Clinical efficacy of CFTR modulator therapy in people with cystic fibrosis carrying the I1234V mutation

BACKGROUND

The cystic fibrosis transmembrane conductance regulator (CFTR) mutation I1234V (I1234V, p.Ile1234Val, c.3700A>G), is a missense-mutation that creates a cryptic splice site, with the formation of a protein lacking 6 amino acids, that is misfolded and misprocessed. The in vitro effects of CFTR modulator (CFTRm) therapies on human bronchial cell models and intestinal organoids carrying this mutation are conflicting. The aim of this study was therefore to explore the clinical efficacy of CFTRm in people with cystic fibrosis (pwCF) carrying this mutation.

METHODS

This was a retrospective descriptive study of the clinical records of homozygous and compound heterozygous (none F508del) pwCF, for the I1234V mutation, that received CFTRm. Parameters explored were body mass index (BMI), forced expiratory volume in one second percent predicted (FEV1%), lung clearance index (LCI) and quantitative sweat chloride measurements.

RESULTS

Mean age was 38.6 ± 14 years (range 21-60). Two subjects were homozygous and five compound heterozygous, with minimal function mutations. Four were pancreatic insufficient and three pancreatic sufficient. The two homozygous subjects received Tezacaftor/Ivacaftor, the remaining Elexacaftor/Tezacaftor/Ivacaftor (ETI); treatment ranged from 6 to 12 months. Mean BMI score increased from 21.7 ± 1.3 to 23.6 ± 2.1 kg/m2 (p = 0.04); FEV1(%pred) increased by 20.14±10.2while mean change in FEV1 in the year prior to CFTRm initiation was -0.14±1.18 (p = 0.0001). Additionally, LCI 2.5% decreased from 18.7 to 14.5 (p = 0.07); sweat chloride decreased from 116±10 to 90±17 mEq/L (p = 0.017) and chronic pseudomonas airway infection was eradicated in one subject.

CONCLUSIONS

This study supports a clinical benefit for CFTRm therapy in pwCF carrying the I1234V mutation.

Antimicrobial Peptides against Multidrug-Resistant Pseudomonas aeruginosa Biofilm from Cystic Fibrosis Patients

Lung infection is the leading cause of morbidity and mortality in cystic fibrosis (CF) patients and is mainly dominated by Pseudomonas aeruginosa. Treatment of CF-associated lung infections is problematic because the drugs are vulnerable to multidrug-resistant pathogens, many of which are major biofilm producers like P. aeruginosa. Antimicrobial peptides (AMPs) are essential components in all life forms and exhibit antimicrobial activity. Here we investigated a series of AMPs (d,l-K₆L₉), each composed of six lysines and nine leucines but differing in their sequence composed of l- and d-amino acids. The d,l-K₆L₉ peptides showed antimicrobial and antibiofilm activities against P. aeruginosa from CF patients. Furthermore, the data revealed that the d,l-K₆L₉ peptides are stable and resistant to degradation by CF sputum proteases and maintain their activity in a CF sputum environment. Additionally, the d,l-K₆L₉ peptides do not induce bacterial resistance. Overall, these findings should assist in the future development of alternative treatments against resistant bacterial biofilms.

A Practical Clinical Score Predicting Respiratory Failure in COVID-19 Patients

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic resulted in repeated surges of patients, sometimes challenging triage protocols and appropriate control of patient flow. Available models, such as the National Early Warning Score (NEWS), have shown significant limitations. Still, they are used by some centers to triage COVID-19 patients due to the lack of better tools.

OBJECTIVES

To establish a practical and automated triage tool based on readily available clinical data to rapidly determine a distinction between patients who are prone to respiratory failure.

METHODS

The electronic medical records of COVID-19 patients admitted to the Sheba Medical Center March-April 2020 were analyzed. Population data extraction and exploration were conducted using a MDClone (Israel) big data platform. Patients were divided into three groups: non-intubated, intubated within 24 hours, and intubated after 24 hours. The NEWS and our model where applied to all three groups and a best fit prediction model for the prediction of respiratory failure was established.

RESULTS

The cohort included 385 patients, 42 of whom were eventually intubated, 15 within 24 hours or less. The NEWS score was significantly lower for the non-intubated patients compared to the two other groups. Our improved model, which included NEWS elements combined with other clinical data elements, showed significantly better performance. The model's receiver operating characteristic curve had area under curve (AUC) of 0.92 with of sensitivity 0.81, specificity 0.89, and negative predictive value (NPV) 98.4% compared to AUC of 0.63 with NEWS. As patients deteriorate and require further support with supplemental O2, the need for re-triage emerges. Our model was able to identify those patients on supplementary O2 prone to respiratory failure with an AUC of 0.86 sensitivity 0.95, and specificity 0.7 NPV 98.9%, whereas NEWS had an AUC of 0.76. For both groups positive predictive value was approximately 35.

CONCLUSIONS

Our model, based on readily available and simple clinical parameters, showed an excellent ability to predict negative outcome among patients with COVID-19 and therefore might be used as an initial screening tool for patient triage in emergency departments and other COVID-19 specific areas of the hospital.

The role of inspiratory capacity and tidal flow in diagnosing exercise ventilatory limitation in Cystic Fibrosis

BACKGROUND

Exercise ventilatory limitation conventionally defined by reduced breathing reserve (BR) may underestimate the effect of lung disease on exercise capacity in patients with mild to moderate obstructive lung diseases.

OBJECTIVE

To investigate whether ventilatory limitation may be present despite a normal BR in Cystic Fibrosis (CF).

METHODS

Twenty adult CF patients (age 16-58y) with a wide range of pulmonary obstruction severity completed a symptom-limited incremental exercise test on a cycle ergometer. Operating lung volumes were derived from inspiratory capacity (IC) measurement during exercise and exercise tidal flow volume loop analysis.

RESULTS

six patients had a severe airway obstruction (FEV₁<45% predicted) and conventional evidence of ventilatory limitation (low BR). Fourteen patients had mild to moderate-severe airway obstructive (FEV₁ 46-103% predicted), and a normal BR [12-62 L/min, BR% (17-40)]. However, dynamic respiratory mechanics demonstrated that even CF patients with mild to moderate-severe lung disease had clear evidence of ventilatory limitation during exercise. IC was decreased by (median) 580 ml (range 90-1180 ml) during exercise, indicating dynamic hyperinflation. Inspiratory reserve volume at peak exercise was 445 ml (241-1350 ml) indicating mechanical constraint on the respiratory system. The exercise tidal flow met or exceeded the expiratory boundary of the maximal flow volume loop over 72% of the expiratory volume (range 40-90%), indicating expiratory flow limitation.

CONCLUSION

Reduced BR as a sole criterion underestimates ventilatory limitation during exercise in mild to moderate-severe CF patients. Assessment of dynamic respiratory mechanics during exercise revealed ventilatory limitation, present even in patients with mild obstruction.

Ear Deformations in Preterm Newborns: Non-Surgical Treatment

ABSTRACT

Approximately 30% of newborns have some degree of congenital ear anomalies, the minority will resolve spontaneously. Deformations can be treated non-surgically, when diagnosed early, whereas malformations surgically only. The authors use the EarWell system proven to achieve excellent results in treating deformations. Although prematurity might raise the risk of ear-deformations compared to term infants, in our experience, there is a longer time frame until effective treatment is initiated due to the cartilage malleability.Treatment included splinting with retractors and taping or a custom-made silicone ear-mold if necessary. Patients were examined weekly, and treatment continued until appropriate ear shape was achieved (6-14 weeks).The authors treated 8 preterm infants during 2018 to 2020 with the above method. Average age of application was 9.25 weeks; treatment was initiated in all patients before the age of 12 weeks. 5/8 had a right-side, 2/8 a left-side, and one a bilateral deformation. Average treatment duration was 10 ± 2.9 weeks. Assessment of satisfaction was made by parents via phone questionnaires; most were pleased with the overall result, while 62% were extremely satisfied.The authors observed higher compliance and longer-lasting malleability of the cartilage in preterm compared to term-infants. They also had fewer complications than in the term group, maybe due to their older (actual age), and more resistant and durable skin compared to a term-infant of the same age. The authors recommend initiating treatment in preterm infants later than accepted practice as results were excellent, and despite the longer treatment duration, this is a better treatment option than surgery.

