Association among the number of teeth, dental prosthesis use, and subjective happiness: A cross-sectional study from the Japan Gerontological Evaluation study (JAGES)

STATEMENT OF PROBLEM

Little is known about the association between the number of teeth and self-rated happiness or the association between dental prosthesis use and self-rated happiness in an older population.

PURPOSE

The purpose of this cross-sectional study was to examine the association between the number remaining of teeth with and without dental prosthesis use and self-rated happiness in an older population.

MATERIAL AND METHODS

The survey data from the 2016 Japan Gerontological Evaluation Study (JAGES) on independent participants aged 65 years or older were assessed. The Poisson regression and multiple imputation methods were used for analyses. Covariates were age, sex, marital status, educational attainment, self-rated health, self-rated economic situation, and symptoms of depression.

RESULTS

The data from 178 090 participants, 81 489 men (45.8%) and 96 601 women (54.2%), were analyzed, with a mean ±standard deviation age of 73.6 ±6.1 years. Overall, 66.4% of the participants were happy, declining to 45.7% in those who had 0 to 9 teeth and no dental prosthesis (n=3102). It was 61.5% in those who had 0 to 9 teeth and used a dental prosthesis (n=41 424), 56.8% in those who had 10 to 19 teeth and no dental prosthesis (n=6719), 65% in those who had 10 to 19 teeth and used a dental prosthesis (n=31 592), 70.5% in those who had ≥20 teeth and no dental prosthesis (n=52 525), and 70.1% in those who had ≥20 teeth and used a dental prosthesis (n=42 728). The interaction analysis showed that the reduction in the probability of being happy among those with fewer teeth was smaller among those who used a dental prosthesis.

CONCLUSIONS

Having a higher number of teeth and using a dental prosthesis were independently associated with being happy. A significant interaction suggested that dental prosthesis use improves happiness among those with moderate to severe tooth loss (<20 remaining teeth).

Factors associated with smoking behaviour changes during the COVID-19 pandemic in Japan: a 6-month follow-up study

BACKGROUND

Smoking behaviour may have changed due to the COVID-19 pandemic, the April 2020 revised smoke-free policy and the high prevalence of heated tobacco product (HTP) use in Japan (10.9% in 2020). This study examined the association between these three events and smoking behaviour changes using 6-month follow-up data from before and during the pandemic.

METHOD

Using longitudinal data from an internet survey conducted in February 2020 (baseline) and follow-up in August to September 2020, prevalence ratios (PR) and 95% confidence intervals (95% CIs) for smoking behaviour changes (increase and quit) were calculated using multivariable Poisson regression with adjustments for potential covariates including three event-related five factors: fear of COVID-19, living in a COVID-19 endemic area, workplace smoking rules, self-imposed smoking rules at home and type of tobacco use (cigarette only/HTP only/dual use). A smoker who reported an increase in smoking intensity in the last month was defined as an increase. A smoker who had stopped both cigarettes and HTPs at follow-up was defined as a quit.

RESULTS

We analysed 1810 tobacco users (1448 males (80%); mean age 50.8 years±13.2 SD). At baseline, 930 participants used cigarettes only, 293 HTPs only and 587 both. While 214 (11.8%) users increased smoking intensity, 259 (14.3%) quit both tobacco products. Those who feared COVID-19 were less likely to quit (PR=0.77, 95% CI 0.68 to 0.95), while living in a COVID-19 endemic area was not associated with either smoking behaviour change. Workplace smoking rules were not associated with either smoking behaviour change, but those with no home smoking ban were less likely to quit. Compared with cigarette-only users, HTP-only users were more likely to quit (PR=1.57, 95% CI 1.17 to 2.11), while dual users were more likely to increase smoking intensity (PR=1.35, 95% CI 1.01 to 1.79).

CONCLUSION

During the pandemic, dual cigarette and HTP use increased smoking intensity, whereas HTP-only use was associated with quitting but fear of COVID-19 and not having a home smoking ban made it harder to quit.

Challenges and way forward for implementation of sugar taxation in the Middle East and North Africa (MENA)

BACKGROUND

Over consumption of added sugar beyond the World Health Organization (WHO) recommended level of 10% of daily energy intake has well-established negative health consequences including oral diseases. However, the average consumption of added sugar in the Middle East and North Africa region (MENA-World Bank's regional classification) is 70% higher than the WHO recommended level. Imposing taxes on added sugar has been proposed by the WHO to decrease its consumption. Yet, only 21.6% of the total MENA population are covered by taxation policies targeting added sugar.

CHALLENGES

Well-recognized challenges for the implementation of sugar taxation in MENA include the tactics used by the food and beverage industry to block these type of policies. However, there are also other unfamiliar hurdles specific to MENA. Historically, there have been incidents of protest and riots partially sparked by increased price of basic commodities, including sugar, in MENA countries. This may affect the readiness of policy makers in the region to impose added sugar taxes. In addition, there are also cultural, lifestyle and consumption behavioural barriers to implementing added sugar taxation. Ultra-processed foods and sugar-sweetened-beverages (SSBs) rich in added sugar are perceived by many in MENA as essential treats regardless of their health risks. Furthermore, some countries even provide subsidies for added sugar. Also, (oral) healthcare providers generally do not engage in policy advocacy mainly due to limited training on health policy.

WAYS FORWARD

Here, we discuss these challenges and suggest some ways forward such as (1) support from a health-oriented political leadership, (2) raising public awareness about the health risks of over consumption of sugar, (3) transparency during the policy-cycle development process, (4) providing a free and safe environment for a community dialogue around the proposed policy, (5) training of (oral) healthcare professionals on science communication and policy advocacy in local lay language/dialect, ideally evidence informed from local/regional studies, (6) selecting the appropriate political window of opportunity to introduce a sugar tax policy, and (7) clear and strict conflict of interest regulations to limit the influence of commercial players on health policy.

