Progression of periodontal destruction and the roles of advanced glycation end products in experimental diabetes.

BACKGROUND: Progression of diabetes-associated periodontal destruction and the roles of advanced glycation end products (AGEs) are investigated. METHODS: Diabetes was induced by streptozocotin injection, and periodontitis was induced via silk ligature placement with Porphyromonas gingivalis lipopolysaccharide injection in 64 Sprague-Dawley rats for 7 to 21 days. The quality of alveolar bone and attachment loss (AL) were measured by microcomputed tomography and histology. Destruction profiles were evaluated by histology, histochemistry, immunohistochemistry, and quantitative assessments of inflammatory cells, expression of receptors for AGEs (RAGE), tartrate-resistant acid phosphatase, and proliferating cell nuclear antigen. RESULTS: Without periodontitis induction, there was no obvious morphologic change in the periodontium, although slight elevations of AGEs and RAGE levels were noted in animals with diabetes. In the group with experimental periodontitis, significant periodontal bone loss was noted in animals both with and without diabetes from day 7, with more progressive bone loss in animals with diabetes during days 14 to 21. Histologically, the disruption of attachment and inflammation were observed from day 7, but subsequently subsided in animals without diabetes. A stronger and more prolonged response with significant AL was observed in animals with diabetes. Stronger inflammation, attenuated and persistent resorptive activity, and weaker proliferating potential were demonstrated by animals with diabetes. AGE deposition and RAGE expression were noted in animals without diabetes but with periodontitis, although levels were considerably elevated in the later stages in animals with diabetes. CONCLUSIONS: Diabetes augments periodontal destruction by reducing the proliferating capability and activating resorptive activities. Presence of the AGE-RAGE axis without diabetes implies that it is involved in the regulation of inflammation.

The rate of change in retinal vessel width and tortuosity in eyes at risk for retinopathy of prematurity.

PURPOSE: To describe the rate of change in retinal vessel width and tortuosity in eyes that develop treatment-requiring, or type 1, retinopathy of prematurity (ROP) versus eyes that do not develop type 1 ROP. METHODS: Posterior poles of eyes of 41 infants at risk for ROP were imaged longitudinally with a 30° fundus camera. Retinal vessel width and tortuosity were measured with computer-assisted image analysis. The rate of change per day in width and tortuosity up to the development of most severe ROP was calculated from linear regression and eyes with (n = 10) and without type 1 ROP (n = 31) were compared. RESULTS: Eyes that developed type 1 ROP had a greater rate of change in width for venules and 3 widest vessels (P < 0.0001), and a greater rate of change in tortuosity for arterioles and 3 most tortuous vessels (P < 0.0001) than eyes that did not develop type 1 ROP. These vessel parameters discriminate the 2 groups well (area under the ROC curve, 0.79-0.90). A combination of venular width and arteriolar tortuosity had the best discriminative ability (area under the ROC curve, 0.96). CONCLUSIONS: In this pilot study, eyes that eventually developed type 1 ROP demonstrated a faster increase in width and tortuosity of retinal vessels compared with those that did not. Further study of the kinetics of retinal vascular change in a larger sample may allow for the earlier identification of vision-threatening ROP.

Digital image analysis in retinopathy of prematurity: a comparison of vessel selection methods.

PURPOSE: To evaluate vessel selection methods to distinguish between eyes with and without retinopathy of prematurity (ROP) and between different stages of ROP when quantifying the associated vessel changes in width and tortuosity semiautomatically from digital retinal images. METHODS: Color digital images from 75 infants screened for ROP were cropped to a standardized diameter of 240 pixels and evaluated by semiautomated vessel analysis software, Computer-Aided Image Analysis of the Retina (CAIAR), to measure retinal vessel width and tortuosity. Two methods of vessel selection were used: (1) clinical observer selecting the most prominent arteriole or venule in each retinal quadrant (4-vessel analysis) and then separately the 4 most prominent arterioles and venules from each quadrant (8-vessel analysis); (2) CAIAR selecting, regardless of retinal quadrant, the 4 widest or most tortuous arterioles or venules. Selected vessels were measured by CAIAR for tortuosity and width. RESULTS: When comparing ROP stages, whether observer or CAIAR selected and whether 4 or 8 vessels were analyzed, we found that arteriolar tortuosity was significantly greater with advancing ROP stage for stage 0 versus stage 2; stage 0 or 1 versus stage 3; stages 1+2 combined versus stage 3; and stage 0 versus 1+2+3 combined (P < 0.01). Venular tortuosity was significantly greater with advancing ROP stage for stage 0 versus stage 3 and stage 0 versus stages 1 and 2+3 combined (P < 0.01). Width parameters did not help us to distinguish between stages. CONCLUSIONS: Distinguishing between arterioles and venules is not necessary to differentiate stage 0 ROP from stage 2 or 3 ROP when one is using CAIAR. Tortuosity shows more promise than width at providing a reliable vessel parameter for distinguishing between eyes without and with ROP.

Risk stratification of preplus retinopathy of prematurity by semiautomated analysis of digital images.

OBJECTIVE: To determine whether quantitative analysis of retinal vessel width and tortuosity from digital images discriminates which eyes with preplus retinopathy of prematurity (ROP) progress to treatment severity. METHODS: Posterior pole images of eyes at first clinical diagnosis of preplus ROP were obtained using a 30 degrees-field, noncontact fundus camera. Width and tortuosity of retinal vessels were analyzed from digital images using computer-assisted image analysis software. Mean width and tortuosity of venules and arterioles were compared in 19 preplus eyes that regressed spontaneously and 11 preplus eyes that progressed to treatment severity. Receiver operating characteristic curve analysis was performed to assess whether width and tortuosity discriminated between groups. RESULTS: Mean widths of venules alone, arterioles alone, and the 3 widest vessels were higher in preplus progressed eyes (P < .04). Mean tortuosity of the 3 most tortuous vessels was higher in preplus progressed than in preplus regressed eyes (P = .01). Most vessel width and tortuosity variables predicted which eyes with preplus progressed to treatment moderately well, with an area under the receiver operating characteristic curve of 0.72 to 0.82. CONCLUSIONS: Digital image analysis of retinal vessel width and tortuosity may be useful in predicting which preplus ROP eyes will require treatment. Because vascular abnormalities are a continuum and clinical diagnosis is subjective, quantitative analysis may improve risk stratification for ROP.