Spontaneous pneumothorax-When do we need to intervene?

BACKGROUND

Pneumothorax can be classified as traumatic, iatrogenic or spontaneous (SP), which can be subdivided into primary spontaneous pneumothorax (PSP), a condition without preexisting lung disease, or secondary spontaneous pneumothorax (SSP) a complication of a preexisting lung disease. Recurrence rate of PSP is 30% whereas for SSP rate is unknown. This article explores the experience of a tertiary center over 20 years.

METHODS

A retrospective case review of patients hospitalized with pneumothorax to investigate the natural history and treatment of SP in a young population in a single tertiary center was conducted. A search of the digital archive (going back to 01/01/1995) of Sheba Medical Center identified hospitalized patients below the age of 40.

RESULTS

The database was composed of the records of 750 patients (612 males, 138 females) who were hospitalized. The recurrence risk for SP after nonoperative treatment was significantly higher. Women were found to have an increased risk of SSP when having SP (OR 2.78). Asthma was the most prevalent disease causing SSP in young people.

CONCLUSIONS

In this large cohort, we found that operative procedure has clear protective effect from recurrence in SP, so surgery should be positively considered when treating SP in hospitalized patients. Among young people and particularly in pediatric patients, when females have a SP, we strongly recommend looking for primary lung disease. More studies are needed to determine the risk factors and produce clear guidelines regarding surgery as first treatment.

Advanced Lung Disease in Patients with Cystic Fibrosis Is Associated with Low Diffusion capacity

BACKGROUND

The single-breath diffusing capacity of the lungs (DLCOSB) test measures the extent to which carbon monoxide (CO) passes from the lung air sacs into the blood. The accessible alveolar volume (VASB) is measured by inert gas during a 10-second period. The single-breath transfer coefficient of the lung for carbon monoxide (KCOSB) is the DLCOSB divided by VASB. Cystic fibrosis (CF) disease comprises progressive airway obstruction with bronchiectasis and parenchyma fibrosis. Yet, the KCOSB appears insignificant in the assessment of pulmonary function in CF.

OBJECTIVES

To challenge the precision of normal KCOSB in CF.

METHODS

The authors collected pulmonary function tests (PFT) data from 74 confirmed CF patients (mean age 26 ± 10 years) with various levels of pulmonary disease severity. Tests included spirometry, DLCOBP, and body plethysmography (BP). Anatomical dead space was calculated by deducting anatomical dead space from total lung capacity TLC(BP) to establish alveolar volume (VABP) and to determine KCOBP. We also included individual data of arterial pCO2 blood-gas level.

RESULTS

KCOSB values were normal or higher in most patients, regardless of patient FEV1 value (R2 = 0.2204; P < 0.02). In contrast, the measurements of KCOBP were low corresponding with low FEV1 values, and negatively correlated with the elevation of trapped air and pCO2 levels (R2 = 0.1383; P = 0.0133, P > 0.05, respectively).

CONCLUSIONS

The 10- second perfusion time of the inert gas during DLCOSB represent the communicative alveolar volume in CF patients with advanced pulmonary disease. The findings justify the use of DLCOSB with the deterioration of FEV1 and elevation of pCO2 levels.

Regenerative endodontics: a promising tool to promote periapical healing and root maturation of necrotic immature permanent molars with apical periodontitis using platelet-rich fibrin (PRF)

PURPOSE

Currently, mineral trioxide aggregate (MTA) apexification is recommended as the preferred treatment for permanent anterior immature necrotic teeth. Apexification treatment does not enable further development and maturation of the teeth, resulting in short roots with thin root canal walls, that often are prone to cervical fractures. This study presents the regenerative endodontic procedure (REP) as an alternative treatment for immature necrotic molars with apical periodontitis or a chronic apical abscess. REP enables periapical healing as well as root lengthening and widening of the dentinal root canal walls.

CASE SERIES RESULTS

Six immature first molars teeth (five mandibular, one maxillary) with apical periodontitis or chronic apical abscess were treated with REP. Patients underwent periodic follow-up visits every 3 months the first year and twice a year thereafter. The final clinical examination revealed no symptoms, no gingival pockets, and no sensitivity to percussion. Cold sensitivity tests were negative. Radiographs revealed full periapical healing in all the treated molars, remarkable root lengthening, and dentinal wall thickening.

CONCLUSION

REP with PRF is feasible and may have some advantages over MTA apexification since it facilitates root elongation, dentinal thickening of the root canals walls, and narrowing of the apical foramen.

Predictors for plication performance following diaphragmatic paralysis in children

INTRODUCTION AND OBJECTIVES

Diaphragmatic paralysis (DP) in children can result from various etiologies. Guidelines for patient selection for diaphragmatic plication (DPL) are lacking. Our objectives were to describe the etiologies of DP and to determine the risk factors and predictors for DPL in the pediatric population.

METHODS

Retrospective data were retrieved from departmental databases on patients with DP from the pediatric, cardiac, and neonatal intensive care departments of Safra Children's Hospital from 2010 to 2017.

RESULTS

DP was diagnosed in 88 patients, 29 with noncardiac surgery-related etiologies, for example, congenital, surgery, trauma, and shock and 59 with cardiac surgery-related etiologies. In total, 27 (31%) patients underwent DPL, and they had significant comorbidities involving respiratory, central nervous, and cardiovascular systems, higher lung injury scores, and lower weight compared with the patients who did not undergo DPL (P = .002, P = .002, P < .001, P = .012, and P = .013, respectively). A multivariate regression model revealed significant independent predictors for DPL, including morbidities of central nervous (odds ratio [OR = 9.651, P = .005), respiratory (OR = 4.875, P = .039), and cardiovascular systems (OR = 23.938, P = .001).

CONCLUSIONS

Etiologies of DP are very diverse in the pediatric population. Comorbidities of respiratory, central nervous, and cardiovascular systems are risk factors for plication requirement in respiratory support-dependent pediatric patients with DP. Early DPL should be considered in these patients.

Pilot study to test inhaled nitric oxide in cystic fibrosis patients with refractory Mycobacterium abscessus lung infection

BACKGROUND

Airways of Cystic Fibrosis (CF) patients are Nitric Oxide (NO) deficient which may contribute to impaired lung function and infection clearance. Mycobacterium abscessus (M. abscessus) infection prevalence is increasing in CF patients and is associated with increased morbidity and mortality. Here, we assess the safety and efficacy of intermittent inhaled NO (iNO) as adjuvant therapy in CF patients with refractory M. abscessus lung infection.

METHODS

A prospective, open-label pilot study of iNO (160 ppm) administered five times/day during hospitalization (14 days), and three times/day during ambulatory treatment (7 days) was conducted. The primary outcome was safety measured by NO-related adverse events (AEs). Secondary outcomes were six-minute walk distance (6MWD), forced expiratory volume in 1 s (FEV₁), and M. abscessus burden in airways.

RESULTS

Nine subjects were recruited. INO at 160 ppm was well-tolerated and no iNO-related SAEs were observed during the study. Mean FEV1 and 6WMD were increased relative to baseline during NO treatment. M. abscessus culture conversion was not achieved, but 3/9 patients experienced at least one negative culture during the study. Mean time to positivity in M. abscessus culture, and qPCR analysis showed reductions in sputum bacterial load. The study was not powered to achieve statistical significance in FEV1, 6WMD, and bacterial load.

CONCLUSIONS

Intermittent iNO at 160 ppm is well tolerated and safe and led to increases in mean 6MWD and FEV1. INO exhibited potential antibacterial activity against M. abscessus. Further evaluation of secondary endpoints in a larger cohort of CF patients is warranted to demonstrate statistical significance.

Omalizumab in allergic bronchopulmonary aspergillosis in patients with cystic fibrosis

Background

Allergic bronchopulmonary aspergillosis (ABPA) is a condition characterized by a Th2 response, serum eosinophilia, and increased total serum IgE to Aspergillus fumigatus. ABPA occurs in cystic fibrosis (CF) and asthma. Omalizumab is a humanized recombinant monoclonal antibody against IgE. Previous studies reported borderline results when treating ABPA with omalizumab.

