Medicalização da assistência ao parto normal: Perfil de gestantes atendidas em uma maternidade de risco habitual / Medicalización de la asistencia del parto natural: Perfil de las mujeres embarazadas atendidas en una maternidad de bajo riesgo / Medicalization of natural childbirth assistance: Profile of pregnancies women in a low-risk maternity hospital

Introdução: O nascimento tem experimentado mudanças na compreensão do parto como processo natural, tornando-o passível de intervenções, como as relacionadas a abreviação do parto através do uso de medicamentos. Objetivo: Descrever o perfil da assistência às gestantes, verificando a prevalência do uso de medicamentos, instrumentos e protocolos, durante o trabalho de parto e parto, em maternidade pública de saúde, destinada à assistência a gestantes de risco habitual. Método: Estudo transversal, descritivo, exploratório e quantitativo, com população por conveniência (n=26 profissionais de saúde). Foram investigadas as características sociodemográficas dos enfermeiros e médicos que prestavam assistência direta ao parto, além daquelas relativas ao uso de medicamentos, instrumentos e protocolos. Os dados foram tabulados no Epiinfo 7.2.2.2, sendo realizada análise estatística descritiva. Resultados: Observou-se que 53,8% são enfermeiros obstetras e 46,2% médicos obstetras. Dentre os entrevistados: 65,4% asseguraram preencher sempre ou quase sempre o partograma, 61,6% aplicam sempre ou quase sempre o índice de Bishop, 57,7% fazem uso de medicamentos para induzir o parto. A prevalência de profissionais que afirmaram não existir protocolos assistenciais ao parto na instituição somou 80,8%. Conclusão: O presente estudo foi relevante para demonstrar que a maioria dos profissionais não usavam medicamentos aceleradores do trabalho de parto; consideravam a integridade das membranas antes da indução medicamentosa, com maior prevalência de uso da ocitocina em relação ao misoprostol nos casos de necessidade de indução com iguais condições do colo uterino. A maior parte dos profissionais afirmou ainda fazer uso de protocolos de assistência ao parto, embora não fossem os institucionais.

Introducción: El nacimiento ha experimentado cambios en la comprensión del parto como un proceso natural, haciéndolo susceptible de intervenciones, como las relacionadas con la abreviación del parto mediante el uso de medicamentos. Objetivo: Describir el perfil de atención de la gestante, para verificar la prevalencia del uso de medicamentos, instrumentos y protocolos durante el trabajo de parto y parto en una maternidad de la red pública de salud, destinada a la asistencia de gestantes de riesgo habitual. Método: Estudio transversal, descriptivo, exploratorio y cuantitativo con población (n=26 profesionales de la salud). Se investigaron las características sociodemográficas de profesionales de enfermería y profesionales médicos que ofrecían asistencia directa durante el parto, además de las relacionadas con el uso de medicamentos, instrumentos y protocolos. Los datos se tabularon en el programa Epiinfo 7.2.2.2 y se realizó el análisis estadístico descriptivo. Resultados: Se observó que el 53.8 % son personal de enfermería obstetricia y el 46.2 % son obstetras. Entre las entrevistadas, el 65.4 % aseguró que siempre o casi siempre completaba el partograma, el 61.6 % siempre o casi siempre aplicaba el índice de Bishop, el 57.7 % utilizaba medicación para inducir el parto. La prevalencia de profesionales que afirmaron que no existían protocolos de atención del parto en la institución fue de 80.8 %. Conclusión: El presente estudio fue relevante para demostrar que la mayoría de los profesionales no utilizaban fármacos para acelerar el trabajo de parto, consideraron la integridad de las membranas antes de la inducción medicamentosa, con mayor prevalencia de uso de oxitocina, en relación al misoprostol en casos de necesidad de inducción con las mismas condiciones del cuello uterino. La mayoría de los profesionales dijeron que todavía hacen uso de los protocolos de atención al parto, aunque no sean institucionales.

