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1.  The association between clinical and radiographic periodontitis measurements during periodontal maintenance 
Journal of periodontology  2012;84(10):1382-1390.
To examine the association between clinical and radiographic periodontitis measurements during two years of periodontal maintenance.
Secondary analyses were performed from a two-year, double-blind, placebo-controlled, randomized clinical trial evaluating the efficacy and safety of subantimicrobial dose doxycycline (SDD) in 128 postmenopausal osteopenic women with moderate to severe chronic periodontitis. Relative clinical attachment level (RCAL) and probing depth (PD) measures were made. Posterior vertical bite-wings were taken for alveolar bone density (ABD) and alveolar bone height (ABH) measurements. Generalized estimating equations were used to model associations.
One-year ABD changes and one-year RCAL/PD changes did not predict two-year ABH changes and ABH/ABD changes, respectively. Baseline RCAL and PD were positively associated with baseline ABH loss (p<0.0001) and baseline probing depths were associated with subsequent ABD and ABH loss (p<0.05 for each). Among placebo (but not SDD) participants, RCAL changes were associated with concurrent ABD loss (p=0.027) when considering one- and two-year changes combined. The odds of ABH loss were higher among sites with concurrent one-year ABD loss versus no change (OR=3.15, p<0.0001) or concurrent PD increases versus no change (OR=1.88, p=0.0025) when considering one- and two-year changes combined.
In postmenopausal osteopenic women undergoing periodontal maintenance, baseline PD was associated with subsequent ABD and ABH loss. Although no longitudinal change preceded another measurement change, changes in probing depths and relative clinical attachment levels appeared to reflect changes in the underlying alveolar bone over time.
PMCID: PMC3612134  PMID: 23205917
alveolar bone loss; doxycycline; osteopenia; periodontal attachment loss; periodontitis; postmenopause
2.  Subantimicrobial dose doxycycline treatment increases serum cholesterol efflux capacity from macrophages 
Subantimicrobial dose doxycycline (SDD) treatment has been reported to reduce the severity of chronic inflammation and to increase serum HDL cholesterol. We determined in a double-blind, placebo-controlled clinical trial, whether SDD affects the ability of serum to facilitate cholesterol removal from macrophages.
Forty-five postmenopausal osteopenic women with periodontitis were randomly assigned to take placebo (n=26) or doxycycline hyclate (20 mg, n=19) tablets twice daily for 2 years. Serum samples were collected at baseline, 1-year, and 2-year appointments. The cholesterol efflux capacity of serum from cultured human macrophages (THP-1) was measured.
SDD subjects demonstrated a significant increase in serum-mediated cholesterol efflux from macrophages at both time points, compared to baseline (p < 0.04 for each). Mean cholesterol efflux levels over the first year of follow-up were 3.0 percentage points (unit change) higher among SDD subjects compared to placebo subjects (p = 0.010), while there was no significant difference in 2-year changes. There were no significant differences in the changes of apolipoprotein A-I, apolipoprotein A-II, or serum amyloid A levels between the groups.
Our results suggest that SDD treatment may reduce the risk of cardiovascular disease in this patient group by increasing the cholesterol efflux capacity of serum.
PMCID: PMC3700361  PMID: 23649042
Atherosclerosis; Clinical trials; Inflammation; Lipids; Macrophages
3.  Arterial Compliance is Increased in Children with Type 2 Diabetes Compared with Normal Weight Peers but Not Obese Peers 
Pediatric diabetes  2013;14(4):259-266.
We reported that obesity was associated with increased arterial compliance in children, possibly due to accelerated vascular maturation. Here we explored the additional burden of type 2 diabetes (T2DM) on vascular function in children.
50 normal weight (BMI 25-75%), 58 obese (BMI≥95%), and 34 children with type 2 diabetes diagnosed by ADA criteria ages 10-18y were studied. Large and small artery elasticity (LAEI and SAEI, respectively) were measured by diastolic pulsewave contour analysis.
SAEI was 27% higher in children with T2DM compared to normal weight children (p=0.005). Mean LAEI for those with T2DM not different from either group. In the group with T2DM, both SAEI and LAEI increased with age up to age 16 years, but declined thereafter. The strongest multivariable model predicting SAEI in children with T2DM combined lean mass, systolic blood pressure, and glucose (r2=0.59); for predicting LAEI, the strongest model included height, systolic blood pressure and LDL-cholesterol (r2=0.61).
