Opioids and older adults: Increasing trends in opioid usage in a dental population compared to a National Database (NHANES).

AIM: To examine self-reported opioid prevalence at a dental school clinic for patients ≥65 years old as compared to national data, comparing gender, ethnicity/race and older adult age groupings. METHODS AND RESULTS: Self-reported prescription opioid medication use was extracted from the medical record for dental patients ≥65 years old who visited the school's general dental clinic (GDC) in 2012 or 2017. This data was compared to the National Health and Nutrition Examination Survey (NHANES) data for 2011-2012 and 2017-18. There was a significant increase in prevalence of opioid use in adults ≥65 between 2012 (4.5%) and 2017 (6.5%) and for ages 65-79 (from 4.7% to 6.3%) and ≥80 (3.4% to 7.9%), women (4.8% to 7.0%), and African Americans (4.7% to 8.4%) in the GDC. Older adults at the GDC reported less opioid use than the NHANES national average for both periods no matter the gender or the age with variable results for race/ethnicity. CONCLUSION: The prevalence of older adults taking opioids in our general dental school clinic population increased significantly in 2017 as compared to 2012 but was lower than the national average for the respective periods. Awareness of existing opioid usage in older adult patients and its higher adverse risk potential is critical when prescribing analgesics for dental pain for this age group.

Results of offering oral rapid HIV screening within a dental school clinic.

To broaden the availability of human immunodeficiency virus (HIV) testing, we offered rapid HIV screening tests to 811 patients attending a dental school for routine dental hygiene care. Study design is a prospective cross-sectional study. The 319 (39.3%) agreeing to test, self-identified as: Hispanic (34.4%), White (25.8%), African American (13.1%), Asian (8.3%), Native American/Pacific Islander (0.9%), more than one race/ethnicity (1.1%) or declining to state (16.5%). Over 35% (n = 113) were first time HIV test takers, with another 2.2% (n = 7) unaware of their testing history. Approximately 60% of the decliners choose "just don't want test today" as the reason. Following a strictly structured algorithm, four possible undiagnosed infections were initially identified, with one completing the algorithm to case confirmation. In conclusion, the confirmed incidence rate finding of HIV seropositivity of 0.31% found through initial screening at the dental clinic, compared with the 0.018% incidence rate of HIV with confirmed diagnosis in Los Angeles County, indicates that a rapid HIV screening test offered in a dental school clinic can potentially play an important role in discovering undiagnosed HIV individuals.

A comparison of urban school- and community-based dental clinics.

BACKGROUND: The objective of the study was to quantitatively compare school- and community-based dental clinics in New York City that provide dental services to children in need. It was hypothesized that the school-based clinics would perform better in terms of several measures. METHODS: We reviewed billing and visit data derived from encounter forms and expense reports from 4 school- and 3 community-based clinics during 12 months in 2004-2005. The health clinics, administered by the Children's Aid Society, provided dental services to children regardless of ability to pay. The assessments were based on 8 performance indicators, including some based on relative value units, and profile of service indicators was used for assessment. Descriptive statistics and results from hypothesis tests are reported. RESULTS: Based on significant and large differences on the indicators, the school-based health clinics appear to have definite advantages over community-based dental clinics. Results were consistent across many indicators. CONCLUSIONS: The results support increasing the number of school-based dental clinics in urban areas that serve children in need. Being based in schools, factors such as transportation issues, parent availability, and missed appointments are greatly reduced. This has great public dental health implications for children in underserved areas. Schools provide a natural location to provide preventive and responsive dental care. Similar advantages could be expected in rural areas and other areas of need.

Report and policy brief from the 4th Africa Conference on Social Aspects of HIV/AIDS Research: innovations in access to prevention, treatment and care in HIV/AIDS, Kisumu, Kenya, 29 April - 3 May 2007.

About 520 delegates from all over Africa and 21 countries attended the conference. This report and policy brief summarises the key findings and suggested policy options that emerged from rapporteur reports of conference proceedings including the following themes: (1) Orphans and vulnerable children, (2) Treatment, (3) Prevention, (4) Gender and male involvement, (5) Male circumcision, (6) People living with HIV/AIDS, (7) Food and nutrition, (8) Socioeconomics, and (9) Politics/policy. Two (11.8%) of the 17 OVC projects from the three countries were classified as best practice interventions. Of the 83 abstracts that were accepted at the conference, only 7 (8.4%) were dealing with antiretroviral therapy (ART). There has been tremendous effort by various organisations to provide information about prevention of HIV/AIDS. Information received by adolescents has been effective in increasing their knowledge, but without positive sexual behaviour change. The conference noted the contribution of gender discrimination and violence to the HIV epidemic and the different risks that men and women face in relation to the epidemic. Social scientists need to study the deep cultural meanings attached to male circumcision among different ethnic groups to be able to guide the debate on the latest biomedical findings on the protective effect of circumcision against HIV. Palliative care and support is crucial for coping among people living with HIV/AIDS (PLWHA) in order to deal with medical and psychological issues. Results from several countries have helped researchers to explore alternative ways of examining poverty in the context of HIV and AIDS. Policy frameworks which are likely to succeed in combating HIV/AIDS need to be updated to cover issues of access, testing, disclosure and stigma. In general, the conference was successful in identifying innovations in access to prevention, treatment and care in HIV/AIDS.

