Return to Play in Youth Athletes: Role of the Radiologist with Focus on the Upper Extremity.

Increase in youth sports participation, longer duration of play, and earlier starting points have increased the prevalence of acute and repetitive overuse musculoskeletal injuries. This rise in injury rates has led to increased efforts to better understand the susceptible sites of injury that are unique to the growing immature skeleton. Upper extremity injuries are currently the best studied, particularly those that occur among pediatric baseball players and gymnasts. The weak link in skeletally immature athletes is the growth plate complex that includes those injuries located at the epiphyseal and apophyseal primary physes and the peripherally located secondary physes. This article reviews the anatomy and function of these growth plate complexes, followed by a discussion of the pathophysiologic mechanisms, spectrum of imaging findings, and existing evidence-based guidelines for injury prevention and return to play.

Anti-Tuberculosis Potential of OJT008 against Active and Multi-Drug-Resistant Mycobacterium Tuberculosis: In Silico and In Vitro Inhibition of Methionine Aminopeptidase.

Despite the recent progress in the diagnosis of tuberculosis (TB), the chemotherapeutic management of TB continues to be challenging. Mycobacterium tuberculosis (Mtb), the etiological agent of TB, is classified as the 13th leading cause of death globally. In addition, 450,000 people were reported to develop multi-drug-resistant TB globally. The current project focuses on targeting methionine aminopeptidase (MetAP), an essential protein for the viability of Mtb. MetAP is a metalloprotease that catalyzes the excision of the N-terminal methionine (NME) during protein synthesis, allowing the enzyme to be an auspicious target for the development of novel therapeutic agents for the treatment of TB. Mtb possesses two MetAP1 isoforms, MtMetAP1a and MtMetAP1c, which are vital for Mtb viability and, hence, a promising chemotherapeutic target for Mtb therapy. In this study, we cloned and overexpressed recombinant MtMetAP1c. We investigated the in vitro inhibitory effect of the novel MetAP inhibitor, OJT008, on the cobalt ion- and nickel ion-activated MtMetAP1c, and the mechanism of action was elucidated through an in silico approach. The compound's potency against replicating and multi-drug-resistant (MDR) Mtb strains was also investigated. The induction of the overexpressed recombinant MtMetAP1c was optimized at 8 h with a final concentration of 1 mM Isopropyl ß-D-1-thiogalactopyranoside. The average yield from 1 L of Escherichia coli culture for MtMetAP1c was 4.65 mg. A preliminary MtMetAP1c metal dependency screen showed optimum activation with nickel and cobalt ions occurred at 100 µM. The half-maximal inhibitory concentration (IC50) values of OJT008 against MtMetAP1c activated with CoCl2 and NiCl2 were 11 µM and 40 µM, respectively. The in silico study showed OJT008 strongly binds to both metal-activated MtMetAP1c, as evidenced by strong molecular interactions and a higher binding score, thereby corroborating our result. This in silico study validated the pharmacophore's metal specificity. The potency of OJT008 against both active and MDR Mtb was <0.063 µg/mL. Our study reports OJT008 as an inhibitor of MtMetAP1c, which is potent at low micromolar concentrations against both active susceptible and MDR Mtb. These results suggest OJT008 is a potential lead compound for the development of novel small molecules for the therapeutic management of TB.

Test variability of the QuantiFERON-TB gold in-tube assay in clinical practice.