Introduction: Birth has experienced changes in the understanding of childbirth as a natural process, making it amenable to interventions, such as those related to shorten the labor time by medication. Objective: To describe the prevalence of the use of drugs, instruments, and protocols in the labor and delivery profile of assistance in a public maternity hospital that nurses low risk pregnancies. Method: This is a cross-sectional, descriptive, exploratory, and quantitative study with population (n=26 health professionals). The sociodemographic characteristics of nurses and doctors who provide direct assistance during childbirth were analyzed in addition to those related to the use of medications, instruments, and protocols. Data were tabulated in the Epiinfo 7.2.2.2 program; then, a descriptive statistical analysis was performed. Results: It was observed that 53.8% are obstetric nurses and 46.2% are obstetricians. Among the interviewees: 65.4% assured that they always or almost always completed the partograph, 61.6% always or almost always applied the Bishop index, 57.7% used medication to induce labor. The prevalence of professionals who stated that there were no childbirth care protocols in the institution totaled 80.8%. Conclusion: The present study was relevant to demonstrate that most professionals did not use drugs for labor induction; they considered the integrity of the membranes before these drugs; and, when induction was needed, there was a higher prevalence of the use of oxytocin in relation to misoprostol in cases with the same conditions of the uterine cervix. Most professionals said that they still use childbirth care protocols although they are not institutional.

As reações do familiar acompanhante de idosos hospitalizados frente às situações de estresse / Las reacciones de la escolta familiar de ancianos hospitalizados frente a las situaciones estresantes / The reactions of the family companion of hospitalized elderly facing stressful situations

Objectives: Characterizing the accompanying family member of hospitalized elderly; describing the family's reactions companion of hospitalized elderly forward to stressful situations; and discussing the possibilities of intervention of the nurse accompanying the family of the elderly. Method: A qualitative, descriptive and exploratory study held in wards of a general hospital with 45 accompanying family members of hospitalized elderly. There were conducted semi-structured interviews and data were submitted to thematic analysis. The study was approved by the ethics committee. Results: The main reactions facing stressful situations: changes in eating habits, use of medicines for relaxation and insomnia and mood swings. For coping with stressful situations seek alternative leisure activities and attachment to religious practices. Conclusion: The accompanying family member of the elderly should also be the focus of nursing care during the hospitalization process, by supporting strategies and educational programs to preserve their health.

Objetivos: Caracterizar o familiar acompanhante de idosos hospitalizados; descrever as reações do familiar acompanhante de idosos hospitalizados frente às situações de estresse e discutir as possibilidades de intervenção do enfermeiro ao familiar acompanhante desses idosos. Método: Estudo qualitativo, descritivo e exploratório realizado em enfermarias de um hospital geral com 45 familiares acompanhantes de idosos hospitalizados. Foi realizada entrevista semiestruturada e os dados foram submetidos à análise temática. O estudo teve aprovação do comitê de ética. Resultados: As principais reações frente às situações de estresse: alterações nos hábitos alimentares, utilização de medicamentos para relaxamento e insônia e mudanças de humor. Para o enfrentamento das situações de estresse buscam atividades alternativas de lazer e apego às práticas religiosas. Conclusão: O familiar acompanhante de idosos deve também ser foco de cuidado da enfermagem durante o processo de hospitalização, mediante estratégias de suporte e programas educativos para preservar sua saúde.

Objetivos: Caracterizar el miembro de la familia que acompaña ancianos hospitalizados; describir reacciones del familiar de ancianos hospitalizados con interés de la familia a las situaciones de estrés y discutir las posibilidades de intervención de la enfermera que acompaña a la familia de los ancianos. Método: Cualitativo, descriptivo y exploratorio celebrado en las salas de un hospital general con 45miembros de la familia acompañantes de ancianos hospitalizados. Se llevó a cabo entrevistas y datos semiestructurados que fueron sometidos al análisis temático. El estudio fue aprobado por el comité de ética. Resultados: Las reacciones principales de situaciones de estrés delanteros: cambios en los hábitos alimenticios, el uso de medicamentos para la relajación y el insomnio y cambios de humor. Para hacer frente a situaciones de estrés se buscan alternativas de ocio y apego a las prácticas religiosas. Conclusión: El miembro de la familia de acompañamiento de las personas mayores debería ser el foco de atención de enfermería durante el proceso de hospitalización, mediante el apoyo a las estrategias y programas educativos para preservar su salud.