Ritually induced growth disturbances and deformities of the orofacial system--a contribution to cranial morphogenesis.

Numerous ritual acts involving the skull result in orofacial changes. The present study focuses on ritual acts of Brazilian Zoé Indians. A distinct deformation effect of the ritual act (wearing a lip-plug) on the morphology of the orofacial system is demonstrated and documented using jaw models. The studies show that the lip-plug significantly influences tooth position and jaw growth. While the maxilla displays palatal displacement of the lateral incisors and elevation of the palate, retraction occurs in the mandible depending upon plug size. Additionally, both the plug and the nutritional habits of the Indians induce marked abrasion of all teeth. Moreover, it is shown that the duration of lip-plug wear is an essential determinant of sustained orofacial changes.

Expression of annexin AI in conventional renal cell carcinoma (CRCC) correlates with tumour stage, Fuhrman grade, amount of eosinophilic cells and clinical outcome.

There is increasing evidence that Annexin AI (ANX AI) expression is dysregulated in several carcinomas and tumour cell lines. In order to gain insight into the putative role of ANX AI in tumorigenesis, clinical outcome and metastatic potential of conventional renal cell carcinomas (CRCCs) we investigated the expression of ANX AI in CRCCs and metastases. Furthermore, it was elucidated whether ANX AI overexpression affects migratory potential in Caki-1 cells. ANX AI immunohistochemistry was performed on 33 samples of CRCCs and 10 metastases. ANX AI expression was assessed in 12 samples by 2-dimensional gelelectrophoresis (2-DE), subsequent mass spectrometry and RT-PCR. Immunohistochemical data were statistically correlated with pathological parameters, amount of eosinophilic cells and clinical outcome. Furthermore, a haptotactic migration assay was done on Caki-1 cells transfected with ANX AI. Immunostaining for ANX AI was found in 18 tumours and all metastases investigated. Intensity of immunohistochemical staining correlated to Fuhrman grade, amount of eosinophilic cells and clinical outcome. 2-DE and RT-PCR confirmed the presence of ANX AI in neoplastic tissue. Overexpression of ANX AI did not significantly influence cell migration. From these findings ANX AI expression seems to be related to Fuhrman grade, clinical outcome and metastatic potential of CRCCs. Thus ANX AI could serve as a prognostic marker for tumour progression.

Expression of Skp2 and p27KIP1 in naevi and malignant melanoma of the skin and its relation to clinical outcome.

Skp2 (S-phase kinase associated protein 2) controls progression from G- to S-phase by promoting the proteolysis of the cyclin dependent kinase inhibitor p27KIP1. Despite the fact that a p27KIP1 decrease has been documented in melanoma progression, the role of Skp2 in these tumours is unknown. We therefore examined by immunohistochemistry the expression of Skp2, p27KIP1 and Ki-67 in 10 naevi (Ns), 15 superficial spreading melanomas (SSMs), 10 nodular melanomas (NMs) and 14 melanoma metastases (Ms). Nuclear Skp2 expression augmented with increasing malignancy (Ns: 1.4%, SSMs: 5.6%, NMs: 17.3%, Ms: 19.1%). In all tumours nuclear Skp2 expression correlated with Ki-67 (p=0.024) and inversely with p27KIP1 (p=0.007). A cytoplasmic reaction for Skp2 was also observed in most tumours and its expression decreased from Ns (12.3%) to SSMs (7.9%) and NMs (4.5%). In contrast, Ms showed an increase of cytoplasmic Skp2 (11.9%) that correlated with its nuclear expression (p=0.016). While nuclear Skp2 expression correlated with the pT-level (p=0.023), Clark-level (p=0.023) and Breslow index (p=0.019), the cytoplasmic Skp2 expression might be of biological significance only in NMs since it correlated with tumour depth (p=0.02) and pT-level (p=0.025). Our data suggests that Skp2 could contribute to melanoma progression. This is further highlighted by the fact that vertical growth phase (VGP) melanomas show significant higher nuclear Skp2 expressions when compared with the harmless radial growth phase (RGP) (p=0.047). Also nuclear Skp2 expression correlates with a reduced survival time (p=0.025) in melanoma.