Methods

A retrospective study to investigate the efficacy of omalizumab in the treatment of ABPA in CF patients was conducted at 3 CF centers in Israel and Belgium. Data were obtained from the digital archive. We measured 4 outcome parameters: forced expiratory volume in 1 second, body mass index, pulmonary exacerbations, and steroid sparing.

Results

The database was composed on the records of 9 patients. None of the outcome parameters showed any improvement. A favorable outcome was observed in patients with higher levels of posttreatment total IgE than those with lower levels. CF-related diabetes and male gender showed trends for poorer outcomes.

Conclusion

No benefits were detected on treating ABPA in CF with omlaizumb. Monitoring the total IgE was not helpful. A prospective randomized double-blind study is needed.

Ivacaftor for the p.Ser549Arg (S549R) gating mutation - The Israeli experience

BACKGROUND

Ivacaftor is a drug that increases the probability of the cystic fibrosis transmembrane conductance regulator (CFTR) chloride channel remaining open. Information about the efficacy of ivacaftor in patients carrying the rare p.Ser549Arg (S549R) CFTR mutation is sparse.

AIM

Efficacy of ivacaftor treatment in patients carrying the p.Ser549Arg (S549R) CFTR mutation.

METHODS

Data obtained from CF patients receiving ivacaftor for one year.

RESULTS

Eight CF patients, mean age 21 ± 10 years, received ivacaftor. After one year, significant improvement was found in FEV₁, increasing from 74% to 88% (p < 0.001), FVC, 89% to 101% (p = 0.019), and FEF_25-75, 59%-76% (p = 0.019). Sweat chloride concentration decreased from 116 ± 8 mmol/L to 51 ± 17 mmol/L (p < 0.001), and BMI increased from 20 ± 3 to 22 ± 4 (p = 0.003). Glucose tolerance improved in five patients. There was no significant change in bacterial colonization.

CONCLUSIONS

Ivacaftor therapy resulted in significant clinical improvement in patients carrying the p.Ser549Arg (S549R) CFTR mutation.

Nationwide genetic analysis for molecularly unresolved cystic fibrosis patients in a multiethnic society: implications for preconception carrier screening

Background

Preconception carrier screening for cystic fibrosis (CF) is usually performed using ethnically targeted panels of selected mutations. This has been recently challenged by the use of expanded, ethnically indifferent, pan‐population panels. Israel is characterized by genetically heterogeneous populations carrying a wide range of CFTR mutations. To assess the potential of expanding the current Israeli preconception screening program, we sought the subset of molecularly unresolved CF patients listed in the Israeli CF data registry comprising ~650 patients.

Methods

An Israeli nationwide genotyping of 152 CF cases, representing 176 patients lacking molecular diagnosis, was conducted. Molecular analysis included Sanger sequencing for all exons and splice sites, multiplex ligation probe amplification (MLPA), and next‐generation sequencing of the poly‐T/TG tracts.

Results

We identified 54 different mutations, of which only 16 overlapped the 22 mutations included in the Israeli preconception screening program. A total of 29/54 (53.7%) mutations were already listed as CF causing by the CFTR2 database, and only 4/54 (7.4%) were novel. Molecular diagnosis was reached in 78/152 (51.3%) cases. Prenatal diagnosis of 24/78 (30.8%) cases could have been achieved by including all CFTR2‐causing mutations in the Israeli panel.

Conclusions

Our data reveal an overwhelming hidden abundance of CFTR gene mutations suggesting that expanded preconception carrier screening might achieve higher preconception detection rates.

Nocardia Colonization: A Risk Factor for Lung Deterioration in Cystic Fibrosis Patients?

Background

Cystic fibrosis (CF) patients are predisposed to infection and colonization with different microbes. Some cause deterioration of lung functions, while others are colonizers without clear pathogenic effects. Our aim was to understand the effects of Nocardia species in sputum cultures on the course of lung disease in CF patients.

Material/Methods

A retrospective study analyzing the impact of positive Nocardia spp. in sputum of 19 CF patients over a period of 10 years, comparing them with similar status patients without Nocardia growth. Pulmonary function tests (PFTs) are used as indicators of lung disease severity and decline rate in functions per year is calculated.

Results

No significant difference in PFTs of CF patients with positive Nocardia in sputum was found in different sub-groups according to number of episodes of growth, background variables, or treatment plans. The yearly decline in PFTs was similar to that recognized in CF patients. The control group patients showed similar background data. However, a small difference was found in the rate of decline of their PFTs, which implies a possibly slower rate of progression of lung disease.

Conclusions

The prognosis of lung disease in CF patients colonized with Nocardia does not seem to differ based on the persistence of growth on cultures, different treatment plans or risk factors. Apparently, Nocardia does not cause a deterioration of lung functions with time. However, it may show a trend to faster decline in PFTs compared to similar status CF patients without isolation of this microorganism in their sputum.

FVC deterioration, airway obstruction determination, and life span in Ataxia telangiectasia

RATIONALE

Forced vital capacity (FVC) values decrease with progress of the disease in Ataxia telangiectasia (AT).

OBJECTIVE

To study the effect of this process on airway obstruction determination and life span in AT.

METHODS

Clinical data and yearly best spirometry maneuvers were collected retrospectively from 37 AT patients (196 spirometry tests) during 5.4 ± 1.8yrs (initial age 4-21 y). Twelve patients were walking (7 of them had recurrent respiratory system infections); 25 subjects were confined to wheelchair, of them 8 patients were towards end-stage lung disease. Spirometry indices included Forced Vital Capacity (FVC), mid-expiratory-flow (FEF25-75), and tidal volume (VT). We calculated FEF25-75/FVC and VT/FVC ratios.

RESULTS

FVC declined from 67 ± 8 while walking to 19 ± 6 %predicted values. FEF25-75 values that were elevated (116 ± 23 %predicted) while walking, decreased to 69 ± 27 %predicted at end-stage where 7 patients responded to bronchodilators. VT/FVC ratio was 0.25 ± 0.06 while walking, increased to 0.35 once on wheelchairs, and further increased to 0.57 ± 0.19 at end-stage disease. FEF25-75/FVC ratio was 2.54 ± 0.70 above normal (∼1.0) increasing to 4.16 ± 0.75 at end stage. A sharp elevation was seen in FEF25-75/FVC ratio when FEV1 was still ∼45 %predicted and 2-years prior to death.

CONCLUSIONS

Having a low baseline-FVC (60% predicted) artificially raises FEF25-75 values, so FEF25-75 of "mild obstruction" values may indicate severe airway obstruction in AT subjects. VT/FVC and FEF25-75/FVC ratios may therefore assist in revealing higher than normal breathing effort. The results further suggest adding VT/FVC and FEF25-75/FVC ratios to pulmonary function assessments in patients with AT.

[Decoronation: treatment protocol for ankylotic root resorption as a consequence of dental trauma]

Severe dental traumatic injuries, such as the complete displacement of a tooth from its socket (Avulsion) or the displacement of a tooth within its socket (Intrusive Luxation), may result in extensive injury to the root surface. As a result, the root surface injury heals without cementum and there is fusion between the alveolar bone and the exposed dentin or anorganic exposed cementum, without any attachment apparatus between them. This phenomenon is known as "dento-alveolar ankylosis" and is accompanied by ankylotic resorption of the root. In a process that results subsequent to the ankylosis, the root surface resorbs, and this is part of the remodeling of the alveolar bone (ankylotic resorption). When the traumatic injury occurs at a young age, lateral and apical growth of the alveolar bone continues without continued physiological eruption of the tooth. As a result, the position of the ankylotic tooth does not change, and with time thetooth appears infra-occluded resulting in severe esthetic and functional consequences. Extraction of the ankylotic tooth is difficult and sometimes even impossible due to the rigid fusion between the bone and the tooth. In addition, attempted extraction of the ankylotic tooth may lead to fracture of the buccal plate and resorption of the alveolar bone. Retention of the ankylotic tooth may lead to damage in bone deposition in the verticaldimension, leading to difficulties in future prosthodonticrehabilitation, research-based information has been incorporated

Mandibular block success rate in relation to needle insertion and position: a self-report survey

AIM

To evaluate possible associations between successful mandibular block injection and location of penetrating the oral mucosa, location of injection on the ramus and the needle insertion length.

