Periodontal status of diabetic and non-diabetic men: effects of smoking, glycemic control, and socioeconomic factors.

Periodontal disease is more prevalent and more severe in diabetic than in non-diabetic individuals but the magnitude of this increase is still being debated. This prospective, cross-sectional study compared the periodontal status of 118 diabetic men and 115 age-matched non-diabetic men. Plaque and gingival indices, bleeding scores, probing depth, loss of attachment, and number of missing teeth were measured in a blinded manner. Smoking status, glycemic control, socioeconomic status, and previous dental care were also assessed. These parameters were significantly higher in diabetic than non-diabetic men: plaque index, P < 0.0001; gingival index, P < 0.0002; bleeding score, P < 0.0001; probing depth, P = 0.0059; loss of attachment, P < 0.0001; and missing teeth, P < 0.005. These parameters were significantly higher in smokers than non-smokers: gingival index, probing depth, and loss of attachment. The duration of diabetes was not significantly related to the periodontal measures. Glycemic control as assessed by fasting plasma glucose and glycohemoglobin values was not significantly correlated to periodontal status. These studies indicate, for this study group, that diabetes significantly affects all measured parameters of periodontal status.

Population characteristics and cigarette yield as determinants of smoke exposure.

Relationships of population characteristics, smoking history, and cigarette yield with smoke exposure as measured by peripheral blood concentrations of thiocyanate, carboxyhemoglobin, nicotine and cotinine were sought in 170 male smokers. This population of smokers had significant elevations of serum thiocyanate, blood carboxyhemoglobin and plasma nicotine and cotinine concentrations as compared with an equal number of age- and sex-matched nonsmokers and these concentrations correlated significantly with past 24-hour cigarette consumption. Although the nicotine yield of the cigarette correlated significantly with plasma cotinine and marginally with plasma nicotine, the reduction in plasma nicotine and cotinine was not proportionate to the reduced yield of the cigarettes, suggesting that smokers partially compensate for the lower yields of their cigarettes. Blood levels of carboxyhemoglobin, nicotine and cotinine were also significantly associated with the weight of the subjects, presumably due to the relationship between weight and the volume of distribution. Univariate and multiple regression analyses provided evidence that coffee and alcohol consumption and years smoked also may be important determinants of smoke exposure.

Puffing topography as a determinant of smoke exposure.

Puffing topography variables were measured in a well-characterized, male population smoking their own brand of cigarette. Of the puffing topography variables, interpuff interval appeared to be the primary determinant of blood concentrations of smoke constituents: however, preliminary data in a homogeneous population according to the nicotine yield of their cigarette suggest that total puff volume per cigarette may also be a significant determinant of blood levels of smoke constituents. Smokers of low nicotine yield cigarettes partially compensated for these lower yields by increasing the total volume puffed per cigarette. Observed differences in puffing topography associated with increased daily cigarette consumption and cumulative smoking history were consistent with a higher smoke exposure per cigarette. Further, although both alcohol and coffee consumption are associated with present and cumulative smoking history, coffee consumption is uniquely associated with differences in puffing topography consistent with a higher smoke exposure per cigarette. However, by multiple regression analyses, neither coffee nor alcohol consumption histories added significantly to the prediction of blood concentrations of smoke constituents over that obtained by smoking history and puffing topography.

Impaired pulmonary clearance of pneumococci in neonatal rats.

Lung infections are a common cause of morbidity and mortality in neonates. To evaluate neonatal lung defenses against pneumococci, we challenged rats with aerosols of encapsulated pneumococci in an airborne infection apparatus. Whereas adult rats cleared greater than 95% of inhaled type 1 or type 25 pneumococci within 4 h, pneumococci proliferated in the lungs of newborn rats and reached 200-600% of the baseline value by 4 h and 1000-1700% by 24 h. As neonatal rats matured, their ability to clear inhaled pneumococci improved, but compared with adults some impairment in clearance was present until approximately 4 wk of age. Newborn rats had significantly fewer resident alveolar macrophages per g of lung tissue than did adults (p less than 0.001). Although the number of resident macrophages increased with time, a significant deficit in alveolar macrophages persisted for the first 3 wk of life (p less than 0.01). Aerosols of pneumococci caused an influx of granulocytes into the lungs of adult rats within 4 h, compared with 24 h for neonatal rats. Even at 24 h after pneumococcal challenge, newborn rats had significantly fewer granulocytes per g of lung tissue (p less than 0.05) than did adults, although 7-day-old rats had reached an adult level by this time. Significant (p less than 0.05) increases in granulocyte chemotactic activity were observed in lavage fluids of adult, but not newborn, rats after pneumococcal challenge. Thus, impaired clearance of pneumococcal aerosols by neonatal rats was associated with an age-dependent deficiency in numbers of resident alveolar macrophages and impaired generation of chemotactic activity and recruitment of granulocytes to the lung.

