Objective: The aim of this study was to compare the oral health status of chronic renal failure (CRF) patients on renal replacement therapy with a matched reference population.
Design: ...Cross‐sectional study.
Subjects: Forty‐two dentate CRF patients – aged 25–52 years old – were matched with a reference group of 808 dentate subjects.
Methods: The oral health was assessed using decayed missing filled (DMF) indices, simplified oral hygiene index and periodontal status. An oral health questionnaire was used to assess self‐reported dental problems. Student t‐tests and chi‐square tests were performed to compare the CRF patients with the controls.
Results: All index‐scores in the CRF patients were comparable with the controls except for number of teeth covered with calculus that was significantly higher (P < 0.05) in CRF patients (4.1 ± 2.6) than in controls (3.0 ± 2.9). The self‐reported oral health questionnaire revealed a trend for increased temporomandibular complaints in CRF patients (16.7%vs 5.7% in controls; P = 0.06) as well as bad taste (31.0%vs 6.8% in controls, P = 0.08)
Conclusions: For most dental aspects, the oral health of CRF patients is comparable with controls.
Introduction
Multiple sclerosis (MS) is a chronic inflammatory disease with an as yet not fully understood etiological background. The geographical distribution of MS is striking with a prevalence ...that increases with latitude. For this reason, vitamin D deficiency is considered a possible pathogenic co-factor in MS.
Materials and methods
To study the role of the vitamin D metabolism in MS, blood samples were taken twice (summer and winter) from 103 patients with MS and 110 healthy controls. Serum concentrations of 25-hydroxyvitamin D (25(OH) D) and 1,25-dihydroxyvitamin D (1,25(OH)2D) were measured, and detailed information on disease characteristics and environmental factors that might influence the vitamin D metabolite levels was collected.
Results
Mean serum 25(OH)D and 1,25(OH)2D concentrations were significantly higher in summer compared to winter in both patients and controls. Using logistic regression methods, we found that in women for every 10 nmol/L increase of serum 25(OH)D level the odds of MS was reduced by 19% (odds ratio 0.81; 95% confidence interval: 0.69–0.95), suggesting a “protective” effect of higher 25(OH)D serum levels. In addition, also restricted to women, a negative correlation was found between Expanded Disability Status Scale and 25(OH)D levels (r = −0.29, P = 0.020).
Conclusions
Our data suggest that higher circulating levels of 25(OH)D are associated with a lower incidence of MS and MS-related disability in women. This may imply clues to the pathogenesis of the sex difference in risk and to the nature of the environmental factors involved in MS.
Interdialytic weight gain in patients on hemodialysis is associated with dry mouth and thirst.
Patients receiving hemodialysis (HD) have to maintain a fluid-restricted diet. Severe thirst can induce ...noncompliance to this diet, resulting in an increase of interdialytic weight gain (IWG = weight predialysis - postdialysis) associated with poor patient outcomes. Because oral dryness may contribute to experienced thirst, we investigated the possible relation between thirst, salivary flow rate, xerostomia, and IWG.
Unstimulated (UWS) and stimulated (CH-SWS) whole saliva were collected from 94 HD patients (64 men, 54.8 ± 15.5 years; 30 women, 59.5 ± 18.7 years). Secretion rates of saliva were determined gravimetrically. Xerostomia was assessed with a validated Xerostomia Inventory (XI), and thirst with a newly developed Dialysis Thirst Inventory (DTI).
Before dialysis, 36.2% of the patients had hyposalivation (UWS ≤0.15 mL/min). The XI scores had a positive relation with IWG (r = .250, P < 0.001). Gender and age differences were observed for thirst, salivary flow rates, and xerostomia. The prevalence and severity of thirst and xerostomia were greater in younger subjects. Patients with urine output did not differ from those without urine output with respect to thirst, xerostomia, and IWG. Correlations were found between thirst (DTI) and both IWG and xerostomia (XI) (r = .329, P < 0.001, respectively; r = .740, P < 0.001). Other correlations were observed between xerostomia and both the salivary flow rate and total number of medications (r=-.252, P < 0.05, respectively; r = .235, P <.05).
