Codesigned standardised referral form: simplifying the complexity.

BACKGROUND: Referring providers are often critiqued for writing poor-quality referrals. This study characterised clinical referral guidelines and forms to understand which data consultant providers require. These data were then used to codesign an evidence-based, high-quality referral form. METHODS: This study used both observational and quality improvement approaches. Canadian referral guidelines were reviewed and summarised. Referral data fields from 150 randomly selected Ontario referral forms were categorised and counted. The referral guideline summary and referral data were then used by referring providers, consultant providers and administrators to codesign a referral form. RESULTS: Referral guidelines recommended 42 types of referral data be included in referrals. Referral data were categorised as patient demographics, provider demographics, reason for referral, clinical information and administrative information. The percentage of referral guidelines recommending inclusion of each type of referral data varied from 8% to 77%. Ontario referral forms requested 264 different types of referral data. Digital referral forms requested more referral data types than paper-based referral forms (55.0±10.6 vs 30.5±8.1; 95% CI p<0.01). A codesigned referral form was created across two sessions with 29 and 21 participants in each. DISCUSSION: Referral guidelines lack consistency and specificity, which makes writing high-quality referrals challenging. Digital referral forms tend to request more referral data than paper-based referrals, which creates administrative burdens for referring and consultant providers. We created the first codesigned referral form with referring providers, consultant providers and administrators. We recommend clinical adoption of this form to improve referral quality and minimise administrative burdens.

Efficacy of Laser-assisted Periodontal Therapy vs. Conventional Scaling and Root Planing.

Background: This study aimed to compare the effectiveness of laser-assisted periodontal therapy (LAPT) with conventional scaling and root planing (CSRP) in the treatment of periodontal disease. The objective was to assess the outcomes of these two treatments on a sample of 30 patients in each group. Materials and Methods: In this study, a total of 60 patients diagnosed with periodontal disease were divided into two groups: the LAPT group and the CSRP group, with 30 patients in each group. The LAPT group received periodontal treatment using laser therapy, while the SRP group underwent traditional SRP. The patients were evaluated for periodontal parameters, including probing depth and clinical attachment level before and after the treatments. Results: After the treatment interventions, both the LAPT group and the CSRP group showed significant improvements in periodontal health. The mean reduction in probing depth was 2.5 mm in the LAPT group and 2.2 mm in the SRP group. In addition, the clinical attachment level increased by 2.8 mm in the LAPT group and 2.5 mm in the SRP group. Statistical analysis using the paired t-test demonstrated a P-value of less than 0.05, indicating the significance of these improvements in both groups. Conclusion: This study suggests that both LAP and CSRP are effective in improving periodontal health in patients with periodontal disease.

Evaluating the Long-Term Outcomes of Periodontal Surgery vs. Non-Surgical Treatment in Aggressive Periodontitis.

Background: Aggressive periodontitis is a severe form of periodontal disease characterized by rapid tissue destruction and tooth loss. The optimal treatment approach for managing this condition remains a topic of debate. Materials and Methods: A retrospective cohort study was conducted, involving patients diagnosed with aggressive periodontitis who received either surgical or non-surgical treatment between 2010 and 2020. Clinical and radiographic data were collected at baseline and regular intervals over a 5-year follow-up period. Surgical interventions included flap surgery, guided tissue regeneration, and bone grafting, while non-surgical treatments comprised scaling and root planning with or without adjunctive antibiotics. The primary outcomes assessed included changes in probing depth, clinical attachment level, tooth loss, and patient-reported quality of life measures. Results: A total of 120 patients were included in the study, with 60 patients in each treatment group. The surgical group demonstrated significantly greater reductions in probing depth and gains in clinical attachment level compared to the non-surgical group (P < 0.05). Tooth loss was significantly lower in the surgical group over the 5 years (P < 0.01). Patient-reported outcomes also favored the surgical group, with improved oral health-related quality of life. However, the surgical group had a higher incidence of postoperative complications. Conclusion: This study suggests that periodontal surgery yields superior long-term outcomes in the management of aggressive periodontitis compared to non-surgical treatment.

Biometric analysis of furcation area of molar teeth and its relationship with instrumentation.