STUDY DESIGN

The study consisted of 101 dentists, of whom, 33 were oral surgeons, 33 certified paediatric dentists and 35 general dental practitioners. The dentists were asked to estimate their rate of success in mandibular block injections, defined as the proportion of their patients for whom only a single carpule was necessary, and to indicate the needle insertion length and the location of the injection on a photograph of a ramus and on a photograph of the oral mucosa.

RESULTS

Injecting a single carpule for achieving full anaesthesia in 90% or more of their patients was reported by 79.3 and 57.8% of the dentists treating children and adults, respectively. Of practitioners treating children, experienced dentists (>5 years in occupation) reported higher success rates than did inexperienced ones (p = 0.05). A positive correlation was found between failure rate reported in children, shorter length of the inserted needle (R = 0.356, p = 0.001) and injecting at the central (superior inferior dimension) most anterior quarters of the ramus (p = 0.006; odd ratio = 3.9375). Routine waiting period of more than 5 min after the injection and before operative treatment was associated with higher rates of failure (p = 0.042, χ(2) = 6.335). No correlation was found between the success rates of mandibular block injection and the location of penetrating the oral mucosa in children (p = 0.94), adults (p = 0.57), or between success rates and the target location on the ramus in adults (p = 0.42).

STATISTICS

χ(2) test was used to determine the significance of differences among proportions and t test for continuous variables. Pearson's correlation analysis was used to analyse the correlation between the length of the needle inserted in children and adults by the same dentist.

CONCLUSIONS

Shorter needle insertion lengths and targeting the injecting to the most anterior quarters of the ramus were positively correlated with failure of anaesthesia in children, according to dentists' reports. A routine waiting period of over 5 min did not increase the success rates of mandibular block injection.

Quality of bitewing radiographs in children in relation to the type of film holder used

AIM

To assess the frequency of use with young uncooperative children of the bitewing radiograph film holders: KWIK-BITE, Snap-a-ray, and a Sticky tape, and to compare the quality of bitewing radiographs achieved with these types of film holders.

STUDY DESIGN

This retrospective study assessed 298 pairs of bitewing radiographs of children aged 3-14 years. The radiographs were evaluated according to age, type of behavioural management approach used, extent and degree of overlapping surfaces, visibility of the alveolar bone, and the presence of folds, cone-cut and elongated teeth.

RESULTS

Snap-a-ray was used more frequently in younger children (p < 0.001), less cooperative children (p < 0.001), and in those who were treated under sedation (p < 0.001). The KWIK-BITE holder was used more frequently in older children (p < 0.001), cooperative children (p = 0.001), and in those under general anaesthesia (p < 0.001). About 76.5 % of the radiographs contained technical errors. The degree of overlapping surfaces in radiographs was not correlated with the type of film holder used, but rather with the degree of children's cooperation.

CONCLUSIONS

The Snap-a-ray film holder was used more frequently in young uncooperative children; nevertheless, its use was not associated with an increased frequency or degree of overlapping surfaces.

Effect of non-functional teeth on accumulation of supra-gingival calculus in children

AIM

To evaluate the occurrence of supra-gingival calculus in children aged 6-9 years with disuse conditions such as: presence of dental pain, open-bite or erupting teeth.

METHODS

A cohort of 327 children aged 7.64±2.12 (range: 6-9) years (45% girls) were screened for presence of supra-gingival calculus in relation to open bite, erupting teeth and dental pain. Presence of dental calculus was evaluated dichotomically in the buccal, palatinal/lingual and occlusal surfaces. Plaque index (PI) and gingival index (GI) were also evaluated.

RESULTS

Supra-gingival calculus was found in 15.9% of the children mainly in the mandibular incisors. Children aged 6-7 years had a higher prevalence of calculus as compared to children aged 7-8 years (23% vs. 13.5%, p=0.057) or 8-9 years (23% vs. 12.4%, p=0.078), respectively. No statistical relation was found between plaque and gingival indices and presence of calculus. The prevalence of calculus among children with openbite was significantly higher than that of children without open-bite (29.4% vs. 10.7%, p=0.0006, OR=3.489). The prevalence of calculus among children with erupting teeth in their oral cavity was higher than that of children without erupting teeth (17.7% vs. 9%, respectively, p=0.119). No statistical correlation was found between presence of dental pain and calculus (15.4% vs. 15.9%; p=0.738).

CONCLUSION

Accumulation of calculus in children aged 6-10 years was found mainly in the mandibular incisors, decreased with age and was correlated with open-bite.

Awareness of orthodontists regarding oral hygiene performance during active orthodontic treatment

AIM

The aim of the present study was orthodontist's awareness for maintenance of several home and professional prevention measures during active orthodontic treatment according to patients' report.

MATERIALS AND METHODS

A structured questionnaire was distributed to 122 patients undergoing active orthodontic treatment with fixed appliances. Patients were treated by 38 different orthodontists. The questionnaire accessed information regarding instructions patients received from their orthodontist concerning maintenance of their oral hygiene during orthodontic treatment.

RESULTS

Most of the patients (94%) reported that their orthodontists informed them at least once about the importance of tooth-brushing, and 74.5% received instructions for correct performance of tooth brushing or alternatively were referred to dental hygienist. However, only 24.5% of the patients reported that their orthodontist instructed them to use the correct fluoride concentration in their toothpaste, to use daily fluoride mouthwash (31.5%) and to brush their teeth once a week with high concentration of fluoride gel (Elmex gel; 10.2%). Only 13.8% received application of high concentration of fluoride gel or varnish at the dental office, and 52% of the patients reported that their orthodontist verified that they attend regular check-ups by their dentist. A significant positive correlation was found between explaining the patients the importance of tooth brushing and the following variables: instructing them on how to brush their teeth correctly (p<0.0001), explaining them which type of toothbrush is recommended for orthodontic patients (p=0.002), recommending to perform daily fluoride oral rinse (p=0.036) and referring them to periodic check-ups (p=0.024).

CONCLUSION

Orthodontists should increase their awareness and commitment for instructing their patient on how to maintain good oral hygiene in order to prevent caries and periodontal disease during orthodontic treatment.

Seroepidemiology of hepatitis C antibodies among dentists and their self-reported use of infection control measures

OBJECTIVES

To determine the prevalence of hepatitis C virus (HCV) antibodies among dentists graduated from various countries and assess the use of infection control measures in their dental practice.

RESEARCH DESIGN

The study included 301 Israeli dentists who attended an annual dental conference. Participants filled out a structured questionnaire regarding demographic (age, gender, number of siblings, number of children) and occupational characteristics. Venous blood was examined for presence of HCV antibodies by enzyme immunoassay and confirmed by a third generation line immunoassay, which assesses antibodies to HCV-core antigens (INN-LIA HCV Ab III update, 100% sensitivity, 100% specificity).

RESULTS

The prevalence of HCV antibodies among Israeli dentists was 1/301 (0.33%), similar to the prevalence range (0.1-0.5%) among the general Israeli population. The studied population included dentists (30.6%) who immigrated from Asia, Eastern Europe and the former USSR, where HCV prevalence ranges from 3.1% to 26.5%. Dentists routinely used gloves (99.6%), gown (93.3%), autoclaves (90.3%), dry heat (29.1%) and mask (81%). Dentists who graduated after 1985 used a mask or gown significantly more often than dentists who graduated before 1985 (p < 0.001 and p = 0.004, respectively).

CONCLUSION

It seems that dentists who usually adhere to basic infection control measures are not at an increased risk for HCV.

Post-operative pain and use of analgesic agents in children following intrasulcular anaesthesia and various operative procedures

AIM

To characterise post-operative pain (PDP) and use of analgesic agents in children.

METHODS

The study consisted of 472 children, who received routine dental treatment. Teeth were anaesthetised by a computerised delivery system, either intrasulculary (CDS-IS) or by local infiltration (CDS-IF). Information regarding post-operative pain and use of analgesic agents was obtained by a telephone call within 24 hours after treatment.

