bluuebunny/crossref_metadata_2025 huggingface dataset:
Growth in Stimulant-naive Children With Attention-Deficit/Hyperactivity Disorder Using Cross-sectional and Longitudinal Approaches
Authors: Hanć Tomasz , Cieślik Joachim
Published: April 2008

OBJECTIVE. The objective of this study was to investigate the growth of stimulant-naive children with attention-deficit/hyperactivity disorder in 3 aspects of development: level, trend, and structure of the process.

PATIENTS AND METHOD. The study sample included 53 individuals between the ages of 6 and 17 years (mean: 11.90). The average level of growth (z scores) in prepubertal, pubertal, and postpubertal stage of development and trend of the process were estimated on the basis of a comparison with growth charts. The prediction of adolescent growth spurt was conducted using the mathematical structural growth model of Jolioceur, Pontier, and Abidi.

RESULTS. Difference between boys with attention-deficit/hyperactivity and the norm was statistically significant in the prepubertal stage and for the average level of growth between the ages of 2 and 17 years. Distinct suppression of growth was found between the ages of 9 and 14. Analysis of development structure revealed an earlier onset of the adolescent growth spurt among boys (difference: 5 months) and a higher velocity of growth at this moment (difference: 0.33 cm/year) than expected values.

CONCLUSIONS. The application of both cross-sectional and longitudinal analyses clearly illustrated the higher level of growth of boys with attention-deficit/hyperactivity in the prepubertal stage, the suppression of growth on the turn of prepubertal and pubertal periods, and earlier occurrence of the spurt onset. Observed differences in the level and trend of growth as well as in the parameters of adolescent growth spurt are linked with disorder-related factors.
Selective Provision of Asthma Self-Management Tools to Families
Authors: Cabana Michael D. , Chaffin D. Curt , Jarlsberg Leah G. , Thyne Shannon M. , Clark Noreen M.
Published: April 2008

OBJECTIVE. Providing asthma education in a primary care setting can be challenging because of time and resource constraints. The purpose of this work was to determine factors associated with the provision of different asthma self-management tools.

METHODS. We conducted a cross-sectional survey with 896 parents of children with asthma (age 2–12 years). We collected information regarding demographics and asthma care, including parent receipt of an asthma action plan, a symptom diary, and asthma information materials; whether an asthma management plan was sent to the child's school; and whether the physician reviewed written instructions on use of a metered-dose inhaler. We used multivariate logistic regression methods to determine factors associated with receipt of different asthma self-management tools controlling for demographic factors.

RESULTS. For families where parents only completed high school, there was greater likelihood of receipt of an asthma action plan and physician review of written instructions about how to use an inhaler. For families with a household income less than twice the poverty line, there was greater likelihood of receipt of an asthma action plan, the physician sending a letter to the child's school regarding the child's asthma, and receipt of an asthma symptom diary.

CONCLUSIONS. In our sample, primary care pediatricians do not routinely provide asthma education in accordance with National Heart, Lung, and Blood Institute asthma guidelines and “triage” which families receive additional asthma education. We believe that the use of targeted asthma education is a symptom of the limited time and competing demands during a typical visit. As a result, those involved in quality improvement need to help physicians become more efficient and effective at providing asthma education within such time constraints or develop alternative systems of providing asthma education.
Association of Childhood Autism Spectrum Disorders and Loss of Family Income
Authors: Montes Guillermo , Halterman Jill S.
Published: April 2008

BACKGROUND. Parents of children with autism have significant out-of-pocket expenditures related to their child's care. The impact of having a child with autism on household income is not known.

OBJECTIVE. The purpose of this work was to estimate the loss of household income associated with childhood autism using a nationally representative sample.

METHODS. Parents of 11684 children enrolled in kindergarten to eighth grade were surveyed by the National Household Education Survey-After School Programs and Activities in 2005. An autism spectrum disorder was defined as an affirmative response to the questions, “has a health professional told you that [child] has any of the following disabilities? 1) autism? 2) pervasive developmental disorder or PDD?” There were 131 children with autism spectrum disorder in the sample and 2775 children with other disabilities. We used ordinal logistic regression analyses to estimate the expected income of families of children with autism given their education level and demographic characteristics and compared the expected income with their reported income.

RESULTS. Both having a child with autism spectrum disorder and having a child with other disabilities were associated with decreased odds of living in a higher income household after controlling for parental education, type of family, parental age, location of the household, and minority ethnicity. The average loss of annual income associated with having a child with autism spectrum disorder was $6200 or 14% of their reported income.

CONCLUSION. Childhood autism is associated with a substantial loss of annual household income. This likely places a significant burden on families in the face of additional out-of-pocket expenditures.
Genetics of Pubertal Timing and Its Associations With Relative Weight in Childhood and Adult Height: The Swedish Young Male Twins Study
Authors: Silventoinen Karri , Haukka Jari , Dunkel Leo , Tynelius Per , Rasmussen Finn
Published: April 2008

OBJECTIVE. Previous studies have suggested that the timing of puberty is associated with BMI in childhood and adult stature. Because the genetic background of these associations is not thoroughly investigated, we aimed to analyze it in a longitudinal twin cohort.

