Dependence Levels as Interim Clinical Milestones Along the Continuum of Alzheimer's Disease: 18-Month Results from the GERAS Observational Study

BACKGROUND

While functional loss forms part of the current diagnostic criteria used to identify dementia due to Alzheimer's disease, the gradual and progressive nature of the disease makes it difficult to recognize clinically relevant signposts that could be helpful in making treatment and management decisions. Having previously observed a significant relationship between stages of functional dependence (the level of assistance patients require consequent to Alzheimer's disease deficits, derived from the Alzheimer's Disease Cooperative Study - Activities of Daily Living Scale) and cognitive severity, we investigated whether measures of functional dependence could be utilized to identify clinical milestones of Alzheimer's disease progression.

OBJECTIVES

To describe the patterns of change in dependence over the course of 18 months in groups stratified according to cognitive Alzheimer's disease dementia severity (determined using the Mini-Mental State Examination score) and to identify characteristics associated with patients showing worsening dependence (progressors) versus those showing no change or improvement (non-progressors).

DESIGN

Analysis of longitudinal data from the GERAS study.

SETTING

GERAS is an 18-month prospective, multicenter, naturalistic, observational cohort study reflecting the routine care of patients with Alzheimer's disease in France, Germany, and the United Kingdom.

PARTICIPANTS

1495 community-living patients, aged ≥55 years, diagnosed with probable Alzheimer's disease dementia, and their caregivers.

MEASUREMENTS

Dependence levels, cognitive function, behavioral symptoms, caregiver burden, and cost were assessed at baseline and at 18 months.

RESULTS

Of 971 patients having both baseline and 18-month data, 42% (408) were progressors and 563 (58%) were non-progressors. This general pattern held for all three levels of baseline Alzheimer's disease dementia severity - mild (Mini-Mental State Examination score 21-26), moderate (15-20) or moderately severe/severe (<15) - with 40-45% of each group identified as progressors and 55-60% as non-progressors. No baseline differences were seen between progressors and non-progressors in cognitive scores or behavioral symptoms, although progressors had significantly shorter times since diagnosis and showed milder functional impairment. Baseline factors predictive of increasing dependence over 18 months included more severe cognitive impairment, living with others, and having multiple caregivers. A higher level of initial dependence was associated with less risk of dependence progression. Total societal costs of care also increased with greater dependence.

CONCLUSIONS

In this large cohort, 42% of Alzheimer's disease dementia patients at all levels of cognitive severity became more dependent within 18 months of observation while 58% did not progress. Dependence levels may be considered as meaningful interim clinical milestones that reflect Alzheimer's disease-related functional deficits, although a time frame that extends beyond 18 months may be necessary to observe changes if used in clinical trials or other longitudinal studies. Recognition of predictors of greater dependence offers opportunities for intervention.

Diffusional kurtosis imaging in assessing renal function and pathology of IgA nephropathy: a preliminary clinical study

AIM

To evaluate renal fibrosis in immunoglobulin A nephropathy (IgAN) using diffusion kurtosis imaging (DKI).

MATERIALS AND METHODS

Twenty patients with biopsy-proven IgAN were enrolled. DKI was performed on a clinical 3 T magnetic resonance imaging (MRI) system, and region-of-interest measurements were conducted to determine mean kurtosis (K), mean diffusivity (D), and apparent diffusion coefficient (ADC) of the kidney cortex. Renal biopsy specimens were scored based on the severity of renal fibrosis. The associations between the DKI data and clinicopathological parameters were investigated.

RESULTS

Both the K and ADC were not only well correlated with the estimated glomerular filtration rate, but also significantly associated with the pathological scores of fibrosis, including the glomerular sclerosis index (K: r=0.759, p<0.001; ADC: r=-0.636, p=0.003) and the percentage of tubular atrophy and interstitial fibrosis (K: r=0.767, p<0.001; ADC: r=-0.702, p=0.001). Further receiver operating characteristic analysis showed that K demonstrated better diagnostic performance in discriminating severe glomerulosclerosis (area under curve [AUC] 0.970, sensitivity 81.8%, specificity 100%), and ADC displayed better capabilities in identifying severe tubular atrophy/interstitial fibrosis (AUC 0.976, sensitivity 100%, specificity 92.9%).

CONCLUSION

This DKI method can be used to detect renal fibrosis in IgAN in a non-invasive manner and may provide additional information for characterisation and surveillance.