In vitro and in vivo anthelmintic response of the seeds of Amomum subulatum roxb and Vitex negundo

Abstract The current study was designed to check the anthelmintic activities of some local plants. Seeds of Amomum (A.) subulatum and Vitex (V.) negundo in different solvents were subjected to in vitro (adult motility assay; AMA and egg hatch assay; EHA) and in vivo (faecal egg count reduction test; FECRT) anthelmintic activity testing protocols using Haemonchus (H.) contortus as an experimental model. The results of AMA, EHA, and FECRT were statistically analysed through linear regression and Duncan multiple range test. In AMA test, at 50 mg mL-1 concentration, the percent mortality of H. contortus was higher in A. subulatum than V. negundo, whereas, in EHA test, A. subulatum was proven better ovicidal (LC50=14.2 µg mL-1) than V. negundo (LC50= 65.7405 µg mL-1). The FECRT also indicated the better efficacy of A. subulatum than V. negundo against natural infection of gastrointestinal (GI) parasites. The crude powder of plants used in this study showed 29.6% to 57.7% anthelmintic. The reduction rate was found higher for A. subulatum (3 g kg-1) as compared to V. negundo (7 g kg-1). Reagrding efficacy analysis of solvents used for plants extract, ethyl acetate and chloroform were found better in increasing ovicidal activity in adult worms (in vitro testing), whereas, the crude aqueous methanol was found better than the crude powders in in vivo testing. It will be beneficial to document the indigenous knowledge to standard scientific procedures for their validation. This study will help to motivate the farmers to make a better choice of cultivation of the indigenous plants because of their varying efficacies as an alternative preventive approach against the GI parasitic infections.

Evaluating the secondary bioactive metabolites in Geodia corticostylifera

Abstract Ophiactis savignyi could be discovered all over the world in tropical marine environments. People could have aided in the spread of O. savignyi, particularly in the western and eastern populations of Panama's Isthmus. The brittle star Ophiactis savignyi, often known as savigny's brittle star, coexists alongside the sponge Geodia corticostylifera. The focus of this research has been to assess the functional relevance of G. corticostylifera secondary metabolites as antifoulant against mussels, protection against generalist fish, and chemical cues to affiliated brittle stars. Both in flow-through and static seawater laboratory studies, O. savignyi which has previously been connected with sponges, was given both treated and control mimics at the same time. The sponge extract was also tested for its ability to protect fish against predators and fouling. Deterrence test using chemicals indicated that the normal level of the sponge extract may also suppress generalist fish predation in the field as well as the mussel Perna perna’s normal attachment in clinical contexts. According to the findings, G. corticostylifera crude extract has many roles in the aquatic environments, apparently being accountable for this sponge's tighter relationship with O. savignyi, which protects the ophiuroid and inhibits epibionts on itself.

Exposure to household dysfunction at childhood and later number of teeth among older Japanese adults: A life course study from the Japan Gerontological Evaluation Study

OBJECTIVES

The aim of this retrospective cohort study was to investigate the life course association between exposure to two household dysfunctions (father violence against mother and parental divorce) at childhood (≤18 years) with later number of remaining teeth (≥65 years) in functionally independent older Japanese population. This was the first study to investigate this research question in the Asian context.

METHODS

The Japan Gerontological Evaluation study (JAGES) self-reported retrospective data gathered in 2013 was used (n = 21,604). Each household dysfunction was binary variable (Yes/No), while the five categories of the number of remaining teeth were ≥20, 10-19, 5-9, 1-4, and no teeth. Sex-stratified ordered logistic regression models were used to calculate the odds ratios (OR) of having fewer teeth. The models were adjusted for age, economic adversity in childhood, educational attainment, comorbidities, and smoking status.

RESULTS

Overall, 46.4% were men and a total of 1149 participants (5.3%) experienced household dysfunction at childhood [men = 642 (6.4%), women = 507 (4.4%)]. The regression models showed higher OR of having fewer teeth among men who experienced a household dysfunction [OR = 1.16; 95% Confidence interval (CI) = 1.00-1.36] than men who did not. This association was not observed among women [OR = 0.94; 95% CI = 0.79-1.13]. Similar magnitude and direction of the association was observed among men but not among women when the two components of household dysfunction were used separately and aggregately as exposure variables.

CONCLUSION

An exposure to a household dysfunction at childhood was associated with having fewer teeth in later life among men but not among women.

The role of science communication and academic health advocacy in improving population oral health and tackling inequalities

Oral conditions are a public health problem globally and stark oral health inequalities exist between and within countries. Yet, oral diseases are rarely considered as a health priority and evidence-informed policy generation is challenging. Science communication and health advocacy are critical in that respect. However, due to time limitations, research workload and other factors, academics are usually hindered from participating in such lengthy endeavours. Here, we make the case that 'science communication and health advocacy task forces' should be a priority at academic institutions. The two main duties of these task forces are knowledge transfer about the burden of oral conditions and patterns of inequalities, and their underlying social and commercial determinants, and advocacy and mediation between the stakeholders involved directly or indirectly in policy making. These interdisciplinary task forces, including both academics and non-academics, should collectively have skills that include (1) knowledge about oral health, dental public health and epidemiology, (2) ability to communicate clearly and coherently and make the case in both lay and scientific language terms, (3) familiarity with digital and social media platforms and ability to create visual aids, videos and documentaries, (4) good negotiation skills and (5) maintaining scientific transparency and avoiding getting involved in confrontation with political parties. In the current context, the role of the academic institutions should not only be the production of knowledge, but also the active transferability and application of this knowledge towards public benefit.

Oral status and homebound status: A 6-year bidirectional exploratory prospective cohort study

OBJECTIVES

Little is known about the association between oral status and homebound status, and there is a possibility of a bidirectional relationship between them. In this exploratory prospective cohort study, we examined the association between four oral status measurements and being homebound bidirectionally.

METHODS

We used 2010-2016 panel data gathered from the Japan Gerontological Evaluation Study. All functionally independent participants aged 65 years or older (n = 26,579) were included in this study. Multiple imputation and Poisson regression were used for analyses. We adjusted for age, sex, education, comorbidity, and depressive symptoms.

RESULTS

In the fully adjusted model, the prevalence ratio (PR) of being homebound at follow-up was 1.42 for having <20 remaining teeth, 1.28 for having chewing difficulty, 0.99 for having choking experience, and 0.94 for having dry mouth at baseline. Reversely, being homebound at baseline predicted having chewing difficulty at follow-up (PR = 1.17), while no significant association was demonstrated with having <20 teeth (PR = 1.00), choking experience (PR = 1.06), and dry mouth (PR = 1.02).

CONCLUSION

Chewing difficulty and having <20 remaining teeth predicted homebound status after 6 years. Reversely, homebound status at baseline only predicted having chewing difficulty at follow-up. These findings may help to determine the oral frailty assessment measures for older people.