The lower arterial compliance in older adolescents with T2DM compared to that of their peers without diabetes may indicate a premature maturation of the vascular system, however, follow up will clarify whether these vascular changes portend an early increase in diabetes associated cardiovascular disease risk.
PMCID: PMC3665759  PMID: 23458165
4.  Optimizing Chemotherapy: Concomitant Medication Lists 
Clinical pharmacology and therapeutics  2010;89(1):10.1038/clpt.2010.253.
Identifying sources of variability in the response to cancer chemotherapy requires knowledge of all variables including concomitant medications, which can alter metabolism and pharmacokinetics of chemotherapy. This study investigated the accuracy of concomitant medication lists in the charts of cancer patients. Collated information from a questionnaire, patient interview and patient’s medical chart were used to obtain validated medication lists. Patients took an average of 4.8 prescription drugs, 1.6 non-prescription drugs and 1.6 other remedies within three days prior to chemotherapy. Medical records did not report 24% of prescription drugs, 84% of non-prescription drugs and 83% of other remedies. Electronic medical records were more complete than paper charts, but failed to report more than 75% of non-prescription drugs and other remedies. Potential drug interactions were noted. This study documents the extent and complexity of concomitant drugs taken by patients undergoing chemotherapy and the deficiencies in recording this information in medical charts.
PMCID: PMC3826435  PMID: 21124312
Chemotherapy; drug interaction; medication reconciliation; medication list; electronic medical records; patient questionnaire
5.  Influenza vaccination responses in human systemic lupus erythematosus: impact of clinical and demographic features 
Arthritis and rheumatism  2011;63(8):2396-2406.
Vaccination against common pathogens, such as influenza, is recommended for SLE patients to decrease infections and improve health. However, most vaccination response reports are limited to evaluation of SLE patients with quiescent disease. This study focuses on understanding the clinical, serological, therapeutic, and demographic factors which influence the response to influenza vaccination in patients with a range of disease activities.
Blood specimens and disease activity information were collected from seventy-two SLE patients at baseline and 2, 6 and 12 weeks after influenza vaccination. Influenza-specific antibody responses were assessed for antibody concentration (Bmax), relative affinity (Ka), and hemagglutination inhibition (HAI). Using a cumulative score, the subjects were evenly divided into high and low responders. Autoantibody levels were evaluated at each time-point by immunofluorescence and standard ELISAs.
Low responders to the vaccine were more likely to have hematologic criteria (p=0.009), exhibit more ACR criteria (p=0.05), and be on concurrent prednisone treatment (p=0.04). Interestingly, European American patients were more likely to be low responders than African Americans (p = 0.03). Following vaccination, low responders were more likely to experience disease flares (p=0.01) and to have increased ANA titers (p = 0.04). Baseline serum interferon alpha activity was significantly higher in patients that experienced a flare after vaccination compared to a matched group of patients that did not flare (p= 0.04).
Ancestral background, prednisone treatment, hematological criteria and evidence of increased disease flares were associated with low antibody responses to influenza vaccination in SLE patients.
PMCID: PMC3149742  PMID: 21598235
6.  Sex Differences in Vascular Compliance in Normal-Weight but Not Obese Boys and Girls: The Effect of Body Composition 
Objectives. To determine the effect of sex and obesity on vascular function in children and explore potential mechanisms that account for differences in vascular function. Methods. Participants were 61 (30 boys) normal-weight (BMI 25–75% ile for age and sex) and 62 (30 boys) obese (BMI ≥ 95% ile) children of ages 8–18 years. Measurements of large and small artery elastic index (LAEI and SAEI, resp.) and reactive hyperemia index (RHI) were obtained at rest, along with anthropometric and biochemical information. Results. In normal-weight children, LAEI was 16% higher in males than females (P = 0.04) with a similar trend for SAEI (13% higher in males, P = 0.067). In obese children, no sex-related differences in vascular measures were observed. In multivariable models, sex differences in arterial compliance were explained by higher lean mass in normal-weight boys. Fat mass predicted LAEI and SAEI in both normal-weight and obese females, but fat mass predicted arterial compliance in boys when fat mass exceeded 24 kg (37% of the sample). Conclusions. Normal-weight males have higher arterial compliance than normal-weight females due to increased lean mass, but sex-related differences were not observed among obese children due to a lack of sex-related differences in lean or fat mass.
PMCID: PMC3312287  PMID: 22505944
7.  Antibody quantity versus quality after influenza vaccination 
Vaccine  2009;27(45):6358-6362.
