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Preisser J, Moss K, Finlayson T, Jones J, Weintraub J. Prediction Model Development and Validation of 12-Year Incident Edentulism of Older Adults in the United States. JDR Clin Trans Res 2023; 8:384-393. [PMID: 35945823 PMCID: PMC10504805 DOI: 10.1177/23800844221112062] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
Abstract
INTRODUCTION Edentulism affects health and quality of life. OBJECTIVES Identify factors that predict older adults becoming edentulous over 12 y in the US Health and Retirement Study (HRS) by developing and validating a prediction model. METHODS The HRS includes data on a representative sample of US adults aged >50 y. Selection criteria included participants in 2006 and 2018 who answered, "Have you lost all of your upper and lower natural permanent teeth?" Persons who answered "no" in 2006 and "yes" in 2018 experienced incident edentulism. Excluding 2006 edentulous, the data set (n = 4,288) was split into selection (70%, n = 3,002) and test data (30%, n = 1,286), and Monte Carlo cross-validation was applied to 500 random partitions of the selection data into training (n = 1,716) and validation (n = 1,286) data sets. Fitted logistic models from the training data sets were applied to the validation data sets to obtain area under the curve (AUC) for 32 candidate models. Six variables were included in all models (age, race/ethnicity, gender, education, smoking, last dental visit) while all combinations of 5 variables (income, alcohol use, self-rated health, loneliness, cognitive status) were considered for inclusion. The best parsimonious model based on highest mean AUC was fitted to the selection data set to obtain a final prediction equation. It was applied to the test data to estimate AUC and 95% confidence interval using 1,000 bootstrap samples. RESULTS From 2006 to 2018, 9.7% of older adults became edentulous. The 2006 mean (SD) age was 66.7 (8.7) for newly edentulous and 66.3 (8.4) for dentate (P = 0.31). The baseline 6-variable model mean AUC was 0.740. The 7-variable model with cognition had AUC = 0.749 and test data AUC = 0.748 (95% confidence interval, 0.715-0.781), modestly improving prediction. Negligible improvement was gained from adding more variables. CONCLUSION Cognition information improved the 12-y prediction of becoming edentulous beyond the modifiable risk factors of smoking and dental care use, as well as nonmodifiable demographic factors. KNOWLEDGE TRANSFER STATEMENT This prediction modeling and validation study identifies cognition as well as modifiable (dental care use, smoking) and nonmodifiable factors (race, ethnicity, gender, age, education) associated with incident complete tooth loss in the United States. This information is useful for the public, dental care providers, and health policy makers in improving approaches to preventive care, oral and general health, and quality of life for older adults.
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Affiliation(s)
- J.S. Preisser
- Biostatistics, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - K. Moss
- Division of Comprehensive Oral Health University of North Carolina at Chapel Hill, Adams School of Dentistry, Chapel Hill, NC, USA
| | - T.L. Finlayson
- Health Management and Policy, San Diego State University School of Public Health, San Diego, CA, USA
| | - J.A. Jones
- University of Detroit Mercy, Detroit, MI, USA
| | - J.A. Weintraub
- Division of Pediatric and Public Health, University of North Carolina at Chapel Hill, Adams School of Dentistry, Chapel Hill, NC, USA
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Jones JA, Moss K, Finlayson TL, Preisser JS, Weintraub JA. Edentulism Predicts Cognitive Decline in the US Health and Retirement Cohort Study. J Dent Res 2023:220345231167805. [PMID: 37314011 PMCID: PMC10399082 DOI: 10.1177/00220345231167805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023] Open
Abstract
This longitudinal cohort study examines if 1) cognitive decline varies by birth cohort, adjusting for covariates, and 2) edentulism and nonuse of dental care predict 10-y cognitive decline (2008-2018). The Health and Retirement Study (HRS) features a representative sample of US adults over age 50. Eligibility criteria included having cognitive interview data available and responding to the question, "Have you lost all of your upper and lower natural permanent teeth?" at 2+ time points between 2006 and 2018. Use of dental care in the past 2 y was assessed. Linear mixed models for repeated measures estimated the trajectories of mean cognition over time for the birth cohorts, adjusted for baseline cognition, dentition status, dental care use, and covariates (demographic characteristics, health behaviors, and medical conditions). Cohort-by-time interaction terms were included to assess if cognitive decline varied by birth cohort. Ten-year change in cognition status (measured by HRS Cogtot27)-categorized as dementia (<7); cognitive impairment, not demented (7-11) 7≤Cogtot27<12; and normal (≥12)-was also investigated according to birth cohort, dentition status, and dental care use. Mean (SD) baseline age was 63.4 (10.1) y (n = 22,728). Older birth cohorts had greater cognitive decline than younger cohorts. Linear mixed-model estimates and 95% confidence intervals for protective factors for cognitive decline included higher baseline cognition (HRS Cogtot27) (0.49; 0.48-0.50), use of dental care in the past 2 y (0.17; 0.10-0.23), and covariates such as greater household wealth and being married. Risk increased with being edentulous (-0.42; -0.56 to -0.28), history of stroke or diabetes, less education, Medicaid recipient, current smoker, loneliness, and poor/fair self-rated health. Edentulism and irregular dental care are among important predictors of cognitive decline. Tooth retention and regular dental care throughout life appear to be important for maintaining oral and cognitive health.
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Affiliation(s)
- J A Jones
- University of Detroit Mercy School of Dentistry, Detroit, MI, USA
| | - K Moss
- Division of Comprehensive Oral Health, University of North Carolina at Chapel Hill, Adams School of Dentistry, Chapel Hill, NC, USA
| | - T L Finlayson
- Health Management and Policy, San Diego State University School of Public Health, San Diego, CA, USA
| | - J S Preisser
- Biostatistics, University of North Carolina Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - J A Weintraub
- Division of Pediatric and Public Health, University of North Carolina at Chapel Hill, Adams School of Dentistry, Chapel Hill, NC, USA
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Meurk C, Roberts S, Lam M, Wittenhagen L, Callaway L, Moss K, Lucke J, Barker R, Waterson E, Rawlinson C, Malmstrom N, Weaver E, Hoehn E, Bosley E, Watson S, Heffernan E. Suicide crises among women and mothers during and around the time of pregnancy: Prevalence and timing of initial contact with first responders and health services. Aust N Z J Psychiatry 2023; 57:291-301. [PMID: 35652302 DOI: 10.1177/00048674221101517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVES Suicide is a leading cause of maternal mortality. Suicidality during and around the time of pregnancy can have detrimental impacts on a child's development and outcomes. This paper examines prevalence, demographic characteristics, and timing of initial contact with first responders and health services for a cohort of women who experienced suicidality during and around the time of pregnancy. METHODS Findings are drawn from the Partners in Prevention (PiP) study, a population-wide linked data set of suicide-related attendances by police or paramedics in Queensland, Australia. A sub-cohort of women was identified, who were between 6 months preconception and 2 years postpartum at the time of a suicide-related contact with police or paramedics (PiP-Maternal). Findings are compared to other girls and women who had a suicide-related contact with police or paramedics (PiP-Female). Prevalence, demographic characteristics, timing of contact with first responders and health services, re-presentations, and mortality are reported. RESULTS The PiP-Maternal cohort comprised 3020 individuals and 3400 births. Women in the PiP-Maternal cohort were younger, more likely to be of Aboriginal and/or Torres Strait Islander descent and live outside of a major city than the PiP-Female cohort. There were high rates of out-of-hours calls to police and ambulance, and similar perceived seriousness of the call between women in the PiP-Maternal and PiP-Female cohorts. Women in the PiP-Maternal cohort were less likely to be admitted to an emergency department within 24 hours, even after matching on covariates. Prevalence of suicidality for women who were pregnant and up to 2 years postpartum was 1.32% (95% CI = [1.27, 1.37]). CONCLUSION Vulnerabilities and high rates of contact with police or paramedics, coupled with lower levels of follow-up, highlight the critical need to improve service responses for women with mental health needs during these phases of life.
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Affiliation(s)
- Carla Meurk
- Forensic Mental Health Group, Queensland Centre for Mental Health Research, Queensland Health, West Moreton Hospital and Health Service, Wacol, QLD, Australia.,School of Public Health, The University of Queensland, Brisbane, QLD, Australia
| | - Susan Roberts
- Lavender Mother and Baby Unit, Gold Coast Hospital and Health Service, Southport, QLD, Australia
| | - Michael Lam
- Queensland Forensic Mental Health Service, Metro North Hospital and Health Service, Brisbane, QLD, Australia
| | - Lisa Wittenhagen
- Forensic Mental Health Group, Queensland Centre for Mental Health Research, Queensland Health, West Moreton Hospital and Health Service, Wacol, QLD, Australia.,School of Public Health, The University of Queensland, Brisbane, QLD, Australia
| | - Leonie Callaway
- Royal Brisbane Clinical Unit, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia.,Department of Obstetric Medicine, Royal Brisbane and Women's Hospital, Metro North Hospital and Health Service, Brisbane, QLD, Australia
| | - Katherine Moss
- Forensic Mental Health Group, Queensland Centre for Mental Health Research, Queensland Health, West Moreton Hospital and Health Service, Wacol, QLD, Australia.,School of Public Health, The University of Queensland, Brisbane, QLD, Australia.,Queensland Forensic Mental Health Service, Metro North Hospital and Health Service, Brisbane, QLD, Australia
| | - Jayne Lucke
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia
| | - Ruth Barker
- Queensland Children's Hospital, Queensland Health, Brisbane, QLD, Australia.,Queensland Injury Surveillance Unit, Jamieson Trauma Institute, Brisbane, QLD, Australia
| | - Elissa Waterson
- Forensic Mental Health Group, Queensland Centre for Mental Health Research, Queensland Health, West Moreton Hospital and Health Service, Wacol, QLD, Australia.,Queensland Forensic Mental Health Service, Metro North Hospital and Health Service, Brisbane, QLD, Australia
| | - Catherine Rawlinson
- Queensland Centre for Perinatal and Infant Mental Health, Children's Health Queensland Hospital and Health Service, Brisbane, QLD, Australia
| | | | - Edward Weaver
- Department of Obstetrics and Gynaecology/Women's and Children's, Griffith University School of Medicine and Dentistry, Sunshine Coast, QLD, Australia
| | - Elisabeth Hoehn
- Queensland Centre for Perinatal and Infant Mental Health, Children's Health Queensland Hospital and Health Service, Brisbane, QLD, Australia
| | - Emma Bosley
- Information Support, Research and Evaluation, Office of the Medical Director, Queensland Ambulance Service, Kedron, QLD, Australia.,School of Clinical Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Shelby Watson
- State Domestic, Family Violence and Vulnerable Persons Unit, Vulnerable Persons Group, Domestic Family Violence and Vulnerable Persons Command, Queensland Police Service, Brisbane, QLD, Australia
| | - Ed Heffernan
- Forensic Mental Health Group, Queensland Centre for Mental Health Research, Queensland Health, West Moreton Hospital and Health Service, Wacol, QLD, Australia.,School of Public Health, The University of Queensland, Brisbane, QLD, Australia.,Queensland Forensic Mental Health Service, Metro North Hospital and Health Service, Brisbane, QLD, Australia
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Schlechter B, Ileana Dumbrava E, Olson D, Saibil S, Pieke B, Bouvier R, Moss K, Turnus N, Bader A, Adib D. 778TiP A phase I/II trial investigating safety and efficacy of autologous TAC T-cells targeting HER2 in relapsed or refractory solid tumors. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Sampath C, Harris EP, Berthaud V, Tabatabai MA, Wilus DM, Crayton MA, Moss K, Webster-Cyriaque J, Southerland JH, Koethe JR, Gangula PR. Periodontal Treatment Reduces Circulating Pro-Inflammatory Cytokine and Chemokine Levels in African American HIV+ Individuals with Virological Suppression. J Dent Appl 2022; 8:477-487. [PMID: 36274905 PMCID: PMC9583701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
INTRODUCTION Periodontal Disease (PD), a chronic inflammatory disease, is highly prevalent among Persons Living With HIV (PLWH) and is characterized by microbial symbiosis and oxidative stress. Our hypothesis stipulates that periodontal therapy attenuates systemic inflammatory and bacterial burden while improving periodontal status in PLWH. METHODS Sixteen African Americans (AA) with suppressed HIV viremia on long-term Antiretroviral Therapy (ART) were recruited to this study. Participants were placed into two groups, based on their dental care status: group 1 (In-Care, IC) and group 2 (Out of Care, OC). Periodontal health was investigated at baseline, 3 months, 6 months, and 12 months. Cytokine/chemokines, microbial phyla, and Asymmetric Dimethylarginine (ADMA, a marker for endothelial cell dysfunction) levels were assessed in the serum. Statistical comparisons between groups and at different visits were performed using multiple comparison tests. RESULTS Across longitudinal visits, periodontal treatment significantly reduced the levels of several cytokines and chemokines. At baseline, the out of care group had significantly higher blood levels of ADMA and actinobacteria than the IC group. Periodontal treatment significantly altered the abundance of circulating genomic bacterial DNA for various phyla in out of care group. CONCLUSIONS Periodontal treatment interventions effectively attenuated circulating pro-inflammatory cytokines and altered microbial translocation, both critical drivers of systemic inflammation in PLWH.