The nursing team and the family member accompanying adult patients in the hospital context. An exploratory study / El equipo de enfermería y el familiar acompañante del paciente adulto en el escenario hospitalario. Un estudio exploratorio

Objective. To identify the actions of family members who accompany adult hospitalized patients and to describe the nursing team's role regarding that person. Methodology. In this qualitative, descriptive and exploratory research, a questionnaire was applied to 30 nursing team members at a teaching hospital located in the State of Rio de Janeiro, using open questions. To interpret the answers, thematic analysis was applied to categorize the identified qualitative variables. Results. Eighty-nine percent of the participants were female. When analyzing the information contained in the answers to the questionnaire, two types of actions were found: the actions the companion can perform for his/her relative and the actions the nursing team needs to perform. In each action, the following categories were verified: affective dimension, practical dimension, moral dimension and inclusion of the family in care. According to the nursing team, the companion plays a very important role in emotional support and help with the patient's basic hygiene, although this care should be offered under nursing orientation. Conclusion. Family companions and nursing team members work together to improve the quality of patient care, with positive reflections for their integration in hospital care, which will enhance its continuity in the home-care context.

Objetivo. Identificar las acciones del familiar acompañante del paciente adulto hospitalizado y describir qué papel tiene el equipo de enfermería con este familiar. Metodología. Investigación cualitativa, descriptiva y exploratoria, en la que se aplicó un cuestionario con preguntas abiertas a 30 personas del equipo de enfermería de un hospital universitario localizado en el Estado do Rio de Janeiro. La toma de la información se realizó en 2010. Las respuestas fueron interpretadas por análisis temático, categorizando las variables cualitativas identificadas. Resultados. El 89% de los participantes pertenecía al sexo femenino. Al analizar la información de las respuestas a las preguntas del cuestionario se encontraron dos tipos de acciones: las que puede brindar el acompañante a su familiar y las propias a desempeñar por enfermería. En cada acción se verificaron las categorías: dimensión afectiva, dimensión práctica, dimensión moral e inclusión de la familia en el cuidado. Para el equipo de enfermería el acompañante tiene un papel muy importante en el apoyo emocional y en la ayuda con la higiene básica del paciente, pero este cuidado debe brindarse bajo la orientación de enfermería. Conclusión. El acompañante familiar y del equipo de enfermería buscan conjuntamente la mejoría de la calidad del cuidado del paciente, lo que se refleja positivamente en su integración en el ámbito de la atención hospitalaria, lo que favorecerá la continuidad del mismo en el espacio domiciliario.

Sistematização da Assistência de Enfermagem ao idoso com doença de alzheimer e transtornos depressivos / Systematization of Nursing Care to the elderly with alzheimer's disease and depressive disorders

Objetivos: elaborar um plano assistencial ao idoso portador de transtornos depressivos e doença de Alzheimer e evidenciar a efetividade da sistematização do cuidado de enfermagem. Método: estudo de caso, de abordagem qualitativa, realizada com cliente de 65 anos, sexo feminino, no Programa A Enfermagem na Atenção à Saúde do Idoso e Seus Cuidadores, em 2009. O projeto foi aprovado pelo Comitê de Ética em Pesquisa sob nº 062/2009. Utilizou-se um formulário, além do prontuário. A análise procedeu-se segundo o raciocínio clínico de Risner. Resultados: identificados os principais diagnósticos de enfermagem segundo a North American Nursing Diagnosis Association, realizou-se o levantamento das intervenções de enfermagem, segundo a Nursing Intervention Classification e os resultados foram avaliados a partir da Nursing Outcomes Classification. Para avaliar as ações de enfermagem, foram descritos os resultados do NOC nos períodos pré e pós-intervenções. Conclusão: a assistência de enfermagem baseada nessas classificações permite cuidado efetivo ao cliente.(AU)

