Sjögren's Syndrome as an Immune-related Adverse Event of Nivolumab Treatment for Gastric Cancer

Immune checkpoint inhibitors can affect any organ, including the salivary glands. A case of Sjögren's syndrome (SjS) induced by nivolumab for the treatment of gastric cancer is herein presented. Nivolumab treatment caused marked tumor shrinkage, but xerostomia developed after two cycles. It took 3 months after symptom onset to confirm the diagnosis of SjS. Prednisolone and pilocarpine hydrochloride did not relieve the symptoms. SjS is a relatively rare immune-related adverse event that might sometimes be overlooked. Since SjS can severely impair a patient's quality of life, oncologists should not miss any signs of salivary gland hypofunction and cooperate with specialists for SjS.

The clinical impact of preoperative body composition differs between male and female colorectal cancer patients

AIM

Patient body composition is an important indicator of metabolic status and is associated with cancer progression. Because body composition varies between men and women, we aimed to examine the difference in clinical impact of preoperative body composition according to sex.

METHOD

We used an integrated dataset of 559 colorectal cancer (CRC) patients. The association between preoperative body composition indices [body mass index (BMI), visceral to subcutaneous fat area ratio (VSR) and skeletal muscle index (SMI)] and patient outcome, clinicopathological factors and preoperative inflammation and nutritional status was analysed, comparing men and women.

RESULTS

Preoperative low BMI and low SMI in men was significantly associated with unfavourable overall survival (OS) [BMI: hazard ratio (HR) 2.22, 95% CI 1.28-4.14, P = 0.004; SMI: HR 2.54, 95% CI 1.61-4.07, P < 0.001] and high VSR in women was significantly associated with unfavourable OS (HR 1.79, 95% CI 1.03-3.02, P = 0.040). Additionally, low SMI in men was significantly associated with deeper tumour invasion and greater distant metastasis and high VSR in women was significantly associated with advanced age, right-sided tumour, lower total lymphocyte count and lower albumin levels. Interestingly, low BMI in men was significantly associated with deeper tumour invasion, but also with favourable inflammation and nutritional status (lower C-reactive protein and higher albumin).

CONCLUSION

The clinical impact of preoperative body composition differed between men and women: SMI in men and VSR in women were good prognosticators. Our findings may provide a novel insight for CRC treatment strategies.

Approach for Compensation System of Asbestos-Related Lung Cancer

Background

The health hazards of asbestos have been globally recognized, especially those among industrial workers with long-term exposure. Lung cancer is one such asbestos-related disease. It occurs not only among workers but also among residents with environmental exposure to asbestos. Patients with work-related exposure can receive occupational compensation, and patients with non-occupational exposure are supported by a separate compensation system in Japan. However, the latter is not well-known among clinicians, and a substantial number of patients may have been left out. We need an effective way to find patients eligible to receive benefits by better understanding the clinical conditions that characterize patients with asbestos-related lung cancer.

Methods

We conducted two types of research: 1. Comparison of clinical characteristics between compensation system recipients (N = 65) and general lung cancer patients diagnosed in 2015, using Japan’s National Database of Hospital-Based Cancer Registry.

2. Estimation of the frequency of pleural plaques among lung cancer patients by double-checking CT scan images of a random sample of lung cancer patients obtained from the HBCR national database (N = 3585).

Results

Patients with squamous cell carcinoma are twice as likely asbestos-induced as patients with other histology overall after adjusting for age, sex and cancer stages, but not smoking status and history. As many as 20% of the CT images were read inconsistently between two radiologists or respiratory disease doctors and we could not obtain the accurate rate of candidacy for the compensation system.

Conclusions

We require more accurate information about pathological characteristics by controlling for smoking status and history among compensation recipients. For radiologic interpretation, more effective education is needed for the radiologists and respiratory disease doctors who treat lung cancer patients.

Key messages

Specific information about asbestos-related lung cancer would lead clinicians to correctly identify asbestos-related lung cancer. Educational system for clinicians would help patients to receive the benefit of compensation.

