bluuebunny/crossref_metadata_2025 huggingface dataset:
A Nursing Home in Arab‐Israeli Society: Targeting Utilization in a Changing Social and Economic Environment
Authors: Suleiman Khalid , Walter‐Ginzburg Adrian
Published: December 2004

This article is a case study of the first 10 years of operation (1992–2002) of the Dabouriya Home for the Aged, the first publicly funded culturally adapted nursing home for Israeli citizens of Arab descent. Although 44% of Arab Israelis and 26% of Jewish Israelis aged 65 and older are disabled, in 1999, 4.3% of the Jewish population but only 0.7% of the Arab‐Israeli population aged 65 or older lived in long‐term care institutions; disabled Arab‐Israeli elderly were mainly cared for by families. As Arab‐Israeli society modernizes and traditional caregiving is reduced, alternatives must be found for this growing, disabled population. Medical and administrative records of 404 people admitted consecutively to a 136‐bed facility over 10 years were analyzed. Two distinct segments of the needy population were served: people with independent activity of daily living (ADL) function but little or no family to provide help with intermediate ADLs and those dependent in ADLs and with health problems, especially dementia. Economic, demographic, and social changes in Arab‐Israeli society may mean that traditional caregivers will not be able to adequately care for this highly disabled population. Administrators of the public health system in Israel should be aware of the underutilization of publicly funded long‐term care by disabled Arab Israelis and the lack of care alternatives for the population that does use nursing homes, because there may be severe consequences in terms of caregiver burden and social stress when disabled elderly people remain in unsuitable environments.
Rapid quantitation of immunoglobulin G antibodies specific for blood group antigens A and B by surface plasmon resonance
Authors: Kimura Shinya , Yurugi Kimiko , Segawa Hidekazu , Kuroda Junya , Sato Kiyoshi , Nogawa Masaki , Yuasa Takeshi , Egawa Hiroto , Tanaka Koichi , Maekawa Taira
Published: December 2004

BACKGROUND:  The measurement of immunoglobulin (Ig) G blood group A/B antibody(anti‐A/B) levels is important for ABO‐unmatched organ recipients because the effective removal of the antibodies improves their prognosis. Currently existing methods to detect IgG anti‐A/B suffer limitations owing to high costs, low throughput, and poor adaptability to automation.

STUDY DESIGN AND METHODS:  We have developed a rapid means to quantitate IgG anti‐A/B by surface plasmon resonance (SPR). To investigate the accuracy, a serially diluted plasma sample from a donor was measured with the SPR method. Moreover, IgG anti‐A/B titers in 45 healthy volunteers were measured both by the SPR and by the standard tube test (TT) method, as were plasma samples from two ABO‐unmatched organ recipients.

RESULTS:  The change in titers when the same plasma was diluted was precisely reflected by the SPR method. The coefficients of correlation between SPR and TT methods for IgG anti‐A and anti‐B were 0.85 and 0.56, respectively. The SPR values also paralleled the TT values, which showed a decline in titers after the removal of antibodies by double‐filtration plasmapheresis or plasma exchange.

CONCLUSION:  This SPR method can be used to measure IgG anti‐A/B titers in the plasma very quickly and quantitatively.
Blood bank on‐call physician's experiences at a large university medical center
Authors: Bryant Barbara J. , Alperin Jack B. , Indrikovs Alexander J.
Published: December 2004

BACKGROUND:  The responsibilities of the blood bank on‐call physician (blood bank physician from here on) encompass many aspects of transfusion medicine and physician education. This physician is available 24 hours a day to address any issues concerning the collection and transfusion of blood and blood components. The purpose of this study was to identify and categorize the issues that may confront a blood bank physician.

STUDY DESIGN AND METHODS:  Each call received over a 4‐month period was logged and the resolution documented. The calls were grouped into five categories: donor issues, therapeutic procedure issues, patient issues, physician education issues, and requests for blood components not meeting previously defined transfusion guidelines.

RESULTS:  The blood bank physician received 224 calls during the study period. To resolve each issue, an additional 1 to 14 telephone calls were needed to gather further information. Number of calls by category were donor issues, 20 (8.9%); therapeutic procedure issues, 9 (4.0%); patient issues, 4 (1.8%); physician education issues, 33 (14.7%); and requests for blood components not meeting previously defined transfusion guidelines, 158 (70.6%). Requests for blood components were denied in 39.8 percent of the cases not meeting guidelines. Other forms of therapy were warranted in 20.9 percent of the cases.

CONCLUSION:  This study revealed that 85.3 percent of the calls referred to the blood bank physician related to physician education and the appropriateness of blood component orders. These results emphasize the need for ongoing education of medical staff in transfusion medicine issues.
Multiple red cell alloantibodies, including anti‐Dib, after allogeneic ABO‐matched peripheral blood progenitor cell transplantation
Authors: Żupańska Barbara , Zaucha J. Maciej , Michalewska Bogumila , Malinowska Aniela , Brojer Ewa , Hellmann Andrzej
Published: December 2004

BACKGROUND:  Data on red blood cell (RBC) alloantibody appearance after hematopoietic progenitor cell transplantation (HPCT) from an ABO‐matched donor are limited.

