Associations of particulate matter with atopic dermatitis and chronic inflammatory skin diseases in South Korea

BACKGROUND

Particulate matter (PM) is a mixture of solid and liquid particles suspended in air, which originates from industrial plants or vehicle emissions. Although the skin is the primary body area of contact with air pollutants, the associations between PM and chronic inflammatory skin diseases has not been well established.

AIM

To investigate associations between PM and atopic dermatitis (AD) and between PM and other chronic inflammatory dermatoses, using data from the Korean Health Insurance Review and Assessment Service.

METHODS

Monthly disease statistics from the seven largest cities in South Korea (Seoul, Busan, Daegu, Incheon, Gwangju, Daejeon, Ulsan) and from Jeju Island (in total, a population of 23 288 000 for all eight areas) were included. Based on daily air pollution level and weather forecast from 2015 to 2019, multivariate negative binomial regression analysis was conducted to estimate monthly visits of AD with respect to outdoor air pollutants: coarse PM with a diameter of ≤ 10 μm (PM10) and fine PM with a diameter of ≤ 2.5 μm (PM2.5) ozone (O₃ ), nitrogen dioxide (NO₂ ), sulphur dioxide (SO₂ ) and carbon monoxide (CO).

RESULTS

Increases in the levels of PM2.5, PM10, SO₂ and CO were associated with significant increases in monthly patient visits for AD. Every 10 μg/m³ increase in PM2.5 and PM10 resulted in patient visit increases of 2.71% (95% CI 0.76-4.71; P < 0.01) and 2.01% (95% CI 0.92-3.11, P < 0.001), respectively, while every 1 part per billion (ppb) increase in SO₂ and every 100 ppb increase in CO resulted in visit increases of 2.26% (95% CI 1.35-3.17; P < 0.001) and 2.86% (95% CI 1.35-4.40; P < 0.001), respectively. O₃ and NO₂ were not associated with increased patient visits for AD. Increases in PM2.5 and PM10 concentrations were also significantly associated with increases in patient visits for psoriasis, seborrhoeic dermatitis and rosacea.

CONCLUSION

Our data suggest that PM is associated with AD and other chronic inflammatory skin diseases.

Active Microelectronic Neurosensor Arrays for Implantable Brain Communication Interfaces

We have built a wireless implantable microelectronic device for transmitting cortical signals transcutaneously. The device is aimed at interfacing a microelectrode array cortical to an external computer for neural control applications. Our implantable microsystem enables presently 16-channel broadband neural recording in a nonhuman primate brain by converting these signals to a digital stream of infrared light pulses for transmission through the skin. The implantable unit employs a flexible polymer substrate onto which we have integrated ultra-low power amplification with analog multiplexing, an analog-to-digital converter, a low power digital controller chip, and infrared telemetry. The scalable 16-channel microsystem can employ any of several modalities of power supply, including via radio frequency by induction, or infrared light via a photovoltaic converter. As of today, the implant has been tested as a sub-chronic unit in non-human primates (~ 1 month), yielding robust spike and broadband neural data on all available channels.

Highly efficient ultra-low blaze angle multilayer grating

We have developed an advanced process for blaze angle reduction of x-ray gratings for the soft, tender, and EUV spectral ranges. The process is based on planarization of an anisotropically etched Si blazed grating followed by a chemically selective plasma etch. This provides a way to adjust the blaze angle to any lower value with high accuracy. Here we demonstrate the reduction of the blaze angle to an extremely low value of 0.04°±0.004°. For a 100 lines/mm grating with a Mo/Si multilayer coating, the grating exhibits diffraction efficiency of 58% in the 1^st diffraction order at a wavelength of 13.3 nm. This technique will be applicable to a wide range of uses of high efficiency gratings for synchrotron sources, as well as for Free Electron Lasers (FEL).

The Impact of Amyloid-β or Tau on Cognitive Change in the Presence of Severe Cerebrovascular Disease

BACKGROUND

As Alzheimer's disease (AD) and cerebral small vessel disease (CSVD) commonly coexist, the interaction between two has been of the considerable interest.

OBJECTIVE

We determined whether the association of Aβ and tau with cognitive decline differs by the presence of significant CSVD.

METHODS

We included 60 subcortical vascular cognitive impairment (SVCI) from Samsung Medical Center and 82 Alzheimer's disease-related cognitive impairment (ADCI) from ADNI, who underwent Aβ (florbetaben or florbetapir) and tau (flortaucipir, FTP) PET imaging. They were retrospectively assessed for 5.0±3.9 and 5.6±1.9 years with Clinical Dementia Rating-sum of boxes (CDR-SB)/Mini-Mental State Examination (MMSE). Mixed effects models were used to investigate the interaction between Aβ/tau and group on CDR-SB/MMSE changes.