Neuroacustica®'s Sound Stimulation Effects over Neurotransmitters, Cortisol, P-Amyloid (1-42), Thromboxane B2 and Telomere, on Cerebral Pons Representative Area, on the back of the head, and other Abnormal Body Locations, Using Bi-Digital O-Ring Test

Thirty patients with marked depletion of neurotransmitters concentrations were noninvasively evaluated by Bi-Digital O-Ring Test (an electro-magnetic field (EMF) resonance phenomenon between two identical substances and amount1 ,2,3). Reference Control Substances (RCS) of Serotonin, Acetylcholine, Dopamine, Cortisol, ~-Amyloid, Thromboxane B2, and Telomere were measured over cerebral pons representative area and any other abnormal region presented, before and after submitted to Neuroacustica® (a 60 minutes sound treatment). The results are as follow. The average Serotonin on cerebral pons was 1.25 before and 150.33 mcg after (p<0.001*), on abnormal area was 12.91 before and 142.73 mcg after (p=0.003*). The average Acetylcholine on cerebral pons was 8.07 before and 1421.17 mcg after (p<0.001*), on abnormal area was 46.46 before and 1181.82 mcg after (p=0.003*). The average Dopamine on cerebral pons was 2.23 before and 156.20 mcg after (p<0.001*), on abnormal area was 8.06 before and 158.09 mcg after (p=0.003*). The average Thromboxane on cerebral pons was 217.80 before and 12.04 ng after (p<0.001*), on abnormal area was 390.00 before and 18.02 ng after (p=0.003*). The average ~-Amyloid on cerebral pons was 17.33 before and 4.30 ng after (p=0.001*), on abnormal area was 10.78 before and 4.86 ng after (p=0.128). The average Cortisol on cerebral pons was 1353.23 before and 59.74 ng after (p<0.001*), on abnormal area was 1037.83 before and 23.82 ng after (p=0.033*). The average Telomere on cerebral pons was 46.08 before and 375.18 ng after (p<0.001*), on abnormal area was 56.50 before and 446.25 ng after (p=0.012*). The average Normal Cell Telomere was 197.49 before and 473.52 ng after (p<0.001*). Extra five patients in the same conditions (low levels of cerebral neurotransmitters) were submitted to the same procedure, and this time for a 24 hours follow up. In conclusion, hearing Neuroacustica® - Part 1, once, had favorable physiological effects, increasing sufficiently normal cell Telomere, Serotonin, Acetylcholine, Dopamine; as well as decreasing satisfactorily Thromboxan B2, Cortisol, ~-Amyloid and Cancer Cell Telomere both in cerebral pons and on abnormal area. The effects may last in about 24 hours. The exposition to EMF, some sort of food and alcohol may cancel it's benefits.

The impact of preoperative anaemia and anaemic subtype on patient outcome in colorectal cancer

AIM

Preoperative anaemia is associated with adverse outcomes in colorectal cancer (CRC). To clarify the reason for this we aimed to comprehensively assess the association of preoperative anaemia with tumour characteristics, host systemic inflammation and nutrition status, and perioperative blood transfusion.

METHOD

We used an integrated database of 592 CRC patients. The association of preoperative anaemic subtype, calculated from haemoglobin and erythrocyte mean corpuscular volume levels, with patient outcome, preoperative serum data relating to systemic inflammation and nutrition and perioperative blood transfusion was analysed.

RESULTS

Preoperative anaemia was significantly associated with poorer overall survival and relapse-free survival (RFS); in particular microcytic anaemia had a trend to poorer RFS than other forms of anaemia (P = 0.0648). In addition, preoperative anaemia was significantly correlated with right-sided tumours, greater depth of tumour invasion, use of neoadjuvant chemotherapy, poorer prognostic nutritional index and higher modified Glasgow Prognostic Score (mGPS). Microcytic anaemia in particular had a strong association with a greater depth of tumour invasion (P = 0.0072) and higher mGPS (P = 0.0058) than other causes of anaemia. Perioperative blood transfusion for CRC patients with anaemia was associated with adverse outcomes.

