bluuebunny/crossref_metadata_2025 huggingface dataset:
Impact of treatment provision on the epidemiological recording of root caries
Authors: Walls A. W. G. , Silver P. T. , Steele J. G.
Published: March 2003

The estimation of root caries prevalence and the identification of risk factors for decay depend upon the successful identification of carious lesions in epidemiological studies. Root surface restorations can either be placed to manage decay or cervical wear/sensitivity. The handling of data for restorations during epidemiological surveys is critical to the accurate assessment of caries prevalence. The objective of this study was to determine the relative frequency of dentists' placing root surface restorations according to their reason for placement. Data for 696 restorations were recorded from 35 dentists. Forty‐five % of restorations were placed because of decay compared with 55% for cervical wear/sensitivity. There were no significant differences in proportion of placement of restoration with age of the patient or between regular and irregular attenders of different ages. Using these data a correction factor was developed for inclusion in the Root Caries Index (RCI) to make allowance for the proportion of restorations placed because of wear/sensitivity. When this correction factor was introduced into an existing data‐set for root caries, the RCI was reduced for all groups. This reduction was greatest in regular attenders. When these data were analysed without making allowance for treatment effects, there was a significant difference in RCI between regular and irregular attenders. When the correction factor was applied to these data, this difference was eliminated.
Metalloproteinase expression in normal and malignant oral keratinocytes: stimulation of MMP‐2 and ‐9 by scatter factor
Authors: Bennett J. H. , Morgan M. J. , Whawell S. A. , Atkin P. , Roblin P. , Furness J. , Speight P. M.
Published: March 2003

Matrix metalloproteinases (MMPs) are Zn2+ dependent proteases produced by a variety of cell types. They have a fundamental role in tissue remodelling, tumour invasion and metastasis. Scatter factor (SF), secreted by fibroblasts, has a paracrine action on epithelial cells and binds the trans‐membrane c‐met receptor inducing loss of adhesion, cell motility and invasiveness in vitro. The purpose of this study was to test if SF can regulate the production of MMPs by epithelial cells. Supernatants from oral squamous cell carcinoma‐derived cells (H375 and H376), a human keratinocyte line (UP), and primary cultures of oral mucosal keratinocytes, grown in the presence or absence of SF, were analysed using 0.1% gelatin zymography. MMPs were characterised by comparison with human recombinant enzymes and by the use of specific inhibitors. Oral mucosal keratinocytes, UP, and H357 cells expressed MMP‐2 and MMP‐9, whilst H376 cells only expressed MMP‐2. SF increased the expression of MMP‐9 in UP and MMP‐2 in H376 supernatants. Both MMP‐2 and MMP‐9 activity were increased in H357 and normal keratinocyte supernatants. This could be blocked using a human recombinant anti‐SF antibody. In all epithelial lines tested, c‐Met, the cell surface receptor for SF, could be detected. The results indicate that SF stimulates MMP expression in UP, H376, H357, and normal oral mucosal cells and points to a role for SF in the regulation of oral keratinocyte behaviour in wound healing and neoplasia.
Prevalence of hepatitis C virus in patients with lichen planus of the oral cavity and chronic liver disease
Authors: Del Olmo Juan A. , Pascual Isabel , Bagán José V. , Serra Miguel A. , Escudero Amparo , Rodriguez Felicidad , Rodrigo José M.
Published: March 2003

Lichen planus (LP) may represent a mucosal reaction to a variety of factors including hepatitis C virus (HCV) infection. We compared the prevalence of HCV infection in patients with LP of the oral mucosa and chronic liver disease (LP‐CLD) with those suffering exclusively from LP or from chronic liver disease (CLD). A total of 267 outpatients participated in a prospective study. There were 41 patients in the LP‐CLD group, 128 in the LP group, and 98 in the CLD group. The diagnosis of LP was based on typical macroscopic and histopathologic features and the diagnosis of liver disease on liver histology. Serum samples were screened for anti‐HCV antibodies. In 89 patients, serum HCV RNA was also measured. The overall prevalence of anti‐HCV antibodies was 29.2%(78/267 patients). Serum HCV RNA levels were positive in 96.2% of anti‐HCV‐positive patients and in none of anti‐HCV‐negative subjects. Anti‐HCV‐positivity was more frequent in the groups of LP‐CLD (78%) and CLD (42.8%) than in the LP group (3.1%). It is concluded that HCV infection plays an etiopathogenetic role in CLD associated with oral LP, whereas according to the present findings, the majority of patients suffering exclusively from oral LP are not infected by the HCV.
Differences in the composition of the subgingival microbiota of two periodontitis populations of different geographical origin. A comparison between Spain and The Netherlands
Authors: Sanz Mariano , Van Winkelhoff Arie Jan , Herrera David , Dellemijn‐Kippuw Nancy , Simón Rosa , Winkel Edwin
Published: March 2003

The purpose of this study was to compare the subgingival microbiota of two geographically distinct patient populations using identical clinical and bacteriological methods. Adult patients with a diagnosis of periodontitis were consecutively selected according to pre‐defined clinical criteria. Microbiological samples were taken from the deepest four sites with bleeding. The samples were plated on blood agar plates, for the determination of the total anaerobic counts and identification of specific bacterial pathogens, and on TSBV and McConkey for isolation of Actinobacillus actinomycetemcomitans and enteric rods, respectively. Thirty‐one patients in Spain and 30 patients in The Netherlands were selected. Both patient groups showed similar clinical characteristics, both in terms of age, gender and periodontal clinical variables. A. actinomycetemcomitans was significantly more prevalent (23.3% vs. 3.2%) in the Dutch group, while Porphyromonas gingivalis was significantly more prevalent (64.5% vs. 36.7%) in the Spanish group. Bacteroides forsythus and most commensal periodontal pathogens showed similar prevalences, except Peptostreptococcus micros that was significantly more frequent in the Dutch group (96.7% vs. 74.2%). In summary, the subgingival microbiota from the Spanish group was characterised by a high prevalence of P. gingivalis and low of A. actinomycetemcomitans, while the flora from the Dutch group was characterised by a high prevalence of A. actinomycetemcomitans and P. micros.
Release of prostaglandin E2, IL‐6 and IL‐8 from human oral epithelial culturemodels after exposure to compounds of dental materials
Authors: Schmalz Gottfried , Schweikl Helmut , Hiller Karl‐Anton
Published: March 2003

