Periodontal associations in cardiovascular diseases: The latest evidence and understanding.

Periodontal and cardiovascular diseases (CVD) are inflammatory diseases. Recent epidemiological studies have associated the effect of periodontitis on CVD progression. Findings of oral pathogens in carotid atheromas provided a plausible relationship between these two diseases. One possible mechanism is the infiltration of oral/periodontal pathogens through inflamed and ulcerated gingival epithelium. This results in translocation of oral pathogens throughout the systemic circulation affecting vascular tissues, and initiating a cascade of inflammatory reactions detrimental to the cardiovascular system. In addition, leakage of pro-inflammatory cytokines/chemokines from the ulcerated periodontium into the bloodstream may cause the production of hepatic acute-phase proteins. Moreover, as chronic bacteremia occurs, the adaptive immune system is activated. Antibodies produced in response to periodontal pathogens trigger a cross-reaction between endothelial cells and modified low-density lipoprotein to enhance the movement of lipids into cells within the vessel wall. Some antibodies and inflammatory cytokines promote the Th1 response, thereby further activating macrophages within the atheroma. These plausible mechanisms are contributing factors in initiating and propagating atherogenesis. This review discusses the current understanding of CVD pathology/periodontitis, potential underlying mechanisms regarding this association, and general guidelines for treating patients with CVD risks.

Analytical methods for the characterization of cationic lipid-nucleic acid complexes.

Five analytical assays are described that provide a platform for systematically evaluating the effect of formulation variables on the physical properties of cationic lipid-DNA complexes (lipoplexes). The assays are for (i) lipid recovery, (ii) total DNA, (iii) free DNA, (iv) nuclease sensitivity, and (v) physical stability by filtration. Lipid recovery was determined by measuring lipid primary amino groups labeled with the fluorescamine reagent in the presence of the detergent Zwittergent. Zwittergent was effective at disrupting lipoplexes, making the primary amine accessible to the fluorescamine reagent. Total DNA was determined with the PicoGreen reagent, also in the presence of Zwittergent. The PicoGreen assay in the absence of Zwittergent gave the percentage of the total DNA that was not complexed with cationic lipid. The results of this assay for free DNA agreed well with the amount of DNA that could be separated from complexes by centrifugation as well as with the amount of DNA that was accessible to DNase I digestion. Monitoring the lipid and DNA recoveries after filtration through polycarbonate membranes provided a quantitative method for assessing changes in lipoplex physical characteristics. Together, these assays provide a convenient high-throughput approach to assess physical properties of lipoplexes, allowing systematic evaluation of different formulations.

Postoperative pain relief following laparoscopic tubal sterilization with silastic bands.

OBJECTIVE: To evaluate postoperative pain relief of intramuscular ketorolac, topical bupivacaine, and placebo in patients undergoing laparoscopic tubal sterilization with silastic bands. METHODS: One hundred five women undergoing laparoscopic tubal sterilization with silastic bands were randomized to one of three groups: one received intramuscular ketorolac and topical placebo applied to the fallopian tubes, the second received intramuscular placebo and topical bupivacaine, and the third received intramuscular placebo and topical placebo. Surgical procedures, anesthesia, and recovery were conducted with standardized protocols. Postoperative pain perception was graded using the modified McGill pain intensity scale at 30 minutes postoperatively, at discharge from the recovery room, and the next morning by telephone interview. Other measured variables included postoperative vomiting, additional analgesia requirement, and length of time spent in the recovery room. RESULTS: Only topical bupivacaine was found to decrease postoperative pain scores significantly over those with placebo, at 30 minutes postoperatively (median score 2 compared with 4, P = .002) and at discharge from the recovery room (median score 2 compared with 3, P = .03). There was no significant decrease in pain scores with intramuscular ketorolac compared with placebo. No differences in pain scores were found between the three groups at the next morning phone call. There were no significant differences between the three groups with respect to requirements for supplemental pain medications in the recovery room, incidence of postoperative vomiting, or length of time spent in the recovery room. CONCLUSION: Topical bupivacaine decreases postoperative pain scores significantly compared with placebo in women undergoing laparoscopic tubal sterilization with silastic bands.