The anatomy of furcation favours the bacterial retention and makes periodontal debridement as well as oral hygiene procedures difficult. Teeth that have lost attachment to a level of the furcation are said to have a furcal invasion or furcation involved.Involvement of furcation in a multi-rooted tooth poses a very different type of clinical situation in terms of establishment of diagnosis, determination of prognosis and of course planning the treatment modality.The present study was carried out on 200 selected extracted human first and second permanent molar teeth based on a predefined criteria. Teeth with prosthetic crowns, fused or fractured roots, those not fully developed, grossly carious or heavily restored at the cementoenamel junction (CEJ) were excluded from the study. The morphology of the root trunk was recorded by measuring various dimensions of the root trunk,including furcal angle and root trunk volume was calculated by using a custom made special apparatus. The furcation areas were debrided with different types of curettes in the market in order to see how best the instrument could be maneuvered in the furcation area. The data so obtained was statistically analysed using SPSS version 22. The highest root trunk volume and the longest root trunk length were found to be in the maxillary second molar. 48.60% furcations didn't allow instrument engagementof furcation area with standard area specific curettes. The proposal of inclusion of root trunk length (mm) is suggested in addition to classification of FI to have assess prognosis and appropriate treatment for of the involved tooth.

Bone augmentation in dental implants among Indian patients.

It is of interest to compare guided bone regeneration (GBR) with titanium mesh, alveolar distraction osteo-genesis (DO), GBR with auto-genous bone and e-PTFE membranes and onlay bone grafts. This helps to restore vertically lacking alveolar ridges and their capacity to sustain the vertical bone growth acquired both prior to and following implant placement. The parameters such as (i) success and survival of dental implants (ii) peri-implant clinical parameters after prosthetic loading at 1 year, 2 year and 3 year follow up (iii) resorption of alveolar ridge regenerated before placement of dental implants and after placement of dental implants were assessed. Data shows that the distraction osteo-genesis is more predictable for long-term prognosis of vertical bone growth. However, all methods help to repair the vertically resorbed edentulous ridges.

Comparative Evaluation of Gingival Crevicular Fluid Interleukin-17, 18 and 21 in Different Stages of Periodontal Health and Disease.

Background and Objectives: The elicitation of a host's immune−inflammatory responses to overcome oral bacterial biofilm challenges is mediated by numerous cytokines. We explored the role of three such cytokines, viz. interleukin (IL)-17, 18 and 21, by measuring their levels in the gingival crevicular fluid (GCF) of Indian individuals with healthy gingiva, chronic gingivitis, or chronic periodontitis. Materials and Method: Ninety systemically healthy individuals were enrolled in the study on the basis of predefined criteria and were categorized into three groups of 30 participants each. Groups A, B and C were composed of a control group with healthy gingiva, subjects with chronic gingivitis and subjects with chronic periodontitis, respectively. The periodontal disease status was assessed on the basis of a subject's gingival index, probing pocket depth, clinical attachment loss and radiographic evidence of bone loss. After the complete history-taking and identification of gingival sulcus/pocket depth areas for GCF collection, a sample was collected from each subject in all groups for an estimation of the cytokine levels using ELISA. Statistical analysis was performed using SPSS v 21.0. Intergroup comparisons were conducted using a post hoc Tukey's test. A value of p < 0.05 was considered to be statistically significant. Results: The mean IL-17, 18 and 21 concentrations in pg/mL was the greatest for Group C (99.67 ± 18.85, 144.61 ± 20.83 and 69.67 ± 12.46, respectively), followed by Group B (19.27 ± 2.78, 22.27 ± 2.43 and 22.74 ± 1.43, respectively) and finally by Group A (healthy control; 11.56 ± 0.99, 17.94 ± 1.24 and 12.83 ± 1.21 respectively). A statistically significant difference in the mean concentrations of two interleukins (IL-17 and IL-18) was observed between Groups A and C and also between Groups B and C. A statistically significant difference in the mean concentrations of IL-21 was observed between Groups B and C. Conclusions: Within the limitations of the present study, the findings revealed that the GCF levels of IL-17, IL-18 and IL-21 rose and correlated well with the severity of the disease. Thus, these cytokines present in GCF have the potential to be considered as biomarkers for periodontal tissue destruction. IL-21 in particular appears to be a promising biomarker for differentiating between gingivitis and periodontitis.