Measurement of the Effective Weak Mixing Angle in pp[over ¯]→Z/γ^{*}→ℓ^{+}ℓ^{-} Events

We present a measurement of the effective weak mixing angle parameter sin^{2}θ_{eff}^{ℓ} in pp[over ¯]→Z/γ^{*}→μ^{+}μ^{-} events at a center-of-mass energy of 1.96 TeV, collected by the D0 detector at the Fermilab Tevatron Collider and corresponding to 8.6  fb^{-1} of integrated luminosity. The measured value of sin^{2}θ_{eff}^{ℓ}[μμ]=0.23016±0.00064 is further combined with the result from the D0 measurement in pp[over ¯]→Z/γ^{*}→e^{+}e^{-} events, resulting in sin^{2}θ_{eff}^{ℓ}[comb]=0.23095±0.00040. This combined result is the most precise measurement from a single experiment at a hadron collider and is the most precise determination using the coupling of the Z/γ^{*} to light quarks.

Blockade of miR-663b inhibits cell proliferation and induces apoptosis in osteosarcoma via regulating TP73 expression

OBJECTIVE

This study aimed to investigate the exact role of miR-663b in osteosarcoma (OS) progression and further explore the underlying molecular mechanisms.

MATERIALS AND METHODS

The miR-663b expression in human OS cell lines was determined by qRT-PCR, and the results suggested that miR-663b was highly expressed in human OS cells. TargetScan was used to predict the potential targets of miR-663b, and the prediction was confirmed by dual-luciferase reporter assay. To investigate the role of miR-663b in OS, miR-663b was down-regulated in U2OS cells using miR-663b inhibitor. CCK8 and flow cytometry were preformed to investigate the proliferation and apoptosis of U2OS cells. Moreover, qRT-PCR and western blot analysis were performed to measure the mRNA and protein expression.

RESULTS

We found that miR-663b directly targets TP73 and negatively regulates TP73 expression. MiR-663b inhibitor significantly decreased the proliferation ability of U2OS cells, while the percentage of apoptotic cells was markedly increased. The level of Bcl-2 was notably inhibited by miR-663b inhibitor, while Bax expression was significantly enhanced. Moreover, miR-663b down-regulation promoted p53 and p21 expression in U2OS cells.

CONCLUSIONS

MiR-663b down-regulation represses proliferation and induces apoptosis in OS by targeting TP73. Therefore, we provide a potential therapeutic target for OS treatment (Fig. 6, Ref. 27).

Risk of pancreatic cancer associated with family history of cancer and other medical conditions by accounting for smoking among relatives

Background

Family history (FH) of pancreatic cancer (PC) has been associated with an increased risk of PC, but little is known regarding the role of inherited/environmental factors or that of FH of other comorbidities in PC risk. We aimed to address these issues using multiple methodological approaches.

Methods

Case-control study including 1431 PC cases and 1090 controls and a reconstructed-cohort study (N = 16 747) made up of their first-degree relatives (FDR). Logistic regression was used to evaluate PC risk associated with FH of cancer, diabetes, allergies, asthma, cystic fibrosis and chronic pancreatitis by relative type and number of affected relatives, by smoking status and other potential effect modifiers, and by tumour stage and location. Familial aggregation of cancer was assessed within the cohort using Cox proportional hazard regression.

Results

FH of PC was associated with an increased PC risk [odds ratio (OR) = 2.68; 95% confidence interval (CI): 2.27-4.06] when compared with cancer-free FH, the risk being greater when ≥ 2 FDRs suffered PC (OR = 3.88; 95% CI: 2.96-9.73) and among current smokers (OR = 3.16; 95% CI: 2.56-5.78, interaction FHPC*smoking P-value = 0.04). PC cumulative risk by age 75 was 2.2% among FDRs of cases and 0.7% in those of controls [hazard ratio (HR) = 2.42; 95% CI: 2.16-2.71]. PC risk was significantly associated with FH of cancer (OR = 1.30; 95% CI: 1.13-1.54) and diabetes (OR = 1.24; 95% CI: 1.01-1.52), but not with FH of other diseases.

Conclusions

The concordant findings using both approaches strengthen the notion that FH of cancer, PC or diabetes confers a higher PC risk. Smoking notably increases PC risk associated with FH of PC. Further evaluation of these associations should be undertaken to guide PC prevention strategies.