CASE REPORT:  A 32‐year‐old Caucasian man with chronic myeloid leukemia, never transfused, conditioned with BuCy120, received granulocyte–colony‐stimulating factor–mobilized peripheral blood progenitor cells from his HLA‐identical sister. Graft‐versus‐host disease (GVHD) prophylaxis consisted of cyclosporine A and methotrexate. The patient engrafted showing complete donor chimerism and developed Grade 3 acute GVHD and subsequently extensive chronic GVHD. He received 2 units of RBCs on Days 13 and 14 without clinical signs of hemolysis.

RESULTS:  Patient was 0 Rh–K–JK(a–) and donor was 0 Rh+K–JK(a–). Pretransplant alloantibody screening was negative in the patient. In the donor, anti‐E was detected before donation, together with anti‐Jka and anti‐Dib 4, 9, and 12 months after donation, likely triggered by RBC transfusion 2 months before cell harvest. In the patient, anti‐Jka was detected on Day +25 and later anti‐E and anti‐Dib as well. In both, a Dia/Dia genotype was identified. Both parents were Di(a+b+).

CONCLUSIONS:  Three kinds of non‐ABO alloantibodies were detected, including anti‐Dib described for the first time after HPCT. The rapid development of antibodies in the recipient despite intensive immunosuppression suggests their production by the donor cells primed by the RBC transfusion before HPC harvest. Their production by the residual host cells cannot be unequivocally excluded, however.
Risk for postoperative infection after transfusion of white blood cell–filtered allogeneic or autologous blood components in orthopedic patients undergoing primary arthroplasty
Authors: Innerhofer Petra , Klingler Anton , Klimmer Christian , Fries Dietmar , Nussbaumer Walter
Published: December 2004

BACKGROUND:  This study was designed to obtain data on the incidence of postoperative infection in patients undergoing elective orthopedic surgery and receiving white blood cell (WBC)‐filtered blood components prepared according to current standards.

STUDY DESIGN AND METHODS:  A total of 308 consecutive orthopedic patients who opted for preoperative autologous blood donation (PAD) for primary unilateral hip and knee replacement surgery were enrolled in a prospective observational study of the incidence of postoperative infection. Patients with contraindications for PAD or with any infectious disease were not included in the study. To identify probably confounding factors, differences between patient groups were analyzed first. Identified factors, which differed between groups, and variables describing blood supply were further tested in uni‐ and multivariate logistic regression analysis for their independent influence on development of postoperative infection. Infection rates were compared on the basis of actual transfusion groups.

RESULTS:  Of the 308 study patients, 101 were not transfused, 85 received their PAD, 100 received allogeneic WBC‐filtered red blood cells (RBCs), and 22 were given autologous RBCs and additionally allogeneic WBC‐filtered RBCs. Overall the infection rate was 6.82 percent (21/308). Infection rates varied significantly between transfusion groups (no transfusion, 6.9%; autologous RBCs, 1.2%; allogeneic WBC‐filtered RBCs, 12.0%; both transfusion types, 4.6%; p = 0.03). Allogeneic recipients showed significantly more infections compared to autologous recipients (p = 0.0053). Multivariate regression analysis confirmed transfusion of allogeneic WBC‐filtered RBCs as an independent variable predicting postoperative infection (odds ratio, 23.65; confidence interval, 1.3‐422.1; p = 0.01).

CONCLUSION:  Differences in postoperative infection rates between allogeneic and autologous recipients are still observable, although universal WBC filtration has been introduced into clinical practice.
Collaborative study to evaluate a working reagent for West Nile virus RNA detection by nucleic acid testing
Authors: Saldanha John , Shead Susan , Heath Alan , Drebot Michael ,   West Nile Virus Collaborative Study Group
Published: December 2004

BACKGROUND: A nucleic acid test (NAT) assay reference reagent for West Nile virus (WNV) RNA, consisting of heat‐inactivated WNV grown in tissue culture and diluted in pooled, negative human plasma, was evaluated and quantitated in a collaborative study in which 14 laboratories participated.

STUDY DESIGN AND METHODS: Participants were requested to assay serial half‐log and log dilutions of the reagent to determine the RNA endpoint. A single endpoint for each such dilution series was calculated with the maximum likelihood method, which assumes that the probability of a positive result at a given dilution follows a Poisson distribution. The calculated endpoint was used to give an estimated “NAT‐detectable units per mL” (not necessarily equivalent to genome equivalents/mL or copies/mL). The assays used by participants included qualitative and quantitative NAT assays and both the commercial WNV assays (Chiron and Roche).

RESULTS: The estimated number of detectable units per mL for the 14 laboratories varied from log 2.0 to 3.0 with the exception of two outliers. The overall mean titer for all the assays was log 2.52 detectable units per mL (330 detectable units/mL). Multiple testing of individual vials by two laboratories indicated that there was no evidence of vial‐to‐vial variation in WNV content of the reference reagent.

CONCLUSION: A reference reagent for WNV NAT assays has been established. The mean titer of the reagent, with the results from 14 laboratories, was 330 detectable units per mL.
Blood donor white blood cell reduction filters as a source of human peripheral blood–derived endothelial progenitor cells
Authors: Teleron Amylynn A. , Carlson Brian , Young Pampee P.
Published: December 2004

BACKGROUND:  Neovascularization in tumors, wounds, and sites of ischemic injury occurs by both angiogenesis (proliferation from existing vessels) and by vasculogenesis (differentiation into endothelial cells from circulating endothelial progenitor cells [EPCs]). EPCs can be obtained from marrow, from cord blood, or by ex vivo expansion of human peripheral blood (PB). The ease of obtaining human PB EPCs has led many recent studies to utilize PB EPCs. The ability to obtain large numbers of PB EPCs would greatly facilitate characterization to further our understanding of EPC biology and their application in cellular gene therapy.