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Affiliation(s)
- C Sampath
- Department of Oral Diagnostic Sciences & Research in Biochemistry Meharry Medical College, School of Dentistry, USA
| | - E P Harris
- Department of Oral Diagnostic Sciences & Research in Biochemistry Meharry Medical College, School of Dentistry, USA
- Meharry Community Wellness Center, USA
| | | | - M A Tabatabai
- Department of Biostatistics, School of Graduate Studies and Research, USA
| | - D M Wilus
- School of Graduate Studies and Research, USA
| | - M A Crayton
- Department of Oral Diagnostic Sciences & Research in Biochemistry Meharry Medical College, School of Dentistry, USA
| | - K Moss
- Division of Oral and Craniofacial Health Sciences, University of North Carolina Adams School of Dentistry, USA
| | | | - J H Southerland
- University of Texas Medical Branch at Galveston, Galveston, USA
| | - J R Koethe
- Vanderbilt University Medical Center, USA
| | - P R Gangula
- Department of Oral Diagnostic Sciences & Research in Biochemistry Meharry Medical College, School of Dentistry, USA
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Thayabaranathan T, Baker C, Andrew NE, Stolwyk R, Thrift AG, Carter H, Moss K, Kim J, Wallace SJ, Brogan E, Grimley R, Lannin NA, Rose ML, Cadilhac DA. Exploring dimensions of quality-of-life in survivors of stroke with communication disabilities - a brief report. Top Stroke Rehabil 2022:1-7. [PMID: 35786371 DOI: 10.1080/10749357.2022.2095087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
BACKGROUND People with communication disabilities post-stroke have poor quality-of-life. OBJECTIVES We aimed to explore the association of self-reported communication disabilities with different dimensions of quality-of-life between 90 and 180 days post-stroke. METHODS Cross-sectional survey data were obtained between 90 and 180 days post-stroke from registrants in the Australian Stroke Clinical Registry recruited from three hospitals in Queensland. The usual follow-up survey included the EQ5D-3L. Responses to the Hospital Anxiety and Depression Scale, and extra questions (e.g. communication disabilities) were also collected. We used χ2 statistics to determine differences. RESULTS Overall, 244/647 survivors completed the survey. Respondents with communication disabilities (n = 72) more often reported moderate to extreme problems in all EQ5D-3L dimensions, than those without communication disabilities (n = 172): anxiety or depression (74% vs 40%, p < .001), pain or discomfort (58% vs 39%, p = .006), self-care (46% vs 18%, p < .001), usual activities (77% vs 49%, p < .001), and mobility (68% vs 35%, p < .001). Respondents with communication disabilities reported less fatigue (66% vs 89%, p < .001), poorer cognitive skills (thinking) (16% vs 1%, p < .001) and lower social participation (31% vs 6%, p < .001) than those without communication disabilities. CONCLUSIONS Survivors of stroke with communication disabilities are more negatively impacted across different dimensions of quality-of-life (as reported between 90 and 180 days post-stroke) compared to those without communication disabilities. This highlights the need for timely and on-going comprehensive multidisciplinary person-centered support.
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Affiliation(s)
- T Thayabaranathan
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia.,Centre for Research Excellence in Stroke Rehabilitation, Victoria, Australia.,Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Victoria, Australia
| | - C Baker
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Victoria, Australia.,Speech Pathology Department, Monash Health, Victoria, Australia
| | - N E Andrew
- Centre for Research Excellence in Stroke Rehabilitation, Victoria, Australia.,Peninsula Clinical School, Central Clinical School, Monash University, Victoria, Australia
| | - R Stolwyk
- Centre for Research Excellence in Stroke Rehabilitation, Victoria, Australia.,Turner Institute for Brain and Mental Health, Monash University, Victoria, Australia
| | - A G Thrift
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia
| | - H Carter
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - K Moss
- The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - J Kim
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia.,Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Victoria, Australia.,The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
| | - S J Wallace
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Victoria, Australia.,Queensland Aphasia Research Centre, University of Queensland, Queensland, Australia
| | - E Brogan
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Victoria, Australia.,School of Medical and Health Sciences, Edith Cowan University, Western Australia, Australia.,Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - R Grimley
- Centre for Research Excellence in Stroke Rehabilitation, Victoria, Australia.,School of Medicine, Griffith University, Birtinya, Queensland, Australia
| | - N A Lannin
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Victoria, Australia.,Central Clinical School, Monash University, Victoria, Australia.,Alfred Health, Melbourne, Victoria, Australia
| | - M L Rose
- Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Victoria, Australia.,School of Allied Health, Human Services and Sport, La Trobe University, Victoria, Australia
| | - D A Cadilhac
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Victoria, Australia.,Centre for Research Excellence in Stroke Rehabilitation, Victoria, Australia.,Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Victoria, Australia.,The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, Victoria, Australia
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Moss K, Russell L, Mehta K, Faisal M, Armstrong D, Verdu E, Dowhaniuk J, Pinto-Sanchez MI. A194 THE ADDITION OF DEAMIDATED GLIADIN PEPTIDE TO TISSUE TRANSGLUTAMINASE ANTIBODIES DOES NOT INCREASE THE ODDS OF CELIAC DISEASE DIAGNOSIS IN AN IGA SUFFICIENT POPULATION. J Can Assoc Gastroenterol 2022. [PMCID: PMC8859345 DOI: 10.1093/jcag/gwab049.193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Previous studies proposed that the combination of IgA anti-tissue transglutaminase 2 IgA (TTG) and IgG deamidated gliadin peptide IgG (DGP) antibodies increases celiac disease (CeD) detection rates. However, this remains controversial.
Aims
To evaluate the performance of adding DGP to TTG antibodies, for the diagnosis of celiac disease (CeD) in the immunoglobulin A (IgA)-sufficient population.
Methods
We included consecutive patients with suspected CeD who had both TTG and DGP serology performed simultaneously from 2017–2020 in Hamilton, Canada. Chart review was performed by 3 reviewers to extract data on biopsies, diagnosis of CeD and genetic HLA-DQ2/DQ8. CeD was defined as positive serology (either TTG and/or DGP) and villous atrophy in duodenal biopsies (≥Marsh-3a). A case was defined as an instance of TTG and DGP performed at a single timepoint. A single patient could have represented multiple cases if TTG and DGP were measured at multiple time points. Sensitivity, specificity, negative and positive predictive values were calculated, and ROC curves were generated. Diagnostic odds ratios (DOR) assessed the performance of each serological strategy compared to duodenal biopsies.
Results
There were 580 patients constituting 823 cases that met inclusion criteria, of whom 441 had CeD. IgA-deficient patients (n=100) were excluded. Of the 723 cases remaining, 337 (214 adult;123 pediatric) had serology performed at the time of CeD diagnosis. TTG increased the odds of CeD diagnosis compared with DGP, Diagnostic Odds Ratio (DOR)=53.22 (95% CI 22.63–119.80) vs DOR=21.28 (95% CI 10.67–42.46). The addition of DGP to TTG did not increase the odds of CeD diagnosis [DGP+TTG DOR=51.39 (95% CI 19.36–135.61) vs TTG alone DOR=53.22 (95% CI 22.63–119.80)]. There were 37 discordant cases where only one of either TTG or DGP was positive. HLA-DQ2/DQ8 were absent in 2/9 cases with isolated increased DGP. Among the discordant cases, TTG outperformed DGP (DOR TTG= 4.29; 95% CI 1.09–16.83 vs DOR DGP=0.23; 95% CI 0.06–0.92).
Conclusions
In the IgA-sufficient population, the addition of DGP to TTG testing does not increase the diagnostic accuracy of CeD serologic screening. This has implications in health-care costs as false positive results prompt further investigations. Given these findings, larger prospective studies should be completed prior to adding DGP antibodies to routine TTG serology.
Funding Agencies
None
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Affiliation(s)
- K Moss
- McMaster University Faculty of Health Sciences, Hamilton, ON, Canada
| | - L Russell
- McMaster University Faculty of Health Sciences, Hamilton, ON, Canada
| | - K Mehta
- McMaster University Faculty of Health Sciences, Hamilton, ON, Canada
| | - M Faisal
- McMaster University Faculty of Health Sciences, Hamilton, ON, Canada
| | - D Armstrong
- McMaster University Faculty of Health Sciences, Hamilton, ON, Canada
| | - E Verdu
- McMaster University Faculty of Health Sciences, Hamilton, ON, Canada
| | - J Dowhaniuk
- McMaster University Faculty of Health Sciences, Hamilton, ON, Canada
| | - M I Pinto-Sanchez
- McMaster University Faculty of Health Sciences, Hamilton, ON, Canada
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Marchesan J, Moss K, Morelli T, Teles F, Divaris K, Styner M, Ribeiro A, Webster-Cyriaque J, Beck J. Distinct Microbial Signatures between Periodontal Profile Classes. J Dent Res 2021; 100:1405-1413. [PMID: 33906500 PMCID: PMC8529299 DOI: 10.1177/00220345211009767] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Precise classification of periodontal disease has been the objective of concerted efforts and has led to the introduction of new consensus-based and data-driven classifications. The purpose of this study was to characterize the microbiological signatures of a latent class analysis (LCA)-derived periodontal stratification system, the Periodontal Profile Class (PPC) taxonomy. We used demographic, microbial (subgingival biofilm composition), and immunological data (serum IgG antibody levels, obtained with checkerboard immunoblotting technique) for 1,450 adult participants of the Dental Atherosclerosis Risk in Communities (ARIC) study, with already generated PPC classifications. Analyses relied on t tests and generalized linear models with Bonferroni correction. Men and African Americans had higher systemic antibody levels against most microorganisms compared to women and Caucasians (P < 0.05). Healthy individuals (PPC-I) had low levels of biofilm bacteria and serum IgG levels against most periodontal pathogens (P < 0.05). Subjects with mild to moderate disease (PPC-II to PPC-III) showed mild/moderate colonization of multiple biofilm pathogens. Individuals with severe disease (PPC-IV) had moderate/high levels of biofilm pathogens and antibody levels for orange/red complexes. High gingival index individuals (PPC-V) showed moderate/high levels of biofilm Campylobacter rectus and Aggregatibacter actinomycetemcomitans. Biofilm composition in individuals with reduced periodontium (PPC-VI) was similar to health but showed moderate to high antibody responses. Those with severe tooth loss (PPC-VII) had significantly high levels of multiple biofilm pathogens, while the systemic antibody response to these microorganisms was comparable to health. The results support a biologic basis for elevated risk for periodontal disease in men and African Americans. Periodontally healthy individuals showed a low biofilm pathogen and low systemic antibody burden. In the presence of PPC disease, a microbial-host imbalance characterized by higher microbial biofilm colonization and/or systemic IgG responses was identified. These results support the notion that subgroups identified by the PPC system present distinct microbial profiles and may be useful in designing future precise biological treatment interventions.
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Affiliation(s)
- J.T. Marchesan
- Division of Comprehensive Oral Health, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - K. Moss
- Division of Oral and Craniofacial Health Sciences, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - T. Morelli
- Division of Comprehensive Oral Health, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - F.R. Teles
- Department of Basic and Translational Sciences, University of Pennsylvania, School of Dental Medicine, Philadelphia, PA, USA
| | - K. Divaris
- Division of Pediatric and Public Health, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - M. Styner
- Department of Medicine, Division of Endocrinology and Metabolism, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - A.A. Ribeiro
- Division of Diagnostic Sciences, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - J. Webster-Cyriaque
- Division of Oral and Craniofacial Health Sciences, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - J. Beck
- Division of Comprehensive Oral Health, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Abstract
Abstract
Background
Acute esophageal necrosis (AEN) is a rare entity associated with diabetic ketoacidosis (DKA). The pathogenesis is thought to be linked to low volume state, microvascular disease, impaired gastric and esophageal motility increasing acid reflex, all rendering the esophagus prone to injury.
Aims
We report a case of AEN as a complication of DKA in a patient without any overt gastrointestinal bleeding (GIB), along with a literature review.
Methods
Keywords “esophageal necrosis” and “diabetic ketoacidosis” were used in MEDLINE and BASE to retrieve English articles reporting cases of AEN in DKA.
Results
A 63 year old male with history of hypertension, dyslipidemia and non-insulin dependent diabetes mellitus presented to Emergency with 5 day history of severe epigastric pain, dysphagia to solids and liquids, nausea and vomiting (without any overt GIB). Most recent HbA1c was 8.4%. His diabetes was managed with metformin and semaglutide. Bloodwork revealed a hemoglobin of 165g/L and leukocytes of 17.9x109/L. Chemistries showed an anion gap of 25 with bicarbonate of 5mmol/L. Venous blood gas showed acidemia (pH=7.02). B-hydroxybutyrate level was 10.2mmol/L. Urinalysis was negative for leukocytes or nitrites. An abdominal CT ruled out bowel obstruction or intra-abdominal infection/abscess as the source of his discomfort but demonstrated circumferential wall thickening of the distal esophagus. No other triggers were found for this patient’s DKA except perhaps a recently started ketogenic diet. After resolution of DKA, he continued to experience severe epigastric pain, reflux symptoms, and dysphagia. An esophagogastroduodenoscopy (EGD) was performed, which showed AEN with circumferential black, necrotic inflammatory changes in the mid to distal esophagus. Erosions were seen in the body and antrum of the stomach, and multiple clean based ulcers were seen in the duodenum. Patient was started on an insulin regimen prior to discharge. Review of literature shows a total of 13 cases of AEN in DKA, with only one case where the patient did not present with any clinical bleeding. Risk factors for AEN include, hypertension, diabetes mellitus, malignancy, male gender, older age, chronic kidney disease, alcohol abuse and cardiovascular disease. While no medications have been linked to AEN, our patient was recently started on semiglutide, which has been implicated in impaired gastric emptying and increased GERD symptoms. This may further explain why the patient developed AEN.