The correlates for protection against influenza infection are incompletely characterized. We have applied an ELISA strategy that distinguishes antibodies against native viral surface antigens (potentially neutralizing) from antibodies directed against internal and denatured viral proteins (not neutralizing) to three groups of vaccinated subjects: (1) participants in a study of repeated annual vaccination (2) elderly subjects and (3) patients with Systemic Lupus Erythematosus compared to control subjects. Antibody increase after vaccination was inversely related to the level of pre-existing antibodies in all groups; most subjects had significant initial antibody levels and showed little increase in amount of antibody after vaccination, but the avidity of their serum antibodies tended to increase. Antibodies against denatured virus proteins varied with vaccine formulation; vaccines that are more recent have less total protein for the same amount of native hemagglutinin. We propose an index consisting of rank order of antibody level plus antibody avidity, both measured against native virus, plus hemagglutination-inhibition antibody titer, as a useful measure of immunity against influenza.
PMCID: PMC2765411  PMID: 19840673
8.  Evaluation of a community-based participatory physical activity promotion project: effect on cardiovascular disease risk profiles of school employees 
BMC Public Health  2010;10:313.
The efficacy of physical activity in improving cardiovascular disease (CVD) risk profiles has been well established. However, the effectiveness of health promotion programs implemented at the community level remains controversial. This study evaluated a school-based work-site physical activity program.
Using a community-based participatory research model, a work-site wellness intervention was implemented in a rural public school system in Southwestern Oklahoma. During the 2005-2006 school year, 187 participants (mean age 45 years) completed a pre intervention screening for CVD risk factors followed by a physical activity promotion program. Post intervention screening was conducted after a 6 month period. During both screening sessions, body composition, blood pressure, lipids, glucose and self-reported physical activity levels were assessed. The focus of the intervention was on promoting physical activity. Opportunities for in school physical activity were created by marking hallways, adding a treadmill in each school, and allowing teachers to use planning periods for physical activity.
During the post intervention screening, compared to pre intervention levels, participants had lower total, low, and high density lipoprotein-cholesterol (t = 5.9, p < 0.0001, t = 2.6, p = 0.01, and t = 13.2, p < 0.0001 respectively), lower systolic blood pressure (t = 2.9, p = 0.004), and higher self-reported physical activity levels (Sign t = -1.901, p = 0.06).
A successful participatory program was associated with improvements in several CVD risk factors among school employees. Limitations of this study such as seasonal variation in the outcome variables and lack of a control group limit our ability to draw solid conclusions about the effectiveness of the intervention.
PMCID: PMC2894775  PMID: 20525391
9.  Use of Prescription and Non-Prescription Medications and Supplements by Cancer Patients during Chemotherapy; Questionnaire Validation 
Cancer patients take medications for coexisting disease and self medicate with over-the-counter drugs (OTCs). A complete analysis of the use of prescription drugs, OTCs and supplements during cancer treatment has never been done.
The study developed and validated a self-administered questionnaire on the use of concomitant medications by patients undergoing treatment with chemotherapy. The questionnaire listed 510 prescription medications, OTCs, and supplements (including vitamins, minerals and herbs). Fifty-two subjects completed the questionnaire while visiting the infusion clinic to receive chemotherapy. On a subsequent visit the subjects brought their medications to the clinic and a pharmacist reviewed their completed questionnaire.
Ninety-six percent of the subjects reported taking prescription medications within three days prior to chemotherapy, 71% reported taking OTCs and 69% reported use of supplements. The subjects took an average of 5.5 (range 0-13) prescription drugs, 2.2 (0-20) OTCs and 1.9 (0-11) supplements. Twenty-one drugs were each taken by at least 10% of the subjects. Acetaminophen was taken by 59.6% of the subjects. One subject reported taking five acetaminophen-containing drugs. The questionnaire’s sensitivity was 92.0%, specificity 99.9%.
Within 3 days prior to chemotherapy, subjects took an average of 9.6 concomitant medications, many of which alter drug metabolism and or disposition. In clinical trials, multivariate analysis of all concomitant medications could add to clinically relevant data to identify drug interactions that negate or potentiate the efficacy of cancer treatment regimens. In some instances, apparent resistance of tumors to chemotherapy may be the result of drug interactions.
PMCID: PMC2656681  PMID: 18719067
Chemotherapy; concomitant medications; drug interactions; over-the-counter medications

Results 1-9 (9)