Lower frequency of focal lip sialadenitis (focus score) in smoking patients. Can tobacco diminish the salivary gland involvement as judged by histological examination and anti-SSA/Ro and anti-SSB/La antibodies in Sjögren's syndrome?

OBJECTIVES—Prospectively collected computer database information was previously assessed on a cohort of 300 patients who fulfilled the Copenhagen classification criteria for primary Sjögren's syndrome. Analysis of the clinical data showed that patients who smoked had a decreased lower lip salivary gland focus score (p<0.05). The aim of this original report is to describe the tobacco habits in patients with primary Sjögren's syndrome or stomatitis sicca only and to determine if there is a correlation between smoking habits and focus score in lower lip biopsies as well as ciculating autoantibodies and IgG.
METHODS—All living patients with primary Sjögren's syndrome or stomatitis sicca only, who were still in contact with the Sjögren's Syndrome Research Centre were asked to fill in a detailed questionnaire concerning present and past smoking habits, which was compared with smoking habits in a sex and age matched control group (n=3700) from the general population. In addition, the patients previous lower lip biopsies were blindly re-evaluated and divided by the presence of focus score (focus score = number of lymphocyte foci per 4 mm(2) glandular tissue) into those being normal (focus score ≤ 1) or abnormal (focus score > 1). Furthermore the cohort was divided into three groups; 10-45, 46-60 and ⩾ 61 years of age. Finally the focus score was related to the smoking habits. Seroimmunological (ANA; anti-SSA/Ro antibodies; anti-SSB/La antibodies; IgM-RF and IgG) samples were analysed routinely.
RESULTS—The questionnaire was answered by 98% (n=355) of the cohort and the percentage of current smokers, former smokers and historical non-smokers at the time of lower lip biopsy was not statistically different from that of the control group. Cigarette smoking at the time of lower lip biopsy is associated with lower risk of abnormal focus score (p<0.001; odds ratio 0.29, 95%CI 0.16 to 0.50). The odds ratio for having focal sialadenitis (focus score( )> 1) compared with having a non-focal sialadenitis or normal biopsy (focus score ⩽ 1) was decreased in all three age groups (10-45: odds ratio 0.27, 95%CI 0.11 to 0.71; 46-60: odds ratio 0.22, 95%CI 0.08 to 0.59; and ⩾ 61: odds ratio 0.36, 95%CI 0.10 to 1.43) although there was only statistical significance in the two younger age groups. Moreover, among current smokers at the time of the lower lip biopsy there was a decreasing odds ratio for an abnormal lip focus score with increasing number of cigarettes smoked per week (p trend 0.00). In the group of former smokers, which included patients that had stopped smoking up to 30 years ago, the results were in between those of the smokers and the historical non-smokers (odds ratio 0.57, 95%CI 0.34 to 0.97, compared with never smokers). Present or past smoking did not correlate with the function of the salivary glands as judged by unstimulated whole sialometry, stimulated whole sialometry or salivary gland scintigraphy. Among former smokers, the median time lapse between the first symptom of primary Sjögren's syndrome and the performance of the lower lip biopsy was approximately half as long as the median time lapse between smoking cessation and biopsy (8 versus 15 years). Hence, symptoms of Sjögren's syndrome are unlikely to have had a significant influence on smoking habits at the time of the biopsy. Among the seroimmunological results only anti-SSA/Ro and anti-SSB/La antibodies reached statistical significance in a manner similar to the way smoking influenced the focus score in lower lip biopsies. On the other hand the level of significance was consistently more pronounced for the influence of smoking on the focus score than for the influence on anti-SSA/Ro and anti-SSB/La autoantibodies.
CONCLUSION—This is believed to be the first report showing that cigarette smoking is negatively associated with focal sialadenitis—focus score >1—in lower lip biopsy in patients with primary Sjögren's syndrome. Furthermore, tobacco seems to decrease the focus score in a dose dependent manner. Smoking may also negatively influence the presence of anti-SSA/Ro and/or anti-SSB/La antibodies in circulating blood. Thus, smoking habits of patients might invalidate the use of both lower lip salivary gland focus score and of anti-SSA/anti-SSB antibodies. It is suggested that the simultaneous performance of other objective tests is required to avoid misdiagnosis of oral involvement in smoking and former smoking patients. Therefore, classification criteria for Sjögren's syndrome that more or less rely on an abnormal focus score and/or presence of anti-SSA/anti-SSB antibodies should be used with great caution.


