Cochlear Implantation in a Child with CINCA Syndrome Who Also Has Wide Vestibular Aqueducts

Cochlear Implants International. Jun, 2011  |  Pubmed ID: 22333493

Chronic infantile neurological cutaneous and articular (CINCA) syndrome is a severe auto-inflammatory disease, due to mutation of the CIAS1 gene. CINCA syndrome should be considered the most severe of a spectrum of three disorders all due to mutation of the CIAS1 gene. CINCA syndrome produces a triad of symptoms of neonatal onset: maculopapular urticarial rash, chronic meningitis, and chronic non-inflammatory arthropathy with recurrent fever. CINCA syndrome is also associated with sensory organ damage, especially progressive hearing loss and loss of vision. In this case report, we present the first case of cochlear implantation in a 13-year-old child with CINCA syndrome. Cochlear implantation was successful at rehabilitating the hearing loss with the child able to continue mainstream education, with her academic performance and speech discrimination both showing marked improvement. Anakinra (an interleukin 1 receptor antagonist) is now in widespread use to treat CINCA syndrome and is known to rapidly reverse the inflammatory features of CINCA syndrome. However, current evidence suggests that anakinra has limited effectiveness in reversing the sensorineural hearing loss seen in CINCA syndrome. We therefore propose that cochlear implantation is a viable treatment option in this rare yet severe auto-inflammatory disease, if the patient has failed to respond to anakinra. Owing to the unknown pathogenesis of the progressive hearing loss seen in CINCA syndrome and the limited effectiveness of anakinra in reversing the progressive hearing loss, we suggest that cochlear implantation is the modality of choice in rehabilitating severe-to-profound hearing loss not responsive to anakinra.

A Smart Micro-drill for Cochleostomy Formation: A Comparison of Cochlear Disturbances with Manual Drilling and a Human Trial

Cochlear Implants International. Sep, 2011  |  Pubmed ID: 22333534

BACKGROUND: Cochleostomy formation is a key stage of the cochlear implantation procedure. Minimizing the trauma sustained by the cochlea during this step is thought to be a critical feature in hearing preservation cochlear implantation. The aim of this paper is firstly, to assess the cochlea disturbances during manual and robotic cochleostomy formation. Secondly, to determine whether the use of a smart micro-drill is feasible during human cochlear implantation. MATERIALS AND METHODS: The disturbances within the cochlea during cochleostomy formation were analysed in a porcine specimen by creating a third window cochleostomy, preserving the underlying endosteal membrane, on the anterior aspect of the basal turn of the cochlea. A laser vibrometer was aimed at this third window, to assess its movement while a traditional cochleostomy was performed. Six cochleostomies were performed in total, three manually and three with a smart micro-drill. The mean and peak membrane movement was calculated for both manual and smart micro-drill arms, to represent the disturbances sustained within cochlea during cochleostomy formation. The smart micro-drill was further used to perform live human robotic cochleostomies on three adult patients who met the National Institute of Health and Clinical Excellence criteria for undergoing cochlear implantation. RESULTS: In the porcine trial, the smart micro-drill preserved the endosteal membrane in all three cases. The velocity of movement of the endosteal membrane during manual cochleostomy is approximately 20 times higher on average and 100 times greater in peak velocity, than for robotic cochleostomy. The robot was safely utilized in theatre in all three cases and successfully created a bony cochleostomy while preserving the underlying endosteal membrane. CONCLUSIONS: Our experiments have revealed that controlling the force of drilling during cochleostomy formation and opening the endosteal membrane with a pick will minimize the trauma sustained by the cochlea by a factor of 20. Additionally, the smart micro-drill can safely perform a bony cochleostomy in humans under operative conditions and preserve the integrity of the underlying endosteal membrane.