Tobacco smokers' neutrophils are desensitized to chemotactic peptide-stimulated oxygen uptake.

Chemotactic peptide-stimulated oxygen uptake and superoxide release were measured in neutrophils from a group of age- and race-matched male tobacco smokers and nonsmokers. The stimulated oxygen uptake in smokers was less than that of nonsmokers. This decreased sensitivity to formyl-methionyl-leucyl-phenylalanine (FMLP) stimulation of O2 uptake was the result of an altered apparent Km and was paralleled by a decrement in superoxide release in smokers. These alterations in neutrophil function, coupled with our previous observation of altered tritiated FMLP binding in smokers, support the hypothesis of a modified response to FMLP in chronic smoker's neutrophils.

Effects of cigarette smoke fractions on the chemotaxis of polymorphonuclear leukocytes.

The effects of cigarette smoking fractions on polymorphonuclear leukocyte (PMN) chemotaxis were determined using the 51Cr-assay. Water-soluble fractions (WSF) of cigarette smoke produced from several tobacco types differed in inhibitory potencies (i.e., flue cured greater than or equal to Maryland greater than or equal to blended greater than Burley greater than or equal to Turkish) corresponding to the respective unsaturated aldehyde content of the smoke from these tobaccos. Fractionation of cigarette smoke condensate (CSC) demonstrated that the more polar fractions were potent inhibitors of chemotaxis whereas those containing nicotine and the polycyclic hydrocarbons were weak inhibitors of chemotaxis. Unlike the inhibitory effects of WSFs, CSC fractions did not inhibit random migration and their inhibition of chemotaxis could not be completely prevented by reduced glutathione. These data suggest that while the alpha, beta-unsaturated aldehydes present in the vapor phase of smoke are among the most potent inhibitors of in vitro PMN chemotaxis, other polar, nonvolatile constituents of cigarette smoke also inhibit chemotaxis and by a mechanism which differs from that of the unsaturated aldehydes.

Altered chemotactic peptide binding in tobacco smokers' neutrophils.

The functions of polymorphonuclear leukocytes from tobacco smokers are altered compared to those from nonsmokers. Since neutrophil chemotaxis and oxidative metabolism are mediated by surface receptors, we studied the association of the chemotactic peptide formyl Met-Leu-Phe with neutrophils from smokers and non-smokers. An apparently single class of binding sites was observed in neutrophils from all the non-smokers, whereas upwardly curving Scatchard plots were obtained for binding to smokers' cells. Thus changes at the receptor level may be responsible for the previously observed alterations in smoker neutrophil function.

Smoking history, cigarette yield and smoking behavior as determinants of smoke exposure.

This study examines how smoking history, cigarette yield and smoking behavior relate to smoke exposure as determined by smoke constituents and their metabolic products in peripheral blood. Recruited without regard to the nicotine yield of their cigarette, male smokers smoked their own cigarettes ad libitum, including one cigarette five minutes prior to venipuncture. Smokers had significant (p = 0.0001) elevations of serum thiocyanate, blood carboxyhemoglobin, plasma nicotine, and cotinine concentrations each of which was significantly associated with past 24-hour cigarette consumption. The nicotine yield of the cigarette significantly correlated with plasma cotinine concentrations and with the smoking behavior variables. Most notably, smokers consuming lower nicotine yielding cigarettes exhibited an increased total puff volume per cigarette, suggesting that smokers of low nicotine yielding cigarettes compensate for these low yields by their smoking behavior. However, the fact that lower plasma cotinine concentrations are present in smokers of low-nicotine cigarettes suggests that this compensation is incomplete. That smoking behavior variables relate to smoke exposure was demonstrated by a significant linear correlation between plasma nicotine and mean puff interval in the total smoking population and between plasma nicotine and total puff volume per cigarette in a subpopulation smoking a single brand of cigarette. These data suggest that smoking history, nicotine yield of the cigarette and smoking behavior are all determinants of smoke exposure. Further, although smokers of low-yield cigarettes appear to compensate by puffing larger volumes per cigarette, this compensation appears to be inadequate to attain an equivalent smoke exposure.(ABSTRACT TRUNCATED AT 250 WORDS)