RATIONALE: Although IFN-γ release assays (IGRAs) are widely used to screen for Mycobacterium tuberculosis infection in high-income countries, published data on repeatability are limited. OBJECTIVES: To determine IGRA repeatability. METHODS: The study population included consecutive patients referred to The Methodist Hospital (Houston, TX) between August 1, 2010 and July 31, 2011 for latent tuberculosis (TB) infection screening with an IGRA (QuantiFERON-TB Gold In-Tube; Cellestis, Carnegie, Australia). We performed multiple IGRA tests using leftover stimulated plasma according to a prospectively formulated quality control protocol. We analyzed agreement in interpretation of test results classified according to manufacturer-recommended criteria and repeatability of quantitative TB response. MEASUREMENTS AND MAIN RESULTS: During the study period, 1,086 test results were obtained from 543 subjects. Per the manufacturer's cut-point, the result of the second test was discordant from that of the first in 28 (8%) of 366 patients with valid test results, including 13 with an initial negative result and 15 with an initial positive result. Although agreement between repeat test results was high (κ = 0.84; 95% confidence interval, 0.79-0.90), the normal expected range of within-subject variability in TB response on retesting included differences of ± 0.60 IU/ml for all individuals (coefficient of variation, 14%), and ± 0.24 IU/ml (coefficient of variation, 27%) for individuals whose initial TB response was between 0.25 and 0.80 IU/ml. CONCLUSIONS: There is substantial variability in TB response when IGRAs are repeated using the same patient sample. IGRA results should be interpreted cautiously when TB response is near interpretation cut-points.

Quality attributes in breast muscle from broilers of an Arkansas randombred line varying in growth rate.

The physico-chemical quality attributes of meat from broilers with significant differences in growth rate were investigated in this study. Two chicken populations from a random mating broiler control population were established as a slow-growing subpopulation (SG) with an average growth rate of 229 g/wk and a fast-growing subpopulation (FG) with an average growth rate of 319 g/wk. The initial pH at 15 min and final pH after 24 h were higher (P < 0.05) in breast muscle from FG than muscle from the SG population. Muscle from the SG had higher (P < 0.05) L* and b* of 57.0 and 11.2, compared with L* and b* of 55.8 and 10.5 from the FG. Although no difference in a* was observed, hue angle was different (P < 0.05) at 52.7 and 50.4 in FG and SG populations, respectively. Water-holding capacity was 25 to 27% and not different between the populations, but 5-d drip loss at 8.48% was higher (P < 0.05) in the muscle from the SG compared with the FG at 6.44%. Cook yield was higher (P < 0.05) in the FG muscle at 86.92% compared with the SG muscle at 85.96%. There was a positive correlation of +0.20 between pH difference and drip loss only in the FG. Significantly higher (P < 0.05) cook yields were observed in muscle from FG than SG chickens. The lower weight, higher L* value, and lower initial and final pH values in the SG population, coupled with higher drip loss and lower cook yield, likely result from differences in growth rate.

The association between local area immigrant fraction and prevalence of cardiovascular diseases in the United States: an observational study.

Background: Local area immigrant fraction is strongly and positively correlated with local life expectancy in the United States. The aim of the study was to determine the relationship between local area immigrant fraction and local prevalence of coronary heart disease (CHD) and stroke. Methods: Cross-sectional study design, with ZIP code as the unit of observation. Demographic data was obtained from the American Community Survey, and linked to indicators of health access (e.g., insurance, annual check-ups, cholesterol screening), obesity, behavior (smoking, exercise), and cardiovascular outcomes data from the 2020 Population Level Analysis and Community Estimates. Multivariable regression and path analyses were used to assess both direct and indirect relationships among variables. Findings: CHD prevalence was lower in the second (3.9% relative difference, 95% CI: 3.1-4.5%), third (6.5%, 95% CI: 5.8-7.1%), and fourth (14.8%, 95% CI: 14.1-15.8%) quartiles of immigrant fraction compared to the lowest (p-trend <0.001). These effects remained robust in multivariable analysis following adjustment for indicators of access, obesity, and behavioral variables (p-trend <0.0001). For stroke, only the highest quartile demonstrated a significant difference in prevalence (2.1%, 95% CI: 1.2-3.0% with full adjustment). In CHD path analysis, ∼45% of the association of immigrant fraction was direct, and ∼55% was mediated through lower prevalence of deleterious behaviors (e.g., smoking). In stroke path analysis, the effect was entirely mediated through indirect effects. Interpretation: In the United States, ZIP codes with higher immigrant fractions have lower prevalence of cardiovascular diseases. These associations are partially mediated through differences in health behaviors at the community level. Funding: NIH (K08CA252635, P30AG0059304, K24HL150476), Stanford University, Rutgers University.