Genetic Admixture and Survival in Diverse Populations with Pulmonary Arterial Hypertension.

Rationale: Limited information is available on racial/ethnic differences in pulmonary arterial hypertension (PAH).Objectives: Determine effects of race/ethnicity and ancestry on mortality and disease outcomes in diverse patients with PAH.Methods: Patients with Group 1 PAH were included from two national registries with genome-wide data and two local cohorts, and further incorporated in a global meta-analysis. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated for transplant-free, all-cause mortality in Hispanic patients with non-Hispanic white (NHW) patients as the reference group. Odds ratios (ORs) for inpatient-specific mortality in patients with PAH were also calculated for race/ethnic groups from an additional National Inpatient Sample dataset not included in the meta-analysis.Measurements and Main Results: After covariate adjustment, self-reported Hispanic patients (n = 290) exhibited significantly reduced mortality versus NHW patients (n = 1,970) after global meta-analysis (HR, 0.60 [95% CI, 0.41-0.87]; P = 0.008). Although not significant, increasing Native American genetic ancestry appeared to account for part of the observed mortality benefit (HR, 0.48 [95% CI, 0.23-1.01]; P = 0.053) in the two national registries. Finally, in the National Inpatient Sample, an inpatient mortality benefit was also observed for Hispanic patients (n = 1,524) versus NHW patients (n = 8,829; OR, 0.65 [95% CI, 0.50-0.84]; P = 0.001). An inpatient mortality benefit was observed for Native American patients (n = 185; OR, 0.38 [95% CI, 0.15-0.93]; P = 0.034).Conclusions: This study demonstrates a reproducible survival benefit for Hispanic patients with Group 1 PAH in multiple clinical settings. Our results implicate contributions of genetic ancestry to differential survival in PAH.

Gender Difference in Damage-Mediated Signaling Contributes to Pulmonary Arterial Hypertension.

Aims: Pulmonary arterial hypertension (PAH) is a progressive lethal disease with a known gender dimorphism. Female patients are more susceptible to PAH, whereas male patients have a lower survival rate. Initial pulmonary vascular damage plays an important role in PAH pathogenesis. Therefore, this study aimed at investigating the role of gender in activation of apoptosis/necrosis-mediated signaling pathways in PAH. Results: The media collected from pulmonary artery endothelial cells (PAECs) that died by necrosis or apoptosis were used to treat naive PAECs. Necrotic cell death stimulated phosphorylation of toll-like receptor 4, accumulation of interleukin 1 beta, and expression of E-selectin in a redox-dependent manner; apoptosis did not induce any of these effects. In the animal model of severe PAH, the necrotic marker, high mobility group box 1 (HMGB1), was visualized in the pulmonary vascular wall of male but not female rats. This vascular necrosis was associated with male-specific redox changes in plasma, activation of the same inflammatory signaling pathway seen in response to necrosis in vitro, and an increased endothelial-leukocyte adhesion in small pulmonary arteries. In PAH patients, gender-specific changes in redox homeostasis correlated with the prognostic marker, B-type natriuretic peptide. Males had also shown elevated circulating levels of HMGB1 and pro-inflammatory changes. Innovation: This study discovered the role of gender in the initiation of damage-associated signaling in PAH and highlights the importance of the gender-specific approach in PAH therapy. Conclusion: In PAH, the necrotic cell death is augmented in male patients compared with female patients. Factors released from necrotic cells could alter redox homeostasis and stimulate inflammatory signaling pathways.

Hemolysis-induced Lung Vascular Leakage Contributes to the Development of Pulmonary Hypertension.

