Model validation for a knowledge and practices survey towards prevention of soil-transmitted helminth infections in rural villages in Indonesia

The rate of soil-transmitted helminth (STH) infection is estimated to be around 20% in Indonesia. Health promotion and health education are cost-effective strategies to supplement STH prevention and control programs. Existing studies suggest that quantitative tools for knowledge, attitudes and practices (KAP) are important to monitor effective community-based STH interventions. However, evidence is limited regarding the applicability of such tools. This study aims to identify the socio-demographic predictors for STH-related knowledge and practices and validate the quantitative tools in population use. A cross-sectional study design was conducted among residents of 16 villages in Central Java, Indonesia. Adult and child respondents were interviewed to assess general knowledge and practices in relation to STH. Two mixed effects models identified the significant factors in predicting knowledge and practice scores. The model predicted knowledge and practice scores were compared with the observed scores to validate the quantitative measurements developed in this study. Participants' socio-demographic variables were significant in predicting an individual's STH-related knowledge level and their hand washing and hygiene practices, taking into account household-level variability. Model validation results confirmed that the quantitative measurement tools were suitable for assessing STH associated knowledge and behaviour. The questionnaire developed in this study can be used to support school- and community-based health education interventions to maximize the effect of STH prevention and control programs.

Using adsorption kinetics to assemble vertically aligned nanorods at liquid interfaces for metamaterial applications

Vertically aligned monolayers of metallic nanorods have a wide range of applications as metamaterials or in surface enhanced Raman spectroscopy. However the fabrication of such structures using current top-down methods or through assembly on solid substrates is either difficult to scale up or have limited possibilities for further modification after assembly. The aim of this paper is to use the adsorption kinetics of cylindrical nanorods at a liquid interface as a novel route for assembling vertically aligned nanorod arrays that overcomes these problems. Specifically, we model the adsorption kinetics of the particle using Langevin dynamics coupled to a finite element model, accurately capturing the deformation of the liquid meniscus and particle friction coefficients during adsorption. We find that the final orientation of the cylindrical nanorod is determined by their initial attack angle when they contact the liquid interface, and that the range of attack angles leading to the end-on state is maximised when nanorods approach the liquid interface from the bulk phase that is more energetically favorable. In the absence of an external field, only a fraction of adsorbing nanorods end up in the end-on state (≲40% even for nanorods approaching from the energetically favourable phase). However, by pre-aligning the metallic nanorods with experimentally achievable electric fields, this fraction can be effectively increased to 100%. Using nanophotonic calculations, we also demonstrate that the resultant vertically aligned structures can be used as epsilon-near-zero and hyperbolic metamaterials. Our kinetic assembly method is applicable to nanorods with a range of diameters, aspect ratios and materials and therefore represents a versatile, low-cost and powerful platform for fabricating vertically aligned nanorods for metamaterial applications.

Adsorption trajectories of nonspherical particles at liquid interfaces

The adsorption of colloidal particles at liquid interfaces is of great importance scientifically and industrially, but the dynamics of the adsorption process is still poorly understood. In this paper we use a Langevin model to study the adsorption dynamics of ellipsoidal colloids at a liquid interface. Interfacial deformations are included by coupling our Langevin dynamics to a finite element model while transient contact line pinning due to nanoscale defects on the particle surface is encoded into our model by renormalizing particle friction coefficients and using dynamic contact angles relevant to the adsorption timescale. Our simple model reproduces the monotonic variation of particle orientation with time that is observed experimentally and is also able to quantitatively model the adsorption dynamics for some experimental ellipsoidal systems but not others. However, even for the latter case, our model accurately captures the adsorption trajectory (i.e., particle orientation versus height) of the particles. Our study clarifies the subtle interplay between capillary, viscous, and contact line forces in determining the wetting dynamics of micron-scale objects, allowing us to design more efficient assembly processes for complex particles at liquid interfaces.

Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study

BACKGROUND

This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery.

METHODS

This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery.

RESULTS

A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498).

CONCLUSION

There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.

A177 BIRTH COHORT SCREENING FOR HEPATITIS C IN AN OUTPATIENT ENDOSCOPY UNIT: A PILOT STUDY

Background

Chronic hepatitis C (HCV) is a curable asymptomatic infection that can progress to liver failure and hepatocellular carcinoma if left untreated. The Canadian Liver Foundation (CLF) recommends one-time HCV screening in all Canadians born from 1945–1975. A large proportion of outpatient endoscopic procedures are for colon cancer screening in this birth cohort providing an opportunity for HCV screening and linkage to HCV care.

Aims

We aimed to assess the feasibility of developing a targeted birth-cohort HCV screening program in the outpatient endoscopy setting.