Thioaptamer targeted discoidal microparticles increase self immunity and reduce Mycobacterium tuberculosis burden in mice.

Worldwide, tuberculosis (TB) remains one of the most prevalent infectious diseases causing morbidity and death in >1.5 million patients annually. Mycobacterium tuberculosis (Mtb), the etiologic agent of TB, usually resides in the alveolar macrophages. Current tuberculosis treatment methods require more than six months, and low compliance often leads to therapeutic failure and multidrug resistant strain development. Critical to improving TB-therapy is shortening treatment duration and increasing therapeutic efficacy. In this study, we sought to determine if lung hemodynamics and pathological changes in Mtb infected cells can be used for the selective targeting of microparticles to infected tissue(s). Thioaptamers (TA) with CD44 (CD44TA) targeting moiety were conjugated to discoidal silicon mesoporous microparticles (SMP) to enhance accumulation of these agents/carriers in the infected macrophages in the lungs. In vitro, CD44TA-SMP accumulated in macrophages infected with mycobacteria efficiently killing the infected cells and decreasing survival of mycobacteria. In vivo, increased accumulations of CD44TA-SMP were recorded in the lung of M. tuberculosis infected mice as compared to controls. TA-targeted carriers significantly diminished bacterial load in the lungs and caused recruitment of T lymphocytes. Proposed mechanism of action of the designed vector accounts for a combination of increased uptake of particles that leads to infected macrophage death, as well as, activation of cellular immunity by the TA, causing increased T-cell accumulation in the treated lungs. Based on our data with CD44TA-SMP, we anticipate that this drug carrier can open new avenues in TB management.

Differentiating between live and dead Mycobacterium smegmatis using autofluorescence.

While there have been research efforts to find faster and more efficient diagnostic techniques for tuberculosis (TB), it is equally important to monitor a patient's response to treatment over time, especially with the increasing prevalence of multi-drug resistant (MDR) and extensively-drug resistant (XDR) TB. Between sputum smear microscopy, culture, and GeneXpert, only culture can verify viability of mycobacteria. However, it may take up to six weeks to grow Mycobacterium tuberculosis (Mtb), during which time the patient may have responded to treatment or the mycobacteria are still viable because the patient has MDR or XDR TB. In both situations, treatment incurs increased patient costs and makes them more susceptible to host-drug effects such as liver damage. Coenzyme Factor 420 (F420) is a fluorescent coenzyme found naturally in mycobacteria, with an excitation peak around 420 nm and an emission peak around 470 nm. Using Mycobacterium smegmatis, we show that live and dead mycobacteria undergo different rates of photobleaching over a period of 2 min. These preliminary experiments suggest that the different photobleaching rates could be used to help monitor a patient's response to TB treatment. In future studies, we propose to describe these experiments with Mtb as both M. smegmatis and Mtb use F420.

Characterization of 2-hydroxy-1-naphthaldehyde isonicotinoyl hydrazone as a novel inhibitor of methionine aminopeptidases from Mycobacterium tuberculosis.

Mycobacterium tuberculosis (Mtb) and the Human Immunodeficiency Virus (HIV) pose a major public health threat. The 2015 World Health Organization (WHO) report estimates that one in three HIV deaths is due to Mtb, the causative agent of Tuberculosis (TB). The lethal synergy between these two pathogens leads to a decline in the immune function of infected individuals as well as a rise in morbidity and mortality rates. The deadly interaction between TB and HIV, along with the heightened emergence of drug resistance, drug-drug interactions, reduced drug efficacy and increased drug toxicity, has made the therapeutic management of co-infected individuals a major challenge. Hence, the development of new drug targets and/or new drug leads are imperative for the effective therapeutic management of co-infected patients. Here, we report the characterization of 2-hydroxy-1-naphthaldehyde isonicotinoyl hydrazone (311), a known inhibitor of HIV-1 replication and transcription as a new inhibitor of methionine aminopeptidases (MetAPs) from Mycobacterium tuberculosis: MtMetAP1a and MtMetAP1c. MetAP is a metalloprotease that removes the N-terminal methionine during protein synthesis. The essential role of MetAP in microbes makes it a promising chemotherapeutic target. We demonstrated that 311 is a potent and selective inhibitor of MtMetAP1a and MtMetAP1c. Furthermore, we found that 311 is active against replicating and aged non-growing Mtb at low micromolar concentrations. These results suggest that 311 is a promising lead for the development of novel class of therapeutic agents with dual inhibition of TB and HIV for the treatment of TB-HIV co-infection.