STUDY DESIGN AND METHODS:  Peripheral blood mononuclear cells (PBMNCs) from whole blood or from the material obtained from white blood cell (WBC) reduction filters were isolated. The cells from both sources were then cultured separately under defined conditions to quantify EPC yield from each source.

RESULTS:  The yield of EPCs per million PBMNCs plated was approximately 3.5‐fold higher from fresh PB. Because greater numbers of PBMNCs were obtained from each filter, however, the mean yield of EPCs from one filter versus fresh blood was 5.4 million versus 0.4 million, respectively (approx. 14‐fold increased yield).

CONCLUSION:  The use of WBC reduction filters provides a safe, inexpensive, and readily available source for large numbers of PBMNCs from which culture‐expanded EPCs can be generated for further study.
New and unusual O alleles at the ABO locus are implicated in unexpected blood group phenotypes
Authors: Hosseini‐Maaf Bahram , Irshaid Nidal M. , Hellberg Åsa , Wagner Thomas , Levene Cyril , Hustinx Hein , Steffensen Rudi , Chester M. Alan , Olsson Martin L.
Published: December 2004

BACKGROUND:  In the ABO blood group system mutations in the A gene may lead to weak A subgroups owing to a dysfunctional 3‐α‐N‐acetylgalactosaminyltransferase.

STUDY DESIGN AND METHODS:  Blood and DNA were investigated to correlate weak A phenotypes with genotype, and an overrepresentation of the infrequent O2 allele was observed. Consequently, 57 available O2 alleles were examined in detail.

RESULTS:  Two new O2 alleles were identified having mutations resulting in Gly229Asp with or without Arg217Cys. A recently described O2 variant (488C>T; Thr163Met) was also found. Surprisingly, both the original and the variant O2 alleles were associated with either O or Aweak phenotypes. Three novel O alleles surfaced in six other samples with suspected A subgroups. These were A1‐like alleles having nonsense mutations causing premature truncation at codons 56, 107, or 181. A second example of the rare O3 allele was also identified. A newly described O1 allele having 768C>A was found to be the third most frequent O allele among Swedish donors. Of the five novel O alleles, three were incorrectly interpreted as A1 following routine ABO genotyping.

CONCLUSION:  Apparent O alleles lacking 261delG may cause weak A expression on red blood cells and/or inhibit anti‐A production. A hypothesis that exchange of genetic material between principally dissimilar O alleles during mitosis (“autologous chimerism”) restores glycosyltransferase activity in some cells would explain this interesting phenomenon.
Genetic methods for detection of antimicrobial resistance
Authors: SUNDSFJORD ARNFINN , SIMONSEN GUNNAR S. , HALDORSEN BJØRG C. , HAAHEIM HÅKON , HJELMEVOLL STIG‐OVE , LITTAUER PIA , DAHL KRISTIN H.
Published: December 2004

Accurate and rapid diagnostic methods are needed to guide antimicrobial therapy and infection control interventions. Advances in real‐time PCR have provided a user‐friendly, rapid and reproducible testing platform catalysing an increased use of genetic assays as part of a wider strategy to minimize the development and spread of antimicrobial‐resistant bacteria. In this review we outline the principal features of genetic assays in the detection of antimicrobial resistance, their advantages and limitations, and discuss specific applications in the detection of methicillin‐resistant Staphylococcus aureus, glycopeptide‐resistant enterococci, aminoglycoside resistance in staphylococci and enterococci, broad‐spectrum resistance to β‐lactam antibiotics in gram‐negative bacteria, as well as genetic elements involved in the assembly and spread of antimicrobial resistance.
Let them fly or light them up: matrix‐assisted laser desorption/ionization time of flight (MALDI‐TOF) mass spectrometry and fluorescence in situ hybridization (FISH)
Authors: SCHWEICKERT BIRGITTA , MOTER ANNETTE , LEFMANN MICHAEL , GÖBEL ULF B.
Published: December 2004

This review focuses on clinical bacteriology and by and large does not cover the detection of fungi, viruses or parasites. It discusses two completely different but complementary approaches that may either supplement or replace classic culture‐based bacteriology. The latter view may appear provocative in the light of the actual market penetration of molecular genetic testing in clinical bacteriology. Despite its elegance, high specificity and sensitivity, molecular genetic diagnostics has not yet reached the majority of clinical laboratories. The reasons for this are manifold: Many microbiologists and medical technologists are more familiar with classical microbiological methods than with molecular biology techniques. Culture‐based methods still represent the work horse of everyday routine. The number of available FDA‐approved molecular genetic tests is limited and external quality control is still under development. Finally, it appears difficult to incorporate genetic testing in the routine laboratory setting due to the limited number of samples received or the lack of appropriate resources. However, financial and time constraints, particularly in hospitals as a consequence of budget cuts and reduced length of stay, lead to a demand for significantly shorter turnaround times that cannot be met by culture‐dependent diagnosis. As a consequence, smaller laboratories that do not have the technical and personal equipment required for molecular genetic amplification techniques may adopt alternative methods such as fluorescence in situ hybridization (FISH) that combines easy‐to‐perform molecular hybridization with microscopy, a technique familiar to every microbiologist. FISH is hence one of the technologies presented here. For large hospital or reference laboratories with a high sample volume requiring massive parallel high‐throughput testing we discuss matrix‐assisted laser desorption ionization time‐of‐flight mass spectrometry (MALDI‐TOF) of nucleic acids, a technology that has evolved from the post‐genome sequencing era, for high‐throughput sequence variation analysis (1, 2).
The development of tools for diagnosis of tularemia and typing of Francisella tularensis
Authors: JOHANSSON ANDERS , FORSMAN MATS , SJÖSTEDT ANDERS
Published: December 2004