METHODS. We studied a Swedish cohort of 99 monozygotic and 76 dizygotic twin pairs born between 1973 and 1979 with weight and length or height measured annually from birth to age 18 years. Age at onset of pubertal growth spurt, age at peak height velocity, and final height were estimated by a parametric JPA2 growth model. The genetic architecture and mutual associations of these traits and childhood BMI were analyzed by linear structural equation modeling.

RESULTS. The heritability estimate was 0.91 for age at onset of pubertal growth spurt, 0.93 for age at peak height velocity, and 0.97 for adult height. Age at onset of pubertal growth spurt was negatively associated with BMI from 1 to 10 years of age and stature in early adulthood. For age at peak height velocity, we found similar associations with childhood BMI and stature in early adulthood. These associations were explained by common genetic factors.

CONCLUSION. Growth during puberty is strictly genetically regulated. These genetic factors also explain why boys who matured early had higher BMI through childhood and taller stature in early adulthood.
Outcome and Growth of Infants Fetally Exposed to Heart Block-Associated Maternal Anti-Ro52/SSA Autoantibodies
Authors: Skog Amanda , Wahren-Herlenius Marie , Sundström Birgitta , Bremme Katarina , Sonesson Sven-Erik
Published: April 2008

OBJECTIVE. The purpose of this work was to analyze outcome with focus on growth in infants fetally exposed to heart block-associated maternal anti-Ro52/SSA autoantibodies and identify maternal factors other than the autoantibodies increasing the risk of fetal heart block.

PATIENTS AND METHODS. Thirty-two pregnancies in 30 anti-Ro52-positive mothers were included. Seven fetuses developed second-degree or third-degree atrioventricular block, 8 developed first-degree atrioventricular block, and 17 had normal atrioventricular conduction, as diagnosed by using Doppler echocardiography. Three of 6 surviving fetuses with second-degree or third-degree atrioventricular block received treatment with fluorinated steroids. Two fetuses with second-degree atrioventricular block converted to first-degree atrioventricular block without any signs of progression during the study period. Maternal and longitudinal infant data were collected from planned neonatal follow-up and childhood health records from birth to 12 months of age in 31 survivors.

RESULTS. Women giving birth to infants with prenatal second-degree or third-degree atrioventricular block were older and with higher parity than those with first-degree atrioventricular block or normal atrioventricular conduction. Second-degree or third-degree atrioventricular block pregnancies were <40 completed weeks, whereas pregnancies with first-degree atrioventricular block or normal atrioventricular conduction had a normal duration. Fetuses with second-degree or third-degree atrioventricular block were retarded by −0.98 ± 0.77 SD in weight at birth and did not show any catch-up during infancy. In contrast, fetuses with first-degree atrioventricular block or normal atrioventricular conduction had a weight reduction of −0.51 ± 1.01 SD with a catch-up during the first months after birth.

CONCLUSIONS. This report documents that newborns with autoantibody-mediated second-degree or third-degree atrioventricular block are retarded in growth, with no catch-up during infancy, whereas fetuses with first-degree atrioventricular block or normal atrioventricular conduction have a normal growth soon after birth. Increased maternal age and/or parity seem to carry an increased risk for fetal heart block.
Toxicity of Buprenorphine Overdoses in Children
Authors: Hayes Bryan D. , Klein-Schwartz Wendy , Doyon Suzanne
Published: April 2008

OBJECTIVE. There are few reports in children of overdoses of buprenorphine, a partial opioid agonist used in the treatment of opioid dependence and pain. The purpose of this study was to analyze buprenorphine overdoses in young children reported by US poison centers to the Researched Abuse, Diversion, and Addiction-Related Surveillance System.

METHODS. A retrospective review of buprenorphine overdoses in children <6 years of age reported to the Researched Abuse, Diversion, and Addiction-Related Surveillance System from November 2002 through December 2005 was performed. Patients lost to follow-up and those ingesting multiple substances were excluded.

RESULTS. Eighty-six cases met inclusion criteria. In the 54 children who developed toxicity, the clinical effects included drowsiness or lethargy (55%), vomiting (21%), miosis (21%), respiratory depression (7%), agitation or irritability (5%), pallor (3%), and coma (2%). There were no fatalities. The mean time to onset of effects was 64.2 minutes, with a range of 20 minutes to 3 hours. Duration of clinical effects was under 2 hours in 11%, 2 to 8 hours in 59%, 8 to 24 hours in 26%, and >24 hours in 4%. Children who ingested ≥2 mg of buprenorphine were more likely to experience clinical effects, and all of the children who ingested >4 mg experienced some effect. No child ingesting <4 mg experienced a severe effect. Of the 22 children administered naloxone, 67% had at least a partial response.

CONCLUSIONS. Buprenorphine overdoses are generally well tolerated in children, with significant central nervous system and respiratory depression occurring in only 7%. Any child ingesting >2 mg and children <2 years of age ingesting more than a lick or taste should be referred to the emergency department for a minimum of 6 hours of observation. Naloxone can be used to reverse respiratory depression.
Dietary Supplements: Inpatient Policies in US Children's Hospitals
Authors: Gardiner Paula , Phillips Russell S. , Kemper Kathi J. , Legedza Anna , Henlon Silas , Woolf Alan D.
Published: April 2008

BACKGROUND. Variations in hospital policies and practices regarding the use of vitamins, minerals, herbs, and other dietary supplements could compromise patient safety and quality of care. We undertook this study to describe pediatric hospital policies regarding dietary supplements.