RESULTS

The frequency of Aβ positivity (45% versus 54.9%, p = 0.556) and mean global FTP SUVR (1.17±0.21 versus 1.16±0.17, p = 0.702) were not different between the two groups. We found a significant interaction effect of Aβ positivity and SVCI group on CDR-SB increase/MMSE decrease (p = 0.013/p < 0.001), and a significant interaction effect of global FTP uptake and SVCI group on CDR-SB increase/MMSE decrease (p < 0.001 and p = 0.030). Finally, the interaction effects of regional tau and group were prominent in the Braak III/IV (p = 0.001) and V/VI (p = 0.003) not in Braak I/II region (p = 0.398).

CONCLUSION

The association between Aβ/tau and cognitive decline is stronger in SVCI than in ADCI. Therefore, our findings suggested that Aβ positivity or tau burden (particularly in the Braak III/IV or V/VI regions) and CSVD might synergistically affect cognitive decline.

Accurate Determination of the Neutron Skin Thickness of ^{208}Pb through Parity-Violation in Electron Scattering

We report a precision measurement of the parity-violating asymmetry A_{PV} in the elastic scattering of longitudinally polarized electrons from ^{208}Pb. We measure A_{PV}=550±16(stat)±8(syst) parts per billion, leading to an extraction of the neutral weak form factor F_{W}(Q^{2}=0.00616  GeV^{2})=0.368±0.013. Combined with our previous measurement, the extracted neutron skin thickness is R_{n}-R_{p}=0.283±0.071  fm. The result also yields the first significant direct measurement of the interior weak density of ^{208}Pb: ρ_{W}^{0}=-0.0796±0.0036(exp)±0.0013(theo)  fm^{-3} leading to the interior baryon density ρ_{b}^{0}=0.1480±0.0036(exp)±0.0013(theo)  fm^{-3}. The measurement accurately constrains the density dependence of the symmetry energy of nuclear matter near saturation density, with implications for the size and composition of neutron stars.

Treatment outcomes in multidrug-resistant tuberculosis according to pyrazinamide susceptibility

BACKGROUND: Pyrazinamide (PZA) is an important anti-tuberculosis drug for multidrug-resistant tuberculosis (MDR-TB). However, PZA has recently been demoted within the hierarchy of TB drugs used for MDR-TB.METHODS: We conducted a retrospective cohort study to investigate treatment outcomes for simple MDR-TB (susceptible to both second-line injectable drugs and fluoroquinolones) according to PZA susceptibility.RESULTS: Among 216 pulmonary MDR-TB patients included in the study, 68 (31.5%) were PZA-resistant (PZA-R). The mean age was 41.8 years, and 63.4% were male. Baseline characteristics such as comorbidity, previous TB history, acid-fast bacilli (AFB) smear positivity and cavitation were similar in PZA-susceptible (PZA-S) and PZA-R patients. The number of potentially effective drugs was slightly higher among PZA-S patients than among the PZA-R (5.1 vs. 4.8, respectively; P = 0.003). PZA was more frequently used in PZA-S patients (73.0%) than in the PZA-R (14.7%), while para-aminosalicylic acid was more frequently used in PZA-R than in PZA-S patients (76.5% vs. 50.7%). The treatment success rate was similar in PZA-S (77.7%) and PZA-R (75.0%) patients. PZA resistance was not associated with treatment success in multivariate analysis.CONCLUSIONS: PZA-resistant simple MDR-TB patients had the same treatment success rate as the PZA-susceptible group even without using novel anti-TB drugs.

Measurement of the Positive Muon Anomalous Magnetic Moment to 0.46 ppm

We present the first results of the Fermilab National Accelerator Laboratory (FNAL) Muon g-2 Experiment for the positive muon magnetic anomaly a_{μ}≡(g_{μ}-2)/2. The anomaly is determined from the precision measurements of two angular frequencies. Intensity variation of high-energy positrons from muon decays directly encodes the difference frequency ω_{a} between the spin-precession and cyclotron frequencies for polarized muons in a magnetic storage ring. The storage ring magnetic field is measured using nuclear magnetic resonance probes calibrated in terms of the equivalent proton spin precession frequency ω[over ˜]_{p}^{'} in a spherical water sample at 34.7 °C. The ratio ω_{a}/ω[over ˜]_{p}^{'}, together with known fundamental constants, determines a_{μ}(FNAL)=116 592 040(54)×10^{-11} (0.46 ppm). The result is 3.3 standard deviations greater than the standard model prediction and is in excellent agreement with the previous Brookhaven National Laboratory (BNL) E821 measurement. After combination with previous measurements of both μ^{+} and μ^{-}, the new experimental average of a_{μ}(Exp)=116 592 061(41)×10^{-11} (0.35 ppm) increases the tension between experiment and theory to 4.2 standard deviations.