A three‐dimensional human tissue model based on TR146 cells isolated from a squamous cell carcinoma of the buccal mucosa was used to test for the release of the proinflammatory molecules prostaglandin E2(PGE2), interleukin 6 (IL‐6), and interleukin 8 (IL‐8) after exposure to nickel chloride (NiCl2), cobalt chloride (CoCl2), palladium chloride (PdCl2), and triethylene glycol dimethacrylate (TEGDMA). These compounds have documented adverse biological effects in vitro. The release of PGE2 from the tissue culture models was inversely correlated with cell viability (MTT assay). Toxic concentrations of NiCl2 and CoCl2 induced the release of PGE2 by factors of about 200–300 compared to controls, but PdCl2 which was nontoxic enhanced PGE2 levels about 10‐fold. TEGDMA, however, did not stimulate PGE2 release. None or weakly toxic concentrations of Ni and Co chloride induced IL‐6 and IL‐8 release by a factor of 5–10 compared to controls. The amounts of IL‐6 were induced 25‐ to 30‐fold by PdCl2 under physiological conditions, and IL‐8 levels were also slightly enhanced. Nontoxic TEGDMA concentrations induced IL‐6 levels 5‐fold, but IL‐8 amounts increased only slightly. We conclude that a steep rise of PGE2 is closely associated with cytotoxicity. On the other hand, the specific induction of IL‐6 occurs at much lower concentrations. Therefore, the measurement of this cytokine may be included as another parameter in evaluating the biological activity of dental materials under nontoxic experimental conditions in vitro.
Effects of phosphoric acid and glutaraldehyde‐HEMA on dentin collagen
Authors: Ritter André V. , Swift Edward J. , Yamauchi Mitsuo
Published: March 2003

The purpose of this study was to evaluate the effects of phosphoric acid (PA) and a proprietary glutaraldehyde‐HEMA aqueous solution (Gluma Desensitizer; GD) on dentin collagen. Specimens of demineralized bovine dentin collagen were treated with either 37% or 50% PA for 1 or 5 min. An additional set of specimens was treated with 37% PA for 1 min followed by GD for 1 min. All specimens were washed with distilled water, lyophilized, reduced with standardized NaB3H4, hydrolyzed with 6 M HCl and subjected to amino acid and cross‐link analyses. The results demonstrated that the treatment of demineralized dentin with PA under the conditions tested did not significantly alter the collagen cross‐links. The GD‐treated samples showed reduction of free lysine (Lys) and hydroxylysine (Hyl) residues, as well as a decrease in the levels of collagen reducible cross‐links. In addition, unidentified reducible compounds were detected by high‐performance liquid chromatography (HPLC) analysis. These compounds may be derived from cross‐links formed between GD‐derived aldehyde and Lys/Hyl of collagen. The findings indicate that PA treatment does not significantly affect dentin collagen amino acid and cross‐link composition, and that GD treatment affects dentin collagen amino acid and cross‐link composition.
Bactericidal effect of delmopinol on attached and planktonic Streptococcus sanguinis cells
Authors: Burgemeister Stefan , Decker Eva‐Maria , Weiger Roland , Brecx Michel
Published: March 2003

The aim of this investigation was to determine the antibacterial effect of varying concentrations of delmopinol‐HCl on attached as well as on planktonic Streptococcus sanguinis cells in vitro. In addition, a possible antiadhesive effect on attached micro‐organisms was to be investigated. S. sanguinis cells were allowed to attach to glass surfaces. These as well as planktonic cells were exposed to delmopinol‐HCl in concentrations ranging from 0.2% to 0.00005% for 2 min. The percentage of vital bacteria was calculated by means of a fluorescence staining method. Total counts of attached bacteria were performed to determine any possible detaching effect by the delmopinol‐HCl. The CFU were determined for the planktonic bacteria. Attached as well as planktonic bacteria showed a marked decrease in vitality following exposure to 0.2% delmopinol‐HCl. After exposure to 0.05% this was only the case with the attached microorganisms. The total number of attached bacteria was not reduced by the delmopinol treatment. During initial dental biofilm formation, delmopinol‐HCl causes a bactericidal effect when applied in concentrations of 0.05% and higher.
Dental anxiety in relation to mental health and personality factors
Authors: Hägglin Catharina , Hakeberg Magnus , Hällström Tore , Berggren Ulf , Larsson Lena , Waern Margda , Pálsson Sigurdur , Skoog Ingmar
Published: March 2003

