The road to ruin: the formation of disease‐associated oral biofilms

Oral Diseases (2010) 16 , 729–739 The colonization of oral surfaces by micro‐organisms occurs in a characteristic sequence of stages, each of which is potentially amenable to external intervention. The process begins with the adhesion of bacteria to host receptors on epithelial cells or in the salivary pellicle covering tooth surfaces. Interbacterial cell–cell binding interactions facilitate the attachment of new species and increase the diversity of the adherent microbial population. Microbial growth in oral biofilms is influenced by the exchange of chemical signals, metabolites and toxic products between neighbouring cells. Bacterial cells on tooth surfaces (dental plaque) produce extracellular polymers such as complex carbohydrates and nucleic acids. These large molecules form a protective matrix that contributes to the development of dental caries and, possibly, to periodontitis. The identification of key microbial factors underlying each step in the formation of oral biofilms will provide new opportunities for preventative or therapeutic measures aimed at controlling oral infectious diseases.     

Varices of the round ligament mimicking an inguinal hernia – an important differential diagnosis during pregnancy

Pregnancy is a recognised risk factor for the development of inguinal hernias due to an increase in intra-abdominal pressure. Whilst often managed conservatively until after the pregnancy, if the hernia presents acutely as a painful or tender groin lump, urgent or emergency repair may be required. Many clinicians rely heavily on clinical examination alone in order to diagnose the presence of such a hernia. In pregnancy, however, in order to prevent unnecessary surgery, the use of ultrasound has a more important role to play in reaching this diagnosis. We report a cautionary case that highlights the need for ultrasound evaluation of all painful groin lumps in pregnant women prior to considering surgery.     

High load for most high risk human papillomavirus genotypes is associated with prevalent cervical cancer precursors but only HPV16 load predicts the development of incident disease

Cervicovaginal human papillomavirus (HPV) viral load has been purported as a potential marker for the detection of high-grade cervical intraepithelial neoplasia or cancer (>/=CIN2). To examine disease association with type-specific viral load for the full-range of anogenital HPV infections, we conducted cross-sectional and prospective analyses of approximately 2,000 HPV-infected women from a 10,000-woman population-based study in Guanacaste, Costa Rica with 7 years of follow-up. Cervical specimens were tested for >40 HPV types using a MY09/MY11 L1 consensus primer PCR method with type-specific dot blot hybridization and PCR signal intensity as a measure of viral load. A positive association was observed between prevalent >/=CIN2 and high viral load compared to low viral load for women with baseline single HPV16 infections (OR = 19.2, 95% CI = 4.4-83.2) and single non-16 carcinogenic infections (OR = 9.2, 95% CI = 2.1-39.9). Inclusion of women with multiple HPV types did not substantially change these associations. In prospective follow-up, only women infected with HPV16 alone (OR = 27.2, 95% = 3.5-213.5) had a strong association between high viral load and incident >/=CIN2; non-16 carcinogenic high viral load was not associated with incident >/=CIN2 (OR = 0.7, 95% CI = 0.2-1.9). Single noncarcinogenic type viral load was not associated with increased risk of prevalent or incident >/=CIN2 (OR = 1.2 and 1.1, respectively). In conclusion, carcinogenic high viral load was associated with prevalent >/=CIN2; however HPV16 was uniquely associated with incident >/=CIN2. The extent to which these observations can be translated into clinical practice must be rigorously examined in the context of the method of viral load measurement and the type-specific differences observed for incident >/=CIN2.     

Undetected chronic obstructive pulmonary disease and asthma in people over 50 years with persistent cough

Background

Chronic obstructive pulmonary disease (COPD) and asthma are underdiagnosed in primary care.

Aim

To determine how often COPD or asthma are present in middle-aged and older patients who consult their GP for persistent cough.

Design of study

A cross-sectional study in 353 patients older than 50 years, visiting their GP for persistent cough and not known to have COPD or asthma.

Setting

General practice in the Netherlands.

Method

All participants underwent extensive diagnostic work-up, including symptoms, signs, spirometry, and body plethysmography. All results were studied by an expert panel to diagnose or exclude COPD and/or asthma. The reproducibility of the panel diagnosis was assessed by calculation of Cohen''s κ statistic in a sample of 41 participants.

Results

Of the 353 participants, 102 (29%, 95% confidence interval [CI] = 24 to 34%) were diagnosed with COPD. In 14 of these 102 participants, both COPD and asthma were diagnosed (4%, 95% CI = 2 to 7%). Asthma (without COPD) was diagnosed in 23 (7%, 95% CI = 4 to 10%) participants. Mean duration of cough was 93 days (median 40 days). The reproducibility of the expert panel was good (Cohen''s κ = 0.90).

Conclusion

In patients aged over 50 years who consult their GP for persistent cough, undetected COPD or asthma is frequently present.     

心梗后患者12周康复锻炼后一次递增负荷运动中VO2、HR、%HRmax、RPP、ST、RPE变化及其相互关系

目的:探讨12周运动心脏康复锻炼对心梗后患者(PMI患者)心脏机能的影响。方法:112名男性PMI患者(均进行了12周运动心脏康复锻炼)进行一次递增负荷运动实验(Ⅰ、Ⅱ、Ⅲ、Ⅳ、Ⅴ级负荷跑速分别为1.7、1.7、1.7、2.5、3.5mph;坡度分别为0.5 %、10 %、12 %、14 %,每一级负荷运动3分钟) ,其间记录每级负荷时的VO2、HR、血压和自我用力感觉(RPE) ,计算心率血压乘积(RPP) ,并持续监测12导联心电图(ECG) ,然后对上述指标进行相关分析并建立了用HR和RPE推测VO2和RPP的回归方程。结果:(1)相邻两级负荷间的VO2、HR、RPP、RPE具有显著差异(P<0.01) ;(2)VO2、HR、最大心率百分数( %HRmax)、RPP、ST段水平(ST)和RPE的峰值分别为26.4±7.1ml·kg-1·min-1、126.8±20.3beats·min-1、80.4±12.9 %、209.0±46.3beats·mmHg·100-1、-1.0±0.7mm和14.9±2.1;(3)运动中VO2、HR、%HRmax、RPP、RPE呈高度正相关,它们与ST呈高度负相关(P<0.01或P<0.05) ,建立了用HR和RPE推测VO2和RPP的回归方程。结论:(1)康复锻炼后利用改良Bruce跑台方案进行机能测试有效;(2)12周康复锻炼后,PMI患者进行运动时其强度不宜超过80 %HRmax或RPE不超过15 ;(3)利用本研究建立的预测方程,可在PMI患者康复活动中,根据其心率或RPE变化间接得知其呼吸循环机能的反应和心肌的耗氧状况。