Pre-assessment triage of orthodontic referrals at an East Yorkshire Hospital.

Inappropriate referrals leading to long waiting lists are a problem for many orthodontic departments throughout the country. This paper describes a method of triaging new patient referrals which aims to reduce the number of appointments generated for inappropriate referrals. The system has been used successfully at Hull Royal Infirmary to reduce new patient waiting times in line with government targets.

Characterization of BGTG-1, a tergal gland-secreted alpha-amylase, from the German cockroach, Blattella germanica (L.).

The protein fraction of the German cockroach, Blattella germanica (L.), tergal gland secretion was examined. SDS-PAGE separation of proteins present in B. germanica tergal gland secretion revealed a tergal gland-secreted protein, BGTG-1, at approximately 63 kDa. BGTG-1 first appeared in tergal gland secretion at 2 days postimaginal moult and the amount of protein observed increased through day 5. A 2051 bp cDNA sequence, bgtg-1, was obtained by RACE polymerase chain reaction and contains a 1494 bp ORF encoding a predicted protein of 498 amino acids. In a Northern hybridization experiment using total RNA from B. germanica tergal gland tissue, a (32)P-labelled bgtg-1 probe hybridized to an RNA approximately 2000 bp and confirmed the 2051 bp cDNA size obtained by RACE PCR. Using the BLASTx sequence similarity search tool, the top match to the bgtg-1 ORF was found to be an alpha-amylase from Drosophila kikkawai (e-value = 1 x 10(-178)). Alignment of the bgtg-1 deduced protein sequence with alpha-amylases from fruit fly, Drosophila melanogaster, honey bee, Apis mellifera (L.) and yellow mealworm, Tenebrio molitor (L.), revealed conserved residues throughout the ORF and sequence identities ranging from 58.4 to 58.2%. Using a gel-based assay, degradation of starch by native BGTG-1 was demonstrated in vitro and we propose that BGTG-1 may be involved in processing phagostimulatory sugars present in B. germanica tergal gland secretion.

Effects of the juvenile hormone analog pyriproxyfen on German cockroach, Blattella germanica (L.), tergal gland development and production of tergal gland secretion proteins.

Male German cockroaches possess secretory glands that secrete fluid into a pair of transverse depressions on the seventh and eighth abdominal tergites. We investigated the effects of altered juvenoid titer during the first part of the last instar on tergal gland secretory tissue development and the production of tergal gland secretion proteins. Male fifth (last) instar nymphs (1-3 days post-emergent) were topically treated with the JH analog pyriproxyfen. Light and transmission electron microscopy demonstrated that treatment with pyriproxyfen produced a visible decrease in the amount of tergal gland tissue present, a deformation of the overall shape of the gland located on tergite seven, and a less orderly arrangement of the secretory cells in the tissue. The protein fraction of tergal gland secretion was examined in pyriproxyfen-treated and control insects 1, 5, and 15 days after the insects molted to the adult stage. Amounts of all tergal secretion proteins were reduced in treated insects.

Knowledge of partner risk and secondary transmission of HIV.

BACKGROUND: The number and proportion of people living longer with HIV and the proportion of people infected heterosexually have increased. We measured the frequency with which people with heterosexually acquired AIDS knew their partners' risk behaviors, the extent of secondary heterosexual transmission of HIV, and characterized people at risk for secondary heterosexual transmission. METHODS: For each of five sites (Alabama, California, Florida, New Jersey, and Texas) and for New York City, a sample of adults with AIDS was interviewed. Primary heterosexual transmission was contact with a partner who had a known risk factor for HIV infection. Secondary transmission was contact with an HIV-positive partner not known to have a risk for HIV. RESULTS: Among men, 35% knew that a sexual partner was HIV infected, 56% of women knew that a sexual partner was HIV infected. Among women, 12% knew that a partner was bisexual. Overall, 79% (460 of 581) reported a partner with a primary risk for HIV; among men, 236 of 293 (81%), and among women, 224 of 288 (78%) reported a partner with a primary risk. People categorized with secondary transmission were significantly more likely to be black and never married. People categorized with secondary transmission were more frequently women (53%), had less than a high school education (48%), and a history of drug use (52%). Men categorized with secondary transmission of HIV had a mean of 22 heterosexual partners; women had a mean of 16 partners. CONCLUSIONS: We found that many heterosexuals with AIDS did not know their sexual partners' risk for HIV, and that secondary heterosexual transmission probably results in a small proportion of all AIDS cases in the U.S.