Rapid development of molecular techniques for the diagnosis of infections and typing of microbes has been seen during the last 10 years. The present review exemplifies this development by presenting the work of the authors and others regarding techniques for the diagnosis of tularemia and typing of Francisella tularensis. The lack of rapid and safe methods for the laboratory diagnosis of tularemia was the rationale behind the development of methods for the direct detection of F. tularensis in clinical specimens. Today, detection by polymerase chain reaction has become an important adjunct to clinical decisions for the early diagnosis of tularemia. The elucidation of the epidemiology and epizootology of the disease has been hampered by the lack of suitable methods. During recent years several DNA‐based methods that allow rapid identification of the four F. tularensis subspecies, including differentiation of strains of the two clinically important subspecies, the highly virulent type A strains and less virulent type B strains, have been developed. Since F. tularensis strains of any origin exhibit highly conserved genomic sequences, the availability of extensive genome sequence data was a prerequisite for the development of a typing system that allows discrimination of individual isolates. The most discriminatory method is based on multiple‐locus variable‐number tandem repeat analysis (MLVA) and uses highly variable parts of the F. tularensis genome. The method will be an important tool in future studies of the molecular epidemiology of tularemia.
Impact of pathogenicity islands in bacterial diagnostics
Authors: OELSCHLAEGER TOBIAS A. , HACKER JÖRG
Published: December 2004

Pathogenicity islands (PAIs) are a distinct class of genomic islands (GEIs), which are acquired by horizontal gene transfer. PAIs harbour virulence genes and some, in addition, antibiotic resistance genes. More often genes conferring antibiotic resistance are encoded by GEIs not containing virulence genes. Both types of genetic elements are found in genomes of various human, animal and plant pathogens. There are PAIs and GEIs which are specific for a certain serotype(s), strain, or pathotype of a species. Furthermore, there are also PAIs which are more widespread and found in bacterial pathogens causing a certain pathogenic effect in the host. Even the lack of a certain PAI might be characteristic for a defined subspecies. Obviously, PAIs can be used as markers for diagnostic purposes to help identify a certain bacterial pathogen, subtype it, estimate the pathogenic potential, and in some cases predict its antibiotic resistance. This all might be achieved for known PAIs/GEIs without cultivating the microorganism of interest by employing PCR and/or DNA‐chip technology. Even yet unknown PAIs can be identified in silico if the genome sequence of the bacterial pathogen under investigation is known. The more PAIs and antibiotic harbouring GEIs are identified and characterized the greater will be the benefits also for diagnostics.
The terracotta figurines from ed‐Dur (Umm al‐Qaiwain, U.A.E.): The animal representations
Authors: Daems Aurelie
Published: December 2004

Ten fragments of animal figurines from ed‐Dur, the largest site of the 1st century A.D. in southeastern Arabia, are published and compared with material from other sites in the Near East. The figurines are discussed in light of broader issues relating to the representation of birds and animals in pre‐Islamic Arabia.
Two wooden coffins from the Shakhoura Necropolis, Bahrain
Authors: Andersen Søren Fredslund , Strehle Helle , Tengberg Margareta , Salman Mustafa Ibrahim
Published: December 2004

This article presents a detailed analysis of two wooden coffins from the 1st centuries BC/AD on Bahrain. New C14 dates are published of samples taken from the coffins, and their method of manufacture is reconstructed. The unexpected conservation of wood in a humid environment like Bahrain is explained.
An analysis of Late Pre‐Islamic copper‐base artefacts from Ed Dur, U.A.E.
Authors: Weeks Lloyd R.
Published: December 2004

The article presents the analytical results of a study of copper‐base artifacts from ed‐Dur, a large site in the United Arab Emirates which was occupied principally during the 1st century A.D. In addition to identifying a number of pieces with high lead content, the analyses have contributed to an understanding of brass and brass distribtion in the Roman Near East.
A clinical long‐term radiographic evaluation of graft height changes after maxillary sinus floor augmentation with a 2 : 1 autogenous bone/xenograft mixture and simultaneous placement of dental implants
Authors: Hatano Naoki , Shimizu Yoshinaka , Ooya Kiyoshi
Published: December 2004