Prediction of tau accumulation in prodromal Alzheimer's disease using an ensemble machine learning approach

We developed machine learning (ML) algorithms to predict abnormal tau accumulation among patients with prodromal AD. We recruited 64 patients with prodromal AD using the Alzheimer’s Disease Neuroimaging Initiative (ADNI) dataset. Supervised ML approaches based on the random forest (RF) and a gradient boosting machine (GBM) were used. The GBM resulted in an AUC of 0.61 (95% confidence interval [CI] 0.579–0.647) with clinical data (age, sex, years of education) and a higher AUC of 0.817 (95% CI 0.804–0.830) with clinical and neuropsychological data. The highest AUC was 0.86 (95% CI 0.839–0.885) achieved with additional information such as cortical thickness in clinical data and neuropsychological results. Through the analysis of the impact order of the variables in each ML classifier, cortical thickness of the parietal lobe and occipital lobe and neuropsychological tests of memory domain were found to be more important features for each classifier. Our ML algorithms predicting tau burden may provide important information for the recruitment of participants in potential clinical trials of tau targeting therapies.

Ruling out Color Transparency in Quasielastic ^{12}C(e,e^{'}p) up to Q^{2} of 14.2 (GeV/c)^{2}

Quasielastic ^{12}C(e,e^{'}p) scattering was measured at spacelike 4-momentum transfer squared Q^{2}=8, 9.4, 11.4, and 14.2  (GeV/c)^{2}, the highest ever achieved to date. Nuclear transparency for this reaction was extracted by comparing the measured yield to that expected from a plane-wave impulse approximation calculation without any final state interactions. The measured transparency was consistent with no Q^{2} dependence, up to proton momenta of 8.5  GeV/c, ruling out the quantum chromodynamics effect of color transparency at the measured Q^{2} scales in exclusive (e,e^{'}p) reactions. These results impose strict constraints on models of color transparency for protons.

Probing the Deuteron at Very Large Internal Momenta

We measure ^{2}H(e,e^{'}p)n cross sections at 4-momentum transfers of Q^{2}=4.5±0.5  (GeV/c)^{2} over a range of neutron recoil momenta p_{r}, reaching up to ∼1.0  GeV/c. We obtain data at fixed neutron recoil angles θ_{nq}=35°, 45°, and 75° with respect to the 3-momentum transfer q[over →]. The new data agree well with previous data, which reached p_{r}∼500  MeV/c. At θ_{nq}=35° and 45°, final state interactions, meson exchange currents, and isobar currents are suppressed and the plane wave impulse approximation provides the dominant cross section contribution. We compare the new data to recent theoretical calculations, where we observe a significant discrepancy for recoil momenta p_{r}>700  MeV/c.

Safety and efficacy of transarterial embolisation for treatment of dorsal pancreatic artery haemorrhage

AIM

To evaluate the safety and efficacy of transarterial embolisation (TAE) of dorsal pancreatic artery (DPA) haemorrhage.

MATERIALS AND METHODS

Nineteen consecutive patients (M:F = 16:3, mean age 59.6 years) who underwent TAE of DPA in three tertiary medical centres between January 2001 to January 2020 were reviewed retrospectively. Angiographic features and the technical and clinical outcomes of TAE were analysed.

RESULTS

The clinical presentations were a bloody drain from the Jackson-Pratt drainage tube (n=8), melaena (n=7), abdominal pain (n=4), and haematochezia (n=3). Angiographic findings included pseudoaneurysm (n=14), contrast media extravasation (n=4), or abrupt cut-off of the arterial branch (n=1). The NBCA (N-butyl-cyanoacrylate; n=4), microcoils (n=4), and a combination of these agents (n=7) were used as embolic agents. The most common origin of the DPA in the present study cohort was the splenic artery (n=7), followed by the coeliac trunk (n=4), common hepatic artery (n=4), and superior mesenteric artery (n=4). Technical and clinical success rates were 100% and 84.2% (16/19), respectively. Of the three clinically unsuccessful cases, two patients were revealed to have newly developed bleeding from another artery. The other patient expired 1 day after the TAE procedure due to a progression of hepatic failure. In one patient, an asymptomatic non-target embolisation occurred in the right posterior tibial artery as a procedure-related complication. No major complications were observed.

CONCLUSION

TAE is safe and effective for the management of bleeding from the DPA. It is important to be aware of the DPA as a potential bleeding source, including the relevant clinical characteristics.

