The effect of clinical interventions on the oral health-related quality of life in older adults.

This paper reviews the literature to assess the effectiveness of oral health interventions in influencing oral health-related quality of life (OHRQoL) in older adults. Clinical studies published in 2010 onwards reporting oral health interventions in older adults and subsequent changes in OHRQoL were systematically searched in Medline, Web of Science and EMBASE databases. Reporting followed Preferred Reporting Items for Systematic Review and Meta-Analysis criteria. Eligibility evaluation and data abstraction from eligible studies were guided by predefined PICO questions and bias assessment by the Quality in Prognosis Studies tool. The search retrieved 144 articles. Of the 20 articles that met the eligibility criteria, 45% (9) reported a statistically significant improvement in OHRQoL. The majority of studies were conducted in adults with complete edentulism (70%) and mainly focused on implant provision to support a removable prosthesis (30%). The search indicates the limited scope of current literature on geriatric dental interventions, focusing mainly on denture realignments, denture fabrication and implant placement. Although the majority of the oral health interventions focused on edentulism and removable prostheses, there are many areas of oral health interventions and their potential impact on OHRQoL in this demographic group that have yet to be explored. © 2022 Australian Dental Association.

Different roles for the Fc epsilon RI gamma chain as a function of the receptor context.

The high affinity immunoglobulin E receptor (Fc epsilon RI) and the B and T cell antigen receptors (TCR) are multimeric complexes containing subunits with cytoplasmic antigen recognition activation motifs (ARAMs). The presence of multiple motifs may be a way to amplify a single signal or provide independent activation modules. Here we have compared the signaling capacity of the same Fc epsilon RI gamma motif in the context of two different receptors, Fc epsilon RI and TCR/CD3, simultaneously reconstituted on the surface of the same zeta-deficient T cell line. Both reconstituted receptors mediate early (phosphorylation) and late (interleukin [IL]-2 release) signals. Mutation of the two tyrosine residues of ARAM gamma alters early signaling by both receptors, but the set of substrates phosphorylated via ARAM gamma is different for each receptor and is thus dependent on the receptor context. Furthermore, the mutations prevent Fc epsilon RI- but not TCR/CD3-mediated IL-2 release. These data demonstrate that ARAM gamma is necessary for allowing both receptors to phosphorylate the complete set of substrates, and that the CD3 complex, unlike the Fc epsilon RI beta chain, contains activation modules capable of compensating for the absence of a functional ARAM gamma in generating late signals such as IL-2 release.

Time series analysis of ambient air-temperature during the period 1970-2016 over Sydney, Australia.

Providing evidence of potential changes in the climate has become increasingly important as it is the first step towards adopting mitigation and adaptation measures and planning for urban resilience. In this study a statistical analysis of the ambient air temperature time series over Sydney, Australia during 1970-2016 has been carried out with the aim to investigate potential changes towards higher temperatures. The dataset has been statistically analyzed using different techniques, concluding that the investigation should be performed on a monthly basis. A persistence analysis was conducted using different statistical approaches to investigate the dependence between consecutive monthly and daily ambient air temperature values. A trend analysis of the ambient air temperature and degree days time series has been conducted using linear regression to estimate the linear trend (slope) and its statistical significance (using a Student-t-test) and the Kendall-Mann test to identify the time at which the tendency starts to occur as well as the time after which it becomes statistically significant.

[Investigation on health status of silica exposed workers in "cotto Fiorentino" companies]. / Indagine sullo stato di salute degli esposti a silice nelle aziende del cotto Fiorentino.

The manufactured in "cotto" is typical of Chianti Fiorentino with about 400 employees. In 2005. the UF PISLL encountered an exposure to silica more than TLV, particularly for some tasks; were prescribed interventions of prevention and was undertaken an investigation of the occupational health status with occupational health physician. We observed 227 workers, 208 males and 19 females, with average age of 43 years and average age working of 15 years. The habit of smoking tobacco was higher than for the general population. The assessment of exposure to silica has been detected for 59 workers (mean 0.05 mg / mc); at pulmonary function testing resulted: 10 with airway obstruction and 4 airflow limitation; by 140 chest X - ray acquired 1 was interstitial pulmonary disease and 1 was bronchopneumonia. Among the diseases not related to exposure to silica, emerging 42 cases of low back pain, 28 hearing loss, 7 with hypertension. Non uniformity in health surveillance and diagnostic criteria highlights the need to cooperate between occupational doctor in public prevention and control service and qualified occupational doctor to ensure a standard of quality in the prevention of disease in exposed to silica.

Effects of cadmium on lymphocyte activation.