Although hemolytic anemia-associated pulmonary hypertension (PH) and pulmonary arterial hypertension (PAH) are more common than the prevalence of idiopathic PAH alone, the role of hemolysis in the development of PAH is poorly characterized. We hypothesized that hemolysis independently contributes to PAH pathogenesis via endothelial barrier dysfunction with resulting perivascular edema and inflammation. Plasma samples from patients with and without PAH (both confirmed by right heart catheterization) were used to measure free hemoglobin (Hb) and its correlation with PAH severity. A sugen (50 mg/kg)/hypoxia (3 wk)/normoxia (2 wk) rat model was used to elucidate the role of free Hb/heme pathways in PAH. Human lung microvascular endothelial cells were used to study heme-mediated endothelial barrier effects. Our data indicate that patients with PAH have increased levels of free Hb in plasma that correlate with PAH severity. There is also a significant accumulation of free Hb and depletion of haptoglobin in the rat model. In rats, perivascular edema was observed at early time points concomitant with increased infiltration of inflammatory cells. Heme-induced endothelial permeability in human lung microvascular endothelial cells involved activation of the p38/HSP27 pathway. Indeed, the rat model also exhibited increased activation of p38/HSP27 during the initial phase of PH. Surprisingly, despite the increased levels of hemolysis and heme-mediated signaling, there was no heme oxygenase-1 activation. This can be explained by observed destabilization of HIF-1a during the first 2 weeks of PH regardless of hypoxic conditions. Our data suggest that hemolysis may play a significant role in PAH pathobiology.

Association of tumor necrosis factor-α (TNF-α) gene promoter polymorphisms with aggressive and chronic periodontitis in the eastern Indian population.

Background: Periodontitis is a very common inflammatory oral disease. Tumor necrosis factor-α (TNF-α) is a cytokine that has been involved with the gingival tissue destruction and remodeling occurrence. We investigated the association of single nucleotide polymorphisms (SNPs) in TNF-α gene promoter region with the susceptibility of aggressive and chronic periodontitis in the eastern Indian population.Methods: A total of 397 DNA samples from venous blood were isolated. 40 individuals were aggressive periodontitis patients, 157 were identified chronic periodontitis patients, and the remaining 200 were healthy individuals. Five SNPs of TNF-α at promoter region (rs361525, rs1800629, rs1799724, rs1800630, and rs1799964) were genotyped by PCR-sequencing in periodontitis patients and control subjects.Results: rs1800629 (-308G/A) polymorphism was more frequent in both aggressive and chronic periodontitis patients compared with the control population, though the allele frequency was different only in aggressive periodontitis patients. On the other hand, both the genotypic and allelic variation of rs361525 (-238G/A) polymorphism were found significantly less frequently in aggressive and chronic periodontitis than in controls. The other polymorphisms like rs1799724 (-857C/T) and rs1799964 (-1031T/C) were significantly different between chronic periodontitis patients and control subjects.Conclusion: The findings suggest that the rs1800629 (-308G/A) polymorphism of TNF-α gene is associated with both aggressive and chronic periodontitis while rs1799724 (-857C/T) and rs1799964 (-1031T/C) polymorphisms of TNF-α gene is associated only with the increased susceptibility to chronic periodontitis.

Diabetes Mellitus Associates with Increased Right Ventricular Afterload and Remodeling in Pulmonary Arterial Hypertension.

BACKGROUND: Diabetes mellitus is associated with left ventricular hypertrophy and dysfunction. Parallel studies have also reported associations between diabetes mellitus and right ventricular dysfunction and reduced survival in patients with pulmonary arterial hypertension. However, the impact of diabetes mellitus on the pulmonary vasculature has not been well characterized. We hypothesized that diabetes mellitus and hyperglycemia could specifically influence right ventricular afterload and remodeling in patients with Group I pulmonary arterial hypertension, providing a link to their known susceptibility to right ventricular dysfunction. METHODS: Using an adjusted model for age, sex, pulmonary vascular resistance, and medication use, associations of fasting blood glucose, glycated hemoglobin, and the presence of diabetes mellitus were evaluated with markers of disease severity in 162 patients with pulmonary arterial hypertension. RESULTS: A surrogate measure of increased pulmonary artery stiffness, elevated pulmonary arterial elastance (P = .012), along with reduced log(pulmonary artery capacitance) (P = .006) were significantly associated with the presence of diabetes mellitus in patients with pulmonary arterial hypertension in a fully adjusted model. Similar associations between pulmonary arterial elastance and capacitance were noted with both fasting blood glucose and glycated hemoglobin. Furthermore, right ventricular wall thickness on echocardiography was greater in pulmonary arterial hypertension patients with diabetes, supporting the link between right ventricular remodeling and diabetes. CONCLUSION: Cumulatively, these data demonstrate that an increase in right ventricular afterload, beyond pulmonary vascular resistance alone, may influence right ventricular remodeling and provide a mechanistic link between the susceptibility to right ventricular dysfunction in patients with both diabetes mellitus and pulmonary arterial hypertension.