High-Precision Determination of Oxygen K_{α} Transition Energy Excludes Incongruent Motion of Interstellar Oxygen

We demonstrate a widely applicable technique to absolutely calibrate the energy scale of x-ray spectra with experimentally well-known and accurately calculable transitions of highly charged ions, allowing us to measure the K-shell Rydberg spectrum of molecular O_{2} with 8 meV uncertainty. We reveal a systematic ∼450  meV shift from previous literature values, and settle an extraordinary discrepancy between astrophysical and laboratory measurements of neutral atomic oxygen, the latter being calibrated against the aforementioned O_{2} literature values. Because of the widespread use of such, now deprecated, references, our method impacts on many branches of x-ray absorption spectroscopy. Moreover, it potentially reduces absolute uncertainties there to below the meV level.

Low-dose CT angiography of the lower extremities: a comparison study of image quality and radiation dose

AIM

To investigate the image quality and radiation dose of ultralow-dose (ULD) and low-dose (LD) lower-extremity computed tomography (CT) angiography (LE-CTA) using the advanced modelled iterative reconstruction (ADMIRE) algorithm to detect peripheral arterial disease (PAD) in comparison with standard-dose (SD) CT.

MATERIALS AND METHODS

One hundred and seven consecutive patients were examined using LE-CTA at 70 kVp and a dual-source scanner to achieve three image sets using 30% (ULD), 70% (LD), and 100% (SD) tube loads. Qualitative analysis was conducted by examining the three image sets for overall quality. The image quality of arterial segments was analysed by two independent readers. In addition, the CT dose index (CTDI_vol) was measured in the three image sets.

RESULTS

The mean overall quality scores were 3.4±0.6 for ULD CT, 3.9±0.3 for LD CT, and 3.9±0.2 for SD CT. Both readers scored the arterial segments as 2-4 (adequate-excellent) in the three image sets. In addition, 89.4% (93/104) and 54.8% (57/104) segments of PAD with calcified plaques were scored 4 between SD and LD CT and between SD and ULD CT, respectively, and 45.2% (47/104) segments had a lower score by one point in ULD CT compared with SD CT. The mean CTDI_vol was 4.1±1.1 mGy for SD CT, 2.9±0.8 mGy for LD CT, and 1.2±0.3 mGy for ULD CT.

CONCLUSIONS

LD/ULD CT at 70 kVp using ADMIRE reconstruction enables a reduction in the radiation dose while enabling adequate evaluation or follow-up of PAD based on LE-CTA.

Development and Validation of a Deep Learning-Based Automatic Brain Segmentation and Classification Algorithm for Alzheimer Disease Using 3D T1-Weighted Volumetric Images

BACKGROUND AND PURPOSE

Limited evidence has suggested that a deep learning automatic brain segmentation and classification method, based on T1-weighted brain MR images, can predict Alzheimer disease. Our aim was to develop and validate a deep learning-based automatic brain segmentation and classification algorithm for the diagnosis of Alzheimer disease using 3D T1-weighted brain MR images.

MATERIALS AND METHODS

A deep learning-based algorithm was developed using a dataset of T1-weighted brain MR images in consecutive patients with Alzheimer disease and mild cognitive impairment. We developed a 2-step algorithm using a convolutional neural network to perform brain parcellation followed by 3 classifier techniques including XGBoost for disease prediction. All classification experiments were performed using 5-fold cross-validation. The diagnostic performance of the XGBoost method was compared with logistic regression and a linear Support Vector Machine by calculating their areas under the curve for differentiating Alzheimer disease from mild cognitive impairment and mild cognitive impairment from healthy controls.

RESULTS

In a total of 4 datasets, 1099, 212, 711, and 705 eligible patients were included. Compared with the linear Support Vector Machine and logistic regression, XGBoost significantly improved the prediction of Alzheimer disease (P < .001). In terms of differentiating Alzheimer disease from mild cognitive impairment, the 3 algorithms resulted in areas under the curve of 0.758-0.825. XGBoost had a sensitivity of 68% and a specificity of 70%. In terms of differentiating mild cognitive impairment from the healthy control group, the 3 algorithms resulted in areas under the curve of 0.668-0.870. XGBoost had a sensitivity of 79% and a specificity of 80%.

CONCLUSIONS

The deep learning-based automatic brain segmentation and classification algorithm allowed an accurate diagnosis of Alzheimer disease using T1-weighted brain MR images. The widespread availability of T1-weighted brain MR imaging suggests that this algorithm is a promising and widely applicable method for predicting Alzheimer disease.

Clinical features and predictors of masked uncontrolled hypertension: from Korean ambulatory blood pressure monitoring (Korabp) registry

Background

Clinical characteristics of patients with masked uncontrolled hypertension (MUCH) are poorly defined, and few studies have reported on clinical predictors of MUCH. We investigated demographic, lifestyle, clinical and blood pressure (BP) characteristics in patients with MUCH and proposed a prediction model for MUCH.