METHODS. We administered a cross-sectional survey of a sample of National Association of Children Hospitals and Related Institutions members. Pharmacy personnel were asked about the following: written policies addressing dietary supplements; how such policies are made; and responsibilities for storage, administration, documentation, and checking for potential interactions. We created a 10-point hospital policy and practices quality score to assess the quality of each policy.

RESULTS. Of the 186 eligible National Association of Children Hospitals and Related Institutions hospitals, 109 responded (59%). Forty-four percent reported having written policies on vitamins and minerals, herbs, and other dietary supplements. Few hospitals had herbs (2%) or other dietary supplements (38%) on formulary. However, most (81%) allowed patients to use their home supply of dietary supplements under defined circumstances, and 64% allowed staff to make recommendations about dietary supplement use. In 70% of hospitals, nurses stored and administered the home supply of dietary supplements. Less than half (46%) required documentation of a check for drug or dietary supplements interactions. One third (32%) had surgical preoperative recommendations regarding dietary supplements. Only 11% of 109 hospitals satisfied the 10 criteria necessary for a perfect hospital policy and practices quality score indicative of quality practices regarding patient use of dietary supplements.

CONCLUSION. Even among those hospitals that have written policies about dietary supplements, there is a wide range in policy quality, which may compromise the safety of patients.
Elevated Morphine Concentrations in Neonates Treated With Morphine and Prolonged Hypothermia for Hypoxic Ischemic Encephalopathy
Authors: Róka Anikó , Melinda Kis Tamas , Vásárhelyi Barna , Machay Tamás , Azzopardi Denis , Szabó Miklós
Published: April 2008

OBJECTIVES. Asphyxia and hypothermia may modify drug pharmacokinetics. We investigated whether analgesia with morphine in neonates with hypoxic ischemic encephalopathy undergoing prolonged moderate systemic hypothermia resulted in elevated serum morphine concentrations compared with normothermic infants.

PATIENTS AND METHODS. Infants from 1 center participating in a multicenter randomized study of moderate whole-body hypothermia after perinatal asphyxia (the Total Body Hypothermia Study) were randomly selected for treatment with hypothermia (n = 10) or for standard care on normothermia (n = 6). Hypothermia (33°C to 34°C) was started before 6 hours of age and maintained for 72 hours. All of the infants were treated with a continuous infusion of morphine-hydrochloride, with the rate adjusted according to clinical status. Serum morphine concentrations were determined at 6, 12, 24, 48, and 72 hours after birth.

RESULTS. Serum morphine concentrations at 24 to 72 hours after birth were (median [range]) 292 ng/mL (137–767 ng/mL) in the hypothermia-treated infants and 206 ng/mL (88–327 ng/mL) in the infants on normothermia, despite similar morphine infusion rates and cumulative doses. Morphine concentrations correlated with morphine infusion rate, cumulative dose, and treatment with hypothermia. Serum morphine concentrations reached a steady state after 24 hours in the normothermic infants but continued to increase throughout the assessment period in the hypothermia group. Morphine clearance was low in both groups: (median [range]) morphine clearance estimated from area under the curve was 0.69 mL/min per kg (0.58–1.21 mL/min per kg) in hypothermic group and 0.89 mL/min per kg (0.65–1.33 mL/min per kg) in infants on normothermia. Serum morphine concentrations >300 nL/mL occurred more often in the hypothermia group and when the morphine infusion rate was >10 μg/kg per h.

CONCLUSIONS. Infants with hypoxic ischemic encephalopathy have reduced morphine clearance and elevated serum morphine concentrations when morphine infusion rates are based on clinical state. Potentially toxic serum concentrations of morphine may occur with moderate hypothermia and infusion rates >10 μg/kg per h.
Early Developmental Processes and the Continuity of Risk for Underage Drinking and Problem Drinking
Authors: Zucker Robert A. , Donovan John E. , Masten Ann S. , Mattson Margaret E. , Moss Howard B.
Published: April 2008

Developmental pathways to underage drinking emerge before the second decade of life. Many scientists, however, as well as the general public, continue to focus on proximal influences surrounding the initiation of drinking in adolescence, such as social, behavioral, and genetic variables related to availability and ease of acquisition of the drug, social reinforcement for its use, and individual differences in drug responses. In the past 20 years, a considerable body of evidence has accumulated on the early (often much earlier than the time of the first drink) predictors and pathways of youthful alcohol use and abuse. These early developmental influences involve numerous risk, vulnerability, promotive, and protective processes. Some of these factors are not related directly to alcohol use, whereas others involve learning and expectancies about later drug use that are shaped by social experience. The salience of these factors (identifiable in early childhood) for understanding the course and development of adult alcohol and other drug use disorders is evident from the large and growing body of findings on their ability to predict adult clinical outcomes. This review summarizes the evidence on early pathways toward and away from underage drinking, with a particular focus on the risk and protective factors and the mediators and moderators of risk for underage drinking that become evident during the preschool and early school years. It is guided by a developmental perspective on the aggregation of risk and protection and examines the contributions of biological, psychological, and social processes within the context of normal development. Implications of this evidence for policy, intervention, and future research are discussed.
Neonatal Dexamethasone Treatment for Chronic Lung Disease of Prematurity Alters the Hypothalamus-Pituitary-Adrenal Axis and Immune System Activity at School Age
Authors: Karemaker Rosa , Kavelaars Annemieke , ter Wolbeek Maike , Tersteeg-Kamperman Marijke , Baerts Wim , Veen Sylvia , Samsom Jannie F. , Visser Gerard H. A. , van Bel Frank , Heijnen Cobi J.
Published: April 2008

OBJECTIVE. To compare long-term effects of neonatal treatment with dexamethasone or hydrocortisone for chronic lung disease of prematurity on the hypothalamus-pituitary-adrenal axis and the immune response in children at school age.