Association Between Toothbrushing Habits and COVID-19 Symptoms

OBJECTIVES

The association between toothbrushing and coronavirus disease 2019 (COVID-19) infections is unknown. The aim of this study was to test the hypothesis that the change in time and frequency of toothbrushing is associated with having COVID-19 symptoms.

METHODS

In this 8-month retrospective cohort study, we used the data from the Japan COVID-19 and Society Internet Survey (JACSIS; N = 22,366), which was conducted between August and September 2020. The logistic regression analyses were used to calculate the odds ratios (ORs) of having the 3 main COVID-19 symptoms (high fever, cough, and taste and smell disorder). Confounders were age, sex, educational attainment, equivalised income level, self-rated health, health literacy, and living area.

RESULTS

The mean age of the participants was 49 years (SD = ±17.3), and 49.2% were male. Overall 2704 (12.1%) participants changed (increased or decreased) the time and frequency of toothbrushing, whilst 19,662 (87.9%) did not change. Only 60 participants (0.3%) had the 3 main COVID-19 symptoms. All logistic regression models showed that those who had a change in time and frequency of toothbrushing had higher odds of having the 3 main COVID-19 symptoms compared to those who had unchanged time and frequency of toothbrushing. The ORs ranged from 6.00 (95% confidence interval [CI], 3.60-9.99) in the crude model to 4.08 (95% CI, 2.38-6.98) in the fully adjusted model.

CONCLUSIONS

The change in time and frequency of toothbrushing from before to after the COVID-19 pandemic was associated with having the 3 main COVID-19 symptoms.

Does remaining teeth and dental prosthesis associate with social isolation? A six-year longitudinal study from the Japan Gerontological Evaluation Study (JAGES)

OBJECTIVES

Social isolation was associated with increased mortality and numerous adverse health outcomes. However, the longitudinal association between oral health and social isolation has not been studied. In this longitudinal prospective cohort study, the association between the number of remaining teeth and dental prosthesis use with social isolation after 6-years follow-up was examined.

METHODS

Functionally independent adults aged 65 years or older, who were not socially isolated in 2010, were followed up until 2016 in the Japan Gerontological Evaluation Study. Data from 26 417 participants were analysed after random forest imputation to address missing data. Logistic regression models were used to calculate the odds ratio (OR) for incident social isolation in 2016 after adjusting for age, sex, educational attainment, income, activities of daily living, living area and having depressive symptoms.

RESULTS

The mean age of the participants at baseline was 72.3 (SD = 5.0). A total of 1,127 (4.3%) participants were socially isolated at follow-up. Of these, 338 (3.2%) had ≥20 teeth (with or without using dental prosthesis), 171 (3.9%) had 10-19 teeth and used dental prosthesis, 112 (4.2%) had 10-19 teeth and did not use the dental prosthesis, 338 (5.1%) had 0-9 teeth and used dental prosthesis, and 168 (7.6%) had 0-9 teeth and did not use the dental prosthesis. Fully adjusted logistic regression models showed that the OR of incident social isolation was higher for those with fewer teeth; OR = 1.13 (95%CI = 0.96-1.33) for those with 10-19 teeth and OR = 1.36 (95%CI = 1.17-1.58) for those with 0-9 teeth, compared to those with ≥20 teeth. The OR of incident social isolation was lower for those who used a dental prosthesis [OR = 0.90, 95%CI = 0.80-1.02)] compared to those who did not use a dental prosthesis. The interaction between the number of teeth and dental prosthesis use demonstrated that the latter mitigated the incidence of social isolation for participants with tooth loss. Compared to those with ≥20 teeth (with or without prosthesis use), participants with 0-9 teeth that did not use a dental prosthesis were 79% [OR = 1.79, 95%CI = 1.49-2.19] more likely to be socially isolated, whereas participants with 0-9 teeth that used a dental prosthesis were only 23% [OR = 1.23, 95%CI = 1.05-1.45] more likely to be socially isolated.

CONCLUSION

Tooth loss was the main predictor for social isolation at follow-up, while no dental prostheses use was an additional risk factor. Dental prosthesis use may reduce the risk of social isolation especially in those with severe tooth loss.

Large Contribution of Oral Status for Death Among Modifiable Risk Factors in Older Adults: The Japan Gerontological Evaluation Study (JAGES) Prospective Cohort Study

BACKGROUND

Oral diseases are preventable and modifiable, but highly prevalent, and cause worse oral status. Particularly, tooth loss has increased in aging societies. However, studies on population-attributable risks of modifiable risk factors for mortality have neglected oral status. This study aimed to investigate the impact of modifiable risk factors on mortality, including oral status.

METHODS

This cohort study used the Japan Gerontological Evaluation Study data, including participants aged ≥65 years. The outcome was death between August 2010 and March 2017. We calculated the hazard ratios (HRs) and population attributable fraction (PAF) of modifiable risk factors (oral status, hypertension, depression, heart disease, diabetes, physical activity, smoking status, and alcohol drinking history) for mortality.

RESULTS

Analyses included 24 175 men and 27 888 women (mean age: 73.8 [6.0] and 74.2 [6.1], respectively). In men, after adjusting for covariates, having no teeth showed the highest hazard ratio (HR = 1.67, 95% confidence interval [CI] = 1.51-1.86) among the modifiable risk factors, and the PAF for the number of teeth (18.2%) was the second largest following age. In women, having no teeth had the third largest HR (HR = 1.37, 95% CI = 1.19-1.56) following current and former smoking. The PAF for the number of teeth (8.5%) was the sixth largest, which was larger than that of smoking status (4.8%).

CONCLUSIONS

In the older population, the HR and PAF of the number of teeth on mortality were sufficiently large compared with other modifiable risk factors, especially in men. Therefore, maintaining good oral status should be included more in global health policies.

