Exploring the association between oral health literacy and alexithymia

Low health literacy and alexithymia have separately been emphasized as barriers to patient-practitioner communication, but the association between the two concepts has not been explored.

OBJECTIVE

To test the hypothesis that low oral health literacy and alexithymia are associated.

METHOD

Adults (n=127) aged 21-80 years (56% women) participated in this cross-sectional study. Oral health literacy was assessed using the interview-based Adult Health Literacy Instrument for Dentistry (AHLID) with scores from 1-5. The self-administered Toronto Alexithymia Scale (TAS-20) was used to assess three distinct TAS-20 factors and TAS-20 total score.

RESULTS

Significant negative correlations between AHLID scores and TAS-20 factors 2, 3 and TAS-20 total score were found. Regression analyses showed that TAS-20 factor 3, externally-oriented thinking (β=-0.21, SE=0.02, p=0.017), and TAS-20 total score (β=-0.18, SE=0.01, p=0.036) were significant predictors of AHLID level.

CONCLUSION

The hypothesis that low oral health literacy is associated with alexithymia was supported. This finding proposes that alexithymia may be considered as a possible factor for low oral health literacy. However, the correlations are not strong, and the results should be regarded as a first step to provide evidence with additional research on this topic being needed.

Abstract P5-08-14: Deregulated histone and cell cycle pathways are associated with anthracycline resistance in breast cancer

Drug resistance in breast cancer is the major obstacle to a successful outcome following chemotherapy treatment. While a well-recognized mechanism of resistance involves upregulation of multidrug resistance (MDR) genes, the complexity and hierarchy of other non-MDR driven pathways are still largely unknown. The aim of this study was to identify pathways contributing to anthracycline resistance using isogenic drug resistant breast cancer cell lines. We generated MDA-MB-231, MCF7, SKBR3 and ZR-75-1 epirubicin-resistant breast cancer cell lines, all of which were cross-resistant to doxorubicin and SN-38; only SKBR3 cell line was also resistant to taxanes. Epirubicin-resistant cells were morphologically different from native cells, and had alterations in apoptosis and cell cycle profile. Using gene expression and small inhibitor analyses we identified deregulation of histone H2A and H2B genes in all four cell lines. These genes contribute to several biological pathways, which include cell cycle, chromosomal maintenance, epigenetics, RNA polymerase and mitochondrial transcription, as well as post-translational protein modifications. Importantly, histone deacetylase and cell cycle/DNA damage small molecule inhibitors reversed resistance and were cytotoxic for all four epirubicin-resistant cell lines confirming that histone and cell cycle pathways are associated with epirubicin resistance. Our study has established a model system for investigating drug resistance in all four breast cancer subtypes and revealed key pathways that contribute to the molecular mechanisms of anthracycline resistance.

Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P5-08-14.

Genetic and pharmacologic inhibition of β-catenin targets imatinib-resistant leukemia stem cells in CML

A key characteristic of hematopoietic stem cells (HSCs) is the ability to self-renew. Genetic deletion of β-catenin during fetal HSC development leads to impairment of self-renewal while β-catenin is dispensable in fully developed adult HSCs. Whether β-catenin is required for maintenance of fully developed CML leukemia stem cells (LSCs) is unknown. Here, we use a conditional mouse model to show that deletion of β-catenin after CML initiation does not lead to a significant increase in survival. However, deletion of β-catenin synergizes with imatinib (IM) to delay disease recurrence after imatinib discontinuation and to abrogate CML stem cells. These effects can be mimicked by pharmacologic inhibition of β-catenin via modulation of prostaglandin signaling. Treatment with the cyclooxygenase inhibitor indomethacin reduces β-catenin levels and leads to a reduction in LSCs. In conclusion, inhibiting β-catenin by genetic inactivation or pharmacologic modulation is an effective combination therapy with imatinib and targets CML stem cells.