Abstract: The aim of the present study was to assess long‐term changes in sinus‐graft height after maxillary sinus floor augmentation and simultaneous placement of implants. A total of 191 patients who underwent maxillary sinus floor augmentation were radiographically followed for up to about 10 years. A 2 : 1 mixture of autogenous bone and bovine xenograft (Bio‐Oss®) was used as the graft material. Sinus‐graft height was measured using 294 panoramic images immediately after augmentation and up to 108 months subsequently. Changes in sinus‐graft height were calculated with respect to implant length and original sinus height. Patients were divided into three groups based on the height of the grafted sinus floor relative to the implant apex: Group I, in which the grafted sinus floor was above the implant apex; Group II, in which the implant apex was level with the grafted sinus floor; and Group III, in which the grafted sinus floor was below the implant apex. After augmentation, the grafted sinus floor was consistently located above the implant apex. After 2–3 years, the grafted sinus floor was level with or slightly below the implant apex. This relationship was maintained over the long term. Sinus‐graft height decreased significantly and approached original sinus height. The proportion of patients classified as belonging to Group III reached a maximum from year 3 onwards. The clinical survival rate of implants was 94.2%. All implant losses occurred within 3 years after augmentation. We conclude that progressive sinus pneumatization occurs after augmentation with a 2 : 1 autogenous bone/xenograft mixture, and long‐term stability of sinus‐graft height represents an important factor for implant success.
Vertical alveolar ridge augmentation by means of a titanium mesh and autogenous bone grafts
Authors: Roccuzzo Mario , Ramieri Guglielmo , Spada Mario Cristina , Bianchi Silvio Diego , Berrone Sid
Published: December 2004

Abstract: The aim of this study is to evaluate a surgical protocol for vertical ridge augmentation in the maxilla and mandible using autogenous onlay bone graft associated with a titanium mesh. A group of 18 partially edentulous patients, presenting the need for vertical bone augmentation of at least 4 mm, were treated before implant placement. During the first surgery, an autogenous bone graft was harvested from either the mandibular ramus or the mental symphysis and secured by means of titanium screws. Particulate bone was added and a titanium micro‐mesh was used to stabilize and protect the graft. After a mean interval of 4.6 months, meshes and screws were removed and 37 endosseous implants were successfully placed. The desired bone gain was reached in all patients. Mean vertical bone augmentation obtained was 4.8 mm (range 4–7 mm). No major complications were recorded at recipient or donor sites. Abutment connection was carried out 2–3 months after implant placement. No implant was lost. Clinical parameters and probing depth, after prosthetic reconstruction, demonstrated the presence of a healthy peri‐implant mucosa. The preliminary results suggest that, by using the presented technique, patients can be successfully rehabilitated by means of implant‐supported prosthesis 6–7 months after the first surgery, even in case of severely atrophied maxilla.
Alveolar distraction osteogenesis vs. vertical guided bone regeneration for the correction of vertically deficient edentulous ridges: A 1–3‐year prospective study on humans
Authors: Chiapasco Matteo , Romeo Eugenio , Casentini Paolo , Rimondini Lia
Published: December 2004

Abstract: The purpose of this prospective study was to compare vertical guided bone regeneration (GBR) and vertical distraction osteogenesis (DO) for their ability in correcting vertically deficient alveolar ridges and their ability in maintaining over time the vertical bone gain obtained before and after implant placement. Eleven patients (group 1) were treated by means of vertical GBR with autogenous bone and e‐PTFE membranes, while 10 patients (group 2) were treated by means of DO. In group 1, six patients received implants at the time of GBR (subgroup 1A), while five patients had implants placed at the time of membrane removal (subgroup 1B). In group 2, implants were placed at the time of distraction device removal. A total of 25 implants were placed in group 1 and 34 implants were placed in group 2 patients. Three to 5 months after implant placement, patients were rehabilitated with implant‐borne dental prostheses. The following parameters were evaluated: (a) bone resorption of the regenerated ridges before and after implant placement; (b) peri‐implant clinical parameters 1, 2, and 3 years after prosthetic loading of implants; (c) survival and success rates of implants. Bone resorption values before and after implant placement were significantly higher in group 1. The results suggested that both techniques may improve the deficit of vertically resorbed edentulous ridges, although distraction osteogenesis seems to be more predictable as far as the long‐term prognosis of vertical bone gain is concerned. Implant survival rates as well as peri‐implant clinical parameters do not differ significantly between the two groups, whereas the success rate of implants placed in group 2 patients was higher than that obtained in group 1 patients.
Osseointegration of Osseotite® and machined titanium implants in autogenous bone graft. A histologic and histomorphometric study in dogs
Authors: Veis Alexander A. , Trisi Paolo , Papadimitriou Serafim , Tsirlis Anastasios T. , Parissis Nikolaos A. , Desiris Angelos K. , Lazzara Richard J.
Published: December 2004

Abstract: It has been shown that a roughened implant surface results in a higher percentage of bone to implant contact (%BIC) than a machined one. A modified implant surface using a dual thermo‐acid etching process (Osseotite®) has been introduced and evaluated clinically, mechanically and histologically. The aim of the present study was the histological evaluation of the %BIC between the Osseotite® or machined surfaces and the autogenous bone graft. Twenty‐two custom‐made split‐type 10‐mm‐long implants having two opposing surfaces (Osseotite® and machined) were placed between the cranial and caudal dorsal iliac spine at the iliac wing of two adult mongrel dogs. An artificial bone defect was created leaving a 2 mm empty space around the coronal 5 mm of the implants, while the apical 5 mm was stabilized in the existing basal bone. The defects around the implants were filled with particulate autogenous bone graft, covered by an Osseoquest® membrane, and left to heal for 5 months. All inserted implants showed a complete integration in the bone tissue. It was found that the resulting %BIC at the Osseotite® surface was significantly higher than at the machined one in both regenerated (46.44±15.81% vs. 28.59±12.04%) and basal bone areas (32.32±15.09% vs. 17.25±7.40%). The findings of this study imply that the use of autogenous bone graft resulted in significantly higher %BIC values in the regenerated area than in the basal bone area itself, for both implant surfaces.
Enhancement of bone volume in guided bone augmentation by cell transplants derived from periosteum: an experimental study in rabbit calvarium bone
Authors: Miyamoto Ikuya , Tsuboi Yoichi , Takahashi Katsu , Hyon Suong‐Hyu , Iizuka Tadahiko
Published: December 2004