Prevalence of Ruminant Paramphistomosis and Comparative Histopathology of the Infected Rumens in Narowal District, Punjab, Pakistan

The present study reports the prevalence of Paramphistomum spp. in small and large ruminants and their association with the histopathology of the infected rumens. A total of 384 animals were screened for Paramphistomum spp. The animals found positive for Paramphistomum spp. were divided into three groups according to the worm load/5 cm2 (G1: 10 - 20 worms/5 cm2 = Low, G2: 20 - 40 worms/5 cm2 = Medium, and G3: >41 worms/5 cm2 = High). Tissue slides were prepared from samples of the rumen (1 cm2) taken from animals positive for ruminal fluke to determine the histological parameters, including epithelial length or thickness, length and width of the ruminal papilla, and thickness of tunica submucosa and mucularis externae. The overall prevalence of Paramphistomum spp. in the ruminant population of district Narowal was 56.25 % with a significant (P < 0.05) variation among different species of ruminants. The highest prevalence was in cattle, followed in order by buffalo, goat, and sheep. Epithelium thickness was significantly correlated with parasite load in large ruminants and the most significant (P < 0.05) decrease in epithelium thickness was in Group B (31.12 ± 1.82 μm) and Group C (31.07 ± 1.68 μm) and a same trend was recorded in small ruminants. Histopathological changes due to Paramphistomum spp. are reported for the first time, which explained the histomorphological and physiological changes in Paramphistomum-infected rumens which might be associated with lowered feed efficiency and productivity in ruminants.

Acute Leukaemias in Bauchi State, Northeastern Nigeria: Pattern of Presentations and Clinical Entities

BACKGROUND

Acute leukaemias are very aggressive diseases that run a rapidly fatal course if not promptly diagnosed and appropriately treated. The clinical presentations range from bone marrow failure such as anaemia, neutropenia or thrombocytopenia to features of organ infiltrations such as lymphadenopathy, splenomegaly, etc, but presentations may be non-specific. Misdiagnosis is very common with delay in diagnosis and prompt treatment being the causes of high morbidity and mortality in acute leukaemias. This study aims to determine the pattern of presentation and various clinical entities of acute leukaemias in Bauchi State, North-Eastern Nigeria.

SUBJECTS, MATERIALS AND METHODS

This was a three year retrospective study in which records of cases of acute leukaemias diagnosed in the Haematology Department of Abubakar Tafawa Balewa University Teaching Hospital (ATBUTH) Bauchi from the bone marrow aspiration cytology register from 1st January, 2018 to 31st December, 2020 were collected. Data on socio-demographic characteristics of the patients that include age, gender, diagnosis as well as subtypes of some of the malignancies diagnosed were also collated. The collated data were analyzed using SPSS Version 20.0. A p-value of < 0.05 was considered significant.

RESULTS

Twenty-nine cases of acute leukaemias were diagnosed during the period under review. Majority of cases had acute lymphoblastic leukaemia (ALL) 19/29 (65.5%) while acute myeloid leukaemia (AML) was seen in 10/29 (34.5%). The mean ± SD age of the patients was 22.2±9.2 years with a range 6 months to 60 years. Males constituted 75.9% (22/29) of the cases of acute leukaemias diagnosed. The male to female ratios for AML and ALL were 2:1 and 2.6:1 respectively. The mean±SD ages for AML and ALL were 27±9.2years and 17.3±11.3 years respectively. The most common form of presentation of acute leukaemia in this study is recurrent anaemia necessitating blood transfusion while proptosis and epistaxis were the least forms of presentation.

CONCLUSION

Acute lymphoblastic leukaemia is the commonest form of acute leukaemias while recurrent anaemia is the commonest form of clinical presentations in our setting. Early referral of patients with clinical features suggestive of acute leukaemias is recommended.

Oral Status and Dementia Onset: Mediation of Nutritional and Social Factors

Some modifiable risk factors for dementia are closely related to oral health. Although eating and speaking abilities are fundamental oral functions, limited studies have focused on the effect of malnutrition and lack of social interaction between oral health and dementia. We investigated the mediating effects of nutritional and social factors on the association between the number of teeth and the incidence of dementia. This 6-y cohort study used data from the Japan Gerontological Evaluation Study targeting older adults aged 65 y and above. The number of teeth (exposure) and covariates in 2010 (baseline survey), mediators (weight loss, vegetable and fruit intake, homeboundness, social network) in 2013, and the onset of dementia (outcome) between 2013 and 2016 were obtained. The Karlson-Holm-Breen mediation method was applied. A total of 35,744 participants were included (54.0% women). The mean age at baseline was 73.1 ± 5.5 y for men and 73.2 ± 5.5 y for women. A total of 1,776 participants (5.0%) had dementia during the follow-up period. There was a significant total effect of the number of teeth on the onset of dementia (hazard ratio, 1.14; 95% CI, 1.01-1.28). Controlling for nutritional and social mediators, the effect of the number of teeth was reduced to 1.10 (95% CI, 0.98-1.25), leaving an indirect effect of 1.03 (95% CI, 1.02-1.04). In the sex-stratified analysis, the proportion mediated by weight loss was 6.35% for men and 4.07% for women. The proportions mediated by vegetable and fruit intake and homeboundness were 4.44% and 4.83% for men and 8.45% and 0.93% for women, respectively. Furthermore, the proportion mediated by social networks was 13.79% for men and 4.00% for women. Tooth loss was associated with the onset of dementia. Nutritional and social factors partially mediated this association.

Examining the associations between oral health and social isolation: A cross-national comparative study between Japan and England

In Western countries, the most important part of the face in communication is the mouth, whereas it is the eyes in Asian countries; thus oral health could be more important in social interactions in Western countries. Our aim was to examine differences in the association between oral health status and social isolation among older people by comparing Japan and England. We used cross-sectional information obtained from adults aged 65+ in two ongoing prospective cohort studies: The Japan Gerontological Evaluation Study (JAGES, N = 120,195) and the English Longitudinal Study of Ageing (ELSA, N = 3,958). The dependent variable, social isolation score (SIS) was calculated from five factors (marital status, social support from children, social support from family, social support from friends, and social participation). The independent variables were self-reported number of remaining teeth (0, 1-9, 10-19, ≥20) and denture use (≥20 teeth, 10-19 teeth with denture, 10-19 teeth without denture, 0-9 teeth with denture, 0-9 teeth without denture), while the covariates in the model were: sex, age, educational attainment, self-rated health, number of comorbidities, household annual equivalized income, mental health status, daily living activities, and smoking status. We examined associations between oral health status and SIS by applying an ordered logit model by country. Compared to England, more Japanese participants were socially isolated (1.4% vs. 5.8%), but fewer were edentulous (13.1% vs. 7.7%). In both countries, poorer oral health further increased the odds of being socially isolated. Pooled analysis of the ordered logit model with an interaction term showed that the association of number of remaining teeth with SIS was stronger in edentulous participants and in England (odds ratio = 1.50, 95% Confidence interval:1.26-1.80). In both countries, oral health was associated with social isolation; this association could be stronger in England than in Japan.

