Peak expiratory flow as a predictor of subsequent disability and death in community-living older persons

OBJECTIVES: To determine whether peak expiratory flow (PEF), when expressed by a validated method using standardized residual (SR) percentile, is associated with subsequent disability and death in older persons.
DESIGN: Prospective cohort study.
SETTING: New Haven, Connecticut.
PARTICIPANTS: Seven hundred fifty-four initially nondisabled, community-living persons aged 70 and older.
MEASUREMENTS: PEF was assessed at baseline along with chronic conditions and smoking history. The onset of persistent disability in activities of daily living (ADLs), continuous mobility disability, and death were ascertained during monthly interviews over a 5-year period.
RESULTS: Participants' mean age was 78.4, 63.7% had a smoking history, and 17.4% reported chronic lung disease. The incidence rates per 100 person-months were 1.00 (95% confidence interval (CI)=0.90–1.12) for ADL disability, 0.80 (95% CI=0.70–0.93) for mobility disability, and 0.44 (95% CI=0.38–0.51) for death. At a PEF less than 10^th SR percentile, identifying nearly one-quarter of the cohort, hazard ratios (HRs) adjusted for multiple confounders, including age, smoking, and chronic lung disease, demonstrated a greater risk of ADL disability (HR=1.79, 95% CI=1.23–2.62), mobility disability (HR=1.89, 95% CI=1.15–3.10), and death (HR=2.31, 95% CI=1.29–4.12).
CONCLUSION: In an elderly cohort, it was found that low PEF, when expressed as an SR percentile, is independently associated with subsequent disability and death. These results support the use of PEF as a potentially valuable risk assessment tool in community-living older persons.     

Nelson's Syndrome: a case report

The aim of this article is to present and discuss several aspects of the pathogenesis, the clinical, hormonal, and imaging diagnosis, and the treatment of Nelson's syndrome, based on a typical patient's report, in whom several therapeutic approaches were shown to be ineffective.     

THE COMPATIBILITY OF DENTURE CLEANSERS AND RESILIENT LINERS

Purpose:

Difficulty in cleaning resilient denture liners remains a material disadvantage. The purpose of the present study was to evaluate the effect of denture cleansers on hardness of resilient liner materials.

Materials and Methods:

Three resilient liners, Luci Sof^® (Dentsply), Molloplast-B^® (Dentax), and Sofreliner^® (Tokuyama), and two denture cleansers, Efferdent^® (Warner-Lamber), and 0.5% alkaline hypochlorite preparation were used. Twenty specimens of each material were prepared, measuring 25X15X3mm. Two denture cleansing approaches were used: 1) alkaline hypochlorite, for 20 minutes; 2) alkaline peroxide, for 30 minutes. This procedure was repeated 8 times a day, during 90 days. The specimens were evaluated before and after 360 and 720 cycles, to simulate 1 and 2 years of clinical cleaning procedures, respectively. The Shore A hardness was evaluated in a durometer (Teclock GS-709A), with a penetrating load of 10N for 1 second. Any macroscopic changes, such as loss of color or alteration in surface texture were recorded by one observer. All numeric data were subject to ANOVA with repeated measures followed by Tukey''s test (α= 0.05).

Results:

All materials were significantly different, independently to time and treatment. Initially, Luci Sof^® and Sofreliner^® immersed in either hypochlorite or peroxide increased the hardness mean values significantly. These hardness mean values decreased significantly after 720 cycles. Molloplast-B^® showed no significant difference after the treatments, in any time.

Conclusions:

Denture cleansers had no effect on hardness of the resilient denture liners evaluated after 2 years of in vivo simulated conditions of hygiene. Sofreliner^® was the smoothest material before and after all treatments.     

Association of adrenergic receptor gene polymorphisms with different fibromyalgia syndrome domains

Objective

Fibromyalgia (FM) patients have signs of relentless sympathetic hyperactivity associated with hyporeactivity to stress. Adrenergic receptors (ARs) are parts of the sympathetic nervous system that are fundamental for maintenance of homeostasis. We undertook this study to correlate α‐AR and β‐AR gene polymorphisms with the presence of FM and with different domains of the FM syndrome as measured by the Fibromyalgia Impact Questionnaire (FIQ).

Methods

We studied 78 Mexican FM patients and 48 age‐matched controls as well as 78 Spanish FM patients and 71 controls. All subjects studied were women. Single‐nucleotide polymorphisms (SNPs) of α_1A‐AR (rs574584, rs1383914, rs1048101, and rs573542), β₂‐AR (rs1042713 and rs1042714), and β₃‐AR (rs4994) were analyzed by 5′ exonuclease TaqMan polymerase chain reaction. Polymorphic haplotypes were constructed after linkage disequilibrium analysis.