Bone morphology is genetically encoded and it is usually difficult to change its structure without invasive surgery. We have tried to stimulate bone augmentation by a combination of guided bone regeneration techniques and cell transplants with collagen scaffolds for the suitable skeletal framework. In vitro‐expanded tibia periosteum cells were used to promote osteogenesis with collagen scaffolds and titanium (Ti) or poly‐l‐lactic acid (PLLA) caps as barriers to create a space facing connective tissue under calvarium skin. This approach was assessed in the defective skull bone of a rabbit model. After a 12‐week healing period, histomorphometric analyses were performed to determine the percentage of newly formed mineralized tissue in the cap. The mean percentage of newly formed mineralized tissue within the cap was 15.4%±3.99 for the Ti cap group, 15.5%±4 for the PLLA cap group, 6.19%±4.94 for the PLLA cap+collagen carrier group and 23.1%±23.1 for the PLLA+collagen carrier+cell transplants group. The cell transplant group showed a significantly higher value than other groups (P<0.05, Wilcoxon signed rank test, Mann–Whitney U‐test). This approach of guided bone augmentation and cultured cell transplants with collagen carrier exhibited significantly greater morphogenesis of mineralized tissue than the control over a 12‐week experimental period.
Early loading (2 or 6 weeks) of sandblasted and acid‐etched (SLA) ITI® implants in the posterior mandible
Authors: Salvi Giovanni E. , Gallini Guido , Lang Niklaus P.
Published: December 2004

Abstract: The aim of this 1‐year prospective controlled clinical trial was to evaluate the effect of early loading of ITI® solid screw titanium implants with a sandblasted and acid‐etched (SLA) surface on clinical and radiographic parameters.

Material and methods: Twenty‐seven consecutively admitted patients presenting bilateral edentulous posterior mandibular areas and in need of prosthetic reconstruction were recruited. Sixty‐seven ITI® standard solid screw implants with an SLA surface, a diameter of 4.1 mm and a length of 8, 10 or 12 mm were installed bilaterally in molar and premolar areas according to a one‐stage surgical protocol. One week (test) and 5 weeks (control) after implant placement, solid ITI® prosthetic abutments were connected using a torque of 35 N cm. No provisional restoration was fabricated. Two weeks (test) and 6 weeks (control) after implant placement, porcelain‐fused‐to‐metal single‐tooth crowns were cemented. Clinical measurements were obtained at day 0 and 2, 6, 12, 24 and 52 weeks thereafter. Periapical radiographs were taken immediately after implant placement, after 6 weeks and at the 1‐year examination.

Results: After 1 year, implant survival was 100%. Two test and one control implants rotated at the time of abutment connection and were left unloaded for 12 additional weeks. At the 1‐year examination, no statistically significant differences were found between the test and control sites with respect to pocket probing depths (2.6 mm±0.5 vs. 2.7 mm±0.5), mean clinical attachment levels (3.1 mm±0.4 vs. 3.2 mm±0.5), mean percentages of sites bleeding on probing (9.7% vs. 8.3%), mean widths of keratinized mucosa (1.8 mm±0.4 vs. 1.9 mm±0.5), mean PerioTest® values (−1.4 PTV±0.9 vs. −1.6 PTV±0.8) or mean crestal bone loss measurements (0.57 mm±0.49 vs. 0.72 mm±0.50).

Conclusion: Based on these results, loading of titanium implants with an SLA surface as early as 2 weeks did not appear to jeopardize the osseointegration healing process in the posterior mandible. Furthermore, implants rotating at 35 N cm, if left unloaded for additional 12 weeks, did not negatively affect clinical and radiographic outcomes.
Plasma TGF‐β1 as a risk factor for gingival overgrowth
Authors: Ellis J. S. , Morgan C. L. , Kirby J. A. , Taylor J. J. , Thomason J. M.
Published: December 2004

Background and Aims: Induction of the pro‐fibrotic growth factor TGF‐β1 has been suggested as a possible mechanism through which immunosuppressant drugs may induce gingival overgrowth. This study aims to investigate plasma levels of TGF‐β1 and relate them to the development and severity of gingival overgrowth in immunosuppressed transplant patients.

Materials and Methods: One hundred and thirty‐two ciclosporin‐treated and 13 tacrolimus‐treated transplant patients and 24 drug‐free control subjects underwent a full periodontal examination including a determination of the presence and severity of gingival overgrowth.

Results: Plasma TGF‐β1 concentrations were determined by ELISA, and were found to be significantly elevated in samples from the transplant patients (mean=29.1 ng/ml) as compared with controls (mean=6.1 ng/ml, p<0.0001). There was no significant difference between the levels of plasma TGF‐β1 in the ciclosporin‐ and tacrolimus‐treated patient groups.

