An epidemiological study on anemia among institutionalized people with intellectual and/or motor disability with special reference to its frequency, severity and predictors

BACKGROUND: To examine the type, frequency, severity, and predictors of anemia and its relationship with co-morbid conditions among institutionalized people with intellectual and/or motor disability. METHODS: We conducted a cross-sectional study at a public facility for people with intellectual and/or motor disability in Ibaraki prefecture, Japan. Health checkup data obtained in 2001 from 477 people with intellectual disability (male: 286, average age 40.6 ± 12.3; female: 191, average age 45.1 ± 11.6) were retrospectively reviewed. RESULTS: The prevalence of anemia among male participants was higher than in female participants for each disability category (intellectual disability, 41.1%, 4.2%; cerebral palsy, 37.5%, 4.8%; Down's syndrome, 15.0%, 0%; severe motor and intellectual disabilities, 61.9%, 16.7%). Most participants with anemia (93.8 – 100%) showed a normocytic normochromic anemia pattern. Multivariate analysis revealed that factors related to an increase in frequency included sex (male), low body mass index (BMI), use of anticonvulsants or major tranquilizers, and a high zinc sulfate turbidity test (ZTT) value. No clinically diagnosed co-morbid condition was found to be related to the presence of anemia. CONCLUSION: A high frequency of mild normocytic normochromic anemia in institutionalized people with intellectual and/or motor disability was observed, particularly among males. Medications and chronic inflammation may increase the risk of anemia

Study protocol for a multi-center, randomized controlled trial to develop Japanese denture adhesive guidelines for patients with complete dentures : the Denture Adhesive Guideline trial : study protocol for a randomized controlled trial

Background: Denture adhesives, characterized as medical products in 1935 by the American Dental Association, have been considered useful adjuncts for improving denture retention and stability. However, many dentists in Japan are hesitant to acknowledge denture adhesives in daily practice because of the stereotype that dentures should be inherently stable, without the aid of adhesives. The aim of this study is to verify the efficacy of denture adhesives to establish guidelines for Japanese users. The null hypothesis is that the application of denture adhesives, including the cream and powder types, or a control (isotonic sodium chloride solution) would not produce different outcomes nor would they differentially improve the set outcomes between baseline and day 4 post-application. Methods: This ten-center, randomized controlled trial with parallel groups is ongoing. Three hundred edentulous patients with complete dentures will be allocated to three groups (cream-type adhesive, powder-type adhesive, and control groups). The participants will wear their dentures with the denture adhesive for 4 days, including during eight meals (three breakfasts, two lunches, and three dinners). The baseline measurements and final measurements for the denture adhesives will be performed on the first day and after breakfast on the fourth day. The primary outcome is a general satisfaction rating for the denture. The secondary outcomes are denture satisfaction ratings for various denture functions, occlusal bite force, resistance to dislodgement, masticatory performance, perceived chewing ability, and oral health-related quality of life. Between-subjects comparisons among the three groups and within-subjects comparisons of the pre- and post-intervention measurements will be performed. Furthermore, a multiple regression analysis will be performed. The main analyses will be based on the intention-to-treat principle. A sample size of 100 subjects per group, including an assumed dropout rate of 10 %, will be required to achieve 80 % power with a 5 % alpha level. Discussion: This randomized clinical trial will provide information about denture adhesives to complete denture wearers, prosthodontic educators, and dentists in Japan. We believe this new evidence on denture adhesive use from Japan will aid dentists in their daily practice even in other countries

Long survival case of trisomy 13 mosaicism in a 7-year-old male

Trisomy 13 is a complication of various congenital abnormalities of the heart, brain, etc. Regarding the vitalprognosis, many die within a year from birth. We herein report on the case of a 7-year 1-month-old boywith mosaicism trisomy 13 with the two considerations mentioned below as the cause for long-term survivalin this case. The first is that there were no serious associated abnormalities to the heart, brain, or otherorgans, and the second is that a tracheotomy was carried out on a repeated respiratory infection with respiratoryfailure. Long-term in-home care was possible for the child and he was observed playing with toys bytouching them. Trisomy 13 has a poor vital prognosis, so some argue that active treatment should be restrained.However, for cases with no severe associated abnormalities, long-term survival may be possiblewith active treatment

アレルギー性気道炎症における性ホルモンおよびリンパ球の役割

Epidemiological data indicate that the prevalence and severity of asthma is higher among females than males after puberty. The influence of sex on asthma incidence suggests that sex hormones could play a role in the pathogenesis of the condition associated with asthma. However, the mechanisms of the affect of sex are not clear. Therefore, in the current study, we investigated the sex differences in allergic inflammation in terms of lymphocyte function, using a murine model of allergic asthma. In either BALB/c or C57BL/6J mice, the airway inflammation in female mice sensitized with OVA followed by OVA inhalation was more severe than that in male mice. The contents of Th2 cytokines, such as IL-4, IL-5 and IL-13, in bronchoalveolar lavage fluid from female mice were significantly increased compared with male mice. The airway inflammation in female mice after adoptive transfer of splenocyte from sensitized female mice was more severe than that in any other combination of donors and recipients. Furthermore, splenocytes from sensitized female mice produced more Th2 cytokines than those from sensitized male mice, upon stimulation with OVA. The degree of airway inflammation induced by lipopolysaccharide inhalation was not significantly different between male and female mice. Our findings suggest that sex differences in allergic airway inflammation are due to those in not only sex hormones but also lymphocytes function

