Management of mucous membrane pemphigoid in a joint oral medicine-dermatology clinic.

BACKGROUND: Mucous membrane pemphigoid (MMP) comprises a group of immunobullous diseases involving the mucosa and skin. Potential sequelae include painful mucosal erosions, vision loss and laryngeal stenosis. AIM: To characterize the features of patients with MMP seen within an Oral Medicine setting, including clinical features, immunofluorescence results and response to treatment. METHODS: A retrospective case note analysis was undertaken. Treatment effect was divided into response and nonresponse using predetermined adjective terms. RESULTS: In total, 42 cases of MMP were identified (18 men, 24 women), mean age 65 years (range 36-85 years). Oral involvement was most common on the gingivae (n = 38; 90.5%) while the most common extraoral sites involved were ocular (n = 13; 31.0%) and skin (n = 12; 28.6%). Features of MMP were found in 21 of 34 (61.8%) of routine biopsies, 31 of 34 (91.2%) direct immunofluorescence samples and 8 of 25 (32.0%) indirect immunofluorescence samples. Topical corticosteroids provided effective symptom control in 9 of 42 cases (21.4%), while systemic therapy was used in 31 of 42 patients (73.8%). Dapsone was prescribed for 25 patients, of whom 18 (72.0%) responded. Mycophenolate mofetil was used in 13 cases and had a response rate of 46.2%. Overall, 27 of 42 patients (64.3%) achieved a response using a tolerable topical or systemic treatment. CONCLUSION: This series demonstrates that MMP has a female predominance and is a disease of older age, with a predilection for specific oral sites. Direct immunofluorescence has a high sensitivity in detecting features of MMP. Although some patients achieve adequate symptom control with topical corticosteroids, many require systemic therapy.

Preferences for physical activity: a conjoint analysis involving people with chronic knee pain.

OBJECTIVE: To investigate individual preferences for physical activity (PA) attributes in adults with chronic knee pain, to identify clusters of individuals with similar preferences, and to identify whether individuals in these clusters differ by their demographic and health characteristics. DESIGN: An adaptive conjoint analysis (ACA) was conducted using the Potentially All Pairwise RanKings of all possible Alternatives (PAPRIKA) method to determine preference weights representing the relative importance of six PA attributes. Cluster analysis was performed to identify clusters of participants with similar weights. Chi-square and ANOVA were used to assess differences in individual characteristics by cluster. Multinomial logistic regression was used to assess associations between individual characteristics and cluster assignment. RESULTS: The study sample included 146 participants; mean age 65, 72% female, 47% white, non-Hispanic. The six attributes (mean weights in parentheses) are: health benefit (0.26), enjoyment (0.24), convenience (0.16), financial cost (0.13), effort (0.11) and time cost (0.10). Three clusters were identified: Cluster 1 (n = 33): for whom enjoyment (0.35) is twice as important as health benefit; Cluster 2 (n = 63): for whom health benefit (0.38) is most important; and Cluster 3 (n = 50): for whom cost (0.18), effort (0.18), health benefit (0.17) and enjoyment (0.18) are equally important. Cluster 1 was healthiest, Cluster 2 most self-efficacious, and Cluster 3 was in poorest health. CONCLUSIONS: Patients with chronic knee pain have preferences for PA that can be distinguished effectively using ACA methods. Adults with chronic knee pain, clustered by PA preferences, share distinguishing characteristics. Understanding preferences may help clinicians and researchers to better tailor PA interventions.

The development and implementation of a biopsy safety strategy for oral medicine.

The development and implementation of a biopsy safety strategy is described in this article. Analysis of previous adverse incidents relating to biopsies acted as a catalyst to review our biopsy pathway at Liverpool University Dental Hospital. Input from all staff involved enabled us to develop a biopsy safety strategy which was divided into five stages: preoperative assessment of patient and procedure, team briefings, biopsy surgical safety checklist, surgical removal and handling of biopsy specimens, and post-biopsy follow-up. It is hoped that other clinical teams will take the opportunity to review their own biopsy processes, in the light of our experience.

Molecular evidence of person-to-person transmission of a pigmented strain of Corynebacterium striatum in intensive care units.

During a 14-month period, a unique strain of Corynebacterium striatum that produces a diffusible brown pigment was isolated from purulent sputa of nine patients and from nonrespiratory sites of two additional patients. Seven nonpigmented clinical isolates from the same period and three reference strains of C. striatum were compared with the brown isolates. Most patients had multiple sputum cultures with no coryneforms before the brown strain emerged, suggesting that the organism was hospital acquired. DNA restriction fragment patterns and Southern hybridization with the att site probe of Corynebacterium diphtheriae indicated that the brown isolates were a single strain which was distinct from the heterogeneous nonpigmented strains. A common source for the brown C. striatum was not recognized, although all of these patients were located in two adjoining intensive care units. All of the brown isolates, three of the nonpigmented clinical isolates, and two reference strains had positive CAMP reactions with Staphylococcus aureus, which has not been reported for C. striatum prior to this study.

