Oral intake of Lactobacillus pentosus strain b240 accelerates salivary immunoglobulin A secretion in the elderly: A randomized, placebo-controlled, double-blind trial

<p>Abstract</p> <p>Background</p> <p>Immunoglobulin A (IgA) secretion in saliva decreases with age and may be the cause of increased vulnerability of the elderly to respiratory infections. The effect of oral intake of lactic acid bacteria on salivary secretory IgA (SIgA) in the elderly has not been reported. The objective of this study was to demonstrate the acceleration of salivary SIgA secretion by oral intake of <it>Lactobacillus pentosus </it>strain b240 (b240) in the elderly.</p> <p>Results</p> <p>A total of 80 healthy elderly individuals were randomly allocated to either an intervention (i.e., b240) or a control (i.e., placebo) group. The elderly individuals in the b240 group were given a sterile water beverage (125 mL) containing heat-killed b240 (4 × 10⁹cells), while those in the placebo group were given only a sterile water beverage (125 mL); both groups received their respective beverages once daily for 12 weeks. Saliva was collected before initiation of the study and every 2 weeks thereafter. Saliva flow rate and SIgA concentration were determined, and the SIgA secretion rate was calculated. The mean salivary SIgA secretion rate in the b240 group steadily increased until week 4 (exhibiting a 20% elevation relative to that at week 0), and then remained stable until week 12. Changes in SIgA secretion rate over the intervention period were significantly greater in the b240 group than in the placebo group. The treatment groups exhibited no significant differences in adverse events.</p> <p>Conclusions</p> <p>Oral intake of <it>L. pentosus </it>strain b240 for 12 weeks significantly accelerated salivary SIgA secretion, thereby indicating its potential utility in the improvement of mucosal immunity and resistance against infection in the elderly.</p

ω-3 Polyunsaturated Fatty Acid Biomarkers and Coronary Heart Disease: Pooling Project of 19 Cohort Studies.