Comparative evaluation of three different rotary instrumentation systems for removal of gutta-percha from root canal during endodontic retreatment: An in vitro study.

CONTEXT: Endodontic retreatment is performed in teeth with endodontic failures. The main goal of retreatment is cleaning and shaping of the root canal with removal of old root filling material. Hand instruments and rotary instruments are mainly used for removing this filling material. AIM OF STUDY: To compare the relative efficacy of three rotary instrumentation systems for removal of gutta-percha from root canal during endodontic retreatment. OBJECTIVE OF STUDY: To find out which NiTi system is more efficacious in retreatment and to check out the efficacy of retreatment with and without use of solvent. MATERIALS AND METHODS: Sixty freshly extracted, single-rooted human mandibular premolars were instrumented with K-files, and each root canal was filled with gutta-percha and AH Plus (Dentsply Detrey, Konstanz, Germany) sealer using lateral compaction. Specimens were then divided into three experimental groups with twenty specimens each. Groups were then subdivided into ten specimens each. Groups were then retreated either with or without solvent. The removal of gutta-percha was performed using ProTaper retreatment files, Mtwo retreatment files, and R-Endo files after 2 weeks. The amount of root canal filling material remnant in the coronal, middle, and apical thirds was measured using stereomicroscope and computer image analysis program. STATISTICAL ANALYSIS USED: Data were evaluated statistically using analysis of variance. RESULTS: ProTaper group was found to have less remnant filling material as compared to the other groups in coronal and middle thirds, but a significant difference was observed between ProTaper and Mtwo and Mtwo and R-Endo in the nonsolvent groups (P < 0.05). Mtwo group demonstrated less amount of remaining filling material in the nonsolvent group. CONCLUSIONS: Both nickel-titanium systems and ProTaper and Mtwo retreatment file systems, were found to be effective in the removal of root canal filling material. However, complete removal of gutta-percha from root canals did not occur with any of the experimental groups.

Associations of Prolonged QTc in Sickle Cell Disease.

Sudden death is a leading cause of mortality in sickle cell disease, implicating ventricular tachyarrhythmias. Prolonged QTc on an electrocardiogram (ECG), commonly seen with myocardial ischemia, is a known risk for polymorphic ventricular tachycardia (VT). We hypothesized that prolonged QTc is associated with mortality in sickle cell disease. ECG were analyzed from a cohort of 224 sickle patients (University of Illinois at Chicago, UIC) along with available laboratory, and echocardiographic findings, and from another cohort of 38 patients (University of Chicago, UC) for which cardiac MRI and free heme values were also measured. In the UIC cohort, QTc was potentially related to mortality with a hazard ratio (HR) of 1.22 per 10ms, (P = 0.015), and a HR = 3.19 (P = 0.045) for a QTc>480ms. In multivariate analyses, QTc remained significantly associated with survival after adjusting for inpatient ECG status (HR 1.26 per 10ms interval, P = 0.010) and genotype status [HR 1.21 per 10ms interval, P = 0.037). QTc trended toward association with mortality after adjusting for both LDH and hydroxyurea use (HR 1.21 per 10ms interval, P = 0.062) but was not significant after adjusting for TRV. In univariate analyses, QTc was related to markers of hemolysis including AST (P = 0.031), hemoglobin (P = 0.014), TR velocity (P = 0.036), higher in inpatients (P<0.001) and those with an SS compared to SC genotype (P<0.001) in the UIC cohort as well as to free heme in the UC cohort (P = 0.002). These findings support a relationship of prolonged QTc with hemolysis and potentially mortality in sickle cell disease.

