[Dynamic changes of oral candida infection and immune status of 46 HIV/AIDS patients during the first year of highly active antiretroviral therapy].

PURPOSE: To monitor oral candida infection and immune status of HIV/AIDS patients during the first year of highly active antiretroviral therapy (HAART), and to explore the relationship between oral candida infection and immune status. METHODS: A total of 46 HIV/AIDS patients were followed up. At baseline, 3, 6 and 12 months after HAART, CD4+T lymphocytes were measured, oral examinations of patients were carried out and the occurrence of oral candidiasis was recorded. Oral rinses were collected, and Sabourd's dextrose agar and CHROMagar candida medium were used to culture and identify oral candida. Statistical analysis was performed by SPSS 25.0 software package. RESULTS: The counts of CD4+T lymphocytes in HIV/AIDS patients at 3, 6 and 12 months after HAART were (327.91±138.82), (329.65±142.66) and (319.98±97.90) cells/mm3, respectively, which were significantly higher than CD4+T lymphocytes(263.39±126.01) at baseline(P<0.05). The prevalence of oral candidiasis at 3, 6 and 12 months after HAART was 26.09%, 21.74% and 23.91%, respectively, which was significantly lower than that(52.17%) at baseline（P<0.05）. The prevalence of oral candidiasis in patients with CD4+T lymphocyte <200 cells/mm3 was significantly higher than that in patients with CD4+T lymphocyte ≥200 cells/mm3（P<0.05）. CONCLUSIONS: HAART can increase CD4+T lymphocytes, reconstruct the immunity of patients and reduce the incidence of oral candidiasis, but the incidence of oral candidiasis significantly increased in patients with CD4+T lymphocyte <200 cells/mm3 .

The effect of home visits on healthcare resource utilisation.

BACKGROUND AND OBJECTIVES: Home visits may change patients' healthcare resource utilisation, including hospital admission, medications, outpatient and emergency room visits. The aim of the present study was to report changes in healthcare resource utilisation after the provision of home healthcare services. METHOD: This was a multicentre follow-up study. Data on health and functional statuses were collected during home visits. Electronic medical records of 12 medical institutions were retrieved (outpatient visits, emergency care use, hospital admissions and prescription medications). The researchers analysed healthcare utilisation and medications before and after enrolment. RESULTS: There were 246 participants. The mean age was 85.5 years (52% men). There was an increase in annual outpatient visits and a decrease in hospital admission days after enrolment (13.7-15.3 visits/year and 17.5-15 days/year, respectively). The number of medical institutions visited increased, but specialties and doctors visited decreased. Oral medications also increased (3.3-4.3 types). DISCUSSION: Home visits help decrease days of hospital admission, but not medications or outpatient or emergency room visits.

Sarcopenia Screened With SARC-F Questionnaire Is Associated With Quality of Life and 4-Year Mortality.

OBJECTIVES: There is no gold standard in diagnosing sarcopenia. We aimed to assess the validity of screening sarcopenia using SARC-F (sluggishness, assistance in walking, rise from a chair, climb stairs, falls). DESIGN: Prospective cohort study. SETTING: Community hospital in Taiwan. PARTICIPANTS: Community-dwelling senior citizens. MEASUREMENTS: Participants were interviewed with a structured questionnaire annually. The questionnaire items were recoded into the 5 items of SARC-F (sluggishness, assistance in walking, rise from a chair, climb stairs, falls). In the baseline year, a subgroup was tested for grip strength and body composition. Healthcare utilization and mortality were based on self-report and hospital records. Our main outcome was 4-year mortality. Secondary outcomes included hospitalization, emergency care use, and quality of life (QOL) measured using the CASP-12 scale (control, autonomy, self-realization, pleasure (control, autonomy, self-realization, pressure). RESULTS: There were 670 participants. The mean age was 76.1 (standard deviation 6.36). One-half were men (n = 340, 50.7%). The prevalence of sarcopenia was 6.1% (n = 41). SARC-F scores were inversely associated with grip strength (P = .001) and skeletal muscle composition (P = .045). Participants with sarcopenia were mostly women (P = .005) and older (P < .001). In univariate analysis, sarcopenia was associated with 1- to 4-year mortalities (P = .033, .001, .001, <.001, respectively), overall hospitalization (P = .004), overall emergency care use (P = .017), and QOL (P < .001). In multivariate model, sarcopenia [odds ratio (OR) 7.35, 95% confidence interval (CI) 2.67-20.18], age (OR 1.19, 95% CI 1.09-1.29 for each year), and taking vitamin D supplements (OR 0.29, 95% CI 0.11-0.74) were factors associated with mortality. CONCLUSIONS: Sarcopenia screened using SARC-F was associated with subsequent QOL, overall hospitalization, overall emergency care use, and 4-year mortality. SARC-F can serve as a quick screening tool of sarcopenia.