Objectives: to develop a plan of care to the elderly with depressive disorders and Alzheimer's disease and demonstrate the effectiveness of the systematization of nursing care. Method: clinical case report, conducted in qualitative approach, with client 65 years old female in Nursing Program in Health Care of the Elderly and Their Caregivers in 2009. The project was approved by the Research Ethics Committee under No. 062/2009. We used a form, beyond the record. The analysis proceeded according to Risner of clinical reasoning. Results: the main nursing diagnoses were identified according to the North American Nursing Diagnosis Association, held a survey of nursing interventions, Nursing Intervention Classification according to and the results were evaluated from the Nursing Outcomes Classification. To evaluate nursing actions were described NOC results in the pre-and post-intervention. Conclusion: nursing care based on these classifications allows effective customer care.(AU)

Objetivos: desarrollar un plan de atención a las personas mayores con trastornos depresivos y la enfermedad de Alzheimer y demostrar la eficacia de la sistematización de la asistencia de enfermería. Método: estudio de caso, el enfoque cualitativo, realizado con el cliente de 65 años de edad las mujeres en el Programa de Enfermería en el Cuidado de la Salud de los ancianos y sus cuidadores en el 2009. El proyecto fue aprobado por el Comité Ético de Investigación bajo el número 062/2009. Se utilizó un formulario, más allá del registro. El análisis realizado de acuerdo a Risner de razonamiento clínico. Resultados: se identifican los principales diagnósticos de enfermería según la Asociación North American Nursing Diagnosis, llevó a cabo una encuesta de las intervenciones de enfermería, enfermería Clasificación de Intervenciones de acuerdo y se evaluaron los resultados de la Clasificación de Resultados de Enfermería. Para evaluar las acciones de enfermería se describieron los resultados NOC en el pre-y post-intervención. Conclusión: la atención de enfermería basada en esta clasificación permite el cuidado eficaz del cliente.(AU)

A double-negative (IgD-CD27-) B cell population is increased in the peripheral blood of elderly people.

The T cell branch of the immune system has been extensively studied in the elderly and it is known that the elderly have impaired immune function, mainly due to the chronic antigenic load that ultimately causes shrinkage of the T cell repertoire and filling of the immunologic space with memory T cells. In the present paper, we describe the IgD(-)CD27(-) double-negative B cell population which (as we have recently described) is higher in the elderly. Most of these cells were IgG(+). Evaluation of the telomere length and expression of the ABCB1 transporter and anti-apoptotic molecule, Bcl2, shows that they have the markers of memory B cells. We also show that these cells do not act as antigen presenting cells, as indicated by the low levels of CD80 and DR, nor do they express significant levels of the CD40 molecule necessary to interact with T lymphocytes through the ligand, CD154. Hence, we hypothesize that these expanded cells are late memory or exhausted cells that have down-modulated the expression of CD27 and filled the immunologic space in the elderly. These cells might be the age-related manifestation of time-enduring stimulation or dysregulation of the immune system.

B cell immunosenescence in the elderly and in centenarians.

The elderly suffer from an increased susceptibility to infectious disease and cancer. Aging of the immune system contributes to this state of affairs due to immunosenescence. Because repeated intermittent or chronic antigen exposure may lead to lymphocyte clonal exhaustion, chronic antigenic stress plays a part in the compromised immunity of the elderly, who have accumulated a lifetime's exposure to infectious agents, autoantigens, and cancer antigens. Literature on immunosenescence has focused mainly on T cell impairment, but B cell compartment is also affected. The age-dependent B cell changes documented by the present review indicate that advanced age per se is a condition characterized by lack of B clonotypic immune response to new extracellular pathogens. In any event, data are suggesting that the loss of naive B cells could represent a hallmark of immunosenescence and could provide a biomarker possibly related to the life span of humans and potentially useful for the evaluation of anti-aging treatment. Since information on the senescence of B cells is of obvious interest, further studies are necessary to confirm these suggestions as well as to extend the number of markers used to characterize the cells.

Impact of CMV and EBV seropositivity on CD8 T lymphocytes in an old population from West-Sicily.