Phase II study of idelalisib, a selective inhibitor of PI3Kδ, for relapsed/refractory classical Hodgkin lymphoma

Background

The phosphatidylinositol-3-kinase delta (PI3Kδ) inhibitor idelalisib has been shown to block downstream intracellular signaling, reduce the production of prosurvival chemokines and induce apoptosis in classical Hodgkin lymphoma (HL) cell lines. It has also been shown to inhibit regulatory T cells and myeloid-derived suppressor cells in other tumor models. We hypothesized that inhibiting PI3Kδ would have both direct and indirect antitumor effects by directly targeting the malignant cells as well as modulating the inflammatory microenvironment. We tested this hypothesis in a phase II study.

Patients and methods

We enrolled 25 patients with relapsed/refractory HL with a median age of 42 years and who had previously received a median of five therapies including 18 (72%) with failed autologous stem cell transplant, 23 (92%) with failed brentuximab vedotin, and 11 (44%) with prior radiation therapy. Idelalisib was administered at 150 mg two times daily; an increase to 300 mg two times daily was permitted at the time of disease progression.

Results

The overall response rate to idelalisib therapy was 20% (95% confidence interval: 6.8%, 40.7%) with a median time to response of 2.0 months. Seventeen patients (68%) experienced reduction in target lesions with one complete remission and four partial remissions. The median duration of response was 8.4 months and median progression-free survival was 2.3 months. The most common grade ≥3 adverse event was elevation of alanine aminotransferase (two patients, 8%). Diarrhea/colitis was seen in three patients and was grade 1-2. There was one adverse event leading to death (hypoxia).

Conclusions

Idelalisib was tolerable and had modest single-agent activity in heavily pretreated patients with HL. Rational combinations with other novel agents may improve response rate and duration of response.

Clinical trial registration

ClinicalTrials.gov # NCT01393106.

Analysis of (CAG)n expansion in ATXN1, ATXN2 and ATXN3 in Chinese patients with multiple system atrophy

Multiple system atrophy (MSA) is a complex and multifactorial neurodegenerative disease, and its pathogenesis remains uncertain. Patients with MSA or spinocerebellar ataxia (SCA) show overlapping clinical phenotypes. Previous studies have reported that intermediate or long CAG expansions in SCA genes have been associated with other neurodegenerative disease. In this study, we screened for the number of CAG repeats in ATXN1, 2 and 3 in 200 patients with MSA and 314 healthy controls to evaluate possible associations between (CAG)_n in these three polyQ-related genes and MSA. Our findings indicated that longer repeat lengths in ATXN2 were associated with increased risk for MSA in Chinese individuals. No relationship was observed between CAG repeat length in the three examined genes and age at onset (AO) of MSA.

Combined Forward-Backward Asymmetry Measurements in Top-Antitop Quark Production at the Tevatron

The CDF and D0 experiments at the Fermilab Tevatron have measured the asymmetry between yields of forward- and backward-produced top and antitop quarks based on their rapidity difference and the asymmetry between their decay leptons. These measurements use the full data sets collected in proton-antiproton collisions at a center-of-mass energy of sqrt[s]=1.96  TeV. We report the results of combinations of the inclusive asymmetries and their differential dependencies on relevant kinematic quantities. The combined inclusive asymmetry is A_{FB}^{tt[over ¯]}=0.128±0.025. The combined inclusive and differential asymmetries are consistent with recent standard model predictions.

Simulation of nonlinear transient elastography: finite element model for the propagation of shear waves in homogeneous soft tissues

In this study, visco-hyperelastic Landau's model, which is widely used in acoustical physic field, is introduced into a finite element formulation. It is designed to model the nonlinear behaviour of finite amplitude shear waves in soft solids, typically, in biological tissues. This law is used in finite element models based on elastography, experiments reported in Jacob et al, the simulations results show a good agreement with the experimental study: It is observed in both that a plane shear wave generates only odd harmonics and a nonplane wave generates both odd and even harmonics in the spectral domain. In the second part, a parametric study is performed to analyse the influence of different factors on the generation of odd harmonics of plane wave. A quantitative relation is fitted between the odd harmonic amplitudes and the non-linear elastic parameter of Landau's model, which provides a practical guideline to identify the non-linearity of homogeneous tissues using elastography experiment.