RESULTS

The overall incidence of PDP was 38%. 60.9% of the children who experienced PDP were given an analgesic agent. Incidence and severity of pain were significantly associated with type of dental procedure. The highest incidence was found after root canal treatment (62.5%) and preformed crowns (60.8%). A higher incidence of PDP was found in teeth with history of pain or abscess as compared to teeth with restoration or caries (p <0.01). Incidence of pain was not associated with restoration material, extension, depth or type (occlusal vs proximal) of restoration, multiple restoration, gender, mode of CDS anaesthesia, or effectiveness of anaesthesia during dental treatment. Analgesic drugs were given mainly after preformed crowns, root canal filling and extractions.

CONCLUSIONS

PDP and analgesic use in children is common, especially after root canal filling, preformed crowns and extractions. CDS-IS is not associated with increased PDP.

[Dental trauma protocol--treatment of avulsion and luxation injury]

The goal of this protocol is to provide clear instructions which simplify the process of decision making and treatment of Luxation and Avulsion. In teeth with a closed apex, one should perform root canal therapy at the second appointment in teeth with injuries of luxation and avulsion (except for injuries of subluxation and concussion). The tooth should be reimplanted at site of accident if it possible. For avulsed teeth, the preferred storage medium is milk. One should condition the roots of teeth which have been avulsed. In teeth which have not finished development, the preferred treatment is to allow the continued development of the root.

[Judicious use of antibiotics in dental practice]

With the discovery of penicillin and entrance into the antibiotic era, the capability of dentists to treat dental infections have changed dramatically. Many antibacterial agents have developed since, but bacterial resistance using diverse mechanisms, have increased concomitantly. Since antimicrobial agents are frequently needed in dentistry, their judicious use is of prime importance. Dental infections can be divided to two main groups according to the origin of the infection. First, odontogenic infections (acute dento-alveolar abscess) originating from the dental pulp are most commonly caused by gram-positive anaerobic or facultative bacteria. Systemic antibiotic should be given concomitantly with drainage of the dento-alveolar abscess, debridment of the root canal of the infected tooth, and placement of inta-canal antimicrobial medication such as calcium hydroxide. Penicillin G, penicillin V (Rafapen) or amoxycillin (moxypen) are the first line systemic antimicrobial agents. In case of no improvement within 2-3 days, second line regimens such as amoxycillin-clavulanate (augmentin), cefuroxime (zinnat) or penicillin and metronidazole are recommended. In patients allergic to penicillin, clindamycinn (dalacin) is preferred over macrolides. The second group of infections originates from the periodontal apparatus, and is caused usually by gram-negative anaerobes bacilli, sometimes with Actinobacillus actinomycetemcomitance (Aa). Systemic antibiotics are only infrequently indicated in this situation, and always accompanied by scaling, root planning and curettage of the infected root and gingiva. In regenerative or post surgical periodontitis, augmentin, metronidazole or metronidazole in combination with penicillin or amoxycillin augmentin are recommended. In aggressive periodontitis the most common pathogen is Aa and therefore tetracycline, augmentin, or metronidazole and amoxicillin are recommended. In necrotizing ulcerative gingivitis, which is caused usually by fusiform bacilli and spirochetes, metronidazole or augmentin are appropriate. In patients with periodontal disease who are allergic to penicillin can be treated with a macrolides.

[Preservation of alveolar bone of un-restorable traumatized maxillary incisors for future]

Anterior maxillary implantation is a challenging treatment for both the surgeon and prosthodontist due to high esthetic demands in this area. However, it is the most traumatized and most exposed region to habits. Prompt and appropriate management can significantly improve prognosis of many dentoalveolar injuries, especially in young patients. Unfortunately, many traumatized teeth are overtreated or left untreated, which lead to a much more complicated treatment at the time of permanent restoration at adulthood. The facial cortical plate over the roots of the maxillary teeth is thin and porous. Periapical infections, as well as prolonged and stubborn surgical treatments (repeated root end surgeries) can cause resorption of the labial plate, migrate to a more palatal position, and may later require an augmentation procedure prior to implant placement. The treatment-options of traumatized, anterior maxillary, un-restorable fractured root and ankylosed infraocluded teeth, in relation to preservation of the adjacent alveolar bone for future use of dental implantation will be discussed. The recommended treatment of crown-root fracture of permanent incisor includes removal of the coronal fragment and supragingival restoration of the fractured root. In severe cases in which the fracture line positions deeply under the gingival margin, this treatment may be supplemented by gingivectomy and/or osteotomy, as well as surgical or orthodontic extrusion of the root. In young patients, use of these treatment options as temporary treatment to preserve the facial cortical plate is important. Preservation of alveolar dimension will enable implantation after the completion of growth and development. Dento-alveolar ankylosis accompanied by replacement resorption is a serious complication following severe injury to the periodontal membrane. This complication develops mainly following avulsion and intrusion but also following lateral luxation and root fracture. Replacement resorption develops after severe damage to the periodontal ligament cells that cover the root surface. As a result of this damage, the periodontal ligament is replaced by bone tissue, causing ankylosis between bone and tooth. Following ankylosis, resorption of cementum and root dentin occurs. These processes eventually result in replacement of the entire root by bone. In young children it could arrest the growth of the alveolar process and create an infra-occluded tooth, resulting in a severe bony defect that is difficult to correct. In addition, loss of the maxillary incisor leads to serious esthetic and restorative problems, particularly when the trauma occurs at a young age. Therefore, ankylosed teeth should be treated as soon as diagnosed. Alternative treatments include intentional extraction and immediate replantation of the ankylosed tooth to its socket after embedding the tooth and the socket in Emdogain. This treatment is indicated only when the ankylosis or the replacement resorption is diagnosed at an early stage or has affected only a small area of the root. When the resorption is diagnosed at a later stage, auto transplantation of first lower pre-molar to the anterior region or decoronation of the ankylosed tooth may be considered. Decoronation is a simple and safe surgical procedure for preservation of alveolar bone prior to implant placement. It should be considered as a treatment option for teeth affected by replacement resorption. The alternative treatment of surgical extraction of an ankylosed tooth often leads to considerable bone loss and reduced bone volume in the oro-facial dimension. This may later necessitate an augmentation procedure.

CONCLUSION

Scrupulous diagnosis of teeth and the alveolar bone after a traumatic injury is necessary. Treatment is multidisciplinary, requiring endodontic, surgical, orthodontic, operative and prosthetic compliance. An individual treatment plan for each patient is necessary. General rule do not apply. Periodic check-up is essential.

Lymphoid elements and apoptosis-related proteins (Fas, Fas ligand, p53 and bcl-2) in lichen sclerosus and carcinoma of the vulva

We studied some of the morphological and immunohistochemical parameters of lichen sclerosus (LS) and carcinomas of the vulva in order to verify some characteristics in LS related to neoplasm transformation. Parameters such as proliferating index, rate of proliferation of lymphoid elements into a tumor and types of such elements were studied. In parallel, the number of cells positive to apoptosis-related proteins such as Fas, Fas ligand, p53 and bcl-2 were evaluated. Biopsy material from patients with different vulvar disorders--22 samples with LS and 23 samples with vulvar squamous cell carcinoma (VSCC)--was studied by the methods of morphometry and immunohistochemistry. In LS, the number of T cells is a few times higher than those of B cells. Among the T cells, the number of killers is significantly higher than the number of helpers. Carcinomas, especially those with lymphoid depletion, are characterized by a further significant increase in some parameters such as the rate of lymphoid proliferation and the number of T helpers and killers. The progression in to tumorigenesis was accompanied with a significant increase in the number of Fas+ and FasL+ lymphocytes. In tumor epithelial cells the proliferative index increased in carcinomas with lymphoid depletion. The number of p53+ epithelial cells increased whereas the number of bcl-2+ cells showed a distinct tendency to decrease with progression in to tumorigenesis. Development of a tumor is manifested in deep changes in relationships between different lymphoid components. Only two lymphoid markers are significantly different in VSCC compared to LS: the number of T killers and macrophages. The other parameters studied (rate of proliferative activity, the total number of T cells and T helpers, B cells, IL-2-connective cells) already showed high expression in LS as the first signs of transformation of this inflammation into neoplasia.