Methods

This is a cross-sectional study of patients born from 1945–1975 presenting to the outpatient endoscopy unit at Hotel Dieu Hospital in Kingston, Ontario in September, 2016. Patients were scheduled for upper endoscopy, colonoscopy, and/or sigmoidoscopy. All patients were given written information on HCV and the CLF recommendation of birth-cohort screening. Patients were then asked to complete a short survey regarding previous HCV screening and acceptance of being screened during their endoscopy visit.

Results

During a 30 day period, 95% (223/235) of eligible patients completed the survey. The cohort was 53% female with a median age of 59 years (IQR 52–66 years). 83% had either never been screened or were unaware of their HCV status. Overall, 87% of participants would be accepting of HCV screening during their endoscopy visit, 9% would not accept screening and 4% stated they were unsure. These results suggest that almost 2,000 patients could be targeted for HCV screening in the endoscopy unit annually.

Conclusions

Most patients born from 1945–1975 presenting for outpatient endoscopy have not been screened for HCV but are accepting of screening during their procedural visit. This identifies a target population for the development of an HCV screening program to increase HCV identification and facilitate linkage to HCV care.

Funding Agencies

None

Sham acupuncture is as efficacious as true acupuncture for the treatment of IBS: A randomized placebo controlled trial

BACKGROUND

Irritable bowel syndrome (IBS) patients increasingly seek out acupuncture therapy to alleviate symptoms, but it is unclear whether the benefit is due to a treatment-specific effect or a placebo response. This study examined whether true acupuncture is superior to sham acupuncture in relieving IBS symptoms and whether benefits were linked to purported acupuncture mechanisms.

METHODS

A double blind sham controlled acupuncture study was conducted with Rome I IBS patients receiving twice weekly true acupuncture for 4 weeks (n=43) or sham acupuncture (n=36). Patients returned at 12 weeks for a follow-up review. The primary endpoint of success as determined by whether patients met or exceeded their established goal for percentage symptom improvement. Questionnaires were completed for symptom severity scores, SF-36 and IBS-36 QOL tools, McGill pain score, and Pittsburg Sleep Quality Index. A subset of patients underwent barostat measurements of rectal sensation at baseline and 4 weeks.

KEY RESULTS

A total of 53% in the true acupuncture group met their criteria for a successful treatment intervention, but this did not differ significantly from the sham group (42%). IBS symptom scores similarly improved in both groups. Scores also improved in the IBS-36, SF-36, and the Pittsburg Sleep Quality Index, but did not differ between groups. Rectal sensory thresholds were increased in both groups following treatment and pain scores decreased; however, these changes were similar between groups.

CONCLUSIONS & INFERENCES

The lack of differences in symptom outcomes between sham and true treatment acupuncture suggests that acupuncture does not have a specific treatment effect in IBS.

Mutations in CRLF1 cause familial achalasia

We here report a family from Libya with three siblings suffering from early onset achalasia born to healthy parents. We analyzed roughly 5000 disease-associated genes by a next-generation sequencing (NGS) approach. In the analyzed sibling we identified two heterozygous variants in CRLF1 (cytokine receptor-like factor 1). Mutations in CRLF1 have been associated with autosomal recessive Crisponi or cold-induced sweating syndrome type 1 (CS/CISS1), which among other symptoms also manifests with early onset feeding difficulties. Segregation analysis revealed compound heterozygosity for all affected siblings, while the unaffected mother carried the c.713dupC (p.Pro239Alafs*91) and the unaffected father carried the c.178T>A (p.Cys60Ser) variant. The c.713dupC variant has already been reported in affected CS/CISS1 patients, the pathogenicity of the c.178T>A variant was unclear. As reported previously for pathogenic CRLF1 variants, cytokine receptor-like factor 1 protein secretion from cells transfected with the c.178T>A variant was severely impaired. From these results we conclude that one should consider a CRLF1-related disorder in early onset achalasia even if other CS/CISS1 related symptoms are missing.

A randomised phase II trial and feasibility study of palliative chemotherapy in frail or elderly patients with advanced gastroesophageal cancer (321GO)

BACKGROUND

Elderly patients are commonly under-represented in cancer clinical trials. The 321GO was undertaken in preparation for a definitive phase three trial assessing different chemotherapy regimens in a frail and/or elderly population with advanced gastroesophageal (GO) cancer.

METHODS

Patients with advanced GO cancer considered unfit for conventional dose chemotherapy were randomly assigned in a 1 : 1 : 1 ratio to: epirubicin, oxaliplatin and capecitabine (EOX); oxaliplatin and capecitabine (OX); and capecitabine alone (X) (all 80% of full dose and unblinded). The primary end point was patient recruitment over an 18-month period. A registration study recorded treatment choice for all patients with advanced GO cancer at trial centres.