Results

The β₂‐AR AC haplotype was a risk factor for the presence of FM. This haplotype had an increased frequency in Mexican patients compared with Mexican controls (42.1% versus 30.5%; P = 0.04). Similarly, 50.4% of Spanish patients had this haplotype compared with 40.0% of Spanish controls (P = 0.05). In Spanish patients, the α_1A‐AR SNP rs1383914 was associated with the presence of FM (P = 0.01), and the α_1A‐AR SNP rs1048101 was linked with FIQ disability (P = 0.02). Mexican patients with the rs574584 GG genotype presented the highest FIQ score compared with Mexican patients with other genotypes (P = 0.01), and in Mexicans SNP rs574584 was associated with FIQ morning stiffness (P = 0.04) and with FIQ tiredness upon awakening (P = 0.02).

Conclusion

AR gene polymorphisms are related to the risk of developing FM and are also linked to different domains of the FM syndrome.

     

Expression profiles of the glucose-dependent insulinotropic peptide receptor and LHCGR in sporadic adrenocortical tumors

Glucose-dependent insulinotropic peptide receptor (GIPR) and LHCGR are G-protein-coupled receptors with a wide tissue expression pattern. Aberrant expression of these receptors has rarely been demonstrated in adult sporadic adrenocortical tumors with a lack of data on pediatric tumors. We quantified the GIPR and LHCGR expression in a large cohort of 55 patients (25 children and 30 adults) with functioning and non-functioning sporadic adrenocortical tumors. Thirty-eight tumors were classified as adenomas whereas 17 were carcinomas. GIPR and LHCGR expression were analyzed by real-time PCR and normal human pancreatic and testicular tissue samples were used as positive controls. Mean expression values were determined by fold increase in comparison with a normal adrenal pool. GIPR mRNA levels were significantly higher in adrenocortical carcinomas than in adenomas from both pediatric and adult groups. LHCGR expression was similar in both carcinomas and adenomas from the pediatric group but significantly lower in carcinomas than in adenomas from the adult group (median 0.06 and 2.3 respectively, P<0.001). GIPR was detected by immunohistochemistry in both pediatric and adult tumors. Staining and real-time PCR results correlated positively only when GIPR mRNA levels were increased at least two-fold in comparison with normal adrenal expression levels. In conclusion, GIPR overexpression was observed in pediatric and adult adrenocortical tumors and very low levels of LHCGR expression were found in all adult adrenocortical carcinomas.     

No association found between the insertion/deletion of a 287-bp alu repeat sequence within intron 16 of the angiotensin-I-converting enzyme (ACE) gene in Mexican patients and binary restenosis after coronary stenting

BACKGROUND: It has been suggested that the incidence of coronary restenosis after a percutaneous coronary intervention is much higher in patients with a 287-bp alu repeat sequence within intron 16 of the angiotensin-I-converting enzyme (ACE) gene (deletion allele) than in others, but published studies are conflicting. METHODS: The presence (insertion) or absence (deletion) of a 287-bp alu repeat sequence within intron 16 of the ACE gene (I/D polymorphism) was analyzed by polymerase chain reaction in a group of 168 patients with coronary artery disease who underwent coronary artery stenting. Basal and procedure coronary angiographies were analyzed searching for angiographic predictors of restenosis and follow-up angiography was analyzed looking for binary restenosis. RESULTS: Distribution of angiotensin converting enzyme I/D polymorphisms was similar in patients with and without restenosis. Similar results were observed when the analysis was made considering the type of stent implanted. On the other hand, the whole group of coronary artery disease patients showed increased frequencies of the D allele (p=0.00001, OR=2.17, 95% CI=1.49-3.16) and ID genotype (p=0.0002, OR=2.58, 95%CI=1.49-4.47) when compared to healthy controls. CONCLUSIONS: Genetic variations of the ACE gene could be a genetic factor related to coronary artery disease in the Mexican mixed racial ancestry individuals, but do not support its role as a risk factor for developing restenosis after coronary stenting.     

p38 Mitogen-Activated Protein Kinase Regulates Myelination

Most neurodegenerative disorders are characterised by deposits of aggregated proteins that are readily visualised by light microscopy. Although the presence of such a bulky structure inside the cell or in the extracellular space is likely not to be healthy, over recent years the idea has emerged that these end-stage aggregates are a relatively safe way to deposit harmful aberrant proteins. Protein quality control is a multi-level security system to safeguard cells from aberrant proteins and is therefore a protective response. However, protein quality control may turn destructive in case of impairment of protein quality control for example by aging or because of overflow of the quality control systems due to prolonged exposure. In many cases the medicine is worse than the cause and the “protective” response of the cell to aggregates kills the cell, rather than the aggregate itself. Here we review the role of protein quality control in neurodegeneration and aim to distinguish protective and destructive responses to aggregates in order to find targets for therapeutic intervention.     

The immune response in Taenia solium cysticercosis: protection and injury

This article reviews current knowledge on the innate and acquired immune responses in human Taenia solium neurocysticercosis, highlighting the conditions that appear to be favourable for the survival or destruction of the parasite and for the benefit or injury to its host.