Microabrasion of teeth with discoloration resembling hypomaturation enamel defects: four-year follow up

Microabrasion with 18% HCl and pumice to remove enamel dysmineralization and improve esthetics is an accepted and effective treatment. This technique can probably be extended even to generalized defects resembling hypomaturation amelogenesis imperfecta that appear on all erupted teeth. Five children aged 9 to 11 with two types of enamel-hypomaturation probably due to developmental defects were treated successfully by microabrasion, with marked improvement of the discoloration. The patients were followed for up to four years. During this period, no tooth-sensitivity or staining was noted. The teeth looked healthier and shinier.

The presence of hepatitis A antibodies in dental workers. A seroepidemiologic study

BACKGROUND

The licensing of hepatitis A vaccine in the United States and other countries in the 1990s raised the question of vaccine candidates. The authors undertook a study to evaluate the presence of antibodies against hepatitis A virus, or HAV, in dental workers.

METHODS

The authors recruited 115 members of the dental staff of Tel Aviv University: 82 dentists, 21 dental assistants, eight dental hygienists and four laboratory technicians. The subjects completed a structured questionnaire regarding demographic information (such as age, sex, number of siblings, number of children) and occupational characteristics. Venous blood was obtained and examined for presence of immunoglobulin G antibodies to HAV by microparticle enzyme immunoassay.

RESULTS

Univariant analysis (chi 2 and Student t test) and multivariate stepwise logistic regression analysis were used to identify variables that were associated with seropositivity. Greater number of years of occupation in dentistry were independently and significantly (P = .0004) associated with seropositivity to HAV. The calculated odds ratio showed that each year of work increased the likelihood of being seropositive by 1.06 (6 percent). Subjects tended to have higher seropositive rates if they were older, had a greater number of children, had a greater number of siblings, had worked in hospitals and worked with children (pediatric dentists and orthodontists).

CONCLUSIONS

This study suggests that HAV can be considered a hazard to dental workers, with risk increasing as the number of years in dentistry increases. More studies with larger sample sizes are needed.

CLINICAL IMPLICATIONS

As HAV infection is associated with morbidity and mortality, dentists--especially those working in areas of endemic HAV (such as Africa, Asia and Latin America)--are encouraged to consider receiving the active vaccine to prevent HAV infection.

In vitro viability, mitogenicity and clonogenic capacities of periodontal ligament fibroblasts after storage in four media supplemented with growth factors

The choice of storage medium for preserving traumatically avulsed teeth is important for the success of future replantation. The objective of this study was to evaluate the effectiveness of growth factors (IGF-1 and PDGF-BB) when added to storage media in preserving the functional abilities of cultured periodontal ligament fibroblasts (PDLF). The evaluated storage media were: ViaSpan, Hanks' balanced salt solution (HBSS), alpha minimal essential medium (alpha MEM), and alpha MEM supplemented with FCS and antibiotic (alpha MEM-S). PDLF were obtained from explants of human healthy extracted teeth. Plates with confluent PDLF were soaked in the various media supplemented with IGF-1 (10 ng/ml) and PDGF-BB (4 ng/ml) for 2, 8 and 24 h at room temperature (24 degrees C). The control group was incubated with the examined storage media without growth factors at 24 degrees C. An additional control group was incubated with culture medium at 37 degrees C without growth factors. After incubation, the viability of the cells was determined by Trypan blue exclusion test. Viable cells were then analyzed for mitogenic (with thymidine) and clonogenic (by culturing one cell/well) capacities. Storage of PDLF with growth factors (GF) for 2, 8 and 24 h decreased their vitality by only 3% (not statistically significant). The mitogenicity of PDLF stored for 2, 8 and 24 h in various media with GF was statistically comparable to that of the control group. Generally, the highest mitogenic capacity of PDLF stored with or without GF was found after 8 h of storage. Increasing the storage period to 24 h decreased the mitogenic capacity of the cells stored with GF by only 10-40% compared to the control group. In contrast, the clonogenic capacity of PDLF stored with GF increased with increasing storage periods by 100-300%, and the highest clonogenic capacity was found in most storage media after 24 h of storage with GF. The highest clonogenic and mitogenic capacities were found in cells stored in HBSS followed by alpha MEM-S. The mitogenic and clonogenic capacities of PDLF stored in various media supplemented with GF for 2-8 h were generally lower than without GF supplementation. The mitogenic and clonogenic effects of GF-supplementation was observed only after 24 h of storage. After 24 h of storage with GF, the clonogenic capacity increased by 8-224% and the mitogenicity by 20-37%, except in cells stored in alpha MEM (-1%). However, these differences were generally not statistically significant. In conclusion, the mitogenic and clonogenic effects of GF were observed only after 24 h of storage at room temperature. HBSS and alpha MEM-S supplemented with GF were the most effective media for preserving the viability, mitogenicity and clonogenic capacity of PDLF stored for 24 h at room temperature. For short periods of storage (2 and 8 h), HBSS and alpha MEM-S without GF were preferable.

In vitro viability, mitogenicity and clonogenic capacity of periodontal ligament cells after storage in four media at room temperature

The choice of storage medium for preserving traumatically avulsed teeth is important for the success of future replantation. The objective of this study was to compare the effectiveness of four recommended storage media (Hank's balanced salt solution [HBSS], culture medium, alpha minimal essential medium [alpha-MEM], and ViaSpan) to preserve cultured periodontal ligament fibroblasts (PDLF) at room temperature (22 degrees C). PDLF were obtained from explants of extracted healthy human teeth. Plates with confluent PDLF were soaked in the various media for 2, 8 and 24 h at room temperature. A control group was incubated with culture medium at 37 degrees C. After incubation, viability of the cells was determined by trypan blue exclusion test. Viable cells were then analyzed for mitogenic (with thymidine) and clonogenic capacity (by culturing one cell/well). Viability of PDLF stored up to 24 h was comparable in all tested media, and the differences were limited to 1%-3%. PDLF stored for up to 24 h in various media had statistically comparable mitogenicity to the control group. After 8 h of storage, the differences were limited to 2%-9%, except for the alpha-MEM group which had 23%-29% lower mitogenic capacity compared to the control group. Increasing the storage time up to 24 h further decreased the mitogenicity of the cells by 22%-47%. The highest mitogenicity after 24 h of storage was found in PDLF stored in culture medium or HBSS, and the lowest in alpha-MEM. PDLF stored for 2-8 h in various media had a comparable clonogenic capacity to the control group. However, after 24 h, the cells' clonogenic ability dropped by 14%-66%. A similar trend of reduction was noted in the mitogenic and clonogenic capacity, although it was statistically significant only in the clonogenic capacity. Culture medium and ViaSpan, followed by HBSS, were the most effective in preserving the clonogenic capacity of PDLF after 24 h of storage. The lowest clonogenic capacity after 24 h of storage was in the alpha-MEM group (66%, P < 0.0025). In conclusion, culture medium, followed by HBSS and ViaSpan, was the most effective media for preserving the viability, mitogenicity and clonogenic capacity of PDLF stored for up to 24 h at room temperature. The lowest functional abilities were found in PDLF stored in alpha-MEM.

The bright edge of the endometrial polyp

OBJECTIVE

To evaluate the accuracy of sonographic detection of endometrial polyps using a new ultrasound marker denoted 'the bright edge of the polyp'.

METHODS

The ultrasound scans of the uterus were examined for the presence of the bright edge in two groups of women. The first, a retrospective group, included 40 women in whom both a histological diagnosis of endometrial polyps and sonographic scans were available for evaluation. The second, a prospective group, included 80 women scheduled for operative hysteroscopy because of endometrial irregularities detected by sonography. In this group the hysteroscopical and histological results of the removed endometrial tissue were correlated with the sonographic diagnosis.

RESULTS

In the retrospective group, the bright edge marker, indicative of the presence of a polyp, was detected in 30 out of 40 scans available for evaluation. In the prospective group this marker was detected in 60 women out of 80. Endometrial polyps were confirmed in 56 of these 60 women. In three cases a submucosal myoma was found and in one case the histology showed simple cystic hyperplasia. Two polyps were found in 20 cases where the bright edge had not been detected. This marker has a sensitivity of 96%, specificity of 82%, positive predictive value of 93%, and negative predictive value of 90% in this group at high risk for endometrial abnormalities.

CONCLUSION

The bright edge of the polyp is an accurate sonographic marker for the detection of endometrial polyps in women with endometrial irregularities demonstrated on ultrasound.