Protein Biosensors Based on Polymer Nanowires, Carbon Nanotubes and Zinc Oxide Nanorods

Sensors (Basel, Switzerland). 2011  |  Pubmed ID: 22163892

The development of biosensors using electrochemical methods is a promising application in the field of biotechnology. High sensitivity sensors for the bio-detection of proteins have been developed using several kinds of nanomaterials. The performance of the sensors depends on the type of nanostructures with which the biomaterials interact. One dimensional (1-D) structures such as nanowires, nanotubes and nanorods are proven to have high potential for bio-applications. In this paper we review these three different kinds of nanostructures that have attracted much attention at recent times with their great performance as biosensors. Materials such as polymers, carbon and zinc oxide have been widely used for the fabrication of nanostructures because of their enhanced performance in terms of sensitivity, biocompatibility, and ease of preparation. Thus we consider polymer nanowires, carbon nanotubes and zinc oxide nanorods for discussion in this paper. We consider three stages in the development of biosensors: (a) fabrication of biomaterials into nanostructures, (b) alignment of the nanostructures and (c) immobilization of proteins. Two different methods by which the biosensors can be developed at each stage for all the three nanostructures are examined. Finally, we conclude by mentioning some of the major challenges faced by many researchers who seek to fabricate biosensors for real time applications.

Pharmacokinetic Drug Interaction Between Gemfibrozil and Sitagliptin in Healthy Indian Male Volunteers

European Journal of Clinical Pharmacology. Dec, 2011  |  Pubmed ID: 22173280

PURPOSE: To study the impact of gemfibrozil co-administration on the pharmacokinetics of sitagliptin in healthy Indian male volunteers. METHODS: A randomized open label two-period crossover study involving 12 healthy Indian male volunteers was conducted at a single center. In each phase, the volunteers were administered sitagliptin as 100 mg tablets, either alone or co-administered with gemfibrozil as 600 mg tablets twice daily for 3 days. There was a 2-week washout period between phases. The venous blood samples were serially collected at 0-12 h post-dose, and plasma concentrations of the study drugs were estimated by a validated high-performance liquid chromatography-ultraviolet method. RESULTS: Relative to the administration of sitagliptin alone, co-administration with gemfibrozil increased the AUC(0-12) (2,167 ± 82.9 vs. 2,970 ± 76.4 ng h/ml; p < 0.0001), AUC(0-∞) (3,621 ± 222.5 vs. 5,574 ± 249.6 ng h/ml; p < 0.0002), C(max) (282.9 ± 7.7 vs. 344.1 ± 5.9 ng/ml; p < 0.0001), and t(½) (7.4 ± 0.6 vs. 10 ± 0.6 h; p = 0.0076) to statistically significant levels. The interindividual differences in the pharmacokinetic parameters of sitagliptin were found to be within acceptable limits (coefficient of variation <20%). No adverse drug events associated with sitagliptin occurred in the subjects during the study period. CONCLUSION: Although the bioavailability of sitagliptin was increased by 54% when co-administered with gemfibrozil, this interaction may not have any clinical significance as sitagliptin has a wide therapeutic index. Hence, in clinical practice, sitagliptin as 100 mg tablets and gemfibrozil as 600 mg tablets may be co-prescribed without much threat of sitagliptin toxicity. However, these results may not hold if the dose of sitagliptin is increased or if is co-prescribed with other antidiabetic drugs and/or cytochrome P450 2C8/human organic anion transporter-3 inhibitors. Further studies are needed to confirm these results in patients.

Intracardiac Left Atrial Tuberculoma in an Eleven-month-old Infant: Case Report

BMC Infectious Diseases. 2011  |  Pubmed ID: 22208878

ABSTRACT:

Reply to "Comment on 'Dual Fluorescence of Ellipticine: Excited State Proton Transfer from Solvent Versus Solvent Mediated Intramolecular Proton Transfer'"