Effects of smoking on inflammatory mediators and their relationship to pulmonary dysfunction.

Study populations of 170 male smokers and 170 age- and sex-matched nonsmokers were used to determine the effects of cigarette smoking on pulmonary function, peripheral blood leukocytes and phase reactive proteins. Further, the interrelationships between these parameters were sought. Consistent with their young age (mean 37 years) and relatively brief smoking history (mean 24 pack-years), the smokers had a significant, yet modest, impairment of pulmonary function as measured by both forced expiratory spirometry and the single breath nitrogen/closing volume test. Smokers exhibited a significant elevation in total peripheral blood leukocytes which was attributable to increases in neutrophils, lymphocytes, monocytes and eosinophils. Similarly, significant increases in the "phase reactive" proteins [i.e., the ninth component of complement (C9), ceruloplasmin and alpha 1-protease inhibitor (alpha 1-PI)] were also observed in smokers. Increases in total leukocytes, neutrophils, C9 and alpha 1-PI were significantly associated with present and cumulative cigarette consumption, blood levels of smoke constituents/metabolites (i.e., carboxyhemoglobin, nicotine and cotinine) and impaired pulmonary function (i.e., FEV1 and FVC). However, duration of smoking (years smoked) and pack-years smoking history were the best predictors of elevations in inflammatory mediators and pulmonary dysfunction. These data support the hypotheses that: a low grade inflammatory reaction is induced in smokers and is dependent upon a dose-related exposure to smoke; and the smoking-induced changes in inflammatory mediators are associated with the observed pulmonary dysfunction.

Lower levels of vitamin C and carotenes in plasma of cigarette smokers.

Plasma levels of vitamins A, C, and E, selenium, and carotenes were determined in 125 male cigarette smokers and 125 age- and race-matched nonsmokers. The smokers had a mean daily consumption of 30.6 cigarettes and a cumulative consumption of 22.8 pack years. Plasma levels of vitamin C and total carotenes were significantly (p less than 0.05) lower in smokers than those of nonsmokers, while levels of vitamin A, selenium, and vitamin E were not significantly different between these two groups. Similar results were found when only those subjects not taking any form of dietary supplements were included for analysis. Except for negative correlation between vitamin A and pack-year, no significant correlates were observed between plasma levels of these micronutrients and indices of smoking status or cigarette consumption in smokers. These data suggest that chronic cigarette smoking is associated with depressed levels of plasma vitamin C and carotenes; however, the relationship between smoking and these plasma micronutrients is still unclear.

Serum antiproteases in smokers and nonsmokers. Relationships to smoking status and pulmonary function.

In this study of 50 relatively young male smokers and an equal number of age- and race-matched male nonsmokers, smokers had a 13.3% (p = 0.007) increase in mean serum alpha 1-proteinase inhibitor (alpha 1-Pl) concentration. This increase in serum alpha 1-Pl concentration was accompanied by increases in both the serum trypsin inhibitory capacity (TIC) (9.9%, p = 0.002) and the elastase inhibitory capacity (EIC) (12.4%, p = 0.001). That cigarette smoking increases serum alpha 1-Pl concentration and total protease inhibitory capacity was further supported by a significant association of alpha 1-PI, TIC, and EIC with increased pack-years smoking history, plasma nicotine, and plasma cotinine concentrations. Pulmonary function did not correlate with serum alpha 1-PI concentration. However, higher serum TIC and EIC did correlate with tests of small airways dysfunction. Highly significant correlations (r greater than or equal to 0.6, p = 0.001) were observed between TIC (or EIC) and alpha 1-PI concentrations. The linear relationships between TIC (or EIC) and serum alpha 1-PI concentration were not significantly different in smokers and nonsmokers. Further, no significant differential effect of smoking on either the TIC or EIC could be demonstrated. A decreased apparent functional activity of alpha 1-PI (i.e., nanomoles of protease inhibited per nanomole of alpha 1-PI) was associated with its higher serum concentration, a phenomenon observed in both smokers and nonsmokers. Thus, although cigarette smoking increases serum alpha 1-PI concentration and total protease inhibitory capacity, no evidence was obtained to suggest that the functional activity of serum alpha 1-PI (against either trypsin or elastase) was directly affected by smoking.