RESULTS

A total of 313 patients were considered for palliative chemotherapy for GO cancer over the 18-month period: 115 received full dose treatment, 89 less than standard treatment or entered 321GO and 111 no treatment. Within 321GO, 55 patients were randomly assigned (19 to OX and X; 17 to EOX). Progression-free survival (PFS) for all patients was 4.4 months and by arm 5.4, 5.6 and 3.0 months for EOX, OX and X, respectively. The number of patients with a good overall treatment utility (OTU), a novel patient-centred endpoint, at 12 weeks was 3 (18%), 6 (32%) and 1 (6%) for EOX, OX and X, respectively. At 6 weeks, 22 patients (41%) had experienced a non-haematologic toxicity ⩾grade 3, most commonly lethargy or diarrhoea. The OTU was prognostic for overall survival in patients alive at week 12 (logrank test P=0.0001).

CONCLUSIONS

It is feasible to recruit elderly and/or frail patients with advanced GO cancer to a randomised clinical trial. The OX is the preferred regimen for further study. Overall treatment utility shows promise as a comparator between treatment regimens for feasibility and randomised trials in the elderly and/or frail GO cancer population.

Lmbrd1 expression is essential for the initiation of gastrulation

The rare inborn cblF defect of cobalamin metabolism is caused by mutations in the limb region 1 (LMBR1) domain containing 1 gene (LMBRD1). This defect is characterized by massive accumulation of free cobalamin in lysosomes and loss of mitochondrial succinyl‐CoA synthesis and cytosolic methionine synthesis. Affected children suffer from heart defects, developmental delay and megaloblastic anemia. LMBRD1 encodes for LMBD1, a predicted lysosomal cobalamin transport protein. In this study, we determine the physiological function of LMBRD1 during embryogenesis by generating Lmbrd1 deficient mice using the Cre/LoxP system. Complete loss of Lmbrd1 function is accompanied by early embryonic death in mice. Whole mount in situ hybridization studies against bone morphogenetic protein 4 and Nodal show that initial formation of the proximal–distal axis is unaffected in early embryonic stages whereas the initiation of gastrulation is disturbed shown by the expression pattern of even skipped homeotic gene 1 and fibroblast growth factor 8 in Lmbrd1 deficient mice. We conclude that intact function of LMBD1 is essential for the initiation of gastrulation.

Multi-layer Flow-modulating Stents for Thoraco-abdominal and Peri-renal Aneurysms: The UK Pilot Study

OBJECTIVE

There remains a population of patients with aortic aneurysms that cannot be treated by conventional endovascular means. Multi-layer flow modulating stents (MFMS) are a novel approach for the treatment of aortic aneurysm; this study reports outcomes of a UK pilot study of first-generation MFMS in thoraco-abdominal (TAAA) and perirenal aneurysms (PAA) in patients who were also unfit for open surgery.

METHODS

Patients with TAAA and PAA unfit for open surgery and with no conventional options for endovascular repair were recruited. Follow-up included CTA at 1, 3, 6, and 12 months, then annually. Outcome measures included 30 day mortality, growth-free survival, branch vessel patency, complications, re-intervention, and maximal aortic diameter.

RESULTS

MFMS were implanted in 14 patients (6 PAA, 8 TAAA) between October 2011 and March 2014 with one (7%) 30 day death and 11 (79%) surviving to 12 months. The median aneurysm growth was 9 mm in the first 12 months following implantation. On mean follow-up of 22.8 months, seven (50%) patients had died including one confirmed rupture. AAA diameter remained stable in only two of the surviving patients. Fifty of 51 covered aortic branches remained patent with no embolic episodes or symptoms of ischaemia in any patient. MFMS dislocation occurred in four patients, leading to re-intervention in two. A total of six re-interventions were performed in five patients (35%) with one post-re-intervention death.

