The impact of periodontitis on oral health‐related quality of life: a review of the evidence from observational studies

Modern population based oral health management requires a complete understanding of the impact of disease in order to provide efficient and effective oral health care and guidance. Periodontitis is an important cause of tooth loss and has been shown to be associated with a number of systemic conditions. The impact of oral conditions and disorders on quality of life has been extensively studied. However, the impact of periodontitis on quality of life has received less attention. This review summarizes the literature on the impact of periodontitis on oral health‐related quality of life (OHRQoL). Relevant publications were identified after searching the MEDLINE and EMBASE electronic databases. Screening of titles and abstracts and data extraction was conducted. Only observational studies were included in this review. Most of the reviewed studies reported a negative impact of periodontitis on OHRQoL. However, the reporting standards varied across studies. Moreover, most of the studies were conducted in developed countries.     

Caffeine-Containing Energy Drinks: Beginning to Address the Gaps in What We Know

Energy drinks are relatively new to the United States but are the fastest growing segment of the beverage market. Humans have a long history of consuming caffeine in traditional beverages, such as cocoa, coffee, tea, and yerba maté, but 2 workshops held at the Institute of Medicine (http://www.iom.edu/Activities/Nutrition/PotentialHazardsCaffeineSupplements/2013-AUG-05.aspx) and the NIH (http://ods.od.nih.gov/News/EnergyDrinksWorkshop2013.aspx) in 2013 highlighted many critical gaps in understanding the biologic and behavioral effects of the mixtures of caffeine, vitamins, herbs, sugar or other sweeteners, and other ingredients that typify caffeine-containing energy drinks (CCEDs). For example, different surveys over the same 2010–2012 timeframe report discrepant prevalence of CCED use by teenagers, ranging from 10.3% in 13–17 y olds to >30% of those in grades 10 and 12. Understanding of functional interactions between CCED ingredients, drivers of use, and biologic and behavioral effects is limited. The 4 speakers in the Experimental Biology 2014 symposium titled “Energy Drinks: Current Knowledge and Critical Research Gaps” described recent progress by their groups in extending our understanding of prevalence of CCED use, sources of caffeine in the United States, drivers of CCED use, and behavioral correlations and effects of CCEDs, including effects on attractiveness of both alcoholic and non-alcoholic beverages.The rapid growth of caffeine-containing energy drink (CCED) sales (1) and the observed increase in energy drink–associated emergency department visits (2) have drawn the attention of the biomedical and nutrition research communities, as well as many others. The objective of the Experimental Biology 2014 Symposium was to provide research updates addressing some of the critical gaps in our understanding of these products that were highlighted during the more extensive workshops in 2013.The first 2 speakers presented new data on the shifting sources of caffeine in the United States and on the complex picture of caffeine use by young people and minorities and its interaction with environment, sleep, and health.The first presentation, “Caffeine Intake in US Children and Adolescents,” by Dr. Naman Ahluwalia summarized new analyses of recently released data on caffeine consumption in 2–19 y olds from the 2009–2010 NHANES and compared these with other recently published analyses. The latest data from the NHANES 24-h diet recalls show little association of sex or socioeconomic status with prevalence of caffeine consumption in this age range. However, amounts of caffeine intake (total or milligrams per kilogram) increased with age and were significantly lower among non-Hispanic blacks than other major race- or origin-related population subgroups. Dr. Ahluwalia reported that 10% of all 12–19 y olds, or 25% of 12- to 19-y-old caffeine consumers, consumed more than the recommended maximum amounts of caffeine for their age and