Reconstruction of Peri-implant Osseous Defects

There is a paucity of data for the effectiveness of reconstructive procedures in the treatment of peri-implantitis. The objective of this study was to compare reconstruction of peri-implant osseous defects with open flap debridement (OFD) plus porous titanium granules (PTGs) compared with OFD alone. Sixty-three patients (36 female, 27 male; mean age 58.4 y [SD 12.3]), contributing one circumferential peri-implant intraosseous defect, were included in a multinational, multicenter randomized trial using a parallel-group design. After OFD and surface decontamination using titanium brushes and hydrogen peroxide, 33 defects received PTGs. The implants were not submerged. All patients received adjunctive perioperative systemic antibiotics. The primary outcome variable (defect fill) was assessed on digitalized radiographs. Clinical measurements of probing depth (PPD), bleeding on probing (BoP), suppuration, and plaque were taken by blinded examiners. After 12 mo, the test group (OFD plus PTG) showed a mean radiographic defect fill (mesial/distal) of 3.6/3.6 mm compared with 1.1/1.0 in the control group (OFD). Differences were statistically significant in favor of the test group ( P < 0.0001). The OFD plus PTG group showed a mean reduction in PPD of 2.8 mm compared with 2.6 mm in the OFD group. BoP was reduced from 89.4% to 33.3% and from 85.8% to 40.4% for the test and control groups, respectively. There was no significant difference in complete resolution of peri-implantitis (PPD ≤4 mm and no BoP at six implant sites and no further bone loss), because this finding was accomplished at 30% of implants in the test group and 23% of implants in the control group. Reconstructive surgery using PTGs resulted in significantly enhanced radiographic defect fill compared with OFD. However, limitations in the lack of ability to discern biomaterial from osseous tissue could not be verified to determine new bone formation. Similar improvements according to clinical measures were obtained after both surgical treatment modalities (ClinicalTrials.gov NCT02406001).

Genetic and epigenetic profiling of CLL disease progression reveals limited somatic evolution and suggests a relationship to memory-cell development

We examined genetic and epigenetic changes that occur during disease progression from indolent to aggressive forms of chronic lymphocytic leukemia (CLL) using serial samples from 27 patients. Analysis of DNA mutations grouped the leukemia cases into three categories: evolving (26%), expanding (26%) and static (47%). Thus, approximately three-quarters of the CLL cases had little to no genetic subclonal evolution. However, we identified significant recurrent DNA methylation changes during progression at 4752 CpGs enriched for regions near Polycomb 2 repressive complex (PRC2) targets. Progression-associated CpGs near the PRC2 targets undergo methylation changes in the same direction during disease progression as during normal development from naive to memory B cells. Our study shows that CLL progression does not typically occur via subclonal evolution, but that certain CpG sites undergo recurrent methylation changes. Our results suggest CLL progression may involve developmental processes shared in common with the generation of normal memory B cells.

A lithium clinic for bipolar patients: 2-year outcome of the first 148 patients

OBJECTIVE

This paper describes the outcome for the first 148 patients referred to a lithium clinic.

METHOD

Two-year follow-up data from treatment charts are reported for all patients entering a lithium clinic in the study period.

RESULTS

Lithium was given as the only mood stabilizer in 132 (89.2%) of the cases. Thirty-two (21.6%) patients were readmitted with a new affective disorder episode. Twenty-nine (19.6%) patients discontinued treatment prematurely. Variables predicting the recurrence of new affective disorder episodes as well as premature discontinuation of treatment were identified.

CONCLUSION

The majority of bipolar patients received lithium for prophylaxis against recurrent affective disorder episodes. The outcome was moderate but comparable to the 30-40% improvement usually reported in follow-up studies of bipolar patients given long-term prophylactic treatment with lithium. Better long-term treatment results for bipolar patients depend on both the development of more effective mood stabilizing drugs or drug combinations and the improvement of patients' adherence to treatment.

A lithium clinic for bipolar patients: 2-year outcome of the first 148 patients

OBJECTIVE

This paper describes the outcome for the first 148 patients referred to a lithium clinic.

METHOD

Two-year follow-up data from treatment charts are reported for all patients entering a lithium clinic in the study period.

RESULTS

Lithium was given as the only mood stabilizer in 132 (89.2%) of the cases. Thirty-two (21.6%) patients were readmitted with a new affective disorder episode. Twenty-nine (19.6%) patients discontinued treatment prematurely. Variables predicting the recurrence of new affective disorder episodes as well as premature discontinuation of treatment were identified.

CONCLUSION

The majority of bipolar patients received lithium for prophylaxis against recurrent affective disorder episodes. The outcome was moderate but comparable to the 30-40% improvement usually reported in follow-up studies of bipolar patients given long-term prophylactic treatment with lithium. Better long-term treatment results for bipolar patients depend on both the development of more effective mood stabilizing drugs or drug combinations and the improvement of patients' adherence to treatment.

