Purpose-Growth factors such as platelet-derived growth factor (PDGF) exert potent effects on wound healing including the regeneration of periodontia. Pyridinoline cross-linked carboxyterminal telopeptide of type I collagen (ICTP) is a well-known biomarker of bone turnover, and as such is a potential indicator of osseous metabolic activity. The objective of this study was to evaluate the release of the ICTP into the periodontal wound fluid (WF) following periodontal reconstructive surgery using local delivery of highly purified recombinant human PDGF (rhPDGF)-BB.Methods-Forty-seven human subjects at five treatment centres possessing chronic severe periodontal disease were monitored longitudinally for 24 weeks following PDGF regenerative surgical treatment. Severe periodontal osseous defects were divided into one of three groups and treated at the time of surgery with either: β-tricalcium phosphate (TCP) osteoconductive scaffold alone (active control), β-TCP+0.3 mg/ml of rhPDGF-BB, or β-TCP+1.0 mg/ml of rhPDGF-BB. WF was harvested and analysed for local ICTP levels by radioimmunoassay. Statistical analysis was performed using analysis of variance and an area under the curve analysis (AUC).Results-The 0.3 and 1.0 mg/ml PDGF-BB treatment groups demonstrated increases in the amount of ICTP released locally for up to 6 weeks. There were statistically significant differences at the week 6 time point between β-TCP carrier alone group versus 0.3 mg/ml PDGF-BB group (p<0.05) and between β-TCP alone versus the 1.0 mg/ml PDGF-BB-treated lesions (p<0.03). The AUC analysis revealed no statistical differences amongst groups.Conclusion-This study corroborates the release of ICTP as a measure of active bone turnover following local delivery of PDGF-BB to periodontal osseous defects. The amount of ICTP released from the WF revealed an early increase for all treatment groups. Data from this study suggests that when PDGF-BB is delivered to promote periodontal tissue engineering of tooth-supporting osseous defects, there is a direct effect on ICTP released from the wound.

Growth factors such as platelet-derived growth factor (PDGF) exert potent effects on wound healing including the regeneration of tooth-supporting structures. This investigation examined the effect of the local delivery of PDGF-BB when combined with reconstructive periodontal surgery on local wound fluid (WF) levels of PDGF-AB, vascular endothelial growth factor (VEGF), and bone collagen telopeptide (ICTP) in humans with advanced periodontitis. Sixteen patients exhibiting localized periodontal osseous defects were randomized to one of three groups (beta-TCP carrier alone, beta-TCP + 0.3 mg/mL of recombinant human PDGF-BB [rhPDGF-BB], or beta-TCP + 1.0 mg/mL of rhPDGF-BB) and monitored for 6 months. WF was harvested and analyzed for PDGF-AB, VEGF, and ICTP WF levels. Teeth contralateral to the target lesions served as controls. Increased levels of VEGF in the WF was observed for all surgical treatment groups with the 1.0 mg/mL rhPDGF-BB group showing the most pronounced difference at 3 weeks in the AUC analysis versus control (p < 0.0001). PDGF-AB WF levels were increased for the carrier alone group compared to both rhPDGFBB groups. Low-dose rhPDGF-BB application elicited increases in ICTP at days 3-5 in the wound healing process, suggesting a promotion of bone turnover at early stages of the repair process (p < 0.02). These results demonstrate contrasting inducible expression patterns of PDGF-AB, VEGF, and ICTP during periodontal wound healing in humans.

Purpose To compare cup to disc ratio (CDR) measurements from images taken with a portable, 45° non-mydriatic fundus camera to images from a traditional table-top mydriatic fundus camera. Design Prospective, cross sectional, comparative instrument validation study. Methods Setting Clinic-based. Study Population 422 eyes of 211 subjects were recruited from the Tilganga Institute of Ophthalmology (Kathmandu, Nepal). Two masked readers measured CDR and noted possible evidence of glaucoma (CDR ≥0.7 or the presence of a notch or disc hemorrhage) from fundus photographs taken with a non-mydriatic portable camera and a mydriatic standard camera. Each image was graded twice. Main Outcome Measures Effect of camera modality on CDR measurement, inter- and intra-observer agreement for each camera for the diagnosis of glaucoma. Results 196 eyes (46.5%) were diagnosed with glaucoma by chart review. 41.2%–59.0% of eyes were remotely diagnosed with glaucoma over grader, repeat measurement, and camera modality. There was no significant difference in CDR measurement between cameras after adjusting for grader and measurement order (estimate=0.004, 95% confidence interval (CI), 0.003–0.011, p=0.24). There was moderate inter-observer reliability for the diagnosis of glaucoma (Pictor (κ=0.54, CI, 0.46–0.61); Topcon (κ=0.63, CI, 0.55–0.70) and moderate intra-observer agreement upon repeat grading (Pictor (κ=0.63 and 0.64, for Graders 1 and 2, respectively); Topcon (κ=0.72 and 0.80, for Graders 1 and 2, respectively). Conclusions A portable, non-mydriatic, fundus camera can facilitate remote evaluation of disc images on par with standard mydriatic fundus photography.

Recent literature on CLABSI prevention shows that a multifaceted approach to improving central line insertion and maintenance practices results in decreased CLABSI rates in both the ICU and non-ICU settings. More data are needed to develop appropriate benchmarks and prevention strategies specific to the non-ICU setting, in which a significant proportion of central line-days and CLABSI occur.