Estimation of interleukin-18 in the gingival crevicular fluid and serum of Bengali population with periodontal health and disease.

CONTEXT: Host's immune response elicits cytokines in response to bacterial challenge. We explore role of one such cytokine interleukin-18 (IL-18) in periodontal health and disease. AIMS: IL-18 is a pro-inflammatory and tumor suppressive cytokine. Dental literatures suggest that IL-18 might have a role to play in the progression from oral health to periodontal disease. Therefore, this study was undertaken to elucidate the level and role of IL-18 in the gingival crevicular fluid (GCF) and serum of individuals with healthy gingiva, chronic gingivitis, chronic periodontitis, and aggressive periodontitis before and after periodontal therapy. SETTINGS AND DESIGN: Eighty individuals chosen for the study were divided into healthy control group (1A), chronic gingivitis (2A), chronic periodontitis (3A), and aggressive periodontitis (4A) with twenty individuals each. Criteria for the division were the subject's gingival index, probing pocket depth, clinical attachment loss, and radiographic evidence of bone loss. MATERIALS AND METHODS: The individuals underwent treatment (scaling in case of Groups 1A and 2A and scaling and root planing followed by flap surgery in Groups 3A and 4A) to form posttreatment Groups 1B, 2B, 3B, and 4B, respectively. Thus, a total of 160 GCF and 160 serum samples were collected and tested by ELISA. STATISTICAL ANALYSIS USED: Intergroup comparison was done by post hoc Tukey's test. RESULTS: The mean IL-18 concentration was greatest in Group 3A (GCF 144.61 pg/µl, serum 55.12 pg/ml) followed by Group 4A (GCF 98.55 pg/µl, serum 39.06 pg/ml), Group 2A (GCF 22.27 pg/µl, serum 27.73 pg/ml) and lowest (GCF 17.94 pg/µl, serum 11.49 pg/ml) in Group 1A. Posttreatment groups (1B-4B) showed reduction in the mean IL-18 concentration in both GCF and serum. CONCLUSIONS: As the inflammation increased, there was a concomitant increase in the level of IL-18 and vice versa following periodontal therapy.

Clinical Evaluation of Neurosensory Changes in the Infraorbital Nerve Following Surgical Management of Zygomatico-Maxillary Complex Fractures.

INTRODUCTION: Zygomatico-orbital fractures are the second most common facial injuries. Trauma to mid-facial region can lead to an alteration or loss of sensation in the facial region which sometimes requires early surgical intervention to aid in an early recovery. AIM: To evaluate the different neurosensory changes in the infraorbital nerve function following common treatment modalities used in the management of zygomatico-maxillary complex fractures. MATERIALS AND METHODS: Thirteen patients selected for the study had unilateral zygomatic complex fracture with altered sensation in the region of distribution of the infraorbital nerve. The fractures were managed either by reduction followed by internal fixation with mini-plates (Group A), reduction alone (Group B) or conservatively (Group C). Infraorbital nerve function tests were done by mechanical, heat and pain threshold detection. Evaluation was done on 1(st), 3(rd), 7(th) day, one month, three months and six months interval in a manner similar to that done at the beginning of the study (Day0). RESULTS: A male predominance with male:female ratio of 5.5:1 and an age range of 21 to 50 years was found with the right side mostly affected. Road traffic accident was the most common aetiology. Most common clinical presentations were sub-conjunctival haemorrhage (84.61%), flattening of the malar prominence (69.23%) with deficit in neurosensory function of infra orbital nerve. Recovery in the infraorbital nerve function was relatively complete in 76.92% cases with partial recovery in 23.07% of the patients. CONCLUSION: Marked improvement in the neurosensory function of the infraorbital nerve was found when some form of treatment either in the form of Open Reduction and Internal Fixation (ORIF) or approach through Gillie's temporal or Keen's intraoral approach were applied as compared to when conservative treatment was provided. In zygomatic complex fractures, any form of treatment employed brought about decompression of the infraorbital nerve which aided in the recovery of the nerve within a span of 1-6 months, except when no treatment was applied.

