Initial experience using propranolol as an adjunctive treatment in children with aggressive recurrent respiratory papillomatosis

We performed a retrospective chart review with a 6-month follow-up to examine the initial use of propranolol as an adjunctive treatment in children with severe recurrent respiratory papillomatosis. This is the first such report. Two of 3 children with severe recurrent respiratory papillomatosis demonstrated a response to oral propranolol therapy, as evidenced by an improved voice and by an increased time between surgical interventions. One child demonstrated no response to propranolol, and medication was halted. Both children who demonstrated a response had undergone more than 10 surgical interventions in the previous year, along with prior treatment including surgical excision and adjuvant therapy. Both children more than doubled the interval between treatments after propranolol administration, and the parents of both children noted marked improvement of the child's voice as measured by their Pediatric Voice-Related Quality of Life score (from 40 to 67.5 in one child and from 27 to 60 in the other child). No child experienced hypoglycemia or blood pressure abnormalities. We conclude that initial use of propranolol as an adjunctive measure in severe recurrent respiratory papillomatosis shows it to have some efficacy in delaying surgical intervention and improving voice. Previous reports have demonstrated relatively safe use of propranolol in children with hemangiomas. Further studies are needed to determine the long-term effectiveness, dosing strategies, and side-effect profile of propranolol for treatment of recurrent respiratory papillomatosis.     

Lactoferrin in the gingival crevice as a marker of polymorphonuclear leucocytes in periodontal diseases

Abstract This study examined lactoferrin (LF) levels in gingival crevicular fluid (GCF) and set out to test the hypothesis that LF could act as a marker of crevicular polymorphonuclear leucocytes (PMN), Therefore, 2 experiments were conducted: (a) to quantify total LF (ng/30 s sample) in GCF; (b) to correlate LF levels (ng/μl) and PMN numbers (PMNs/μl) in gingival crevicular washings (GCW). GCF was collected from 71 sites in a total of 22 patients. These sites were classified on the basis of clinical indices of gingivitis (GI) and pocket depth (PD) into three clinical groups:‘healthy’, ‘gingivitis’ and ‘periodontitis’. GCWs were obtained from an additional 63 sites in 21 patients. LF in GCF and GCWs was assayed by a sandwich ELISA. Total leucocyte and differential counts were performed on the GCWs. GCF LF (ng/30 s) correlated positively with GI (r=0.418, p<0.001), PD (r=0.415, p<0.001) and GCF volume (r=0.624, p<0.001). Gingivitis (n=21) and periodontitis sites (n=24) demonstrated significantly higher (p<0.05) total GCF LF than healthy (n=26) sites. In GCWs LF (ng/μl) showed stronger correlations with clinical indices (GI: r=0.452, PD: r=0.513, p<0.001) than did PMN numbers (PMNs/μl) (GI: r=0.279, PD: r=0.388, p<0.05). LF correlated strongly with PMNs in GCWs (r=0.531, p<0.001) and provides a simple and effective marker of crevicular PMN numbers.     

ABO blood group, secretor state, and susceptibility to recurrent urinary tract infection in women

ABO blood group and secretor state was determined in 319 women with recurrent urinary tract infection and compared with those of a control group of 334 women of similar age ranges. Women of blood groups B and AB who are non-secretors of blood group substances showed a significant relative risk of recurrent urinary tract infection of 3.12 (95% confidence limits, 1.49 and 6.52) in comparison with other types. This appears to be a genuine example of synergy in which absence of anti-B isohaemagglutinin and secretor substances combines to give an increased risk of recurrent urinary tract infection. Determination of blood group and secretor state may provide additional information in identifying those at risk.     

Blood group, secretor status, and susceptibility to infection by Neisseria gonorrhoeae.

To determine whether the presence or absence of anti-B isohaemagglutinin in individuals of blood group B increases their susceptibility to gonococcal infections 567 new patients attending a sexually transmitted disease clinic were screened for blood group and secretor status. Of the patients with blood group B, 20.1% had gonorrhoea and 12% had not. A higher percentage (20.9%) of patients with no anti-B isohaemagglutinin had gonorrhoea compared with those without (12.1%). There was, however, no synergy between the absence of anti-B isohaemagglutin and nonsecretion of water-soluble blood group B antigen. Further research is needed to determine the underlying host-parasite interactions responsible for the increased susceptibility to gonorrhoea in these individuals.     

