Bullous pemphigoid induced by vildagliptin: a report of three cases

To report three cases of bullous pemphigoid in patients treated with vildagliptin. Case 1: An 86‐year‐old woman presented with bullous pemphigoid after 1 month of treatment with vildagliptin and metformin. After introduction of clobetasol, the symptoms resolved although vildagliptin was continued. However, the skin lesions reappeared 3 months later. Sustained remission was achieved only after definitive withdrawal of vildagliptin. Case 2: A 79‐year‐old man presented with bullous pemphigoid after 37‐month treatment with gliclazide, vildagliptin and metformin. The disease at first responded to clobetasol but 3 months later the lesions reappeared. They finally regressed when the gliptin was discontinued. Case 3: A 77‐year‐old woman, treated with gliclazide and vildagliptin for 26 months, presented with bullous pemphigoid, which responded well to discontinuation of the gliptin and topical clobetasol. Gliptins are new molecules for treatment of type 2 diabetes mellitus, which have been suspected of implication in bullous pemphigoid. Such cases have been described in the literature (seven with vildagliptin and three with sitagliptin). In nine of these cases, the gliptin was associated with metformin, but the latter had never been considered responsible. The mechanism implicated in the development of bullous pemphigoid has not yet been clearly identified, but may involve a modified immune response or alteration of the antigenic properties of the epidermal basement membrane. These reports support the risk of bullous pemphigoid in patients exposed to gliptins.     

Software Architecture for Smart Emotion Recognition and Regulation of the Ageing Adult

This paper introduces the architecture of an emotion-aware ambient intelligent and gerontechnological project named “Improvement of the Elderly Quality of Life and Care through Smart Emotion Regulation”. The objective of the proposal is to find solutions for improving the quality of life and care of the elderly who can or want to continue living at home by using emotion regulation techniques. A series of sensors is used for monitoring the elderlies’ facial and gestural expression, activity and behaviour, as well as relevant physiological data. This way the older people’s emotions are inferred and recognized. Music, colour and light are the stimulating means to regulate their emotions towards a positive and pleasant mood. Then, the paper proposes a gerontechnological software architecture that enables real-time, continuous monitoring of the elderly and provides the best-tailored reactions of the ambience in order to regulate the older person’s emotions towards a positive mood. After describing the benefits of the approach for emotion recognition and regulation in the elderly, the eight levels that compose the architecture are described.     

Time in hemodialysis modulates the levels of genetic damage in hemodialysis patients

It is assumed that hemodialysis treatment can diminish the levels of genetic damage in circulating lymphocytes by cleaning the blood of uremic toxins that cause oxidative stress. However, the hemodialysis process by itself may also induce genomic damage by producing reactive oxygen species (ROS). We conducted a follow‐up study in a group of 70 hemodialysis patients followed for a mean time of 15 months. We investigated the effect of exposure time in hemodialysis on the levels of genetic damage in peripheral blood lymphocytes using the micronucleus assay. In addition, genetic damage after in vitro irradiation with 0.5 Gy was also analyzed to evaluate changes in radiosensitivity. Our results showed that, at the end of the study, there was a decrease in both the basal levels of genetic damage (9.9 ± 1.0 vs. 7.6 ± 0.7) and radiosensitivity values (38.5 ± 3.0 vs. 27.6 ± 2.4). We conclude that hemodialysis procedures may act as an ameliorating factor reducing the genetic damage present in chronic kidney disease patients. Environ. Mol. Mutagen. 55:363–368, 2014. © 2014 Wiley Periodicals, Inc.     

P21 Design and operation of a human breath freshness panel

Objective  Practical treatment of halitosis requires tongue cleaning since volatile sulphur compounds (VSC) seems mainly to be from the tongue coating. From this point of view, mechanical tools such as tongue brushes or scrapers have been developed. However, approaches by chemical tongue cleaning have not been reported. Thus we developed tablets containing protease from kiwifruits, which could resolve tongue coating, and assessed the effects of the protease tablet to control tongue coating.
Methods  Crossover studies and double blind experiments were designed using volunteers with informed consent. The trial was done twice per volunteer, that is, they had a tablet with or without the addition of protease from kiwifruits (test and placebo) with intervening washout periods of at least 2 weeks. The degree of change in tongue coating was evaluated visually using a tongue coating score which consisted of an area component (0–3) and a thickness component (0–3). An image analyzer was also used to measure the changing in actual area of coating.
Results  The average value of the tongue coating scores after taking a test tablet (11.4 ± 5.2) was significantly smaller ( P  < 0.01) than before taking the tablet (18.8 ± 7.0). Image analyzer measurements also showed significant reduction ( P  < 0.01) of tongue coating by taking test tablet. On the other hand, a placebo tablet showed no significant effects in both analyses.
Conclusions  This study indicated that taking protease tablets could reduce tongue coating. We are planning further clinical trials that can show reduced VSC concentrations in mouth air with decreasing tongue coating.     