Little is known about the longitudinal course of dental anxiety in relation to age, mental health and personality factors. In 1968–69 a representative sample of 778 women aged 38 to 54 yr took part in a psychiatric examination. Three hundred and ten were followed up in 1992–93. A phobia questionnaire, including assessment of dental fear, and the Eysenck Personality Inventory were distributed to the participants at both occasions. High dental fear was reported by 16.8% of the women at baseline and was associated with a higher number of other phobias, a higher level of neuroticism, more psychiatric impairment, more social disability due to phobic disorder, and a higher anxiety level. Among women who reported high dental fear in 1968–69 (n=36), 64% remitted and 36% remained fearful. Among women with low dental fear in 1968–69 (n=274), 5% reported high dental fear in 1992–93. Chronicity was associated with higher neuroticism, lower extraversion, and more psychiatric impairment at base‐line. Remission was associated with higher extraversion at baseline. Dental anxiety increased or decreased over time in concert with the number of other fears.
Prevalence of cervical spinal pain in craniomandibular pain patients
Authors: Visscher Corine M. , Lobbezoo Frank , De Boer Wim , Van Der Zaag Jacques , Naeije Machiel
Published: March 2003

It has often been suggested that patients with a craniomandibular disorder (CMD) more often suffer from a cervical spine disorder (CSD) than persons without a CMD. However, in most studies no controlled, blind design was used, and conclusions were based on differing signs and symptoms. In this study, the recognition of CMD and CSD was based upon the presence of pain. The aim of this study was to determine the prevalence of cervical spinal pain in persons with or without craniomandibular pain, using a controlled, single‐blind design. From 250 persons, a standardised oral history was taken, and a physical examination of the masticatory system and the neck was performed. Three classification models were used: one based on symptoms only; a second on signs only; and a third one based on a combination of symptoms and signs. The CMD patients were also subdivided in three subgroups: patients with mainly myogenous pain; mainly arthrogenous pain; and both myogenous and arthrogenous pain. Craniomandibular pain patients more often showed cervical spinal pain than persons without craniomandibular pain, independent of the classification model used. No difference in the prevalence of cervical spinal pain was found between the three subgroups of craniomandibular pain patients.
The curve of Spee and craniofacial morphology: a multiple regression analysis
Authors: Farella Mauro , Michelotti Ambra , Van Eijden Theo M. G. J. , Martina Roberto
Published: March 2003

The aim of this study was to investigate the relationship between the curve of Spee and skeletal facial morphology. Dental casts and lateral cephalograms were obtained from 59 orthodontic patients. The amount of concavity of the curve of Spee was calculated by a second‐order quadratic interpolation of buccal cusp tips obtained from lateral digital photographs of the teeth. The cephalometric analysis aimed to evaluate the sagittal and vertical craniofacial dimensions as well as the position of the mandibular condyle with respect to the occlusal plane. These variables, included in a multiple regression model, could explain 34% of the total variance of the curve of Spee. The amount of the curvature was significantly related to (a) the horizontal position of the condyle with respect to the dentition, (b) the sagittal position of the mandible with respect to the anterior cranial base, and (c) the ratio between the posterior and anterior facial height. No significant relationship was found between the curve of Spee and any of the other cephalometric variables. The curve of Spee was not influenced by age and gender of the subjects investigated.
Enamelysin and kallikrein‐4 mRNA expression in developing mouse molars
Authors: Hu Jan C‐C. , Sun Xiaoling , Zhang Chuhua , Liu Shengxi , Bartlett John D. , Simmer James P.
Published: March 2003

Proteolytic processing and degradation of enamel matrix proteins appears to be an essential feature of dental enamel formation. The source and character of proteolytic activity in the enamel matrix of developing teeth changes as enamel formation progresses. Two proteinases have been isolated from the extracellular enamel matrix of developing teeth: enamelysin (MMP‐20), a matrix metalloproteinase, and kallikrein‐4 (KLK4), a serine proteinase. Here, we ask if the expression of MMP‐20 and KLK4 correlate with the stage‐associated changes in the digestion of enamel proteins. Using in situ hybridization, we localized MMP‐20 and KLK4 mRNA in mouse maxillary first molars on postnatal days 1, 2, 3, 5, 6, 7, 9, 11, and 14. Enamelysin signal was first detected in preameloblasts, ameloblasts, and odontoblasts on day 2, but not in ameloblasts covering the enamel‐free zone. Enamelysin signal declined in ameloblasts on day 6 but persisted in the dental pulp. In contrast, KLK4 transcripts were first observed on day 3 in pulp and on day 6 in ameloblasts covering the enamel‐free zone. the KLK4 signal was present in maturation‐stage ameloblasts on days 9, 11, and 14. The expression patterns of MMP‐20 and KLK4 by ameloblasts in mouse molars are stage‐specific and complementary.
Living with a child with a severe orofacial handicap: experiences from the perspectives of parents
Authors: Trulsson Ulrika , Klingberg Gunilla
Published: March 2003

Orofacial functions include competences/abilities such as eating, breathing, speech/language, mimicry, as well as oral health, and disturbances are common in children with rare disorders. To describe parental experiences of orofacial function and needs in children with rare disorders, in‐depth interviews focusing on orofacial function were carried out with 14 parents. Interviews were transcribed verbatim and analysed in open, axial (theoretical) and selective coding processes according to Grounded Theory. Two core categories emerged from data in the analysis: ‘the vulnerable family’ and ‘support perceived from others’. The data indicated the importance of a balance between these two core categories: the strain caused by living in a family with a child with a severe disability/handicap, and the availability of perceived support from caregivers and significant others. This balance was necessary for the parents in developing self‐reliance and in reconciling themselves to their life situations. Parents described orofacial dysfunction in terms of feeding and communication problems, needs for orthodontic treatment to reduce risk of trauma or improve chewing, and drooling. Oral health issues such as dental caries and gingivitis were not mentioned. Five aspects of good professional attitude were recognized: respect, involvement, continuity, knowledge, and availability.
Correlation of Local Interleukin‐1beta Levels with Specific IgA Response Against Gardnerella vaginalis Cytolysin in Women with Bacterial Vaginosis
Authors: CAUCI SABINA , DRIUSSI SILVIA , GUASCHINO SECONDO , ISOLA MIRIAM , QUADRIFOGLIO FRANCO
Published: March 2003

PROBLEM: Mucosal immune system activation may represent a critical determinant of adverse sequelae correlated with bacterial vaginosis, as HIV sexual transmission, upper genital tract infections, cervicitis, endometritis, postsurgical infections, and adverse pregnancy outcomes as preterm delivery (PTD), low birth weight (LBW).

