bluuebunny/crossref_metadata_2025 huggingface dataset:
Inflammatory potential of dust from schools and building related symptoms
Authors: Allermann L , Meyer H W , Poulsen O M , Nielsen J B , Gyntelberg F
Published: August 2003

Aims:To test whether the inflammatory potential of dust samples might be used to differentiate schools with high and low prevalence of building related symptoms (BRS) among the occupants.

Methods:Ten schools with high prevalence of BRS and 10 schools with low prevalence were selected. Dust collected from floors, horizontal surfaces, and exhaust outlets was tested at five concentrations on the lung epithelial cell line A549. The potency of the dust (PF) to stimulate IL-8 secretion was calculated from the initial linear part of the dose-response curves. The organic fraction of the dust samples was determined by incineration.

Results:The schools with low prevalence of symptoms had a BRS% of 4.4–11.0 and the schools with high prevalence a BRS% of 19.6–31.9. The PF of floor dust and surface dust correlated, and the PF was associated with the organic content of the dust. The schools with low prevalence of symptoms had a significantly lower PF than the schools with high prevalence. Using the cut point value of 4.5 ng IL-8/mg floor dust, significantly more high prevalence schools were found above the cut point than below.

Conclusion:The PF of the floor dust samples correlated significantly with the prevalence of symptoms in the schools. The content of endotoxin and microorganisms did not seem to explain the inflammatory potential of the dust or BRS, and the substances in the dust causing the inflammatory potential are presently unknown.
Intervention strategies to reduce musculoskeletal injuries associated with handling patients: a systematic review
Authors: Hignett S
Published: August 2003

Aims:To report, analyse, and discuss the results of a systematic review looking at intervention strategies to reduce the risk factors associated with patient handling activities.

Methods:A search strategy was devised to seek out research between 1960 and 2001. Inclusion/exclusion criteria limited the entry of papers into the review process. A checklist was selected and modified to include a wide range of study designs. Inter-rater reliability was established between six reviewers before the main review process commenced. Each paper was read by two reviewers and given a quality rating score, with any conflicts being resolved by a third reviewer. Papers were grouped by category: multifactor, single factor, and technique training based interventions.

Results:A total of 2796 papers were found, of which 880 were appraised. Sixty three papers relating to interventions are reported in this paper. The results are reported as summary statements with the associated evidence level (strong, moderate, limited, or poor).

Conclusion:There is strong evidence that interventions predominantly based on technique training have no impact on working practices or injury rates. Multifactor interventions, based on a risk assessment programme, are most likely to be successful in reducing risk factors related to patient handling activities. The seven most commonly used strategies are identified and it is suggested that these could be used to form the basis of a generic intervention programme, with additional local priorities identified through the risk assessment process. Health care providers should review their policies and procedures in light of these findings.
Haematological effects among silk screening workers exposed to 2-ethoxy ethyl acetate
Authors: Loh C-H , Shih T-S , Liou S-H , Lin Y-C , Hsieh A-T , Chen C-Y , Liao G-D
Published: August 2003

Background:2-Ethoxy ethyl acetate (2-EEA) is a solvent with broad industrial and commercial applications. It has been reported to cause hematological toxicity, infertility, and teratogenesis.

Aims:To investigate the haematological effects in 2-EEA exposed workers.

Methods:Workers from one silk screening shop (n = 29), using 2-EEA as the major cleaning and printing solvent, were recruited as a high exposure group. Workers with indirect and non-exposure to 2-EEA (n = 56) were recruited as the comparison group. Venous blood was collected for blood routine examination. Air concentration of 2-EEA in this plant was measured by eight hour personal sampling.

Results:The geometric mean (GM) of air concentration of 2-EEA in the high exposure group was 7.41 ppm (range 1.35–16.5 pppm). The mean exposure of female workers (GM = 9.34 ppm) was significantly higher than that of male workers (GM = 4.87 ppm). The GM of air 2-EEA concentration in the comparison group was 0.07 ppm (range: non-detectable to 3.62 ppm, n = 26). The haemoglobin and haematocrit in the female high 2-EEA exposure workers were significantly lower than those of female workers in the comparison group. No difference was found between male 2-EEA high exposure and comparison group workers. The haemoglobin, haematocrit, and RBC count in the study population had a significant dose-response relation with air 2-EEA levels.

Conclusion:Results suggest that 2-EEA is a haematological toxicant, which leads to anaemic status in high exposure female workers.
Prognosis of shoulder tendonitis in repetitive work: a follow up study in a cohort of Danish industrial and service workers
Authors: Bonde J P , Mikkelsen S , Andersen J H , Fallentin N , Baelum J , Svendsen S W , Thomsen J F , Frost P , Thomsen G , Overgaard E , Kaergaard A ,   the PRIM Health Study Group
Published: August 2003

Background:The physical and psychosocial work environment is expected to modify recovery from shoulder disorders, but knowledge is limited.

Methods:In a follow up study of musculoskeletal disorders in industrial and service workers, 113 employees were identified with a history of shoulder pain combined with clinical signs of shoulder tendonitis. The workers had yearly reexaminations up to three times. Quantitative estimates of duration, repetitiveness, and forcefulness of current tasks were obtained from video recordings. Perception of job demands, decision latitude, and social support was recorded by a job content questionnaire. Recovery of shoulder tendonitis was analysed by Kaplan-Meier survival technique and by logistic regression on exposure variables and individual characteristics in models, allowing for time varying exposures.