Method

We analyzed 2044 subjects taking antihypertensive medication enrolled in the Korean Ambulatory Blood Pressure Monitoring (Kor-ABP) registry, who were categorized into controlled hypertension (n=481, normal office BP, normal 24-hour ABP), pseudo-uncontrolled hypertension (n=131, high office BP, normal 24-hour ABP), MUCH (n=380, normal office BP, high 24-hour ABP), and sustained uncontrolled hypertension (n=1,052; high office BP and high 24-hour ABP).

Result

The prevalence of MUCH increased with office systolic BP (SBP) and diastolic BP (DBP), whereas it was not associated with the numbers of antihypertensive drugs. But in patients with a high office SBP (≥130 mmHg), the prevalence of MUCH increased with decreasing numbers of antihypertensive drugs (interaction p=0.008; Figure 1A). Multiple logistic regression analysis identified high office SBPs and DBPs, prior stroke, dyslipidemia and single anti-hypertensive agent use as independent predictors of MUCH (Table 1). A prediction model using these predictors showed a high diagnostic accuracy (C-index 0.833) and a goodness of fit for the presence of MUCH (Figure 1B).

Conclusion

MUCH is associated with the borderline increase in office BP and the underuse of anti-hypertensive drugs as well as dyslipidemia and prior stroke, which underscores the importance of achieving the optimal BP control level in the high risk patients. The proposed model would accurately predict MUCH in patients with controlled office BP.

Figure 1

Funding Acknowledgement

Type of funding source: None

Empagliflozin treatment does not affect the hypertensive response to Ang II administration to rats but decreases oxidative stress in the arterial wall, and endothelial and cardiac dysfunction

Background

Selective sodium-glucose cotransporter 2 (SGLT2) inhibitors have shown cardiovascular protection in type 2 diabetes patients with established cardiovascular disease independently of glycemic control. Angiotensin II (Ang II) and H2O2 have been shown to be strong inducers of the expression of SGLT2 and 1 in endothelial cells promoting oxidative stress and endothelial dysfunction.

Purpose

This study examined the cardiovascular protective effect of empagliflozin (empa) in a normoglycemic experimental model of hypertension in the rat.

Methods

Male Wistar rats received empa (30 mg/kg/day) provided in the diet for 5 weeks. After 1 week, rats underwent sham surgery (sham rats) or surgery with implantation of an osmotic mini-pump infusing Ang II (0.4 mg/kg/d) for 4 weeks. Systolic blood pressure (SBP) was assessed by sphygmomanometry, the cardiac function using echocardiography, the expression level of target proteins by immunofluorescence staining, and the level of oxidative stress using dihydroethidium staining.

Results

Angiotensin II administration increased systolic blood pressure from about 130 to 180 mmHg, which was not affected by the empa treatment. The 4-week Ang II treatment did not significantly affect the systolic cardiac function (cardiac output, left ventricle ejection fraction) but impaired the diastolic function as indicated by a reduced E' and IVRT values, and an increased E/E' value. The Ang II treatment increased significantly the heart and right ventricle weight whereas the left ventricle + septum weight was slightly but not significantly increased. No such functional and structural changes were observed in the Ang II + empa treatment group. An increased immunofluorescence eNOS signal in the endothelium, and a higher level of ROS throughout the aorta wall were observed in the Ang II-treated group, both of which were significantly reduced in the empa + Ang II-treated group. In the Ang II-treated group, the high level of oxidative stress in the aorta was significantly reduced by the AT1 receptor antagonist losartan, the NADPH oxidase inhibitor VAS-2871, the eNOS inhibitor NG-nitro-L-arginine and also to a greater extent by the selective SGLT2 inhibitor empa compared to the dual SGLT1/2 inhibitor sotagliflozin.

Conclusion(s)

The present findings indicate that although the empa treatment did not affect the hypertensive response of rats to Ang II, the SGLT2 inhibitor prevented the deleterious impact of Ang II on the diastolic cardiac function and remodeling, and the upregulation of eNOS expression and oxidative stress in the aorta wall. Thus, these findings highlight the protective potential of empa on the cardiovascular system in a normoglycemic hypertensive experimental model.

Funding Acknowledgement

Type of funding source: Private company. Main funding source(s): Boehringer Ingelheim Pharma GmbH & Co KG (Biberach an der Riss, Germany)

Differences in the clinical characteristics and long-term outcome of peripartum tako-tsubo cardiomyopathy and peripartum cardiomyopathy

Background

Some peripartum-associated cardiomyopathy patients present similarly to those of tako-tsubo cardiomyopathy (TCM), little is known about the clinical course of peripartum TCM.