CONCLUSIONS

Preoperative anaemia, especially microcytic anaemia, was associated with poor patient outcomes, possibly due to poor systemic inflammatory and nutritional status, and it was not improved by perioperative blood transfusion. Our data suggest that preoperative anaemia and the anaemic subtype may serve as an easily available predictor of outcome in CRC.

Progressive Cortical Neuronal Damage and Extracranial-Intracranial Bypass Surgery in Patients with Misery Perfusion

BACKGROUND AND PURPOSE

Misery perfusion may cause selective neuronal damage in atherosclerotic ICA or MCA disease. Bypass surgery can improve misery perfusion and may prevent neuronal damage. On the other hand, surgery conveys a risk for neuronal damage. The purpose of this retrospective study was to determine whether progression of cortical neuronal damage in surgically treated patients with misery perfusion is larger than that in surgically treated patients without misery perfusion or medically treated patients with misery perfusion.

MATERIALS AND METHODS

We evaluated the distribution of benzodiazepine receptors twice by using PET and ¹¹C-labeled flumazenil in 18 surgically treated patients with atherosclerotic ICA or MCA disease (9 with misery perfusion and 9 without) and no perioperative stroke before and after bypass surgery; in 8 medically treated patients with misery perfusion and no intervening ischemic event; and in 7 healthy controls. We quantified abnormal decreases in the benzodiazepine receptors of the cerebral cortex within the MCA distribution and compared changes in the benzodiazepine receptor index among the 3 groups.

RESULTS

The change in the benzodiazepine receptor index in surgically treated patients with misery perfusion (27.5 ± 15.6) during 7 ± 5 months was significantly larger than that in surgically treated patients without misery perfusion (-5.2 ± 9.4) during 6 ± 4 months (P < .001) and in medically treated patients with misery perfusion (3.2 ± 15.4) during 16 ± 6 months (P < .01).

CONCLUSIONS

Progression of cortical neuronal damage in surgically treated patients with misery perfusion and no perioperative stroke may occur and may be larger than that in medically treated patients with misery perfusion and no intervening ischemic event.

Non-verbal Communication Method Based on a Biochemical Marker for People with Severe Motor and Intellectual Disabilities

This study evaluated a novel non-verbal communication method for people with severe motor and intellectual disabilities (SMID) based on a biochemical marker, salivary amylase. The physical and psychological status of 10 people with SMID was quantitatively evaluated using a hand-held salivary amylase activity monitor. Each patient needed daily gastric and/or bronchial tube exchanges and these medical procedures were thought to cause severe distress and pain. Salivary amylase activity and heart rate were simultaneously measured during 32 medical procedures. The medical procedures resulted in a significant mean increase for individuals of 70% in salivary amylase activity. The increase in salivary amylase activity was more than four-fold that observed for heart rate. The structural equation modelling analysis also demonstrated a significant correlation between pain and salivary amylase activity. Our data indicate that salivary amylase activity might be used as a non-verbal method of assessing pain in people with SMID.

Effect of LSKL peptide on thrombospondin 1-mediated transforming growth factor β signal activation and liver regeneration after hepatectomy in an experimental model

Background

A strategy for accelerating liver regeneration after hepatectomy would offer great benefits in preventing postoperative liver failure and improving surgical outcomes. Transforming growth factor (TGF) β is a potent inhibitor of hepatocyte proliferation. Recently, thrombospondin (TSP) 1 has been identified as a negative regulator of liver regeneration by activation of local TGF-β signals. This study aimed to clarify whether the LSKL (leucine–serine–lysine–leucine) peptide, which inhibits TSP-1-mediated TGF-β activation, promotes liver regeneration after hepatectomy in mice.

Methods

Mice were operated on with a 70 per cent hepatectomy or sham procedure. Operated mice received either LSKL peptide or normal saline intraperitoneally at abdominal closure and 6 h after hepatectomy. Perioperative plasma TSP-1 levels were measured by enzyme-linked immunosorbent assay in patients undergoing hepatectomy.

