***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND Evidence suggests an association between periodontal disease and coronary heart disease ( CHD ) . C-reactive protein ( CRP ) , fibrinogen , and white blood cell ( WBC ) counts are markers of inflammation , and their systemic levels have been associated with CHD risk . This pilot study investigated the effect of non-surgical periodontal therapy on systemic levels of CRP , fibrinogen , and WBC counts in subjects with CHD or no CHD ( NCHD ) . METHODS Twenty-seven angiographically defined patients with CHD and 18 subjects with NCHD aged > or=40 years were recruited for the study . Periodontal disease was measured through the clinical parameters bleeding on probing ( BOP ) and probing depth ( PD ) . All subjects received non-surgical periodontal therapy that included oral hygiene instructions and subgingival scaling and root planing .  Systemic levels of inflammatory markers ( CRP , fibrinogen , and WBC counts ) were measured prior to and 1 month after periodontal therapy . RESULTS Seventeen subjects with CHD and 11 subjects with NCHD completed the study . Subjects with CHD or NCHD experienced significant reductions in BOP ( 59 % and 34 % , respectively ; P < 0.05 ) and PD ( 41 % and 35 % , respectively ; P < 0.05 ) , with non-significant intergroup differences ( P > 0.05 ) . In all subjects , CRP , fibrinogen , and WBC counts were reduced significantly ( 21 % to 40 % ) after periodontal therapy ( P < 0.05 ) . CONCLUSIONS Periodontal treatment result ed in significant decreases in BOP and PD and lowered serum inflammatory markers in patients with CHD or NCHD . This may result in a decreased risk for CHD in the treated patients . These findings will allow pursuit of a large-scale r and omized intervention trial in this population BACKGROUND Chronic infections , such as periodontitis , are associated with increased risk of systemic diseases driven by a persistent low- grade systemic inflammation and metabolic changes . Severity of periodontitis has also been associated with increased systolic blood pressure ( BP ) . However , the issue remains poorly investigated . We aim ed to estimate the effect of periodontal therapy on traditional and novel cardiovascular risk factors in systemically healthy individuals who have periodontitis . METHODS We enrolled 40 otherwise healthy patients with severe chronic generalized periodontitis in a 6-month pilot intervention trial . Individuals were r and omized either to a st and ard course of periodontal therapy ( subgingival scaling and root planing ) or an intensive one ( including the adjunctive use of a locally delivered antimicrobial , IPT ) . RESULTS Compared to control , IPT produced significant reductions in a cluster of inflammatory markers at 1 ( P = .0406 ) and 2 ( P = .0060 ) months together with an improvement in lipid markers at 2 ( P = .0320 ) and 6 ( P = .0432 ) months after therapy . Intensive periodontal therapy produced greater reductions in IL-6 at 1 ( 0.4 + /- 0.2 ng/L difference , 95 % CI 0.03 - 0.9 , P = .0284 ) and 2 months ( 0.3 + /- 0.2 ng/L difference , 95 % CI 0.1 - 0.8 , P = .0284 ) , together with decreases in C-reactive protein ( 0.4 + /- 0.2 mg/L difference , 95 % CI 0.01 - 0.8 , P = .0438 ) and total cholesterol ( 0.3 + /- 0.1 mmol/L difference , 95 % CI 0.04 - 0.6 , P = .0254 ) . Moreover , a 7 + /- 3-mm Hg decrease in systolic BP was observed at 2 months in the IPT group ( 95 % CI 1 - 12 , P = .0211 ) , and this difference was greater in current smokers ( 14 + /- 5 mm Hg 95 % CI 3 - 25 , P = 0.0124 ) . Intensive periodontal therapy subjects exhibited a 1.53 % + /- 1.20 % ( 95 % CI 1.05 - 2.24 , P = .0290 ) and 2.00 % + /- 1.42 % ( 95 % CI 0.98 - 4.09 , P = .0568 ) decreases in cardiovascular risk scores ( Framingham ) at 2 and 6 months , respectively , when compared to those in the st and ard group . CONCLUSIONS Our findings suggest that intensive periodontal treatment  reduces systemic inflammatory markers and systolic BP , and improves lipid profiles with subsequent changes in cardiovascular risk when compared to st and ard therapy BACKGROUND Systemic inflammation may impair vascular function , and epidemiologic