The effects of cadmium (Cd) on phytohemoagglutinin or phorbol myristate acetate-induced lymphocyte activation were investigated and a dose-dependent inhibition of cell proliferation was found. Kinetic studies revealed that the Cd-sensitive step is an early event of T cell stimulation. Failure of IL2 secretion and reduction of IL2 receptor expression in the Cd-treated cells are also reported. Regardless of which mechanism is responsible for Cd effects, our studies show that the inhibition of lymphocyte activation is associated with reduced [3H]phorbol dibutyrate binding to Ca2+-phospholipid-dependent protein kinase and altered breakdown of phosphatidylinositols. Thus, Cd interferes with two biochemical events which play a critical role in lymphocyte signal transduction and activation.

Health risks from acid rain: a Canadian perspective.

Acidic deposition, commonly referred to as acid rain, is causing serious environmental damage in eastern Canada. The revenues from forest products, tourism and sport fishing are estimated to account for about 8% of the gross national product. The impact on human health is not as clearcut and a multi-department program on the Long-Range Transport of Airborne Pollutants (LRTAP) was approved by the federal government in June 1980. The objectives of the LRTAP program are to reduce wet sulfate deposition to less than 20 kg/ha per year in order to protect moderately sensitive areas. This will require a 50% reduction in Canadian SO2 emissions east of the Saskatchewan/Manitoba border and concomitant reductions in the eastern U.S.A. The objectives of the health sector of the program are to assess the risk to health posed by airborne pollutants which are subjected to long-range transport and to monitor the influence of abatement programs. Two major epidemiology studies were undertaken in 1983, one in which the health effects related to acute exposure to transported air pollutants were studied in asthmatic and nonasthmatic children, and another in which the effects of chronic exposure to these pollutants were studied in school children living in towns with high and low levels of pollutants. Preliminary analysis of the data do not indicate major health effects, but definitive conclusions must await final analysis. Studies on the indirect effects of acid deposition on water quality have shown that acidified lake water left standing in the plumbing system can adversely affect water quality and that federally set guidelines for copper and lead are exceeded. Flushing of the system before using the water rectifies the situation. Additional studies are planned to further delineate the magnitude of the health effects of acidified lake water.

B non-Hodgkin's lymphoma in a haemophilia patient with idiopathic CD4+ T-lymphocytopenia.

We report here a case of an HIV-uninfected, anti-hepatitis C virus (HCV) positive haemophiliac, who was transfused with blood and intermediate purity factor VIII concentrates. Since 1988, a progressive decline in the CD4+ T-cell count was recorded, and in 1993 a B-cell non-Hodgkin's lymphoma (B-NHL) was diagnosed. The morphological appearance of the tumor with features of intermediate/mantle zone lymphoma, and the absence of EBV sequences within the tumor, ruled out the occurrence of a typical "opportunistic" lymphoma. However it is possible that the blood product therapy and its infectious complications may have played a role on immune function impairment.

Idiopathic thrombocytopenic purpura treated with steroid therapy does not prevent acute myocardial infarction: a case report.

We report the case of a 65-year-old man affected by idiopathic thrombocytopenic purpura, who developed an acute myocardial infarction after 2 years of steroid therapy. Thrombocytopenia was initially recognized 11 years earlier, and became severe during the past 2 years [platelets (PLTS) 10000-30000/microl]. He was treated with steroids, initially to perform a surgical procedure (prednisone 75 mg/day), subsequently to maintain a platelet count of about 50000/microl (prednisone 12.5 mg/day). After 1 year of treatment, he began to complain about exertional angina and dyspnea. His blood pressure became elevated and cholesterol level raised. The exercise electrocardiogram, previously manifesting ischaemic changes, normalized after 1 month of steroid wash-out; however, steroid therapy was reinstituted (prednisone 5 mg per day). One year later, he suffered an infero-lateral non-Q-wave myocardial infarction. It seems likely that the severe coronary atherosclerosis present in our patient developed despite a low platelet count, under the spur of a heavier risk factor profile. Steroid therapy could have had a role as a precipitating agent of the acute event, and the opportunity of alternative treatments is considered.

Intrahepatic vascular shunting for portal hypertension: early experience with the transjugular intrahepatic porto-systemic shunt.