METHOD OF STUDY: Levels of interleukin‐1beta (IL‐1beta), anti‐Gardnerella vaginalis hemolysin (Gvh) IgA, pH, Nugent score, and number of leukocytes were measured in vaginal fluids of 60 fertile women with bacterial vaginosis and of 64 healthy controls.

RESULTS: Vaginal IL‐1beta levels were nearly 13‐fold higher in women with bacterial vaginosis (BV) and were associated with anti‐Gvh IgA response. IL‐1beta was positively correlated with leukocyte counts in the smear both in healthy and bacterial vaginosis positive women.

CONCLUSIONS: Induction of the proinflammatory cytokine IL‐1beta may be a necessary event to elicit an innate immune response to control anaerobic genital tract infections. High levels of vaginal IL‐1beta are associated with mounting of an antigen‐specific mucosal immune response in women with bacterial vaginosis. Parallel induction of innate and adaptive immune response may be associated with protection from ascent of micro‐organisms to the upper genital tract, and from acquiring viral infection through the vaginal tract.
Prospect for Immunocontraception using the NH2‐terminal Recombinant Peptide of Human Zona Pellucida Protein (hZPA)
Authors: KOYAMA KOJI , HASEGAWA AKIKO , GUPTA SATISH K.
Published: March 2003

PROBLEM: The zona pellucida is a feasible candidate for contraceptive vaccine. Our previous study showed that a human zona pellucida (ZPA) recombinant protein produced antiserum that inhibited human in vitro fertilization in rabbits. The objective of this study is to examine whether the human recombinant protein produce fertilization‐blocking antiserum in a non‐human primate.

METHOD OF STUDY: The amino terminal regions consisting of pig (198 amino acids) and human (206 amino acids) zona pellucida proteins were prepared by Escherichia coli to produce antisera in bonnet monkeys (Macaca radiata). Antibody production was assessed by immunofluorescent staining and enzyme‐linked immunosorbent assay (ELISA). Fertilization‐blocking test was carried out using human oocytes that had failed in intracytoplasmic sperm injection (ICSI) treatment under patient's informed consent.

RESULTS: Both antisera against pig and human recombinant proteins recog‐nized native human zona pellucida by immunofluorescent staining. However, anti‐recombinant human ZPA reacted to native pig zona protein more strongly than pig zona pellucida by ELISA. When human oocytes were treated with antisera before insemination, anti‐human ZPA antiserum inhibited human sperm binding to human zona pellucida, but anti‐pig ZPA antiserum did not.

CONCLUSIONS: Bonnet monkey produced fertilization‐blocking antibody by immunization with human recombinant ZPA. The homologous or highly similar sequence is effective for developing a contraceptive vaccine when using recombinant peptides.
Evolutionary Genetics and Infertility
Authors: GILL III THOMAS J.
Published: March 2003

PROBLEM: Mapping the human genome and advances in human evolution indicate a critical role for genetics in the study of reproduction.

METHOD OF STUDY: Literature in human evolution, genetics and reproduction.

RESULTS: This paper will focus on three points: (1) the course of primate evolution, (2) implications of this course for reproduction in humans, and (3) evolutionary mechanisms. Reproduction is the driving force of evolution, and sex selection is the important factor in determining reproductive activity. The hypothesis will be presented that the reproductive inefficiency of Homo sapiens (one of four pregnancies succeeds) is the consequence of the development of genetic isolation from other species of Homo that was necessary to drive the evolution of Homo sapiens. This hypothesis is based on the evidence that Homo sapiens and Homo neanderthalensis are separate species and that intermating would not yield fertile offspring (Haldane's Rule). This mating barrier involves zoological and linguistic differences and genetic mechanisms preventing fertile interspecies mating (chromosomal incompatibilities, disruption of genomic imprinting and recessive lethal defects).

CONCLUSIONS: The medical and philosophical implications of modern reproductive technologies that may circumvent mating barriers must be addressed prospectively: propagation of genetic defects that would be eliminated by natural selection; the specter of `genetic enhancement'; human cloning; and attempts to control the future direction of the evolution of Homo sapiens.
Macrophage Migration Inhibitory Factor in Human Pregnancy and Labor
Authors: Ietta F. , Todros T. , Ticconi C. , Piccoli E. , Zicari A. , Piccione E. , Paulesu L.
Published: March 2003

PROBLEM: Macrophage migration inhibitory factor (MIF) is a proinflammatory cytokine involved in reproduction. Presently there is no information on the possible involvement of MIF in the onset of labor.

METHODS: Macrophage migration inhibitory factor was assayed, by enzyme‐linked immunosorbent assay (ELISA), in maternal serum (MS) and amniotic fluid (AF) both, at midtrimester and at term, as well as in cord serum (CS) at birth. Extraembryonic membranes were analyzed by immunohistochemistry.

RESULTS: Amniotic fluid MIF concentrations were significantly higher at term (median 62.10 ng/mL) than at midtrimester (median 20.07 ng/mL) and reached a peak in term labor (median 258.80 ng/mL). The AF/MS ratio varied from a median of 4.34 at midtrimester and 33.7 at term labor. The MS/CS ratio was 0.4. Migration inhibitory factor immunoreactivity was found in different cell layers of the extraembryonic membranes.