IMPORTANCE: The role of ω-3 polyunsaturated fatty acids for primary prevention of coronary heart disease (CHD) remains controversial. Most prior longitudinal studies evaluated self-reported consumption rather than biomarkers. OBJECTIVE: To evaluate biomarkers of seafood-derived eicosapentaenoic acid (EPA; 20:5ω-3), docosapentaenoic acid (DPA; 22:5ω-3), and docosahexaenoic acid (DHA; 22:6ω-3) and plant-derived α-linolenic acid (ALA; 18:3ω-3) for incident CHD. DATA SOURCES: A global consortium of 19 studies identified by November 2014. STUDY SELECTION: Available prospective (cohort, nested case-control) or retrospective studies with circulating or tissue ω-3 biomarkers and ascertained CHD. DATA EXTRACTION AND SYNTHESIS: Each study conducted standardized, individual-level analysis using harmonized models, exposures, outcomes, and covariates. Findings were centrally pooled using random-effects meta-analysis. Heterogeneity was examined by age, sex, race, diabetes, statins, aspirin, ω-6 levels, and FADS desaturase genes. MAIN OUTCOMES AND MEASURES: Incident total CHD, fatal CHD, and nonfatal myocardial infarction (MI). RESULTS: The 19 studies comprised 16 countries, 45 637 unique individuals, and 7973 total CHD, 2781 fatal CHD, and 7157 nonfatal MI events, with ω-3 measures in total plasma, phospholipids, cholesterol esters, and adipose tissue. Median age at baseline was 59 years (range, 18-97 years), and 28 660 (62.8%) were male. In continuous (per 1-SD increase) multivariable-adjusted analyses, the ω-3 biomarkers ALA, DPA, and DHA were associated with a lower risk of fatal CHD, with relative risks (RRs) of 0.91 (95% CI, 0.84-0.98) for ALA, 0.90 (95% CI, 0.85-0.96) for DPA, and 0.90 (95% CI, 0.84-0.96) for DHA. Although DPA was associated with a lower risk of total CHD (RR, 0.94; 95% CI, 0.90-0.99), ALA (RR, 1.00; 95% CI, 0.95-1.05), EPA (RR, 0.94; 95% CI, 0.87-1.02), and DHA (RR, 0.95; 95% CI, 0.91-1.00) were not. Significant associations with nonfatal MI were not evident. Associations appeared generally stronger in phospholipids and total plasma. Restricted cubic splines did not identify evidence of nonlinearity in dose responses. CONCLUSIONS AND RELEVANCE: On the basis of available studies of free-living populations globally, biomarker concentrations of seafood and plant-derived ω-3 fatty acids are associated with a modestly lower incidence of fatal CHD.ARIC was carried out as a collaborative study supported by National Heart, Lung, and Blood Institute contracts HHSN268201100005C, HHSN268201100006C, HHSN268201100007C, HHSN268201100008C, HHSN268201100009C, HHSN268201100010C, HHSN268201100011C, and HHSN268201100012C), R01HL087641, R01HL59367 and R01HL086694; National Human Genome Research Institute contract U01HG004402; and National Institutes of Health contract HHSN268200625226C. The authors thank the staff and participants of the ARIC study for their important contributions. Infrastructure was partly supported by Grant Number UL1RR025005, a component of the National Institutes of Health and NIH Roadmap for Medical Research. CHS was supported by contracts HHSN268201200036C, HHSN268200800007C, N01HC55222, N01HC85079, N01HC85080, N01HC85081, N01HC85082, N01HC85083, N01HC85086, and grant U01HL080295 from the National Heart, Lung, and Blood Institute (NHLBI), with additional contribution from the National Institute of Neurological Disorders and Stroke (NINDS). Additional support was provided by R01AG023629 from the National Institute on Aging (NIA). A full list of principal CHS investigators and institutions can be found at CHS-NHLBI.org. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health The Costa-Rican adult study was supported by grant R01HL081549 from the National Institutes of Health. EURAMIC was supported by the Commission of the European Communities, as a Concerted Action within Directorate General-XII, with additional support from Directorate General-V Europe against Cancer. The national studies were financed by the Dutch Ministry of Health. Ulster Cancer Foundation and Milk Intervention Board. Grant AKT76 from Cancer Research Switzerland. Swiss National Science Foundation Grant 32-9257-87. Spanish FIS and Ministry of Science and Education, and German Federal Health Office EPIC-Norfolk was funded by grants from Medical Research Council and Cancer Research UK. Dr. Imamura also received support from the Medical Research Council Epidemiology Unit Core Support (MC_UU_12015/5). HPFS was supported by the NIH grants UM1 CA167552, R01 HL35464, AA11181, HL35464, CA55075, HL60712 and P30 DK46200 The InChianti study was supported as a ‘targeted project’ (ICS 110.1\RS97.71) by the Italian Ministry of Health and in part by the Intramural Research Program of the NIH (Contracts N01-AG-916413 and N01-AG-821336 and Contracts 263 MD 9164 13 and 263 MD 821336) KIND (Kuopio Ischaemic Heart Disease Risk Factor Study) was supported by grants from the Academy of Finland, Helsinki, Finland (grants 41471, 1041086) MCCS (Melbourne Collaborative Cohort Study) recruitment was funded by VicHealth and Cancer Council Victoria. The MCCS was further supported by Australian NHMRC grants 209057, 251553 and 504711 and by infrastructure provided by Cancer Council Victoria. Cases and their vital status were ascertained through the Victorian Cancer Registry (VCR) and the Australian Institute of Health and Welfare (AIHW), including the National Death Index and the Australian Cancer Database. MESA and the MESA SHARe project are conducted and supported by the National Heart, Lung, and Blood Institute (NHLBI) in collaboration with MESA investigators. Support for MESA is provided by contracts N01-HC-95159, N01-HC-95160, N01-HC-95161, N01-HC-95162, N01-MEHC-95163, N01-HC-95164, N01-HC-95165, N01-HC-95166, N01-HC-95167, N01-HC-95168, N01-HC-95169, UL1-TR-001079, and UL1-TR-000040. Funding for SHARe genotyping was provided by NHLBI Contract N02-HL-64278. Genotyping was performed at Affymetrix (Santa Clara, California, USA) and the Broad Institute of Harvard and MIT (Boston, Massachusetts, USA) using the Affymetric Genome-Wide Human SNP Array 6.0. NSHDS I & II (The Northern Sweden Health & Disease Study I & II) was supported by the Swedish Cancer Society and the Swedish Research Council NHS (Nurses’ Health Study) was supported by research grants UM1 CA186107, R01 CA49449, R01 HL034594, P01CA87969, R01HL034594, and R01HL088521 of the National Institutes of Health The PHS (Physician’s Health Study) was supported by grant R21 HL088081, CA-34944 and CA-40360, and CA-097193 from the National Cancer Institute and grants HL-26490 and HL-34595from the National Heart, Lung, and Blood Institute, Bethesda, MD. The 3C (Three-City) study was conducted under a partnership agreement between the Institut National de la Santé et de la Recherche Médicale (INSERM), the University Bordeaux 2 Victor Segalen and Sanofi-Aventis. The Fondation pour la Recherche Médicale funded the preparation and initiation of the study. The Three-City study was also supported by the Caisse Nationale Maladie des Travailleurs Salariés, Direction Générale de la Santé, MGEN, Institut de la Longévité, Conseils Régionaux d’Aquitaine et Bourgogne, Fondation de France, Ministry of Research-INSERM Programme “Cohortes et collections de données biologiques”, Agence Nationale de la Recherche (grant number COGINUT ANR-06-PNRA-005), the Fondation Plan Alzheimer (grant number FCS 2009-2012), and the Caisse Nationale pour la Solidarité et l’Autonomie (CNSA) . Dr Samieri was on a grant from the “Fondation Plan Alzheimer” SHHEC (Scottish Heart Health Extended Cohort) study was funded by the Scottish Health Department Chief Scientist Organization; British Heart Foundation; FP Fleming Trust. The authors would like to acknowledge Dr. Roger Tavendale for his work with the Scottish Heart Health Study. SCHS (Singapore Chinese Health Study) was supported by the Singapore National Medical Research Council (grant number: NMRC 1270/2010) and the U.S. NIH (grant numbers: R01CA 144034 and UM1 CA182876) ULSAM 50 and 70 were funded by the Swedish Research Council for Health, Working Life and Welfare (FORTE) Uppsala City Council (ALF) and Swedish Research CouncilThis is the final version of the article. It first appeared from American Medical Association via http://dx.doi.org/10.1001/jamainternmed.2016.292