Long-term blood glucose monitoring with implanted telemetry device in conscious and stress-free cynomolgus monkeys

AIMS

Continuous blood glucose monitoring, especially long-term and remote, in diabetic patients or research is very challenging. Nonhuman primate (NHP) is an excellent model for metabolic research, because NHPs can naturally develop Type 2 diabetes mellitus (T2DM) similarly to humans. This study was to investigate blood glucose changes in conscious, moving-free cynomolgus monkeys (Macaca fascicularis) during circadian, meal, stress and drug exposure.

MATERIALS AND METHODS

Blood glucose, body temperature and physical activities were continuously and simultaneously recorded by implanted HD-XG telemetry device for up to 10 weeks.

RESULTS AND DISCUSSION

Blood glucose circadian changes in normoglycemic monkeys significantly differed from that in diabetic animals. Postprandial glucose increase was more obvious after afternoon feeding. Moving a monkey from its housing cage to monkey chair increased blood glucose by 30% in both normoglycemic and diabetic monkeys. Such increase in blood glucose declined to the pre-procedure level in 30 min in normoglycemic animals and >2 h in diabetic monkeys. Oral gavage procedure alone caused hyperglycemia in both normoglycemic and diabetic monkeys. Intravenous injection with the stress hormones, angiotensin II (2 μg/kg) or norepinephrine (0.4 μg/kg), also increased blood glucose level by 30%. The glucose levels measured by the telemetry system correlated significantly well with glucometer readings during glucose tolerance tests (ivGTT or oGTT), insulin tolerance test (ITT), graded glucose infusion (GGI) and clamp.

CONCLUSION

Our data demonstrate that the real-time telemetry method is reliable for monitoring blood glucose remotely and continuously in conscious, stress-free, and moving-free NHPs with the advantages highly valuable to diabetes research and drug discovery.

Identification of translationally controlled tumor protein in promotion of DNA homologous recombination repair in cancer cells by affinity proteomics

Translationally controlled tumor protein(TCTP) has been implicated in the regulation of apoptosis, DNA repair and drug resistance. However, the underlying molecular mechanisms are poorly defined. To better understand the molecular mechanisms underlying TCTP involved in cellular processes, we performed an affinity purification-based proteomic profiling to identify proteins interacting with TCTP in human cervical cancer HeLa cells. We found that a group of proteins involved in DNA repair are enriched in the potential TCTP interactome. Silencing TCTP by short hairpin RNA in breast carcinoma MCF-7 cells leads to the declined repair efficiency for DNA double-strand breaks on the GFP-Pem1 reporter gene by homologous recombination, the persistent activation and the prolonged retention of γH2AX and Rad51 foci following ionizing radiation. Reciprocal immunoprecipitations indicated that TCTP forms complexes with Rad51 in vivo, and the stability maintenance of Rad51 requires TCTP in MCF-7 cells under normal cell culture conditions. Moreover, inactivation of TCTP by sertraline treatment enhances UVC irradiation-induced apoptosis in MCF-7 cells, and causes sensitization to DNA-damaging drug etoposide and DNA repair inhibitor olaparib. Thus, we have identified an important role of TCTP in promoting DNA double-stand break repair via facilitating DNA homologous recombination processes and highlighted the great potential of TCTP as a drug target to enhance conventional chemotherapy for cancer patients with high levels of TCTP expression.

[MRI of the finger ligament and tendon injuries: imaging technique and clinical application]

Objective: To explore the MRI technique and the clinical application in ligament and tendons of fingers. Methods: The study was reviewed and approved by an institutional review board of hospital.A total of 20 normal volunteers and 50 patients from Beijing Jishuitan Hospital between May 2012 and May 2015 with finger injuries were chosen to undergo magnetic resonance examination by using Achieva 3.0 T MR produced by Philips.Scanning from coronal, sagittal and axial view in T(1)-weighted and proton fat saturation sequence (PD-FS), choosing suitable parameters, in order to get clear images of finger tendons and ligaments. Results: Twenty normal volunteers without tendons or ligament injuries showed homogeneous low-signal-intensity on T(1)-weighted and proton fat saturation sequence (PD-FS) images.In the 50 patients with finger injuries, there were 33 cases of ligament injuries, 10 cases of extensor tendon injuries and 7 cases of flexor tendon injuries. There were 8 cases of all the 50 cases combined with bone fracture.The injured ligaments and tendons became thicker and discontinued in T(1)WI and demonstrated heterogeneously increased signal intensity with edema in the soft tissues surrounding the injured sites in PD-FS. Conclusion: MRI can demonstrate the anatomy and injuries features of ligament and tendons in fingers accurately.It is significance for the early diagnosis and treatment protocols of the ligament and tendons injuries.