data suggest a possible link between periodontitis and cardiovascular disease . METHODS We r and omly assigned 120 patients with severe periodontitis to community-based periodontal care ( 59 patients ) or intensive periodontal treatment ( 61 ) . Endothelial function , as assessed by measurement of the diameter of the brachial artery during flow ( flow-mediated dilatation ) , and inflammatory biomarkers and markers of coagulation and endothelial activation were evaluated before treatment and 1 , 7 , 30 , 60 , and 180 days after treatment . RESULTS Twenty-four hours after treatment , flow-mediated dilatation was significantly lower in the intensive-treatment group than in the control-treatment group ( absolute difference , 1.4 % ; 95 % confidence interval [ CI ] , 0.5 to 2.3 ; P=0.002 ) , and levels of C-reactive protein , interleukin-6 , and the endothelial-activation markers soluble E-selectin and von Willebr and factor were significantly higher ( P<0.05 for all comparisons ) . However , flow-mediated dilatation was greater and the plasma levels of soluble E-selectin were lower in the intensive-treatment group than in the control-treatment group 60 days after therapy ( absolute difference in flow-mediated dilatation , 0.9 % ; 95 % CI , 0.1 to 1.7 ; P=0.02 ) and 180 days after therapy ( difference , 2.0 % ; 95 % CI , 1.2 to 2.8 ; P<0.001 ) . The degree of improvement was associated with improvement in measures of periodontal disease ( r=0.29 by Spearman rank correlation , P=0.003 ) . There were no serious adverse effects in either of the two groups , and no cardiovascular events occurred . CONCLUSIONS Intensive periodontal treatment result ed in acute , short-term systemic inflammation and endothelial dysfunction . However , 6 months after therapy , the benefits in oral health were associated with improvement in endothelial function OBJECTIVE : To test the feasibility of creating a valid and reliable checklist with the following features : appropriate for assessing both r and omised and non-r and omised studies ; provision of both an overall score for study quality and a profile of scores not only for the quality of reporting , internal validity ( bias and confounding ) and power , but also for external validity . DESIGN : A pilot version was first developed , based on epidemiological principles , review s , and existing checklists for r and omised studies . Face and content validity were assessed by three experienced review ers and reliability was determined using two raters assessing 10 r and omised and 10 non-r and omised studies . Using different raters , the checklist was revised and tested for internal consistency ( Kuder-Richardson 20 ) , test-retest and inter-rater reliability ( Spearman correlation coefficient and sign rank test ; kappa statistics ) , criterion validity , and respondent burden . MAIN RESULTS : The performance of the checklist improved considerably after revision of a pilot version . The Quality Index had high internal consistency ( KR-20 : 0.89 ) as did the subscales apart from external validity ( KR-20 : 0.54 ) . Test-retest ( r 0.88 ) and inter-rater ( r 0.75 ) reliability of the Quality Index were good . Reliability of the subscales varied from good ( bias ) to poor ( external validity ) . The Quality Index correlated highly with an existing , established instrument for assessing r and omised studies ( r 0.90 ) . There was little difference between its performance with non-r and omised and with r and omised studies . Raters took about 20 minutes to assess each paper ( range 10 to 45 minutes ) . CONCLUSIONS : This study has shown that it is feasible to develop a checklist that can be used to assess the method ological quality not only of r and omised controlled trials but also non-r and omised studies . It has also shown that it is possible to produce a checklist that provides a profile of the paper , alerting review ers to its particular method ological strengths and weaknesses . Further work is required to improve the checklist and the training of raters in the assessment of external validity BACKGROUND Studies investigating effects of periodontal treatment ( PT ) on markers of inflammation in healthy subjects show conflicting results . Few studies have investigated the effects of PT among subjects with coronary heart disease ( CHD ) risk factors . AIM To report the results of a pilot prospect i ve study on the effects of periodontal treatment on markers of inflammation among subjects with CHD risk factors . MATERIAL AND METHODS Seventy three patients aged 53+/-6 years ( 25 % males ) with chronic periodontitis , dyslipidemia and other CHD risk factors were subjected to PT consisting on root planning and oral metronidazol and amoxicillin for 7 days .  