Lessons Learned From 11 Countries on Programs Promoting Intergenerational Solidarity

Objective: The goal of this project was to develop a systematic framework through which interventions promoting intergenerational solidarity in 11 countries could be assessed. Background: Although intergenerational solidarity—the exchange of material, social, and emotional support and care between family generations—benefits both the country&apos;s economic well-being (macro-level) and the individual&apos;s physical, mental, and social well-being (micro-level), decreasing intergenerational solidarity is evident in many industrialized countries. Interventions promoting intergenerational solidarity are increasingly being developed, but few are described in the literature. Moreover, no unifying framework describing them exists. Method: Representatives from 11 countries convened to identify interventions promoting intergenerational solidarity. After several meetings, a unifying framework was created. Representatives selected a convenience sample of programs and abstracted information based on the framework. Results: The outcome of social well-being was virtually ubiquitous in most programs. Countries appeared to take a broad view of intergenerational solidarity, focusing on interactions among generations, rather than interactions within families. Discussion and Implications: The framework enabled the systematic abstraction and assessment of programs. Most programs had no standard method of evaluating their outcomes. Longitudinal evaluations would be optimal if we want to identify the best practices in intergenerational solidarity programs. © 2020 National Council on Family Relation

RESULTS OF OUTPATIENT PROGRAM ON EFFECTIVE THERAPY OF REFRACTORY ARTERIAL HYPERTENSION

Aim. To increase in efficacy of antihypertensive therapy in patients with refractory arterial hypertension (HT).Material and methods. Patients with refractory HT were revealed during first month of program. The causes of refractory HT were analyzed. Combined antihypertensive therapy was prescribed to reach target level of blood pressure (BP). This therapy lasted 24 weeks and included angiotensin converting enzyme (ACE) inhibitor, thiazid diuretic (indapamide) and dihydropyridine calcium antagonist (nifedipine XL).Results. 200 patients with refractory HT were revealed. True refractory HT took place in 59,9% of patients and pseudo refractory HT – in 40,1% of patients. Lack of diuretics or combined antihypertensive therapy were the main reason of insufficient BP control. Proposed 3-drugs therapy resulted in reduction of systolic BP from 190 to 132 Hg mm and diastolic BP from 104 to 81 Hg mm. Target level of BP was reached in 94% patients. There were no side effects which demanded to stop therapy.Conclusion. High incidence of pseudorefractory HT (40,1%) is revealed. Significant prevalence of renal disturbances especially chronic interstitial inflammatory could be responsible for refractory HT development. Use of 3-drugs therapy (ACE inhibitor, indapamide and nifedipine XL) provides effective control of BP in refractory and pseudorefractory HT.</p

Competition for self ligands restrains homeostatic proliferation of naive CD4 T cells

T cell antigen receptor (TCR) diversity is a critical feature of adaptive immunity. However, restriction of TCR diversity is a potential risk during immune reconstitution by homeostatic proliferation. What peripheral mechanisms are in place to maintain TCR diversity during recovery from lymphopenia? Here, we examine competition between several monoclonal CD4 T cell populations in RAG(−/−) and TCR Tg RAG(−/−) environments. The results suggest that specific self ligands constitute a critical limiting resource essential for homeostatic proliferation of naive CD4 T cells. In addition, T cells ignore large numbers of competitors as long as their TCR specificity is different and other non-MHC resources are not limiting. Therefore, the numbers of self ligands expressed in the periphery set the limits on TCR diversity