Results

Administration of LSKL peptide attenuated Smad2 phosphorylation at 6 h. S-phase entry of hepatocytes was accelerated at 24 and 48 h by LSKL peptide, which resulted in faster recovery of the residual liver and bodyweight. Haematoxylin and eosin tissue staining and blood biochemical examinations revealed no significant adverse effects following the two LSKL peptide administrations. In the clinical setting, plasma TSP-1 levels were lowest on the first day after hepatectomy. However, plasma TSP-1 levels at this stage were significantly higher in patients with subsequent liver dysfunction compared with levels in those without liver dysfunction following hepatectomy.

Conclusion

Only two doses of LSKL peptide during the early period after hepatectomy can promote liver regeneration. The transient inhibition of TSP-1/TGF-β signal activation using LSKL peptide soon after hepatectomy may be a promising strategy to promote subsequent liver regeneration.

Validation experiment of a numerically processed millimeter-wave interferometer in a laboratory

We propose a new interferometer system for density profile measurements. This system produces multiple measurement chords by a leaky-wave antenna driven by multiple frequency inputs. The proposed system was validated in laboratory evaluation experiments. We confirmed that the interferometer generates a clear image of a Teflon plate as well as the phase shift corresponding to the plate thickness. In another experiment, we confirmed that quasi-optical mirrors can produce multiple measurement chords; however, the finite spot size of the probe beam degrades the sharpness of the resulting image.

Dietary phosphorus overload aggravates the phenotype of the dystrophin-deficient mdx mouse

Duchenne muscular dystrophy is a lethal X-linked disease with no effective treatment. Progressive muscle degeneration, increased macrophage infiltration, and ectopic calcification are characteristic features of the mdx mouse, a murine model of Duchenne muscular dystrophy. Because dietary phosphorus/phosphate consumption is increasing and adverse effects of phosphate overloading have been reported in several disease conditions, we examined the effects of dietary phosphorus intake in mdx mice phenotypes. On weaning, control and mdx mice were fed diets containing 0.7, 1.0, or 2.0 g phosphorus per 100 g until they were 90 days old. Dystrophic phenotypes were evaluated in cryosections of quadriceps and tibialis anterior muscles, and maximal forces and voluntary activity were measured. Ectopic calcification was analyzed by electron microscopy to determine the cells initially responsible for calcium deposition in skeletal muscle. Dietary phosphorus overload dramatically exacerbated the dystrophic phenotypes of mdx mice by increasing inflammation associated with infiltration of M1 macrophages. In contrast, minimal muscle necrosis and inflammation were observed in exercised mdx mice fed a low-phosphorus diet, suggesting potential beneficial therapeutic effects of lowering dietary phosphorus intake on disease progression. To our knowledge, this is the first report showing that dietary phosphorus intake directly affects muscle pathological characteristics of mdx mice. Dietary phosphorus overloading promoted dystrophic disease progression in mdx mice, whereas restricting dietary phosphorus intake improved muscle pathological characteristics and function.

A cohort study of toner-handling workers on inflammatory, allergic, and oxidative stress markers

Objectives:

This study examines the relationship between toner exposure and its health effects in terms of biomarkers which are known to assess the damages to humans caused by toxic material exposure.

Methods:

The subjects were 1504 male workers aged below 50 in 2003 in a Japanese toner and photocopier manufacturing company. Personal exposure measurements, pulmonary function tests, chest X-ray examinations, biomarker measurement, and a questionnaire about respiratory symptoms were conducted. We will report about biomarker measurement in this study. Cross-sectional survey studies and a longitudinal study from 2003 to 2008 were conducted.

Results:

Few significant findings were associated with the toner exposure in both the cross-sectional and the longitudinal studies. The higher toner exposure concentrations did not induce effects on increasing biomarkers.

