Interview with Julie Knobil

An oral interview with Juile (Hotchkiss) Knobil, research professor of physiology and then integrative biology at the Medical School, where she lectured on mammalian physiology and perinatal endocrinology.

Interview with Dianna Milewicz

An oral interview with Dianna Milewicz, M.D., Ph.D., Professor and Vice Chairman of the Department of Internal Medicine at The University of Texas Medical School at Houston and Director of the M.D./Ph.D. Program and co-Director of the Biomedical Engineering Center. Her research interests include the genetic basis of cardiovascular diseases, and understanding the effect of identified mutations on protein function. She has recently established a genetic core laboratory to provide molecular biology and genetic expertise to clinicians who want to initiate genetic studies on their patient populations.

Interview with Anna Steinberger

An oral interview with Dr. Anna Steinberger, who taught and conducted basic research in Reproductive Biology and served as Assistant Dean for Faculty Affairs at UT Medical School-Houston. Her research yielded over 250 scientific articles, books, and book chapters for which she received numerous awards and recognitions in the USA and abroad.

Interview with Dorothy Otto

Interview with Dorothy Otto, Associate Professor at the School of Nursing, University of Texas Houston Health Science Center.

Epstein-Barr virus infection of Langerhans cell precursors as a mechanism of oral epithelial entry, persistence, and reactivation.

Epstein-Barr virus (EBV) is a ubiquitous human herpesvirus associated with many malignant and nonmalignant human diseases. Life-long latent EBV persistence occurs in blood-borne B lymphocytes, while EBV intermittently productively replicates in mucosal epithelia. Although several models have previously been proposed, the mechanism of EBV transition between these two reservoirs of infection has not been determined. In this study, we present the first evidence demonstrating that EBV latently infects a unique subset of blood-borne mononuclear cells that are direct precursors to Langerhans cells and that EBV both latently and productively infects oral epithelium-resident cells that are likely Langerhans cells. These data form the basis of a proposed new model of EBV transition from blood to oral epithelium in which EBV-infected Langerhans cell precursors serve to transport EBV to the oral epithelium as they migrate and differentiate into oral Langerhans cells. This new model contributes fresh insight into the natural history of EBV infection and the pathogenesis of EBV-associated epithelial disease.

Comparison of accuracy captured by different controlled languages in oral pathology diagnoses.

This project was comparing the accuracy of capturing the oral pathology diagnoses among different coding systems. 55 diagnoses were selected for comparison among 5 coding systems. The results of accuracy in capturing oral diagnoses are: AFIP (96.4%), followed by Read 99 (85.5%), SNOMED 98 (74.5%), ICD-9 (43.6%), and CDT-3 (14.5%). It shows that the currently used coding systems, ICD-9 and CDT-3, were inadequate, whereas the AFIP coding system captured the majority of oral diagnoses. In conclusion, the most commonly used medical and dental coding systems lack terms for the diagnosis of oral and dental conditions.

Physical activity and survival after a first myocardial infarction: The Corpus Christi Heart Project

Previous studies have demonstrated that habitual physical activity is associated with a reduced risk of incident coronary heart disease (CHD). However, the role of physical activity in lowering the risk of all-cause mortality, CHD mortality, reinfarction, or receipt of a revascularization procedure after a first myocardial infarction (MI) remains unresolved, particularly in minority populations. To investigate the associations between physical activity and risk of all-cause mortality, CHD mortality, reinfarction, and receipt of a revascularization procedure, this study was conducted among Mexican-American and non-Hispanic white women and men who survived a first MI. The Corpus Christi Heart Project, a population-based cardiovascular surveillance study, provide data which included vital status, survival time, medical history, CHD risk factor information, including level of physical activity among Mexican-American and non-Hispanic white adults who had experienced a first MI between May, 1988 and April, 1990. MI patients were interviewed at baseline and annually thereafter until their death or through May, 1995. A categorical variable was created to reflect change in level of physical activity following the first MI; categories included (1) sedentary with no change, (2) decreased activity, (3) increased activity, and (4) moderate activity with no change (the referent group). Proportional hazards regression analyses were used to assess the relationship of level of physical activity and risk of death, reinfarction, or receipt of a revascularization procedure adjusting for age, sex, ethnicity, severity of MI, and CHD risk factor status. Over a 7-year follow-up period, the relative risk (95% confidence intervals) of all-cause mortality was 4.67 (2.27, 9.60) for the sedentary-no change group, 2.33 (0.96, 5.67) for the decreased activity group, and 0.52 (0.11, 2.41) for the increased activity group. The relative risk of CHD mortality was 6.92 (2.05, 23.34) for the sedentary-no change group, 2.40 (0.55, 10.51) for the decreased activity group, and 1.58 (0.26, 9.65) for the increased activity group. The relative risk for reinfarction was 2.50 (1.52, 4.10) for the sedentary-no change group, 2.26 (1.24, 4.12) for the decreased activity group, and 0.52 (0.21, 1.32) for the increased activity group. Finally, the relative risk for receipt of a revascularization procedure was 0.65 (0.39, 1.07) for the sedentary-no change group, 0.45 (0.22, 0.92) for the decreased activity group, and 1.01 (0.51, 2.02) for the increased activity group. No interactions were observed for ethnicity or severity of first MI. These results are consistent with the hypothesis that moderate physical activity is independently associated with a lower risk of all-cause mortality, CHD mortality, and reinfarction, but not revascularization, among Mexican-American and non-Hispanic white, female and male, first MI patients. These results also support the current recommendation that physical activity plays an important role in the secondary prevention of CHD. ^