Effect of impulse duration on patients' perception of electrical stimulation and block effectiveness during axillary block in unsedated ambulatory patients

BACKGROUND AND OBJECTIVES

Chronaxie of the motor-neurons (A-alpha) is shorter than that of the sensory A-delta and C neurons. Therefore, a short current impulse should elicit a painless muscle twitch. This randomized, double-blind study of patients having ambulatory axillary block by multiple neurostimulations compared patients' perception of electrical stimulation, latency, and quality of analgesia and the incidence of adverse effects.

METHODS

In group S (short impulse, n = 44) 0.1-ms-current impulses were used and in group L (long impulse, n = 43) 0.3-ms impulses were used. Initial amplitude was 2 mA. Local anesthetic was injected near the 4 terminal nerves (musculocutaneous, median, ulnar, radial) after reaching a target amplitude between 0.1 and 0.5 mA. Patients were specifically requested to categorize sensation of electrical stimulation "electric shocks" as follows: no discomfort, discomfort, pain. Pain was then quantified on a visual analog scale (VAS). Surgically ineffective blocks were supplemented after 30 minutes. A patient was defined as ready for surgery (complete block) when analgesia was present in all areas distal to the elbow.

RESULTS

There were no significant differences between groups in quali- and quantitative assessments of electrical stimulation. Eight patients (18%) in either group described the sensation as "strange or funny." Eight patients in group S and 13 (30%) in group L reported discomfort during stimulation. Twenty-eight patients (64%) in S group and 22 (52%) in L group experienced pain. Median VAS (0 to 100) of this pain was 21 and 24, respectively. Block performance time was 9 minutes in L group and 11 minutes in S group (P < .001), but the latency of analgesia was 23 minutes for both groups and the times to achieve complete block were, therefore, similar: 32 minutes in L group and 34 minutes in S group (not significant [NS]). Nine group S and 8 group L patients required supplementary blocks (NS). The incidence of vessel punctures and accidental intravascular injections were also similar in both groups.

CONCLUSIONS

This study did not confirm our hypothesis that short-current impulses (0.1 ms) make neurostimulation of peripheral nerves painless, by selectively depolarizing motor-neurons. Longer impulses (0.3 ms) shorten block performance time, probably by easier location of the nerves, but the clinical relevance of this finding is doubtful.

Allosteric effects of Pit-1 DNA sites on long-term repression in cell type specification

Reciprocal gene activation and restriction during cell type differentiation from a common lineage is a hallmark of mammalian organogenesis. A key question, then, is whether a critical transcriptional activator of cell type-specific gene targets can also restrict expression of the same genes in other cell types. Here, we show that whereas the pituitary-specific POU domain factor Pit-1 activates growth hormone gene expression in one cell type, the somatotrope, it restricts its expression from a second cell type, the lactotrope. This distinction depends on a two-base pair spacing in accommodation of the bipartite POU domains on a conserved growth hormone promoter site. The allosteric effect on Pit-1, in combination with other DNA binding factors, results in the recruitment of a corepressor complex, including nuclear receptor corepressor N-CoR, which, unexpectedly, is required for active long-term repression of the growth hormone gene in lactotropes.

Combinatorial roles of the nuclear receptor corepressor in transcription and development

Transcriptional repression plays crucial roles in diverse aspects of metazoan development, implying critical regulatory roles for corepressors such as N-CoR and SMRT. Altered patterns of transcription in tissues and cells derived from N-CoR gene-deleted mice and the resulting block at specific points in CNS, erythrocyte, and thymocyte development indicated that N-CoR was a required component of short-term active repression by nuclear receptors and MAD and of a subset of long-term repression events mediated by REST/NRSF. Unexpectedly, N-CoR and a specific deacetylase were also required for transcriptional activation of one class of retinoic acid response element. Together, these findings suggest that specific combinations of corepressors and histone deacetylases mediate the gene-specific actions of DNA-bound repressors in development of multiple organ systems.

Evaluation of a new bioabsorbable barrier for recession therapy: a feasibility study

BACKGROUND

The objective of this study was to evaluate the feasibility of a new polylactic acid bioabsorbable barrier in the treatment of gingival recession.

METHODS

Twenty patients with buccal recession defects (Miller class I, II, and III; mean recession: 4.0 +/- 1.2 mm; range: 2.0 to 6.8 mm) participated. After thorough scaling and root surface conditioning with 10% tetracycline-HCl, a trapezoidal mucoperiosteal flap was prepared. A customized barrier was applied to cover the defect. Barriers adhered directly to tooth and bone and no sutures were used. The barrier was subsequently covered by a coronally positioned flap. Assessments of probing depths were performed by means of a controlled-force electronic probe, and recession was determined on stone models with a digital caliper at baseline and 12 months following therapy.