In HD patients, xerostomia (XI) and thirst (DTI) are associated with a higher IWG. Our data provide evidence that, in HD patients, xerostomia is related to both salivary flow rate and thirst (DTI).
Mounting evidence correlate vitamin D3 (cholecalciferol) supplementation or higher serum levels of vitamin D (25(OH)D) with a lower risk of developing multiple sclerosis (MS), reduced relapse rate, ...slower progression or fewer new brain lesions. We present here the case of a woman who was diagnosed with MS in 1990. From 1980 to 2000, her ability to walk decreased from ~20 to 1 km per day. Since January 2001, a vitamin D3 supplement was ingested daily. The starting dose was 20 mcg (800 IU)/day and escalated to 100 mcg (4000 IU)/day in September 2004 and then to 150 mcg (6000 IU)/day in December 2005. Vitamin D3 intake reduced muscular pain and improved ambulation from 1 (February 2000) to 14 km/day (February 2008). Vitamin D intake over 10 years caused no adverse effects: no hypercalcaemia, nephrolithiasis or hypercalciuria were observed. Bowel problems in MS may need to be addressed as they can cause malabsorption including calcium, which may increase serum PTH and 1,25(OH)2D levels, as well as bone loss. We suggest that periodic assessment of vitamin D3, calcium and magnesium intake, bowel problems and the measurement of serum 25(OH)D, PTH, Ca levels, UCa/Cr and bone health become part of the integral management of persons with MS.
Background. Most patients on haemodialysis (HD) have to maintain a fluid-restricted diet to prevent a high interdialytic weight gain (IWG). The prevalence of xerostomia (the feeling of a dry mouth) ...is higher in HD patients than in controls. Recently, we demonstrated that xerostomia and thirst were positively correlated with IWG in HD patients. Thus, this may play a role as a stimulus for fluid intake between dialysis sessions. The aim of the present study was to investigate the effect of chewing gum or a saliva substitute on xerostomia, thirst and IWG. Methods. This study was a randomized two-treatment crossover design with repeated measures. After the use of chewing gum or saliva substitute for 2 weeks, a wash-out period of 2 weeks was introduced and hereafter the other regimen was carried out. Xerostomia and thirst were assessed by validated questionnaires as xerostomia inventory (XI) and dialysis thirst inventory (DTI), at baseline and after each treatment period, as were IWG and salivary flow rates. Results. Sixty-five HD patients (42 men, 54.6±14.1 years; 23 women, 54.7±16.3 years) participated in this study. Chewing gum decreased XI from 29.9±9.5 to 28.1±9.1 (P<0.05). Chewing gum as well as a saliva substitute reduced DTI significantly (P<0.05), but no differences occurred for the average IWG or salivary flow rates. Conclusions. The use of chewing gum and, to a lesser extent, a saliva substitute may alleviate thirst and xerostomia in some HD patients.
To evaluate acute effects of hemodialysis (HD) on the salivary flow rate, pH and biochemical composition before, during and after completion of a dialysis session.
Unstimulated whole saliva (UWS) and ...chewing-stimulated whole saliva (CH-SWS) were collected in 94 HD patients. Salivary flow rate, pH, concentrations of total protein, albumin, cystatin C, secretory immunoglobulin A (S-IgA) and of sodium, potassium and urea were measured.
HD had an acute stimulating effect on the salivary flow rate (UWSbefore = 0.30+/-0.22 ml/min, UWSduring = 0.39+/-0.25 ml/min, p < 0.005). The mean pH of UWS showed a small but significant increase during HD mainly due to an increased watery secretion from the salivary glands. The salivary biochemical constituents changed markedly, but no significant difference in output was found. The electrolyte concentration did not change significantly during dialysis. The level of urea in CH-SWS declined to 40% (Ureabefore = 25.+/-6.4 mmol/l, Ureaduring = 15.3+/-4.5 mmol/1).
This study shows that HD has significant acute effects on both salivary secretion rate and protein concentrations in saliva. We conclude that the observed changes in salivary concentrations and proteins are mainly due to an increased watery secretion from the salivary glands.