Increased neutrophil myeloperoxidase activity associated with cigarette smoking.

Neutrophils from 49 young male smokers contained significantly higher myeloperoxidase (MPO) activity than those from 49 age-matched, nonsmoking controls, while the elastase-like activity was not different in the two populations. MPO activity was increased in some smokers, but did not correlate significantly with the increased number of peripheral blood neutrophils, cigarette usage (present or cumulative), or the mild pulmonary dysfunction detected by forced expiratory spirometry and the single breath nitrogen test. This increased MPO activity in smokers' neutrophils may contribute to the greater risk of obstructive pulmonary disease in some smokers by an exacerbation of the protease-antiprotease imbalance in the lung. This hypothesis is supported by the prior observations that neutrophils are recruited in greater numbers into the lungs of smokers and that MPO (in the presence of H2O2 and chloride ion) oxidatively inactivates antiproteases of both the alveoli and the mucus-lined airways.

Increased plasma concentrations of C9, C1-inhibitor and alpha 1-protease inhibitor associated with cigarette smoking.

The association between various parameters of acute and chronic smoking status and plasma levels of three proteins, C9, C1-inhibitor (C1-INH) and alpha 1-protease inhibitor (alpha 1-PI) were determined for 49 male cigarette smokers and 49 age-matched nonsmokers (mean age = 32.2 years). The mean number of cigarettes smoked was 28.7 per day while the cumulative consumption was only 18.1 pack-years. Plasma levels of all three proteins were significantly higher in the smokers than nonsmokers. Plasma C9 and alpha 1-PI concentrations correlated with cumulative cigarette consumption and plasma nicotine concentrations. While C1-INH concentration did not correlate with either cumulative cigarette consumption or plasma nicotine concentration, it correlated significantly with serum thiocyanate concentration. No consistent correlation was found between plasma concentration of these proteins and parameters of pulmonary function.

Protective action of thiols on neutrophil function.

A reduced chemotactic responsiveness of polymorphonuclear leukocytes (PMN) isolated from peripheral blood of smokers has previously been demonstrated and suggested to be an acute effect of smoking. The purpose of our studies were to determine: if the exposure of PMN to cigarette smoke in vitro inhibits chemotaxis; which fractions/components of smoke were the most potent inhibitors; the mechanism of chemotaxis inhibition. Whole smoke, the gas phase of smoke and the water-soluble fraction (WSF) of smoke condensate were all shown to be potent inhibitors of PMN chemotaxis. Upon fractionation of cigarette smoke condensate according to the polarity of the constituents, the polar fractions were the most potent inhibitors, while the nonpolar fractions were relatively weak inhibitors. Among the polar constituents tested the alpha, beta-unsaturated aldehyde, acrolein and crotonaldehyde were the most potent inhibitors of PMN chemotaxis. Cysteine completely protected PMN chemotaxis from the inhibitory effects of WSF, acrolein and crotonaldehyde, but provided only partial protection against the effects of whole cigarette smoke and the gas phase of smoke. Reduced glutathione completely protected against the effects of WSF and ony partially protected against the effects of the polar fractions of cigarette smoke. Impaired PMN chemotaxis as a result of smoke exposure may contribute to the increased susceptibility of heavy smokers to bronchopulmonary infections.

Effect of smoking on peripheral blood leukocytes and serum antiproteases.