weight. Looking at dietary sources of caffeine, her analyses find 1.7% of 12–19 y olds consuming CCEDs, whereas Mitchell et al. (3), based on 7-d diaries collected for the Kanter Worldpanel Beverage Consumption survey, report 10.3% of 13–17 y olds consuming CCEDs.Looking at longitudinal trends in dietary sources of caffeine, Dr. Ahluwalia summarized an analysis of NHANES data for 1999–2010 by Branum et al. (4) that finds a significant decrease in the percentage of caffeine that 2–22 y olds are obtaining from sodas and a significant increase in the percentage coming from coffee and CCEDs. The trend toward an increased percentage of caffeine intake coming from CCEDs was significant only for those subgroups aged ≥11 y.Dr. Ahluwalia’s analysis shows that 4.4% of the caffeine consumed by 12–19 y olds was from CCEDs in NHANES 2009–2010. This is slightly more than Branum et al. reported for 12–18 y olds in their analyses of the 1999–2010 NHANES data but less than they reported for 19–22 y olds (10.3% of caffeine from CCEDs). In closing, Dr. Ahluwalia pointed out that the comparison of different epidemiologic studies of CCED use or caffeine intake is challenging due to differences, for example, in the age groupings used and in whether data analyzed are from the whole population or caffeine consumers only.Dr. Michael A. Grandner summarized the epidemiologic associations among race and ethnicity, socioeconomic status, prevalence of sleep insufficiency, and worse health outcomes, including increased risk of cardiovascular disease and mortality, in his presentation on “Disparities in Energy Product Use, Sleep, and Health Outcomes.” For example, he pointed out that short sleep duration is not only associated with hypertension in epidemiologic studies but is a marker for significantly increased risk of incident hypertension, with differences in mean sleep duration apparently mediating the difference between white and black Americans in longitudinal change in diastolic blood pressure (5). Dr. Grandner then asked how social, cultural, and environmental differences might interact with CCED consumption to influence sleep patterns and other health-relevant behaviors. He reported new findings that blacks and whites differ substantially in their attitudes toward sleep, with whites significantly more likely to endorse connections between insufficient sleep and adverse consequences. These data, as well as the association of an overall energy-dense dietary pattern with poverty (perhaps abetted by the applicability of Supplemental Nutrition Assistance Program benefits to CCEDs and other sugar-sweetened beverages), reports that minority communities are exposed to more CCED advertising than white communities, which might lead one to hypothesize higher rates of CCED consumption by blacks and Hispanics than by non-Hispanic whites. The NHANES data that Dr. Ahluwalia reported for 2–19 y olds did not appear to support this hypothesis but instead showed higher rates of caffeine consumption (from all sources) for non-Hispanic whites and Mexican-Americans than for blacks. However, the NHANES data do not include a large enough number of CCED consumers to support meaningful analyses of consumption by population subgroups. An analysis of data on sports and energy drink use from the 2007–2010 National Health Interview Survey reported that prevalence of use of beverages from this substantially larger category was higher among the Hispanic/Latino group than among non-Hispanic blacks, whose prevalence of use was in turn higher than that of non-Hispanic whites. Each of the foregoing analyses has different strengths and weaknesses in its ability to address racial or ethnic differences in CCED use, and each differs from the others in substantial methodologic details, such that it is not possible to directly compare them. Dr. Grandner concluded that, because CCEDs are an emerging phenomenon, there are currently few clear population patterns in their use beyond the consistently higher prevalence of use by adolescents and younger adults.The next 2 presentations took the symposium into experimental data on the behavioral effects of CCEDs.Dr. Jennifer L. Temple presented on the “Physiological, Psychological, and