Conclusions
AEN is a rare entity, especially in the context of DKA. Usually patients present with overt GIB; however, on occasion dysphagia, nausea, and vomiting can be the predominant symptoms. Hence, the threshold to perform EGD in patients with DKA should be low, given their low volume state and potentially impaired gastrointestinal motility due to microvascular disease or medications, putting them at higher risk for AEN.
Funding Agencies
None
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Affiliation(s)
- T Mahmood
- Medicine, McMaster University Faculty of Health Sciences, Toronto, ON, Canada
| | - K Moss
- Medicine, McMaster University Faculty of Health Sciences, Toronto, ON, Canada
| | - R Spaziani
- Medicine, McMaster University Faculty of Health Sciences, Toronto, ON, Canada
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10
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Hartley A, Hardcastle SA, Paternoster L, McCloskey E, Poole KES, Javaid MK, Aye M, Moss K, Granell R, Gregory J, Williams M, Tobias JH, Gregson CL. Individuals with high bone mass have increased progression of radiographic and clinical features of knee osteoarthritis. Osteoarthritis Cartilage 2020; 28:1180-1190. [PMID: 32417557 DOI: 10.1016/j.joca.2020.03.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 03/16/2020] [Accepted: 03/26/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE High bone mass (HBM) is associated with an increased prevalence of radiographic knee OA (kOA), characterized by osteophytosis. We aimed to determine if progression of radiographic kOA, and its sub-phenotypes, is increased in HBM and whether observed changes are clinically relevant. DESIGN A cohort with and without HBM (L1 and/or total hip bone mineral density Z-score≥+3.2) had knee radiographs collected at baseline and 8-year follow-up. Sub-phenotypes were graded using the OARSI atlas. Medial/lateral tibial/femoral osteophyte and medial/lateral joint space narrowing (JSN) grades were summed and Δosteophytes, ΔJSN derived. Pain, function and stiffness were quantified using the WOMAC questionnaire. Associations between HBM status and sub-phenotype progression were determined using multivariable linear/poisson regression, adjusting for age, sex, height, baseline sub-phenotype grade, menopause, education and total body fat mass (TBFM). Generalized estimating equations accounted for individual-level clustering. RESULTS 169 individuals had repeated radiographs, providing 330 knee images; 63% had HBM, 73% were female, mean (SD) age was 58 (12) years. Whilst HBM was not clearly associated with overall Kellgren-Lawrence measured progression (RR = 1.55 [0.56.4.32]), HBM was positively associated with both Δosteophytes and ΔJSN individually (adjusted mean differences between individuals with and without HBM 0.45 [0.01.0.89] and 0.15 [0.01.0.29], respectively). HBM individuals had higher WOMAC knee pain scores (β = 7.42 [1.17.13.66]), largely explained by adjustment for osteophyte score (58% attenuated) rather than JSN (30% attenuated) or TBFM (16% attenuated). The same pattern was observed for symptomatic stiffness and functional limitation. CONCLUSIONS HBM is associated with osteophyte progression, which appears to contribute to increased reported pain, stiffness and functional loss.
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Affiliation(s)
- A Hartley
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - S A Hardcastle
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Royal National Hospital for Rheumatic Diseases, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - L Paternoster
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - E McCloskey
- Academic Unit of Bone Metabolism, Department of Oncology and Metabolism, The Mellanby Centre for Bone Research, University of Sheffield, Sheffield, UK; Centre for Metabolic Diseases, University of Sheffield Medical School, Sheffield, UK; Centre for Integrated Research Into Musculoskeletal Ageing, University of Sheffield Medical School, Sheffield, UK
| | - K E S Poole
- Cambridge NIHR Biomedical Research Centre and the Wellcome Trust Clinical Research Facility, Cambridge
| | - M K Javaid
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - M Aye
- Department of Diabetes, Endocrinology and Metabolism, Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | - K Moss
- Centre for Rheumatology, St George's Hospital, St George's Healthcare NHS Trust, London, UK
| | - R Granell
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - J Gregory
- Institute of Medical Science, School of Medicine, University of Aberdeen, Aberdeen, UK
| | - M Williams
- Department of Radiology, Southmead Hospital, North Bristol NHS Trust, Bristol UK
| | - J H Tobias
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - C L Gregson
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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11
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Qureshi S, Moss K, Ezeonyeji A, Sandhu V. FRI0448 FOUR CASES OF SYPHILIS MIMICKING RHEUMATOLOGICAL CONDITIONS PRESENTING TO THE GENERAL RHEUMATOLOGY SERVICE AT ST GEORGES HOSPITAL, LONDON, UK IN 2018-2019. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.4270] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Background:Sir William Osler once wrote: “He, who knows syphilis, knows medicine”.Whilst the Tuskegee Syphilis trials live in infamy, the advent of succesful penicillin treatment and sexual health education resulted in the lowest recorded incidence ever in 20011.Unfortunately, cases of syphilis have nearly tripled in the past decade (from 2,847 in 2009 to 7,541 in 2018 in the UK)1. WHO now estimates the global median prevalence of Syphilis, among men who have sex with men, is 6%2The current cohort of clinicians will therefore have limited clinical experience of Syphilis, which can often mimic rheumatic conditions. We present the clinical experience of a tertiary teaching centre hospital.Objectives:To identify the scope of clinical cases, with a diagnosis of Syphilis, during 2018-2019 at St Georges University Hospital, London, UK.Methods:Clinical cases were identified by health professionals and a retrospective review of medical records was undertaken.Results:There were 4 cases identified during 2018-19.PatientAgeSexPast Medical HistorySymptomatologyRisk FactorsPresumed DiagnosisSerology169MaleHypertensionGCABilateral visual loss, rashMSMPrednisoloneTocilizumabGCA-related visual lossRPR 1:64TPPA 1: 10248246FemaleNilJoint pain and swelling, rashHepatitis B Core Antibody positiveUndifferentiatedInflammatory ArthritisRPR 1: 16340MaleNilJoint pain, alopecia, uveitis and rash, weight lossMSMPrimary SyphilisRPR 1: 16TPPA 1: 10248486FemalePulmonary Sarcoidosis, Squamous cell carcinoma of left maxillary sinusLower motor neuron facial nerve palsyPrednisoloneSarcoidosisRPR 1:4TPPA 1:80GCA: Giant cell arteritis, MSM: Men who have sex with men, RPR: rapid plasma regain, TPPA: Treponema pallidum particle agglutination assayCase 1:The patient was diagnosed with bilateral uveitis secondary to primary syphilis, and immunosuppression may have contributed to this.Case 2:The rash developed after the initial presentation and an extended infection screen was performed.Case 3:The patient had a 6 month duration of symptoms and had had a negative sexual health screen 1 year prior to presentation.Case 4:The patient had no features of extra pulmonary sarcoidosis and an infectious screen was undertaken.All 4 cases were referred to the Infectious Disease Unit for treatment. 3 patients received standard treatment with Penicillin, and 1 patient received an oral course of Doxycycline, due to a penicillin allergy.2 of the 4 cases had complete resolution of symptoms, and 2 of the cases had only partial resolution of symptoms at the time of publication.Conclusion:Syphilis can present with an inflammatory arthritis, PMR and GCA –type symptoms, ocular inflammation, neurological disturbance and rashes that can mimic autoimmune conditions.Our cases highlight the increasing incidence, as well as the risk of reactivation following immunosuppression. Current practice does not advise routine testing for syphilis prior to initiation of immunosuppressive therapy. However the rising incidence should prompt careful evaluation, and detailed sexual history, particularly in high risk groups. The diagnostic test interpretation and treatment requires close collaboration with Infectious Diseases Specialists.References:[1]https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/805903/2018_Table_1_STI_diagnoses_and_rates_in_England_by_gender.ods[2]Report on global sexually transmitted infection surveillance 2018, WHO, ISBN: 978-92-4-156569-1Disclosure of Interests:None declared
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12
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Murugan N, Sagong C, Cuamatzi Castelan AS, Moss K, Roth T, Drake CL, Cheng P. 0203 To and From the Night Shift: Risky On-the-Road Driving in Night Shift Workers. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Drowsy driving is a common occupational hazard for night shift workers (NSWs). While sleep loss is commonly identified as the primary culprit of drowsy driving, another critical factor to consider is circadian phase. However, the role of circadian phase in driving safety has not been well characterized in NSWs. This study examined if dim light melatonin offset (DLMOff, i.e. the cessation of melatonin secretion) is also a relevant phase marker of susceptibility to four different subtypes of risky on-the-road driving behaviors.
Methods
On-the-road driving was monitored over 8 weeks via a mobile application that tracked risky driving behaviors using accelerometer and GPS data from cell phones (N=15; 3052 total driving events recorded). Risky driving behaviors included: 1) frequency of hard-braking events, 2) frequency of aggressive-acceleration events, 3) duration of excessive-speeding, and 4) duration of phone-usage. At week 2, participants spent 24 hours in-lab where hourly saliva samples were collected and assayed for melatonin, and DLMOff was calculated. Phase angle of driving events relative to DLMOff was used as the predictor in nested mixed-effects regressions, with risky driving behaviors as the outcome variables.
Results
The most common occurrences of risky driving were phone-usage and hard-braking. On average, NSWs had 46.7% and 42.0% of driving events with at least one occurrence of phone-usage and hard-braking, respectively. Rates of aggressive-acceleration and speeding were 24.4% and 20.4%. Positive phase angles (i.e. driving after DLMOff) were associated with reduced rates of hard-braking and aggressive-acceleration, but not of phone-usage and excessive-speeding. Specifically, rates of hard-braking and aggressive-acceleration decreased by 4.5% (p<.01) and 3.4% (p=.05) every two hours following DLMOff, respectively.
Conclusion
The study suggests DLMOff appears to be an important variable for predicting accident risk in NSWs. If replicated, circadian phase should be considered in recommendations to increase occupational health and safety of NSWs.
Support
Support for this study was provided to PC by NHLBI (K23HL138166).
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Affiliation(s)
- N Murugan
- Henry Ford Health System, Detroit, MI
| | - C Sagong
- Henry Ford Health System, Detroit, MI
| | | | - K Moss
- Henry Ford Health System, Detroit, MI
| | - T Roth
- Henry Ford Health System, Detroit, MI
| | - C L Drake
- Henry Ford Health System, Detroit, MI
| | - P Cheng
- Henry Ford Health System, Detroit, MI
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13
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Marchesan JT, Byrd KM, Moss K, Preisser JS, Morelli T, Zandona AF, Jiao Y, Beck J. Flossing Is Associated with Improved Oral Health in Older Adults. J Dent Res 2020; 99:1047-1053. [PMID: 32321349 DOI: 10.1177/0022034520916151] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
The effect of preventive oral habits is largely unexplored in older individuals. The purpose of this study was to evaluate the associations between home use of flossing and prevalence of periodontal disease and caries in older adults. Five-year incident tooth loss was also evaluated. Data on 686 individuals ≥65 y-old from the Piedmont 65+ Dental Study were examined including: 1) interproximal clinical attachment level (iCAL), 2) interproximal probing depth (iPD), 3) numbers of caries, and 4) missing teeth. Flossing behavior was evaluated according to the Periodontal Profile Class (PPC) system. Five-year follow-up data (n = 375) was evaluated for incident tooth loss. Dichotomous and categorical variables were analyzed using Pearson chi-square tests as well as covariate-adjusted Cochran-Mantel-Haenszel tests. Multiple linear regression compared clinical parameters based on flossing behavior. Elderly flossers had lower (mean, SE) %iCAL≥3 mm (38.2, 2.38 vs. 48.8, 1.56) and %iPD≥4 mm (8.70, 1.41 vs. 14.4, 0.93) compared to nonflossers (P ≤ 0.005). Flossers showed less coronal caries compared to nonflossers (P = 0.02). Baseline number of missing teeth (mean, SE) was 11.5 (0.35) in nonflossers compared to 8.6 (0.53) in flossers (P < 0.0001). Regular dental visitors had lower oral disease levels compared to episodic dental users. The majority of flossers classified into PPC-Stage I (health) whereas nonflossers classified as PPC-Stages V, VI, and VII (disease). At the 5-y follow-up visit, the average tooth loss for flossers was ~1 tooth compared to ~4 teeth lost for nonflossers (P < 0.0001). Among all teeth, molars showed the highest benefit (>40%) for flossing behavior (P = 0.0005). In conclusion, the extent of oral disease for older individuals was significantly less in flossers than in nonflossers. Flossers showed less periodontal disease, fewer dental caries, and loss of fewer teeth over a 5-y period. These findings further support flossing as an important oral hygiene behavior to prevent oral disease progression in older adults.
