Diabetes and the associated incidence of subclinical atherosclerosis and coronary artery disease: Implications for management.

BACKGROUND: We sought to examine the prevalence, sensitivity, and specificity of coronary calcium (CC), a marker of atherosclerosis, in a population of symptomatic and asymptomatic diabetic persons. METHODS: We used electron beam tomography (EBT) to quantitate CC in 168 symptomatic (chest pain or anginal equivalent) persons with diabetes who underwent coronary angiography and then compared this with a cohort of 155 asymptomatic persons with diabetes. RESULTS: In the 168 symptomatic diabetic persons, 124 (74%) had obstructive coronary artery disease (CAD) by angiography. Receiver-operator characteristic curve analysis was used to maximize sensitivity and specificity for obstructive CAD (>50% stenosis), which established a CC score of 102 as optimal. With use of this cut point, EBT has a sensitivity of 77% and a specificity of 77% for detecting obstructive CAD. Of the 155 asymptomatic diabetic persons, 72% had CC and 48% had a CC score >102. The presumed prevalence of obstructive disease (on the basis of EBT scores and prevalence of CC) among asymptomatic diabetic persons is quite high (as high as symptomatic persons without diabetes). Analyzing the 323 diabetic patients demonstrated no significant age difference in CC scores between women and men. CONCLUSIONS: This study confirms that higher CC scores should be used in diabetic patients to improve the specificity of CC to determine obstructive disease. EBT can allow a noninvasive diagnosis of CAD before clinical presentation, allowing for more therapy for those in which CC is detected. These results suggest that asymptomatic diabetic persons have the same atherogenic burden of those patients with CAD without diabetes. The high prevalence of CC in asymptomatic persons with diabetes supports the need for aggressive management of diabetes and associated risk factors.

Adherence to and penetration through endothelial cells by oral treponemes.

Oral spirochetes were co-incubated with monolayers of endothelial cells seeded into multiwell plates or onto filters mounted in plastic chambers. Attachment was assessed using an enzyme-linked immunosorbent assay and scanning electron microscopy. Invasiveness was determined by monitoring media beneath filters within chambers for spirochetes using darkfield microscopy. Transmission electron microscopy was used to estimate intercellular and intracellular passage of spirochetes through monolayers. All tested treponemes attached to monolayers in a dose- and time-dependent manner, except Treponema phagedenis. A few treponemes were observed within host cell cytoplasm. Unidentified spirochetes obtained from dental plaque were also invasive. Results indicate that oral spirochetes possess virulence-associated characteristics shared with pathogenic spirochetes. Further studies should examine the possibility that invasive spirochetes could disseminate from within affected gingiva.

"I have a future" comprehensive adolescent health promotion: cultural considerations in program implementation and design.

"I Have a Future" Adolescent Health Promotion Program is a life options program. The program uses the Nguzo Saba (seven principles) and African philosophy to systematically address violence and attitudes reinforcing the use of violence. The Nguzo Saba promotes self-respect, and commitment to and support for developing a positive community. Data was collected from four public housing developments--two served as match control sites. Adolescents residing in neighborhoods in which the program operated had greater acceptance of the Nguzo Saba than those in matched communities. Those who perceived themselves as having life options engaged in fewer delinquent/violent acts. There was a strong negative correlation between the acceptance of the Nguzo Saba and the number of reported delinquent/violent behaviors. There was a positive relationship between the acceptance of the Nguzo Saba and positive self-concept, psychosocial maturity, and clarity of goals.

The effect of scrubbing and irrigation with normal saline, povidone iodine, and cefazolin on wound bacterial counts in a guinea pig model.

This study examines the effects of povidone iodine, normal saline, and cefazolin alone and after scrubbing on bacterial counts in contaminated animal lacerations. Twelve albino guinea pigs each received four lacerations inoculated with a standard inoculum of Staphylococcus aureus. Twelve hours after inoculation, each wound was biopsied to ensure contamination and then either treated or left as an untreated control. One wound on each animal was an untreated control. The remaining three lacerations on six pigs were irrigated with cefazolin (CZ) solution, normal saline, or 1% (wt/vol) povidone iodine solution (PI). Three lacerations on another six pigs were treated with 20% poloxamer 188 scrub (scrub) alone, scrub followed by PI irrigation (SCR/PI), or scrub followed by CZ irrigation (SCR/CZ). Quantitative bacteriology was performed on tissue biopsies 2 hours (time 1), 7 hours (time 2), and 12 hours (time 3) after irrigation. Posttreatment counts for PI, CZ, and normal saline irrigation were not different from control or one another (P > .05). Bacterial counts for SCR/PI were significantly lower than control (P < .05) for all posttreatment biopsies (1.8 to 2.9 mean log(10) decrease). SCR/CZ was significantly lower than control (P < .05) at times 2 and 3 only (1.7 to 2.0 mean log(10) decrease). In this guinea pig model, cleansing 12-hour-old lacerations contaminated with S aureus using SCR/PI or SCR/CZ significantly reduced bacterial counts over 12 hours.

Cardiac, aortic, pericardial, and pulmonary receptors in the dog.

Afferent nerve activity from left and right atrial, left and right ventricular, interventricular septal, papillary muscle, pericardial, aortic and pulmonary vascular receptors was recorded from the left T3 white ramus communicans and the innominate, dorsal, recurrent, ventromedial, craniovagal and caudovagal cardiac nerves in alpha-chloralose-anesthetized dogs. The receptors were localized and the nature of the stimuli required to excite these receptors was also determined. Some ventricular receptors were excited during maximal contraction of the myocardium. Other ventricular and aortic receptors were stimulated by elevation of intracardiac or aortic pressure. The pericardial, atrial, and papillary muscle receptors were excited by stretching the surrounding tissue. The discharge patterns of these receptors were not always synchronous with the events of the cardiac cycle. The stimuli required to excite each type of receptor (ventricular, atrial, etc.) and their resultant discharge patterns were not identical for all of the receptors. Excitation of cardiac receptors with sympathetic afferents resulted in 1--2 spikes per cardiac cycle, whereas receptors with vagal afferents resulted in bursts of spikes per cardiac cycle.