Behavioral Effects of Caffeine in Children and Adolescents.” She summarized data showing that caffeine increased liking for sugar-sweetened, novel-flavored beverages. The change in “liking” was dose dependent (observed at 2 mg/kg caffeine but not at 1 mg/kg), and aspects of responses to the beverages depended on both sex and developmental status (prepubertal vs. postpubertal). Dr. Temple reported that analysis of data from the national Youth Risk Behavior Surveillance System for grades 9–12 showed a strong association of a number of risk behaviors with daily soda consumption. These associations also exhibited sex differences, with several associations (including those for involvement in physical fights and reporting multiple sex partners) stronger for females than males. Given the relatively high prevalence of CCED use by adolescents and young adults, there appears to be a strong need for additional research aimed at better understanding the relations between CCED use, sex, and risk behaviors.Dr. Temple reported on a pilot study exploring factors that might influence CCED-purchasing behavior of 15–25 y olds. In a laboratory-based, model convenience-store setting, increasing the price of CCEDs reduced the number of servings purchased. Consistent with the association of CCED consumption and risk-taking, adding a warning label to the CCEDs increased the number of servings purchased.Dr. Cecile A. Marczinski addressed “Energy Drinks Mixed with Alcohol: What Are the Risks?” in the final talk of the session. As background, Dr. Marczinski summarized recent data on prevalence of use of CCEDs combined with alcoholic beverages [alcohol mixed with energy drinks (AmED)]. According to the 2012 Monitoring the Future study (1), 26% of those in grade 12, 34% of college students, and 37% of young adults reported having used AmED in the past year. This prevalence of use is a concern because of the increasing numbers of emergency department visits associated with consumption of CCEDs either alone or in combination with alcohol (2) and because AmED consumption (compared with consumption of alcohol alone) was also reported to be associated with drinking to higher blood alcohol concentrations, greater risk of intending to drive while intoxicated or riding with an intoxicated driver, and increases in other risk-taking behaviors (6). Dr. Marczinski went on to describe experiments her group performed to begin to understand why AmED consumers may consume more alcohol than those consuming alcohol alone. In these studies, the effect of the CCED on desire to consume more of the beverage appears more pronounced than in the studies of non-alcoholic beverages described by Dr. Temple; clearly bringing alcohol into the mix is likely to bring more, and likely different, signaling mechanisms into play. In randomized, double-blinded studies of college students of both sexes (equal numbers in each experiment), Dr. Marczinski and her colleagues find that, although consuming an alcoholic beverage (without caffeine) increases the rating of desire for more alcohol over ∼40 min, those consuming AmED indicate substantially greater desire for more alcohol than those consuming a control (similarly flavored beverage with the same alcohol content but without added CCEDs) and that the increased desire for alcohol lasts substantially longer in those consuming AmED (6). This effect was dose dependent for the CCED but not for the doses of alcohol tested (equivalent to 2 shots of vodka). Dr. Marczinski hypothesized that the pharmacologic basis for these observations may be modulation of the pharmacologic or other effects of alcohol by the well-known inhibitory effect of caffeine on adenosine signaling in the central nervous system.Many critical gaps in our understanding of CCEDs remain to be addressed. Among these are the contribution of ingredients other than caffeine and sugar to the metabolic, physiologic, and behavioral effects of CCEDs, elucidation of the mechanisms underlying the modulation of alcohol response by CCEDs, and better data on the prevalence of use of CCEDs and on their acute and long-term effects on appetite, metabolism, BMI, alertness, sleep patterns, and cognition.     