Periodontal clinical parameters , serum C-reactive protein ( CRP ) , fibrinogen levels and erythrocyte sedimentation rate ( ESR ) were assessed before and at 6 weeks after PT . Polymorphisms at the ILlA-889 and IL1B+3954 genes were also genotyped . RESULTS After the treatment period , CRP levels significantly increased from 3.6+/-3.7 mg/ L to 5.4+/-5.7 mg/L ( p = 0.001 ) . No significant changes were observed in fibrinogen levels and ESR . Higher post-treatment CRP levels were significantly associated with the composite polymorphic genotype at the ILlA-889 and IL1B+3954 genes ( p = 0.0001 ) , and extensive periodontitis ( p = 0.005 ) . Moderate alcohol consumption appeared as a protective factor for CRP elevation ( p = 0.029 ) . CONCLUSIONS The increase of the CRP levels after PT in patients with CVD risk factors appeared associated with IL-1 gene polymorphisms and extensive periodontitis Most studies linking obesity and periodontal disease have been cross-sectional in design . We examined whether gains in body weight , waist circumference , and arm fat area are associated with periodontitis progression in 893 non-diabetic men followed for up to four decades in the prospect i ve VA Dental Longitudinal Study .  Probing pocket depth ( PPD ) was measured by calibrated examiners . Repeated- measures generalized linear models estimated the mean cumulative numbers of teeth with PPD events ( PPD > 3 mm ) at each dental examination and the slopes associated with increasing numbers of affected teeth over time . Means were adjusted for baseline PPD , education , and cigarette pack-years , and time-dependent values of age , mean plaque score , cigarette packs/day , brushing , and flossing . Men who were overweight at baseline and gained weight most rapidly ( > 0.19 kg/yr or ~15 lb during follow-up ) had significantly more PPD events than men in the lowest tertile of weight gain ( ≤ -0.05 kg/yr ) . Overweight men whose waist circumference increased > 0.14–0.39 or > 0.39 cm/yr experienced more PPD events than men in the lowest tertile ( ≤ 0.14 cm/yr ) . Increase in arm fat area was associated with disease progression in normal-weight men . These results suggest that tracking adiposity changes with easily obtained anthropometric measures may help predict risk of periodontitis progression BACKGROUND We investigated the effect of oral alendronate ( ALN ) treatment on radiological and clinical measurements of periodontal disease in postmenopausal women without hormone replacement therapy . METHODS We evaluated the effect of 6 months of ALN treatment in 40 postmenopausal women , 55 to 65 years old with established periodontal disease , in a controlled , double-masked , prospect i ve study . Volunteers were paired by age and r and omized to receive ALN ( 10 mg/day ) or placebo for the study period . Periodontal mechanical treatment was carried out in both groups . At baseline and after treatment , clinical evaluation , hormone blood levels , distance from the crestal alveolar bone ( CAB ) to the cemento-enamel junction ( CEJ ) , calcaneus bone mineral density ( BMD ) , hormone levels , serum N-telopeptide ( NTx ) , and bone-specific alkaline phosphatase ( BSAP ) were assessed . RESULTS Periodontal disease conditions improved in both groups , but greater improvement in probing depth ( -0.8 + /- 0.3 mm versus -0.4 + /- 0.4 mm , P = 0.02 ) and gingival 
    Output:
    
Whereas no difference was found in clinical periodontal parameters , significant differences in inflammatory or metabolic parameters were found between overweight/obese and normal-weight patients , but existing evidence is weak