Purpose

To know clinicial characteristics and outcomes of peripartum TCM, in comparison with peripartum cardiomyopathy (PPCM)

Methods and results

Of 31 pregnancy-associated cardiomyopathy patients in a tertiary hospital, 10 cases of peripartum TCM and 21 cases of PPCM were found. Maternal near-missed death was significantly more common in the peripartum TCM group than in the PPCM group (100.0% vs. 76.2%, p=0.030). Complete recovery was observed with all peripartum TCM cases, while 23.8% of the PPCM cases had residual left ventricle (LV) dysfunction. LV ejection fraction greater than 30% on the initial echocardiogram independently predicted early echocardiographic recovery of left ventricular systolic function (odds ratio 331.33, 95% confidence interval 3.87–28402.60, p=0.011). There was no difference between the two groups in terms of the rate of adverse clinical events at 3 years of follow-up (PPCM group: 26.3% [5/19] vs. TCM group: 33.3% [3/9], p=0.750).

Conclusions

One-third of pregnancy-associated cardiomyopathy patients had peripartum TCM. With contemporary supportive care, both PPCM and peripartum TCM patients had a low mortality rate and excellent long-term outcomes.

Kaplan-Meier survival curves for death,

Funding Acknowledgement

Type of funding source: None

Association between APOE ε2 and Aβ burden in patients with Alzheimer- and vascular-type cognitive impairment

OBJECTIVE

To investigate the association between APOE genotype and β-amyloid (Aβ) burden, as measured by PET in patients with subcortical vascular cognitive impairment (SVCI) and those with Alzheimer disease-related cognitive impairment (ADCI).

METHODS

This was a cross-sectional study of 310 patients with SVCI and 999 with ADCI. To evaluate the effects of APOE genotype or diagnostic group on Aβ positivity, we performed multivariate logistic regression analyses. Further distinctive underlying features of latent subgroups were examined by employing a latent class cluster analysis approach.

RESULTS

In comparison with ε3 homozygotes, in the ADCI group, ε2 carriers showed a lower frequency of Aβ positivity (odds ratio [OR] 0.43, 95% confidence interval [CI] 0.23-0.79), while in the SVCI group, ε2 carriers showed a higher frequency of Aβ positivity (OR 2.26, 95% CI 1.02-5.01). In particular, we observed an interaction effect of ε2 carrier status and diagnostic group on Aβ positivity (OR 5.12, 95% CI 1.93-13.56), in that relative to ε3 homozygotes, there were more Aβ-positive ε2 carriers in the SVCI group than in the ADCI group. We also identified latent subgroups of Aβ-positive APOE ε2 carriers with SVCI and Aβ-positive APOE ε4 carriers with ADCI.

CONCLUSIONS

Our findings suggest that APOE ε2 is distinctly associated with Aβ deposition in patients with SVCI and those with ADCI. Our findings further suggest that there is a distinctive subgroup of Aβ-positive APOE ε2 carriers with SVCI among patients with cognitive impairment.

Associations between Household Water Fluoridation Status and Plain Tap or Bottled Water Consumption

INTRODUCTION

The benefits of community water fluoridation for preventing dental caries are attenuated if people do not consume tap water.

OBJECTIVES

We examined associations between household water fluoride content and consuming plain tap or bottled water among US youth.

METHODS

We used National Health and Nutrition Examination Survey data for 2013 to 2016 for 5,193 youth aged 2 to 19 y. Fluoride content in youth's household tap water samples was measured electrometrically with ion-specific electrodes and designated low (<0.6 mg/L) or about optimal (0.6 to 1.2 mg/L). Plain tap and bottled water consumption was obtained from one 24-h dietary recall. We used binomial regression models to estimate adjusted prevalence ratios (APRs) and 95% CIs for consuming plain tap water (including tap only or both tap and bottled) and consuming only bottled water as related to household water fluoride content (low or about optimal) and sociodemographic characteristics.

RESULTS

On a given day, 52.6% of youth consumed plain tap water (43.8% exclusively and 8.8% both tap and bottled) and 28%, only bottled water. Neither tap water (APR, 0.96; 95% CI, 0.84 to 1.10) nor only bottled water (APR, 1.03; 95% CI, 0.86 to 1.22) consumption was associated with household water fluoride content. Non-Hispanic Black youth and Hispanic youth were about 30% relatively less likely to consume tap water and 60% to 80% relatively more likely to consume only bottled water than non-Hispanic Whites. Low income, low parental education, and no past-year dental visit were associated with not consuming tap water.

CONCLUSION

Half of youth consumed plain tap water on a given day. Consuming plain tap water was not associated with community water fluoridation status. This study is the first to find that up to 50% of the population served by fluoridated water may not receive its full caries-preventive benefits due to not consuming plain tap water.