Association of serum uromodulin with mortality and cardiovascular disease in the elderly-the Cardiovascular Health Study.

BackgroundUromodulin (UMOD) is released by renal tubular cells into the serum (sUMOD) and urine. Lower urine UMOD has been linked to mortality and cardiovascular disease but much less is known about sUMOD. We evaluated the association of sUMOD with these outcomes in community-dwelling older adults.MethodsWe measured sUMOD in a random subcohort of 933 participants enrolled in the Cardiovascular Health Study. The associations of sUMOD with all-cause mortality, incident heart failure (HF) and incident cardiovascular disease (CVD; myocardial infarction, stroke and mortality due to coronary disease or stroke) were evaluated using multivariable Cox regression, adjusting for study participants' demographics, estimated glomerular filtration rate (eGFR), albuminuria and CVD risk factors. Generalized additive models with splines were used to address the functional form of sUMOD with outcomes. Due to nonlinear associations of sUMOD with all outcomes, 2.5% of the values on either end of the sUMOD distribution were excluded from the analyses, limiting the range of sUMOD to 34.3-267.1 ng/mL.ResultsThe mean age was 78 ± 5 years, 40% were male, sUMOD level was 127 ± 64 ng/mL, eGFR was 63 mL/min/1.73&nbsp;m2 and 42% had CKD defined as eGFR &lt;60 mL/min/1.73&nbsp;m2. Patients in the lower sUMOD quartiles had lower eGFR and higher albuminuria (P &lt; 0.01, respectively). During a median follow-up of 9.9 years, 805 patients died, 283 developed HF and 274 developed CVD. In multivariable analysis, higher sUMOD was significantly associated with a lower hazard for mortality {hazard ratio [HR] 0.89 [95% confidence interval (CI) 0.80-0.99] per 1 standard deviation (SD) higher sUMOD}, CVD [HR 0.80 (95% CI 0.67-0.96)] and the composite endpoint [HR 0.88 (95% CI 0.78-0.99)]; the association with HF was not statistically significant [HR 0.84 (95% CI 0.70-1.01)].ConclusionHigher sUMOD is independently associated with a lower risk for mortality and CVD in older adults

Análise das complicações tardias em operações anorretais: experiência de um serviço de referência em coloproctologia Analysis of late complications of anorectal procedures: experience of a referral coloproctology unit