Molecular epidemiology of Mycobacterium tuberculosis among South African gold miners.

RATIONALE: HIV-associated tuberculosis remains a major health problem among the gold-mining workforce in South Africa. We postulate that high levels of recent transmission, indicated by strain clustering, are fueling the tuberculosis epidemic among gold miners. OBJECTIVES: To combine molecular and epidemiologic data to describe Mycobacterium tuberculosis genetic diversity, estimate levels of transmission, and examine risk factors for clustering. METHODS: We conducted a cross-sectional study of culture-positive M. tuberculosis isolates in 15 gold mine shafts across three provinces in South Africa. All isolates were subject IS6110-based restriction fragment length polymorphisms, and we performed spoligotyping analysis and combined it with basic demographic and clinical information. MEASUREMENTS AND MAIN RESULTS: Of the 1,602 M. tuberculosis patient isolates, 1,240 (78%) had genotyping data available for analysis. A highly diverse bacillary population was identified, comprising a total of 730 discrete genotypes. Four genotypic families (Latin American Mediterranean spoligotype family; W-Beijing; AH or X; and T1-T4) accounted for over 50% of all strains. Overall, 45% (560/1,240) of strains were genotypically clustered. The minimum estimate for recent transmission (n - 1 method) was 32% (range, 27-34%). There were no individual-level risk factors for clustering, apart from borderline evidence for being non-South African and having self-reported HIV infection. CONCLUSIONS: The high M. tuberculosis genetic diversity and lack of risk factors for clustering are indicative of a universal risk for disease among gold miners and likely mixing with nonmining populations. Our results underscore the urgent need to intensify interventions to interrupt transmission across the entire gold-mining workforce in South Africa.

Bone-resorbing activity and prostaglandin E produced by human periodontal ligament cells in vitro.

Human periodontal ligament (PDL) cells were derived from healthy premolars extracted for orthodontic treatment and were utilized for in vitro experiments in passages 4-6. Human PDL cells were seeded in tissue culture tubes and incubated with interleukin-1 alpha (IL-1 alpha), IL-1 beta, tumor necrosis factor-alpha (TNF-alpha), interferon-gamma (IFN-gamma), indomethacin, parathyroid hormone (PTH), or their combinations, for 1 h. The medium was then replaced with serum-free BGJb medium and incubated for 24 h without further additions. Prostaglandin E (PGE) concentrations in the conditioned media (CM) were measured by radioimmunoassay, and bone-resorbing activity was measured using 45Ca-labeled neonatal mouse calvariae. The results of this study indicated that (1) unstimulated cultured PDL cells produced PGE, and PDL CM stimulated bone resorption; (2) cytokine-treated (IL-1 alpha, IL-1 beta, and TNF-alpha) PDL cells had increased production of PGE and bone-resorbing activity compared to unstimulated PDL cells; (3) indomethacin completely inhibited PGE production from unstimulated PDL cells but only partially inhibited bone-resorbing activity, indicating that PDL cells produced nonprostaglandin bone-resorbing factor(s); (4) IFN-gamma did not change PGE or bone-resorbing activity production by cytokine-stimulated PDL cells; and (5) PTH treatment of PDL cells in addition to cytokines (IL-1 alpha, IL-1 beta, and TNF-alpha) had additive effects on the production of bone-resorbing activity and synergistic effects on PGE production compared to cytokine treatment alone.

Evaluation of fluoride prophylaxis pastes.