Conclusions: Furthermore, concomitant treatment with calcium channel blockers did not influence the levels of plasma TGF‐β1 in the patients group. The relationship between gingival overgrowth, independent periodontal variables and TGF‐β1 plasma concentrations was examined using univariate and multivariate regression analyses; low TGF‐β1 plasma concentrations were found to be a risk factor for gingival overgrowth in immunosuppressed patients concomitantly receiving a calcium channel blocker.
Guided tissue regeneration in intrabony periodontal defects following treatment with two bioabsorbable membranes in combination with bovine bone mineral graft
Authors: Vouros Ioannis , Aristodimou Elena , Konstantinidis Antonis
Published: December 2004

Aim: Comparison of two bioabsorbable barriers (collagen and polylactic acid (PLA) membranes) combined with a bovine bone mineral (BBM) graft, with an access flap procedure (AFP) alone for treating intrabony defects.

Material and Methods: Thirty‐four subjects participated in this prospective, controlled clinical trial. Baseline clinical examination (probing depth (PD), clinical attachment level (CAL)) of selected sites was performed 2 months after completion of conservative treatment in conjunction with hard‐tissue measurements to ascertain the depth of the defect (cementoenamel junction to the bottom of the defects). After randomly dividing patients into three groups (two membrane groups, one control group), full thickness flaps were elevated and exposed root surfaces planed before filling defects with bone graft and positioning a barrier membrane covering the defect. The control group was treated identically except for the barrier and bone graft placement. Clinical treatment outcomes were finally evaluated 12 months after surgery for changes of PD and CAL. Radiographs at baseline and 12 months were compared using non‐standardized digital radiography.

Results: A mean reduction in PD value of 5.08 mm and mean CAL gain of 4.39 mm occurred in the collagen‐BBM group. Corresponding values for the PLA‐BBM group were 4.72 and 3.71 mm, while acess flap procedure (AFP) sites produced values of 2.50 and 2.43 mm. All improvements in clinical parameters were statistically significant (p<0.001) within groups for all variables. Both membranes produced statistically greater PD reduction and CAL gain compared with AFP treatment (p<0.05). Comparison between barrier groups failed to reveal any statistically significant difference in probing pocket depth reduction (p=0.56) or in CAL gain (p=0.34).

Conclusion: Placement of the two barrier membranes used in the present study in combination with BBM graft significantly improved clinical and radiographic parameters of deep intrabony pockets and proved superior to access flap alone.
Assessing the responsiveness of measures of oral health‐related quality of life
Authors: Locker David , Jokovic Aleksandra , Clarke Martha
Published: December 2004

Abstract  – 

Objectives: This paper illustrates ways of assessing the responsiveness of measures of oral health‐related quality of life (OHRQoL) by examining the sensitivity of the oral health impact profile (OHIP)‐14 to change when used to evaluate a dental care program for the elderly.

Methods: One hundred and sixteen elderly patients attending four municipally funded dental clinics completed a copy of the OHIP‐14 prior to treatment and 1 month after the completion of treatment. The post‐treatment questionnaire also included a global transition judgement that assessed subjects' perceptions of change in their oral health following treatment at the clinics. Change scores were calculated by subtracting post‐treatment OHIP‐14 scores from pre‐treatment scores. The longitudinal construct validity of these change scores were assessed by means of their association with the global transition judgements. Measures of responsiveness included effect sizes for the change scores, the minimal important difference, and Guyatt's responsiveness index. An receiver operating characteristic (ROC) curve was constructed to determine the accuracy of the change scores in predicting whether patients had improved or not as a result of the treatment.

Results: Based on the global transition judgements, 60.2% of subjects reported improved oral health, 33.6% reported no change, and only 6.2% reported that it was a little worse. These changes are reflected in mean pre‐ and post‐treatment OHIP‐14 scores that declined from 15.8 to 11.5 (P < 0.001). Mean change scores showed a consistent gradient in the expected direction across categories of the global transition judgement, but differences between the groups were not significant. However, paired t‐tests showed no significant differences in the pre‐ and post‐treatment scores of stable subjects, but showed significant declines for subjects who reported improvement. Analysis of data from stable subjects indicated that OHIP‐14 had excellent test–retest reliability with an intraclass correlation coefficient (ICC) of 0.84. Effect size based on change scores for all subjects and subgroups of subjects were small to moderate. The ROC analysis indicated that OHIP‐14 change scores were not good ‘diagnostic tests’ of improvement. The minimal important difference for the OHIP‐14 was of 5‐scale points, but detecting this difference would require relatively large sample sizes.

Conclusions: OHIP‐14 appeared to be responsive to change. However, the magnitude of change that it detected in the context described here was modest, probably because it was designed primarily as a discriminative measure. The psychometric properties of the global transition judgements that often provide the ‘gold standard’ for responsiveness studies need to be established.
Reliability and validity of the Dental Satisfaction Questionnaire in a population of 23‐year‐olds in Norway
Authors: Skaret Erik , Berg Einar , Raadal Magne , Kvale Gerd
Published: December 2004

Abstract  – 

Objective:  The aim of this study was to explore the internal structure, reliability, and construct validity of the Dental Satisfaction Questionnaire (DSQ) in a population of young adults in Norway.