Herpes viruses (particularly CMV and to some extent EBV) might play a role in accelerating the deterioration of immune functions with age. Indeed, it has been demonstrated that chronic infection with CMV causes an expansion of specific CD8 T lymphocytes and that this is related to a shrinkage of the T cell repertoire in very elderly people, predicting mortality. We have analysed CD8 T cells in young and old healthy Sicilians who were both CMV- and EBV-seropositive. Our data confirm expansions of T cells specific for the HLA-A2-restricted pp65 (495-503) CMV epitope up to nearly 14% of total peripheral CD8 cells in certain elderly individuals (range 0-14%). However, the mean percentage of CMV-specific cells in the elderly was not greater than the young (range 0.2-3%). The CMV-specific CD8 cells in the elderly were predominantly CD45RA+, but in the young they were mostly CD45RO+. Our findings are somewhat different from published reports from Northern European populations, both in terms of mean numbers and surface phenotypes. These findings may reflect disparate hygienic and nutritional conditions 70-90 yr ago, which were very different in Northern and Southern Europe at that time, as well as a different genetic background.

Inflammation, longevity, and cardiovascular diseases: role of polymorphisms of TLR4.

The total burden of infection at various sites may affect the progression of atherosclerosis, the risk being modulated by host genotype. The role of lipopolysaccaride receptor TLR4 is paradigmatic. It initiates the innate immune response against gram-negative bacteria; and TLR4 polymorphisms, as ASP299GLY, suggested to attenuate receptor signaling, have been described. We demonstrated that TLR4 ASP299GLY polymorphism shows a significantly lower frequency in patients affected by myocardial infarction compared to controls, whereas centenarians show a higher frequency. Thus, people genetically predisposed to developing weak inflammatory activity, seem to have fewer chances of developing cardiovascular diseases (CVD) and, subsequently, live longer if they do not become affected by serious infectious diseases. These results are in agreement with our other data demonstrating how genetic background may exert the opposite effect with respect to inflammatory components in CVD and longevity. In the present report, to validate this hypothesis, the levels of interleukin (IL)-6, a pro-inflammatory cytokine involved in atherosclerosis and longevity, were determined by an enzyme-linked immuno-sorbent assay (ELISA) in supernatants from a whole blood assay after stimulation with subliminal doses of lipopolysaccaride (LPS) from Escherichia coli (E. coli). The samples, genotyped for the ASP299GLY polymorphism, were challenged with LPS for 4, 24, and 48 h. What we found was that Il-6 values were significantly lower in carriers bearing TLR4 mutation. Therefore, the pathogen burden, by interacting with host genotype, determines the type and intensity of the immune-inflammatory responses accountable for pro-inflammatory status, CVD, and unsuccessful aging. On the other hand, our present data seem to explain the inconclusive results obtained in case-control studies taking into account the role of functional IL-6 polymorphisms in successful and unsuccessful aging. In fact, IL6 levels seem to depend, in addition, on IL-6 polymorphisms and on innate immunity gene polymorphisms as well.

The nACHR4 594C/T polymorphism in Alzheimer disease.

Alzheimer disease (AD) is the most common form of dementia with complex etiology and multifactorial origin. Although several neurochemical deficits have been described in AD patients, explanation of the nature of the cognitive disturbance is focused on the "cholinergic hypothesis." The neuronal nicotinic acetylcholine receptor (neuronal nAChR) belongs to the superfamily of ionic channel activated by ligand. This paper presents a population-based population association study, testing the hypothesis that variants of the nAChR gene confer genetic susceptibility to AD. The authors analyzed two cohorts constituted by 60 controls and 80 AD patients in which significant increase of 594T polymorphism in patients affected by AD versus controls was found. However, further studies are necessary to confirm this polymorphism trend and to establish the polymorphism functionality and its correlation with behavioral and cognitive deficit.

Memory B cell subpopulations in the aged.