Survival after AIDS diagnosis in adolescents and adults during the treatment era, United States, 1984-1997.

CONTEXT: Declines in the number of acquired immunodeficiency syndrome (AIDS) deaths were first observed in 1996, attributed to improvements in antiretroviral therapy and an increase in the proportion of persons receiving therapy. OBJECTIVE: To examine national trends in survival time among persons diagnosed as having AIDS in 1984-1997. DESIGN, SETTING, AND SUBJECTS: Retrospective cohort study using data from a population-based registry of AIDS cases and deaths reported in the United States. MAIN OUTCOME MEASURE: Months of survival after AIDS diagnosis through December 31, 1998, compared by year of diagnosis. RESULTS: Among 394 705 persons with an AIDS-defining opportunistic illness (OI) diagnosed in 1984-1997, median survival time improved from 11 months for 1984 diagnoses to 46 months for 1995 diagnoses. Among persons with an OI diagnosed in 1996 and 1997, 67% were alive at least 36 months after diagnosis and 77% were alive at least 24 months after diagnosis, respectively. Among 296 621 AIDS cases diagnosed during 1993-1997, 65% were based on immunologic criteria and 35% on OI criteria; 80% were among men; and 42% were among non-Hispanic blacks, 40% among non-Hispanic whites, 17% among Hispanics, 1% among Asians/Pacific islanders, and less than 1% among American Indians/Alaska natives. The probability of surviving at least 24 months increased from 67% for those with immunologic diagnoses in 1993 to 90% in 1997 and from 49% for those with OI diagnoses in 1993 to 80% in 1997. Survival time increased with each year of diagnosis from 1984 to 1997 for blacks, whites, and Hispanics. The greatest annual survival gains occurred among persons receiving an AIDS diagnosis in 1995 and 1996. CONCLUSIONS: Survival time after AIDS diagnosis improved from 1984 to 1997. While AIDS incidence is declining, improved survival times present a growing public health challenge as the number of persons living with chronic human immunodeficiency virus disease/AIDS increases.

Cytochrome P450 MA expression in insecticide-resistant German cockroaches (Dictyoptera: Blattellidae).

Cytochrome P450 monooxygenases are detoxification enzymes commonly involved in insecticide resistance by insects. Recently, an overexpressed form of this enzyme, P450 MA, was purified from an insecticide-resistant strain of German cockroach, Blattella germanica (L.), and polyclonal antisera (anti-P450 MA) was produced. To test hypotheses that the overexpressed condition of P450 MA has evolved in > 1 geographic location and that P450 MA might be involved in insecticide resistance to specific insecticides, investigations were conducted using 4 insecticide-resistant and 1 susceptible German cockroach strains. In western blots that used anti-P450 MA antiserum as a probe, substantial differences in expression of P450 MA were observed. Strains showing the highest P450 MA expression had both the highest tolerance to the organophosphate insecticide chlorpyrifos and cytochrome P450-mediated demethylation activity. Results support the hypothesis that cytochrome P450 MA is potentially overexpressed in insecticide-resistant populations on a global scale.

Is there really a heterosexual AIDS epidemic in the United States? Findings from a multisite validation study, 1992-1995. Mode of Transmission Validation Study Group.

The objective of this study was to verify the mode of exposure to the human immunodeficiency virus (HIV) among cases who obtained acquired immunodeficiency syndrome (AIDS) through heterosexual contact and to determine the proportion of cases initially reported with no risk but whose exposure may have been heterosexual. Adults aged > or = 13 years with AIDS, diagnosed from 1992 through 1995 with heterosexual risk or no risk at six US study sites (Alabama, California, Florida, New Jersey, New York City, and Texas), were eligible. Heterosexual risk was validated in 82% (1,610/1,952) of the heterosexual cases. Men were more likely than women to have a risk other than heterosexual (24% vs. 13%, chi2 p < 0.01). An HIV risk was identified for 351 (55%) of those cases with no risk, and men were more likely than women to remain without risk (48% vs. 38%, chi2 P = 0.02). Of the 415 men with no risk, 215 (52%) were reclassified: 94 (44%) were men who had sex with men, 61 (28%) were injection drug users, 48 (22%) had a heterosexual risk, and 12 (6%) had other exposures. Of the 219 women with no risk, 136 (62%) were reclassified: 82 (60%) had a heterosexual risk, 47 (35%) were injection drug users, and 6 (4%) had infection associated with transfusion. In conclusion, most cases reported with heterosexually acquired AIDS had valid heterosexual risk exposures.