CONCLUSIONS: The increased secretion of MIF in AF at term, particularly at term labor, suggests that MIF contributes to the inflammatory events leading to labor.
Antiprothrombin Antibodies are Associated with Pregnancy Loss in Patients with the Antiphospholipid Syndrome
Authors: von Landenberg P. , Matthias T. , Zaech J. , Schultz M. , Lorber M. , Blank M. , Shoenfeld Y.
Published: March 2003

OBJECTIVE: To document the clinical association between the history of pregnancy loss in patients with the diagnosis of primary or secondary antiphospholipid syndrome (APS) and the presence of different antiprothrombin antibody subtypes [immunoglobulin G (IgG), IgM and IgA] in a cohort of patients with APS.

METHODS: Records of 170 female patients with primary APS, or APS secondary to systemic lupus erythematosus (SLE) or secondary to other autoimmune diseases were studied.

RESULTS: In female APS patients with IgG antiprothrombin antibodies (n = 105) significant associations to pregnancy loss (p < 0.0001), early pregnancy loss (p < 0.0001) and a negative association to thrombocytopenia (p < 0.01) could be identified. In the group of patients with IgG antiprothrombin antibodies and at least one pregnancy (n = 84) a significant association with pregnancy loss (p < 0.005) and especially with early pregnancy loss (p < 0.0001) was demonstrated. No association with other immunoglobulin subtypes of antiprothrombin antibodies could be documented. In the subgroup of patients with primary APS and at least one pregnancy in the history, pregnancy loss (p < 0.005) and early pregnancy loss (p < 0.0001) were found to be highly associated with the presence of IgG antiprothrombin antibodies. IgG antiprothrombin antibodies represent the highest independent risk factor for pregnancy loss with an odds ratio of 4.5. There was no statistically significant association with venous or arterial thrombosis in all IgG antiprothrombin antibody positive patients

CONCLUSION: The results of this study document the association of IgG antiprothrombin antibodies with pregnancy loss and in particular early pregnancy loss in a large and well‐characterized cohort of patients. We would recommend routine testing for antiprothrombin antibodies in young female patients with APS.
Effect of Intravenous Immunoglobulin Treatment on the Th1/Th2 Balance in Women with Recurrent Spontaneous Abortions
Authors: Graphou Olga , Chioti Athanasia , Pantazi Ageliki , Tsekoura Christina , Kontopoulou Virginia , Georgiadou Eleftheria , Balafoutas Christos , Koussoulakos Stavros , Margaritis Loukas H. , Varla‐Leftherioti Marighoula
Published: March 2003

PROBLEM: The way by which intravenous immunoglobulin (IvIg) acts to prevent immunlogically mediated recurrent spontaneous abortions (RSA) has not been clarified. In the present study, a possible effect of IvIg on the T helper cell (Th1/Th2) balance was investigated in abortions of either alloimmune or autoimmune abnormalities.

METHOD OF STUDY: The study included 21 women treated with IvIg before conception because of a history of RSA characterized by alloimmune abnormalities (n = 15) or associated with anti‐phospholipid antibodies (APA) (n = 6). Peripheral blood samples, collected before and 5 days after the first IvIg infusion, were stimulated, and Th1 and Th2 cells were detected by flow‐cytometric analysis using a combination of monoclonal antibodies against T‐cell surface markers and intracellular interferon (IFN)‐γ and interleukin (IL)‐4. The percentage of IFN‐γ‐producing (Th1) and IL‐4‐producing (Th2) cells and the Th1/Th2 ratio were compared between pre‐ and post‐infusion samples.

RESULTS: A decrease of Th1 percentage in 66.6% of the cases and a concurrent Th2 percentage increase (47.61%) resulted in a decrease in the Th1/Th2 ratio in most of the cases (76.1%) (p < 0.01). Similar results were found in Group A (Th1/Th2 decreased in 60% of the cases, p < 0.05), while in Group B the effect of IvIg was not clear (Th1/Th2 increased in three and decreased in another three cases).

CONCLUSION: Our finding suggests that IvIg administration in women with alloimmune RSA enhances Th2 polarization. This is not always the case with APA‐associated abortions.
Intravenous Immunoglobulin Treatment in Women with Recurrent Abortions: Increased Cytokine Levels and Reduced Th1/ Th2 Lymphocyte Ratio in Peripheral Blood
Authors: Yamada Hideto , Morikawa Mamoru , Furuta Itsuko , Kato Emi H. , Shimada Shigeki , Iwabuchi Kazuya , Minakami Hisanori
Published: March 2003

PROBLEM:  The aim of this study was to investigate changes in peripheral blood Th1/Th2 cytokine levels and lymphocyte ratios after massive intravenous immunoglobulin (MIVIg) treatment for women with recurrent spontaneous abortion (RSA) of unexplained etiology.

METHOD OF STUDY:  Serum Th1 (IFN‐γ, TNF‐α) and Th2 cytokine (IL‐4, IL‐10) levels were assessed by ELISA methods (n = 9) and peripheral blood Th1/Th2 lymphocyte ratios (n = 4) by flow cytometry before and after MIVIg treatments in women with four or more consecutive RSA.