CONCLUSION

These first-generation MFMS were unstable and dislocated frequently. It is uncertain whether MFMS implantation influenced the natural history of these aneurysms as none decreased in size, but two remain stable after a mean of 22.8 months. Although side branch patency was maintained, our results do not support the continued use of these first-generation devices. Further development is needed if this technology is to have a role in treatment of aortic aneurysm.

c-MYC is a radiosensitive locus in human breast cells

Ionising radiation is a potent human carcinogen. Epidemiological studies have shown that adolescent and young women are at increased risk of developing breast cancer following exposure to ionising radiation compared with older women, and that risk is dose-dependent. Although it is well understood which individuals are at risk of radiation-induced breast carcinogenesis, the molecular genetic mechanisms that underlie cell transformation are less clear. To identify genetic alterations potentially responsible for driving radiogenic breast transformation, we exposed the human breast epithelial cell line MCF-10A to fractionated doses of X-rays and examined the copy number and cytogenetic alterations. We identified numerous alterations of c-MYC that included high-level focal amplification associated with increased protein expression. c-MYC amplification was also observed in primary human mammary epithelial cells following exposure to radiation. We also demonstrate that the frequency and magnitude of c-MYC amplification and c-MYC protein expression is significantly higher in breast cancer with antecedent radiation exposure compared with breast cancer without a radiation aetiology. Our data also demonstrate extensive intratumor heterogeneity with respect to c-MYC copy number in radiogenic breast cancer, suggesting continuous evolution at this locus during disease development and progression. Taken together, these data identify c-MYC as a radiosensitive locus, implicating this oncogenic transcription factor in the aetiology of radiogenic breast cancer.

Central adiponectin acutely improves glucose tolerance in male mice

Adiponectin, an adipocyte-derived hormone, regulates glucose and lipid metabolism. It is also antiinflammatory. During obesity, adiponectin levels and sensitivity are reduced. Whereas the action of adiponectin in the periphery is well established the neuroendocrine role of adiponectin is largely unknown. To address this we analyzed the expression of adiponectin and the 2 adiponectin receptors (AdipoR1 and AdipoR2) in response to fasting and to diet-induced and genetic obesity. We also investigated the acute impact of adiponectin on central regulation of glucose homeostasis. Adiponectin (1 μg) was injected intracerebroventricularly (ICV), and glucose tolerance tests were performed in dietary and genetic obese mice. Finally, the influence of ICV adiponectin administration on central signaling cascades regulating glucose homeostasis and on markers of hypothalamic inflammation was assessed. Gene expression of adiponectin was down-regulated whereas AdipoR1 was up-regulated in the arcuate nucleus of fasted mice. High-fat (HF) feeding increased AdipoR1 and AdipoR2 gene expression in this region. In mice on a HF diet and in leptin-deficient mice acute ICV adiponectin improved glucose tolerance 60 minutes after injection, whereas normoglycemia in control mice was unaffected. ICV adiponectin increased pAKT, decreased phospho-AMP-activated protein kinase, and did not change phospho-signal transducer and activator of transcription 3 immunoreactivity. In HF-fed mice, ICV adiponectin reversed parameters of hypothalamic inflammation and insulin resistance as determined by the number of phospho-glycogen synthase kinase 3 β(Ser9) and phospho-c-Jun N-terminal kinase (Thr183/Tyr185) immunoreactive cells in the arcuate nucleus and ventromedial hypothalamus. This study demonstrates that the insulin-sensitizing properties of adiponectin are at least partially based on a neuroendocrine mechanism that involves centrally synthesized adiponectin.

High-fat diet induces leptin resistance in leptin-deficient mice

The occurrence of type II diabetes is highly correlated with obesity, although the mechanisms linking the two conditions are incompletely understood. Leptin is a potent insulin sensitiser and, in leptin-deficient, insulin insensitive, Lep(ob/ob) mice, leptin improves glucose tolerance, indicating that leptin resistance may link obesity to insulin insensitivity. Leptin resistance occurs in response to a high-fat diet (HFD) and both hyperleptinaemia and inflammation have been proposed as causative mechanisms. Scrutinising the role of hyperleptinaemia in this process, central hyperleptinaemia in Lep(ob/ob) mice was induced by chronic i.c.v. infusion of leptin (4.2 μg/day) over 10 days. This treatment led to a dramatic decline in body weight and food intake, as well as an improvement in glucose tolerance. Transfer to HFD for 4 days markedly arrested the beneficial effects of leptin on these parameters. Because Lep(ob/ob) mice are exquisitely sensitive to leptin, the possibility that leptin could reverse HFD-induced glucose intolerance in these animals was investigated. HFD led to increased body weight and glucose intolerance compared to a low-fat diet (LFD). Older and heavier Lep(ob/ob) mice were used as body weight-matched controls. Mice in each group received either i.p. leptin (1.25 mg/kg) or vehicle, and glucose tolerance, food intake and the number of phosphorylated signal transducer and activator of transcription (pSTAT)3 immunoreactive cells in the arcuate nucleus (ARC) and ventromedial hypothalamus (VMH) were analysed. Leptin improved glucose tolerance (P = 0. 019) and reduced food intake in Lep(ob/ob) mice on LFD (P ≤ 0.001) but was ineffective in mice on HFD. Furthermore, when leptin was administered centrally, the glucose tolerance of Lep(ob/ob) mice on HFD was significantly impaired (P = 0.007). Although leptin induced the number of pSTAT3 immunoreactive cells in the ARC and VMH of Lep(ob/ob) mice on LFD, HFD was associated with elevated pSTAT3 immunoreactivity in vehicle-treated Lep(ob/ob) mice that was unaffected by leptin treatment, suggesting central leptin resistance. Negating central inflammation by co-administering a c-Jun n-terminal kinase (JNK) inhibitor reinstated the glucose-lowering effects of leptin. These findings demonstrate that Lep(ob/ob) mice develop leptin resistance on a HFD independent of hyperleptinaemia and also indicate that the JNK inflammatory pathway plays a key role in the induction of diet-induced glucose intolerance.