INTRODUÇÃO: as operações anorretais correspondem a 80% do movimento do coloproctologista. O índice de complicações tardias após estas operações é indefinido, e varia de acordo com o tipo de operação e serviço onde estas são realizadas. OBJETIVO: estabelecer a taxa de complicações tardias decorrentes das operações anorretais e fatores de risco que pudessem estar associados a estas complicações. MÉTODO: estudo retrospectivo (série de casos) dos pacientes submetidos a operações anorretais entre janeiro de 2007 e julho de 2009. Variáveis estudadas: sexo, idade, operação, sistema de saúde, técnica de anestesia, complicações tardias, além da taxa de reoperações realizadas. RESULTADOS: foram avaliados 430 pacientes (234 mulheres - 54,4%), submetidos a 453 operações anorretais. A hemorroidectomia foi o mais freqüente procedimento realizado: 50,3% das operações. Encontrou-se 102 complicações tardias pós-operatórias, representando 22,52% dos casos. A fissura anal residual foi a complicação mais freqüente (54%/ n=55). Somente 38 pacientes necessitaram de reintervenção cirúrgica (8,83%). Não houve diferença significativa em relação ao sexo, idade, sistema de saúde e ao tipo de operação realizada com as complicações encontradas. CONCLUSÕES: a taxa de complicações tardias foi de 22,52%, com reintervenções cirúrgicas em 8,83% dos pacientes. Não houve fator de risco para complicações identificado nesta série de casos.<br>INTRODUCTION: anorectal procedures consist 80% of surgical cases in colorectal surgery practice. The exact rate of long-term complications after anorectal surgery is unknown. This number is variable according to the medical centres and the type of procedures. OBJECTIVE: to evaluate the long-term complications secondary to anorectal procedures, as well as the risk factors that might be associated with these complications. METHOD: retrospective analysis, including anorectal procedures performed between January 2007 and July 2009. The characteristics analyzed were: sex, age, type of surgery, health system, long-term complications and reoperations performed. RESULTS: 430 patients submitted to 453 anorectal procedures were studied (54,4% female). Hemorrhoidectomy was the most common procedure (50,3% of all operations). The mean period of follow-up was 164,7 days and 102 long-term complications were identified, occurring in 22,52% of all procedures. Residual fissure in ano was the most frequent complication (54%, n=55). Only 38 patients needed reoperation (8,83% of all cases). There was no statistical significance between sex, age, health system and type of surgery in relation to the complications found. CONCLUSIONS: the long-term complication rate was 22,52%, with reoperations performed in 8,83% of all patients. There was no risk factor for long-term complications identified in this case series

Esfincterotomia lateral interna associada à hemorroidectomia no tratamento da doença hemorroidária: vantagem ou desvantagem? Open haemorrhoidectomy with associated lateral internal sphincterotomy for treatment of haemorrhoids: advantage or disadvantage?

RACIONAL: A importância de realizar-se esfincterotomia concomitantemente com hemorroidectomia, para melhor controle de dor pós-operatória, ainda é motivo de grande discussão acadêmica. OBJETIVOS: Estudar as implicações clínicas da esfincterotomia lateral interna associada à hemorroidectomia, no tratamento cirúrgico da doença hemorroidária. Pacientes e MÉTODOS: Foram avaliados 20 pacientes portadores de doença hemorroidária, submetidos à "hemorroidectomia aberta" pela técnica de Miligan-Morgan, distribuídos em dois grupos: Grupo 1: Hemorroidectomia sem esfincterotomia (sem ELI) e Grupo 2: Hemorroidectomia com esfincterotomia (com ELI). Analisou-se a dor e a continência anal pós-operatória utilizando-se parâmetros clínicos e manométricos. A dor, complicações pós-operatórias e a presença de sintomas de incontinência anal foram avaliadas no pós-operatório. Todos os pacientes foram submetidos à eletromanometria anorretal, tanto no pré como no pós-operatório, e os dados coletados foram comparados entre os dois grupos de estudo. RESULTADOS: Não houve diferença, entre os dois grupos, na incidência de complicações pós-operatórias. O uso de narcóticos foi maior no Grupo I nas 1as 24 horas. Entretanto, a dor foi maior no Grupo II no 3º e 7º dia de pós-operatório. O tempo de cicatrização da ferida operatória foi semelhante nos dois grupos. A incidência de sintomas de incontinência anal foi significativamente maior para o grupo tratado com esfincterotomia. CONCLUSÃO: A esfincterotomia lateral interna associada à hemorroidectomia para o tratamento de doença hemorroidária avançada não reduziu a dor pós-operatória, além de ter aumentado o risco de incontinência anal.<br>BACKGROUND: The importance of using associated sphincterotomy for better pain control in patients who underwent hemorrhoidectomy remains controversial in the literature. AIM: Determine the role of associated sphincterotomy in patients submitted to surgical treatment for hemorrhoids. Patients and METHODS: Twenty patients who underwent Milligan Morgan hemorrhoidectomy were distributed in two groups: Group 1: Hemorrhoidectomy without sphincterotomy and Group 2: Hemorrhoidectomy with sphincterotomy. Post-operative pain, complications as well anal continence was evaluated. Moreover, pre and post-operative manometry was performed, and collected data was compared between the two groups of patients. RESULTS: There was no difference in the incidence of post-operative complications. Although group I used more narcotics and analgesics in the post-operative time, pain was significantly higher at 3rd and 7th post-operative day for Group II patients. Wound healing time was similar for both groups. Anal incontinence was significantly higher for patients who underwent sphincterotomy. CONCLUSION: Hemorrhoidectomy with associated internal lateral sphincterotomy did not reduce post-operative pain, and increased the risk of post-operative incontinence