Porphyromonas gingivalis lipopolysaccharide increases lipid accumulation by affecting CD36 and ATP-binding cassette transporter A1 in macrophages.

Porphyromonas gingivalis lipopolysaccharide (P. gingivalis LPS) promotes macrophage-derived foam cell formation, however, the mechanisms are not well established. In macrophages, lipid uptake is mediated by scavenger receptors including SR-A and CD36, while the cholesterol efflux is mediated by ATP-binding cassette transporter G1 (ABCG1), ABCA1 and SR-BI. We further investigated the mechanisms underlying the dysregulation by P. gingivalis LPS of these regulators resulting in the promotion of lipid accumulation in THP-1-derived macrophages. Our results showed that P. gingivalis LPS exacerbated lipid accumulation in oxidized low-density lipoprotein (oxLDL)-treated macrophages. However, cholesterol efflux was inhibited by P. gingivalis LPS in THP-1-derived macrophages. In oxLDL-untreated macrophages, P. gingivalis LPS treatment caused an increase in CD36 mRNA and protein levels, and a decrease in ABCA1 mRNA and protein levels, while having no effect on SR-A, SR-BI or ABCG1 expression. Upregulation of CD36 by P. gingivalis LPS resulted from activation of c-Jun/AP-1, and this was confirmed by the inhibition of increased CD36 expression after AP-1 inhibition using SP600125. However, the decreased protein stability of ABCA1 by P. gingivalis LPS was a result of increased calpain activity. Moreover, small hairpin RNA (shRNA) targeting heme oxygenase-1 (HO-1) augmented the P. gingivalis LPS-induced atherogenic effects on the expression of c-Jun/AP-1, CD36, ABCA1 and calpain activity. Accordingly, P. gingivalis LPS-regulated promotion of lipid accumulation in foam cells was also exacerbated by HO-1 shRNA. These results indicate that P. gingivalis LPS confers a exacerbation effect on the formation of foam cells by a novel HO-1-dependent mediation of cholesterol efflux and lipid accumulation in macrophages.

Tumor necrosis factor-α gene polymorphisms and risk of oral cancer: evidence from a meta-analysis.

Numerous studies have been conducted regarding association between TNF-α and oral cancer risk, but the results remain controversial. The present meta-analysis is performed to acquire a more precise estimation of relationships. Databases of Pubmed, the Cochrane library and the China National Knowledge Internet (CNKI) were retrieved until August 10, 2013. Pooled odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated with fixed- or random-effect models. The heterogeneity assumption was assessed by I-squared test. Among the eight included case-control studies, all were focused on TNF-α-308G>A and four also concerned the TNF-α-238G>A polymorphism. It was found that oral cancer risk were significant decreased with the TNF-α-308G>A polymorphism in the additive genetic model (GG vs. AA, OR=0.19, 95% CI: [0.04, 1.00], P=0.05, I2=68.9%) and the dominant genetic model (GG+GA vs. AA, OR=0.22, 95% CI: [0.06, 0.82], P=0.03, I2=52.4%); however, no significant association was observed in allele contrast (G vs. A, OR=0.70, 95% CI: [0.23, 2.16], P=0.54, I2=95.9%) and recessive genetic models (GG vs. GA+AA, OR=0.72, 95% CI: [0.33, 1.57], P=0.41, I2=93.1%). For the TNF-α-238G>A polymorphism, significant associations with oral cancer risk were found in the allele contrast (G vs. A, OR=2.75, 95% CI: [1.25, 6.04], P=0.01, I2=0.0%) and recessive genetic models (GG vs. GA+AA, OR=2.23, 95%CI: [1.18, 4.23], P=0.01, I2=0.0%). Conclusively, this meta-analysis indicates that TNF-α polymorphisms may contribute to the risk of oral cancer. Allele G and the GG+GA genotype of TNF-α- 308G>A may decrease the risk of oral cancer, while allele G and the GG genotype of TNF-α-238G>A may cause an increase.

Diagnosis of human papillomavirus infection by abnormal cervical cytology is highly reproducible after vaginal douching.