GLP-1 receptor activated insulin secretion from pancreatic β-cells: mechanism and glucose dependence

The major goal in the treatment of type 2 diabetes mellitus is to control the hyperglycaemia characteristic of the disease. However, treatment with common therapies such as insulin or insulinotrophic sulphonylureas (SU), while effective in reducing hyperglycaemia, may impose a greater risk of hypoglycaemia, as neither therapy is self-regulated by ambient blood glucose concentrations. Hypoglycaemia has been associated with adverse physical and psychological outcomes and may contribute to negative cardiovascular events; hence minimization of hypoglycaemia risk is clinically advantageous. Stimulation of insulin secretion from pancreatic β-cells by glucagon-like peptide 1 receptor (GLP-1R) agonists is known to be glucose-dependent. GLP-1R agonists potentiate glucose-stimulated insulin secretion and have little or no activity on insulin secretion in the absence of elevated blood glucose concentrations. This 'glucose-regulated' activity of GLP-1R agonists makes them useful and potentially safer therapeutics for overall glucose control compared to non-regulated therapies; hyperglycaemia can be reduced with minimal hypoglycaemia. While the inherent mechanism of action of GLP-1R agonists mediates their glucose dependence, studies in rats suggest that SUs may uncouple this dependence. This hypothesis is supported by clinical studies showing that the majority of events of hypoglycaemia in patients treated with GLP-1R agonists occur in patients treated with a concomitant SU. This review aims to discuss the current understanding of the mechanisms by which GLP-1R signalling promotes insulin secretion from pancreatic β-cells via a glucose-dependent process.

Albumin-Binding and Angiogenic Domains of SPARC Located at Its C-Terminus

Background: SPARC (Secreted Protein Acidic and Rich in Cysteine) is an albumin-binding glycoprotein overexpressed in breast cancer and is associated with poor prognosis and shorter overall survival. We have previously shown that SPARC expression appeared to correlate with response to nanoparticle albumin-bound (nab) paclitaxel (Abraxane) in head-and-neck and pancreatic-cancer patients. To further define the role of SPARC, recombinant-human SPARC (rhSPARC) was characterized to identify its albumin-binding and angiogenic domain.Materials and methods: The albumin-binding site on SPARC was defined by testing the binding of Alexa 488-labeled BSA to immobilized rhSPARC in a solid-phase-binding assay and in a competitive-binding assay in presence of increasing concentration of various SPARC-derived peptides. The angiogenic activity of rhSPARC was evaluated using a HUVEC tube-formation assay.Results: The SPARC albumin-binding assay revealed a pattern of saturable and specific binding with an estimated Kd of 700 µM very near the known plasma concentration of albumin (600 µM). Competitive binding with Cathepsin K-digested SPARC and SPARC-derived peptides defined the albumin-binding domain to be amino acids 209-223 in the C-terminal region. In the HUVEC tube-formation assay, rhSPARC was pro-angiogenic at 10 µg/ml and anti-angiogenic at 100 µg/ml. The angiogenic domain of SPARC was located to the C-terminal of SPARC.Discussion: The albumin-binding domain of SPARC was located to residues aa209-223, supporting its role as a target for nab-technology-based drug delivery. We confirmed that SPARC can promote angiogenesis at physiological concentrations, contributing to the role of SPARC in a more aggressive tumor phenotype. The angiogenic domain of SPARC is located within a 54-aa sequence of its C-terminus. SPARC could be a potential therapeutic target and a biomarker for predicting response to nab-paclitaxel.

Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 2144.