Sports behaviour among HIV-infected versus non-infected individuals in a Berlin cohort

Physical activity has been recommended based on beneficial effects described in HIV-infected patients. However, such guidelines do not take into account actual sport behaviours and general attitudes towards physical activity. To evaluate actual sport activity and attitudes towards sport in HIV-infected versus non-infected individuals we conducted an anonymous questionnaire investigating the prevalence, as well as possible changes, in sports engagement and the overall attitude to physical activity. A total of 283 patients of a general care facility specialized in the treatment of HIV/AIDS in Berlin, Germany, participated; 124 were HIV infected and 159 were non-infected, mostly men who have sex with men (MSM) (88%), with a median age of 35 years. The HIV-infected participants had a median CD4+ count of 554 cells/µL and 48.8% of them were using antiretroviral therapy (ART) at the time of survey. The proportion of patients actually performing physical activity was significantly lower (P = 0.028) within the HIV-infected group (61.3%) than within the non-infected group (74.2%). This difference remained significant after accounting for possible confounders such as age, gender, injecting drug use and sexual preferences. Previously reported sport activity prevalence was similar in both groups on leaving school. From our data we could not identify an association between the time of HIV diagnosis and changes in sports activity. In conclusion, fewer HIV-infected individuals report physical activity than non-infected individuals. Sociodemographic studies to evaluate potential differences in sports behaviour are required in order to inform exercise guidelines for HIV-infected patients.

Abstract 301: Ccl17 and Ccr4 co-localize in mouse lung adenomas in vivo and are associated with epithelial cell migration in vitro

Lung cancer is the leading cause of cancer deaths among men and women in the United States and improved treatments are urgently needed. Like many cancers, long-term inflammation is now recognized to be a contributing factor in the progression of lung cancer from a benign to a malignant state. Exactly how inflammation contributes to lung cancer is incompletely understood. Chemokines are a group of proteins that function by attracting immune cells to areas of higher chemokine concentrations. Specific chemokine-chemokine receptor pairs control the migratory response of many inflammatory cell types. It is known that chemokines and chemokine receptors can also have direct effects on cancer cells. Using in situ hybridization, we determined that the chemokine Ccl17 and its receptor Ccr4 are coordinately induced in tumor cells in transgenic and benzo(a)pyrene-induced mouse models of lung cancer. In addition, multiple subsets of T lymphocytes within mouse lung tissue express Ccr4. Immunohistochemistry localized CCR4 to cancer cells in 11 of 32 (34%) human non-small cell lung cancer biopsies while staining was not detected in 12 non-neoplastic lung biopsies. We identified human lung cancer cell lines expressing CCR4 using flow cytometry and immunofluorescence. Treatment of human NCI-H292 lung cancer cells with CCL17 peptide induced migration in a collagen-dependent manner in a transwell migration assay. The presence of Ccr4 on both lung cancer cells and lymphocytes suggests that this receptor has multiple roles in regulating lung tumor promotion and progression. Characterization of these roles may provide novel targets to inhibit lung tumor progression. Future studies will directly address the function of Ccr4 during lung tumorigenesis in vivo.

Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 301. doi:1538-7445.AM2012-301

Subcutaneous abdominal wall masses: radiological reasoning

OBJECTIVE

A 36-year-old woman presented to her primary care physician with right lower abdominal pain. Her physician subsequently requested a CT to rule out appendicitis. Contrast-enhanced CT was performed and revealed no evidence of appendicitis but showed two subcutaneous ovoid soft-tissue masses anterior to the rectus sheath in the upper pelvis. Pelvic MRI confirmed the two masses, which showed mild enhancement. The objective of this article is to discuss a diagnostic approach to subcutaneous soft-tissue masses in the abdominal wall. Diagnosis was endometriosis of the abdominal wall.

CONCLUSION

Integrating salient imaging findings with clinical history is crucial when approaching the diagnosis of subcutaneous soft-tissue masses. The diagnosis of endometriosis should be entertained when soft-tissue masses are seen in the distribution of a cesarean section scar in a woman of reproductive age. Pain, particularly with a cyclic pattern, is highly suggestive of endometriosis. If endometriosis is suspected on CT or ultrasound, MRI can be performed for further evaluation. Definitive diagnosis is made with biopsy. Because subcutaneous nodules are so amenable percutaneous biopsy, imaging features, although of interest, are somewhat ancillary to the diagnostic workup.