Conclusion:

There was no evidence of excessive inflammatory, allergic, or oxidative stress reaction in toner-handling workers as compared to non-handling workers, despite some sporadically significant findings. There are no other reports of a longitudinal epidemiological study with regard to toner exposure; this report significantly contributes to toner exposure literature. Although in the current well-controlled working environment, the toner exposure concentrations are quite low; further studies are needed to completely understand the health effects toner may have, however small they may be.

A cohort study using pulmonary function tests and x-ray examination in toner-handling workers: cross-sectional and longitudinal analyses from 2003 to 2008

OBJECTIVES

This study uses pulmonary function tests and chest x-ray examinations to examine the relationship between toner-handling work and its health effects.

METHODS

The subjects were 1504 male workers in a Japanese toner and photocopier manufacturing company, in the age range from 19 to 50 years in 2003. Personal exposure measurements, pulmonary function tests, chest x-ray examinations, biomarker measurements, and a questionnaire about respiratory symptoms were conducted. The present study reports the results of pulmonary function tests and chest x-ray examinations conducted in the subjects, which includes a cross-sectional study on the toner handling and non-handling workers and a longitudinal study from 2003 to 2008.

RESULTS

Few significant findings were suspected to be caused by toner exposure found in pulmonary function indices in both the cross-sectional and longitudinal studies. Any obvious fibrotic findings in chest x-ray findings related to the toner exposure could not be found out.

CONCLUSION

No evidence of adverse effects on pulmonary function indices and chest x-rays was present in the toner-handling workers as compared to the nonspecifically exposed workers. Although the toner exposure concentration is quite low in the current well-controlled working environment, even among the toner-handling workers, we would like to continue this study in the future to verify the toner exposure health effects.

Chronic hemodynamic compromise and cerebral ischemic events in asymptomatic or remote symptomatic large-artery intracranial occlusive disease

BACKGROUND AND PURPOSE

In asymptomatic or remote symptomatic LAICOD, the risk of ischemic events is low in general, but there may be a subgroup of higher risk patients who require aggressive medical management. The purpose of this study was to determine whether chronic hemodynamic compromise is a predictor of ischemic events in asymptomatic or remote symptomatic LAICOD.

MATERIALS AND METHODS

We prospectively studied 51 asymptomatic, 19 coexistent asymptomatic, and 19 remote (>6 months) symptomatic patients with atherosclerotic intracranial internal carotid artery or middle cerebral artery disease by using (15)O-PET. MP was defined as decreased CBF, increased OEF, and a decreased CBF/CBV ratio. All patients were followed up for 2 years or until occurrence of stroke or TIA or death.

RESULTS

Bypass surgery was performed in 4 patients (2 with MP). Three cerebral ischemic events (1 TIA in an asymptomatic patient, 1 stroke, and 1 TIA in a remote symptomatic patient) occurred in the vascular territory ipsilateral to LAICOD. Kaplan-Meier analysis with censoring at the time of bypass surgery revealed that the incidence of ipsilateral ischemic events in patients with MP (2/5) was significantly higher than that in patients without MP (1/84) (log-rank test; P < .0001). The relative risk conferred by MP was 83.1 (95% confidence interval, 6.8-1017.4; P < .001). The incidence of ipsilateral ischemic events in patients with decreased CBF/CBV (2/9) was also significantly higher than that of patients without it (1/80) (P = .0001).

CONCLUSIONS

Chronic hemodynamic compromise may be a predictor of ischemic events in both asymptomatic and remote symptomatic LAICOD.

Distribution of 16 EPA-priority polycyclic aromatic hydrocarbons (PAHs) in sludges collected from nine Tunisian wastewater treatment plants

Polycyclic aromatic hydrocarbons (PAHs) are organic compounds which may be present as contaminants in wastewater sewage sludge. Due to their toxicity and persistence in the solid phase, information should be gathered relating to their presence in sewage sludge in order to determine their contamination risks after land application. In this study, sewage sludge samples from nine Tunisian wastewater treatment plants (WWTPs) were characterized for the total content in 16 EPA-priority PAHs using an optimized extraction protocol. These WWTPs differ in the type of applied treatment and the wastewater source. Through this first assessment of PAHs in Tunisian sludges, their total concentration varied from 96 to the highest level of 7718 ng g(-1). Regardless of the source of wastewater, the highest PAH content was found in sludges deriving from untreated wastewater (natural lagooning). In addition, some correlation was found between the distribution patterns of each PAH, the type of applied treatment on one hand and the wastewater source on other hand.