PATIENTS AND METHODS. A total of 156 prematurely born children were included in this retrospective matched cohort study. Children treated with dexamethasone (n = 52) or hydrocortisone (n = 52) were matched for gestational age, birth weight, grade of infant respiratory distress syndrome, grade of periventricular or intraventricular hemorrhage, gender, and year of birth. A reference group of 52 children not treated with corticosteroids was included for comparison. Plasma adrenocorticotropic hormone and cortisol in response to a social stress task were determined. Cytokine production was analyzed after in vitro stimulation of whole-blood cultures.

RESULTS. The Trier Social Stress Test adapted for children induced an adrenocorticotropic hormone and cortisol response in all of the groups. The adrenocorticotropic hormone response was blunted in the dexamethasone group. The overall cortisol level was lower in the dexamethasone than in the hydrocortisone and reference group. Cortisol and adrenocorticotropic hormone in the hydrocortisone and reference groups were similar. The ratio of T-cell mitogen-induced interferon-γ/interleukin-4 secretion was significantly higher in the dexamethasone group than in the hydrocortisone group. Interferon-γ production and the ratios of interferon-γ/interleukin-4 and interferon-γ/ interleukin-10 were significantly higher in the dexamethasone group than the reference group. However, production of these cytokines did not differ between the hydrocortisone and the reference groups.

CONCLUSION. Neonatal treatment of prematurely born children with dexamethasone but not with hydrocortisone resulted in long-lasting programming effects on hypothalamus-pituitary-adrenal axis and on the T-helper 1/T-helper 2 cytokine balance. Follow-up of these children is required to investigate long-term clinical consequences. We recommend that authors of previously performed randomized, controlled trials on neonatal glucocorticoid treatment include immune and neuroendocrine analyses in prolonged follow-up of these children.
Strength Training by Children and Adolescents
Authors:   Council on Sports Medicine and Fitness
Published: April 2008

Pediatricians are often asked to give advice on the safety and efficacy of strength-training programs for children and adolescents. This statement, which is a revision of a previous American Academy of Pediatrics policy statement, defines relevant terminology and provides current information on risks and benefits of strength training for children and adolescents.
School Readiness
Authors: High Pamela C. ,   and the Committee on Early Childhood, Adoption, and Dependent Care and Council on School Health
Published: April 2008

School readiness includes the readiness of the individual child, the school's readiness for children, and the ability of the family and community to support optimal early child development. It is the responsibility of schools to be ready for all children at all levels of readiness. Children's readiness for kindergarten should become an outcome measure for community-based programs, rather than an exclusion criterion at the beginning of the formal educational experience. Our new knowledge of early brain and child development has revealed that modifiable factors in a child's early experience can greatly affect that child's learning trajectory. Many US children enter kindergarten with limitations in their social, emotional, cognitive, and physical development that might have been significantly diminished or eliminated through early identification of and attention to child and family needs. Pediatricians have a role in promoting school readiness for all children, beginning at birth, through their practices and advocacy. The American Academy of Pediatrics affords pediatricians many opportunities to promote the physical, social-emotional, and educational health of young children, with other advocacy groups. This technical report supports American Academy of Pediatrics policy statements “Quality Early Education and Child Care From Birth to Kindergarten” and “The Inappropriate Use of School ‘Readiness’ Tests.”
Medical Conditions Affecting Sports Participation
Authors: Rice Stephen G. ,   and the Council on Sports Medicine and Fitness
Published: April 2008

This Clinical Report was retired July 2018.

Children and adolescents with medical conditions present special issues with respect to participation in athletic activities. The pediatrician can play an important role in determining whether a child with a health condition should participate in certain sports by assessing the child's health status, suggesting appropriate equipment or modifications of sports to decrease the risk of injury, and educating the athlete, parent(s) or guardian, and coach regarding the risks of injury as they relate to the child's condition. This report updates a previous policy statement and provides information for pediatricians on sports participation for children and adolescents with medical conditions.
Snail bioaccumulation of triclocarban, triclosan, and methyltriclosan in a north texas, usa, stream affected by wastewater treatment plant runoff
Authors: Coogan Melinda A , Point Thomas W. La
Published: April 2008