KNOWLEDGE TRANSFER STATEMENT

Half of US youth consumed plain tap water on a given day. Consuming plain tap water was not associated with community water fluoridation status. This finding suggests that up to 50% of the population served by fluoridated water systems may not receive its full caries-preventive benefits due to not consuming plain tap water. Our findings add support for the need to identify and address barriers to tap water consumption and promote health benefits of fluoridation.

Bronchovascular bundle thickening on CT as a predictor of survival and brain metastasis in patients with stage IA peripheral small cell lung cancer

AIM

To determine if bronchovascular bundle (BVB) thickening on pretreatment computed tomography (CT) images helps predict survival in patients with peripheral small cell lung cancer (pSCLC) ≤3 cm.

MATERIALS AND METHODS

The pretreatment CT examinations of 79 histopathologically proven pSCLC ≤3 cm (TNM stage I, 21; II, 13; III, 22; IV, 23) were reviewed retrospectively. The CT characteristics of the nodule and associated findings, including BVB thickening, were evaluated. Progression-free survival (PFS), overall survival (OS), and brain metastasis-free survival were compared with the presence of BVB thickening using Kaplan-Meier and Cox regression analysis.

RESULTS

Among the 79 patients, 34 (43%) had BVB thickening. BVB thickening was prevalent in patients with mediastinal lymph node metastasis (50.9% versus 22.7%; p=0.024) and distant metastasis (60.9% versus 35.7%; p=0.049). Out of the 21 patients with TNM stage IA disease, the 16 patients (76.2%) without BVB thickening showed better PFS, OS, and brain metastasis-free survival (mean, 1,762 versus 483 days; p=0.019: 2,243 versus 1,328 days; p=0.038: 2,274 versus 1,287 days; p=0.038, respectively). Multivariate Cox regression analysis showed that the absence of BVB thickening (hazard ratio [HR], 7.806; 95% CI, 1.241-49.091; p=0.029) and surgery (HR, 0.075; 95% CI, 0.008-0.746; p=0.027) were independent and useful prognostic factors for PFS.

CONCLUSIONS

BVB thickening was found more frequently in patients with advanced-stage pSCLC ≤3 cm, and the PFS was more favourable in patients without BVB thickening, with a similar tendency to that of OS and brain metastasis-free survival, in stage IA pSCLC.

Appropriate reference region selection of 18F-florbetaben and 18F-flutemetamol beta-amyloid PET expressed in Centiloid

The Centiloid (CL) is a method for standardizing amyloid beta (Aβ) quantification through different ligands and methods. To find the most appropriate reference region to reduce the variance in the Aβ CL unit between ¹⁸F-florbetaben (FBB) and ¹⁸F-flutemetamol (FMM), we conducted head-to-head comparisons from 56 participants using the direct comparison of FBB-FMM CL (dcCL) method with four reference regions: cerebellar gray (CG), whole cerebellum (WC), WC with brainstem (WC + B), and pons. The FBB and FMM dcCL units were highly correlated in four reference regions: WC (R² = 0.97), WC + B (R² = 0.98), CG (R² = 0.92), and pons (R² = 0.98). WC showed the largest effect size in both FBB and FMM. Comparison of the variance of the dcCL values within the young control group showed that with FBB, WC + B had the smallest variance and with FMM, the WC had the smallest variance. Additionally, WC + B showed the smallest absolute difference between FBB and FMM, followed by the WC, pons, and CG. We found that it would be reasonable to use the WC or WC + B as the reference region when converting FBB and FMM SUVRs into dcCL, which can increase the accuracy of standardizing FBB and FMM PET results.

Treatment of Molar Incisor Malformation and the short term follow-up: Case reports

BACKGROUND

Molar Incisor Malformation (MIM) or Molar Root Incisor malformation (MRIM) is a recently discovered root malformation with constricted pulp and abnormally located furcation presented in permanent first molars and sometimes incisors.

CASE REPORT

Two cases that feature MIM are presented with the description of the characteristic tooth form, clinical/radiographic examination, medical history, the supposed aetiology, treatment procedure and results at the 2-year follow-up. Conservative endodontic treatment was performed in both cases, furcation perforation and canal perforation were filled with MTA (Mineral Trioxide Aggregate), and a good prognosis was observed after 2 years of follow-up. Furthermore, recommended treatment options are discussed to provide a more appropriate treatment for the patients.

CONCLUSION

Patients with MIM need to be treated at the right time to avoid severe infection and other problems. Early diagnosis with appropriate treatment is more likely to lead to a more favourable prognosis.

Potential anti-ageing effect of chondroitin sulphate through skin regeneration

OBJECTIVE

Skin ageing is inevitably exposed through its typical features such as wrinkles and sagging. Therefore, skin anti-ageing is a major issue in cosmetic research to prevent and improve ageing symptoms using effective ingredients. Chondroitin sulphate (CS), a type of glycosaminoglycan, is an important structural component of the extracellular matrix (ECM) and is involved in various biological processes, such as cell proliferation, differentiation and migration. Here, we aimed to investigate the effects of CS on skin regeneration and examine its efficacy as a potential safe and effective skin anti-ageing ingredient.

