Denture stomatitis and its risk indicators in south Brazilian older adults

doi:10.1111/j.1741‐2358.2009.00295.x
Denture stomatitis and its risk indicators in south Brazilian older adults Objective: The purpose of this study was to evaluate if socio‐demographic, behaviour and health variables are risk indicators for denture‐related stomatitis in community‐dwelling older adults from Carlos Barbosa, Brazil. Materials and methods: In this cross‐sectional study, 872 subjects aged 60 years or more were evaluated. Data collection included dental examinations and questionnaires to assess socio‐demographic, behaviour, general and oral health data. All questionnaires and examinations were carried out during 2004. Associations between the independent variables and the outcomes ‘prevalence of denture stomatitis’ or ‘prevalence of granular stomatitis’ were adjusted by means of multivariate logistic regressions. Results: Participants with denture stomatitis were significantly more likely to be females, to display increased amounts of plaque, and significantly less likely to visit the dentist for treatment. Participants with granular stomatitis were significantly more likely to be females and participants with granular stomatitis were significantly more likely to be females, aged 70 years or more and current smokers. In addition, participants with granular stomatitis displayed increased amounts of plaque. Conclusion: The data presented here confirms the central role of denture biofilm accumulation in denture stomatitis. It also indicates that smoking may increase susceptibility to infection in its most severe form.     

Root caries incidence and associated risk factors in middle-aged and older adults

Data from population-based longitudinal studies required to assess the incidence of root caries and associated risk factors are sparse in the literature. To this end, a group of 130 middle-aged and older adults were examined for root caries at baseline and at a follow-up visit between nine and 24 months (median: 16 months). Dental examinations were conducted by one examiner at a Tufts dental clinic using NIDR defined diagnostic criteria. Fifty percent of subjects in this study population developed one or more new root caries lesions over the follow-up period. Also, an annualised increment of 0.60 (SD: 0.72) decayed and filled surfaces per person was observed for the 45–59 year old group while the 70+ group showed an annualised increment of 1.38 (SD: 1.97) DFS in this study. Multivariate logistic regression analysis identified past root caries experience, high plaque score, and high number of teeth (>= 22) to be positively associated with new root caries (p < 0.05).     

Macrolide antibiotics for oral intake in the treatment and prevention of suppurative surgical infection]

The authors studied the clinical efficacy of antibiotics of the macrolides group--erythromycin, oleandomycin, triacetylalleandomycin and leukomycin--in complex treatment of 280 patients with suppurative surgical infection caused by a gram-positive, mainly staphylococcal, microbial flora. Various medicinal forms were used: tablets, capsules, granules, syrup. Efficacy of treatment comprised 70-78 per cent. Tolerance of antibiotics was good in the majority of patients.     

Framingham risk score and alternatives for prediction of coronary heart disease in older adults

Background

Guidelines for the prevention of coronary heart disease (CHD) recommend use of Framingham-based risk scores that were developed in white middle-aged populations. It remains unclear whether and how CHD risk prediction might be improved among older adults. We aimed to compare the prognostic performance of the Framingham risk score (FRS), directly and after recalibration, with refit functions derived from the present cohort, as well as to assess the utility of adding other routinely available risk parameters to FRS.

Methods

Among 2193 black and white older adults (mean age, 73.5 years) without pre-existing cardiovascular disease from the Health ABC cohort, we examined adjudicated CHD events, defined as incident myocardial infarction, CHD death, and hospitalization for angina or coronary revascularization.

Results

During 8-year follow-up, 351 participants experienced CHD events. The FRS poorly discriminated between persons who experienced CHD events vs. not (C-index: 0.577 in women; 0.583 in men) and underestimated absolute risk prediction by 51% in women and 8% in men. Recalibration of the FRS improved absolute risk prediction, particulary for women. For both genders, refitting these functions substantially improved absolute risk prediction, with similar discrimination to the FRS. Results did not differ between whites and blacks. The addition of lifestyle variables, waist circumference and creatinine did not improve risk prediction beyond risk factors of the FRS.

Conclusions

The FRS underestimates CHD risk in older adults, particularly in women, although traditional risk factors remain the best predictors of CHD. Re-estimated risk functions using these factors improve accurate estimation of absolute risk.     

Trunk kinematics and fall risk of older adults: translating biomechanical results to the clinic.

This paper reviews some of our experiences over nearly 15 years of trying to determine modifiable factors that contribute to the high incidence of fall by older adults. As part of our approach, we have subjected healthy young and older adults to very large postural disturbances during locomotion, in the form of trips and slips, to which rapid compensatory responses have been necessary to avoid falling. For both trips and slips, the ability to limit trunk motion has consistently discriminated older adults who fall from both younger adults and older adults who have been able to avoid falling. We have shown that the ability to limit trunk motion can be rapidly acquired, or learned, by older adults as a result of task-specific training. The learned motor skill has demonstrated short-term retention and has been shown to effectively decrease fall-risk due to trips. Collectively, we believe the works strongly suggests that the traditional exercise-based fall-prevention and whole-body, task-specific training can synergize to reduce falls and fall-related injury in older adults.     