Aggressive periodontitis: A clinico-hematological appraisal.

BACKGROUND: Human leukocyte antigens (HLA) have been considered a candidate of genetic risk markers for aggressive periodontitis (AP). AP has also been associated with polymorphonuclear leukocyte (PMN) dysfunction. The role of monocyte subsets in AP has also not been completely explored. Therefore, the present study was undertaken to assess in, AP subjects, the possible association between defective PMN adhesion and ß2-integrin expression; defective neutrophil migration and actin polymerization level; the expression of ABO blood group and HLA antigen; and the percentage of CD14+ CD16+ monocytes and CD45RA monocytes. All these parameters have been compared with the subjects of chronic periodontitis (CP) and healthy controls. MATERIALS AND METHODS: A total of 45 subjects of the age group 20-50 years, free from any known systemic disease, were divided into three groups - Group I - periodontally healthy control (n = 15), Group II - CP (n = 15) and Group III - AP (n = 15). Peripheral blood samples were collected. ABO grouping and HLA typing were performed. ß2-integrin expression, actin polymerization level and percentage of CD14+ CD16+ monocytes and CD45RA monocytes were estimated by fluorescence-activated cell sorter analysis. RESULTS: Most of the subjects of AP belonged to the blood group AB, and an increased frequency of HLA-A30, CW1 and DR1 (P < 0.1) and B44 and DQ2 (P < 0.05) were also observed in this group. In the AP group, both average values (ß2-integrin and actin level) were significantly less than those of normal subjects (P < 0.001). The mean percentage of CD14+ CD16+ monocytes was found to be maximum in CP, followed by AP, and then in healthy subjects, while the mean percentage of CD45RA was maximum in AP, followed by CP, and then in healthy subjects. CONCLUSIONS: With the present state of knowledge from this study, a definite association of ABO blood groups and HLA phenotypes with periodontal diseases is yet to be established. Leukocytic functional defects were found in AP subjects. A statistically significant percentage of CD14+ CD16+ and CD45RA monocytes were found in AP subjects as compared with the normal control and CP groups.

The autosomal recessive inheritance of hereditary gingival fibromatosis.

Hereditary gingival fibromatosis (HGF) is a rare condition which is marked by enlargement of gingival tissue that covers teeth to various extents leading to aesthetic disfigurement. This study presents a case of a 28-year-old female patient and 18-year-old male who belong to the same family suffering from HGF with chief complaint of overgrowing swelling gingiva. The presence of enlarged gingiva with the same eruption was found in their other family members with no concomitant drug or medical history, and the occurrence of HGF has been found in one generation of this family which may indicate the autosomal recessive inheritance pattern of HGF. Hereditary gingival fibromatosis is an idiopathic condition as its etiology is unknown and it was found to recur in some cases even after surgical treatment. Both patients underwent thorough oral prophylaxis and later surgical therapy to correct the deformity.

Effect of apoptosis-inducing antitumor agents on endocardial endothelial cells.

Chemotherapy is one of the common treatment modalities for cancer. Some of the antineoplastic drugs have, however, been found to be toxic for vascular endothelium, resulting in complications such as endothelial dysfunction, thromboembolism, heart failure, and cardiomyopathy. In this study, we investigated the cytotoxic effect of widely used antitumor agents doxorubicin, camptothecin, and thapsigargin on primary and immortalized porcine endocardial endothelial cells and compared with the effects of these agents on human umbilical vein endothelial cells, human aortic endothelial cells, and EA.hy926 cells. Our study revealed that endocardial endothelial cells are relatively resistant to apoptosis induced by these drugs. Interestingly, our study indicates that response to antitumor agents greatly differs depending on the site of origin of endothelial cells. Doxorubicin, camptothecin, and thapsigargin induce mitochondrial-dependent cell death following loss of mitochondrial membrane potential (MMP) in vascular endothelial cells, with subsequent increase in sub-G0 population. In endocardial endothelial cells, there was no MMP loss; and only cell cycle arrest either at G1 or S phases was observed when the cells were treated with doxorubicin, camptothecin, and thapsigargin.