Longitudinal dynamics of infection and serum antibody in A. actinomycetemcomitans periodontitis

OBJECTS: This report describes one of the first prospective studies delineating the relationship between infection, host antibody responses and disease exacerbations and remissions in a distinct subset of periodontitis patients infected with A. actinomycetemcomitans. DESIGN: The design of this longitudinal study included visits for each patient approximately every 2 months for up to 3 years. SUBJECTS AND METHODS: Subjects (n = 51) included 16 adult periodontitis (AP) and 11 early-onset periodontitis (EOP) patients with elevated serum IgG antibody to A. actinomycetemcomitans and infection with this microorganism, 12 AP patients with normal levels of anti-Aa antibody, and 12 normal subjects. MEASUREMENT OUTCOMES: Clinical parameters included a gingival index, plaque index, bleeding on probing, pocket depth, and attachment level. Disease activity was defined as loss of attachment during the monitoring intervals. Serum IgG, IgM and IgA antibody to A. actinomycetemcomitans Y4 (serotype b) was quantit-ated using an ELISA. Subgingival plaque samples were examined for A. actinomycetemcomitans using colony immunobiotting. Human serum IgG antibody specificities to outer membrane antigens (OMA) of A. actinomycetemcomitans Y4 were determined using Western immunoblotting. RESULTS: A. actinomycetemcomitans-infected AP patients had a higher frequency of teeth infected when compared to the EOP patients. However, the EOP patients exhibited a trend for higher levels of A. actinomycetemcomitans in those teeth that were infected. Active disease patients demonstrated a significantly greater frequency of infected sites, as well as significant elevations in the proportions of A. octinomycetemcomitans. Both EOP and AP groups showed significantly elevated IgG, IgM and IgA antibody to A. actinomycetemcornitans when compared to a periodontally normal group. The level of IgG antibody was significantly elevated in A. actinomycetemcomitans-positive patients with active disease, while IgA antibody was decreased in a number of the active group patients. Plaque samples derived from active sites showed a clear and significant increase in A. actinomycetemcomitans that occurred from 2–6 months prior to the identification of disease activity. Approximately 70% of the active disease patients showed an increase in IgG antibody level by 2–4 months prior to disease activity. Studies of the antigen reactivity patterns of serum IgG indicated that antibody to antigens of 65, 58, 48, 29 and 24 kDa were more frequent in patients who showed active disease, while those patients with the greatest frequency of active disease appeared to show a general decrease in the recognition of the A. actinomycetemcomitans OMA. CONCLUSIONS: It appears that A. actinomycetemcomitans infection relates to a particular type of disease with accompanying antibody responses that reflect periods of active disease. The dynamics of A. actinomycetemcomitans infection and the level and specificity of systemic antibody responses to this pathogen support an important contribution of the immune response to managing this infection.     

应激干预对抑郁症患者皮电和心率的影响

目的：了解放松训练和静坐两种干预方式对抗心算对抑郁症患者皮电和心率的影响，以及正常人、单纯抑郁症患者和伴焦虑症状的抑郁症患者在皮电和心率上的差异。方法：选择2006—06／09在河北医科大学第一附属医院精神卫生科门诊及住院的单纯抑郁症和伴焦虑症状的抑郁症患者各24例作为单纯抑郁症组和伴焦虑抑郁症组，均符合中国精神障碍分类与诊断标准，每组男女各12例，年龄17—50岁。选择同期院内医护人员及患者家属24人作为对照组，男女各12人，年龄19-47岁。所有对象对实验均知情同意。以心算为应激源，放松训练和静坐为干预手段，记录被试在基线期、干预期、应激期及恢复期的皮电和心率。结果：抑郁症患者48例及健康对照者24人全部进人结果分析。①在基线期，伴焦虑抑郁组心率明显高于单纯抑郁症组和对照组，皮电明显低于另外两组（P〈0．01），单纯抑郁症组和对照组皮电和心率比较，差异均不明显（P〉0．05）。②在干预期，被试的皮电升高，心率下降，放松训练的效果明显好于静坐，尤其对伴焦虑症状的抑郁症患者效果最好，静坐会加重伴焦虑症状的抑郁症患者的紧张状态。③在应激期，放松训练有效的对抗心算引起的皮电下降以及心率的升高，效果明显好于静坐组。④恢复期放松训练和静坐时的皮电、心率指标基本都恢复到静息状态。结论：①静息状态下伴焦虑症状的抑郁症患者的交感神经功能亢进，兴奋性高于单纯抑郁症患者和正常人。②放松训练可以缓解交感神经的紧张程度，并能够较静坐更好的对抗应激引起的交感神经活动增强。③静坐对单纯抑郁症患者和正常人有放松作用，但可引起伴焦虑症状的抑郁症患者更多的紧张情绪。