Macrolide antibiotics inhibit prostaglandin E2 synthesis and mRNA expression of prostaglandin synthetic enzymes in human leukocytes

We investigated the action of macrolide antibiotics, which are considered to have anti-inflammatory activity, on lipopolysaccharide (LPS)-stimulated prostaglandin (PG) E2 synthesis and the expression of mRNAs for cytosolic phospholipase A2 (cPLA2), cyclooxygenase (COX)-1, and COX-2 in human leukocytes. The production of LPS-stimulated PGE2 was significantly increased in peripheral polymorphonuclear leukocytes (PMNLs) and in mononuclear leukocytes (MNLs). Amounts of mRNAs for COX-2 and cPLA2, but not for COX-1, were enhanced by LPS in PMNLs and MNLs. The LPS-enhanced PGE2 synthesis and the expression of cPLA2 and COX-2 mRNAs were inhibited by clarithromycin, azithromycin and dexamethasone in PMNLs and MNLs. The mRNA expression of COX-1 in PMNLs was decreased by clarithromycin and azithromycin. Macrolide antibiotics inhibited PGE2 synthesis in human leukocytes by suppressing cPLA2, COX-1, and COX-2 mRNA expression. These data indicate one mechanism of macrolide anti-inflammatory activity.     

Diffuse optical assessment of cerebral‐autoregulation in older adults stratified by cerebrovascular risk

Diagnosis of cerebrovascular disease (CVD) at early stages is essential for preventing sequential complications. CVD is often associated with abnormal cerebral microvasculature, which may impact cerebral‐autoregulation (CA). A novel hybrid near‐infrared diffuse optical instrument and a finger plethysmograph were used to simultaneously detect low‐frequency oscillations (LFOs) of cerebral blood flow (CBF), oxy‐hemoglobin concentration ([HbO₂]), deoxy‐hemoglobin concentration ([Hb]) and mean arterial pressure (MAP) in older adults before, during and after 70° head‐up‐tilting (HUT). The participants with valid data were divided based on Framingham risk score (FRS, 1‐30 points) into low‐risk (FRS ≤15, n = 13) and high‐risk (FRS >15, n = 11) groups for developing CVD. The LFO gains were determined by transfer function analyses with MAP as the input, and CBF, [HbO₂] and [Hb] as the outputs (CA ∝ 1/Gain) . At resting‐baseline, LFO gains in the high‐risk group were relatively lower compared to the low‐risk group. The lower baseline gains in the high‐risk group may attribute to compensatory mechanisms to maintain stronger steady‐state CAs. However, HUT resulted in smaller gain reductions in the high‐risk group compared to the low‐risk group, suggesting weaker dynamic CAs. LFO gains are potentially valuable biomarkers for early detection of CVD based on associations with CAs.     

Soft tissue stiffness over the hip increases with age and its implication in hip fracture risk in older adults

Risk of hip fracture depends on the bone strength as well as the impact force delivered to the proximal femur during falls, and femoral soft tissue may help to reduce the hip fracture risk by attenuating the impact force. Femoral soft tissue stiffness was measured from a large sample, and compared how this was affected by age, gender and site.One hundred fifty healthy individuals (fifty-two young (aged between 19 and 29), forty-eight middle-aged (30–64), and fifty old (over 65)) participated. Each age group included an equal number of males and females. Using an automated hand-held indentation device, soft tissue stiffness was measured over twelve sites with respect to the greater trochanter (GT).For both left and right hips, the stiffness was associated with age (p < 0.0005), gender (p < 0.0005), and site (p < 0.0005). On average, the stiffness was 26% greater in older than young adults (321.5 versus 254.3 N/m). On average across twelve sites, the regression analysis indicated that the stiffness increases 1.33 N/m every year (“soft tissue stiffness over the hip = 1.33*age + 221.8”; R = 0.518, p < 0.0005). Furthermore, the stiffness was 18% greater in male than female (308.8 versus 262.6 N/m), and differed across twelve sites over the hip, being greatest (424.2 N/m) at the GT, and least (206.3 N/m) at the superior gluteal region.The results provide insights into the shock absorbing property of soft tissue over the hip, and inform the improvement of fall-related injury prevention interventions (i.e., hip protector, safe landing strategies) in older adults.     

