Acidic proline-rich protein Db and caries in young children.

Polymorphic, acidic proline-rich proteins (PRPs) in saliva influence the attachment of bacteria associated with caries. Our aims were to detect one of three acidic PRP alleles of the PRH1 locus (Db) using polymerase chain-reaction (PCR) on genomic DNA, and to determine its association with caries. DNA was obtained from buccal swabs from Caucasian and African-American children, and their caries experience was recorded. PCR primers designed around exon 3 of the PRH1 locus gave a 416-base product representing Db and a 353-base product representing the other two alleles (Pa or Pif). In Caucasians, Db gene frequency was 14%, similar to Db protein from parotid saliva. In African-Americans, however, it was 37%, 18% lower than Db from parotid saliva (reported previously). Compared with African-Americans, all Caucasians had significantly greater Streptococcus mutans colonization, but only Db-negative Caucasians had significantly more caries. Alleles linked to Db may explain racial differences in caries experience.

Antibody-based diagnostic for 'refractory' periodontitis.

OBJECTIVE: About 10-15% of US adults are 'refractory' to therapy for chronic periodontitis. Recently, studies suggest that these patients have elevated lysine decarboxylase activity in the sulcular microbiota. The aim of this study was to determine whether an elevated IgG antibody response to lysine decarboxylase, alone or with antibody to other bacterial antigens and baseline clinical measurements, would predict 'refractory' patients with high accuracy. METHODS: Chronic periodontitis patients were treated using scaling and root planing (SRP) followed by maintenance SRP and 3-monthly re-examinations. If there was a loss of mean full mouth attachment or more than three sites appeared with > 2.5 mm new loss within a year, the subjects were re-treated (modified Widman flap surgery and systemically administered tetracycline). If attachment loss as above recurred, the subjects were 'refractory'. Baseline clinical measurements and specific antibody responses were used in a logistic regression model to predict 'refractory' subjects. RESULTS: Antibody to a peptide portion of lysine decarboxylase (HKL-Ab) and baseline bleeding on probing (BOP) prevalence measurements predicted attachment loss 3 months after initial therapy [pIAL = loss (0) or gain (1)]. IgG antibody contents to a purified antigen from Actinomyces spp. (A-Ab) and streptococcal d-alanyl glycerol lipoteichoic acid (S-Ab) were related in 'refractory' patients (R2 = 0.37, p < 0.01). From the regression equation, the relationship between the antibodies was defined as linear (pLA/S-Ab = 0) or non-linear pLA/S-Ab = 1). Using pLA/S-Ab, pIAL and age, a logistic regression equation was derived from 48 of the patients. Of 59 subjects, 37 had 2-4 mm attachment loss and were assigned as 'refractory' or successfully treated with 86% accuracy. CONCLUSION: HKL-Ab facilitated an accurate prediction of therapeutic outcome in subjects with moderate periodontitis.

Bone volume collected from dental implant sites during osteotomy.

PURPOSE: Little research has been done to determine the amount of bone harvested from implant site preparations using an inline bone collector. This study looked at the amount of bone that can be harvested from common dental implant osteotomies. PATIENTS AND METHODS: A total of 24 implants were placed in 9 patients over a 3-month period. Implant size ranged from 3.75 x 13 mm to 4.75 x 13 mm. Nine implants were placed in the maxilla, and 15 implants were placed in the mandible. Seven patients were female, and 2 patients were male. The patient age ranged from 27 to 72 years. Four patients had implants placed within 5 years after tooth extraction, and 5 patients had implants placed 5 years after tooth extraction: an analysis of variance was used to determine if there were statistical differences between maxilla versus mandible, male versus female, and edentulism less than or greater than 5 years. RESULTS: The average bone volume from the 24 osteotomies was 0.195 +/- 0.099 mL. The average osteotomy site measured 4.02 x 12.90 mm. There were no statistical differences noted among maxilla and mandible, gender, or time of edentulism. CONCLUSIONS: When using an inline bone collector to harvest implant osteotomy sites, an average of 0.195 mL of bone can be obtained from a site approximately 4.0 x 13 mm. This bone can often be combined with a xenograft or alloplastic material to provide extra bulk to fill peri-implant defects. When multiple implant sites are prepared, often sufficient bone can be obtained with the bone collector alone.

A comparison between BMI and Conicity index on predicting coronary heart disease: the Framingham Heart Study.