The Journal of Physical Chemistry. A. Jan, 2012  |  Pubmed ID: 22233206

Cyclin-dependent Kinase 9 Activity Regulates Neutrophil Spontaneous Apoptosis

PloS One. 2012  |  Pubmed ID: 22276149

Neutrophils are the most abundant leukocyte and play a central role in the immune defense against rapidly dividing bacteria. However, they are also the shortest lived cell in the blood with a lifespan in the circulation of 5.4 days. The mechanisms underlying their short lifespan and spontaneous entry into apoptosis are poorly understood. Recently, the broad range cyclin-dependent kinase (CDK) inhibitor R-roscovitine was shown to increase neutrophil apoptosis, implicating CDKs in the regulation of neutrophil lifespan. To determine which CDKs were involved in regulating neutrophil lifespan we first examined CDK expression in human neutrophils and found that only three CDKs: CDK5, CDK7 and CDK9 were expressed in these cells. The use of CDK inhibitors with differing selectivity towards the various CDKs suggested that CDK9 activity regulates neutrophil lifespan. Furthermore CDK9 activity and the expression of its activating partner cyclin T1 both declined as neutrophils aged and entered apoptosis spontaneously. CDK9 is a component of the P-TEFb complex involved in transcriptional regulation and its inhibition will preferentially affect proteins with short half-lives. Treatment of neutrophils with flavopiridol, a potent CDK9 inhibitor, increased apoptosis and caused a rapid decline in the level of the anti-apoptotic protein Mcl-1, whilst Bcl2A was unaffected. We propose that CDK9 activity is a key regulator of neutrophil lifespan, preventing apoptosis by maintaining levels of short lived anti-apoptotic proteins such as Mcl-1. Furthermore, as inappropriate inhibition of neutrophil apoptosis contributes to chronic inflammatory diseases such as Rheumatoid Arthritis, CDK9 represents a novel therapeutic target in such diseases.

Ultrasound Mediated Catalyst Free Synthesis of 6H-1-benzopyrano[4,3-b]quinolin-6-ones Leading to Novel Quinoline Derivatives: Their Evaluation As Potential Anti-cancer Agents

Bioorganic & Medicinal Chemistry. Jan, 2012  |  Pubmed ID: 22202437

A facile and catalyst free synthesis of 6H-1-benzopyrano[4,3-b]quinolin-6-ones has been accomplished via the reaction of 4-chloro-2-oxo-2H-chromene-3-carbaldehyde with various aromatic amines in the presence of ultrasound. Some of these compounds were converted to the corresponding 2-(3-(hydroxymethyl)quinolin-2-yl)phenols and further structure elaboration of a representative quinoline derivative is presented. Molecular structure of two representative compounds was confirmed by single crystal X-ray diffraction study. Many of these compounds were evaluated for their anti-proliferative properties in vitro against four cancer cell lines and several compounds were found to be active. Further in vitro studies indicated that inhibition of sirtuins could be the possible mechanism of action of these molecules.

Developing a Music Programme for Preschool Children with Cochlear Implants

Cochlear Implants International. Feb, 2012  |  Pubmed ID: 22333655

Although music perception is especially challenging for cochlear implant (CI) users, young CI users' musical perception abilities are improved by participation in structured musical activities. OBJECTIVES: To design, implement, evaluate, and publish a music training programme with a monitoring tool for preschool CI users, for use in family-centred habilitation programmes. METHODS: We devised a programme of musical activities, Musical EARS(®), and a curriculum-related hierarchical Evaluation Form to represent performance. The programme included sections on singing; recognizing songs, tunes, and timbre; and responding appropriately to music and rhythm. It was implemented over 18 months at Ilkses Rehabilitation Centre, with 25 paediatric MED-EL CI users split into three groups of varying age, duration of CI use, and ability. RESULTS: Mean total scores increased significantly for all groups. Scores increased unevenly across subscales. Participation in and enjoyment of musical activities increased for both children and parents. Significant correlations were found between scores and length of CI use. DISCUSSION: The training programme effectively enriches child CI users' musical experience. To varying degrees, children learned to perform the Musical EARS(®) activities. The study allowed us to validate the lesson content and the hierarchical nature of the Evaluation Form. We conclude that prelingually deafened CI users should be systematically involved in musical activities to help them acquire skills acquired more easily by hearing peers.

Tobacco Addiction and The Risk of Upper Aerodigestive Tract Cancer in A Multicenter Case-Control Study

Cancer Epidemiology, Biomarkers & Prevention : a Publication of the American Association for Cancer Research, Cosponsored by the American Society of Preventive Oncology. Feb, 2012  |  Pubmed ID: 22337537