高龄孕妇孕早期心律失常及转归分析

目的：观察高龄孕妇孕早期ECG异常及心律失常发生特点,记录孕早期房性及室性心律失常的后期转归情况。方法：290例孕妇按照年龄分为35岁以下组,35~39岁组和40~45岁组。行心电图检查,系统分析心电图波形,采集记录异常心电图变化,包括ST段改变、各型心律失常等,记录房性、室性心律失常的好转率及加重率。结果：35~39岁组和40~45岁组心律失常发生率显著高于35岁以下组（P<0.05）;35~39岁组和40~45岁组ST段异常发生率显著高于35岁以下组（P<0.05）;40~45岁组QRS波增宽发生率高于35岁以下组（P<0.05）。35~39岁组和40~45岁组的窦性心动过速、窦性心律不齐和房性早搏发生率显著低于35岁以下组（P<0.05）;40~45岁组阵发性室上速发生率显著高于35岁以下组（P<0.05）,35~39岁组和40~45岁组室性早搏和房颤发生率均显著高于35岁以下组（P<0.05）。40~45岁组的房性心律失常恢复率显著低于35岁以下组（P<0.05）;40~45岁组的房性和室性心律失常加重率显著高于35岁以下组（P<0.05）。35~39岁组的ECG异常组、40~45岁ECG异常组发生率显著高于35岁以下组和35~39岁组的ECG正常组（P<0.05）;35~39岁组及40~45岁的ECG异常组胎儿窘迫发生率显著高于35岁以下组（P<0.05）。结论：高龄与孕早期心律失常发生有正相关,并且高龄因素降低孕期心律失常自行恢复率而升高心律失常恶化发生率,高龄孕妇伴有心电图异常对围生儿状况有不良影响。     

Macrolide antibiotics inhibit the degradation of the glucocorticoid-responsive cytochrome P-450p in rat hepatocytes in vivo and in primary monolayer culture

Treatment of rats with macrolide antibiotics such as triacetyloleandomycin (TAO) dramatically increases the hepatic concentration of a cytochrome P-450 indistinguishable from P-450p, the major liver cytochrome induced by glucocorticoids such as dexamethasone (Wrighton, S. A., Maurel, P., Schuetz, E. G., Watkins, P. B., Young, B., and Guzelian, P. S. (1985) Biochemistry 24, 2171-2178). To investigate the mechanism of induction of P-450p, we treated rats for 4 days with these agents and found that dexamethasone and TAO induced the synthesis of P-450p at least 70- and 35-fold over control values, respectively, as estimated from measurements of P-450p mRNA translatable in a cell-free system. However, the accumulation of P-450p holocytochrome (measured as TAO-metabolite spectral complex) or P-450p protein (measured by quantitative immunoblotting) increased at least 150-fold by TAO but only 32-fold by dexamethasone. The possibility that TAO decreases the degradation of P-450p was supported by the observation that administration of TAO to dexamethasone-treated rats labeled with NaH[14C]O3 and [3H]-delta-aminolevulinic acid retarded the decay of radioactive immunoprecipitable P-450p protein (t1/2 = 60 versus 14 h) and heme (t1/2 = 73 versus 10 h). To confirm these results, P-450p protein synthesis was measured as radioactivity incorporated into immunoprecipitable P-450p in primary monolayer cultures of adult rat hepatocytes incubated with [3H]leucine. Dexamethasone treatment of the cultures stimulated P-450p synthesis by at least 30-fold whereas macrolides were without effect. However, macrolide antibiotics but not dexamethasone inhibited the disappearance of radiolabeled P-450p from cultured hepatocytes similar to the results obtained in vivo. We conclude that macrolide antibiotics induce P-450p, the most rapidly turning over cytochrome yet reported, by stimulating its synthesis indirectly and by blocking its degradation, significantly.     

Macrolide antibiotics modulate ERK phosphorylation and IL-8 and GM-CSF production by human bronchial epithelial cells

Macrolide antibiotics decrease proinflammatory cytokine production in airway cells from subjects with chronic airway inflammation. However, in subjects with chronic obstructive pulmonary disease, short-term azithromycin (AZM) therapy causes a transient early increase in the blood neutrophil oxidative burst followed by a decrease in inflammatory markers with longer administration. We studied the effects of clarithromycin (CAM) and AZM on proinflammatory cytokine production from normal human bronchial epithelial (NHBE) cells. CAM decreased IL-8 over the first 6 h and then significantly increased interleukin (IL)-8 at 12-72 h after exposure (P < 0.0001). AZM also increased IL-8 at 24 and 48 h, and CAM increased granulocyte-macrophage colony-stimulating factor at 48 h. In the presence of LPS, both CAM and AZM dose-dependently increased IL-8 secretion over 24 h, but after 5 days of exposure to 10 microg/ml CAM there is suppression of IL-8 (P < 0.001). PD-98059, an inhibitor of MAP kinase/ERK kinase, inhibited CAM-induced IL-8 (P < 0.0001) and GM-CSF (P < 0.01) release. The p38 MAP kinase inhibitor SB-203580 increased CAM-induced IL-8 release (P < 0.001), and the c-jun NH2-terminal kinase inhibitor SP-600125 had no effect on IL-8. At 120 min and 6 h, CAM increased phospho-ERK1/2 (pERK) but not phospho-p38 or phospho-JNK. Over the first 90 min, CAM at 10 microg/ml inhibited pERK and then increased pERK in parallel with measured IL-8 secretion. After daily CAM exposure for 5 days, both IL-8 and pERK returned to baseline. The p38 MAP kinase inhibitor, SB-203580 increased ERK phosphorylation and IL-8 secretion. These results suggest that macrolide antibiotics can differentially modulate proinflammatory cytokine secretion in NHBE cells, in part through ERK.