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Background:The clinical efficacy and safety of doxycycline hyclate (8.5% w/w) delivered subgingivally in a biodegradable polymer (DH) was compared to placebo control (VC), oral hygiene (OH), and scaling and root planing (SRP) in 2 multi‐center studies. Methods:Each study entered 411 patients who demonstrated moderate to severe periodontitis. Patients had 2 or more quadrants each with a minimum of 4 qualifying pockets ≥5 mm that bled on probing. At least 2 of the pockets were ≥7 mm. Treatment with DH, VC, OH, or SRP was provided at baseline and again at month 4. Clinical parameters were recorded monthly. Results:DH and SRP resulted in nearly identical clinical changes over time in both studies. Mean 9 month clinical attachment level gain (ALG) was 0.8 mm for the DH group and 0.7 mm for the SRP group in Study 1, and 0.8 mm (DH) and 0.9 mm (SRP) in Study 2. Mean probing depth (PD) reduction was 1.1 mm for the DH group and 0.9 mm for the SRP group in Study 1 and 1.3 mm for both groups in Study 2. Frequency distributions showed an ALG ≥2 mm in 29% of DH sites versus 27% of SRP sites in Study 1 and 31% of DH sites versus 34% of SRP sites in Study 2. PD reductions ≥2 mm were seen in 32% of DH sites versus 31% of SRP sites in Study 1 and 41% of DH sites versus 43% of SRP sites in Study 2. Comparisons between DH, VC, and OH treatment groups showed DH treatment to be statistically superior to VC and OH. Safety data demonstrated a benign safety profile with use of the DH product. Conclusions:Results of this trial demonstrate that treatment of periodontitis with subgingivally delivered doxycycline in a biodegradable polymer is equally effective as scaling and root planing and superior in effect to placebo control and oral hygiene in reducing the clinical signs of adult periodontitis over a 9‐month period. This represents positive changes resulting from the use of subgingivally applied doxycycline as scaling and root planing was not limited regarding time of the procedure or use of local anesthesia. J Periodontol 1999;70:490‐503.

Hemophagocytic lymphohistiocytosis (HLH) is a life-threatening, rapidly progressive hematologic disorder involving uncontrolled immune system activation. HLH has been associated with viral infections, including human immunodeficiency virus (HIV) infections. We report a case of a critically ill 30-year-old female who was hospitalized with HIV-associated HLH, with a CD4 count of 4 cells/mL and HIV viral load of 1,842,730 copies/mL. After ruling out other potential infectious causes of HLH, antiretroviral therapy (ART) was initiated with darunavir, ritonavir, tenofovir, and emtricitabine. Within one week of initiation of ART, the patient began to improve clinically and hematologically and was stable enough for discharge from the hospital three weeks after starting therapy. This case suggests that treatment with ART in patients with HIV-associated HLH should be considered even in critically ill patients with low CD4 counts.

Isozyme analysis using starch gel electrophoresis was used to examine possible genetic differences among populations of 4 Aphthona species which were associated with 4 different Euphorbia species and 4 different environmental types in Europe. Aphthona species evaluated in the study included A. cyparissiae (Kock), A. flava Guillebeau, A. lacertosa Rosenhauer, and A. nigriscutis Foudras. Euphorbia host plant species considered in this study included E. cyparissias L., E. esula L., E. lucida Waldstein-Wartemberg and Kitaibel, and E. virgata Waldstein-Wartemberg and Kitaibel. Cluster analysis of genetic distances obtained from isozyme analysis easily distinguished populations of the 4 flea beetle species as 4 distinct groups. Based on the dendrogram generated from cluster analysis, populations of A. lacertosa and A. nigriscutis were found to be more similar genetically than either species to populations of A. flava or A. cyparissiae. The greatest genetic distance was found between populations of A. cyparissiae and A. lacertosa, which occur in different habitats and on different spurge species. A relatively high genetic distance also was found between populations of A. cyparissiae and A. nigriscutis, which are species that occur in similar habitats and on similar spurge species. Measurable degrees of genetic variability were found between populations (within a species) for 2 of the 4 Aphthona species sampled.