Can quantitative 18F-FDG PET/CT and serum cytokine analysis differentiate ARVC from cardiac sarcoidosis?

Background

Arrhythmogenic right ventricular cardiomyopathy (ARVC) and Cardiac Sarcoidosis (CS) may both cause malignant arrhythmia and sudden death, but differentiating the two can be difficult.

Purpose

To investigate the role of quantitative FDG PET/CT at distinguishing ARVC from CS, and explore whether addition of an inflammatory panel correlates with PET uptake, aiding diagnosis.

Methods

10 patients with CS, 10 with ARVC were enrolled. Participants were prospectively studied with PET/CT. LV uptake was quantified using software and a 17-segment model, measuring maximum standardised uptake (SUVmax) and mean myocardial uptake, comparing these to a local normal reference range (21 volunteers) using a z-score. Blood levels of IL-1b, IL-6, IL-8, IL10, IL-12p40, MCP-1, TGFb, GRO, TNFa, IFNy, FGF2, PDGF were measured using ELISA, compared with 10 healthy controls.

Results

There were no significant differences in cytokine levels between CS and ARVC; most cytokine levels were higher in CS, except IL-6, IL-8 and MCP-1 in ARVC (Table 1). Increased PET uptake was noted in 1 segment of 1 ARVC patient, and in 1–2 segments of 5 CS patients (z-scores 2.25 SD; 2.15–2.38 SD). No pattern of uptake distinguished ARVC from CS, qualitatively assessing LV polar maps (Figure 1A, B). SUVmax and mean uptake were higher in CS vs. ARVC (p&lt;0.05; p=0.13). No significant correlation between cytokine levels and PET uptake was detected (Figure 1C, D).

Conclusion

Quantitative PET/CT uptake and a blood inflammatory panel did not have utility in differentiating the two conditions in our population. There was generally more PET and serum inflammatory activity in CS.

Funding Acknowledgement

Type of funding source: Public hospital(s). Main funding source(s): NHS Endowments

Initial experience with the convergent procedure for longstanding persistent atrial fibrillation: A 5 year dataset

In patients with longstanding persistent atrial fibrillation (AF), outcomes from catheter ablation remain suboptimal. The convergent procedure combines minimally invasive surgical ablation with subsequent catheter ablation, and may contribute towards maintenance of sinus rhythm in this patient group. We performed the convergent procedure on 43 patients with longstanding persistent AF from 2013–2018. Patients underwent clinical review at 3, 6, and 12 months and thereafter as necessitated by their symptoms. Our dataset describes patients’ baseline characteristics and rhythm control protocols, as well as outcomes including arrhythmia recurrence, the need for antiarrhythmic drugs, requirement for repeat rhythm control procedures, and complications. These data provide a real world insight into the risks and benefits of the convergent procedure in patients with longstanding persistent AF.

4324Fast-field cycling magnetic resonance detection of intracellular iron in the nanomolar range - A pre-requisite for in-vivo study of inflammation

Background

Ultra-small superparamagnetic iron oxide (USPIO) nanoparticles are phagocytosed by macrophages and when subjected to magnetic resonance imaging (MRI) detect inflammation. We describe a novel MR technique where the magnetic field is rapidly cycled (Fast field-cycling MR, FFC-MR), assessing T1 dispersion over a range of low (100μT-0.2T) fields and offering superior T1-based iron quantification.

AIM

To quantify iron using the FFC-MR R1 (1/T1) dispersion profile and flow cytometry features of USPIO-laden cells, in comparison to colorimetric assays.

Methods

Murine J774 macrophage-like cells were incubated with 0–200μg/ml Fe as USPIO (ferumoxytol) for 16 hours, washed and suspended in 500μl PBS/2mM EDTA. Prussian blue staining confirmed USPIO phagocytosis. Relaxation was measured using a clinical, in-house built prototype 0.2T FFC-MR system with a custom test tube coil. R1 dispersion was derived from a saturation recovery sequence (Fig. 1A). R1 (s–1) values were calculated with a monoexponential curve fitting algorithm, R2 of fits were ≥0.999. R1 dispersion profiles were generated plotting R1 against the magnetic field (T). Quantification of side scatter (SCC) intensity and the USPIO-occupied fraction of total cell area was performed with imaging flow cytometry. A colorimetric assay provided validation of cell iron content. All data are mean±SEM, analysed with t-tests, Pearson correlation and linear regression; statistical significance set at p<0.05.

Results

Table 1 shows quantitative data derived by all 3 modalities with increasing USPIO exposure. FFC-MR detection of intracellular iron was excellent (p≤0.001 vs. control for all), with separation of average R1 dispersion profiles (Fig. 1B), strong correlation with colorimetry (r=0.993 p<0.001) and good fit on linear regression model (R2=0.9222, Fig 1C). Flow cytometry quantification of SCC was comparable (p≤0.001 for all), whereas USPIO-occupied area was only sensitive at exposures ≥10μg/ml USPIO (r=0.967 p<0.001 & r=0.983 p<0.001 vs. colorimetric respectively). FFC-MR detected iron at ≥1.12ng/μg protein.

USPIO exposure (μg/ml medium) 0 5 10 40 80 100 200 FFC-MR Mean R1 1x106 cell suspension (s–1) 0.308±0.014 0.356±0.013** 0.432±0.016** 0.706±0.021** 1.174±0.031** 1.239±0.033** 1.599±0.041** Flow cytometry USPIO area/cell area 0.034±0.001 0.036±0.001 0.037±0.001* 0.069±0.001** 0.085±0.001** 0.090±0.001** 0.097±0.001** Flow cytometry SSC intensity 26860 32815** 39573** 69285** 80967** 82693** 86373** Colorimetric assay Iron concentration 1x106 cells (ng/μg protein) 0.115±0.118 1.121±0.045** 2.074±0.084** 5.496±0.134** 8.421±0.269** 9.771±0.100** 12.398±0.233** SSC = side-scattered light; *p<0.05 vs. control; **p<0.001 vs. control.