OBJECTIVE: To evaluate whether human papillomavirus (HPV) activity in symptomatic patients with abnormal Papanicolaou smears (minimal abnormal cytology) was affected by a complete vaginal douche, applied to the cervix prior to colposcopic examination. MATERIALS AND METHODS: A total of 132 women with abnormal Papanicolaou smears were prospectively registered in this study from 1999 to 2004. Two specimens were collected from each patient; one before and one after the cervix was swabbed with a complete vaginal douche during a colposcopic examination. We compared the HPV detection results before and after douching in the same patients. The samples were analyzed using the Hybrid Capture II assay. RESULTS: Before douching, 57.6% (76/132) of the samples were HPV-positive, compared with 58.3% (77/132) of the samples after douching. There was a strong correlation between the cervical HPV detection rates between the before and after douche samples (p<0.001). The kappa statistic was 0.891 for the correlation (positive- positive, negative-negative) and the discrepancy (positive-negative) between the inter-douche rates of HPV activity. A comparison of the HPV assay before and after vaginal douching demonstrated a statistically significant relationship (p<0.001). The sensitivity of the HPV test after douching was higher (97.8%) than that before douching (95.6%). The false-negative rate before douching in women with inflammatory smears was 3% (4/132) and the false-positive rate before douching in women with atypical squamous cells of undetermined significance was 2.1% (3/132). CONCLUSION: Our results indicate that self-administration of a vaginal douche is not a reliable method of eradicating HPV infection.

Management of primary abdominal pregnancy: twelve years of experience in a medical centre.

BACKGROUND: The aim of this study was to evaluate our institution's 12-year experience in managing primary abdominal pregnancy by laparotomy or laparoscopy. METHODS: We identified 11 cases of primary abdominal pregnancy treated at our institution between January 1994 and December 2005, and separated the cases into 2 groups based on type of surgical management. The outcome measures we evaluated were operative time, blood loss and duration of hospital stay. In addition, the incidence rates for all types of ectopic pregnancy were recorded. Analysis excluded secondary abdominal pregnancy. RESULTS: Of the 11 primary abdominal pregnancies, 6 were treated with laparotomy and 5 with laparoscopy. The laparoscopy group had significantly better results in operative time, blood loss and hospital stay (p<0.05). The difference in gestational age was not significant (p=0.141), even after excluding the patient whose abdominal pregnancy was only identified after cesarean delivery. CONCLUSION: Our experience shows a trend toward better management of primary abdominal pregnancy with laparoscopy. These patients had shorter operative time, reduced blood loss, and fewer days in hospital then patients treated with laparotomy. Choice of management should depend on the patient's condition, gestational age of the pregnancy, and the physician's clinical experience.

[Oral isolates of Saccharomyces in patients with oral fungal infection and their susceptibility to antifungal drugs].

OBJECTIVE: To understand whether there were any differences of sensitivity to antifungals between the species of Saccharomyces (Candidas) isolated from oral cavity in the patients with oral candidosis and healthy volunteers. Observing the effect of nystatin topically used and discussing preliminarily the relationship between MIC and clinical effect in order to offer reference for clinical treatment. METHODS: The experiment was carried on 61 patients with candidosis in experimental group and 43 healthy volunteers in control group and isolates of Saccharomyces were obtained by the oral rinse technical method. To isolate and identify Saccharomyces in oral cavity by CHROMagar Saccharomyces culture medium and test the MIC of several antifungal agents such as nystatin, ketoconazole and fluconazole against Saccharomyces by NCCLSM27-A microdilution assay. 31 patients in experimental group were administered with nystatin, observing the clinical effect a week later and comparing the results with the MIC. RESULTS: (1) The incidence of Saccharomyces was 78.69% and 30.23% in experimental group and control group respectively. The proportion of Saccharomyces albicans was 80.70% (experimental group) and 92.31% (control group). (2) There was no significant difference between the susceptibility of Saccharomyces albicans to fluconazole and ketoconazole (P > 0.05), but the MIC data of azole antifungals were lower than nystatin. (3) The susceptibility of Saccharomyces albicans to fluconazole, ketoconazole and nystatin was 95.65%, 80.43%, and 89.13%, and a few isolates were resistent to antifungal agents. (4) The effectiveness of nystatin was 87.10%, and there were a few cases which MIC differs from the clinical effect. CONCLUSION: At present, the resistance of Saccharomyces in patients with oral fungal infection is not significant, most Saccharomyces albicans are sensitive to fluconazole, ketoconazole and nystatin. The MIC of fluconazole and ketoconazole are lower than nystatin, implying when the clinical effect of nystain is poor, to use an azole antifungal is optional. The MIC is relative to therapeutic effect to some degree, but it is not consistent completely.