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The presence of periodontal diseases (PDs) often strongly correlates with other severe chronic inflammatory conditions, including cardiovascular disease, diabetes, and arthritis. However, the mechanisms through which these diseases interact are unclear. In PD, tissue and bone destruction in the mouth is driven by elevated recruitment of polymorphonuclear neutrophils (PMNs), which are primed and recruited from the circulation to sites of inflammation. We predicted that systemic effects on PMN mobilization or priming could account for the interaction between PD and other inflammatory conditions. We tested this using a mouse model of ligature-induced PD and found elevated PMN counts specifically in bone marrow, supporting a systemic effect of periodontal tissue inflammation on PMN production. In contrast, mice with induced peritonitis had elevated PMN counts in the blood, peritoneum, and colon. These elevated counts were further significantly increased when acute peritonitis was induced after ligature-induced PD in mice, revealing a synergistic effect of multiple inflammatory events on PMN levels. Flow cytometric analysis of CD marker expression revealed enhanced priming of PMNs from mice with both PD and peritonitis compared to mice with peritonitis alone. Thus, systemic factors associated with PD produce hyperinflammatory PMN responses during a secondary infection. To analyze this systemic effect in humans, we induced gingival inflammation in volunteers and also found significantly increased activation of blood PMNs in response to ex vivo stimulation, which reverted to normal following resolution of gingivitis. Together, these results demonstrate that periodontal tissue inflammation has systemic effects that predispose toward an exacerbated innate immune response. This indicates that peripheral PMNs can respond synergistically to simultaneous and remote inflammatory triggers and therefore contribute to the interaction between PD and other inflammatory conditions. This suggests larger implications of PD beyond oral health and reveals potential new approaches for treating systemic inflammatory diseases that interact with PD. [ABSTRACT FROM AUTHOR]

Background and purpose: Hemorrhagic transformation (HT) is a complication of stroke that can occur spontaneously or after treatment. We aimed to assess the inter‐ and intrarater reliability of HT diagnosis. Methods: Studies assessing the reliability of the European Cooperative Acute Stroke Study (ECASS) classification of HT or of the presence (yes/no) of HT were systematically reviewed. A total of 18 raters independently examined 30 post‐thrombectomy computed tomography scans selected from the Aspiration versus STEnt‐Retriever (ASTER) trial. They were asked whether there was HT (yes/no), what the ECASS classification of the particular scan (0/HI1/HI2/PH1/PH2) (HI indicates hemorrhagic infarctions and PH indicates parenchymal hematomas) was and whether they would prescribe an antiplatelet agent if it was otherwise indicated. Agreement was measured with Fleiss' and Cohen's κ statistics. Results: The systematic review yielded four studies involving few (≤3) raters with heterogeneous results. In our 18‐rater study, agreement for the presence of HT was moderate [κ = 0.55; 95% confidence interval (CI), 0.41–0.68]. Agreement for ECASS classification was only fair for all five categories, but agreement improved to substantial (κ = 0.72; 95% CI, 0.69–0.75) after dichotomizing the ECASS classification into 0/HI1/HI2/PH1 versus PH2. The inter‐rater agreement for the decision to reintroduce antiplatelet therapy was moderate for all raters, but substantial among vascular neurologists (κ = 0.70; 95% CI, 0.57–0.84). Conclusion: The ECASS classification may involve too many categories and the diagnosis of HT may not be easily replicable, except in the presence of a large parenchymal hematoma. [ABSTRACT FROM AUTHOR]

Background and purpose: An external validation of the selection criteria of diffusion‐weighted imaging or computerized tomography perfusion assessment with clinical mismatch in the triage of wake‐up and late‐presenting strokes undergoing the Neurointervention with Trevo (DAWN) and the Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke (DEFUSE3) trials was conducted in a cohort of unknown onset stroke (UOS) patients treated with thrombectomy. Methods: A validation cohort of UOS patients was selected from a prospectively collected thrombectomy database to match the inclusion criteria of DAWN and DEFUSE 3. Patients with an initial National Institutes of Health Stroke Scale (NIHSS) ≥10 were stratified according to the DAWN selection criteria. Patients ≤90 years old with an initial NIHSS ≥6 were stratified according to the DEFUSE 3 selection criteria. The proportions of patients with a modified Rankin Scale (mRS) ≤2 at 3 months follow‐up were compared between DAWN‐eligible patients and the DAWN trial thrombectomy group, and between DEFUSE 3‐eligible patients and the DEFUSE 3 trial thrombectomy group. Results: Of the 60/102 (59%) DAWN‐eligible patients, 26 patients (43%) reached a mRS ≤2 at 3 months follow‐up [versus 52/107 patients (49%) in the DAWN trial thrombectomy group; P = 0.52]. Of the 100/117 (85%) DEFUSE 3‐eligible patients, 48 patients (48%) reached a mRS ≤2 at 3 months follow‐up [versus 41/92 patients (45%) in the DEFUSE 3 trial thrombectomy group; P = 0.67]. Of the DAWN‐ineligible and DEFUSE 3‐ineligible patients who underwent thrombectomy, 38% (16/42) and 41% (7/17) of patients reached a mRS ≤2, respectively. Conclusion: The results of the DAWN and DEFUSE 3 trials were externally validated in a UOS cohort where the trials' selection criteria identified a similar proportion of responders to thrombectomy. [ABSTRACT FROM AUTHOR]