Conclusion

Field-cycling MR is capable of highly accurate intracellular USPIO quantification, which has potential to non-invasively detect clinically relevant amounts of iron in inflammatory cardiovascular diseases.

Acknowledgement/Funding

NHS Grampian Endowment Fund

Income or education, which has a stronger association with dental implant use in elderly people in Japan?

OBJECTIVES

Although inequalities in dental implant use based on educational level have been reported, no study has used income as a proxy for the socioeconomic status. We examined: (i) income inequalities in implant use; and (ii) whether income or education has a stronger association with implant use in elder Japanese.

METHODS

In 2016, a self-reported questionnaire was mailed to participants aged 65 years or older living across Japan as part of the ongoing Japan Gerontological Evaluation Study. We used data from 84,718 respondents having 19 or fewer teeth. After multiple imputation, multi-level logistic regression estimated the association of dental implant use with equivalised income level and years of formal education. Confounders were age, sex, and density of dental clinics in the residential area.

RESULTS

3.1% of respondents had dental implants. Percentages of dental implant use among the lowest (≤ 9 years) and highest (≥ 13 years) educational groups were 1.8 and 5.1, respectively, and among the lowest (0 < 12.2 '1,000 USD/year') and highest (≥ 59.4 '1,000 USD/year') income groups were 1.7 and 10.4, respectively. A fully adjusted model revealed that both income and education were independently associated with dental implant use. Odds ratios for implant use in the highest education and income groups were 2.13 [95% CI = 1.94-2.35] and 4.85 [95% CI = 3.78-6.22] compared with the lowest education and income groups, respectively. From a model with standardised variables, income showed slightly stronger association than education.

CONCLUSION

This study reveals a public health problem that even those with the highest education but low income might have limited accessibility to dental implant services.

Study on Portulaca Oleracea Native Species as Vegetal Source of Omega-3 and Omega-6 Fatty Acids

Fatty grass, grasita or purslane (Portulaca oleracea L.) is an important plant identified as a natural weed in field crops and lawns. Purslane is widespread worldwide and is popular as edible plants in many areas of Europe, Asia and the Mediterranean region. This plant possesses mucilaginous substances of great medicinal importance. It is a rich source of potassium, magnesium and calcium and has the potential to be used as a vegetal source of omega-3 and omega-6. It is very good as a source of alpha-linolenic acid (ALA) and gamma-linolenic acid (GLA) and contains the highest amount compared to any other green leafy vegetables. It also contains significant amounts of alpha-tocopherol and ascorbic acid, as well as an increased content of oxalate in fresh leaves. The antioxidant value and nutritional content of purslane are important for human consumption. It reveals a huge nutritional potential and indicates the potential for future use of this plant in food industry, dietary supplements, drugs, cosmetics and products for body care.

The Influence of Extraction Solvent on the Active Principles Content of Portulaca Oleracea Native Species

In this paper, a study on the influence of extraction solvent on the active principles content of purslane - Portulaca oleracea extracts was performed. For the study were used both fresh and dried plants, chopped by plant chopping machine. The following extracts were obtained and analysed in the solvent systems mentioned below: (fresh) purslane extract in Ethanol 30%, (dry) purslane extract in Ethanol 30%; (fresh) purslane extract in EtOH 70%, (dry) purslane extract in EtOH 70%; (fresh) purslane extract in propylene glycol 20%, (dry) purslane extract in propylene glycol 20%; (fresh) purslane extract in PG 100%, (dry) purslane extract in PG 100%; (fresh) purslane extract in glycerine 20%, (dry) purslane extract in glycerine 20%; (fresh) purslane extract in R glycerine, (dry) purslane extract in R glycerine; purslane hydro-alcoholic glycerine extract. The results obtained in the study performed on purslane extracts in different solvents show that the capitalization of purslane can become very profitable and with beneficial effects on economy in our country, both in terms of food and as medicinal plant.

An insight into the ecobiology, vector significance and control of Hyalomma ticks (Acari: Ixodidae): A review

Ticks (Acari:Ixodoidea) are important ectoparasites infesting livestock and human populations around the globe. Ticks can cause damage directly by affecting the site of infestation, or indirectly as vectors of a wide range of protozoa, bacteria and viruses which ultimately lead to lowered productivity of livestock populations. Hyalomma is a genus of hard ticks, having more than 30 species well-adapted to hot, humid and cold climates. Habitat diversity, vector ability, and emerging problem of acaricidal resistance in enzootic regions typify this genus in various countries around the world. This paper reviews the epidemiology, associated risk factors (temperature, climate, age, sex, breed etc.), vector role, vector-pathogen association, and reported control strategies of genus Hyalomma. The various proteins in saliva of Hyalomma secreted into the blood stream of host and the prolonged attachment are responsible for the successful engorgement of female ticks in spite of host immune defense system. The various immunological approaches that have been tried by researchers in order to cause tick rejection are also discussed. In addition, the novel biological control approaches involving the use of entomo-pathogenic nematodes and Bacillus thuringiensis (B. thuringiensis) serovar thuringiensis H14; an endotoxin, for their acaricidal effect on different species and life cycle stages of Hyalomma are also presented.

Abstract P4-06-04: Germline alterations in African-American versus Caucasian patients with triple-negative breast cancer in the era of multi-gene panel testing

Background. Triple negative breast cancer (TNBC) has been associated with a relatively high rate of germline BRCA1/2 deleterious mutations (11-20%). With use of panel testing, additional predisposition genes are being identified. Among Caucasian (CC) patients (pts), pathogenic germline variants in BRCA1/2 are mainly associated with TNBC. However, these may not fully explain the higher incidence of TNBC among African Americans (AA). Additionally, partly due to under-testing among AA, the distribution of predisposition genes for AA TNBC pts is unknown, and a greater proportion of germline alterations may be classified as a variant of uncertain significance (VUS). We hypothesized that additional clinically significant germline mutations in genes, other than in BRCA1/2, may explain the increased incidence of TNBC among AA, which may be better elucidated by panel testing.

Methods. A retrospective chart review was completed of all self-identified CC and AA TNBC pts who presented to two institutions from 10/2013 to 12/2016. A total of 596 pts were analyzed. 434 (73%) were CC and 162 (27%) were AA. Clinicopathologic features including histologic subtype, age, gender, bilateral disease and stage were examined. Patients were assessed for meeting the National Comprehensive Cancer Network (NCCN) criteria for genetic testing in TNBC, type of testing performed, and the results. The distribution of mutations in higher penetrance genes (BRCA1, BRCA2, and PALB2), pathogenic variants in other genes, and VUS in AA vs. CC were analyzed. Significance was determined using a two-tailed Fisher exact test with significance of p&lt;0.05.