Impact of oral contraceptives on weight, body composition, and cardiovascular disease risk factors in women age 18--30 years participating in a 15-week exercise program

Objective. To assess differences in body weight, body composition, total cholesterol, blood pressure, and blood glucose between OC users and non-users age 18-30 y before and after a 15-week cardiovascular exercise program in Houston, TX from 2003 to 2007.^ Study Design. Secondary analysis of prospective data. ^ Study Subjects. 453 Non-Hispanic white (NHW), Hispanic, and African American (AA) women age 18-30 y with no previous live birth, a history of menstruating, no use of other hormonal contraceptives or medications, no menopause or hysterectomy, and no current pregnancies.^ Measurements. Demographic data, medication use, and menstrual history were assessed via self-administered questionnaires at baseline. Anthropometric and laboratory measures were taken at baseline and 15-weeks. ^ Data Analysis. Linear regression assessed the association between OC use and study variables at baseline, and the change in study variables from baseline to 15-weeks. Logistic regression assessed the association between OC use and CVD risk. Each analysis was also stratified by race/ethnicity. ^ Results. At baseline, OC users had higher total cholesterol (p<.0005) and were above cholesterol risk cut points for CVD (OR=4.3, 95% CI=2.4-7.7) compared to non-users. At baseline, OC use was also associated with higher diastolic blood pressure (p=.018) compared to non-users, primarily in non-Hispanic whites (p=.007). OC use was associated with lower blood glucose compared to non-users in Hispanics only (p=.008). OC use was associated with absolute change in diastolic blood pressure (p=.044) and total cholesterol (p=.003). There was evidence that OC use may affect individuals differently based on race/ethnicity for certain obesity and CVD risk factors.^ Conclusions. OC users and non-users responded similarly to a 15-week cardiovascular exercise program. Exceptions included a greater change in diastolic blood pressure and total cholesterol among NHW and Hispanic OC users compared to non-users after exercise intervention. At baseline, OC use was associated with diastolic blood pressure and was most strongly associated with increased levels of total cholesterol. OC users were at greater risk of having total cholesterol above CVD risk cut points than non-users.^

The School Sealant Program: An evaluation of the oral health education component

Dental caries is a common preventable childhood disease leading to severe physical, mental and economic repercussions for children and their families if left untreated. A needs assessment in Harris County reported that 45.9% of second graders had untreated dental caries. In order to address this growing problem, the School Sealant Program (SSP), a primary preventive initiative, was launched by the Houston Department of Health and Human Services (HDHHS) to provide oral health education, and underutilized dental preventive services to second grade children from participating Local School Districts (LSDs). ^ To determine the effectiveness and efficiency of the SSP, a program evaluation was conducted by the HDHHS between September 2007 and June 2008 for the Oral Health Education (OHE) component of the SSP. The objective of the evaluation was to assess short term changes in oral health knowledge of the participants and determine if these changes, if any, were due to the OHE sessions. An 8-item multiple choice pre/post test was developed for this purpose and administered to the participants before and immediately after the OHE sessions. ^ The present project analyzed pre and post test data of 1,088 second graders from 22 participating schools. Changes in overall and topic-specific knowledge of the program participants before and after the OHE sessions were analyzed using the Wilcoxon's signed rank test. ^ Results. The overall knowledge assessment showed a statistically significant (p <0.001) increase in the dental health knowledge of the participants after the oral health education sessions. Participants in the higher scoring category (7-8 correct responses) increased from 9.5% at baseline to 60.8% after the education sessions. Overall knowledge increased in all school regions with the highest knowledge gains seen in the Central and South regions. Males and females had similar knowledge gains. Significant knowledge differences were also found for each of the topic specific categories (functions of teeth, healthy diet, healthy habits, dental sealants; p<0.001) indicating an increase in topic specific knowledge of the participants post-health education sessions. ^ Conclusions. The OHE sessions were successful in increasing the short term oral health knowledge of the participants. ^