[Molecular aspects of alterations in normal normal conjunctival epithelium. Role of apoptosis-associated genes]. / Molekulare Aspekte der Alterung des normalen Bindehautepithels Zur Bedeutung apoptoseassoziierter Gene.

BACKGROUND: The aim of the present study was to evaluate the age-dependent physiological expression pattern of apoptosis-related genes in the normal conjunctiva. PATIENTS AND METHODS: Healthy probands (group A: 24 probands and group B: 24 probands) were subjected to modified impression cytology using a PTFE membrane for evaluation of age-dependent expression of apoptosis-related genes in the normal conjunctiva. RNA was isolated from the cytologic impression specimens and used for cDNA synthesis employing SuperScriptTM II reverse transcriptase. RESULTS: RT-PCR revealed the detection of apoptosis-related mRNAs as follows (group A compared to group B): Apaf-1: 4.2/4.2%, Bcl-2: 41.7/41.7%, Bim: 0/0%, Bag-1: 70.8/100%, p53: 0/8.3%, Casp-3: 4.2/66.7%, Casp-5: 70.8/37.5%, Casp-8: 62.5/20.8%, Casp-9: 25/12.5%, c-myc: 83.3/95.8%, BAX: 91.7/70.8%, and BAD: 95.8/87.5%. CONCLUSION: The results revealed an age-dependent expression of apoptosis-associated genes (proapoptotic: Casp-3, Casp-5, Casp-8, antiapoptotic Bag-1) in normal human conjunctiva. Taken together these investigations provide basic information to understand the expression of apoptosis-associated genes in various diseases of the conjunctiva.

Expression of annexin II in conventional renal cell carcinoma is correlated with Fuhrman grade and clinical outcome.

Conventional renal cell carcinomas (CRCCs) were investigated for the expression of annexin II (ANX II) to determine out whether this calcium-binding protein could serve as a useful prognostic marker. CRCCs and adjacent nonneoplastic tissue from 33 patients were investigated for ANX II by immunohistochemistry, RT-PCR, and western blot analysis. ANX II expression was correlated with tumor differentiation (Fuhrman grade) and to clinical outcome. Tumors were composed of ANX II positive and negative cells. In grade I tumors only a weak membranous staining was seen in immunopositive cells. In grade II and III tumors, however, ANX II was seen in the cytoplasm and at the cell membranes of tumor cells. On serial sections membranous and cytoplasmic immunoreactivity for ANX II occurred predominantly in eosinophilic cells whereas clear cells were mostly immunonegative. The ANX II expression in CRCCs was correlated with clinical outcome and Fuhrman grade. Since ANX II expression is correlated with Fuhrman grade and clinical outcome it may be a useful marker for prognosis in CRCC.

Intractable ventricular tachycardia and bridging to heart transplantation with a non-pulsatile flow assist device in a patient with isolated left-ventricular non-compaction.

Intractable ventricular tachycardia was investigated in a 51-year-old man with isolated left ventricular non-compaction during implantation of an automated internal cardioverter-defibrillator. Favorable bridging to cardiac transplantation was achieved with the DeBakey left ventricular assist device (LVAD).

Antibodies against glutamic acid decarboxylase: prevalence in neurological diseases.

UNLABELLED: High prevalence of autoantibodies against glutamic acid decarboxylase (GAD-Ab) in stiff man syndrome (SMS) not only helps diagnosis, but also suggests immune mediated impairment of GABAergic functions. However, the presence of GAD-Ab has also been reported in other neurological syndromes. Therefore the prevalence of GAD-Ab was investigated in SMS, progressive encephalomyelitis with rigidity and myoclonus (PERM), and in other neurological diseases (OND). Serum antibodies against the GAD isoforms, GAD65 and GAD67, were investigated with radioimmunoassays in 13 patients with SMS, nine with PERM, 279 consecutive patients with OND, and in 100 normal controls. RESULTS: Prevalence of GAD65Ab was around 80% in patients with SMS/PERM compared with 5% in patients with OND and 1% in normal controls. Prevalence of GAD67Ab was 60% in SMS/PERM, 2% in patients with OND, and 1% in normal controls. Raised GAD-Ab clustered in an OND subgroup with sporadic progressive ataxia, but not in OND subgroups with recognised neuroimmunological diseases. In conclusion, increased GAD-Ab is neither a non-specific epiphenomenon of neuronal damage nor a common feature of recognised neuroimmunological disorders. In neurological diseases, GAD-Ab may be a pathogenetic agent or a marker for an ongoing autoimmune process, or both.

The morphology of mesangial cells cultured at high density and in collagen gels.

