An oral health survey of vulnerable older people in Belgium

Objectives

The aim of this study was to gain insight in the oral health of persons aged 65 years or more.

Materials and methods

Data were obtained from 652 vulnerable older persons (≥65) by means of a clinical oral examination. Additional demographic data were gathered including age, gender, residence, and care dependency.

Results

The mean age of the total study sample was 83 (7.7) years and 71 % was female. Nearly 33 % of the sample was living at home with support, and 67 % was residing in nursing homes. The number of occluding pairs was low and the proportion of edentulous people was highest among persons with the highest care dependency. The mean Decay-missing-filled teeth index (DMFT) was 20.3 (9.0). A prosthetic treatment need and inadequate oral hygiene levels were observed in 40 % and more than 60 % of the subjects, respectively. The highest treatment need was observed in the oldest age group and the highest mean dental plaque in older persons with the highest care dependency.

Conclusions

The oral health in frail older people in Belgium is poor. The restorative and prosthetic treatment need is high and oral hygiene levels are problematic. Age, residence, and care dependency seemed to have some influence on oral health parameters.

Clinical significance

In the long term, the most important future challenge of oral health care policies is to identify older adults before they begin to manifest such oral health deterioration. Regular dental visits should be strongly promoted by all (oral) health care workers during the lifespan of all persons including older adults.

     

Extracellular nucleoside diphosphate kinase NM23/NDPK modulates normal hematopoietic differentiation

OBJECTIVE: We previously demonstrated the presence of nucleoside diphosphate kinase NDPK/NM23 in normal human plasma. It also was reported that extracellular NM23 could inhibit differentiation of certain hematopoietic cell lines. We further investigated the extracellular effect of NM23 on hematopoiesis by adding recombinant NM23-H1, NM23-H2, and NM23-H3 proteins to in vitro differentiation assays of normal human hematopoietic progenitors. MATERIALS AND METHODS: To study the effect on the earlier stages of hematopoietic maturation, NM23 was added to serum-free pre-colony-forming unit (pre-CFU) assays starting from immature CD34++CD38- bone marrow cells. Serum-free CFU assays starting from CD34+ CD38+ bone marrow cells were used as a model for terminal hematopoietic differentiation. RESULTS: In pre-CFU assays, none of the NM23 isoforms used significantly changed the expansion of CD34++CD38- cells, nor did NM23 alter the CD34++ CD38- cell lineage commitment. In contrast, terminal differentiation of CD34+CD38+ progenitor cells in CFU assays was significantly altered by addition of NM23 protein. More erythroid burst-forming units and fewer macrophage colonies were observed in cultures containing any of the NM23 isoforms examined. Similar effects were observed using the enzymatically inactive H118N mutant of NM23-H1, strongly suggesting that the observed effect is independent of the nucleoside diphosphate kinase activity of NM23. CONCLUSION: We demonstrated a modulating effect of extracellular NM23 proteins on the terminal stages of normal hematopoietic differentiation. Therefore, the fairly high concentrations of NM23 constitutively present in plasma could have a physiologic role in supporting erythropoiesis and inhibiting excessive macrophage formation.     

Nutzen einer VDD-Defibrillationselektrode zur Aufzeichnung von atrialen Elektrogrammen bei Vorhofflimmern/-flattern

BACKGROUND: Monitoring of atrial signals improves the accuracy in identifying supraventricular tachyarrhythmias to prevent inappropriate therapies in patients with implantable cardioverter-defibrillators (ICD). Since complications due to the additional atrial lead were found in dual chamber ICD systems with 2 leads, we designed a single-pass VDD-lead for use with dual chamber ICDs. PATIENTS AND METHODS: After promising animal experiments in a German multicenter study a prototype VDD lead (single-coil defibrillation electrode with 2 additional fractally coated rings for bipolar sensing in the atrium) was temporarily used in 20 patients. Atrial and ventricular signals were recorded during sinus rhythm, atrial flutter, atrial fibrillation and ventricular tachycardia or ventricular fibrillation. Terminations of ventricular arrhythmias were performed by internal DC shock. RESULTS: The implantation of the electrode was successful in 18 of 20 patients. Mean atrial pacing threshold was 2.45 +/- 0.9 V/0.5 ms, mean atrial impedance was 215 +/- 31 Ohm. Atrial amplitudes were greater during sinus rhythm (2.7 +/- 1.6 mV) than during atrial flutter (1.36 +/- 0.28 mV, p < 0.05) or atrial fibrillation (0.92 +/- 0.29 mV, p < 0.01). During ventricular fibrillation atrial "sinus"-signals had significantly (p < 0.01) lower amplitudes than during sinus rhythm. Mean ventricular sensing was 13.3 +/- 7.9 mV, mean ventricular impedance was 577 +/- 64 Ohm. Defibrillation was successful with 20 J shock. 99.6% of P waves could be detected in sinus rhythm and 85 +/- 9.9% of flutter waves during atrial flutter. During atrial fibrillation 55% of atrial signals could be detected without modification of the signal amplifier. CONCLUSIONS: A new designed VDD dual chamber electrode provides stable detection of atrial and ventricular signals during sinus rhythm and atrial flutter. For reliable detection of atrial fibrillation modifications of the signal amplifier are necessary.     