Grazing by freshwater snails promotes nutrient turnover in algal communities. Grazed algal compartments may include antimicrobial agents and metabolites, such as triclocarban (TCC), triclosan (TCS), and methyltriclosan (MTCS), which are incompletely removed by wastewater treatment plant (WWTP) processing. The present study quantifies snail bioaccumulation factors (BAFs) for TCC, TCS, and MTCS at the outfall of Pecan Creek (TX, USA), the receiving stream for the city of Denton (TX, USA) WWTP. Helisoma trivolvis (Say) is ubiquitous and thrives under standard laboratory conditions, leading to its choice for this bioaccumulation study in conjunction with Cladophora spp. Along with providing substrate for epiphytic growth, Cladophora spp. provide a source of food and shelter for H. trivolvis. After being caged for two weeks, algae and snails were collected from the WWTP outfall, along with water-column samples, and analyzed by isotope dilution gas chromatography-mass spectrometry for TCS and MTCS and by liquid chromatography-mass spectrometry for TCC. Algal and snail samples were analyzed before exposure and found to be below practical quantitation limits for all antimicrobial agents. Triclocarban, TCS, and MTCS in water samples were at low-ppt concentrations (40–200 ng/L). Triclocarban, TCS, and MTCS were elevated to low-ppb concentrations (50–300 ng/g fresh wt) in caged snail samples and elevated to low-ppb concentrations (50–400 ng/g fresh wt) in caged algal samples. Resulting snail and algal BAFs were approximately three orders of magnitude, which supports rapid bioaccumulation among algae and adult caged snails at this receiving stream outfall. The results further support TCC, TCS, and MTCS as good candidate marker compounds for evaluation of environmental distribution of trace WWTP contaminants.
Acute, sublethal exposure to a pyrethroid insecticide alters behavior, growth, and predation risk in larvae of the fathead minnow (Pimephales promelas)
Authors: Floyd Emily Y , Geist Juergen P , Werner Inge
Published: April 2008

The present study determined the effects of environmentally relevant, short-term (4-h) exposure to the pyrethroid insecticide esfenvalerate on mortality, food consumption, growth, swimming ability, and predation risk in larvae of the fathead minnow (Pimephales promelas). Acute effect concentrations were determined, and in subsequent experiments, fish were exposed to the following measured sublethal concentrations: 0.072, 0.455, and 1.142 μg/L of esfenvalerate. To measure growth rates (% dry wt/d), 8-d-old fathead minnows were exposed to esfenvalerate for 4 h, then transferred to control water and held for 7 d. Food consumption and abnormal swimming behavior were recorded daily. Additional behavioral experiments were conducted to evaluate how esfenvalerate affects the optomotor response of the fish. To quantify predation risk, esfenvalerate-exposed fathead minnow larvae were transferred to 9.5-L aquaria, each containing one juvenile threespine stickleback (Gasterosteus aculeatus). Sticklebacks were allowed to feed for 45 min, after which the number of surviving minnows was recorded. No mortality occurred during 4-h exposures to esfenvalerate, even at nominal concentrations of greater than 20 μg/L. Delayed mortality (50%) was observed at 2 μg/L after an additional 20 h in clean water. Fish exposed to 0.455 and 1.142 μg/L of esfenvalerate exhibited impaired swimming and feeding ability as well as reduced growth compared to fish exposed to 0.072 μg/L and controls. Predation risk also was significantly increased for larvae exposed to 0.455 and 1.142 μg/L of esfenvalerate. These results demonstrate that larval fish experiencing acute exposures to sublethal concentrations of this insecticide exhibit significant behavioral impairment, leading to reduced growth and increased susceptibility to predation, with potentially severe consequences for their ecological fitness.
Predicting survival of grass shrimp (Palaemonetes pugio) exposed to naphthalene, fluorene, and dibenzothiophene
Authors: Unger Michael A , Newman Michael C , Vadas George G
Published: April 2008

The composition and persistence of dissolved polycyclic aromatic hydrocarbons (PAHs) released to the water column during oil spills are altered by weathering, tidal transport, and addition of dispersants. Conventional toxicity effect metrics, such as the median lethal concentration (LC50), are inaccurate predictors of mortality from all toxicant exposure duration/concentration combinations likely to occur during spills. In contrast, survival models can predict the proportions of animals dying as a consequence of exposures differing in duration and intensity. Extending previous work with ethylnaphthalene, dimethylnaphthalene, and phen-anthrene, survival time models were developed that include exposure duration and concentration to predict time to death for grass shrimp (Palaemonetes pugio). Two additional PAHs (naphthalene and fluorene) and a heterocyclic aromatic hydrocarbon (dibenzothiophene) were evaluated for the present study. Preliminary explorations of these models confirmed that quantitative structure-activity regression models were possible for predicting survival model parameters from compound characteristics. Conventional 48-h LC50s also were calculated for the compounds and combined with published LC50s to predict relative PAH toxicity to P. pugio based on octanol-water partitioning.
Quantification of C60 fullerene concentrations in water
Authors: Chen Zhuo , Westerhoff Paul , Herckes Pierre
Published: April 2008