In vitro viability, mitogenicity and clonogenic capacity of periodontal ligament cells after storage in six different media

The choice of storage medium for preserving traumatically avulsed teeth is important for the success of future replantation. The objectives of this study were to evaluate the effectiveness of six different media: culture medium, alpha minimal essential medium (alpha-MEM), milk, Hank's balanced salt solution (HBSS), ViaSpan and conditioned medium (CM) to preserve cultured periodontal ligament fibroblasts (PDLF). Periodontal ligament fibroblasts were obtained from explants of human healthy extracted teeth. Plates with confluent PDLF were soaked in the various media for 2, 8 and 24 h at 4 degrees C. A control group was incubated with culture medium at 37 degrees C. After incubation, cell viability was determined by trypan blue exclusion test. Viable cells were then analyzed for mitogenic (with thymidine) and clonogenic capacity (by culturing one cell/well). Storage of PDLF up to 24 h decreased their vitality by only 2%-14%. Vitality of the PDLF after 2, 8 and 24 h was highest when stored in milk or HBSS (91%-97%) and lowest when stored in ViaSpan or CM (82%-93%). PDLF stored for 2-8 h in various media had a mitogenic capacity comparable to the control. However, increasing the storage period to 24 h decreased the mitogenicity of the cells by 3%-39%. The highest mitogenicity was found in PDLF stored in milk or HBSS and the lowest in CM or ViaSpan. The clonogenic capacity of the cells dropped by 38%-71% after 24 h and was the best indicator of the deteriorating effect of long storage. Milk and HBSS were the most effective in preserving the clonogenic capacity. Nevertheless, reduction in the viability, mitogenicity or clonogenic capacity was statistically significant in nearly all the tested media only after 24 h of incubation. In conclusion, HBSS and milk were the most effective media for preserving the viability, mitogenicity and clonogenic capacity after storage for up to 24 h at 4 degrees C.

Detection of adeno-associated virus type 2 sequences in the human genital tract

Adeno-associated virus (AAV) is a defective parvovirus with unknown pathogenicity. It requires helper functions for its normal replication in human tissue and therefore is not readily isolated from clinical specimens. We have used the PCR method to examine the following clinical samples for the presence of AAV sequences: (i) 15 nasopharyngeal aspirates from symptomatic patients, (ii) 7 swab or fluid specimens from vesicles of patients suspected of having varicella-zoster virus infections, (iii) 21 human papilloma virus-positive genital biopsy specimens, (iv) 61 genital swab specimens from women suspected of having herpes simplex virus (HSV) infection examined either directly or following propagation in tissue culture, (v) 62 samples of first-trimester aborted material, including 38 samples from spontaneous abortions and 24 samples from induced abortions, (vi) 11 samples of chorionic villi taken from women undergoing genetic prenatal diagnosis, and (vii) three lots of cultured human embryonic cells. AAV sequences were detected only in samples taken from the genital tracts of women suspected of having HSV infection and not in any of the other types of samples. Samples from 11 patients were positive for AAV: for 4 patients the original swab sample was positive, for 4 patients the cultured swab sample was positive, and for 3 patients both the original swab samples and the cultures were positive. Five of the 11 patients were infected with HSV. Our study demonstrates the presence of AAV in the female genital tract. However, in contrast to a previous report (E. Tobiasch, M. Rabreau, K. Geletneky, S. Larue-Charlus, F. Severin, N. Becker, and J. R. Schlehofer, J. Med. Virol. 44:215-222, 1994), we did not find solid evidence of its replication in maternal or embryonal tissues from the first trimester of pregnancy. The questions of a potential pathogenic etiology of AAV and the interaction with HSV remain open.

A single ataxia telangiectasia gene with a product similar to PI-3 kinase

A gene, ATM, that is mutated in the autosomal recessive disorder ataxia telangiectasia (AT) was identified by positional cloning on chromosome 11q22-23. AT is characterized by cerebellar degeneration, immunodeficiency, chromosomal instability, cancer predisposition, radiation sensitivity, and cell cycle abnormalities. The disease is genetically heterogeneous, with four complementation groups that have been suspected to represent different genes. ATM, which has a transcript of 12 kilobases, was found to be mutated in AT patients from all complementation groups, indicating that it is probably the sole gene responsible for this disorder. A partial ATM complementary DNA clone of 5.9 kilobases encoded a putative protein that is similar to several yeast and mammalian phosphatidylinositol-3' kinases that are involved in mitogenic signal transduction, meiotic recombination, and cell cycle control. The discovery of ATM should enhance understanding of AT and related syndromes and may allow the identification of AT heterozygotes, who are at increased risk of cancer.

Neutrophil modulation by Actinobacillus actinomycetemcomitans. II. Phagocytosis and development of respiratory burst

Compromised neutrophil function has been found in a number of patients with localized juvenile periodontitis (LJP), although the pathogenic mechanism is unknown. Since infection with Actinobacillus actinomycetemcomitans is frequently found in patients with LJP, we have evaluated in vitro the effect of a bacterial extract of A. actinomycetemcomitans on the development of the respiratory burst by neutrophils. Pre-incubation of neutrophils with bacterial extract increased H2O2 induced by FMLP and zymosan in a dose-dependent fashion. Substitution of FMLP for bacterial extract produced similar results. Moreover, FMLP and bacterial extract had an additive effect on superoxide production following phagocytosis of zymosan. In contrast, bacterial extract significantly decreased PMA-stimulated H2O2, but pre-incubation with FMLP instead of bacterial extract failed to decrease PMA-stimulated H2O2. Bacterial extract did not change the percentage of cells activated by FMLP, opsonized zymosan, or PMA. Heat-treated bacterial extract induced effects similar to non-treated extract. Bacterial extract treated with proteinase K or phenol extraction increased FMLP or zymosan stimulated H2O2 equivalent to non-treated bacterial extract. In contrast, proteinase K or phenol extraction abolished the inhibitory effect of bacterial extract on PMA-stimulated H2O2 production. The bacterial extract component(s) that inhibits PMA-stimulated H2O2 is therefore a protein(s), resistant to 56 degrees C, and is not endotoxin. The partially activated state of PMNs exposed to A. actinomycetemcomitans extract, combined with their reduced ability to respond to a protein kinase C-dependent stimulus, may partially explain the abnormalities noted in LJP patients.

Neutrophil modulation by Actinobacillus actinomycetemcomitans I. Chemotaxis, surface receptor expression and F-actin polymerization

Localized juvenile periodontitis is an early onset periodontitis, usually localized to molars and incisors. Patients usually present with decreased chemotaxis of systemic neutrophils (PMNs) and infection with Actinobacillus actinomycetemcomitans. The pathogenic mechanisms involved have not been clarified. The purpose of this study was to determine if an extract of A. actinomycetemcomitans could induce changes in PMN chemotaxis similar to those reported in LJP patients. It was demonstrated that the bacterial extract was chemotactic for neutrophils. When neutrophils were pre-incubated with the bacterial extract, chemotaxis toward zymosan-activated serum, FMLP and the bacterial extract was inhibited in two different chemotaxis assays (Boyden chamber and under-agarose). Bacterial extract had no effect on random migration in either assay. Pre-incubation with the extract induced increased expression of CD11b/CD18 (Mac-1), Gp110, and FMLP receptors and increased F-actin polymerization following FMLP or PMA stimulation compared to cells not treated with the extract. Treatment of the bacterial extract with proteinase K or phenol extraction reversed the PMN chemotaxis inhibition activity, but increased significantly the random migration of PMNs. Heating the bacterial extract to 56 degrees C had no effect on its activity. The component(s) in the bacterial extract that inhibits chemotaxis is therefore a protein(s), not sensitive to 56 degrees C, and is not endotoxin. This study suggests that A. actinomycetemcomitans may contribute to the pathogenesis of localized juvenile periodontitis by inhibiting chemotaxis. Interference with chemotaxis by A. actinomycetemcomitans, however, occurs through a mechanism other than inhibition of actin assembly, reduction of CD11b/CD18 or Gp110 expression, or blockage/downregulation of FMLP receptors.