Periodontal disease and incident diabetes: a seven-year study

Diabetes is associated with a high prevalence of periodontal disease, but little is known about the effects of periodontal disease on incident diabetes. In total, 5848 non-diabetic individuals aged 30-59 yrs who completed a health examination were analyzed in this study. They were divided into three categories: no pathological pockets, moderate periodontitis, or severe periodontitis. Incident diabetes was defined as newly diagnosed cases with fasting plasma glucose > 125 mg/dL. Cox proportional hazards models estimated the effect of periodontitis on incident diabetes during a seven-year follow-up period. Moderate and severe periodontitis was significantly associated with an increased risk of diabetes in unadjusted analyses, but the magnitude of the association decreased after full adjustment [hazard ratio (HR) = 1.00, 95% confidence interval (95% CI) = 0.77-1.30 and HR = 1.28, 95% CI = 0.89-1.86, respectively]. Our findings do not indicate an apparent association between periodontitis and incident diabetes, although there was a tendency for increased risk.

Preconditioning with subneurotoxic allyl nitrile: protection against allyl nitrile neurotoxicity

High-dose cruciferous allyl nitrile can induce behavioral abnormalities in rodents, while repeated exposure to allyl nitrile at subneurotoxic levels can increase phase 2 detoxification enzymes in many tissues, although the brain has not been investigated yet. In the present study, we examined the effect of 5 days repeated exposure to subneurotoxic allyl nitrile (0-400 micromol/kg/day) on the brain. Elevated glutathione S-transferase activity was recorded in the striatum, hippocampus, medulla oblongata plus pons, and cortex. Enhancement of quinone reductase activity was observed in the medulla oblongata plus pons, hippocampus, and cortex. In the medulla oblongata plus pons, elevated glutathione levels were recorded. Following repeated subneurotoxic allyl nitrile exposure (0-400 micromol/kg/day), mice were administered a high-dose allyl nitrile (1.2 mmol/kg) which alone led to appearance of behavioral abnormalities. Compared with the 0 micromol/kg/day group, animals in the 200 and 400 micromol/kg/day pre-treatment groups exhibited decreased behavioral abnormalities and elevated GABA-positive cell counts in the substantia nigra pars reticulata and the interpeduncular nucleus. These data suggest that repeated exposure to subneurotoxic levels of allyl nitrile can induce phase 2 enzymes in the brain, which together with induction in other tissues, may contribute to protection against allyl nitrile neurotoxicity.

Cross-sectional study on respiratory effect of toner-exposed work in manufacturing plants, Japan: pulmonary function, blood cells, and biochemical markers

The aim of the study is to examine the relationship between toner-exposed work and health indices related to respiratory disorders and to confirm the baseline of a cohort study to clarify the effect of toner exposure in manufacturing plants. Subjects were 1614 male workers (809 toner-exposed workers and 805 referents) who were engaged in toner manufacturing plants in Japan (Fuji Xerox Co., Ltd). The age of subjects was from 19 to 59 years, and the average age was 40.2 years(median 40 years, SD 7.67). We conducted a pulmonary function test (PEFR, VC, FVC, FEV(1.0)%, V25/Ht) and a blood cell test (RBC, Hb, Hct, Plt, WBC, cell contents of WBC) and measured biochemical indices in blood (ALT, AST, gamma-GTP, CRP, IgE) and 8-hydroxy-2'-deoxyguanosine (8-OHdG) in urine. Student t-test and logistic regression analysis were applied to compare between the toner-exposed workers and the referents and to analyze the relationship among indices of effects and independent factors. There was no significant difference between the two groups in blood cell count and biochemical indices. Inflammation- and allergy-related markers such as 8OHdG and IgE also showed no significant difference between toner-exposed workers and the referents. The influence of smoking on pulmonary function indices was observed, but there was no relationship between the pulmonary function and toner-exposed work. In this article, we report a preliminary cross-sectional analysis in the subjects of a cohort study. No difference in pulmonary function indices was observed between the toner-exposed workers and the referents, and there was no consistent relationship between the exposure status and examined indices; however, the prevalence of subjective respiratory symptoms was higher in the exposed workers as presented in another report. Further analysis is important in the ongoing cohort study to clarify the effect of toner exposure on respiratory systems.