Primary mesangial cells (rat) from monolayer cultures of the 6th to 12th passage and permanent SV40 Mes13 cells were grown at high density in organoid culture at the medium/air interphase. After adaptation to the in vitro conditions, both mesangial cell types developed after 7 days a synthesis apparatus (endoplasmic reticulum, Golgi apparatus) and produced matrix which consisted of Lamina densa-like material, collagenous fibrils and filaments. Unspecific contacts, gap junctions and adhesion belts could be demonstrated in the contact areas. Additionally, some cells exhibited thick bundles of actin filaments. A close resemblance of the mesangial cells in high density culture to those in vivo can, therefore, be stated. Hence, they differentiated with regard to their matrix formation, contraction and contact behaviour and can therefore be used for experimental studies within a short culture period of 7 days. Cell aggregates in monolayer culture and in cultures in collagen gels had not differentiated at this stage.

C-cells of marmosets (Callithrix jacchus).

The localization and fine structure of C-cells of the thyroid glands from 31 marmosets (Callithrix jacchus) of different age groups (newborn to 11 years old) were investigated by electron microscopy and immunomorphology (APAAP, calcitonin). Calcitonin-positive cells were found concentrated in the middle third of the gland. Their localization in the follicular wall or in the interstitial space could not clearly be demonstrated by light microscopy. In adult animals, they were always located within the basal lamina, as revealed by electron microscopy. In newborn animals, their localization was difficult because of the dense cell packing. The fine structure of the C-cells with their 200 nm electron-dense granules corresponded to that of other species. Two cell types could be distinguished: (1) granule-rich cells in the storing phase and (2) cells with fewer granules and well-developed rough endoplasmic reticulum in the synthesis phase. The concentration of C-cells in the middle third of the marmoset thyroid gland renders this species especially suitable for morphological investigations and in vitro experiments.

The thyroid gland of Callithrix jacchus in organ culture.

Thyroid glands from 7 marmosets (Callithrix jacchus) of different age groups (newborn, 2 weeks, 2, 7, 8 and 11 months, and 8 years) were grown as organ culture according to Trowell at the medium/air interphase for 3 to 30 days. The morphology of thyroid tissue was well preserved until the end of the culture period. Necroses were only occasionally seen in connective tissue. In contrast to the in vivo situation, the number of lysosome-like inclusions changed considerably and cell-cell contacts became loose. After the addition of TSH the number of apical microvilli, apical granules and coated vesicles rose. The basal surface of follicle cells enlarged due to the formation of processes or ridges and invaginations. Mitosis could be observed. These findings show that, using the Trowell culture technique, thyroid tissue can be grown for up to 4 weeks without showing distinct changes in its morphology. Its responsiveness to the application of TSH is maintained in vitro. Hence, this technique is suitable also for long-term endocrinological, pharmacological and toxicological investigations.

Morphology of thyroid follicular cells from adult marmosets (Callithrix jacchus).

The existence of follicles with a "super flat" epithelium and the large number of primary and especially secondary lysosomes and lipofuscin granules in these cells are characteristic features of the thyroid gland of adult marmosets (Callithrix jacchus, new-world monkeys). It is supposed that these morphological findings are indications of a relatively low function and early ageing.

The interstitial space of the thyroid gland of marmosets (Callithrix jacchus).

The interstitial space of the thyroid gland of adult marmosets contains, like the stroma of other organs, cells and intercellular substance (matrix), blood vessels (predominantly capillaries), lymph vessels and unmyelinated nerves. It is demarcated from the follicular epithelium, the capillaries and Schwann cells by a basal lamina (BL). The perifollicular BL shows thickenings of up to 3 microns over long distances or a multilayered arrangement. These thickened segments exhibit numerous epithelial processes and ridges; in other words, the contour of the basal cell membrane is very irregular in these areas. Indentations of capillaries into the epithelium are rarely observed. The endothelium is only slightly porous. Lymph capillaries occur in large numbers. They originate freely in the interstitial space, show gaps or unspecific contacts between the thin endothelial cells; a basal lamina is missing. Bundles of 10-nm thick filaments (anchor filaments) extend to the endothelial cells of the lymph capillaries. Thin and very long (up to 8 microns) plate-like processes surround the capillaries or run parallel to the outer contour of the follicles. They originate at the poles of oval, fibroblast-like cells. Since these cells are FXIII- and C3bi-positive, they can be considered as dendritic cells. They obviously play a role in the frequently-observed autoimmune diseases of this species. In addition, monocytes and all transitional forms including macrophages, fibrocytes and lymphocytes as well as numerous mast cells occur. In the region of the BL, integrins of the beta 1-group (alpha 6) can be demonstrated immunohistologically in addition to the usual components (collagen type IV, laminin and heparan sulfate-proteoglycan). Of the fibrillar collagens type I does not occur, type III occurs only in small amounts, whereas types V and VI are observed in large amounts. The presented findings may serve as basis for more extensive experiments on these primates.