Performance evaluation of 26 combinations of chemical protective clothing materials and chemicals after repeated exposures and decontaminations

Effective decontamination of chemical protective clothing (CPC) is essential for reducing occupational skin diseases and disorders during a reuse scenario. To protect the workforce, the efficacy of decontamination methods and the reusability of CPC need to be evaluated. In this study, performance of 14 CPC materials against 12 liquid chemicals was evaluated based on standardized breakthrough time (BT) and steady-state permeation rate (SSPR). Thermal and water-detergent decontamination methods were used. Exposure/decontamination was repeated up to 11 cycles, or until the material failed, so that further testing became impossible. Changes in BT and SSPRs were determined for each material and chemical combination. There were 20 and 13 combinations that were able to complete 11 cycles with thermal and detergent methods, respectively. By comparing the beginning and ending cycles, mean BT increased 9% with the thermal method but slightly decreased (3.3%) with the detergent method, while mean SSPR decreased 2% with the thermal method, but slightly increased (1.4%) with the detergent method. Less than half of the changes were found statistically different (p < 0.05). Generally, the thermal method had higher decontamination efficacy than the detergent method.

Neutrophils are required for 3-methylcholanthrene-initiated, butylated hydroxytoluene-promoted lung carcinogenesis

Multiple studies have shown a link between chronic inflammation and lung tumorigenesis. Inbred mouse strains vary in their susceptibility to methylcholanthrene (MCA)-initiated butylated hydroxytoluene (BHT)-promoted lung carcinogenesis. In the present study we investigated whether neutrophils play a role in strain dependent differences in susceptibility to lung tumor promotion. We observed a significant elevation in homeostatic levels of neutrophils in the lungs of tumor-susceptible BALB/cByJ (BALB) mice compared to tumor-resistant C57BL/6J (B6) mice. Additionally, BHT treatment further elevated neutrophil numbers as well as neutrophil chemoattractant keratinocyte-derived cytokine (KC)/chemokine (C-X-C motif) ligand 1 (Cxcl1) levels in BALB lung airways. Lung CD11c+ cells were a major source of KC expression and depletion of neutrophils in BALB mice resulted in a 71% decrease in tumor multiplicity. However, tumor multiplicity did not depend on the presence of T cells, despite the accumulation of T cells following BHT treatment. These data demonstrate that neutrophils are essential to promote tumor growth in the MCA/BHT two-step lung carcinogenesis model.

Regulation of Alr1 Mg transporter activity by intracellular magnesium

Mg homeostasis is critical to eukaryotic cells, but the contribution of Mg transporter activity to homeostasis is not fully understood. In yeast, Mg uptake is primarily mediated by the Alr1 transporter, which also allows low affinity uptake of other divalent cations such as Ni(2+), Mn(2+), Zn(2+) and Co(2+). Using Ni(2+) uptake to assay Alr1 activity, we observed approximately nine-fold more activity under Mg-deficient conditions. The mnr2 mutation, which is thought to block release of vacuolar Mg stores, was associated with increased Alr1 activity, suggesting Alr1 was regulated by intracellular Mg supply. Consistent with a previous report of the regulation of Alr1 expression by Mg supply, Mg deficiency and the mnr2 mutation both increased the accumulation of a carboxy-terminal epitope-tagged version of the Alr1 protein (Alr1-HA). However, Mg supply had little effect on ALR1 promoter activity or mRNA levels. In addition, while Mg deficiency caused a seven-fold increase in Alr1-HA accumulation, the N-terminally tagged and untagged Alr1 proteins increased less than two-fold. These observations argue that the Mg-dependent accumulation of the C-terminal epitope-tagged protein was primarily an artifact of its modification. Plasma membrane localization of YFP-tagged Alr1 was also unaffected by Mg supply, indicating that a change in Alr1 location did not explain the increased activity we observed. We conclude that variation in Alr1 protein accumulation or location does not make a substantial contribution to its regulation by Mg supply, suggesting Alr1 activity is directly regulated via as yet unknown mechanisms.