RESULTS:  Pre‐treatment serum IFN‐γ (0.06 ± 0.09 pg/mL, mean ± SD), TNF‐α (0.21 ± 0.45 pg/mL), IL‐4 (0.70 ± 1.16 pg/mL), and IL‐10 (1.12 ± 1.67 pg/mL) increased to 0.17 ± 0.16 pg/mL, 0.77 ± 0.28 pg/mL, 1.82 ± 0.89 pg/mL, and 3.44 ± 0.48 pg/mL, respectively, after MIVIg treatments (P < 0.05). CD4‐positive IFN‐γ/IL‐4 lymphocyte ratios (17.3 ± 9.1) were reduced to 11.5 ± 7.1 after treatment (P < 0.05).

CONCLUSIONS:  Massive intravenous immunoglobulin treatments increased peripheral blood cytokine levels and decreased Th1/Th2 lymphocyte ratios; thus, MIVIg treatments modify the peripheral Th1/Th2 balance.
Pulp revascularization of replanted immature dog teeth after different treatment methods
Authors: Yanpiset K. , Trope M.
Published: March 2003

Abstract – The purpose of the present study was to determine the effect of topical treatment with doxycycline and/or the application of unfilled resin to the anatomical crown on the occurrence of revascularization in reimplanted dog teeth. Ninety‐six teeth in 4 young mongrel dogs were used. Eighty one teeth were atraumatically extracted and divided into four groups. Group 1, 17 teeth were kept dry for 5 min and then replanted. Group 2, 21 teeth were soaked with a freshly prepared solution of doxycycline (1 mg/20 mL saline) for 5 min before replantation. Group 3, 23 teeth were soaked with the doxycycline solution for 5 min, and then replanted. The crowns were coated with 2 layers of light cured unfilled resin. Group 4, 20 teeth were kept dry for 5 min, and then replanted. The crowns were treated as with the teeth in Group 3. Three months after surgery, radiographic evaluation revealed that 27 teeth had continued root development and 32 teeth showed arrested root development with periradicular pathosis. The remaining 17 teeth, which had arrested root development but no signs of periradicular pathosis, were all histologically evaluated for final assessment. The occurrence of revascularization according to treatment group was 29.4%, 60%, 60%, 36.8% in Group 1, 2, 3, and 4, respectively. A multiple logistic regression analysis in SAS indicated there was no significant association between vitality and dog (P=0.7564). Soaking for 5 min in doxycycline significantly increased the revascularization rate (P=0.024) while the addition of resin to the crown did not result in an increased incidence of pulp revascularization (P=0.823).
Tongue piercing and associated oral and dental complications
Authors: De Moor R. J. G. , De Witte A. M. J. C. , De Bruyne M. A. A.
Published: March 2003

Abstract – The insertion of metal objects into intraoral and perioral sites is growing in popularity. However, there are numerous oral and dental complications associated with tongue piercing. Fifteen patients with tongue piercings (pierced in the body of the tongue, anterior to the lingual frenum) attending the dental office of the authors, with and without complaints, were clinically and radiographically examined. The most common dental problem registered was chipping of teeth. Furthermore, two cracked teeth and four teeth with cusp fractures were also seen. One case of selective dental abrasion was registered. Trauma to the lingual anterior gingiva was the most common gingival problem. A salivary flow stimulating effect was only reported by 2 of the 15 individuals. None of the patients complained of interference with speech, mastication and swallowing. One case of galvanic currents produced by the appliance was registered. On the basis of the registered data, we concluded that patients need to be better informed of the potential complications associated with tongue and oral piercings, and that the dental profession can serve this role.
The sealing ability of an epoxy resin root canal sealer used with five gutta‐percha obturation techniques
Authors: De Moor R. J. G. , De Boever J. G.
Published: March 2003

Abstract – The purpose of the present study was to evaluate the apical sealing ability of an epoxy resin root canal sealer (AH‐26) when used with different gutta‐percha obturation techniques (i.e. cold lateral condensation, warm vertical condensation, hybrid condensation) and with Thermafil and Soft‐Core obturators. Straight single‐rooted teeth with mature apices were prepared according to the crown‐down/step‐back technique and divided in five groups of 45 teeth and one group of 12 control teeth. After root canal filling 15 teeth of each group were kept for 1 day, another 15 teeth for 1 week, and another 15 teeth for 4 months at 37 °C in vacutainers in 80% relative humidity. The 237 teeth were immersed in india ink for 90 hours, each root was split and sectioned longitudinally, and the maximum extent of leakage was measured using a stereomicroscope at ×6 magnification. It became clear that leakage occurred whatever technique was combined with AH26 and that leakage increased with time. The amount of apical leakage and the number of leaking teeth in the Soft‐Core obturator groups was significantly higher than all other 4 gutta‐percha obturation techniques combined with AH26. In this respect, the hybrid gutta‐percha condensation technique turned out to be superior to the four other condensation techniques.
Percutaneous dilational tracheostomy: a safer technique  of airway management using a microlaryngeal tube
Authors: Fisher L. , Duane D. , Lafreniere L. , Read D.
Published: March 2003

Management of the airway in an intubated patient during formation of a tracheostomy can be hazardous. The usual method involves withdrawal of the tracheal tube, which has been providing a secure airway, prior to inserting the tracheostomy tube. A method of airway management, using a microlaryngeal tube, has been devised with the aim of maintaining full tracheal intubation and ventilation until the correct position of the tracheostomy tube can be verified. An audit of 250 successive cases of percutaneous tracheostomy demonstrated this method to be safe and effective.
Role of perineal sonography in the evaluation of patients with stress urinary incontinence
Authors: Sendag Fatih , Vidinli Halit , Kazandi Mert , Itil Ismail M. , Askar Niyazi , Vidinli Berna , Pourbagher Ali
Published: March 2003

Objective: The aim of the study was to determine the role of perineal sonography in diagnosis of stress urinary incontinence.