Cytochrome P450 purification and immunological detection in an insecticide resistant strain of German cockroach (Blattella germanica, L.).

A German cockroach strain, Munsyana (MA) had 80-fold resistance to the pyrethroid insecticide cypermethrin, 4.5-fold greater total cytochrome P450 content and 2.5-fold greater cytochrome P450-mediated N-demethylation of 4-chloro-N-methylaniline compared to the susceptible Johnson Wax (JWax) strain. Immobilized artificial membrane high performance liquid chromatography (IAM-HPLC) of microsomal proteins from the MA strain enriched cytochrome P450 greater than 70-fold. Following purification, a single protein band of M(r) = 49,000 (P450 MA), was detected by silver-staining SDS PAGE gels. Antiserum to the purified protein from the MA strain (anti-P450 MA) was produced in mice. Anti-P450 MA inhibited cytochrome P450-mediated N-demethylation by 4-fold in both MA and JWax strains. In Western blots of microsomal proteins, anti-P450 MA differentiated single MA and JWax individuals by recognizing and M(r) 49,000 protein band in only the MA strain. In JWax cockroaches, the M(r) 49,000 band was only detectable in Western analysis following induction with pentamethylbenzene (PMB). PMB induction also increases N-demethylation 2.6 and 8.0-fold in the MA and JWax strains, respectively. These results are consistent with the hypothesis that insecticide resistance in the MA strain is due to over-expression of a cytochrome P450.

Genetic mapping of a major locus controlling pyrethroid resistance in Tribolium castaneum (Coleoptera: Tenebrionidae).

Tribolium castaneum (Herbst) strain QTC279 is highly resistant to deltamethrin and other synthetic pyrethroids. This strain was shown to carry at least 1 resistance gene, PyR-1, on linkage group 9, approximately 20 map units from the visible mutant marker, pearl. Three-point mapping involving pearl and another visible mutant marker, cola, indicated a gene order of pearl-cola-PyR-1. Evidence of a 2nd LG9-linked resistance factor (R) mapping in the gene order R-p-co was also observed. Other resistance factors were clearly present in QTC279, but were not genetically mapped. Piperonyl butoxide, an inhibitor of cytochrome P450-mediated oxidative metabolism, significantly increased the toxicity of deltamethrin to a strain derived from QTC279 that carries PyR-1, strain pR. Compared to susceptible beetles, QTC279 and pR had elevated and comparable levels of cytochrome P450 protein. The significance of pyrethroid resistance in T. castaneum is discussed.

Trends in heterosexually acquired AIDS in the United States, 1988 through 1995.

We used national AIDS surveillance data to characterize trends in the numbers and proportions of heterosexually acquired AIDS cases diagnosed from January 1988 through December 1995 among adults and adolescents. We adjusted for expansion of the 1993 AIDS surveillance case definition and for delays in reporting, and we redistributed cases initially reported without risk. The chi-square test for linear trend was used to analyze trends at the p < 0.01 level by half-year of diagnosis and by sex, age, race or ethnicity, geographic region of residence at diagnosis, and partner's HIV exposure risk. From 1988 through 1995, heterosexual contact accounted for 10% of all AIDS cases. Heterosexual contact increased the most rapidly of all HIV exposure modes, with increases found among men and women in all age groups; among blacks, whites, and Hispanics: and among persons living in all geographic regions of the country. Blacks and Hispanics accounted for 75% of all persons reported with AIDS attributed to heterosexual contact. Although heterosexual contact with an injection drug user (IDU) accounted for most cases until 1993, cases increased most rapidly among persons reporting heterosexual contact with an HIV-infected partner whose risk was not specified. Findings suggest continued growth of the heterosexual AIDS epidemic. Because of the disproportionate and increasing number of heterosexually acquired AIDS cases among blacks and Hispanics, black and Hispanic communities at risk for HIV infection should be considered a high priority for prevention and education programs specifically targeting heterosexually active adolescents and adults. Epidemiologic and behavioral research and prevention program evaluation are urgent public health priorities to better control and prevent the further spread of HIV among heterosexually active adults and adolescents.

New approaches to syphilis control. Finding opportunities for syphilis treatment and congenital syphilis prevention in a women's correctional setting.