The treatment of patients with portal hypertension and hemorrhaging varices remains an enigma within the surgeon's world. Many procedures have been described, which suggests that no general consensus exists regarding the proper care for these individuals. Also, these procedures usually lead to massive blood use and exposure to patients who have had multiple blood transfusions, thus posing an extreme infectious risk to the surgical team. Eight patients refractory to repeated esophageal sclerotherapy with advanced portal hypertension underwent the transjugular intrahepatic portosystemic shunt (TIPS) procedure. One other patient with altered anatomy underwent transjugular porto-caval shunt (TPCS) procedure via the caudate lobe of the liver. All procedures were successful in stopping esophageal hemorrhage within 6 hours of shunting. The portal-hepatic vein pressure gradient pre-shunt averaged 20 mm Hg, and post-shunt averaged 11 mm Hg. Two patients developed encephalopathy, which was controlled with medication and/or diet modifications. Three patients classified as Child's C-plus died within 1 week of their shunting procedure, and one patient, who had received greater than 60 units of blood, within 10 days pre-shunt, died 45 days post-shunt of multi-system organ failure. Four of the original nine patients are now classified as Child's A with active lives, eligible for transplantation without altered abdominal anatomy. The follow-up period is from 5 to 11 months. TIPS and TPCS are methods that should be considered the front-line invasive management techniques for patients with portal hypertension who have failed esophageal sclerotherapy.

Splenomegaly as the first manifestation of thyroid cancer metastases.

We report the case of a 65-year-old man who developed a symptomatic splenomegaly due to spleen metastasis from thyroid follicular carcinoma. In 1982, at the age of 53, the patient had undergone a thyroid lobectomy for a cold node, followed one year later by a second intervention for a microfollicular adenoma. He was subsequently administered thyroid suppressive therapy with no further follow-up. The diagnosis of spleen metastases from thyroid cancer was first suspected on the basis of history, high serum thyroglobulin (Tg) levels, and the presence of pulmonary 99Tc uptake. The patient underwent a splenectomy, during which vast infiltration involving the diaphragm, spleen, stomach, colon and pancreas, was found. Histological and immunohistochemical results showed that the spleen and diaphragm metastases derived from thyroid follicular carcinoma. Radioiodine uptake by the pulmonary metastases confirmed the thyroid source. Retrospective re-evaluation of the thyroid tissue removed in 1983 revealed a histological pattern consistent with follicular carcinoma, which could not be unequivocally attributed to the widely or minimally invasive form. To our knowledge this is the first report of splenomegaly as the first manifestation of thyroid cancer metastases. In this paper cases of splenomegaly due to metastatic spread are reviewed and the management of the present case is discussed.

Effects of glycosaminoglycans and protamine chloridrate on platelet aggregation induced by collagen and thrombin.

The effects of heparin (HE), dermatan sulfate (DS), heparan sulfate (HS) and protamine chloridrate (PC) on platelet aggregation were studied. Both PC and the three glycosaminoglycans (GAGs) did not influence collagen-induced platelet aggregation. In contrast, all the tested GAGs blocked thrombin-induced platelet aggregation. HE and HS were equivalent and very effective, while DS was also but to a lesser extent. This could be because HE and HS act via both antithrombin III and heparin-cofactor II, whereas DS exerts its action on the latter only. PC, too, inhibited, in a dose-dependent fashion, thrombin-induced platelet aggregation, probably by competing with the thrombin affinity binding sites on the platelet surface. When the GAGs were tested together with PC, HE was shown to be the most effective: on a weight-for-weight basis, an identical amount of PC was unable to counteract the inhibitory effect of HE, while it partially reversed those of DS and HS. A full reversal of the inhibitory effect of DS and HS was never observed, in spite of adding increasing amounts of PC. It seems likely that plasma components may preserve the bindings of such GAGs with their cofactors.

Interaction between histidine-rich glycoprotein and platelet factor 4 with dermatan sulfate and low-molecular-weight dermatan sulfate.

There is a controversy about whether or not histidine-rich glycoprotein (HRG), the most abundant plasma protein with glycosaminoglycans-neutralizing capacity, is able to prevent the inhibition of human thrombin by heparin cofactor II (HC II) in the presence of dermatan sulfate (DS). The authors studied the interaction of DS and low molecular weight DS, in a purified system with HRG, platelet factor 4 (PF 4), and with HC II. Their results show that HRG, like PF 4, has an affinity, not only for heparin, but also for DS. However, this affinity seems very weak. In fact, HRG is 10 times less effective than PF 4 in neutralizing the 50% antithrombin activity of HC II in the presence of DS.

Blood pressure measurement in haemodialysis patients.