Cigarette smokers have an increased risk of chronic obstructive airways disease which has been attributed to a protease-antiprotease imbalance in the lung. The neutrophil is an important source of proteases as well as of myeloperoxidase, which oxidatively inactivates alpha-1-proteinase inhibitor (alpha-1-PI). The purpose of this study is to evaluate the protease-antiprotease imbalance hypothesis by measuring changes in peripheral blood components in a group of 110 young, male, asymptomatic smokers and an equal number of age-matched non-smokers. Significant (p = 0.001), but modest impairment of pulmonary function was observed in the smokers as measured by both forced expiratory spirometry and the single breath nitrogen test. A 35% increase (p = 0.0001) in peripheral blood leukocytes in smokers was attributable to increases in neutrophils (44%), lymphocytes (31%) and monocytes (23%). This increase in leukocyte count correlated significantly (p less than or equal to 0.01) with some of the more sensitive indicators of airway obstruction (FEV1/FVC, CV/VC, CC/TLC, and delta N2/L). Myeloperoxidase activity of neutrophils isolated from peripheral blood of smokers was 13% higher than in non-smokers, while elastase activity per neutrophil was apparently unaffected by smoking. In 50 subject pairs, elevations in serum alpha-1-PI concentrations in smokers (13.7%) were comparable to similar increases in trypsin (9.9%) and elastase (12.4%) inhibitory capacities. Expressed as nanomoles protease inhibited per nanomole of alpha-1-PI, the apparent functional activity of alpha-1-PI was unaltered by smoking. However, a lower, apparent functional activity of alpha-1-PI against trypsin and elastase was observed in both smokers and non-smokers with higher serum alpha-1-PI concentrations. Thus, in a population of young smokers, changes in leukocyte count, neutrophil lysosomal enzyme activities, and functional serum antiprotease activity appear to be consistent with the establishment of a protease-antiprotease imbalance. This imbalance may predispose these smokers to obstructive lung disease.

A case study of a nontraditional basic science curriculum.

This article presents a critical analysis of the ten-year experience of the Department of Oral Biology of the University of Kentucky College of Dentistry with a nontraditional basic science curriculum. The factors that led to the adoption of this curriculum are outlined, and its effects on students, faculty, and the college's administration are described. The pitfalls inherent in this approach and in the individualized self-instructional format for teaching the basic sciences to dental students are discussed. This critical evaluation is aimed at providing information for those contemplating similar sweeping curricular changes in the future to enable them to make rational decisions and to help them predict the effects of such changes on the educational program.

Complement levels in cigarette smokers: elevation of serum concentrations of C5, C9, and C1-inhibitor.

Serum levels of 13 individual complement component and control proteins were measured in 25 male cigarette smokers and 25 male non-smokers. A significant elevation of the mean serum levels of C5, C9 and C1-inhibitor was demonstrated for the smokers while levels of C1q, C2, C4, C3, C6, C8, Factor B, properdin, C3b inactivator and beta 1H did not differ significantly between the two groups. Serum level of C9 in individual smokers correlated significantly with both the present amount of consumption and cumulative consumption, while C5 level correlated with present consumption. The complement profile in the cigarette smoker is similar to that observed in certain inflammatory conditions. The elevation of C5, C9 and C1-inhibitor levels may reflect the presence of a low grade inflammatory process in the cigarette smoker.

Effects of cigarette smoke and its constituents on the adherence of polymorphonuclear leukocytes.

The in vitro effects of the water-soluble fraction of whole cigarette smoke (WSF) and two alpha, beta-unsaturated aldehydes of cigarette smoke (acrolein and crotonaldehyde) on polymorphonuclear leukocyte (PMNL) adherence were determined with nylon fiber columns. Each of these cigarette smoke constituents caused a dose-dependent inhibition of PMNL adherence. However, at least fivefold higher concentrations of these agents were necessary to inhibit adherence as compared with those necessary to achieve the same level of inhibition of PMNL chemotaxis. Furthermore, inhibition of adherence by WSF could be differentiated from its effects on chemotaxis in that reduced glutathione completely protected chemotaxis from the effects of WSF but only afforded partial protection to PMNL adherence. These data suggest that the inhibitory effects of WSF, acrolein, and crotonaldehyde on PMNL chemotaxis are not due to their inhibition of adherence. Finally, although PMNL adherence is considered to be an integral part of the chemotactic mechanism, differentiation between these two PMNL functions may be possible, since some inhibitors of chemotaxis do not have corresponding inhibitory effects on adherence.