A randomized clinical trial to compare the Goshgarian and Nance palatal arch

The aim of this trial was to evaluate whether a Nance or Goshgarian palatal arch was most effective for prevention of mesial drift, distal tipping, prevention of mesio-palatal rotation of the upper first permanent molars, and patient comfort and ease of removal. Patients were recruited from a district general hospital and a specialist orthodontic practice and randomly allocated to a Goshgarian (n = 29) or a Nance (n = 28) group. Pre-treatment study models (T1) were taken followed by the placement of the palatal arch, premolar extractions, and upper and lower fixed appliances. The clinical end point was 6 months (T2), at which time, an impression for an upper study model was taken. The amount of upper first permanent molar mesial movement, distal tipping, and mesio-palatal rotation was measured by scanning T1 and T2 study models and then using a software program to calculate molar changes. In addition, the patients recorded their discomfort scores using a seven-point Likert scale at each recall visit. Forty-nine patients (86 per cent) completed the trial. t-tests were used to compare molar movements between the Goshgarian and Nance palatal arch groups. There were no statistically significant differences between the palatal arches in terms of prevention of mesial drift or distal tipping (P > 0.05). There was a statistically significant difference in the amount of molar rotation between the arch types, with both exhibiting some disto-palatal rotation even though they were not activated for this movement. The Goshgarian palatal arch produced marginally more disto-palatal rotation than the Nance arch (P = 0.02), although this may not be considered clinically significant. A Mann-Whitney test revealed that there was also a statistically significant difference in pain scores between the Goshgarian and the Nance arch, with the latter being associated with more discomfort (P = 0.001). This trial did not support any preference in the use of the Goshgarian or Nance palatal arch, unless the slightly reduced patient discomfort with the Goshgarian arch is considered significant.

Testing the effect of including oral health in general health checks for elderly patients in medical practice--a randomized controlled trial

AIM

To test the feasibility and effectiveness of an oral health referral process for elderly patients (aged 75 years or over) attending a preventive health check (PHC) with their general medical practitioner.

OBJECTIVES

To evaluate the effectiveness of the process in increasing dental attendance at baseline and 6 months after the intervention. To identify key characteristics of those who accepted an oral health visit (OHV). To determine the proportion of people attending the OHV who required treatment and subsequently attended a dentist.

SETTING

Three general medical practices in east Cheshire, UK.

DESIGN

A randomized controlled trial.

METHOD

Elderly patients attending their general medical practice for PHCs were randomly assigned to a test group, who were invited to attend for an OHV, and to a control group, who received no intervention. Six months after the PHC the effectiveness of the process was measured.

RESULTS

Some 50% of those invited for an OHV accepted. Those accepting were more likely to be edentulous, wear dentures or have a current oral health problem, than those declining. Regression analysis showed the best predictors of acceptance to be having a current dental problem or pain and not having a regular dentist. The mean time since their last dental visit was 8.1 years which was significantly longer than those declining the OHV. 63% of individuals attending the OHV were assessed as having a realistic treatment need and 70% of those referred went on to complete the course of treatment. In the test group a highly significant increase in reported dental visiting was found at sixth month evaluation. The primary care staff were happy to include the dental checklist and felt it was a valuable addition to the PHC.

CONCLUSIONS

The offer of an OHV was taken up most readily by those with current oral problems, or pain and those with no regular dentist. The inclusion of a dental checklist within the PHC for elderly patients together with help with arranging a dental appointment shows promise as a way of ensuring the dental needs of this group are met.

Which orthodontic archwire sequence? A randomized clinical trial

The aim of this study was to compare three orthodontic archwire sequences. One hundred and fifty-four 10- to 17-year-old patients were treated in three centres and randomly allocated to one of three groups: A = 0.016-inch nickel titanium (NiTi), 0.018 x 0.025-inch NiTi, and 0.019 x 0.025-inch stainless steel (SS); B = 0.016-inch NiTi, 0.016-inch SS, 0.020-inch SS, and 0.019 x 0.025-inch SS; and C = 0.016 x 0.022-inch copper (Cu) NiTi, 0.019 x 0.025-inch CuNiTi, and 0.019 x 0.025-inch SS. At each archwire change and for each arch, the patients completed discomfort scores on a seven-point Likert scale at 4 hours, 24 hours, 3 days, and 1 week. Time in days and the number of visits taken to reach a 0.019 x 0.025-inch SS working archwires were calculated. A periapical radiograph of the upper left central incisor was taken at the start of the treatment and after placement of the 0.019 x 0.025-inch SS wire so root resorption could be assessed. There were no statistically significant differences between archwire sequences A, B, or C for patient discomfort (P > 0.05) or root resorption (P = 0.58). The number of visits required to reach the working archwire was greater for sequence B than for A (P = 0.012) but this could not be explained by the increased number of archwires used in sequence B.