Materials and methods: Thirty patients with stress urinary incontinence and 17 age‐matched control patients were included in the study. Perineal sonography was carried out in both groups to evaluate the role of this technique in the diagnosis of stress urinary incontinence. By using the posterior edge of the symphysis pubis as a reference point, posterior urethra‐vesical angle (beta angle) and the angle between the vertical axis and urethral axis (alpha angle) were measured at rest and on straining. Bladder neck mobility was evaluated only at the cephalocaudal plane by measuring the desensus diameter.

Results: Posterior urethro‐vesical angle (beta angle) was found to be significantly different between the study and control groups both at rest and on straining (P < 0.05). The angle between the vertical axis and urethral axis (alpha angle) was found to be significantly different between study and control groups only on straining (P < 0.05). Cephalocaudal distance (desensus diameter) was longer in patients with stress urinary incontinence (P < 0.05).

Conclusion: Perineal sonography has an important role in diagnosing patients with stress urinary incontinence.
Antenatal pelvic organ mobility is associated with delivery mode
Authors: Dietz Hans P. , Moore Kate H. , Steensma Anneke B.
Published: March 2003

Objective: Relaxation of pelvic ligaments may facilitate parturition in certain animal species. Biomechanical properties of pelvic connective tissue may also influence progress of labour in the human female. This study was designed to test whether peripheral joint mobility or pelvic organ mobility as measures of connective tissue biomechanical properties are associated with progress in labour and delivery mode.

Design: Prospective clinical observational study.

Setting: Tertiary obstetric service.

Sample: 200 nulliparous women recruited in antenatal clinic.

Methods: Translabial ultrasound was used to obtain data on third trimester pelvic organ mobility. Upper limb joint mobility was assessed clinically.

Main outcome measures: Gestational length, length of first and second stage of labour, delivery mode.

Results: Pelvic organ mobility was significantly associated with total length of second stage (P = 0.034 to P = 0.002). This was mainly due to the length of passive, not active second stage. There also was a statistically significant association between delivery mode and pelvic organ descent (P = 0.007 to P = 0.001), with the lowest mobility seen in women who required a Caesarean section in second stage. Joint mobility did not correlate with delivery data.

Conclusion: Third trimester pelvic organ mobility is associated with duration of second stage and delivery mode.
Cellular copper content modulates differentiation and self‐renewal in cultures of cord blood‐derived CD34+ cells
Authors: Peled Tony , Landau Efrat , Prus Eugenia , Treves Abraham J. , Fibach Eitan
Published: March 2003

Summary.  Several clinical observations have suggested that copper (Cu) plays a role in regulating haematopoietic progenitor cell (HPC) development. To further study this role we used an ex vivo system. Cord blood‐derived CD34+ cells were cultured in liquid medium supplemented with Kit‐ ligand, FLt3, interleukin 6 (IL‐6), thrombopoietin and IL‐3. Under these conditions, Cu content, measured by atomic absorption, was 7 ng/107 cells. Modulation of intracellular Cu was achieved by supplementing the cultures with the Cu chelator tetraethylenepentamine, which reduced cellular Cu (4 ng/107 cells), or ceruloplasmin or Cu sulphate that elevated cellular Cu (18 and 14 ng/107 cells respectively). The results indicated that low Cu content delayed differentiation, as measured by the surface antigens CD34, CD14 and CD15, colony‐forming unit (CFU) frequency and cell morphology, while high Cu accelerated differentiation compared with Cu unmanipulated cultures. As a result, expansion of total cells, CFU and CD34+ cells in low Cu was extended (12–16 weeks), and in high Cu was shortened (2–4 weeks), compared with control cultures (6–8 weeks). These effects required modulation of intracellular Cu only during the first 1–3 weeks of the culture; the long‐term effects persisted thereafter, suggesting that the decision process for either self‐renewal or differentiation is taken early during the culture. This novel method of controlling cell proliferation and differentiation by copper and copper chelators might be utilized for ex vivo manipulation of HPC for various clinical applications.
Multidrug resistance mechanisms in chronic lymphocytic leukaemia
Authors: Consoli Ugo , Santonocito AnnaMaria , Stagno Fabio , Fiumara Paolo , Privitera Antonella , Parisi Giuseppina , Giustolisi Giada M. , Pavone Biagia , Palumbo Giuseppe A. , Di Raimondo Francesco , Milone Guglielmo Giuseppe, Patrizia , Giustolisi Rosario
Published: March 2003

Summary. We evaluated the presence of P‐glycoprotein (P‐gp)‐170, multidrug resistance protein (MRP), lung resistance protein (LRP)‐56 and Bcl‐2 in CD19‐positive cells from 100 cases of chronic lymphocytic leukaemia (CLL). P‐gp‐170 was found in 73% of the CLL cases with no significant difference regarding stage or previous treatment. LRP‐56 protein was homogeneously distributed with no differences for stage or treatment. MRP protein was detected at a low level of expression in 49·4% of CLL patients with no differences for stage or treatment. Bcl‐2 protein was expressed at a high level in all CLL patients and higher levels were found in the advanced stage. This leads us to conclude that P‐gp, MRP, LRP‐56 and Bcl‐2 are frequently expressed in CLL. P‐gp, MRP and LRP are not correlated to stage or previous treatment. Bcl‐2 is higher in advanced‐stage patients. The clinical and biological significance of these zMDR mechanisms in CLL remains to be fully explained.
Effect of chronic renal failure on mortality rate following arterial reconstruction
Authors: Gerrard D J , Ray S A , Barrio E A , Wood C H , Scoble J E , Taylor P R
Published: March 2003

Background

There is some evidence that patients with renal failure who have arterial procedures may have a poor outcome. This study compared the hospital mortality rate of arterial surgery in patients with chronic renal failure and those with normal renal function.