Abstract P4-07-07: Reduced expression of miR-200c-3p contributes to cell migration and invasion in paclitaxel-resistant breast cancer cell

Background: miRNAs are a class of small noncoding RNA molecules that regulate gene expression by degradation of target mRNAs or inhibition of translation. Metastasis is one of the major problems that give obstacles to improve the clinical outcome of breast cancer. However, the underlying molecular mechanism of breast cancer metastasis remains largely unclear. Emerging studies have demonstrated that miRNAs play an important part in tumor invasion and metastasis. In the present study, we aimed to investigate the role and mechanism of miR-200c-3p in regulating the migration and invasion of paclitaxel-resistant breast cancer cells, and identify potential targets for breast cancer treatments.

Material and methods: Paclitaxel-resistant breast cancer cell line MCF-7/Tax was established by stepwise selection in increasing concentration of paclitaxel. The 50% inhibitory concentration and cell viability were measured by the MTT assay. The expression level of miR-200c-3p in MCF-7/Tax and the parental MCF-7 cells was assessed by quantitative real-time RT-PCR. Gain-of-function and loss-of-function study on cell migration and invasion abilities were carried out by transfection of miR-200c-3p mimics or inhibitors respectively. The molecular target of miR-200c-3p was verified by dual-luciferase reporter assay.

Results: Paclitaxel-resistant breast cancer cell line MCF-7/Tax was established. Compared with parental MCF-7 cells, expression of miR-200c-3p determined by real-time RT-PCR was significantly down-regulated in paclitaxel-resistant MCF-7/Tax cells. The ability of migration and invasion of paclitaxel-resistant MCF-7/Tax cells was obviously increased as compared to parental MCF-7 cells. In addition, we found that up-regulation of miR-200c-3p expression inhibited the migration and invasion of MCF-7/Tax cells, while down-regulation of miR-200c-3p expression increased the migration and invasion of MCF-7/Tax cells. Dual-luciferase reporter assay demonstrated that SOX2 was one of the direct targets of miR-200c-3p in breast cancer.

Conclusions: Our results indicate that reduced expression of miR-200c-3p plays a crucial role in cell migration and invasion of paclitaxel-resistant breast cancer cell, and miR-200c-3p may suppress the cell migration and invasion possibly partially through SOX2. Our findings suggest that miR-200c-3p may serve as a promising therapeutic target for breast cancer metastasis.

Keywords miRNA · Breast cancer ·Invasion

Acknowledgments: The project supported by the grant of the Natural Science Foundation of Zhejiang Province (No.LQ13H160016), and the Medical Sciences and Technology of Zhejiang Province (No.2013KYA026, No.2015DTA004).

Citation Format: Wang X, Chen J, Chen Z, Huang J, Ye W. Reduced expression of miR-200c-3p contributes to cell migration and invasion in paclitaxel-resistant breast cancer cell [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-07-07.

[Risk factors for long-term result of endovascular treatment for auto-immune disease related abdominal aorta pseudo-aneurysm]