Vision and touch in ageing: Crossmodal selective attention and visuotactile spatial interactions

We investigated whether ageing affects crossmodal selective attention (the ability to focus on a relevant sensory modality and ignore an irrelevant modality) and the spatial constraints on such selective processing. Three groups of 24 participants were tested: Young (19-25 years), Young-Old (65-72 years) and Old-Old (76-92 years). The participants had to judge the elevation of vibrotactile targets (upper/index finger and lower/thumb), presented randomly to either hand while ignoring concurrent visual distractors. In a second task, the role of the target and distractor modalities was reversed. Crossmodal selective attention was assessed by comparing performance in the presence versus absence of distractors. Spatial constraints on selective attention were also investigated by comparing the effect of distractors presented on the same versus opposite side as the target. When attending to touch, the addition of visual distractors had a significantly larger effect on error rates in both of the older groups as compared to the Young group. This indicates that ageing has a detrimental effect on crossmodal selective attention. In all three age groups, performance was impaired when the target and distractor were presented at incongruent as compared to congruent elevations in both tasks. This congruency effect was modulated by the relative spatial location of the target and distractor in certain conditions for the Young and the Young-Old group. That is, participants in the two younger age groups found it harder to attend selectively to targets in one modality, when distractor stimuli came from the same side rather than from the opposite side. However, no significant spatial modulation was found in the Old-Old group. This suggests that ageing may also compromise spatial aspects of crossmodal selective attention.

Balance marks cognitive changes in old age because it reflects global brain atrophy and cerebro-arterial blood-flow

In healthy old age biomarkers such as Balance robustly correlate with measures of mental abilities such as scores on tests of intelligence, reaction times and memory. A plausible explanation is that balance reflects general physiological fitness and so also neurophysiological integrity, but direct evidence is lacking. Brain scans measured age-associated loss of brain volume and cerebro-arterial blood flow (CBf) in 69 volunteers aged from 62 to 81 years who also took the Tinetti Balance test battery, 3 tests of fluid intelligence, 3 tests of decision speed and a memory test. Balance, but not atrophy or CBf, predicted intelligence test scores. Balance, atrophy, and CBf all independently predicted speed and memory scores but, after variance in atrophy and CBf had been considered, predictions from Balance were no longer significant. It appears that in these tests Balance marks cognitive performance in old age because it reflects gross age-related neurophysiological changes.

Visuotactile temporal order judgments in ageing

We report an experiment on the effects of ageing on crossmodal temporal perception. Young (mean age = 21.7 years) and old (mean age = 75.1 years) participants were presented with pairs of visual and vibrotactile stimuli to either hand and required to make unspeeded temporal order judgments (TOJs) regarding which sensory modality appeared to have been presented first. The stimulus onset asynchrony (SOA) between the two stimuli was varied using the method of constant stimuli. Temporal precision, as indexed by the just noticeable difference (JND), was better (i.e., JNDs were lower) when the stimuli were presented from different positions (M = 101 ms) rather than from the same position (M = 120 ms), as has been demonstrated previously. Additionally, older observers required more time (i.e., their JNDs were larger) to accurately perceive the temporal order (M = 131 ms) as compared to younger observers (M = 98 ms). Our results confirm that ageing deleteriously affects crossmodal temporal processing even when the spatial confound inherent in previous research has been ruled out.

Relative preservation of 'animate' knowledge in an atypical presentation of herpes simplex virus encephalitis

A comprehensive battery of neuropsychological tests designed to assess primary cognitive functions, including language and semantic memory, was given to MG, a patient with confirmed herpes simplex virus encephalitis. MG's initial jargon aphasia resolved over time to leave her with a mild phonological impairment. She had a very mild amnesia that was worse for verbal material and a category-specific impairment of semantic memory. This latter impairment resulted in a significant anomia that was worse for manmade/artefact items than for animate kinds. Her naming difficulties were associated with a mild impairment in comprehension that was not specific to category or feature type. MRI revealed a strongly asymmetric and atypical distribution of pathology in MG with the disease affecting the left medial temporal lobe, temporal pole, left frontotemporal and temporoparietal regions.