We interviewed 1038 HIV-positive inpatients in public hospitals in Miami, Florida, and Atlanta, Georgia, to examine patient factors associated with use of HIV care, use of antiretroviral therapy, and unprotected sexual intercourse. Multivariate analyses and multiple logistic regression models showed that use of crack cocaine and heavy drinking were associated with never having had an HIV-care provider, high-risk sexual behavior, and not receiving antiretroviral therapy. Inpatient interventions that link and retain HIV-positive persons in primary care services could prevent HIV transmission and unnecessary hospitalizations. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To highlight the importance of intraoperative translabial ultrasound, for identification of diverticular neck allowing complete resection of periurethral diverticula and decrease in the recurrence rate. Material and methods: This study included 4 women of age range between 38 and 68 years presenting for recurrent urinary tract infections and urethral pain. All had translabial urethral ultrasound and cystoscopy with and without U/C guidance. Results: Prior cystoscopy in all these patients failed to demonstrate the diverticulum. Translabial ultrasound showed the diverticula some of which were infected. Ultrasound was used intraoperatively to guide the surgeon. With this approach the abnormality was confirmed and the neck of the diverticulum was identified through percutaneous needle insertion. This allowed complete resection of the diverticula. Conclusion: Translabial ultrasound is a non-invasive technique that plays a major role in examining the urethra and identifying the periuthral diverticula. In our experience, it was very useful as an adjunct to guide the surgeon intraoperatively allowing complete excision of the diverticulum. [Copyright &y& Elsevier]

A laboratory study was undertaken to evaluate the durability of cementitiously stabilized aggregate specimens subjected to wet-dry (W-D) cycles, representing a base course in a pavement structure. Specifically, cylindrical specimens of aggregates stabilized with 15% cement kiln dust (CKD), 10% class C fly ash, or 10% fluidized bed ash were prepared, cured for 28 days, and then subjected to W-D cycles prior to testing for resilient modulus (Mr). Four aggregates were selected in this experimental study: (1) Meridian, (2) Richard Spur, (3) Sawyer and (4) Hanson. Results showed that the Mr values decreased as W-D cycles increased up to 30, except for Sawyer specimens stabilized with 15% CKD. These specimens exhibited an increase in Mr values with W-D cycles up to 8, beyond which a reduction occurred. The performance of the stabilized specimens is believed to depend upon SAF (Silica, Alumina and Ferric Oxide compounds) and free lime of the stabilizing agents. Also, the optimum moisture content (OMC) and maximum dry density (MDD), were found to be a good indicator of performance pertaining to stabilization and W-D action. A regression model correlating Mr with W-D cycles, SAF, free lime, OMC and MDD offered statistically promising results. [ABSTRACT FROM AUTHOR]

The present study focuses on investigating the effect of freeze–thaw (FT) cycles, referred to as environmental effect in this paper, on aggregates stabilized with various stabilizing agents, namely, cement kiln dust (CKD), Class C fly ash (CFA), and fluidized bed ash (FBA). Cylindrical specimens were compacted and cured for 28 days in a moist room with a constant temperature and controlled humidity. After curing, specimens were subjected to 0, 8, 16, and 30 FT cycles, and then tested for resilient modulus (Mr). Results showed that Mr values of stabilized specimens decreased with increasing FT cycles up to 30. The reasons for such changes are explained by the increase in moisture content during thawing and the formation of ice lenses within the pores during freezing, causing distortion of the matrix of particles. It was also found that the decrease in Mr values varied with the type of stabilizing agents. The CKD-stabilized Meridian and Richard Spur aggregates exhibited a higher reduction in Mr values than the corresponding values of CFA- and FBA-stabilized specimens. The CFA-stabilized Sawyer specimens performed better than their CKD- and FBA-stabilized counterparts. [ABSTRACT FROM AUTHOR]