METHODS

We investigated the effects of CS on cell proliferation in normal human keratinocytes and fibroblasts. Then, cell migration, ECM synthesis and related signalling pathways were examined in fibroblasts through gene and protein expression analysis. Finally, the effect on skin wound healing and regeneration was validated using a full-thickness skin wound model and an aged skin model.

RESULTS

Chondroitin sulphate treatment increased the proliferation of keratinocytes and fibroblasts. It also stimulated the migration and synthesis of ECM components of fibroblasts. Further analysis revealed that CS induced the expression of type I procollagen by activating the extracellular signal-regulated kinase pathway. Using a full-thickness skin wound model and an aged skin model, we confirmed that CS treatment promoted skin wound healing and regeneration.

CONCLUSION

Together, our results indicated that CS has the potential to facilitate skin regeneration, implying that CS could be clinically applied to improve skin ageing.

Surface Point Cloud Ultrasound with Transcranial Doppler: Coregistration of Surface Point Cloud Ultrasound with Magnetic Resonance Angiography for Improved Reproducibility, Visualization, and Navigation in Transcranial Doppler Ultrasound

Transcranial Doppler (TCD) ultrasound is a standard tool used in the setting of recent sub-arachnoid hemorrhage (SAH). By tracking velocity in the circle-of-Willis vessels, vasospasm can be detected as interval velocity increase. For this disease process, repeated TCD velocity measurements over many days is the basis for its usefulness. However, a key limitation to TCD is its user dependence, which is itself largely due to the fact that exact information about probe positioning is lost between subsequent scans. Surface point cloud ultrasound (SPC-US) was recently introduced as a general approach combining ultrasound and three-dimensional surface imaging of patient + probe. In the present proof-of-principle demonstration, we have applied SPC-US to TCD and co-registered the skin surface with that from MRA images to provide a roadmap of the vasculature in 3D space for better speed, accuracy, reproducibility, and potential semi-automation of TCD. Collating the acronyms, we call the combined approach SPC-US-TCD. TCD of the M1 was obtained while three-dimensional photographic images were obtained with the Structure Sensor camera. MRA imaging was also obtained. SPC-US-TCD and corresponding MRA 3D reconstruction images were co-registered in MeshMixer using the skin surfaces for alignment. A cylinder the width of the TCD probe was placed over the fused images and aligned with the direction and orientation of the TCD probe to demonstrate the acoustic beam. In the fused images, the acoustic beam intersects the right M1 segment of the middle cerebral artery (MCA). The angle of insonation is well demonstrated and measurable in various planes. Distance measurements made in Blender localized the TCD probe position based on three skin surface landmarks, and tabulated orientation based on three angles along the corresponding directions. SPC-US-TCD provides valuable information that is otherwise not present in TCD studies. By co-registering SPC-US-TCD data with that from cross sectional vessel imaging, precise probe location relative to external skin surface landmarks as well as 3D vessel location relative to TCD probe placement offers the potential to provide a roadmap that improves exam reproducibility, speed of acquisition, and accuracy. The goal of future work is to demonstrate this improvement statistically by application to multiple patients and scans.

Exploring stories of learning and professional development: interactions between GP personal tutors and medical students

BACKGROUND

The demanding environment at medical school results in some students being prone to a high risk of mental health issues. GMC recommendations include positioning personal tutors for pastoral support and to act as academic role models. Tutors who are clinicians, such as GPs, could help students develop their academic and professional narratives. Our study explores interactions between GP tutors and students and evaluates how personal tutoring can support the ways in which students respond to the medical school culture and its demands.

METHOD

Six pairs of GP tutors and medical students had three personal tutor meetings over 9 months. Twelve meetings were recorded. A dialogical narrative analytical approach was used to assess how students' problems and reflective processes were negotiated with tutors. Three themes were formed to consolidate findings.

RESULTS

Tutors' affirmations helped students develop an alternative narrative to perfectionism focusing on 'doing well' and self-care. Reflection on students' perceptions of a medical career were prompted by tutors who encouraged students to keep an open-minded and enthusiastic outlook. Active participation from students sometimes required tutors to relinquish hierarchical power and share personal experiences.

CONCLUSION

GP tutors can help reframe student narratives of perfectionism and professionalism by expressing their vulnerabilities and working collaboratively. With clear guidance, there is potential for personal tutors working as GPs, to benefit students in the long run both academically and professionally. However, this should go hand in hand with a transformation of medical school culture to prevent sole focus on building student resilience.