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Affiliation(s)
- J T Marchesan
- Department of Comprehensive Oral Health, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - K M Byrd
- Department of Oral and Craniofacial Health Sciences, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - K Moss
- Department of Oral and Craniofacial Health Sciences, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - J S Preisser
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - T Morelli
- Department of Comprehensive Oral Health, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - A F Zandona
- Department of Comprehensive Care, School of Dental Medicine, Tufts University, Boston, MA, USA
| | - Y Jiao
- Department of Comprehensive Oral Health, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - J Beck
- Department of Comprehensive Oral Health, Adams School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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14
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Abstract
BACKGROUND There is conflicting and equivocal evidence for the efficacy of compulsory community treatment within Australia and overseas, but no study from Queensland. In addition, although people from Indigenous or culturally and linguistically diverse backgrounds are over-represented in compulsory admissions to hospital, little is known about whether this also applies to compulsory community treatment. AIMS We initially investigated whether people from Indigenous or culturally and linguistically diverse backgrounds in terms of country of birth, or preferred language, were more likely to be on compulsory community treatment using statewide databases from Queensland. We then assessed the impact of compulsory community treatment on health service use over the following 12 months. Compulsory community treatment included both community treatment orders and forensic orders. METHODS Cases and controls from administrative health data were matched on age, sex, diagnosis and time of hospital discharge (the index date). Multivariate analyses were used to examine potential predictors of compulsory community treatment, as well as impact on bed-days, time to readmission or contacts with public mental health services in the subsequent year. RESULTS We identified 7432 cases and controls from January 2013 to February 2017 (total n = 14,864). Compulsory community treatment was more likely in Indigenous Queenslanders (adjusted odds ratio = 1.45; 95% confidence interval = [1.28, 1.65]) subjects coming from a culturally and linguistically diverse background (adjusted odds ratio = 1.54; 95% confidence interval = [1.37, 1.72]), or those who had a preferred language other than English (adjusted odds ratio = 1.66; 95% confidence interval = [1.30, 2.11]). While community contacts were significantly greater in patients on compulsory community treatment, there was no difference in bed-days while time to readmission was shorter. Restricting the analyses to just community treatment orders did not alter these results. CONCLUSION In common with other coercive treatments, Indigenous Australians and people from culturally and linguistically diverse backgrounds are more likely to be placed on compulsory community treatment. The evidence for effectiveness remains inconclusive.
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Affiliation(s)
- Steve Kisely
- School of Medicine, The University of Queensland and Princess Alexandra Hospital, Woolloongabba, QLD, Australia.,Metro South Health Service, Woolloongabba, QLD, Australia.,Griffith Criminology Institute (GCI), Griffith University, Mount Gravatt, QLD, Australia.,Departments of Psychiatry, and Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - Katherine Moss
- School of Medicine, The University of Queensland and Princess Alexandra Hospital, Woolloongabba, QLD, Australia.,Metro South Health Service, Woolloongabba, QLD, Australia
| | - Melinda Boyd
- School of Medicine, The University of Queensland and Princess Alexandra Hospital, Woolloongabba, QLD, Australia.,Metro South Health Service, Woolloongabba, QLD, Australia
| | - Dan Siskind
- School of Medicine, The University of Queensland and Princess Alexandra Hospital, Woolloongabba, QLD, Australia.,Metro South Health Service, Woolloongabba, QLD, Australia
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15
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Moss K, Wyder M, Braddock V, Arroyo D, Kisely S. Compulsory community treatment and ethnicity: Findings from a culturally and linguistically diverse area of Queensland. Int J Law Psychiatry 2019; 62:154-159. [PMID: 30274852 DOI: 10.1016/j.ijlp.2018.09.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 08/31/2018] [Accepted: 09/19/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To compare the use of community treatment orders (CTOs) and forensic orders (FOs) in a culturally and linguistically diverse (CALD) population to that in a non-CALD population. METHODS We analysed the relationship between coming from a CALD background and the use of CTOs and FOs on discharge from hospital using merged data from the Metro South Addiction and Mental Health Service's Transitions of Care (ToC) and Consumer Integrated Mental Health Application (CIMHA) databases. RESULTS Nine hundred and seventy-six individual records were included in the data set, of whom eighty-six were from a CALD background (8.8%). Three hundred and eleven patients were on compulsory community treatment. Use of compulsory community treatment (CTOs and FOs) was similar for those born in Australasia, British Isles, North America and Europe but significantly higher for those born elsewhere even after adjusting for socio-demographic and clinical variables (Adj OR 2.19, 95% CI 1.36-3.52). The use of an interpreter significantly increased the likelihood of compulsory community treatment (Adj OR 2.76, 95% CI 1.20-6.35). Restricting the analyses to CTOs only did not alter these results. CONCLUSIONS Metro South residents from a CALD background outside of Europe were over-represented on compulsory community treatment orders. This could reflect the difficulties in accessing voluntary services, communication barriers, stigma associated with mental illness, discrimination, or issues related to accurately diagnosing mental illness cross-culturally. Clinicians need to be aware of the complexity of working with people from diverse cultures and apply these orders judiciously.
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Affiliation(s)
- Katherine Moss
- Metro South Addiction and Mental Health Services, University of Queensland, Brisbane, QLD, Australia; School of Medicine, University of Queensland, Brisbane, QLD, Australia.
| | - Marianne Wyder
- Metro South Addiction and Mental Health Services, University of Queensland, Brisbane, QLD, Australia
| | - Vivienne Braddock
- Metro South Addiction and Mental Health Services, University of Queensland, Brisbane, QLD, Australia
| | - David Arroyo
- School of Medicine, University of Queensland, Brisbane, QLD, Australia
| | - Steve Kisely
- Metro South Addiction and Mental Health Services, University of Queensland, Brisbane, QLD, Australia; School of Medicine, University of Queensland, Brisbane, QLD, Australia
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16
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Moss K, Douglas S, Daly B, Lipson A, Blackstone E. END OF LIFE AND QUALITY OF LIFE IN OLDER ADULTS WITH ADVANCED CANCER: A QUALITATIVE ANALYSIS WITH CAREGIVERS. Innov Aging 2018. [DOI: 10.1093/geroni/igy023.2601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- K Moss
- Case Western Reserve University
| | | | - B Daly
- Case Western Reserve University
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17
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Yu YH, Doucette-Stamm L, Rogus J, Moss K, Zee RYL, Steffensen B, Ridker PM, Buring JE, Offenbacher S, Kornman K, Chasman DI. Family History of MI, Smoking, and Risk of Periodontal Disease. J Dent Res 2018; 97:1106-1113. [PMID: 29928831 DOI: 10.1177/0022034518782189] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Periodontal disease (PD) shares common risk factors with cardiovascular disease. Our hypothesis was that having a family history of myocardial infarction (FamHxMI) may be a novel risk factor for PD. Risk assessment based on FamHxMI, conditional on smoking status, was examined given the strong influence of smoking on PD. Exploratory analysis with inflammatory biomarkers and genetic determinants was conducted to understand potential mechanistic links. The Women's Genome Health Study (WGHS) is a prospective cohort of US female health care professionals who provided blood samples at baseline in the Women's Health Study, a 2 × 2 factorial clinical trial investigating vitamin E and aspirin in the prevention of cardiovascular disease and cancer. PD was ascertained via self-report over 12 y of follow-up. Prevalence (3,442 cases), incidence (1,365 cases), and survival analysis of PD were investigated for associations of FamHxMI as well as in strata of FamHxMI by smoking. Kruskal-Wallis, chi-square tests, multivariate regression, and Cox proportional hazard models were used for the analyses. In the WGHS, women with FamHxMI showed higher risk of ever having PD. A particularly high-risk group of having both FamHxMI and smoking at baseline was highlighted in the prevalence and risk of developing PD. PD risk increased according to the following strata: no FamHxMI and nonsmokers (reference), FamHxMI and nonsmokers (hazard ratio [HR] = 1.2, 95% CI = 1.0 to 1.5), smokers without FamHxMI (HR = 1.3, 95% CI = 1.2 to 1.5), and smokers with FamHxMI (HR = 1.5, 95% CI = 1.2 to 1.8). An independent analysis by the dental Atherosclerosis Risk in Communities study ( N = 5,552) identified more severe periodontitis cases among participants in the high-risk group (smokers with FamHxMI). Further examination of interactions among inflammatory biomarkers or genetic exploration with FamHxMI did not explain the risk increase of PD associated with FamHxMI in the WGHS. Future efforts based on an integrative-omics approach may facilitate validation of these findings and suggest a mechanistic link between PD and FamHxMI.
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Affiliation(s)
- Y H Yu
- 1 Department of Periodontology, School of Dental Medicine, Tufts University, Boston, MA, USA.,2 Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | | | - J Rogus
- 3 Interleukin Genetics, Waltham, MA, USA
| | - K Moss
- 4 Department of Periodontology, University of North Carolina, Chapel Hill, NC, USA
| | - R Y L Zee
- 2 Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.,5 Department of Pediatric Dentistry, School of Dental Medicine, Tufts University, Boston, MA, USA
| | - B Steffensen
- 1 Department of Periodontology, School of Dental Medicine, Tufts University, Boston, MA, USA
| | - P M Ridker
- 2 Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - J E Buring
- 2 Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - S Offenbacher
- 4 Department of Periodontology, University of North Carolina, Chapel Hill, NC, USA
| | - K Kornman
- 3 Interleukin Genetics, Waltham, MA, USA
| | - D I Chasman
- 2 Division of Preventive Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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18
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Tallent G, Cheng P, Fellman-Couture C, Tonnu C, Moss K, Arnedt T, Drake C. 0397 Impact of Behavioral Insomnia Treatments on Quality of Life in Post-Menopausal Women. Sleep 2018. [DOI: 10.1093/sleep/zsy061.396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - P Cheng
- Henry Ford Health Systems, Novi, MI
| | | | - C Tonnu
- Henry Ford Health Systems, Novi, MI
| | - K Moss
- Henry Ford Health Systems, Novi, MI
| | - T Arnedt
- University of Michigan, Ann Arbor, MI
| | - C Drake
- Henry Ford Health Systems, Novi, MI
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19
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Marchesan JT, Morelli T, Moss K, Preisser JS, Zandona AF, Offenbacher S, Beck J. Interdental Cleaning Is Associated with Decreased Oral Disease Prevalence. J Dent Res 2018; 97:773-778. [PMID: 29481764 DOI: 10.1177/0022034518759915] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
The purpose of this study was to evaluate the associations between interdental cleaning behavior and the prevalence of caries and periodontal disease and numbers of missing teeth, with data from the National Health and Nutrition Examination Survey (2011 to 2012 and 2013 to 2014). Analysis included the following parameters: interproximal clinical attachment level (iCAL) ≥3 mm, interproximal probing depth (iPD) ≥4 mm, number of coronal and interproximal caries, number of missing teeth, ≥1 surfaces with coronal caries, and periodontal profile classes (PPCs). Chi-square was used for bivariate associations. Associations of interdental cleaning with outcomes were assessed with multiple linear regression and generalized logit regression, adjusting for age, race, sex, diabetes, smoking, education, dental visits, and sugar consumption. Nonusers had a significantly higher percentage of sites with iCAL ≥3 mm and iPD ≥4 mm as compared with individuals who used interdental cleaning devices ( P < 0.0001). Individuals with a higher frequency of cleaning (4 to 7×/wk) had a significantly lower extent of sites with iCAL ≥3 mm as compared with lower-frequency cleaning (1 to 3×/wk; P ≤ 0.05). Interdental cleaning users showed lower numbers of coronal caries, interproximal coronal caries, and missing teeth as compared with nonusers ( P < 0.0001). Nonusers had 1.73-times (95% confidence interval, 1.53 to 1.94) higher odds for having ≥1 surfaces of coronal caries as compared with interdental cleaning users, regardless of the weekly frequency. Individuals were less likely to be in diseased PPCs if they were interdental cleaning users. Low-frequency cleaners (1 to 3×/wk) had significantly greater odds (1.43; 95% confidence interval, 1.08 to 1.88) to have severe disease (PPC-G) versus health (PPC-A) than were high-frequency cleaners (4 to 7×/wk). Interdental cleaning users showed lower levels of periodontal disease and caries and lower numbers of missing teeth. Higher frequency of interdental cleaning was correlated with increased periodontal health. Individuals with severe periodontal disease could show additional oral health benefits by increasing cleaning frequency. The data support the use of interdental cleaning devices as an oral hygiene behavior for promoting health.