Diabetic muscle infarction (DMI) is a rare complication of diabetes mellitus occurring in patients with poorly controlled insulin-dependent diabetes. In previous reports, the diagnosis of this condition was based on the pathologic studies, although MRI examinations were performed in a few patients as part of the diagnostic work-up. In this report, we describe two additional cases of DMI where the diagnosis was based on the MRI findings in conjunction with the clinical picture and laboratory studies. The patients usually present with thigh or calf pain and swelling, are afebrile, and have normal white blood cell count. MRI examination typically shows diffuse swelling and increased signal intensity on T2-weighted images in the affected muscles, with no focal fluid collections. In the proper clinical setting, these findings are diagnostic of DMI and patients should be spared unnecessary invasive diagnostic examinations such as lower extremity venograms and biopsies. [ABSTRACT FROM AUTHOR]

Abstract Background Classically protein kinase A (PKA) and transcription factor activator protein 1 (AP-1) mediate the cyclic AMP (cAMP) induced-corticotrophin releasing hormone (CRH) expression in the placenta. However enteric Gram (-) bacterial cell wall component lipopolysaccharide (LPS) may also induce-CRH expression via Toll like receptor (TLR)4 and its adaptor molecule Myd88. Here we investigated the role of MyD88, TRIF and IRAK2 on cAMP-induced CRH promoter activation in JEG3 cells in the absence of LPS/TLR4 stimulation. Methods JEG3 cells were transfected with CRH-luciferase and Beta-galactosidase expression vectors and either empty or dominant-negative (DN)-MyD88, DN-TRIF or DN-IRAK2 vectors using Fugene6 (Roche). cAMP-induced CRH promoter activation was examined by using a luminometer and luciferase assay. Calorimetric Beta-galactosidase assays were performed to correct for transfection efficiency. Luciferase expression vectors of cAMP-downstream molecules, CRE and AP-1, were used to further examine the signaling cascades. Results cAMP stimulation induced AP-1 and CRE promoter expression and led to dose-dependent CRH promoter activation in JEG3 cells. Inhibition of MyD88 signaling blocked cAMP-induced CRE and CRH promoter activation. Inhibition of TRIF signaling blocked cAMP-induced CRH but not CRE expression, while inhibition of IRAK2 did not have an effect on cAMP-induced CRH expression. Conclusion MyD88 and TRIF exert direct regulatory effect on cAMP-induced CRH promoter activation in JEG3 cells in the absence of infection. MyD88 most likely interacts with molecules upstream of IRAK2 to regulate cAMP-induced CRH expression.

Discusses use of salt techniques in the treatment of patients with periodontal diseases. Effect of alcohol-based mouthwashes on teeth; Other efficacious treatments available for periodontal disease.

Bronchopulmonary dysplasia, the most prevalent chronic lung disease of prematurity, is often treated with glucocorticoids (GCs) such as dexamethasone (DEX), but their use is encumbered with several adverse somatic, metabolic, and neurologic effects. We previously reported that systemic delivery of the GC prodrug ciclesonide (CIC) in neonatal rats activated glucocorticoid receptor (GR) transcriptional responses in lung but did not trigger multiple adverse effects caused by DEX. To determine whether limited systemic metabolism of CIC was solely responsible for its enhanced safety profile, we treated neonatal rats with its active metabolite desisobutyryl-ciclesonide (Des-CIC). DEX but not Des-CIC caused a reduction in body weight as well as reduced insulin-like growth factor-1 serum levels and chronic hyperglycemia in neonatal rats. However, Des-CIC was as effective as DEX in reducing the expression of various bleomycin-induced proinflammatory cytokine mRNAs. In vitro studies with various cell types demonstrate the potent GR transactivation and transrepression activity of Des-CIC, although genome-wide transcriptomic analyses reveal differences in DEX vs. Des-CIC responses in neonatal rat lung and liver tissue. Des-CIC is a GR super-agonist as revealed by an in vitro coregulator peptide binding assay. In addition, molecular dynamics simulations revealed unique Des-CIC-dependent allosteric signaling pathways between specific residues in the GR ligand-binding domain and receptor surfaces interacting with coregulator peptides. Thus, Des-CIC is a potential novel selective GR modulator that could impart a favorable therapeutic index for CIC use for even modest durations of GC exposure which could have long-lasting adverse somatic, metabolic, or neurologic effects., (© The Author(s) 2024. Published by Oxford University Press on behalf of National Academy of Sciences.)