Results:Some 50% of workers recovered within 10 months (95% CI 6 to 14 months). Higher age was strongly related to slow recovery, while physical job exposures were not. Perception of demands, control, and social support at the time when the shoulder disorder was diagnosed, were associated with delayed recovery, but these psychosocial factors did not predict slow recovery in incident cases identified during follow up.

Conclusion:The median duration of shoulder tendonitis in a cross sectional sample of industrial and service workers was in the order of 10 months. This estimate is most likely biased towards too high a value. Recovery was strongly reduced in higher age. Physical workplace exposures and perceived psychosocial job characteristics during the period preceding diagnosis seem not to be important prognostic factors.
Downsizing of staff is associated with lowered medically certified sick leave in female employees
Authors: Theorell T , Oxenstierna G , Westerlund H , Ferrie J , Hagberg J , Alfredsson L
Published: August 2003

Aim:To determine whether changes in number of staff in work sites are associated with medically certified sick leave among employees with an increased risk of developing cardiovascular disease.

Methods:The 5720 employees (aged 18–65) were from the WOLF study of cardiovascular risk factors in working men and women in greater Stockholm during the years 1992–95. From the medical examination a cardiovascular score was calculated for each participant. The WOLF study base was linked to a Statistics Sweden registry of economic and administrative activities. Sick leave spells lasting for at least 15 days during the calendar year following downsizing/expansion were identified for each subject.

Results:In multiple logistic regression an increased likelihood of having no medically certified sick leave (15 days or more) was found in women during the year following both downsizing and expansion. These analyses were adjusted for age and cardiovascular score. A high cardiovascular risk score reduced the likelihood of having no medically certified sick leave. The inclusion of psychosocial work environment variables did not change the results markedly. Separate analyses of women with and without high cardiovascular score showed that downsizing had a more pronounced effect on reduced long term sick leave among those with high than among those without low cardiovascular score. There were no consistent findings in men.

Conclusions:There is evidence of a reduction of long term sick leave in women after downsizing and this is particularly evident among those with high cardiovascular score.
Was Japan's Level of Investment in the 1990's Excessive?
Authors: Guest Ross S. , McDonald Ian M.
Published: August 2003

In this paper a method for calculating the socially optimal level of aggregate investment is developed. That method is then applied to Japan. It is found that in the 1990's the level of investment in Japan was excessive, in the sense that it exceeded the socially optimal level. The degree of over-investment in Japan in the 1990's has averaged about 5.5 per cent of GDP per year according to the calculations in this paper.
A new characterization of some alternating and symmetric groups
Authors: Khosravi Amir , Khosravi Behrooz
Published: August 2003

We suppose that p = 2α3β + 1, where α ≥ 1,  β ≥ 0, and p ≥ 7 is a prime number. Then we prove that the simple groups An, where n = p, p + 1, or p + 2, and finite groups Sn, where n = p, p + 1, are also uniquely determined by their order components. As corollaries of these results, the validity of a conjecture of J. G. Thompson and a conjecture of
Shi and Bi (1990) both on An, where n = p, p + 1, or p + 2, is obtained. Also we generalize these conjectures for the groups Sn, where n = p, p + 1.
Three theorems on cosymplectic hypersurfaces of six‐dimensionalHermitian submanifolds of the Cayley algebra
Authors: Al-Othman Ahmad , Banaru M.
Published: August 2003

It is proved that cosymplectic hypersurfaces of six‐dimensional
Hermitian submanifolds of the octave algebra are ruled manifolds.
A necessary and sufficient condition for a cosymplectic hypersurface
of a Hermitian submanifold M6 ⊂ O to be a minimal submanifold
of M6 is established. It is also proved that a six‐dimensional
Hermitian submanifold M6 ⊂ O satisfying the g‐cosymplectic
hypersurfaces axiom is a Kählerian manifold.
Toeplitz operators with BMO symbols and the Berezin transform
Authors: Zorboska Nina
Published: August 2003

We prove that the boundedness and compactness of the Toeplitz
operator on the Bergman space with a BMO1 symbol is completely determined by the boundary behaviour of its Berezin
transform. This result extends the known results in the cases when the symbol is either a positive L1‐function or an L∞ function.
Random entropy and recurrence
Authors: Dajani Karma , Meester Ronald
Published: August 2003

We show that a cocycle, which is nothing but a generalized random walk with index set ℤd, with bounded step sizes is recurrent whenever its associated random entropy is zero, and transient whenever its associated random entropy is positive.
This generalizes a well‐known one‐dimensional result and implies
a Polya type dichotomy for this situation.
α‐compactness in smooth topological spaces
Authors: Park Chun-Kee , Min Won Keun , Kim Myeong Hwan
Published: August 2003

We introduce the concepts of smooth α‐closure and smooth α‐interior of a fuzzy set which are generalizations of smooth closure and smooth interior of a fuzzy set defined by Demirci (1997) and obtain some of their structural properties.
A new proof of semicontinuity by Young measures and an approximation theorem in Orlicz‐Sobolev spaces
Authors: Bianconi Barbara
Published: August 2003

We give a new approach to study the lower semicontinuity properties of nonautonomous variational integrals whose energy densities satisfy general growth conditions. We apply the theory of Young measures and properties of Orlicz‐Sobolev spaces to prove semicontinuity result.
On the mild solutions of higher‐order differential equations in Banach spaces
Authors: Lan Nguyen Thanh
Published: August 2003