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Affiliation(s)
- J T Marchesan
- 1 Department of Periodontology, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,2 Center for Oral and Systemic Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - T Morelli
- 1 Department of Periodontology, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,2 Center for Oral and Systemic Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - K Moss
- 2 Center for Oral and Systemic Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,3 Department of Oral and Craniofacial Health Sciences, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - J S Preisser
- 2 Center for Oral and Systemic Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,4 Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - A F Zandona
- 5 Department of Operative Dentistry, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - S Offenbacher
- 1 Department of Periodontology, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,2 Center for Oral and Systemic Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - J Beck
- 2 Center for Oral and Systemic Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,6 Department of Dental Ecology, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Abstract
OBJECTIVES To examine compliance with routine metabolic monitoring at four rehabilitation facilities within the Metro South Addiction and Mental Health Services in Queensland. METHODS A retrospective chart audit was undertaken on 63 residents of rehabilitation facilities with electronic health records from 1 October 2014 to 30 March 2015. RESULTS Evidence of any metabolic monitoring was recorded for 87% of residents. Compliance rates differed for monitoring waist circumference (97%), blood pressure (97%), high-density lipoprotein (79%), triglycerides (81%) and plasma glucose (83%). Evidence of communication with residents and primary healthcare providers were each found in 41% of the sample. CONCLUSIONS In current clinical practice, metabolic monitoring is high for residents of rehabilitation facilities in Queensland with serious mental illness. However, many residents do not receive adequate communication regarding their results and, disturbingly, results are not forwarded to their primary healthcare providers. This can result in people not receiving treatment for modifiable factors of metabolic syndrome.
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Affiliation(s)
- Catherine Benson
- Registrar, Psychiatry, Metro South Addiction and Mental Health Services, Brisbane, QLD, Australia
| | - Steve Kisely
- Professor, Psychiatry, Metro South Addiction and Mental Health Services; University of Queensland, Brisbane, QLD, Australia
| | - Nicole Korman
- Consultant, Psychiatry, Rehabilitation Academic and Clinical Unit, Metro South Addiction and Mental Health Services, Brisbane, QLD, Australia
| | - Katherine Moss
- Registrar, Psychiatry, Metro South Addiction and Mental Health Services; University of Queensland, Brisbane, QLD, Australia
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Affiliation(s)
- K. Moss
- Case Western Reserve University, Cleveland, Ohio,
| | - N. Deutsch
- University of Virginia, Charlottesville, Virginia,
| | - P. Hollen
- University of Virginia, Charlottesville, Virginia,
| | - K. Rose
- University of Tennessee Knoxville, Knoxville, Tennessee
| | - V. Rovnyak
- University of Virginia, Charlottesville, Virginia,
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Doecke JD, Hartnell F, Bampton P, Bell S, Mahy G, Grover Z, Lewindon P, Jones LV, Sewell K, Krishnaprasad K, Prosser R, Marr D, Fischer J, R Thomas G, Tehan JV, Ding NS, Cooke SE, Moss K, Sechi A, De Cruz P, Grafton R, Connor SJ, Lawrance IC, Gearry RB, Andrews JM, Radford-Smith GL. Infliximab vs. adalimumab in Crohn's disease: results from 327 patients in an Australian and New Zealand observational cohort study. Aliment Pharmacol Ther 2017; 45:542-552. [PMID: 27995633 DOI: 10.1111/apt.13880] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 06/19/2016] [Accepted: 11/06/2016] [Indexed: 12/14/2022]
Abstract
BACKGROUND Maintenance anti-tumour necrosis factor-α (anti-TNFα) treatment for Crohn's disease is the standard of care for patients with an inadequate response to corticosteroids and immunomodulators. AIM To compare the efficacy and safety of infliximab and adalimumab in clinical practice and assess the value of concomitant immunomodulator therapy. METHODS We performed an observational cohort study in consecutive patients with Crohn's disease qualifying for anti-TNFα treatment in Australia and New Zealand between 2007 and 2011. Demographic and clinical data were prospectively recorded to identify independent factors associated with induction and maintenance of response to infliximab or adalimumab, or to either anti-TNFα therapy. RESULTS Three hundred and twenty-seven patients (183 infliximab, 144 adalimumab) successfully applied for treatment. Eighty-nine percent responded in all groups and median maintenance of response was similar for the two agents. Concomitant immunomodulator with infliximab, but not adalimumab, demonstrated a significantly longer response overall (P = 0.002), and significantly fewer disease and treatment-related complications (P = 0.017). Corticosteroids at baseline, and/or in the preceding 12 months, were associated with a 9-13 times greater risk of disease flare during maintenance treatment as compared to no corticosteroids (P < 0.0001). Maintenance of response was similar in the anti-TNF naïve and anti-TNF experienced subgroups. CONCLUSIONS In this large, real-life study, we demonstrate infliximab and adalimumab to have similar response characteristics. However, infliximab requires concomitant immunomodulator to achieve optimal maintenance of response comparable to adalimumab monotherapy. The results of this study will assist clinicians in further optimising patient care in their day-to-day clinical practice.
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Affiliation(s)
- J D Doecke
- Parkville, Vic., Australia.,Brisbane, Qld, Australia
| | | | | | - S Bell
- Melbourne, Vic., Australia
| | - G Mahy
- Townsville, Qld, Australia
| | | | | | | | | | | | | | | | | | | | | | | | | | - K Moss
- Bedford Park, SA, Australia
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23
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Furquim CP, Soares GMS, Ribeiro LL, Azcarate-Peril MA, Butz N, Roach J, Moss K, Bonfim C, Torres-Pereira CC, Teles FRF. The Salivary Microbiome and Oral Cancer Risk: a Pilot Study in Fanconi Anemia. J Dent Res 2016; 96:292-299. [PMID: 27827319 DOI: 10.1177/0022034516678169] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Fanconi anemia (FA) is a rare genetic disease characterized by chromosomal instability and impaired DNA damage repair. FA patients develop oral squamous cell carcinoma (OSCC) earlier and more frequently than the general population, especially after hematopoietic stem cell transplantation (HSCT). Although evidence of an etiological role of the local microbiome and carcinogenesis has been mounting, no information exists regarding the oral microbiome of FA patients. The aim of this study was to explore the salivary microbiome of 61 FA patients regarding their oral health status and OSCC risk factors. After answering a questionnaire and receiving clinical examination, saliva samples were collected and analyzed using 16S rRNA sequencing of the V3-V4 hypervariable region. The microbial profiles associated with medical and clinical parameters were analyzed using general linear models. Patients were young (mean age, 22 y) and most had received HSCT ( n = 53). The most abundant phyla were Firmicutes [mean relative abundance (SD), 42.1% (10.1%)] and Bacteroidetes [(25.4% (11.4%)]. A history of graft-versus-host disease (GVHD) ( n = 27) was associated with higher proportions of Firmicutes (43.8% × 38.5%, P = 0.05). High levels of gingival bleeding were associated with the genera Prevotella (22.25% × 20%), Streptococcus (19.83% × 17.61%), Porphyromonas (3.63% × 1.42%, P = 0.03), Treponema (1.02% × 0.28%, P = 0.009), Parvimonas (0.28% × 0.07%, P = 0.02) and Dialister (0.27% × 0.10%, P = 0.04). Finally, participants transplanted over 11 y ago showed the highest levels of Streptococcus (18.4%), Haemophilus (12.7%) and Neisseria (6.8%). In conclusion, FA patients that showed poor oral hygiene harbored higher proportions of the genera of bacteria compatible with gingival disease. Specific microbial differences were associated with a history of oral GVHD and a history of oral mucositis.
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Affiliation(s)
- C P Furquim
- 1 Graduate Program in Dentistry, Federal University of Paraná, Curitiba, PR, Brazil
| | - G M S Soares
- 2 Department of Stomatology, Federal University of Paraná, Curitiba, PR, Brazil
| | - L L Ribeiro
- 3 Bone Marrow Transplantation Unit, Hospital de Clínicas, Federal University of Paraná, Curitiba, PR, Brazil
| | - M A Azcarate-Peril
- 4 Department of Cell Biology and Physiology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - N Butz
- 4 Department of Cell Biology and Physiology, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - J Roach
- 5 Department of Research Computing, University of North Carolina, Chapel Hill, NC, USA
| | - K Moss
- 6 Department of Dental Ecology, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - C Bonfim
- 3 Bone Marrow Transplantation Unit, Hospital de Clínicas, Federal University of Paraná, Curitiba, PR, Brazil
| | - C C Torres-Pereira
- 2 Department of Stomatology, Federal University of Paraná, Curitiba, PR, Brazil
| | - F R F Teles
- 7 Department of Periodontology, University of North Carolina at Chapel Hill, School of Dentistry, Chapel Hill, NC, USA
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Abstract
In a previous report, we demonstrated the inverse association of high serum 8-isoprostane levels, a marker for oxidative stress, with decreased serum IgG antibodies to oral bacteria. The association between increased serum IgG with increased plaque and periodontitis (increased probing depths) was attenuated by high systemic oxidative stress. Other investigations have reported a role for systemic oxidative stress as a stimulus of hepatic C-reactive protein (CRP) response. These observations led us to hypothesize that the reported relationship of periodontitis to elevated serum CRP, a systemic inflammatory marker, may be modified by oxidative stress and that the levels of serum antibodies to oral bacteria might be an intermediary explanatory variable linking the association of systemic oxidative stress, periodontal disease, and levels of CRP. This hypothesis was explored as a secondary analysis of the Dental ARIC (Atherosclerosis Risk in Communities) study using serum levels of CRP, serum IgG levels to 16 oral organisms, serum levels of 8-isoprostane, and periodontal status. The findings indicate periodontitis is associated with high CRP in the presence of elevated oxidative stress that serves to suppress the IgG response. Only within the highest 8-isoprostane quartile was periodontitis (pocket depth) associated with increased serum CRP levels (P = 0.0003). Increased serum IgG antibody levels to oral bacteria were associated with lowered serum CRP levels. Thus, systemic oxidative stress, which has been demonstrated to be associated with increased levels of CRP in other studies, appears to be associated with the suppression of bacterial-specific IgG levels, which in the presence of periodontal disease can result in an enhanced systemic CRP response. Conversely, individuals with increased serum IgG antibodies to plaque bacteria exhibit lowered serum CRP levels. These 2 factors, oxidative stress and the serum IgG response, appear to function in opposing directions to modify serum levels of CRP and the association with periodontitis.
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Affiliation(s)
- R E Singer
- Center for Oral and Systemic Diseases and Department of Periodontology, University of North Carolina at Chapel Hill, School of Dentistry, Chapel Hill, NC, USA
| | - K Moss
- Center for Oral and Systemic Diseases and Department of Dental Ecology, University of North Carolina at Chapel Hill, School of Dentistry, Chapel Hill, NC, USA
| | - S J Kim
- Center for Oral and Systemic Diseases and Department of Periodontology, University of North Carolina at Chapel Hill, School of Dentistry, Chapel Hill, NC, USA
| | - J D Beck
- Center for Oral and Systemic Diseases and Department of Dental Ecology, University of North Carolina at Chapel Hill, School of Dentistry, Chapel Hill, NC, USA
| | - S Offenbacher
- Center for Oral and Systemic Diseases and Department of Periodontology, University of North Carolina at Chapel Hill, School of Dentistry, Chapel Hill, NC, USA
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Marchesan J, Morelli T, Moss K, Barros S, Ward M, Jenkins W, Aspiras M, Offenbacher S. Association of Synergistetes and Cyclodipeptides with Periodontitis. J Dent Res 2015. [DOI: 10.1177/0022034515594779] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
The purpose of this study was to evaluate the microbial community (MC) composition as it relates to salivary metabolites and periodontal clinical parameters in a 21-d biofilm-overgrowth model. Subjects ( N = 168) were enrolled equally into 5 categories of periodontal status per the biofilm-gingival interface classification. Microbial species within subgingival plaque samples were identified by human microbiome identification microarray. Whole saliva was analyzed by liquid chromatography–mass spectrometry and gas chromatography–mass spectrometry for metabolite identification. Phylum was grouped into MCs according to principal component analysis. Generalized linear and regression models were used to examine the association among MC, species, periodontal clinical parameters, and salivary metabolome. Multiple comparisons were adjusted with the false discovery rate. The study population was distributed into 8 distinct MC profiles, designated MC-1 to MC-8. MC-2 explained 14% of the variance and was dominated by Synergistetes and Spirochaetes. It was the only community structure significantly associated with high probing depth ( P = 0.02) and high bleeding on probing ( P = 0.008). MC-2 was correlated with traditional periodontal pathogens and several newly identified putative periodontal pathogens: Fretibacterium fastidiosum, Fretibacterium sp. OT360/OT362, Filifactor alocis, Treponema lecithinolyticum, Eubacterium saphenum, Desulfobulbus sp. /OT041, and Mogibacterium timidum. Synergistetes phylum was strongly associated with 2 novel metabolites—cyclo (-leu-pro) and cyclo (-phe-pro)—at 21 d of biofilm overgrowth ( P = 0.02). In subjects with severe periodontitis (P2 and P3), cyclo (-leu-pro) and cyclo (-phe-pro) were significantly associated with increased changes in probing depth at 21 d of biofilm overgrowth ( P ≤ 0.05). The analysis identified a MC dominated by Synergistetes, with classic and putative newly identified pathogens/pathobionts associated with clinical disease. The metabolomic discovery of 2 novel cyclodipeptides that have been reported to serve as quorum-sensing and/or bacteriocidal/bacteriostatic molecules, in association with Synergistetes, suggests a potential role in periodontal biofilm dysbiosis and periodontal disease that warrants further investigation.
