154 results on '"CLARK WB"'
Search Results
2. Access to oral health and health care reform–inside the President's Task Force
- Author
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Clark, WB, primary
- Published
- 1994
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3. The Use of Sanders Neurotoxoid I (Modified Snake Venom) in the Treatment of Recurrent Herpes Simplex of the Cornea: Progress Report
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Thomas Ci, Baldone Ja, and Clark Wb
- Subjects
Research Report ,Venoms ,business.industry ,Idoxuridine ,Herpes Simplex ,Herpesviridae Infections ,General Medicine ,Virology ,Corneal Diseases ,Cornea ,medicine.anatomical_structure ,Recurrent herpes simplex ,Snake venom ,Chronic Disease ,Cornea diseases ,medicine ,Disease ,Intramuscular injection ,business ,Snake Venoms ,medicine.drug - Published
- 1962
4. Integration of the basic, behavioral, and biomaterials sciences with the clinical curriculum
- Author
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Shreve, WB, Mohammed, H, Mealiea, WL, and Clark, WB
- Abstract
An approach to effective integration of the basic, behavioral, and biomaterials sciences with the clinical curriculum is described. Teaching is accomplished by both scientists and clinicians on multidisciplinary teams. The instructional format is based on terminal objectives that are stated in behavioral terms. Examples of the objectives and the manner in which they are fulfilled are presented.
- Published
- 1980
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5. Glaucoma screening in aeromedical examination
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J F, CLARK WB CULVER
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Humans ,Mass Screening ,Glaucoma ,Diagnostic Techniques, Ophthalmological - Published
- 1962
6. The influence of lymphoid reconstitution kinetics on clinical outcomes in allogeneic stem cell transplantation.
- Author
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Kobulnicky DJ, Sabo RT, Sharma S, Shubar Ali AS, Kobulnicky KM, Roberts CH, Clark WB, Chung HM, McCarty JM, and Toor AA
- Subjects
- Adult, Disease-Free Survival, Female, Graft vs Host Disease blood, Graft vs Host Disease immunology, Graft vs Host Disease prevention & control, Hematologic Neoplasms blood, Hematologic Neoplasms immunology, Hematologic Neoplasms mortality, Humans, Immunosuppressive Agents pharmacology, Immunosuppressive Agents therapeutic use, Kinetics, Lymphocyte Count, Lymphoid Tissue cytology, Lymphoid Tissue immunology, Male, Middle Aged, Models, Biological, Neoplasm Recurrence, Local immunology, Neoplasm Recurrence, Local prevention & control, Retrospective Studies, Survival Analysis, Transplantation Conditioning methods, Transplantation, Homologous, Treatment Outcome, Young Adult, Graft vs Host Disease epidemiology, Hematologic Neoplasms therapy, Hematopoietic Stem Cell Transplantation, Neoplasm Recurrence, Local epidemiology, T-Lymphocytes immunology
- Abstract
Lymphoid recovery following myeloablative stem cell transplantation (SCT) displays a logistic pattern of exponential growth followed by a plateau. Within this logistic framework, lymphoid recovery is characterized by the parameters R (slope of ascent), a (time of maximal rate of ascent) and K (plateau), the 'steady-state' lymphocyte count. A retrospective analysis of allogeneic SCT performed from 2008 to 2013 was undertaken to compare lymphoid recovery and clinical outcomes in 131 patients with acute myelogenous leukemia, acute lymphocytic leukemia, and myelodysplastic syndromes. Using Prism software, a logistic curve was successfully fit to the absolute lymphocyte count recovery in all patients. Patients were classified according to the magnitude and rate of lymphoid recovery; pattern A achieved an absolute lymphocyte counts (ALC) of >1000/μL by day 45, pattern B an ALC 500 < x < 1000/μL, and pattern C an ALC <500/μL. Pattern A was characterized by a higher mean K (p < .0001) compared with patterns B and C. Patients with patterns B and C were more likely to have mixed T cell chimerism at 90 d following SCT (p = .01). There was a trend towards improved survival (and relapse-free survival) in those with pattern A and B at 1 year compared to pattern C (p = .073). There was no difference in cGVHD (p = .42) or relapse (p = .45) between pattern types. Cytomegalovirus (CMV), aGVHD, and all relapse were heralded by deviation from logistic behavior. Pattern C patients were more likely to require donor lymphocyte infusion (DLI) (p = .017). Weaning of tacrolimus post-transplant was associated with a second, separate logistic expansion in some patients. This study demonstrated that lymphoid reconstitution follows a prototypical logistic recovery and that pattern observed correlates with T cell chimerism and need for DLI, and may influence survival.
- Published
- 2018
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7. A Prospective Trial of Extracorporeal Photopheresis for Chronic Graft-versus-Host Disease Reveals Significant Disease Response and No Association with Frequency of Regulatory T Cells.
- Author
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Gandelman JS, Song DJ, Chen H, Engelhardt BG, Chen YB, Clark WB, Giver CR, Waller EK, Jung DK, and Jagasia M
- Subjects
- Aged, Chronic Disease, Female, Humans, Male, Middle Aged, Prospective Studies, Graft vs Host Disease therapy, Photopheresis methods, T-Lymphocytes, Regulatory metabolism
- Abstract
Extracorporeal photopheresis (ECP) is an accepted treatment for chronic graft-versus-host disease (cGVHD); however, the mechanism of action is unclear. We conducted a prospective multicenter clinical trial to assess ECP response rates using the 2005 National Institutes of Health (NIH) consensus criteria and to assess the relationship between regulatory T cells (Tregs) and treatment response (NCT01324908). Eighty-three patients with any NIH subtype of cGVHD were enrolled, irrespective of number of prior lines of treatment, and 6 were subsequently excluded because of the absence of follow-up from cancer relapse, infection, or study withdrawal. Study outcomes were provider-assessed response and formal response by 2005 NIH criteria. Peripheral blood samples were collected at prespecified study visits and were analyzed by flow cytometry for Tregs. In a heavily pretreated cohort of patients, with a median of 2 prior lines of therapy, 62.3% of patients had a provider-assessed response to ECP and 43.5% had response by NIH criteria. These assessments showed only a slight agreement (kappa statistic, .09). In a logistic regression model that included previously identified risk factors such as bilirubin, platelet count, and time from transplant to study entry, no clinical factors were associated with the provider's response assessment. Furthermore, there was no significant difference in percentage of Tregs in blood leukocytes at study entry and completion or in overall change in Treg frequency between ECP responders and nonresponders. ECP was associated with a clinically significant decrease in median prednisone dose (.36 to .14 mg/kg, P < .001) from study entry to last visit and a significant decrease in global severity of cGVHD and total body surface area with erythematous rash. Overall, ECP was able to deliver response using NIH response criteria in a highly pretreated cohort with moderate and severe cGVHD independent of most previous risk factors for adverse outcomes of cGVHD., (Copyright © 2018 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.)
- Published
- 2018
- Full Text
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8. The Microbiome and Hematopoietic Cell Transplantation: Past, Present, and Future.
- Author
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Andermann TM, Peled JU, Ho C, Reddy P, Riches M, Storb R, Teshima T, van den Brink MRM, Alousi A, Balderman S, Chiusolo P, Clark WB, Holler E, Howard A, Kean LS, Koh AY, McCarthy PL, McCarty JM, Mohty M, Nakamura R, Rezvani K, Segal BH, Shaw BE, Shpall EJ, Sung AD, Weber D, Whangbo J, Wingard JR, Wood WA, Perales MA, Jenq RR, and Bhatt AS
- Subjects
- Humans, Hematopoietic Stem Cell Transplantation, Microbiota
- Published
- 2018
- Full Text
- View/download PDF
9. Low-dose splenic irradiation prior to hematopoietic cell transplantation in hypersplenic patients with myelofibrosis.
- Author
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Kalman NS, Mukhopadhyay ND, Roberts CH, Chung HM, Clark WB, McCarty JM, Toor AA, and Song S
- Subjects
- Aged, Biomarkers, Female, Humans, Male, Middle Aged, Transplantation Conditioning, Treatment Outcome, Hematopoietic Stem Cell Transplantation adverse effects, Hematopoietic Stem Cell Transplantation methods, Preoperative Care, Primary Myelofibrosis diagnosis, Primary Myelofibrosis therapy, Radiation Dosage, Splenomegaly pathology, Splenomegaly radiotherapy
- Published
- 2017
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10. Treatment of acute fibrinous organizing pneumonia following hematopoietic cell transplantation with etanercept.
- Author
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Simmons GL, Chung HM, McCarty JM, Toor AA, Farkas D, Miller K, and Clark WB
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- Humans, Male, Middle Aged, Pneumonia pathology, Transplantation Conditioning methods, Etanercept adverse effects, Hematopoietic Stem Cell Transplantation adverse effects, Pneumonia therapy, Transplantation Conditioning adverse effects
- Published
- 2017
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11. Dynamical System Modeling of Immune Reconstitution after Allogeneic Stem Cell Transplantation Identifies Patients at Risk for Adverse Outcomes.