The literature on immunosenescence has focused mainly on T cell impairment. With the aim of gaining insight into B cell immunosenescence, the authors investigated the serum IgD levels in 24 young and 21 old people and analyzed their relationship with the number of CD19+CD27+ memory cells. Serum IgD were quantified by the use of radial immunodiffusion and the lymphocyte population CD19+CD27+ was identified by a FACScan flow cytometer. Serum IgD levels were significantly lower (p < 0.0001) in old subjects, and the percentage of CD19+CD27+ lymphocytes were significantly increased (p = 0.01) in old subjects. Finally, a significant negative correlation was found (p = 0.01) between serum concentrations of IgD and CD19+CD27+. The present results show that the levels of IgD are negatively age-related to the amount of B memory cells. This suggests that the B repertoire available to respond to new antigenic challenges is decreased in the elderly. In fact, many memory IgD- B cells fill immunologic space, and the number of naïve IgD+ B cells is dramatically decreased. Therefore, these preliminary results suggest that a decrease of naïve IgD+CD27- B cells and a concomitant increase of memory IgD-CD27+ B cells could represent hallmarks of B immunosenescence, might provide biomarkers related to the lifespan of humans, and could be useful for the evaluation of antiaging treatments.

A study of serum immunoglobulin levels in elderly persons that provides new insights into B cell immunosenescence.

The literature on immunosenescence has focused mainly on T cell impairment. With the aim of gaining insight into B cell immunosenescence, we investigated the serum immunoglobulin levels in a cohort of 166 subjects (20-106 years). Serum IgG (and IgG subclasses) were quantified by the nephelometric technique, IgE by CAP system fluorescence enzyme immunoassay, and IgD by radial immunodiffusion (RID). There was an age-related increase of IgG and IgA; the IgG age-related increase was significant only in men, but IgG1 levels showed an age-related increase both in men and women, whereas IgG3 showed an age-related increase only in men. IgE levels remain unchanged, whereas IgD and IgM serum levels decreased with age; the IgM age-related decrease was significant only in women, likely due to the relatively small sample of aged men. Thus, in the elderly the B cell repertoire available to respond to new antigenic challenge is decreased. A lot of memory IgD- B cells are filling immunological space and the amount of naïve IgD+ B cells is dramatically decreased. This shift away from a population of predominantly naïve B cells obviously reflects the influences of cumulative exposure to foreign pathogens over time. These age-dependent B cell changes indicate that advanced age is a condition characterized by lack of clonotypic immune response to new extracellular pathogens. In any event, the increase of memory B cells and the loss of naïve B cells, as measured by serum IgD levels, could represent hallmarks of immunosenescence and could provide useful biomarkers possibly related to the life span of humans.

Impairment of gamma/delta T lymphocytes in elderly: implications for immunosenescence.

Gamma/delta T lymphocytes cells recognize the antigen in a non-classical way and are considered the third branch of the immune system devoted to defend the integrity of the body. Ageing is characterized by an impairment of the main way of protection (the adaptive branch) but, successfully aged people show compensatory mechanisms of defense such as proneness to inflammation. Moreover, very old subjects show an increased number of NK cells. We have previously demonstrated that gamma delta T lymphocytes are reduced in elderly. In the present paper we have studied some characteristics of these cells to evaluate the possibility that these cells might balance the decreased action of the adaptive branch in successfully aged people. Cytofluorimetric analysis of cells collected from young, old and centenarian subjects has been used to evaluate the ability of these cells to expand in vitro. Here we demonstrate that gamma delta T cells are impaired in the ability to proliferate to different stimuli such as isopentenyl pyrophoshate, that select gamma delta T lymphocytes bearing delta 2 chain, other than to phytohemagglutinin and anti-CD3 that are polyclonal activators. Moreover, we demonstrate that gamma delta T cells in aged and centenarians show an enhanced sensitivity to undergo apoptosis induced both by alpha-Fas and TNF-alpha. All together these data suggest that gamma delta T lymphocytes are impaired in elderly and suggest that the reduced ability to proliferate and the reduced number of circulating gamma delta T lymphocytes is due to the proneness to apoptosis. Finally on the basis of these data, we conclude that gamma delta T lymphocytes, do not participate in the remodeling of the immune system due to the reduction of classical T cell response and replacement by NK cells in elderly.

CD4+ CCR5+ and CD4+ CCR3+ lymphocyte subset and monocyte apoptosis in patients with acute visceral leishmaniasis.