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Affiliation(s)
- J.T. Marchesan
- Center for Oral and Systemic Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Periodontology, School of Dentistry, University of North Carolina at Chapel hill, Chapel Hill, NC, USA
| | - T. Morelli
- Center for Oral and Systemic Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Periodontology, School of Dentistry, University of North Carolina at Chapel hill, Chapel Hill, NC, USA
| | - K. Moss
- Department of Dental Ecology, School of Dentistry, University of North Carolina at Chapel hill, Chapel Hill, NC, USA
| | - S.P. Barros
- Center for Oral and Systemic Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Periodontology, School of Dentistry, University of North Carolina at Chapel hill, Chapel Hill, NC, USA
| | - M. Ward
- Philips Oral Healthcare, Dental & Scientific Affairs, Bothell, WA, USA
| | - W. Jenkins
- Philips Oral Healthcare, Dental & Scientific Affairs, Bothell, WA, USA
| | | | - S. Offenbacher
- Center for Oral and Systemic Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Periodontology, School of Dentistry, University of North Carolina at Chapel hill, Chapel Hill, NC, USA
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Ahmed T, Yalakki L, Moss K. AB0396 Smoking Prevalence in an Established Cohort of Rheumatoid Arthritis Patients in a Large Uk Teaching Hospital. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.1090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Rhodin K, Divaris K, North KE, Barros SP, Moss K, Beck JD, Offenbacher S. Chronic periodontitis genome-wide association studies: gene-centric and gene set enrichment analyses. J Dent Res 2014; 93:882-90. [PMID: 25056994 DOI: 10.1177/0022034514544506] [Citation(s) in RCA: 80] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Recent genome-wide association studies (GWAS) of chronic periodontitis (CP) offer rich data sources for the investigation of candidate genes, functional elements, and pathways. We used GWAS data of CP (n = 4,504) and periodontal pathogen colonization (n = 1,020) from a cohort of adult Americans of European descent participating in the Atherosclerosis Risk in Communities study and employed a MAGENTA approach (i.e., meta-analysis gene set enrichment of variant associations) to obtain gene-centric and gene set association results corrected for gene size, number of single-nucleotide polymorphisms, and local linkage disequilibrium characteristics based on the human genome build 18 (National Center for Biotechnology Information build 36). We used the Gene Ontology, Ingenuity, KEGG, Panther, Reactome, and Biocarta databases for gene set enrichment analyses. Six genes showed evidence of statistically significant association: 4 with severe CP (NIN, p = 1.6 × 10(-7); ABHD12B, p = 3.6 × 10(-7); WHAMM, p = 1.7 × 10(-6); AP3B2, p = 2.2 × 10(-6)) and 2 with high periodontal pathogen colonization (red complex-KCNK1, p = 3.4 × 10(-7); Porphyromonas gingivalis-DAB2IP, p = 1.0 × 10(-6)). Top-ranked genes for moderate CP were HGD (p = 1.4 × 10(-5)), ZNF675 (p = 1.5 × 10(-5)), TNFRSF10C (p = 2.0 × 10(-5)), and EMR1 (p = 2.0 × 10(-5)). Loci containing NIN, EMR1, KCNK1, and DAB2IP had showed suggestive evidence of association in the earlier single-nucleotide polymorphism-based analyses, whereas WHAMM and AP2B2 emerged as novel candidates. The top gene sets included severe CP ("endoplasmic reticulum membrane," "cytochrome P450," "microsome," and "oxidation reduction") and moderate CP ("regulation of gene expression," "zinc ion binding," "BMP signaling pathway," and "ruffle"). Gene-centric analyses offer a promising avenue for efficient interrogation of large-scale GWAS data. These results highlight genes in previously identified loci and new candidate genes and pathways possibly associated with CP, which will need to be validated via replication and mechanistic studies.
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Affiliation(s)
- K Rhodin
- Department of Pediatric Dentistry, School of Dentistry, University of North Carolina, Chapel Hill, NC, USA
| | - K Divaris
- Department of Pediatric Dentistry, School of Dentistry, University of North Carolina, Chapel Hill, NC, USA Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - K E North
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA Carolina Center for Genome Sciences, Chapel Hill, NC, USA
| | - S P Barros
- Department of Periodontology, School of Dentistry, University of North Carolina, Chapel Hill, NC, USA
| | - K Moss
- Department of Dental Ecology, School of Dentistry, University of North Carolina, Chapel Hill, NC, USA
| | - J D Beck
- Department of Dental Ecology, School of Dentistry, University of North Carolina, Chapel Hill, NC, USA
| | - S Offenbacher
- Department of Periodontology, School of Dentistry, University of North Carolina, Chapel Hill, NC, USA
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Cortezzo DE, Sanders MR, Brownell E, Moss K. Neonatologists' perspectives of palliative and end-of-life care in neonatal intensive care units. J Perinatol 2013; 33:731-5. [PMID: 23579489 DOI: 10.1038/jp.2013.38] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2012] [Revised: 02/18/2013] [Accepted: 03/11/2013] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Determine palliative and end-of-life care practices, barriers and beliefs among US neonatologists, and relationships between practice characteristics and palliative care delivery. STUDY DESIGN A descriptive cross-sectional survey with ordinal measurements. The survey was sent to 1885 neonatologists. RESULTS There were 725 responses (38.5%) with 653 (34.6%) completing the survey. Of those, 58.0% (n=379) have palliative care teams and 72.0% (n=470) have staff support groups or bereavement services. Palliative care education was deemed important (n=623) and needed. Barriers include emotional difficulties, staff disagreements and difficulty forming palliative care teams. Palliative care teams or staff bereavement groups were significantly predictive of willingness to initiate palliative care and more positive views or experiences. CONCLUSION Neonatologists believe that palliative care is important. Education and palliative care teams help provide quality care. Exploration of differing views of palliative care among team members is needed.
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Affiliation(s)
- D E Cortezzo
- Division of Neonatology, Department of Pediatrics, Connecticut Children's Medical Center, University of Connecticut School of Medicine, Hartford, CT 06106, USA.
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Dean OM, Jeavons S, Malhi GS, Cotton SM, Tanious M, Kohlmann K, Hewitt K, Moss K, Allwang C, Schapkaitz I, Robbins J, Cobb H, Dodd S, Bush A, Berk M. Deserves a hearing? A case report of remitting tinnitus with N-acetyl cysteine. Afr J Psychiatry (Johannesbg) 2013; 16:238-240. [PMID: 24051561 DOI: 10.4314/ajpsy.v16i4.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- O M Dean
- 1. Deakin University, School of Medicine, Barwon Health, Geelong, Australia; 2. The Florey Institute of Neuroscience and Mental Health, Parkville, Australia; 3. University of Melbourne, Department of Psychiatry, Parkville, Australia
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Yalakki Jagadeesh L, Hepburn A, Hughes R, Bourke B, Garood T, Horwood N, Ewence A, Lloyd M, Makanjuola D, Reilly P, Moss K, Hajela V, Higgens C, Sandhu V, Stuart B, Kiely P. AB0461 The burden of behçet’s disease in the south thames and, se coast regions – a regional review. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.2783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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31
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Atkins C, Liu Q, Minthorn E, Zhang SY, Figueroa DJ, Moss K, Stanley TB, Sanders B, Goetz A, Gaul N, Choudhry AE, Alsaid H, Jucker BM, Axten JM, Kumar R. Characterization of a novel PERK kinase inhibitor with antitumor and antiangiogenic activity. Cancer Res 2013; 73:1993-2002. [PMID: 23333938 DOI: 10.1158/0008-5472.can-12-3109] [Citation(s) in RCA: 339] [Impact Index Per Article: 30.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The unfolded protein response (UPR) is a signal transduction pathway that coordinates cellular adaptation to microenvironmental stresses that include hypoxia, nutrient deprivation, and change in redox status. These stress stimuli are common in many tumors and thus targeting components of the UPR signaling is an attractive therapeutic approach. We have identified a first-in-class, small molecule inhibitor of the eukaryotic initiation factor 2-alpha kinase 3 (EIF2AK3) or PERK, one of the three mediators of UPR signaling. GSK2656157 is an ATP-competitive inhibitor of PERK enzyme activity with an IC(50) of 0.9 nmol/L. It is highly selective for PERK with IC(50) values >100 nmol/L against a panel of 300 kinases. GSK2656157 inhibits PERK activity in cells with an IC(50) in the range of 10-30 nmol/L as shown by inhibition of stress-induced PERK autophosphorylation, eIF2α substrate phosphorylation, together with corresponding decreases in ATF4 and CAAT/enhancer binding protein homologous protein (CHOP) in multiple cell lines. Oral administration of GSK2656157 to mice shows a dose- and time-dependent pharmacodynamic response in pancreas as measured by PERK autophosphorylation. Twice daily dosing of GSK2656157 results in dose-dependent inhibition of multiple human tumor xenografts growth in mice. Altered amino acid metabolism, decreased blood vessel density, and vascular perfusion are potential mechanisms for the observed antitumor effect. However, despite its antitumor activity, given the on-target pharmacologic effects of PERK inhibition on pancreatic function, development of any PERK inhibitor in human subjects would need to be cautiously pursued in cancer patients.
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Affiliation(s)
- Charity Atkins
- GlaxoSmithKline, Oncology R&D, Collegeville, Pennsylvania 19426, USA
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Divaris K, Monda K, North K, Olshan A, Lange E, Moss K, Barros S, Beck J, Offenbacher S. Genome-wide association study of periodontal pathogen colonization. J Dent Res 2012; 91:21S-28S. [PMID: 22699663 PMCID: PMC3383103 DOI: 10.1177/0022034512447951] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Pathological shifts of the human microbiome are characteristic of many diseases, including chronic periodontitis. To date, there is limited evidence on host genetic risk loci associated with periodontal pathogen colonization. We conducted a genome-wide association (GWA) study among 1,020 white participants of the Atherosclerosis Risk in Communities Study, whose periodontal diagnosis ranged from healthy to severe chronic periodontitis, and for whom "checkerboard" DNA-DNA hybridization quantification of 8 periodontal pathogens was performed. We examined 3 traits: "high red" and "high orange" bacterial complexes, and "high" Aggregatibacter actinomycetemcomitans (Aa) colonization. Genotyping was performed on the Affymetrix 6.0 platform. Imputation to 2.5 million markers was based on HapMap II-CEU, and a multiple-test correction was applied (genome-wide threshold of p < 5 × 10(-8)). We detected no genome-wide significant signals. However, 13 loci, including KCNK1, FBXO38, UHRF2, IL33, RUNX2, TRPS1, CAMTA1, and VAMP3, provided suggestive evidence (p < 5 × 10(-6)) of association. All associations reported for "red" and "orange" complex microbiota, but not for Aa, had the same effect direction in a second sample of 123 African-American participants. None of these polymorphisms was associated with periodontitis diagnosis. Investigations replicating these findings may lead to an improved understanding of the complex nature of host-microbiome interactions that characterizes states of health and disease.
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Affiliation(s)
- K. Divaris
- Department of Pediatric Dentistry, School of Dentistry, University of North Carolina-Chapel Hill, 228 Brauer Hall, CB#7450, NC 27599, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, NC, USA
| | - K.L. Monda
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, NC, USA
- The Center for Observational Research, Amgen Inc., Thousand Oaks, CA, USA
| | - K.E. North
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, NC, USA
- Carolina Center for Genome Sciences, University of North Carolina-Chapel Hill, NC, USA
| | - A.F. Olshan
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, NC, USA
| | - E.M. Lange
- Department of Genetics, School of Medicine, University of North Carolina-Chapel Hill, NC, USA
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina-Chapel Hill, NC, USA
| | - K. Moss
- Department of Dental Ecology, School of Dentistry, University of North Carolina-Chapel Hill, NC, USA
| | - S.P. Barros
- Department of Periodontology, School of Dentistry, University of North Carolina-Chapel Hill, NC, USA
| | - J.D. Beck
- Department of Dental Ecology, School of Dentistry, University of North Carolina-Chapel Hill, NC, USA
| | - S. Offenbacher
- Department of Periodontology, School of Dentistry, University of North Carolina-Chapel Hill, NC, USA
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Lee S, Childerhouse A, Moss K. Gastrointestinal symptoms and granulomatous vasculitis involving the liver in giant cell arteritis: a case report and review of the literature. Rheumatology (Oxford) 2011; 50:2316-7. [DOI: 10.1093/rheumatology/ker278] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Ouellet D, Laquerre S, Minthorn E, Arnone M, Bleam M, Liu Q, Moss K, Lebowitz P. Abstract 5035: Predictions of therapeutic doses of a B-Raf inhibitor, GSK2118436, based on exposure-response modeling of preclinical tumor biomarker and xenograft data. Cancer Res 2011. [DOI: 10.1158/1538-7445.am2011-5035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: GSK2118436 is a potent inhibitor of B-Raf, a signal transduction kinase in the MAPK pathway that can be mutated to become an oncogenic driver in several human cancers, including melanomas (70%). GSK2118436 inhibits in a dose dependant manner phoshorylation of ERK (pERK) in cell lines encoding B-RafV600E mutation leading to inhibition of cell proliferation and tumor regression.