The fluoride (F) uptake from two commercial prophylaxis pastes and a newly formulated prophylaxis paste was compared. The enamel fluoride uptake of 26 extracted sound human molars was measured using an acid etch biopsy method. The F uptakes in ppm (mean +/- SEM) for the control prophy pastes (C), Zircate treatment paste (Z), an APF paste (Nuppro,A), and a new experimental paste (N) were 1145 +/- 65,1245 +/- 72,1857 +/- 296, and 1841 +/- 321, respectively. The enamel biopsy depths in micrometers (mean +/- S.D.) for the control, Zircate APF pastes, and Newpaste were 6.64 +/- 1.75, 7.4 +/- 2.32, 6.55 +/- 2.23 and 7.69 +/- 1.80. The Newpaste appeared to give a significantly higher fluride uptake than Zircate and control pastes, but was very similar to an APF paste.

Interactive effects between cytokines on PGE production by human periodontal ligament fibroblasts in vitro.

Mononuclear cell production of cytokines that stimulate fibroblast production of prostaglandin E (PGE) is an important mechanism by which mononuclear cells regulate fibroblast function. The objective of this investigation was to determine the effects of the cytokines interleukin 1 beta (IL-1 beta), interleukin 1 alpha (IL-1 alpha), tumor necrosis factor alpha (TNF-alpha), and interferon gamma (IFN-gamma), alone or in paired combinations, on PGE production by near-confluent human periodontal ligament (PDL) fibroblasts in vitro. Premolars extracted in the course of orthodontic treatment were used for this study. Fibroblast cultures, free of epithelial cells, were obtained after the fourth subculture by the use of accurately-timed trypsin treatment. Cells in the fourth to sixth passage, incubated in DMEM supplemented with 10% equine serum, were used for these experiments. Cells (1 x 10(5)) were seeded in 12- x -75-mm tissue culture tubes and incubated with various doses of IL-1 beta, IL-1 alpha, TNF-alpha, and IFN-gamma, alone or in specific combinations, for 15 min, two, 12, 24, and 72 h. PGE concentrations in the media were measured by radio-immunoassay. The results showed that human PDL fibroblasts responded to the administration of cytokines by an elevation in the synthesis of PGE in a dose- and time-related fashion. The increase in PGE production was inhibited by the addition of indomethacin. The interactions between these cytokines varied in degree, depending on the particular combinations of cytokines. In addition, the administration of cytokine combinations was found to be additive, synergistic, subtractive, or suppressive on the production of PGE by PDL fibroblasts, depending on the duration of incubation. These experiments demonstrate the importance of the consideration of the interplay between cytokines produced by mononuclear cells on the mechanisms that regulate the functions of PDL fibroblasts.

Involvement of PGE synthesis in the effect of intermittent pressure and interleukin-1 beta on bone resorption.

Human periodontal ligament (PDL) fibroblasts, cultured from extracted healthy premolars, and a cloned osteogenic cell line (MC3T3-E1) were used in this study to determine the effect of intermittent pressure on bone resorption. Cells (1 x 10(5] were incubated with BGJb medium in the presence or absence of the following factors: intermittent negative (-30 g/cm2) or positive (30 g/cm2) hydrostatic pressure and interleukin-1 beta (IL-1 beta, 1 ng/mL), for 24 h. Conditioned media (CM) generated from cultures of either cell types were used for prostaglandin E (PGE) assay, bone resorption assay, and assessment of osteoclast (OC)-like cell formation. Unstimulated PDL fibroblasts or MC3T3-E1 cells produced measurable amounts of PGE and bone-resorbing activity as measured by 45Ca released from mouse calvaria and OC-like cells. IL-1 beta-treated cells showed significantly elevated levels of PGE, bone resorption, and OC-like cell formation, as compared with unstimulated cells. Intermittent positive pressure (IPP) alone stimulated PGE production, but the resultant CM did not stimulate bone resorption or OC-like cell formation when IPP was applied to either cell type. The application of IPP, together with IL-1 beta in CM, caused a slight increase in the number of alpha-like cells, as compared with that of IL-1 beta-treated CM in both cell types. On the other hand, direct application of IPP on mouse bone-marrow cultures significantly increased the number of OC-like cells. This effect was additive in combination with either CM from unstimulated cells or exogenous addition of PGE2.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of parathyroid hormone and cytokines on prostaglandin E synthesis and bone resorption by human periodontal ligament fibroblasts.