PURPOSE: This study examined the relationship of mortality and morbidity of coronary heart disease with body mass index (BMI) and Conicity index (CI). METHODS: Among 5209 Framingham Heart Study participants, 1882 men and 2373 women had waist and weight measurement at the 4th examination period and height measured on the 5th visit. These were used for BMI and CI. RESULTS: During a 24-year follow-up, 597 men and 468 women developed CHD and 248 men and 150 women died from CHD associated causes. In men the relative risks (RR) (95% confidence interval) adjusted for age, hypertension, diabetes, smoking status, and total cholesterol for CHD incidence in 2nd, 3rd, and 4th quartiles of BMI were 1.28 (1.0, 1.65), 1.45 (1.13, 1.86), and 1.53 (1.19, 1.96). The RR for CHD incidence in the 4th quartile of BMI in women was 1.56 (1.16, 2.08). No CI quartiles were risk factors for CHD incidence. There was 86% higher risk of CHD related death in the 4th quartile of BMI than the 1st quartile of BMI in women. In men no significantly higher risks of death were found across the quartiles of BMI. No associations were found between CI quartiles and CHD mortality. CONCLUSIONS: Obesity as measured by BMI is an important risk factor for CHD incidence in men and women and for CHD mortality in women. CI was not associated with an increase in CHD incidence or mortality. Thus, BMI is a better marker than CI for predicting CHD incidence and mortality.

Predictive value of compression ultrasonography for deep vein thrombosis in symptomatic outpatients: clinical implications of the site of vein noncompressibility.

BACKGROUND: Compression ultrasonography has a high negative predictive value for deep vein thrombosis in symptomatic outpatients. Limited data are available on factors influencing positive predictive value. The objective of this study was to evaluate the positive predictive value of compression ultrasonography according to the anatomic site of vein noncompressibility. METHODS: We performed a prospective cohort study of 756 consecutive outpatients with suspected first-episode deep vein thrombosis. Compression ultrasonography was performed at the initial visit: results were abnormal if a noncompressible segment was identified or normal if all segments were fully compressible. Venography was performed in patients with abnormal compression ultrasonography results. Positive predictive value was determined according to the site of noncompressibility: common femoral vein only, popliteal vein only, or both sites. Venography was the reference standard for the presence of deep vein thrombosis. RESULTS: Positive predictive value was 16.7% (95% confidence interval, 0.4%-64.1%) for noncompressibility isolated to the common femoral vein compared with 91.3% (95% confidence interval, 72.0%-98.9%) for the popliteal vein only and 94.4% (95% confidence interval, 72.7%-99.9%) for both sites (P<.001). Of 15 patients with isolated noncompressibility of the common femoral vein, 8 (53%) had pelvic neoplasm or abscess compared with 2 (5%) of 42 with noncompressibility of the popliteal vein only and 6 (13%) of 47 with noncompressibility of both sites (P<.001). CONCLUSIONS: The positive predictive value of noncompressibility isolated to the common femoral vein is too low to be used alone as the diagnostic end point for giving anticoagulant therapy. Noncompressibility isolated to the common femoral vein is a diagnostic marker for pelvic disease.

Monitoring low-dose warfarin therapy by a central laboratory and implications for clinical trials and patient care. The Coumadin Aspirin Reinfarction (CARS) Pilot Study Group.

The central laboratory provides International Normalized Ratio results in close agreement with the local laboratory for monitoring the anticoagulant effect of low-dose warfarin. A central laboratory may have practical advantages for patients in rural areas that lack laboratory facilities for anticoagulant monitoring.

Exogenous oestrogen affects calcium metabolism differently from exogenous testosterone in ovariectomized or orchiectomized rats fed a high fructose diet severely deficient in magnesium.

To investigate interactions between sex hormones, dietary fructose, and a severe magnesium deficiency on calcium metabolism, 10 week old ovariectomized (OVX) female, and orchiectomized (ORX) males rats were studied. The OVX and ORX animals were divided into two groups: one half of the animals in each group was injected with beta-oestradiol-3-benzoate dissolved in sesame oil twice a week; the other half was injected with testosterone cypionate in sesame oil twice a week. All animals were pari-fed a severely magnesium-deficient fructose diet. After a 4 week experimental period, a 24 h urine sample was collected for measurements of cAMP, calcium, magnesium, and phosphorus. Blood was collected for determination of calcium, magnesium, phosphorus, 25-hydroxy- and 1.25-dihydroxycholecalciferol [25(OH)D, 1.25(OH)2D], and parathyroid hormone (PTH). Femurs were used for measurements of bone mineral content (BMC) and density (BMD). Oestrogen treatment produced hypercalcaemia and hypercalciuria, and, further, this was higher in female than in male rats. In contrast, testosterone treatment produced hypocalcaemia and hypocalciuria. Hypocalcaemia in testosterone-treated animals may stimulate secretion of PTH. Testosterone-treated animals had significantly lower BMD than oestrogen-treated animals. High circulating PTH seemed to cause bone loss in the testosterone group. High PTH may stimulate hydroxylation of 25(OH) D to 1.25(OH)2D in the kidneys, and high circulating 1.25(OH)2D would antagonize bone formation. Either endogenous or exogenous oestrogen increased kidney calcification. The study indicates that oestrogen-fructose-magnesium interaction on calcium metabolism was significantly different from that of testosterone.