Several studies suggest that the 24 hour ambulatory blood pressure monitoring (ABPM) predicts left ventricular hypertrophy more accurately than conventional blood pressure measurement (CBPM) with mercury sphygmomanometer. We estimated the left ventricular mass by M-mode echocardiography in 58 patients on regular haemodialysis treatment during the midweek haemodialysis (HD) interval. ABPM was recorded during the 24 hours preceding the dialysis session and the average of values were compared with the average of the 13 pre HD CBPM recorded by nurses during the month preceding the echocardiography study. The two types of BP measurements correlated significantly with each other, (systolic BP r = 0.62; p < 0.001 and diastolic BP r = 0.74; p < 0.001). The correlation of left ventricular mass with pre-HD systolic BP was stronger (r = 0.54; p < 0.001) than with 24h-systolic BP (r = 0.33; p < 0.01). The overall accuracy of prediction was also similar (68% for pre HD-CBPM; 67% for 24h-ABPM). Measurements of diastolic BP did not correlate significantly with LVM. Our data suggest that 24h-ABPM does not offer any advantage over pre HD-CBPM in predicting left ventricular hypertrophy in HD patients.

[Proposal for using mechanical staplers with Polysorb in creation of orthotopic neobladder]. / Proposta di utilizzo delle suturatrici meccaniche con caricatore Polisorb nel confezionamento delle neovesciche ortotopiche.

After radical cysto-prostatectomy the bladder substitute is made from an ileal segment, opened along its antimesenteric border and folded; the results are in general good. The success of this procedure demands attention to detail, hemostasis and gentle handling of tissue so this surgery depends an unusual degree of commitment to meticulous technique. The very low rate complications, obtained with mechanical sutures in gastrointestinal surgery, incited the Authors using the staplers GIA and TA Polysorb for detubularized ileal segment. They are very manageable, easy to use and the follow-up shows the absence of urinary stone; so the team approach is less tedious and strenuous. The Authors present their results of 11 neobladder-staplers made with 35 cm of detubularized ileal segment without folding.

[Normalization of the prolactin values during alfa-interferon therapy: the considerations with a female patient with anti-HCV-positive chronic hepatitis and prolactin-secreting hypophyseal microadenoma]. / Normalizzazione dei valori di prolattina in corso di terapia con alfa-interferon: considerazioni su una paziente affetta da epatite cronica anti-HCV positiva e microadenoma ipofisario prolattino-secernente.

We report the case of a 45-year-old woman suffering from anti-hepatitis C virus (HCV) positive chronic active hepatitis and amenorrhea-galactorrhea syndrome due to a prolactin-secreting pituitary microadenoma. She was repeatedly given alpha-interferon for hepatitis, and a concomitant normalization of plasma prolactin levels, with disappearance of the related symptoms, was observed during the treatment. Further experience is needed in order to verify the therapeutical effectiveness of alpha-interferon on prolactin-secreting tumors.

[The use of bipolar PlasmaKinetic resectoscope in endoscopic resection of the prostate: our experience].

Prostatic endoscopic resection (TURP) is a reference method in the treatment of prostatic obstruction. In the past decades, the method used a monopolar resectoscope. In the last years, various technologies have been studied to improve the efficacy of endoscopic resection. As per our experience, we have thence ascertained the variations of the hematic crasis and of the mictional asset in TURP patients treated with bipolar knives. 20 patients underwent bipolar plasmakinetic resection of the prostate. Their age ranged between 58 yrs and 82 yrs (av.: 70.2 yrs), the adenoma volume, checked with TR ultrasound scanning, was between 33 and 44 cc (av.: 37.6), the Qmax was between 6.4 and 9.0 mL/min (av.: 7.42 mL/min). A 24Ch resectoscope and spinal anesthesia were used. Bleeding during resection was never relevant; therefore resection never had to be stopped. After about 36 hours from surgery, the patients' sanguification was checked again: a 6.53% reduction of the number of erythrocytes, compared to pre-surgery data, was observed, together with a 6.73% decrease of hemoglobin concentration, and a 6.3% decrease of hematocrit. Continuous irrigation was suspended during the first day, catheter was removed on the 48th hour in 15 cases, and on the 72nd in 5 cases: the patients were discharged on day 3 in 16 cases, and on day 4 in 4 cases. A flux evaluation was performed after 3 months, which showed a Qmax between 16.6 and 24 mL/min (av.: 19.11), with a significant increase in the maximum flow rate. The use of the new technologies in prostatic endoscopic resection has allowed us to improve the efficacy of such a method. Above all, the use of a bipolar electrosurgical knife enables us to associate a basal hemostasis with the resection of the prostatic tissue. Thus, the hematic loss is low, as we have been able to ascertain also in our own experience. This gave us the possibility to quickly stop continuous irrigation and to early remove the catheter. This way, hospitalization was sensibly reduced (av. 76.8 hours). The maximum flow rate, in the short term, has been good. We have been able, in our experience, to assess that this technology represents a useful guarantee to improve the results of prostatic endoscopic resection.