The potential involvement of apoptosis in the pathogenesis of visceral leishmaniasis (VL) was examined by studying spontaneous and Leishmania antigen (LAg)-induced apoptosis using cryopreserved peripheral blood mononuclear cells (PBMC) of Sicilian patients with VL. Results indicate that monocytes and T lymphocytes from acute VL patients show a significantly higher level of apoptosis compared with that observed in healed subjects. The percentage of apoptotic cells was higher in monocytes than in T lymphocytes. T cells involved in programmed cell death (PCD) were mainly of the CD4(+) phenotype. In particular, the T helper 1-type (Th1) subset, as evaluated by chemokine receptor-5 (CCR5) expression, is involved in this process. Cell death in Th1-type uses a CD95-mediated mechanism. Furthermore, Th1-type CCR5(+) cells are prone to cell suicide in an autocrine or paracrine way, as attested by enhanced expression of CD95L in acute VL patients. The reduction in Th1-type cells by apoptosis was confirmed by the decrease in interferon-gamma secretion. In conclusion, apoptosis of monocytes, CD4(+) and CD4(+) CCR5(+) T cells could be involved in the failure of cell mediated immunity that is responsible for severe immune-depression in VL.

Looking for immunological risk genotypes.

Several functional markers of the immune system may be used either as markers of successful aging or conversely as markers of unsuccessful aging. Particularly, a combination of high CD8 and low CD4 and poor T cell proliferation has been associated with a higher two-year mortality in very old subjects. Therefore, genetic determinants of longevity should reside in those polymorphisms for the immune system genes that regulate immune responses. Concerning these changes in T cell subpopulations, how much they depend on the immunogenetic background and how much they depend on individual antigenic load, such as chronic infections, should be assessed. As previously demonstrated in our population, the interleukin (IL)-2 high-producer genotype is less frequent in old men than in young people; conversely, the IL-10 high-producer genotype is increased in old men. In this study, we tried to assess the role of low- and high-producer genotypes for IL-10 and IL-2 in the CD4 and CD8 absolute values, taking into account gender and age. The results suggest that old men carrying an anti-inflammatory IL-10 high-producer genotype or a proinflammatory IL-2 low-producer genotype show the lowest values of CD8 cells. Although in our study we were not able to show any correlation with CD4 values and no functional assessment of T cell was performed, these results suggest that cytokine genotypes may be involved in the subpopulation dynamics in old age.

B cells in the aged: CD27, CD5, and CD40 expression.

Ageing is characterized by numerous changes in lymphocyte subpopulations. In the present paper we have focused on B cells carrying the surface markers CD27, CD5 and CD40. CD27 is considered a marker of primed (memory) cells and its engagement promotes the differentiation of memory B cells into plasma cells. CD5 is expressed on B1 cells, which are considered to be responsible for T cell-independent antibody production other than autoantibodies. The CD40 molecule binds CD40L (CD154) and is necessary for T-dependent antibody responses. Here we show that the absolute number of CD5+ and CD40+ B cells is decreased in the elderly, while CD27+ B lymphocytes only marginally decrease in centenarians. However, there is a decrease of the percentage of CD5+ B cells, an increase of CD27+ B cells, while CD40 does not change significantly. These data, together with the increased number of NK cells during aging, suggest different regulation of antibody production in the elderly which might be another example of immune remodeling with aging, based on interactions between human B and NK cells.

Gamma/delta T lymphocytes are affected in the elderly.

gammadelta T lymphocytes are considered to represent a link between the inflammatory response and adaptive immunity. In the present paper we investigated whether these cells play any role in the remodeling of the immune system described in the elderly. We show that the absolute number of gammadelta T cells in peripheral blood of old and very old subjects is reduced. Moreover, gammadelta T cells from old people and centenarians show enhanced levels of the early activation marker CD69 both after culture in medium alone and in LPS-stimulated cells. Furthermore, they show a basal increased production of tumor necrosis factor (TNF)-alpha as evaluated at the single cell level. Additionally, the response of these cells to IPP in "in vitro" cultures is in part impaired. These results suggest that the high level of basal activation of gammadelta T cells is due to the "inflamed" environment. However, the changes in number and function of gammadelta T lymphocytes might influence the resolution of inflammatory immune responses in the elderly.