BACKGROUND: With prostitution and drugs the most common reasons for arrest among New York City (NYC) women, female arrestees are at high risk for acquiring syphilis and delivering congenitally infected babies. Despite routine syphilis screening of all NYC inmates, many are released before the need for treatment is recognized, and once released, few could be found for treatment. GOALS: To improve syphilis treatment rates among female correctional inmates in NYC. STUDY DESIGN: At a women's correctional health clinic, on-site, rapid, qualitative nontreponemal syphilis testing (STAT rapid plasma reagin [RPR]) and on-line access to the local syphilis case registry were introduced to supplement the usual admission medical evaluation. Treatment decisions made using the authors' jail protocol were compared with treatment criteria used in NYC's sexually transmitted disease (STD) clinics. Patients consisted of a consecutive sample of 685 remandees admitted one or more times during the day shift, March 24, 1993, to July 31, 1993, who had a full complement of mandatory admission medical tests. Using the study protocol, syphilis treatment decisions were made and needed treatment was furnished at the end of the admission medical evaluation. The main outcome measures were correct identification and treatment of syphilis in this population, compared with standard NYC Department of Health (DOH) STD clinic practice, as well as the effect of the jail protocol on pregnancy outcomes and need to treat offspring for congenital syphilis. RESULTS: Compared with NYC DOH STD clinic practice, the study protocol was 95% sensitive and 88% specific in arriving at appropriate treatment for syphilis. Treatment at the end of the admission medical evaluation increased syphilis treatment rates from 7% to 84% of women with indications for treatment and to 88% of pregnant women with indications for treatment. Prospective follow-up for birth outcomes revealed no spontaneous abortions and eight live births. Seven of the eight did not need congenital syphilis treatment because their mothers were adequately treated while incarcerated. CONCLUSIONS: Qualitative (or STAT) RPR testing and access to DOH syphilis case registry data provide prompt and accurate diagnostic information that can lead to an overall increase in the number of inmates appropriately treated (with a minimum amoung of overtreatment) in a women's correctional facility. This protocol may be applicable in other high-risk, transient populations.

Unexplained opportunistic infections and CD4+ T-lymphocytopenia without HIV infection. An investigation of cases in the United States. The Centers for Disease Control Idiopathic CD4+ T-lymphocytopenia Task Force.

BACKGROUND: The clinical and public health importance of recent reports of patients with CD4+ T-lymphocytopenia without human immunodeficiency virus (HIV) infection is unclear. We conducted investigations to determine the demographic, clinical, and immunologic features of patients with idiopathic CD4+ T-lymphocytopenia; whether the syndrome is epidemic or transmissible; and the possible causes. METHODS: We reviewed 230,179 cases in the Centers for Disease Control and Prevention (CDC) AIDS Reporting System and performed interviews, medical-record reviews, and laboratory analyses of blood specimens from adults and adolescents who met the CDC case definition of idiopathic CD4+ T-lymphocytopenia (< 300 CD4+ cells per cubic millimeter or a CD4+ cell count < 20 percent of total T cells on two occasions and no evidence of infection on HIV testing), their sexual contacts, household contacts, and persons who had donated blood to them. RESULTS: We interviewed 31 of the 47 patients identified with idiopathic CD4+ T-lymphocytopenia and 23 of their contacts. There were 29 male and 18 female patients, with a mean age of 43 years (range, 17 to 78); 39 were white, 4 were Asian, 2 were Hispanic, and 2 were black. Eighteen patients (38 percent) had one or more risk factors for HIV infection: seven had hemophilia, six had engaged in homosexual sex, six had received blood transfusions, and two had had heterosexual sex partners who were at risk for HIV infection. The other 29 patients (62 percent) had no identified risk factors for HIV infection. Nineteen persons (40 percent) had AIDS-defining illnesses (18 had opportunistic infections), 25 (53 percent) had conditions that were not AIDS-defining, and 3 (6 percent) were asymptomatic. We tested blood from 28 patients: 8 (29 percent) were found to have CD4+ T-lymphocyte counts of less than 300 cells per cubic millimeter, and 6 had CD8+ T-lymphocytopenia (< 250 cells per cubic millimeter). Ten sex partners, three household contacts, and four children of the patients, as well as six persons who had donated blood to the patients, were immunologically and clinically normal. CONCLUSIONS: This investigation of patients with idiopathic CD4+ T-lymphocytopenia and unexplained opportunistic infections indicates that the disorder is rare and represents various clinical and immunologic states. The investigation of contacts revealed no evidence of a new transmissible agent that causes lymphocytopenia.