For the higher‐order abstract differential equation u(n)(t) = Au(t) + f(t), t ∈ ℝ, we give a new definition of mild solutions. We then characterize the regular admissibility of a translation‐invariant subspace ℳ of BUC(ℝ, E) with respect to the above‐mentioned equation in terms of solvability of the operator equation AX − X𝒟n = C. As applications, periodicity and almost periodicity of mild solutions are also proved.
Perturbed Fredholm boundary value problems for delay differential systems
Authors: Boichuk Alexander A. , Grammatikopoulos Myron K.
Published: August 2003

Boundary value problems for systems of ordinary differential equations with a small parameter ε and with a finite number of measurable delays of the argument are considered. Under the assumption that the number m of boundary conditions does not exceed the dimension n of the differential system, it is proved that the point ε = 0 generates ρ‐parametric families (where ρ = n − m) of solutions of the initial problem. Bifurcation conditions of such solutions are established. Also, it is shown that the index of the operator, which is determined by the initial boundary value problem, is equal to ρ and coincides with the index of the unperturbed problem. Finally, an algorithm for construction of solutions (in the form of Laurent series with a finite number terms of negative power of ε) of the boundary value problem under consideration is suggested.
Metastatic Breast Tumour Regression Following Treatment by a Gene‐Modified Vaccinia Virus Expressing MUC1 and IL‐2
Authors: Scholl Susy , Squiban Patrick , Bizouarne Nadine , Baudin Martine , Acres Bruce , von Mensdorff-Pouilly Silvia , Shearer Moira , Beuzeboc Philippe , Van Belle S. , Uzielly B. , Pouillart Pierre , Taylor-Papadimitriou Joyce , Miles David
Published: August 2003

MUC1 is expressed by glandular epithelial cells. It is
overexpressed in the majority of breast tumours, making it a
potential target for immune therapy. The objectives of the
present study were to evaluate the anti‐tumour activity and
tolerance of repeated administration of TG1031 (an attenuated
recombinant vaccinia virus containing sequences coding for human
MUC1 and the immune stimulatory cytokine IL‐2) in patients with
MUC1‐positive metastatic breast cancer. This was an open‐label,
randomised study comparing two dose levels, 5 × 10E6 and 5 × 10E7 pfu, with 14 patients in each arm. The treatment was administered intramuscularly every 3 weeks for the first 4 doses and every 6 weeks thereafter, until progression. Two patients had a partial tumour regression
(>50%), and 15 patients had stable disease as their best overall response until at least the 5th injection. Partial regression lasted for 11 months in one patient and for 12 months in the second patient who then underwent surgical resection of
her hepatic metastases. The most frequent adverse events included
inflammation at injection site: 7 patients, itching or pain at
injection site: 5 patients, and moderate fever: 6 patients. One
responding patient developed antinuclear, anti‐DNA, and increased
anti‐TPO antibodies after the fifth injection, and which resolved
at the end of treatment. The treatment regimes were well
tolerated with a low toxicity profile. Although clinical efficacy
remains limited, this study demonstrates the potential use of
MUC1‐based immune therapy in breast cancer.
Practical Modeling Concepts for Connective Tissue Stem Cell and Progenitor Compartment Kinetics
Authors: Muschler George F. , Midura Ronald J. , Nakamoto Chizu
Published: August 2003

Stem cell activation and development is central to skeletal
development, maintenance, and repair, as it is for all tissues.
However, an integrated model of stem cell proliferation,
differentiation, and transit between functional compartments has
yet to evolve. In this paper, the authors review current
concepts in stem cell biology and progenitor cell growth and
differentiation kinetics in the context of bone formation. A
cell‐based modeling strategy is developed and offered as a tool
for conceptual and quantitative exploration of the key kinetic
variables and possible organizational hierarchies in bone tissue
development and remodeling, as well as in tissue engineering
strategies for bone repair.
Angiotensin-Converting Enzyme Inhibition Influences Serum Levels of Advanced Glycation End Products in Patients with Coronary Artery Disease: Results from a HOPE Substudy
Authors: Kilhovd B.K. , Hjerkinn E. , Seljeflot I. , Reikvam Å.
Published: August 2003

Background: Advanced glycation end products (AGEs) are assumed to be involved in the development of premature atherosclerosis in diabetic patients, and it has recently been suggested that AGEs play a role in the atherosclerotic process in general. No study has examined the effect of medical intervention on circulating AGEs. Objective: To investigate whether angiotensin-converting enzyme (ACE) inhibitor therapy can influence the circulating levels of AGEs. Methods: Forty-two patients (35 men, 7 women, mean age ± SD 66.5 ± 6.0 years) participating in the Heart Outcomes Prevention Evaluation (HOPE) study were examined. Of these, 24 had been randomized to treatment with the ACE inhibitor ramipril and 18 to placebo at the start of the study. Serum levels of AGEs were measured with a polyclonal anti-AGE antibody, using a competitive immunoassay, in samples obtained from the patients at baseline and after 54 months of follow-up. Results: The serum AGE levels (median and 5th to 95th percentile in parentheses) increased significantly in the placebo group from 4.6 (0.3–17.2) U/ml to 7.7 (4.3–23.2) U/ml (p < 0.005) and in the ramipril group from 5.8 (2.7–14.1) U/ml to 7.2 (2.4–21.0) U/ml (p < 0.005). The increase of serum AGEs was significantly lower in the ramipril group than in the placebo group (p < 0.05). Conclusions: The serum levels of AGEs increased in high-risk patients with coronary artery disease over a period of 4.5 years. As compared with placebo, ramipril gave a lower increase of serum AGEs. Interference with AGEs may be a mechanism by which ACE inhibitors have a protective effect in the development of atherosclerosis.
Investigation and Treatment of Subclinical Coronary Atherosclerosis
Authors: Davies J.R. , Weissberg P.L.
Published: August 2003