Quality of care for breast cancer patients in Japan: An analysis of the Japanese Breast Cancer Registry

6547

Background: In Japan, growing concern that patients do not receive optimum care led to the enactment of the Cancer Control Act in 2006, which mandates the government to undertake initiatives in ensuring the quality of cancer care. Here, we evaluated the current status of breast cancer care in Japan using process-of-care quality indicators (QIs) for breast cancer care. Methods: Combining clinical evidence and expert opinion, we developed 45 QIs covering the continuum of breast cancer care from initial evaluation to follow-up. Each QI describes standards of a particular aspect of care, and its score is calculated as the percentage of applicable patients who received the recommended care (adherence score). Of the 45 QIs, 7 could be scored using data in the Japanese Breast Cancer Registry, which covers about 40% of all Japanese breast cancer patients and has been continuously maintained since 1975. Results: The study population included 15,227 patients registered by 224 facilities in 2005. On average, patients received 72.1% of recommended care. However, substantial variation in adherence was seen across QIs (21–98%). Adherence score was less than 85% in five of seven QIs. Variation across facilities was observed in six QIs. Conclusions: The quality of breast cancer care in Japan has room for improvement in many aspects of care. Although the amount of data in the cancer registry suitable for quality assessment is limited, it is useful in detecting quality problems.

[Table: see text]

No significant financial relationships to disclose.

The Effects of Smoking on Dental Care Utilization and Its Costs in Japan

Smoking has been established as an important risk factor for periodontal disease and tooth loss. The purpose of this study was a prospective evaluation of the effects of smoking on dental care utilization and its costs, based on data from 5712 males aged 20–59 yrs. Age, dental health behavior, and history of diabetes were adjusted in a multivariate analysis. Current smokers accrued 14% higher dental care costs than never-smokers over a five-year period. This difference in annual dental care costs was mainly attributable to the increased percentage of participants in the ‘higher dental care cost’ category among current smokers. There was no clear trend identified for the dose-dependent effects of smoking on dental care utilization and its costs. Past smokers incurred lower dental care costs compared with current smokers. Smoking may have played a key role in the increment of dental care utilization and its costs via deterioration in oral conditions.

Lead retention mechanisms and hydraulic conductivity studies of various bentonites for geoenvironment applications

Four bentonites from various sources were exposed to batch adsorption testing, selective sequential extraction and consolidation tests to investigate their metal retention capacity and hydraulic conductivity for geoenvironmental application such as in clay barrier materials. The Japanese bentonites (JB1-JB3) contain approximately 2-4% of carbonate and trace amount of zeolite (JB2 and JB3), whereas the US bentonite has < 1% carbonate and no zeolite. The rank of smectite content in the bentonites are USB > JB1 > JB3 > JB2. The materials ranked as JB2 approximately JB3 > JB1 > USB, according to retention capacity, while after the removal of carbonate the retention capacity order was JB1 approximately JB2 approximately JB3 > USB. SSE results indicate that carbonate plays a major role at low Pb solution concentration and precipitate as PbCO3. Once the carbonate is exhausted, the clay composition dominates the sorption process. The hydraulic conductivity of the bentonite mixtures (basalt + 10% bentonite) using water was kUSB < kJB1 < kJB3 < kJB2, consistent with the smectite content and swelling power, with USB having the highest proportion of smectite. Among the Japanese bentonites studied, JB1 is the best candidate for barrier material, comparable to the widely used USB.