- Author
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Toor AA, Sabo RT, Roberts CH, Moore BL, Salman SR, Scalora AF, Aziz MT, Shubar Ali AS, Hall CE, Meier J, Thorn RM, Wang E, Song S, Miller K, Rizzo K, Clark WB, McCarty JM, Chung HM, Manjili MH, and Neale MC
- Subjects
- Adult, Aged, Female, Graft vs Host Disease etiology, Graft vs Host Disease immunology, Graft vs Host Disease mortality, Hematologic Neoplasms immunology, Hematologic Neoplasms mortality, Hematologic Neoplasms pathology, Humans, Immunosuppressive Agents therapeutic use, Lymphocyte Transfusion statistics & numerical data, Male, Middle Aged, Nonlinear Dynamics, Prognosis, Prospective Studies, Recurrence, Risk, Siblings, Survival Analysis, Transplantation, Homologous, Unrelated Donors, Whole-Body Irradiation, Antilymphocyte Serum therapeutic use, Graft vs Host Disease prevention & control, Hematologic Neoplasms therapy, Hematopoietic Stem Cell Transplantation adverse effects, Models, Immunological, Transplantation Conditioning
- Abstract
Systems that evolve over time and follow mathematical laws as they evolve are called dynamical systems. Lymphocyte recovery and clinical outcomes in 41 allograft recipients conditioned using antithymocyte globulin (ATG) and 4.5-Gy total body irradiation were studied to determine if immune reconstitution could be described as a dynamical system. Survival, relapse, and graft-versus-host disease (GVHD) were not significantly different in 2 cohorts of patients receiving different doses of ATG. However, donor-derived CD3(+) cell reconstitution was superior in the lower ATG dose cohort, and there were fewer instances of donor lymphocyte infusion (DLI). Lymphoid recovery was plotted in each individual over time and demonstrated 1 of 3 sigmoid growth patterns: Pattern A (n = 15) had rapid growth with high lymphocyte counts, pattern B (n = 14) had slower growth with intermediate recovery, and pattern C (n = 10) had poor lymphocyte reconstitution. There was a significant association between lymphocyte recovery patterns and both the rate of change of donor-derived CD3(+) at day 30 after stem cell transplantation (SCT) and clinical outcomes. GVHD was observed more frequently with pattern A, relapse and DLI more so with pattern C, with a consequent survival advantage in patients with patterns A and B. We conclude that evaluating immune reconstitution after SCT as a dynamical system may differentiate patients at risk of adverse outcomes and allow early intervention to modulate that risk., (Copyright © 2015 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.)
- Published
- 2015
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12. Stem cell transplantation as a dynamical system: are clinical outcomes deterministic?
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Toor AA, Kobulnicky JD, Salman S, Roberts CH, Jameson-Lee M, Meier J, Scalora A, Sheth N, Koparde V, Serrano M, Buck GA, Clark WB, McCarty JM, Chung HM, Manjili MH, Sabo RT, and Neale MC
- Abstract
Outcomes in stem cell transplantation (SCT) are modeled using probability theory. However, the clinical course following SCT appears to demonstrate many characteristics of dynamical systems, especially when outcomes are considered in the context of immune reconstitution. Dynamical systems tend to evolve over time according to mathematically determined rules. Characteristically, the future states of the system are predicated on the states preceding them, and there is sensitivity to initial conditions. In SCT, the interaction between donor T cells and the recipient may be considered as such a system in which, graft source, conditioning, and early immunosuppression profoundly influence immune reconstitution over time. This eventually determines clinical outcomes, either the emergence of tolerance or the development of graft versus host disease. In this paper, parallels between SCT and dynamical systems are explored and a conceptual framework for developing mathematical models to understand disparate transplant outcomes is proposed.
- Published
- 2014
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13. Satisfaction with work-life balance and the career and retirement plans of US oncologists.
- Author
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Shanafelt TD, Raymond M, Kosty M, Satele D, Horn L, Pippen J, Chu Q, Chew H, Clark WB, Hanley AE, Sloan J, and Gradishar WJ
- Subjects
- Adult, Career Choice, Family Characteristics, Female, Humans, Male, Middle Aged, Societies, Medical, Surveys and Questionnaires, United States, Job Satisfaction, Medical Oncology, Personal Satisfaction, Physicians psychology, Retirement
- Abstract
Purpose: To evaluate satisfaction with work-life balance (WLB) and career plans of US oncologists., Methods: The American Society of Clinical Oncology conducted a survey of US oncologists evaluating satisfaction with WLB and career plans between October 2012 and March 2013. The sample included equal numbers of men and women from all career stages., Results: Of 2,998 oncologists contacted, 1,490 (49.7%) returned surveys. From 1,117 oncologists (37.3% of overall sample) completing full-length surveys, we evaluated satisfaction with WLB and career plans among the 1,058 who were not yet retired. The proportion of oncologists satisfied with WLB (n = 345; 33.4%) ranked lower than that reported for all other medical specialties in a recent national study. Regarding career plans, 270 oncologists (26.5%) reported a moderate or higher likelihood of reducing their clinical work hours in the next 12 months, 351 (34.3%) indicated a moderate or higher likelihood of leaving their current position within 24 months, and 273 (28.5%) planned to retire before 65 years of age. Multivariable analyses found women oncologists (odds ratio [OR], 0.458; P < .001) and those who devoted greater time to patient care (OR for each additional hour, 0.977; P < .001) were less likely to be satisfied with WLB. Satisfaction with WLB and burnout were the strongest predictors of intent to reduce clinical work hours and leave current position on multivariable analysis., Conclusion: Satisfaction with WLB among US oncologists seems lower than for other medical specialties. Dissatisfaction with WLB shows a strong relationship with plans to reduce hours and leave current practice. Given the pending US oncologist shortage, additional studies exploring interactions among WLB, burnout, and career satisfaction and their impact on career and retirement plans are warranted.
- Published
- 2014
- Full Text
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14. Anti-thymocyte globulin for conditioning in matched unrelated donor hematopoietic cell transplantation provides comparable outcomes to matched related donor recipients.
- Author
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Portier DA, Sabo RT, Roberts CH, Fletcher DS, Meier J, Clark WB, Neale MC, Manjili MH, McCarty JM, Chung HM, and Toor AA
- Subjects
- Cohort Studies, Female, Graft vs Host Disease prevention & control, Humans, Male, Middle Aged, Myelodysplastic Syndromes surgery, Precursor Cell Lymphoblastic Leukemia-Lymphoma surgery, Randomized Controlled Trials as Topic, Retrospective Studies, Survival Analysis, Tissue Donors, Transplantation, Homologous, Treatment Outcome, Unrelated Donors, Antilymphocyte Serum therapeutic use, Hematopoietic Stem Cell Transplantation methods, Transplantation Conditioning methods
- Abstract
Rabbit anti-thymocyte globulin (ATG) is used as prophylaxis against GVHD following allogeneic hematopoietic cell transplantation (HCT). At our institution, ATG is exclusively used in the conditioning of matched unrelated donor (URD) transplant recipients. A total of 50 URD HCT recipients who received ATG (ATG group) were retrospectively compared with 48 matched related donor (MRD) HCT recipients who did not receive ATG (no ATG group). There were no significant differences between the groups in rates of day 100 mortality, acute GVHD or relapse. Chronic GVHD incidence was significantly lower in the ATG group (P = 0.007). At a median follow-up of 36 months in the entire cohort, 50% patients are alive in the ATG group and 63% of the patients are alive in the no ATG group (P = 0.13). We conclude that the administration of ATG to patients undergoing URD HCT preserves the anti-leukemia benefit of the transplant, while reducing the risk of developing GVHD, resulting in OS rates that are comparable to MRD HCT recipients.
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- 2012
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15. Epigenetic induction of adaptive immune response in multiple myeloma: sequential azacitidine and lenalidomide generate cancer testis antigen-specific cellular immunity.
- Author
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Toor AA, Payne KK, Chung HM, Sabo RT, Hazlett AF, Kmieciak M, Sanford K, Williams DC, Clark WB, Roberts CH, McCarty JM, and Manjili MH
- Subjects
- Adult, Aged, Antineoplastic Combined Chemotherapy Protocols administration & dosage, Azacitidine administration & dosage, Boronic Acids administration & dosage, Bortezomib, Dexamethasone administration & dosage, Doxorubicin administration & dosage, Drug Administration Schedule, Female, Humans, Lenalidomide, Male, Middle Aged, Multiple Myeloma drug therapy, Multiple Myeloma surgery, Plasma Cells immunology, Prospective Studies, Pyrazines administration & dosage, Thalidomide administration & dosage, Thalidomide analogs & derivatives, Transplantation, Autologous, Antigens, Neoplasm immunology, Antineoplastic Combined Chemotherapy Protocols therapeutic use, Azacitidine pharmacology, DNA Methylation drug effects, Epigenesis, Genetic drug effects, Immunity, Cellular drug effects, Lymphocyte Transfusion, Multiple Myeloma immunology, Peripheral Blood Stem Cell Transplantation, T-Cell Antigen Receptor Specificity drug effects
- Abstract
Patients with multiple myeloma (MM) undergoing high dose therapy and autologous stem cell transplantation (SCT) remain at risk for disease progression. Induction of the expression of highly immunogenic cancer testis antigens (CTA) in malignant plasma cells in MM patients may trigger a protective immune response following SCT. We initiated a phase II clinical trial of the DNA hypomethylating agent, azacitidine (Aza) administered sequentially with lenalidomide (Rev) in patients with MM. Three cycles of Aza and Rev were administered and autologous lymphocytes were collected following the 2nd and 3rd cycles of Aza-Rev and cryopreserved. Subsequent stem cell mobilization was followed by high-dose melphalan and SCT. Autologous lymphocyte infusion (ALI) was performed in the second month following transplantation. Fourteen patients have completed the investigational therapy; autologous lymphocytes were collected from all of the patients. Thirteen patients have successfully completed SCT and 11 have undergone ALI. Six patients tested have demonstrated CTA up-regulation in either unfractionated bone marrow (n = 4) or CD138+ cells (n = 2). CTA (CTAG1B)-specific T cell response has been observed in all three patients tested and persists following SCT. Epigenetic induction of an adaptive immune response to cancer testis antigens is safe and feasible in MM patients undergoing SCT., (© 2012 Blackwell Publishing Ltd.)
- Published
- 2012
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16. Genetic variation in donor CTLA-4 regulatory region is a strong predictor of outcome after allogeneic hematopoietic cell transplantation for hematologic malignancies.