The first manifestation of atherosclerosis is commonly sudden death. Yet despite the fact that the disease has a long asymptomatic phase, diagnostic tests and treatments are largely only available to patients with symptoms. In this review, we discuss recent advances in technology and understanding of the disease process that are providing novel ways to identify patients at risk of having or developing asymptomatic atherosclerosis. We then review some of the disease-modifying drugs, such as antiplatelet agents, cholesterol-lowering drugs, and angiotensin-converting enzyme inhibitors, that can be used to reduce the risk of major adverse clinical events.
Making Two Wrongs Right – Case of Using a Patient’s Diabetes insipidus to Treat HisHeart Failure: Experience with Vasopress in Antagonists from Animal Studies and Clinical Trials
Authors: Fischi Michael C. , Trichon Benjamin , Velazquez Eric , Blazing Michael , O’Conner Christopher
Published: August 2003

The precise control of body water and solute concentrations is a function of several hormones acting on both the kidneys and circulatory system, with arginine vasopressin (AVP) playing a key role in this homeostatic process. Vasopressin, also known as antidiuretic hormone, is secreted from the posterior pituitary in response to signals generated from hypothalamic osmoreceptors when increased plasma osmolality is detected. Neurohormonal activation in congestive heart failure results in a nonosmotic release of AVP which promotes vasoconstriction, water retention, and hyponatremia. Two of the receptor subtypes to which AVP binds, V1a and V2, play a role in smooth muscle cell contraction and control the expression of aquaporins in the collecting duct. These receptors have become targets for the medical treatment of heart failure. Research has shown that vasopressin receptor blockers have the ability to favorably alter hemodynamics and stimulate diuresis in animal and human heart failure cases. We describe the case of a patient with central diabetes insipidus whose inability to create vasopressin was utilized to his advantage in the management of his nonischemic cardiomyopathy with heart failure.
Hypovitaminosis D in Older Adults
Authors: Allain Theresa J. , Dhesi Jugdeep
Published: August 2003

Vitamin D deficiency is increasingly recognised as a common problem among older adults. In addition to the well-known role of vitamin D in calcium homeostasis and the maintenance of bone health, recent research has started to characterise the importance of vitamin D in neuromuscular function and the way this may relate to functional performance and falls risk in older adults. In this review we describe the current state of knowledge relating to the neuromuscular effects of vitamin D and discuss treatment options.
Aging and Arterial Blood Pressure Variability during Orthostatic Challenge
Authors: Shi Xiangrong , Huang Guoyuan , Smith Scott A. , Zhang Rong , Formes Kevin J.
Published: August 2003

Background: It has been demonstrated that a decrease in vagal cardiac function compromises arterial blood pressure (ABP) stability during orthostatic challenge. Augmentations in low-frequency (LF) ABP oscillations are indicative of this change in autonomic hemodynamic control. Aging is associated with diminished arterial baroreflex sensitivity and vagal cardiac dysfunction. However, the effect of aging on the stability of ABP during an orthostatic challenge remains to be elucidated. Objective: The purpose of this study was to investigate ABP stability with aging during central hypovolemia induced by lower-body negative pressure (LBNP). Methods: Graded LBNP up to –40 mm Hg was applied in 16 older (65 ± 3 years of age) and 16 younger (25 ± 3 years of age) healthy adults. ABP variability was analyzed by fast Fourier transform. LF spectral density (0.04–0.15 Hz) was extracted to provide an index of vasomotor responsiveness. Results: Both LF systolic blood pressure (SBP) variability and diastolic blood pressure variability were augmented with LBNP. The rate of increase in LF SBP variability was augmented significantly greater in older as compared with younger subjects (p = 0.049). In addition, LF SBP variability was inversely correlated with decreases in pulse pressure in both age groups (r = –0.84, p = 0.01). The magnitude of the decreases in SBP and pulse pressure during LBNP was significantly affected by age, with the largest changes occurring in older subjects. The altered ABP response that manifested in older individuals was associated with a significant diminution in the reflex tachycardiac response elicited by LBNP. Conclusions: Induction of central hypovolemia via graded LBNP augments LF ABP variability. This increased ABP variability is significantly greater in older individuals. Our data suggest that aging is associated with ABP instability during orthostatic challenge.
Effect of L-Carnitine on Carrageenan-Induced Inflammation in Aged Rats
Authors: İzgüt-Uysal V. Nimet , Ağaç Arzu , Derin Narin
Published: August 2003