The growing usage of nanomaterials is causing emerging concern regarding their environmental behavior in aquatic environments. A major need is the capability to detect and quantify nanomaterials in complex water matrices. Carbon60 fullerene is of special interest because of the widespread application of nanocarbon technology. The present study focuses on how to separate and concentrate fullerenes from water containing salts and organic matter and then quantify their concentrations using liquid chromatography coupled with mass spectrometry (LC/MS). The stable aqueous C60 aggregates (nC60) prepared in the present study were approximately 60 to 70 nm in diameter and had an ultraviolet (UV) extinction coefficient of 0.0263 L/mg-cm at 347 nm, which equated to a UV detection limit of 0.4 mg/L based upon an absorbance of 0.01 cm−1. Ultraviolet analysis is not applicable to use in waters containing salts or organics (e.g., tap water) because of their interferences and potential to aggregate nC60 The LS/MS analysis detected C60 as single fullerene rather than aggregates. Three techniques were developed to separate and concentrate nC60 from ultrapure and tap water into toluene to facilitate LC/MS determination: Evaporation of sample to dryness; extraction using 20% NaCl into toluene; and solid-phase extraction. The first two methods had limitations for use in complex water matrices, but aqueous nC60 concentration as low as 300 ng/L in water were quantified using solid-phase extraction (SPE) separation method. This is the first publication on the application of extraction methods for nC60 from ultrapure and tap waters and determination of detection limits by LC/MS.
Tunnel Technique With a Surgical Maneuver to Increase the Graft Extension: Case Report With a 3‐Year Follow‐Up
Authors: Ribeiro Fernando S. , Zandim Daniela L. , Pontes Ana Emília F. , Mantovani Rafael V. , Sampaio José Eduardo C. , Marcantonio Elcio
Published: April 2008

Background: This article reports a clinical case with a 3‐year follow‐up in which a subepithelial connective tissue graft (SCTG) was used with the tunnel technique to treat multiple gingival recessions, and describes a technique used to enlarge the extension of the graft.

Methods: A 41‐year‐old female patient was referred for evaluation and treatment of maxillary multiple recessions. Following basic therapy, the plaque index was 23%, and the gingival index was 12%. Thus, SCTG with the tunnel technique was proposed to provide root coverage of Miller Class I recession on teeth #8 through #11 and a Miller Class III recession on tooth #12. After the donor area had been prepared, SCTG was removed and split cross‐sectionally to lengthen it. The graft was placed through the tunnel and sutured.

Results: Two weeks after the surgical procedure, the tissue color was nearly homogeneous with some reddish regions where the connective tissue was left uncovered, and there were no signs of incisions or suture marks. After 3 years of follow‐up, the mean coverage of the recessions was 2.2 ± 0.7 mm (74.2%), which corresponded to the gain of keratinized tissue. In addition, a gain in tissue thickness was observed.

Conclusion: In a long‐term evaluation, the tunnel technique with the elongated SCTG was used successfully for treatment of multiple gingival recessions with an increase of the soft tissue volume and gain of keratinized tissue.
Gingival Metastasis From Salivary Duct Carcinoma of the Parotid Gland
Authors: Bernabé Daniel G. , Veronese Luiz A. , Miyahara Glauco I. , Conrado‐Neto Sebastião , Biasoli Éder R.
Published: April 2008

Background: This article reports a rare case of metastasis of salivary duct carcinoma of the parotid gland to the gingiva and reviews the occurrence of metastatic processes to the oral mucosa.

Methods: A 67‐year‐old white male presented with a chief complaint of a painless nodular tissue growth on the gingiva with reportedly 5 months of evolution. The intraoral examination revealed a reddish, superficially ulcerated nodular lesion (∼2 cm in diameter) on the right mandibular buccal attached gingiva, and the clinical aspect was that of a benign reactive lesion. The patient had undergone a parotidectomy for removal of a salivary duct carcinoma of the parotid gland almost 1 year before. A biopsy of the gingival lesion was performed, and the biopsied tissue was forwarded for histopathologic examination.

Results: The analysis of the histopathologic sections of the gingival lesion revealed histomorphologic characteristics very similar to those of the primary parotid gland tumor. The definitive diagnosis was gingival metastasis from a salivary duct carcinoma of the parotid gland. The patient died of complications of a pulmonary metastasis 1 month after the diagnosis of the oral metastatic lesion.

Conclusions: Gingival lesions that mimic reactive and hyperplastic lesions may be metastases from malignant neoplasias of diverse origins. An accurate and timely diagnosis is crucial to establish proper and immediate treatment of the metastatic tumor and possibly identify an occult primary malignant neoplasia.
Coronally Positioned Flap Plus Resin‐Modified Glass Ionomer Restoration for the Treatment of Gingival Recession Associated With Non‐Carious Cervical Lesions: A Randomized Controlled Clinical Trial
Authors: Santamaria Mauro Pedrine , Suaid Fabricia Ferreira , Casati Marcio Zaffalon , Nociti Francisco Humberto , Sallum Antonio Wilson , Sallum Enilson Antônio
Published: April 2008

Background: The aim of this randomized clinical trial was to evaluate the treatment of gingival recession associated with non‐carious cervical lesions by a coronally advanced flap alone (CAF) or in combination with a resin‐modified glass ionomer restoration (CAF+R).

Methods: Nineteen subjects with bilateral Miller Class I buccal gingival recessions associated with non‐carious cervical lesions were selected. The recessions were assigned randomly to receive CAF or CAF+R. Bleeding on probing (BOP), probing depth (PD), relative gingival recession (RGR), clinical attachment level (CAL), non‐carious cervical lesion height (CLH), and dentin sensitivity (DS) were measured at baseline; 45 days; and 2, 3, and 6 months postoperatively. Keratinized tissue width (KTW) and keratinized tissue thickness (KTT) were measured at baseline and 6 months. The height of the non‐carious cervical lesion located on the root and crown were estimated, allowing calculation of root coverage.

