Dental status and mortality in institutionalized elderly people

Background:   Inadequate dentition for mastication is one of the major issues associated with systemic health for institutionalized elderly people, but its prognostic value and related deaths have not been fully examined.
Methods:   Four hundred and three patients aged 65 and older were recruited from nine nursing homes and were prospectively followed up for morbidity and mortality for 5 years in Japan. These patients were classified into three groups according to dental status: patients who had adequate dentition with natural teeth only or natural teeth with partial dentures (Group A); those who were edentulous but wearing full dentures (Group B); and those who had inadequate dentition without dentures (Group C).
Results:   Dental status was strongly related to age, cognitive function and activities of daily living. After allowing for confounding effects, the 2-year risk of mortality among those in Group C was 1.84 times that of Group A (95% confidence interval 1.01–3.36, P  = 0.047). Furthermore, the 5-year mortality rate in Group C was higher than that in Group A, whereas that was not significant with a hazard ratio of 1.30 (0.90–1.88, P  = 0.168). The main causes of death were respiratory infections, which explained 14.1% of all causes of death in Group A, 14.3% in Group B and 18.3% in Group C. Any associations between a specific cause of death and the different dental status did not reach a significant level.
Conclusion:   Inadequate dental status is associated with high overall mortality. Our findings suggest that systemic attention to dental status should be recommended in institutionalized elderly people.     

Linear erosions on Kerckring's folds may be diagnostic of Zollinger-Ellison syndrome

Endoscopy of the upper gastrointestinal tract was performed in eight patients with Zollinger-Ellison syndrome (ZES) and in 20 patients with stomal ulcer (non-ZES). All ZES patients had hypergastrinemia and a positive secretin provocation test. In three ZES patients studied before gastric surgery, edematous or erosive changes were present in the second portion of the duodenum. In the seven ZES patients studied postoperatively, examination revealed erosive changes in the distal portion of the duodenum and/or upper jejunum. These changes were frequently in a line on the uppermost part of Kerckring's folds. In the non-ZES patients, however, endoscopy revealed no erosive change in the distal part of the duodenum. We propose that such linear erosions on Kerckring's folds may be diagnostic of ZES.     

Effects of advanced glycation endproducts on the generation of macrophage-mediated oxidized low-density lipoprotein

Macrophages have a receptor that recognizes advanced glycation endproducts (AGE). In this study, we evaluated the effect of AGEs on the generation of macrophage-mediated oxidized low-density lipoprotein (LDL) by measuring the electrophoretic mobilities and lipid hydroperoxide (LHPO) levels of LDL. In the absence of the macrophage monolayer, the differences of the electrophoretic mobilities or LHPO levels of native (n) LDL did not differ significantly between control (c) bovine serum albumin (BSA) and those with AGE-BSA. In the presence of the macrophage monolayer, however, the difference was significant with higher levels after the incubation with AGE-BSA than with c-BSA. In the case of cLDL and glycated (g) LDL, the electrophoretic mobilities and LHPO levels of LDL after 20 h incubation with AGE-BSA in the presence of the macrophage monolayer were significantly higher than those with c-BSA. There were no significant differences, however between the electrophoretic mobilities and LHPO levels of cLDL and of gLDL. These results suggest that AGEs stimulate the generation of macrophage-mediated oxidized LDL, but do not directly stimulate the oxidative modification of gLDL.     

Restoration of contractile function in isolated cardiomyocytes from failing human hearts by gene transfer of SERCA2a

BACKGROUND: Failing human myocardium is characterized by abnormal relaxation, a deficient sarcoplasmic reticulum (SR) Ca(2+) uptake, and a negative frequency response, which have all been related to a deficiency in the SR Ca(2+) ATPase (SERCA2a) pump. METHODS AND RESULTS: To test the hypothesis that an increase in SERCA2a could improve contractile function in cardiomyocytes, we overexpressed SERCA2a in human ventricular myocytes from 10 patients with end-stage heart failure and examined intracellular Ca(2+) handling and contractile function. Overexpression of SERCA2a resulted in an increase in both protein expression and pump activity and induced a faster contraction velocity (26.7+/-6.7% versus 16.6+/-2.7% shortening per second, P<0.005) and enhanced relaxation velocity (32. 0+/-10.1% versus 15.1+/-2.4%, P<0.005). Diastolic Ca(2+) was decreased in failing cardiomyocytes overexpressing SERCA2a (270+/-26 versus 347+/-30 nmol/L, P<0.005), whereas systolic Ca(2+) was increased (601+/-38 versus 508+/-25 nmol/L, P<0.05). In addition, the frequency response was normalized in cardiomyocytes overexpressing SERCA2a. CONCLUSIONS: These results support the premise that gene-based therapies and targeting of specific pathways in human heart failure may offer a new modality for the treatment of this disease.     

Specific receptors for epidermal growth factor in human bone tumour cells and its effect on synthesis of prostaglandin E2 by cultured osteosarcoma cell line

Using tumour cell lines derived from human bone tumours, specific binding sites for epidermal growth factor (EGF), a potent growth stimulator in many tissues, and its effect on synthesis of prostaglandin (PG) E2, a potent bone-resorbing factor, by cultured osteosarcoma cell line were studied. Three tumour cell lines, one osteosarcoma (HOSO) and two giant cell tumours of the bone (G-1 and G-2), all possessed specific binding sites for 125I-labelled EGF: the apparent dissociation constant was approximately 4-10 X 10(-10) M and the maximal binding capacity was 50 000-80 000 sites/cell. EGF had no mitogenic effect in these cell lines. However, these cell lines did not have specific binding sites for 125I-labelled parathyroid hormone (PTH) or calcitonin. HOSO line produced and secreted PGE2 into medium, while no significant amount of PGE2 was demonstrated in G-1 or G-2 line. EGF significantly stimulated PGE2 production in HOSO line in a dose-dependent manner (0.5-50 ng/ml); its stimulatory effect was completely abolished by indomethacin, an inhibitor of PG biosynthesis. Exogenous PGE1 significantly stimulated cyclic AMP formation in HOSO line, whereas PGF2 alpha, PTH, calcitonin, or EGF had no effect. None of these calcium-regulating hormones affected cyclic AMP generation in either G-1 or G-2 line. These data indicate that human bone tumour cells have specific EGF receptors unrelated to cell growth, and suggest that EGF may be involved in bone resorption through a PGE2-mediated process in human osseous tissues.