- Author
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Jagasia M, Clark WB, Brown-Gentry KD, Crawford DC, Fan KH, Chen H, Kassim A, Greer JP, Engelhardt BG, and Savani BN
- Subjects
- Adolescent, Adult, Aged, CTLA-4 Antigen immunology, Female, Graft vs Tumor Effect immunology, Hematologic Neoplasms immunology, Humans, Male, Middle Aged, Polymorphism, Single Nucleotide immunology, Risk Factors, Secondary Prevention, Survival Analysis, T-Lymphocytes, Cytotoxic cytology, T-Lymphocytes, Cytotoxic immunology, Tissue Donors, Transplantation, Homologous, Treatment Outcome, CTLA-4 Antigen genetics, Hematologic Neoplasms therapy, Hematopoietic Stem Cell Transplantation, Polymorphism, Single Nucleotide genetics
- Abstract
Relapse remains a major cause of death after allogeneic hematopoietic cell transplantation (allo-HCT). Graft-versus-tumor effect is primarily mediated by donor T cells. Cytotoxic T lymphocyte antigen-4 (CTLA-4) is a critical inhibitor of T cell proliferation. Single nucleotide polymorphisms (SNPs) in CTLA-4 may affect immune responses. We hypothesized that CTLA-4 SNPs will be associated with disease control after allo-HCT. One hundred sixty-four adult patients with the availability of pretransplantation recipient and donor DNA samples were included in this analysis. Ten tagSNPs of the CTLA-4 gene were identified. Donor CTLA-4 SNP rs4553808 was associated with decreased relapse-free survival (RFS) (P = .019) and overall survival (OS) (P = .033). In multivariable analysis of an additive genetic model, genotype of CTLA-4 SNP rs4553808 was an independent risk factor for inferior RFS (hazard ratio [HR] = 1.73, 95% confidence interval [CI] 1.10-2.71, P = .017) and OS (HR = 1.84, 95% CI 1.13-3.0, P = .015). CTLA-4 SNPs can be used to identify high-risk patient subsets that may benefit from preemptive immunomodulation to decrease relapse rates and improve survival., (Copyright © 2012 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.)
- Published
- 2012
- Full Text
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17. Persistent anemia after implantation of the total artificial heart.
- Author
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Mankad AK, Tang DG, Clark WB, Flattery M, Harton S, Katlaps GJ, Stribling WK, Cooke RH, Hess ML, Kasirajan V, and Shah KB
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- Adult, Aged, Anemia blood, Anemia physiopathology, C-Reactive Protein metabolism, Erythropoietin blood, Female, Heart Ventricles, Hematocrit, Hemolysis physiology, Humans, Luminescent Measurements, Male, Middle Aged, Retrospective Studies, Anemia etiology, Heart Transplantation adverse effects, Heart-Assist Devices adverse effects
- Abstract
Background: The total artificial heart (TAH) replaces the heart with 2 pneumatic pumps and 4 tilting disk mechanical valves. It was hypothesized that patients receiving TAH support have persistent hemolysis that resolves after heart transplantation (HT)., Methods and Results: Hematocrit (HCT) was compared in patients on TAH to left ventricular assist device (LVAD) support for bridge to HT. Data were compared with t tests. The TAH (n = 36; mean age 47 ± 13 years) and LVAD patients (n = 14; mean age 53 ± 12 years) were supported for a median of 83 (interquartile range [IQR] 43-115) and 106 days (IQR 84-134), respectively. Hematocrit was similar between the TAH and LVAD patients (34 ± 6% vs 37 ± 5%; P = .07) at baseline. After placement, TAH patients had lower HCT at 2 (20 ± 2% vs 24 ± 3%), 4 (22 ± 3% vs 26 ± 3%), 6 (22 ± 4% vs 30 ± 4%), and 8 weeks (23 ± 4% vs 33 ± 5%; P < .001 for all). There were no differences in HCT at 1 (30 ± 4% vs 29 ± 7%; P = .42) and 3 months (35 ± 7% vs 35 ± 4%; P = .98) after removal of the devices for HT. TAH patients had undetectable haptoglobin in 96% of assessments, increased lactate dehydrogenase (1,128 ± 384 units/L), and detectable plasma free hemoglobin in 40% of measurements (21 ± 15 mg/dL). High sensitivity C-reactive protein (52 ± 50 mg/dL) was elevated, and reticulocyte production index was decreased (1.6 ± 0.6)., Conclusions: Patients implanted with a TAH have persistent anemia that resolves only after HT. The association of hemolysis, ineffective erythropoiesis, and inflammation with the TAH warrants further study., (Copyright © 2012 Elsevier Inc. All rights reserved.)
- Published
- 2012
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18. Favorable outcomes in patients with high donor-derived T cell count after in vivo T cell-depleted reduced-intensity allogeneic stem cell transplantation.
- Author
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Toor AA, Sabo RT, Chung HM, Roberts C, Manjili RH, Song S, Williams DC Jr, Edmiston W, Gatesman ML, Edwards RW, Ferreira-Gonzalez A, Clark WB, Neale MC, McCarty JM, and Manjili MH
- Subjects
- Adult, Aged, Animals, Antilymphocyte Serum pharmacology, CD3 Complex immunology, Chimerism, Cohort Studies, Graft Survival, Graft vs Host Disease prevention & control, Hematologic Neoplasms immunology, Hematologic Neoplasms mortality, Humans, Immunosuppressive Agents administration & dosage, Immunosuppressive Agents therapeutic use, Lymphocyte Count, Lymphocyte Depletion, Middle Aged, Rabbits, Recurrence, Survival Rate, T-Lymphocytes cytology, T-Lymphocytes drug effects, Treatment Outcome, Hematologic Neoplasms therapy, Hematopoietic Stem Cell Transplantation, T-Lymphocytes immunology, Transplantation Conditioning methods, Transplantation, Homologous
- Abstract
Patients with hematologic malignancies were conditioned using a rabbit antithymocyte globulin-based reduced-intensity conditioning regimen for allogeneic stem cell transplantation. Donor-derived CD3(+) cell count (ddCD3), a product of CD3(+) cell chimerism and absolute CD3(+) cell count, when <110/μL at 8 weeks post-stem cell transplantation predicted a high risk of sustained mixed chimerism and relapse. Alternatively, patients with a higher ddCD3 developed graft-versus-host disease more frequently, and when partially chimeric, had higher rates of conversion to full donor chimerism after withdrawal of immunosuppression. Early data from our small cohort of patients indicate that ddCD3 at 8 weeks may be used to guide decisions regarding withdrawal of immunosuppression and administration of donor lymphocyte infusion in partially T cell-depleted reduced-intensity regimens., (Published by Elsevier Inc.)
- Published
- 2012
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19. Genetic variation in recipient B-cell activating factor modulates phenotype of GVHD.
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Clark WB, Brown-Gentry KD, Crawford DC, Fan KH, Snavely J, Chen H, Savani BN, Kassim A, Greer JP, Schuening FG, Engelhardt BG, and Jagasia MH
- Subjects
- Adolescent, Adult, Aged, Female, Genotype, Graft vs Host Disease pathology, Hematopoietic Stem Cell Transplantation adverse effects, Humans, Male, Middle Aged, Phenotype, Transplantation, Homologous, Young Adult, B-Cell Activating Factor genetics, Graft vs Host Disease genetics, Polymorphism, Single Nucleotide
- Abstract
B-cell activating factor (BAFF) single nucleotide polymorphisms (SNPs) are associated with autoimmune diseases. Because patients with classic and overlap chronic GVHD (cGVHD) have features of autoimmune diseases, we studied the association of recipient and/or donor BAFF SNPs with the phenotype of GVHD after allogeneic stem cell transplantation. Twenty tagSNPs of the BAFF gene were genotyped in 164 recipient/donor pairs. GVHD after day 100 occurred in 124 (76%) patients: acute GVHD (aGVHD) subtypes (n = 23), overlap GVHD (n = 29), and classic cGVHD (n = 72). In SNP analyses, 9 of the 20 tag SNPs were significant comparing classic/overlap cGVHD versus aGVHD subtypes/no GVHD. In multivariate analyses, 4 recipient BAFF SNPs (rs16972217 [odds ratio = 2.72, P = .004], rs7993590 [odds ratio = 2.35, P = .011], rs12428930 [odds ratio2.53, P = .008], and rs2893321 [odds ratio = 2.48, P = .009]) were independent predictors of GVHD subtypes, adjusted for conventional predictors of cGVHD. This study shows that genetic variation of BAFF modulates GVHD phenotype after allogeneic stem cell transplantation.
- Published
- 2011
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20. Extramedullary relapses after allogeneic stem cell transplantation for acute myeloid leukemia and myelodysplastic syndrome.
- Author
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Clark WB, Strickland SA, Barrett AJ, and Savani BN
- Subjects
- Animals, Humans, Leukemia, Myeloid, Acute prevention & control, Myelodysplastic Syndromes prevention & control, Postoperative Complications prevention & control, Postoperative Complications surgery, Secondary Prevention, Transplantation, Homologous, Leukemia, Myeloid, Acute surgery, Myelodysplastic Syndromes surgery, Stem Cell Transplantation adverse effects
- Published
- 2010
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21. Ex vivo culture with human brain endothelial cells increases the SCID-repopulating capacity of adult human bone marrow.
- Author
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Chute JP, Saini AA, Chute DJ, Wells MR, Clark WB, Harlan DM, Park J, Stull MK, Civin C, and Davis TA
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- Adult, Animals, Cell Division, Cells, Cultured transplantation, Coculture Techniques, Colony-Forming Units Assay, Endothelium cytology, Graft Survival, Humans, Mice, Mice, Inbred NOD, Mice, SCID, Transplantation, Heterologous, Brain cytology, Hematopoietic Stem Cell Transplantation, Hematopoietic Stem Cells cytology
- Abstract
Adult human bone marrow (ABM) is an important source of hematopoietic stem cells for transplantation in the treatment of malignant and nonmalignant diseases. However, in contrast to the recent progress that has been achieved with umbilical cord blood, methods to expand ABM stem cells for therapeutic applications have been disappointing. In this study, we describe a novel culture method that uses human brain endothelial cells (HUBECs) and that supports the quantitative expansion of the most primitive measurable cell within the adult bone marrow compartment, the nonobese diabetic/severe combined immunodeficient (NOD/SCID) repopulating cell (SRC). Coculture of human ABM CD34(+) cells with brain endothelial cells for 7 days supported a 5.4-fold increase in CD34(+) cells, induced more than 95% of the CD34(+)CD38(-) subset to enter cell division, and produced progeny that engrafted NOD/SCID mice at significantly higher rates than fresh ABM CD34(+) cells. Using a limiting dilution analysis, we found the frequency of SRCs within fresh ABM CD34(+) cells to be 1 in 9.9 x 10(5) cells. Following HUBEC culture, the estimated frequency of SRCs increased to 1 in 2.4 x 10(5) cells. All mice that received transplants of HUBEC-cultured cells showed B-lymphoid and myeloid differentiation, indicating that a primitive hematopoietic cell was preserved during culture. Noncontact HUBEC cultures also maintained SRCs at a level comparable to contact HUBEC cultures, suggesting that cell-to-cell contact was not required. These data demonstrate that human brain endothelial cells possess a unique hematopoietic activity that increases the repopulating capacity of adult human bone marrow.