Methods

A consecutive series of 1718 patients undergoing arterial reconstructive surgery (excluding amputation) was entered prospectively on to a computerized database. Chronic renal failure was defined as a serum creatinine level over 400 µmol/l, or dialysis (either peritoneal or haemodialysis), or a successful renal transplant. Mortality was assessed at 30 days or in hospital.

Results

There were 69 patients (4·0 per cent) who were defined as having chronic renal failure. The mortality rate in this group was 23 per cent (16 patients) compared with 7·3 per cent (120 patients) of the 1649 patients without renal failure. The mortality rate was highest in patients undergoing urgent or emergency surgery and in those undergoing reconstruction for lower limb occlusive disease. The main causes of death were related to the cardiovascular system.

Conclusion

Patients with chronic renal failure undergoing arterial surgery have a poor outcome compared with those with normal renal function.
Phase I study of percutaneous cryotherapy for colorectal liver metastasis
Authors: Huang A , McCall J M , Weston M D , Mathur P , Quinn H , Henderson D C , Allen-Mersh T G
Published: March 2003

Background

The aim was to determine the safety and feasibility of percutaneous cryotherapy for treating irresectable colorectal liver metastases.

Methods

Liquid nitrogen cryoprobes were inserted percutaneously into metastases using the Seldinger technique under computed tomographic guidance. Single-probe treatments were performed with either 3·6- or 6·3-mm cryoprobes (ice-ball volumes 18 and 59 cm3 respectively), or dual-probe treatments with two adjacent 6·3-mm probes (ice-ball volume 205 cm3). Treatment involved a single freeze–thaw cycle.

Results

Fifteen patients received 25 single-probe treatments and seven patients received 14 dual-probe treatments. The treatment-related mortality rate was zero and complications occurred after six of 39 treatments. Liver metastasis growth was significantly delayed for 2 months after dual-probe but not single-probe treatment. Metastasis cryotherapy stimulated an immediate rise, followed by a fall, in serum carcinoembryonic antigen (CEA) level, associated with immune upregulation that was significantly greater after dual-probe treatments.

Conclusion

Ablation zones that were approximately four times larger than those produced by previously described percutaneous techniques delayed the growth of metastases, reduced serum CEA concentration, and induced detectable inflammatory and T-lymphocyte responses. Percutaneous cryotherapy for treatment of colorectal liver metastases is feasible and may have a place in conjunction with chemotherapy.
Randomized clinical trial assessing the side-effects of glyceryl trinitrate and diltiazem hydrochloride in the treatment of chronic anal fissure
Authors: Kocher H M , Steward M , Leather A J M , Cullen P T
Published: March 2003

Introduction

Glyceryl trinitrate (GTN) ointment (0·2 per cent) has an efficacy of up to 68 per cent in healing chronic anal fissure, but with headache as a major side-effect. Diltiazem hydrochloride (DTZ) cream (2 per cent) is expected to have fewer side-effects.

Methods

A prospective double-blind randomized two-centre trial requiring at least 26 patients in each group (α = 0·05, β = 0·9) was instituted after approval of the local ethics committee, to compare the incidence of side-effects (primary endpoint) with 0·2 per cent GTN ointment and 2 per cent DTZ cream in the treatment of chronic anal fissure. Treatments were applied perianally, twice daily for 6–8 weeks. All patients gave written informed consent.

Results

Both groups were comparable in patient demographics and clinical characteristics. Twelve patients violated the protocol, withdrew or did not attend follow-up. There were more side-effects with GTN (21 of 29 patients) than with DTZ (13 of 31) (relative risk (RR) 1·84 (95 per cent confidence interval (c.i.) 1·11 to 3·04), P = 0·01). In particular, more headaches occurred with GTN (17 of 29 patients) than with DTZ (eight of 31) (RR 2·06 (95 per cent c.i. 1·18 to 3·59), P = 0·01). There were no significant differences in healing and symptomatic improvement rates between patients receiving GTN (25 of 29) and DTZ (24 of 31).

Discussion

DTZ cream caused substantially fewer headaches than GTN ointment. There was no significant difference in the healing or improvement of chronic anal fissure between the treatments. DTZ may be the preferred first-line treatment for chronic anal fissure.
Risk of femoral hernia after inguinal herniorrhaphy
Authors: Mikkelsen T , Bay-Nielsen M , Kehlet H
Published: March 2003

Background

Small case series have suggested an increased risk of femoral hernia after previous inguinal herniorrhaphy, but no large-scale data with complete follow-up are available.

Methods

Data were extracted from the Danish Hernia Database covering the interval from 1 January 1998 to 1 July 2001, and included 34 849 groin hernia repairs.

Results

Of 1297 femoral hernia repairs, 71 patients had previously had an operation for inguinal hernia within the observation period. These 71 femoral hernias represented 7·9 per cent of all reoperations for groin hernia recorded in the database. The median time to reoperation for a ‘recurrent’ femoral hernia after previous inguinal herniorrhaphy was 7 months, compared with 10 months for inguinal recurrences. The risk of developing a ‘recurrent’ femoral hernia after previous inguinal herniorrhaphy was 15 times higher than the rate of femoral hernia repair in the general population.

Conclusion

This study of 34 849 groin hernia repairs demonstrated a 15-fold greater incidence of femoral hernia after inguinal herniorrhaphy compared with the spontaneous incidence. These femoral recurrences occurred earlier than inguinal recurrences, suggesting that they were possibly femoral hernias overlooked at the primary operation.