Properties of some three-state, steady-state Ising systems, according to the Bragg-Williams approximation

We consider the steady-state properties of a lattice of three-state, cycling enzyme molecules, with nearest-neighbor interactions treated by the Bragg-Williams (mean field) approximation. Only a few particular cases are examined, but these illustrate the rich phase-transition possibilities of this class of systems. "Bifurcation" cases were treated in a previous paper; the present examples are of the nonbifurcation type. However, a few new theoretical properties of bifurcation cases are included.

The radiologic workup of a palpable breast mass

The finding of a palpable breast mass on physical examination often warrants a radiologic workup including directed ultrasonography, diagnostic mammography, and, at times, biopsy with ultrasonographic guidance. The choice of initial imaging study is most often guided by the patient's age at presentation. Communicating the clinical findings to both the patient and the radiologist helps ensure the selection of the most appropriate imaging studies and helps in the interpretation of those studies. Every woman with a palpable breast mass, regardless of her age, should undergo imaging to exclude or establish the diagnosis of cancer.

Understanding Oropharyngeal Dysphagia

Providing services in the home to a patient with oropharyngeal dysphagia remains a clinical challenge. All health care providers involved in the care of patients with dysphagia need to understand the complexities of swallow physiology, its impact on the patient's overall well-being, and the experience the patient has recently undergone. Namely, it is important to know if the patient is returning home after an acute care stay, if the patient is returning home after a stay at a rehabilitation center, or if simply the patient has become increasingly decompensated while at home. This will allow the clinician working in the home to understand the work-up and possible treatments the patient has thus far undergone, and possibly better understand the overall etiology. Furthermore, it is important to understand that while returning home may be one of the most exciting moments for the patient and his/her family, it may also be the most stressful, as the patient is probably returning home with a different set of needs. This article provides an in-depth approach and discussion of the subject of swallow physiology, diagnosis, and treatment, and provides a resource for all members of the patient care team. It concentrates on the experience of older adults diagnosed with oropharyngeal dysphagia who are returning home.

Tai Chi versus brisk walking in elderly women

PURPOSE

to compare the effects of a short style of Tai Chi versus brisk walking training programme on aerobic capacity, heart rate variability (HRV), strength, flexibility, balance, psychological status and quality of life in elderly women.

METHODS

nineteen community-dwelling, sedentary women (aged 71.4 +/- 4.5 years) were randomly assigned to Tai Chi Chuan (TCC; n = 11) or brisk walking group (BWG; n = 8). A separate group of elderly women was recruited from the same population to act as a sedentary comparison group (SCG; n = 8). The exercise groups met for 1 h, three days per week for 12 weeks. Outcomes measured before and after training included estimated VO2max, spectral analysis of HRV (high-frequency, low-frequency power as well as high- and low-frequency power in normalised units) as a measure of autonomic control of the heart, isometric knee extension and handgrip muscle strength, single-leg stance time, the State Trait Anxiety Inventory (STAI), Profile of Mood States (POMS) and Short Form-36 (SF-36) questionnaires.

RESULTS

significant improvement was seen in estimated VO(2)max in the TCC group (TCC versus SCG P = 0.003, TCC versus BWG P = 0.08). The mean within-person change of high-frequency power in normalised units (HFnu) increased [8.2 (0.14-16.3)], representing increased parasympathetic activity, and low-frequency power in normalised units (LFnu) decreased [-8.7 (-16.8-0.5)], representing decreased sympathetic activity, in the TCC group only. Significant gains were also seen in the non-dominant knee extensor strength and single-leg stance time (TCC versus BWG P < 0.05).

CONCLUSIONS

a short style of TCC was found to be an effective way to improve many fitness measures in elderly women over a 3-month period. TCC was also found to be significantly better than brisk walking in enhancing certain measures of fitness including lower extremity strength, balance and flexibility.