Methods:  The DSQ scale was mailed to a representative sample of 968 subjects aged 23 years in two Norwegian counties. The reliability assessment of the instrument was based on internal consistency analysis (Cronbach's alpha). A factor analysis (principal component) was used to confirm the internal structure of the scale. The construct validity of the DSQ was indicated by: (i) its correlation with the patients' beliefs regarding the way dentists deliver care, indexed by the Dental Beliefs Survey (DBS); and (ii) differences in DSQ scores between subjects who had dropped out from dental care at the age of 23 years and regular attenders.

Results:  The response rate was 69%. The alpha (Cronbach's) coefficient for the overall construct of DSQ was 0.81 (n = 655), and 0.65 or more for the subscales pain management, quality, and access. The correlation coefficient between the sum‐scores of DSQ and DBS for the entire sample was r = −0.69. Subjects in the dropout group had significantly lower satisfaction with dental care than the rest of the group (P < 0.001).

Conclusions:  This study generally confirms the structure of the DSQ instrument and indicates that it is a reliable and valid instrument in cultures other than the one for which it was previously tested.
The association between dental anxiety and oral health‐related quality of life in Britain
Authors: McGrath Colman , Bedi Raman
Published: December 2004

Abstract  – 

Objective:  The aim of this study was to identify associations between level of dental anxiety and the impact of oral health on quality of life (OHQOL) in Britain, controlling for sociodemographic and oral health status (self‐reported) factors.

Methods:  The basic research design included a cross‐sectional study involving a random probability sample of 3000 UK residents. The outcome measures were: levels of dental anxiety, which were measured on the Corah Dental Anxiety Scale (DAS), and the impact of OHQOL, which was assessed using UK oral health‐related quality of life instrument (OHQoL‐UK (W)©).

Results:  DAS was correlated with OHQoL‐UK (W)© scores (P < 0.01). Having controlled for sociodemographic factors (age, gender and social class) and oral health status factors (self‐reported number of teeth possessed and denture status), known confounding factors associated with OHQOL, those with high levels of dental anxiety (DAS ≥ 15) were approximately two times as likely to be among those experiencing the poorest OHQOL (below the population median OHQoL‐UK (W)© score) in Britain (P < 0.001; OR = 1.93; 95% CI 1.41, 2.65).

Conclusion:  Dental anxiety is associated with the impact oral health has on life quality. Those experiencing high levels of dental anxiety are among those with the poorest oral health‐related quality of life in Britain.
Productive efficiency and its determinants in the Finnish Public Dental Service
Authors: Widström Eeva , Linna Miika , Niskanen Tapani
Published: December 2004

Abstract  – 

Objective:  Our objective was to investigate the cost efficiency of the Public Dental Service (PDS), which, until 2000, was responsible for organising dental care for children and younger adults born in 1956 and later.

Methods:  Input and output data and information on various organisational and environmental characteristics were collected from 228 municipal PDS units in Finland. First, non‐parametric data envelopment analysis (DEA) was employed to assess efficiency. In the second stage, econometric Tobit analysis was used to explore various predictors of cost efficiency, technical efficiency and allocative efficiency. As input in the DEA model we used personnel full‐time equivalents and material and other costs expressed in monetary terms, and as output we used the number of treated patients.

Results:  The study showed big differences in cost efficiency between the PDS units studied. The average cost inefficiency was 30%. Approximately two‐thirds of the observed cost inefficiency was because of technical inefficiency and one‐third because of allocative inefficiency. High state‐subsidy levels, and a high proportion of young patients predicted inefficiency, and young population and low socioeconomic conditions in the municipality predicted efficiency. The results also indicated that many PDS units could have improved allocative efficiency by increasing the relative numbers of auxiliaries in relation to dentists. On the other hand, some units were too small to employ full‐time dental hygienists efficiently.

Conclusions:  In the Finnish PDS, there are uncommitted resources that could be reallocated so as to improve overall efficiency.
HIV+ MALT lymphoma remission induced by highly active antiretroviral therapy alone
Authors: Girard Thomas , Luquet‐Besson Isabelle , Baran‐Marszak Fanny , Raphaël Martine , Boué François
Published: December 2004

Abstract:  MALT lymphoma is usually described in association with Helicobacter pylori, HCV, HHV8, Campylobacter jejuni or in a setting of overreactive immunity. In HIV+ patients, MALT lymphoma is most commonly described in children. We describe here an original case of HIV+ MALT lymphoma with bronchial, conjuctival and laryngeal involvement for which a clinical and histopathological remission has been obtained with HAART alone. We conclude that HIV, as well as H. pylori, C. jejuni and HCV can target lymphogenesis in MALT lymphoma.
Improvement of idiopathic thrombocytopenic purpura by antithyroid therapy
Authors: Sugimoto Koichi , Sasaki Makoto , Isobe Yasushi , Tamayose Kenji , Hieda Masashi , Oshimi Kazuo
Published: December 2004

Abstract:  Here we report a case of idiopathic thrombocytopenic purpura accompanied by Graves’ disease. Improvement in thyroid function with methimazole led to the spontaneous recovery of the platelet count from 8 × 109/L to 84 × 109/L. Furthermore, the second fall and recovery of the platelet count well coincided with the recurrence of hyperthyroidism after the discontinuation of methimazole and its normalization by resumption of the drug, respectively. These parallel fluctuations of platelet and thyrotropin because of the cessation and resumption of antithyroid therapy suggests that correction of hyperthyroidism may be beneficial to the control of an imbalance in the immune system which impairs not only thyroid but also the platelet.