Background: It is known that L-carnitine is a cofactor in the transport of fatty acids across the inner mitochondrial membrane for β-oxidation. However, L-carnitine is an antioxidant compound widely used for the treatment of deficits in functions due to the aging process. Objective: The purpose of the study was to investigate the effect of L-carnitine on carrageenan-induced inflammation in aged rats. Methods:L-Carnitine (50 mg/kg/day) or control vehicle was given by gavage for 30 consecutive days to young (2-month-old) and aged (24-month old) rats. 6 ml of air was injected subcutaneously into the dorsum of each rat, followed 2 days later by 4 ml of 2% carrageenan. After 2 days, the exudate was collected from the inflamed site of each rat. The quantity of collected exudate and the number of cells which have migrated to the inflamed site were determined. Results: No differences were observed in quantity of exudate in all groups; a decrease in the number of exudate cells was established in aged rats. However, L-carnitine treatment significantly increased the number of exudate cells in both young and aged rats. The exudate cells from the aged rats exhibited a decline of both phagocytic and chemotactic activities as compared with those from the young rats, and the decreased functions were significantly enhanced by L-carnitine treatment. However, superoxide anion release was seen to be unchanged in exudate cells due to aging, and L-carnitine intake decreased the production of superoxide anion by these cells in young and aged rats. Conclusions: These findings demonstrate that L-carnitine is capable of restoring the age-related changes in the functions of inflammatory cells. Moreover, L-carnitine may play a protective role in the tissue destruction in inflammation by decreasing the superoxide anion production.
Circulating Vascular Cell Adhesion Molecules VCAM-1, ICAM-1, and E-Selectin in Dependence on Aging
Authors: Richter Volker , Rassoul Fausi , Purschwitz Kathrin , Hentschel Bettina , Reuter Wolfgang , Kuntze Thomas
Published: August 2003

Background: Elevated levels of circulating cell adhesion molecules (cCAMs) such as vascular cell adhesion molecule-1 (VCAM-1), intercellular adhesion molecule-1 (ICAM-1), and endothelial leukocyte adhesion molecule-1 (E-selectin) are found in subjects with vascular diseases and in subjects with several risk factors for atherosclerosis. However, data evaluating cCAMs and biological age are limited. Objective: The purpose of this study was to assess in subjects with different cardiovascular risk profiles the levels of cVCAM-1, cICAM-1, and cE-selectin in dependence on age. Methods: The following groups of subjects were included in the study: 282 apparently healthy subjects of the average population aged 18–89 years, 77 vegetarians who are characterized by a favourable global cardiovascular risk profile, 94 patients with coronary heart disease, and 181 patients with peripheral arterial occlusive disease. Blood samples were obtained after an overnight fast for measurement of cCAMs, lipoproteins, and other clinical/biochemical parameters. The cCAM levels were determined by the use of monoclonal antibody based enzyme-linked immunosorbent assays. Results: Amongst the cCAMs, cVCAM-1 is uniquely elevated in elderly persons with different risks for atherosclerosis, including subjects of the average population, vegetarians with a favourable risk profile, and patients with both coronary heart disease and peripheral arterial occlusive disease. With respect to cICAM-1, an age-dependent elevation was found in the control subjects included in the study. The cE-selectin levels were not correlated with age. Moreover, no associations of cCAMs with serum lipid and lipoprotein levels were found. Conclusion: The results of the present study indicate that cVCAM-1 is an age-dependent parameter independent of cardiovascular risk.
Systemic Diseases in Association with Microbial Species in Oral Biofilm from Elderly Requiring Care
Authors: Senpuku H. , Sogame A. , Inoshita E. , Tsuha Y. , Miyazaki H. , Hanada N.
Published: August 2003

Background: The oral cavity is a reservoir for colonization and infection of systemic organs by pathogenic bacteria. It is understood that aging, tooth eruption, hormonal changes, active disease, oral hygiene, and other factors have an influence on biofilm formation and bacterial accumulation in the oral cavity. Objective: To understand the influence of systemic health care on microfloral changes, we conducted epidemiological studies of nursing home residents in an attempt to elucidate the relationship between underlying systemic diseases and the isolation frequency of oral opportunistic pathogens. Methods: The prevalence of bacteria and fungi causing pneumonia in association with oral biofilm bacteria were determined using detection culture plates. The influences of gender, age, denture-wearing status, number of teeth, and bedridden status in the patients residing in nursing homes were then analyzed. Results: The isolation frequency rates of Candida albicans, Pseudomonadaceae, Staphylococcus spp., and some strains of Enterobacteriaceae in plaque samples, as well as C. albicans and Xanthomonas maltophilia in samples from the pharynx, were significantly higher in those requiring systemic care (mean age 83.9 years) than in those who did not require such care (mean 71.0 years). In particular, the frequencies of Pseudomonas spp., C. albicans, and Serratia marcescens in plaque were significantly higher in those who were bedridden. Furthermore, the isolation of Pseudomonas spp. and Klebsiella pneumoniae, and/or C. albicans in plaque was significantly associated with heart disease. Conclusion: The coexistence of Pseudomonas spp. and C. albicans in elderly with 10–19 teeth is a potential indicator of high risk for pneumonia and heart disease. Therefore, attention to oral hygiene and professional care for removing the indicators may diminish the occurrence of systemic disease in the elderly requiring systemic care.
Red Cell Shape Changes in the Blood of People 60 Years of Age and Older Imply a Role for Blood Rheology in the Aging Process
Authors: Simpson L.O. , O’Neill D.J.
Published: August 2003