BACKGROUND: While previous studies on tobacco and alcohol and the risk of upper aerodigestive tract (UADT) cancers have clearly shown dose-response relations with the frequency and duration of tobacco and/or alcohol, studies on addiction to tobacco itself as a risk factor for UADT cancer have not been published, to our knowledge. The aim of this report is to assess whether smoking addiction is a risk factor for UADT SCC risk in the multicenter case-control study (ARCAGE) in Western Europe independent of tobacco smoking or alcohol drinking intensity or duration.METHODS: The analyses included 1,905 ever smoking UADT SCC cases (871 oral cavity/oropharynx, 814 hypopharynx/larynx, 127 esophagus, and 93 overlapping oral cavity/pharynx) and 1,489 ever smoking controls. The addiction variables included first cigarette after waking up, difficulty refraining from smoking in places where it is forbidden, and cigarettes per day. Odds ratios (OR) and 95% confidence intervals (95% CI) for UADT cancers with addiction variables were estimated with unconditional logistic regression, adjusting for center, age, sex, education level, alcohol consumption, and tobacco smoking.RESULTS: Among current smokers, 76.47% of cases were categorized in the highest addiction level, whereas 54.69% of controls were in that category. The participants who smoked their first cigarette within 5 minutes of waking up were two times more likely to develop UADT SCC (OR = 2.22, 95% CI 1.57-3.15) than those who smoked 60 minutes after waking up. A higher modified Fagerstram score, reflecting greater tobacco addiction, was associated with an increased risk of UADT SCC among current smokers, but not among former smokers.CONCLUSION: We observed that time to first cigarette after waking up was associated with UADT SCC risk, regardless of heavy smoking or alcohol drinking behaviors. These results are consistent with residual effect of smoking that was not captured by the questionnaire responses alone. Cancer Epidemiol Biomarkers Prev; 21(3); 1-9. ©2012 AACR.

The Role of Polymorphisms in DNA Repair Genes and HPV 18 Integration Status in Cervical Dysplasia

Cancer Epidemiology, Biomarkers & Prevention : a Publication of the American Association for Cancer Research, Cosponsored by the American Society of Preventive Oncology. Feb, 2012  |  Pubmed ID: 22337542

Despite the fact that cervical cancer is one of the leading causes of death in women worldwide, research has yet to elucidate why some HPV-infected women develop cancerous lesions while others are able to clear the infection. Previous studies have shown that HPV integration status may be associated with cervical cancer development, and yet, host genetic factors that may be involved in the viral integration process have not yet been identified. The purpose of this study was to examine the association between both HPV 18 viral integration status and single nucleotide polymorphisms (SNPs) in non-homologous end-joining (NHEJ) DNA repair pathway genes on cervical dysplasia. Specifically, we sought to compare women with no dysplasia to those with low-grade or high-grade squamous intraepithelial lesions.METHODS: A total of 765 women were selected from two large trials designed to evaluate optical technologies for cervical cancer. Genotyping was performed using the Illumina Golden Gate platform. HPV 18 integration status was determined using a previously established protocol. Chi-square tests were conducted to determine which SNPs were associated with normal cytology, low-grade, or high-grade lesions. Among participants with cervical dysplasia, polytomous logistic regression models were used to evaluate the effect of each polymorphism on viral integration status. An additive genetic model was used for all tests. P-values were adjusted using the false discovery rate method.RESULTS: Women with high-grade lesions were significantly younger than women with low-grade or no lesions. Tag-SNPs in 13 DNA repair genes, including MRE11A, ATM, and XRCC4, were significantly associated with cervical dysplasia. Most participants had a mix of both episomal and integrated HPV 18. Tag-SNPs in the XRCC4, PRKCH, and MRE11A genes were found to be significantly associated with HPV 18 integration status.CONCLUSION: Our study indicates that host genetic variation in NHEJ DNA repair pathway genes, including MRE11A and XRCC4, are significantly associated with HPV 18 integration, and that these genes may play a key role in determining cervical cancer development and progression. This is the first study to examine host genetic variation in association with the viral integration event. Cancer Epidemiol Biomarkers Prev; 21(3); 1-9. ©2012 AACR.

Pituitary Carcinoma Recurrent to the Lumbar Intradural Extramedullary Space: Case Report

The Journal of Spinal Cord Medicine. Feb, 2012  |  Pubmed ID: 22333938

CONTEXT: Pituitary tumors are rare, and pituitary carcinomas are rarer still. Prognosis is poor, with less than 50% of patients surviving past 1 year after diagnosis. In this case of spinal metastasis from an adrenocorticotropic hormone-secreting pituitary carcinoma, the intradural extramedullary metastases recurred in the same lumbar area 6 years apart. FINDINGS: Fourteen years prior to presentation in our clinic, a 48-year-old woman was diagnosed with pituitary adenoma which was treated with resection followed by radiation. Eight years later, an intradural extramedullary spinal drop metastasis at L2-L3 was again treated with resection and radiation. Three years later, magnetic resonance imaging (MRI) revealed a mass encasing the right carotid artery, which was treated for 1 year with chemotherapy using temozolomide (Temodar). Three years later, MRI showed intradural extramedullary metastases at the L3-L4 intervertebral disc space and behind the L3 vertebral body; treatment was again resection followed by radiation. Back pain and weakness resolved after surgery and her neurological examination returned to baseline. There was no evidence of recurrence 1 year after surgery. Conclusion/clinical relevance: In this unusual case, this pituitary carcinoma metastasized twice in 6 years to virtually the same intradural extramedullary lumbar region. Surgical resection of these masses aided in relieving neurological symptoms and prolonging life.