Protozoal colonization of the intestinal tract in institutionalized Romanian children.

To determine the prevalence of intestinal parasitic infections in 92 Romanian children institutionalized at Colentina Hospital (Bucharest, Romania) and at the Dystrophic Center (Vidra, Romania), medical charts were reviewed and complete physical examinations were performed. The nutritional status of each child was evaluated, and their sera were tested for the presence of antibodies to human immunodeficiency virus (HIV) and Cryptosporidium. Fecal samples were collected in 10% formalin and examined by an immunofluorescent assay and by trichrome staining for intestinal parasites. At least one protozoan was identified in 77% of the fecal specimens examined. Giardia lamblia (72% of cases), Cryptosporidium parvum (12%), and Entamoeba coli (4%) were the only parasites identified. Stepwise logistic regression revealed that the only factors predictive of giardia colonization were normal nutritional status (P < .01) and HIV seropositivity (P < .02), while cryptosporidium colonization was only associated with where the children lived (P < .01). Seventy-three percent of the children had IgA and/or IgG antibodies to Cryptosporidium in their sera. The presence of these antibodies was strongly associated with the severity of symptoms present in the HIV-infected children (P < .01). Protozoal colonization of the intestinal tract is common in institutionalized Romanian children and may play a role in causing morbidity and mortality in this high-risk group of children.

Effect of treatment with low-dose warfarin-aspirin on activated factor VII.

Factor VII is an independent risk factor for ischemic heart disease. We performed a prospective study to evaluate the effect of combined low-dose warfarin-aspirin on activated factor VII (factor VIIa) and to determine if abruptly stopping this treatment is associated with a rebound in the level of factor VIIa. Thirty-three patients with clinically stable coronary artery disease were treated with combined 3 mg warfarin and 80 mg aspirin daily for 8 weeks. The factor VIIa level was measured before treatment, weekly during treatment, and 2 weeks after stopping treatment. The mean percent of pretreatment levels of factor VIIa for weeks 1 through 8 of treatment were 60%, 60%, 72%, 70%, 71%, 70%, 74%, and 87%, respectively (P < .05 compared with pretreatment for weeks 1 through 7 inclusive); 2 weeks after stopping treatment, the level was 122% (95% confidence interval [CI]; 111% to 133%; P < .001 compared with pretreatment). The mean percent level of factor VIIa on-treatment was 74% (P < .001). Factor VIIa is reduced by 26% on average during treatment. This finding provides further rationale for the antithrombotic effect of low-dose warfarin. The results suggest a rebound in the factor VIIa level may occur after treatment is stopped. The potential rebound and its clinical importance should be evaluated by further studies.

The effect of phenylephrine on Müller muscle. A blepharogram study of eyelid motion.

PURPOSE: The blepharogram technique is used to study the effect of a drug on blinking. The authors show that ocular instillation of phenylephrine, a stimulant of Müller muscle of the eyelid, accelerates the up phase of the blink. METHODS: Motion of a tiny search coil glued to the eyelid moving in a weak magnetic field modifies an induced alternating current which is amplified and used to display the position of the upper eyelid in degrees on the ordinate of a graph with time in milliseconds on the abscissa. The graph is called a blepharogram. Blepharogram studies and individual blink analysis show the effect of phenylephrine on eyelid motion (blinking). RESULTS: Instillation of phenylephrine accelerated the up phase of the blink in all ten experimental subjects. In 65% of subjects, phenylephrine also produced or increased newly described N and M blepharogram patterns. CONCLUSION: This is the first instrumental detection of the effect of a pharmacologic agent on eyelid motion. The blepharogram technique provides insight into eyelid physiology and can be used to study any neuromuscular condition that affects eyelid motion.

Lateral cephalometric analysis of skeletal patterns in patients with and without internal derangement of the temporomandibular joint.