Cultured human periodontal ligament fibroblasts showed synergistic elevations in the synthesis of prostaglandin E and production of cAMP by the administration of parathyroid hormone and cytokines (interleukin 1 alpha, -1 beta, or tumour necrosis factor-alpha). Unstimulated conditioned media derived from these fibroblasts contained bone-resorbing activity. In addition, conditioned media generated by cytokine-or parathyroid hormone-treated fibroblasts showed further increases in bone-resorbing activity. The effects were additive when the hormone was combined with either one of the cytokines in stimulating bone resorption. These findings suggest that the effect of parathyroid hormones and cytokines together on bone resorption can be mediated in part by human periodontal ligament fibroblasts via PGE production and subsequent PGE action on the osteoclasts.

Immunohistochemical assessment of the effect of chemical and mechanical stimuli on cAMP and prostaglandin E levels in human gingival fibroblasts in vitro.

These were evaluated by: (1) a combined immunohistochemical-microphotometric procedure (IH) and (2) conventional radiometric assays. Human gingival fibroblasts were in the sixth passage, grown and maintained in Dulbecco minimal essential medium (DMEM) supplemented with 10 per cent horse serum. For chemical and hormonal stimuli, cells (2 x 10(4] were seeded on tissue-culture chamber/slides, and incubated with graded doses of either parathyroid hormone (PTH) or prostaglandin E2 (PGE2) for assessment of their adenosine-3',5'-monophosphate (cAMP) levels, and with indomethacin or colchicine for their effect on PGE levels. For mechanical stimuli, cells (1 x 10(6] were seeded on culture dishes with a flexible plastic membrane and stretched for 5, 30, 60 or 120 min by placing the membrane over a convex surface and weighting the dish cover. After freeze drying, cells were stained by an immunoperoxidase technique for either cAMP or PGE, using monoclonal antibodies. The staining intensity of fibroblasts was determined at 600 nm wavelength. Per cent light absorbance of 15 cells in each slide was measured and the results tested by analysis of variance. The gingival fibroblasts responded to the drugs and hormones in a dose- and time-related fashion. Stretching significantly increased their synthesis of PGE with concomitant increase in cAMP. The IH results were compared with the radiometric assays to confirm the validity of this technique; both assays were valid for describing the quantitative responses of these cells to the stimuli. In particular, the IH method could localize those intracellular sites which demonstrated chances in relative cAMP and PGE concentrations in response to hormonal stimuli.

The interactive effects of mechanical stress and interleukin-1 beta on prostaglandin E and cyclic AMP production in human periodontal ligament fibroblasts in vitro: comparison with cloned osteoblastic cells of mouse (MC3T3-E1).

Human periodontal ligament fibroblasts and a cloned osteogenic cell line (MC3T3-E1) were seeded (4 x 10(5) cells) on 60 mm Petriperm dishes, which have a flexible plastic growth surface. Cells were stretched by placing the dish on top of a spheroidal convex template, equilibrated to 37 degrees C. The amount of stretch was varied by changing the curvature of the template and calculated as percentage stretch. Both types of cell responded to mechanical stress by elevated synthesis of PGE and cAMP; the addition of interleukin-1 beta to mechanically stretched cells produced further elevation. Synergism between mechanical stress and interleukin-1 beta was found at certain lengths of incubation. The production of cAMP was secondary and dependent on the newly synthesized PGE, as shown in the presence of indomethacin. The two cell types were also different in terms of the timing of their response to mechanical stress and interleukin-1 beta. In the absence of stimuli, periodontal fibroblasts tended to produce PGE continually over time, whereas the MC3T3-E1 cells did not. However, both cell types had elevated PGE levels in response to the stimuli used in this experiment. Periodontal fibroblasts responded to mechanical stress and interleukin-1 beta with significant elevations of PGE as early as 15 min, whereas the MC3T3-E1 cells required 2 h to produce significant elevations for mechanical stress and 15 min for interleukin-1 beta. These findings indicate that the chemical and mechanical signals on these cells are mediated by surface receptors. Locally produced autocrine or paracrine factors can modify the effect of mechanical stress on periodontal and bone cells via the cAMP pathway.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of cytokines on prostaglandin E and cAMP levels in human periodontal ligament fibroblasts in vitro.