Immune Responses Contribute to Depression, Fatigue, and Pain in Hematopoietic Stem Cell Transplant Recipients

Cancer Epidemiology, Biomarkers & Prevention : a Publication of the American Association for Cancer Research, Cosponsored by the American Society of Preventive Oncology. Feb, 2012  |  Pubmed ID: 22337541

Deficits in Health-Promoting Behaviors Among Veteran and Non-Veteran Male Cancer Survivors in Texas

Cancer Epidemiology, Biomarkers & Prevention : a Publication of the American Association for Cancer Research, Cosponsored by the American Society of Preventive Oncology. Feb, 2012  |  Pubmed ID: 22337548

OBJECTIVES: Cancer survivors may have increased risk for additional malignancies and illnesses. Veterans comprise a significant proportion of Texas male cancer survivors and may differ in their health status and needs from non-veterans. It is unknown whether they differ in general health-promotion strategies. This study sought to identify deficits in health-promoting behaviors among Texas male cancer survivors and to determine whether veteran-status predicts differences along these behaviors.METHODS: Using the Behavioral Risk Factor Surveillance System 2009 survey, we conducted secondary analysis of 280 veteran and 250 non-veteran Texas male cancer survivors. Data were analyzed using Fisher's exact test and logistic-regression models.RESULTS: Survivors averaged 68 years (SD = 11.4) and were primarily white (93%), married (71.5%), college graduates (51%), and non-smokers (91%). Respondents reported several different cancer diagnoses; most commonly prostate (28%). More non-veterans than veterans were obese (31.6% vs. 22.5%; p = 0.03). Veteran-status was not associated with other co-morbidities, current smoking, binge drinking, or fruit/vegetable consumption. However, only 22% met recommendations for daily fruits/vegetables. In multivariate regression, veterans were less likely to meet moderate (OR = 0.54, 95% CI = 0.30-0.95) and vigorous (OR = 0.67, 95% CI = 0.45-0.99) physical-activity recommendations, but were more likely to have had health examinations within the previous year (OR = 1.77, 95% CI = 1.11-2.83).CONCLUSION: Texas male cancer survivors reported deficits across important health behaviors, including dietary and physical-activity recommendations. Veterans reported low compliance with physical-activity guidelines, in spite of evidence-based veterans health-promotion programs, e.g., MOVE! ®. Our results suggest veterans' adherence to routine care may offer a point of intervention to implement health-promotion guidelines among cancer survivors. Further research is needed to understand how to use the growing focus on cancer survivorship within the VA healthcare system to encourage greater adoption of health promotion practices among veteran cancer survivors. Cancer Epidemiol Biomarkers Prev; 21(3); 1-9. ©2012 AACR.

Ruminant Fatty Acids and Prostate Cancer Risk in the Alpha-Tocopherol, Beta-Carotene Cancer Prevention Study

Cancer Epidemiology, Biomarkers & Prevention : a Publication of the American Association for Cancer Research, Cosponsored by the American Society of Preventive Oncology. Feb, 2012  |  Pubmed ID: 22337551

PIVKA-II Plasma Levels As Markers of Subclinical Vitamin K Deficiency in Term Infants

The Journal of Maternal-fetal & Neonatal Medicine : the Official Journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians. Feb, 2012  |  Pubmed ID: 22280352