Concordance between medical records and personal interview in ascertaining breast cancer and diabetes status: Analysis of the south Texas women's health project

Accurate ascertainment of risk factors and disease status is vital in public health research for proper classification of research subjects. The two most common ways of obtaining this data is by self-report and review of medical records (MRs). South Texas Women’s Health Project was a case-control study looking at interrelationships between hormones, diet, and body size and breast cancer among Hispanic women 30-79 years of age. History of breast cancer, diabetes mellitus (DM) and use of DM medications was ascertained from a personal interview. At the time of interview, the subject identified her major health care providers and signed the medical records release form, which was sent to the designated providers. The MRs were reviewed to confirm information obtained from the interview.^ Aim of this study was to determine the sensitivity and specificity between MRs and personal interview in diagnosis of breast cancer, DM and DM treatment. We also wanted to assess how successful our low-cost approach was in obtaining pertinent MRs and what factors influenced the quality of MR or interview data. Study sample was 721 women with both self-report and MR data available by June 2007. Overall response rate for MR requests was 74.5%. MRs were 80.9% sensitive and 100% specific in confirming breast cancer status. Prevalence of DM was 22.7% from the interviews and 16% from MRs. MRs did not provide definite information about DM status of 53.6% subjects. Sensitivity and specificity of MRs for DM status was 88.9% and 90.4% respectively. Disagreement on DM status from the two sources was seen in 15.9% subjects. This discordance was more common among older subjects, those who were married and were predominantly Spanish speaking. Income and level of education did not have a statistically significantly association with this disagreement.^ Both self-report and MRs underestimate the prevalence of DM. Relying solely on MRs leads to greater misclassification than relying on self-report data. MRs have good to excellent specificity and thus serve as a good tool to confirm information obtained from self-report. Self-report and MRs should be used in a complementary manner for accurate assessment of DM and breast cancer status.^

Thrombolytic therapy for acute myocardial infarction: A cohort study to evaluate a selective approach to invasive diagnosis and therapy. The Corpus Christi Heart Project

Coronary perfusion with thrombolytic therapy and selective reperfusion by percutaneous transluminal coronary angioplasty (PTCA) were examined in the Corpus Christi Heart Project, a population-based surveillance program for hospitalized acute myocardial infarction (MI) patients in a biethnic community of Mexican-Americans (MAs) and non-Hispanic whites (NHWs). Results were based on 250 (12.4%) patients who received thromobolytic therapy in a cohort of 2011 acute MI cases. Out of these 107 (42.8%) underwent PTCA with a mean follow-up of 25 months. There were 186 (74.4%) men and 64 (25.6%) women; 148 (59.2%) were NHWs, 86 (34.4%) were MAs. Thrombolysis and PTCA were performed less frequently in women than in men, and less frequently in MAs than in NHWs.^ According to the coronary reperfusion interventions used, patients were divided in two groups, those that received no-PTCA (57.2%) and the other that underwent PTCA (42.8%) after thrombolysis. The case-fatality rate was higher in no-PTCA patients than in the PTCA (7.7% versus 5.6%), as was mortality at one year (16.2% versus 10.5%). Reperfusion was successful in 48.0% in the entire cohort and (51.4% versus 45.6%) in the PTCA and no-PTCA groups. Mortality in the successful reperfusion patients was 5.0% compared to 22.3% in the unsuccessful reperfusion group (p = 0.00016, 95% CI: 1.98-11.6).^ Cardiac catheterization was performed in 86.4% thrombolytic patients. Severe stenosis ($>$75%) obstruction was present most commonly in the left descending artery (52.8%) and in the right coronary artery (52.8%). The occurrence of adverse in-hospital clinical events was higher in the no-PTCA as compared to the PTCA and catheterized patients with the exception of reperfusion arrythmias (p = 0.140; Fisher's exact test p = 0.129).^ Cox regression analysis was used to study the relationship between selected variables and mortality. Apart from successful reperfusion, age group (p = 0.028, 95% CI: 2.1-12.42), site of acute MI index (p = 0.050) and ejection-fraction (p = 0.052) were predictors of long-term survival. The ejection-fraction in the PTCA group was higher than (median 78% versus 53%) in the no-PTCA group. Assessed by logistic regression analysis history of high cholesterol ($>$200mg/dl) and diabetes mellites did have significant prognostic value (p = 0.0233; p = 0.0318) in long-term survival irrespective of treatment status.^ In conclusion, the results of this study support the idea that the use of PTCA as a selective intervention following thrombolysis improves survival of patients with acute MI. The use of PTCA in this setting appears to be safe. However, we can not exclude the possibility that some of these results may have occurred due to the exclusion from PTCA of high risk patients (selection bias). ^