- Published
- 2002
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22. Expectant management of intramural ectopic pregnancy.
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Bernstein HB, Thrall MM, and Clark WB
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- Adult, Female, Humans, Pregnancy, Pregnancy, Ectopic diagnostic imaging, Prenatal Care, Ultrasonography, Uterus, Abortion, Spontaneous, Pregnancy, Ectopic therapy
- Abstract
Background: Intramural ectopic pregnancy is unusual, difficult to diagnose, and associated with a high rate of uterine rupture., Case: A 35-year-old, gravida 3, para 0-0-2-0 was diagnosed with intramural ectopic pregnancy by ultrasound showing a gestational sac surrounded completely by myometrium. It was confirmed by laparoscopy. With expectant management, the gestation resolved spontaneously., Conclusion: Early diagnosis by ultrasound of intramural ectopic pregnancy permits expectant management which, if successful, would aid in maintaining fertility.
- Published
- 2001
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23. Radial club hand with a short hypoplastic radius treated surgically.
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Kevau I and Clark WB
- Subjects
- Child, Preschool, Forearm abnormalities, Forearm surgery, Humans, Male, Hand Deformities, Congenital surgery, Radius abnormalities, Radius surgery
- Published
- 1998
- Full Text
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24. Microbiology of otitis externa.
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Clark WB, Brook I, Bianki D, and Thompson DH
- Subjects
- Adolescent, Adult, Aged, Bacteria, Aerobic isolation & purification, Bacteria, Anaerobic isolation & purification, Bacterial Infections diagnosis, Child, Female, Humans, Male, Middle Aged, Prospective Studies, Otitis Externa microbiology
- Abstract
Microbiologic and clinical data from 26 patients with otitis externa were prospectively evaluated. Specimens were processed for aerobic and anaerobic bacteria. Bacterial growth was noted in 23 specimens. A total of 33 aerobic and 2 anaerobic bacteria were recovered. Aerobic bacteria only were isolated in 21 (91%) patients, anaerobic bacteria only in 1 (4%), and mixed aerobic and anaerobic bacteria in 1 (4%). The most common isolates were Pseudomonas aeruginosa (14 instances), Staphylococcus aureus (7), Acinetobacter calcoaceticus (2), Proteus mirabilis (2), Enterococcus faecalis (2), Bacteroides fragilis (1), and Peptostreptococcus magnus (1). One isolate was recovered in 13 (57%) patients, 2 isolates in 8 (35%), and 3 isolates in 2 (9%). These data illustrate the polymicrobial nature of otitis externa in about half of the patients and the role of anaerobic bacteria in 8% of them. Further studies are warranted to evaluate the therapeutic implications of these findings.
- Published
- 1997
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25. Fimbrial-mediated colonization of murine teeth by Actinomyces naeslundii.
- Author
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Beem JE, Hurley CG, Nesbitt WE, Croft DF, Marks RG, Cisar JO, and Clark WB
- Subjects
- Actinomyces metabolism, Analysis of Variance, Animals, Bacterial Adhesion physiology, Colony Count, Microbial, Dental Plaque metabolism, Dental Plaque microbiology, Durapatite, Female, Glucose metabolism, Humans, Mice, Mice, Inbred BALB C, Saliva physiology, Sucrose metabolism, Actinomyces physiology, Fimbriae, Bacterial physiology, Tooth microbiology
- Abstract
Groups of mice fed diets high in sucrose or glucose were orally inoculated with 10(10), 10(9) or 10(8) colony-forming units of one of the following Actinomyces naeslundii strains possessing the type 1 (T1+) and/or the type 2 (T2+) fimbriae: T14VJ1 (T1+, T2+), 5519 (T1+), 5951 (T2+), and 147 (non-fimbriated). Ninety-six hours after inoculation their upper jaws were cultured to look at the implantation of each of these strains on the teeth. In mice fed a sucrose diet, regardless of the presence or absence of fimbriae, each bacterial strain colonized 100% of the mice at the highest inoculation doses of the infecting organism. But at a dose of 10(8), T14V-J1 was the only strain which colonized 100% (12/12) of the mice, 5519 colonized 10/11, 5951 colonized 9/11 and 147 colonized 7/11. These differences were not statistically significant. When mice were fed a high-glucose diet, 100% infection was achieved with strains T14V-J1, 5519 and 5951 only at the highest dose of 10(10) colony-forming units. Strain 147 colonized in 8/9 of the mice at that dosage. At lower dosages, no bacterial strain implanted in 100% of the mice. In the glucose experiment at a dose of 10(8), strains expressing the T1 fimbriae implanted significantly better than strains without the T1 fimbriae. At a dose of 10(9) colony-forming units, the parent strain T14V-J1 implanted significantly better than strains without the T1 fimbriae. Similarly, strain 5519 (T1+) implanted significantly better than 5951 and implanted better than 147, although the difference was not significant. These results suggest that while the presence of the T1 and T2 fimbriae may confer some advantage in the establishment of these organisms in vivo, even the strains without fimbriae were able to colonize. Strains T14VJ1 and 5519 were found to bind well to hydroxyapatite treated with mouse saliva, while strains 5951 and 147 did not. Only T2 fimbriated strains T14V-J1 and 5951 exhibited a lactose-reversible coaggreation with indigenous strains of enterococci that may contribute to the elevated levels of colonization of strain 5951 in vivo.
- Published
- 1996
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26. Avulsion of the ischial apophysis.
- Author
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Gill DR and Clark WB
- Subjects
- Child, Humans, Ischium diagnostic imaging, Ischium surgery, Male, Radiography, Fractures, Bone diagnostic imaging, Fractures, Bone surgery, Ischium injuries, Running injuries
- Abstract
Avulsion of the ischial apophysis is a rare injury. We report the successful treatment of an avulsion of the ischial apophysis by open reduction and internal fixation.
- Published
- 1996
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27. A multi-center clinical trial of a new chairside test in distinguishing between diseased and healthy periodontal sites. II. Association between site type and test outcome before and after therapy.
- Author
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Magnusson I, Persson RG, Page RC, DeRouen TA, Crawford JM, Cohen RL, Chambers DA, Alves ME, and Clark WB
- Subjects
- Adult, Dental Scaling, Female, Humans, Male, Odds Ratio, Periodontitis pathology, Periodontitis therapy, Point-of-Care Systems, Predictive Value of Tests, Treatment Outcome, Aspartate Aminotransferases analysis, Clinical Enzyme Tests, Gingival Crevicular Fluid enzymology, Periodontitis diagnosis
- Abstract
The aim of the present study was to evaluate the association between the outcome of a chairside test measuring gingival crevicular fluid (GCF) levels of the enzyme aspartate aminotransferase (AST) and other clinical measures of disease including probing depth, severity of inflammation, and GCF flow before and after therapy. We studied 91 patients with moderate to severe periodontitis. Eight sites with probing depths between 5 mm and 8 mm and obvious signs of inflammation were selected and designated diseased sites. Four sites with probing depth < or = 3 mm with no or minimal signs of inflammation were selected and designated non-diseased sites in patients. Thirty healthy individuals were enrolled and four sites in each were selected and designated healthy controls. Patients were treated with scaling and root planing and control subjects with supragingival prophylaxis. Measurements including GCF volume, gingival inflammation, and probing depth were performed at screening baseline, 1 week later at pretreatment baseline, and at weeks 2 and 4 after treatment. AST content of GCF was measured using a chairside colorometric test. It was concluded that the outcome of the test is an effective objective measure distinguishing between diseased sites and non-diseased sites in patients and control subjects when evaluated both prior to and following application of therapy. Use of this simple chairside test, when combined with other standard diagnostic procedures, provides an objective measurement permitting improved capacity to distinguish between diseased and non-diseased periodontal sites, and to better assess and monitor the outcome of therapy.
- Published
- 1996
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28. Inhibition of adherence of Actinomyces naeslundii (Actinomyces viscosus) T14V-J1 to saliva-treated hydroxyapatite by a monoclonal antibody to type 1 fimbriae.
- Author
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Nesbitt WE, Beem JE, Leung KP, Stroup S, Swift R, McArthur WP, and Clark WB
- Subjects
- Actinomyces viscosus classification, Actinomyces viscosus immunology, Adhesins, Bacterial, Animals, Antibody Specificity, Bacterial Outer Membrane Proteins immunology, Female, Fimbriae, Bacterial ultrastructure, Immunoglobulin Fab Fragments immunology, Immunoglobulin G immunology, Immunohistochemistry, Mice, Mice, Inbred Strains, Microscopy, Electron, Protein Binding, Saliva physiology, Actinomyces viscosus physiology, Antibodies, Bacterial immunology, Antibodies, Monoclonal immunology, Bacterial Adhesion immunology, Durapatite, Fimbriae, Bacterial immunology
- Abstract
A monoclonal antibody to Actinomyces naeslundii (A. viscosus) T14V-J1 type 1 fimbriae, capable of inhibiting the adherence of this bacterium to salivary proline-rich protein-treated hydroxyapatite, was generated by immunization of SWR mice with A. naeslundii 55-19, a strain derived from T14V-J1 that possess only type 1 fimbriae. Supernatants of hybridomas were screened for reactivity with purified type 1 fimbriae. An IgG monoclonal antibody, 86-49E, blocked the adsorption of the parent strain to proline-rich protein-treated hydroxyapatite by 77% with 1.0 microgram/ml of the monoclonal antibody; the Fab fragment derived from this monoclonal antibody inhibited adherence by 38% at the same concentration. Similarly, the adherence of strain 55-19 was inhibited by 100% and 64% to proline-rich protein-treated hydroxyapatite with 1.0 micrograms/ml of IgG and Fab fragments respectively. Control monoclonal antibody to the subunit of type 1 fimbriae, as well as to Actinobacillus actinomycetemcomitans caused only minimal adherence inhibition. Monoclonal antibody 86-49E also agglutinated both type 1 fimbriae-bearing strains of A. naeslundii T14V-J1 and 55-19 but not strains 59-51 and 147, which lack type 1 fimbriae. Further confirmation of the specificity of monoclonal antibody 86-49E was obtained using these fimbria-deficient mutant strains in an enzyme-linked immunosorbent assay, with the monoclonal antibody binding only to strains possessing type 1 fimbriae. Immunogold labeling in conjunction with electron microscopy suggested binding of monoclonal antibody 86-49E occurring near the distal end of the fimbriae. In contrast, when a monoclonal antibody specific for the type 1 fimbrial subunit but not capable of adherence inhibition was used together with 86-49E in double-labeling experiments, extensive labeling of the fimbriae by the subunit antibody was noted. These data suggest that a monoclonal antibody specific for the type 1 fimbriae of A. naeslundii that is capable of binding to a discrete site on the fimbriae has the capacity to inhibit the adsorption of this organism to saliva-treated hydroxyapatite.