Five-drop samples of venous blood, which was fixed immediately, were obtained from 76 males and 91 females who were 60 years of age and older, and did not take part in competitive sport, and from 73 males and 50 females participating in the Golden Oldies Soccer tournament or in the Dunedin Masters’ Games. Most participants were nonsmokers. Those in the competitive group indicated a higher level of activity than those in the noncompetitive group, and the majority of participants indicated high levels of well-being. 30 different medical diagnoses were recorded including hypertension (36 cases), arthritis (17 cases), diabetes (6 cases), angina (6 cases) and coronary heart disease (7 cases). Most samples had high values for flat cells. Increased values for cells with altered margins were found in 7 males and 7 females, while 6 males and 1 female sample had increased values for cells with surface changes. It is concluded that some factor or factors in the aging process are responsible for red cell shape transformation. As high values for flat cells occur in people with chronic disorders, the lack of symptoms or evidence of dysfunction in people over 60 implies that survival is a consequence of having larger than usual capillaries.
Hyperthyroidism in Patients Older than 55 Years: An Analysis of the Etiology and Management
Authors: Díez Juan J.
Published: August 2003

Background: Hyperthyroidism is a common disease in the elderly. Although some studies on the prevalence of this thyroid disorder have been performed in the aged population, several aspects of hyperthyroidism, such as etiology and treatment effectiveness, have not been fully characterized in large series of aged patients. Objective: The aims of the present study were to determine the frequency of the diverse etiologies of hyperthyroidism, and to assess the effectiveness of therapy in adult patients older than 55 years. Methods: We performed a descriptive, observational, cross-sectional study in the setting of a hospital endocrinology clinic. We studied a group of 313 patients with hyperthyroidism. There were 246 women (78.6%, age 67.02 ± 8.35 years) and 67 men (21.4% age 63.34 ± 7.63 years). Overt hyperthyroidism was diagnosed in 167 patients (53.4%) and subclinical hyperthyroidism in the remaining 146 subjects (46.6%). In every patient we studied: the etiology; presence or absence of goiter; time of evolution from diagnosis; previously and presently used treatments; current thyroid functional status (free thyroxine and thyrotropin concentrations); adequacy of disease control, and thyroid autoimmune status. Results:  The different etiologies of hyperthyroidism were as follows: toxic multinodular goiter 43.1%; Graves’ disease 21.4%; iatrogenic thyrotoxicosis 16.0%; toxic adenoma 11.8%; iodine-induced thyrotoxicosis 1.2%; subacute thyroiditis 1.0%; painless thyroiditis 0.3%; factitious thyrotoxicosis 0.3%; TSH-secreting pituitary adenoma 0.6%, and unknown etiology 3.8%. Etiology was related to age, sex, presence of goiter, degree of hyperthyroidism and autoimmune status. 77.6% of patients had been diagnosed in the last 5 years, and 91.3% in the last 10 years. Preferred therapies were thionamide drugs in patients with Graves’ disease and radioiodine in patients with hyperthyroidism due to nodular disease. Surgery was performed in a limited number of patients. Periodic follow-up was used in patients with subclinical hyperthyroidism. Control of the disease was adequate in 65.3% and inadequate in 34.7% of patients who received any kind of previous therapy. In this group of patients, logistic regression analysis showed that the probability of attaining good control of hyperthyroidism was greater in patients with overt thyrotoxicosis compared to patients with subclinical thyrotoxicosis. Conclusion: In patients older than 55 years, toxic multinodular goiter is the most frequent etiology of spontaneous hyperthyroidism, followed by Graves’ disease and toxic adenoma. Most patients with thyroid hyperfunction can be adequately controlled, provided that effective therapy is administered. Patients with overt hyperthyroidism seem to have a higher probability of attaining adequate control of their disease than patients with subclinical hyperthyroidism, regardless of age, sex or etiology.
Favorable Toxicity Profile of Raltitrexed in Elderly Patients Treated for Colorectal Cancer: A Case Series
Authors: Franchi F. , Pastore C. , Caporale A. , Fabiani O. , Rossi L. , Seminara P.
Published: August 2003

Background: Age-related physiological changes may lead to an increased toxicity of chemotherapy in the elderly, thus making tumor treatment difficult in this increasing subset of patients. Objective: Since many trials claimed a favorable therapeutic index with raltitrexed, the aim of our preliminary study was to evaluate the anticancer activity and the toxic profile of this drug in the elderly. Methods: Thirteen elderly patients with colorectal cancer, aged 75–90 years, were enrolled in a monochemotherapy treatment with raltitrexed. Due to their advanced age, the drug was administered with a 33% reduction of the dose. Results: One partial response, four disease stabilizations, and two disease progressions were observed in 7 patients with advanced colorectal cancer. The patients with response or disease stabilisation had a satisfactory time to progression. Four out of 6 patients treated in the adjuvant setting for Dukes’ C colorectal cancer remain disease free at observation periods of 15+ to 29+ months. Toxicity was virtually absent in all patients. Conclusions: The activity of monochemotherapy with raltitrexed appears to be appealing, above all because it is observed in the absence of toxicity. Though recent reports suggest some concern about severe complications of treatment with raltitrexed, administration of reduced doses of this drug seems to be a putative therapy for those patients who, because of their age, are highly susceptible to the adverse effects of chemotherapy.
Predictors of Suicide in the Old Elderly
Authors: Waern Margda , Rubenowitz Eva , Wilhelmson Katarina
Published: August 2003

