The effectiveness of differing dental health education programmes in improving the oral health of adults with mental handicaps attending Birmingham adult training centres.

There are few published data available relating to dental health in adults with handicaps, or to the effectiveness of dental health education in this group. The present study involved 382 people attending four different adult training centres in Birmingham, UK. Following baseline examinations all participants were given oral hygiene instruction and a scale and polish. Each of the centres was then randomly allocated to one of the four treatment regimens. No specific treatment was provided for the control group; daily supervised toothbrushing was carried out by the participants in the other three groups, with the addition of a three-monthly scale and polish and reinforcement of oral hygiene instruction in group 3 and one-monthly input in group 4. The participants were re-examined after three months and then at six-monthly intervals until 24 months after the baseline examination. The results showed that those people left to their own devices to carry out toothbrushing at home following instruction were not achieving an acceptable standard. Those who were reminded, encouraged and motivated by the adult training centre staff were obviously capable of better standards of oral care. The input of an experienced dental hygienist on a regular basis improved the periodontal condition considerably. Although there were significant differences between the groups throughout the study, particularly in the presence of calculus, the differences between the one-monthly and three-monthly hygienist input were not clinically very apparent after two years, and therefore a one-monthly input would be difficult to justify on a cost benefit basis.     

Superoxide dismutase in the erythrocytes of acute alcoholics during detoxification

The activity of erythrocyte superoxide dismutase in acute alcoholic patients on admission does not form a single population but clusters in two groups either above or below the normal range. The values in both groups revert towards the normal after a week of treatment. The divergent activities of this free radical scavenging enzyme between the two groups could not be explained by differences in age, haematology or liver function tests but are likely to be acute responses, possibly to diverse drinking patterns in the period immediately preceding admission.     

SPLENECTOMY FOR IMMUNE THROMBOCYTOPENIC PURPURA: AUCKLAND EXPERIENCE 1979–87

Of 148 elective splenectomies performed in auckland during 1979-s7, 48 were performed as therapy for immune thrombocytopenic purpura (itp). In all cases medical therapy had either failed to maintain their platelet count (36 patients), or side-effects of medical treatment had made continuation unacceptable (12 patients). The mean age of the group was 31 years and there were 15 males and 33 females. Thirty-four of 48 patients (71%) had a favourable response to splenectomy: platelet count was maintained above 150 × 10⁹/1 and medical therapy was no longer required. There was no operative or inhospital mortality. Seven patienls experienced postoperative complications (mainly infections) of which none were life-threatening. There was no difference in response between males and females (67% and 73% response rate, respectively), and the response rates of europeans and non-europeans were similar (71% and 69%, respectively). By contrast, the average age of the responders ((29 years) was almost 10 years younger than the non-responders (38 years). It is concluded that the use of splenectomy as therapy for patienls with itp. Who have either failed to respond to medical management or for various reasons cannot tolerate the complications associated with steroid therapy, is a safe procedure which in the present series was associated with no operative mortality and an acceptably low rale of morbidity. Younger itp patients (< 30 years) have a better chance of responding favourably to splenectomy than do older patienls (> 40 years).     

Induction of Lymphokine-Activated Killer Activities in Peripheral Blood Lymphocytes and Regional Lymph Node Lymphocytes Against PC-9 Cultured Adenocarcinoma and Autologous Pulmonary Adenocarcinoma Cells

The cytotoxic activities, of the peripheral blood lymphocytes(PBL) and regional lymph node lymphocytes (LNL) generated byincubation with recombinant IL-2 (rIL-2) in vitro, have beenstudied to assess their effects on autologous pulmonary adenocarcinomacells from 21 patients with lung cancer. The lymphokine-activatedkiller (LAK) activities of PBL were 22.9±14.8% for autologouspulmonary adenocarcinoma cells and 44.9±20% for PC-9cells. A previous coculture of autologous tumor cells with PBL(ATS-LAK) showed no Increase in induction of cytotoxicity toautologous tumor cells. The LAK activities of LNL were significantlylower than those of PBL. The cytotoxicities of rIL-2 activatedlymphocytes seemed lower in well differentiated pulmonary adenocarcinomathan in moderately and poorly differentiated adenocarcinoma,and higher in patients with lymph node metastasis than in thosewithout; they appeared, however, not to be related to clinicalstage or degree of infiltration of T-zone histiocytes into thecancer stroma. The cytotoxicity to autologous tumor cells wasnot significantly different in the presence of the Ia antigenexpressed on tumor cells, but the cytotoxicity to la positivePC-9 cells was significantly higher for rIL-2 activated lymphocytesfrom patients with lung cancer cells which were la positivethan from those where they were la negative. The presence ofla antigen on tumor cells seemed important for antitumor activity.     

