Evaluation of medical and dental visits in New York City: Opportunities to identify persons with and at risk for diabetes mellitus in dental settings

Objective

The identification of persons with or at risk for chronic diseases is a new practice paradigm for oral healthcare. Diabetes mellitus (DM) is a chronic disease of particular importance to oral health providers. This study sought to understand healthcare utilization patterns that would support the introduction of this new practice paradigm.

Methods

The primary and oral healthcare utilization patterns of New York City (NYC) adults were assessed using data collected from the 2013 NYC Community Health Survey. We stratified healthcare utilization patterns by type of provider, insurance, DM diagnosis and DM modifiable risk factors.

Results

Of 6.4 million NYC adults, an estimated 676 000 (10.5%) reported a previous diagnosis of DM, and 3.9 million (69.5%) were identified with one or more modifiable risk factor for DM. Of these at risk individuals, 2.2 million (58.9%) received dental services in the past 12 months, and 545 000 (14.3%) did not see a primary care provider during the same period. Of the approximately 1.16 million adults without health insurance, an estimated 338 000 (26.2%) had a dental visit only.

Conclusion

Healthcare utilization patterns in this urban setting suggest that oral healthcare providers can support the identification of patients with and at risk for DM who may otherwise not have the opportunity for screening.     

Inheritance of nasal dermoid sinus cyst and evidence for association with third ventricle colloid cyst

Purpose  

The purpose of this paper is to study the possible inheritance of nasal dermoid sinus cyst in the Finnish population.     

Perinatal Exposure to Bisphenol A or Diethylstilbestrol Increases the Susceptibility to Develop Mammary Gland Lesions After Estrogen Replacement Therapy in Middle-Aged Rats

The development of the mammary gland is a hormone-regulated event. Several factors can dysregulate its growth and make the gland more susceptible to cellular transformation. Among these factors, perinatal exposure to xenoestrogens and hormone replacement therapy has been associated with increased risk of developing breast cancer. Here, we assessed the effects induced by estrogen replacement therapy (ERT) in ovariectomized (OVX) middle-aged rats and whether perinatal exposure to diethylstilbestrol (DES) or bisphenol A (BPA) modified these effects in the mammary gland. Pregnant rats were orally exposed to vehicle, 5 μg DES/kg/day, or 0.5 or 50 μg BPA/kg/day from gestational day 9 until weaning. Then, 12-month-old offspring were OVX and treated with 17β-estradiol for 3 months. Morphological changes and the percentage of epithelial cells that proliferated or expressed estrogen receptor alpha (ESR1) and progesterone receptor (PR) were analyzed in mammary gland samples of 15-month-old animals. ERT induced lobuloalveolar hyperplasia and ductal cysts in the mammary gland of middle-aged rats, associated with a higher proliferation index of epithelial cells. Perinatal exposure to DES followed by ERT increased the number of cysts and induced the formation of fibroadenoma and ductal carcinoma in situ, without modifying the expression of ESR1 or PR. Also, after 3 months of ERT, BPA-exposed rats had a higher incidence of ductal hyperplasia and atypical lobular hyperplasia than animals under ERT alone. In conclusion, perinatal exposure to xenoestrogens increases the susceptibility of the mammary gland to develop cysts and hyperplastic lesions when confronted with ERT later in life.     

An immunotoxin with greatly reduced immunogenicity by identification and removal of B cell epitopes

Recombinant immunotoxins are hybrid proteins composed of an Fv that binds to a tumor antigen fused to a bacterial or plant toxin. Immunotoxin BL22 targets CD22 positive malignancies and is composed of an anti-CD22 Fv fused to a 38-kDa fragment of Pseudomonas exotoxin A (PE38). BL22 has produced many complete remissions in drug-resistant Hairy cell leukemia, where many treatment cycles can be given, because neutralizing antibodies do not form. In marked contrast, only minor responses have been observed in trials with immunotoxins targeting solid tumors, because only a single treatment cycle can be given before antibodies develop. To allow more treatment cycles and increase efficacy, we have produced a less immunogenic immunotoxin by identifying and eliminating most of the B cell epitopes on PE38. This was accomplished by mutation of specific large hydrophilic amino acids (Arg, Gln, Glu, Lys) to Ala, Ser, or Gly. The new immunotoxin (HA22-8X) is significantly less immunogenic in three strains of mice, yet retains full cytotoxic and anti-tumor activities. Elimination of B-cell epitopes is a promising approach to the production of less immunogenic proteins for therapeutic purposes.