Purpose: To predict clinical relevant doses based on exposure-response relationship from preclinical pERK inhibition tumor xenograft data and exposure observed in first-time-in-human (FTIH) study.
Methods: Tumor pERK and tumor volume measurements from nude mouse xenograft models, including colon carcinoma and melanoma encoding B-RafV600E mutation, were pooled for the analysis. GSK2118436 was administered using a wide range of oral (0.1 to 300 mg/kg QD, 5 to 300 mg/kg BID) and continuous IV (3 to 100 mg/kg/day) doses. Tumor pERK inhibition was characterized as a function of GSK2118436 concentration using an inhibitory Emax model. For tumor regression, tumor volume was described using a linear growth model with tumor death rate expressed as a function of GSK2118436 concentration. The analyses were conducted using nonlinear mixed effects modeling. To extrapolate to clinical exposure, GSK2118436 concentrations in mouse were corrected for blood:plasma ratio.
Results: The relationship between preclinical tumor pERK inhibition and exposure was described using a mean (90% CI) plasma IC50 of 18.5 (4.3-32.4) ng/mL (35.5nM). In preclinical models, tumor regression was observed at 30mg/kg QD orally and 3mg/kg IV and was dependent on dosing regimen. Based on exposure observed in IV studies, tumor regression was associated with >70% pERK inhibition. Tumor growth was characterized with a mean rate of 1.04 mm3/hr and was inhibited by GSK2118436 with a mean (90% CI) plasma IC50 of 28 (5.9-50.4) ng/mL (53.8nM) for tumor death rate. The model was successful in describing data observed with different modes of administration. In the FTIH study, inhibition of tumor pERK was exposure-related with >80% inhibition predicted at doses ≥100 mg BID. Consistent with target inhibition, administration of the recommended Phase 2 dose of 150 mg BID resulted in clinical activity in subjects with B-Raf-mutant melanoma. Mean exposure at trough exceeded 100 ng/mL (192nM), which is >3-fold the target exposure for tumor growth inhibition (53.8nM) based on the preclinical model. Conclusions: The exposure-response models developed using preclinical tumor pERK inhibition and mouse xenograft data translated well to the clinical biomarker and efficacy data observed with GSK2118436 and support 150 mg BID as a clinically effective dose.
Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 102nd Annual Meeting of the American Association for Cancer Research; 2011 Apr 2-6; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2011;71(8 Suppl):Abstract nr 5035. doi:10.1158/1538-7445.AM2011-5035
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Affiliation(s)
| | | | | | | | | | - Qi Liu
- 2GlaxoSmithKline, Upper Providence, PA
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Offenbacher S, Barros S, Mendoza L, Mauriello S, Preisser J, Moss K, de Jager M, Aspiras M. Changes in gingival crevicular fluid inflammatory mediator levels during the induction and resolution of experimental gingivitis in humans. J Clin Periodontol 2010; 37:324-33. [PMID: 20447255 DOI: 10.1111/j.1600-051x.2010.01543.x] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM The goal of this study is to characterize the changes in 33 biomarkers within the gingival crevicular fluid during the 3-week induction and 4-week resolution of stent-induced, biofilm overgrowth mediated, experimental gingivitis in humans. METHODS Experimental gingivitis was induced in 25 subjects for 21 days followed by treatment with a sonic powered toothbrush for 28 days. Clinical indices and gingival crevicular fluids were collected weekly during induction and biweekly during resolution. Samples were analysed using a bead-based multiplexing analysis for the simultaneous measurements of 33 biomarkers within each sample including cytokines, matrix-metalloproteinases (MMPs) and adipokines. Prostaglandin-E(2) was measured by enzyme-linked immunoadsorbant assay. Statistical testing using general linear models with structured covariance matrices were performed to compare stent to contralateral (non-stent) changes in clinical signs and in biomarker levels over time. RESULTS Gingivitis induction was associated with a significant 2.6-fold increase in interleukin 1-beta (IL-beta), a 3.1-fold increase in IL-1alpha and a significant decrease in multiple chemokines as well as MMPs-1, -3 and 13. All changes in clinical signs and mediators rebounded to baseline in response to treatment in the resolution phase. CONCLUSIONS Stent-induced gingivitis is associated with marked, but reversible increases in IL-alphaa and IL-1beta with suppression of multiple chemokines as well as selected MMPs.
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Affiliation(s)
- Steven Offenbacher
- UNC Center for Oral and Systemic Diseases, North Carolina Oral Health Institute, UNC School of Dentistry, Durham, NC 27709, USA.
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Singer RE, Moss K, Beck JD, Offenbacher S. Association of systemic oxidative stress with suppressed serum IgG to commensal oral biofilm and modulation by periodontal infection. Antioxid Redox Signal 2009; 11:2973-83. [PMID: 19496702 PMCID: PMC2861534 DOI: 10.1089/ars.2009.2591] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
To assess the impact of systemic oxidative stress on humoral immune responses, we examined the relation between levels of serum 8-isoprostane and serum IgG antibodies against 17 microorganisms in the commensal oral biofilm among the ARIC population of community-dwelling adults (n = 4,717). Bivariately, serum 8-isoprostane was associated with age, race/center, education, smoking, serum triglycerides, and the extent of periodontal disease severity. Total IgG antibody directed to the oral biofilm was significantly associated with race/center, hypertension, triglycerides, periodontal disease severity, plaque, and serum 8-isoprostane. In multivariate models, the highest quartile of increased 8-isoprostane displayed marked reductions (44%) in biofilm IgG antibody in contrast to small increases in total IgG antibody level for the highest quartiles of oral bacterial burden or periodontal disease severity (19 and 12%, respectively; p < 0.0001). Increased 8-isoprostane was associated with decreased total IgG antibody (p < 0.0001) in subjects with or without extensive periodontal disease and/or biofilm and with suppression of IgG responses across the entire biofilm composition. Increased systemic oxidative stress is associated with a generalized decrease of serum IgG antibody responses to the oral biofilm. Levels of oral microbial burden, periodontitis severity, and smoking are, by comparison, minor modifiers of serum IgG responses to the commensal oral biofilm.
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Affiliation(s)
- R E Singer
- Center for Oral and Systemic Diseases and Department of Periodontology, University of North Carolina at Chapel Hill School of Dentistry, Chapel Hill, NC, USA
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Moss K, O'Driscoll K, Eldridge P, Varma T, Wieshmann UC. Risk factors for early post-operative psychiatric symptoms in patients undergoing epilepsy surgery for temporal lobe epilepsy. Acta Neurol Scand 2009; 120:176-81. [PMID: 19486325 DOI: 10.1111/j.1600-0404.2008.01149.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE De-novo psychiatric symptoms may develop within 3 months after a temporal lobectomy for epilepsy. The objective of this study was to identify presurgical risk factors for psychiatric symptoms. METHODS Twenty-seven patients who had a temporal lobectomy for epilepsy were included. Twenty-four had hippocampal sclerosis or gliosis, and three had cavernous haemagiomata. Twelve had operations on the left, and 15 on the right side. Twenty-four patients were rendered free of seizures (SZ) with loss of awareness, three had early post-operative convulsions, one continued to have habitual SZ. RESULTS Nine patients (33%) developed low mood, anxiety and emotional lability within 3 months after surgery. Patients with early post-operative psychiatric symptoms were younger (27.9/34.8 years, P = 0.01), and more anxious on the presurgical Hospital Anxiety and Depression Scale (12/8.44, P = 0.02) than patients without post-operative psychiatric symptoms. There was also an association between right temporal lobectomies and early post-surgical symptoms (P = 0.02 Fisher's exact test). CONCLUSION Potential risk factors were age, anxiety and operation on the right side. Larger studies are required to determine if these risk factors are independent.
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Affiliation(s)
- K Moss
- Department of Neurology, Liverpool, UK
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Hardwicke MA, Oleykowski CA, Plant R, Wang J, Liao Q, Moss K, Newlander K, Adams JL, Dhanak D, Yang J, Lai Z, Sutton D, Patrick D. GSK1070916, a potent Aurora B/C kinase inhibitor with broad antitumor activity in tissue culture cells and human tumor xenograft models. Mol Cancer Ther 2009; 8:1808-17. [PMID: 19567821 DOI: 10.1158/1535-7163.mct-09-0041] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The protein kinases, Aurora A, B, and C have critical roles in the regulation of mitosis and are frequently overexpressed or amplified in human tumors. GSK1070916, is a novel ATP competitive inhibitor that is highly potent and selective for Aurora B/C kinases. Human tumor cells treated with GSK1070916 show dose-dependent inhibition of phosphorylation on serine 10 of Histone H3, a substrate specific for Aurora B kinase. Moreover, GSK1070916 inhibits the proliferation of tumor cells with EC(50) values of <10 nmol/L in over 100 cell lines spanning a broad range of tumor types. Although GSK1070916 has potent activity against proliferating cells, a dramatic shift in potency is observed in primary, nondividing, normal human vein endothelial cells, consistent with the proposed mechanism. We further determined that treated cells do not arrest in mitosis but instead fail to divide and become polyploid, ultimately leading to apoptosis. GSK1070916 shows dose-dependent inhibition of phosphorylation of an Aurora B-specific substrate in mice and consistent with its broad cellular activity, has antitumor effects in 10 human tumor xenograft models including breast, colon, lung, and two leukemia models. These results show that GSK1070916 is a potent Aurora B/C kinase inhibitor that has the potential for antitumor activity in a wide range of human cancers.
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MESH Headings
- Animals
- Antineoplastic Agents/therapeutic use
- Aurora Kinase A
- Aurora Kinase B
- Aurora Kinases
- Aza Compounds/therapeutic use
- Blotting, Western
- Cell Cycle/drug effects
- Cell Proliferation/drug effects
- Cells, Cultured
- Endothelium, Vascular/cytology
- Endothelium, Vascular/drug effects
- Enzyme-Linked Immunosorbent Assay
- Female
- Fluorescent Antibody Technique
- Humans
- Immunoenzyme Techniques
- Indoles/therapeutic use
- Mice
- Mice, Inbred NOD
- Mice, Nude
- Mice, SCID
- Neoplasms, Experimental/drug therapy
- Neoplasms, Experimental/metabolism
- Neoplasms, Experimental/pathology
- Phosphorylation/drug effects
- Protein Kinase Inhibitors/therapeutic use
- Protein Serine-Threonine Kinases/antagonists & inhibitors
- Umbilical Veins/cytology
- Umbilical Veins/drug effects
- Xenograft Model Antitumor Assays
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Andriankaja OM, Barros SP, Moss K, Panagakos FS, DeVizio W, Beck J, Offenbacher S. Levels of serum interleukin (IL)-6 and gingival crevicular fluid of IL-1beta and prostaglandin E(2) among non-smoking subjects with gingivitis and type 2 diabetes. J Periodontol 2009; 80:307-16. [PMID: 19186972 DOI: 10.1902/jop.2009.080385] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND The goal of this study was to assess whether non-smoking patients with type 2 diabetes present with increased levels of local and systemic proinflammatory mediators and, if so, whether such an increase is associated with enhanced clinical gingival inflammation compared to non-smoking patients without diabetes. METHODS We used a cross-sectional database consisting of 725 self-reported lifelong non-smokers aged 53 to 74 years. Gingival crevicular fluid (GCF) levels of interleukin (IL)-1beta and prostaglandin E(2) (PGE(2)) and serum levels of IL-6 were measured using enzyme-linked immunosorbent assay. No participant had probing depth >3 mm. Participants with bleeding on probing (BOP) in <10% of sites were classified as healthy, whereas those with BOP in >or=10% of sites were defined as having biofilm-gingival interface (BGI) gingivitis. RESULTS Approximately 53% (n = 385) and 11% (n = 80) of the sample had BGI gingivitis and type 2 diabetes, respectively. The mean age-adjusted level of GCF IL-1beta was significantly elevated in the diabetic group compared to the non-diabetic group (P = 0.048), but serum IL-6 (P = 0.14) and GCF PGE(2) were not (P = 0.98). The mean GCF IL-1beta and PGE(2) levels were significantly elevated in subjects with BGI gingivitis (136.2 +/- 112.9 ng/ml and 277.2 +/- 187.2 ng/ml, respectively) compared to subjects with gingival health (95.9 +/- 82.9 ng/ml and 205.7 +/- 149.6 ng/ml, respectively), regardless of diabetic status (P <0.001 for both). However, serum IL-6 was elevated in subjects with BGI gingivitis compared to subjects with gingival health only among subjects with diabetes (2.9 +/- 3.2 pg/ml versus 1.5 +/- 1.4 pg/ml; P = 0.008). With the exception of serum IL-6 in subjects without diabetes, an increase in the levels of proinflammatory mediators was associated with increased odds of having BGI gingivitis. The associations were stronger in the diabetic group. CONCLUSIONS Type 2 diabetes may increase the host inflammatory response to oral biofilm, which, in turn, may exacerbate preconditions associated with gingivitis in susceptible individuals. Furthermore, systemic inflammation, as demonstrated by the increased level of serum IL-6, is associated with BGI gingivitis among non-smoking patients with diabetes.