Background: Seniors aged 75 and above have the highest suicide rates of all age groups in most industrialized countries. However, research concerning risk factors for suicide in the old elderly is sparse. Objective: The purpose was to determine predictors for suicide among the old elderly (75+). Data concerning the young elderly (65–74 years) are shown for comparison. Methods: 85 consecutive cases of suicide that occurred in western Sweden and 153 control persons with the same sex, birth year, and zip code as the suicide cases were randomly selected from the tax register. The old elderly group included 38 cases and 71 controls; the young elderly group included 47 cases and 82 controls. Data concerning the suicide cases were collected through interviews with close informants; controls were interviewed in person. The interview included questions on past-year life events and mental and physical health. Medical records were reviewed for cases and controls. The Cumulative Illness Rating Scale – Geriatrics was used to rate illness burden. Results: Family conflict, serious physical illness, loneliness, and both major and minor depressions were associated with suicide in the 75+ group. Economic problems predicted suicide in the younger but not in the older elderly. Old elderly suicide victims with depression (major or minor) were less likely to have received depression treatment than their younger counterparts. Conclusions: Better recognition and treatment of both major and minor depression should constitute an important target for the prevention of suicide in the old elderly. Intervention studies with large numbers of senior participants are sorely needed.
The Privilege to Be Old
Authors: Davidovic Mladen , Erceg P. , Trailov D. , Djurica S. , Milosevic D. , Stevic R.
Published: August 2003

Background: Ample evidence has proven that the functional property of cells decreases over the years. Nevertheless, although it has taken decades to convince ourselves that elderly people belong to a specific age group both biologically and medicinally, and in whom special criteria have to be taken into consideration, it seems that even they themselves do not present an homogenous group. Objective: Today we often hear of authors of studies speaking of two subpopulation groups – one group that ages by all the laws of aging that we have encountered and accepted thus far, and the other group that seems to postpone aging due to ‘programmed death’, or more specifically due to low mastery/low emotional support or because of additional reasons; however, the existence of the two groups seems eminent. Methods: The identification of these two groups would allow us to find more realistic results in studies, and therefore a more efficient therapy for certain diseases. Results: This hypothesis does not contradict the theories of aging that we have accepted (at least not the majority) and also does not contradict the fact that there is a large interindividual variability. This hypothesis doubts and claims there are exceptions to the initial assumption of geriatrists and gerontologists that ‘parallel to the aging process, the functions of all organs and organ systems lessen.’ Conclusion: The identification of these two groups would allow us to find more realistic results in studies, and therefore more efficient therapy for certain diseases.
Identification of Human Papillomavirus DNA in Cutaneous Lesions of Cowden Syndrome
Authors: Schaller Jörg , Rohwedder Angela , Burgdorf Walter H.C. , Itin Peter H. , Lautenschlager Stephan
Published: August 2003

Background: Cowden syndrome (CS) or multiple hamartoma syndrome is a cancer-associated genodermatosis inherited in an autosomal dominant pattern. One of the diagnostic criteria is facial papules which are felt to be trichilemmomas, benign hair follicle tumors, which some consider to be induced by human papillomavirus (HPV). Objective: To search for HPV in skin tumors, especially trichilemmomas, from patients with CS. Methods: Skin lesions from patients with CS were classified histologically. Each tumor was then analyzed for HPV DNA by polymerase chain reaction with different primer sets; positive amplicons were typed by direct sequencing. Results: Twenty-nine biopsies from 7 patients with CS were investigated. Only 2 of 29 tumors clinically suspected of being trichilemmomas were confirmed histologically. In addition, 3 sclerotic fibromas, also typical of CS, were found, as well as 1 sebaceous hyperplasia. The other 23 lesions showed histological features of HPV- induced tumors in various stages of development. HPV DNA was found in 19 of 29 cutaneous lesions. Tumors without any histological signs of HPV induction were negative for HPV DNA. Two tumors which were histologically classified as common warts contained HPV types 27 and 28. All the 17 other HPV types belong to the group of epidermodysplasia-verruciformis-associated types. Conclusions: The majority of cutaneous lesions in CS contain HPV DNA. They may have a variety of histological patterns. Trichilemmomas are not clinically distinctive and can be difficult to identify in CS patients.
Serum Levels of Tumor Necrosis Factor and Interleukin-13 Are Elevated in Patients with Localized Scleroderma
Authors: Hasegawa Minoru , Sato Shinichi , Nagaoka Tetsuya , Fujimoto Manabu , Takehara Kazuhiko
Published: August 2003

Background: The enhanced production of some cytokines may be related to the pathogenesis of localized scleroderma (LSc). Objective: To determine whether serum levels of tumor necrosis factor (TNF) and interleukin (IL)-13 are elevated, and whether they correlated with clinical or serological features in patients with LSc. Methods: Serum levels of TNF and IL-13 were examined by ELISA in 45 patients with LSc and in 20 healthy controls. Results: The frequency of serum TNF detection was significantly higher in patients with LSc (24%) compared with that in healthy controls (0%). The frequency of serum IL-13 detection was also significantly higher in patients with LSc (29%) compared with that in controls (0%). In patients with LSc, elevated TNF levels significantly correlated with the presence of IgM antihistone antibodies, anti-single-stranded DNA antibodies, elevated serum IL-6 levels, the number of linear lesions, and muscle involvement. Elevated IL-13 levels were significantly associated with the number of plaque lesions and the total number of lesions. Conclusions: These results suggest that TNF and IL-13 may be associated with the development of LSc.
Frequency of X-Linked Ichthyosis in Coastal Southern Italy: A Study on a Representative Sample of a Young Male Population
Authors: Ingordo Vito , D’Andria Giuliano , Gentile Ciro , Decuzzi Marco , Mascia Enrico , Naldi Luigi
Published: August 2003