RESULTS

Eight barriers showed limited exposure (1 to 2 mm) with minimal signs of gingival inflammation between 2 and 6 weeks following surgery. Comparing baseline measurements with outcomes at 12 months, significant root coverage and probing attachment gain were observed (P <0.0001, paired t test). Mean gingival recession was reduced to 0.4 +/- 0.5 mm, corresponding to a mean root coverage of 91.9%, and overall attachment gains amounted to 4.2 mm. A significant gain of keratinized tissue was found (2.9 +/- 0.7 mm), and mean probing depths were slightly reduced from 2.2 to 1.7 mm.

CONCLUSIONS

The results of this study indicate favorable outcomes after using a new bioabsorbable barrier material for root coverage in recession-type defects.

Osseointegration of preformed polymethylmethacrylate craniofacial prostheses coated with bone marrow-impregnated poly (DL-lactic-co-glycolic acid) foam

Osseointegration of bone marrow-PLGA-coated, preformed polymethylmethacrylate cranioplasties offers the possibility of reducing: operative time, periimplant seroma and infection, metallic fixation, and periprosthetic resorption following surgical skull remodeling. These alloplastic materials are FDA-approved but previously have not been used together to promote cranioplasty incorporation. The objective of this study was to determine whether the use of PLGA foam coating improves host osseointegration of preformed, textured, polymethylmethacrylate prosthetic cranioplasties. A critical-sized cranial defect was created in two groups of 10 and one group of three rabbits. The defect was filled with either a textured, preformed polymethylmethacrylate disc or a textured, preformed polymethylmethacrylate disc coated with poly (DL-lactic-co-glycolic acid). Both implants were immersed in autologous bone marrow for 20 minutes before implantation. Half of each group of 10 were killed at 3 weeks, and the remainder at 6 weeks. A third group of three rabbits with excised periosteum was evaluated at 6 weeks. Histologic analysis of the discs determined relative amounts of cancellous bone formation adjacent to the prostheses. Woven trabecular bone was present at each host bone to implant perimeter interface at 3 weeks, with fine fibrous capsular formation around the implants. Thicker, lamellar trabeculae were present at 6 weeks with an increased fibrous layer surrounding both types of implants. Bone formed on the superficial and deep implant surfaces in a noncontiguous fashion. Two of five measures showed that total bone formation was significantly greater in the PLGA-coated implants. Polymethylmethacrylate discs coated with bone marrow-impregnated PLGA foam demonstrate increased bone formation at 3 and 6 weeks as compared with non-coated preformed polymethylmethacrylate discs. Only implants with preserved periosteum showed bone formation away from the host-implant interface (centrally) on the superficial surface at 6 weeks.

High-titer MSCV-based retrovirus generated in the pCL acute virus packaging system confers sustained gene expression in vivo

Retroviral gene transfer using vectors encoding tumor suppressor genes has been tested repeatedly as a potential anti-tumor therapy. However, most attempts have been hindered by the inability to deliver genes efficiently and to obtain sustained expression in cells growing in vivo. In this paper we describe a method for producing high-titer MSCV virus using the pCL acute retroviral packaging system. This method facilitates the generation of MSCV virus encoding genes that convey the cytostatic or cytocidal phenotypes of benefit in the treatment of cancer. Amphotropic MSCV virus with an average titer of 6 x 10(6) CFU/ml has been routinely produced in this system. We demonstrate that, unlike the pCL retroviral vectors, the MSCV vector is capable of directing sustained in vivo expression of the green fluorescent protein in infected glioma cells following implantation and tumor growth in nude mice.

Diverse signaling pathways modulate nuclear receptor recruitment of N-CoR and SMRT complexes

Several lines of evidence indicate that the nuclear receptor corepressor (N-CoR) complex imposes ligand dependence on transcriptional activation by the retinoic acid receptor and mediates the inhibitory effects of estrogen receptor antagonists, such as tamoxifen, suppressing a constitutive N-terminal, Creb-binding protein/coactivator complex-dependent activation domain. Functional interactions between specific receptors and N-CoR or SMRT corepressor complexes are regulated, positively or negatively, by diverse signal transduction pathways. Decreased levels of N-CoR correlate with the acquisition of tamoxifen resistance in a mouse model system for human breast cancer. Our data suggest that N-CoR- and SMRT-containing complexes act as rate-limiting components in the actions of specific nuclear receptors, and that their actions are regulated by multiple signal transduction pathways.