Total NIH support to US dental schools, 2005-2009

This study compared total NIH research funding across US dental institutions from 2005 to 2009. Utilizing the online NIH RePORT, we obtained comprehensive award data for US dental schools by funding NIH Institutes/Centers (ICs). Fifty dental schools were awarded a total of $974.393 million, 69.3% from NIDCR and 30.7% from 21 other ICs. These provided the majority of support to 12 schools. Greater than 50% of non-NIDCR support came from 4 ICs. The median dental school NIH portfolio was $14.572 million, with a minimum of $0.241 million and a maximum of $88.609 million. Forty-six schools received $544.899 million for R01 awards. Thirty-five schools were awarded $100 million in research training and career development grants. Several dramatic differences are found for dental schools' rankings based on total NIH dollars compared with NIDCR-only support. Dollars from ICs other than NIDCR increased 34.6% between 2005 and 2009. Grants to US dental institutions comprised 50% or less of total NIDCR awards globally from 2005 through 2009. Funds received from all NIH ICs are an objective metric for evaluation of the research performance of dental schools. NIDCR has played a diminishing role in funding research at US dental schools between 2005 and 2009.     

Interleukin-1beta modulates proinflammatory cytokine production in human epithelial cells

Periodontitis is a chronic human inflammatory disease initiated and sustained by dental plaque microorganisms. A major contributing pathogen is Porphyromonas gingivalis, a gram-negative bacterium recognized by Toll-like receptor 2 (TLR2) and TLR4, which are expressed by human gingival epithelial cells (HGECs). However, it is still unclear how these cells respond to P. gingivalis and initiate inflammatory and immune responses. We have reported previously that HGECs produce a wide range of proinflammatory cytokines, including interleukin-6 (IL-6), IL-8, granulocyte-macrophage colony-stimulating factor, tumor necrosis factor alpha (TNF-alpha), and IL-1beta. In this study, we show that IL-1beta has a special role in the modulation of other inflammatory cytokines in HGECs challenged with P. gingivalis. Our results show that the increased production of IL-1beta correlates with the cell surface expression of TLR4, and more specifically, TLR4-normal HGECs produce fourfold more IL-1beta than do TLR4-deficient HGECs after challenge. Moreover, blocking the IL-1beta receptor greatly reduces the production of "secondary" proinflammatory cytokines such as IL-8 or IL-6. Our data indicate that the induction of IL-1beta plays an important role in mediating the release of other proinflammatory cytokines from primary human epithelial cells following challenge with P. gingivalis, and this process may be an inflammatory enhancement mechanism adopted by epithelial cells.     

Relative proportions of mononuclear cell types in periodontal lesions analyzed by immunohistochemistry

In this study, we investigated the relative proportions of infiltrating mononuclear inflammatory cells in sections of granulation tissue from periodontitis lesions in both adult periodontitis (AP) and early onset periodontitis (EOP) patients. We utilised a set of cluster of differentiation (CD) antigen-specific monoclonal antibodies to detect different cell types within the tissues. These included anti-CD 20 (B cells), anti-CD 3 (pan T cells) and anti-CD 45RO (memory T cells), anti-CD 4 (helper T cells) anti-CD 8 (suppressor T cells) and anti-CD 68 (monocyte/macrophage). Biopsies of granulation tissue were obtained from 9 patients with adult periodontitis (AP), from 10 patients with early onset periodontitis (EOP) and for comparative purposes, biopsies of gingival tissue from 4 patients with AP. A significantly greater number of T cells (p < 0.05) were observed in EOP and gingival sections than in AP sections. In addition, a greater number of B cells were observed in the granulation tissues than in the gingiva (p < 0.05). The relative numbers of B cells (CD 20). T cells (CD 3) and macrophages (CD 68) were expressed as a percentage of their combined total for each of the patient groups and indicated that the proportion of B lymphocytes was greater in AP sections than in EOP or gingival sections (p < 0.02). The proportion of T cells was lower in the AP periodontitis sections than in the EOP periodontitis sections (p < 0.05). There were no significant differences in the proportion of macrophages between the 3 categories of tissue specimens. The relative ratios of B cells (CD 20) to T cells (CD 3) and B cells (CD 20) to memory T cells (CD 45RO) and macrophages (CD 68) to T cells (CD 3) and memory T cells (CD 45RO) were analyzed and indicated that there was a significant increase in the B to T cell ratio in AP sections compared to EOP and gingival sections (p < 0.02). There was also a significant increase in the macrophage to T cell ratio in AP sections as indicated by CD 68 to CD 3 ratios (p < 0.05). There were no differences regarding the relative proportions of memory T cells or in the ratios of CD 4+ to CD 8+ T cells in the different disease categories. In conclusion, these differences in the relative proportions of B cells, T cells and macrophages may reflect a difference in the immunopathology of AP and EOP.