed for all years combined, as well as for the years when prevalence was highest and lowest.

RESULTS

The prevalence of C. trachomatis in this population was 10%, with a 42% decrease (13.2-7.6%) over the 5-year period. Logistic regression identified nine demographic, behavioral, and clinical predictors (p < 0.0001) associated with chlamydial infections. Predictor models from the highest and lowest prevalence years varied little from the combined model. Individual year predictor models showed poor sensitivity and were similar for these 2 years. The screening criteria could not identify a group of adolescents with a prevalence less than 6%.

CONCLUSIONS

Several individual risk factors were strongly associated with C. trachomatis, but no single risk factor or combination of risk factors used for selective screening could identify more than 42% of infections in our population. These findings support earlier national recommendations and the need for universal screening of sexually active female adolescents.

Evaluation of antimicrobial mouthrinses and their bactericidal effectiveness

The mechanisms of action of antimicrobials have been based in the past on in vitro data obtained from laboratory experiments performed on pure cultures of bacteria. A more complete understanding of oral antimicrobials and their mechanisms of action will results from testing of agents in systems that more closely resemble environmental areas existing in the oral cavity. It is proposed that mechanisms of drug action be studied with a drug held at suboptimal (sublethal) concentrations for short periods and in a dynamic environment that resembles the mouth. Adequate guidelines provided by the American Dental Association Council on Dental Therapeutics are available and have helped to determine the efficacy of these agents over long periods in appropriate populations.

AIDS presenting as focal segmental membranous glomerulopathy

The case of a young, heterosexual man who was investigated for proteinuria is reported. A renal biopsy specimen showed a focal and segmental membranous glomerulopathy. He was later found to be HIV positive and died from cerebral infarction associated with HIV vasculitis 16 months after his initial presentation. Unusual forms of immune complex mediated glomerulopathies should alert the pathologist to the possibility of HIV associated disease.

Effect upon plaque formation and gingivitis of a triclosan/copolymer/fluoride dentifrice: a 6-month clinical study

A total of 159 adult male and female subjects between 18 and 63 years of age, were entered into a 6-month, double-blind clinical study to assess the effects of a dentifrice containing 0.3% triclosan and 2% of a copolymer of methoxyethylene and maleic acid on supragingival plaque formation and gingivitis, as compared to a placebo dentifrice. Both the triclosan and placebo dentifrices contained 0.243% sodium fluoride in a silica base. The subjects had to demonstrate at least mild gingivitis (modified Loe-Silness score > or = 1.0), be free of advanced periodontal disease, have a modified Quigley-Hein Plaque Index score of at least 1.5 and have a minimum of 20 natural, uncrowned teeth. The subjects were stratified into two balanced groups according to baseline plaque and gingivitis scores. At zero time or baseline, all subjects received a complete and thorough oral prophylaxis and were assigned to the use of either the placebo dentifrice or the triclosan/copolymer dentifrice for the next 6 months. Subjects were evaluated for gingivitis and supragingival plaque formation after 3 and 6 months product use. After 3 months, when compared to the placebo dentifrice, the triclosan/copolymer dentifrice provided the following statistically significant reductions (at 99% confidence levels): (1) a 10.0% reduction in supragingival plaque formation; (2) a 20.8% reduction in plaque formation on tooth surfaces with highest baseline plaque scores; (3) a 21.9% reduction in gingivitis, and (4) 30.5% less sites with severe gingivitis, i.e. gingival bleeding.(ABSTRACT TRUNCATED AT 250 WORDS)

Sexual abuse as a factor in adolescent pregnancy and child maltreatment

Two-thirds of a sample of 535 young women from the state of Washington who became pregnant as adolescents had been sexually abused: Fifty-five percent had been molested, 42 percent had been victims of attempted rape and 44 percent had been raped. Compared with adolescent women who became pregnant but had not been abused, sexually victimized teenagers began intercourse a year earlier, were more likely to have used drugs and alcohol and were less likely to practice contraception. The abused adolescents were also more likely to have been hit, slapped or beaten by a partner and to have exchanged sex for money, drugs or a place to stay. Young women in the abused group were also more likely to report that their own children had been abused or had been taken from them by Child Protective Services.

The Nat Health filesIn which Nat Health helps TV casualty star charlie use his hands for the first time. by David Fine

The name's Health. Nat Health, Special Investigator into services that care.

Multicenter evaluation of tetracycline fiber therapy: I. Experimental design, methods, and baseline data

The study design and baseline characteristics of a multicenter trial to test the effectiveness and safety of locally delivered tetracycline for treatment of adult periodontitis are described. Local delivery was provided by 0.5 mm diameter ethylene vinyl acetate copolymer fibers loaded 25% with tetracycline hydrochloride which were placed into periodontal pockets and maintained by an adhesive for 10 (+/- 2) days. A total of 113 subjects (56 male and 57 female; mean age 49.3 yr) at five centers participated in the study. Subjects were selected who had 4 nonadjacent teeth with 6-10 mm pockets that bled on probing. The selected sites in each subject were randomly assigned to 4 test groups: tetracycline fiber, control fiber, scaling with root planing, or untreated. A balanced experimental design was thereby established in which each subject contributed equally by providing 4 clinically comparable sites for evaluation. To provide a more specific model for testing periodontitis therapy, gingivitis was treated prior to the initiation of the study by prophylaxis with supragingival calculus removal and home care instruction. Clinical response variables measured were pocket depth reduction, attachment level gain and bleeding on controlled-force probing measured at baseline, 30 d, and 60 d. Levels of 6 bacterial species selected as probable periodontal pathogens were measured by DNA probe analysis of plaque samples. The design of this study provided several unique analytical opportunities. Controls included a comparison with conventional treatment, analysis of vehicle effects, and effects at untreated sites. Comparison of the test group with controls permitted evaluation of the principal variables that could effect interpretation of results.(ABSTRACT TRUNCATED AT 250 WORDS)

Multicenter evaluation of tetracycline fiber therapy: II. Clinical response

The safety and efficacy of periodontal disease treatment by intrapocket placement of tetracycline (TC) fibers was investigated in a 60-day multicenter study conducted by selecting 4 sites in each subject with 6-10 mm pockets that bled on probing. Sites were randomly assigned to 1 of 4 test groups: TC fiber therapy, scaling, control fiber (fibers without drug), or untreated. TC fibers and control fibers were placed to fill the pocket and were maintained with a cyanoacrylate adhesive for 10(+/- 2) d. Scaling was performed for a minimum of 5 min under local anesthesia. Following initial tooth cleaning procedures, pocket depth, attachment level and bleeding on controlled-force probing were measured at baseline and at 30 d, and 60 d following therapy. Analysis of data from 107 subjects who had complete clinical data sets indicated that TC fiber therapy significantly decreased pocket depth, increased attachment level, and decreased bleeding on controlled-force probing to a greater extent than observed in all other test groups including scaling. These effects were greater than, and in addition to, effects that occurred due to prophylaxis and improved home care. No serious adverse side-effects attributed to TC fiber therapy were observed. No TC fiber-treated sites abscessed and superinfection was not noted. A transient redness at fiber removal was seen at 21% of the sites. Although fibers were placed without anesthesia, mild pain on initial placement was infrequent (19%) and abated rapidly. The results indicate that TC fiber placement provides a safe and effective means for treatment of periodontal infections.