Results: Both groups showed statistically significant gains in CAL and soft tissue coverage. The differences between groups were not statistically significant for BOP, PD, RGR, CAL, KTW, and KTT after 6 months. The percentages of CLH covered were 56.14% ± 11.74% for CAF+R and 59.78% ± 11.11% for CAF (P >0.05). The root and crown surfaces affected by the non‐carious cervical lesion were 1.67 ± 0.31 mm and 0.96 ± 0.29 mm, respectively, for CAF+R and 1.59 ± 0.37 mm and 1.01 ± 0.33 mm, respectively, for CAF. The estimated root coverage was 88.02% ± 19.45% for CAF+R and 97.48% ± 15.36% for CAF (P >0.05). CAF+R reduced DS significantly compared to CAF (P <0.05).

Conclusions: Both procedures provided similar soft tissue coverage after 6 months. Despite the fact that a greater reduction in DS was observed after CAF+R, longitudinal observations are necessary to confirm these results.
Periodontal Manifestation of Leukocyte Adhesion Deficiency Type I
Authors: Dababneh Reem , Al‐wahadneh Adel M. , Hamadneh Shamekh , Khouri Antwan , Bissada Nabil F.
Published: April 2008

Background: Leukocyte adhesion deficiency type I (LAD‐I) is an autosomal recessive immunodeficiency disorder characterized by defects in the integrin receptors of white blood cells that lead to impaired adhesion and chemotaxis. Affected patients are susceptible to recurrent bacterial and fungal infections, impaired pus formation, delayed wound healing, and periodontitis.

Methods: A case of generalized advanced periodontal destruction of the permanent and deciduous dentition in a young Jordanian girl with a severe phenotype of LAD‐I is presented in this report. The medical diagnosis was made based on the characteristic clinical and laboratory findings, in particular the total absence of CD18, CD11b, and CD11c as determined by flow cytometry sorting.

Results: Periodontal findings in this patient include the early onset of the disease, which affected the primary teeth and permanent dentitions, the intense redness and inflammation of the gingiva, and the rapid periodontal destruction that seems refractory to conventional non‐surgical periodontal therapy.

Conclusion: This report emphasizes the importance of the differential diagnosis of severe immunodeficiency disorders in children and adolescents and mandates the importance of combined care by medical and dental practitioners to prevent tooth loss and control oral infection.
Effect of Platelet‐Rich Plasma on Cell Adhesion, Cell Migration, and Myofibroblastic Differentiation in Human Gingival Fibroblasts
Authors: Cáceres Mónica , Hidalgo Rodrigo , Sanz Antonio , Martínez Jorge , Riera Paula , Smith Patricio C.
Published: April 2008

Background: Platelet‐rich plasma is a blood‐derived fraction that contains a high concentration of platelets and growth factors. It was proposed that the use of this platelet concentrate stimulates tissue repair. However, little is known about the biologic response of gingival fibroblasts to platelet's derived growth factors. In the present study, we evaluated whether platelet‐rich plasma modulated cell adhesion, cell migration, and myofibroblastic differentiation in primary cultures of human gingival fibroblasts.

Methods: We studied the response of primary cultures of gingival fibroblasts to thrombin‐activated platelet‐rich plasma fractions. Cell adhesion was evaluated through a colorimetric assay. Cell spreading, actin cytoskeleton remodeling, and focal adhesion distribution were assessed through light and immunofluorescence microscopy. Cell migration was analyzed using a bicameral cell culture system. Smooth muscle actin production was studied through Western blotting.

Results: Exposure of gingival fibroblasts to platelet‐rich plasma stimulated adhesion and spreading of cells on fibronectin matrices, the development of actin‐enriched cellular extensions, and formation of focal adhesions. Platelet‐rich plasma also promoted cell migration and invasion through a reconstituted basement membrane matrix. Differentiation into the myofibroblastic phenotype, assessed through the production of smooth muscle actin, was also stimulated by platelet‐rich plasma preparations.

Conclusion: Platelet‐rich plasma may modulate several cell responses potentially involved in wound healing such as cell adhesion, cell migration, and myofibroblastic differentiation.
Gingival Enlargement as a Manifestation of Tuberous Sclerosis: Case Report and Periodontal Management
Authors: Korol Urszula B. , Schoor Robert , Nanda Veena , Almas Khalid , Phelan Joan A.
Published: April 2008

Background: Tuberous sclerosis is an autosomal‐dominant inherited disease involving many organs of the body. Oral manifestations include gingival enlargement, fibromas, and dental enamel pitting. The report presents a case of tuberous sclerosis with gingival enlargement histologically consistent with angiofibroma, describes its successful periodontal management, and reviews the literature associated with oral manifestations of tuberous sclerosis.

Methods: A 26‐year‐old white male presented to the Department of Periodontics and Implant Dentistry, New York University College of Dentistry, with a diagnosis of tuberous sclerosis and a chief complaint of gingival enlargement affecting mastication and esthetics. Following a complete medical history review, consultation with the patient's medical team at New York University Medical Center, and a thorough oral and periodontal examination, a treatment plan was developed that included oral hygiene instructions, mechanical debridement, and periodontal reevaluation. This was followed by gingivectomy, which provided improved function and esthetics. Excised tissue was submitted for histologic examination. The patient was followed every 2 months for assessment of the outcome of the surgical treatment. An extensive search of the dental and dermatologic literature was performed on MEDLINE.