Results. 306/434 (71%) CC and 98/162 (60%) AA TNBC pts met criteria for genetic testing (p=0.023). For those who met NCCN criteria for testing, 216/306 (71%) CC and 66/98 (67%) AA TNBC pts underwent testing (p=0.61). For all pts, the average age of first diagnosis was 59.5 (SD 14) for CC vs. 62.4 (SD 12.9) for AA pts. For pts who underwent testing, regardless of meeting NCCN criteria, 18% (40/221) of CC vs.12% (8/68) of AA patients had a mutation in a higher penetrance gene (p=0.27), 1% (3/221) of CC vs. 3% (2/68) of AA had a mutation in other genes (BRIP1, Lynch genes; p=0.34), and 16% (36/221) of CC vs. 18% (12/68) of AA had a VUS (p=0.982). Of VUS, 42% (5/12) in AA vs. 19% (7/36) in CC were in higher penetrance breast cancer genes (p=0.14).

Conclusion. More CC than AA TNBC pts met criteria for genetic testing. This difference may in part be explained by the later age at diagnosis for AA given that age is a major factor in determining genetic testing. Broadening eligibility for testing in AA may help to identify more patients with an underlying genetic predisposition to TNBC. No difference was seen in the frequency of higher penetrance genes, other genes, and VUS between AA and CC pts. However, important non-BRCA genes were identified with panel testing in both AA and CC pts. In addition to broadening testing criteria for existing multi-gene panels, further genetic analysis may be necessary to explain the predisposition to TNBC in AA pts. To our knowledge, this is the first report of evaluation of predisposition genes among AA TNBC pts using germline panel testing.

Citation Format: Nizialek EA, Gopalakrishnan D, Yanda C, Abbas H, Kline M, Stephens M, Grobmyer SR, Eng C, Mitchell A, Pederson H, Vinayak S. Germline alterations in African-American versus Caucasian patients with triple-negative breast cancer in the era of multi-gene panel testing [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-06-04.

Abstract P4-10-13: Analyses of racial disparities in genetic testing and surgical management of patients with triple-negative breast cancer in the era of multigene panel testing

Background

Under-utilization of genetic counseling and testing among African-American (AA) women with breast cancer (BC) has been reported in previous studies, and there are concerns that disparities may widen with further genomic advances. Our objective was to compare AA and Caucasian (CC) patients with triple-negative breast cancer (TNBC) with regards to referral for genetic counseling, patterns of genetic testing, and patient-compliance with genetic counseling recommendations. We chose TNBC since a majority of these patients would qualify for genetic counseling ± testing. We also analyzed for differences between the two races in prevalence of deleterious BC-associated mutations, stage of BC on presentation, and surgical choices.

Methods

In this retrospective medical records-based observational study, we included all patients in our tumor registry with TNBC diagnosed between 09/01/2013 and 02/28/2017. Race, clinical characteristics and details pertaining to genetic counseling and testing were recorded. X2 test was used to compare categorical variables. A p-value &lt; 0.05 was considered significant.

Results

477 patients -358 CC and 96 AA- with TNBC were included. Mean age was 60.3 years. 331 patients met National Comprehensive Cancer Network (NCCN) criteria for genetic counseling - of these, 85.5% had genetic consult order placed, 72.8% attended counseling, and 71.9% underwent genetic testing (multigene panel testing 55.0%, BRCA 1/2 testing 39.9%, single-site testing 2.5%, and multisite-3 testing 2.5%). Between CC and AA, no significant differences were found in the proportion of qualifying patients who had referral for genetic counseling (84.7 vs 87.7%, p=0.562), attended counseling (72.2% vs 73.7%, p=0.816), or underwent genetic testing (72.1% vs 70.1%, p=0.764). The choices of type of genetic tests were also not significantly different between the two groups (p=0.349). Though the prevalence of highly penetrant mutations in breast cancer-associated genes trended to be higher among CC than AA (14.1% vs 9.5%), this difference did not reach statistical significance (p=0.429). In our population, stage of TNBC at presentation was comparable between the two races – 80.4% of CC presented with stage I or II disease compared to 80.2% of AA (p=0.931). The two groups were also comparable with regards to the choices of breast surgery and reconstruction, as shown in the table.

  CaucasiansAfrican-Americansp-valueSurgery TypePartial Mastectomy154(47.4%)38(44.7%)0.317 Unilateral Mastectomy101(31.1%)35(41.2%) Bilateral Mastectomy70(21.5%)12(14.1%)ReconstructionYes96(56.1%)24(51.1%)0.535 No75(43.9%)23(48.9%)Reconstruction TypeImplant87(90.6%)19(79.2%)0.118 Tissue Flap9(9.4%)5(20.8%)

Conclusions

Contrary to previous reports, in this cohort of TNBC patients, we did not identify significant disparities between AA and CC in patterns of referral for genetic counseling, in patient compliance with testing or in type of testing performed. Also, no significant differences were found between the two races in choices of breast surgery or reconstruction. As a caveat, with an overall insured rate of ˜97% across our network, the uninsured population may have been under-represented by our cohort.

Citation Format: Gopalakrishnan D, Yanda C, Abbas H, Kline M, Stephens M, Grobmyer SR, Pederson HJ. Analyses of racial disparities in genetic testing and surgical management of patients with triple-negative breast cancer in the era of multigene panel testing [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-10-13.

Outcome of a screening programme for the prevention of neonatal invasive early-onset group B Streptococcus infection in a UK maternity unit: an observational study

BACKGROUND

Against a background of failure to prevent neonatal invasive early-onset group B Streptococcus infections (GBS) in our maternity unit using risk-based approach for intrapartum antibiotic prophylaxis, we introduced an antenatal GBS carriage screening programme to identify additional women to target for prophylaxis.

OBJECTIVES

To describe the implementation and outcome of an antepartum screening programme for prevention of invasive early-onset GBS infection in a UK maternity unit.

DESIGN

Observational study of outcome of screening programme (intervention) with comparison to historical controls (preintervention).