Catastrophic antiphospholipid syndrome complicating orthotopic liver transplantation

Catastrophic antiphospholipid syndrome (CAPS) is an acutely devastating situation characterized by widespread thrombotic microangiopathy in the presence of elevated titers of antiphospholipid antibodies. We describe a 57-year old woman who underwent liver transplantation for primary sclerosing cholangitis and developed this malignant variant of the antiphospholipid syndrome.     

Results of a phase I/II trial of recombinant human granulocyte- macrophage colony-stimulating factor in very low birthweight neonates: significant induction of circulatory neutrophils, monocytes, platelets, and bone marrow neutrophils

Neonates, especially those of very low birthweight (VLBW), have an increased risk of nosocomial infections secondary to deficiencies in development. We previously demonstrated that granulocyte-macrophage colony-stimulating factor (GM-CSF) production and mRNA expression from stimulated neonatal mononuclear cells are significantly less than that from adult cells. Recombinant murine GM-CSF administration to neonatal rats has resulted in neutrophilia, increased neutrophil production, and increased survival of pups during experimental Staphylococcus aureus sepsis. In the present study, we sought to determine the safety and biologic response of recombinant human (rhu) GM-CSF in VLBW neonates. Twenty VLBW neonates (500 to 1,500 g), aged < 72 hours, were randomized to receive either placebo (n = 5) or rhuGM-CSF at 5.0 micrograms/kg once per day (n = 5), 5.0 micrograms/kg twice per day (n = 5), or 10 micrograms/kg once per day (n = 5) given via 2-hour intravenous infusion for 7 days. Complete blood counts, differential, and platelet counts were obtained, and tibial bone marrow aspirate was performed on day 8. Neutrophil C3bi receptor expression was measured at 0 and 24 hours. GM-CSF levels were measured by a sandwich enzyme-linked immunosorbent assay at 2, 4, 6, 12, and 24 hours after the first dose of rhuGM-CSF. At all doses, rhuGM-CSF was well tolerated, and there was no evidence of grade III or IV toxicity. Within 48 hours of administration, there was a significant increase in the circulating absolute neutrophil count (ANC) at 5.0 micrograms/kg twice per day and 10.0 micrograms/kg once per day, which continued for at least 24 hours after discontinuation of rhuGM-CSF. When the ANC was normalized for each patient's first ANC, there was a significant increase in the ANC on days 6 and 7 at each dose level. By day 7, all tested doses of rhuGM- CSF resulted in an increase in the absolute monocyte count (AMC) compared with placebo-treated neonates. In those receiving rhuGM-CSF 5.0 micrograms/kg twice per day, there was additionally a significant increase in the day 7 and 8 platelet count. Tibial bone marrow aspirates demonstrated a significant increase in the bone marrow neutrophil storage pool (BM NSP) at 5.0 micrograms/kg twice per day and 10.0 micrograms/kg once per day. Neutrophil C3bi receptor expression was significantly increased 24 hours after the first dose of rhuGM-CSF at 5.0 micrograms/kg once per day. The elimination half-life (T1/2) of rhuGM-CSF was 1.4 +/- 0.8 to 3.9 +/- 2.8 hours.(ABSTRACT TRUNCATED AT 400 WORDS)     

青年人群腰椎骨密度及标准差对骨质疏松检出率的影响：多中心、大样本分析

背景: 不同地区骨峰值和标准差不同，对骨质疏松诊断率有较大影响。探讨建立一完整数据库为中国人骨质疏松诊断准确性提供依据。 目的：探讨青年人腰椎骨密度和标准差正常参考值影响骨质疏松症检出率的程度。 设计、时间及地点：调查分析，于1997-01/1999-12分别在北京、上海、广州、南京、嘉兴和成都市完成。 对象：采用前瞻性及回顾性方法对全国6个中心骨密度参考数据库中11 418人进行调查统计分析；男3 666人，女7 752人；年龄20岁~90岁；分别来自北京(2 385人)、广州(1 178人)、上海(1 404人)、南京(2 938人)、成都(1 425人)、嘉兴(2 088人),受试者来源于社区调查、健康体检和健康志愿者。 方法：用GE-Lunar公司的DXA仪测量骨密度，调查全国6个中心11 418人L2~L4腰椎后前位和髋部骨密度，建立了骨密度参考数据库。6个中心的仪器内部精度0.3%~0.7%，仪器间的精度1.1%。 主要观察指标：①6个中心不同年龄组腰椎骨密度分布。②青年人群骨密度及其标准差值对骨质疏松症检出率的影响。 结果：中国汉族女性以腰椎进行骨质疏松症诊断的青年人群的骨密度和标准差值，6个中心，最大差值分别为0.098 g/cm2和0.027 g/cm2。用6个中心及总体各自的青年人平均骨密度和标准差值为参考标准，对同一人群计算T-score和获得的骨质疏松症检出率不相同；发现青年人平均骨密度每变化0.01 g/cm2，则骨质疏松症检出率变化1.6%(呈正相关)，其标准差值每变化 0.01 g/cm2，则骨质疏松症检出率变化4%(呈负相关)。 结论：青年人平均骨密度和标准差值不同引起骨质疏松症检出率也不相同。为了让不同中心的骨质疏松症检出率有可比性,建议同一个类型的骨密度仪,同一个种族,同一个地区用一个设计较完善大样本的参考数据库,以其青年人正常参考值计算T-score。