Honeybee Venom Proteome Profile of Queens and Winter Bees as Determined by a Mass Spectrometric Approach

Venoms of invertebrates contain an enormous diversity of proteins, peptides, and other classes of substances. Insect venoms are characterized by a large interspecific variation resulting in extended lists of venom compounds. The venom composition of several hymenopterans also shows different intraspecific variation. For instance, venom from different honeybee castes, more specifically queens and workers, shows quantitative and qualitative variation, while the environment, like seasonal changes, also proves to be an important factor. The present study aimed at an in-depth analysis of the intraspecific variation in the honeybee venom proteome. In summer workers, the recent list of venom proteins resulted from merging combinatorial peptide ligand library sample pretreatment and targeted tandem mass spectrometry realized with a Fourier transform ion cyclotron resonance mass spectrometer (FT-ICR MS/MS). Now, the same technique was used to determine the venom proteome of queens and winter bees, enabling us to compare it with that of summer bees. In total, 34 putative venom toxins were found, of which two were never described in honeybee venoms before. Venom from winter workers did not contain toxins that were not present in queens or summer workers, while winter worker venom lacked the allergen Api m 12, also known as vitellogenin. Venom from queen bees, on the other hand, was lacking six of the 34 venom toxins compared to worker bees, while it contained two new venom toxins, in particularly serine proteinase stubble and antithrombin-III. Although people are hardly stung by honeybees during winter or by queen bees, these newly identified toxins should be taken into account in the characterization of a putative allergic response against Apis mellifera stings.     

Early smoking is associated with peak bone mass and prevalent fractures in young,healthy men

Smoking is associated with lower areal bone mineral density (aBMD) and higher fracture risk, although most evidence has been derived from studies in elderly subjects. This study investigates smoking habits in relation to areal and volumetric bone parameters and fracture prevalence in young, healthy males at peak bone mass. Healthy male siblings (n = 677) at the age of peak bone mass (25 to 45 years) were recruited in a cross‐sectional population‐based study. Trabecular and cortical bone parameters of the radius and cortical bone parameters of the tibia were assessed using peripheral quantitative computed tomography (pQCT). Areal bone mass was determined using dual energy X‐ray absorptiometry (DXA). Sex steroids and bone markers were determined using immunoassays. Prevalent fractures and smoking habits were assessed using questionnaires. Self‐reported fractures were more prevalent in the current and early smokers than in the never smokers (p < .05), with a fracture prevalence odds ratio for early smokers of 1.96 (95% confidence interval 1.18–3.24) after adjustment for age, weight, educational level, and alcohol use and exclusion of childhood fractures. Current smoking was associated with a larger endosteal circumference (β = 0.027 ± 0.009, p = .016) and a decreased cortical thickness (β = ?0.034 ± 0.01, p = .020) at the tibia. In particular, early smokers (≤16 years) had a high fracture risk and lower areal BMD, together with a lower cortical bone area at the tibia and lower trabecular and cortical bone density at the radius. An interaction between free estradiol and current smoking was observed in statistical models predicting cortical area and thickness (β = 0.29 ± 0.11, p = .01). In conclusion, smoking at a young age is associated with unfavorable bone geometry and density and is associated with increased fracture prevalence, providing arguments for a disturbed acquisition of peak bone mass during puberty by smoking, possibly owing to an interaction with sex steroid action. © 2010 American Society for Bone and Mineral Research     

Ischaemic cardiogenic shock

Cardiogenic shock is an important complication of myocardial infarction/ischaemia with a mortality of approximately 50%. Pivotal to treatment is prompt diagnosis with emergency revascularization, as delaying revascularization for medical stabilization is associated with a significantly higher mortality. Early intubation and ventilation are recommended, together with mechanical circulatory support using intra-aortic balloon counterpulsation. The use of inotropic agents is potentially hazardous as they generally increase myocardial oxygen demand, thereby exacerbating ischaemia. When required, inotropes should be administered as early as possible and reduced/stopped as soon as adequate organ perfusion is restored. The inotrope/vasopressor combination used should be titrated according to the patient’s haemodynamics, guided by clinical examination, echocardiography and cardiac output monitoring. Mechanical complications are increasingly rare in the post-revascularization era; however, they remain potentially lethal. Prompt diagnosis using echocardiography is key, and early discussion with surgical colleagues is required. Although prognosis in cardiogenic shock is poor, our increasing understanding of the immune/inflammatory nature of the condition may result in the development of pharmacological agents which limit the ongoing myocardial/organ damage. This, together with safer and more effective mechanisms of advanced circulatory support may improve outcomes in cardiogenic shock in the future.