SETTING

Hospital and community-based maternity services provided by Northwick Park and Central Middlesex Hospitals in North West London.

PARTICIPANTS

Women who gave birth between March 2014 and December 2015 at Northwick Park Hospital.

METHODS

Women were screened for GBS at 35-37 weeks and carriers offered intrapartum antibiotic prophylaxis. Screening programme was first introduced in hospital (March 2014) and then in community (August 2014). Compliance was audited by review of randomly selected case records. Invasive early-onset GBS infections were defined through GBS being cultured from neonatal blood, cerebrospinal fluid or sterile fluids within 0-6 days of birth.

MAIN OUTCOME

Incidence of early-onset GBS infections.

RESULTS

6309 (69%) of the 9098 eligible women were tested. Screening rate improved progressively from 42% in 2014 to 75% in 2015. Audit showed that 98% of women accepted the offer of screening. Recto-vaginal GBS carriage rate was 29.4% (1822/6193). All strains were susceptible to penicillin but 11.3% (206/1822) were resistant to clindamycin. Early onset GBS rate fell from 0.99/1000 live births (25/25276) in the prescreening period to 0.33/1000 in the screening period (Rate Ratio=0.33; p=0.08). In the subset of mothers actually screened, the rate was 0.16/1000 live births (1/6309), (Rate Ratio=0.16; p<0.05).

CONCLUSIONS

Our findings confirm that an antenatal screening programme for prevention of early-onset GBS infection can be implemented in a UK maternity setting and is associated with a fall in infection rates.

Effect of some biotic factors on microbially-induced calcite precipitation in cement mortar

Sporosarcina pasteurii, a common soil bacterium has been tested for microbial treatment of cement mortar. The present study also seeks to investigate the effects of growth medium, bacterial concentration and different buffers concerning the preparation of bacterial suspensions on the compressive strength of cement mortar. Two growth media, six different suspensions and two bacterial concentrations were used in the study. The influence of growth medium on calcification efficiency of S. pasteurii was insignificant. Significant improvement in the compressive as well as the tensile strength of cement mortar was observed. Microbial mineral precipitation visualized by Scanning Electron Microscopy (SEM) shows fibrous material that increased the strength of cement mortar. Formation of thin strands of fillers observed through SEM micrographs improves the pore structure, impermeability and thus the compressive as well as the tensile strengths of the cement mortar. The type of substrate and its molarity have a significant influence on the strength of cement mortar.

Robotic esophagectomy: new era of surgery

Esophagectomy is a surgical operation which requires technical expertise to decrease the morbidity and mortality frequently associated with this advance procedure. Various minimally invasive esophagectomy techniques have been developed to decrease the negative impact of esophageal resection. Recently, robotic assisted esophagectomies have been described with a wide variety in technique and outcome disparity. This article is a summation review of the current literature regarding the various techniques and surgical outcomes of robotic assisted esophagectomies.

No evidence for relevant QT interval prolongation in mitotane-treated patients with adrenocortical carcinoma

OBJECTIVE

We designed a single-center retrospective study to assess the QT interval duration and to describe cardio vascular events among patients treated with mitotane for a adrenocortical carcinoma (ACC).

DESIGN

We selected 14 patients (6 males and 8 females) that met the following criteria: ACC treated with mitotane, for whom an electrocardiogram (ECG) at baseline (before mitotane initiation) was available and for whom at least one ECG was available during the course of mitotane therapy together with a concomitant mitotane plasma level determination.

RESULTS

Mean mitotane plasma level at baseline and after treatment showed a significant increase (mean level increased from 0 to 14.9±2 mg/l). At baseline and before mitotane was initiated all QTc intervals were <450 msec for men and <460 msec for women. During the treatment phase with mitotane, no QTc>470 msec was found in any patients respectively for men and women. In addition, no patient showed any significant QTc prolongation (>5% or >10 msec) at any time during mitotane treatment. During a mean follow-up of 15.9±3.5 months (range 2-45 months). No cardiovascular deaths or hospitalization for cardiovascular events was documented. No torsades de pointes were documented on ECG. No syncope, dizziness, heart failure were observed during follow up. Six out of 14 patients died during the follow-up, in five cases due to the progression of the disease, one patient died suddenly at home during followup.

CONCLUSION

This short and retrospective series shows no evidence that mitotane induce any QT prolongation, even when plasma levels are well above the therapeutic window.

Response to antenatal HIV testing and prevention of parent to child transmission: an experience in a tertiary hospital in Chitwan, Nepal

The antenatal screening of HIV in all women is becoming an integral part of routine antenatal checkup in Nepal, by prevention of parent to child transmission (PPTCT) program. The aim was to analyze the response to implementation of PPTCT program in a peripheral hospital and to study the involvement of husbands for counseling and testing. Data of 3360 women attending the antenatal clinic from January 2010 to December 2010. Data of husband counseling and testing was also analyzed. Acceptability of the test after pretest counseling is 99 %. Women attended post test counseling and collected reports in 58.6%. Sero prevalence of HIV was 0.73% of which 62.5% came for post test counseling. Only 10 % of husbands of total antenatal cases came for counseling of which 6.6% got tested. The acceptability of the test after pretest counseling is satisfactory but the follow up for the post test counseling is to be improved. There is need to enhance male involvement to make husband friendly antenatal clinic.DOI: http://dx.doi.org/10.3126/jcmsn.v7i3.6707 Journal of College of Medical Sciences-Nepal, 2011, Vol-7, No-3, 36-38

Electrochemical Lithium Insertion/Extraction in Partially Reduced α-MoO3

This work concerns with synthesis, structural, thermal and electrochemical characterization of molybdenum oxides (stoichiometric MoO3, sub-stoichiometric oxide MoO3− x (where x is a small fraction) with layered type structure. XRD investigations of the samples proved that the crystal structure of the layered α-MoO3) has been maintained after the reduction process.

The reduced samples exhibited a drastically improved charge/discharge cycling stability and capacity retention on cycling in 1 M LiClO4/propylene carbonate. At higher cycle numbers (approx. cycle 50) the discharge capacity of the reduced molybdenum oxides stabilizes at a level of approx. 50 mAh g−1, whereas the non-reduced MoO3 has retained only about 45 mAh g−1 after 20 cycles. This significant improvement of the rechargeability may be related to improvement in the electronic conductivity after reduction process.