Twenty-three female volunteers with normal temporomandibular joints (TMJ) were compared with 24 female patients with documented TMJ internal derangements. Magnetic resonance imaging and lateral cephalometric radiographs were used to investigate the relationship between TMJ disk displacement and skeletal facial form. Results indicated that the patients with internal derangements have significantly smaller mandibles and maxillae. However, these sagittal measurements of jaw length were not associated with disproportionate changes in other cephalometric variables. In general, no district relationship was found between the morphologic features of the face and the internal derangements of the temporomandibular joint.

Changes in maternity care and the impact on nurses and nursing practice.

OBJECTIVE: To determine changes maternity nurses have experienced and the impact these changes have had on nursing practice. DESIGN: Descriptive survey using a randomized sample. PARTICIPANTS: Four hundred fifty-one inpatient female maternity nurses. MAIN OUTCOME MEASURES: Changes in maternity care, impact of the changes on nursing practice, and personal and professional perceptions and activities before and after the changes. RESULTS: Reported changes were use of technology, legal climate, shorter patient stay, cost containment, inclusion of family, cross training, consumer demand, and single-room maternity care. Inclusion of the family, technology, and single-room care were rated highly for worth and improvement in quality of care. Though described as challenging and rewarding, change was an energy drain. Change was often seen as a result of administrative mandate. CONCLUSIONS: Perceptions of change vary, but no change is easy to implement. Opportunities for staff input, administrative support, and adequate time and staffing levels during change facilitate adjustment.

Epidemiologic patterns of nosocomial infections in 10 Oklahoma hospitals.

The epidemiology of nosocomial infections was studied for 5 years in 10 Oklahoma hospitals. These were categorized into small and large hospitals. The seven small hospitals averaged 47 beds and the three large hospitals averaged 266 beds. Overall, most of the infected patients were < 5 years of > 60 years of age. Females accounted for the majority of the infections. In general, the three most common sites of infection were the urinary tract, surgical wounds, and the lower respiratory tract. Escherichia coli was the single most frequently identified agent followed by Staphylococcus aureus and Staphylococcus epidermidis. The most frequently reported risk factors among patients acquiring a nosocomial infection were the use of prior antibiotics, indwelling urinary catheters, and intravenous catheters or cut-down. The specific problems associated with nosocomial infections, such as sites of infection, risks of infection, and the types of organisms isolated, essentially had not changed much since the 1960s, the 1970s, and for most of the 1980s.

Analysis and aggregation of CMHC outcome data in a statewide evaluation system: a case report.

Several potential procedures for simplifying and aggregating treatment outcome data from CMHCs differing in outcome instrumentation and methodology are presented and illustrated. Their respective advantages, disadvantages, and suitability for various purposes are explored, and considerations in selecting a particular method or technique are discussed. Findings obtained by using these techniques to analyze treatment outcome data from nine CMHCs over a three-year period are presented. Selected results highlighting the relative importance of methodological, subject, status, diagnostic, treatment process, and service delivery variables are presented. The implications of these findings for the problems and limitations inherent in cross-CMHC comparisons are illustrated and discussed. Applications for aggregated and non-aggregated analyses are suggested, and an illustration using aggregated outcome data to identify potential predictor variables for positive outcomes is presented along with differences for various outcome groupings.

Multidisciplinary approach to breast cancer control.

A multidisciplinary approach to breast cancer control was developed through a network of 22 hospitals, and data were collected over two time periods to evaluate the impact of the network. A total of 1,800 cases of female breast cancer treated during the baseline period of 1971 to 1973 were compared with 2,102 current cases treated during the 1975 to 1977 study period. These cases were compared with regard to detection, diagnosis, and primary therapy. Several improvements in the diagnosis and treatment of patients studied in the later period indicate the program has had a positive impact. Improvements include an increase in case accrual by an average of 100 cases per year; an increase in detection of early (in situ and localized) and advanced disease; an increase in the proportion of patients whose interval from first symptoms to diagnosis was less than one month; a threefold increase in the proportion of patients diagnosed before admission; the increased use of simple or modified radical mastectomy (from 11% to 25%); a reduction in the number of patients whose mastectomy was done by a physician who did five or fewer mastectomies per year; an increase in the number of patients receiving bone, liver, or spleen scans; and an improvement in the quantity and quality of information in hospital charts, such as family history of cancer, history of benign breast disease, and menstrual history. Data are also provided on primary therapy and method of detection according to stage and tumor size.