Many patients on haemodialysis (HD) therapy suffer from a dry mouth and xerostomia. This can be relieved by mechanical and gustatory stimulation or palliative care. The aim of this crossover study ...was to investigate the effect and preferences of a sugar-free chewing gum (Freedent WhiteTM) and a xanthan gum-based artificial saliva (XialineTM) in the management of xerostomia in chronic HD patients. Sixty-five HD patients participated in a 6-week crossover trial. The artificial saliva was rated significantly lower than the chewing gum for effectiveness, taste and a global assessment. No preference differences were found for gender and age, although older subjects rated the artificial saliva with a higher mark. Thirty-nine subjects (60%) preferred chewing gum, 15% (n = 10) preferred the artificial saliva. Therefore, both chewing gum and artificial saliva could play an important role in the palliative care of xerostomia in HD patients.
Objectives: Chewing gums have been studied for clinical use to stimulate the salivary flow rate in healthy and diseased individuals. However, differences in preferences of chewing gums may influence ...patient compliance during long‐term use. Therefore, we compared the effect of several chewing gums on the flow rate of whole saliva and pH, and investigated the preferences of these gums. Methods: 83 healthy subjects participated in the first part of the study. Both parafilm‐stimulated and chewing gum‐stimulated whole saliva from 8 different chewing gums was collected and salivary flow rate and pH were determined. In another group of 112 healthy subjects, we investigated the preferences for the chewing gums with a 10‐item questionnaire. Results: All gums had comparable effects on salivary flow rate and pH. The average increase in flow rate was 187% during the first minute of chewing compared with parafilm stimulation. After 10 minutes of gum chewing, the amount of saliva was equal to parafilm stimulation. The questionnaire showed differences in preferences for the chewing gums, which were related to taste and gum shape. Gender interactions were observed for sparkling taste (p = 0.019), total judgement (p = 0.047) and the willingness to use the gum for several weeks (p = 0.037). Conclusions: Although all chewing gums stimulated the salivary flow rate equally, the observed differences in preferences may influence long‐term compliance. Therefore, we recommend that chewing gums are tested before the start of clinical studies, to identify the most accepted chewing gum for specific groups of patients.
In high light conditions, cyanobacteria dissipate excess absorbed energy as heat in the light-harvesting phycobilisomes (PBs) to protect the photosynthetic system against photodamage. This process ...requires the binding of the red active form of the Orange Carotenoid Protein (OCPr), which can effectively quench the excited state of one of the allophycocyanin bilins. Recently, an in vitro reconstitution system was developed using isolated OCP and isolated PBs from Synechocystis PCC 6803. Here we have used spectrally resolved picosecond fluorescence to study wild-type and two mutated PBs. The results demonstrate that the quenching for all types of PBs takes place on an allophycocyanin bilin emitting at 660 nm (APCQ660) with a molecular quenching rate that is faster than (1 ps)−1. Moreover, it is concluded that both the mechanism and the site of quenching are the same in vitro and in vivo. Thus, utilization of the in vitro system should make it possible in the future to elucidate whether the quenching is caused by charge transfer between APCQ660 and OCP or by excitation energy transfer from APCQ660 to the S1 state of the carotenoid—a distinction that is very hard, if not impossible, to make in vivo.
Cyanobacteria are oxygen-evolving photosynthetic organisms that harvest sunlight and convert excitation energy into chemical energy. Most of the light is absorbed by large light harvesting complexes ...called phycobilisomes (PBs). In high-light conditions, cyanobacteria switch on a photoprotective mechanism called non-photochemical quenching (NPQ): During this process, absorption of blue-green light transforms the inactive orange form of the orange carotenoid protein OCP (OCPo) into the red active form OCPr that subsequently binds to the PB, resulting in a substantial loss of excitation energy and corresponding decrease of the fluorescence. In wild-type cells, the quenching site is a bilin chomophore that fluoresces at 660 nm and which is called APCQ 660. In the present work, we studied NPQ in two different types of mutant cells (CB and CK) that possess significantly truncated PBs, using spectrally resolved picosecond fluorescence spectroscopy. The results are in very good agreement with earlier in vitro experiments on quenched and unquenched PBs, although the fraction of quenched PBs is far lower in vivo. It is also lower than the fraction of PBs that is quenched in wild-type cells, but the site, rate, and location of quenching appear to be very similar.
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