The contribution of non-ocular response inhibition to visual inhibition of return

Inhibition of return (IOR) refers to slowed responses to targets presented at the same location as a preceding stimulus. IOR is typically investigated using a cue-target design, in which subjects respond only to the second stimulus of a pair. In such tasks, the measurement of 'true' IOR may be confounded by the effect of non-ocular response inhibition, because the participant must suppress any tendency to respond (e.g. key press) to the first stimulus. This confound may be eliminated using a target-target design, in which responses are made to both stimuli. We assessed the contribution of non-ocular response inhibition to visual IOR, measured in a cue-target task, by testing participants on both cue-target and target-target detection tasks, with identical timings and stimuli. Significant IOR was obtained in both tasks but, at a stimulus onset asynchrony (SOA) of 1400 ms, IOR magnitude was significantly greater in the cue-target condition than in the target-target condition. However, at an SOA of 1800 ms, there was no significant difference in the magnitude of IOR between the two tasks. Thus, a proportion of the total IOR effect observed in visual cue-target tasks can be attributed to non-ocular response inhibition, but this process appears to decay more rapidly than does 'true' IOR, having dissipated by 1800 ms following cue onset.

The development of multiplex simple sequence repeat (SSR) markers to complement distinctness, uniformity and stability testing of rape (Brassica napus L.) varieties

To assess the potential of multiplex SSR markers for testing distinctness, uniformity and stability of rape (Brassica napus L.) varieties, we developed three multiplex SSR sets composed of five markers each. These were used to measure the extent of diversity within and between a set of ten varieties using a fluorescence-based semi-automated detection technology. Also, we evaluated the significance of any correlation between SSRs, pedigree and five of the morphological characters currently used for statutory distinctness, uniformity and stability testing of rape varieties. An assignment test was allowed to identify 99% of the plants examined, with the correct variety based on the analysis of 48 individual plants for each variety. Principal coordinate analysis confirmed that a high degree of separation between varieties could be achieved. Varieties were separated in three groups corresponding to winter, spring and forage types. These results suggested that it should be possible to select a set of markers for obtaining a suitable separation. Diversity within varieties varied considerably, according to the variety and the locus examined. No significant correlation was found between SSR and morphological data. However, genetic distances measured by SSRs were correlated to pedigree. These results suggested that SSRs could be used for pre-screening or grouping of existing and candidate varieties, allowing the number of varieties that need to be grown for comparison to be reduced. Multiplex SSR sets gave high-throughput reproducible results, thus reducing the costs of SSR assessment. Multiplex SSR sets are a promising way forward for complementing the current variety testing system in B. napus.

Synthesis and structure-activity relationships of guanine analogues as phosphodiesterase 7 (PDE7) inhibitors

The synthesis of a novel series of guanine analogues is reported. The compounds have been assessed in vitro and some analogues have been found to be inhibitors of phosphodiesterase type 7 (PDE7).

The relationship among dental status, nutrient intake, and nutritional status in older people

Dental health status may influence nutrition. The objective of this part of the National Diet and Nutrition Survey was to assess if there is a relationship between dental status in people 65 years and older and intake of certain nutrients and any link between dental status and blood-derived values of key nutrients. Random national samples of independently living subjects and those living in institutions had dental examinations, interviews, four-day food diaries, and blood and urine analyzed. In the sample living independently, intakes of most nutrients were lower in edentate than dentate subjects. Intake of non-starch polysaccharides, protein, calcium, non-heme iron, niacin, and vitamin C was significantly lower in edentate subjects. People with 21 or more teeth consumed more of most nutrients, particularly of non-starch polysaccharide. This relationship in intake was not apparent in the hematological analysis. Plasma ascorbate and plasma retinol were the only analytes significantly associated with dental status.

Patterns of cognitive ageing

Neuroanatomical evidence suggests that normal ageing affects some brain areas, and the "local" functions they support, earlier and more severely than others. Changes appear to be especially marked in the hippocampus, temporal association and prefrontal cortex. Evidence from classical neuropsychological studies suggests that these brain areas are associated with memory and "executive" functions, respectively. We may, therefore, expect that tests purported to measure these functions may be disproportionately affected in old age and that there may be evidence for some separation of these functions even within neurologically normal populations. What we also know, however, is that measures reflecting general fluid ability also decline with increasing age, so any hypothesis relating to specific "local" deficits must acknowledge and account for any "globar" changes in performance. Volunteers (n = 162) aged between 60-80 years who had completed the Cattell and Cattell Culture Fair Intelligence Test (CCF) completed the Cambridge Automated Neuropsychological Test Battery (CANTAB). The CANTAB has been administered to several patient populations and tests from the battery have been shown to be sensitive to damage in both temporal and prefrontal areas (Owen et al., 1996). Results from the test battery showed that both the Paired Associate Learning and Spatial Recognition tests were the most sensitive to normal ageing even when CCF is accounted for. In contrast, this performance on the "executive" tests, shown to be sensitive to frontal lobe damage was not related to age, and CCF scores predicted performance on these tests. These results are discussed in relation to theories of cognitive ageing and patterns of change and in relation to several important methodological and theoretical considerations for the study of executive function.