Abstract Background: As the vitamin K content of human milk is low and the newborn infant's stores of vitamin K are small, vitamin K deficiency with hemorrhage in the newborn is a worldwide problem. Proteins Induced by Vitamin K Absence (PIVKA-II) are the inactive under-?-carboxylated forms of vitamin K-dependent clotting factors and they could be useful in predicting subclinical vitamin K deficiency (VKD). Objectives: To demonstrate that PIVKA-II are earlier markers of subclinical VKD than Prothrombin time (PT) in exclusively breast fed newborns. Methods: A prospective, controlled, randomized study, including 53 term newborns receiving vitamin K prophylaxis (0.5 mg im) at birth, was performed. At 30 days newborns were divided into three groups (G) receiving respectively: 25 ?g/die of vitamin K (G I), 12 ?g/die (G II) or placebo (G III). PIVKA II and PT were measured on 30th and 90th days of life. Results: G III and GII showed a significant increase in PIVKA II from 30 to 90 days of life respectively from 2.6 to 4.7 (p = 0.001) and from 2.3 to 3.5 (p<0.001). No significant changes were found in GI. PT showed no significant changes among groups. Conclusions: PT is a less sensitive marker than PIVKA II. Oral supplementation with 25 ?g/die avoids an increase of PIVKA II. Despite increased PIVKA II do not mean an impending occurrence of bleeding, they highlight a subclinical VKD and its relative risk.

Novel Therapeutic Approaches to CNS Metastases in Malignant Phaeochromocytomas - Case Report of the First Patient with a Large Cystic CNS Lesion

Clinical Endocrinology. Jan, 2012  |  Pubmed ID: 22288775

Clofarabine, Cyclophosfamide, and Etoposide for the Treatment of Relapsed or Resistant Acute Leukemia in Pediatric Patients

Leukemia & Lymphoma. Feb, 2012  |  Pubmed ID: 22303898

ABSTRACT Clofarabine is a promising, new chemotherapeutic agent that is active in the treatment of pediatric acute leukemia. Forty children ( 16 AML, 24 ALL), aged 1-20 years (median 7.6 years) with relapsed or refractory Acute Lymphoblastic Leukemia (ALL) or Acute Myeloid Leukemia (AML) were treated because of resistance to first line treatment (5) , or for first (22) , second (11), or third relapse (2) . They received clofarabine (40 mg/m(2)/day) associated with etoposide (100 mg/m(2)/day) and Cyclophosphamide (440 mg/m(2)/day) administered as 1 or 2 induction cycles (5 days of chemotherapy) in an attempt to reach complete remission (CR) or CR without platelet recovery (CRp). This was followed by 1 to 3 consolidation cycles (4 days of chemotherapy) for a maximum of 4 cycles. Seven (44%) out of 16 and 10 (42%) out of 24 evaluable children with AML and ALL respectively, responded to treatment. The most common adverse events were infections and gastrointestinal and hepatic toxicity. Thirteen (76%) out of 17 responders underwent SCT. 24-month OS was 25%, while it was 59% among patients who responded to the first induction cycle. Our study suggests that this drug regimen is well tolerated and can be effective in heavily pretreated relapsed or refractory pediatric patients with acute leukemia.

Unusual Reason for Chronic Musculoskeletal Pain

Indian Pediatrics. Jan, 2012  |  Pubmed ID: 22318111

Cox-2 Expression in Gingival Biopsies From Periodontal Patients is Correlated With Connective Tissue Loss

Journal of Periodontology. Feb, 2012  |  Pubmed ID: 22324469

Objectives: The objective of this study was to compare cyclooxygenase-2 (COX-2) protein expression in gingival biopsies from chronic periodontitis patients, gingivitis patients and individuals with no periodontal disease (control group) and to establish its relationship with clinical variables and connective tissue loss in lamina propria. Material and Methods: A cross-sectional and analytic study was conducted in 108 gingival biopsies from 52 patients with chronic periodontitis, 39 with gingivitis and 17 with no periodontal disease. All biopsies were processed for conventional histopathological study, immunohistochemical determination of COX-2 protein expression and automatic quantification of connective tissue by image analysis. Results: The protein expression of COX-2, mainly produced by plasma cells and monocytes, was significantly related to the presence of periodontal disease, bleeding index, intensity of inflammatory infiltrate and loss of connective tissue in lamina propria of gingival biopsies (p<0.01, Spearman test). COX-2 expression was also directly correlated with attachment loss (p<0.05, Spearman test). Conclusion: COX-2 protein expression is higher in patients with gingivitis and chronic periodontitis than in non-periodontal patients and is inversely correlated with the amount of connective tissue in lamina propria as determined by image analysis. This finding suggests that COX-2 participates in mechanisms and pathway signalling related to the destruction of fibrillar support structures of the periodontium.