The stimulation of PGE synthesis and cAMP production by cytokines have important physiological effects in many target tissues. The effects of interleukin-1 alpha and -1 beta, tumour necrosis factor-alpha and interferon-gamma on PGE and cAMP production by periodontal ligament fibroblasts were studied. Fibroblasts in the 4th-6th passage, grown and maintained in DMEM supplemented with 10% equine serum, were incubated with graded doses of the various cytokines for 0.25, 0.5, 1.2, 4, 24, 48 or 72 h. At the end of each incubation, PGE in the medium and the cellular content of cAMP were evaluated by a combined immunohistochemical microphotometric procedure, and conventional radiometric assays. The fibroblasts responded to all the cytokines with a dose- and time-related increase in the levels of PGE and cAMP. Such increases were inhibited by the inclusion of indomethacin in the medium. The addition of exogenous PGE reversed that inhibition in respect of cAMP production. Immunohistochemical localization showed PGE predominantly in the cytoplasm and cAMP in the nucleus. These findings indicate that: (1) human periodontal ligament fibroblasts respond to these cytokines by increased synthesis of PGE and the production of cAMP; and (2) the cAMP production is secondary to the PGE synthesis. They suggest that these cytokines may regulate the function of these fibroblasts in physiological remodelling of the periodontium, as well as in inflammatory reactions.

Medical data mining using evolutionary computation.

In this paper, we introduce a system for discovering medical knowledge by learning Bayesian networks and rules. Evolutionary computation is used as the search algorithm. The Bayesian networks can provide an overall structure of the relationships among the attributes. The rules can capture detailed and interesting patterns in the database. The system is applied to real-life medical databases for limb fracture and scoliosis. The knowledge discovered provides insights to and allows better understanding of these two medical domains.

Management of space problems in the primary and mixed dentitions.

BACKGROUND: According to the Third National Health and Nutrition Examination Survey, crowding and irregularity remain a consistent problem for children. Management of space problems continues to play an important role in a dental practice. It also represents an area of major interaction between the primary provider and the specialists. This article attempts to update clinicians on the current knowledge of space management. DESCRIPTION OF CONDITION: Proper management of space in the primary and mixed dentitions can prevent unnecessary loss in arch length. Diagnosing and treating space problems requires an understanding of the etiology of crowding and the development of the dentition to render treatment for the mild, moderate and severe crowding cases. Most crowding problems with less than 4.5 millimeters can be resolved through preservation of the leeway space, regaining space or limited expansion in the late mixed dentition. In cases with 5 to 9 mm of crowding, some can be approached with expansion after thorough diagnosis and treatment planning. Most of these cases will require extraction of permanent teeth to preserve facial esthetics and the integrity of the supporting soft tissue. Serial extraction or guidance of eruption is reserved for treatment of severe tooth-size/arch-size discrepancies. Due to variations in the timing and extraction sequence depending on the diagnosis, serial extraction should be reserved for those who can complete the treatment successfully. CLINICAL IMPLICATIONS: The recommended timing of referring patients with moderate crowding to specialists for treatment is in the late mixed-dentition stage of development. Patients with severe crowding will require earlier evaluation for serial extraction.

Orthodontic treatment of the primary dentition.

Five patients were treated for corrections of problems in the primary dentition. Anterior and posterior crossbite, deep overbite malocclusion, and overbite malocclusion were treated with simple removable orthodontic appliances. Early orthodontic treatment for these patients helped resolve any functional problems that could interfere with later growth and development, such as health and function of the TMJ complex.