Objective: To summarize results of endovascular treatment for auto-immune disease related abdominal aorta pseudo-aneurysm(AIPA), and to analysis clinical predictors of long term major adverse clinical events(MACE). Methods: Retrospectively collected endovascular treatment for AIPA cases in Peking Union Medical College Hospital within 2000 to 2015. Twenty-nine cases with AIPA treated by endovascular therapy were enrolled in this study. Twenty five cases were male, range from 23 to 67 years old, mean age was (39.3±11.4) years old.Demographic characters, locations of aneurysms, type to auto-immune disease, immuno medical therapy, operation strategy and long term follow-up data were reported. Statistical analysis was made to verify clinical predictors of long-term MACE. Results: Among the 29 cases, 22 cases with bechet's disease, 4 cases with Takayasu's arteritis, 2 cases with systemic lupus erythematosus, 1 cases with polyarteritis nodosa. Eight cases had ruptured or pending ruptured pesudo-aneurysms, the rest 21 cases had dull pain or no overt symptome. Twenty-four cases had infra-renal artery aneurysms, two were para-and supra-renal artery, two were supra-celiac artery, and the rest one had multiple aneurysms involved thoracic and abdominal aorta.All the cases received regular immune medical therapy except the three emergency cases. All the operations were under general anaesthesia. Nineteen cases underwent classical Endovascular aortic aneurysm repair (EVAR), 5 cases underwent fenestration EVAR, the rest 5 cases underwent hybrid procedure. All the 29 operations were successful, without conversion to open surgery. Major peri-operation complication included 3 incision infection, 3 pulmonary infection. No death occurred. All the cases received regular follow-up from 1 to 120 months. There were five recurrence of pseudo-aneurysm, 1 case suffered from iliac limb occlusion. 5 cases received re-intervention procedure. No occlusion of revascularizal visceral artery was found during follow-up. There were 3 deaths during follow-up, with 1 aneurysm related death, the rest died due to other reasons. Single factors logical regressions analysis showed discontinuing immune medicine therapy and age no less than 40 years significantly related long-term MACE(P<0.05). Meanwhile, type of original auto-immune disease, none classical EVAR were not significant related to MACE. Conclusions: Endovascular therapy is safe and effective for AIPA. Regular peri-operation and long-term immunotherapy is key to success.

Systematic review and meta-analysis on the significance of salvage esophagectomy for persistent or recurrent esophageal squamous cell carcinoma after definitive chemoradiotherapy

The therapeutic strategy to be recommended in case of recurrent or persistent squamous cell esophageal cancer after completed definitive chemoradiotherapy (dCRT) has to be documented. Salvage esophagectomy has traditionally been recognized as a viable option, but many clinicians oppose the use of surgery due to the associated excessive morbidity and mortality. 'Second-line' chemoradiotherapy (CRT) without surgery may offer a treatment alternative in these difficult and demanding clinical situations. Until now, no comprehensive attempt has been carried out to compare the respective therapeutic options. A systematic literature search was performed focusing on studies comparing survival and treatment-related mortality in patients submitted to salvage esophagectomy or second-line CRT for recurrent or persistent esophageal squamous cell carcinoma after dCRT. Hazard ratios and risk ratios were calculated to compare the effect of these therapeutic strategies on overall survival and treatment-related mortality, respectively. Four studies containing 219 patients, with persistent or recurrent esophageal squamous cell carcinoma after dCRT, were included in the meta-analysis. The analysis revealed an overall survival benefit following salvage esophagectomy with a pooled hazard ratio for death of 0.42 (95% confidence interval 0.21-0.86, P = 0.017) compared with second-line CRT. A treatment-related mortality of 10.3% was recorded in the 36 patients who were submitted to salvage esophagectomy, while it was impossible to perform a meta-analysis comparing treatment-related mortality between the groups. Salvage esophagectomy offers significant gain in long-term survival compared with second-line CRT, although the surgery is potentially at a price of a high treatment-related mortality.

Oral health impact of halitosis in Chinese adults

OBJECTIVES

To compare differences in oral health-related quality of life (OHRQoL) between halitosis and non-halitosis patients and to explore relationships between halitosis and OHRQoL.

METHODS

Patients who visited the halitosis clinic at the Ninth People's Hospital and were diagnosed with halitosis were included in the halitosis group. The control group consisted of patients without halitosis. All participants were assessed for halitosis (volatile sulphur compound measurements with a portable sulphide monitor, Oral Chroma and organoleptic tests), underwent a clinical oral examination (dental caries status and periodontal condition) and completed a questionnaire. Oral health-related quality of life was measured using the Oral Health Impact Profile (OHIP-14, Chinese version).

RESULTS

A total of 204 patients (102 halitosis and 102 controls) were included. The halitosis group had significantly higher OHIP-14 scores (severity) than the control group (15.7 versus 7.9, P < 0.001). The mean number of items with negative impact (extent) was significantly different between the halitosis and control groups (1.8 versus 0.3, P < 0.001). Around 56% of participants in the halitosis group reported at least one item with 'fairly often' or 'very often' (prevalence), while 21% did so in the control group (P < 0.001). In halitosis patients, the most commonly reported negative impacts were within the domains of 'psychological discomfort' and 'psychological disability'.

CONCLUSIONS

Oral health-related quality of life status was significantly poorer in halitosis patients than in non-halitosis patients. Halitosis patients may experience some degree of psychological discomfort and disability.