Separation of cytochrome P-450 containing vesicles from the midgut microsomal fraction of Manduca sexta.

1. Microsomes prepared from midgut tissue of Manduca sexta by differential centrifugation are a heterogeneous population of vesicles. 2. Upon centrifugation of microsomes in a sucrose gradient of 30%, 15% and 10%, specific activity of cytochrome P-450 catalyzed O-demethylation of p-nitroanisole (a marker enzyme for endoplasmic reticulum) was increased 2.5 to 3.5-fold in the 15% fraction. 3. Specific activities of alkaline phosphatase and leucine aminopeptidase (marker enzymes for brush border membranes) were increased 3.1 to 5.7-fold in the pellet. 4. Differential centrifugation is a useful step in the purification of cytochrome P-450 enzymes.

Sucrose esters of carboxylic acids in glandular trichomes ofSolanum berthaultii deter settling and probing by green peach aphid.

Removal of type B trichome exudate fromSolanum berthaultii leaflets leads to a decrease in tarsal gumming and mortality and an increase in feeding by the green peach aphid,Myzus persicae. Type B trichome exudate of theS. berthaultii accession PI 473331 is composed of a complex of 3',3,4,6-tetra-O-acyl sucroses containing primarily short-chain branched carboxylic acids. The acyl constituents are primarily derived from 2-methylpropanoic, 2-methylbutyric, and 8-methylnonanoic acids but constituents derived fromn-decanoic and dodecanoic acids are also present. Sucrose esters inhibit settling and probing by aphids in glass feeding cages.

Myristicin, safrole, and fagaramide as phytosynergists of xanthotoxin.

The methylenedioxyphenyl-containing (MDP) inhibitors of mixed-function oxidase detoxification enzymes, myristicin, safrole, fagaramide, and isosafrole, occur with xanthotoxin or other toxic furanocoumarins in plants of the families Umbelliferae and Rutaceae. All four MDP compounds have a synergistic effect on the toxicity of xanthotoxin toHeliothis zea. Myristicin also increased the phototoxicity of xanthotoxin in the presence of UV light. The term phytosynergist is used to describe plant compounds that are present at concentrations producing no toxic effect by themselves but have a synergistic effect on cooccurring toxins.

Decreased sensitivity of mixed-function oxidases frompapilio polyxenes to inhibitors in host plants.

Caterpillars ofPapilio polyxenes, the black swallowtail, feed on umbellifers that contain both toxic furanocoumarins and methylenedioxyphenyl compounds such as myristicin and safrole. These phytosynergists enhance the toxicity of furanocoumarins by inhibiting mixed-function oxidases (MFOs), the detoxification enzymes responsible for metabolizing furanocoumarins. In model substrate assays, MFOs fromP. polyxenes are twice as active as MFOs fromHeliothis zea, a generalist herbivore not adapted to feeding on either furanocoumarins or furanocoumarin/phytosynergist combinations.P. polyxenes MFOs are 10 and 46 times less sensitive to inhibition by myristicin and safrole, respectively, thanH. zea MFOs and eight times less sensitive to inhibition by safrole than MFOs fromPapilio troilus, a closely related species that does not encounter furanocoumarin/phytosynergist combinations in its diet. Higher MFO activity and decreased sensitivity to MFO inhibitors are important adaptations that allow black swallowtail caterpillars to feed on many umbelliferous plants.

The diagnostic value of panoramic radiographs in children aged nine to ten years.

The increased awareness of the possible harmful effects of ionizing radiation has resulted in concern at the number of panoramic radiographs taken in General Dental Practice. A study has been carried out to examine the diagnostic value obtained from panoramic radiographs taken at 9-10 years of age. Nine-hundred-and-eighty-two radiographs were examined and 261 (26.5 per cent) showed findings which would be of significance in orthodontic diagnosis and treatment planning.

The stability of the lower labial segment following surgical correction of Class III skeletal discrepancy.

There has been some controversy over the post-operative changes that may take place in tooth position following orthognathic surgery. The present study was designed to observe the changes that take place in the position of the incisors following surgery to correct class III skeletal discrepancies. It was found that the postoperative changes that occur in the axial inclination of the lower incisors are small enough to be clinically insignificant, provided an adequate overbite has been established. Any changes that do occur will probably be associated with a small increase in the mandibular maxillary planes angle, with possibly some upper incisor proclination and reduction of overbite.