Predicting ocular irritancy and recovery from injury using Madin-Darby canine kidney cells

Two promising cell culture assays, using Madin-Darby canine kidney cells, for predicting eye irritancy, the fluorescein leakage assay and the neutral red release assay, have been adapted to try and assess the ability of damaged cells to recover from chemical-induced injury. The fluorescein leakage and neutral red release protocols are similar but measure injurious effects on different parts of the cells, namely the tight junctions and the cell membrane, respectively. Both endpoints have previously given equivalent rankings of chemicals in order of their eye irritancy potential. Sixteen compounds of varying irritancy potential and chemical nature were tested using the two assays. In both assays, little or no cell recovery was measured 72 hr after a mildly injurious exposure, although using the fluorescein leakage assay, five test agents displayed substantial recovery and two displayed significant deterioration of the cell layer after removal of the test material. Comparing these in vitro results with in vivo data suggests that the fluorescein leakage assay, in its current format, does not predict the likely recovery rate of ocular tissue after chemical damage.     

Antigenic mapping of the surface proteins of rhesus rotavirus

Monoclonal antibodies have been produced and used to map the functional topography of the surface proteins of rhesus rotavirus (RRV) that mediate viral neutralization. Ten monoclonal antibodies directed to VP7 were studied in neutralization assays and competitive binding studies. A large neutralization domain with several interrelated epitopes on VP7 was apparent. Twelve monoclonal antibodies directed to VP3 were used in similar studies and delineated at least 2 distinct neutralization domains on that protein. Neutralizing monoclonal antibodies directed at both VP3 and VP7 were used to isolate viral antigenic variants, which were than studied in neutralization and hemagglutination inhibition assays. The viral variant studies, while confirming the general conclusions obtained from the competitive binding studies, allowed the apparent distinction of two separate neutralization domains on VP7 and three on VP3. All VP7-specific monoclonal antibodies (mAb) mediated serotype-specific neutralization, but a VP3-specific mAb was identified that neutralized rotaviruses of three distinct serotypes. No alteration of viral virulence was apparent in studies of suckling mice orally inoculated with antigenic variant viruses selected with our panel of neutralizing VP3 or VP7-specific mAbs.     

Engraftment rates related to busulphan and cyclophosphamide dosages for displacement bone marrow transplants in fifty children

The use of busulphan and cyclophosphamide permitted engraftment in 44 of 49 children receiving 'displacement' bone marrow transplants. Three patients who received T-cell-depleted marrow cells from HLA-haploidentical donors failed to engraft and other graft failures were due to inadequate induction dosage. Our standard schedule comprises busulphan 80 mg/m2/day x 4 days (adjusted if necessary to a minimum of 4 mg/kg/day or a maximum of 5 mg/kg/day) followed by cyclophosphamide 2 g/m2/day x 4 days but reduced so as not to exceed 75 mg/kg/day, a maximum dose preferred for patients with full marrows (e.g. those with thalassaemia major). Of 21 recipients of mixed lymphocyte culture (MLC)-negative donor marrow cells with full engraftment at 100 days, there were three late rejections. Of patients transplanted with marrow from MLC-positive donors, one had late rejection after cyclosporin A toxicity had necessitated withdrawal of the drug at day + 146 but six other patients, whose cyclosporin A was stopped routinely 1 year, remain well with full grafts. Ten patients died as a result of graft-versus-host disease. We are therefore exploring new approaches to T-cell depletion and storing autologous marrow for use in the event of graft failure. If necessary, a second transplant with busulphan and cyclophosphamide is best performed at 3 months after full recovery of the host. We conclude that elective transplants can be performed successfully in children with normal immune function without the need for irradiation.