Juvenile periodontitis: a review of pathogenesis, diagnosis and treatment

Juvenile periodontitis (JP) and its treatment has become a critical concern to the practicing dentist. Actinobacillus actinomycetemcomitans has been diagnosed as the prime etiological agent associated with this disease. Decreased chemotaxis and phagocytosis of polymorphonuclear leukocytes have also been described in these patients. The precise treatment regimen must be individualized for each patient. In addition to aggressive antibiotic therapy, root planing, curettage or a surgical approach, with mandatory follow-up care, should be considered. This review discusses the etiology and pathogenesis of JP and recommends treatment regimens, according to patient diagnosis.

Leukemia inhibitory factor improves survival of retroviral vector-infected hematopoietic stem cells in vitro, allowing efficient long-term expression of vector-encoded human adenosine deaminase in vivo

Low recovery and poor retroviral vector infection efficiency of hematopoietic stem cells has hindered application of gene therapy for disease affecting blood-forming tissues. Developmental restriction (or death) of stem cells during ex vivo infection has contributed to these difficulties. In these studies we report that the cytokine leukemia inhibitory factor (LIF) directly or indirectly supported the survival of hematopoietic stem cells during culture of bone marrow with vector-producing fibroblasts, resulting in efficient recovery of stem cells able to compete for engraftment in irradiated recipient animals. The infection efficiency of hematopoietic stem cells recovered from these cultures was approximately 80%; and all recipients (20/20) of the LIF-treated marrow were stably engrafted with the progeny of provirus-bearing stem cells. Expression of vector-encoded human adenosine deaminase (hADA) was detected in all recipients at levels averaging 15-50% of endogenous murine ADA in all their hematolymphoid tissues. Survival of stem cells in untreated cultures was approximately 10% of that observed from LIF-treated cultures, resulting in poor engraftment of recipient animals with transplanted cells. The infection efficiency of the few stem cells recovered from untreated cultures, however, was high (approximately 80%), suggesting that LIF did not have an effect on infection efficiency per se, but acted at the level of stem cell survival. Consistent with the poor engraftment observed in the control animals, expression of vector-encoded ADA was only approximately 4-20% of the endogenous levels. These results support the postulated role of LIF as a regulator of hematopoiesis and suggest that cytokine stimulation can positively affect inefficient retroviral vector transduction in hematopoietic stem cells.

Trisomy 9 confined to the placenta: prenatal diagnosis and neonatal follow-up

Chorionic villus sampling (CVS), performed on a woman in the 23rd menstrual week because of bilateral fetal hydronephrosis and suspected intrauterine growth retardation (IUGR), documented trisomy 9 in all cells examined. Chromosomes of amniocytes and fetal blood lymphocytes were normal. The ongoing pregnancy was monitored closely, and at 37 weeks, a phenotypic normal male infant was delivered. Multiple placental biopsies showed 47,XY,+9, while a repeat chromosome analysis of the infant and biopsies from the amniotic membrane were normal (46,XY). This case further emphasizes the association between placental aneuploidy and IUGR. To our knowledge, nonmosaic trisomy 9 in CVS confined to the chorionic villi and later confirmed in the placenta has not been reported previously.

Reduced antibody-dependent cellular cytotoxicity to herpes simplex virus-infected cells of salivary polymorphonuclear leukocytes and inhibition of peripheral blood polymorphonuclear leukocyte cytotoxicity by saliva

Blood polymorphonuclear leukocytes (BPMN) have been shown to mediate antibody-dependent cellular cytotoxicity (ADCC) against HSV-infected cells. Although HSV infections are frequently found in the oral cavity, the ADCC capacity of salivary PMN (SPMN) has not been studied, mainly because methods to isolate SPMN were not available. We have recently developed a method to isolate SPMN, and in this study have evaluated their ADCC activity against HSV-infected cells. SPMN were obtained by repeated washings of the oral cavity, and separated from epithelial cells by nylon mesh filtration. ADCC was quantitatively determined by 51Cr release from HSV-infected Chang liver cells. SPMN in the presence of antibody were able to destroy HSV-infected cells, but SPMN were much less effective in mediating ADCC than BPMN (3.4% vs 40.7%, p less than 0.0001). In the presence of antiviral antibody, SPMN were able to adhere to HSV-infected cells, but less so than BPMN (34% vs 67%), and specific antibody-induced adherence was significantly lower in SPMN (p less than 0.04). The spontaneous adherence to HSV-infected cells was higher for SPMN than BPMN. SPMN demonstrated up-regulation of the adhesion glycoprotein CD18, but down-regulation of the FcRIII receptor. Incubation with saliva decreased ADCC capacity of BPMN, up-regulated CD18 expression, and down-regulated FcRIII expression.

Reduced antibody-dependent cellular cytotoxicity to herpes simplex virus-infected cells of salivary polymorphonuclear leukocytes and inhibition of peripheral blood polymorphonuclear leukocyte cytotoxicity by saliva

Blood polymorphonuclear leukocytes (BPMN) have been shown to mediate antibody-dependent cellular cytotoxicity (ADCC) against HSV-infected cells. Although HSV infections are frequently found in the oral cavity, the ADCC capacity of salivary PMN (SPMN) has not been studied, mainly because methods to isolate SPMN were not available. We have recently developed a method to isolate SPMN, and in this study have evaluated their ADCC activity against HSV-infected cells. SPMN were obtained by repeated washings of the oral cavity, and separated from epithelial cells by nylon mesh filtration. ADCC was quantitatively determined by 51Cr release from HSV-infected Chang liver cells. SPMN in the presence of antibody were able to destroy HSV-infected cells, but SPMN were much less effective in mediating ADCC than BPMN (3.4% vs 40.7%, p less than 0.0001). In the presence of antiviral antibody, SPMN were able to adhere to HSV-infected cells, but less so than BPMN (34% vs 67%), and specific antibody-induced adherence was significantly lower in SPMN (p less than 0.04). The spontaneous adherence to HSV-infected cells was higher for SPMN than BPMN. SPMN demonstrated up-regulation of the adhesion glycoprotein CD18, but down-regulation of the FcRIII receptor. Incubation with saliva decreased ADCC capacity of BPMN, up-regulated CD18 expression, and down-regulated FcRIII expression.

Solitary thick intra-uterine membranes not associated with the amniotic band syndrome; three case reports

Three cases in which a single intra-uterine membrane with a free and thickened edge was identified by ultrasound antenatally are presented. The bands turned out to be thickenings of the fetal membranes. In one case intra-uterine adhesions were documented by hysterosalpingography (HSG) and hysteroscopy before conception. One infant suffered from hypospadias. The diagnosis of intra-uterine bands or membranes should turn our attention to a possible intra-uterine pathology.

A new method for isolation of salivary neutrophils and determination of their functional activity

The purposes of this study were to develop a new method for isolating salivary neutrophils (SPMNs), and to determine their functional activity. Studies of neutrophils in the oral cavity have been largely limited to crevicular PMNs, because of difficulties in obtaining viable SPMNs free of epithelial cells. A method to obtain SPMNs is presented. Donors performed rapid sequential rinsings by placing in their mouths 15 mL of Hanks' balanced salt solution [free of calcium or magnesium ions (HBSS-CMF)], which contained 0.1% gelatin, then swishing the solution for 30 s, and expectorating into a polypropylene receptacle containing 400 mL 4 degrees C HBSS-CMF. This sequence was repeated for 20 min. The collected solution was stirred for 10 min, the cells were washed, and the re-suspended pellet was passed sequentially through a 20-microns and a 10-microns nylon mesh. The cells consisted of 97.7 +/- 1.7% SPMNs, only 2.3% epithelial cells, and were almost free of oral debris. The SPMNs were studied for CD11b expression, H2O2 production, and F-actin polymerization. SPMNs had significantly higher resting values for CD11b, H2O2 production, and F-actin polymerization compared with blood neutrophils (BPMNs). SPMNs responded to stimulation by chemotactic peptide or phorbol ester in a dose-dependent fashion, with levels of CD11b, H2O2, and F-actin comparable with BPMNs at optimal stimulant concentrations. The elevated resting levels of CD11b, H2O2, and F-actin for SPMNs were probably caused by exposure to gingival and oral bacteria.(ABSTRACT TRUNCATED AT 250 WORDS)