- Published
- 1996
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29. Prevotella intermedia fimbriae mediate hemagglutination.
- Author
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Leung KP, Fukushima H, Nesbitt WE, and Clark WB
- Subjects
- Animals, Antibodies, Monoclonal, Bacterial Adhesion physiology, Bacterial Outer Membrane Proteins immunology, Endopeptidases pharmacology, Epitopes, Erythrocytes microbiology, Fimbriae, Bacterial chemistry, Fimbriae, Bacterial immunology, Hot Temperature, Humans, Hydrogen-Ion Concentration, Immunoglobulin Fab Fragments immunology, Immunoglobulin G immunology, Immunohistochemistry, Mice, Mice, Inbred BALB C, Periodontal Pocket microbiology, Prevotella intermedia immunology, Prevotella intermedia ultrastructure, Rabbits, Antibodies, Bacterial immunology, Fimbriae, Bacterial physiology, Hemagglutination drug effects, Hemagglutination immunology, Hemagglutination physiology, Prevotella intermedia physiology
- Abstract
Our earlier studies demonstrated that clinical strains of Prevotella intermedia, isolated from human periodontal pockets, possess various types of fimbria (surface appendages) as determined ultrastructurally. These bacteria have the ability to agglutinate selected mammalian erythrocytes. Hemagglutinating activity exhibited by these cells may be attributable to these surface structures. Strain 17, which possess fimbriae of 8 nm in diameter and readily agglutinates human, monkey, sheep, rabbit, and mouse erythrocytes was selected to determine whether these fimbriae possessed the hemagglutinating activity. Fimbriae were mechanically sheared, concentrated by ammonium sulfate precipitation, solubilized in 10 mM Tris-HCl buffer containing 0.5% deoxycholate and partly purified by ultracentrifugation in a 10-50% linear sucrose gradient. Isolated fimbriae banded at a density of 1.20-1.15 g/ml, appeared fairly uniform ultrastructurally, and possessed hemagglutinating activity. The hemagglutinating activity of P. intermedia whole cells and isolated fimbriae was reduced by treatment with proteases and eliminated by treatment with heat at 80 degrees C for 10 min. The optimal pH for the hemagglutination was 7.0. In the process of hemagglutination, P. intermedia whole cells and isolated fimbriae bound to rabbit erythrocytes as observed by: (a) decrease in the hemagglutinating activity of bacterial whole cells and isolated fimbriae after incubation with rabbit erythrocytes, (b) increase in hemagglutinating activity of the red cells used for absorption, and (c) the presence of P. intermedia whole cells and fimbriae on red cells after absorption as revealed by immunoelectron microscopy. Both the immune immunoglobulin G of the rabbit polyclonal anti-fimbriae antibody and the immune immunoglobulin G and its Fab fragments of the murine monoclonal anti-fimbriae antibody were effective inhibitors of hemagglutination mediated by isolated fimbriae. Immunogold labeling showed that the monoclonal antibody bound specifically to P. intermedia fimbriae. These results collectively suggest that the hemagglutination exhibited by P. intermedia may be attributable to the fimbriae or the fimbrial-associated components.
- Published
- 1996
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30. Coaggregation of Candida albicans with oral Actinomyces species.
- Author
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Grimaudo NJ, Nesbitt WE, and Clark WB
- Subjects
- Actinomyces chemistry, Actinomyces viscosus physiology, Bacterial Adhesion drug effects, Candida albicans chemistry, Carbohydrate Metabolism, Carbohydrates pharmacology, Chelating Agents pharmacology, Detergents pharmacology, Ecosystem, Edetic Acid pharmacology, Fungal Proteins metabolism, Hot Temperature, Humans, Membrane Proteins metabolism, Oxidants pharmacology, Polysaccharides, Bacterial metabolism, Saliva physiology, Urea pharmacology, Actinomyces physiology, Bacterial Adhesion physiology, Candida albicans physiology
- Abstract
Eight strains of Actinomyces were examined for their ability to coaggregate in vitro with four strains of Candida albicans. The Actinomyces coaggregated to various degrees with all of the Candida strains. Exposure of the Candida but not the Actinomyces to heat, trypsin, proteinase K, amphotericin B or trichodermin abolished coaggregation. All sugars tested did not inhibit any of the reactions. All coaggregating pairs were disaggregated by the addition of SDS, but nonionic detergents had no effect. The addition of urea or EDTA completely reversed coaggregation. Actinomyces strains were sensitive to periodate oxidation, whereas the Candida strains were unaffected. These data suggest that the coaggregations involve a protein on the Candida surface that may interact with carbohydrates or carbohydrate-containing molecules on the surface of the Actinomyces. These observations expand the known range of intergeneric coaggregations occurring between human oral microbes and indicate that coaggregation of C. albicans and Actinomyces may be an important factor in oral colonization by this yeast.
- Published
- 1996
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31. A multicenter clinical trial of PerioGard in distinguishing between diseased and healthy periodontal sites. (I). Study design, methodology and therapeutic outcome.
- Author
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Persson GR, Alves ME, Chambers DA, Clark WB, Cohen R, Crawford JM, DeRouen TA, Magnusson I, Schindler T, and Page RC
- Subjects
- Adult, Black People, Dental Prophylaxis, Dental Scaling, Female, Follow-Up Studies, Gingivitis diagnosis, Gingivitis enzymology, Gingivitis therapy, Humans, Male, Middle Aged, Periodontal Diseases enzymology, Periodontal Pocket diagnosis, Periodontal Pocket enzymology, Periodontal Pocket therapy, Periodontitis diagnosis, Periodontitis enzymology, Periodontitis therapy, Periodontium enzymology, Research Design, Root Planing, Treatment Outcome, White People, Aspartate Aminotransferases analysis, Gingival Crevicular Fluid enzymology, Periodontal Diseases diagnosis, Periodontal Diseases therapy, Periodontium anatomy & histology, Reagent Kits, Diagnostic
- Abstract
We designed and performed a multicenter clinical trial to determine the relationship between measurements of the level of the enzyme aspartate aminotransferase (AST) in gingival crevicular fluid (GCF) to other measures used to detect periodontal disease and monitor outcome of treatment, including pocket depth and gingival inflammation. 32 periodontitis patients were enrolled at the University of Washington, Seattle, 30 at the University of Florida, Gainesville, and 34 at the University of Illinois, Chicago. 10 periodontally normal control subjects were enrolled at each location. 8 diseased and 4 healthy sites were designated for study in each patient and 8 healthy sites designated in each control subject. Measures of disease included pocket depth, severity of gingival inflammation, and GCF volume. AST levels were measured using the PerioGard test kit. Clinical measurements were made and GCF samples harvested and tested 2x before and 2x after therapy consisting of scaling and root planing under local anesthetic. Specific design and other issues are discussed, including selection of patients and control subjects, sample size, selection of experimental test sites, methods for assessment of diseased and therapeutic improvement, harvesting of GCF and selection of appropriate biostatistical methods for data analysis. Demographics of the patient populations at the 3 locations are reported. As expected, therapy induced only negligible changes in the measures of disease at healthy sites in control subjects, and relatively minor improvement in healthy sites in patients. In contrast, statistically significant improvement relative to pretreatment baseline status in all 3 measures of disease was observed for diseased sites at all 3 study locations with all p-values less than 0.0002. The magnitude of improvement was comparable to that reported previously by others. The % of PerioGard-positive sites decreased significantly between the screening baseline and both post-treatment visits for patients at all 3 locations, with p values of 0.0001 to <0.0008.
- Published
- 1995
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32. Drinking-related problems in the United States: description and trends, 1984-1990.
- Author
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Midanik LT and Clark WB
- Subjects
- Adolescent, Adult, Aged, Alcohol Drinking adverse effects, Alcohol Drinking psychology, Alcoholic Intoxication complications, Alcoholic Intoxication epidemiology, Alcoholic Intoxication psychology, Alcoholism complications, Alcoholism psychology, Cross-Sectional Studies, Female, Humans, Incidence, Male, Middle Aged, Population Surveillance, Social Environment, Social Problems psychology, Socioeconomic Factors, United States, Alcohol Drinking epidemiology, Alcoholism epidemiology, Social Problems trends
- Abstract
Objective: This study uses two national alcohol surveys to assess rates of drinking problems from 1984 to 1990, to examine any changes in reports of drinking problems within demographic subgroups, and to evaluate the role of alcohol use versus demographic variables in predicting drinking problems in the 1990 survey only., Method: Data were obtained from two national alcohol surveys that utilized household probability samples within the 48 contiguous states in 1984 and 1990. Weights to adjust for design effects and nonresponse were applied to both samples of current drinkers., Results: No significant changes were found for reports of three or more dependence symptoms (6.7% in 1984, 7.6% in 1990) or two or more social consequences (10.9% in 1984, 12.8% in 1990). Significant increases in reports of two or more social consequences were found for younger people, never married individuals and respondents who were not employed. A significant increase in reports for three or more dependence symptoms was also found for the unemployed group. Based on a cross-sectional analysis of the 1990 survey only, alcohol use variables were significant predictors of drinking problems. With the exception of younger age, demographic characteristics did not significantly predict alcohol problems., Conclusions: Although drinking problems are pervasive, they may not be sensitive to immediate changes in alcohol consumption. One explanation may be the changing social climate around drinking to which most drinkers have been, and are continuing to be, exposed.