Evidence of multiple taxa within commercially available reference strains of Corynebacterium xerosis.

Attempts to identify coryneform isolates resembling Corynebacterium xerosis can lead clinical microbiologists to identification schemes with conflicting descriptions which result in confusing C. xerosis with Corynebacterium striatum. For the present study we purchased all available American Type Culture Collection and National Collection of Type Cultures reference cultures of C. xerosis (n = 10) and C. striatum (n = 4) and analyzed them as follows: (i) analysis of biochemical reactions in conventional tests and in the Rapid CORYNE system, (ii) whole-cell fatty acid analysis by using the gas-liquid chromatography research software of Microbial ID, Inc., and (iii) analysis of DNA homology in dot blot hybridizations. Three C. xerosis strains were indistinguishable from the C. striatum strains in whole-cell fatty acid analyses and DNA hybridizations and shared very similar biochemical reactions. The remaining seven strains of C. xerosis clustered into five groups on the basis of fatty acid patterns, DNA hybridizations, and biochemical tests. No reference strain of C. striatum fit the species description in Bergey's Manual of Systematic Bacteriology. The type strains of both C. striatum and C. xerosis fit their respective descriptions by the Centers for Disease Control and Prevention. This study suggests that the 10 commercially available reference strains of C. xerosis represent six different taxa which should be assigned to new species.

Use of a Western blotting technique in the purification of a cysteine proteinase inhibitor.

In Western blotting procedures, proteins are resolved in sodium dodecyl sulfate-polyacrylamide gels with subsequent electrophoretic transfer onto nitrocellulose membranes. Although this procedure is generally employed as an analytical technique for assessing interactions of proteins with antibodies, the present report describes the use of Western blotting as a preparative procedure in the purification of a biologically active proteinase inhibitor from the cellular slime mold, Dictyostelium discoideum. The feasibility of using Western blotting for inhibitor purification depended upon the unique stability properties of the inhibitor under denaturing conditions.

Dissociation of proteinase-inhibitor complexes by trichloroacetate.

It was demonstrated that the addition of high concentrations of the chaotrope, sodium trichloroacetate, to proteinase assays provided for a dissociation of proteinase-inhibitor complexes. The complexes evaluated contained a heat-stable, polypeptide inhibitor of cysteine proteinases isolated from the cellular slime mold, Dictyostelium discoideum. The proteinases that were present in separate complexes included either D. discoideum proteinases or the plant proteinase papain. The general assay procedures described may be useful in detection of endogenous proteinase-inhibitor complexes in many systems.

Antibodies that recognize phosphodiester-linked amino-N-acetylglucosamine-1-phosphate residues.

An affinity chromatography procedure was developed for isolating antibodies that recognized phosphodiester-linked alpha-N-acetylglucosamine-1-phosphate (alpha-GlcNAc-1-P) residues. The affinity resin consisted of uridine-5'-diphospho-alpha-N-acetylglucosamine (UDPGlcNAc) conjugated to Sepharose. Antiserum prepared against Proteinase 1 from the cellular slime mold, Dictyostelium discoideum was used as a source of the anti-alpha-GlcNAc-1-P antibodies. Immunoblot assays showed that the affinity-isolated antibodies recognized phosphoglycosylated subunits of Proteinase 1, and that UDPGlcNAc blocked this interaction.

Products of phospholipid metabolism in Bacillus stearothermophilus.

The products of phospholipid turnover in Bacillus stearothermophilus were determined in cultures labeled to equilibrium and with short pulses of [32P]phosphate and [2-3H]glycerol. Label lost from the cellular lipid pool was recovered in three fractions: low-molecular-weight extracellular products, extracellular lipid, and lipoteichoic acid (LTA). The low-molecular-weight turnover products were released from the cells during the first 10 to 20 min of a 60-min chase period and appeared to be derived primarily from phosphatidylglycerol turnover. Phosphatidylethanolamine, which appeared to be synthesized in part from the phosphatidyl group of phosphatidylglycerol, was released from the cell but was not degraded. The major product of phospholipid turnover was LTA. Essentially all of the label lost from the lipid pool during the final 40 min of the chase period was recovered as extracellular LTA. The LTA appeared to be derived primarily from the turnover of cardiolipin and the phosphatidyl group of phosphatidylglycerol. Three types of LTA were isolated; an extracellular LTA was recovered from the culture medium, and two types of LTA were extracted from membrane preparations or whole-cell lysates by the hot phenol-water procedure. Cells contained 1.5 to 2.5 mg of cellular LTA per g of cells (dry weight), over 50% of which remained associated with the membrane when cells were fractionated. Over 75% of the 3H label incorporated into the cellular LTA pool during a 90-min labeling period was released from the cells during the first cell doubling after the chase. Label lost from the lipid pool was incorporated into cellular LTA which was then modified and released into the culture medium.