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Affiliation(s)
- O M Andriankaja
- School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7450, USA.
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Abstract
BACKGROUND A molecular epidemiologic study provided the opportunity to characterize the biology of the biofilm-gingival interface (BGI) in 6,768 community-dwelling subjects. METHODS Disease classifications and multivariable models were developed using clinical, microbial, inflammatory, and host-response data. The purpose was to identify new clinical categories that represented distinct biologic phenotypes based upon DNA checkerboard analyses of eight plaque bacteria, serum immunoglobulin G (IgG) titers to 17 bacteria, and the gingival crevicular fluid (GCF) levels of 16 inflammatory mediators. Five BGI clinical conditions were defined using probing depths (PDs) and bleeding on probing (BOP) scores. Subjects with all PDs < or = 3 mm were grouped as BGI-healthy (14.3% of sample) or BGI-gingivitis (BGI-G, 15.1%). Subjects with one or more PDs > or = 4 mm [deep lesion (DL)] were divided into low BOP (18.0%), moderate BOP (BGI-DL/MB, 39.7%), and severe BOP (BGI-DL/SB, 12.9%). RESULTS Subjects with BGI-G had increased levels of Campylobacter rectus-specific serum IgG levels (P = 0.01), and those with BGI-DL/SB had increased IgG levels to Porphyromonas gingivalis (P < 0.0003) and C. rectus (P < 0.01). BGI-DL/SB subjects had an excessive GCF interleukin (IL)-1beta and prostaglandin E2 response and an enhanced chronic inflammatory response with significant increases in GCF IL-6 and monocyte chemotactic peptide-1. Within BGI-DL/SB subjects, more severe pocketing and BOP were associated with higher levels of GCF IL-1beta, not higher microbial counts or plaque scores. CONCLUSIONS New BGI classifications create categories with distinct biologic phenotypes. The increased titers of C. rectus IgG among 68.5% of the BGI-G subjects and elevated P. gingivalis titers among BGI-DL/MB and BGI-DL/SB subjects (63.8% and 75.7%, respectively) are strongly supportive of the microbial specificity of pathogenesis for BGI categories.
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Affiliation(s)
- S Offenbacher
- Center for Oral and Systemic Diseases and Department of Periodontology, School of Dentistry, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599-7455, USA.
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Abstract
OBJECTIVE Using single-voxel proton spectroscopy we aimed to investigate changes in metabolite levels in key brain regions during hypomania and euthymia in patients with bipolar disorder (BD). METHOD Nine patients with a diagnosis of BD and nine age, sex, education, and handedness-matched comparison subjects underwent magnetic resonance proton spectroscopy (H(1)-MRS) using a 1.5 T magnet. Patients were assessed whilst hypomanic and euthymic. Metabolite (N-acetyl asparTate, NAA; myo-inositol, mI; choline, Cho) levels in the basal ganglia (BG), anterior cingulate cortex (AC), and frontal cortex (FC) were compared both between groups and within the patient group. RESULTS Multivariate analysis revealed significant complex relationships between metabolite levels and brain regions with significant differences observed both between bipolar patients (hypomanic and euthymic) and controls, and across the two mood states. Hypomanic patients had lower mean metabolite levels when averaged across the AC and FC regions, compared with the controls. They also had a smaller difference in mean metabolite levels between the BG and FC than the control group. Euthymic patients were also found to have a smaller difference in the level of NAA between the BG and AC than the control group. CONCLUSION This exploratory study of BD demonstrates significant differences in metabolite levels that vary both with respect to brain region and mood state. Not withstanding the confounding effects of medication and the limitation of small sample size the findings are important as they demonstrate that a longitudinal approach is a useful design especially in the context of a long-term phasic illness.
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Affiliation(s)
- G S Malhi
- Department of Psychological Medicine, Northern Clinical School, University of Sydney, Sydney, New South Wales, Australia.
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Abstract
OBJECTIVE This case report suggests that screening of patients with psychiatric symptoms using modern neuroimaging can help identify organic causes of mental illness. METHOD A single case study was reported. RESULTS We report the case of a 25-year-old woman with a recent diagnosis of bipolar II disorder having an magnetic resonance imaging (MRI) scan as part of a research project that reveals an intraventricular brain tumour. The latter is most likely the cause of her irritability and 'hypomanic' symptoms and is defined anatomically using diffusion tensor imaging and structural and functional imaging using MRI and positron emission tomography. CONCLUSION The lesion in this individual case most probably produces mood symptoms by impinging upon the fornix, a component of the limbic system. However, more generally, the increase in diagnosis of bipolar disorder has to be tempered against alternate causes of similar symptoms and necessitates vigilance of potential organic mechanisms.
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Affiliation(s)
- J Xu
- Department of Circulation and Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway
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Moss K, Casey B, Lo J, McIntire D, Leveno K. Weekly versus Daily Blood Glucose Monitoring in Women with Gestational Diabetes. J Investig Med 2003. [DOI: 10.1177/108155890305100623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- K Moss
- University of Texas Southwestern Medical Center at Dallas, Doris Duke Clinical Research Fellowship Program, Dallas, TX
| | - B Casey
- University of Texas Southwestern Medical Center at Dallas, Doris Duke Clinical Research Fellowship Program, Dallas, TX
| | - J Lo
- University of Texas Southwestern Medical Center at Dallas, Doris Duke Clinical Research Fellowship Program, Dallas, TX
| | - D McIntire
- University of Texas Southwestern Medical Center at Dallas, Doris Duke Clinical Research Fellowship Program, Dallas, TX
| | - K Leveno
- University of Texas Southwestern Medical Center at Dallas, Doris Duke Clinical Research Fellowship Program, Dallas, TX
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Moss K, Casey B, Lo J, Mclntire D, Leveno K. WEEKLY VERSUS DAILY BLOOD GLUCOSE MONITORING IN WOMEN WITH GESTATIONAL DIABETES. J Investig Med 2003. [DOI: 10.1136/jim-51-06-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Choy EHS, Hazleman B, Smith M, Moss K, Lisi L, Scott DGI, Patel J, Sopwith M, Isenberg DA. Efficacy of a novel PEGylated humanized anti-TNF fragment (CDP870) in patients with rheumatoid arthritis: a phase II double-blinded, randomized, dose-escalating trial. Rheumatology (Oxford) 2002; 41:1133-7. [PMID: 12364632 DOI: 10.1093/rheumatology/41.10.1133] [Citation(s) in RCA: 145] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Biological products that neutralize tumour necrosis factor alpha (TNF-alpha) are beneficial in rheumatoid arthritis (RA). We studied the effects of CDP870, a novel anti-TNF-alpha antibody fragment modified to obtain a prolonged plasma half-life ( approximately 14 days). METHODS Thirty-six patients were randomized in a double-blind, ascending-dose group study to a single intravenous infusion of placebo (n = 12) or 1, 5 or 20 mg/kg CDP870 (each n = 8). The patients were predominantly female (30/36), had a mean age of 56 yr and a mean duration of RA of 13 years. They had received a mean of five DMARDs or experimental therapies (with 1 month washout before the study started) and had active disease. Continuation of NSAIDs and up to 7.5 mg prednisolone daily was allowed. Following the blinded dosing period, 32 patients received a single open-label infusion of either 5 or 20 mg/kg CDP870. RESULTS In the blinded dosing period, 6/12 placebo patients withdrew from the study (for deteriorating RA < or =4 weeks after dosing). Two of 24 CDP870-treated patients withdrew, both in the 1 mg/kg group (for deteriorating RA or lost to follow up >4 weeks after dosing). The proportion of patients with ACR20 improvement for the per-protocol population with the last observation carried forward was 16.7, 50, 87.5 and 62.5% after 0, 1, 5 and 20 mg/kg CDP870 respectively (combined treatment effect, P = 0.012, primary analysis) at 4 weeks and 16.7, 25, 75 and 75% (P = 0.032) at 8 weeks. The proportion of patients with ACR50 improvement for the per-protocol population with the last observation carried forward was 0, 12.5, 12.5 and 50% after 0, 1, 5 and 20 mg/kg CDP870 respectively (combined treatment effect, P = 0.079) at 4 weeks and 0, 12.5, 12.5 and 50% (P = 0.079) at 8 weeks. Following the open-label dose of CDP870, similar beneficial effects were achieved. CONCLUSION CDP870 is effective, was very well tolerated in this small study, and has an extended duration of action following one or more intravenous doses.
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Affiliation(s)
- E H S Choy
- Academic Department of Rheumatology, GKT School of Medicine, King's College London, King's College Hospital, London, UK
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Moss K, Keen R. Usefulness of bone densitometry in postmenopausal women with clinically diagnosed vertebral fractures. Ann Rheum Dis 2002; 61:667-8; author reply 668. [PMID: 12079924 PMCID: PMC1754151 DOI: 10.1136/ard.61.7.667-a] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Moss K. Learner retention of anatomical information presented in a digital two-dimensional format versus a digital three-dimensional format. J Biocommun 2002; 28:4-10. [PMID: 11697230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
This pilot study investigated learner retention of anatomical information presented in a digital two-dimensional format versus a digital three-dimensional format. Thirty-six undergraduate art students were selected by double-blind random assignment to use one of two instructional treatments: a digital two-dimensional presentation of basic brain anatomy or a digital three-dimensional presentation of the same information. Although both groups improved from pre- to post-tests, the data revealed no significant difference in test scores between the two treatments.
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Affiliation(s)
- K Moss
- Insect Division, Natural History Museum, University of Michigan, USA
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48
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Abstract
OBJECTIVE To assess the long-term outcome of a cohort of 46 patients with idiopathic myositis by assessing both health status, as measured by the SF-36, and cumulative survival probability over a 20-yr follow-up period at a single rheumatology centre. Methods and results. Forty-six patients under long-term follow-up from 1978 to 1999 were identified from our database. All patients fulfilled three out of four of the Bohan and Peter criteria for myositis. We excluded those with malignancy-associated disease and those with inclusion body myositis. Twenty-three patients (50%) had adult-onset polymyositis, 14 (30.4%) had adult-onset dermatomyositis, one had childhood-onset dermatomyositis and eight (17.4%) had an overlap syndrome (associated with either systemic lupus erythematosus or rheumatoid arthritis). During the course of the disease, seven patients (15.2%) went into full remission, eight (17.4%) had monophasic illness, nine (19.6%) had a relapsing-remitting course, 16 (34.8%) had chronic progressive illness and six (13.04%) died. All patients had significantly lower SF-36 scores in all aspects of health compared with the general population (P< or =0.001). Patients with chronic progressive illness had significantly greater bodily pain (P< or =0.05, t-test) than those with a relapsing-remitting illness, but did not differ in other aspects of health. There was no significant difference in the scores in the different domains of the SF-36 between the patients with active disease and those with inactive disease (0.05<P<0.1). Six of the 46 patients died. Cumulative survival probability was calculated. The five-year survival rate was 95% and the 10-yr survival rate 83.8%. CONCLUSION Patients with myositis report significantly poorer health compared with the general population. Health status and disease activity are important outcome measures in the assessment of patients with myositis.
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Affiliation(s)
- S M Sultan
- Centre for Rheumatology, Department of Medicine, University College Hospital, London W1P 9PG, UK
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49
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Affiliation(s)
- I Haq
- Centre for Rheumatology, 4th Floor Arthur Stanley House, 40-50 Tottenham Street, London W1T 4NJ, UK
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50
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Oh WK, George DJ, Kaufman DS, Moss K, Smith MR, Richie JP, Kantoff PW. Neoadjuvant docetaxel followed by radical prostatectomy in patients with high-risk localized prostate cancer: a preliminary report. Semin Oncol 2001; 28:40-4. [PMID: 11685727 DOI: 10.1016/s0093-7754(01)90153-8] [Citation(s) in RCA: 52] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Effective treatment options for high-risk localized prostate cancer are limited. Patients at high risk for recurrence include those with biopsy Gleason scores of 8 to 10, prostate specific antigen (PSA) levels > 20 ng/mL, and clinical stage T3 disease. Docetaxel chemotherapy is active in hormone-refractory prostate cancer, either combined with estramustine or used as a single agent. To determine if systemic therapy can improve the outcome of radical prostatectomy in men with high-risk localized prostate cancer, we are undertaking a pilot phase II clinical trial of weekly docetaxel at 36 mg/m(2) for up to 6 months, followed by surgery. Patients are monitored with weekly visits, monthly digital rectal examinations, PSA measurement, and testosterone tests, and endorectal magnetic resonance imaging done at baseline, after two cycles, and again after six cycles. To date, 15 patients have been enrolled, and 70 cycles of chemotherapy have been administered. Toxicity has been mostly grade 1 in intensity, and fatigue has been the most common grade 2 toxicity reported. The primary endpoint of the trial is measurement of pathologic complete response rate, for which data are not yet available. Recruitment to the trial is ongoing.
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Affiliation(s)
- W K Oh
- Lank Center for Genitourinary Oncology, Department of Adult Oncology, Dana-Farber Cancer Institute, Boston, MA 02115, USA
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