- Published
- 1995
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33. Ethnic differences in performance of screening instruments for identifying harmful drinking and alcohol dependence in the emergency room.
- Author
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Cherpitel CJ and Clark WB
- Subjects
- Adolescent, Adult, Black or African American psychology, Aged, Alcoholism epidemiology, Alcoholism psychology, Breath Tests, Cross-Cultural Comparison, Female, Humans, Male, Middle Aged, Mississippi epidemiology, Patient Care Team, Psychiatric Status Rating Scales statistics & numerical data, Psychometrics, Sampling Studies, Sensitivity and Specificity, White People psychology, Wounds and Injuries epidemiology, Wounds and Injuries ethnology, Wounds and Injuries psychology, Black or African American statistics & numerical data, Alcoholism ethnology, Emergency Service, Hospital, Mass Screening, Personality Assessment statistics & numerical data, White People statistics & numerical data
- Abstract
This study examines sensitivity and specificity figures associated with screens used to predict harmful drinking and alcohol dependence among current drinkers. The study population comes from a probability sample of emergency room patients in Jackson, MS. Data are presented by gender and injury status (injured versus noninjured) for Blacks and for Whites. The Composite International Diagnostic Interview was used to assess ICD-10 criteria for harmful drinking and alcohol dependence, which were taken as standards. Predictors include screening instruments (CAGE, AUDIT, brief MAST, TWEAK, and History of Trauma Scale), breathalyzer reading, self-reported consumption before the injury or noninjury event, quantity and frequency of drinking, and an abbreviated alcohol dependence experiences measure used in general population surveys. Single items from these screening instruments were also tested as predictors. Overall, the TWEAK and the AUDIT performed best in terms of sensitivity and specificity, but variation across subgroups suggests that the search for a good screening instrument for general use must be continued.
- Published
- 1995
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34. Treatment of subjects with refractory periodontal disease.
- Author
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Magnusson I, Low SB, McArthur WP, Marks RG, Walker CB, Maruniak J, Taylor M, Padgett P, Jung J, and Clark WB
- Subjects
- Adult, Amoxicillin therapeutic use, Amoxicillin-Potassium Clavulanate Combination, Bacteria isolation & purification, Case-Control Studies, Clavulanic Acids therapeutic use, Clindamycin therapeutic use, Combined Modality Therapy, Dental Plaque Index, Dental Scaling, Follow-Up Studies, Gingival Hemorrhage prevention & control, Humans, Middle Aged, Periodontal Attachment Loss drug therapy, Periodontal Attachment Loss microbiology, Periodontal Attachment Loss therapy, Periodontal Diseases drug therapy, Periodontal Diseases microbiology, Periodontal Index, Placebos, Recurrence, Root Planing, Drug Therapy, Combination therapeutic use, Periodontal Diseases therapy
- Abstract
The aim of the present study was to evaluate the effect of non-surgical periodontal therapy with the adjunct of a selected antibiotic in subjects diagnosed with refractory periodontal disease. 21 subjects were selected for the study; all had a history of periodontal surgery, tetracycline therapy, and regular maintenance by a periodontist. When disease activity was detected, a bacterial sample was taken and a whole plaque susceptibility test was performed. Before the outcome of the susceptibility test the subjects were assigned to either antibiotic or placebo therapy. All subjects received scaling and rootplaning prior to antibiotic or placebo therapy. Based on the susceptibility test, subjects in the antibiotic group were treated either with Augmentin or clindamycin. The results demonstrated that in subjects with refractory periodontal disease there was no significant difference (N.S.) in the proportion of sites losing attachment before and after treatment (11.3% and 12.4%, respectively) over a 2-year post therapy observation period. However, the proportion of sites showing gain of attachment increased from 0.9% before therapy to 5.1% (p = 0.029) following selective antibiotic therapy when combined with scaling and rootplaning. The remainder of sites showed no change between pre- and post-therapy monitoring periods. The progression of attachment loss in the active sites could not be completely stopped over the entire 2-year period. After 12-15 months following therapy, there was a tendency towards new loss of attachment and an increase of pocket depth. However, all 4 subjects treated with placebo drug demonstrated continuous deterioration and had to be retreated. Although the proportion of sites losing attachment decreased from 5.1% to 2.3% (N.S.), the proportion of sites gaining attachment also decreased from 2.0% to 1.0% (N.S.). The results suggest that scaling and rootplaning together with selected antibiotic therapy repeated every 12-15 months may be beneficial for these subjects although it may not completely stop progressive attachment loss.
- Published
- 1994
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35. The demographic distribution of US drinking patterns in 1990: description and trends from 1984.
- Author
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Midanik LT and Clark WB
- Subjects
- Adolescent, Adult, Alcohol Drinking psychology, Attitude to Health, Cross-Sectional Studies, Data Collection, Female, Humans, Logistic Models, Male, Middle Aged, Risk Factors, United States epidemiology, Black or African American statistics & numerical data, Alcohol Drinking epidemiology, Alcohol Drinking trends, Hispanic or Latino statistics & numerical data, Population Surveillance, White People statistics & numerical data
- Abstract
Objectives: Since 1981, per capita consumption of alcohol (based on sales figures) has decreased in the United States. This study describes drinking patterns in the 1990 national alcohol survey by demographic correlates and assesses changes in drinking patterns from the 1984 survey., Methods: Data were obtained from a national household probability sample within the 48 contiguous states; face-to-face interviews were conducted with 2058 adults. The instrument contained questions pertaining to the respondent's background, attitudes toward alcohol, and use of alcohol., Results: The proportions of current drinkers; current drinkers of wine, beer, and liquor; weekly drinkers; and drinkers who reported having five or more drinks per occasion at least once a week were significantly lower in 1990 than in 1984. These changes remained significant when demographic characteristics were controlled by logistic regression. The findings held for Whites only; there were no significant trends for Blacks or Hispanics., Conclusions: While there has been a downward turn in alcohol use in the United States, the correlates of alcohol use have not changed. How these shifts affect alcohol-related problems is an important area for future research.
- Published
- 1994
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36. Modeling the relationship between clinical, microbiologic, and immunologic parameters and alveolar bone levels in an elderly population.
- Author
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Wheeler TT, McArthur WP, Magnusson I, Marks RG, Smith J, Sarrett DC, Bender BS, and Clark WB
- Subjects
- Age Factors, Aged, Aggregatibacter actinomycetemcomitans isolation & purification, Alveolar Bone Loss immunology, Alveolar Bone Loss microbiology, Alveolar Process diagnostic imaging, Bacteroides isolation & purification, Campylobacter isolation & purification, Capnocytophaga isolation & purification, Cross-Sectional Studies, Dental Care for Aged, Dental Plaque Index, Eikenella corrodens isolation & purification, Fusobacterium nucleatum isolation & purification, Humans, Immunoblotting, Immunoglobulin G blood, Leukocyte Count, Linear Models, Periodontal Index, Porphyromonas gingivalis isolation & purification, Predictive Value of Tests, Radiography, Risk Factors, Alveolar Bone Loss etiology, Antibodies, Bacterial blood, Dental Plaque microbiology, Tooth Mobility complications
- Abstract
A cross-sectional periodontal study of 74 subjects aged 65 to 75 years was performed. Clinical data were collected and related to microbiological and immunological data. A statistical model (step-wise multiple regression) of factors related to bone loss was created initially using clinical data only; then by adding either the microbiologic or immunologic data; and then by using clinical, microbiologic, and immunologic data together. When only clinical data were considered, three factors were found to have significant positive correlations with bone loss. Tooth mobility accounted for 17% of the variability in the alveolar bone level measurements, probing depth for 12%(r2), and plaque index for 3%, for a total of 32% of the variability explained by these clinical factors. Tooth mobility and probing depth were clinical factors which remained significant in the model when the microbiological data were also considered. As percentages of the total cultivable microbiota, E. corrodens (r2 = 14%) and black-pigmenting Prevotella intermedia (r2 = 4%) correlated positively with alveolar bone loss. The addition of the microbiologic data only increased the r2 to 33%. When immunological data were considered with the clinical data, pocket depth and tooth mobility were the clinical parameters which remained in the model. IgG antibody levels to P. gingivalis W83 and/or 381 (r2 = 24%) A. actinomycetemcomitans 627 (r2 = 2%) were the significant immunologic measures having a positive correlation with bone loss. Anti-F. nucleatum levels had a significant negative correlation. A total of 50% of the variability in alveolar bone level was accounted for in the model by the addition of specific serum antibody levels to subgingival plaque microorganisms. When clinical, microbiological, and immunological measurements were all considered together, antibody to P. gingivalis W83 and/or 381 (r2 = 42%), percentage of B-lymphocytes (r2 = 3%), probing depth (r2 = 4%), anti-E. corrodens levels (r2 = 2%), and anti-P. gingivalis 33277 levels (r2 = 4%) all had significant positive correlation with loss of alveolar bone. The number of enteric bacteria, anti-F. nucleatum levels, and anti-P. intermedia levels each had a significant negative correlation with alveolar bone heights. The r2 for this model was 75%. These results indicated that antibody levels to subgingival plaque microorganisms and tooth mobility were the best predictors of bone loss in the elderly patients tested in this study.
- Published
- 1994
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37. Specific Antibodies and Their Potential Role in Periodontal Diseases.
- Author
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McArthur WP and Clark WB
- Abstract
Periodontal diseases are thought to result from inflammatory responses to bacterial challenges in the gingival crevicular area. Antibodies are a major host-protective mechanism in many bacterial infections. Consequently, the antibody responses to suspected periodontal pathogenic bacteria have been extensively measured as to their relationship to diseases and specificity for suspected pathogens associated with progressing disease sites. Recently, studies on the bacterial immunogen characterization, antibodysubclass identification, and antibody biological capabilities have been reported. Although increased antibody levels to certain suspected periodontal pathogens were associated with periodontal diseases in humans, little evidence exists as to the role of these antibodies in the infectious process. In vivo experiments in animals indicated that specific antibodies against certain suspected periodontal pathogens were associated with suppression of bacterial colonization, limiting the spread of infection, and a decrease in alveolar bone loss. However, in vitro as well as in vivo experiments suggested that phagocytic cells are required for efficient bactericidal activity of antibodies and that the presence of other sensitized immune cells may either have inhibited or enhanced the infectivity of certain periodontal pathogens. Possible explanations for the observed inconsistencies are presented and the potential for utilization of specific anti-periodontal pathogen responses in the understanding and prevention of diseases is discussed. J Periodontol 1993; 64:807- 818., (© 1993 American Academy of Periodontology.)