Treatment of gingival recession with titanium reinforced barrier membranes versus connective tissue grafts

It was the aim of this study to compare barrier membrane therapy with connective tissue grafts in the treatment of recession defects. Fifteen patients with 2 paired vestibular recession defects participated in the study. After thorough scaling and root surface conditioning with tetracycline-HCl, defects were randomly assigned to 1 of 2 treatment modalities. In one of the defects, a trapezoidal mucoperiosteal flap was prepared, and a titanium reinforced expanded polytetrafluoroethylene membrane was adapted to the defect and secured by a sling suture. The membrane was subsequently covered by a coronally positioned flap secured with crown attached sutures. The other defect was treated with a connective tissue graft employing the "envelope technique." Twelve months after therapy, both treatment modalities showed significant root coverage and probing attachment gain. Gingival recession decreased from 3.6+/-0.7 mm to 0.5+/-0.5 mm for membrane treated defects and from 3.6+/-1.0 mm to 0.5+/-0.5 mm following use of grafts, corresponding to mean root coverages of 87.1% and 86.9%, respectively. Mean gains of keratinized tissue of 1.5 mm (membrane) and 2.5 mm (graft) could be observed. Thus, the results of this study demonstrate that both titanium reinforced barrier membranes and connective tissue grafts can be successfully used to treat periodontal recession defects.

Progressive peri-implantitis. Incidence and prediction of peri-implant attachment loss

The aim of this prospective study was to characterize an implant patient population exhibiting clinical signs of peri-implantitis and to determine subsequently the incidence of progressive attachment loss. The predictive values of diagnostic parameters were evaluated. 25 patients with 54 endosseous implants that had been loaded for 41 +/- 15 months were included in the study. Clinical parameters included the assessment of plaque, bleeding on probing, probing depth, attachment levels, and Periotest values. Probing measurements were performed in duplicate by means of a controlled force electronic probe (Periprobe). Peri-implant crevicular fluid samples were collected and assayed for neutral proteolytic enzyme (NPE) activity (Periocheck). Analysis of duplicate baseline probing data revealed a high degree of reproducibility (mean difference: 0.1 +/- 0.3 mm). A minimum threshold of 1.0 mm (> 3 x S.D.) loss of probing attachment was chosen to classify a site as positive for breakdown. Alternatively, the tolerance method was employed to identify sites with progressive attachment loss. After 6 months, irrespective of the analytical method, 6 percent of all sites (in 19% of the implants) and 28% of the patients had experienced further peri-implant attachment loss. There were significant differences (p < 0.05) in mean plaque (73% vs. 45%) and NPE (36% vs. 12%) scores between patients with progressive peri-implantitis and those with stable peri-implant conditions. Both bleeding on probing and the NPE-test were characterized by high negative predictive values, and thus negative scores can serve as indicators for stable peri-implant conditions. For monitoring peri-implant health during recall visits, attachment level recordings with a controlled force electronic probe in conjunction with enzymatic diagnostic tests of the host response can be recommended.

Allosteric stabilization of 3H-N-methylscopolamine binding in guinea-pig myocardium by an antidote against organophosphate intoxication

W84 (hexamethylene-bis-[dimethyl-(3-phthalimidopropyl)-ammonium bromide]) protects overadditively against an organophosphate-intoxication when applied in combination with atropine. Further experimental evidence led to the hypothesis that W84 exerted an allosteric effect on muscarinic acetylcholine receptors. In order to investigate the action of W84 on the receptor level, binding studies with 3H-N-methylscopolamine were performed in homogenized and intact guinea-pig myocardium. For sake of comparison three bispyridinium oximes were included, i.e. Uno3 (trimethylene-bis-[4-hydroxyiminomethyl-pyridinium] dibromide mono-2,6-dichlorobenzylether), obidoxime, and TMB4. In cardiac membrane suspensions, all compounds inhibited 3H-NMS-binding after 2 hrs of incubation concentration-dependently by reducing its affinity, whereas leaving the number of binding sites unaltered. However, with increasing concentrations W84 suppressed 3H-NMS-binding less than expected for a competitive antagonist. Kinetic studies revealed that W84 did not only slow the association of 3H-NMS, but additionally retarded its dissociation over the entire range of concentrations that inhibited 3H-NMS-binding. At lmM, W84 augmented the half life time of the 3H-NMS-receptor complexes from a control value of 4 min to more than 120 min. The stabilization of the radioligand-receptor complexes is indicative of an allosteric effect of W84. Obidoxime, TMB4 and Uno3 at low concentrations acted like competitive inhibitors of 3H-NMS-binding. From 10(-5)M onwards, Uno3 retarded 3H-NMS-dissociation concentration-dependently. It is concluded that the effect of bisquaternary compounds on 3H-NMS-association and -dissociation is mediated via binding to two separate sites, i.e. the muscarinic receptor site and an allosteric effector site, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)