Results: Histologic examination of the gingival tissue revealed features consistent with angiofibroma. Fifteen months following gingivectomy, the contours and gingival surface appearance remained normal.

Conclusions: The gingival enlargement was histologically consistent with the characteristic angiofibromas of tuberous sclerosis. The gingival enlargement responded very well to gingivectomy and periodontal maintenance.
5‐Year Longitudinal Study of Survival Rate and Periodontal Parameter Changes at Sites of Maxillary Canine Autotransplantation
Authors: Arikan Fatih , Nizam Nejat , Sonmez Sule
Published: April 2008

Background: Although dental transplantation is an accepted treatment modality, few studies have evaluated the prognosis for autotransplantation of maxillary canines, and changes in clinical periodontal parameters still need to be demonstrated. The objectives of this long‐term study were to evaluate the prognosis and changes in clinical attachment level (CAL), probing depth (PD), soft tissue recession (REC), and radiographic bone level changes between years 1 and 5 for autotransplanted maxillary canines.

Methods: Thirty subjects with 32 impacted canines were scheduled for transplantation. Transplanted teeth were splinted for 4 weeks, and endodontic treatments were performed within 1 year after the operation. Radiographs were taken, and PD and CAL were measured for up to 5 years. Progressive root resorption was observed in two teeth, and one tooth was extracted during year 4.

Results: The survival rate was 93.5%. CAL and PD tended to increase slightly at all sites, especially at palatal sites after transplantation, whereas the greatest CAL and PD were found at approximal sites, and REC was the same as natural teeth.

Conclusions: Maxillary canine transplantation can be a reliable treatment alternative. Clinical measurements demonstrated long‐term stability. Based on the literature and the present findings, maxillary canine transplantation can be suggested as a promising treatment modality.
Periodontal Disease in Hispanic Americans With Type 2 Diabetes
Authors: Novak M. John , Potter Richard M. , Blodgett Janet , Ebersole Jeffrey L.
Published: April 2008

Background:Diabetes is a major risk factor for the development of periodontal disease in certain populations. The prevalence of type 2 diabetes is increased in Hispanic Americans, but its impact on the extent and severity of periodontal disease in this population has not been determined.

Methods:Sixty‐three Hispanic Americans, aged 33 to 72 years, from South Texas were grouped based on the presence or absence of type 2 diabetes. Past medical histories, including smoking, were obtained. Periodontal status was evaluated by measuring probing depth (PD), clinical attachment level (CAL), plaque, bleeding on probing, visual gingival inflammation, and calculus.

Results:Type 2 diabetes was associated frequently with major medical complications in this population. Diabetes was associated with significantly more calculus formation and tooth loss and an increased extent and severity of periodontitis. Subjects with diabetes had nearly three times the mean CAL and frequency of PD >6 mm than subjects without diabetes and nearly twice the frequency of moderate to advanced attachment loss (≥3 mm). Smoking and diabetes had significant independent effects on mean CAL and the frequency of deep pockets. Diabetes and smoking combined were associated with a significantly higher frequency of sites with CAL ≥3 mm compared to healthy non‐smokers, healthy smokers, and non‐smokers with diabetes.

Conclusions:Hispanic Americans with type 2 diabetes had more supra‐ and subgingival calculus, an increased extent and severity of periodontal destruction, and an increased frequency of tooth loss due to periodontitis. An additive/synergistic contribution of type 2 diabetes and smoking for increasing the extent of periodontal disease was observed.
Root Coverage Outcome May Be Affected by Heavy Smoking: A 2‐Year Follow‐Up Study
Authors: Andia Denise C. , Martins Ângela G. , Casati Márcio Z. , Sallum Enilson A. , Nociti Francisco H.
Published: April 2008

Background: Although subepithelial connective tissue graft (CTG) has been reported to be a predictable procedure for root coverage, the impact of smoking on the long‐term outcome of periodontal plastic surgery is unclear. Hence, the aim of this study was to evaluate the effect of smoking, on a long‐term basis, on the stability of gingival tissue following CTG treatment of gingival recession.

Methods: Twenty‐two defects were treated by CTG in canine and premolar Miller Class I and II gingival recessions (11 smokers and 11 non‐smokers). The following clinical measurements were obtained at baseline and at 1, 2, 3, 4, 6, 12, 18, and 24 months after surgery: plaque and gingival indexes, extension of gingival recession (GR), probing depth (PD), clinical attachment level (CAL), and gingival thickness. Individuals smoking ≥20 cigarettes/day for ≥5 years were considered smokers.

Results: Data analysis demonstrated that both groups presented similar plaque and gingival indexes (P >0.05), and an intragroup analysis showed that CTG was able to promote root coverage and increase gingival thickness in both groups over time (P <0.05). However, at 24 months postoperatively, statistical analysis showed that smokers presented poorer outcomes with regard to PD, GR, and CAL (P <0.05); in addition, a more satisfactory stabilization of the gingival tissue was found in the non‐smoker group.

Conclusion: Smoking may represent a challenge to root coverage outcome for CTG because smoking significantly affected the stability of gingival tissue over time.