- Published
- 1993
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38. The strategy and advantage in use of an electronic probe for attachment measurement.
- Author
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Clark WB, Magnusson I, Namgung YY, and Yang MC
- Subjects
- Analysis of Variance, Electronics, Medical, Humans, Reproducibility of Results, Sensitivity and Specificity, Periodontal Attachment Loss diagnosis, Periodontics instrumentation
- Abstract
Attachment level has been used as the "gold standard" for assessment of the progression of periodontal disease. However, the measurement of attachment level by periodontal probing can be subject to a large number of error sources. Recently, we have designed experiments by using an electronic probe to identify the magnitude of error components due to the instrument, gingival tissue condition, position or probing angle, and time interval between replicate probings. Even with a very careful clinical setting, a few percent of uncontrollable large errors or outliers could not be avoided. A previously used 'option-3' probing scheme to reduce the unexpected large error is justified from the mathematical viewpoint.
- Published
- 1993
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39. A role for antibiotics in the treatment of refractory periodontitis.
- Author
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Walker CB, Gordon JM, Magnusson I, and Clark WB
- Subjects
- Bacteria drug effects, Bacteria isolation & purification, Combined Modality Therapy, Humans, Periodontitis microbiology, Anti-Bacterial Agents therapeutic use, Periodontitis drug therapy
- Abstract
Refractory periodontitis is considered by many investigators to be a separate disease entity that is descriptive of a particular patient who has multiple sites, rather than a few individual sites, that do not respond to conventional periodontal treatment modalities. Such patients continue to demonstrate loss of attachment and alveolar bone despite frequent periodontal treatment which includes surgical intervention, scaling and root planing, and often systemically-administered tetracycline. Controlled clinical studies have demonstrated that both clindamycin-hydrochloride and amoxicillin/clavulanate potassium (Au) are beneficial when used in conjunction with periodontal scaling. Gordon et al. found improvements in attachment levels, inflammation, suppuration, and a decrease in pocket depths for up to 2 years following a 7-day course of clindamycin given in conjunction with a full-mouth scaling. The incidence of disease activity decreased from an annual rate of 8% of all sites prior to antibiotic treatment to 0.5% after treatment. Magnusson, reporting on a similar group treated with a 14-day course of Au, found an average loss of attachment of 2.2 mm and an increase in pocket depth of 1.5 mm in sites demonstrating disease progression prior to antibiotic treatment. At 3 months post-antibiotic therapy, these sites had regained an average of 2 mm of attachment and pocket depths had decreased an equivalent amount. Both attachment levels and pocket depths remained relatively stable for up to 12 months post-therapy. In an ongoing study, 30 subjects with refractory periodontitis were treated with either clindamycin or Au in conjunction with scaling or scaling plus a placebo. Prior to antibiotic treatment, but while being scaled at 3-month intervals, sites with disease activity lost an average 2.4 mm of attachment. At 3 months post-treatment, the clindamycin-treated group showed an average gain of 2.1 mm, the Au-treated group gained 1.9 mm, and the scaling group gained 1.4 mm in attachment. The clindamycin group remained relatively stable for up to 21 months and the Au group remained stable for about 15 months without additional treatment. Five of the 6 subjects treated with scaling alone required additional treatment within 9 months. Preliminary analyses have indicated that at least two patterns or rates of attachment loss may be associated with refractory periodontitis and that each pattern may be indicative of a different microflora. The pattern associated with a relatively rapid loss of attachment was characterized by a Gram-negative flora which contained spirochetes, P. intermedia, and Fusobacterium species.(ABSTRACT TRUNCATED AT 400 WORDS)
- Published
- 1993
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40. Mechanisms of initiation and progression of periodontal disease.
- Author
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Clark WB and Löe H
- Subjects
- Dental Plaque complications, Disease Progression, Humans, Longitudinal Studies, Models, Biological, Periodontal Attachment Loss epidemiology, Periodontal Attachment Loss etiology, Periodontal Attachment Loss pathology, Periodontal Diseases pathology, Prognosis, Periodontal Diseases epidemiology, Periodontal Diseases etiology
- Published
- 1993
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41. Coaggregation of Prevotella intermedia with oral Actinomyces species.
- Author
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Nesbitt WE, Fukushima H, Leung KP, and Clark WB
- Subjects
- Detergents, Dietary Carbohydrates pharmacology, Endopeptidases pharmacology, Hot Temperature, Humans, In Vitro Techniques, Saliva microbiology, Actinomyces cytology, Bacterial Adhesion, Bacteroides cytology, Mouth microbiology
- Abstract
Five strains of Prevotella intermedia were examined for their ability to coaggregate with various gram-positive and gram-negative species of oral bacteria. Two of the P. intermedia strains coaggregated with selected Actinomyces species, P. intermedia 27 with Actinomyces viscosus T14V and Actinomyces naeslundii ATCC 12104, PK606, PK984, and PK947, and P. intermedia 113 with Actinomyces odontolyticus WVU 1546 and Actinomyces israelii WVU 838. Exposure of both Prevotella strains but not the Actinomyces strains to heat, trypsin, or proteinase K abolished most coaggregations. All pairs were disaggregated by the addition of sodium dodecyl sulfate, but only those coaggregations involving P. intermedia 113 were reversed by the addition of 2.0 M urea. P. intermedia 27 was sensitive to periodate oxidation, whereas the partner strains were stable to this treatment. Most coaggregations occurred in the presence of saliva; however, reactions involving P. intermedia 27 were not as strong as those of buffer-suspended cells. Treatment of both P. intermedia 113 coaggregations pairs with proteinase K and the results obtained from suspensions of these pairs in saliva suggest that different surface molecules of this P. intermedia strain may mediate each of these coaggregations. These data suggest that all of these coaggregations involve either a protein or glycoprotein on the Prevotella strain, which may interact with carbohydrates or carbohydrate-containing molecules on the surface of the Actinomyces strain.
- Published
- 1993
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42. Change detection on longitudinal data in periodontal research.
- Author
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Yang MC, Namgung YY, Marks RG, Magnusson I, and Clark WB
- Subjects
- Humans, Longitudinal Studies, Office Visits, Periodontal Diseases diagnosis, Regression Analysis, Sensitivity and Specificity, Severity of Illness Index, Decision Support Techniques, Models, Statistical, Periodontal Diseases pathology
- Abstract
Longitudinal data of attachment level (AL) or the alveolar bone level are often used to assess the progression of periodontal disease. This paper tries to identify the most efficient method to detect the changes of AL in a general periodontal research environment; that is, a sequential decision based on multiple sites. Several existing methods suggested in the periodontal research literature such as the tolerance, running median, cusum, and regression methods as well as change-point detection methods in the statistical literature are examined. It is found that the regression method is most convenient among the several methods that are equally effective in change detection. Formulae, tables and their usage are discussed in detail.
- Published
- 1993
- Full Text
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43. Evaluation of reliability and reproducibility of dental indices.
- Author
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Marks RG, Magnusson I, Taylor M, Clouser B, Maruniak J, and Clark WB
- Subjects
- Analysis of Variance, Calibration, Dental Calculus diagnosis, Dental Plaque diagnosis, Gingival Hemorrhage diagnosis, Gingivitis diagnosis, Humans, Observer Variation, Reproducibility of Results, Tooth Discoloration diagnosis, Dental Plaque Index, Oral Hygiene Index, Periodontal Index
- Abstract
Evaluation of periodontal therapy involves the use of several oral indices to describe the health status of hard and soft tissues. It was the objective of the present study to evaluate the reliability and reproducibility of some of these indices. A calibration and standardization session was designed to calibrate 10 examiners and a "gold standard" (an experienced examiner) in evaluating the following indices: the Volpe-Manhold calculus index (VM), the Lobene stain index (SI), a non-invasive modification of the Löe-Silness gingival index (GI), the papillary bleeding score (PBS) of Loesche, and the plaque index (PI) of Quigley-Hein as modified by Turesky. For each index, the average intraclass correlation was calculated between two subject visits. The highest intraclass correlation, 0.94, was found for PBS. The intraclass correlation for PI was 0.70 and for VM, 0.65. The lowest intraclass correlations were for stain, 0.47, and GI, 0.25. Intra-subject correlations between the 2 visits were good for all indices, but were best for PBS, followed by VM. PBS seems to be the most reliable index (both intra- and inter-examiner) for measuring the oral health status and is therefore recommended for use in clinical studies.
- Published
- 1993
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44. Measuring clinical attachment: reproducibility of relative measurements with an electronic probe.
- Author
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Clark WB, Yang MC, and Magnusson I
- Subjects
- Adult, Alveolar Bone Loss diagnosis, Equipment Design, Gingiva anatomy & histology, Humans, Periodontal Pocket diagnosis, Periodontics methods, Periodontium anatomy & histology, Probability, Reproducibility of Results, Time Factors, Electronics, Medical instrumentation, Gingivitis diagnosis, Periodontics instrumentation, Periodontitis diagnosis
- Abstract
During the past few years, improvements in detecting longitudinal changes in clinical attachment or alveolar bone density have been introduced. For example, constant-force electronic probes and computer-assisted subtraction analysis of longitudinal radiographs have been reported to be more sensitive and reproducible in detecting changes in clinical attachment or alveolar bone density, respectively. Use of these new technologies requires that sources of measurement error be identified and their contribution quantified. This study investigated the reproducibility of a constant-force electronic probe in a careful clinical setting. Measurements were performed from individually fabricated acrylic stents. Three groups of subjects were selected for the study: 10 adults without oral disease, 10 adults with gingivitis, and 10 adults with moderate periodontitis. Four probing designs were employed to investigate the reproducibility of the probe. In design A, the probe tip was left in the sulcus between successive probings. In design B, the probe tip was removed from the gingival margin between probings but the next probing followed immediately. In design C, successive whole-mouth probings were interrupted by a 5-minute interval and a mouth rinse. In design D there was a 4-week interval between each successive probing. Three measurements were taken at each site for each design. The main purpose of this study was to identify variance components in the attachment level variation. The maximum probing error standard deviation ranged from 0.2 to 0.3 mm depending on the periodontal health of the subject. This level of variation is considerably smaller than that found in most previous studies.(ABSTRACT TRUNCATED AT 250 WORDS)
- Published
- 1992
- Full Text
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45. Reproducibility of an electronic probe in relative attachment level measurements.