Background: No reports on the frequency of X-linked ichthyosis (XLI) in the Italian general population and few surveys on the frequency of XLI in large communities in the world are available. Objective: The aim of this study was the assessment of the frequency of XLI in a large representative sample of the Italian male population. Subjects and Methods: This study involved young men who enlisted as conscripts in the Italian Navy from January 1998 through February 2002, examined, prior to enlistment, at the Draft Council’s Medical Unit of the Italian Navy in Taranto, Italy, to evaluate their psychophysical fitness. All the patients with an ichthyosiform condition were referred to the Department of Dermatology of the Navy Hospital, underwent a thorough dermatological examination and completed a questionnaire regarding their personal and familial history. Pertinent results of the other clinical investigations were recorded and the final diagnosis was formulated on the basis of all these data. Results: From January 1998 through February 2002, of 75,653 young men examined, 15 cases of XLI were diagnosed, with a frequency of 1:5,043 or 1.98 per 10,000 (95% confidence interval based on the Poisson distribution 1.01–2.90). Four out of 15 cases (26.6%) showed corneal opacities. No other significant associated pathological change was observed. Conclusions: As this study is a survey involving a large male sample, homogeneous with reference to age, race and country of origin (southern Italy), the frequency of XLI could be estimated at about 1.98 per 10,000 males. These data are roughly in agreement with estimates from other European surveys.
Dermoscopic Features of Plaque Psoriasis and Lichen Planus: New Observations
Authors: Vázquez-López Francisco , Manjón-Haces José Antonio , Maldonado-Seral Cayetana , Raya-Aguado Cristina , Pérez-Oliva Narciso , Marghoob Ashfaq A.
Published: August 2003

Background: Dermoscopic features of common inflammatory dermatoses are not well studied and previous reports on this topic are limited to the search of vascular features (capillaroscopy). Objective: Dermoscopic features of psoriasis and lichen planus (LP) are investigated to determine both vascular and nonvascular features of these two dermatoses. Patients and Methods: Dermoscopic images of 25 patients with LP and 20 patients with plaque psoriasis (PP) were evaluated. Findings were statistically analyzed including the reproducibility of scoring (Cohen’s kappa statistics). Results: Our observations clearly showed that the evaluation of both vascular and nonvascular findings improved the surface microscopy of these diseases. A vascular feature (homogeneous red globules) was the most significant dermoscopic finding in the PP dermoscopic pattern (20/20, 100%; p < 0.001). A nonvascular feature (whitish striae) was the most significant dermoscopic feature in the LP pattern (23/25, 92%; p < 0.001). Dermoscopic features of LP also included gray-blue dots, comedo, milium-like cysts, and vascular structures (red lines). The intraobserver and interobserver reproducibility of scoring was very high (k value, 0.9). Conclusion: Our study shows for the first time that the efficacy of surface microscopy of common inflammatory dermatoses may be improved by investigating both vascular and nonvascular findings and its practicability in daily practice by using the dermoscope. Although dermoscopy does not provide clear additional help in the clinical differentiation between typical PP and LP, it could be helpful in patients with darker skin and for teaching settings.
Adult Langerhans Cell Histiocytosis Limited to the Skin
Authors: Singh Asha , Prieto Victor G. , Czelusta Adam , McClain Kenneth L. , Duvic Madeleine
Published: August 2003

Background: The incidence of Langerhans cell histiocytosis (LCH) is 4–5 per million in children with only 30% of this number having an adult onset. While dermatological manifestations occur in as many as 50% of cases, disease limited to the skin is uncommon among reported cases of adult LCH. Objectives and Methods: To present 3 new cases of adult LCH and a review of the literature of isolated cutaneous LCH in adults. Results: Three adults with scalp, vulvar and generalized LCH lesions had refractory responses to treatment. Conclusions: LCH may present with unusual cutaneous manifestations limited to the skin in adults. Optimal treatment has not yet been determined.
Changing Trends in Numbers of Deaths from Malignant Melanoma in Japan, 1955–2000
Authors: Ohtsuka Hisashi , Nagamatsu Shogo
Published: August 2003

Background: The incidence and number of deaths from cutaneous malignant melanoma have been reported to increase in many countries. However, those in Japan have not been analyzed yet. Objective: To analyze the changing trends in the number of deaths from melanoma in Japan. Methods: We analyzed the annual trends in numbers of deaths from melanoma from 1955 to 2000 in Japan on the basis of the data from the Vital Statistics of Japan, Statistics and Information Department, Minister’s Secretariat, Ministry of Health, Labor and Welfare. Results: The general trends in numbers of deaths from melanoma were upward. The annual increased ratio of deaths from melanoma was 6.3% (95% confidence interval: 4.6–8.1%). There was no gender difference in the annual increase in mortality (p < 0.05). The general trends in age-standardized death rates were also upward, although the death rates slowed between 1977 and 2000. The number and proportion of deaths among the elderly were increasing. The peak age group of deaths was roughly the fifties in 1955–1960, the sixties in 1961–1977 and the seventies after 1978. More than 50% of deaths occurred at or after 60 years of age after 1975 in both sexes, increasing to over 70% in 2000. Conclusion: Elderly individuals should be a focus of health promotion activities.