アレルギー性気道炎症におけるAT II la受容体の機能解析

Chronic airway inflammation and airway hyperresponsiveness (AHR) are fundamental features leading to airway narrowing in bronchial asthma. Airway inflammation in asthmatics is characterized with the accumulation and activation of inflammatory cells such as eosinophils and mast cells, which is orchestrated by a network of Th2 cytokines, such as IL-4 and IL-5, released mainly from CD^+_4 T lymphocytes. The peptide hormone angiotensin II (AT II) plays an important role in the regulation of arterial blood pressure. Plasma levels of renin and AT II were reported to be elevated during acute exacerbation of asthma, and studies using type 1 AT II receptor (AT1) antagonist (ARE) suggested the involvement of the receptor in the pathogenesis of asthma. However, the pathogenic roles of AT II and AT1 in asthmatic airway inflammation remains elusive. Therefore, we investigated the effect of ATla gene deletion (ATlaKO) on allergen-induced airway inflammation using a murine model of allergic asthma. In sensitized wild type mice (WT), the numbers of inflammatory cells in bronchoalveolar lavage fluids (BALF) were increased with a peak on 5 days after antigen challenge. In ATlaKO mice, in contrast, those were increased with two peaks on 3 and 7 days, which were significantly higher than in WT. The contents of IL-4 and IL-5 in BALF of ATlaKO mice 1 day after the challenge were significantly higher than those of WT mice. These date suggest that ATla play a pivotal role in allergic airway inflammation via, at least in part, the downregulation of Th2 cytokine expression

精神的ストレスによるアレルギー性気道炎症の増悪

Stress and other psychological factors have long been hypothesized to be associated with asthma symptoms. One of the fundamental features of bronchial asthma is chronic airway inflammation, characteristic of the infiltration and activation of inflammatory cells, such as eosinophils and T lymphocytes. Psychological stress can modulate the inflammatory response through activation of hypothalamus-pituitary-adrenal axis and the sympathetic nervous system increasing the secretion of cortisol and catecholamines. However, the mechanisms linking stress and asthma are not well defined. Therefore, we investigated the effects of psychological stress on asthmatic airway inflammation using a murine model of allergic asthma. Female BALB/c mice and C57BL/6J mice were exposed to restraint stress (RS) during the antigen inhalation, which procedure was repeated 3 times for every seven days. Seven days after the last procedure, the mice were challenged with ovalbumin (OVA), and the airway inflammation was evaluated by the numbers of inflammatory cells in bronchoalveolar lavage fluids. RS significantly increased the numbers of total cells and lymphocytes in BALB/c mice. In C57BL/6J mice, in contrast, the numbers of inflammatory cells were not significantly different between mice exposed and not exposed to RS. Our findings suggest that psychological stress can enhance antigen-induced airway inflammation and, furthermore, that genetic background is involved in the pathogenesis of stress-induced asthma. This model using female BALB/c mice may be useful to elucidate the mechanisms by which psychological stress exacerbates asthma symptoms

The Distinctive Effects of Acute and Chronic Psychological Stress on Airway Inflammation in a Murine Model of Allergic Asthma

ABSTRACTBackgroundPsychological stress has long been recognized to be associated with asthma symptoms. There appear to be individual differences in the susceptibility to even the same kind of stress, and furthermore, stress responses are different between the types of the stress, acute and chronic, even in the same person. However, the mechanisms linking stress to asthma are not well defined. Psychological stress upregulates the expression of endogenous opioids. The opioids stimulate the hypothalamus-pituitary-adrenal axis and sympathetic and adrenomedullary system, through the activation of μ-opioid receptor (MOR) to release stress hormones, such as cortisol and catecholamines, respectively. These hormones can modulate immune responses via the induction of Th1 immunity.MethodsFemale BALB/c and C57BL/6, wild and MOR-deficient, mice sensitized with ovalbumin (OVA) were exposed to OVA with or without either acute or chronic restraint stress. Airway inflammation was evaluated by the measurement of the number of inflammatory cells and cytokine contents in bronchoalveolar lavage fluids.ResultsIn BALB/c mice, but not in C57BL/6 mice, the number of total cells, eosinophils and lymphocytes in the acute stress group were significantly decreased compared with those in the non-acute stress group. In contrast, chronic stress significantly increased the cell numbers and the contents of IL-4 and IL-5 in both mouse strains. Furthermore, these exacerbations were abolished in MOR-deficient mice.ConclusionsThese results suggest that acute stress modifies the allergic airway responses distinctively depending on the genetic background, and MOR is involved in the chronic psychological stress-induced exacerbation of allergic airway inflammation