- Author
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Yang MC, Marks RG, Magnusson I, Clouser B, and Clark WB
- Subjects
- Adult, Alveolar Bone Loss pathology, Equipment Design, Gingival Pocket pathology, Gingivitis pathology, Humans, Middle Aged, Periodontal Pocket pathology, Periodontitis pathology, Reproducibility of Results, Signal Processing, Computer-Assisted, Electronics, Medical instrumentation, Gingival Pocket diagnosis, Periodontal Pocket diagnosis, Periodontics instrumentation
- Abstract
4 probing designs have been employed to investigate the reproducibility of the Florida Probe. 3 groups (each composed of 10 subjects) were selected for the study: healthy adults, gingivitis subjects, and periodontitis subjects. The 4 probing designs were as follows: (a) the probe tip was left in the sulcus between successive probings; (b) the probe tip was removed from the gingival margin between probings but the next probing followed immediately; (c) successive whole-mouth probings were interrupted by a 5-min interval and a mouthrinse; (d) there was a 4-week interval between each probing. 3 measurements were taken for each design. The main purpose of this study was to identify variance components in the attachment level variation. The maximum probing error standard deviation was found to be around 0.3 mm, which is considerably smaller than that found in most previous studies. The errors associated with the periodontal condition and probing effect were also estimated. The variance components obtained here can be used for determining the sample size in controlled clinical studies.
- Published
- 1992
- Full Text
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46. Results from studies of periodontal disease at the University of Florida.
- Author
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Marks RG, Yang MC, and Clark WB
- Subjects
- Florida, Humans, Models, Statistical, Periodontal Diseases physiopathology, Periodontics instrumentation, Regression Analysis, Reproducibility of Results, Diagnosis, Oral statistics & numerical data, Periodontal Diseases pathology
- Published
- 1992
- Full Text
- View/download PDF
47. Isolation and characterization of Actinomyces viscosus mutants defective in binding salivary proline-rich proteins.
- Author
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Nesbitt WE, Beem JE, Leung KP, and Clark WB
- Subjects
- Actinomyces viscosus isolation & purification, Adsorption, Antibodies, Monoclonal immunology, Bacterial Adhesion, Dental Pellicle, Fimbriae, Bacterial metabolism, Humans, Mutation, Proline-Rich Protein Domains, Actinomyces viscosus metabolism, Peptides metabolism, Salivary Proteins and Peptides metabolism
- Abstract
Recent studies have provided evidence for human salivary proline-rich proteins (PRPs) serving as potential receptors in the acquired pellicle for Actinomyces viscosus type 1 fimbriae. We report here the isolation of mutants derived from A. viscosus T14V-J1 which are defective in binding to PRPs partially purified from parotid gland saliva. Mutagenesis with ethyl methanesulfonate preceded enrichment for cells nonreactive with PRPs by successive adsorptions with PRP-treated latex beads. Screening was accomplished by random selection of 250 isolated colonies from each of four enrichment cycles and reaction with PRP-treated latex beads in microtiter plates. Two mutants of independent origin were examined for adherence to hydroxyapatite treated with either PRPs, proline-rich glycoproteins, deglycosylated proline-rich glycoproteins, or whole saliva. Additional surface properties that were examined included agglutination with polyclonal antisera to type 1 and type 2 fimbriae, agglutination by a monoclonal antibody to type 1 fimbriae that inhibits adherence of the parent strain to saliva-treated hydroxyapatite, the ability to bind monoclonal antibody to the type 1 fimbrial subunit, and lactose-reversible coaggregation with Streptococcus sanguis 34. Both mutants exhibited reduced binding to hydroxyapatite treated with whole saliva or salivary protein preparations but were still capable of reaction with antiserum to type 1 and type 2 fimbriae. In addition, these mutants possessed the ability to bind monoclonal antibody to the type 1 fimbrial subunit in amounts comparable to the amount bound by the parent strain but were not agglutinated by the adherence-inhibiting monoclonal antibody. When considered with previously published data, these results suggest that an adhesive molecule is probably associated with type 1 fimbriae and allows for the interaction of A. viscosus with constituents in the salivary pellicle.
- Published
- 1992
- Full Text
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48. Predictive power of various models for longitudinal attachment level change.
- Author
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Yang MC, Marks RG, Clark WB, and Magnusson I
- Subjects
- Disease Susceptibility, Epithelial Attachment pathology, Epithelial Attachment physiopathology, Humans, Periodontal Diseases pathology, Periodontal Pocket pathology, Probability, Sensitivity and Specificity, Stochastic Processes, Time Factors, Models, Statistical, Periodontal Diseases physiopathology, Periodontal Pocket physiopathology
- Abstract
Several statistical models that have been suggested in the periodontal literature for describing longitudinal attachment level changes, such as the gradual loss, single-burst, multiple-burst, and random walk models as well as other models introduced in this paper are compared by their power to predict future attachment loss. The data used in this analysis is from 1061 sites of 8 subjects, with moderate to severe periodontal disease, monitored monthly for about a year. This study found that none of the suggested models could significantly outperform the naïve mean predictor, which predicts the future attachment level from the past mean. It was also found that no single model, such as the burst, gradual, or random walk, together with measurement error can fully explain the variation in the data. These results indicate that in the course of one year, the attachment level change may not follow the same model. Consequently, a model that fits well to past data cannot be accurately extended to the future.
- Published
- 1992
- Full Text
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49. Phenotypic characteristics and DNA relatedness in Prevotella intermedia and similar organisms.
- Author
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Fukushima H, Moroi H, Inoue J, Onoe T, Ezaki T, Yabuuchi E, Leung KP, Walker CB, Clark WB, and Sagawa H
- Subjects
- DNA Probes, DNA, Bacterial analysis, Humans, Nucleic Acid Hybridization, Periodontal Diseases microbiology, Phenotype, Saliva microbiology, Bacteroides classification, Bacteroides genetics
- Abstract
We have recently isolated from the gingival pockets, periapical lesions and saliva some anaerobic gram-negative, black-pigmented rods. Many of these isolates exhibited phenotypic characteristics similar to Prevotella intermedia (Bacteroides intermedius). However, several of these isolates, although resembling P. intermedia in most of the phenotypic expressions, were capable of fermenting lactose, a biochemical characteristic atypical of P. intermedia. These atypical clinical isolates (strains capable of fermenting lactose) and isolates exhibiting more typical phenotypic characteristics (i.e., lactose nonfermenting) were definitively identified as P. intermedia by DNA-DNA hybridization using a photoprobe biotin method. Quantitative hybridization of clinical isolates with labeled DNA of P. intermedia-type strains (ATCC 25611 and ATCC 33563) showed that almost all the clinical strains isolated from disease sites of adults belonged to the ATCC 25611 group, whereas strains isolated from the saliva of children belonged to the ATCC 33563 group. These data, together with the phenotypic characterization of the isolates, suggested that P. intermedia is a heterogeneous species both phenotypically and genetically.
- Published
- 1992
- Full Text
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50. The effect of 3 mouthrinses on plaque and gingivitis development.
- Author
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Maruniak J, Clark WB, Walker CB, Magnusson I, Marks RG, Taylor M, and Clouser B
- Subjects
- Actinomyces viscosus drug effects, Adolescent, Aggregatibacter actinomycetemcomitans drug effects, Anti-Infective Agents, Local administration & dosage, Bacteroides drug effects, Capnocytophaga drug effects, Chlorhexidine administration & dosage, Chlorhexidine therapeutic use, Double-Blind Method, Drug Combinations, Female, Fusobacterium nucleatum drug effects, Humans, Hydrogen Peroxide administration & dosage, Iodine administration & dosage, Male, Middle Aged, Mouthwashes administration & dosage, Placebos, Porphyromonas gingivalis drug effects, Povidone administration & dosage, Salicylates administration & dosage, Terpenes administration & dosage, Water, Anti-Infective Agents, Local therapeutic use, Chlorhexidine analogs & derivatives, Dental Plaque prevention & control, Gingivitis prevention & control, Hydrogen Peroxide therapeutic use, Iodine therapeutic use, Mouthwashes therapeutic use, Povidone therapeutic use, Salicylates therapeutic use, Terpenes therapeutic use
- Abstract
The aim of this study was to evaluate the effect of 3 mouthrinses, Listerine Antiseptic (thymol), Peridex (chlorhexidine), Perimed (povidone iodine and hydrogen peroxide), and a placebo (water) on the development of dental plaque and gingivitis, when used as the only oral hygiene procedure for 14 days. 71 subjects were entered into a randomized, double-blind study. At the baseline examination, papillary bleeding score (PBS), and plaque index (PI) were registered, after which subjects received supragingival prophylaxis and were assigned to 1 of 4 study cells. Subjects were asked to refrain from all oral hygiene procedures except for the supervised 14-day 2 x daily rinsing with the assigned preparation. At day 14, the same clinical parameters were again registered. Statistical analysis was performed by a one-way analysis of variance (ANOVA) to compare the 4 groups, followed by Duncan's multiple range test to determine specific group differences. At baseline, average PBS and PI scores were similar for all 4 groups. After 14 days, the average PBS for Peridex and Perimed was significantly lower than for Listerine Antiseptic and water. The frequency of interdental units with a PBS greater than 2 was significantly lower for Peridex and Perimed than for Listerine Antiseptic and water. We concluded that both Peridex and Perimed were effective in reducing plaque and gingivitis when used as a 2 x daily mouthrinse by subjects refraining from other oral hygiene procedures. In vitro, a synergistic effect was assumed when inhibition was achieved with Perimed at the same or greater dilution than was achieved with povidone-iodine alone.
- Published
- 1992
- Full Text
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